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Wolner ZJ, Yélamos O, Liopyris K, Rogers T, Marchetti MA, Marghoob AA. Enhancing Skin Cancer Diagnosis with Dermoscopy. Dermatol Clin 2017; 35:417-437. [PMID: 28886798 DOI: 10.1016/j.det.2017.06.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Dermoscopy increases the sensitivity for skin cancer detection, decreases the number of benign lesions biopsied for each malignant diagnosis, and enables the diagnosis of thinner melanomas compared with naked eye examination. Multiple meta-analyses have identified that dermoscopy improves the diagnostic accuracy for melanoma when compared with naked eye examination. In addition, studies have established that dermoscopy can aid in the detection of keratinocyte carcinomas. Dermoscopy triage algorithms have been developed to help novices decide when a biopsy or a referral is most appropriate. In this article, the authors illustrate the dermoscopic features that assist in identifying melanoma and keratinocyte carcinomas.
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Affiliation(s)
- Zachary J Wolner
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 East 60th Street, New York, NY 10022, USA
| | - Oriol Yélamos
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 East 60th Street, New York, NY 10022, USA
| | - Konstantinos Liopyris
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 East 60th Street, New York, NY 10022, USA
| | - Tova Rogers
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 East 60th Street, New York, NY 10022, USA
| | - Michael A Marchetti
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 East 60th Street, New York, NY 10022, USA
| | - Ashfaq A Marghoob
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 East 60th Street, New York, NY 10022, USA.
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Dengel LT, Petroni GR, Judge J, Chen D, Acton ST, Schroen AT, Slingluff CL. Total body photography for skin cancer screening. Int J Dermatol 2014; 54:1250-4. [PMID: 25515157 DOI: 10.1111/ijd.12593] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 11/22/2013] [Accepted: 11/30/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Total body photography may aid in melanoma screening but is not widely applied due to time and cost. We hypothesized that a near-simultaneous automated skin photo-acquisition system would be acceptable to patients and could rapidly obtain total body images that enable visualization of pigmented skin lesions. METHODS From February to May 2009, a study of 20 volunteers was performed at the University of Virginia to test a prototype 16-camera imaging booth built by the research team and to guide development of special purpose software. For each participant, images were obtained before and after marking 10 lesions (five "easy" and five "difficult"), and images were evaluated to estimate visualization rates. Imaging logistical challenges were scored by the operator, and participant opinion was assessed by questionnaire. RESULTS Average time for image capture was three minutes (range 2-5). All 55 "easy" lesions were visualized (sensitivity 100%, 90% CI 95-100%), and 54/55 "difficult" lesions were visualized (sensitivity 98%, 90% CI 92-100%). Operators and patients graded the imaging process favorably, with challenges identified regarding lighting and positioning. CONCLUSIONS Rapid-acquisition automated skin photography is feasible with a low-cost system, with excellent lesion visualization and participant acceptance. These data provide a basis for employing this method in clinical melanoma screening.
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Affiliation(s)
- Lynn T Dengel
- Department of Surgery, University of Virginia Health Systems, Charlottesville, VA, USA
| | - Gina R Petroni
- Department of Public Health Sciences, University of Virginia Health Systems, Charlottesville, VA, USA
| | - Joshua Judge
- Department of Surgery, University of Virginia Health Systems, Charlottesville, VA, USA
| | - David Chen
- Department of Biomedical Engineering, University of Virginia Health Systems, Charlottesville, VA, USA
| | - Scott T Acton
- Department of Biomedical Engineering, University of Virginia Health Systems, Charlottesville, VA, USA
| | - Anneke T Schroen
- Department of Surgery, University of Virginia Health Systems, Charlottesville, VA, USA
| | - Craig L Slingluff
- Department of Surgery, University of Virginia Health Systems, Charlottesville, VA, USA
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Masood A, Al-Jumaily AA. Computer aided diagnostic support system for skin cancer: a review of techniques and algorithms. Int J Biomed Imaging 2013; 2013:323268. [PMID: 24575126 PMCID: PMC3885227 DOI: 10.1155/2013/323268] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 10/30/2013] [Indexed: 11/17/2022] Open
Abstract
Image-based computer aided diagnosis systems have significant potential for screening and early detection of malignant melanoma. We review the state of the art in these systems and examine current practices, problems, and prospects of image acquisition, pre-processing, segmentation, feature extraction and selection, and classification of dermoscopic images. This paper reports statistics and results from the most important implementations reported to date. We compared the performance of several classifiers specifically developed for skin lesion diagnosis and discussed the corresponding findings. Whenever available, indication of various conditions that affect the technique's performance is reported. We suggest a framework for comparative assessment of skin cancer diagnostic models and review the results based on these models. The deficiencies in some of the existing studies are highlighted and suggestions for future research are provided.
