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Friche P, Moulis L, Du Thanh A, Dereure O, Duflos C, Carbonnel F. Training Family Medicine Residents in Dermoscopy Using an e-Learning Course: Pilot Interventional Study. JMIR Form Res 2024; 8:e56005. [PMID: 38739910 PMCID: PMC11130775 DOI: 10.2196/56005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/05/2024] [Accepted: 03/20/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Skin cancers are the most common group of cancers diagnosed worldwide. Aging and sun exposure increase their risk. The decline in the number of dermatologists is pushing the issue of dermatological screening back onto family doctors. Dermoscopy is an easy-to-use tool that increases the sensitivity of melanoma diagnosis by 60% to 90%, but its use is limited due to lack of training. The characteristics of "ideal" dermoscopy training have yet to be established. We created a Moodle (Moodle HQ)-based e-learning course to train family medicine residents in dermoscopy. OBJECTIVE This study aimed to evaluate the evolution of dermoscopy knowledge among family doctors immediately and 1 and 3 months after e-learning training. METHODS We conducted a prospective interventional study between April and November 2020 to evaluate an educational program intended for family medicine residents at the University of Montpellier-Nîmes, France. They were asked to complete an e-learning course consisting of 2 modules, with an assessment quiz repeated at 1 (M1) and 3 months (M3). The course was based on a 2-step algorithm, a method of dermoscopic analysis of pigmented skin lesions that is internationally accepted. The objectives of modules 1 and 2 were to differentiate melanocytic lesions from nonmelanocytic lesions and to precisely identify skin lesions by looking for dermoscopic morphological criteria specific to each lesion. Each module consisted of 15 questions with immediate feedback after each question. RESULTS In total, 134 residents were included, and 66.4% (n=89) and 47% (n=63) of trainees fully participated in the evaluation of module 1 and module 2, respectively. This study showed a significant score improvement 3 months after the training course in 92.1% (n=82) of participants for module 1 and 87.3% (n=55) of participants for module 2 (P<.001). The majority of the participants expressed satisfaction (n=48, 90.6%) with the training course, and 96.3% (n=51) planned to use a dermatoscope in their future practice. Regarding final scores, the only variable that was statistically significant was the resident's initial scores (P=.003) for module 1. No measured variable was found to be associated with retention (midtraining or final evaluation) for module 2. Residents who had completed at least 1 dermatology rotation during medical school had significantly higher initial scores in module 1 at M0 (P=.03). Residents who reported having completed at least 1 dermatology rotation during their family medicine training had a statistically significant higher score at M1 for module 1 and M3 for module 2 (P=.01 and P=.001). CONCLUSIONS The integration of an e-learning training course in dermoscopy into the curriculum of FM residents results in a significant improvement in their diagnosis skills and meets their expectations. Developing a program combining an e-learning course and face-to-face training for residents is likely to result in more frequent and effective dermoscopy use by family doctors.
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Affiliation(s)
- Pauline Friche
- University Department of Family Medicine, University of Montpellier, Montpellier, France
| | - Lionel Moulis
- Clinical Research and Epidemiology Unit, Department of Public Health, Montpellier University Hospital, Montpellier, France
- Pathogenesis and Control of Chronic and Emerging Infections, University of Montpellier, Institut national de la santé et de la recherche médicale, Etablissement français du sang, University of Antilles, Montpellier, France
| | - Aurélie Du Thanh
- Pathogenesis and Control of Chronic and Emerging Infections, University of Montpellier, Institut national de la santé et de la recherche médicale, Etablissement français du sang, University of Antilles, Montpellier, France
- Department of Dermatology, Montpellier University Hospital, Montpellier, France
- Department of Dermatology, University of Montpellier, Montpellier, France
| | - Olivier Dereure
- Department of Dermatology, Montpellier University Hospital, Montpellier, France
- Department of Dermatology, University of Montpellier, Montpellier, France
| | - Claire Duflos
- Clinical Research and Epidemiology Unit, Department of Public Health, Montpellier University Hospital, Montpellier, France
- Department of Public Health, University of Montpellier, Montpellier, France
| | - Francois Carbonnel
- University Department of Family Medicine, University of Montpellier, Montpellier, France
- Desbrest Institute of Epidemiology and Public Health, Unité Mixte de Recherche, Unité d'accueil 11, University of Montpellier, Institut national de la santé et de la recherche médicale, Montpellier, France
- University Multiprofessional Health Center Avicenne, Montpellier, France
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Dessinioti C, Liopyris K, Stratigos AJ. Diagnosis of invasive cutaneous squamous cell carcinoma, imaging and staging. Ital J Dermatol Venerol 2024; 159:118-127. [PMID: 38650493 DOI: 10.23736/s2784-8671.24.07670-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
The assessment of patients with a lesion raising the suspicion of an invasive cutaneous squamous cell carcinoma (cSCC) is a frequent clinical scenario. The management of patients with cSCC is a multistep approach, starting with the correct diagnosis. The two main diagnostic goals are to differentiate from other possible diagnoses and correctly recognize the lesion as cSCC, and then to determine the tumor spread (perform staging), that is if the patient has a common primary cSCC or a locally advanced cSCC, or a metastatic cSCC (with in-transit, regional lymph nodal, or rarely distant metastasis). The multistep diagnostic approach begins with the clinical characteristics of the primary cSCC, it is complemented with features with dermoscopy and, if available, reflectance confocal microscopy and is confirmed with histopathology. The tumor spread is assessed by physical examination and, in some cases, ultrasound and/or computed tomography or magnetic resonance imaging, mainly to investigate for regional lymph node metastasis or for local infiltration into deeper structures. In the last step, the clinical, histologic and radiologic findings are incorporated into staging systems.
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Affiliation(s)
- Clio Dessinioti
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - Konstantinos Liopyris
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - Alexander J Stratigos
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece -
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Dessinioti C, Tsiakou A, Christodoulou A, Stratigos AJ. Clinical and Dermoscopic Findings of Nevi after Photoepilation: A Review. Life (Basel) 2023; 13:1832. [PMID: 37763236 PMCID: PMC10532922 DOI: 10.3390/life13091832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/21/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023] Open
Abstract
Atypical clinical and dermoscopic findings, or changes in pigmented melanocytic lesions located on body areas treated with lasers or intense pulsed light (IPL) for hair removal (photoepilation), have been described in the literature. There are three prospective studies in a total of 79 individuals with 287 melanocytic nevi and several case reports reporting the dermoscopic findings and changes after photoepilation. Clinical changes have been reported in 20-100% of individuals, while dermoscopic changes have been observed in 48% to 93% of nevi. More frequent dermoscopic changes included bleaching, the development of pigmented globules, and irregular hyperpigmented areas and regression structures, including gray areas, gray dots/globules, and whitish structureless areas. The diagnostic approach for pigmented lesions with atypical dermoscopic findings and changes after photo-epilation included reflectance confocal microscopy, sequential digital dermoscopy follow-up, and/or excision and histopathology. Challenges pertaining to these diagnostic steps in the context of photoepilation include the detection of findings that may warrant a biopsy to exclude melanoma (ugly duckling, irregular hyperpigmented areas, blue-gray or white areas, and loss of pigment network), the potential persistence of changes at follow-up, and that a histopathologic diagnosis may not be possible due to the distortion of melanocytes or complete regression of the lesion. Furthermore, these diagnostic approaches can be time-consuming, require familiarization of the physician with dermoscopic features, may cause anxiety to the individual, and highlight that avoiding passes of the laser or IPL devices over pigmented lesions is key.
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Affiliation(s)
- Clio Dessinioti
- 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, 16121 Athens, Greece
| | - Andriani Tsiakou
- State Department of Dermatology-Venereology, Andreas Sygros Hospital, 16121 Athens, Greece
| | - Athina Christodoulou
- 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, 16121 Athens, Greece
| | - Alexander J. Stratigos
- 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, 16121 Athens, Greece
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Pigmented Bowen Disease in the Acral Region: A Diagnostic Challenge. Am J Dermatopathol 2023; 45:235-236. [PMID: 36921300 DOI: 10.1097/dad.0000000000002393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
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Avilés-Izquierdo JA, García-Piqueras P, Ciudad-Blanco C, Lozano-Masdemont B, Lázaro-Ochaita P, Bellón-Cano JM, Rodríguez-Lomba E. Do not PASS any melanoma without diagnosis: a new simplified dermoscopic algorithm. Int J Dermatol 2023; 62:518-523. [PMID: 36661139 DOI: 10.1111/ijd.16573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/19/2022] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Dermoscopic algorithms for melanoma diagnosis could be time-expending, and their reliability in daily practice lower than expected. OBJECTIVE To propose a simplified dermoscopic algorithm for melanoma diagnosis. MATERIAL AND METHODS A multicenter retrospective analysis of 1,120 dermoscopic images of atypical melanocytic tumors (320 melanomas and 800 non-melanomas) was performed. An algorithm based on polychromia, asymmetry in colors or structures, and some melanoma-specific structures was designed. Univariate and multivariate logistic regression analysis was calculated to estimate the coefficients of each potential predictor for melanoma diagnosis. A score was developed based on the dermoscopic evaluations performed by four experts blinded to histological diagnosis. RESULTS Most melanomas had ≥3 colors (280; 84.5%), asymmetry in colors or structures (289; 90.3%), and at least one melanoma-specific structure (316; 98.7%). PASS score ≥3 had a 91.9% sensibility, 87% specificity, and 88.4% diagnostic accuracy for melanoma. PASS algorithm showed an area under the curve (AUC) of 0.947 (95% CI 0.935-0.959). LIMITATIONS This study was retrospective. A comparison between the performances of different dermoscopic algorithms is difficult because of their designs. CONCLUSION PASS algorithm showed a very good diagnostic accuracy, independently of the observers' experience, and it seems easier to perform than previous dermoscopic algorithms.
