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Cohort studyInternational journal of dermatology · 2026

Reflectance Confocal Microscopy Integrated With Dermoscopy in a Real-World Tertiary Referral Cohort: Diagnostic Agreement, Management Outcomes, and Number Needed to Excise in 1057 Lesions.

Luca Ambrosio, Claudio Conforti, Giovanni Di Lella … Giovanni Pellacani

DermatologyCohort study

Reflectance confocal microscopy and dermoscopy show only fair agreement in lesion diagnosis.

Reflectance Confocal Microscopy Integrated With Dermoscopy in a Real-World Tertiary Referral Cohort: Diagnostic Agreement, Management Outcomes, and Number Needed to Excise in 1057 Lesions.

Luca Ambrosio … Giovanni Pellacani

International journal of dermatology · 2026

Background

Accurate non-invasive assessment of cutaneous lesions requires integration of diagnostic information with real-world management outcomes.

Methods

This retrospective observational study included 886 patients with 1057 cutaneous lesions evaluated by combined dermoscopy and reflectance confocal microscopy at a tertiary referral center between October 2023 and September 2024.

n = 931 lesions

Results

confocal and dermoscopy diagnoses agreed only fair, not reliably interchangeable

kappa 0.21 (95% CI 0.17 to 0.25)

null 0

0.17

0.25

CI excludes the null - significant

More results

Diagnostic distributions were significantly associated (χ 2 = 571.3, df = 9, p < 0.001), with substantial discordance, particularly within melanocytic categories.

Histopathological confirmation was available for 225 lesions (21.3%), indicating verification bias.

More results

In the dedicated melanocytic excision subset, 162 excised lesions yielded 41 melanomas, resulting in a numbers needed to excise (numbers needed to excise) value of 3.95.

Malignant non-melanocytic detection yield was 39.0% among histologically confirmed excised non-melanocytic lesions.

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Conclusion · 1 of 2

In this real-world tertiary referral cohort, reflectance confocal microscopy integrated with dermoscopy supported lesion stratification and management across diagnostic categories.

Conclusion · 2 of 2

The significant association but fair agreement between modalities highlights their complementary role. Diagnostic performance estimates should be interpreted within the histology-confirmed subset and in light of verification bias.

Post

Reflectance Confocal Microscopy Integrated With Dermoscopy in a Real-World Tertiary Referral Cohort: Diagnostic Agreement, Management Outcomes, and Number Needed to Excise in 1057 Lesions.

Reflectance confocal microscopy and dermoscopy show only fair agreement in lesion diagnosis.

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