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Actas Dermo-sifiliograficas 2016Dermoscopy is a noninvasive technique that improves accuracy in the diagnosis of cutaneous lesions. The recognition and differential diagnosis of lentigo maligna (LM)...
Dermoscopy is a noninvasive technique that improves accuracy in the diagnosis of cutaneous lesions. The recognition and differential diagnosis of lentigo maligna (LM) and lentigo maligna melanoma (LMM) is challenging, especially in the early stages when there are no distinctive clinical features. Early diagnosis and appropriate treatment can improve prognosis. Several dermoscopic features have been described for LM and LMM. The following 4 criteria in combination have achieved a diagnostic sensitivity of 89% and a specificity of 96%: asymmetric pigmented follicular openings, dark rhomboidal structures, slate gray dots, and slate gray globules. A biopsy is warranted when dermoscopic examination reveals a grayish coloring. For a flat pigmented lesion acquired in adulthood, a histopathological diagnosis of "atypical junctional nevus" is not to be accepted uncritically. LM and LMM can also appear in sites other than the face, and dermoscopy can facilitate their recognition. Dermoscopy is an essential tool for physical examination.
Topics: Dermoscopy; Diagnosis, Differential; Humans; Hutchinson's Melanotic Freckle; Skin Neoplasms
PubMed: 26875792
DOI: 10.1016/j.ad.2016.01.001 -
JAMA Dermatology Jun 2016Both colors and structures are considered important in the dermoscopic evaluation of skin lesions but their relative significance is unknown. (Comparative Study)
Comparative Study
IMPORTANCE
Both colors and structures are considered important in the dermoscopic evaluation of skin lesions but their relative significance is unknown.
OBJECTIVE
To determine if diagnostic accuracy for common skin lesions differs between gray-scale and color dermoscopic images.
DESIGN, SETTING, AND PARTICIPANTS
A convenience sample of 40 skin lesions (8 nevi, 8 seborrheic keratoses, 7 basal cell carcinomas, 7 melanomas, 4 hemangiomas, 4 dermatofibromas, 2 squamous cell carcinomas [SCCs]) was selected and shown to attendees of a dermoscopy course (2014 Memorial Sloan Kettering Cancer Center dermoscopy course). Twenty lesions were shown only once, either in gray-scale (n = 10) or color (n = 10) (nonpaired). Twenty lesions were shown twice, once in gray-scale (n = 20) and once in color (n = 20) (paired). Participants provided their diagnosis and confidence level for each of the 60 images. Of the 261 attendees, 158 participated (60.5%) in the study. Most were attending physicians (n = 76 [48.1%]). Most participants were practicing or training in dermatology (n = 144 [91.1%]). The median (interquartile range) experience evaluating skin lesions and using dermoscopy of participants was 6 (13.5) and 2 (4.0) years, respectively.
MAIN OUTCOMES AND MEASURES
Diagnostic accuracy and confidence level of participants evaluating gray-scale and color images. Two separate analyses were performed: (1) an unpaired evaluation comparing gray-scale and color images shown either once or for the first time, and (2) a paired evaluation comparing pairs of gray-scale and color images of the same lesion.
RESULTS
In univariate analysis of unpaired images, color images were less likely to be diagnosed correctly compared with gray-scale images (odds ratio [OR], 0.8; P < .001). Using gray-scale images as the reference, multivariate analyses of both unpaired and paired images found no association between correct lesion diagnosis and use of color images (OR, 1.0; P = .99, and OR, 1.2; P = .82, respectively). Stratified analysis of paired images using a color by diagnosis interaction term showed that participants were more likely to make a correct diagnosis of SCC and hemangioma in color (P < .001 for both comparisons) and dermatofibroma in gray-scale (P < .001).
CONCLUSIONS AND RELEVANCE
Morphologic characteristics (ie, structures and patterns), not color, provide the primary diagnostic clue in dermoscopy. Use of gray-scale images may improve teaching of dermoscopy to novices by emphasizing the evaluation of morphology.
