JScholar Publishers Systematic Review and Meta-Analysis of the Accuracy of Confocal Micros- copy in the Diagnosis of Skin Cancer Rahman A 1,* , Miller S 2 , Whittington B 2 , Tee C 2 , Mclellan G 2 , Cole D 2 , Spence R 2 , Rajpara S 1,2 1 Aberdeen Royal Inirmary, Foresterhill Aberdeen, Scotland, UK 2 University of Aberdeen, Aberdeen, UK Review Open Access *Corresponding author: Dr. Atiya Rahman, 311, Street No 39, G 9/1 Islamabad, Pakistan ; Tel: 0923345252383; Email: atiya_rahman7@yahoo.com ©2015 he Authors. Published by the JScholar under the terms of the Crea- tive Commons Attribution License http://creativecommons.org/licenses/ by/3.0/, which permits unrestricted use, provided the original author and source are credited. J Cancer Res herap Oncol 2015 | Vol 3: 104 Journal of Cancer Research and herapeutic Oncology Received Date: March 13, 2015; Accepted Date: May 08, 2015; Published Date: May 11, 2015 Citation: Rahman A, et al.. (2015) Systematic Review and Meta-Analysis of the Accuracy of Confocal Microscopy in the Diag- nosis of Skin Cancer. J Cancer Res herap Oncol 1: 1-8. Introduction Abstract Background: Nonmelanoma skin cancer (Basal Cell Cancer (BCC) and Squamous Cell Cancer (SCC)) are the most prevalent cancer in the light-skinned population. he incidence of melanoma has been increasing steadily throughout the world. Early recognition of skin cancer without doing biopsy remains challenging. he development of noninvasive diagnostic technolo- gies is highly relevant and desired. Confocal Laser Scanning Microscopy (CLSM) enables in vivo and ex vivo imaging of hu- man skin at a quasi-histologic resolution. Methods and Materials: Several databases like Medline, Embase, all EBM reviews (ACP Journal Club, Cochrane Controlled Trials Register, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Efects) and Journals@Ovid were used to perform a literature search on CLSM in the diagnosis of melanoma and non melanoma skin cancers. Standards for Reporting of Diagnosis Accuracy (STARD) initiative checklist and National Institute for Health and Clinical Excellence (NICE) guidelines on methodology were used to assess the quality of the studies found. Eight studies fulilling relevant criteria inclusive of assessment of diagnostic accuracy of CSLM and histopathology were selected. Heterogeneity among the studies was assessed and the data was pooled for meta- analysis. Results: he eight included studies did not have considerable heterogeneity between them. he pooled sensitivity for mela- noma diagnosis was 91.4% and for BCC diagnosis was 90.1%. Pooled speciicities were 79.9% and 92.6% for malignant mela- noma and BCC respectively. Diagnostic odds ratios for melanoma and BCC were 80.1 and 358.1 respectively. Conclusions: From the limited good quality available literature we found that CLSM has the potential to be an additional non- invasive diagnostic test to dermoscopy for the diagnosis of BCC and melanoma. he incidence of non melanoma skin cancer, BCC and SCC has increased by 10% per annum; with 2-3 million new cases diagnosed worldwide each year [1]. Worldwide the incidence of melanoma is increasing faster than any other cancer, with rates doubling every 10-20 years in the Caucasian population. In the UK the incidence of melanoma has quadrupled over the last 40 years [2]. Early diagnosis is of utmost importance in the management of skin cancers to prevent or minimize the morbidity and mortality associated with them. In specialized centres the ac- curacy of clinical diagnosis, on the basis of an unaided eye, of melanoma is only around 60% [3]. Histology remains the gold standard for the diagnosis of skin cancers. Various non invasive methods like dermoscopy [4,5], Raman spectrosco- py [6], CLSM [7] and others like positron emission tomogra- phy, ultrasonography, Doppler, computed tomography, mag- netic resonance imaging, optical coherence tomography and terahertz imaging have been used to improve the diagnostic performance. Out of these, dermoscopy has been in routine use for the diagnosis of the skin cancer. It provides a non in- vasive, rapid, in vivo examination of the supericial layers of the skin. It has a sensitivity and speciicity of 86% and 89% respectively for cutaneous melanoma [5]. he requirement to develop a better imaging tool remains. CLSM, a non-invasive diagnostic tool, was irst reported in 1995 to be used in vivo on human tissue [8]. Since then, there has been many studies evaluating its role in viewing the microscopic features of nor- mal skin [9] and various lesions such as cutaneous neoplasms [10,11], pigmented lesions [12,13,14], actinic keratosis [15], sebaceous gland hyperplasia [16], psoriasis [17], irritant and allergic contact dermatitis [18,19]. CLSM can distinguish melanocytes from other pigmented lesions like pigmented