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At least 19 recordsLinked to original sources
PubMed2006

Clinical selection of melanocytic lesions for dermoscopy decreases the identification of suspicious lesions in comparison with dermoscopy without clinical preselection.

BACKGROUND: In most cases dermoscopy is performed only on lesions selected by clinical inspection which present worrying clinical features or appear to deviate from the patient's average type of naevus. Thus, possible early malignant melanomas (MMs) or MM precursors, lacking typical clinical characteristics, may elude the dermoscopic examination. OBJECTIVES: To perform a comparison between two different approaches to the patient's examination, one based on a clinical preselection of lesions to be examined by dermoscopy, and the other consisting of the dermoscopic scrutiny of all melanocytic lesions with a diameter>or=2 mm (total dermoscopy). METHODS: Sixty-three consecutive patients with MM, undergoing periodic dermoscopic examinations of their naevi, were enrolled in the study. The patients first underwent an assessment of the entire skin with the unaided eye for the identification of lesions for dermoscopy. Subsequently, the patients underwent dermoscopic examination of all melanocytic lesions. Images of naevi identified by clinical examination or by total dermoscopy as having dermoscopic aspects characteristic of a suspicious lesion, i.e. necessitating either surgical excision or follow-up examinations, were separately recorded, classified and described employing the ABCD rule of dermoscopy and the seven-point checklist. RESULTS: Five hundred and fifty-one lesions were chosen by clinical inspection for subsequent dermoscopic examination; among these, 117 were considered for excision or follow-up. Ninety-two further lesions were identified for excision or follow-up by employing only total dermoscopy. Dermoscopy scores of lesions selected by clinical inspection plus dermoscopy were similar to those identified by dermoscopy alone. In the former group, 13 lesions showed either an ABCD or a seven-point score corresponding to a suspicious lesion, whereas eight such lesions were identified only by total dermoscopy. Thus, by clinical selection plus dermoscopy we were able to identify only 62% of dermoscopically suspicious lesions. CONCLUSIONS: Clinical selection of melanocytic lesions for dermoscopic examination is associated with the 'loss' of a conspicuous number of lesions which deserve surgical excision or follow-up examinations. Total dermoscopy, enabling the detection of suspicious lesions, together with storage, retrieval and sequential comparison of their images, could enhance MM diagnosis by follow-up, in comparison with clinical preselection for dermoscopy.

Adult↗
PubMed2002

Pre-operative diagnosis of pigmented skin lesions: in vivo dermoscopy performs better than dermoscopy on photographic images.

BACKGROUND: Epiluminescence microscopy (ELM) (dermoscopy, dermatoscopy) is a technique for non-invasive diagnosis of pigmented skin lesions that improves the diagnostic performance of dermatologists. Little is known about the possible influence of associated clinical features on the reliability of dermoscopic diagnosis during in vivo examination. OBJECTIVE: To compare diagnostic performance of in vivo dermoscopy (combined clinical and dermoscopic examination) with that of dermoscopy performed on photographic slides (pure dermoscopy). DESIGN: This case series comprised 256 pigmented skin lesions consecutively identified as suspicious or equivocal during examination in a general dermatological clinic. Clinical examination and in vivo dermoscopy were performed before excision by two trained dermatologists. The same observers carried out dermoscopy on photographic slides at a later time, and these three diagnostic classifications were reviewed together with the histological findings for the individual lesions. This was carried out in a university hospital. RESULTS: In vivo dermoscopy performed better than dermoscopy on photographic slides for classification of pigmented skin lesions compared with histological diagnosis, and both performed better than general clinical diagnosis. In vivo dermoscopic diagnosis of melanoma showed 98.1% sensitivity, 95.5% specificity and 96.1% diagnostic accuracy while dermoscopic diagnosis of melanoma on photographic slides was less reliable with 81.5% sensitivity, 86.7% specificity and 85.2% diagnostic accuracy. In particular, diagnosis of melanoma based on photographic slides led to nine false negative cases (three in situ, six invasive; thickness ranges 0.2-1.5 mm). CONCLUSIONS: In vivo dermoscopy, i.e. combined clinical and dermoscopic examination, is more reliable than dermoscopy on photographic slides. In clinical practice, therefore, in vivo dermoscopy cannot be considered independent from associated clinical characteristics of the lesions, which help the trained observer to reach a more precise classification. This may have implications on the reliability of ELM diagnosis made by an observer not fully trained in the clinical diagnosis of pigmented skin lesions or by a remote observer during digital ELM teleconsultation.

