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American Journal of Clinical Dermatology Nov 2018In the 1980s, the increasing incidence of skin cancers prompted the development of noninvasive medical devices to improve skin cancer diagnosis in daily dermatology... (Review)
Review
In the 1980s, the increasing incidence of skin cancers prompted the development of noninvasive medical devices to improve skin cancer diagnosis in daily dermatology practice. As a result of the development of these noninvasive techniques, diagnosis is now established earlier and with better accuracy. These advances are of great benefit to high-risk patients, who previously would have had to undergo several excisions. In this review, we focus on the classic technique of dermoscopy and the more recent digital version, as well as on advanced noninvasive imaging techniques, such as reflectance confocal microscopy and optical coherence tomography. On the basis of their specific features, these noninvasive medical devices can be used not only to diagnose and monitor melanoma and nonmelanoma skin cancers but also to choose the best therapy and follow the patient's response to treatment in vivo.
Topics: Dermatology; Dermoscopy; Humans; Medical Oncology; Microscopy, Confocal; Photochemotherapy; Preoperative Care; Prognosis; Skin; Skin Neoplasms; Tomography, Optical Coherence; Treatment Outcome
PubMed: 30374899
DOI: 10.1007/s40257-018-0367-4 -
Journal of Primary Health Care Mar 2020Dermoscopy in primary care enhances clinical diagnoses and allows for risk stratifications. We have compiled 25 recommendations from our experience of dermoscopy in a...
Dermoscopy in primary care enhances clinical diagnoses and allows for risk stratifications. We have compiled 25 recommendations from our experience of dermoscopy in a wide range of clinical settings. The aim of this study is to enhance the application of dermoscopy by primary care clinicians. For primary care physicians commencing dermoscopy, we recommend understanding the aims of dermoscopy, having adequate training, purchasing dermoscopes with polarised and unpolarised views, performing regular maintenance on the equipment, seeking consent, applying contact and close non-contact dermoscopy, maintaining sterility, knowing one algorithm well and learning the rules for special regions such as the face, acral regions and nails. For clinicians already applying dermoscopy, we recommend establishing a platform for storing and retrieving clinical and dermoscopic images; shooting as uncompressed files; applying high magnifications and in-camera improvisations; explaining dermoscopic images to patients and their families; applying toggling; applying scopes with small probes for obscured lesions and lesions in body creases; applying far, non-contact dermoscopy; performing skin manipulations before and during dermoscopy; practising selective dermoscopy if experienced enough; and being aware of compound lesions. For clinicians in academic practice for whom dermatology and dermoscopy are special interests, we recommend acquiring the best hardware available with separate setups for clinical photography and dermoscopy; obtaining oral or written consent from patients for taking and publishing recognisable images; applying extremely high magnifications in search of novel dermoscopic features that are clinically important; applying dermoscopy immediately after local anaesthesia; and further augmenting images to incorporate messages beyond words to readers.
Topics: Algorithms; Dermoscopy; Diagnosis, Differential; Humans; Information Storage and Retrieval; Melanoma; Physical Examination; Primary Health Care; Risk Assessment; Risk Factors; Sensitivity and Specificity; Skin Neoplasms
PubMed: 32223845
DOI: 10.1071/HC19057 -
Skin Research and Technology : Official... Jan 2024There are no standards for evaluating skin photoaging. Dermoscopy is a non-invasive detection method that might be useful for evaluating photoaging.
BACKGROUND
There are no standards for evaluating skin photoaging. Dermoscopy is a non-invasive detection method that might be useful for evaluating photoaging.
OBJECTIVE
To assess the correlation between the dermoscopic evaluation of photoaging and clinical and pathological evaluations.
METHODS
The age, clinical evaluation (Fitzpatrick classification, Glogau Photoaging Classification, and Chung's standardized image ruler), histopathology (Masson staining and MMP-1 immunohistochemistry), and dermoscopy (Hu's and Isik's) of 40 donor skin samples were analyzed statistically, and Spearman rank correlation analysis was performed.
RESULTS
There was a robust correlation between the total Hu scores and Isik dermoscopy. The correlation of dermoscopy with histopathology was higher than that of clinical evaluation methods. There is a strong correlation between telangiectases and lentigo. Xerosis, superficial wrinkle, diffuse erythema, telangiectases, and reticular pigmentation were significantly correlated with the three clinical evaluation methods. Superficial wrinkles were correlated with Masson, MMP-1, various clinical indicators, and other dermoscopic items.
CONCLUSION
There is a good correlation between dermoscopy and clinical and histopathological examination. Dermoscopy might help evaluate skin photoaging.
Topics: Humans; Skin Aging; Matrix Metalloproteinase 1; Dermoscopy; Lentigo; Telangiectasis; Skin Neoplasms
PubMed: 38221782
DOI: 10.1111/srt.13578 -
Journal of the European Academy of... Feb 2023Amelanotic/hypomelanotic lentigo maligna and lentigo maligna melanoma (AHLM/LMM) may be very difficult to diagnose at an early stage.
