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Alessandra Chiarugi

Publications and source records attributed to Alessandra Chiarugi.

10 recordsLinked to original sources
PubMed2006

Baseline factors influencing decisions on digital follow-up of melanocytic lesions in daily practice: an Italian multicenter survey.

BACKGROUND: Guidelines for optimized use of digital follow-up of melanocytic lesions are not yet available, and little is known about inclusion criteria adopted in clinical practice. OBJECTIVE: Our purpose was to describe the frequency of digital follow-up adoption in melanoma screening, the characteristics of patients and lesions selected, and the predictors of duration of the intervals of digital follow-up. METHODS: Baseline characteristics of patients and lesions selected for digital follow-up in 12 Italian pigmented lesion clinics were examined. Predictors of a short follow-up interval ( 4.75) was associated only with a marginal effect on the scheduled duration of follow-up interval (OR 1.34, 95% CI 0.97-1.86). These findings were confirmed by a multivariate analysis. LIMITATIONS: The adoption of different digital dermoscopy systems in the participating centers may have limited the reliability of the TDS assigned by a central group to dermoscopy images. CONCLUSIONS: Practicing dermatologists who use digital epiluminescence microscopy in screening for melanoma decided to submit at least one melanocytic lesion to digital follow-up for approximately 1 patient for every 5 examined. This implies costs and time spent that need to be evaluated together with the benefits of this procedure from a large-scale perspective. The lack of well-defined guidelines for inclusion and exclusion criteria may hamper optimized use of digital follow-up in daily practice.

Adult↗
PubMed2005

Examination of lesions (including dermoscopy) without contact with the patient is associated with improper management in about 30% of equivocal melanomas.

BACKGROUND: In clinical practice, decisions regarding management of a pigmented skin lesion are based on morphologic examination, as well as on anamnestic, emotional, and medicolegal aspects. In some cases, the "ugly duckling" sign may be an indication for excision of a morphologically featureless melanoma. Therefore, examination of pigmented skin lesions based on clinical and dermoscopic images, without contact with the patient, may be associated with a not negligible risk of incorrect lesion management. OBJECTIVE: In this study, we tried to assess to what extent lesion management based on purely morphologic examination diverges from optimal management based on in vivo examination with direct contact with the patient, lesion history, and clinical and dermoscopic evaluation. METHODS: The study included clinical and dermoscopic images of 100 diagnostically equivocal pigmented lesions, including 20 early melanomas and 5 pigmented basal cell carcinomas consecutively referred for surgery; the images were reviewed by six dermatologists who specialize in melanoma screening and were previously trained in dermoscopy. RESULTS: The percentage of melanomas correctly classified was less than 50% both for naked eye and combined examination. Regarding lesion management, only about 70% of malignancies (melanomas and basal cell carcinomas) are correctly referred for surgery by observers. Similar results have been obtained focusing on melanoma (72.5%). CONCLUSION: Facing difficulties in diagnosing pigmented skin tumors, lesion management based on the morphology of the lesion, even including dermoscopic images, but without direct contact with the patient, diverges greatly from the gold standard management established by face-to-face examination and comports a not negligible risk of leaving a melanoma unexcised.

Adult↗
PubMed2004

Addition of dermoscopy to conventional naked-eye examination in melanoma screening: a randomized study.

OBJECTIVE: We sought to assess the difference in lesion management between combined examination (naked-eye and dermoscopy) and conventional naked-eye examination in evaluations for melanoma; and to assess the impact on patient treatment of facilities for digital follow-up of diagnostically equivocal lesions. METHODS: We conducted a randomized, controlled trial at a pigmented lesion clinic in a university hospital. A total of 938 consecutive subjects presenting between November 1, 2001, and March 31, 2002, were eligible and 25 were excluded because they were younger than 12 years of age; hence 913 subjects were enrolled. Participants were randomized to combined examination with mandatory excision of equivocal lesion (arm B) and with possibility of digital follow-up according to the clinician's decision (arm C), or to conventional naked-eye examination (mandatory excision of equivocal lesion) (arm A). The same pigmented lesion clinic staff examined all subjects. RESULTS: Combined examination determined a significant reduction in the percentage of patients referred for operation (9.0% vs 15.6%) (P =.013). When facilities for digital follow-up of equivocal lesions were available, the percentage of patients classified as harboring lesions difficult to diagnose increased (group C, 35.8%; group B, 17.8%; P <.01). About half of them were immediately referred for operation whereas the remainder submitted to second examination (digital follow-up). Two melanomas (1 in situ and 1 invasive, 0.40-mm thick) were diagnosed after second examination performed 6 months later. The number of melanomas eventually excised within the study were similar among the 3 allocation groups (3, 2, and 3, respectively). CONCLUSIONS: the addition of dermoscopy to conventional naked-eye examination is associated with a significant reduction of number of pigmented skin lesions excised for diagnostic verification. The possibility of digital follow-up of equivocal lesions is associated with a not negligible occurrence of initial melanomas left unexcised until the second consultation.

