RCM at Evidence level 1b: Highest level possible

Febuary 2, 2025 – Reflectance Confocal Microscopy (RCM) has gained increasing importance in dermatological diagnostics in recent years. This non-invasive method enables a detailed real-time visualization of the skin layers and thus provides a precise assessment of skin lesions. RCM has proven to be particularly useful for improving diagnostic accuracy in lesions that are difficult to classify clinically or dermatoscopically.

In the latest European guidelines for skin cancer diagnostics, RCM has now been officially classified as level 1b evidence. This means that the method is based on the highest level of evidence, which underlines the importance and reliability of this technology. According to the guidelines, reflectance confocal microscopy should be used in particular for the further assessment of skin lesions that appear uncertain during visual inspection or dermatoscopy, provided that the technique is available.

This classification is based on extensive clinical studies and meta-analyses that have shown that RCM can outperform both the sensitivity and specificity of dermatoscopic methods. In particular, when it comes to identifying melanomas, including amelanotic variants, RCM offers a valuable addition to conventional diagnosis and helps to avoid unnecessary excisions.

The introduction of RCM with level 1b evidence in the guidelines represents a significant advance in dermatological practice and will help to further improve the accuracy and efficiency of skin cancer diagnosis. For dermatologists, this means that they can now fall back on another scientifically based method to more reliably assess difficult cases.