Experience In Dermoscopy 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.

Pattern Analysis of Benign and Malignant Atypical Melanocytic Skin Lesions of Palms and Soles: Variations of Dermoscopic Features According to Anatomic Site and Personal Experience.

Background: The differential diagnosis of atypical melanocytic skin lesions localized on palms and soles represents a diagnostic challenge: indeed, this spectrum encompasses atypical nevi (AN) and early-stage melanomas (EN) displaying overlapping clinical and dermoscopic features. This often generates unnecessary excisions or delayed diagnosis. Investigations to date were mostly carried out in specific populations, focusing either on acrolentiginous melanomas or morphologically typical acquired nevi. Aims: To investigate the dermoscopic features of atypical melanocytic palmoplantar skin lesions (aMPPLs) as evaluated by variously skilled dermatologists and assess their concordance; to investigate the variations in dermoscopic appearance according to precise location on palms and soles; to detect the features with the strongest association with malignancy/benignity in each specific site. Methods: A dataset of 471 aMPPLs-excised in the suspect of malignancy-was collected from 10 European Centers, including a standardized dermoscopic picture (17×) and lesion/patient metadata. An anatomical classification into 17 subareas was considered, along with an anatomo-functional classification considering pressure/friction, (4 macroareas). A total of 156 participants (95 with less than 5 years of experience in dermoscopy and 61 with ≥than 5 years) from 17 countries performed a blinded tele-dermoscopic pattern analysis over 20 cases through a specifically realized web platform. Results: A total of 37,440 dermoscopic evaluations were obtained over 94 (20%) EM and 377 (80%) AN. The areas with the highest density of EM compared to AN were the heel (40.3% EM/aMPPLs) of the sole and the "fingers area" (33%EM/aMPPLs) of the palm, both characterized by intense/chronic traumatism/friction. Globally, the recognition rates of 12 dermoscopic patterns were non statistically different between 95 dermatology residents and 61 specialists: aMPPLs in the plantar arch appeared to be the most "difficult" to diagnose, the parallel ridge pattern was poorly recognized and irregular/regular fibrillar patterns often misinterpreted. Regarding the aMPPL of the "heel area", the parallel furrow pattern (p = 0.014) and lattice-like pattern (p = 0.001) significantly discriminated benign cases, while asymmetry of colors (p = 0.002) and regression structures (p = 0.025) malignant ones. In aMPPLs of the "plantar arch", the lattice-like pattern (p = 0.012) was significant for benignity and asymmetry of structures, asymmetry of colors, regression structures, or blue-white veil for malignancy. In palmar lesions, no data were significant in the discrimination between malignant and benign aMPPLs. Conclusions: This study highlights that (i) the pattern analysis of aMPPLs is challenging for both experienced and novice dermoscopists; (ii) the histological distribution varies according to the anatomo-functional classification; and (iii) different dermoscopic patterns are able to discriminate malignant from benign aMPPLs within specific plantar and palmar areas.

The Comparative Use of Multiple Electronic Devices in the Teledermoscopic Diagnosis of Early Melanoma.

Background: The use of mobile electronic devices as support to medical activity was largely implemented in the past decade. Introduction: Our first aim was to evaluate the frequency of use of different electronic devices, that is, personal computer (PC), notebook, tablet, smartphone, in a pool of dermatologists recruited to perform multiple online testing session on difficult melanocytic skin lesions (MSLs) cases. The second aim was to evaluate the feasibility of each device in terms of teledermatologic diagnostic performance; the use of four different diagnostic methods, that is, intuitive diagnosis and three dermoscopic algorithms, was also investigated. Materials and Methods: A total of 111 dermatologists with 4 different levels of experience in dermoscopy, performed 4 tests (intuitive diagnosis and iDScore, ABCD rule, 7-point-checklist-based diagnosis) on 979 MSLs blinded cases. Each testing session was performed with a preferred device. Results: The overall highest areas under the receiver operating characteristic (AUROC) (82%) was obtained by young generation dermoscopists 1-4 years experience) when using an integrated clinical dermoscopic algorithm (iDScore) on a notebook. The average dermatologist using the iDScore obtained AUROC 77.40% with large screen devices (PC and notebook) 77.6% with small screen (tablet, smartphone) and 78.2% by combining the two. Discussion: Young generation of dermoscopists alternately use different devices, whereas elderly generation still prefer to use the PC. The diagnostic performances obtained with small/large screen were not statistically different from those obtained with fixed/mobile devices. Conclusions: Mobile devices were feasible tools to achieve adequate diagnostic accuracy in difficult MSLs, on a teledermatology setting, independently from participant skill level/age.

