Use Of Dermoscopy Research Articles

A case of Stewart–Treves Syndrome of the lower limbs: The usefulness of dermoscopy

A case of Stewart–Treves Syndrome of the lower limbs: The usefulness of dermoscopy

General practice registrars' use of dermoscopy: Prevalence, associations and influence on diagnosis and confidence.

Dermoscopy increases accuracy for melanoma diagnosis by trained primary care physicians. We aimed to establish prevalence of dermatoscope use by general practice registrars, and identify factors associated with dermatoscope use and the implications of dermatoscope use for diagnosis and confidence in diagnosis. This was a cross-sectional study nested within the Registrar Clinical Encounters in Training (ReCEnT) project, an ongoing multi-site cohort study of general practice registrars' consultations. The study was conducted during two six-monthly rounds of ReCEnT data collection in four regional training providers in2014. Forty-nine per cent of registrars reported having dermoscopy training. Dermoscopy was used in 61% of consultations involving skin or pigmented lesion checks. Dermatoscope use changed provisional diagnosis in 22% of instances and increased diagnostic confidence in 55%. Dermoscopy is performed by general practice registrars in a modest proportion of skin and pigmented lesion checks. Its use influences registrars' diagnoses and increases their confidence in their diagnoses.

Dermoscopy for melanoma detection and triage in primary care: a systematic review

ObjectiveMost skin lesions first present in primary care, where distinguishing rare melanomas from benign lesions can be challenging. Dermoscopy improves diagnostic accuracy among specialists and is promoted for use by...

Dermoscopy of Inflammatory Dermatoses (Inflammoscopy): An Up-to-Date Overview.

In addition to its use in pigmented and nonpigmented skin tumors, dermoscopy is gaining appreciation in assisting the diagnosis of nonneoplastic diseases, especially inflammatory dermatoses (inflammoscopy). In this field, dermoscopic examination should be considered as the second step of a "2-step procedure," always preceded by the establishment of a differential diagnosis on the basis of clinical examination. In this paper, we sought to provide an up-to-date overview on the use of dermoscopy in common inflammatory dermatoses based on the available literature data. For practical purposes, the analyzed dermatoses are grouped according to the clinical presentation pattern, in line with the 2-step procedure principle: erythematous-desquamative and papulosquamous dermatoses, papulokeratotic dermatoses, erythematous facial dermatoses, sclero-atrophic dermatoses, and miscellaneous.

Value of Dermoscopy in a Population-Based Screening Sample by Dermatologists.

The use of dermoscopy improves the diagnosis of skin cancer significantly in trained dermatologists. However, to evaluate its cost-effectiveness in daily practice, not only sensitivity but also the excision rate is important. We examined the diagnostic accuracy of cases from a true population-based sample scored by general dermatologists. One hundred twenty-six dermatologists were randomly assigned to 145 digital cases of lesions detected at a skin cancer screening. This resulted in 4,655 case evaluations using a web application. Accuracy of diagnosis and treatment was correlated with the histological diagnosis or expert opinion. The larger portion (89.7%) of the participating dermatologists reported using their dermatoscope daily. The odds of making a correct diagnosis of melanoma using dermoscopy was 5.38 compared with naked-eye examination (NEE). Dermoscopy increased sensitivity for skin cancer diagnosis from 70.6% to 84.6%, but this was associated with a small but significant decrease in specificity of 3.5%. To detect 1 skin cancer, 5.23 lesions had to be biopsied/excised in this sample and this was not significantly improved by dermoscopic evaluation. Dermoscopy significantly increased the confidence about making a correct diagnosis, especially in seborrheic keratosis, Bowen disease, and melanoma. Dermoscopy significantly improved diagnostic accuracy, the sensitivity of skin cancer detection, and the confidence in diagnosis especially for seborrheic keratosis, Bowen disease, and melanoma. However, this finding was not reflected in a significant reduction in the number needed to excise in this sample.