Adult↗
PubMed2002

Use of and beliefs about dermoscopy in the management of patients with pigmented lesions: a survey of dermatology residency programmes in the United States.

Dermoscopy is a non-invasive technique that can be utilized for the clinical diagnosis of pigmented lesions. The aim of this study was to assess the utilization and beliefs about the usefulness of dermoscopy in the evaluation of pigmented lesions by physicians in dermatology residency programmes, and to determine the extent of dermoscopy training received by residents in these programmes. Questionnaires were sent to the directors of all the accredited dermatology residency programmes in the United States (n = 105). A follow-up postcard questionnaire was sent to the chief resident of all the responding programmes. Eighty-three physicians responded to the questionnaire (79%). Fifty-one per cent of the respondents (n = 42) reported utilizing dermoscopy. Reported reasons for using dermoscopy by respondents included the fact that it helps detect melanoma early (74%), leads to fewer biopsies (74%) and reduces patient anxiety (64%). Lack of training (51%) and lack of usefulness (42%) were amongst the reported reasons for not utilizing dermoscopy. Sixty-seven per cent of respondents reported an increase of approximately 50% in the use of dermoscopy over the past 5 years, and 45% anticipated an increase in use over the next 5 years. Thirty-eight per cent of chief residents from the responding programmes reported receiving training in dermoscopy during residency. In conclusion, half of the dermatology residency programmes currently use dermoscopy in the evaluation of pigmented lesions. The main reason for not using dermoscopy was a lack of training. Respondents anticipated a future increase in the use of dermoscopy.

Dermatology↗
PubMed2004

Improvement of malignant/benign ratio in excised melanocytic lesions in the 'dermoscopy era': a retrospective study 1997-2001.

BACKGROUND: Because of the many limitations of studies based on the diagnostic setting of excised lesions, the impact of dermoscopy (epiluminescence microscopy, dermatoscopy) in melanoma screening during practice remains to be established. OBJECTIVES: We assumed that effects of the use of dermoscopy on some indicators of diagnostic performance in melanoma screening should be traceable retrospectively; therefore, we analysed the impact of routine dermoscopy use on the malignant/benign ratio in excised melanocytic lesions. METHODS: Preoperative and histological diagnosis of 3053 melanocytic lesions [319 melanomas (10.4%)] consecutively diagnosed and excised at the Department of Dermatology, University of Florence in the period 1997-2001 inclusive were retrieved. Six dermatologists who selected the lesions to excise and who performed preoperative diagnosis were divided into two groups according to their use of dermoscopy in routine activity (n = 2 dermoscopy users and n = 4 nonusers). The study period was divided into a predermoscopy period (1997), a shift phase (1998) and a dermoscopy period (1999-2001). RESULTS: During the study period, the malignant/benign ratio improved in dermoscopy users only (from 1 : 18 to 1 : 4.3, P = 0.037). No significant difference was found for nonusers (from 1 : 11.8 to 1 : 14.4). Dermoscopy users were more likely to have a melanoma diagnosed within a series of excised lesions than nonusers, even taking into account potential confounders such as sex, age and study period by means of multivariate analysis (odds ratio 1.55, 95% confidence interval 1.17-2.01). The percentage of 'problem' naevi (naevi with architectural disorder with or without cytological atypia and Spitz or Reed naevi) over the total number of excised lesions was higher in dermoscopy users than in nonusers (year 2001, 51.6% vs. 40.9%, P = 0.014). Similar findings were obtained after exclusion from the data set of lesions excised for cosmetic reasons. CONCLUSIONS: The adoption of dermoscopy in routine melanoma screening is followed by an improvement of the malignant/benign ratio in excised lesions, suggesting a more appropriate selection of pigmented lesions referred to surgery. Because of the possible limitations of a retrospective study design, future confirmation of this finding by means of a prospective, randomized study is advisable. The introduction of dermoscopy in routine practice may have major implications in large-scale melanoma screening with cost savings and a reduction of the dermosurgery workload.

