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Silveri OC, James F, Dickens B. Variability of Leser-Trélat Sign Secondary to Melanoma In Situ. Cureus 2024; 16:e53639. [PMID: 38449989 PMCID: PMC10917397 DOI: 10.7759/cureus.53639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
Leser-Trélat sign (LTS) is characterized as an eruptive display of multiple seborrheic keratoses (SKs) in association with malignancy. This case highlights the variable presentation of LTS secondary to melanoma. To our knowledge, this LTS pattern is the first case where the sign manifests as a subtle pattern secondary to melanoma. This stands in contrast to the five documented cases in the literature of LTS-melanoma, which exhibited distinctive and eruptive patterns. A 64-year-old Caucasian female presented for a wellness examination. No personal history of skin cancer was noted. Patient displayed an onset proliferation of SKs with an irregular, sub-centimeter macular nevus over her right lateral mid back. A 6mm punch biopsy was significant for melanoma in situ, arising within a lentiginous compound dysplastic nevus, focally abutting one peripheral tissue edge. A re-excision with a minimum of 5mm margins was completed and the specimen was negative for residual in situ melanoma. Because of the rare occurrence of this delicate pattern at the site of the melanoma, this presentation adds to the knowledge surrounding this diagnosis. This case emphasizes the importance of maintaining vigilance regarding skin manifestations associated with disease and highlights the critical importance of observation and identification of subtle physical exam findings.
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Affiliation(s)
- Olivia C Silveri
- Dermatology, Edward Via College of Osteopathic Medicine, Blacksburg, USA
| | - Franklin James
- Dermatology, Edward Via College of Osteopathic Medicine, Blacksburg, USA
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2
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Morin M, Björklund S, Nilsson EJ, Engblom J. Bicontinuous Cubic Liquid Crystals as Potential Matrices for Non-Invasive Topical Sampling of Low-Molecular-Weight Biomarkers. Pharmaceutics 2023; 15:2031. [PMID: 37631245 PMCID: PMC10459996 DOI: 10.3390/pharmaceutics15082031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/14/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023] Open
Abstract
Many skin disorders, including cancer, have inflammatory components. The non-invasive detection of related biomarkers could therefore be highly valuable for both diagnosis and follow up on the effect of treatment. This study targets the extraction of tryptophan (Trp) and its metabolite kynurenine (Kyn), two compounds associated with several inflammatory skin disorders. We furthermore hypothesize that lipid-based bicontinuous cubic liquid crystals could be efficient extraction matrices. They comprise a large interfacial area separating interconnected polar and apolar domains, allowing them to accommodate solutes with various properties. We concluded, using the extensively studied GMO-water system as test-platform, that the hydrophilic Kyn and Trp favored the cubic phase over water and revealed a preference for locating at the lipid-water interface. The interfacial area per unit volume of the matrix, as well as the incorporation of ionic molecules at the lipid-water interface, can be used to optimize the extraction of solutes with specific physicochemical characteristics. We also observed that the cubic phases formed at rather extreme water activities (>0.9) and that wearing them resulted in efficient hydration and increased permeability of the skin. Evidently, bicontinuous cubic liquid crystals constitute a promising and versatile platform for non-invasive extraction of biomarkers through skin, as well as for transdermal drug delivery.
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Affiliation(s)
- Maxim Morin
- Biofilms—Research Center for Biointerfaces, Malmö University, SE-205 06 Malmö, Sweden (S.B.); (E.J.N.)
- Department of Biomedical Science, Faculty of Health and Society, Malmö University, SE-205 06 Malmö, Sweden
| | - Sebastian Björklund
- Biofilms—Research Center for Biointerfaces, Malmö University, SE-205 06 Malmö, Sweden (S.B.); (E.J.N.)
- Department of Biomedical Science, Faculty of Health and Society, Malmö University, SE-205 06 Malmö, Sweden
| | - Emelie J. Nilsson
- Biofilms—Research Center for Biointerfaces, Malmö University, SE-205 06 Malmö, Sweden (S.B.); (E.J.N.)
- Department of Biomedical Science, Faculty of Health and Society, Malmö University, SE-205 06 Malmö, Sweden
| | - Johan Engblom
- Biofilms—Research Center for Biointerfaces, Malmö University, SE-205 06 Malmö, Sweden (S.B.); (E.J.N.)