Topics: Adult; Aged; Color; Dermatology; Dermoscopy; Female; Humans; Keratosis, Seborrheic; Male; Middle Aged; Multivariate Analysis; Nevus; Retrospective Studies; Skin Diseases; Skin Neoplasms; Young Adult
PubMed: 27007917
DOI: 10.1001/jamadermatol.2016.0270 -
Medicine Mar 2017Livedoid vasculopathy (atrophie blanche) is a form of thrombotic vasculopathy. It is characterized by small ulcers that become crusted, and heal after several months to... (Observational Study)
Observational Study
Livedoid vasculopathy (atrophie blanche) is a form of thrombotic vasculopathy. It is characterized by small ulcers that become crusted, and heal after several months to produce white atrophic scars. The most commonly affected sites are the lower legs, in particular the dorsum of the feet and ankles. To date, the dermoscopic features of livedoid vasculopathy have not been clearly described in the literature. In this observational study, we sought to evaluate the dermoscopic patterns of livedoid vasculopathy and determine whether the dermoscopic features are associated with certain histopathological characteristics. We evaluated 9 patients with livedoid vasculopathy by dermoscopy. Skin biopsy specimens were stained with hematoxylin and eosin for histopathologic examination, and dermoscopic features were correlated with histopathological characteristics. In the majority of patients with livedoid vasculopathy, examination with dermoscopy revealed central crusted ulcers or ivory white areas associated with peripheral pigmentation in a reticular pattern. In addition, increased vascular structures including linear and glomerular vessels were found. On histopathological examination, the central ivory white areas correlated with dermal fibrosis, the reticular pigmentation corresponded to epidermal basal layer hyperpigmentation or melanin within melanophages in the dermal papillae, and the vascular structures correlated with dilatation and proliferation of capillaries in the upper dermis. In summary, the most common dermoscopic features of livedoid vasculopathy identified in this study were central crusted ulcers or ivory white scar-like areas associated with peripheral reticular pigmentation and increased vascular structures. The characterization of dermoscopic criteria for livedoid vasculopathy may improve the accuracy in the clinical diagnosis and follow-up of this disease.
Topics: Adult; Dermoscopy; Female; Humans; Leg; Male; Middle Aged; Skin; Vascular Diseases
PubMed: 28296736
DOI: 10.1097/MD.0000000000006284 -
Skin Research and Technology : Official... Mar 2022Melanocytic nevi (MN) can be classified into three subtypes according to the depth of the nests of nevus cells which is important for management. High-frequency...
BACKGROUND
Melanocytic nevi (MN) can be classified into three subtypes according to the depth of the nests of nevus cells which is important for management. High-frequency ultrasound (HF-US) can clearly reveal the lesion size, contour, depth, and internal structures. However, the HF-US studies of MN according to subtypes are limited. We aimed to describe the HF-US features of MN and explore its value in accurate classification.
MATERIALS AND METHODS
This retrospective study was conducted from January 2018 to November 2019. Eighty-five patients with MN were included and examined by 50 and 20 MHz HF-US. The HF-US features were recorded including morphological flatness, depth, shape, boundary, internal echogenicity, hyperechoic spots, lateral acoustic shadow, posterior echoic patterns, mushroom signs, and straw-hat signs. Each image was evaluated by two physicians independently, and the consistency was tested.
RESULTS
Eleven lesions could not be detected by HF-US. The rest 74 lesions underwent ultrasonic analysis. MN appeared as strip-shaped or oval, hypoechoic areas localized in the epidermis and dermis under ultrasonography. A strong consistency between HF-US and dermoscopy of determining the lesion depth was achieved (κ = 0.935, p < 0.001). The hyperechoic spots were found in 57.6% intradermal nevi. The mushroom signs were seen in 34.8% intradermal nevi, and the straw-hat signs were seen in all the compound nevi.
CONCLUSION
MN can be correctly classified using HF-US, and it had a strong correlation with dermoscopic and clinical classification. HF-US could further reveal the internal morphological features of MN, which may support more precise classification and management.
Topics: Dermoscopy; Humans; Melanoma; Nevus, Pigmented; Retrospective Studies; Skin Neoplasms; Ultrasonography
PubMed: 34865255
DOI: 10.1111/srt.13123 -
Indian Journal of Dermatology,... 2021
Topics: Adult; Arteriovenous Malformations; Dermoscopy; Hemangioma; Humans; Male; Skin Neoplasms
PubMed: 31650977
DOI: 10.4103/ijdvl.IJDVL_213_19 -
Current Oncology (Toronto, Ont.) Sep 2023Line-field confocal optical coherence tomography (LC-OCT) can help the clinical diagnosis of skin diseases. The present study aimed to evaluate the sensitivity,...