Female↗
PubMed2006

Conventional and polarized dermoscopy features of dermatofibroma.

OBJECTIVE: To evaluate dermoscopic features and patterns of dermatofibromas using conventional and polarized light dermoscopy. DESIGN: Dermatofibromas were imaged using conventional nonpolarized contact dermoscopy (NPD), polarized contact dermoscopy (PCD), and polarized noncontact dermoscopy, followed by evaluation and comparison of dermoscopic features of the lesions. SETTING: Dermatology clinic specializing in pigmented lesions. Patients Fifty patients with dermatofibromas. RESULTS: The most common features of dermatofibromas observed with NPD and PCD were central white scarlike patches (37 [74%] and 42 [84%], respectively), brown globulelike structures (21 [42%] and 22 [44%]), vascular structures (24 [48%] and 22 [44%]), and a peripheral fine pigmented network (36 [72%] for both). A newly described feature observed with PCD was a central white patch characterized by shiny white streaks. With polarized noncontact dermoscopy, the most characteristic feature was a central pink hue or "vascular blush" (44 [88%]) and visibility of blood vessels (41 [82%]). The most common pattern identified with NPD and PCD was the combination of a peripheral pigmented network and a central white patch in 28 (56%) and 31 (62%) of lesions, respectively. With polarized noncontact dermoscopy, the most common pattern was a central pink hue with a peripheral pigmented network (23 [46%]). There was good to excellent agreement when comparing NPD with PCD images, but there was a variable level of agreement when polarized noncontact dermoscopy images were compared with NPD and PCD images. CONCLUSIONS: Conventional and polarized light dermoscopy are not equivalent but may be complementary. This study highlights some salient differences. We were able to identify new dermoscopic features and patterns not previously described with conventional dermoscopy. These new criteria can aid in the diagnosis of dermatofibroma.

Dermoscopy↗
PubMed2002

Diagnostic accuracy of dermoscopy.

The accuracy of the dinical diagnosis of cutaneous melanoma with the unaided eye is only about 60%. Dermoscopy, a non-invasive, in vivo technique for the microscopic examination of pigmented skin lesions, has the potential to improve the diagnostic accuracy. Our objectives were to review previous publications, to compare the accuracy of melanoma diagnosis with and without dermoscopy, and to assess the influence of study characteristics on the diagnostic accuracy. We searched for publications between 1987 and 2000 and identified 27 studies eligible for meta-analysis. The diagnostic accuracy for melanoma was significantly higher with dermoscopy than without this technique (log odds ratio 4.0 [95% CI 3.0 to 5.1] versus 2.7 [1.9 to 3.4]; an improvement of 49%, p = 0.001). The diagnostic accuracy of dermoscopy significantly depended on the degree of experience of the examiners. Dermoscopy by untrained or less experienced examiners was no better than clinical inspection without dermoscopy. The diagnostic performance of dermoscopy improved when the diagnosis was made by a group of examiners in consensus and diminished as the prevalence of melanoma increased. A comparison of various diagnostic algorithms for dermoscopy showed no significant differences in their diagnostic performance. A thorough appraisal of the study characteristics showed that most of the studies were potentially influenced by verification bias. In conclusion, dermoscopy improves the diagnostic accuracy for melanoma in comparison with inspection by the unaided eye, but only for experienced examiners.

Dermatology↗
PubMed2001

Dermoscopy as a second step in the diagnosis of doubtful pigmented skin lesions: how great is the risk of missing a melanoma?