- Department of Biomedical Science, Faculty of Health and Society, Malmö University, SE-205 06 Malmö, Sweden
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3
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Yürekli A, Akay BN. New diagnostic approach in seborrheic keratosis: Cryosign. J Cosmet Dermatol 2022; 21:7224-7225. [PMID: 36136098 DOI: 10.1111/jocd.15367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 09/02/2022] [Indexed: 01/06/2023]
Affiliation(s)
- Aslan Yürekli
- Kuşadası Public Hospital Dermatology Clinic, Aydın, Turkey
| | - Bengü Nisa Akay
- Ankara Univercity Medical Faculty Dermatology Clinic, Ankara, Turkey
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4
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Morin M, Björklund S, Jankovskaja S, Moore K, Delgado-Charro MB, Ruzgas T, Guy RH, Engblom J. Reverse Iontophoretic Extraction of Skin Cancer-Related Biomarkers. Pharmaceutics 2021; 14:79. [PMID: 35056976 PMCID: PMC8778044 DOI: 10.3390/pharmaceutics14010079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/16/2021] [Accepted: 12/22/2021] [Indexed: 11/16/2022] Open
Abstract
Non-invasive methods for early diagnosis of skin cancer are highly valued. One possible approach is to monitor relevant biomarkers such as tryptophan (Trp) and kynurenine (Kyn), on the skin surface. The primary aim of this in vitro investigation was, therefore, to examine whether reverse iontophoresis (RI) can enhance the extraction of Trp and Kyn, and to demonstrate how the Trp/Kyn ratio acquired from the skin surface reflects that in the epidermal tissue. The study also explored whether the pH of the receiver medium impacted on extraction efficiency, and assessed the suitability of a bicontinuous cubic liquid crystal as an alternative to a simple buffer solution for this purpose. RI substantially enhanced the extraction of Trp and Kyn, in particular towards the cathode. The Trp/Kyn ratio obtained on the surface matched that in the viable skin. Increasing the receiver solution pH from 4 to 9 improved extraction of both analytes, but did not significantly change the Trp/Kyn ratio. RI extraction of Trp and Kyn into the cubic liquid crystal was comparable to that achieved with simple aqueous receiver solutions. We conclude that RI offers a potential for non-invasive sampling of low-molecular weight biomarkers and further investigations in vivo are therefore warranted.
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Affiliation(s)
- Maxim Morin
- Department of Biomedical Science, Faculty of Health and Society, Malmö University, SE-205 06 Malmö, Sweden; (S.B.); (S.J.); (T.R.)
- Biofilms—Research Center for Biointerfaces, Malmö University, SE-205 06 Malmö, Sweden
| | - Sebastian Björklund
- Department of Biomedical Science, Faculty of Health and Society, Malmö University, SE-205 06 Malmö, Sweden; (S.B.); (S.J.); (T.R.)
- Biofilms—Research Center for Biointerfaces, Malmö University, SE-205 06 Malmö, Sweden
| | - Skaidre Jankovskaja
- Department of Biomedical Science, Faculty of Health and Society, Malmö University, SE-205 06 Malmö, Sweden; (S.B.); (S.J.); (T.R.)
- Biofilms—Research Center for Biointerfaces, Malmö University, SE-205 06 Malmö, Sweden
| | - Kieran Moore
- Department of Pharmacy & Pharmacology, University of Bath, Claverton Down, Bath BA2 7AY, UK; (K.M.); (M.B.D.-C.); (R.H.G.)
| | - Maria Begoña Delgado-Charro
- Department of Pharmacy & Pharmacology, University of Bath, Claverton Down, Bath BA2 7AY, UK; (K.M.); (M.B.D.-C.); (R.H.G.)
| | - Tautgirdas Ruzgas
- Department of Biomedical Science, Faculty of Health and Society, Malmö University, SE-205 06 Malmö, Sweden; (S.B.); (S.J.); (T.R.)
- Biofilms—Research Center for Biointerfaces, Malmö University, SE-205 06 Malmö, Sweden
| | - Richard H. Guy
- Department of Pharmacy & Pharmacology, University of Bath, Claverton Down, Bath BA2 7AY, UK; (K.M.); (M.B.D.-C.); (R.H.G.)
| | - Johan Engblom
- Department of Biomedical Science, Faculty of Health and Society, Malmö University, SE-205 06 Malmö, Sweden; (S.B.); (S.J.); (T.R.)