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Affiliation(s)
- Ammara Masood
- School of Electrical, Mechanical and Mechatronic Engineering, University of Technology, Broadway Ultimo, Sydney, NSW 2007, Australia
| | - Adel Ali Al-Jumaily
- School of Electrical, Mechanical and Mechatronic Engineering, University of Technology, Broadway Ultimo, Sydney, NSW 2007, Australia
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Skin parameter map retrieval from a dedicated multispectral imaging system applied to dermatology/cosmetology. Int J Biomed Imaging 2013; 2013:978289. [PMID: 24159326 PMCID: PMC3789448 DOI: 10.1155/2013/978289] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 07/15/2013] [Accepted: 07/29/2013] [Indexed: 10/30/2022] Open
Abstract
In vivo quantitative assessment of skin lesions is an important step in the evaluation of skin condition. An objective measurement device can help as a valuable tool for skin analysis. We propose an explorative new multispectral camera specifically developed for dermatology/cosmetology applications. The multispectral imaging system provides images of skin reflectance at different wavebands covering visible and near-infrared domain. It is coupled with a neural network-based algorithm for the reconstruction of reflectance cube of cutaneous data. This cube contains only skin optical reflectance spectrum in each pixel of the bidimensional spatial information. The reflectance cube is analyzed by an algorithm based on a Kubelka-Munk model combined with evolutionary algorithm. The technique allows quantitative measure of cutaneous tissue and retrieves five skin parameter maps: melanin concentration, epidermis/dermis thickness, haemoglobin concentration, and the oxygenated hemoglobin. The results retrieved on healthy participants by the algorithm are in good accordance with the data from the literature. The usefulness of the developed technique was proved during two experiments: a clinical study based on vitiligo and melasma skin lesions and a skin oxygenation experiment (induced ischemia) with healthy participant where normal tissues are recorded at normal state and when temporary ischemia is induced.
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Hauschild A, Egberts F, Garbe C, Bauer J, Grabbe S, Hamm H, Kerl H, Reusch M, Rompel R, Schlaeger M. Melanocytic nevi. J Dtsch Dermatol Ges 2011; 9:723-34. [PMID: 21762380 DOI: 10.1111/j.1610-0387.2011.07741.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Axel Hauschild
- Department of Dermatology, Venereology and Allergy, University Clinic Schleswig-Holstein–Campus Kiel, Schittenhelmstr. 7D-24105 Kiel, Germany.
