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Park C, Kim DH, Hur K, Mun JH. Clinical and histopathological features of lentigo maligna and lentigo maligna melanoma: a retrospective analysis in Korea. Front Med (Lausanne) 2024; 10:1249796. [PMID: 38249976 PMCID: PMC10799555 DOI: 10.3389/fmed.2023.1249796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 12/07/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction Lentigo maligna (LM) and lentigo maligna melanoma (LMM) are rare in Asian countries. The histopathological diagnosis of LM is often challenging, and misdiagnosis is common. Although histopathologic features of LM/LMM are known, statistical analysis of them were scarcely reported. In this study, we aimed to investigate the histopathological characteristics of LM/LMM in Korean patients and identify key histopathological clues distinguishing LM from benign lentigo. Methods We performed a retrospective study of the clinical and histopathological features of patients diagnosed with LM/LMM at our center between 2011 and 2022. We assessed the histopathological features in each case based on 16 pathological criteria according to previous literature. Pathologically confirmed cases of benign lentigo were analyzed for comparison. Results Twenty-one patients (10 with LM and 11 with LMM) were analyzed. Several statistically significant difference existed between the features of LM and benign lentigo (N = 10), including asymmetry of overall structure (p < 0.001), cytologic atypia (p < 0.001), predominant single-cell proliferation (p < 0.001), melanocytic nests (p = 0.033), melanocytes forming rows (p = 0.003), pagetoid spread of melanocytes (p < 0.001), and hair follicle invasion by atypical melanocytes (p < 0.001). Degree of solar elastosis was more severe in group "Age ≥ 60" (p = 0.015), and group "Diameter ≥ 20 mm" (p = 0.043). Presence of elongated rete ridges were less common in the older than 60 age group (p = 0.015) and group "Diameter ≥ 20 mm." Invasion was associated with mitosis (p = 0.001, OR 49.285), multinucleated cells (p = 0.035, OR 17.769), and degree of lymphocyte infiltration (p = 0.004). Conclusion This study investigated the clinical and histopathologic characteristics of LM and LMM in Koreans. Although histopathological diagnosis is challenging, especially in the early stages of LM, our data showed essential histopathological changes in architectural, cytological, and dermal patterns. Considering the potential aggressiveness of LM/LMM, it is essential to recognize its histopathological features and provide timely management.
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Affiliation(s)
- Chanyong Park
- Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dong Hyo Kim
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Dermatology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Keunyoung Hur
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Dermatology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Je-Ho Mun
- Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Dermatology, Seoul National University Hospital, Seoul, Republic of Korea
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Tartaglia J, Ciolfi C, Sartor E, Caroppo F, Salmaso R, Del Forno B, Belloni Fortina A. Osteonevus of Nanta in a 3-year-old child with dermatoscopic characterization. JAAD Case Rep 2023; 38:120-122. [PMID: 37534106 PMCID: PMC10393582 DOI: 10.1016/j.jdcr.2023.05.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023] Open
Affiliation(s)
- Jacopo Tartaglia
- Dermatology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Christian Ciolfi
- Dermatology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Emma Sartor
- Dermatology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Francesca Caroppo
- Dermatology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
- Pediatric Dermatology Regional Center, Department of Women’s and Children’s Health, University of Padua, Padua, Italy
| | - Roberto Salmaso
- Surgical Pathology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Biancamaria Del Forno
- Surgical Pathology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Anna Belloni Fortina
- Dermatology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
- Pediatric Dermatology Regional Center, Department of Women’s and Children’s Health, University of Padua, Padua, Italy
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Abbas Q, Daadaa Y, Rashid U, Ibrahim MEA. Assist-Dermo: A Lightweight Separable Vision Transformer Model for Multiclass Skin Lesion Classification. Diagnostics (Basel) 2023; 13:2531. [PMID: 37568894 PMCID: PMC10417387 DOI: 10.3390/diagnostics13152531] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/22/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
