Confocal microscopy represents one of the most recent and promising innovations in the field of early diagnosis of skin tumors. Currently it allows, in association with dermatoscopic observation, a greater specificity and sensitivity for the diagnosis of melanocytic and not-melanocytic skin tumors compared to dermoscopy alone. In particular, its usefulness is maximum for the evaluation of small skin lesions or those that pose doubts to the dermatoscopic evaluation. It also allows the identification of skin carcinomas in the initial development phase and to evaluate precancerous lesions in order to highlight the degree of severity and above all to identify possible outbreaks of carcinoma in the context of these lesions.
The aim of the project is to identify the confocal microscopy criteria that correlate with cutaneous carcinoma in the initial phase of development starting from a precancerous lesion or from apparently healthy skin, especially when it comes to small lesions (
Specifically, the project is divided into 4 phases: 1) in vivo evaluation with confocal microscopy of suspected skin lesions, 2) final diagnosis obtained by histological examination, 3) analysis of the data obtained with measuring of the sensitivity and specificity of the method, 4) real possibility of applying the method to daily clinical practice.
The primary objective of this project is to be able to identify confocal microscopy criteria that are sufficiently sensitive and specific to identify skin carcinomas in the early phase of development, that is when the lesions are still too small to have sufficient criteria for a correct clinical and / or dermatoscopic diagnosis or when the tumor lesion is not yet evident in the context of a pre-existing precancerous lesion or photo-damaged skin. This is to optimize the possibilities of early diagnosis. Secondary objectives are the production of line guides, cost-benefit evaluation, reduction of unnecessary surgical procedures.
The aim of the project is to integrate into the daily clinical practice the use of confocal microscopy for those lesions that pose major diagnostic difficulties to the clinician, relative to the field of non-melanoma skin cancer. Considering that often these small lesions are localized in delicate districts such as the face, the possibility of avoiding unnecessary surgical removal certainly determines, in addition to a reduction in costs for the NHS, also a considerable benefit for the patient.
Furthermore, the possibility of assessing the presence and frequency of specific confocal microscopy criteria for carcinomatous lesions, especially in the initial phase, could allow the formulation of guidelines and specific score systems to further increase the predictive value of the method in cases where this it is really necessary, that is to say the lesions that it is not possible to evaluate with a sufficient degree of certainty with the clinic and dermatoscopy alone and that, for this reason, are often sent to surgical removal even when this is actually not necessary.