Correlation between sequential digital dermoscopy, in vivo confocal microscopy, and histopathological features in amelanotic melanomas
DOI:
https://doi.org/10.70577/7tdr9f39Keywords:
amelanotic melanoma; digital dermoscopy; reflectance confocal microscopy; histopathology; diagnostic accuracyAbstract
Background: Amelanotic/hypomelanotic melanoma (AHM) accounts for 2%–8% of all cutaneous melanomas. Its median Breslow thickness (1.60 mm) is significantly greater than that of pigmented melanoma (0.68 mm), reflecting a diagnostic delay and a poorer prognosis. The absence of pigment invalidates the classic ABCD criteria, and conventional dermoscopy loses sensitivity. Objective: To evaluate the correlation between sequential digital dermoscopy (SDD), in vivo reflectance confocal microscopy (RCM), and histopathological features in the diagnosis of amelanotic melanoma. Methods: Systematic review following PRISMA 2020 guidelines. A systematic search was conducted in PubMed/MEDLINE, Europe PMC, and Google Scholar (January 2000 to September 2026). Two independent reviewers selected studies, extracted data, and assessed risk of bias using the QUADAS-2 tool. Certainty of evidence was assessed using GRADE. Results: Eight studies were included (n = 8). Dermoscopy showed a sensitivity of 70% and a specificity of 56% for the diagnosis of AHM. RCM presented a false-negative rate of 12.1%. In a series of 583 histologically confirmed melanomas, RCM identified melanoma criteria in almost all lesions, regardless of their clinical or dermoscopic presentation. Conclusions: SDD provides value in dynamic monitoring; RCM acts as an "optical biopsy" with cellular resolution; histopathology with immunohistochemistry remains the reference standard. A stepwise diagnostic pathway is proposed: dermoscopy (with sequential follow-up) → RCM (cytological confirmation) → histopathology (definitive diagnosis).
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Copyright (c) 2026 Erika Paulina Cayo Camino, Gissela Elizabeth Yungan Yamberla, Delia Thaiz Proaño Gaibor, Johanna Carolina Álvarez Jiménez, Mishell Antonella Román Arévalo (Autor/a)
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