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Affiliation(s)
| | - Paloma García-Piqueras
- Department of Dermatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Cristina Ciudad-Blanco
- Department of Dermatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Pizzichetta MA, Polesel J, Perrot JL, Rubegni P, Fiorani D, Rizzo A, Stanganelli I, Magi S, Mazzoni L, Medri M, Dominici MM, Toffolutti F, Farnetani F, Lippolis N, Pedroni G, Ciardo S, Condorelli AG, Conforti C, Pellacani G, Zalaudek I, Puglisi F, Cinotti E. Amelanotic/hypomelanotic lentigo maligna: Dermoscopic and confocal features predicting diagnosis. J Eur Acad Dermatol Venereol 2023; 37:303-310. [PMID: 36196781 PMCID: PMC10092015 DOI: 10.1111/jdv.18636] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 09/12/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Amelanotic/hypomelanotic lentigo maligna and lentigo maligna melanoma (AHLM/LMM) may be very difficult to diagnose at an early stage. OBJECTIVES To quantify the predictive value of dermoscopic and reflectance confocal microscopy (RCM) features for AHLM/LMM. METHODS Dermoscopic and RCM images of histopathologically diagnosed AHLM/LMM, amelanotic/hypomelanotic benign lesions (AHBL), and amelanotic/hypomelanotic basal and squamous cell carcinomas (AHBCC/AHSCC) of the head and neck from consecutive patients were retrospectively collected and blindly evaluated by three observers to assess presence or absence of dermoscopic and RCM criteria. RESULTS Overall, 224 lesions in 216 patients including LM/LMM (n = 55, 24.6%), AHBL (n = 107, 47.8%) and AHBCC/AHSCC (n = 62, 27.7%) were analysed. Multivariable analysis showed that milky-red areas (OR = 5.46; 95% CI: 1.51-19.75), peripheral light brown structureless areas (OR = 19.10; 4.45-81.96), linear irregular vessels (OR = 5.44; 1.45-20.40), and asymmetric pigmented follicles (OR = 14.45; 2.77-75.44) at dermoscopy, and ≥3 atypical cells in five fields (OR = 10.12; 3.00-34.12) and focal follicular localization of atypical cells at dermo-epidermal junction (DEJ) (OR = 10.48; 1.10-99.81) at RCM were significantly independent diagnostic factors for AHLM/LMM vs. AHBL. In comparison with AHBCC/AHSCC, peripheral light brown structureless area (OR = 7.11; 1.53-32.96), pseudonetwork around hair follicles (OR = 16.69; 2.73-102.07), and annular granular structures (OR = 42.36; 3.51-511.16) at dermoscopy and large dendritic (OR = 6.86; 3.15-38.28) and round pagetoid cells (OR = 26.78; 3.15-227.98) at RCM led to a significantly increased risk of diagnosing AHLM/LMM. CONCLUSIONS Amelanotic/hypomelanotic lentigo maligna and lentigo maligna melanoma may have the same dermoscopic features of AHM on other body sites, such as milky red areas, peripheral light brown structureless areas and linear irregular vessels. These features, asymmetric pigmented follicles and at RCM ≥ 3 atypical cells in five fields and focal follicular extension of atypical cells at DEJ may help in recognizing AHLM/LMM even when LM conventional features (e.g., obliteration of hair follicles under dermoscopy and large pagetoid cells under RCM) are absent or present only in very small areas of the lesion.
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Affiliation(s)
- Maria A Pizzichetta
- Department of Dermatology, University of Trieste, Trieste, Italy.,Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Jerry Polesel
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Jean L Perrot
- Department of Dermatology, University Hospital of Saint Etienne, Saint-Etienne, France
| | - Pietro Rubegni
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy
| | - Diletta Fiorani
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy
| | - Arianna Rizzo
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy
| | - Ignazio Stanganelli
- Department of Dermatology, University of Parma, Parma, Italy.,Skin Cancer Unit, Istituto Scientifico Romagnolo per lo Studio dei Tumori "Dino Amadori" (IRST) IRCCS, Meldola, Italy
| | - Serena Magi
- Skin Cancer Unit, Istituto Scientifico Romagnolo per lo Studio dei Tumori "Dino Amadori" (IRST) IRCCS, Meldola, Italy
| | - Laura Mazzoni
- Skin Cancer Unit, Istituto Scientifico Romagnolo per lo Studio dei Tumori "Dino Amadori" (IRST) IRCCS, Meldola, Italy
| | - Matelda Medri
- Skin Cancer Unit, Istituto Scientifico Romagnolo per lo Studio dei Tumori "Dino Amadori" (IRST) IRCCS, Meldola, Italy
| | - Michele M Dominici
- Division of Dermatology, Department of Medicina and Surgery, Azienda Ospedaliera-Universitaria di Parma, Parma, Italy
| | - Federica Toffolutti
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Francesca Farnetani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Nicola Lippolis
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Gioia Pedroni
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Silvana Ciardo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandra G Condorelli
- Dermatologic Unit, Department of Medical Specialities Arcispedale Santa Maria Nuova, IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Claudio Conforti
- Department of Dermatology, University of Trieste, Trieste, Italy
| | - Giovanni Pellacani
- Department of Dermatology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Iris Zalaudek
- Department of Dermatology, University of Trieste, Trieste, Italy
| | - Fabio Puglisi
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy.,Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Elisa Cinotti
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy
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Yuki A, Takatsuka S, Abe R, Takenouchi T. Diagnostic accuracy of dermoscopy for 934 basal cell carcinomas: A single-center retrospective study. J Dermatol 2023; 50:64-71. [PMID: 36229917 DOI: 10.1111/1346-8138.16607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/18/2022] [Accepted: 09/26/2022] [Indexed: 01/04/2023]
Abstract
Although the efficacy of dermoscopic diagnosis of basal cell carcinoma (BCC) has already been established, most studies have been conducted in Western countries. However, there are racial differences in the clinicopathological characteristics of BCC, highlighting the need for a survey among Asians. Herein, we aimed to investigate the diagnostic accuracy of dermoscopy in 934 Japanese patients with BCC and statistically analyze the clinicopathological factors affecting diagnostic accuracy. We analyzed 5093 skin lesions, including 934 BCCs that were diagnosed consecutively from 1998 to 2018. The sensitivity and specificity of dermoscopic diagnosis for BCC were calculated. The sensitivity and specificity of dermoscopic diagnosis were 92.2% and 96.0%, respectively. There were 73 false-negative cases of BCCs that were clinically diagnosed with other diseases. The most common incorrect clinical diagnosis was seborrheic keratosis (n = 18), followed by melanocytic nevus (n = 15). Multiple logistic regression analysis showed that sensitivity was significantly lower in BCCs located on the trunk and extremities, which showed low pigmentation (less than 10% of the lesion surface) and were diagnosed by a resident dermatologist. Experience of 3-6 months of 12 resident dermatologists revealed increased sensitivity. Dermoscopy is a reliable tool for the accurate diagnosis of BCC in Japanese individuals. Care should be taken when diagnosing BCCs of the trunk and extremities, and the less-pigmented subtype because of lower sensitivity. A certain amount of experience is required to improve the skills for dermoscopy.
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Affiliation(s)
- Akihiko Yuki
- Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.,Department of Dermatology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Sumiko Takatsuka
- Department of Dermatology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Riichiro Abe
- Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tatsuya Takenouchi
- Department of Dermatology, Niigata Cancer Center Hospital, Niigata, Japan
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Giuffrida R, Conforti C, Blum A, Buljan M, Guarneri F, Hofmann-Wellenhof R, Longo C, Paoli J, Rosendahl C, Soyer HP, Jurakić Tončić R, Vezzoni R, Zalaudek I. Vascular Diameter as Clue for the Diagnosis of Clinically and/or Dermoscopically Equivocal Pigmented and Non-Pigmented Basal Cell Carcinomas and Nodular Melanomas. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121761. [PMID: 36556965 PMCID: PMC9786710 DOI: 10.3390/medicina58121761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/24/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022]
Abstract
Background and objectives: Dermoscopy is a useful tool for the early and non-invasive diagnosis of skin malignancies. Besides many progresses, heavily pigmented and amelanotic skin tumors remain still a challenge. We aimed to investigate by dermoscopy if distinctive morphologic characteristics of vessels may help the diagnosis of equivocal nodular lesions. Materials and Methods: A collage of 16 challenging clinical and dermoscopic images of 8 amelanotic and 8 heavily pigmented nodular melanomas and basal cell carcinomas was sent via e-mail to 8 expert dermoscopists. Results: Dermoscopy improved diagnostic accuracy in 40 cases. Vessels were considered the best clue in 71 cases. Focusing on the diameter of vessels improved diagnosis in 5 cases. Conclusions: vascular diameter in addition to morphology and arrangement may be a useful dermoscopic clue for the differential diagnosis of clinically equivocal nodular malignant tumors.
