Diagnosis Of Pigmented Skin Tumors Research Articles

Sensitivity and specificity of exvivo dermatoscopy: a case series.

Sensitivity and specificity of exvivo dermatoscopy (EVD) for malignancy detection of skin tumors is unknown. We sought to assess whether the use of EVD could be a useful adjunct to histopathological diagnosis of pigmented skin tumors, including cases where complete clinical information is inadequate or missing. EVD was performed on 195 excised, formalin-fixed pigmented skin tumors. Of 183 eligible lesions, 104 (56.8%) were melanocytic and 79 (43.2%) nonmelanocytic. Overall, 54 (29.5%) were malignant: 10 melanomas, 39 basal cell carcinomas, and five squamous cell carcinomas. Ex vivo images were devoid of red color. The following colors were seen: light and dark brown, grey, blue, black, and white. All structures typical for pigmented melanocytic and nonmelanocytic lesions were observed. In malignant nonmelanocytic lesions, diagnostic accuracy and sensitivity for malignant/benign decision was not better when combining visual assessment and EVD but diagnostic specificity improved by 3.0%. For melanoma, combined diagnostics improved diagnostic accuracy, sensitivity, and specificity for 9.6, 30.0, and 7.5%, respectively. For dermatopathologists, EVD offers increased specificity for all categories of tumors and increased diagnostic accuracy, sensitivity, and specificity for melanoma. With EVD view, the dermatopathologist can instantly find areas of interest, thus minimizing the possibility for missing a malignant lesion.

SPECTROPHOTOMETRIC DIAGNOSIS OF DERMATOSCOPIC IMAGES OF PIGMENTED SKIN TUMORS

The method of diagnosis of pigmented skin tumors using spectrophotometric analysis (SPM) of dermatoscopic images was analyzed in the article. The obtained results indicate the possibility of using SPM as an addition to the standard methods of dermatoscopic diagnostics to make the correct diagnosis that is confirmed by clinical examples and are histologically proven.

Assessment of SIAscopy in the triage of suspicious skin tumours

Spectrophotometric Intracutaneous Analysis (SIAscopy) is a non-invasive, computerized technique for the diagnosis of pigmented skin tumours. The analysis is based on the evaluation of skin chromophores, i.e. melanin, haemoglobin and collagen within the epidermis and papillary dermis. Our aim was to assess the diagnostic validity of SIAscopy in the detection of melanoma and non-melanoma skin cancers compared to the clinical-dermoscopic diagnosis and the histopathologic results of the excised lesions. In total, 188 lesions of 180 patients were examined by dermoscopy and SIAscopy. A SIAscopy scoring system was first compared with the clinical-dermoscopic diagnosis and then with the histopathologic diagnosis of the excised lesions. With respect to the clinical-dermoscopic evaluation, SIAscopy had sensitivity and specificity values of 85.7% and 65.4% respectively. Of the 188 evaluated lesions, 44 were excised with histopathologic examination revealing 31 malignant tumours, including 18 melanomas. With respect to histopathology SIAscopy had a sensitivity of 83.9%. Seven of the 13 benign excised lesions were scored as malignant by SIAscopy resulting in a specificity of 46.1%. SIAscopy cannot replace the standard of care in skin cancer diagnosis, which includes clinical and dermoscopic examination. However, considering that the technique does not require specific training and expertise, it might represent an additional, relatively cost-effective tool to select lesions for referral.

Diagnosis of Pigmented Skin Tumours in a Dermatological Setting: Different Aspects of the Number Needed to Excise as a Measure of Efficiency

The increasing incidence of melanoma prompts a need for efficient management of this patient group. In this study, we use the number needed to excise (NNE), as a measurement of the efficiency of diagnosing melanoma. From January 2009 to December 2012, postoperative records from all patients were prospectively registered. All excised tumours with the histopathological diagnosis of naevus, melanoma or seborrhoeic keratosis were included. NNE values, both excluding and including seborrhoeic keratosis, changes over time, as well as patient- and tumour-related factors influencing NNE were determined. In total, 1,717 cases were included. The overall NNE value was 6.5, and the value fell significantly (r = 0.959, p = 0.041) during the 4-year study period from 8.2 to 4.8. NNE values decreased with increasing patient age to 1.8 in patients ≥ 80 years of age. The overall NNE value including seborrhoeic keratosis was 6.8.

Hidden under a Cauliflower-Like Skin Tumor: Chromoblastomycosis

We present the case of an 80-year-old patient with a recurrent hyperpigmented and cauliflower-like skin tumor on the stump of his left index finger. Despite suggestive clinical appearance for chromoblastomycosis the tumor was initially clinically and also histopathologically misdiagnosed as recurrent squamous cell carcinoma. Due to a cardiogenic shock, the patient died shortly after the diagnosis of chromoblastomycosis, before adequate treatment could be introduced. In non-tropical regions chromoblastomycosis is an uncommon chronic fungal infection with Fonsecaea pedrosoi being the most prevalent etiological agent. Mostly lower extremities are involved. It is not unusual that, clinically, in the absence of pigmentation, and, histopathologically, because of pseudoepitheliomatous hyperplasia of the epidermis, chromoblastomycosis is confounded with squamous cell cancer, and delays in diagnosis of one to 3 years are common. Therefore, a high grade of clinical suspicion and inclusion of chromoblastomycosis in the differential diagnosis of pigmented skin tumors are important to initiate adequate therapy. Our case is remarkable in many aspects. The localization on an upper extremity and the grade of invasiveness with involvement of bone are unusual; furthermore the lack of a tropical travel history emphasizes that the infection almost surely occurred in Switzerland.

