Malignant Skin Lesions Research Articles

Skin Cancer Incidence in Organ Transplant Recipients Referred for Benign Skin Conditions.

Solid organ transplant recipients (SOTRs) are at ∼100-fold increased risk for developing skin cancers compared with the general population, with increased morbidity and mortality. These patients are closely followed by dermatology; however, it is unclear how referral reasons from nondermatologic providers affect care in these patients. This study examines the reason SOTRs are referred to dermatologic care by nondermatologic providers as a potential predictor of nonmelanoma skin cancer (NMSC) outcomes. A retrospective case-control study was conducted with the records of 353 adult SOTRs referred to a specialized transplant dermatology clinic within an academic tertiary care center between 2007 and mid-2012. Eighty-one patients were diagnosed with 491 total premalignant and malignant skin lesions. A considerable proportion of patients diagnosed with NMSC were referred for benign skin conditions such as rash or acne. These results indicate that some SOTRs referred to dermatology for benign skin disorders are incidentally diagnosed with cutaneous malignancies; this is concerning given that referrals for benign skin conditions may delay appropriate care for cutaneous malignancies and preventative care. Better risk stratification, improved interdisciplinary collaboration, and prompt referrals for dermatologic care are needed in the care of SOTRs.

25668 To biopsy or not to biopsy? Medical student assessment of malignant vs benign skin lesions

Background: Medical students receive limited training on skin neoplasms and standardized tests rarely assess dermatologic knowledge in concrete situations. Since most skin lesions are seen by nondermatologists, assessing need-to-biopsy is an important skill for all medical students.

Skin conditions among 20th century politicians and world leaders.

The health of world leaders is a legitimate source of concern for the global population, and for historians. Cognitive disorders may impact their mandate decisions, particularly when occurring early in office [1]. Cancer and cardio-vascular diseases may lead to disability with impossibility to carry out expected duties or unexpected death with power vacuum [2]. World history has repeatedly showed that politicians tended to keep their illnesses hidden from the public long before they became obvious [2].

Statutory skin cancer screening in Germany : Motivation and motives for participation versus nonparticipation

HintergrundIm Jahr 2008 wurde in Deutschland das gesetzliche Hautkrebsscreening (gHKS) für gesetzlich Versicherte ab 35 Jahren eingeführt. Primäres Ziel ist es, maligne Veränderungen der Haut frühzeitig zu diagnostizieren, die Mortalität zu reduzieren sowie die Morbidität und Lebensqualität zu verbessern. Obwohl das gHKS vor mehr als einer Dekade eingeführt wurde, wird dieses nur von einem Teil wahrgenommen.Ziel der ArbeitWelche Gründe bestehen für die geringe Teilnahmequote am gHKS in der berechtigten Normalbevölkerung?MethodikIn computergestützten Telefoninterviews mit einer repräsentativen Bevölkerungsstichprobe (N = 1015) gesetzlich Versicherter ab 18 Jahren wurden im Januar 2019 die Einstellung zum Thema Hautkrebs, die Rate der Inanspruchnahme des gHKS sowie die Gründe für die Nichtteilnahme erhoben. Ein Teil der Daten wurde mit vorausgehenden Erhebungen aus den Jahren 2011, 2013 und 2015 verglichen.ErgebnisseUnter den 1015 Teilnehmern wurde das Thema Hautkrebs von 40 % als besorgniserregend eingestuft. Zum gHKS waren 75,4 % der Befragten berechtigt. Von diesen hatten 52,6 % bisher noch nie am gHKS teilgenommen. Die Inanspruchnahme nahm im Alter jedoch zu. Ferner war die Nichtteilnehmerquote bei gehobenem Schulabschluss mit 45 % deutlich niedriger als bei niedrigem Schulabschluss mit 58 %. Der Anspruch auf das gHKS war 35 % der Nichtteilnehmer nicht bekannt. Als Grund für die Nichtteilnahme nannten 20 % Zeitmangel, 58 % sahen keine Notwendigkeit, weil sie sich gesund fühlen. Generell hielten aber 91 % aller 1015 Befragten Früherkennungsuntersuchungen für sinnvoll und hatten zu 66 % bereits an anderen Vorsorgeuntersuchungen teilgenommen.DiskussionDie mit etwa 50 % geringe Teilnehmerquote am gHKS sowie die abnehmende Besorgnis in der Bevölkerung um das Thema Hautkrebs legen nahe, dass eine weitere, auch risikogruppenorientierte Aufklärung der Bevölkerung über die Relevanz des Themas Hautkrebs notwendig ist.