Evaluation of the Number-Needed-to-Biopsy Metric for the Diagnosis of Cutaneous Melanoma

To date, no concerted effort has been made to date to evaluate the literature on number-needed-to-biopsy (NNB) metrics, particularly to account for the differences in clinician type and melanoma prevalence in certain geographic locations. To review and synthesize worldwide data for NNB for the diagnosis of cutaneous melanoma. MEDLINE, Embase, and PubMed databases were searched for English-language articles published worldwide from January 1, 2000, to November 28, 2018. A total of 46 studies were included that addressed NNB for at least 3681 clinicians worldwide and included 455 496 biopsied tumors and 29 257 melanomas; primary care practitioner (PCP) data were only available from Australia. Articles were screened for eligibility, and possible overlapping data sets were resolved. Data extracted included clinician specialization, use of dermoscopy, geographic region and location-specific health care system, study design, number of benign tumors, number of melanomas, and NNB. The review followed the PRISMA guidelines. The NNB for the diagnosis of cutaneous melanoma. A total of 46 studies were included that addressed NNB for at least 3681 clinicians worldwide and included 455 496 biopsied tumors and 29 257 melanomas; primary care practitioner (PCP) data were only available from Australia. The reported NNB ranged from 2.2 to 287, and the weighted mean NNB for all included publications was 15.6. The exclusion of publications structured as all biopsied tumors, owing to variable data characterization, resulted in reported NNB ranging from 2.2 to 30.5, with a global weighted mean NNB of 14.8 for all clinicians, 7.5 for all dermatologists, 14.6 for Australian PCPs, and 13.2 for all US-based dermatological practitioners, including dermatologists and advanced practice professionals. The summary effect size (ES) demonstrates that a mean 4% of biopsies demonstrated melanoma for study stratum A (all biopsied skin tumors, ES, 0.04; 95% CI, 0.03-0.05), and a mean 12% of biopsies demonstrated melanoma for study strata B (melanocytic tumors on pathology review, ES, 0.12; 95% CI, 0.10-0.14) and C (clinical concern for melanoma, ES; 0.12; 95% CI, 0.09-0.14). The existing NNB for cutaneous melanoma appeared to vary widely worldwide, lacking standardization in the metric and its reporting, and according to clinician characteristics as well; the NNB of US-based clinicians may warrant further exploration.

Plantar pilonidal sinus: difficult to detect without the use of dermoscopy!

Plantar pilonidal sinus: difficult to detect without the use of dermoscopy!

Dermoscopy use in UK primary care: a survey of GPs with a special interest in dermatology.

BackgroundMelanoma accounts for 90% of skin cancer mortality and typically presents in primary care, where it can be challenging to distinguish from benign lesions. Dermoscopy is a tool for skin visualization that is routinely used for melanoma diagnosis in secondary care. However, the role of dermoscopy in primary care remains unclear.ObjectivesTo determine views on, and use of, dermoscopy by dermatology‐interested general practitioners (GPs).MethodsAn online questionnaire was emailed to the UK Primary Care Dermatology Society members in February 2018, and responses collected over the following 4 weeks.ResultsA total of 205 responses were analysed. Most respondents were GPs (94%), aged over 50 (53%), had a postgraduate dermatological qualification (67%) and used dermoscopy regularly when reviewing pigmented skin lesions (97%). Dermoscopy use was commoner amongst GPs who had worked longer in primary care and had experience of secondary care dermatology. Most had undertaken training in dermoscopy (91%), although one‐fifth (20%) had not updated their training in over 5 years. Most of those who had received only 1 day of face‐to‐face training reported feeling confident using a dermatoscope. Few respondents (11%) reported access to teledermatology or teledermoscopy for urgent or routine referrals.Conclusions UK GPs with a special interest in dermatology are routinely using dermoscopy in the primary care setting. More research is needed to establish optimal approaches to training and updating GP dermoscopy skills. When dermoscopy has been shown to be safe, effective, acceptable and cost‐effective in this setting, more GPs may also be able to gain and maintain the skills to implement dermoscopy into routine primary care. Technological advances, including incorporation of artificial intelligence (AI) and algorithms to guide GPs, could also contribute to widening use of dermoscopy among GPs.