In vivo differentiation of pigmented skin tumors with laser Doppler perfusion imaging

Malignant melanomas show a higher heterogeneity in their architecture and a higher vessel density because of neovascularization compared to benign melanocytic skin tumours. In this study the validity of the newly developed Laser Doppler Perfusion Imager (LDPI) with a lateral resolution of 100 microns in the differential diagnosis of pigmented skin tumours was investigated. The perfusion of 116 pigmented skin tumours was s measured with LDPI; 44 malignant melanomas, five melanoma metastases, 59 dysplastic nevi and eight basal cell carcinomas were studied before excision for precise histological diagnosis. There is a significantly higher perfusion of the malignant melanomas (3.15 +/- 1.87 AU) compared to dysplastic nevi (1.14 +/- 0.97 AU) (p < 0.01). By calculating a ratio of the mean perfusion in the tumour and the mean perfusion in adjacent healthy skin, the potential source of error because of regional differences in perfusion is eliminated. The ratio of malignant melanomas (10.78 +/- 9.18) is significantly higher than these of melanoma metastases (4.20 +/- 1.66), basal cell carcinomas (3.24 +/- 1.32) and dysplastic nevi (2.85 +/- 1.32). The high resolution LDPI has the potential to be a non-invasive screening method for preoperative differential diagnosis of pigmented skin tumours. Besides the epiluminescence microscopy and sonographic determination of the tumour thickness, we have now the possibility to get preoperative information about tumour vascularization.

Korrelation auflichtmikroskopischer Charakteristika maligner Melanome mit den Tumor- Invasionsstufen nach Clark

Many epiluminescence microscopy (ELM) characteristics of malignant melanoma support the differential diagnosis of pigmented skin tumors. A preinvasive evaluation of level of invasion would be valuable for planning the excision margins. Since sonography for tumor thickness measurement is rarely available in a practice we searched for specific ELM criteria correlating with Clark's level of invasion. In our retrospective study of 120 malignant melanomas of 30 ELM features were studied for their correlation and the association was significant for 15 features.The following criteria were found only in level III-IV melanomas: intralesional horizontally elongated blood vessels, spontaneous microhemorrhages, plaster-of-Paris-like lacunae, grey-blue/yellowish-brown/reddish saccular pattern and eccentric nodes (reddish, livid, blue). 7 characteristics were predominantly found in level III-IV melanomas and seldom in "thin" melanomas (level I-II): deeply localized gray-blue/-brown fragmentary network, whitish-opaque septa, whitish- or bluish-opaque veil, negative pigmented network, areola with evenly arranged capillaries, polymorphic capillaries. Perivascular melanophages, eccentric dark blotches, pseudotrabeculae of melanophages and greyish-blue annular perifollicular pigmentations were the most significant association of ELM criteria in "thin" melanomas (level I-II). Epiluminescence microscopy is not only a tool for the differentiation of melanocytic lesions but also for a preinvasive evaluation of Clark's level of invasion.

TME15/458: Next Generation Telemedicine Network Service for Counselling on Diagnosis of Pigmented Skin Tumours at the Point of Care

IntroductionIt is estimated that one in every 70 persons born in 2000 will develop malignant melanoma, one of the most deadly forms of cancer, and that the number of cases doubles every 6 years. The progressing sub-specialisation in medicine results in concentration of experts in few medical centres and deficits of expert knowledge in other, predominantly rural areas. The patient has to be sent to an expert in a medical centre for further diagnosis, which means inconvenience for the patient and costs for the medical care system. Contact between physicians and specialists will be strengthened and the transfer of medical knowledge from centres to periphery intensified.MethodsTeledermoscopy, the combined use of dermoscopy and telemedicine technologies represents a new approach for the diagnosis of pigmented skin tumours including malignant melanomas. Value of new internet technologies to examine the skin of patients with digital cameras, sending the pictures to centres of excellence for diagnoses and returning them to the points of care will be proven. The possibility of the immediate second opinion on diagnoses is a major advantage of this network.ResultsA network infrastructure, consisting of computer systems, software and communications equipment to support teledermoscopy services will be installed. Applications based on expertise in medicine as well as information technologies will be developed, allowing multi-lingual, user-friendly and secure access to the network from any computer connected to the Internet. Examination of patients will be performed on a face-to-face basis in centres of excellence and by about thirty general physicians and dermatologists. For the purpose of dermatalogic diagnostics different digital cameras will be evaluated. Digital images will be electronically submitted to the TELDOM Platform, a multi-tier, CORBA-based distributed application framework. An automated system of image analysis in order to analyse size, structure and colours of the lesions together with a diagnostic algorithm using artificial networking techniques will be developed.DiscussionThe internet based network will develop an innovative medical system for screening, diagnosis and therapy of skin tumours. It will improve quality of life by providing a user-friendly society and thus increase quality of health by providing easy access to expert medical counselling for individuals with equivocal pigmented skin tumours which will be realised with new generation telemedicine systems for teleconsultation and telecare at the point of need.