Evaluation Of Pigmented Skin Lesions Research Articles

Dermoscopy Education for Plastic Surgery Residents: How a Brief Theoretical Course and Practical Training Have an Impact.

Currently, the evaluation of pigmented skin lesions relies on dermoscopy, which has become the standard of care. As melanoma is one of the principal areas of expertise in plastic surgery, it is essential that diagnostic skills be acquired during the course of specialization. This study aimed to assess the impact and effectiveness of a brief and intensive dermoscopy training program for plastic surgery residents. This study was carried out on a group of 41 doctors, who were divided into three categories based on their experience in dermoscopy (none, intermediate, and advanced). A preliminary assessment of each participant's baseline knowledge was conducted by using a 15-query test. Subsequently, the participants attended a 90-minute lecture on diagnostic techniques and the process of differentiating between various skin lesions. To determine the effectiveness of the lecture in improving diagnostic skills, the participants were tested immediately after the lecture and again after a 3-month period. At the conclusion of the final examination, all three groups achieved an accuracy rate of at least 80% for dermatoscopic diagnosis. However, none of the groups was completely successful. The variations in diagnostic accuracy among the three groups are presented, and P values were calculated for each group. The short, intensive course of dermoscopy has proven to have a significant positive impact on plastic surgeons in their postdegree training program.

Revisited Otsu Algorithm for Skin Cancer Segmentation

Computer-aided technology can be used to perform a quantitative and objective evaluation of pigmented skin lesions during the clinical assessment procedure. This helps to expedite the procedure. The growing development of non-invasive techniques can be of significant benefit in the early identification of malignant melanoma, which can, in turn, help to minimize the necessity for invasive biopsies. The system is primarily focused on two principal schemes: Establishing an effective lesion border detection method and then creating an efficient classification scheme. We address two primary areas in this work. First, we study skin lesion detection to analyze any sign of malignancy for skin cancer diagnosis. This is followed by the system implementation of a color-based method for all the images from the RGB color space using a revisited OTSU thresholding segmentation scheme. The results proved to be promising with at least an 80% accuracy detection rate for a wide range of clinical skin lesion images.

Analysis of pigmented skin lesions and malignant melanoma by Laser Doppler flowmetry - Report of different cases and further analysis by a neuronal network.

Dermatoscopy is successfully used for the early diagnosis of suspicious skin lesions, however, correct diagnosis depends on training. There is evidence that wavelet analysis by Laser Doppler flowmetry (LDF) can identify malignant melanomas by their hypervascularization and changes in the capillary morphology. To show the capability of LDF in the distinction of melanomas and benign pigmented skin lesions based on data collected over 16 years. Evaluation of pigmented skin lesions was based on clinical information. The LDF measurements were taken. The suspect lesion was excised afterwards for histological work-up. Four case reports are presented. Data collected over 16 years was processed into a neuronal network to estimate the dignity of the lesion. A total of 517 suspicious lesions were analyzed by LDF. In the histological work-up, 114 lesions turned out to be melanomas, whereas 403 benign naevi were secured. Specificity to detect melanomas was good based on the clinical information. The LDF increases the sensitivity of melanoma detection, which is also illustrated in four case reports. In addition to clinical parameters, such as color and border, information from the LDF can help in the diagnosis of malignant melanomas. The LDF provides information on the vascularization of the skin lesion.

Teledermoscopy in High-risk Melanoma Patients: A Comparative Study of Face-to-face and Teledermatology Visits.

Teledermoscopy is considered a reliable tool for the evaluation of pigmented skin lesions. We compared the management decision in face-to-face visits vs. teledermatology in a high-risk melanoma cohort using total-body photography, macroscopic and dermoscopic images of single lesions. Patients were assessed both face-to face and by 4 remote teledermatologists. Lesions identified as suspicious for skin cancer by face-to-face evaluation underwent surgical excision. The teledermatologists recommended "self-monitoring", "short-term monitoring", or "excision". A 4-year monitoring was completed in a cohort of participating subjects. The general agreement, calculated by prevalence and bias-adjusted κ (PABAK), showed almost perfect agreement (PABAK 0.9-0.982). A total of 23 lesions were excised; all teledermatologists identified the 9 melanomas. The greatest discrepancy was detected in "short-term monitoring". During 4-year monitoring one melanoma was excised that had been considered benign. In conclusion, melanoma identification by experts in pigmented lesions appears to be equivalent between face-to-face and teledermatological consultation.