Line-field confocal optical coherence tomography (LC-OCT) can help the clinical diagnosis of skin diseases. The present study aimed to evaluate the sensitivity, specificity, and diagnostic accuracy of LC-OCT for the diagnosis of the most frequent non-melanoma skin cancers (NMSCs), i.e., basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Comparing LC-OCT diagnostic performances with those of dermoscopy, histopathological examination was used as a gold standard. For every study endpoint, the diagnostic ability of LC-OCT revealed superiority over the dermoscopic examination. In particular, a significant increase in specificity was observed. Sensitivity, specificity, and diagnostic accuracy of dermoscopy and LC-OCT for the diagnosis of malignancy were, respectively, 0.97 (CI 0.94-0.99), 0.43 (CI 0.36-0.51), and 0.77 (CI 0.72-0.81) for dermoscopy and 0.99 (CI 0.97-1.00), 0.90 (CI 0.84-0.94), and 0.96 (CI 0.93-0.97) for LC-OCT. The positive predictive value (PPV) resulted in 0.74 (CI 0.69-0.78) for dermoscopy and 0.94 (CI 0.91-0.97) for LC-OCT, and the negative predictive value (NPV) was 0.89 (CI 0.81-0.95) for dermoscopy and 0.98 (CI 0.95-1.00) for LC-OCT. Finally, our real-life study showed a potentially important role of LC-OCT in the non-invasive diagnosis of NMSCs, especially BCC. The real-time imaging technique could spare unnecessary biopsies with an increased sensitivity, a much higher specificity, and better accuracy than clinical assessment with dermoscopy alone.
Topics: Humans; Tomography, Optical Coherence; Sensitivity and Specificity; Dermoscopy; Skin Neoplasms; Carcinoma, Basal Cell
PubMed: 37887539
DOI: 10.3390/curroncol30100639 -
Australian Journal of General Practice Aug 2019Dermoscopy increases accuracy for melanoma diagnosis by trained primary care physicians. We aimed to establish prevalence of dermatoscope use by general practice...
BACKGROUND AND OBJECTIVES
Dermoscopy increases accuracy for melanoma diagnosis by trained primary care physicians. We aimed to establish prevalence of dermatoscope use by general practice registrars, and identify factors associated with dermatoscope use and the implications of dermatoscope use for diagnosis and confidence in diagnosis.
METHOD
This was a cross-sectional study nested within the Registrar Clinical Encounters in Training (ReCEnT) project, an ongoing multi-site cohort study of general practice registrars' consultations. The study was conducted during two six-monthly rounds of ReCEnT data collection in four regional training providers in 2014.
RESULTS
Forty-nine per cent of registrars reported having dermoscopy training. Dermoscopy was used in 61% of consultations involving skin or pigmented lesion checks. Dermatoscope use changed provisional diagnosis in 22% of instances and increased diagnostic confidence in 55%.
DISCUSSION
Dermoscopy is performed by general practice registrars in a modest proportion of skin and pigmented lesion checks. Its use influences registrars' diagnoses and increases their confidence in their diagnoses.