A dermatologist-like automatic classification system is developed in this paper to recognize nine different classes of pigmented skin lesions (PSLs), using a separable vision transformer (SVT) technique to assist clinical experts in early skin cancer detection. In the past, researchers have developed a few systems to recognize nine classes of PSLs. However, they often require enormous computations to achieve high performance, which is burdensome to deploy on resource-constrained devices. In this paper, a new approach to designing SVT architecture is developed based on SqueezeNet and depthwise separable CNN models. The primary goal is to find a deep learning architecture with few parameters that has comparable accuracy to state-of-the-art (SOTA) architectures. This paper modifies the SqueezeNet design for improved runtime performance by utilizing depthwise separable convolutions rather than simple conventional units. To develop this Assist-Dermo system, a data augmentation technique is applied to control the PSL imbalance problem. Next, a pre-processing step is integrated to select the most dominant region and then enhance the lesion patterns in a perceptual-oriented color space. Afterwards, the Assist-Dermo system is designed to improve efficacy and performance with several layers and multiple filter sizes but fewer filters and parameters. For the training and evaluation of Assist-Dermo models, a set of PSL images is collected from different online data sources such as Ph2, ISBI-2017, HAM10000, and ISIC to recognize nine classes of PSLs. On the chosen dataset, it achieves an accuracy (ACC) of 95.6%, a sensitivity (SE) of 96.7%, a specificity (SP) of 95%, and an area under the curve (AUC) of 0.95. The experimental results show that the suggested Assist-Dermo technique outperformed SOTA algorithms when recognizing nine classes of PSLs. The Assist-Dermo system performed better than other competitive systems and can support dermatologists in the diagnosis of a wide variety of PSLs through dermoscopy. The Assist-Dermo model code is freely available on GitHub for the scientific community.
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Affiliation(s)
- Qaisar Abbas
- College of Computer and Information Sciences, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 11432, Saudi Arabia; (Y.D.); (M.E.A.I.)
| | - Yassine Daadaa
- College of Computer and Information Sciences, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 11432, Saudi Arabia; (Y.D.); (M.E.A.I.)
| | - Umer Rashid
- Department of Computer Science, Quaid-i-Azam University, Islamabad 44000, Pakistan;
| | - Mostafa E. A. Ibrahim
- College of Computer and Information Sciences, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 11432, Saudi Arabia; (Y.D.); (M.E.A.I.)
- Department of Electrical Engineering, Benha Faculty of Engineering, Benha University, Qalubia, Benha 13518, Egypt
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Baig AR, Abbas Q, Almakki R, Ibrahim MEA, AlSuwaidan L, Ahmed AES. Light-Dermo: A Lightweight Pretrained Convolution Neural Network for the Diagnosis of Multiclass Skin Lesions. Diagnostics (Basel) 2023; 13:diagnostics13030385. [PMID: 36766490 PMCID: PMC9914027 DOI: 10.3390/diagnostics13030385] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023] Open
Abstract
Skin cancer develops due to the unusual growth of skin cells. Early detection is critical for the recognition of multiclass pigmented skin lesions (PSLs). At an early stage, the manual work by ophthalmologists takes time to recognize the PSLs. Therefore, several "computer-aided diagnosis (CAD)" systems are developed by using image processing, machine learning (ML), and deep learning (DL) techniques. Deep-CNN models outperformed traditional ML approaches in extracting complex features from PSLs. In this study, a special transfer learning (TL)-based CNN model is suggested for the diagnosis of seven classes of PSLs. A novel approach (Light-Dermo) is developed that is based on a lightweight CNN model and applies the channelwise attention (CA) mechanism with a focus on computational efficiency. The ShuffleNet architecture is chosen as the backbone, and squeeze-and-excitation (SE) blocks are incorporated as the technique to enhance the original ShuffleNet architecture. Initially, an accessible dataset with 14,000 images of PSLs from seven classes is used to validate the Light-Dermo model. To increase the size of the dataset and control its imbalance, we have applied data augmentation techniques to seven classes of PSLs. By applying this technique, we collected 28,000 images from the HAM10000, ISIS-2019, and ISIC-2020 datasets. The outcomes of the experiments show that the suggested approach outperforms compared techniques in many cases. The most accurately trained model has an accuracy of 99.14%, a specificity of 98.20%, a sensitivity of 97.45%, and an F1-score of 98.1%, with fewer parameters compared to state-of-the-art DL models. The experimental results show that Light-Dermo assists the dermatologist in the better diagnosis of PSLs. The Light-Dermo code is available to the public on GitHub so that researchers can use it and improve it.
