ABCD Criteria Research Articles

Evaluation of Levenberg–Marquardt neural networks and stacked autoencoders clustering for skin lesion analysis, screening and follow‐up

Traditional methods for early detection of melanoma rely on the visual analysis of the skin lesions performed by a dermatologist. The analysis is based on the so‐called ABCDE (Asymmetry, Border irregularity, Colour variegation, Diameter, Evolution) criteria, although confirmation is obtained through biopsy performed by a pathologist. The proposed method exploits an automatic pipeline based on morphological analysis and evaluation of skin lesion dermoscopy images. Preliminary segmentation and pre‐processing of dermoscopy image by SC‐cellular neural networks is performed, in order to obtain ad‐hoc grey‐level skin lesion image that is further exploited to extract analytic innovative hand‐crafted image features for oncological risks assessment. In the end, a pre‐trained Levenberg–Marquardt neural network is used to perform ad‐hoc clustering of such features in order to achieve an efficient nevus discrimination (benign against melanoma), as well as a numerical array to be used for follow‐up rate definition and assessment. Moreover, the authors further evaluated a combination of stacked autoencoders in lieu of the Levenberg–Marquardt neural network for the clustering step.

Pediatric melanoma update.

Pediatric melanoma is a rare disease that affects approximately 6 out of every one million children and accounts for 1-4% of all melanomas. This article reviews the epidemiology, etiology, diagnosis, treatment and prognosis of pediatric melanoma - with particular attention to recent updates in the literature. While awareness of melanoma increases among the general population, recent data suggest stable and even declining incidence rates among certain pediatric populations. Studies have examined clinical features and presentations of melanoma among the pediatric population and the conventional ABCDE criteria (asymmetrical shape, border, color, diameter, evolving lesion) used to diagnosis adult melanoma may not be entirely appropriate for pediatric melanoma; as such, additional pediatric-ABCD and CUP criteria (color changing, ulceration, pyogenic granuloma-like lesions) have been proposed. Dermoscopy serves as a valuable tool to detect suggestive patterns among pediatric skin lesions, and aids in the monitoring of skin lesions and detection of melanoma among children and adolescents. The etiology and pathogenesis of the pediatric melanoma is currently being investigated; studies have examined the genetic alterations that may be involved with the development of pediatric melanomas including TERT promoter, BRAF, and NRAS among others. While genetic testing using molecular techniques such as comparative genomic hybridization and fluorescence in-situ hybridization is helpful for diagnosis in certain contexts, molecular workup is not considered standard of care among pediatric melanoma cases, and in fact has not been proven to reliably distinguish between benign and malignant spitzoid tumors in children. Our growing understanding of melanoma has informed treatment decisions regarding management of positive sentinel lymph nodes, use of adjuvant therapy, and use of immunotherapy in treatment plans.

Clinical and dermoscopic characterization of pediatric and adolescent melanomas: Multicenter study of 52 cases

Knowledge regarding the morphologic spectrum of pediatric melanoma (PM) is sparse, and this may in part contribute to delay in detection and thicker tumors. To analyze the clinicodermoscopic characteristics of PM. Retrospective study of 52 melanomas diagnosed in patients before the age of 20years. On the basis of its clinical, dermoscopic, and histopathologic characteristics, PM can be classified as spitzoid or nonspitzoid. The nonspitzoid melanomas (n=37 [72.3%]) presented in patients with a mean age of 16.3years (range, 8-20) and were associated with a high-risk phenotype and a pre-existing nevus (62.2%). The spitzoid melanomas (n=15 [27.7%]) were diagnosed in patients at a mean age of 12.5years (range, 2-19) and were mostly de novo lesions (73.3%) located on the limbs (73.3%). Whereas less than 25% of PMs fulfilled the modified clinical ABCD criteria (amelanotic, bleeding bump, color uniformity, de novo at any diameter), 40% of spitzoid melanomas did. Dermoscopic melanoma criteria were found in all cases. Nonspitzoid melanomas tended to be multicomponent (58.3%) or have nevus-like (25%) dermoscopic patterns. Spitzoid melanomas revealed atypical vascular patterns with shiny white lines (46.2%) or an atypicalpigmented spitzoid pattern (30.8%). There was good correlation between spitzoid subtype histopathologically and dermoscopically (κ=0.66). A retrospective study without re-review of pathologic findings. Dermoscopy in addition to conventional and modified clinical ABCD criteria helps in detecting PM. Dermoscopy assists in differentiating spitzoid from nonspitzoid melanomas.