Incidence and associated factors of sudden unexpected death in advanced cancer patients: A multicenter prospective cohort study

PurposeA sudden unexpected death has significant negative impacts on patients, family caregivers, and medical staff in hospice/palliative care. This study aimed to clarify the incidence and associated factors of sudden unexpected death according to four definitions in advanced cancer patients.MethodsWe performed a prospective cohort study in 23 inpatient hospices/palliative care units in Japan. Advanced cancer patients aged ≥18 years who were admitted to inpatient hospices/palliative care units were included. The incidence and associated factors of sudden unexpected death were evaluated in all enrolled patients according to four definitions: (a) rapid decline death, defined as a sudden death preceded by functional decline over 1–2 days; (b) surprise death, defined if the primary responsible palliative care physician answered “yes” to the question, “Were you surprised by the timing of the death?”; (c) unexpected death, defined as a death that occurred earlier than the physicians had anticipated; and (d) performance status (PS)‐defined sudden death, defined as a death that occurred within 1 week of functional status assessment with an Australia‐modified Karnofsky PS ≥50.ResultsAmong 1896 patients, the incidence of rapid decline death was the highest (30‐day cumulative incidence: 16.8%, 95% CI: 14.8–19.0%), followed by surprise death (9.6%, 8.1–11.4%), unexpected death (9.0%, 7.5–10.8%), and PS‐defined sudden death (6.4%, 5.2–8.0%). Male sex, liver metastasis, dyspnea, malignant skin lesion, and fluid retention were significantly associated with the occurrence of sudden unexpected death.ConclusionSudden unexpected death is not uncommon even in inpatient hospices/palliative care units, with range of 6.4–16.8% according to the different definitions.

DiaMole: Mole Detection and Segmentation Software for Mobile Phone Skin Images.

Results This study developed mole detection and segmentation software DiaMole using mobile phone images. DiaMole utilized multiple deep learning algorithms for the object detection problem and mole segmentation problem. An object detection algorithm generated a rectangle tightly surrounding a mole in the mobile phone image. Moreover, the segmentation algorithm detected the precise boundary of that mole. Three deep learning algorithms were evaluated for their object detection performance. The popular performance metric mean average precision (mAP) was used to evaluate the algorithms. Among the utilized algorithms, the Faster R-CNN could achieve the best mAP = 0.835, and the integrated algorithm could achieve the mAP = 0.4228. Although the integrated algorithm could not achieve the best mAP, it can avoid the missing of detecting the moles. A popular Unet model was utilized to find the precise mole boundary. Clinical users may annotate the detected moles based on their experiences. Conclusions DiaMole is user-friendly software for researchers focusing on skin lesions. DiaMole may automatically detect and segment the moles from the mobile phone skin images. The users may also annotate each candidate mole according to their own experiences. The automatically calculated mole image masks and the annotations may be saved for further investigations.

MO997INCIDENTAL SKIN CANCER AFTER KIDNEY TRANSPLANTATION: A REGIONAL POPULATION BASED-COHORT STUDY (2015-2020)

