RESUMEN
BACKGROUND/OBJECTIVES: 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. METHOD: 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. RESULTS: 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. CONCLUSION: 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.
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Dermoscopía , Enfermedades de la Piel/patología , Biopsia/estadística & datos numéricos , Competencia Clínica , Humanos , Variaciones Dependientes del Observador , Factores de TiempoRESUMEN
BACKGROUND: Nodular melanoma (NM) may be biologically aggressive compared with the more common superficial spreading melanoma (SSM), with recent data suggesting underlying genetic differences between these 2 subtypes. To better define the clinical behavior of NMs, the authors compared their clinical and histopathologic features to those of SSMs at their institution, a tertiary referral center, over 3 decades. METHODS: A total of 1,684 patients diagnosed with 1,734 melanomas were prospectively enrolled. Of these, 1,143 patients (69% SSM, 11% NM, 20% other) were diagnosed between 1972 and 1982; 541 patients (54% SSM, 23% NM, 23% other) were diagnosed between 2002 and the present. Differences between the features of NM and SSM within each time period as well as changes over time were analyzed. RESULTS: The authors found that SSMs are now diagnosed as thinner lesions (P < .0001) with a low incidence of histologic ulceration (P < .0001), whereas there was no significant change in the median tumor thickness or ulceration status of NMs over time (P = .10, P = .30, respectively). The median age at diagnosis of NM, however, did significantly increase over time (51 years to 63 years, P < .01). The median duration of NMs was reported to be only 5 months compared with 9 months in SSM patients. CONCLUSIONS: The authors' data suggest that improvements have been made in the early detection of SSM but not NM. Modifications of current screening practices, including increased surveillance of high-risk patients with an emphasis on the "E" for "evolution" criterion of the ABCDE acronym used for early detection of melanoma, are thus warranted.
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Melanoma/diagnóstico , Neoplasias Cutáneas/diagnóstico , Detección Precoz del Cáncer , Femenino , Humanos , Masculino , Melanoma/patología , Persona de Mediana Edad , Invasividad Neoplásica , Neoplasias Cutáneas/patología , Factores de TiempoRESUMEN
BACKGROUND: Studies have demonstrated differences in colors and dermoscopic structures observed with polarized dermoscopes (PDs) and nonpolarized dermoscopes (NPDs). OBJECTIVE: The objective was to evaluate whether diagnosis and diagnostic confidence changes when viewing dermoscopic images from NPDs and PDs. METHODS: A total of 100 dermatologists participated in the study. Twenty-five pigmented lesions were shown in the study, consisting of 7 seborrheic keratoses (SK), 3 basal cell carcinomas, 2 atypical nevi, 5 malignant melanomas (MM), 3 dermatofibromas, 3 blue nevi, and 2 hemangiomas. Two images of each lesion (one NPD and one PD) were included. The McNemar test and paired t-test were used for the statistical analysis. RESULTS: Ninety-one participants completed the study. Significant differences in the diagnoses were observed for the SK, atypical nevus, and MM images. Seventy-five percent and 59% of the final participants correctly diagnosed SK when presented with the NPD and PD images, respectively. For MM, 23 and 34% made the correct diagnoses with the NPD and PD images, respectively. CONCLUSIONS: Viewing lesions with NPD versus PD can affect the diagnosis and diagnostic confidence of physicians that are novices with dermoscopy. Further studies including physicians at different expertise levels and a larger sample of lesions are needed to further explore the differences.
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Dermoscopía/instrumentación , Enfermedades de la Piel/diagnóstico , Humanos , Microscopía de Polarización , Trastornos de la Pigmentación/diagnóstico , Proyectos Piloto , Neoplasias Cutáneas/diagnósticoRESUMEN
OBJECTIVE: To evaluate the performance of dermoscopists in diagnosing small pigmented skin lesions (diameter
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Inteligencia Artificial , Competencia Clínica , Dermoscopía/instrumentación , Diagnóstico por Computador/instrumentación , Procesamiento de Imagen Asistido por Computador/instrumentación , Melanoma/diagnóstico , Neoplasias Cutáneas/diagnóstico , Biopsia , Diagnóstico Diferencial , Síndrome del Nevo Displásico/patología , Humanos , Melanoma/patología , Invasividad Neoplásica/patología , Sensibilidad y Especificidad , Piel/patología , Neoplasias Cutáneas/patologíaRESUMEN
OBJECTIVE: To determine the utility of the current diameter criterion of larger than 6 mm of the ABCDE acronym for the early diagnosis of cutaneous melanoma. DESIGN: Cohort study. SETTING: Dermatology hospital-based clinics and community practice offices. Patients A total of 1323 patients undergoing skin biopsies of 1657 pigmented lesions suggestive of melanoma. MAIN OUTCOME MEASURE: The maximum lesion dimension (diameter) of each skin lesion was calculated before biopsy using a novel computerized skin imaging system. RESULTS: Of 1657 biopsied lesions, 853 (51.5%) were 6 mm or smaller in diameter. Invasive melanomas were diagnosed in 13 of 853 lesions (1.5%) that were 6 mm or smaller in diameter and in 41 of 804 lesions (5.1%) that were larger than 6 mm in diameter. In situ melanomas were diagnosed in 22 of 853 lesions (2.6%) that were 6 mm or smaller in diameter and in 62 of 804 lesions (7.7%) that were larger than 6 mm in diameter. Conclusion The diameter guideline of larger than 6 mm provides a useful parameter for physicians and should continue to be used in combination with the A, B, C, and E criteria previously established in the selection of atypical lesions for skin biopsy.
