Reflectance confocal microscopy for diagnosing keratinocyte | Figure 1
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Reflectance confocal microscopy for diagnosing keratinocyte skin cancers in adults
Cochrane Review; 10 studies reporting on 11 study cohorts. All 11 cohorts reported data for the detection of basal cell carcinoma (BCC), including 2037 lesions (464 with BCC); and four cohorts reported data for the detection of cutaneous squamous cell carcinoma (cSCC), including 834 lesions (71 with cSCC).
Objectives
To determine the diagnostic accuracy of RCM for the detection of BCC, cSCC, or any skin cancer in adults with any suspicious lesion and lesions that are difficult to diagnose (equivocal); and to compare its accuracy with that of usual practice (visual inspection or dermoscopy, or both).
Authors' conclusions
There is insufficient evidence for the use of RCM for the diagnosis of BCC or cSCC in either population group. A possible role for RCM in clinical practice is as a tool to avoid diagnostic biopsies in lesions with a relatively high clinical suspicion of BCC. The potential for, and consequences of, misclassification of other skin cancers such as melanoma as BCCs requires further research. Importantly, data are lacking that compare RCM to standard clinical practice (with or without dermoscopy).
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Exfoliative Cytology for Diagnosing Skin Cancers
Cochrane Review; 9 studies contributing a total of 1655 lesions to our analysis, including 1120 basal cell carcinoma (BCCs; 14 datasets), 41 cutaneous squamous cell carcinoma (cSCCs) and 10 melanomas.
Objectives
To determine the diagnostic accuracy of exfoliative cytology for detecting basal cell carcinoma (BCC) in adults, and to compare its accuracy with that of standard diagnostic practice (visual inspection with or without dermoscopy).
Authors' conclusions
The utility of exfoliative cytology for the primary diagnosis of skin cancer is unknown, as all included studies focused on the use of this technique for confirming strongly suspected clinical diagnoses. For the confirmation of BCC in lesions with a high clinical suspicion, there is evidence of high sensitivity and specificity. Since decisions to treat low-risk BCCs are unlikely in practice to require diagnostic confirmation given that clinical suspicion is already high, exfoliative cytology might be most useful for cases of BCC where the treatments being contemplated require a tissue diagnosis (e.g. radiotherapy). The small number of included studies, poor reporting and varying methodological quality prevent us from drawing strong conclusions to guide clinical practice.
Read the full Cochrane Review here
Visual Inspection and Dermoscopy
Cochrane Review; 24 publications reporting on 24 study cohorts, providing 27 visual inspection datasets (8805 lesions; 2579 malignancies) and 33 dermoscopy datasets (6855 lesions; 1444 malignancies).
Objectives
To determine the diagnostic accuracy of visual inspection and dermoscopy, alone or in combination, for the detection of (a) basal cell carcinoma (BCC) and (b) cutaneous squamous cell carcinomas (cSCC), in adults. We separated studies according to whether the diagnosis was recorded face-to-face (in person) or based on remote (image-based) assessment.
Authors' conclusions
Dermoscopy may be a valuable tool for the diagnosis of BCC as an adjunct to visual inspection of a suspicious skin lesion following a thorough history-taking including assessment of risk factors for keratinocyte cancer. The evidence primarily comes from secondary-care (referred) populations and populations with pigmented lesions or mixed lesion types. There is no clear evidence supporting the use of currently-available formal algorithms to assist dermoscopy diagnosis.
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Computer-Assisted Diagnosis (CAD) Systems
Cochrane Review; 42 studies, 24 evaluating digital dermoscopy-based computer-assisted diagnosis (CAD) systems (Derm–CAD) in 23 study cohorts with 9602 lesions (1220 melanomas, at least 83 BCCs, 9 cSCCs).
Objectives
To determine the accuracy of CAD systems for diagnosing cutaneous invasive melanoma & atypical intraepidermal melanocytic variants, basal cell carcinoma (BCC) or cutaneous squamous cell carcinoma (cSCC) in adults, & to compare its accuracy with that of dermoscopy.
Authors' conclusions
In highly selected patient populations, all CAD types demonstrate high sensitivity, & could prove useful as a back-up for specialist diagnosis to assist in minimising the risk of missing melanomas. However, the evidence base is currently too poor to understand whether CAD system outputs translate to different clinical decision-making in practice. Insufficient data are available on the use of CAD in community settings, or for the detection of keratinocyte cancers. The evidence base for individual systems is too limited to draw conclusions for practice. Prospective comparative studies are required that evaluate the use of already evaluated CAD systems as diagnostic aids, by comparison to face-to-face dermoscopy.
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Basal-Cell Carcinoma (BCC)
Basal-cell carcinoma (BCC), also known as basal-cell cancer, is the most common type of skin cancer. It often appears as a painless raised area of skin, that may be shiny with small blood vessels running over it or it may present as a raised area with ulceration. Basal-cell cancer (BCC) grows slowly and can damage the tissue around it but is unlikely to spread to distant areas or result in death.
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