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Rice ZP, Weiss FJ, DeLong LK, Curiel-Lewandrowski C, Chen SC. Utilization and rationale for the implementation of total body (digital) photography as an adjunct screening measure for melanoma. Melanoma Res 2010; 20:417-21. [PMID: 20729763 DOI: 10.1097/cmr.0b013e32833d327b] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wang SQ, Hashemi P. Noninvasive Imaging Technologies in the Diagnosis of Melanoma. ACTA ACUST UNITED AC 2010; 29:174-84. [DOI: 10.1016/j.sder.2010.06.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Gamble RG, Jensen D, Suarez AL, Hanson AH, McLaughlin L, Duke J, Dellavalle RP. Outpatient Follow-up and Secondary Prevention for Melanoma Patients. Cancers (Basel) 2010; 2:1178-97. [PMID: 24281112 PMCID: PMC3835125 DOI: 10.3390/cancers2021178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Revised: 06/02/2010] [Accepted: 06/03/2010] [Indexed: 02/07/2023] Open
Abstract
Health care providers and their patients jointly participate in melanoma prevention, surveillance, diagnosis, and treatment. This paper reviews screening and follow-up strategies for patients who have been diagnosed with melanoma, based on current available evidence, and focuses on methods to assess disease recurrence and second primary occurrence. Secondary prevention, including the roles of behavioral modification and chemoprevention are also reviewed. The role of follow-up dermatologist consultation, with focused physical examinations complemented by dermatoscopy, reflectance confocal microscopy, and/or full-body mapping is discussed. Furthermore, we address the inclusion of routine imaging and laboratory assessment as components of follow-up and monitoring of advanced stage melanoma. The role of physicians in addressing the psychosocial stresses associated with a diagnosis of melanoma is reviewed.
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Affiliation(s)
- Ryan G. Gamble
- Department of Dermatology, University of Colorado Denver, Aurora, CO, USA; E-Mail: (R.G.G.); (J.D.J.)
| | - Daniel Jensen
- Department of Dermatology, University of Colorado Denver, Aurora, CO, USA; E-Mail: (R.G.G.); (J.D.J.)
| | - Andrea L. Suarez
- Department of Dermatology, University of Colorado Denver, Aurora, CO, USA; E-Mail: (R.G.G.); (J.D.J.)
| | - Anne H. Hanson
- Kansas City University of Medicine and Biosciences, Kansas City, MO, USA; E-Mail:
| | - Lauren McLaughlin
- Rocky Vista University College of Osteopathic Medicine, Parker, CO, USA; E-Mail:
| | - Jodi Duke
- Department of Dermatology, University of Colorado Denver, Aurora, CO, USA; E-Mail: (R.G.G.); (J.D.J.)
- School of Pharmacy, University of Colorado, Aurora, CO, USA; E-Mail:
| | - Robert P. Dellavalle
- Department of Dermatology, University of Colorado Denver, Aurora, CO, USA; E-Mail: (R.G.G.); (J.D.J.)
- Dermatology Service, Denver Veterans Affairs Medical Center, Denver, CO, USA
- Epidemiology Department, Colorado School of Public Health, Aurora, CO, USA
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Terushkin V, Oliveria SA, Marghoob AA, Halpern AC. Use of and beliefs about total body photography and dermatoscopy among US dermatology training programs: an update. J Am Acad Dermatol 2010; 62:794-803. [PMID: 20223561 DOI: 10.1016/j.jaad.2009.09.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Revised: 08/31/2009] [Accepted: 09/08/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND Total body photography (TBP) and dermatoscopy are imaging techniques used to treat patients with pigmented lesions. OBJECTIVE We sought to describe use, training, logistics, and beliefs about these tools among residency programs and to assess changes during a 10-year period. METHODS Surveys were sent to all directors (n = 111) and chief residents (n = 109) of US dermatology training programs. RESULTS A total of 83 (74.8%) attendings answered the questionnaire. In all, 59 (71.1%) reported using TBP, an 11.9% increase (P = .2484) over the past decade. Reasons for using TBP included: reduces patient anxiety (81.4%), helps detect early melanoma (78.0%), and leads to fewer biopsies (66.1%). Logistical (79.2%) and financial (45.8%) constraints were reasons for not using TBP. Seventy respondents (84.3%) reported using dermatoscopy, a 40.0% increase (P = .0001) over the 10-year period. Reasons for dermatoscopy use were consistent over time: helps find melanoma in curable stage (75.7%), reduces patient anxiety (61.4%), and leads to fewer biopsies (57.1%). The most common reason for not using dermatoscopy remained lack of training (38.5%). A total of 92 (84.4%) residents completed their survey, of which 41 (44.6%) and 81 (88.0%) reported using TBP and dermatoscopy, respectively. In all, 62 (67.4%) and 79 (85.9%) respondents would prefer additional training in TBP and dermatoscopy, respectively. LIMITATIONS Results may not be applicable to the general dermatology community. CONCLUSIONS Use of dermatoscopy among residency programs has increased significantly during the last decade. A more modest increase in the use of TBP was observed. Barriers to diffusion of these technologies into practice persist, including insufficient logistics and training.