Abstract Background and Aims Long-term immunosuppression in solid organ transplant (SOT) recipients could be associated with high risk of cutaneous malignancies. Any suspicious lesion should be excised and sent for pathologic examination. Method We performed a descriptive retrospective single-center study to evaluate the incidence of all skin cancer lesions in 372 kidney transplanted recipients between January 2015 to July 2020 with at least 6 months of follow-up. Results We identified 53 recipients who developed skin diseases during post transplant period. Mean age was 63y, predominantly men (62%), caucasian race, with light phototype (I-II 95%).Mean follow-up were 16 months (45% first year, 23% second year, and 32%> 3 years). 70% of the patients were over 60y with an earlier development of the lesions. Actinic keratosis was the most frequent non- excised lesion. 27 patients were biopsied (51%) in whom 66% showed malignant skin lesions (squamous cell carcinoma-SCC: 39%; Basal cell carcinoma-BCC: 50%; melanoma 11%). The most frequent immunosuppressive treatment (IS) associated between these recipients was the combination of tacrolimus (Tac) and mycophenolate (MMF; 62%) versus tacrolimus (Tac) and everolimus scheme (EVE; 38%). Up to 18.5% had multiple and mixed carcinomas. 4 to 5 patients of them were with MMF regimen. This treatment was also more frequent among patients with SCC (33%). Conclusion

Dermatoscopy is effective method for diagnostics of skin neoplasms in workers with industrial carcinogens

Introduction. One of the urgent problems of medicine around the world is the growth of malignant diseases. The impact of the production environment in developing professional and production-related skin malignancies is a sensitive area of occupational health. The high prevalence of precancerosis and the increase in the incidence of skin cancer in people of working age indicates the need to improve diagnostic and preventive measures. One of the most effective recognized non-invasive differential diagnoses of skin tumors with high diagnostic accuracy and sensitivity is dermatoscopy. The study aims to substantiate the importance of dermatoscopic diagnosis of skin neoplasms in workers with industrial carcinogens. The researchers analyzed the available literature and statistical data on the impact of industrial carcinogens on benign and malignant skin lesions in workers in various industries. Specialists from Clinic of the "Izmerov Research Institute of Occupational Health" examined 1,136 people during periodic medical examinations. The features of the signs of neoplasms evaluate according to the principle of their presence or absence. There were two groups: group 1 (n=648) consisted of persons who have contact with industrial carcinogens according to the special assessment of working conditions (SAWC), group 2 (n=488) - persons who do not have contact with carcinogens in the workplace. We found that the frequency of benign skin neoplasms increases depending on the length of work in contact with a production carcinogen. Researchers developed the criteria of clinical and anamnestic signs (the main of which are the working conditions). Dermatoscopic criteria for the initial signs of malignancy of skin neoplasms allow us to form a group of dynamic observations of skin neoplasms in patients working with carcinogens during periodic medical examinations. We formed a group of 38 people (29 from the first and 9 from the second group) for monitoring the dynamics of changes in neoplasms with an appearance to a dermatovenerologist after three months. Specialists sent seven people for additional examination by an oncologist to clarify the degree of existing signs of dysplasia. The formation of a dynamic observation group with the risk of malignancy of skin neoplasms will optimize early diagnosis and ensure high efficiency of treatment in outpatient settings.

Towards Accurate Diagnosis of Skin Lesions Using Feedforward Back Propagation Neural Networks.

In the automatic detection framework, there have been many attempts to develop models for real-time melanoma detection. To effectively discriminate benign and malign skin lesions, this work investigates sixty different architectures of the Feedforward Back Propagation Network (FFBPN), based on shape asymmetry for an optimal structural design that includes both the hidden neuron number and the input data selection. The reason for the choice of shape asymmetry was based on the 5–10% disagreement between dermatologists regarding the efficacy of asymmetry in the diagnosis of malignant melanoma. Asymmetry is quantified based on lesion shape (contour), moment of inertia of the lesion shape and histograms. The FFBPN has a high architecture flexibility, which indicates it as a favorable tool to avoid the over-parameterization of the ANN and, equally, to discard those redundant input datasets that usually result in poor test performance. The FFBPN was tested on four public image datasets containing melanoma, dysplastic nevus and nevus images. Experimental results on multiple benchmark data sets demonstrate that asymmetry A2 is a meaningful feature for skin lesion classification, and FFBPN with 16 neurons in the hidden layer can model the data without compromising prediction accuracy.