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Zawodny P, Stój E, Kulig P, Skonieczna-Żydecka K, Sieńko J. VISIA Skin Analysis System as a Tool to Evaluate the Reduction of Pigmented Skin and Vascular Lesions Using the 532 Nm Laser. Clin Cosmet Investig Dermatol 2022; 15:2187-2195. [PMID: 36267688 PMCID: PMC9578358 DOI: 10.2147/ccid.s380388] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/22/2022] [Indexed: 11/23/2022]
Abstract
Purpose Esthetic medicine is a rapidly developing field of medicine that is not only beneficial in terms of external appearance, but also significantly improves overall quality of life. Currently, pigmented and vascular skin lesions are more prevalent due to multiple environmental factors and are a characteristic manifestation of skin aging. The development of modern laser therapy has contributed to the successful management of multiple skin conditions. The aim of our study was to show the effect of concomitant reduction of both vascular and hyperpigmented skin lesions located on the facial area after repetitive 532 nm laser therapy and to emphasize that the detection of such observation was possible due to the implementation of System of Skin Analysis and Assessment. Patients and Methods We retrospectively analyzed 100 patients' records with "VISIA" Skin Analysis System after 532nm laser therapy. Results Laser therapy significantly decreased VISIA scores for all tested lesions, ie, macules, pigmented and vascular lesions (p<0.0001 for all). The efficacy of laser treatment was not significantly different regarding skin phototype (p>0.05) and did not correlate with age of participants (p>0.05). The more laser sessions were performed, the higher improvement in vascular lesion VISIA scores was observed (r=0.26, p=0.0097). Conclusion 532 nm laser therapy is effective regarding vascular and hyperpigmented skin lesions located on the facial area. The System of Skin Analysis and Assessment is a good tool to test the treatment efficacy during regular follow-up procedure.
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Affiliation(s)
| | | | - Piotr Kulig
- Department of General Pathology, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | | | - Jerzy Sieńko
- Department of General and Transplantation Surgery, Pomeranian Medical University in Szczecin, Szczecin, 70-111, Poland,Correspondence: Jerzy Sieńko, Department of General and Transplantation Surgery, Pomeranian Medical University, Szczecin, Poland, Tel +48 91 466-11-36, Fax +48 91 466 11 30, Email
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Lyakhov PA, Lyakhova UA, Nagornov NN. System for the Recognizing of Pigmented Skin Lesions with Fusion and Analysis of Heterogeneous Data Based on a Multimodal Neural Network. Cancers (Basel) 2022; 14:1819. [PMID: 35406591 DOI: 10.3390/cancers14071819] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/30/2022] [Accepted: 03/30/2022] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Skin cancer is one of the most common cancers in humans. This study aims to create a system for recognizing pigmented skin lesions by analyzing heterogeneous data based on a multimodal neural network. Fusing patient statistics and multidimensional visual data allows for finding additional links between dermoscopic images and medical diagnostic results, significantly improving neural network classification accuracy. The use by specialists of the proposed system of neural network recognition of pigmented skin lesions will enhance the efficiency of diagnosis compared to visual diagnostic methods. Abstract Today, skin cancer is one of the most common malignant neoplasms in the human body. Diagnosis of pigmented lesions is challenging even for experienced dermatologists due to the wide range of morphological manifestations. Artificial intelligence technologies are capable of equaling and even surpassing the capabilities of a dermatologist in terms of efficiency. The main problem of implementing intellectual analysis systems is low accuracy. One of the possible ways to increase this indicator is using stages of preliminary processing of visual data and the use of heterogeneous data. The article proposes a multimodal neural network system for identifying pigmented skin lesions with a preliminary identification, and removing hair from dermatoscopic images. The novelty of the proposed system lies in the joint use of the stage of preliminary cleaning of hair structures and a multimodal neural network system for the analysis of heterogeneous data. The accuracy of pigmented skin lesions recognition in 10 diagnostically significant categories in the proposed system was 83.6%. The use of the proposed system by dermatologists as an auxiliary diagnostic method will minimize the impact of the human factor, assist in making medical decisions, and expand the possibilities of early detection of skin cancer.
