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BMJ Open Aug 2019Most skin lesions first present in primary care, where distinguishing rare melanomas from benign lesions can be challenging. Dermoscopy improves diagnostic accuracy...
OBJECTIVE
Most skin lesions first present in primary care, where distinguishing rare melanomas from benign lesions can be challenging. Dermoscopy improves diagnostic accuracy among specialists and is promoted for use by primary care physicians (PCPs). However, when used by untrained clinicians, accuracy may be no better than visual inspection. This study aimed to undertake a systematic review of literature reporting use of dermoscopy to triage suspicious skin lesions in primary care settings, and challenges for implementation.
DESIGN
A systematic literature review and narrative synthesis.
DATA SOURCES
We searched MEDLINE, Cochrane Central, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and SCOPUS bibliographic databases from 1 January 1990 to 31 December 2017, without language restrictions.
INCLUSION CRITERIA
Studies including assessment of dermoscopy accuracy, acceptability to patients and PCPs, training requirements, and cost-effectiveness of dermoscopy modes in primary care, including trials, diagnostic accuracy and acceptability studies.
RESULTS
23 studies met the review criteria, representing 49 769 lesions and 3708 PCPs, all from high-income countries. There was a paucity of studies set truly in primary care and the outcomes measured were diverse. The heterogeneity therefore made meta-analysis unfeasible; the data were synthesised through narrative review. Dermoscopy, with appropriate training, was associated with improved diagnostic accuracy for melanoma and benign lesions, and reduced unnecessary excisions and referrals. Teledermoscopy-based referral systems improved triage accuracy. Only three studies examined cost-effectiveness; hence, there was insufficient evidence to draw conclusions. Costs, training and time requirements were considered important implementation barriers. Patient satisfaction was seldom assessed. Computer-aided dermoscopy and other technological advances have not yet been tested in primary care.
CONCLUSIONS
Dermoscopy could help PCPs triage suspicious lesions for biopsy, urgent referral or reassurance. However, it will be important to establish further evidence on minimum training requirements to reach competence, as well as the cost-effectiveness and patient acceptability of implementing dermoscopy in primary care.
TRIAL REGISTRATION NUMBER
CRD42018091395.
Topics: Biopsy; Dermoscopy; Humans; Melanoma; Primary Health Care; Reproducibility of Results; Skin Neoplasms; Triage
PubMed: 31434767
DOI: 10.1136/bmjopen-2018-027529 -
Chinese Medical Journal Jun 2022The dermoscopic features of rosacea have already been reported. However, the current findings are incomplete, and little is known about phymatous rosacea. Hence, this...
BACKGROUND
The dermoscopic features of rosacea have already been reported. However, the current findings are incomplete, and little is known about phymatous rosacea. Hence, this study aimed to summarize and compare the dermoscopic features and patterns of three rosacea subtypes (erythematotelangiectatic [ETR], papulopustular [PPR], and phymatous [PHR]) in the Chinese Han population and to evaluate whether these features differ with patients' genders, ages, and durations.
METHODS
Dermoscopic images of 87 rosacea patients were collected in non-polarized and polarized dermoscopy contact modes at 20-fold magnification. Dermoscopic features, including vessels, scales, follicular findings, and other structures, were summarized and evaluated.
RESULTS
The reticular linear vessels and red diffuse structureless areas of ETR were distinctive. For PPR, red diffuse structureless areas, reticular linear vessels, yellow scales, follicular plugs, and follicular pustules were typical dermoscopic criteria. The common dermoscopic features of PHR were: orange diffuse structureless areas, linear vessels with branches, perifollicular white color, orange focal structureless areas, and white lines. The following features statistically differed among the three rosacea subtypes: reticular linear vessels ( P < 0.001), unspecific linear vessels ( P = 0.005), linear vessels with branches ( P < 0.001), yellow scales ( P = 0.001), follicular plugs ( P < 0.001), perifollicular white color ( P < 0.001), red diffuse structureless areas ( P = 0.022), orange diffuse structureless areas ( P < 0.001), red focal structureless areas ( P = 0.002), orange focal structureless areas ( P = 0.003), white lines ( P < 0.001), follicular pustules ( P < 0.001), and black vellus hairs ( P < 0.001).
CONCLUSIONS
The dermoscopic patterns of ETR are red diffuse structureless areas and reticular linear vessels. For PPR, the pattern comprehends combinations of red diffuse structureless areas, reticular linear vessels, yellow scales, follicular plugs, and follicular pustules. Meanwhile, PHR is characterized by remarkable orange diffuse structureless areas, linear vessels with branches, perifollicular white color, orange focal structureless areas, and white lines.