Dermoscopy for the Pediatric Dermatologist Part III: Dermoscopy of Melanocytic Lesions

Melanocytic nevi encompass a variety of lesions, including blue, Spitz, congenital, and acquired nevi. These nevi can occasionally manifest clinical morphologies resembling melanoma, and the presence of such nevi in children can elicit anxiety in patients, parents, and clinicians. Dermoscopy has been shown to increase the diagnostic accuracy for melanoma and to help differentiate melanoma from nevi, ultimately aiding in the decision-making process as to whether to perform a biopsy. Dermoscopy is the perfect instrument to use during the evaluation of pigmented skin lesions in children because it is painless and provides important information for the clinician that can assist in formulating appropriate management decisions. This review highlights the most common benign dermoscopic patterns encountered in nevi and discuss the 10 most common dermoscopic structures seen in melanomas. Lesions manifesting a benign dermoscopic pattern and lacking any melanoma-specific structures do not need to be excised and can safely be monitored. In contrast, melanomas will invariably deviate from the benign nevus patterns and will usually manifest at least 1 of the 10 melanoma-specific structures: atypical network, negative network, streaks, crystalline structures, atypical dots and globules, irregular blotch, blue-white veil, regression structures, peripheral brown structureless areas, and atypical vessels. It is important to be cognizant of the fact that melanomas in childhood usually do not manifest the clinical ABCD features. Instead, they are often symmetric, amelanotic, nodular lesions. Although the clinical appearance may not be alarming, with dermoscopy they will invariably manifest at least one melanoma-specific structure, the most common being atypical vascular structures and crystalline structures.

Dermatoscopy: An overview of subsurface morphology

Within the past two decades, an exponential number of publications have emerged on the topic of dermatoscopy, most, if not all, reporting the benefits of using a dermatoscope. Dermatoscopy has been promoted to be useful in diagnosing not only pigmented skin lesions but also a wide range of skin conditions that are infectious, hamartomatous, and inflammatory in nature. Whether or not dermatoscopy truly has a relevant diagnostic role in such a wide range of skin conditions remains to be proven. The diagnostic technique, however, has fundamentally changed the way pigmented lesions are evaluated by dermatologists, as it offers a more methodical and disciplined approach to evaluate them. This review highlights the contribution of dermatoscopy with respect to morphologic characterization and evaluation of pigmented skin lesions.

Feasibility of a Two-Step Teledermatologic Approach for the Management of Patients with Multiple Pigmented Skin Lesions

BACKGROUND Recent studies demonstrating accuracy of teledermatology and teledermoscopy in the evaluation of pigmented skin lesions (PSL) have been performed only on PSL previously selected by face-to-face examination. OBJECTIVES The objective was to investigate the feasibility of teledermatology for the management of individuals exhibiting multiple PSL with a two-step procedure. MATERIALS AND METHODS In the first step, remote consultants selected clinically equivocal lesions evaluating a teletransmitted clinical image of patients' backs. In the second step, dermoscopic images of selected lesions were evaluated. Management recommendations of both steps were compared with face-to-face. RESULTS For a total of 465 PSL in 18 patients, the agreement between the face-to-face and the two remote experts resulted moderate (κ value, 0.530–0.565) in the first step and substantial (κ value, 0.681–0.703) in the second step. CONCLUSIONS Although there are limitations of this pilot experience (population and technical restrictions), our results provide preliminary evidence that a two-step teledermatologic approach may be feasible in managing individuals with multiple PSL.

