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Griffiths Acha J, Gamo Villegas R, Floristán Murúzabal U, Pampín Franco A, Sarró Fuente C, Pinedo Moraleda F, López Estebaranz JL. Extrafacial lentigo maligna: A progression model and enhanced diagnostic techniques using dermatoscopy and reflectance confocal microscopy. J Cutan Pathol 2024. [PMID: 38837796 DOI: 10.1111/cup.14665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 04/18/2024] [Accepted: 05/20/2024] [Indexed: 06/07/2024]
Abstract
Lentigo maligna (LM) is a subtype of lentiginous melanoma confined to the epidermis, which is associated with chronic sun exposure. Its clinical, dermatoscopic, and histopathological diagnosis can be challenging, particularly in the early and advanced stages, requiring appropriate clinicopathological correlation. This article reviews the clinical presentation, diagnosis through noninvasive methods (dermoscopy and confocal microscopy), and provides insights for diagnosis of extrafacial LM through the presentation of four representative clinical cases from different phases of a theoretical-practical progression model. Recognizing these lesions is crucial, as once they invade the dermis, they can behave like any other type of melanoma.
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Lalama MJ, Avila A, Jaimes N. Dermoscopic structures and patterns used in melanoma detection. Ital J Dermatol Venerol 2024; 159:294-302. [PMID: 38619202 DOI: 10.23736/s2784-8671.24.07834-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Melanoma is the leading cause of skin cancer-related deaths. Yet, early detection remains the most cost-effective means of preventing death from melanoma. Early detection can be achieved by a physician and/or the patient (also known as a self-skin exam). Skin exams performed by physicians are further enhanced using dermoscopy. Dermoscopy is a non-invasive technique that allows for the visualization of subsurface structures that are otherwise not visible to the naked eye. Evidence demonstrates that dermoscopy improves the diagnostic accuracy for skin cancer, including melanoma; it decreases the number of unnecessary skin biopsies of benign lesions and improves the benign-to-malignant biopsy ratio. Yet, these improvements are contingent on acquiring dermoscopy training. Dermoscopy is used by clinicians who evaluate skin lesions and perform skin cancer screenings. In general, under dermoscopy nevi tend to appear as organized lesions, with one or two structures and colors, and no melanoma-specific structures. In contrast, melanomas tend to manifest a disorganized pattern, with more than two colors and, usually, at least one melanoma-specific structure. This review is intended to familiarize the reader with the dermoscopic structures and patterns used in melanoma detection.
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Affiliation(s)
- Maria J Lalama
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Alejandra Avila
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Natalia Jaimes
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA -
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
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Licata G, Brancaccio G, Ronchi A, Borsari S, Longo C, Piana S, Cinotti E, Dragotto M, Rubegni P, Argenziano G, Moscarella E. Is reflectance confocal microscopy useful in the differential diagnosis of extra facial lentigo maligna? A retrospective multicentric case-control study. J Eur Acad Dermatol Venereol 2023; 37:2474-2480. [PMID: 37478292 DOI: 10.1111/jdv.19379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/28/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Extra facial lentigo maligna (EF-LM) arises outside the head and neck area. EF-LM presents the classic histological features of lentigo maligna. The dermoscopic aspects of EF-LM have been poorly studied. OBJECTIVE The primary aims of our study were to analyse and describe the clinical, dermoscopic and confocal microscopy features of a series of histologically confirmed EF-LM. METHOD We conducted a retrospective and multicentric study. From our database, we selected 48 cases of thin melanomas on photodamaged skin with histological features of EF-LM of which clinical, dermoscopic and confocal microscopy images were available, and a control group of 45 lesions, that can be subjected to differential diagnosis such as solar lentigo, lichenoid keratosis, seborrheic keratosis and melanocytic nevi, of which dermoscopic and confocal microscope images were available. RESULTS Extra facial lentigo maligna had a higher prevalence of lentigo-like pigment patterns, angulated lines and zigzag structures. At confocal microscopy, LM-EF cases showed a higher prevalence of pagetoid spreading, round cells, dendritic cells in the epidermis, atypical cells at the dermo-epidermal junction, dendritic cells at the junction, meshwork pattern and elastosis. Our study shows that reflectance confocal microscopy (RCM) has a sensitivity of 90% and a specificity of 97% for the differential diagnosis of this type of melanoma. CONCLUSIONS Extra facial lentigo maligna does not have the classic dermoscopic features of superficial spreading melanoma, the most observed dermoscopic criteria are angulated lines and lentigo-like pigment patterns without lentigo-like border. RCM can be a valuable imaging tool for the evaluation of all those suspicion skin lesions at dermoscopy highlighting cellular atypia suggestive for melanoma.