Paediatric melanoma.

Paediatric melanoma, although rare, is the most common skin cancer in children. Our current knowledge on paediatric melanoma incidence trends is expanding, as several studies have addressed this issue with conflicting results. Known risk factors for paediatric melanoma include family history of melanoma, a previous history of malignancy, large congenital nevi, numerous melanocytic nevi, sunburns, increased UV exposure and a sun-sensitive phenotype. In younger children, melanoma more often presents with atypical features, such as a changing, amelanotic or uniformly coloured, often bleeding lesion, not fulfilling in most cases the conventional ABCDE criteria. The major differential diagnoses are melanocytic nevi, proliferative nodules in congenital nevi and atypical Spitz tumours. Moreover, in the younger age group non-Caucasian children are over-represented, tumours tend to be thicker and lymph nodes are often involved. Despite the frequent diagnosis at an advanced stage, the overall survival is fair in paediatric melanoma. Specific guidelines for management of melanoma in children do not exist, and most often the disease is treated similarly to melanoma in adults.

A mathematical analysis of the ABCD criteria for diagnosing malignant melanoma

The medical community currently employs the ABCD (asymmetry, border irregularity, color variegation, and diameter of the lesion) criteria in the early diagnosis of a malignant melanoma. Although many image segmentation and classification methods are used to analyze the ABCD criteria, it is rare to see a study containing mathematical justification of the parameters that are used to quantify the ABCD criteria. In this paper, we suggest new parameters to assess asymmetry, border irregularity, and color variegation, and explain the mathematical meaning of the parameters. The suggested parameters are then tested with 24 skin samples. The parameters suggested for the 24 skin samples are displayed in three-dimensional coordinates and are compared to those presented in other studies (Ercal et al IEEE Trans. Biomed. Eng. 41 837–45, Cheerla and Frazier Int. J. Innovative Res. Sci., Eng. Technol. 3 9164–83) in terms of Pearson correlation coefficient and classification accuracy in determining the malignancy of the lesions.

Dermatoscopy in the evaluation of cutaneous lesions in patients with familial atypical multiple-mole melanoma syndrome

Skin cancer is currently the most common cancer type afflicting North Americans today and with an aging population the incidence is likely to increase. Certain skin cancers such as melanoma can result in significant morbidity and mortality especially if not identified and treated early. The traditional ABCDE rule (asymmetric shape, irregular borders, variation in colour, diameter >6 mm and evolution/elevation of the lesion) used to identify concerning tumours will in fact miss many early melanomas. This problem is exacerbated in patients with hereditary forms of melanoma such as Familial Atypical Multiple- Mole Melanoma (FAMMM) syndrome where multiple atypical nevi satisfying the ABCDE criteria are present and would therefore warrant biopsy. Most of these biopsies would be unnecessary and would increase the patient’s morbidity. Dermatoscopy is a clinical tool that provides a bridge between clinical and histopathologic evaluation and has proven to be helpful in triaging suspicious lesions in the general population and to be a first-line screening tool to increase the detection of early melanomas in patients with FAMMM.