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Abstract
Recognizing early forms of melanoma may have significant impact on decreasing mortality from this malignancy. As a result, multiple efforts have focused on developing new and improving current early detection strategies. These include educating patients about the importance of performing skin self-examination, increasing rates of complete skin examinations by physicians in the context of routine care, initiating mass screening campaigns, creating specialized skin cancer clinics, and developing better diagnostic tools through advances in technology. In this article, the current state of these efforts is reviewed.
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Affiliation(s)
- Vitaly Terushkin
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, 160 East 53rd Street, New York, NY 10022, USA
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Marghoob AA, Changchien L, DeFazio J, Dessio WC, Malvehy J, Zalaudek I, Halpern AC, Scope A. The most common challenges in melanoma diagnosis and how to avoid them. Australas J Dermatol 2009; 50:1-13; quiz 14-5. [DOI: 10.1111/j.1440-0960.2008.00496_1.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tran KT, Wright NA, Cockerell CJ. Biopsy of the pigmented lesion—When and how. J Am Acad Dermatol 2008; 59:852-71. [DOI: 10.1016/j.jaad.2008.05.027] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Revised: 05/16/2008] [Accepted: 05/27/2008] [Indexed: 11/28/2022]
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Marghoob AA, Borrego JP, Halpern AC. Congenital Melanocytic Nevi: Treatment Modalities and Management Options. ACTA ACUST UNITED AC 2007; 26:231-40. [DOI: 10.1016/j.sder.2008.03.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Risser J, Pressley Z, Veledar E, Washington C, Chen SC. The impact of total body photography on biopsy rate in patients from a pigmented lesion clinic. J Am Acad Dermatol 2007; 57:428-34. [PMID: 17624623 DOI: 10.1016/j.jaad.2007.02.036] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2006] [Revised: 02/20/2007] [Accepted: 02/25/2007] [Indexed: 11/25/2022]
Abstract
BACKGROUND Total body cutaneous photography is increasingly being used by dermatologists to monitor patients at risk for the development of melanoma, but limited evidence exists regarding the impact of such photography on melanoma and melanoma-related outcomes. OBJECTIVE We sought to compare biopsy number in patients with multiple atypical nevi in their first year of care at our pigmented lesion clinic (PLC) between those who received total body skin examination alone and those who received total body skin examination and total body digital photography (TBDP). We sought to identify predictors of biopsy number and number of dysplastic nevi diagnosed in patients with multiple atypical nevi. METHODS A chart review was performed of patients attending the PLC during the years 1998 to 2003 to identify the number of biopsies performed in the first year of care. Patient demographics, melanoma risk factors, and melanoma outcome events were also abstracted from the charts. RESULTS The mean number of biopsies performed in patients in their first year of care at the PLC in those who did not receive TBDP was equal to the mean number of biopsies performed in patients who did receive TBDP (0.82 and 0.8, respectively). Linear regression analysis revealed that the interaction term between a lack of both personal history of melanoma and severe dysplastic nevi (-0.930, P = .005) has a significant protective effect on the number of biopsies. Similar regression analysis also showed that the interaction term between a lack of both personal history of melanoma and of severe dysplastic nevi (-1.209, P < .0001), increasing provider experience (-0.047, P = .029), and increased number of biopsies before the initial PLC (-0.028, P = .050) have a statistically significant protective effect on the number of dysplastic nevi diagnosed in the first year of PLC. TBDP did not have an effect on the number of biopsies or on the number of dysplastic nevi diagnosed in the first year of care at the PLC. LIMITATIONS This study is limited by being retrospective in nature, having a small sample size, and having a short follow-up period. CONCLUSION Overall, this small retrospective study does not provide evidence that would suggest that TBDP changes provider behavior in caring for patients at high risk for melanoma. Rather, our study supports the fact that a patient's positive history of melanoma and a history of severe dysplastic nevi have the most significant impact on provider biopsy behavior, resulting in a lower threshold to biopsy suggestive lesions.