Feasibility of a Two-Step Teledermatologic Approach for the Management of Patients with Multiple Pigmented Skin Lesions

Recent studies demonstrating accuracy of teledermatology and teledermoscopy in the evaluation of pigmented skin lesions (PSL) have been performed only on PSL previously selected by face-to-face examination. The objective was to investigate the feasibility of teledermatology for the management of individuals exhibiting multiple PSL with a two-step procedure. In the first step, remote consultants selected clinically equivocal lesions evaluating a teletransmitted clinical image of patients' backs. In the second step, dermoscopic images of selected lesions were evaluated. Management recommendations of both steps were compared with face-to-face. For a total of 465 PSL in 18 patients, the agreement between the face-to-face and the two remote experts resulted moderate (kappa value, 0.530-0.565) in the first step and substantial (kappa value, 0.681-0.703) in the second step. Although there are limitations of this pilot experience (population and technical restrictions), our results provide preliminary evidence that a two-step teledermatologic approach may be feasible in managing individuals with multiple PSL.

High‐resolution ultrasound reflex transmission imaging and digital photography: potential tools for the quantitative assessment of pigmented lesions

High-resolution ultrasound (HRU) is a relatively cheap imaging method that shows small quantitative differences between benign naevi and melanoma. Previous studies using B-mode display suggest that these arise from their differing attenuating properties. Attenuation characteristics, however, are better evaluated using reflex transmission imaging (RTI). White light clinical (WLC) photography is an even cheaper imaging method that is routinely used for monitoring but less frequently in everyday diagnosis. As features from each method may have an independent origin, two such modalities may be of greater diagnostic value than either method alone. However, although quantitative analysis of digital photographs is being developed to aid tumour diagnosis, in vivo RTI for the evaluation of pigmented skin lesions has not previously been described. This paper presents the feasibility of performing RTI in vivo and evaluates the reliability of the objective features used. The potential of the combination of quantitative RTI and white light (WL) digital photography data for the classification of pigmented lesions was assessed. Randomly selected patients were recruited via a skin cancer screening clinic. RTI data were acquired from each index lesion with a 20 MHz single-element scanner. WL images were taken using a high-resolution (2.8 Mpixels) digital camera. Quantitative features calculated from both images were used to derive a discriminant rule. This equation was then applied to reclassify each case based on its quantitative criteria. The resultant classification was compared with histological diagnosis. Twenty-four lesions (10 melanoma and 14 naevi) were studied. On RTI, no subjective differences were observed between benign naevi and melanoma. Many lesions were either not visible on RTI or lacked clearly definable borders. Consequently, the WL photographs were used to draw lesion boundaries on RT images for feature calculation. Melanoma were less attenuating than naevi on RTI (P=0.026) and had greater red colour variegation on WL imaging (P=0.016). The combination of quantitative parameters (two from RTI and four from photographs) improved sensitivity for this sample without compromising the specificity of 100% compared with either modality alone. The procedure is highly reproducible (r=0.85 between two operators). Pigmented skin lesions can be quantitatively defined from RTI data acquired in vivo and a significant difference in attenuation is shown. However, accurate registration of the RT image with a corresponding photograph was crucial for this purpose and only possible when corresponding points could be reliably identified on both images. Combination of features from ultrasound and optical images may synergistically improve diagnostic accuracy and a larger study is warranted to investigate this.

Computer-aided dermoscopy for diagnosis of melanoma

BackgroundComputer-aided dermoscopy using artificial neural networks has been reported to be an accurate tool for the evaluation of pigmented skin lesions. We set out to determine the sensitivity and specificity of a computer-aided dermoscopy system for diagnosis of melanoma in Iranian patients.MethodsWe studied 122 pigmented skin lesions which were referred for diagnostic evaluation or cosmetic reasons. Each lesion was examined by two clinicians with naked eyes and all of their clinical diagnostic considerations were recorded. The lesions were analyzed using a microDERM® dermoscopy unit. The output value of the software for each lesion was a score between 0 and 10. All of the lesions were excised and examined histologically.ResultsHistopathological examination revealed melanoma in six lesions. Considering only the most likely clinical diagnosis, sensitivity and specificity of clinical examination for diagnosis of melanoma were 83% and 96%, respectively. Considering all clinical diagnostic considerations, the sensitivity and specificity were 100% and 89%. Choosing a cut-off point of 7.88 for dermoscopy score, the sensitivity and specificity of the score for diagnosis of melanoma were 83% and 96%, respectively. Setting the cut-off point at 7.34, the sensitivity and specificity were 100% and 90%.ConclusionThe diagnostic accuracy of the dermoscopy system was at the level of clinical examination by dermatologists with naked eyes. This system may represent a useful tool for screening of melanoma, particularly at centers not experienced in the field of pigmented skin lesions.