Dermoscopic and Clinical Features of Cutaneous Melanoma: A Retrospective Study

Background: Melanoma is one of the tumors whose incidence and mortality have risen more rapidly during the last few decades in the caucasians worldwide. Material and Methods: Twenty one cutaneous melanomas in 21 patients were evaluated retrospectively. The preoperative diagnosis was based on clinical criteria according to ABCD rule and dermoscopic criteria according to two stage diagnostic method. All melanomas were confirmed by histopathologically. All melanomas evaluated the presence or absence of global and local dermoscopic patterns as defined by the Consensus Meeting on Dermoscopy held via Internet. Results: The 21 lesions were obtained from 14 men (age range: 19-87; mean age: 59.1) and 7 women (age range: 24-87; mean age: 63.4) ranging in age from 19 to 87 years (mean age: 60.6). There was a predilection of melanomas for the face (8 of 21; 38%). Lesions were suspected to be malignant in all cases (100%) according to the clinical ABCD criteria. The most common histological type was superficial spreading melanoma (8; 38%) followed by nodular melanoma (7; 33.3%). Fifteen of the melanomas were invasive; six were in-situ melanomas. In all cases, lesions presented melanoma-specific dermoscopic patterns. In global dermoscopic features, multicomponent pattern was observed in 7 (33.3%) of the melanomas, although other patterns were also found. Conclusion: In our case series, we evaluate dermoscopic pattern analysis which was melanoma specific in all cases. But the true percentage of unremarkable melanomas is greater because some melanomas were resected with no clinical suspicion and without dermoscopic analysis. According to these findings, dermoscopy should be performed in all lesions with positive history or clinical suspicion or before excision even if there is no clinical suspicion.

Immunosuppression is an independent prognostic factor associated with aggressive tumor behavior in cutaneous melanoma

A number of factors other than those identified by the American Joint Committee on Cancer (AJCC) may have prognostic significance in the evaluation of melanoma. We sought to evaluate commonly recorded clinical features potentially associated with aggressive melanoma. We conducted a retrospective case-control study. We included patients given a diagnosis of cutaneous melanoma with at least 5years of follow-up or documented metastases. Patients were divided into nonaggressive and aggressive groups. Univariate and multivariate statistical analyses were performed to evaluate the association of multiple clinical and histologic parameters and metastases. We included 141 patients. Significant prognostic factors in univariate analysis associated with nonaggressive disease included history of dysplastic nevus syndrome and ABCDE criteria. Significant factors in univariate analysis associated with aggressive disease included age and immunosuppression. Only age and immunosuppression remained significant in multivariate analysis when controlled across statistically significant histologic variables from AJCC. The study is retrospective and has a small sample size. Older patients and those with a history of immunosuppression may be at higher risk for aggressive disease and should be closely monitored after an initial diagnosis of melanoma.

Early detection of melanoma: Reviewing the ABCDEs

Over the course of their nearly 30-year history, the ABCD(E) criteria have been used globally in medical education and in the lay press to provide simple parameters for assessment of pigmented lesions that need to be further evaluated by a dermatologist. In this article, the efficacy and limitations of the ABCDE criteria as both a clinical tool and a public message will be reviewed.

Atypical Presentation of Malignant Melanoma in a 16 Months Old Child

Malignant melanoma in childhood and adolescence is rare but incidences have been seen to rise. Prognostic factors, risk factors and prognosis have similarities to melanoma in adulthood but paediatric melanoma presents a diagnostic challenge as it often lacks the classical features of adult pigmented malignant melanoma and histologically is difficult to diagnose. This case report describes a clinically atypical presentation of melanoma on the thigh of a 16 month old boy. Initially seen at five months old by a dermatologist were a punch biopsy of the element was made with histological diagnosis; unusual congenital nevus. The element hereafter evolved and at the time of diagnosis measured 7.5 mm in Breslow thickness. Sentinel node biopsy and full body scans were made with no sign of metastasis. Like other cases reported, the melanoma did not exhibit the classical characteristics of the ABCD criteria which may have played a part in delaying diagnosis. Studies suggest that delayed diagnosis in children is not uncommon and younger patients present with more advanced disease at the time of diagnosis. To facilitate earlier recognition of melanoma in children additions to the conventional ABCD criteria have been suggested. This report illustrates that malignant melanoma should always be taken into consideration when presented with lesions of the skin and that a high level of clinical awareness and suspicion is required in order to hasten diagnosis and maybe improve prognosis in cutaneous malignant melanoma in children and adolescents.

