International expert recommendations on image acquisition for in vivo reflectance confocal microscopy of cutaneous tumors

Background: No international recommendations exist for a minimum imaging requirement per lesion using reflectance confocal microscopy (RCM). This may be beneficial given the increasing use of remote RCM interpretation internationally. Objective: To develop international expert recommendations for image acquisition using tissue-coupled RCM for diagnosis of cutaneous tumors. Methods: Using a modified Delphi approach, a core group developed the scope and drafted initial recommendations before circulation to a larger group, the Cutaneous Imaging Expert Resource Group of the American Academy of Dermatology. Each review round consisted of a period of open comment, followed by revisions. Results: The recommendations were developed after 5 alternating rounds of review among the core group and the Cutaneous Imaging Expert Resource Group. These were divided into subsections of imaging personnel, recommended lesion criteria, clinical and lesion information to be provided, lesion preparation, image acquisition, mosaic cube settings, and additional captures based on lesion characteristics and suspected diagnosis. Limitations: The current recommendations are limited to tissue-coupled RCM for diagnosis of cutaneous tumors. It is one component of the larger picture of quality assurance and will require ongoing review. Conclusions: These recommendations serve as a resource to facilitate quality assurance, economical use of time, accurate diagnosis, and international collaboration. ( J Am Acad Dermatol 2024;90:537-44.)