BACKGROUND
Amelanotic/hypomelanotic lentigo maligna and lentigo maligna melanoma (AHLM/LMM) may be very difficult to diagnose at an early stage.
OBJECTIVES
To quantify the predictive value of dermoscopic and reflectance confocal microscopy (RCM) features for AHLM/LMM.
METHODS
Dermoscopic and RCM images of histopathologically diagnosed AHLM/LMM, amelanotic/hypomelanotic benign lesions (AHBL), and amelanotic/hypomelanotic basal and squamous cell carcinomas (AHBCC/AHSCC) of the head and neck from consecutive patients were retrospectively collected and blindly evaluated by three observers to assess presence or absence of dermoscopic and RCM criteria.
RESULTS
Overall, 224 lesions in 216 patients including LM/LMM (n = 55, 24.6%), AHBL (n = 107, 47.8%) and AHBCC/AHSCC (n = 62, 27.7%) were analysed. Multivariable analysis showed that milky-red areas (OR = 5.46; 95% CI: 1.51-19.75), peripheral light brown structureless areas (OR = 19.10; 4.45-81.96), linear irregular vessels (OR = 5.44; 1.45-20.40), and asymmetric pigmented follicles (OR = 14.45; 2.77-75.44) at dermoscopy, and ≥3 atypical cells in five fields (OR = 10.12; 3.00-34.12) and focal follicular localization of atypical cells at dermo-epidermal junction (DEJ) (OR = 10.48; 1.10-99.81) at RCM were significantly independent diagnostic factors for AHLM/LMM vs. AHBL. In comparison with AHBCC/AHSCC, peripheral light brown structureless area (OR = 7.11; 1.53-32.96), pseudonetwork around hair follicles (OR = 16.69; 2.73-102.07), and annular granular structures (OR = 42.36; 3.51-511.16) at dermoscopy and large dendritic (OR = 6.86; 3.15-38.28) and round pagetoid cells (OR = 26.78; 3.15-227.98) at RCM led to a significantly increased risk of diagnosing AHLM/LMM.
CONCLUSIONS
Amelanotic/hypomelanotic lentigo maligna and lentigo maligna melanoma may have the same dermoscopic features of AHM on other body sites, such as milky red areas, peripheral light brown structureless areas and linear irregular vessels. These features, asymmetric pigmented follicles and at RCM ≥ 3 atypical cells in five fields and focal follicular extension of atypical cells at DEJ may help in recognizing AHLM/LMM even when LM conventional features (e.g., obliteration of hair follicles under dermoscopy and large pagetoid cells under RCM) are absent or present only in very small areas of the lesion.
Topics: Humans; Hutchinson's Melanotic Freckle; Skin Neoplasms; Retrospective Studies; Diagnosis, Differential; Microscopy, Confocal; Dermoscopy
PubMed: 36196781
DOI: 10.1111/jdv.18636 -
Anais Brasileiros de Dermatologia 2021Dermoscopy is an essential in vivo diagnostic technique in the clinical evaluation of skin tumors. Currently, the same can also be said about its implications when... (Review)
Review
Dermoscopy is an essential in vivo diagnostic technique in the clinical evaluation of skin tumors. Currently, the same can also be said about its implications when approaching different clinical situations in Dermatology. A growing number of reports on dermatological scenarios and diseases have been published, in which dermoscopy has been of great diagnostic help. The term "entomodermoscopy" was coined to describe dermoscopic findings in skin infestations and also in dermatoses of infectious etiology. In part I of this article, the main dermoscopic descriptions of zoodermatoses and bacterial infections will be addressed. In many of them, such as scabies, pediculosis, myiasis, and tungiasis, it is possible to identify the pathogen and, consequently, attain the diagnosis more quickly and use the technique to follow-up therapeutic effectiveness. In other situations that will be described, dermoscopy can allow the observation of clinical findings with greater detail, rule out differential diagnoses, and increase the level of confidence in a clinical suspicion.
Topics: Bacterial Infections; Dermoscopy; Humans; Skin Diseases; Skin Diseases, Parasitic; Skin Neoplasms
PubMed: 34620524
DOI: 10.1016/j.abd.2021.04.007 -
Family Medicine Apr 2023Diagnosing skin disorders is a core skill in family medicine residency. Accurate diagnosis of skin cancers has a significant impact on patient health. Dermoscopy...
BACKGROUND AND OBJECTIVES
Diagnosing skin disorders is a core skill in family medicine residency. Accurate diagnosis of skin cancers has a significant impact on patient health. Dermoscopy improves a physician's accuracy in diagnosing skin cancers. We aimed to quantify the current state of dermoscopy use and training in family medicine residencies.