The role of dermoscopy and digital dermoscopy follow-up in the clinical diagnosis of melanoma: clinical and dermoscopic features of 99 consecutive primary melanomas.

Background:Early recognition is the most important intervention to improve melanoma prognosis.Objective:To report the value of dermoscopy and digital dermoscopy in the clinical diagnosis of malignant melanoma (MM).Methods:Retrospective analysis of 99 consecutive primary MMs diagnosed between 2010 and 2013. The MMs were divided into 3 groups: 1) the MM was the reason for consultation (MMC), 2) the MM was detected during routine control of nevi (MMRC), and 3) the MM was detected due to changes observed during digital dermoscopy follow-up (MMDFU). Clinical, dermoscopic and histologic features were assessed.Results:A total of 99 MMs were diagnosed in 89 patients (55% male) with a mean age of 50.8 (18-93) years. Of all the MMs, 35 were the reason for patient consultation (MMC), 52 were detected during routine control of nevi (MMRC) and 12 were diagnosed due to changes observed with digital dermoscopy (MMDFU). On clinical examination, 74.2 % of MMC met the 4 ABCD criteria, while only 30.7 % of MMRC and 8.3 % of MMDFU. Most MMC were correctly classified as malignant according to dermoscopy, but 44.2% of MMRC and only 16.7% of MMDFU. 22.9% of MMC, 50% of MMRC and 58.3% of MMDFU were in situ. Mean Breslow thickness was significantly lower in the MMDFU group (0.52 mm) than in the MMRC and MMDFU groups (0.77 and 1.43 mm respectively).Conclusions:The use of dermoscopy and digital dermoscopy allows the detection of MMs in early stages, even in the absence of specific criteria for malignancy.

High-level intuitive features (HLIFs) for intuitive skin lesion description.

A set of high-level intuitive features (HLIFs) is proposed to quantitatively describe melanoma in standard camera images. Melanoma is the deadliest form of skin cancer. With rising incidence rates and subjectivity in current clinical detection methods, there is a need for melanoma decision support systems. Feature extraction is a critical step in melanoma decision support systems. Existing feature sets for analyzing standard camera images are comprised of low-level features, which exist in high-dimensional feature spaces and limit the system's ability to convey intuitive diagnostic rationale. The proposed HLIFs were designed to model the ABCD criteria commonly used by dermatologists such that each HLIF represents a human-observable characteristic. As such, intuitive diagnostic rationale can be conveyed to the user. Experimental results show that concatenating the proposed HLIFs with a full low-level feature set increased classification accuracy, and that HLIFs were able to separate the data better than low-level features with statistical significance. An example of a graphical interface for providing intuitive rationale is given.

CDKN2A mutations could influence the dermoscopic pattern of presentation of multiple primary melanoma: a clinical dermoscopic genetic study.

Patients who develop cutaneous melanoma are at increased risk of developing a second primary melanoma. There are many aetiological reasons by which the risk of a second melanoma increases. Among others, genetic factors may contribute to modulating this risk. The risk of identifying a CDKN2A germline mutation increases with the number of primary melanomas and with the presence of familial history of melanoma. Patients with melanoma are especially encouraged to have regular follow-up visits with their dermatologist to perform clinical and dermatoscopic examination. In particular, dermoscopy could be very useful in multiple primary melanoma (MPM) patients. To analyse the clinical and dermatoscopic features of multiple melanomas, focusing on those features that are more frequently found in the same patient to recognize them earlier and understand whether they appear with the similar peculiar dermatoscopic features, especially in CDKN2A carriers. Medical records of MPM patients were selected from a database including 1065 patients with histopathologically proven melanoma diagnosis, all treated at the dermatology clinic of the University of Florence from 2000 to 2013. Pictures of melanoma were independently and blindly administered to three dermatologist experts in dermoscopy to evaluate the presence or absence of ABCD criteria for each clinical image, and the main pattern for the dermoscopic images. The results were then analyzed and crossed to rate the clinical and dermoscopic features of MPM. Seventy five (7.0%) of 1065 patients included in our database were found to carry an MPM disease. Among them, we selected 12 (16%) patients with three or more MPMs. The presence of the CDKN2A melanoma susceptibility gene was observed in 4/12 (33.33%) patients; two patients presented the C500G and c.5+1delG polymorphisms in the CDKN2A gene. In CDKN2A carriers, each patient showed a similar and specific dermatoscopic pattern in their lesions. Even being aware of the limitations of this study, according to hereditary characters and their modes of transmissions, we could speculate that for each patient with a CDKN2A germline mutation, it is possible to find the same kind of dermoscopical pattern among their melanocytic tumours.