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Affiliation(s)
- Jessica Risser
- Department of Dermatology, Emory University, Atlanta, GA 30322, USA
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Abstract
PURPOSE OF REVIEW Early diagnosis has the greatest potential for short-term impact on melanoma mortality. We highlight recent trends in early melanoma detection and address the related challenges and opportunities. RECENT FINDINGS Significant strides have been made in the early diagnosis of melanoma. Success has been achieved through improved awareness of early signs of melanoma and identification of high-risk cohorts. Detection pressure, however, may also be resulting in the diagnosis of indolent disease, leading to unnecessary morbidity and cost. A looming imbalance of supply and demand for melanoma detection services is anticipated with the aging of the baby boom generation. Prioritization of other preventive services and a growing emphasis on cosmetic dermatology are anticipated to exacerbate this imbalance. While a paucity of hard data have precluded adoption of formal screening recommendations for melanoma, general consensus supports opportunistic screening and identification of high-risk individuals who may benefit from specialized surveillance with dermoscopy and whole-body photography. Research is needed to distinguish biologically indolent and aggressive melanoma, to develop and test evolving technologies to aid diagnosis, and to assess the utility of specific public health strategies for melanoma detection. SUMMARY Significant strides have been made in early melanoma detection, but multiple challenges remain.
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Affiliation(s)
- Allan C Halpern
- Memorial Sloan-Kettering Cancer Center, New York, New York, USA
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Abstract
The minimum requirement for the general dermatologist for clinically assessing pigmented skin lesions is dermoscopy. In expert hands, this technique has been shown to improve both the sensitivity and specificity for the diagnosis of melanoma. This is also reflected by lower benign melanoma excision ratios and decreased excision rates. Evidence is mounting for the routine use of total body skin photography for patients with a very high risk of developing cutaneous melanoma. Both long-term (12 months) and short-term (3 months) digital dermoscopy monitoring has been shown to allow the detection of dermoscopically featureless melanoma and is central for the clinical assessment of melanocytic lesions at the Sydney Melanoma Diagnostic Center. The use of automated instruments for the diagnosis of cutaneous melanoma is still in an experimental phase, and its utility is dependent on the evidence that such instruments give a clinically useful expert second opinion. Currently, other noninvasive diagnostic techniques, such as in vivo confocal scanning laser microscopy, are reserved for clinical research settings.
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Affiliation(s)
- Scott W Menzies
- Sydney Melanoma Diagnostic Center, Cancer Center, University of Sydney, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia.
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Abstract
Patients presenting with congenital melanocytic nevi (CMN) need individualized treatment based upon nevus size, thickness, location, risk for developing melanoma, and psychological characteristics of the patient and family. The present authors review CMN types and prognoses, as well as absolute and relative indications for treatment. Risks and benefits of several treatment options are discussed, including surgical options, such as excision, chemical peels, dermabrasion and curettage, and laser therapy. The main focus of treatment is, in all cases, to address the concern for developing melanoma, at the same time optimizing the aesthetic and functional outcomes.