Dermoscopy, with and without visual inspection, for diagnosing melanoma in adults.

Dermoscopy, with and without visual inspection, for diagnosing melanoma in adults.

Computer-automated ABCD versus dermatologists with different degrees of experience in dermoscopy

Dermoscopy is a very useful and non-invasive technique for in vivo observation and preoperative diagnosis of pigmented skin lesions (PSLs) inasmuch as it enables analysis of surface and subsurface structures that are not discernible to the naked eye. The authors used the ABCD rule of dermoscopy to test the accuracy of melanoma diagnosis with respect to a panel of 165 PSLs and the intra- and inter-observer diagnostic agreement obtained between three dermatologists with different degrees of experience, one General Practitioner and a DDA for computer-assisted diagnosis (Nevuscreen(®), Arkè s.a.s., Avezzano, Italy). 165 Pigmented Skin Lesions from 165 patients were selected. Histopathological examination revealed 132 benign melanocytic skin lesions and 33 melanomas. The kappa statistic, sensitivity, specificity and predictive positive and negative values were calculated to measure agreement between all the human observers and in comparison with the automated DDA. Our results revealed poor reproducibility of the semi-quantitative algorithm devised by Stolz et al. independently of observers' experience in dermoscopy. Nevuscreen(®) (Arkè s.a.s., Avezzano, Italy) proved to be 'user friendly' to all observers, thus enabling a more critical evaluation of each lesion and representing a helpful tool for clinicians without significant experience in dermoscopy in improving and achieving more accurate diagnosis of PSLs.

Influence of time on dermoscopic diagnosis and management

Dermoscopy aids in clinical decision-making. However, time pressure is a common reason precluding its use. We evaluated the effect of time on lesion recognition and management decisions utilising clinical and dermoscopic images. In all, 100 dermoscopic images were presented to 15 dermatologists with experience in dermoscopy and seven non-experts (dermatology residents). Each lesion was displayed thrice in succession. The dermoscopic image was initially presented for 1 s (t1). The same dermoscopic image was shown again without time constraints (t2) and then a final time with additional images of the clinical context (t3). Participants provided a diagnosis, their level of confidence and biopsy predilection after evaluating each image. For benign lesions, both groups rarely changed their diagnosis. However, an improvement in the number of correct benign diagnoses was observed when the lesion was shown in a clinical context. For malignant lesions, both groups improved when more time and clinical context was given; nevertheless, non-experts were more likely to change the diagnosis towards the correct one as more time was given and tended to perform more biopsies, in particular of benign lesions. Limitations were a small number of participants and an artificial study setting. Dermoscopy uses analytical and non-analytical reasoning approaches. We suggest that non-analytical reasoning is employed when rapid clinical decisions need to be made, especially during the evaluation of benign lesions. We conclude that dermoscopy is relatively rapid and non-time-consuming technique that adds relevant information and guides clinicians towards appropriate management decisions.