Topics: Dermoscopy; Female; Folliculitis; Humans; Male; Rosacea
PubMed: 35838412
DOI: 10.1097/CM9.0000000000002151 -
Anais Brasileiros de Dermatologia 2021Despite being widely used in different areas of dermatology, there have been few studies evaluating the benefit of dermoscopy in the interpretation of patch tests,...
BACKGROUND
Despite being widely used in different areas of dermatology, there have been few studies evaluating the benefit of dermoscopy in the interpretation of patch tests, especially in weak and doubtful reactions.
OBJECTIVES
To evaluate the role of dermoscopy in the interpretation of patch tests and describe the main findings of the reactions.
METHOD
Prospective study, carried out in dermatology reference centers in southern Brazil, which evaluated the final results of patch tests analyzed with the aid of dermoscopy.
RESULTS
77 patients and 160 reactions were included. The most prevalent substances were nickel sulphate (23.8%), kathon CG (9.4%), and perfume mix (8.8%). The main dermoscopic findings were reaction area greater than half of the chamber site (90%), homogeneous erythema (86.9%), vesicles (30%), crusts (21.3%), perifollicular erythema (35%), pore reaction (19.4%) and pustules (8.8%). Dermoscopy was found to facilitate the definition of erythema in reactions on black skin and when due to substances with deposition of pigment. Of the 64 weak or doubtful reactions, 36 (56.25%) showed a change in the final result after dermoscopy evaluation; of the 36 doubtful reactions, 33 (91.6%) showed a change in the final result after dermoscopy evaluation (p < 0.001).
STUDY LIMITATIONS
The probable limitation of the study is its sample size. Though certain significance levels have been reached, other possible relationships may not have been observed.
CONCLUSION
Dermoscopy improves significantly the interpretation of patch tests, especially in weak and doubtful reactions.
Topics: Dermatitis, Allergic Contact; Dermoscopy; Erythema; Humans; Patch Tests; Prospective Studies
PubMed: 34629194
DOI: 10.1016/j.abd.2021.04.006 -
Indian Journal of Dermatology,... 2014Early lesions of vitiligo can be confused with various other causes of hypopigmentation and depigmentation. Few workers have utilized dermoscopy for the diagnosis of...
BACKGROUND
Early lesions of vitiligo can be confused with various other causes of hypopigmentation and depigmentation. Few workers have utilized dermoscopy for the diagnosis of evolving lesions of vitiligo.
AIM
To analyze the dermoscopic findings of evolving lesions in diagnosed cases of vitiligo and to correlate them histopathologically.
METHODS
Dermoscopy of evolving lesions in 30 diagnosed cases of vitiligo was performed using both polarized light and ultraviolet light.
RESULT
On polarized light examination, the pigmentary network was found to be reduced in 12 (40%) of 30 patients, absent in 9 (30%), and reversed in 6 (20%) patients; 2 patients (6.7%) showed perifollicular hyperpigmentation and 1 (3.3%) had perilesional hyperpigmentation. A diffuse white glow was demonstrable in 27 (90%) of 30 patients on ultraviolet light examination. Melanocytes were either reduced in number or absent in 12 (40%) of 30 patients on histopathology.
CONCLUSION
Pigmentary network changes, and perifollicular and perilesional hyperpigmentation on polarized light examination, and a diffuse white glow on ultraviolet light examination were noted in evolving vitiligo lesions. Histopathological examination was comparatively less reliable. Dermoscopy appears to be better than routine histopathology in the diagnosis of evolving lesions of vitiligo and can obviate the need for a skin biopsy.
Topics: Cell Count; Dermoscopy; Humans; Melanocytes; Pigmentation; Ultraviolet Rays; Vitiligo
PubMed: 25382506
DOI: 10.4103/0378-6323.144144 -
Anales de Pediatria Feb 2021
Topics: Dermoscopy; Humans; Leishmaniasis, Cutaneous
PubMed: 32386935
DOI: 10.1016/j.anpedi.2020.04.003 -
Chinese Medical Journal Jan 2021
Topics: Dermoscopy; Diagnosis, Differential; Humans; Nevus; Skin Abnormalities; Skin Neoplasms
PubMed: 33410613
DOI: 10.1097/CM9.0000000000001280 -
Journal of the American Academy of... Jan 2021
Topics: Administration, Cutaneous; Dermatology; Dermoscopy; Ethanol; Hand Sanitizers; Hemangioma; Humans; Nevus, Pigmented; Photography; Skin; Skin Neoplasms; Smartphone; Telemedicine
PubMed: 32771542
DOI: 10.1016/j.jaad.2020.07.119 -
Skin Research and Technology : Official... Jul 2023Acquired perforating dermatosis (APD) is a rare skin condition characterized by degenerated materials eliminated from the dermis. Several retrospective studies on APD...