BACKGROUND: Little is known about the occurrence of false negatives in the diagnosis of melanoma using dermoscopy in clinical practice: in the literature dermoscopy only increased the accuracy of diagnosis of equivocal lesions that were to undergo biopsy anyway. AIM AND METHODS: We collected the 81 lesions clinically diagnosed as probable melanomas by experienced specialists (from a series of 256 pigmented skin lesions submitted to excisional biopsy) and reviewed them for possible false negative results in the diagnosis of melanoma using in vivo dermoscopy and dermoscopy performed on slide images. Both procedures were carried out by the same experienced dermatologists who classified the lesions clinically. RESULTS: Dermoscopy made on slide images (observers blinded for clinical features of the lesions) yielded three false negative results (91% sensitivity) in a group of 35 histologically confirmed melanomas. In vivo dermoscopy showed better results, with no melanomas missed (100% sensitivity). The frequency of false positive results in the diagnosis of melanoma was 13.5% (11 of 81) with dermoscopy on slide images and 2.5% (two of 81) with in vivo dermoscopy. CONCLUSIONS: Only in vivo dermoscopy by fully trained dermatologists with both clinical and dermoscopic experience avoids the risk of misclassification of melanomas otherwise correctly classified on clinical grounds.

Dermatology↗
PubMed2003

Computerized digital dermoscopy.

Within the past 15 years, dermoscopy has become a widely used non-invasive technique for physicians to better visualize pigmented lesions. Dermoscopy has helped trained physicians to better diagnose pigmented lesions. Now, the digital revolution is beginning to enhance standard dermoscopic procedures. Using digital dermoscopy, physicians are better able to document pigmented lesions for patient follow-up and to get second opinions, either through teledermoscopy with an expert colleague or by using computer-assisted diagnosis. As the market for digital dermoscopy products begins to grow, so do the number of decisions physicians need to make when choosing a system to fit their needs. The current market for digital dermoscopy includes two varieties of relatively simple and cheap attachments which can convert a consumer digital camera into a digital dermoscope. A coupling adapter acts as a fastener between the camera and an ordinary dermoscope, whereas a dermoscopy attachment includes the dermoscope optics and light source and can be attached directly to the camera. Other options for digital dermoscopy include complete dermoscopy systems that use a hand-held video camera linked directly to a computer. These systems differ from each other in whether or not they are calibrated as well as the quality of the camera and software interface. Another option in digital skin imaging involves spectral analysis rather than dermoscopy. This article serves as a guide to the current systems available and their capabilities.

Journal Article↗
PubMed2006

Identification of clinically featureless incipient melanoma using sequential dermoscopy imaging.

OBJECTIVES: To examine the role of sequential dermoscopy imaging in detecting incipient melanoma and to elucidate the impact of length of follow-up on the relevance of observed changes. DESIGN: Baseline and follow-up images of melanomas and melanocytic nevi excised only because of changes across time were inspected on a computer screen and assessed according to prospectively defined criteria. Lesions were stratified into 3 groups according to the length of follow-up. SETTING: Three hospital-based referral centers in Europe and Australia. Patients Four hundred sixty-one patients selected for digital dermoscopy monitoring. MAIN OUTCOME MEASURES: Description and comparison of dermoscopy features and changes in melanomas and melanocytic nevi at baseline and after follow-up. RESULTS: We inspected baseline and follow-up images of 499 melanocytic skin lesions from 461 patients. The histopathologic diagnosis was melanoma in 91 cases and melanocytic nevus in 408. Most melanomas (58.2%; n = 53) were in situ, and the median thickness of invasive melanomas was 0.38 mm. Dermoscopy features of melanomas and nevi did not differ significantly at baseline. After follow-up of 1.5 to 4.5 months, 61.8% of the melanomas showed no specific dermoscopy features for melanoma. This value declined to 45.0% after follow-up of 4.5 to 8.0 months and to 35.1% after more than 8.0 months. We could not differentiate melanomas and changing nevi by means of observed changes or dermoscopy features when follow-up was shorter than 4.5 months. With longer follow-up, melanomas tended to enlarge asymmetrically with architectural and color changes, and nevi tended to enlarge symmetrically without architectural and color changes. CONCLUSIONS: Sequential dermoscopy imaging detects incipient melanomas when they are still featureless. Interpretation of changes observed during follow-up depends on the length of follow-up.

