Precision at the Cutting Edge: Ex Vivo Confocal Microscopy for Perioperative Tumour Thickness Assessment in Melanoma

Ex vivo confocal laser microscopy (EVCM) represents a promising diagnostic tool for the immediate assessment of fresh tissue, with significant potential for the management of melanoma. This study aimed to evaluate the accuracy of EVCM in determining perioperative tumour thickness, a critical factor in guiding treatment strategies for melanoma. A total of 27 confirmed melanomas of varying thickness and from multiple anatomic sites were analysed using both EVCM and gold standard conventional histopathology. Tumour thickness was independently measured using confocal tumour thickness (CTT) and histopathological tumour thickness (HTT) and subsequently compared using correlation analysis, Spearman's correlation coefficient and Bland-Altman plot. Our findings demonstrate a high correlation between HTT and CTT, with a Spearman's correlation coefficient of 0.94. Bland-Altman analysis revealed a mean difference of -0.19 ± 0.72 mm between CTT and HTT, indicating a strong agreement between the two measurement methods. These results underscore the potential of EVCM as a reliable tool for perioperative evaluation of tumour thickness in melanoma, potentially streamlining the decision-making process for surgical margins and improving patient outcomes. Further studies with larger sample sizes are warranted to validate these findings and explore the broader applicability of EVCM in clinical practice.