Enhanced classification of malignant melanoma lesions via the integration of physiological features from dermatological photographs.

Traditional methods for early detection of melanoma rely upon a dermatologist to visually assess a skin lesion using the ABCDE (Asymmetry, Border irregularity, Color variegation, Diameter, Evolution) criteria before confirmation can be done through biopsy by a pathologist. However, this visual assessment strategy taken by dermatologists is hampered by clinician subjectivity and suffers from low sensitivity. Computer-aided diagnostic methods based on dermatological photographs are being developed to aid in the melanoma diagnosis process, but most of these methods rely only on superficial, topographic features that can be limiting in characterizing melanoma. In this work, a hybrid feature model is introduced for characterizing skin lesions that combines low-level and high-level features, and augments them with a set of physiological features extracted from dermatological photographs using a nearest-neighbor nonlinear model to improve classification performance. The physiological features extracted from the lesion for the proposed hybrid feature model include those based on: i) eumelanin concentrations, ii) pheomelanin concentrations, and iii) blood oxygen saturation. The proposed hybrid feature model was evaluated on 206 dermatological photographs of skin lesions (119 confirmed melanoma cases, 87 confirmed non-melanoma cases) using a cross validation scheme. The experimental results show that the proposed hybrid feature model, with integrated physiological features, provided improved sensitivity, specificity, precision and accuracy for the purpose of melanoma classification.

Pediatric melanoma: Results of a large cohort study and proposal for modified ABCD detection criteria for children

Clinical and histopathologic features of childhood melanoma are poorly characterized. Atypical clinical presentations and ambiguous microscopic findings may contribute to diagnostic delays. We sought to determine whether conventional ABCDE melanoma detection criteria (Asymmetry, Border irregularity, Color variegation, Diameter >6 mm, Evolution [any morphologic or symptomatic change in the lesion]) adequately detects pediatric melanoma and to evaluate clinicopathologic and outcome differences between younger and older children. This was a retrospective study of children given the diagnosis of melanoma (N = 60) or ambiguous melanocytic tumors treated as melanoma (N = 10) before age 20 years from 1984 to 2009 at the University of California, San Francisco. Seventy patients were divided into 2 age groups: 0 to 10 years (N = 19, group A) and 11 to 19 years (N = 51, group B). Clinical, histopathologic, and outcomes data were collected. Main outcome measures were time from diagnosis to death and predictors of metastasis and death. In all, 60% of group A and 40% of group B children did not present with conventional ABCDE criteria. Rather, amelanosis, bleeding, "bumps," uniform color, variable diameter, and de novo development were most common. Histopathological subtypes differed significantly between groups (P = .002). In all, 44% were histopathologically unclassifiable using current melanoma subtypes. Stage IIA disease or higher comprised 92% and 46% of groups A and B, respectively (P = .05). Ten patients died: 1 in group A and 9 in group B. Of these, 70% had amelanotic lesions, and 60% had at least 1 major risk factor. Breslow thickness predicted metastasis (adjusted odds ratio 12.8 [CI 1.4-115]). The retrospective design resulted in incomplete data capture. Additional ABCD detection criteria (Amelanotic; Bleeding, Bump; Color uniformity; De novo, any Diameter) used together with conventional ABCDE criteria may facilitate earlier recognition and treatment of melanoma in children.