Austria↗
PubMed2005

Dermoscopy for skin cancer detection.

PURPOSE OF REVIEW: The worldwide incidence of melanoma and nonmelanoma skin cancers is increasing alarmingly. The development of new techniques such as dermoscopy leads to a consequent progress in skin cancers screening. The purpose of this review is to highlight recent advances in dermoscopy, reviewing primary research articles published in the last year. RECENT FINDINGS: With the recent standardization of diagnostic procedures obtained by the Consensus Net Meeting on Dermoscopy and the definition of new melanoma-specific criteria, the efficacy in early melanoma diagnosis is improved. Dermoscopy is cost effective, leading to a decreased number of excised benign lesions, and the dermoscopic follow-up allows early detection of melanomas. However, the technique must be performed by experts in order not to miss melanomas. For this reason, instruction in dermoscopy is mandatory. Moreover, computer-aided diagnosis has been tested to be a valid support for physicians. Teledermoscopy is a new tool that allows a second expert opinion to manage atypical lesions. SUMMARY: Dermoscopy opens up a new dimension on clinical morphology of skin lesions. Digital follow-up examinations, computer-aided diagnosis, and teledermoscopy are new facilities that will change the current management of skin cancers in general and melanoma in particular. Dermoscopy in the hands of experienced physicians has higher discriminatory power than naked-eye examination to detect skin cancers.

Dermoscopy↗
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↗
PubMed1998

Reliability and inter-observer agreement of dermoscopic diagnosis of melanoma and melanocytic naevi. Dermoscopy Panel.

The aim of this study was to analyse the reliability and the inter-observer agreement of dermoscopy in the diagnosis of melanocytic skin lesions. Nine dermatologists, with a different training experience and who routinely used dermoscopy in different hospitals in Italy, evaluated clinical and dermoscopy photographs of 15 melanocytic lesions (four invasive melanomas, four histologically common naevi, and seven naevi with histological atypia). A further series of dermoscopic photographs of 40 melanocytic lesions was evaluated to quantify inter-observer concordance in recognizing dermoscopic criteria. Compared to the true (histological) diagnosis, clinical diagnosis (categories: melanoma, common naevus, atypical naevus) was correct in 40% of cases (range, 27-53%). The percentage raised to 55% (40-73%) by the use of dermoscopy, with an average improvement of 15.6%. Concerning melanoma, clinical diagnosis resulted in a sensitivity of 41.9%, specificity of 77.8%, positive predictive value (PPV) of 36.1%, negative predictive value (NPV) of 81.8%. By using dermoscopy, an improvement of diagnostic performance was found (sensitivity 75%, specificity 88.8%, VPP 71.0%, VPN 90.7%). The inter-observer agreement in melanoma diagnosis, by using dermoscopy, was similar to that obtained by clinical examination (k statistics = 0.54 and 0.52, respectively). Concerning dermoscopic criteria, the best agreement among observers was found for pseudopods, a dermoscopic parameter related to the radial growth phase of melanoma. We conclude that dermoscopy is an useful tool for a non-invasive diagnosis of melanocytic skin lesions, improving the diagnostic performance compared to clinical examination.

Adult↗
PubMed2006

Level of confidence in diagnosis: clinical examination versus dermoscopy examination.