BACKGROUND
Acquired perforating dermatosis (APD) is a rare skin condition characterized by degenerated materials eliminated from the dermis. Several retrospective studies on APD have been reported; however, few data are available on Chinese APD and their features on dermoscopy and reflective confocal microscope (RCM) assays.
OBJECTIVE
The aim of this study was to retrospectively evaluate the clinical and histopathologic data of 37 acquired perforating dermatosis cases, and assess their features on dermoscopy and RCM.
METHODS
Thirty-seven APD patients were retrospectively enrolled in our study. We characterized the clinical histopathological features, concomitant diseases, treatment responses, and the dermoscopy and RCM findings.
RESULTS
Pruritus was the most common symptom, with the lower extremities as the most predilection sites (86.5%, n = 32; 91.9%, n = 34, respectively). Concomitant diseases were found in 34 patients (92.6%), among which diabetes mellitus was the most common, followed by thyroid nodules, allergic dermatosis, and chronic renal insufficiency. Dermoscopy and RCM assays were performed in 11 patients. The typical RCM images were hyperreflective cord-like structures from the epidermis to dermis. Dermoscopy features of fully developed lesions showed central ulceration with peripheral hairpin-like or loop-like capillaries with characteristic garland arrangements.
CONCLUSION
APD is an uncommon skin disorder associated with various systemic conditions in Chinese individuals. Thyroid disorders are an overlooked complication and may play an important role in the development of APD. The results of this study indicate that noninvasive dermoscopy and RCM examination are helpful in the rapid diagnosis and early intervention of APD.
Topics: Humans; Retrospective Studies; Dermoscopy; Skin Diseases; Skin; Microscopy, Confocal; Skin Neoplasms
PubMed: 37522501
DOI: 10.1111/srt.13416 -
Journal of Digital Imaging Aug 2018Imaging is increasingly being used in dermatology for documentation, diagnosis, and management of cutaneous disease. The lack of standards for dermatologic imaging is an... (Review)
Review
Imaging is increasingly being used in dermatology for documentation, diagnosis, and management of cutaneous disease. The lack of standards for dermatologic imaging is an impediment to clinical uptake. Standardization can occur in image acquisition, terminology, interoperability, and metadata. This paper presents the International Skin Imaging Collaboration position on standardization of metadata for dermatologic imaging. Metadata is essential to ensure that dermatologic images are properly managed and interpreted. There are two standards-based approaches to recording and storing metadata in dermatologic imaging. The first uses standard consumer image file formats, and the second is the file format and metadata model developed for the Digital Imaging and Communication in Medicine (DICOM) standard. DICOM would appear to provide an advantage over using consumer image file formats for metadata as it includes all the patient, study, and technical metadata necessary to use images clinically. Whereas, consumer image file formats only include technical metadata and need to be used in conjunction with another actor-for example, an electronic medical record-to supply the patient and study metadata. The use of DICOM may have some ancillary benefits in dermatologic imaging including leveraging DICOM network and workflow services, interoperability of images and metadata, leveraging existing enterprise imaging infrastructure, greater patient safety, and better compliance to legislative requirements for image retention.
Topics: Dermatology; Dermoscopy; Diagnostic Imaging; Humans; Internationality; Metadata; Radiology Information Systems; Reproducibility of Results; Skin Diseases; United States
PubMed: 29344752
DOI: 10.1007/s10278-017-0045-8 -
Lasers in Surgery and Medicine Jan 2017Following more than two decades of effort, reflectance confocal microscopy (RCM) imaging of skin was granted codes for reimbursement by the US Centers for Medicare and... (Review)
Review
Following more than two decades of effort, reflectance confocal microscopy (RCM) imaging of skin was granted codes for reimbursement by the US Centers for Medicare and Medicaid Services. Dermatologists in the USA have started billing and receiving reimbursement for the imaging procedure and for the reading and interpretation of images. RCM imaging combined with dermoscopic examination is guiding the triage of lesions into those that appear benign, which are being spared from biopsy, against those that appear suspicious, which are then biopsied. Thus far, a few thousand patients have been spared from biopsy of benign lesions. The journey of RCM imaging from bench to bedside is certainly a success story, but still much more work lies ahead toward wider dissemination, acceptance, and adoption. We present a brief review of RCM imaging and highlight key challenges and opportunities. The success of RCM imaging paves the way for other emerging optical technologies, as well-and our bet for the future is on multimodal approaches. Lasers Surg. Med. 49:7-19, 2017. © 2016 Wiley Periodicals, Inc.
Topics: Adult; Aged; Biopsy, Needle; Cost-Benefit Analysis; Dermoscopy; Female; Humans; Immunohistochemistry; Male; Medicaid; Medicare; Microscopy, Confocal; Middle Aged; Outcome Assessment, Health Care; Skin Neoplasms; United States
PubMed: 27785781
DOI: 10.1002/lsm.22600