Utility of dermoscopy in nail psoriasis: Its correlation with the Nail Psoriasis Severity Index (NAPSI) and psoriatic arthritis

Utility of dermoscopy in nail psoriasis: Its correlation with the Nail Psoriasis Severity Index (NAPSI) and psoriatic arthritis - IJCED- Print ISSN No: - 2581-4710 Online ISSN No:- 2581-4729 Article DOI No:- 10.18231/j.ijced.2019.026, IP Indian Journal of Clinical and Experimental Dermatology-IP Indian J Clin Exp Derma

Dermoscopy Use in Primary Care: A Scoping Review

Patients in many countries with new or changing skin lesions will first consult a primary care physician, often called a general practitioner (GP). With the dramatic rise in melanoma incidence over recent decades, dermoscopy offers a tool with an evidence base supporting its use in skin lesion assessment. How GPs use dermoscopy is unclear. A scoping literature review was carried out to examine the current state of published evidence about dermoscopy use in primary care. The methodological steps taken in this review followed those developed by Arksey and O'Malley, as revised by Levac and colleagues. Four electronic databases were searched for evidence published up to January 2018 describing the use of dermoscopy in a generalist primary care setting. Seven articles were identified for analysis. All included articles have been published since 2007. Most were questionnaire studies and revealed that generally a small minority of GPs use dermoscopy, although some jurisdictions such as Australia report greater use. Dermoscopy is generally used only for the assessment of pigmented skin lesions, but is not used consistently. Several perceived barriers to dermoscopy use, including the need for training, have been reported. There is a paucity of data on dermoscopy use among GPs, and diversity in questionnaire items prevents comparison between jurisdictions. Perceived barriers to dermoscopy use require more in-depth exploration, potentially including qualitative data, to evaluate them more fully. Understanding these factors, including how GPs train in dermoscopy, will be crucial in widening dermoscopy use in primary care.

Dermoscopy of Dermatofibrosarcoma Protuberans: What Do We Know?

Dermatofibrosarcoma protuberans (DFSP) is an uncommon mesenchymal tumor of intermediate malignancy. Its rarity and slow progression often imply a delayed diagnosis. There are few previous reports of dermoscopic features of DFSP and most are single case descriptions. To report 2 cases of DFSP and their dermoscopic features, as well as conduct a review of all previous cases published addressing the use of dermoscopy in this tumor. We conducted a literature search for all dermoscopic cases of DFSP. In addition, we presented 2 additional cases and compared them to the earlier findings. We summarized the main dermoscopic findings of DFSP based on analysis from 32 patients. The most common features of this tumor are the presence of vessels (81%), followed by a pigmented network (78%) and a pinkish background (66%). DFSP can mimic benign lesions and the diagnosis may be challenging. Dermoscopy is an important tool that may enhance clinical suspicion toward the diagnosis of DFSP.

Reliability assessment and validation of the dermal pigmentation area and severity index: a new scoring method for acquired dermal macular hyperpigmentation.

Dermal pigmentation area and severity score (DPASI) is a recently proposed scoring system for acquired dermal macular hyperpigmentation (ADMH). To determine the reliability and validity of DPASI. After standardized training, three researchers independently rated 55 patients with ADMH on two consecutive days within 1week, to determine intra-rater and inter-rater reliability. Validation was performed by comparing DPASI with the physician global assessment score. Test-retest reliability of individual raters tested by Pearson's r showed good correlation for all three raters (r=0.984, P<0.0001; r=0.983, P<0.000 and r=0.970, P<0.0001). Inter-rater agreement computed by intra-class correlation coefficient also showed good correlation (ICC=0.997, P<0.0001). Internal consistency as measured by Cronbach's alpha was 0.997. The score faired well in face and content validity (I-CVI of 0.87). On usability assessment, the scale had a median score of 4 on a scale from 1 to 5. The meantime taken to score the patients were 307.2±83, 308.9±84.4, 350.15±91.8s by three observers, respectively. The DPASI is a reliable measure of ADMH severity. The use of dermoscopy decreases inter and intra-observer variation resulting in a more objective score.