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Affiliation(s)
- Roberta Giuffrida
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, 98124 Messina, Italy
- Correspondence:
| | - Claudio Conforti
- Department of Dermatology and Venereology, Dermatology Clinic, Maggiore Hospital, University of Trieste, 34125 Trieste, Italy
| | - Andreas Blum
- Hautarzt-und Lehrpraxis Konstanz, Augustinerplatz 7, 78462 Konstanz, Germany
| | - Marija Buljan
- Department of Dermatology and Venereology, Sestre Milosrdnice University Hospital Centre, 10000 Zagreb, Croatia
- School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Fabrizio Guarneri
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, 98124 Messina, Italy
| | - Rainer Hofmann-Wellenhof
- Nonmelanoma Skin Cancer Unit, Department of Dermatology and Venerology, Medical University of Graz, 8036 Graz, Austria
| | - Caterina Longo
- Department of Dermatology, University of Modena and Reggio Emilia, 41124 Modena, Italy
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - John Paoli
- Department of Dermatology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
| | - Cliff Rosendahl
- School of Medicine, The University of Queensland, Brisbane, QLD 4102, Australia
| | - H. Peter Soyer
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, QLD 4102, Australia
| | | | - Roberta Vezzoni
- Department of Dermatology and Venereology, Dermatology Clinic, Maggiore Hospital, University of Trieste, 34125 Trieste, Italy
| | - Iris Zalaudek
- Department of Dermatology and Venereology, Dermatology Clinic, Maggiore Hospital, University of Trieste, 34125 Trieste, Italy
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Polesie S, Gillstedt M, Kittler H, Rinner C, Tschandl P, Paoli J. Assessment of melanoma thickness based on dermoscopy images: an open, web-based, international, diagnostic study. J Eur Acad Dermatol Venereol 2022; 36:2002-2007. [PMID: 35841304 PMCID: PMC9796258 DOI: 10.1111/jdv.18436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/14/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Preoperative assessment of whether a melanoma is invasive or in situ (MIS) is a common task that might have important implications for triage, prognosis and the selection of surgical margins. Several dermoscopic features suggestive of melanoma have been described, but only a few of these are useful in differentiating MIS from invasive melanoma. OBJECTIVE The primary aim of this study was to evaluate how accurately a large number of international readers, individually as well as collectively, were able to discriminate between MIS and invasive melanomas as well as estimate the Breslow thickness of invasive melanomas based on dermoscopy images. The secondary aim was to compare the accuracy of two machine learning convolutional neural networks (CNNs) and the collective reader response. METHODS We conducted an open, web-based, international, diagnostic reader study using an online platform. The online challenge opened on 10 May 2021 and closed on 19 July 2021 (71 days) and was advertised through several social media channels. The investigation included, 1456 dermoscopy images of melanomas (788 MIS; 474 melanomas ≤1.0 mm and 194 >1.0 mm). A test set comprising 277 MIS and 246 invasive melanomas was used to compare readers and CNNs. RESULTS We analysed 22 314 readings by 438 international readers. The overall accuracy (95% confidence interval) for melanoma thickness was 56.4% (55.7%-57.0%), 63.4% (62.5%-64.2%) for MIS and 71.0% (70.3%-72.1%) for invasive melanoma. Readers accurately predicted the thickness in 85.9% (85.4%-86.4%) of melanomas ≤1.0 mm (including MIS) and in 70.8% (69.2%-72.5%) of melanomas >1.0 mm. The reader collective outperformed a de novo CNN but not a pretrained CNN in differentiating MIS from invasive melanoma. CONCLUSIONS Using dermoscopy images, readers and CNNs predict melanoma thickness with fair to moderate accuracy. Readers most accurately discriminated between thin (≤1.0 mm including MIS) and thick melanomas (>1.0 mm).
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Affiliation(s)
- S. Polesie
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Department of Dermatology and Venereology, Region Västra GötalandSahlgrenska University HospitalGothenburgSweden
| | - M. Gillstedt
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Department of Dermatology and Venereology, Region Västra GötalandSahlgrenska University HospitalGothenburgSweden
| | - H. Kittler
- Department of DermatologyMedical University of ViennaViennaAustria
| | - C. Rinner
- Center of Medical Statistics, Informatics and Intelligent Systems (CeMSIIS)Medical University of ViennaViennaAustria
| | - P. Tschandl
- Department of DermatologyMedical University of ViennaViennaAustria
| | - J. Paoli
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Department of Dermatology and Venereology, Region Västra GötalandSahlgrenska University HospitalGothenburgSweden
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Saito S, Kuriyama Y, Uchiyama A, Yasuda M, Motegi SI. Capillaroscopy in Pigmented Basal Cell Carcinoma Smaller than 3-mm Diameter: A Report of Four Lesions. Acta Derm Venereol 2022; 102:adv00762. [DOI: 10.2340/actadv.v102.2522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract is missing (Short communication)
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11
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Shahriari N, Rabinovitz H, Oliviero M, Grant-Kels JM. Reflectance confocal microscopy: Melanocytic and nonmelanocytic. Clin Dermatol 2021; 39:643-656. [PMID: 34809769 DOI: 10.1016/j.clindermatol.2021.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Reflectance confocal microscopy (RCM) is a noninvasive imaging tool that has the potential to revolutionize dermatology. Extensive research in this area in conjunction with the recent assignment of reimbursement codes has made the clinical use of this technology a practical reality. Though there is awareness and use of this technology at large academic centers, a knowledge gap still remains in interpreting RCM images among the dermatology community. We review the key RCM features of melanocytic and nonmelanocytic lesions to provide guidance in distinguishing benign entities from malignant dermatologic neoplasms.
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Affiliation(s)
- Neda Shahriari
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut, USA.
| | - Harold Rabinovitz
- Dr Philip Frost Department of Dermatology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Margaret Oliviero
- Dr Philip Frost Department of Dermatology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
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12
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Kinoshita-Ise M, Sachdeva M. Update on trichoscopy: Integration of the terminology by systematic approach and a proposal of a diagnostic flowchart. J Dermatol 2021; 49:4-18. [PMID: 34806223 DOI: 10.1111/1346-8138.16233] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 01/18/2023]
Abstract
Trichoscopy represents a non-invasive diagnostic modality widely used in daily practice. Despite the common perception that this technique has been fairly established, some key issues remain to be addressed. Complexity and inconsistency in terminology in past literature are likely to confuse investigators when they are recording, reporting, and retrieving the findings. In addition, a diagnostic algorithm adopting sufficiently integrated and updated findings is not readily available. By adopting a systematic review approach, this review attempted to redefine major trichoscopic findings and integrate their synonyms individually into the most frequently used terms besides identifying and discussing terms which potentially cause confusion. The findings are categorized into five subgroups: hair shaft, follicular, perifollicular, scalp findings, and hair distribution pattern abnormalities. The calculation of sensitivities and positive predictive values of such redefined findings was conducted by reviewing the descriptions in the past literature on major hair diseases, including alopecia areata, androgenetic alopecia/female pattern hair loss, telogen effluvium, trichotillomania, lichen planopilaris, frontal fibrosing alopecia, central centrifugal cicatricial alopecia, discoid lupus erythematosus, folliculitis decalvans, tinea capitis, and dissecting cellulitis, to confirm the diagnostically meaningful findings for representative diseases. This attempt redefined, for instance, yellow dots, short vellus hairs, exclamation mark hairs, black dots, and broken hairs as the findings of diagnostic significance for alopecia areata and hair diameter diversity, peripilar sign, and focal atrichia for androgenetic alopecia/female pattern hair loss. An updated diagnostic flowchart is proposed with the instructions to maximize its usefulness. Current limitations and future perspectives of trichoscopy as well as other emerging non-invasive diagnostic modalities for hair diseases are also discussed.
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Affiliation(s)
| | - Muskaan Sachdeva
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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13
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Polesie S, Sundback L, Gillstedt M, Ceder H, Dahlén Gyllencreutz J, Fougelberg J, Johansson Backman E, Pakka J, Zaar O, Paoli J. Interobserver Agreement on Dermoscopic Features and their Associations with In Situ and Invasive Cutaneous Melanomas. Acta Derm Venereol 2021; 101:adv00570. [PMID: 34596231 PMCID: PMC9425618 DOI: 10.2340/actadv.v101.281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Several melanoma-specific dermoscopic features have been described, some of which have been reported as indicative of in situ or invasive melanomas. To assess the usefulness of these features to differentiate between these 2 categories, a retrospective, single-centre investigation was conducted. Dermoscopic images of melanomas were reviewed by 7 independent dermatologists. Fleiss' kappa (κ) was used to analyse interobserver agreement of predefined features. Logistic regression and odds ratios were used to assess whether specific features correlated with melanoma in situ or invasive melanoma. Overall, 182 melanomas (101 melanoma in situ and 81 invasive melanomas) were included. The interobserver agreement for melanoma-specific features ranged from slight to substantial. Atypical blue-white structures (κ=0.62, 95% confidence interval 0.59-0.65) and shiny white lines (κ=0.61, 95% confidence interval 0.58-0.64) had a substantial interobserver agreement. These 2 features were also indicative of invasive melanomas >1.0 mm in Breslow thickness. Furthermore, regression/peppering correlated with thin invasive melanomas. The overall agreement for classification of the lesions as invasive or melanoma in situ was moderate (κ=0.52, 95% confidence interval 0.49-0.56).
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Affiliation(s)
- Sam Polesie
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SE-413 45 Gothenburg, Sweden.