Telederm.org: Freely Available Online Consultations in Dermatology

“e-Health matters. It can improve access to healthcare and boost the quality and effectiveness of the service offered. e-Health describes the application of information and communications technologies across the whole range of functions that affect the health sector.” This is the introductory statement of a recent communication from the European Commission that produced the report “e-Health—Making Healthcare Better for European Citizens: An Action Plan for a European e-Health Area” [1]. Easy access to expert medical information and counseling independent of social, economic, ethnic, and regional factors is regarded as a major goal of medical policy today. The visual nature of dermatology makes this discipline an obvious candidate for telemedicine techniques, and the feasibility and reliability of teledermatology is already well-established [2,3]. In recent years the teledermatology group of the Department of Dermatology at the Medical University of Graz, Austria, has been involved in several national and international teledermatology projects, with particular emphasis on clinical dermatology, clinicopathologic correlation, and evaluation of pigmented skin lesions [4,5]. Among the activities of the teledermatology group was the organization of the Third European Symposium on Teledermatology in Graz in November 2002 (http://telederm.uni-graz.at). Furthermore, together with colleagues from the Department of Dermatology in Jena, Germany, the Graz teledermatology group founded the International Society of Teledermatology (http://www.teledermatology-society.org), whose goal is to promote the worldwide exchange of knowledge and expertise in all aspects of dermatology.

Community perceptions of suspicious pigmented skin lesions: are they accurate when compared to general practitioners?

Community responses ( n = 925, response rate = 71%) of a series of eight photographs of pigmented skin lesions were compared against those of general practitioners ( n = 114, response rate = 77%), considered to be the most relevant gold standard. The eight photographs included three melanomas, two potentially malignant lesions and three benign pigmented lesions. Over the pool of lesions examined, the average probability that community members thought a lesion was likely to be skin cancer (0.68 [99% CI = 0.66–0.69]) was higher ( p < 0.0001) than that of the comparison general practitioners 0.58 [99% CI = 0.55–0.62]. This reflects a general (but not consistent) inflated propensity to over-diagnose among community members. The average probability that respondents indicated they would seek medical advice for a lesion was 0.71 [99% CI = 0.70–0.73]. As expected, this was strongly associated with their perceptions of the skin lesion. These results suggest that the community can play a valuable role in assessing the need for medical evaluation of pigmented skin lesions.

The 'common mole' from the point of view of digital dermoscopy analysis: subjective vs. objective evaluation of easy pigmented skin lesions.

The term 'common mole', often used to describe a subset of benign pigmented skin lesions, is traditionally defined on the basis of morpho-chromatic features. In recent years, certain research groups have developed equipment and methods, such as digital dermoscopy analysis, that enable objective evaluation of pigmented skin lesions. In this study we use a digital dermoscopy analyser trained for the recognition of pigmented skin lesions to compare the subjective definition of 'common' and the mathematical concept of 'close to the mean of measurements'. A subset (100) of digital images of flat pigmented lesions, obtained in daily practice, were classified by trained and non-expert clinicians as common moles (60) or clear-cut melanoma (40), and processed with a DB-Mips analyser. The resulting parameters, validated by a classifier, were used to evaluate Hotelling's T2 multivariate distances from the mean. 'Common' moles could not be clearly defined in terms of closeness to the means of objectively evaluated parameters. Their diagnosis indudes many other evaluations and clusters of variables. The clinical semantics of the term 'common' does not conform to any unambiguous mathematical definition.

Automated diagnosis of pigmented skin lesions.