BACKGROUND: Confidence is an important factor in decision making and may influence patient care. OBJECTIVES: To evaluate whether short-training-based dermoscopy increases confidence in the diagnosis of skin lesions. METHODS AND MATERIALS: After a 1-hour course on dermoscopy, 20 pairs of clinical and dermoscopic images of lesions were presented to 19 dermatology residents with little or no dermoscopy experience. After viewing the clinical image, they were asked to assess their confidence in the diagnosis in a seven-point scale, with 1 reflecting that the respondent was 100% confident that the lesion was benign, while number 7 reflected 100% confidence that it was malignant. The same technique was used for dermoscopic images. RESULTS: Ten of the 20 pairs of evaluations showed a significant difference (p<.05). The largest differences were observed in lesions where clinical scores suggested that participants were uncertain about the diagnosis, but tended to decide that the lesion was benign after dermoscopy. Dermoscopy did not improve confidence in the evaluation of dysplastic lesions as well as lesions with obvious clinical diagnoses. CONCLUSIONS: Short-training-based dermoscopy improved confidence in the diagnosis of clinically challenging skin lesions, but the impact was not demonstrable for clinically obvious lesions and dysplastic nevi.

Adult↗
PubMed2003

Diagnosis of pigmented skin lesions by dermoscopy: web-based training improves diagnostic performance of non-experts.

BACKGROUND: Dermoscopy has been shown to enhance the diagnosis of melanoma. However, use of dermoscopy requires training and expertise to be effective. OBJECTIVES: To determine whether an Internet-based course is a suitable tool in teaching dermoscopy, and to evaluate the diagnostic value of pattern analysis and diagnostic algorithms in colleagues not yet familiar with this technique. METHODS: Sixteen colleagues who were not experts in dermoscopy were asked to evaluate the dermoscopic images of 20 pigmented skin lesions using different diagnostic methods (i.e. pattern analysis, ABCD rule, seven-point checklist and Menzies' method), before and after an Internet-based training course on dermoscopy. Mean +/- SEM sensitivity, specificity and diagnostic accuracy, and kappa (kappa) intraobserver agreement were evaluated for each diagnostic method before and after training for the 16 participants. Differences between mean values were assessed by means of two-tailed Wilcoxon rank-sum tests. RESULTS: There was a considerable improvement in the dermoscopic melanoma diagnosis after the Web-based training vs. before. Improvements in sensitivity and diagnostic accuracy were significant for the ABCD rule and Menzies' method. Improvements in sensitivity were also significant for pattern analysis, whereas the sensitivity values were high for the seven-point checklist in evaluations both before and after training. No significant difference was found for specificity before and after training for any method. There was a significant improvement in the kappa intraobserver agreement after training for pattern analysis and the ABCD rule. For the seven-point checklist and Menzies' method there was already good agreement before training, with no significant improvement after training. CONCLUSIONS: We demonstrated that Web-based training is an effective tool for teaching dermoscopy.

Clinical Competence↗
PubMed2006

Dermoscopy features of melanoma incognito: indications for biopsy.

BACKGROUND: To avoid missing melanoma, the current practice is to biopsy all suggestive skin lesions. Although most cases of melanoma exhibit clinical clues leading to the correct diagnosis, melanoma can mimic benign lesions. Dermoscopy has been shown to increase the diagnostic accuracy of clinically equivocal lesions, but little is known about its ability to detect melanoma in the context of lesions that appear clinically benign. METHODS: We present 7 difficult-to-diagnose melanomas, in which additional clues provided by dermoscopy increased the index of suggestion and led us to perform a biopsy. RESULTS: Our cases highlight the following 7 management rules: 1) Dermoscopy should not be used only for suggestive skin lesions. 2) Biopsy lesions missing clinicodermoscopic correlation. 3) Biopsy lesions with unspecific pigment pattern. 4) Biopsy lesions with spitzoid features. 5) Biopsy lesions with extensive regression features. 6) In patients with multiple nevi, biopsy lesions changing after short-term follow-up. 7) Biopsy pink lesions with an atypical vascular pattern. LIMITATIONS: The reported series of cases is small. Dermoscopy has not been rigorously compared with handheld magnification (as with a x7 loupe). CONCLUSIONS: Dermoscopy can increase the index of suggestion to perform biopsy in difficult-to-diagnose melanomas.

Adolescent↗