- Biofilms—Research Center for Biointerfaces, Malmö University, SE-205 06 Malmö, Sweden
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5
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Spyridonos P, Gaitanis G, Likas A, Bassukas I. Characterizing Malignant Melanoma Clinically Resembling Seborrheic Keratosis Using Deep Knowledge Transfer. Cancers (Basel) 2021; 13:cancers13246300. [PMID: 34944920 PMCID: PMC8699430 DOI: 10.3390/cancers13246300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/10/2021] [Accepted: 12/13/2021] [Indexed: 12/26/2022] Open
Abstract
Simple Summary Malignant melanomas (MMs) with aypical clinical presentation constitute a diagnostic pitfall, and false negatives carry the risk of a diagnostic delay and improper disease management. Among the most common, challenging presentation forms of MMs are those that clinically resemble seborrheic keratosis (SK). On the other hand, SK may mimic melanoma, producing ‘false positive overdiagnosis’ and leading to needless excisions. The evolving efficiency of deep learning algorithms in image recognition and the availability of large image databases have accelerated the development of advanced computer-aided systems for melanoma detection. In the present study, we used image data from the International Skin Image Collaboration archive to explore the capacity of deep knowledge transfer in the challenging diagnostic task of the atypical skin tumors of MM and SK. Abstract Malignant melanomas resembling seborrheic keratosis (SK-like MMs) are atypical, challenging to diagnose melanoma cases that carry the risk of delayed diagnosis and inadequate treatment. On the other hand, SK may mimic melanoma, producing a ‘false positive’ with unnecessary lesion excisions. The present study proposes a computer-based approach using dermoscopy images for the characterization of SΚ-like MMs. Dermoscopic images were retrieved from the International Skin Imaging Collaboration archive. Exploiting image embeddings from pretrained convolutional network VGG16, we trained a support vector machine (SVM) classification model on a data set of 667 images. SVM optimal hyperparameter selection was carried out using the Bayesian optimization method. The classifier was tested on an independent data set of 311 images with atypical appearance: MMs had an absence of pigmented network and had an existence of milia-like cysts. SK lacked milia-like cysts and had a pigmented network. Atypical MMs were characterized with a sensitivity and specificity of 78.6% and 84.5%, respectively. The advent of deep learning in image recognition has attracted the interest of computer science towards improved skin lesion diagnosis. Open-source, public access archives of skin images empower further the implementation and validation of computer-based systems that might contribute significantly to complex clinical diagnostic problems such as the characterization of SK-like MMs.
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Affiliation(s)
- Panagiota Spyridonos
- Department of Medical Physics, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
- Correspondence: (P.S.); (I.B.)
| | - George Gaitanis
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece;
| | - Aristidis Likas
- Department of Computer Science & Engineering, School of Engineering, University of Ioannina, 45110 Ioannina, Greece;
| | - Ioannis Bassukas
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece;
- Correspondence: (P.S.); (I.B.)
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6
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Janowska A, Oranges T, Iannone M, Romanelli M, Dini V. Seborrheic keratosis-like melanoma: a diagnostic challenge. Melanoma Res 2021; 31:407-412. [PMID: 34132226 DOI: 10.1097/cmr.0000000000000756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This article summarizes the main epidemiologic and diagnostic features of seborrheic keratosis-like (SK-like) melanoma. We performed a review of the current literature. The real and current incidence and prevalence of SK-like melanoma are unknown. Many lesions are misdiagnosed and not excised with histopathologic confirmation, or excised without an appropriate surgical approach due to a benign clinical and dermoscopic appearance. SK-like melanoma presents both melanoma and SK features. SK-like melanoma and SK are often clinically indistinguishable even for experienced dermatologists. Clinically, it develops as a black-dark brown or light slightly elevated, papule, nodule or plaque with rapid growth and a regular or irregular shape. SK-like melanoma presents melanocytic and nonmelanocytic dermoscopic features. Irregular dark-brown dots/globules, a blue-grayish veil, streaks, irregular pigmentation or network and brown lines point to a melanoma diagnosis. Among the nonmelanocytic features, milia-like cysts and comedo-like openings have been highlighted. The association of polarized and nonpolarized dermoscopic techniques is more accurate for studying the dermoscopic features of SK-like melanoma. If the dermoscopic features are unclear, further investigations with reflectance confocal microscopy (RCM) or biopsy with histologic examination are essential. SK-like melanoma is a dermatologic challenge. Careful clinical and dermoscopic evaluation favor a correct diagnosis. In unclear cases, it is important to perform a biopsy with histologic examination to confirm the correct diagnosis.
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Affiliation(s)
| | - Teresa Oranges
- Department of Dermatology, University of Pisa, Pisa
- Department of Pediatrics, Dermatology Unit, Meyer Children's University Hospital, Florence, Italy
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7
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Sun MD, Halpern AC. Advances in the Etiology, Detection, and Clinical Management of Seborrheic Keratoses. Dermatology 2021; 238:205-217. [PMID: 34311463 DOI: 10.1159/000517070] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/06/2021] [Indexed: 11/19/2022] Open
Abstract
Seborrheic keratoses (SKs) are ubiquitous, generally benign skin tumors that exhibit high clinical variability. While age is a known risk factor, the precise roles of UV exposure and immune abnormalities are currently unclear. The underlying mechanisms of this benign disorder are paradoxically driven by oncogenic mutations and may have profound implications for our understanding of the malignant state. Advances in molecular pathogenesis suggest that inhibition of Akt and APP, as well as existing treatments for skin cancer, may have therapeutic potential in SK. Dermoscopic criteria have also become increasingly important to the accurate detection of SK, and other noninvasive diagnostic methods, such as reflectance confocal microscopy and optical coherence tomography, are rapidly developing. Given their ability to mimic malignant tumors, SK cases are often used to train artificial intelligence-based algorithms in the computerized detection of skin disease. These technologies are becoming increasingly accurate and have the potential to significantly augment clinical practice. Current treatment options for SK cause discomfort and can lead to adverse post-treatment effects, especially in skin of color. In light of the discontinuation of ESKATA in late 2019, promising alternatives, such as nitric-zinc and trichloroacetic acid topicals, should be further developed. There is also a need for larger, head-to-head trials of emerging laser therapies to ensure that future treatment standards address diverse patient needs.