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Affiliation(s)
- Jennifer Tromberg
- Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Affiliation(s)
- Jamie MacKelfresh
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia, USA
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Marghoob AA, Swindle LD, Moricz CZM, Sanchez Negron FA, Slue B, Halpern AC, Kopf AW. Instruments and new technologies for the in vivo diagnosis of melanoma. J Am Acad Dermatol 2003; 49:777-97; quiz 798-9. [PMID: 14576657 DOI: 10.1016/s0190-9622(03)02470-8] [Citation(s) in RCA: 118] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The principal objective of screening individuals at risk for melanoma is detection of cutaneous melanoma during the curable stages of its early evolution. Unaided visual inspection of the skin is often suboptimal at diagnosing melanoma. Improving the diagnostic accuracy for melanoma remains an area of active research. These research efforts have focused on both the detection of early melanoma and the in-depth evaluation of suspicious pigmented lesions for the presence or absence of melanoma. Numerous instruments are under investigation to determine their usefulness in imaging and ascertaining a correct in vivo diagnosis of melanoma. It is anticipated that some of these tools, alone or in combination, will improve our ability to differentiate, in vivo, melanoma from its simulators. Ultimately, these advances may prevent unnecessary biopsies (increased specificity) while increasing the sensitivity for diagnosing melanoma. This article reviews the current instruments and new technologies for the in vivo diagnosis of melanoma. Learning objective At the conclusion of this learning activity, participants should be acquainted with the instruments designed to facilitate the early detection of melanoma. They should also be familiar with the basic technology behind these instruments and should recognize the potential benefits and limitations inherent in each.
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Oliveria SA, Sachs D, Belasco KT, Halpern AC. Adoption of new technologies for early detection of melanoma in dermatologic practice. J Am Acad Dermatol 2003; 49:955-9. [PMID: 14576692 DOI: 10.1016/s0190-9622(03)02464-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The identification and diagnosis of early melanoma will reduce unnecessary operations and may be important in reducing mortality from melanoma and impacting cost savings to the health system. New technologies are being developed and used at some specialized centers to facilitate the detection and diagnosis of early melanoma for patients at high risk. These technologies include but are not limited to digital photography, dermoscopy, computerized image analysis systems, and confocal scanning laser microscopy. To most effectively implement these novel approaches, it is important to identify the key factors that influence the adoption or diffusion of new medical technologies. We propose patient-, physician-, and health care system-related factors that influence the diffusion of new technologies for the early detection of skin cancer. Studies involving physicians and patients in a variety of clinical settings need to be conducted to achieve a greater understanding of the barriers to the adoption of these new technologic tools that are intended to aid in skin cancer screening.
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Affiliation(s)
- Susan A Oliveria
- Memorial Sloan-Kettering Cancer Center, New York, NY 10022, USA.
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Halpern AC, Marghoob AA, Bialoglow TW, Witmer W, Slue W. Standardized positioning of patients (poses) for whole body cutaneous photography. J Am Acad Dermatol 2003; 49:593-8. [PMID: 14512902 DOI: 10.1067/s0190-9622(03)02125-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Whole body photography (WBP) has been used for decades by some specialized pigmented lesion clinics as an aid to early melanoma detection in high-risk persons. The recent advent of digital imaging systems for acquiring and archiving whole body skin images has resulted in greater dissemination of this technique. This in turn has led to the recent establishment of a Category III Current Procedural Terminology code for WBP. Here we present a proposed set of standardized body poses for WBP on the basis of the extant literature and the experience of a panel of experts in the field. The proposed poses were developed with consideration of patient comfort and technical efficiency. The poses were optimized to comply with a predetermined set of desirable technical parameters as assessed in a series of 20 consecutive patients. The resulting set of poses is presented as a first step toward the increased standardization of dermatologic WBP.
