Background. The clinical history of a given pigmented lesion could in fluence the therapeutic decision. Teledermatology and automated image analysis also hold great potential for revolutionizing dermatology services. ...Background. The clinical history of a given pigmented lesion could in fluence the therapeutic decision. Teledermatology and automated image analysis also hold great potential for revolutionizing dermatology services. Aim. The aim of this retrospective study was to evaluate the diagnostic accuracy of users with differ ent experiences in dermoscopy with and without information about patients and th eir history compared with classification by an automated analysing system. Setti ng. One hundred and fifty-seven dermoscopic images of pigmented lesions, taken and proved by histopathology at the Pigmented Lesions Clinic of theDepartment o f Dermatology of the University Tuebingen,Germany, were included. Methods. All i mages were viewed by three investigators with different experience: excellent (A ), average (B) and beginner (C). In the first dermoscopic classification, no inf ormation was available. After 3 months the same images were once more classified by the three investigators, now with the information about the patients and the ir history. The melanocytic lesions were tested by the Tuebinger Mole Analyser. Results. For user A the sensitivity, specificity and diagnostic accuracy reveale d no improvement on including the history (81.3% to 84.4% , 94.6% to 92.3% and 92.0% to 90.7% ), whereas user B clearly improved his results (75.0% to 87.5% , 76.9% to 88.5% and 76.5% to 88.3% ). No change in the sensiti vity was seen by user C (84.4% ), but there was a clear improvement in the spec ificity (69.2% to 87.7% )-and diagnostic accuracy (72.2% to 87.0% ). Usi ng the computer algorithm, a sensitivity of 100% , a specificity of 76.9% and a diagnostic accuracy of 81.9% were achieved. Conclusions. The study revealed results relevant to the use of dermoscopy: (1) continuing dermoscopic education influences the diagnostic accuracy; (2) the history is helpful for averaged use rs and beginners in dermoscopy; (3) digital image analysis has the highest sensi tivity, but a lower specificity compared to the clinicians; and (4) digi展开更多
Background: Guidelines for optimized use of digital follow-up of melanocytic lesions are not yet available, and little is known about inclusion criteria adopted in clinical practice. Objective: Our purpose was to desc...Background: Guidelines for optimized use of digital follow-up of melanocytic lesions are not yet available, and little is known about inclusion criteria adopted in clinical practice. Objective: Our purpose was to describe the frequency of digital follow-up adoption in melanoma screening, the characteristics of patients and lesions selected, and the predictors of duration of the intervals of digital follow-up. Methods: Baseline characteristics of patients and lesions selected for digital follow-up in 12 Italian pigmented lesion clinics were examined. Predictors of a short follow-up interval (≤3months) compared with a 6-month interval were investigated by means of logistic regression analysis. Results: Out of 2116 subjects consecutively examined, 409 were submitted to digital follow-up (19.3%), with 1.6 mean lesions found per patient (range, 1-9; median, 1). According to an a posteriori analysis, 15.2%of the lesions were diagnostically equivocal and 7.8%of lesions had a total dermoscopy score (TDS) suggestive of malignancy. However, large differences in the TDS were found among the participating centers. Determinants of a short follow-up interval, adopted in 40.8%of patients, were the personal history of melanoma (odds ratio [OR] 2.56, 95%confidence interval [CI] 1.09-5.99) and the presence of atypical nevi (at least one atypical nevus (OR 4.54, 95%CI 2.45-8.42). Unexpectedly, the dermoscopic atypia of the lesion (TDS > 4.75) was associated only with a marginal effect on the scheduled duration of follow-up interval (OR 1.34, 95%CI 0.97-1.86). These findings were confirmed by a multivariate analysis. Limitations: The adoption of different digital dermoscopy systems in the participating centers may have limited the reliability of the TDS assigned by a central group to dermoscopy images. Conclusions: Practicing dermatologists who use digital epiluminescence microscopy in screening for melanoma decided to submit at least one melanocytic lesion to digital follow-up for approximately 1 patient for every 5 examined. Thi展开更多
In order to investigate the possible role of dermoscopy in the non-invasive classification of combined nevi, we analyzed dermoscopic features of a series of combined nevi consecutively excised. Two dermatologists expe...In order to investigate the possible role of dermoscopy in the non-invasive classification of combined nevi, we analyzed dermoscopic features of a series of combined nevi consecutively excised. Two dermatologists expert in dermoscopy retrospectively evaluated all images based on the presence of dermoscopic findings to analyze which epiluminescence microscopy features were more frequently associated with each type of combined nevus. Dermoscopy may provide useful information in the non-invasive diagnosis of combined nevi, allowing a conservative management, but this may be limited to combined nevi including a blue nevus component. Conversely, combined nevi including a Spitz nevus component may be difficult to classify even by dermoscopy, thus requiring careful monitoring or surgical excision.展开更多