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Affiliation(s)
- Gaetano Licata
- Dermatology Unit, San Antonio Abate Hospital, Trapani, Italy
| | - Gabriella Brancaccio
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Andrea Ronchi
- Division of Pathology, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Stefania Borsari
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Caterina Longo
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Dermatology Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - Simonetta Piana
- Pathology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elisa Cinotti
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Martina Dragotto
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Pietro Rubegni
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Giuseppe Argenziano
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Elvira Moscarella
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
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Sortino AMF, Soares de Sá BC, Martins MA, Bertolli E, de Paula RB, Lopes Pinto CA, David Filho WJ, Tavoloni Braga JC, Duprat Neto JP, Carraro DM, Curado MP. Multiple Primary Melanoma: A Five-Year Prospective Single-Center Follow-Up Study of Two MC1R R/R Genotype Carriers. Life (Basel) 2023; 13:2102. [PMID: 37895483 PMCID: PMC10608495 DOI: 10.3390/life13102102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/10/2023] [Accepted: 10/15/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Multiple primary melanoma (MPM) is a diagnostic challenge even with ancillary imaging technologies available to dermatologists. In selected patients' phenotypes, the use of imaging approaches can help better understand lesion characteristics, and aid in early diagnosis and management. METHODS Under a 5-year prospective single-center follow-up, 58 s primary melanomas (SPMs) were diagnosed in two first-degree relatives, with fair skin color, red hair, green eyes, and personal history of one previous melanoma each. Patients' behavior and descriptive demographic data were collected from medical records. The information on the first two primary melanomas (PMs) were retrieved from pathology reports. The characteristics of 60 melanomas were collected from medical records, video dermoscopy software, and pathology reports. Reflectance confocal microscopy (RCM) was performed prior to excision of 22 randomly selected melanomas. RESULTS From February 2018 to May 2023, two patients underwent a pooled total of 214 excisional biopsies of suspect lesions, resulting in a combined benign versus malignant treatment ratio (NNT) of 2.0:1.0. The number of moles excised for each melanoma diagnosed (NNE) was 1.7:1.0 and 6.9:1.0 for the female and male patient respectively. The in-situ melanoma/invasive melanoma ratio (IIR) demonstrated a higher proportion of in-situ melanomas for both patients. From June 2018 to May 2023, a total of 58 SPMs were detected by the combination of total body skin exam (TBSE), total body skin photography (TBSP), digital dermoscopy (DD), and sequential digital dermoscopy imaging (SDDI) via comparative approach. The younger patient had her PM one month prior to the second and third cutaneous melanomas (CMs), characterizing a case of synchronous primary CM. The male older relative had a total of 7 nonsynchronous melanomas. CONCLUSIONS This CM cohort is composed of 83.3% in-situ melanoma and 16.7% invasive melanoma. Both patients had a higher percentage of SPM with clinical nevus-like morphology (84.5%), global dermoscopic pattern of asymmetric multiple component (60.3%) and located on the lower limbs (46.6%). When RCM was performed prior to excision, 81% of SPM had features suggestive of malignancy. As well, invasive melanomas were more frequent in the lower limbs (40%). In the multivariate model, for the two high-risk patients studied, the chance of a not associated with nevus ("de novo") invasive SPM diagnosis is 25 times greater than the chance of a diagnosis of a nevus-associated invasive SPM.