A dermoscopy survey to assess who is using it and why it is or is not being used

Dermoscopy is a noninvasive method of evaluation of the colors and microstructures of the epidermis, dermo-epidermal junction, and papillary dermis not visible to the naked eye. These structures are correlated with histologic features and used to assess whether a lesion is benign or malignant, further indicating whether or not the lesion should be biopsied. To obtain a better understanding of how many dermatologists are utilizing dermoscopy and their reasons for doing or not doing so. A survey was conducted focusing on the prevalence of the use of dermoscopy by US dermatologists, the method by which they learned dermoscopy, how often they use or do not use it, and whether or not they feel it is effective. The survey was distributed to dermatologists attending a dermoscopy seminar at the American Academy of Dermatology's (AAD's) Summer Academy Meeting in 2007, as well as to dermatologists who expressed an interest in dermoscopy. E-mail addresses were also obtained from dermatologists who attended the AAD's Summer Academy Meeting, and subsequent surveys were e-mailed to them as a secondary means of obtaining the data. The survey was conducted online through a website: http://www.surveymonkey.com. One hundred and five dermatologists started the survey and ninety-seven finished it, a completion percentage of 92.4%. Of the 105 dermatologists who began the survey, the majority (63; 60%) had training or experience in dermoscopy, and 42 (40%) did not. Of the 63 individuals who responded positively to having training or experience in dermoscopy, the majority (41; 69.5%) learned dermoscopy through attendance of a seminar; reading a book and spending time with an experienced dermatologist were the second most popular methods of learning dermoscopy. The frequency of dermoscopy was evaluated, and it was found that 44 (42.7%) dermatologists used dermoscopy more than once daily, but 44 (42.7%) dermatologists reported never having used dermoscopy. Further information was obtained with regard to whether or not published algorithms were used by dermatologists to diagnose pigmented lesions. Pattern analysis was the most common algorithm used by 51 (89.5%) dermatologists questioned. The dermatologists were also questioned as to why they thought dermoscopy was effective or ineffective. The majority of dermatologists (32; 61.5%) believed that it was effective because it reduced patient anxiety. Helping to detect melanoma early was the second most popular reason for believing dermoscopy to be effective. Twenty-three (62.2%) dermatologists thought dermoscopy was ineffective as it was not more useful for detecting melanoma earlier than traditional methods. Eleven (29.7%) dermatologists said that they thought that dermoscopy took too long, which made it ineffective. To build on this, an additional question was asked: how long does dermoscopy take? The overwhelming response of dermatologists (52; 82.5%) was that dermoscopy took less than 1 min to evaluate one lesion. Dermoscopy is a widely used tool for the diagnosis of pigmented skin lesions. The use of dermoscopy is increasing in popularity amongst dermatologists, making it necessary to better understand dermoscopy and to analyse why physicians use it or do not use it. The survey indicated that the majority of physicians used dermoscopy in order to reduce patient anxiety and to detect melanoma early. The main reason why dermatologists found dermoscopy to be ineffective was that they felt that it was not useful in detecting melanoma earlier than traditional methods; 35% of dermatologists surveyed believed that dermoscopy required excessive training. These results imply that current training methods need to be modified. Training is limited to large dermatology centers and is not being transferred to general centers, which would allow it to be more accessible to a larger group of dermatologists in training. There is also a need to make the learning of dermoscopy easier and to establish a universal method of teaching. Overall, there is a need for improvement in the education of dermoscopy, ranging from training to information on the basics of dermoscopy. This would include aspects such as how long the average examination takes and dermoscopy's effectiveness compared with alternate methods.

Three-point checklist of dermoscopy: an open internet study

In a pilot study, the three-point checklist of dermoscopy has been shown to represent a valid and reproducible tool with high sensitivity for the diagnosis of skin cancer in the hands of a small group of nonexperts. To re-evaluate these preliminary results in a large number of observers independently from their profession and expertise in dermoscopy. The study was conducted via the internet to provide worldwide access for participants. After a short web-based tutorial, the participants evaluated dermoscopic images of 165 (116 benign and 49 malignant) skin lesions (15 training and 150 test lesions). For each lesion participants scored the presence of the three-point checklist criteria (asymmetry, atypical network and blue-white structures). Kappa values, odds ratios, sensitivity, specificity and likelihood ratios were estimated. Overall, 150 participants joined the study. The three-point checklist showed good interobserver reproducibility (kappa value: 0.53). Sensitivity for skin cancer (melanoma and basal cell carcinoma) was 91.0% and this value remained basically uninfluenced by the observers' professional profile. Only 20 participants lacking any experience in dermoscopy performed significantly more poorly, but the sensitivity was still remarkably high (86.7%) when considering that they were untrained novices in dermoscopy. The specificity was 71.9% and was significantly influenced by the profession, with dermatologists performing best. Our study confirms that the three-point checklist is a feasible, simple, accurate and reproducible skin cancer screening tool.