Zosteriform cutaneous leishmaniasis.

Dear Editor, We would like to discuss on the report on “Zosteriform cutaneous leishmaniasis” [1] Ramot et al. reported that “dermoscopy has proven to be an accessible and easy tool to diagnose such atypical presentation of cutaneous leishmaniasis, and dermatologists in endemic areas should be familiar with its typical dermoscopic features” [1]. In fact, cutaneous leishmaniasis is an important tropical dermatological infection. To diagnose it, the practitioner has to perform laboratory investigation to confirm the diagnosis [2]. The use of “in vivo confocal microscopy” is presently mentioned as a new noninvasive tool to diagnose cutaneous leishmaniasis [3,4]. As noted by Taheri et al., the appearance by dermoscopy of cutaneous leishmaniasis is varied [4]. The “paronychial, annular, palmoplantar, zosteriform, erysipeloid, and sporotrichoid” appearance of cutaneous leishmaniasis is not common and can be easily missed. The limitation in diagnosis seems not due to limitation of the dermoscopy toll but the awareness of the practitioner on the disease, cutaneous leishmaniasis [5]. In endemic areas of cutaneous leishmaniasis, use of dermoscopy in the investigation of any cases of zosteriform cutaneous lesions to rule out cutaneous leishmaniasis is suggested.

A case of a superficial spreading melanoma in situ diagnosed via digital dermoscopic monitoring with high dynamic range conversion.

A 48-year-old woman presented with a 3 mm, pigmented macule at her first visit to our clinic. The macule, which showed complete symmetry and a typical network, was tentatively diagnosed as a Clark nevus; a 6-month follow-up was recommended, and the patient returned 7 months later. At the second visit, the lesion had enlarged to a diameter of 5 mm, and dermoscopy revealed that it had maintained its typical pigment network. At this point, evidence-based monitoring would have led to excision but the decision was made to continue monitoring. Owing to poor compliance, the patient went another 2 years without follow-up. When we assess small lesions, such as this, the usefulness of dermoscopy is apparent. Additionally, we examined the benefits and drawbacks of high dynamic range (HDR) conversion of the dermoscopy images and their helpfulness for inspecting small lesions. Although the delicate structures present in the lesion can be recognized by a dermoscopy expert and HDR image conversion has a capacity to highlight important structures, there is also a risk that HDR image conversion may mask some of the structural changes. However, a comparison of the original dermoscopy images with the HDR-converted images provides newly trained dermoscopists the opportunity to recognize new findings and to distinguish the differences in the findings between both the types of images. Therefore, such comparisons might be useful for obtaining an accurate diagnosis by using dermoscopy and HDR image conversion.

Dermoscopy of subungual red comets associated with tuberous sclerosis complex.

We report here our experience on the use of dermoscopy for the detection of subungual red comets, which are sometimes present in the nails of patients affected by tuberous sclerosis complex. Dermoscopy allowed us to visualize, with better resolution than the naked eye, very tortuous capillaries surrounded by a whitish halo and close parallel binary tortuous capillaries. In some cases, subungual red comets are associated with the presence of periungual or subungual fibromas, but their exact pathogenesis remains unknown.

Digital imaging applications and informatics in dermatology.

In this chapter, we present the use of whole slide imaging (WSI) and dermoscopy in the field of dermatology. Image digitization has allowed for increasing computer-assisted clinical decision-making. An introduction to common digital imaging data sources such as WSI and dermoscopy is provided. We also review some commonly used image quantification methods and their potential applications in dermatology. Finally, we review how machine learning approaches utilize novel large dermatology image datasets.