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Affiliation(s)
- Mary D Sun
- Icahn School of Medicine at Mount Sinai, New York, New York, USA,
| | - Allan C Halpern
- Dermatology Service, Memorial Sloan Kettering, New York, New York, USA
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8
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Quantitative Multispectral Imaging Differentiates Melanoma from Seborrheic Keratosis. Diagnostics (Basel) 2021; 11:diagnostics11081315. [PMID: 34441250 PMCID: PMC8392390 DOI: 10.3390/diagnostics11081315] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 12/27/2022] Open
Abstract
Melanoma is a melanocytic tumor that is responsible for the most skin cancer-related deaths. By contrast, seborrheic keratosis (SK) is a very common benign lesion with a clinical picture that may resemble melanoma. We used a multispectral imaging device to distinguish these two entities, with the use of autofluorescence imaging with 405 nm and diffuse reflectance imaging with 525 and 660 narrow-band LED illumination. We analyzed intensity descriptors of the acquired images. These included ratios of intensity values of different channels, standard deviation and minimum/maximum values of intensity of the lesions. The pattern of the lesions was also assessed with the use of particle analysis. We found significantly higher intensity values in SKs compared with melanoma, especially with the use of the autofluorescence channel. Moreover, we found a significantly higher number of particles with high fluorescence in SKs. We created a parameter, the SK index, using these values to differentiate melanoma from SK with a sensitivity of 91.9% and specificity of 57.0%. In conclusion, this imaging technique is potentially applicable to distinguish melanoma from SK based on the analysis of various quantitative parameters. For this application, multispectral imaging could be used as a screening tool by general physicians and non-experts in the everyday practice.
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9
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Niforou A, Sgouros D, Lallas A, Zaras A, Scope A, Tsao H, Argenziano G, Longo C, Kittler H, Stratigos A. The spectrum of morphologic patterns of nodular melanoma: a study of the International Dermoscopy Society. J Eur Acad Dermatol Venereol 2021; 35:e762-e765. [PMID: 34058031 DOI: 10.1111/jdv.17428] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/19/2021] [Indexed: 01/13/2023]
Affiliation(s)
- A Niforou
- 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - D Sgouros
- 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - A Lallas
- 1st Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - A Zaras
- 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - A Scope
- The Kittner Skin Cancer Screening & Research Institute, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - H Tsao
- Wellman Center for Photomedicine at Massachusetts General Hospital, Boston, MA, USA.,Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - G Argenziano
- Dermatology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - C Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.,Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unit a Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - H Kittler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - A Stratigos
- 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
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10
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Alessandrini A, Piraccini BM, Veronesi G, Ferrari T, Dika E. A heart-shaped brown lesion. Int J Dermatol 2021; 60:e381. [PMID: 33846969 DOI: 10.1111/ijd.15590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 03/23/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Aurora Alessandrini
- Dermatology, IRCCS of Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Bianca M Piraccini
- Dermatology, IRCCS of Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Giulia Veronesi
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Tiziano Ferrari
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Emi Dika
- Dermatology, IRCCS of Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
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11
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Zhang H, Wei G, Zhang C, Xu Q, Zhang C. Aminolevulinate photodynamic therapy (ALA-PDT) for giant seborrheic keratosis of the head: A case report. Photodiagnosis Photodyn Ther 2020; 32:102015. [PMID: 32950725 DOI: 10.1016/j.pdpdt.2020.102015] [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: 06/21/2020] [Revised: 09/03/2020] [Accepted: 09/11/2020] [Indexed: 10/23/2022]
Abstract
Although Seborrheic keratosis of the head is very common, giant seborrheic keratosis is rare. This condition should be distinguished from other skin malignant tumors by skin histopathological and immunohistochemistry. We report a case of a 61-year-old woman who presented with a large, dark-brown, well-demarcated plaque on the top of her head of seven years duration which then progressed rapidly for one year. Dermoscopy, histopathological examination and immunohistochemical examination were performed successively. The patient was diagnosed with seborrheic keratosis. She was treated with aminolevulinate photodynamic therapy (ALA-PDT). The lesion was reduced and thinned following treatment. Therefore, we believe that ALA-PDT is a choice for the treatment of giant seborrheic keratosis, especially in some special areas that affect appearance and function.