Identification of Risk of Occurring Skin Cancer (Melanoma) Using Convolutional Neural Network (CNN)

Skin cancer is one of the most common malignancy in human, has drawn attention from researchers around the world. As skin cancer can turn into fatal if not treated in its earliest stages, the necessity of devising automated skin cancer diagnosis system that can automatically detect skin cancer efficiently in its earliest stage in a faster process than traditional one is of crucial importance. In this paper, a computer aided skin cancer diagnosis system based Convolutional Neural Network method has been shown. Our proposed system consists of five stages namely image acquisition, image preprocessing, image segmentation, feature extraction and classification We remove hair any noise from the images using dull then use median filter to smoothen the images. Next, k-means algorithm was applied for image segmentation on the preprocessed images. Finally, the segmented images were fed into CNN model for feature extraction and classification. The developed system can classify benign and melanoma type skin cancers from Dermoscopic images as accurate as 80.47%. While developing the skin cancer detection system, we compare accuracy score of other models such as Artificial Neural Network (ANN), K-Nearest Neighbor (KNN) and Random Forest with our proposed system. The proposed method has been tested on ‘ISIC Challenge 2016’ test dataset and an accuracy rate of 80.47% was obtained for accurately classifying benign and malignant skin lesions by our proposed model.

Xeroderma Pigmentosum: An Uncommon Risk Factor for Aggressive Follicular Thyroid Carcinoma

Abstract Introduction: Follicular thyroid carcinoma (FTC) is the second most common thyroid cancer, which typically presents in an older populations, and carries a near 100% 5-year relative survival rate if diagnosed prior to cancer spreading outside of the thyroid. Clinical Case: A 26-year old female presented to emergency room with persistent jaw pain, despite course of antibiotics prescribed by dentist. She has a past medical history of xeroderma pigmentosum (XP) with over 130 surgeries for malignant skin lesions, as well as benign multinodular goiter for which she underwent total thyroidectomy at the age of 18, with pathology reporting benign tissue and follicular adenoma. Emergency room imaging of maxillofacial/sinus incompletely captured a mass in the left paratracheal region, extending into the lumen of the trachea. Patient was then transferred to University Hospital for further evaluation. Dedicated neck imaging confirmed 4.6cm mass in expected area of thyroid gland, invading into left tracheal wall, cervical esophagus, and hypopharynx. Additional imaging revealed numerous pulmonary nodules, and a 4mm enhancing focus of left superior temporal gyrus. Nuclear positron emission tomography imaging revealed regions of hypermetabolic activity in the left maxillary sinus, the facial nodules, cervical lymph nodes, and mass like region of hypermetabolic activity in the thyroid bed. Biopsy confirmed follicular thyroid parenchyma, concerning for follicular carcinoma. Patient then underwent mass resection and tracheostomy. Some thyroid tissue was left on contralateral side to malignancy due to adjacency to only functional recurrent laryngeal nerve. Pathology following surgery confirmed follicular thyroid carcinoma, with evidence of angioinvasion. Thyroglobulin mass spectrometry prior to surgery was 302 ng/mL. Conclusion: While it is well known that patients with XP suffer from early development of mucocutaneous and ocular cancers in sun-exposed areas, these patients also have increased risk for multinodular goiter as well as internal malignancies. Furthermore, treatment of any internal malignancy is limited due to inability for patients with XP to be treated with radiation. Providers for patients with XP should have very low thresholds to investigate all new symptoms aggressively, maximizing chances of diagnosing malignancies in early stages.