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14
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Bhatti A, Chowdhary S, Ferrise T, Govardhanam N, Parish A, Tropper Y, Vlahovic TC. Plantar Verruca and Dermoscopy: An Update. Clin Podiatr Med Surg 2021; 38:513-520. [PMID: 34538428 DOI: 10.1016/j.cpm.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Traditionally, plantar warts or verrucae are often diagnosed by visual appearance and the lateral squeeze test. At times, these methods are not able to elucidate the difference between a plantar wart and a callus. The use of the dermatoscope can not only distinguish the difference between a wart and a callus, which ultimately helps to customize treatment plans to increase efficacy, but also be used to follow the therapeutic effects of treatment. The dermatoscope is a tool that can be used in the diagnosis of plantar verrucae and in assessment of the success of therapy.
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Affiliation(s)
- Adam Bhatti
- Temple University School of Podiatric Medicine, 148 North 8th Street, Philadelphia, PA 19107, USA
| | - Saakshi Chowdhary
- Temple University School of Podiatric Medicine, 148 North 8th Street, Philadelphia, PA 19107, USA
| | - Thomas Ferrise
- Temple University School of Podiatric Medicine, 148 North 8th Street, Philadelphia, PA 19107, USA
| | - Naga Govardhanam
- Temple University School of Podiatric Medicine, 148 North 8th Street, Philadelphia, PA 19107, USA
| | - Alexandra Parish
- Temple University School of Podiatric Medicine, 148 North 8th Street, Philadelphia, PA 19107, USA
| | - Yaakov Tropper
- Temple University School of Podiatric Medicine, 148 North 8th Street, Philadelphia, PA 19107, USA
| | - Tracey C Vlahovic
- Temple University School of Podiatric Medicine, 148 North 8th Street, Philadelphia, PA 19107, USA.
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15
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Minagawa A, Mikoshiba Y, Koga H, Okuyama R. Dermoscopy image-based self-learning on computer improves diagnostic performance of medical students compared with classroom-style lecture in ultra-short period. J Dermatol 2020; 47:1432-1435. [PMID: 32885874 DOI: 10.1111/1346-8138.15592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/05/2020] [Accepted: 08/07/2020] [Indexed: 11/28/2022]
Abstract
The educational effectiveness of dermoscopy image-based self-learning on a computer for medical students has not been well examined. To assess the effect of an image-based self-learning session on the dermoscopic diagnostic performance for malignant melanoma (MM), basal cell carcinoma, melanocytic nevus and seborrheic keratosis (SK) on non-acral regions in comparison with a conventional classroom-style lecture, 114 fourth-year medical students (mean age, 23.7 years; male : female, 73:41) were enrolled. The subjects were randomly assigned to either a self-learning to lecture (SL) or lecture to self-learning (LS) group to receive a 15-min image-based self-learning computer session and a 15-min video lecture session in different orders. The user interface of the digital content was the same as that on a website (https://dz-image.casio.jp). Diagnostic performance was determined using the total number of correct answers for the four diseases and by malignancy prediction in examination A (before training), B (after receiving one session) and C (after receiving both sessions). The examinations were all unique and contained five dermoscopic images each of the four diseases. The total number of correct answers and malignancy prediction results for examination B were significantly higher in the SL group than in LS (11.6 and 15.2 vs 10.1 and 13.4, respectively; both P < 0.01), with no remarkable differences for examination C (13.5 and 16.8 vs 13.3 and 16.4, respectively; P = 0.62 and P = 0.21). In subanalyses, the number of correct answers for SK in examination B was significantly higher in the SL group (3.6 vs. 1.8, P < 0.01), while that for MM was significantly lower (2.2 vs 3.0, P < 0.01). Diagnostic performance was comparable between sexes for examination B. In conclusion, computer-assisted dermoscopy image-based self-learning may be a suitable and non-inferior alternative to classroom-style instruction for medical students within an ultra-short training period.
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Affiliation(s)
- Akane Minagawa
- Department of Dermatology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yasutomo Mikoshiba
- Department of Dermatology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hiroshi Koga
- Department of Dermatology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Ryuhei Okuyama
- Department of Dermatology, Shinshu University School of Medicine, Matsumoto, Japan
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16
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Kaushik A, Natsis N, Gordon SC, Seiverling EV. A practical review of dermoscopy for pediatric dermatology part I: Melanocytic growths. Pediatr Dermatol 2020; 37:789-797. [PMID: 32748996 DOI: 10.1111/pde.14291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The value of dermoscopy in the detection of skin cancer is well established. Less is published on the utility of dermoscopy in the evaluation of pediatric skin disease. Our review (in two parts) aims to serve as an update on pediatric dermoscopy and to provide readers with a practical application for the use of dermoscopy in pediatric dermatology clinics. In part I, we propose a dermoscopy algorithm for pediatric skin disease and melanocytic growths, and in part II, we address vascular growths, common skin infections, and inflammatory conditions for which dermoscopy is valuable.
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Affiliation(s)
- Anshika Kaushik
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital-San Diego, San Diego, CA, USA.,Department of Dermatology, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Nicola Natsis
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital-San Diego, San Diego, CA, USA.,University of California San Diego School of Medicine, San Diego, CA, USA
| | | | - Elizabeth V Seiverling
- Department of Dermatology, Tufts Medical Center, Boston, MA, USA.,Division of Dermatology, Maine Medical Center & Maine Medical Partners, Portland, ME, USA
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17
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Lallas A, Lallas K, Tschandl P, Kittler H, Apalla Z, Longo C, Argenziano G. The dermoscopic inverse approach significantly improves the accuracy of human readers for lentigo maligna diagnosis. J Am Acad Dermatol 2020; 84:381-389. [PMID: 32592885 DOI: 10.1016/j.jaad.2020.06.085] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/16/2020] [Accepted: 06/19/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND A recently introduced dermoscopic method for the diagnosis of early lentigo maligna (LM) is based on the absence of prevalent patterns of pigmented actinic keratosis and solar lentigo/flat seborrheic keratosis. We term this the inverse approach. OBJECTIVE To determine whether training on the inverse approach increases the diagnostic accuracy of readers compared to classic pattern analysis. METHODS We used clinical and dermoscopic images of histopathologically diagnosed LMs, pigmented actinic keratoses, and solar lentigo/flat seborrheic keratoses. Participants in a dermoscopy masterclass classified the lesions at baseline and after training on pattern analysis and the inverse approach. We compared their diagnostic performance among the 3 timepoints and to that of a trained convolutional neural network. RESULTS The mean sensitivity for LM without training was 51.5%; after training on pattern analysis, it increased to 56.7%; and after learning the inverse approach, it increased to 83.6%. The mean proportions of correct answers at the 3 timepoints were 62.1%, 65.5, and 78.5%. The percentages of readers outperforming the convolutional neural network were 6.4%, 15.4%, and 53.9%, respectively. LIMITATIONS The experimental setting and the inclusion of histopathologically diagnosed lesions only. CONCLUSIONS The inverse approach, added to the classic pattern analysis, significantly improves the sensitivity of human readers for early LM diagnosis.
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Affiliation(s)
- Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece.
| | | | - Philipp Tschandl
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Harald Kittler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Zoe Apalla
- Second Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Caterina Longo
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico di Reggio Emilia, Reggio Emilia, Italy; Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
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18
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Berglund S, Bogren L, Paoli J. Diagnostic accuracy and safety of short-term teledermoscopic monitoring of atypical melanocytic lesions. J Eur Acad Dermatol Venereol 2020; 34:1233-1239. [PMID: 31838783 DOI: 10.1111/jdv.16144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/12/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Short-term dermoscopic monitoring (STDM) of atypical melanocytic lesions (AML) after 3.0-4.5 months can be used to detect featureless melanomas without performing countless unnecessary excisions of nevi. Recently, short-term teledermoscopic monitoring (STTM) was incorporated into the STDM clinical routine at Sahlgrenska University Hospital in Gothenburg, Sweden. Follow-up images for STTM were taken by an assistant nurse with subsequent teledermoscopic assessment by a dermatologist. OBJECTIVES The purpose of this study was to evaluate the diagnostic accuracy and safety of STTM. METHODS In this retrospective observational study, data from electronic health records of patients with teledermoscopically monitored AMLs were explored. The number of changed and excised AMLs and their histopathological diagnoses were recorded. The excised AMLs were categorized into three subgroups according to when they changed and were excised: (i) following STTM, (ii) after planned long-term follow-up or (iii) after unplanned long-term follow-up. RESULTS A total of 686 patients with 883 AMLs were monitored with STTM. Sixty-two AMLs (7.0%) were excised following STTM, 14 (1.6%) after planned long-term follow-up and 10 (1,1%) after unplanned long-term follow-up. Twenty-one melanomas were detected using STTM, three after planned long-term follow-up and three after unplanned long-term follow-up. All melanomas were in situ (n = 20) or thin and non-ulcerated (n = 7; median Breslow thickness 0.4 mm, range 0.3-0.8 mm). The sensitivity for the diagnosis of melanoma by means of STTM with the option of additional planned follow-up was 88.9%, and the specificity was 93.9%. The number of AMLs needed to monitor in order to detect one melanoma with the STTM routine was 32.7, and the number needed to excise was 3.2. CONCLUSIONS STTM of AMLs was safe and allowed for high diagnostic accuracy. All detected melanomas were in situ or thin and non-ulcerated. Furthermore, a considerable number of unnecessary excisions were spared.