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Affiliation(s)
- Huanhuan Zhang
- Department of Dermato-venereology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Guo Wei
- Department of Dermato-venereology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Chunmin Zhang
- Department of Dermato-venereology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qingqing Xu
- Department of Dermato-venereology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Chunhong Zhang
- Department of Dermato-venereology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
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12
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Longo C, Mazzeo M, Raucci M, Cornacchia L, Lai M, Bianchi L, Peris K, Pampena R, Pellacani G. Dark pigmented lesions: Diagnostic accuracy of dermoscopy and reflectance confocal microscopy in a tertiary referral center for skin cancer diagnosis. J Am Acad Dermatol 2020; 84:1568-1574. [PMID: 32730850 DOI: 10.1016/j.jaad.2020.07.084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/09/2020] [Accepted: 07/23/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND There is lack of studies on the diagnostic accuracy of dermoscopy and reflectance confocal microscopy (RCM) for dark pigmented lesions. OBJECTIVE To assess the diagnostic accuracy of dermoscopy plus confocal microscopy for melanoma diagnosis of dark pigmented lesions in real life. METHODS Prospective analysis of difficult dark lesions with clinical/dermoscopic suspicion of melanoma referred for RCM for further analysis. The outcome could be excision or dermoscopic digital follow-up. RESULTS We included 370 clinically dark lesions from 350 patients (median age, 45 y). Because of the clinical/dermoscopic/RCM approach, we saved 129 of 213 unnecessary biopsies (specificity of 60.6%), with a sensitivity of 98.1% (154/157). The number needed to excise with the addition of RCM was 1.5 for melanoma diagnosis. LIMITATIONS Single institution based; Italian population only. CONCLUSIONS This study showed that RCM coupled with dermoscopy increases the specificity for diagnosing melanoma, and it helps correctly identify benign lesions. Our findings provide the basis for subsequent prospective studies on melanocytic neoplasms belonging to patients in different countries.
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Affiliation(s)
- Caterina Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy; Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy.
| | - Mauro Mazzeo
- Department of Dermatology, Policlinico Tor Vergata, Italy University of Rome "Tor Vergata", Rome, Italy
| | - Margherita Raucci
- Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
| | - Luigi Cornacchia
- Università Cattolica del Sacro Cuore, Dermatologia, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli IRCCS, Unità Operativa Complessa di Dermatologia, Rome, Italy
| | - Michela Lai
- Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
| | - Luca Bianchi
- Department of Dermatology, Policlinico Tor Vergata, Italy University of Rome "Tor Vergata", Rome, Italy
| | - Ketty Peris
- Università Cattolica del Sacro Cuore, Dermatologia, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli IRCCS, Unità Operativa Complessa di Dermatologia, Rome, Italy
| | - Riccardo Pampena
- Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
| | - Giovanni Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
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13
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Hofmann MA, Keim U, Jagoda A, Forschner A, Fink C, Spänkuch I, Tampouri I, Eigentler T, Weide B, Haenssle HA, Garbe C. Die Dermatofluoroskopie als Diagnoseverfahren bei verschiedenen pigmentierten Hautläsionen: Stärken und Schwächen. J Dtsch Dermatol Ges 2020; 18:682-691. [DOI: 10.1111/ddg.14163_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 10/17/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Maja Ann Hofmann
- Klinik für Dermatologie Venerologie und Allergologie Charité – Universitätsmedizin Berlin
| | - Ulrike Keim
- Zentrum für Dermatoonkologie Universitäts‐Hautklinik Eberhard Karls Universität Tübingen
| | - Agata Jagoda
- Klinik für Dermatologie Venerologie und Allergologie Charité – Universitätsmedizin Berlin
| | - Andrea Forschner
- Zentrum für Dermatoonkologie Universitäts‐Hautklinik Eberhard Karls Universität Tübingen
| | - Christine Fink
- Universitäts‐Hautklinik Heidelberg Ruprecht‐Karls‐Universität Heidelberg
| | - Iris Spänkuch
- Zentrum für Dermatoonkologie Universitäts‐Hautklinik Eberhard Karls Universität Tübingen
| | - Ioanna Tampouri
- Zentrum für Dermatoonkologie Universitäts‐Hautklinik Eberhard Karls Universität Tübingen
| | - Thomas Eigentler
- Zentrum für Dermatoonkologie Universitäts‐Hautklinik Eberhard Karls Universität Tübingen
| | - Benjamin Weide