Since advanced melanoma remains practically incurable, early detection is an important step toward a reduction in mortality. High expectations are entertained for a technique known as dermoscopy or epiluminescence light microscopy; however, evaluation of pigmented skin lesions by this method is often extremely complex and subjective. To obviate the problem of qualitative interpretation, methods based on mathematical analysis of pigmented skin lesions, such as digital dermoscopy analysis, have been developed. In the present study, we used a digital dermoscopy analyzer (DBDermo-Mips system) to evaluate a series of 588 excised, clinically atypical, flat pigmented skin lesions (371 benign, 217 malignant). The analyzer evaluated 48 parameters grouped into 4 categories (geometries, colors, textures and islands of color), which were used to train an artificial neural network. To evaluate the diagnostic performance of the neural network and to check it during the training process, we used the error area over the receiver operating characteristic curve. The discriminating power of the digital dermoscopy analyzer plus artificial neural network was compared with histologic diagnosis. A feature selection procedure indicated that as few as 13 of the variables were sufficient to discriminate the 2 groups of lesions, and this also ensured high generalization power. The artificial neural network designed with these variables enabled a diagnostic accuracy of about 94%. In conclusion, the good diagnostic performance and high speed in reading and analyzing lesions (real time) of our method constitute an important step in the direction of automated diagnosis of pigmented skin lesions.

Digital videomicroscopy improves diagnostic accuracy for melanoma

Background: To enhance the clinical evaluation of pigmented skin lesions (PSL), examination of PSL at a high magnification and computer-aided diagnosis have been introduced. Besides surface microscopes, “videomicroscopes” that are provided with polarized light are commercially available. Images recorded in the polarizing mode are comparable with those obtained after application of a drop of oil and a glass slide. Objective: The purpose of this study was to evaluate the usefulness of a digital videomicroscope equipped with a dedicated program for the diagnosis of melanocytic PSL by assessing the digital features referring to benign and malignant PSL images and by comparing the clinical assessment performed on 20-fold magnified images to computer diagnosis that were provided by the discriminant analysis calculation carried out on the numeric values describing the images. Methods: Nine hundred seventeen melanocytic PSL images, corresponding to 852 nevi and 65 melanomas, were considered. For microscopic examination, a 10- (39 cases), 20- (501 cases), or 50-fold magnification (377 cases) was chosen according to the size of the lesion, enabling the whole lesion to be seen on the monitor. All digital images were framed and analyzed with software that calculates different features related to the geometry, color distribution, and internal pattern of the lesion. Features referring to benign and malignant PSL were compared. Moreover, 90 PSL images recorded by a ×20 magnification, corresponding to 59 benign PSL and 31 malignant melanomas, were evaluated by 2 observers, 1 observer experienced in videomicroscopy and 1 observer, an untrained dermatologist. Sensitivity and specificity were estimated for observer assessment and computer diagnosis. Results: Significant differences between values referring to benign and malignant PSL were observed for most numeric features. Sensitivity was higher for the computer assessment and lower for the inexperienced observer, whereas specificity was the same for the computer and the trained observer. Conclusion: Numeric features referring to benign PSL significantly differ from those of malignant PSL images. Elaboration of videomicroscopic images by means of a dedicated program improves diagnostic accuracy over the simple examination of pigmented skin lesions by means of magnifying and polarizing systems. (J Am Acad Dermatol 1998;39:175-81.)

Epiluminescence Microscopy versus Clinical Evaluation of Pigmented Skin Lesions: Effects of Operator’s Training on Reproducibility and Accuracy

Background: An acceptable level of reliability is a prerequisite for the introduction of epiluminescence microscopy (ELM) into the diagnosis of pigmented skin lesions. Objective: To assess the effects of a training program on the reproducibility and accuracy of ELM as compared to clinical evaluation. Methods: Before and after the program, 48 clinical images and their ELM counterparts were independently evaluated by seven participants. Reproducibility was measured by the κ index, accuracy by the rate of exact diagnoses (RED) assuming histology as a reference. Results: We observed (i) no effect of training on clinical reproducibility, (II) an improved reproducibility of ELM diagnoses of nonmelanocytic lesions (NML) and melanomas but not of melanocytic nevi (MN), (iii) a greater increase in the clinical RED of NML and melanomas compared with MN and (iv) a similar though more pronounced increase in the RED on ELM. Conclusions: The effects of training were greater for ELM as compared to clinical diagnosis, and for NML and melanomas as compared to MN.