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Affiliation(s)
- S Berglund
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Dermatology and Venereology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - L Bogren
- Department of Dermatology and Venereology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - J Paoli
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Dermatology and Venereology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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19
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Kato J, Horimoto K, Sato S, Minowa T, Uhara H. Dermoscopy of Melanoma and Non-melanoma Skin Cancers. Front Med (Lausanne) 2019; 6:180. [PMID: 31497603 PMCID: PMC6712997 DOI: 10.3389/fmed.2019.00180] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 07/29/2019] [Indexed: 12/24/2022] Open
Abstract
Dermoscopy is a widely used non-invasive technique for diagnosing skin tumors. In melanocytic tumors, e.g., melanoma and basal cell carcinoma (BCC), the effectiveness of dermoscopic examination has been fully established over the past two decades. Moreover, dermoscopy has been used to diagnose non-melanocytic tumors. Here, we review novel findings from recent reports concerning dermoscopy of melanoma and non-melanoma skin cancers including BCC, sebaceous carcinoma, actinic keratosis, Bowen's disease, squamous cell carcinoma (SCC), Merkel cell carcinoma (MCC), extramammary Paget's disease (EMPD), and angiosarcoma.
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Affiliation(s)
- Junji Kato
- Department of Dermatology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Kohei Horimoto
- Department of Dermatology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Sayuri Sato
- Department of Dermatology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tomoyuki Minowa
- Department of Dermatology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hisashi Uhara
- Department of Dermatology, Sapporo Medical University School of Medicine, Sapporo, Japan
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20
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Augustsson A, Paoli J. Effects of a 1-Day Training Course in Dermoscopy Among General Practitioners. Dermatol Pract Concept 2019; 9:195-199. [PMID: 31384492 DOI: 10.5826/dpc.0903a04] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2019] [Indexed: 10/31/2022] Open
Abstract
Background General practitioners (GPs) are often the first point of contact for Swedish patients seeking medical advice for skin lesions of concern, but many lack training in dermoscopy. Objective To examine the effects of a 1-day training course in dermoscopy among Swedish GPs. Methods The intervention group consisted of GPs who underwent a 1-day training course in dermoscopy and a control group that did not undergo any education. Before the training course, the intervention group performed a test consisting of 30 dermoscopy cases including 9 different benign and malignant melanocytic and nonmelanocytic diagnoses. The participants then took the same test directly after the course and again after 6 months. The control group took the same test twice with a 6-month interval in between tests in order to avoid recall bias. Results Twenty-seven GPs in the intervention group took the test before and immediately after the course with an improvement of their median test scores by 8 points (13 vs 20 correct answers, P < 0.01). Eighteen participants also took the test a third time after 6 months with similar results compared with the second test (median scores of 20.5 vs 20.0, P = 0.3). In the control group, 16 persons preformed both tests with an improvement of their median score by 2 points (13.5 vs 15.5 correct answers, P = 0.06). Conclusions The results of this study show positive effects on diagnostic accuracy in a test situation among GPs receiving a 1-day training course in dermoscopy.
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Affiliation(s)
| | - John Paoli
- Department of Dermatology and Venereology, Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Department of Dermatology and Venereology, Gothenburg, Sweden
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21
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Ferrante di Ruffano L, Dinnes J, Deeks JJ, Chuchu N, Bayliss SE, Davenport C, Takwoingi Y, Godfrey K, O'Sullivan C, Matin RN, Tehrani H, Williams HC. Optical coherence tomography for diagnosing skin cancer in adults. Cochrane Database Syst Rev 2018; 12:CD013189. [PMID: 30521690 PMCID: PMC6516952 DOI: 10.1002/14651858.cd013189] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Early accurate detection of all skin cancer types is essential to guide appropriate management and to improve morbidity and survival. Melanoma and squamous cell carcinoma (SCC) are high-risk skin cancers, which have the potential to metastasise and ultimately lead to death, whereas basal cell carcinoma (BCC) is usually localised, with potential to infiltrate and damage surrounding tissue. Anxiety around missing early cases needs to be balanced against inappropriate referral and unnecessary excision of benign lesions. Optical coherence tomography (OCT) is a microscopic imaging technique, which magnifies the surface of a skin lesion using near-infrared light. Used in conjunction with clinical or dermoscopic examination of suspected skin cancer, or both, OCT may offer additional diagnostic information compared to other technologies. OBJECTIVES To determine the diagnostic accuracy of OCT for the detection of cutaneous invasive melanoma and atypical intraepidermal melanocytic variants, basal cell carcinoma (BCC), or cutaneous squamous cell carcinoma (cSCC) in adults. SEARCH METHODS We undertook a comprehensive search of the following databases from inception up to August 2016: Cochrane Central Register of Controlled Trials; MEDLINE; Embase; CINAHL; CPCI; Zetoc; Science Citation Index; US National Institutes of Health Ongoing Trials Register; NIHR Clinical Research Network Portfolio Database; and the World Health Organization International Clinical Trials Registry Platform. We studied reference lists and published systematic review articles. SELECTION CRITERIA We included studies of any design evaluating OCT in adults with lesions suspicious for invasive melanoma and atypical intraepidermal melanocytic variants, BCC or cSCC, compared with a reference standard of histological confirmation or clinical follow-up. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data using a standardised data extraction and quality assessment form (based on QUADAS-2). Our unit of analysis was lesions. Where possible, we estimated summary sensitivities and specificities using the bivariate hierarchical model. MAIN RESULTS We included five studies with 529 cutaneous lesions (282 malignant lesions) providing nine datasets for OCT, two for visual inspection alone, and two for visual inspection plus dermoscopy. Studies were of moderate to unclear quality, using data-driven thresholds for test positivity and giving poor accounts of reference standard interpretation and blinding. Studies may not have been representative of populations eligible for OCT in practice, for example due to high disease prevalence in study populations, and may not have reflected how OCT is used in practice, for example by using previously acquired OCT images.It was not possible to make summary statements regarding accuracy of detection of melanoma or of cSCC because of the paucity of studies, small sample sizes, and for melanoma differences in the OCT technologies used (high-definition versus conventional resolution OCT), and differences in the degree of testing performed prior to OCT (i.e. visual inspection alone or visual inspection plus dermoscopy).Pooled data from two studies using conventional swept-source OCT alongside visual inspection and dermoscopy for the detection of BCC estimated the sensitivity of OCT as 95% (95% confidence interval (CI) 91% to 97%) and specificity of 77% (95% CI 69% to 83%).When applied to a hypothetical population of 1000 lesions at the mean observed BCC prevalence of 60%, OCT would miss 31 BCCs (91 fewer than would be missed by visual inspection alone and 53 fewer than would be missed by visual inspection plus dermoscopy), and OCT would lead to 93 false-positive results for BCC (a reduction in unnecessary excisions of 159 compared to using visual inspection alone and of 87 compared to visual inspection plus dermoscopy). AUTHORS' CONCLUSIONS Insufficient data are available on the use of OCT for the detection of melanoma or cSCC. Initial data suggest conventional OCT may have a role for the diagnosis of BCC in clinically challenging lesions, with our meta-analysis showing a higher sensitivity and higher specificity when compared to visual inspection plus dermoscopy. However, the small number of studies and varying methodological quality means implications to guide practice cannot currently be drawn.Appropriately designed prospective comparative studies are required, given the paucity of data comparing OCT with dermoscopy and other similar diagnostic aids such as reflectance confocal microscopy.