- Zentrum für Dermatoonkologie Universitäts‐Hautklinik Eberhard Karls Universität Tübingen
| | - Holger A. Haenssle
- Universitäts‐Hautklinik Heidelberg Ruprecht‐Karls‐Universität Heidelberg
| | - Claus Garbe
- Zentrum für Dermatoonkologie Universitäts‐Hautklinik Eberhard Karls Universität Tübingen
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14
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Hofmann MA, Keim U, Jagoda A, Forschner A, Fink C, Spänkuch I, Tampouri I, Eigentler T, Weide B, Haenssle HA, Garbe C. Dermatofluoroscopy diagnostics in different pigmented skin lesions: Strengths and weaknesses. J Dtsch Dermatol Ges 2020; 18:682-690. [PMID: 32657017 DOI: 10.1111/ddg.14163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 10/17/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND The melanin fluorescence of skin lesions is measurable with two-photon excitation, a process termed dermatofluoroscopy, which has shown a shift from the green spectra in benign melanocytic lesions to the red spectra in melanoma. This study addressed the question as to which kind of pigmented lesions can be correctly diagnosed as melanin-bearing malignant tumors. METHODS 476 pigmented lesions including 101 cutaneous melanomas were analyzed with dermatofluoroscopy, measuring the melanin fluorescence in a grid-like fashion with a separation of measurement points of 0.2 mm. The results of the dermatofluoroscopy are presented as a diagnostic score with a cut-off score of ≥ 28 for the diagnosis of melanin-bearing malignant tumors, and were compared to the gold standard of histopathology. RESULTS A highly significant difference (p < 0.0001) between the diagnostic scores of different skin tumors was found. Dermatofluoroscopy scores showed the highest sensitivity for melanomas (92.1 %). Interestingly, most pigmented basal cell carcinomas (BCCs, 88.9 %) were diagnosed as melanin-bearing malignant tumors. A higher sensitivity for the correct diagnosis was observed in older patients (≥ 53 years, p = 0.003), in patients with skin tanning (p = 0.025), and in patients with freckles during childhood (p = 0.046). CONCLUSIONS Two-photon fluorescence is an innovative technique for the diagnosis of pigmented skin lesions, and shows a high sensitivity for detection of melanomas and pigmented BCCs.
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Affiliation(s)
- Maja Ann Hofmann
- University Department of Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrike Keim
- Center of Dermatooncology, Department of Dermatology, Eberhard Karls University, Tübingen, Germany
| | - Agata Jagoda
- University Department of Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andrea Forschner
- Center of Dermatooncology, Department of Dermatology, Eberhard Karls University, Tübingen, Germany
| | - Christine Fink
- Department of Dermatology, University of Heidelberg, Germany
| | - Iris Spänkuch
- Center of Dermatooncology, Department of Dermatology, Eberhard Karls University, Tübingen, Germany
| | - Ioanna Tampouri
- Center of Dermatooncology, Department of Dermatology, Eberhard Karls University, Tübingen, Germany
| | - Thomas Eigentler
- Center of Dermatooncology, Department of Dermatology, Eberhard Karls University, Tübingen, Germany
| | - Benjamin Weide
- Center of Dermatooncology, Department of Dermatology, Eberhard Karls University, Tübingen, Germany
| | | | - Claus Garbe
- Center of Dermatooncology, Department of Dermatology, Eberhard Karls University, Tübingen, Germany
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15
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Gori N, Esposito I, Del Regno L, D'Amore A, Peris K, Di Stefani A. Leser-Trélat sign as a rare manifestation of cutaneous melanoma. Dermatol Reports 2020; 12:8665. [PMID: 32685126 PMCID: PMC7366130 DOI: 10.4081/dr.2020.8665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/20/2020] [Indexed: 11/22/2022] Open
Abstract
Leser-Trélat Sign (LTS) is a rare paraneoplastic syndrome characterized by the sudden eruption of multiple seborrheic keratoses in patients with internal malignancy, commonly localized in the gastrointestinal tract. We report an 80-year-old female patient showing a rapid increase in the number and size of seborrheic keratosis associated with the diagnosis of a cutaneous nodular melanoma (Breslow thickness: 4.5 mm) located on the right flank. After the excision of melanoma, subsequent staging procedures resulted negative, moreover no evidence of melanoma recurrence and no changes of the seborrheic keratoses was detected after a follow-up of 52 months. Although the association between melanoma and Leser Trelat sign is rare, an accurate skin examination with the aid of dermatoscopy searching for undiagnosed skin cancers, should be suggested in patient with sudden eruption of keratosis seborrheic to early diagnose and treat a possible melanoma.
