In addition to dermoscopy, reflectance mode confocal microscopy (CM) is the most recent instrumental innovation in the field of early diagnosis of skin tumours. In clinical practice, CM often allows differential diagnosis among melanocytic and non melanocytic entities, that cannot be distinguished by clinical or dermoscopic examination alone. In addition, in association with dermoscopy, the microscopic examination of the skin lesions achieves a better accuracy on equivocal skin lesions compared to dermoscopic examination alone, as well as a much higher specificity, compared with naked eye and/or dermoscopic examination alone. This has led to a significant reduction of unnecessary excision, and a significant reduction of the costs for the National Health System. The project aim is to implement a Network for skin cancer diagnosis hinged on the systematic integration of dermoscopy and in-vivo CM for the management of pigmented and non-pigmented skin tumours.
Overall, the project is divided into 3 phases: 1) introduction of in vivo CM in the Pigmented Lesion Clinic of the Dermatology Unit of the S. Andrea Hospital in Rome; 2) spread of in vivo CM on the territory; 3) finalization of the systematic use of CM in the territory-hospital integrated system for management of skin cancer.
The main outcome is that to reduce the costs related to unnecessary excision with increment of early diagnoses of skin tumours. Secondary outcomes are represented by production of guidelines, evaluation of the cost-benefit, and analysis of the risks through the integration of the different Teaching Hospital in a structured program for skin cancer management.