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Affiliation(s)
- Allan C Halpern
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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Scheinfeld NS, Flanigan K, Moshiyakhov M, Weinberg JM. Trends in the use of cameras and computer technology among dermatologists in New York City 2001-2002. Dermatol Surg 2003; 29:822-5; discussion 826. [PMID: 12859381 DOI: 10.1046/j.1524-4725.2003.29215.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Photography and computers can enhance dermatologic visit documentation and care. OBJECTIVE To determine dermatologists' use of cameras and computers. METHODS We surveyed computer and camera use during the Dermatologic Society of Greater New York's meetings in January 2001 and 2002. RESULTS Approximately 75% of dermatologists can use computers. Between 2001 and 2002, 35-mm film camera use by attending and resident dermatologists fell from 60% to 47% and 43% to 32%, respectively, and digital camera increased from 25% to 38% and 35% to 59%, respectively. Approximately 50% of dermatologists use instant cameras. Approximately 15% of dermatologists use no camera. Most find images useful; however, medical dermatologists usually image only interesting patients, and dermatologic surgeons image almost all patients. Approximately 15% of dermatologist used electronic medical records (EMRs). CONCLUSION Computers and cameras are widely used but have not changed dermatologic practice. Images are not used to track skin disease or integrated with EMRs nor are EMRs widely used, probably because of difficulty of use and limited computer literacy. Where images appear to add value, for example, for preoperative and postoperative documentation among dermatologic surgeons, camera use is common, suggesting that utility drives technology adoption.
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Affiliation(s)
- Noah S Scheinfeld
- Department of Dermatology, St. Luke's-Roosevelt Hospital Center, New York, New York, USA.
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Commentaries. Dermatol Surg 2003. [DOI: 10.1097/00042728-200308000-00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Carli P, De Giorgi V, Giannotti B. Why digital follow-up of dermoscopically equivocal pigmented lesions should be discouraged. Br J Dermatol 2003; 148:1272-3. [PMID: 12828766 DOI: 10.1046/j.1365-2133.2003.05363.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Halpern AC. Total body skin imaging as an aid to melanoma detection. SEMINARS IN CUTANEOUS MEDICINE AND SURGERY 2003; 22:2-8. [PMID: 12773009 DOI: 10.1053/sder.2003.50000] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Total body skin imaging (TBSI) is being increasingly used as an aid to melanoma detection in high-risk individuals. In this article, we review the rationale, techniques, advantages, and potential pitfalls of TBSI as an aid to melanoma detection. We highlight the technical and clinical considerations relevant to implementation of TBSI in clinical practice.
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Affiliation(s)
- Allan C Halpern
- Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA
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Marghoob AA, Borrego JP, Halpern AC. Congenital melanocytic nevi: treatment modalities and management options. SEMINARS IN CUTANEOUS MEDICINE AND SURGERY 2003; 22:21-32. [PMID: 12773011 DOI: 10.1053/sder.2003.50002] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Congenital melanocytic nevi can be cosmetically disfiguring, give rise to melanoma, and suggest the presence of neurocutaneous melanocytosis. Management decisions must be tailored for each patient and each nevus, taking into consideration the risk for developing malignancy, risk for developing symptomatic neurocutaneous melanocytosis, cosmetic implications of having the nevus, cosmetic implications of any resultant surgical scars from their removal, adverse effects that the nevus may have on psycho-social development, and the adverse effects and long-term sequelae of any surgical intervention. The advantages and disadvantages of different modalities used in the treatment of congenital melanocytic nevi are discussed. Organizational flow diagrams are presented to help clinicians in managing patients with different sized congenital melanocytic nevi.
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Abstract
OBJECTIVES To describe a systematic method for skin cancer assessment, applying current standard practices for integration into nursing practice. To provide the fundamentals of performing a skin cancer assessment for the nonmelanoma skin cancers, basal cell carcinoma, and squamous cell carcinomas, and melanoma. Included in this discussion are risk profile calculations, mechanics of skin cancer assessment, descriptions of suspicious lesions, patient management, and follow-up. DATA SOURCES Textbooks, research, review of the literature, and clinical experience. CONCLUSIONS Skin cancer assessment is a skill that nurses can learn and implement into practice. IMPLICATIONS FOR NURSING PRACTICE Knowledge and practice of good skin cancer assessment skills enhances nursing competence and positively influences patient outcomes.
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