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Affiliation(s)
| | - Jacqueline Dinnes
- University of BirminghamInstitute of Applied Health ResearchEdgbaston CampusBirminghamUKB15 2TT
- University Hospitals Birmingham NHS Foundation Trust and University of BirminghamNIHR Birmingham Biomedical Research CentreBirminghamUK
| | - Jonathan J Deeks
- University of BirminghamInstitute of Applied Health ResearchEdgbaston CampusBirminghamUKB15 2TT
- University Hospitals Birmingham NHS Foundation Trust and University of BirminghamNIHR Birmingham Biomedical Research CentreBirminghamUK
| | - Naomi Chuchu
- University of BirminghamInstitute of Applied Health ResearchEdgbaston CampusBirminghamUKB15 2TT
| | - Susan E Bayliss
- University of BirminghamInstitute of Applied Health ResearchEdgbaston CampusBirminghamUKB15 2TT
| | - Clare Davenport
- University of BirminghamInstitute of Applied Health ResearchEdgbaston CampusBirminghamUKB15 2TT
| | - Yemisi Takwoingi
- University of BirminghamInstitute of Applied Health ResearchEdgbaston CampusBirminghamUKB15 2TT
- University Hospitals Birmingham NHS Foundation Trust and University of BirminghamNIHR Birmingham Biomedical Research CentreBirminghamUK
| | - Kathie Godfrey
- The University of Nottinghamc/o Cochrane Skin GroupNottinghamUK
| | | | - Rubeta N Matin
- Churchill HospitalDepartment of DermatologyOld RoadHeadingtonOxfordUKOX3 7LE
| | - Hamid Tehrani
- Whiston HospitalDepartment of Plastic and Reconstructive SurgeryWarrington RoadLiverpoolUKL35 5DR
| | - Hywel C Williams
- University of NottinghamCentre of Evidence Based DermatologyQueen's Medical CentreDerby RoadNottinghamUKNG7 2UH
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22
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Dinnes J, Deeks JJ, Chuchu N, Matin RN, Wong KY, Aldridge RB, Durack A, Gulati A, Chan SA, Johnston L, Bayliss SE, Leonardi‐Bee J, Takwoingi Y, Davenport C, O'Sullivan C, Tehrani H, Williams HC. Visual inspection and dermoscopy, alone or in combination, for diagnosing keratinocyte skin cancers in adults. Cochrane Database Syst Rev 2018; 12:CD011901. [PMID: 30521688 PMCID: PMC6516870 DOI: 10.1002/14651858.cd011901.pub2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Early accurate detection of all skin cancer types is important to guide appropriate management, to reduce morbidity and to improve survival. Basal cell carcinoma (BCC) is almost always a localised skin cancer with potential to infiltrate and damage surrounding tissue, whereas a minority of cutaneous squamous cell carcinomas (cSCCs) and invasive melanomas are higher-risk skin cancers with the potential to metastasise and cause death. Dermoscopy has become an important tool to assist specialist clinicians in the diagnosis of melanoma, and is increasingly used in primary-care settings. Dermoscopy is a precision-built handheld illuminated magnifier that allows more detailed examination of the skin down to the level of the superficial dermis. Establishing the value of dermoscopy over and above visual inspection for the diagnosis of BCC or cSCC in primary- and secondary-care settings is critical to understanding its potential contribution to appropriate skin cancer triage, including referral of higher-risk cancers to secondary care, the identification of low-risk skin cancers that might be treated in primary care and to provide reassurance to those with benign skin lesions who can be safely discharged. OBJECTIVES To determine the diagnostic accuracy of visual inspection and dermoscopy, alone or in combination, for the detection of (a) BCC and (b) cSCC, in adults. We separated studies according to whether the diagnosis was recorded face-to-face (in person) or based on remote (image-based) assessment. SEARCH METHODS We undertook a comprehensive search of the following databases from inception up to August 2016: Cochrane Central Register of Controlled Trials; MEDLINE; Embase; CINAHL; CPCI; Zetoc; Science Citation Index; US National Institutes of Health Ongoing Trials Register; NIHR Clinical Research Network Portfolio Database; and the World Health Organization International Clinical Trials Registry Platform. We studied reference lists and published systematic review articles. SELECTION CRITERIA Studies of any design that evaluated visual inspection or dermoscopy or both in adults with lesions suspicious for skin cancer, compared with a reference standard of either histological confirmation or clinical follow-up. DATA COLLECTION AND ANALYSIS Two review authors independently extracted all data using a standardised data extraction and quality assessment form (based on QUADAS-2). We contacted authors of included studies where information related to the target condition or diagnostic thresholds were missing. We estimated accuracy using hierarchical summary ROC methods. We undertook analysis of studies allowing direct comparison between tests. To facilitate interpretation of results, we computed values of sensitivity at the point on the SROC curve with 80% fixed specificity and values of specificity with 80% fixed sensitivity. We investigated the impact of in-person test interpretation; use of a purposely-developed algorithm to assist diagnosis; and observer expertise. MAIN RESULTS We included 24 publications reporting on 24 study cohorts, providing 27 visual inspection datasets (8805 lesions; 2579 malignancies) and 33 dermoscopy datasets (6855 lesions; 1444 malignancies). The risk of bias was mainly low for the index test (for dermoscopy evaluations) and reference standard domains, particularly for in-person evaluations, and high or unclear for participant selection, application of the index test for visual inspection and for participant flow and timing. We scored concerns about the applicability of study findings as of 'high' or 'unclear' concern for almost all studies across all domains assessed. Selective participant recruitment, lack of reproducibility of diagnostic thresholds and lack of detail on observer expertise were particularly problematic.The detection of BCC was reported in 28 datasets; 15 on an in-person basis and 13 image-based. Analysis of studies by prior testing of participants and according to observer expertise was not possible due to lack of data. Studies were primarily conducted in participants referred for specialist assessment of lesions with available histological classification. We found no clear differences in accuracy between dermoscopy studies undertaken in person and those which evaluated images. The lack of effect observed may be due to other sources of heterogeneity, including variations in the types of skin lesion studied, in dermatoscopes used, or in the use of algorithms and varying thresholds for deciding on a positive test result.Meta-analysis found in-person evaluations of dermoscopy (7 evaluations; 4683 lesions and 363 BCCs) to be more accurate than visual inspection alone for the detection of BCC (8 evaluations; 7017 lesions and 1586 BCCs), with a relative diagnostic odds ratio (RDOR) of 8.2 (95% confidence interval (CI) 3.5 to 19.3; P < 0.001). This corresponds to predicted differences in sensitivity of 14% (93% versus 79%) at a fixed specificity of 80% and predicted differences in specificity of 22% (99% versus 77%) at a fixed sensitivity of 80%. We observed very similar results for the image-based evaluations.When applied to a hypothetical population of 1000 lesions, of which 170 are BCC (based on median BCC prevalence across studies), an increased sensitivity of 14% from dermoscopy would lead to 24 fewer BCCs missed, assuming 166 false positive results from both tests. A 22% increase in specificity from dermoscopy with sensitivity fixed at 80% would result in 183 fewer unnecessary excisions, assuming 34 BCCs missed for both tests. There was not enough evidence to assess the use of algorithms or structured checklists for either visual inspection or dermoscopy.Insufficient data were available to draw conclusions on the accuracy of either test for the detection of cSCCs. AUTHORS' CONCLUSIONS Dermoscopy may be a valuable tool for the diagnosis of BCC as an adjunct to visual inspection of a suspicious skin lesion following a thorough history-taking including assessment of risk factors for keratinocyte cancer. The evidence primarily comes from secondary-care (referred) populations and populations with pigmented lesions or mixed lesion types. There is no clear evidence supporting the use of currently-available formal algorithms to assist dermoscopy diagnosis.
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Affiliation(s)
- Jacqueline Dinnes
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
- University Hospitals Birmingham NHS Foundation Trust and University of BirminghamNIHR Birmingham Biomedical Research CentreBirminghamUK
| | - Jonathan J Deeks
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
- University Hospitals Birmingham NHS Foundation Trust and University of BirminghamNIHR Birmingham Biomedical Research CentreBirminghamUK
| | - Naomi Chuchu
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | - Rubeta N Matin
- Churchill HospitalDepartment of DermatologyOld RoadHeadingtonOxfordUKOX3 7LE
| | - Kai Yuen Wong
- Oxford University Hospitals NHS Foundation TrustDepartment of Plastic and Reconstructive SurgeryOxfordUK
| | - Roger Benjamin Aldridge
- NHS Lothian/University of EdinburghDepartment of Plastic Surgery25/6 India StreetEdinburghUKEH3 6HE
| | - Alana Durack
- Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation TrustDermatologyHills RoadCambridgeUKCB2 0QQ
| | - Abha Gulati
- Barts Health NHS TrustDepartment of DermatologyWhitechapelLondonUKE11BB
| | - Sue Ann Chan
- City HospitalBirmingham Skin CentreDudley RdBirminghamUKB18 7QH
| | - Louise Johnston
- NIHR Diagnostic Evidence Co‐operative Newcastle2nd Floor William Leech Building (Rm M2.061) Institute of Cellular Medicine Newcastle UniversityFramlington PlaceNewcastle upon TyneUKNE2 4HH
| | - Susan E Bayliss
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | - Jo Leonardi‐Bee
- The University of NottinghamDivision of Epidemiology and Public HealthClinical Sciences BuildingNottingham City Hospital NHS Trust Campus, Hucknall RoadNottinghamUKNG5 1PB
| | - Yemisi Takwoingi
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
- University Hospitals Birmingham NHS Foundation Trust and University of BirminghamNIHR Birmingham Biomedical Research CentreBirminghamUK
| | - Clare Davenport
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | | | - Hamid Tehrani
- Whiston HospitalDepartment of Plastic and Reconstructive SurgeryWarrington RoadLiverpoolUKL35 5DR
| | - Hywel C Williams
- University of NottinghamCentre of Evidence Based DermatologyQueen's Medical CentreDerby RoadNottinghamUKNG7 2UH
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Tognetti L, Cevenini G, Moscarella E, Cinotti E, Farnetani F, Mahlvey J, Perrot J, Longo C, Pellacani G, Argenziano G, Fimiani M, Rubegni P. An integrated clinical-dermoscopic risk scoring system for the differentiation between early melanoma and atypical nevi: the iDScore. J Eur Acad Dermatol Venereol 2018; 32:2162-2170. [DOI: 10.1111/jdv.15106] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 05/22/2018] [Indexed: 12/23/2022]
Affiliation(s)
- L. Tognetti
- Dermatology Unit; Department of Medical, Surgical and NeuroSciences; University of Siena; Siena Italy
- Department of Medical Biotechnologies; University of Siena; Siena Italy
| | - G. Cevenini
- Department of Medical Biotechnologies; University of Siena; Siena Italy
| | - E. Moscarella
- Dermatology Unit; University of Campania; Naples Italy
- Skin Cancer Unit Arcispedale S. Maria Nuova-IRCCS; Reggio Emilia Italy
| | - E. Cinotti
- Dermatology Unit; Department of Medical, Surgical and NeuroSciences; University of Siena; Siena Italy
| | - F. Farnetani
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - J. Mahlvey
- Melanoma Unit; Department of Dermatology; University of Barcelona; Barcelona Spain
| | - J.L. Perrot
- Dermatology Unit; University Hospital of St-Etienne; Saint Etienne France
| | - C. Longo
- Skin Cancer Unit Arcispedale S. Maria Nuova-IRCCS; Reggio Emilia Italy
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - G. Pellacani
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - G. Argenziano
- Dermatology Unit; University of Campania; Naples Italy
| | - M. Fimiani
- Dermatology Unit; Department of Medical, Surgical and NeuroSciences; University of Siena; Siena Italy
| | - P. Rubegni
- Dermatology Unit; Department of Medical, Surgical and NeuroSciences; University of Siena; Siena Italy
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Pezzini C, Mandel VD, Persechino F, Ciardo S, Kaleci S, Chester J, De Carvalho N, Persechino S, Pellacani G, Farnetani F. Seborrheic keratoses mimicking melanoma unveiled by in vivo reflectance confocal microscopy. Skin Res Technol 2018; 24:285-293. [PMID: 29363175 DOI: 10.1111/srt.12427] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Seborrheic keratoses (SebK) with atypical dermoscopy presentation are increasingly reported. These lesions do not exhibit typical dermoscopy features of SebK and sometimes mimic melanoma, thus complicating the differential diagnosis. Reflectance confocal microscopy (RCM) is a non-invasive tool, which allows an in vivo imaging of the skin. The study objectives were to evaluate the agreement between RCM classification and histological diagnoses, and the reliability of well-known RCM criteria for SebK in the identification of SebK with atypical dermoscopy presentation. MATERIALS AND METHODS We retrospectively analysed at RCM excised lesions presenting in dermoscopy ≥1 score at revisited 7-point checklist. The study population consisted of cases showing no melanocytic RCM findings. Lesions were investigated for distinct non-melanocytic RCM features, blinded from histopathology diagnoses. Histopathology matching was then performed before statistical analysis. RESULTS The study consisted of 117 cases, classified at RCM as SebK (71 cases), dermatofibroma (18 cases), basal cell carcinoma (13 cases), squamous cell carcinoma (2 cases), and "non-specific" (13 cases). Overall K strength of agreement at histopathology matching proved 0.76. Of the 71 cases classified at RCM with SebK, agreement was achieved in 97%. CONCLUSION Reflectance confocal microscopy classification proved high agreement with histopathology for SebK with atypical dermoscopy presentations, allowing an early differential diagnosis. RCM features in this group of lesions were similar to those described for typical cases of SebK, and may assist clinician therapy decision making, whilst avoiding unnecessary excisions.