Adult↗
PubMed2004

Pigmented Bowen's disease mimicking cutaneous melanoma: clinical and dermoscopic aspects.

BACKGROUND: Pigmented Bowen's disease (BD) (squamous cell carcinoma in situ) has been rarely described among white patients. OBJECTIVE AND METHODS: We report the case of a 48-year-old white male presenting a lesion of pigmented BD on his left thigh, clinically mimicking a superficial spreading melanoma. RESULTS: Naked-eye physical examination revealed a single 1.8 x 1.5 cm, hyperpigmented plaque with a rough surface, which appeared irregularly shaped and sharply demarcated. The assessment of this uncommon tumor by means of dermoscopy, never reported in literature before, was performed. According to standardized terminology, none among the well-established dermoscopic criteria useful to discriminate between melanocytic and nonmelanocytic origin was detected within the lesion. A reticular pigmentation simulated remnants of atypical pigment network, being of uncertain diagnostic value in the preoperative classification of the lesion. Other recognized patterns were irregular, brown globular structures and wide regression-like areas. None of the features diagnostic for pigmented basal cell carcinoma was found as well. CONCLUSION: The correct classification of nonmelanocytic origin of the lesion was therefore achieved only at histologic examination, after the complete surgical excision. In spite of its rarity, pigmented BD should be included among those lesions, which may simulate cutaneous melanoma. According to criteria validated by literature, dermoscopy failed to improve a preoperative classification of this peculiar skin tumor.

Bowen's Disease↗
PubMed2003

The problem of false-positive diagnosis in melanoma screening: the impact of dermoscopy.

The predictive value of melanoma diagnosis made by visual examination during pigmented lesion screening is low. This creates the problem of false-positive diagnoses, which lead to unnecessary treatment and scarring. The purpose of this study was to evaluate the impact of dermoscopy (epiluminescence microscopy, dermatoscopy) on the false-positive rate in the routine melanoma screening activity of a pigmented lesion clinic (PLC). In a series of 133 subjects consecutively referred to the PLC, lesions defined as suspicious or equivocal on visual examination were examined by dermoscopy. Only lesions also defined as suspicious on dermoscopy were excised; other lesions were observed at follow-up examinations. Among the 2542 pigmented lesions observed, clinical examination led to identification of 43 suspicious lesions, 13 of which were also suspicious on dermoscopy and were subsequently excised. Histopathological examination revealed three malignant melanomas. Compared with visual examination alone, the addition of dermoscopy to the subgroup of clinically equivocal lesions resulted in an increase in specificity from 98.4% to 99.6% and in positive predictive value from 6.9% to 23%. The specificity of the visit outcome 'subject to be referred for surgical excision' increased from 69.2% to 92.3%. No false-negative melanoma diagnoses on dermoscopy were observed during a follow-up period of 4 years. The addition of dermoscopy to routine PLC activity as a second-level examination led to a reduction in the number of false-positive diagnoses, thus producing an overall increase in the specificity and positive predictive value of melanoma diagnosis.

Adult↗
PubMed2003

Effect of lesion size on the diagnostic performance of dermoscopy in melanoma detection.

BACKGROUND: Dermoscopy is able to correctly classify a higher number of melanomas than naked-eye examination. Little is known however about factors which may influence the diagnostic performance during practice. The aim of the study was to analyze the effect of size of the lesion on diagnostic performance of dermoscopy in melanoma detection. METHODS: Eight dermatologists examined clinical and, separately, clinical and dermoscopic (combined examination) images of 200 melanocytic lesions previously excised [64 melanomas, 24 in situ and 40 invasive (median thickness 0.30 mm) and 136 melanocytic nevi]. After examination, diagnostic performance was analyzed in accordance with the major diameter of the lesions divided into 3 groups, i.e. small (less than 6 mm), intermediate (between 6 and 9 mm) and large (10 mm or more) lesions. These groups were shown to be highly comparable concerning the microstaging of melanomas (median thickness value 0.30, 0.22 and 0.32 mm, respectively). RESULTS: Dermoscopy increased the diagnostic performance of naked-eye examination of both intermediate and large lesions [sensitivity value: +19.3 (p = 0.002) and +10.3 (p = 0.007); diagnostic accuracy value: +7.4 (p = 0.004) and +6.1 (p = 0.07)]. On the contrary, no statistically significant increase was found dealing with small lesions (sensitivity +3.7, p = 0.66; diagnostic accuracy -1.7, p = 0.55). CONCLUSIONS: The diagnostic improvement associated with the addition of dermoscopy to naked-eye examination is influenced by the size of the lesion, i.e. it is lacking with lesions up to 6 mm in diameter. The optimized use of dermoscopy in melanoma detection is obtained dealing with melanocytic lesions 6 mm in diameter or larger.

