Objective
To improve prebiopsy diagnostic accuracy and surgical management of pigmented appearing
lesions on the lips, particularly melanoma, using in vivo reflectance confocal microscopy
(RCM).
Study Design
Prospective case series over a 12-month period between 2015 and 2016. The setting
was two specialist dermatology referral centers with expertise in confocal microscopy.
The study population was a consecutive sample of patients with pigmentation of the
lip for which the cause was uncertain clinically, whose differential diagnosis included
melanoma, and who had undergone both in vivo RCM and subsequent biopsy. The outcome
measures were RCM features, dermoscopy features, and histopathological diagnosis.
Results were reported by descriptive analysis and correlations made between RCM features
and histopathology.
Results
Eight patients were recruited for the study. In vivo RCM facilitated the targeting
of small biopsies to identify two in situ oral melanoma recurrences and successfully
mapped an in situ oral melanoma before wide excision. Suprabasal dendritic pagetoid
cells and epidermal disarray on RCM were useful indicators for in situ melanoma of
the lip. Previously described dermoscopy features for mucosal melanoma were not very
helpful in diagnosing melanoma in our series. Challenges included evaluating inflamed
lesions with pigment incontinence.
Conclusions
RCM can assist in the diagnosis and management of pigmented lip lesions, but additional
studies are required to further evaluate these initial observations.
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Article info
Publication history
Published online: August 23, 2016
Accepted:
August 11,
2016
Received in revised form:
June 18,
2016
Received:
April 3,
2016
Footnotes
N.G. Maher was awarded an Australian Postgraduate Award from the University of Sydney for his master of philosophy degree.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