文摘Background. The clinical history of a given pigmented lesion could in fluence the therapeutic decision. Teledermatology and automated image analysis also hold great potential for revolutionizing dermatology services. Aim. The aim of this retrospective study was to evaluate the diagnostic accuracy of users with differ ent experiences in dermoscopy with and without information about patients and th eir history compared with classification by an automated analysing system. Setti ng. One hundred and fifty-seven dermoscopic images of pigmented lesions, taken and proved by histopathology at the Pigmented Lesions Clinic of theDepartment o f Dermatology of the University Tuebingen,Germany, were included. Methods. All i mages were viewed by three investigators with different experience: excellent (A ), average (B) and beginner (C). In the first dermoscopic classification, no inf ormation was available. After 3 months the same images were once more classified by the three investigators, now with the information about the patients and the ir history. The melanocytic lesions were tested by the Tuebinger Mole Analyser. Results. For user A the sensitivity, specificity and diagnostic accuracy reveale d no improvement on including the history (81.3% to 84.4% , 94.6% to 92.3% and 92.0% to 90.7% ), whereas user B clearly improved his results (75.0% to 87.5% , 76.9% to 88.5% and 76.5% to 88.3% ). No change in the sensiti vity was seen by user C (84.4% ), but there was a clear improvement in the spec ificity (69.2% to 87.7% )-and diagnostic accuracy (72.2% to 87.0% ). Usi ng the computer algorithm, a sensitivity of 100% , a specificity of 76.9% and a diagnostic accuracy of 81.9% were achieved. Conclusions. The study revealed results relevant to the use of dermoscopy: (1) continuing dermoscopic education influences the diagnostic accuracy; (2) the history is helpful for averaged use rs and beginners in dermoscopy; (3) digital image analysis has the highest sensi tivity, but a lower specificity compared to the clinicians; and (4) digi
文摘Background: Guidelines for optimized use of digital follow-up of melanocytic lesions are not yet available, and little is known about inclusion criteria adopted in clinical practice. Objective: Our purpose was to describe the frequency of digital follow-up adoption in melanoma screening, the characteristics of patients and lesions selected, and the predictors of duration of the intervals of digital follow-up. Methods: Baseline characteristics of patients and lesions selected for digital follow-up in 12 Italian pigmented lesion clinics were examined. Predictors of a short follow-up interval (≤3months) compared with a 6-month interval were investigated by means of logistic regression analysis. Results: Out of 2116 subjects consecutively examined, 409 were submitted to digital follow-up (19.3%), with 1.6 mean lesions found per patient (range, 1-9; median, 1). According to an a posteriori analysis, 15.2%of the lesions were diagnostically equivocal and 7.8%of lesions had a total dermoscopy score (TDS) suggestive of malignancy. However, large differences in the TDS were found among the participating centers. Determinants of a short follow-up interval, adopted in 40.8%of patients, were the personal history of melanoma (odds ratio [OR] 2.56, 95%confidence interval [CI] 1.09-5.99) and the presence of atypical nevi (at least one atypical nevus (OR 4.54, 95%CI 2.45-8.42). Unexpectedly, the dermoscopic atypia of the lesion (TDS > 4.75) was associated only with a marginal effect on the scheduled duration of follow-up interval (OR 1.34, 95%CI 0.97-1.86). These findings were confirmed by a multivariate analysis. Limitations: The adoption of different digital dermoscopy systems in the participating centers may have limited the reliability of the TDS assigned by a central group to dermoscopy images. Conclusions: Practicing dermatologists who use digital epiluminescence microscopy in screening for melanoma decided to submit at least one melanocytic lesion to digital follow-up for approximately 1 patient for every 5 examined. Thi
文摘In order to investigate the possible role of dermoscopy in the non-invasive classification of combined nevi, we analyzed dermoscopic features of a series of combined nevi consecutively excised. Two dermatologists expert in dermoscopy retrospectively evaluated all images based on the presence of dermoscopic findings to analyze which epiluminescence microscopy features were more frequently associated with each type of combined nevus. Dermoscopy may provide useful information in the non-invasive diagnosis of combined nevi, allowing a conservative management, but this may be limited to combined nevi including a blue nevus component. Conversely, combined nevi including a Spitz nevus component may be difficult to classify even by dermoscopy, thus requiring careful monitoring or surgical excision.