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Styła M, Giżewski T. The Study of Usefulness of a Set of Fractal Parameters to Build Classes of Disease Units Based on Images of Pigmented Skin Lesions. Diagnostics (Basel) 2021; 11:1773. [PMID: 34679471 PMCID: PMC8535145 DOI: 10.3390/diagnostics11101773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/15/2021] [Accepted: 09/24/2021] [Indexed: 11/17/2022] Open
Abstract
Dermatoscopic images are also increasingly used to train artificial neural networks for the future to provide fully automatic diagnostic systems capable of determining the type of pigmented skin lesion. Therefore, fractal analysis was used in this study to measure the irregularity of pigmented skin lesion surfaces. This paper presents selected results from individual stages of preliminary processing of the dermatoscopic image on pigmented skin lesion, in which fractal analysis was used and referred to the effectiveness of classification by fuzzy or statistical methods. Classification of the first unsupervised stage was performed using the method of analysis of scatter graphs and the fuzzy method using the Kohonen network. The results of the Kohonen network learning process with an input vector consisting of eight elements prove that neuronal activation requires a larger learning set with greater differentiation. For the same training conditions, the final results are at a higher level and can be classified as weaker. Statistics of factor analysis were proposed, allowing for the reduction in variables, and the directions of further studies were indicated.
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Affiliation(s)
- Monika Styła
- Chair and Department of Biophysics, Medical University of Lublin, 20-090 Lublin, Poland
- Department of Electrical Engineering and Electrotechnologies, Faculty of Electrical Engineering and Computer Science, Lublin University of Technology, 20-618 Lublin, Poland;
| | - Tomasz Giżewski
- Department of Electrical Engineering and Electrotechnologies, Faculty of Electrical Engineering and Computer Science, Lublin University of Technology, 20-618 Lublin, Poland;
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Christensen GB, Nagaoka T, Kiyohara Y, Johansson I, Ingvar C, Nakamura A, Sota T, Nielsen K. Clinical performance of a novel hyperspectral imaging device for cutaneous melanoma and pigmented skin lesions in Caucasian skin. Skin Res Technol 2021; 27:803-809. [PMID: 33651425 DOI: 10.1111/srt.13023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 01/17/2021] [Accepted: 01/25/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The quest for diagnostic tools for the detection of cutaneous malignant melanoma (cMM) is ongoing. A challenge in cMM care is not overlooking cMM at an early stage, while simultaneously avoiding unnecessary biopsies or excisions of benign pigmented skin lesions (PSLs). A novel hyperspectral imaging (HSI) device is shown to have potential for differentiating equivocal PSLs in Asian skin types. Our objective was to assess the accuracy of the HSI device in distinguishing between cMM and benign PSLs in patients with Caucasian skin types. METHODS Patients with Caucasian skin types (Fitzpatrick I-II), enrolled for excisional biopsies of PSLs were included and examined using the HSI device. The discrimination index (DI) was used to demonstrate the sensitivity (SE) and specificity (SP) in comparison with the re-evaluated histopathology diagnoses. RESULTS In 186 patients, 202 pigmented skin lesions were included. The sensitivity to detect cMM was 96.7% (87/90), and the specificity for benign lesions was 42.1% (45/107). The AUC was 0.800 (95% confidence interval (CI): 0.740-0.861). CONCLUSIONS Our novel HSI device showed a high sensitivity in detecting malignant lesions in patients with Caucasian skin types. Compared with analogous technologies, as multispectral imaging or electrical impedance spectroscopy, our device showed similar or better accuracy in differentiating cMM from benign PSLs. Therefore, it might be a useful clinical tool in skin types I-IV and where further triage of pigmented skin lesions is important.