Assessing hairdressers' knowledge of scalp and neck melanoma and their willingness to detect lesions and make referrals to dermatologists

Assessing hairdressers' knowledge of scalp and neck melanoma and their willingness to detect lesions and make referrals to dermatologists

Primary Tumor Thickness as a Prognostic Factor in Merkel Cell Carcinoma: The Next Big Thing?

Fifty years ago, there was a cutaneous malignancy that was rapidly increasing in incidence and beginning to receive serious scrutiny by surgical oncologists, dermatopathologists, and dermatologists. It nearly always presented at a locally advanced stage with an expectation of a poor outcome. Prognostic factors were poorly understood, so the occasional patient with advanced disease who defied expectations and survived long-term was a notable and mysterious case. Controversy surrounded the management of the regional lymph nodes, despite recognition that they were frequently the first (and sometimes the only) site of metastatic involvement—in part because of pessimism that distant dissemination of tumor had already occurred and hence treating the nodes was a futile effort. The name of this malignancy? Melanoma. So what changed over the past 5 decades? One of the most significant advances in understanding the prognosis of melanoma came in 1969, when Wallace Clark and colleagues called attention to the prognostic significance of the level of tumor invasion into the dermis. Soon thereafter, Alexander Breslow introduced the micrometer measurement of tumor thickness that now bears his name. Importantly, Breslow showed that tumor thickness was a better prognostic marker than Clark’s levels of invasion or measured tumor diameter, while noting that ‘‘in general all measurements of tumor size increased with the stage of invasion, but there was a great deal of overlap.’’ Unfortunately, in 1970, relatively few melanomas were diagnosed at the earliest stages of thickness and invasion that portended a favorable prognosis. A second transformational event was the introduction of easily understandable and applicable diagnostic criteria for identifying pigmented lesions suspicious for representing early melanoma (and hence requiring biopsy)—the ABCD criteria. Increasingly, melanomas were diagnosed at an early stage where the expectation was for an excellent outcome, and those few patients who developed distant disease were an exception to the norm. Indeed, outcomes quickly improved to the point that aggressive surgical management of the regional nodes became controversial because of the perception that most patients would not have evidence of metastasis and hence were being subjected to morbidity without prospect of benefit. Of course, this set the stage for the third revolutionary development—sentinel lymph node biopsy. At last, melanomas with early dissemination to the regional nodes could be reliably identified and treated, and the number of cases with truly unexpected outcomes dramatically decreased. Even with recognizing how far we have come in this disease, thick melanomas are still a major challenge, especially in elderly patients. Once a melanoma exceeds 4 mm in thickness, while ulceration and sentinel node status retain prognostic importance, our ability to predict which patients will do well or poorly is fairly limited. Nonetheless, the recognition of the clinical significance of that 4 mm thickness cutoff has unequivocally improved our understanding of the natural history of melanoma. Today, there is another cutaneous malignancy, Merkel cell carcinoma, that is rapidly increasing in incidence and beginning to receive serious scrutiny by surgical oncologists, dermatopathologists, and dermatologists. It nearly always presents at a locally advanced stage, usually in This is an Editorial commentary regarding the article by Lim et al. doi:10.1245/s10434-012-2509-x.

Melanoma recognition framework based on expert definition of ABCD for dermoscopic images