Humans↗
PubMed2002

The gold standard for photographing pigmented skin lesions for diagnostic purposes: contact versus distant imaging.

BACKGROUND: It is mandatory that a new diagnostic method be validated by comparison with a well-established reference procedure before being introduced for use in clinical practice. In the field of pigmented skin lesions (PSL), clinical examination should be considered the reference procedure for new diagnostic methods, such as dermoscopy. However, it has not yet been established which is the best photographic procedure for obtaining the most informative clinical images to be used in a formal diagnostic setting. METHODS: In this study we investigated the diagnostic information provided by the two most popular methods currently used for clinical photographing of PSL: "contact" images obtained with a Dermaphot (Heine Ltd) at original x 10 magnification without oil application and "distant" images obtained with a macro objective from a distance of 10 cm. RESULTS: Two experienced dermatologists observed clinical images of a series of 57 PSL (11 melanomas, 31 melanocytic nevi, 10 pigmented basal cell carcinomas, and four other diagnoses). The degree of concordance between the diagnoses based on "contact" and "distant" images (melanoma/non-melanoma) was very good (k = 0.819). Regarding histology, the degree of concordance was better when the diagnosis was based on "contact" images (k = 0.54) than "distant" images (k = 0.47). In particular, "contact" images were superior to "distant" images for diagnosis of non-melanoma lesions (specificity of melanoma diagnosis 87.7% vs. 83.6%), but we found no difference in melanoma detection (73% of sensitivity for both methods). CONCLUSIONS: Although the two photographic procedures appear to provide similar levels of diagnostic information, the "contact" method seems to provide a higher specificity for melanoma diagnosis.

Basal Cell Carcinoma↗
PubMed2002

Multiple synchronous cutaneous melanomas: implications for prevention.

BACKGROUND: A subset of about 3-5% of melanoma patients present a second primary melanoma. OBSERVATIONS: We describe two cases of primary multiple synchronous melanomas consecutively observed in the last 6 months in our department in two male patients presenting multiple atypical nevi. In both patients, the second melanoma was diagnosed by the clinician who had identified the first one, but at the time of the first follow-up consultation, 3 months later. The delayed discovery of the second melanoma required another referral for surgery with additional discomfort for the patients. Concern about the first lesion (the thickest in both cases) probably rendered the second one less evident to both patients and clinician, until the first follow-up examination after excision of the first lesion. CONCLUSION: We stress the need for careful and thorough examination of the whole body surface at the time of detection of a cutaneous melanoma in subjects with multiple atypical moles because the finding of synchronous multiple melanomas is not uncommon.

Humans↗
PubMedDate not supplied

Results of surveillance programme aimed at early diagnosis of cutaneous melanoma in high risk Mediterranean subjects.

OBJECTIVE: To investigate the impact of a surveillance program aimed at early diagnosis of melanoma in a cohort of subjects classified at risk on the basis of their number of nevi. To compare the number of observed cases of melanoma in the cohort to that expected number in the general population of the same area. METHODS: Two hundred and eighteen subjects with no personal or family history of melanoma residing in the Florence district who showed more than 30 common acquired nevi and 3 or more atypical nevi (high-risk) have been followed for an average period of 3.4 years (range 1-6.5); an additional intermediate-risk group with 237 subjects was also enrolled. RESULTS: Four incident melanomas were detected in 218 high-risk subjects followed for a total of 741.7 person-years; no melanoma was detected in the lower risk group. All the 4 detected melanomas were in situ (Clark level I), with an average interval since enrollment of 4.6 years (range 1.4-6.5). In accordance with age-and sex-specific incidence rates of melanoma (including in situ forms) in the general population of the area, the standardized incidence ratio (SIR) in the cohort was 44.1 (95% CI 16.5-117.5). CONCLUSIONS: Subjects with more than 30 common nevi and 3 or more atypical nevi show about a 40-fold increased risk of developing melanoma. Even allowing for some degree of diagnostic anticipation due to periodic controls the risk appears higher than in the intermediate risk population. As a consequence of active follow up of individuals, all the detected tumors were at favourable prognosis. Periodic examination of these subjects should therefore be recommended as part of a prevention program for cutaneous melanoma in southern European populations.

Adolescent↗