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Inteligencia Artificial , Dermoscopía/instrumentación , Diagnóstico por Computador/instrumentación , Procesamiento de Imagen Asistido por Computador/instrumentación , Melanoma/diagnóstico , Neoplasias Cutáneas/diagnóstico , Piel/patología , Adulto , Anciano , Biopsia , Carcinoma in Situ/diagnóstico , Carcinoma in Situ/patología , Estudios de Cohortes , Diagnóstico Diferencial , Síndrome del Nevo Displásico/diagnóstico , Síndrome del Nevo Displásico/patología , Femenino , Humanos , Queratosis/diagnóstico , Queratosis/patología , Masculino , Melanoma/patología , Persona de Mediana Edad , Estadificación de Neoplasias , Nevo Pigmentado/diagnóstico , Nevo Pigmentado/patología , Guías de Práctica Clínica como Asunto , Valor Predictivo de las Pruebas , Curva ROC , Neoplasias Cutáneas/patologíaAsunto(s)
Algoritmos , Dermoscopía , Procesamiento de Imagen Asistido por Computador , Melanoma/diagnóstico , Neoplasias Cutáneas/diagnóstico , Biopsia , Carcinoma in Situ/diagnóstico , Carcinoma in Situ/patología , Diagnóstico Diferencial , Síndrome del Nevo Displásico/diagnóstico , Síndrome del Nevo Displásico/patología , Humanos , Melanoma/patología , Nevo/diagnóstico , Nevo/patología , Sensibilidad y Especificidad , Piel/patología , Neoplasias Cutáneas/patologíaRESUMEN
BACKGROUND: The color, architecture, symmetry, and homogeneity (CASH) algorithm for dermoscopy includes a feature not used in prior algorithms, namely, architecture. Architectural order/disorder is derived from current concepts regarding the biology of benign versus malignant melanocytic neoplasms. OBJECTIVE: We sought to evaluate the accuracy of the CASH algorithm. METHODS: A total CASH score (TCS) was calculated for dermoscopic images of 325 melanocytic neoplasms. Sensitivity, specificity, diagnostic accuracy, and receiver operating characteristic curve analyses were performed by comparing the TCS with the histopathologic diagnoses for all lesions. RESULTS: The mean TCS was 12.28 for melanoma, 7.62 for dysplastic nevi, and 5.24 for nondysplastic nevi. These differences were statistically significant (P < .001). A TCS of 8 or more yielded a sensitivity of 98% and specificity of 68% for the diagnosis of melanoma. LIMITATIONS: This is a single-evaluator pilot study. Additional studies are needed to verify the CASH algorithm. CONCLUSIONS: The CASH algorithm can distinguish melanoma from melanocytic nevi with sensitivity and specificity comparable with other algorithms. Further study is warranted to determine its intraobserver and interobserver correlations.
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Algoritmos , Dermoscopía/normas , Melanoma/ultraestructura , Neoplasias Cutáneas/ultraestructura , Área Bajo la Curva , Estudios Transversales , Dermoscopía/métodos , Diagnóstico Diferencial , Melanocitos/ultraestructura , Melanoma/diagnóstico , Nevo Pigmentado/congénito , Nevo Pigmentado/diagnóstico , Nevo Pigmentado/ultraestructura , Pigmentación , Proyectos Piloto , Valor Predictivo de las Pruebas , Curva ROC , Reproducibilidad de los Resultados , Índice de Severidad de la Enfermedad , Neoplasias Cutáneas/diagnósticoRESUMEN
"Fat fingers" are thick digitate linear, curvilinear, branched, or oval/circular dermoscopic structures typically seen in seborrheic keratoses where they represent the gyri of their cerebriform surfaces. Their recognition is very useful in the diagnosis of these lesions, especially when the classic features (eg, milia, comedo-like openings) are absent. Histologically and by confocal microscopy the "fat finger" gyri are accentuated by pigmented keratin filling the sulci. "Fat fingers" must be differentiated from other linear structures such as "network-like structures"; branched streaks; network; globules; pigmented ovoid-nests; and streaks/pseudopods seen in different melanocytic and non-melanocytic lesions.