Topics: Adolescent; Adult; Aged; Australia; Child; Child, Preschool; Cohort Studies; Cross-Sectional Studies; Dermoscopy; Education, Medical, Continuing; General Practice; Humans; Infant; Medical Staff, Hospital; Middle Aged; Prevalence; Self Efficacy
PubMed: 31370131
DOI: 10.31128/AJGP-11-18-4773 -
Indian Journal of Dermatology,... 2023Background The utility of preoperative and perioperative dermoscopy in standard surgical excision for radical excision of primary basal cell carcinoma remain unexplored.... (Observational Study)
Observational Study
Background The utility of preoperative and perioperative dermoscopy in standard surgical excision for radical excision of primary basal cell carcinoma remain unexplored. Aims To evaluate the use of preoperative and perioperative dermoscopy for precise mapping of margins during standard surgical excision of primary basal cell carcinoma. Methods In this retrospective, observational study, 17 patients clinically diagnosed with various morphological subtypes of basal cell carcinoma were included. Data about previous history, clinical examination of lesions and regional lymph nodes and preoperative dermoscopy were retrieved. After standard surgical excision had been carried out as per mapping of lateral margins, all the excised surgical specimens were subjected to perioperative dermoscopy and later reconfirmed with histopathology. Results Seventeen patients with mean age of 60.82 ± 9.99 years and median disease duration of 14 months were analysed. Clinically, basal cell carcinomas were of pigmented superficial subtype [6 (35.3%)], followed by pigmented nodular [5 (29.4%)], nodulo-ulcerative [4 (23.5%)] and micro nodular [2 (11.8%)]. Mean extension of clinical margin after dermoscopy was 0.59 ± 0.52 mm. Mean pre-assessed depth of tumour and mean depth of tumour were 3.46 ± 0.89 mm and 3.49 ± 0.92 mm, respectively. No recurrence was reported. Frequently found pre-operative dermoscopic features were maple leaf like structures [6 (35%)], blue grey dots and globules [6 (35%)] and short fine telangiectasias [6 (35%)]. Commonly observed perioperative dermoscopic features were: (1) irregular band with brown-grey pigmentation of dots, globules, streaks and pseudopodia like extensions [3 (50%)]; (2) irregular band of pseudo granulomatous structureless vascular areas in psoriasiform pattern with diffuse white streaks in pseudopodia like manner [1 (50%)]; (3) irregular band of pseudo granulomatous structureless vascular areas in psoriasiform pattern with streaks of white pseudopodia like structureless areas [1 (50%)]. Limitation This was a single-centre study with a small sample size. Conclusion This study highlights significance of preoperative and perioperative dermoscopy for precise planning and radical excision of primary basal cell carcinoma by standard surgical excision.
Topics: Humans; Middle Aged; Aged; Skin Neoplasms; Dermoscopy; Retrospective Studies; Carcinoma, Basal Cell; Pigmentation Disorders
PubMed: 37317762
DOI: 10.25259/IJDVL_325_2022 -
Health Technology Assessment... Jul 2016Skin cancer is one of the most common cancers in the UK. The main risk factor is exposure to ultraviolet radiation from sunlight or the use of sunbeds. Patients with... (Review)
Review
BACKGROUND
Skin cancer is one of the most common cancers in the UK. The main risk factor is exposure to ultraviolet radiation from sunlight or the use of sunbeds. Patients with suspicious skin lesions are first examined with a dermoscope. After examination, those with non-cancerous lesions are discharged, but lesions that are still considered clinically suspicious are surgically removed. VivaScope(®) is a non-invasive technology designed to be used in conjunction with dermoscopy to provide a more accurate diagnosis, leading to fewer biopsies of benign lesions or to provide more accurate presurgical margins reducing the risk of cancer recurrence.
OBJECTIVES
To evaluate the clinical effectiveness and cost-effectiveness of VivaScope(®) 1500 (Caliber Imaging and Diagnostics, Rochester, NY, USA; Lucid Inc., Rochester, NY, USA; or Lucid Inc., MAVIG GmbH, Munich, Germany) and VivaScope(®) 3000 (Caliber Imaging and Diagnostics, Rochester, NY, USA) in the diagnosis of equivocal skin lesions, and VivaScope 3000 in lesion margin delineation prior to surgical excision of lesions.
DATA SOURCES
Databases (MEDLINE, EMBASE and The Cochrane Library) were searched on 14 October 2014, reference lists of included papers were assessed and clinical experts were contacted for additional information on published and unpublished studies.
METHODS
A systematic review was carried out to identify randomised controlled trials (RCTs) or observational studies evaluating dermoscopy plus VivaScope, or VivaScope alone, with histopathology as the reference test. A probabilistic de novo economic model was developed to synthesise the available data on costs and clinical outcomes from the UK NHS perspective. All costs were expressed as 2014 prices.