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Affiliation(s)
- Gustav Boelsgaard Christensen
- Department of Dermatology, Skane University Hospital, Lund University, Lund, Sweden.,Department of Clinical Sciences Lund, Dermatology, Lund University, Lund, Sweden
| | - Takashi Nagaoka
- Department of Computational System Biology, Kindai University, Kinokawa, Japan
| | - Yoshio Kiyohara
- Dermatology Division, Shizuoka Cancer Center Hospital, Nagaizumi, Japan
| | - Iva Johansson
- Department of Pathology, Skane University Hospital, Lund University, Lund, Sweden.,Department of Clinical Sciences Lund, Pathology, Lund University, Lund, Sweden
| | - Christian Ingvar
- Department of Surgery, Skane University Hospital, Lund University, Lund, Sweden.,Department of Clinical Sciences Lund, Surgery, Lund University, Lund, Sweden
| | - Atsushi Nakamura
- Waseda Research Institute for Science and Engineering, Waseda University, Shinjuku, Japan
| | - Takayuki Sota
- Waseda Research Institute for Science and Engineering, Waseda University, Shinjuku, Japan.,Department of Electrical Engineering and Bioscience, Waseda University, Shinjuku, Japan
| | - Kari Nielsen
- Department of Dermatology, Skane University Hospital, Lund University, Lund, Sweden.,Department of Clinical Sciences Lund, Dermatology, Lund University, Lund, Sweden.,Department of Dermatology, Helsingborg Hospital and Skane University Hospital, Lund University, Lund, Sweden
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Del Rosario F, Farahi JM, Drendel J, Buntinx-Krieg T, Caravaglio J, Domozych R, Chapman S, Braunberger T, Dellavalle RP, Norris DA, Fathi R, Alkousakis T. Performance of a computer-aided digital dermoscopic image analyzer for melanoma detection in 1,076 pigmented skin lesion biopsies. J Am Acad Dermatol 2018; 78:927-934.e6. [PMID: 29678380 DOI: 10.1016/j.jaad.2017.01.049] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 01/27/2017] [Accepted: 01/29/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Digital dermoscopic image analysis of pigmented skin lesions (PSLs) has become increasingly popular, despite its unclear clinical utility. Unbiased, high-powered studies investigating the efficacy of commercially available systems are limited. OBJECTIVE To investigate the diagnostic performance of the FotoFinder Mole-Analyzer in assessing PSLs for cutaneous melanoma. METHODS In this 15-year retrospective study, the histopathologies of 1076 biopsied PSLs among a total of 2500 imaged PSLs were collected. The biopsied PSLs were categorized as benign or malignant (cutaneous melanoma) based on histopathology. Analyzer scores (0-1.00) for these PSLs were obtained and grouped according to histopathology. RESULTS At an optimized cutoff score of 0.50, a sensitivity of 56% and a specificity of 74% were achieved. The area under the receiver operating characteristics curve was 0.698, indicating poor accuracy as a diagnostic tool. LIMITATIONS This study had a retrospective design and involved only a single institution. CONCLUSION Our study reveals a low sensitivity of the scoring function of this digital dermoscopic image analyzer for detecting cutaneous melanomas. Physicians must apply keen clinical judgment when using such devices in the screening of suspicious PSLs.
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Affiliation(s)
| | | | | | | | | | - Renee Domozych
- University of Central Florida College of Medicine, Orlando, Florida
| | - Stephanie Chapman
- Michigan State University, College of Human Medicine, Grand Rapids, Michigan
| | - Taylor Braunberger
- University of North Dakota School of Medicine, Grand Forks, North Dakota
| | | | - David A Norris
- University of Colorado School of Medicine, Aurora, Colorado
| | - Ramin Fathi
- University of Colorado School of Medicine, Aurora, Colorado
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Sakai H, Ando Y, Ikinaga K, Tanaka M. Estimating melanin location in the pigmented skin lesions by hue-saturation-lightness color space values of dermoscopic images. J Dermatol 2018; 44:490-498. [PMID: 28447351 DOI: 10.1111/1346-8138.13725] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 11/08/2016] [Indexed: 11/27/2022]
Abstract
The depth of melanin in the skin can be estimated roughly by observation of the color exhibited on dermoscopy. Currently, there are no objective methods to estimate it. The aim of the present study was to clarify the relationship between the depth of melanin in the skin and the color variation exhibited, and to objectively estimate the 3-D location of melanin in the pigmented skin lesions from dermoscopic images. Representative colors in dermoscopic images of acral compound nevus, Spitz nevus and blue nevus were evaluated by the subjectively perceived color on dermoscopy and objective values in hue-saturation-lightness color space values. Brown colors due to small quantities of superficial melanin in the skin had high saturation and low lightness values, whereas black colors due to large quantities of superficial melanin had low saturation and low lightness values. On the other hand, colors due to melanin in the dermis were perceived as blue-gray on dermoscopy, but extracted colors showed gray-brown hue and intermediate saturation and high lightness values. In all cases, extracted representative colors of pigmented skin lesions had similar hue values within the red-orange range. Objective estimation of the 3-D location of melanin in the pigmented skin lesions is possible by the saturation and lightness values of the colors extracted from dermoscopic images. Subjectively perceived colors of melanin, especially in the dermis, can be modified by the surrounding environment effect and blue color perception.