Access to a dermatoscope during dermatology courses motivates students’ towards thorough skin examination

Introduction. Dermatoscope is a tool for a skin examination, used especially in early detection of malignant skin lesions. Non-dermatologists are being trained for opportunistic melanoma detection with the usage of dermatoscopy, however, still non-satisfactory. This study was aimed to determine whether practical dermoscopy adjunct to traditional, lecture and seminar-based medical school curriculum would improve the perceived relevance of regular skin examination and basic skin lesions differentiation. Material and method. Fourth-year medical students participating in a 3-week-long dermatology course were randomly assigned to two groups: the first one called A with limited access to a dermatoscope and the second one called B, with unlimited access to dermatoscopes throughout the course. All participants answered surveys concerning their attitude towards skin examination, with a rating scale from 1 to 5, before and after the course. Also, all participants completed an image-based dermoscopy test for distinguishing benign from malignant skin lesions. Results. Students assigned to group B significantly improved their perceived importance of routine skin examination (mean scores before 4.38; after 4.57, P = 0.03). No such tendency was observed in group A — before 4.40, after 4.49 (P = 0.29). Students in the group with higher dermatoscope availability considered buying a dermatoscope more often (61%) than those without (44%) (P = 0.037). No significant score difference was observed when testing skin lesions identification, mean for extended access 7.84 vs. normal 7.64 points (P = 0.69). Conclusions. Higher availability of dermatoscopy during dermatology rotations may encourage students to use this tool in future clinical practice and improve early detection of malignant skin lesions.

An enhanced technique of skin cancer classification using deep convolutional neural network with transfer learning models

Skin cancer is one of the top three perilous types of cancer caused by damaged DNA that can cause death. This damaged DNA begins cells to grow uncontrollably and nowadays it is getting increased speedily. There exist some researches for the computerized analysis of malignancy in skin lesion images. However, analysis of these images is very challenging having some troublesome factors like light reflections from the skin surface, variations in color illumination, different shapes, and sizes of the lesions. As a result, evidential automatic recognition of skin cancer is valuable to build up the accuracy and proficiency of pathologists in the early stages. In this paper, we propose a deep convolutional neural network (DCNN) model based on deep learning approach for the accurate classification between benign and malignant skin lesions. In preprocessing we firstly, apply filter or kernel to remove noise and artifacts; secondly, normalize the input images and extract features that help for accurate classification; and finally, data augmentation increases the number of images that improves the accuracy of classification rate. To evaluate the performance of our proposed, DCNN model is compared with some transfer learning models such as AlexNet, ResNet, VGG-16, DenseNet, MobileNet, etc. The model is evaluated on the HAM10000 dataset and ultimately we obtained the highest 93.16% of training and 91.93% of testing accuracy respectively. The final outcomes of our proposed DCNN model define it as more reliable and robust when compared with existing transfer learning models.

Clinical Diagnosis has a High Negative Predictive Value in Evaluation of Malignant Skin Lesions.

Background The increasing incidence of skin cancers in fair-skinned population and its relatively good response to treatment make its accurate diagnosis of great importance. We evaluated the accuracy of clinical diagnosis of malignant skin lesions by comparing the clinical diagnosis with histological diagnosis as the gold standard. Materials and Methods In this retrospective study, we assessed all the pathology reports from specimens sent to a university hospital laboratory in 3 consecutive years from March 2008 to March 2010. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive and negative likelihood ratios were calculated for clinical diagnosis of malignant skin lesions stratified by their histological subtype. Results A total 4,123 specimen were evaluated. The sensitivity and specificity for clinical diagnosis of malignancy were 90.48% and 82.85%, respectively, whereas the negative predictive value was shown to be 99.06%. The positive and negative likelihood ratios were 5.23 and 0.11, respectively. Conclusion Pathological assessment of skin lesions remains the cornerstone of skin cancer diagnosis. The high NPV and the relatively low PPV indicate that clinical diagnosis is more efficient in ruling out malignancies rather than diagnosing them.

Detection of Human Papillomaviruses (HPVs) by Immunohistochemistry (P16ink4a) In Verrucous Skin Lesions

Even though the p16 marker allows us to distinguish between benign and malignant verrucous skin lesions, we are unable to determine the patient's Human Papillomaviruses (HPVs) status despite the existence of recognized histopathological features that indicate its presence like koilocytic change, since a proper correlation couldn’t be made between this feature and p16 expression. Even though PV type 16 and 18 are a risk factor for developments of anogenital skin lesion diffuse p16 expression cannot always be attributed to HPVs as there may be several other risk factors causing skin lesions, unlike in cervical lesions such as squamous cell carcinomas, many studies have established the role of oncogenic HPVs with its carcinogenesis. This marker cannot be used as a surrogate for detection of HPV infection. The present study was the expression of p16INK4A in histological sections of verrucous skin lesions. To compare the expression of p16INK4a in benign, premalignant and malignant lesions involving the skin and comparing the pattern of expression of p16INK4a in skin lesions by immunohistochemistry and correlating the results with certain histological parameters that might indicate HPV infection.