METHODS
We included questions on dermoscopy training in the 2021 Council of Academic Family Medicine Educational Research Alliance (CERA) survey of family medicine residency program directors. The survey asked about access to a dermatoscope, the presence of faculty with experience using dermoscopy, the amount of dermoscopy didactic time, and the amount of hands-on dermoscopy training.
RESULTS
Of 631 programs, 275 program directors (43.58% response rate) responded. Half of the responding programs (50.2%) had access to a dermatoscope, and 54.2% had a faculty member with experience using dermoscopy. However, only 6.8% of residents had 4 or more hours of didactics on dermoscopy over their entire training. Only 16.2% had 4 or more hours of hands-on dermoscopy use. Over half (58.9%) of programs planned to add more dermoscopy training. We did not find any correlations between the program's size/type/location and dermoscopy training opportunities.
CONCLUSIONS
Despite reasonable access to a dermatoscope and the presence of at least one faculty member with dermoscopy experience, most family medicine residency programs provided limited dermoscopy training opportunities. Research is needed to better understand how to facilitate dermoscopy training in family medicine residencies.
Topics: Humans; Internship and Residency; Family Practice; Dermoscopy; Curriculum; Surveys and Questionnaires
PubMed: 37043187
DOI: 10.22454/FamMed.2023.368813 -
Scientific Data Jun 2024Advancements in dermatological artificial intelligence research require high-quality and comprehensive datasets that mirror real-world clinical scenarios. We introduce a...
Advancements in dermatological artificial intelligence research require high-quality and comprehensive datasets that mirror real-world clinical scenarios. We introduce a collection of 18,946 dermoscopic images spanning from 2010 to 2016, collated at the Hospital Clínic in Barcelona, Spain. The BCN20000 dataset aims to address the problem of unconstrained classification of dermoscopic images of skin cancer, including lesions in hard-to-diagnose locations such as those found in nails and mucosa, large lesions which do not fit in the aperture of the dermoscopy device, and hypo-pigmented lesions. Our dataset covers eight key diagnostic categories in dermoscopy, providing a diverse range of lesions for artificial intelligence model training. Furthermore, a ninth out-of-distribution (OOD) class is also present on the test set, comprised of lesions which could not be distinctively classified as any of the others. By providing a comprehensive collection of varied images, BCN20000 helps bridge the gap between the training data for machine learning models and the day-to-day practice of medical practitioners. Additionally, we present a set of baseline classifiers based on state-of-the-art neural networks, which can be extended by other researchers for further experimentation.
Topics: Dermoscopy; Humans; Skin Neoplasms; Spain; Neural Networks, Computer; Artificial Intelligence; Machine Learning
PubMed: 38886204
DOI: 10.1038/s41597-024-03387-w -
Clinical and Experimental Dermatology May 2022Around 70% of cutaneous malignant melanomas (MMs) develop de novo, and small-diameter or 'tiny' lesions are expected to represent the earliest manifestation of most MMs.
BACKGROUND
Around 70% of cutaneous malignant melanomas (MMs) develop de novo, and small-diameter or 'tiny' lesions are expected to represent the earliest manifestation of most MMs.
AIM
To describe the clinical, histopathological and dermoscopic features of tiny MMs, and to investigate the impact of imaging tools, including total body photography (TBP) and sequential digital dermoscopy imaging (SDDI) in their detection.
METHODS
Consecutive MMs diagnosed over 2 years in a referral centre were retrospectively included. Tiny MMs were defined as MMs with a diameter of ≤ 5 mm on dermoscopy. Dermoscopic features and the performance of four imaging methods were evaluated.
RESULTS
Of the 312 MMs included, 86 (27.6%) measured ≤ 5 mm, and 44.2% of these were invasive. Tiny MMs were more frequently excised for being new and/or changing compared with nontiny MMs (77.9% vs. 50.9%; P < 0.001). Half of the tiny MMs would have been missed by the dermoscopic seven-point checklist (48.2%) or the three-point checklist (49.4%), while Menzies' method and the revised pattern analysis correctly identified respectively 65.9% and 63.5% of the tiny MMs. The most frequent positive features for tiny MMs were asymmetry in structure or colour (77.6%), brown dots (65.9%), irregular dots and globules (76.5%) and atypical pigment network (44.7%). Dermoscopic features predictive of invasion in tiny MMs were atypical vascular pattern (OR = 26.5, 95% CI 1.5-475.5, P < 0.01), shiny white lines (OR = 12.4, 95% CI 0.7-237.8, P = 0.04) and grey/blue structures (OR = 3.7, 95% CI 1.3-10.5, P = 0.01).
CONCLUSION
Tiny MMs are frequently invasive and represent a clinical, dermoscopic and histopathological challenge. Dermoscopy alone has suboptimal diagnostic accuracy. Early diagnosis relies on the detection of new or changing lesions aided by TBP and SDDI.
