PracticeUpdate Conference Series World Congress of Dermatology 2019

In-Vivo Confocal Microscopy Offers Diagnostic Benefits For SuspectedMelanoma When combined with dermoscopy, it helps reduce unnecessary excision of benign lesions. U se of in-vivo reflectance confocal microscopy (RCM) as a second non-invasive imaging technique following dermoscopy significantly reduced the number of unnecessary lesion excisions while still main- taining high sensitivity for diagnosis of melanoma, according to the results of a prospective trial.

“Previously, both retrospective and prospective observational studies assessed the diagnostic accuracy of in-vivo RCM combined with clinical and dermoscopic evaluation. [Thus,] a clinical trial on the additional utility of RCM was needed to further validate this tool,” Riccardo Pampena, MD, of the Centro Oncologico Ad Alta Tecnologica Diagnostica in Reggio Emilia, Italy and Giovanni Pellacani, MD, of the University of Modena and Reggio Emilia in Italy and WCD 2019 congress president indicated in a joint statement to Elsevier’s PracticeUpdate . The study investigators consecutively enrolled patients with at least one skin lesion suspected to be melanoma at three Italian centers (Modena, Reggio Emilia and Ravenna). A total of 1435 lesions were randomly assigned to one of two study arms: one consisting of dermoscopy plus RCM (n=746), and the other consisting of dermoscopy alone (n=689).

Dr. Riccardo Pampena

Small intestinal bacterial overgrowth (SIBO) has also been linked with rosacea in a 2008 study. Complete eradication of the SIBO with rifaximin therapy resulted in dramatic clinical improvement that was maintained for 9 months. Another study demonstrated the benefit of Lactobacillus paracasei (NCC 2461) on skin reac- tivity, and yet another showed benefits of this same probiotic for moderate-to-severe dandruff. In a 2003 study, the consumption of Lactobacillus rhamnosus strains by pregnant mothers and con- tinued by infants up to 6 months reduced the risk of eczema by almost 50% in at-risk children aged 2 and 4 years. A double-blind, randomized clinical trial showed that the administration of B. infantis led to the reduction of plasma levels of C-reactive protein and TNF-α that were elevated at baseline in patients with ulcerative colitis, chronic fatigue syndrome, and psoriasis. Studies with L. acidophi- lus and B. lactis have yielded similar results. Nevertheless, fully harnessing the therapeutic potential of the microbiome is hampered by lack of research, said Dr. Pignatti. Manufacturers of pro- biotics favor a direct-to-consumer approach that bypasses clinical trials. Some recent studies have failed to show a beneficial and lasting impact of pro- biotic supplementation on gut health. On reason for this, said Dr. Pignatti, is that supplementation with probiotics is not likely to be effective without diet and lifestyle habits that support a healthy microbi- ome. In particular, a diet high in whole foods, fiber and healthy fats and low in sugar and processed foods is essential. Other lifestyle factors such as good sleep habits and regular exercise can also play a positive role.

Dr. Giovanni Pellacani

As of an 8-month preliminary analysis, histopathological reports were available for a total of 717 lesions, 221 lesions in the dermoscopy plus RCM arm and 496 lesions in the dermoscopy alone arm. A total of 446 of the excised lesions (62.2%) were diagnosed as benign: 119 of the benign excised lesions were in the dermoscopy plus RCM arm, and 327 were in the dermoscopy alone arm. Meanwhile, 271 of the excised lesions (37.8%) were diagnosed as malignant. Of the malignant excised lesions, 102 were in the dermoscopy plus RCM arm and 169 were in the dermoscopy alone arm. Dr. Pampena and Dr. Pellacani reported that the addition of RCM meant that more than 60% of benign lesions could be saved from unnecessary excision, given the 99.1% sensitivity and 62.7% specificity seen with this device. “Our preliminary results support the indication for widespread use of confocal microscopy in melanoma diagnosis, combined with clinical and dermoscopic examination,” Dr. Pampena and Dr. Pellacani concluded. “New devices allowing a faster image acquisition are further supporting this process. “The most important practical implication is the possibility to save a [mean- ingful number] of benign lesions from unnecessary excision without losing melanoma cases,” Dr. Pampena and Dr. Pellacani noted. “We’ve calculated a number needed to excise of 1.4 with the additional use of in-vivo RCM, as compared to a value of 3.0 for clinical/dermoscopic examination alone. “The main unanswered question regards the economic impact of RCM on the healthcare system,” they added. “This aspect will be covered in the second part of the study, through a cost-benefit analysis.”

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WCD 2019 • PRACTICEUPDATE CONFERENCE SERIES