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Affiliation(s)
- C Pezzini
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - V D Mandel
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - F Persechino
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - S Ciardo
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - S Kaleci
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - J Chester
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - N De Carvalho
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - S Persechino
- Dermatology Unit, NESMOS Department, S. Andrea Hospital, University of Rome "Sapienza", Rome, Italy
| | - G Pellacani
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - F Farnetani
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
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25
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Togawa Y. Review of vasculature visualized on dermoscopy. J Dermatol 2017; 44:525-532. [DOI: 10.1111/1346-8138.13686] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 10/06/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Yaei Togawa
- Department of Dermatology; Chiba University Graduate School of Medicine; Chiba Japan
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26
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Tanaka T, Tada Y, Ohnishi T, Watanabe S. Usefulness of real-time tissue elastography for detecting the border of basal cell carcinomas. J Dermatol 2016; 44:438-443. [DOI: 10.1111/1346-8138.13578] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 08/02/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Takamitsu Tanaka
- Department of Dermatology; Teikyo University School of Medicine; Tokyo Japan
| | - Yayoi Tada
- Department of Dermatology; Teikyo University School of Medicine; Tokyo Japan
| | - Takamitsu Ohnishi
- Department of Dermatology; Teikyo University School of Medicine; Tokyo Japan
| | - Shinichi Watanabe
- Department of Dermatology; Teikyo University School of Medicine; Tokyo Japan
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27
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Mun JH, Park SM, Kim GW, Song M, Kim HS, Ko HC, Kim BS, Kim MB. Clinical and dermoscopic characteristics of extramammary Paget disease: a study of 35 cases. Br J Dermatol 2016; 174:1104-7. [DOI: 10.1111/bjd.14300] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J.-H. Mun
- Department of Dermatology; Seoul National University College of Medicine; Seoul Korea
| | - S.-M. Park
- Department of Dermatology; Pusan National University College of Medicine, and Medical Research Institute; Pusan National University Hospital; 179 Gudeok-Ro Seo-Gu Busan 602-739 Korea
| | - G.-W. Kim
- Department of Dermatology; Pusan National University College of Medicine, and Medical Research Institute; Pusan National University Hospital; 179 Gudeok-Ro Seo-Gu Busan 602-739 Korea
| | - M. Song
- Department of Dermatology; Pusan National University College of Medicine, and Medical Research Institute; Pusan National University Hospital; 179 Gudeok-Ro Seo-Gu Busan 602-739 Korea
| | - H.-S. Kim
- Department of Dermatology; Pusan National University College of Medicine, and Medical Research Institute; Pusan National University Hospital; 179 Gudeok-Ro Seo-Gu Busan 602-739 Korea
| | - H.-C. Ko
- Department of Dermatology; Pusan National University College of Medicine, and Medical Research Institute; Pusan National University Hospital; 179 Gudeok-Ro Seo-Gu Busan 602-739 Korea
| | - B.-S. Kim
- Department of Dermatology; Pusan National University College of Medicine, and Medical Research Institute; Pusan National University Hospital; 179 Gudeok-Ro Seo-Gu Busan 602-739 Korea
| | - M.-B. Kim
- Department of Dermatology; Pusan National University College of Medicine, and Medical Research Institute; Pusan National University Hospital; 179 Gudeok-Ro Seo-Gu Busan 602-739 Korea
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28
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Takahashi A, Hara H, Aikawa M, Ochiai T. Dermoscopic features of small size pigmented basal cell carcinomas. J Dermatol 2015; 43:543-6. [PMID: 26458728 DOI: 10.1111/1346-8138.13173] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 09/03/2015] [Indexed: 11/30/2022]
Abstract
Dermoscopic images of histologically proven pigmented basal cell carcinomas (BCC) were retrospectively assessed to compare the dermoscopic features of BCC of 3 mm or less in diameter (n = 6) with BCC of 4-6 mm in diameter (n = 11). All lesions lacked the presence of a pigment network. BCC with a diameter of 3 mm or less had fewer positive dermoscopic features compared with the 4-6 mm in diameter BCC. Multiple blue-gray globules and large blue-gray ovoid nests were frequently present. Dermoscopy is a useful tool for early diagnosis of pigmented BCC, even when they are small.
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Affiliation(s)
- Asuka Takahashi
- Department of Dermatology, Nihon University Hospital, Tokyo, Japan
| | - Hiroyuki Hara
- Department of Dermatology, Nihon University Hospital, Tokyo, Japan.,Department of Functional Morphology, Nihon University School of Medicine, Tokyo, Japan
| | - Miwa Aikawa
- Department of Dermatology, Nihon University Hospital, Tokyo, Japan
| | - Toyoko Ochiai
- Department of Dermatology, Nihon University Hospital, Tokyo, Japan
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29
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Edamitsu T, Minagawa A, Koga H, Uhara H, Okuyama R. Eccrine porocarcinoma shares dermoscopic characteristics with eccrine poroma: A report of three cases and review of the published work. J Dermatol 2015; 43:332-5. [DOI: 10.1111/1346-8138.13082] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 07/15/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Tomohiro Edamitsu
- Department of Dermatology; Shinshu University School of Medicine; Matsumoto Japan
| | - Akane Minagawa
- Department of Dermatology; Shinshu University School of Medicine; Matsumoto Japan
| | - Hiroshi Koga
- Department of Dermatology; Shinshu University School of Medicine; Matsumoto Japan
| | - Hisashi Uhara
- Department of Dermatology; Shinshu University School of Medicine; Matsumoto Japan
| | - Ryuhei Okuyama
- Department of Dermatology; Shinshu University School of Medicine; Matsumoto Japan
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30
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Dasgeb B, Morris MA, Mehregan D, Siegel EL. Quantified ultrasound elastography in the assessment of cutaneous carcinoma. Br J Radiol 2015; 88:20150344. [PMID: 26268142 DOI: 10.1259/bjr.20150344] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the feasibility of high-frequency ultrasound and ultrasound elastography (USE) in discriminating benign from malignant skin lesions in a prospective cohort study and to introduce the use of a "strain ratio" for evaluation of skin lesions. METHODS A commercial ultrasound system with a 14-MHz transducer was used to visualize skin lesions requiring biopsy on clinical evaluation. Anatomic ultrasound and USE imaging of the skin lesions was performed using 2- to 4-mm gel stand-off pads. A region of interest was manually selected over the area of each lesion with the lowest strain. The concept of a strain ratio of the compressibility of the normal skin at the corresponding layer to that of the least compressible region of a lesion in question was created and applied. This ratio was subsequently correlated with blind histopathological evaluation for malignancy. RESULTS 55 patients were included in the study with a total of 67 lesions evaluated. 29 lesions were malignant and 38 benign. All malignant lesions had strain ratios ≥3.9. All benign lesions had strain ratios ≤3.0. A diagnostic value between 3.0 and 3.9 would result in 100% sensitivity and specificity in the characterization of these lesions as malignant. CONCLUSION This pilot study demonstrated that USE plus strain ratio appears to be a promising modality in providing diagnostic determination between cancerous and benign primary solitary skin lesions prior to biopsy. ADVANCES IN KNOWLEDGE This is the first reported study applying an original mathematical elastographic ratio, or strain ratio, to evaluate primary solitary skin lesions.