Diagnosis and categorization of acral melanocytic lesions using teledermoscopy

We performed a multicentre study to test the validity of teledermoscopy for diagnosing acral melanoma and to evaluate inter-observer agreement on the classification of acral melanocytic lesions. Dermoscopic images of 77 acral melanocytic lesions (71 common melanocytic naevi and 6 melanomas) were sent by email to 11 dermatologists with different degrees of experience in dermoscopy. The observers analysed the images on a computer monitor to diagnose acral melanoma or atypical lesions and to categorize all lesions. All 11 observers, regardless of their degree of experience, obtained high values for sensitivity (mean 0.91, SD 0.09) and specificity (mean 0.95, SD 0.04) with regard to the diagnosis of melanoma. The inter-observer agreement was good to excellent (kappa 0.49-0.88) for the categorization of acral melanocytic lesions. All six melanomas were correctly classified as 'atypical pattern' and all observers recommended surgical excision. Teledermoscopy represents a useful tool for the diagnosis of acral melanoma and for the categorization of patterns that suggest benign or potentially malignant acral melanocytic lesions.

Evaluation of the reproducibility of total dermoscopic score of the Stolz’s ABCD rule as a preoperative predictor of melanoma thickness

Several studies demonstrated the usefulness of dermoscopy in the preoperative detection of cutaneous melanoma thickness. Three different approaches, including pattern analysis, the combination of clinical and dermoscopic criteria, and attribution of total dermoscopic score (TDS) according to the Stolz’s ABCD rule may be used. The aim of our study was to evaluate the reproducibility of TDS of the ABCD rule as a preoperative predictor of melanoma thickness, involving dermatologists with different degrees of experience in dermoscopy. Dermoscopic images of 73 melanomas were examined by 7 dermatologists classified in two groups: experts (3) and non experts (4) in dermoscopy. The results of the study showed a 6.2 TDS cut-off point for the detection of melanomas with Breslow thickness ≥ 0.75 mm with 85.7% of sensitivity, 80.0% of specificity, and 82.2% of diagnostic accuracy (AUC value, 0.848), when the method was applied by the experts. A good agreement between the experts (k value, 0.66) and a poor agreement between the non experts (k value, 0.22) were observed. In conclusion, TDS provides useful information for the preoperative assessment of melanoma thickness > 0.75 mm, as reported in a previous study. However, this method has been proved to be more accurate when it is applied by dermatologists expert in dermoscopy.

Interobserver Agreement on Dermoscopic Features of Pigmented Basal Cell Carcinoma

BACKGROUND A dermoscopic method based on the absence of a pigment network and the presence of at least one of six positive features has been described for diagnosis of pigmented basal cell carcinoma (BCC). OBJECTIVE To evaluate the observers' global agreement and interobserver agreement on each dermoscopic parameter of the method recently proposed. METHODS Dermoscopic images of 56 pigmented BCCs were examined by five observers with different degrees of experience in dermoscopy. RESULTS An overall full agreement was reached for the absence of pigment network (k = 1). Very good agreement was detected for the presence of spoke wheel areas (k = 0.85) and arborizing vessels (k = 0.72), and good agreement was shown for ulceration (k = 0.49) and multiple blue-gray globules (k = 0.41). No agreement was identified on large blue-gray ovoid nests (k = 0.28) and leaflike areas (k = 0.26). CONCLUSION We confirm the reproducibility of the method and show that ulceration, spoke wheel areas, and arborizing telangiectases represent the most robust positive parameters.

Teledermoscopy - results of a multicentre study on 43 pigmented skin lesions

We performed a multicentre study to evaluate the agreement between the direct clinical diagnosis and the telediagnosis of 43 cutaneous pigmented lesions. Digital clinical and dermoscopic images of the 43 pigmented skin lesions (11 melanomas, 23 melanocytic naevi, three basal cell carcinomas, three lentigines, two seborrhoeic keratoses and one angiokeratoma) were sent by email to 11 colleagues (six dermatologists, two residents in dermatology, one oncologist, one specialist in internal medicine and one general practitioner) in 10 centres. These 11 colleagues had different degrees of experience in dermoscopy. With histopathology as the gold standard, an average of 85% of the telediagnoses were correct, with results varying from 77% to 95%, whereas face-to-face diagnosis by an expert dermatologist was correct in 91% of cases. The kappa value for all participants ranged from 0.35 to 0.87. The results confirm that teledermoscopy can be a reliable technique for the diagnosis of pigmented skin lesions but one that will depend on the expertise of the observer.