Melanoma segmentation using bio-medical image analysis for smarter mobile healthcare

Dermoscopy is an excellent method of detecting melanoma in its early stages. Skin is the principal organ of human body. It covers bones, muscles and all parts of the body. Melanoma is rare, but it is the most dangerous form of skin cancer. It is curable if it is detectedin its early stages. Digital dermoscopy help dermatologists in theexamination of cancerous skin lesions. It enables doctors to capture microscopic images of moles by using amobile phone, corresponding application or any handy scope device. Segmentation is used to divide the image into different segments. Segmentation, classification and feature extraction are the three fundamental stages of arecognition system that helps in matching the analysis of skin lesion. Melanoma occurs due to the presence of Melanocytes in the body. With the use of dermoscopy, the dermatologists can examine individual lesions more closely. In our paper, we have proposed an approach that can automatically preprocess the image and then segment the lesion.The gradient magnitude of the image is calculatedto filter the images. We have marked the foreground objects to segment the lesion from background precisely. The proposed technique is tested on European dataset of dermoscopic images. Results of segmented images are compared with other competitors to exhibit the superiority of the recommended approach. Matlab 2016a is used for successful simulation of the experiment.

Use of Nail Dermoscopy in the Management of Melanonychia: Review.

The term melanonychia describes a black-brown-gray pigmentation of the nail plate that, in most cases, appears as a longitudinal band. Melanonychia can be observed at any age, affecting one digit or several digits, in both fingernails and toenails. Its causes can be difficult to differentiate clinically and depend on the number of bands and on their color, edge, and width. For this reason, especially in adults and when the pigmentation is localized in one single digit, biopsy and histopathological examination still represent the gold standard for a definitive diagnosis. Dermoscopy should be used routinely in the evaluation of a pigmented nail, as it provides important information for the management of melanonychia and can help avoid unnecessary nail biopsies. In cases of melanonychia it is important to establish whether the pigment is melanin or not and to determine whether the pigmentation of melanin is due to activation or proliferation and whether it is benign or malignant.

The use of Dermoscopy Following a one-day Workshop Among Family Medicine Residents

Skin cancer is the most common form of cancer in the United States. The purpose of this study is to determine if a single grand rounds workshop impacts the use of dermoscopy in a single Family Medicine Residency training program. Dermoscopy is a non-invasive tool to allow for higher magnification of skin lesions thereby increasing the ability to assess qualities which are unable to be seen by the naked eye. This study utilized a pre- and post-workshop survey questionnaire to assess participant practices in evaluation, diagnosis, and management of skin lesions. Eighteen (18) residents completed the survey prior to the grand rounds workshop. Nine (9) residents completed the follow-up survey three-months post-workshop. The results showed that the frequency of dermoscopy use increased post-workshop (Pearson’s Chi Square=8.83, p=0.012; Fischer’s Exact=0.008) and residents felt dermoscopy decreased the need to refer skin lesions (Pearson’s Chi Square=9.11, p=0.028; Fischer’s Exact=0.023). However, there was no significant change in resident comfort level when using dermoscopy post-educational workshop (Pearson’s Chi Square=5.34, p=0.255; Fischer’s Exact=0.272).

Current and emerging treatment strategies for hair loss in women of color.

Hair loss is common in women of color, and is associated with significant psychosocial complaints. Early clinical recognition and prompt initiation of intervention with medical treatment is critical to halt the disease process. In this article, we review the clinical presentations of nonscarring and scarring alopecias in women of color, use of dermoscopy for early recognition of the disease process, and medical, procedural, and surgical interventions. In conditions that result in scarring alopecia, such as late-stage traction, frontal fibrosing, or central centrifugal cicatricial alopecia, patients may benefit from procedural interventions, such as hair transplantation, platelet rich plasma injections, low-level laser therapy, or scalp therapy.