Marseille, 14-15/06/2024.
iToBoS project was presented in the Meeting of the French Society of Skin Surgery.
Dr. Josep Malvehy, from the Dermatology Department at Hospital Clínic de Barcelona, delivered a presentation at the 2024 Marseille conference of the French Society of Skin Surgery, focusing on the use of non-invasive imaging technologies to better define the surgical margins of lentigo maligna (LM). This topic is particularly relevant as LM, a form of in situ melanoma, is known for its poorly defined borders and high recurrence rates, making surgical excision challenging.
The session began with an overview of the current difficulties in managing lentigo maligna, especially in defining its margins. Dr. Malvehy explained that LM often extends into sun-damaged skin, making it hard for dermatologists to visually distinguish between malignant tissue and benign sun-damage-induced melanocytic hyperplasia. Traditional methods like histopathology, while effective, often leave uncertainty due to the overlap between atypical melanocytes in LM and adjacent sun-damaged skin, leading to challenges in achieving clear surgical margins.
Dr. Malvehy then introduced the role of non-invasive imaging technologies, particularly reflectance confocal microscopy (RCM) and dermoscopy, in addressing these challenges. He discussed how RCM allows for in vivo examination of the skin at a cellular level, enabling the detection of LM margins without the need for invasive biopsies. By analyzing three zones of the LM (center, edge, and surround), RCM can help differentiate between malignant and benign lesions, providing more accurate pre-surgical margin mapping. This reduces the risk of recurrence by ensuring that surgeons excise all cancerous tissue while sparing as much healthy tissue as possible.
One of the key points of the presentation was the comparison of histopathology and RCM in defining LM margins. Dr. Malvehy highlighted that while histopathology remains the gold standard, RCM offers significant advantages in terms of non-invasiveness and real-time evaluation. Moreover, the use of dermoscopy alongside RCM provides a more comprehensive view of the lesion, particularly in cases where the LM is amelanotic or difficult to visualize. The integration of advanced imaging technologies into clinical workflows mirrors the approach of the iToBoS project, seeking to improve early melanoma detection by combining imaging data with other clinical and genomic information, highlighting the importance of innovative, holistic tools in managing skin cancer.
The presentation also addressed the clinical implications of using these technologies for lentigo maligna. Dr. Malvehy emphasized the importance of accurate margin mapping in preventing recurrence, as incomplete excisions are a leading cause of LM returning post-surgery. He cited recent studies showing that the use of RCM and dermoscopy can improve the detection of subclinical LM spread, allowing for more precise surgical planning.
In conclusion, Dr. Malvehy called for greater integration of non-invasive imaging technologies like RCM into routine clinical practice, particularly for managing complex cases of lentigo maligna. He highlighted the ongoing research into improving these tools and stressed the need for continued collaboration between dermatologists, surgeons, and imaging specialists to ensure the best outcomes for patients. By the end of the session, attendees had a deeper understanding of the challenges in treating LM and the potential of non-invasive imaging to improve surgical precision and reduce recurrence rates.
Learn more at Journées Communes Groupe chirurgical & Imagerie cutanée non invasive 2024 - SFD | Ask Naos Pro France.