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Affiliation(s)
- Niccolò Gori
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Dermatologia, Rome; Università Cattolica del Sacro Cuore, Dermatologia, Rome, Italy
| | - Ilaria Esposito
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Dermatologia, Rome; Università Cattolica del Sacro Cuore, Dermatologia, Rome, Italy
| | - Laura Del Regno
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Dermatologia, Rome; Università Cattolica del Sacro Cuore, Dermatologia, Rome, Italy
| | - Alessandra D'Amore
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Dermatologia, Rome; Università Cattolica del Sacro Cuore, Dermatologia, Rome, Italy
| | - Ketty Peris
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Dermatologia, Rome; Università Cattolica del Sacro Cuore, Dermatologia, Rome, Italy
| | - Alessandro Di Stefani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Dermatologia, Rome; Università Cattolica del Sacro Cuore, Dermatologia, Rome, Italy
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16
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Shahriari N, Grant-Kels JM, Rabinovitz H, Oliviero M, Scope A. Reflectance confocal microscopy: Diagnostic criteria of common benign and malignant neoplasms, dermoscopic and histopathologic correlates of key confocal criteria, and diagnostic algorithms. J Am Acad Dermatol 2020; 84:17-31. [PMID: 32565210 DOI: 10.1016/j.jaad.2020.05.154] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/02/2020] [Accepted: 05/14/2020] [Indexed: 01/11/2023]
Abstract
Reflectance confocal microscopy (RCM) is a high-resolution, noninvasive tool that is currently approved by the US Food and Drug Administration for obtaining and interpreting images of the skin and cutaneous neoplasms with the goal of decreasing unnecessary biopsy procedures in patients with benign lesions. The second article in this continuing medical education series focuses on identifying key criteria for the diagnosis of common skin cancers-melanoma, basal cell carcinoma, and squamous cell carcinoma. We contrast these findings with RCM features of common benign lesions-melanocytic nevi, solar lentigo, seborrheic keratosis, lichen planus-like keratosis, and sebaceous hyperplasia. We also correlate the dermoscopic and histopathologic findings with the RCM features.
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Affiliation(s)
- Neda Shahriari
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut.
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut; Department of Dermatology, University of Florida, Gainesville, Florida
| | - Harold Rabinovitz
- Skin and Cancer Associates, Plantation, Florida; Dermatology Department, Medical College of Georgia at Augusta University, Augusta, Georgia
| | | | - Alon Scope
- The Kittner Skin Cancer Screening and Research Institute, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Dermatology Service, Memorial Sloan-Kettering Center, New York, New York
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17
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Conforti C, Giuffrida R, Vezzoni R, Resende FSS, di Meo N, Zalaudek I. Dermoscopy and the experienced clinicians. Int J Dermatol 2020; 59:16-22. [PMID: 31222814 DOI: 10.1111/ijd.14512] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 03/27/2019] [Accepted: 05/13/2019] [Indexed: 01/24/2023]
Abstract
For several decades, melanoma diagnosis was based on symptoms rather than clinical features. In fact, until the 1970s melanoma was widely not recognized and only diagnosed when presenting as a large, ulcerated, and bleeding nodule. Today it is well known that ulceration and bleeding are symptoms of an advanced stage; thus, it comes not as a surprise that the prognosis of melanoma at that time was very poor. This paper was developed to recognize dermoscopy as an integrative part of the clinical examination, bearing in mind that naked eye diagnosis can change after dermoscopy outcomes, and to help clinicians avoid the concept: "If in doubt, cut it out".
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Affiliation(s)
- Claudio Conforti
- Dermatology Clinic, Ospedale Maggiore, University of Trieste, Trieste, Italy
| | - Roberta Giuffrida
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, Messina, Italy
| | - Roberta Vezzoni
- Dermatology Clinic, Ospedale Maggiore, University of Trieste, Trieste, Italy
| | | | - Nicola di Meo
- Dermatology Clinic, Ospedale Maggiore, University of Trieste, Trieste, Italy
| | - Iris Zalaudek
- Dermatology Clinic, Ospedale Maggiore, University of Trieste, Trieste, Italy
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18
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Abstract
Seborrheic keratosis (SK) is a common benign epidermal tumor with predominance in adult patients. Whereas common SKs are more frequent in Caucasians, dermatosis papulosa nigra is more prevalent in patients with a Fitzpatrick skin type of at least 3. There seems to be a link between extrinsic skin aging and the occurrence of SK. Mutations of fibroblast growth factor receptor 3 and other signaling molecules are a frequent finding in SK lesions. However, this does not translate into any malignant potential. Viral infections are particularly common in genital lesions, although their pathogenetic relevance for SK is questionable. Different histologic and clinical subtypes have been identified. The great variability of SKs raises some difficulties in diagnosis. Dermoscopy is the preferred non-invasive diagnostic method, in particular to differentiate pigmented SKs from other pigment tumors, including cutaneous melanoma. Eruptive SKs can be a paraneoplastic condition known as the Leser–Trélat sign. New targeted cancer treatments can cause a pseudo-Leser–Trélat sign. The treatment in practice is mainly minor surgery, including cryosurgery, shave excisions, and laser-assisted removal. The medical approaches have only limited effects. Recently, two formulations for topical therapy have been evaluated: a product with 40% hydrogen peroxide (HP40) and an aqueous nitric–zinc complex. Based on clinical trials, HP40 seems to be a promising alternative to surgery, in particular for facial lesions.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Dresden, 01067, Germany
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19
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Carrera C. The Many Faces of Seborrheic Keratosis. ACTAS DERMO-SIFILIOGRAFICAS 2019. [DOI: 10.1016/j.adengl.2018.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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20
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Carrera C. The Many Faces of Seborrheic Keratosis. ACTAS DERMO-SIFILIOGRAFICAS 2019; 110:338. [PMID: 30846163 DOI: 10.1016/j.ad.2018.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 12/23/2018] [Indexed: 11/16/2022] Open
Affiliation(s)
- C Carrera
- Unidad de Melanoma, Departamento de Dermatología, Hospital Clínic, Barcelona, España.
