Melanoma clinicopathological groups characterized and compared with dermoscopy and reflectance confocal microscopy

Background: Dermoscopic and reflectance confocal microscopy (RCM) correlations between morphologic groups of melanoma have not yet been described. Objective: Describe and compare dermoscopic and RCM features of cutaneous melanomas with histopathological confirmation. Methods: Single center, retrospective analysis of consecutive melanomas evaluated with RCM (2015-2019). Lesions were clinically classified as typical, nevus-like, amelanotic/nonmelanoma skin cancer (NMSC)-like, seborrheic keratosis (SK)-like and lentigo/lentigo maligna (LM)-like. Presence or absence of common facial and nonfacial melanoma dermoscopic and RCM patterns were recorded. Clusters were compared with typical lesions by multivariate logistic regression. Results: Among 583 melanoma lesions, significant differences between clusters were evident (compared to typical lesions). Observation of dermoscopic features ([50% of lesions) in amelanotic/NMSC-like lesions consistently displayed 3 patterns (atypical network, atypical vascular pattern + regression structures), and nevus-like and SK-like lesions and lentigo/LM-like lesions consistently displayed 2 patterns (atypical network + regression structures, and nonevident follicles + heavy pigmentation intensity). Differences were less evident with RCM, as almost all lesions were consistent with melanoma diagnosis. Limitations: Small SK-like lesions sample, single RCM analyses (no reproduction of outcome). Conclusion: RCM has the potential to augment our ability to consistently and accurately diagnose melanoma independently of clinical and dermoscopic features. ( J Am Acad Dermatol 2024;90:309-18.)