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Affiliation(s)
- Bahar Dasgeb
- 1 Department of Medicine Dermatology Service, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA.,2 Analytical and Stochastic Biomedical Physics Section, National Institutes of Health, Bethesda, MD, USA
| | - Michael A Morris
- 3 Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, MD, USA.,4 Department of Internal Medicine, Mercy Medical Center, Baltimore, MD, USA
| | - Darius Mehregan
- 5 Department of Dermatology, Wayne State University, Dearborn, MI, USA.,6 Pinkus Dermatopathology Laboratories, Monroe, MI, USA
| | - Eliot L Siegel
- 3 Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, MD, USA.,7 Department of Diagnostic Radiology and Nuclear Medicine, Baltimore Veterans Affairs Medical Center, Baltimore, MD, USA
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31
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Pizzichetta MA, Kittler H, Stanganelli I, Bono R, Cavicchini S, De Giorgi V, Ghigliotti G, Quaglino P, Rubegni P, Argenziano G, Talamini R. Pigmented nodular melanoma: the predictive value of dermoscopic features using multivariate analysis. Br J Dermatol 2015; 173:106-14. [PMID: 25916655 DOI: 10.1111/bjd.13861] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Nodular melanoma (NM), representing 10-30% of all melanomas, plays a major role in global mortality related to melanoma. Nonetheless, the literature on dermoscopy of NM is scanty. OBJECTIVES To assess odds ratios (ORs) to quantify dermoscopic features of pigmented NM vs. pigmented superficial spreading melanoma (SSM), and pigmented nodular nonmelanocytic and benign melanocytic lesions. METHODS To assess the presence or absence of global patterns and dermoscopic criteria, digitized images of 457 pigmented skin lesions from patients with a histopathological diagnosis of NM (n = 75), SSM (n = 93), and nodular nonmelanocytic and benign melanocytic lesions (n = 289; namely, 39 basal cell carcinomas, 85 seborrhoeic keratoses, 81 blue naevi, and 84 compound/dermal naevi) were retrospectively collected and blindly evaluated by three observers. RESULTS Multivariate analysis showed that ulceration (OR 4.07), homogeneous disorganized pattern (OR 10.76), and homogeneous blue pigmented structureless areas (OR 2.37) were significantly independent prognostic factors for NM vs. SSM. Multivariate analysis of dermoscopic features of NM vs. nonmelanocytic and benign melanocytic lesions showed that the positive correlating features leading to a significantly increased risk of NM were asymmetric pigmentation (OR 6.70), blue-black pigmented areas (OR 7.15), homogeneous disorganized pattern (OR 9.62), a combination of polymorphous vessels and milky-red globules/areas (OR 23.65), and polymorphous vessels combined with homogeneous red areas (OR 33.88). CONCLUSIONS Dermoscopy may be helpful in improving the recognition of pigmented NM by revealing asymmetric pigmentation, blue-black pigmented areas, homogeneous disorganized pattern and abnormal vascular structures, including polymorphous vessels, milky-red globules/areas and homogeneous red areas.
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Affiliation(s)
- M A Pizzichetta
- Division of Medical Oncology - Preventive Oncology, Centro di Riferimento Oncologico, National Cancer Institute, Via Franco Gallini, 2, 33081, Aviano, Italy
| | - H Kittler
- Department of Dermatology, University of Vienna, Vienna, Austria
| | - I Stanganelli
- Skin Cancer Unit, Istituto Tumori Romagna (IRST), Meldola, Italy
| | - R Bono
- Istituto Dermopatico Immacolata, IRCCS, Rome, Italy
| | - S Cavicchini
- Department of Dermatology, Fondazione Ospedale Maggiore Policlinico IRCCS, Milan, Italy
| | - V De Giorgi
- Department of Dermatology, University of Florence, Florence, Italy
| | - G Ghigliotti
- Clinic of Dermatology, IRCCS San Martino - Ist, Genoa, Italy
| | - P Quaglino
- Dermatologic Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - P Rubegni
- Department of Dermatology, University of Siena, Siena, Italy
| | - G Argenziano
- Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy
| | - R Talamini
- Unit of Epidemiology and Biostatistics, Centro di Riferimento Oncologico, National Cancer Institute, Via Franco Gallini, 2, 33081, Aviano, Italy
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32
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Abstract
Use of dermoscopy has been proven to increase diagnostic accuracy for melanoma. It is frequently used by dermatologists and other healthcare providers during skin cancer screening and in the evaluation of concerning skin lesions. Studies have shown that it is useful in the diagnosis of many nononcologic cutaneous diseases as well as in the monitoring of disease progression and treatment response. Furthermore, dermoscopy has the potential to aid in pathology specimen sectioning, translational research and medical technology development. Its broad applications and ease of use will make it an increasingly influential tool in healthcare. In this article, we review the established uses of dermoscopy by different healthcare providers and its potential future applications.
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Affiliation(s)
- Xinyuan Wu
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael A Marchetti
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ashfaq A Marghoob
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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33
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Hermes HM, Sahu J, Schwartz LR, Lee JB. Clinical and histologic characteristics of clinically unsuspected melanomas. Clin Dermatol 2014; 32:324-30. [DOI: 10.1016/j.clindermatol.2013.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Bellucci C, Arginelli F, Bassoli S, Magnoni C, Seidenari S. Dermoscopic yellow structures in basal cell carcinoma. J Eur Acad Dermatol Venereol 2013; 28:651-4. [DOI: 10.1111/jdv.12092] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 12/07/2012] [Indexed: 11/29/2022]
Affiliation(s)
- C. Bellucci
- Department of Dermatology and Venereology; University of Modena and Reggio Emilia; Modena Italy
| | - F. Arginelli
- Department of Dermatology and Venereology; University of Modena and Reggio Emilia; Modena Italy
| | - S. Bassoli
- Department of Dermatology and Venereology; University of Modena and Reggio Emilia; Modena Italy
| | - C. Magnoni
- Department of Dermatology and Venereology; University of Modena and Reggio Emilia; Modena Italy
| | - S. Seidenari
- Department of Dermatology and Venereology; University of Modena and Reggio Emilia; Modena Italy
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35
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Tschandl P, Rosendahl C, Kittler H. Accuracy of the first step of the dermatoscopic 2-step algorithm for pigmented skin lesions. Dermatol Pract Concept 2012; 2:203a08. [PMID: 23785610 PMCID: PMC3663352 DOI: 10.5826/dpc.0203a08] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 05/31/2012] [Indexed: 12/03/2022] Open
Abstract
Objectives: To evaluate the frequency of misclassifications of equivocal pigmented lesions according to the first step of the dermatoscopic 2-step algorithm. Patients and Methods: 707 consecutive cases from 553 patients of central Europe and Australia were included in the study. Dermatoscopic images were evaluated in a blinded fashion for the presence of features described in the 2-step algorithm to determine their melanocytic or non-melanocytic origin. Mucosal, genital and non-pigmented lesions were excluded. Results: The sensitivity of the first step was 97.1% for patients from Australia and 96.8% for patients from central Europe. The specificity was 33.6% for Australian patients and 67.9% for European patients. The most common reasons for misclassification were the presence of a pigmented network in a non-melanocytic lesion (n=68, 25.2%) and the absence of dermatoscopic features of melanocytic and non-melanocytic lesions in 69 (25.6%) non-melanocytic lesions. Conclusion: The first step of the dermatoscopic 2-step algorithm, if applied consistently, has high sensitivity but low specificity. Many non-melanocytic lesions, especially solar lentigines and seborrheic keratoses, are wrongly classified as melanocytic. The worse performance of the first step algorithm in Australian patients is probably due to a higher rate of solar lentigines in patients with severely sun-damaged skin.
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Affiliation(s)
- Philipp Tschandl
- Department of Dermatology, Division of General Dermatology, Medical University of Vienna, Austria
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Gulia A, Massone C. Advances in dermoscopy for detecting melanocytic lesions. F1000 MEDICINE REPORTS 2012; 4:11. [PMID: 22719794 PMCID: PMC3370664 DOI: 10.3410/m4-11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Over the last 30 years dermatological approaches to diagnosis and management of melanocytic lesions have been revolutionized by the introduction of dermoscopy. Continuous improvements are being made in applying the technique, mostly in melanoma diagnosis, follow-up of melanocytic lesions and nevogenesis. Identification of new dermoscopic criteria, such as the dermoscopic island and the blue-black color for thin and nodular melanoma, respectively, further add two new weapons in the dermoscopical armamentarium for diagnosis of otherwise featureless melanoma. Recent advances show that short-term, 3-month, follow-up is the optimum time interval to identify minimal changes in initially featureless melanomas. Nevertheless, long-term follow-up is still useful for the recognition of changes in melanomas with a very low-rate of growth. Dermoscopy greatly improves diagnosis and early excision of melanomas and reduces the number of unnecessary excisions.
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Affiliation(s)
- Andrea Gulia
- Department of Dermatology, University of L’AquilaL’AquilaItaly
- Department of Dermatology, Medical University of GrazGraz, Auenbruggerplatz 8, A-8036 GrazAustria
| | - Cesare Massone
- Department of Dermatology, Medical University of GrazGraz, Auenbruggerplatz 8, A-8036 GrazAustria
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Phan A, Dalle S, Thomas L. [Hairpin vessels]. Ann Dermatol Venereol 2011; 138:542-4. [PMID: 21700081 DOI: 10.1016/j.annder.2011.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 02/16/2011] [Indexed: 11/18/2022]
Affiliation(s)
- A Phan
- Service de dermatologie, centre hospitalier Lyon-Sud, Pierre-Bénite cedex, France
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