RESULTS
Sixteen studies were included in the review, but they were too heterogeneous to be combined in a meta-analysis. One of two diagnostic studies that were deemed most representative of UK clinical practice reported that dermoscopy plus VivaScope 1500 was significantly more sensitive than dermoscopy alone in the diagnosis of melanoma (97.8% vs. 94.6%; p = 0.043) and significantly more specific than dermoscopy alone in the diagnosis of non-melanoma (92.4% vs. 26.74%; p < 0.000001). The results of another study suggest 100% [95% confidence interval (CI) 86.16% to 100%] sensitivity for dermoscopy plus VivaScope 1500 versus 100% (95% CI 91.51% to 100%) for dermoscopy alone. Specificity varied from 51.77% to 80.2% depending on the analysis set used. In terms of margin delineation with VivaScope, one study found that 17 out of 29 patients with visible lentigo maligna (LM) had subclinical disease of > 5 mm beyond the dermoscopically identified margin. Using 'optimistic' diagnostic data, the economic model resulted in an incremental cost-effectiveness ratio (ICER) of £8877 per quality-adjusted life-year (QALY) (£9362 per QALY), while the 'less favourable' diagnostic data resulted in an ICER of £19,095 per QALY (£25,453 per QALY) in the diagnosis of suspected melanomas. VivaScope was also shown to be a dominant strategy when used for the diagnostic assessment of suspected basal cell carcinoma (BCC). Regarding margin delineation of LM, mapping with VivaScope was cost-effective, with an ICER of £10,241 per QALY (£11,651 per QALY). However, when VivaScope was used for diagnosis as well as mapping of LM, then the intervention cost was reduced and VivaScope became a dominant strategy.
LIMITATIONS
There is an absence of UK data in the included studies and, therefore, generalisability of the results to the UK population is unclear.
CONCLUSIONS
The use of VivaScope appears to be a cost-effective strategy in the diagnostic assessment of equivocal melanomas and BCCs, and in margin delineation of LM prior to surgical treatment.
FUTURE WORK
High-quality RCTs are required in a UK population to assess the diagnostic accuracy of VivaScope in people with equivocal lesions.
STUDY REGISTRATION
This study is registered as PROSPERO CRD42014014433.
FUNDING
The National Institute for Health Research Health Technology Assessment programme.
Topics: Carcinoma, Basal Cell; Cost-Benefit Analysis; Dermoscopy; Germany; Humans; Melanoma; Microscopy, Confocal; Models, Econometric; Observational Studies as Topic; Randomized Controlled Trials as Topic; Sensitivity and Specificity; Skin Diseases; Skin Neoplasms; Technology Assessment, Biomedical
PubMed: 27483991
DOI: 10.3310/hta20580 -
Skin Research and Technology : Official... Apr 2024To establish accurate and objective dermoscopic diagnostic criteria and grading standards for males and females with androgenetic alopecia (AGA).
OBJECTIVES
To establish accurate and objective dermoscopic diagnostic criteria and grading standards for males and females with androgenetic alopecia (AGA).
METHODS
Twenty patients each with AGA, diffuse alopecia areata, telogen effluvium, and healthy controls were enrolled in the current study. In addition, 60 patients with grades F1/V1, F2/V2, and F3/V3 AGA (20 cases each) were enrolled. The patients underwent dermoscopic examinations. The sensitivity and specificity of the diagnostic criteria were based on the 60 AGA and 60 non-AGA. In addition, 150 patients diagnosed with AGA clinically and by dermoscopy were enrolled to calculate the accuracy of the grading criteria.
RESULTS
The diagnostic criteria included primary, secondary, and exclusion criteria. The grading criteria included three indices, which divided the severity of AGA into grades 1, 2, and 3. The sensitivity and specificity of the diagnostic criteria were 98.3% and 96.7% respectively. The accuracy of grade 1, 2, and 3 dermoscopic grading criteria were 96%, 92%, and 100% respectively, with a total accuracy of 96%.
LIMITATIONS
To test the diagnostic and grading criteria, more patients need to be collected.
CONCLUSIONS
The dermoscopic diagnostic and grading criteria are objective with good accuracy, which could provide a reasonable basis for the early diagnosis, grading treatment, and improved prognosis for AGA.
Topics: Male; Female; Humans; Dermoscopy; Alopecia; Alopecia Areata
PubMed: 38533753
DOI: 10.1111/srt.13649