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Affiliation(s)
- Hiroshi Sakai
- Department of Dermatology, Osaka Police Hospital, Osaka, Japan
| | - Yoshimi Ando
- Department of Dermatology, Osaka Police Hospital, Osaka, Japan
| | - Kuniko Ikinaga
- Department of Dermatology, Osaka Police Hospital, Osaka, Japan
| | - Masaru Tanaka
- Department of Dermatology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
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Verzi AE, Quan VL, Walton KE, Martini MC, Marghoob AA, Garfield EM, Kong BY, Isales MC, VandenBoom T, Zhang B, West DP, Gerami P. The diagnostic value and histologic correlate of distinct patterns of shiny white streaks for the diagnosis of melanoma: A retrospective, case-control study. J Am Acad Dermatol 2017; 78:913-919. [PMID: 29138058 DOI: 10.1016/j.jaad.2017.11.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 10/24/2017] [Accepted: 11/02/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Shiny white streaks (SWSs) are best visualized with polarized dermoscopy and correlate with dermal fibroplasia histopathologically. SWSs have been described at higher frequencies in melanomas than in benign nevi. OBJECTIVE We assessed the diagnostic value of different patterns of SWSs and their histologic correlate in melanocytic lesions. METHODS Polarized dermoscopic images of 1507 histopathologically diagnosed melanocytic neoplasms were analyzed for presence and pattern of SWSs. Histology was also reviewed for correlation. RESULTS Among 1507 melanocytic neoplasms, SWSs were observed in 31 of 144 melanomas (22%) and 22 of 1363 benign neoplasms (1.6%) (P < .001). The sensitivity and specificity of SWSs for melanoma were 22% and 98%, respectively. Diffuse SWSs exhibited the greatest diagnostic value for melanoma, with sensitivity of 11.8% and specificity of 99.5%. Focal central and peripheral SWSs were comparable in diagnostic significance. The presence of SWSs was highly uncommon in dysplastic nevi, whereas in certain benign subgroups of nevi such as Spitz nevi and atypical genital special site nevi, SWSs were not uncommon. Diffuse SWSs correlated with greater breadth of deep fibroplasia than focal SWSs (P = .009), and SWSs correlated with greater Breslow depth among melanomas (P = .007). LIMITATIONS This study was retrospective. CONCLUSION Polarized dermoscopy is a valuable diagnostic tool in the identification of SWSs, a feature that is highly specific for melanoma.
