P056 Reflectance confocal microscopy and basal cell carcinoma: is it time to embrace the new technology?

Reflectance confocal microscopy (RCM) is a noninvasive technique for in vivo examination of the skin. In vivo RCM can be used to diagnose basal cell carcinoma (BCC) noninvasively. Previous studies have demonstrated that RCM is an accurate technique for the diagnosis of BCC. RCM has the advantage that it is noninvasive and provides the diagnosis within a few minutes. By contrast, the current standard of care requires an invasive biopsy, taking several days before the result is available, and is costly and can result in sampling errors. We provide a snapshot of how we have integrated RCM into our service, and how it has reduced the number of biopsies, resulting in significant cost savings and shortening patients’ pathways. Sixty-three patients with suspected BCC of the head and neck were referred to our RCM clinic in January, February and March 2023. A diagnosis of BCC was made by RCM in real time in 89% of cases (56 of 63). Confirmation of the diagnosis of BCC in clinic facilitated discussion with the patient at the same outpatient attendance with regards to treatment, without the need for an additional outpatient visit. Overall, 11% of patients (seven of 63) suspected of having a BCC, whose diagnosis could not be confirmed by RCM, required a biopsy that confirmed the diagnosis of BCC. The median turnaround time for the biopsy result was 12 days. The cost of a punch biopsy in our hospital is £330 per patient, of which £176 is attributable to histopathology costs. Following the diagnosis of BCC, 73% (46 of 63) were referred directly for Mohs surgery, 12% (eight of 63) had conventional excision, 5% (three of 63) were referred for radiotherapy, and 10% (six of 63) were managed conservatively. We have shown that integrating RCM into our dermatology service has negated the need for biopsy in 89% of head and neck BCCs referred to the RCM clinic. RCM has resulted in shortening of patients’ pathways, it has reduced the pressure on our histopathology service, it has lessened the risk of false negative biopsies due to sampling errors, and it has produced significant cost savings. The diagnosis of BCC by RCM is a simple skill to acquire and allows the clinician to make the diagnosis with a few minutes. For patients, it is a more acceptable method of diagnosing BCC without recourse to biopsy. For the wider NHS, it has the potential for significant cost savings.