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Dermoscopía , Queratosis Seborreica/diagnóstico , Adulto , Humanos , Queratosis Seborreica/patología , Masculino , Microscopía Confocal , PigmentaciónRESUMEN
BACKGROUND: Confidence is an important factor in decision making and may influence patient care. OBJECTIVES: To evaluate whether short-training-based dermoscopy increases confidence in the diagnosis of skin lesions. METHODS AND MATERIALS: After a 1-hour course on dermoscopy, 20 pairs of clinical and dermoscopic images of lesions were presented to 19 dermatology residents with little or no dermoscopy experience. After viewing the clinical image, they were asked to assess their confidence in the diagnosis in a seven-point scale, with 1 reflecting that the respondent was 100% confident that the lesion was benign, while number 7 reflected 100% confidence that it was malignant. The same technique was used for dermoscopic images. RESULTS: Ten of the 20 pairs of evaluations showed a significant difference (p<.05). The largest differences were observed in lesions where clinical scores suggested that participants were uncertain about the diagnosis, but tended to decide that the lesion was benign after dermoscopy. Dermoscopy did not improve confidence in the evaluation of dysplastic lesions as well as lesions with obvious clinical diagnoses. CONCLUSIONS: Short-training-based dermoscopy improved confidence in the diagnosis of clinically challenging skin lesions, but the impact was not demonstrable for clinically obvious lesions and dysplastic nevi.
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Competencia Clínica , Dermatología/educación , Dermoscopía , Examen Físico , Adulto , Intervalos de Confianza , HumanosAsunto(s)
Melanoma/diagnóstico , Neoplasias Cutáneas/diagnóstico , Algoritmos , Diagnóstico Precoz , HumanosAsunto(s)
Enfermedad de Bowen/diagnóstico , Hiperpigmentación/diagnóstico , Melanoma/diagnóstico , Microscopía/métodos , Neovascularización Patológica/diagnóstico , Neoplasias Cutáneas/diagnóstico , Enfermedad de Bowen/patología , Diagnóstico Diferencial , Humanos , Hiperpigmentación/patología , Melanoma/patología , Neovascularización Patológica/patología , Neoplasias Cutáneas/patologíaRESUMEN
Dermoscopy is an in vivo method for the early diagnosis of malignant melanoma and the differential diagnosis of pigmented lesions of the skin. It has been shown to increase diagnostic accuracy over clinical visual inspection in the hands of experienced physicians. This article is a review of the principles of dermoscopy as well as recent technological developments.
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Dermoscopía , Algoritmos , Diagnóstico Diferencial , Humanos , Melanoma/diagnóstico , Neoplasias Cutáneas/diagnóstico , Pigmentación de la PielRESUMEN
CONTEXT: The incidence of cutaneous melanoma has increased over the past several decades, making its early diagnosis a continuing public health priority. The ABCD (Asymmetry, Border irregularity, Color variegation, Diameter >6 mm) acronym for the appraisal of cutaneous pigmented lesions was devised in 1985 and has been widely adopted but requires reexamination in light of recent data regarding the existence of small-diameter (< or =6 mm) melanomas. EVIDENCE ACQUISITION: Cochrane Library and PubMed searches for the period 1980-2004 were conducted using search terms ABCD and melanoma and small-diameter melanoma. Bibliographies of retrieved articles were also used to identify additional relevant information. EVIDENCE SYNTHESIS: Available data do not support the utility of lowering the diameter criterion of ABCD from the current greater than 6 mm guideline. However, the data support expansion to ABCDE to emphasize the significance of evolving pigmented lesions in the natural history of melanoma. Physicians and patients with nevi should be attentive to changes (evolving) of size, shape, symptoms (itching, tenderness), surface (especially bleeding), and shades of color. CONCLUSIONS: The ABCD criteria for the gross inspection of pigmented skin lesions and early diagnosis of cutaneous melanoma should be expanded to ABCDE (to include "evolving"). No change to the existing diameter criterion is required at this time.
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Melanoma/diagnóstico , Neoplasias Cutáneas/diagnóstico , Humanos , Guías de Práctica Clínica como AsuntoRESUMEN
The rising incidence of cutaneous malignant melanoma has been observed in the past decades. Currently, there is no cure for metastatic melanoma; only early diagnosis followed by prompt excision of cutaneous lesions ensures a good prognosis. The clinical ABCD rule is created as a framework for differentiating melanomas from benign pigmented skin lesions, and it serves as the basis for current clinical diagnosis. The ABCD rule relies on four simple clinical morphologies of melanoma: 1) Asymmetry, 2) Border irregularity, 3) Color variegation, and 4) Diameter greater than 6 mm. Although it is valuable, it has its limitations. Currently, the diagnostic accuracy for physicians is about 65%. This statistic implies that 1) melanomas with subtle signs are missed as benign lesions, and 2) benign lesions are over diagnosed as melanomas, which lead to unnecessary biopsies.