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21
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Wang FY, Liu RF, Chuang G, Yang CH, Chang YY. Smartphone wallpapers for dermoscopy training in medical students and residents. Int J Dermatol 2019; 58:345-349. [PMID: 30656675 DOI: 10.1111/ijd.14338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 10/25/2018] [Accepted: 11/19/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Several dermoscopy training programs have found the accuracy of dermoscopy examination depends on adequate training of practitioners. Smartphones are readily available and time-efficient tools for dermoscopy training. AIM To evaluate the learning efficacy of utilizing dermoscopy smartphone wallpapers to train medical students, PGY (postgraduate year)-1 trainees, and junior dermatological residents without prior dermoscopy training. METHODS We designed smartphone wallpapers with dermoscopy pictures and features of several common melanocytic and nonmelanocytic conditions. Pretests and posttests were performed before and after a 10-day-long smartphone wallpaper training program to evaluate their diagnostic accuracy using dermoscopy images. RESULTS Significant progressions were noted between the pretest and posttest scores both in the nonmelanocytic (P < 0.001) and the melanocytic (P = 0.003) sections. Medical students and PGY-1 trainees demonstrated more significant improvement in nonmelanocytic lesions, compared to dermatology residents. Residents of dermatology showed more progression in the melanocytic section than nonresidents. LIMITATIONS There were limited participants. The frequency and time allotted by each participant in perusing the wallpapers were variable. Further study of the application on clinical practice is still needed. CONCLUSION Smartphone wallpapers training improves dermoscopic interpretation significantly in medical students, PGY-1 trainees, and dermatological residents. The background knowledge of dermatology has an effect on the degree of improvement in the training course.
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Affiliation(s)
- Fang-Ying Wang
- Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ren-Feng Liu
- Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Gary Chuang
- Division of Dermatology, UCLA School of Medicine, Los Angeles, CA, USA
| | - Chih-Hsun Yang
- Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yao-Yu Chang
- Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
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22
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Klebanov N, Gunasekera NS, Lin WM, Hawryluk EB, Miller DM, Reddy BY, Christman MP, Beaulieu D, Rajadurai S, Duncan LM, Sober AJ, Tsao H. Clinical spectrum of cutaneous melanoma morphology. J Am Acad Dermatol 2018; 80:178-188.e3. [PMID: 30165162 DOI: 10.1016/j.jaad.2018.08.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/10/2018] [Accepted: 08/18/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Melanoma can mimic other cutaneous lesions, but the full spectrum and prevalence of these morphologic variants remain largely unknown. OBJECTIVE To classify nonacral cutaneous melanomas into distinct morphologic clusters and characterize clusters' clinicopathologic features. METHODS All pathologic melanoma diagnoses (occurring during 2011-2016) were reviewed for routine prebiopsy digital photographs (n = 400). Six dermatologists independently assigned lesions into 1 of 14 diagnostic classes on the basis of morphology. Image consensus clusters were generated by K-means; clinicopathologic features were compared with analysis of variance and χ2. RESULTS Five morphologic clusters were identified: typical (n = 136), nevus-like (n = 81), amelanotic/nonmelanoma skin cancer (NMSC)-like (n = 70), seborrheic keratosis (SK)-like (n = 68), and lentigo/lentigo maligna (LM)-like (n = 45) melanomas. Nevus-like melanomas were found in younger patients. Nevus-like and lentigo/LM-like melanomas tended to be thinner and more likely identified on routine dermatologic examinations. NMSC-like melanomas were tender, thicker, more mitotically active, and associated with prior NMSC. Typical and SK-like melanomas had similar clinicopathologic features. LIMITATIONS Cluster subdivision yielded diminished sample sizes. Visual assignment was performed without clinical context. CONCLUSION When primary cutaneous melanomas were assigned into diagnostic groups and subjected to novel consensus clustering, recurrent morphologic patterns emerged. The spectrum of these morphologies was unexpectedly diverse, which might have implications for visual training and possibly clinical diagnosis.
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Affiliation(s)
- Nikolai Klebanov
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nicole S Gunasekera
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - William M Lin
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Elena B Hawryluk
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - David M Miller
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Bobby Y Reddy
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Mitalee P Christman
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Derek Beaulieu
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Suvithan Rajadurai
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lyn M Duncan
- Pathology Service, Massachusetts General Hospital, Boston, Massachusetts
| | - Arthur J Sober
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Hensin Tsao
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts.
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