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Affiliation(s)
- Anna Eliza Verzi
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Victor L Quan
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kara E Walton
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Mary C Martini
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ashfaq A Marghoob
- Dermatology Service, Memorial Sloan Kettering Cancer Center, Hauppage, New York, New York
| | - Erin M Garfield
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Betty Y Kong
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Maria Cristina Isales
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Timothy VandenBoom
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Bin Zhang
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Dennis P West
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
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Kittler H, Marghoob AA, Argenziano G, Carrera C, Curiel-Lewandrowski C, Hofmann-Wellenhof R, Malvehy J, Menzies S, Puig S, Rabinovitz H, Stolz W, Saida T, Soyer HP, Siegel E, Stoecker WV, Scope A, Tanaka M, Thomas L, Tschandl P, Zalaudek I, Halpern A. Standardization of terminology in dermoscopy/dermatoscopy: Results of the third consensus conference of the International Society of Dermoscopy. J Am Acad Dermatol 2016; 74:1093-106. [PMID: 26896294 DOI: 10.1016/j.jaad.2015.12.038] [Citation(s) in RCA: 162] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 12/15/2015] [Accepted: 12/20/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Evolving dermoscopic terminology motivated us to initiate a new consensus. OBJECTIVE We sought to establish a dictionary of standardized terms. METHODS We reviewed the medical literature, conducted a survey, and convened a discussion among experts. RESULTS Two competitive terminologies exist, a more metaphoric terminology that includes numerous terms and a descriptive terminology based on 5 basic terms. In a survey among members of the International Society of Dermoscopy (IDS) 23.5% (n = 201) participants preferentially use descriptive terminology, 20.1% (n = 172) use metaphoric terminology, and 484 (56.5%) use both. More participants who had been initially trained by metaphoric terminology prefer using descriptive terminology than vice versa (9.7% vs 2.6%, P < .001). Most new terms that were published since the last consensus conference in 2003 were unknown to the majority of the participants. There was uniform consensus that both terminologies are suitable, that metaphoric terms need definitions, that synonyms should be avoided, and that the creation of new metaphoric terms should be discouraged. The expert panel proposed a dictionary of standardized terms taking account of metaphoric and descriptive terms. LIMITATIONS A consensus seeks a workable compromise but does not guarantee its implementation. CONCLUSION The new consensus provides a revised framework of standardized terms to enhance the consistent use of dermoscopic terminology.
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Affiliation(s)
- Harald Kittler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria.
| | - Ashfaq A Marghoob
- Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Giuseppe Argenziano
- Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Reggio Emilia, Italy
| | - Cristina Carrera
- Melanoma Unit, Department of Dermatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER ER), Instituto de Salud Carlos III, Barcelona, Spain
| | | | - Rainer Hofmann-Wellenhof
- Department of Dermatology and Venerology, Nonmelanoma Skin Cancer Unit, Medical University of Graz, Graz, Austria
| | - Josep Malvehy
- Melanoma Unit, Department of Dermatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER ER), Instituto de Salud Carlos III, Barcelona, Spain
| | - Scott Menzies
- Sydney Melanoma Diagnostic Center, Sydney Cancer Center, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Susana Puig
- Melanoma Unit, Department of Dermatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER ER), Instituto de Salud Carlos III, Barcelona, Spain
| | | | - Wilhelm Stolz
- Department of Dermatology, Klinikum München, Munich, Germany
| | - Toshiaki Saida
- Department of Dermatology, Shinshu University School of Medicine, Matsumoto, Japan
| | - H Peter Soyer
- Dermatology Research Center, University of Queensland, School of Medicine, Translational Research Institute, Brisbane, Australia
| | - Eliot Siegel
- University of Maryland Medical Center, Baltimore Department of Veterans Affairs Medical Center, Baltimore, Maryland
| | - William V Stoecker
- Department of Dermatology, University of Missouri Health Sciences Center, Columbia, Missouri
| | - Alon Scope
- Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Dermatology, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Masaru Tanaka
- Department of Dermatology, Keio University, Tokyo, Japan
| | - Luc Thomas
- Service de Dermatologie, Center Hospitalier Universitaire de Lyon, Lyon, France
| | - Philipp Tschandl
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Iris Zalaudek
- Department of Dermatology and Venerology, Nonmelanoma Skin Cancer Unit, Medical University of Graz, Graz, Austria
| | - Allan Halpern
- Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, New York
