Ignacio Gómez-Martín, Sara Moreno, Xavier Duran, Ramon M. Pujol, Sonia Segura
DOI: 10.2340/00015555-3029

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.

Pink flat skin lesions on the legs represent a diagnostic challenge due to the paucity of specific clinical and dermo­scopic features. A prospective study of a series of 114 pink flat skin lesions on the legs in elderly people was performed to describe the utility of reflectance confocal micro­scopy (RCM) in this clinical context. RCM resulted in 85.1% diagnostic accuracy, 97.5% sensitivity and 88.2% specificity for non-melanoma skin cancer diagnosis. A diagnostic RCM algorithm for pink flat lesions on the legs is proposed. RCM, as a secondary evaluation after dermoscopy, may improve diagnostic accuracy, sensitivity and specificity and may avoid the need for invasive biopsies.