Diagnostic Accuracy of Non-melanocytic Pink Flat Skin Lesions on the Legs: Dermoscopic and Reflectance Confocal Microscopy Evaluation

Abstract

Pink flat skin lesions on the legs in elderly people represent a diagnostic challenge due to the paucity of clinical and dermoscopic evidence. A prospective study of 114 pink flat lesions on the legs of 85 elderly patients was performed to describe the utility of reflectance confocal microscopy in this clinical context. Evaluation of clinical, dermoscopic and confocal parameters and calculation of diagnostic accuracy/sensitivity/specificity for non-melanoma skin cancer diagnosis of each technique were carried out. Thirty-four benign and 80 malignant neoplasms were analysed. A correct clinical diagnosis was established in 49.1% of cases (sensitivity 68.7%, specificity 73.5%). Dermoscopy achieved 59.6% correct diagnosis (sensitivity 85%, specificity 67.6%) and confocal microscopy evaluation after clinical and dermoscopic evaluation rendered a correct diagnosis in 85.1% of cases (sensitivity 97.5%, specificity 88.2%). Confocal microscopy may improve diagnostic accuracy, sensitivity and specificity as a secondary evaluation after dermoscopy. A diagnostic confocal algorithm for pink flat lesions on the legs is proposed.