The findings of a new systematic review may help to standardize reflectance confocal microscopy (RCM) terminology, which is used to describe non-melanocytic lesions (NMLs). The findings were published in the Journal of the American Academy of Dermatology.
“This was an excellent article which essentially developed a common terminology for NMLs, or other growths of the skin,” said Hung Doan, MD, PhD, an assistant professor of dermatology at MD Anderson Cancer Center and UTHealth McGovern Medical School, in an interview with Cancer Network. “[It] is the first step that will allow dermatologists and non-dermatologists to be able to communicate RCM findings for both melanocytic and non-melanocytic lesions in an objective manner.”
RCM is an emerging technology that allows clinicians to visualize the skin at near- or “quasi-histological” resolution noninvasively—while the lesion of interest is in the living organism, Doan explained.
Researchers independently analyzed 31 studies from between 1997 and 2017 to identify all published RCM terms used to describe basal cell carcinoma, squamous cell carcinoma, and seborrheic keratosis/solar lentigo/lichen planus–like keratosis. Similar terms were grouped based on both a related definition and by histopathological correlates.
In total, the investigators identified 139 RCM terms, which they pared down to 66 terms based on synonymous definitions. The resulting list “provides the basis for future NMLs terminology consensus,” the authors concluded.
According to Doan, these results can be utilized as a tool that can help clinicians become more acquainted with RCM. It can also aid clinicians and non-clinicians alike in communicating RCM findings in a logical and understandable manner, he said.
Doan noted that the study does have several limitations. “The main weakness is that only two of the authors extracted the data from the included studies; while disagreements were resolved by consensus and if no agreement was reached, a third author served as the tie breaker,” he said. “This [strategy] could have its own inherent biases in identifying appropriate papers and in identifying the distinct words. Also, the authors identify that their statistical process may have been influenced by the frequency of publications from a specific researcher or group.”
In a separate interview with Cancer Network, Shawn Demehri, MD, PhD, a medical oncologist in the Department of Dermatology at Massachusetts General Hospital Cancer Center, said the results will be useful as RCM use moves beyond the research setting. “As RCM becomes more available for clinical use, the revision of terminology to describe the skin lesions using RCM will be of great value,” he said.
According to Demehri, the study’s limitations lie in its format as a review article, meaning its scope is limited to the studies selected for review.
Doan also highlighted the increasing value of RCM to practicing clinicians. “As the technology has continuously developed during the past 20 years, based on the number of [emerging] publications, RCM is slowly gaining traction and acceptance. More recently the Centers for Medicare and Medicaid Services has allotted billable Current Procedural Terminology (CPT) codes for reimbursement for RCM imaging services.”