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Walter FM, Prevost AT, Vasconcelos J, Hall PN, Burrows NP, Morris HC, Kinmonth AL, Emery JD. Using the 7-point checklist as a diagnostic aid for pigmented skin lesions in general practice: a diagnostic validation study. Br J Gen Pract 2013; 63:e345-53. [PMID: 23643233 PMCID: PMC3635581 DOI: 10.3399/bjgp13x667213] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 11/10/2012] [Accepted: 01/08/2013] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND GPs need to recognise significant pigmented skin lesions, given rising UK incidence rates for malignant melanoma. The 7-point checklist (7PCL) has been recommended by NICE (2005) for routine use in UK general practice to identify clinically significant lesions which require urgent referral. AIM To validate the Original and Weighted versions of the 7PCL in the primary care setting. DESIGN AND SETTING Diagnostic validation study, using data from a SIAscopic diagnostic aid randomised controlled trial in eastern England. METHOD Adults presenting in general practice with a pigmented skin lesion that could not be immediately diagnosed as benign were recruited into the trial. Reference standard diagnoses were histology or dermatology expert opinion; 7PCL scores were calculated blinded to the reference diagnosis. A case was defined as a clinically significant lesion for primary care referral to secondary care (total 1436 lesions: 225 cases, 1211 controls); or melanoma (36). RESULTS For diagnosing clinically significant lesions there was a difference between the performance of the Original and Weighted 7PCLs (respectively, area under curve: 0.66, 0.69, difference = 0.03, P<0.001). For the identification of melanoma, similar differences were found. Increasing the Weighted 7PCL's cut-off score from recommended 3 to 4 improved detection of clinically significant lesions in primary care: sensitivity 73.3%, specificity 57.1%, positive predictive value 24.1%, negative predictive value 92.0%, while maintaining high sensitivity of 91.7% and moderate specificity of 53.4% for melanoma. CONCLUSION The Original and Weighted 7PCLs both performed well in a primary care setting to identify clinically significant lesions as well as melanoma. The Weighted 7PCL, with a revised cut-off score of 4 from 3, performs slightly better and could be applied in general practice to support the recognition of clinically significant lesions and therefore the early identification of melanoma.
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Affiliation(s)
- Fiona M Walter
- Department of Public Health & Primary Care, Strangeways Research Laboratory, Cambridge.
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Seidenari S, Burroni M, Dell'Eva G, Pepe P, Belletti B. Computerized evaluation of pigmented skin lesion images recorded by a videomicroscope: comparison between polarizing mode observation and oil/slide mode observation. Skin Res Technol 1995; 1:187-91. [PMID: 27326721 DOI: 10.1111/j.1600-0846.1995.tb00042.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND/AIMS It has now been established that ELM significantly improves the clinical diagnosis of pigmented skin lesions, particularly when associated with image analysis on digital pictures. Besides surface microscopes, so called "videomicroscopes" are nowadays commercially available. Thanks to their practicality and to their reasonable price and small volume, they could be usefully employed by general practitioners or peripheral dermatologists in their practice. The aim of our study was to evaluate the usefulness and the handiness of a videomicroscope provided with polarized light, and to compare images recorded in the polarizing mode to those of the same lesions recorded after application of oil and a glass slide. METHODS 114 images of benign pigmented skin lesions were recorded both in polarizing mode and in oil/slide mode observation. Digital images were then analyzed by means of a dedicated software, evaluating 34 different parameters. RESULTS The instrument is easy to handle and the acquisition of images is simple and quick. Polarizing mode observation enables the recognition of subsurface structures, like pigment network and capillaries. Red and blue components in the images tend to be more pronounced, when images are acquired by the polarizing system, whereas green components are prominent in oil images. Values referring to dark areas are also higher for oil images. However, the 2 observation modes provide digital images, whose values, in most cases, do not differ statistically. CONCLUSION Videomicroscopes are cheap, space saving, and enable a quick examination of skin areas to be imaged. The possibility of a rapid switch from surface to subsurface polarizing mode observation, makes the examination procedure even faster. Our data demonstrate that polarizing mode observation and recording can be employed as a basis for clinical and computerized epiluminescence, particularly in situations, where a rapid screening of numerous patients and lesions is necessary.
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Affiliation(s)
- S Seidenari
- Department of Dermatology, University of Modena, ItalyStudio Dell'Eva-Burroni, Firenze, Italy
| | - M Burroni
- Department of Dermatology, University of Modena, ItalyStudio Dell'Eva-Burroni, Firenze, Italy
| | - G Dell'Eva
- Department of Dermatology, University of Modena, ItalyStudio Dell'Eva-Burroni, Firenze, Italy
| | - P Pepe
- Department of Dermatology, University of Modena, ItalyStudio Dell'Eva-Burroni, Firenze, Italy
| | - B Belletti
- Department of Dermatology, University of Modena, ItalyStudio Dell'Eva-Burroni, Firenze, Italy
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