Distance Learning and Spaced Review to Complement Dermoscopy Training for Primary Care.

Dermoscopy aids in skin cancer identification. For family physicians who use dermoscopy, there is higher sensitivity for melanoma detection than naked-eye examination. There is a shortage of dermoscopy training for primary care providers. The triage amalgamated dermoscopic algorithm (TADA) is designed for novice dermoscopists. While TADA can be taught in a short dermoscopy workshop, spaced review and blended learning strategies improve knowledge retention. This study determined the impact that the addition of a distance learning platform has on clinical dermoscopy use. Moreover, it evaluated dermoscopic image identification (knowledge retention) following the addition of distance learning via Extension for Community Health Outcomes (ECHO) to a traditional TADA dermoscopy workshop. Primary care providers voluntarily attended a 120-minute TADA dermoscopy workshop. Participants completed pre-intervention, post-TADA, and post-ECHO tests of 30 dermoscopic images of benign and malignant skin lesions. A survey was also administered to analyze clinical dermoscopy use and prior dermoscopy training. Twenty-seven residents, faculty, and advanced practice providers participated in this longitudinal observational cohort study. Mean test scores (out of 30) for images of benign and malignant lesions improved from 20.29 pre-intervention to 24.62 post-TADA and 27.63 post-ECHO (P < .001). On average, participants attended 4 ECHO sessions (out of 7 total) and there was a positive correlation (r = 0.77) between the number of ECHOs attended and post-ECHO scores. Dermoscope use increased from 37.0% to 96.3% (P < .001). Distance learning and spaced review complement dermoscopy workshop training for primary care.

A 28-year single institution experience with primary skin malignancies in the pediatric population

The aim of this study is to report our institution’s experience with pediatric skin malignancies. A single institution retrospective review of pediatric patients with a primary skin malignancy from 1992 to 2020 was performed. Demographics, tumor characteristics and treatment outcomes were reviewed. Ninety-nine patients with 109 primary malignant skin lesions were reviewed. The most common lesion was malignant melanoma [MM] (n = 50, 45.9%). Compared to non-melanoma skin cancer (NMSC), MM were more likely to present on trunk or extremities (p=.01, OR = 3.2), and be misdiagnosed (p=.03, OR = 2.7). NMSC were more common in the head and neck region (p=.01, OR = 3.2), and were associated with a personal history of skin cancer (p=.0005, OR = 17.1) or a known risk factor (p=.04, OR = 2.5). Patients with MM were 12.4-times more likely to develop metastatic disease compared to NMSC (p<.0001). Increased Breslow’s thickness also increased the odds of developing metastatic disease (p=.03, OR = 1.6 per 1-mm increase). Interval time between lesion recognition and diagnostic biopsy or surgical treatment did not impact overall survival. Malignant melanoma was the most common malignancy in our cohort, followed by basal cell carcinoma. Malignant melanoma was the most likely tumor to be misdiagnosed and/or metastasize. Treatment delays did not impact risk of metastasis, recurrence or survival rate, though some patients succumbed to disease. These results may be attributed to small sample size or the biology of melanoma in pediatric patients. Awareness of skin malignancies in the pediatric population is imperative to providers and the public, with low threshold for specialty consultation and excision when warranted.

