The use of in vivo reflectance confocal microscopy for the diagnosis of melanoma

The use of reflectance confocal microscopy (RCM) for imaging the skin non-invasively has risen constantly during the last decade. One of the main fields of application is in skin cancer diagnosis and, in particular, melanoma diagnosis. Nowadays, RCM is regarded as a secondary level imaging tool, after clinical and dermoscopic examination. Several studies have investigated the diagnostic accuracy of RCM as compared to dermoscopic examination, and its value in enhancing early diagnosis of dermoscopic difficult melanomas. Its axial resolution and its non-invasive and easy clinical application represent the key features for the diffusion of this technique. Areas covered: The purpose of this paper was to review the principles behind RCM image acquisition as well as to describe and discuss key RCM features of melanoma. Moreover, we conducted a literature search in order to highlight the current available evidence about RCM sensitivity and specificity in the diagnosis of melanoma. Expert opinion: During the last decade, we have witnessed an increased interest in noninvasive imaging tools for the diagnosis of skin cancer. RCM is one of the most studied of a series of diagnostic methods emerging in the field of melanoma imaging. RCM is nowadays a well-established technique, integrated in the diagnostic armamentarium of the dermatologist in many referral centres. Most probably in the future, RCM will be more and more frequently available in tertiary referral centres, thus the knowledge of the pros and cons of the tool and its clinical applicability is of upmost importance in order to allow correct referrals with the final aim of improving diagnostic accuracy.