Topics: Dermoscopy; Humans; Melanoma; Research; Retrospective Studies; Skin Neoplasms
PubMed: 34997617
DOI: 10.1111/ced.15094 -
PloS One 2023Dermoscopy is a safe, rapid, and non-invasive tool that aids in the clinical examination of pigmented and non-pigmented lesions. The upward trend in the use of...
INTRODUCTION
Dermoscopy is a safe, rapid, and non-invasive tool that aids in the clinical examination of pigmented and non-pigmented lesions. The upward trend in the use of dermoscopy can be attributed to the availability of compact hand-held and sophisticated dermoscopes, that are small enough to be carried around in a pocket. The extent of dermoscopy is not only limited to the evaluation of cutaneous lesions but also involves its use in the assessment of mucosal lesions along with lesions of hair and nails.
METHODS
In a descriptive cross-sectional study, subjects (n = 100) with oral or genital mucosal lesions will be enrolled. Following a thorough clinical examination, a dermoscopy of the lesion will be performed with Dermlite DL4© Dermoscope, having a magnification of 10x. Images obtained would be stored and evaluated for observing specific morphologic patterns on dermoscopy which would be utilized to describe those patterns and arrive at a specific diagnosis. Descriptive statistics will include mean and standard deviation to summarise quantitative variation. Dermoscopic features of oral and genital mucosal lesions will be estimated in percentage.
PURPOSE OF STUDY
Mucosal lesions several times mimic each other morphologically. Performing a biopsy is not always feasible for oral and genital lesions because they may be difficult to reach and tend to bleed more profusely compared to the skin surface due to its rich vascular nature. Dermoscopy is a non-invasive tool that helps in the diagnosis that is used mostly for the evaluation of non-mucosal lesions. For the same reason, there is no or minimal information in the published literature with regard to dermoscopic patterns of mucosal lesions. The current study intends to describe dermoscopic patterns in oral and genital mucosal diseases so that this important information would assist the diagnosis in a non-invasive manner thereby reducing the need for invasive investigations like mucosal biopsy.
EXPECTED CLINICAL OUTCOMES
To summarize, this research is intended to add to the scarce literature on dermoscopic findings of oral and genital mucosal lesions. The study findings would establish the diagnosis and eliminate the need for unwarranted invasive biopsies of mucosal lesions and, if need be, help in the selection of the biopsy site.
Topics: Humans; Skin Neoplasms; Cross-Sectional Studies; Dermoscopy; Biopsy; Genitalia
PubMed: 37582080
DOI: 10.1371/journal.pone.0289562 -
Journal of the European Academy of... Jun 2022The incidence of non-melanoma skin cancer is on the rise and melanoma is among the most common cancers in the United States. Establishing an early diagnosis is essential... (Review)
Review
The incidence of non-melanoma skin cancer is on the rise and melanoma is among the most common cancers in the United States. Establishing an early diagnosis is essential for improving the prognosis of patients with skin cancer. High-resolution non-invasive imaging techniques may represent key tools for helping to identify and monitor early signs of skin cancer in seemingly healthy skin. Cumulative lifetime sun exposure leads to photoaging and photocarcinogenenis and the reaction of the skin to this solar-induced damage is balanced between the DNA repair and photoprotection defence mechanisms of melanocytes and keratinocytes. In the first part of this article we provide an overview of these defence mechanisms and of the photoaging process, and discuss how non-invasive imaging can be used to evaluate these changes. We then propose a model in which skin aging manifestations can be classified according to subject-specific sun-damage reaction profiles observed by reflectance confocal microscopy (RCM) and optical coherence tomography (OCT). These photoaging profiles include an atrophic phenotype characterized by actinic keratosis, and a hypertrophic phenotype characterized by hyperplastic pigmented skin. According to our model, these phenotypes may be predictive of predispositions to different types of skin cancer: squamous cell carcinoma for the atrophic phenotype and lentigo maligna and freckles for the hypertrophic phenotype. In addition to RCM and OCT, dermoscopy is another non-invasive technique that has improved the diagnosis of skin cancer. In the second part of this article, we describe how the YouDermoscopy™ application can improve skills and thus enhance the dermoscopic recognition of sun-induced skin tumours, and then show how this training tool enables its users to collaborate with dermatologists worldwide to obtain second opinions for the diagnosis of ambiguous lesions. Altogether, RCM, OCT and dermoscopy are valuable tools that can contribute significantly to improving the early diagnosis of precancerous and cancerous lesions.
Topics: Dermoscopy; Diagnosis, Differential; Humans; Hutchinson's Melanotic Freckle; Melanoma; Microscopy, Confocal; Mobile Applications; Skin Neoplasms
PubMed: 35738810
DOI: 10.1111/jdv.18197