Non-Melanoma Skin Cancers: A Teaching Hospital-Based Study

Context: The mortality rate of non-melanoma skin cancers (Basal cell carcinoma [BCC] and squamous cell carcinoma [SCC]) is low. This implies a high morbidity state. The cost implication to the health sector may be huge depending on its magnitude. The data generated from this study will give an insight of the burden of non-melanoma skin cancers (NMSC) on our health facility as well as being utilized for the purpose of records and ultimately for planning locally and nationally.Aims and objectives: To determine the frequency, age and sex distribution of NMSC.Materials and Methods: A descriptive cross-sectional retrospective study. All cases of NMSC (BCC and SCC) diagnosed histologically between January 2004 and December 2013 in the Department of Morbid Anatomy, University of Benin Teaching Hospital were analysed.Results: The NMSC accounted for 36.90% of malignant skin lesions. Their age spanned from the 2nd to the 9th decade with a mean age in the 5th decade (47.49 years). There was no significant sexual predilection (male:female = 1.03:1). SCC and BCC accounted for 82.61% and 17.39% respectively of NMSC. The head and neck region was the most common site of presentation of these tumours.Conclusion: The NMSC comprises a notable portion (36.9%) of malignant skin tumours. The frequency of SCC was by far higher than that of BCC. The mean age of NMSC, SCC and BCC was in the 5th decade (40-49years). No significant sexual predilection was noted in this study. The head and neck region was the most common site for NMSC.

Teaching Skin Cancer Detection to Medical Students Using a Dermoscopic Algorithm.

Early detection of melanoma skin cancer improves survival rates. Training family physicians in dermoscopy with the triage amalgamated dermoscopic algorithm (TADA) has high sensitivity and specificity for identifying malignant skin neoplasms. In this study we evaluated the effectiveness of TADA training among medical students, compared with practicing clinicians. We incorporated the TADA framework into 90-minute workshops that taught dermoscopy to family physicians, primary care residents, and first- and second-year medical students. The workshop reviewed the clinical and dermoscopic features of benign and malignant skin lesions and included a hands-on interactive session using a dermatoscope. All participants took a 30-image pretest and a different 30-image posttest. Forty-six attending physicians, 25 residents, and 48 medical students participated in the workshop. Mean pretest scores were 20.1, 20.3, and 15.8 for attending physicians, resident physicians and students, respectively (P<.001); mean posttest scores were 24.5, 25.9, and 24.1, respectively (P=.11). Pre/posttest score differences were significant ( P<.001) for all groups. The medical students showed the most gain in their pretest and posttest scores. After short dermoscopy workshop, medical students perform as well as trained physicians in identifying images of malignant skin lesions. Dermoscopy training may be a valuable addition to the medical school curriculum as this skill can be used by primary care physicians as well as multiple specialists including dermatologists, gynecologists, otolaryngologists, plastic surgeons, and ophthalmologists, who often encounter patients with concerning skin lesions.

Xeroderma pigmentosum in Yemen

The incidence of xeroderma pigmentosum (XP) in Yemen seems to be quite high but there are no previous reports. To study the clinicoepidemiologic aspect of XP in Yemen. All 40 patients (24 male and 16 female patients from 32 families) treated and followed between 1997 and 2014 were subjected to detailed analysis with the help of a standardized protocol. The diagnosis was based on clinical features and histopathologic data, when needed. The diagnosis of tumors was confirmed by histopathologic examination in all cases. The median age of onset of initial manifestations was 9.5months, and that of malignant lesions was 7years. Parents of the patients were not affected, but history of consanguinity was recorded in 38. Initial lesions, such as dryness of the skin and freckles on the face, were noticed in all patients. In addition, erythema of the face with photosensitivity was observed in 21 patients. Premalignant and malignant skin lesions observed later were actinic keratosis in 15 patients, lentigo maligna in one, squamous cell carcinoma (SCC) in 10, and basosquamous carcinoma in one. Eyes were affected with SCC in seven and malignant melanoma (MM) in two patients. SCC of the lip developed in two patients and that of the tongue in one patient. Judicious use of acitretin in 12 patients showed good result. XP in Yemen is characterized by a relatively high incidence, high percentage of consanguinity in parents of the patients, early onset of initial manifestations, malignant tumors, and severe ocular and oral lesions. Acitretin showed good result.