Melanoma Recognition based on clinical ABCD rule is widely used for clinical diagnosis of pigmented skin lesions in dermoscopy images. However, the current computer-aided diagnostic (CAD) systems for classification between malignant and nevus lesions using the ABCD criteria are imperfect due to use of ineffective computerized techniques. In this study, a novel melanoma recognition system (MRS) is presented by focusing more on extracting features from the lesions using ABCD criteria. The complete MRS system consists of the following six major steps: transformation to the CIEL*a*b* color space, preprocessing to enhance the tumor region, black-frame and hair artifacts removal, tumor-area segmentation, quantification of feature using ABCD criteria and normalization, and finally feature selection and classification. The MRS system for melanoma-nevus lesions is tested on a total of 120 dermoscopic images. To test the performance of the MRS diagnostic classifier, the area under the receiver operating characteristics curve (AUC) is utilized. The proposed classifier achieved a sensitivity of 88.2%, specificity of 91.3%, and AUC of 0.880. The experimental results show that the proposed MRS system can accurately distinguish between malignant and benign lesions. The MRS technique is fully automatic and can easily integrate to an existing CAD system. To increase the classification accuracy of MRS, the CASH pattern recognition technique, visual inspection of dermatologist, contextual information from the patients, and the histopathological tests can be included to investigate the impact with this system.

Low risk of vascular events following urgent treatment of transient ischaemic attack: the Aarhus TIA study

Patients with TIA have a high short-time risk of stroke and an increased long-term risk of ischaemic vascular events compared with the general population. Urgent intervention may reduce short-time stroke risk, but little is known about the effect beyond 3 months. We examined 1-year outcome and risk factor management in patients with TIA after urgent intervention. All patients with TIA referred to Aarhus University Hospital 1 March 2007-28 February 2008 were seen by an acute TIA team (ATT), integrating outpatient care and stroke unit facilities. Preventive treatment was initiated immediately, including fast-track surgery for carotid stenosis. Follow-up including nurse-conducted health counseling was carried out after 7, 90, and 365 days. A total of 306 patients were included. Stroke, myocardial infarction, or vascular death occurred in 5.2% during 1 year of follow-up. The cumulated stroke rate was 1.6%, 2.0%, and 4.4% after 7, 90, and 365 days, respectively, compared to expected 4.5% [relative risk (RR) 0.36, 95% CI 0.13-0.98] and 7.5% (RR 0.26, 95% CI 0.11-0.63) after 7 and 90 days using ABCD(2) criteria. Recurrent TIA occurred in 10.2% (n = 32). Secondary prevention targets were attained in 47.6% after 1 year. Carotid surgery was performed in 8.1%; median time to operation was 11 days after contact with the ATT. Urgent intervention after TIA by an ATT covering outpatient and stroke unit facilities combined with nurse-conducted health counseling is associated with a low 1-year risk of new vascular events and may improve risk factor control.

Melanomas Detected in a Follow-up Program Compared With Melanomas Referred to a Melanoma Unit

To compare melanomas diagnosed in patients included in follow-up programs with melanomas diagnosed in patients referred to a melanoma unit. Retrospective analysis of 215 consecutive melanomas diagnosed between 2007 and 2008. Melanoma Unit, Hospital Clinic of Barcelona, Barcelona, Spain. The study included 201 patients (105 men and 96 women), 40 of whom were included in a follow-up program in our unit and 161 of whom were referred for evaluation. Clinical (ABCD algorithm), dermoscopic (ABCD rule of dermoscopy), and main histologic characteristics were evaluated in both groups. Most melanomas diagnosed in follow-up did not fulfill some of the ABCD criteria, and only 12.0% fulfilled all 4 ABCD criteria, in contrast with 63.6% of the melanomas referred for evaluation (P < .001). The total dermoscopy score was lower in melanomas diagnosed in follow-up (5.04 vs. 6.39, P < .01), and 36% were misclassified as benign in this group according to the total dermoscopy score. Seventy percent of melanomas diagnosed in follow-up were in situ; among invasive melanomas, the Breslow index was significantly lower in the group of melanomas diagnosed in follow-up, with a mean (range) of 0.55 (0.25-0.90) mm vs 1.72 (0.25-13.00) mm (P < .001). The inclusion of patients who are at high risk for melanoma in follow-up programs allows the detection of melanomas in early stages, with good prognosis, even in the absence of clinical and dermoscopic features of melanoma. In the general population without specific surveillance, melanoma continues to be diagnosed at more advanced stages.