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Affiliation(s)
- Ana Maria Fagundes Sortino
- Clínica Dermatológica Dermatis, Rua Joaquim Floriano 466, Itaim Bibi, São Paulo 04534-002, SP, Brazil
- Hospital Sírio-Libanês, Rua Dona Adma Jafet 115, Bela Vista, São Paulo 01308-050, SP, Brazil
| | | | - Marcos Alberto Martins
- Centro Universitário Saúde ABC, Surgery Department, Avenida Lauro Gomes 2000, Vila Sacadura Cabral, Santo André 09060-870, SP, Brazil
| | - Eduardo Bertolli
- Hospital Sírio-Libanês, Rua Dona Adma Jafet 115, Bela Vista, São Paulo 01308-050, SP, Brazil
- A Beneficência Portuguesa de São Paulo–BP Mirante, Rua Martiniano de Carvalho 965, Bela Vista, São Paulo 01323-001, SP, Brazil
| | - Rafaela Brito de Paula
- AC Camargo Cancer Center, Rua Pires da Mota 1.167, Aclimação, São Paulo 01529-001, SP, Brazil
| | | | - Waldec Jorge David Filho
- Hospital Alemão Oswaldo-Cruz, Rua Treze de Maio 1815, Bela Vista, São Paulo 01323-903, SP, Brazil;
| | | | | | - Dirce Maria Carraro
- AC Camargo Cancer Center, Rua Pires da Mota 1.167, Aclimação, São Paulo 01529-001, SP, Brazil
| | - Maria Paula Curado
- AC Camargo Cancer Center, Rua Pires da Mota 1.167, Aclimação, São Paulo 01529-001, SP, Brazil
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Pietkiewicz P, Giedziun P, Idziak J, Todorovska V, Lewandowicz M, Lallas A. Diagnostic Accuracy of Hyperpigmented Microcircles in Dermatoscopy of Non-Facial Non-Acral Melanomas: A Pilot Retrospective Study using a Public Image Database. Dermatology 2023; 239:976-987. [PMID: 37666232 DOI: 10.1159/000533820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/22/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Grey perifollicular circles are a dermatoscopic clue to melanoma, especially in facial skin. So far, no other adnexal clues than follicular have been investigated in this diagnosis. OBJECTIVES The study aimed to analyse the prevalence of hyperpigmented periadnexal microcircles (HMs) in melanoma and its common simulators at non-facial non-acral sites, analyse the relation between the presence of HM, regression and hypopigmentation, and evaluate the diagnostic accuracy of this structure in melanoma. METHODS International Skin Imaging Collaboration (69,445 images) was searched in April 2020 for the pathology-confirmed dermatoscopic images with metadata including sex, age bin, and declared non-acral non-facial anatomic site. The final study sample (5,408 images, 1,326 of which were melanomas) was evaluated by expert dermatoscopist blinded to the diagnosis and labelled for the presence of ≥3 HM distributed centrally (cHM) or peripherally (pHM), hypopigmentation, and classic dermatoscopic regression structures. A subset of 40 images was labelled by 7 raters (2 residents, 5 experts) to assess interobserver agreement. We compared the presence of pHM with the presence of regression as well as performed a set of independent χ2 tests to evaluate the discriminatory power and its fragility. Performance of the models was assessed using measures of discrimination and calibration. RESULTS HM were significantly more prevalent in melanomas than in non-melanomas and nevi. Fair/good interobserver agreement for HM was reached for all the raters, and moderate/good for experts only (single rater/average, respectively). Regardless of regression/hypopigmentation status, pHM were significantly more common in melanoma than in non-melanomas or nevi and were observed significantly more often in melanomas on sun-damaged skin (upper extremity, posterior torso). No significant differences between the groups were found for cHM. pHM proved a high odds ratio in the tests as to the classical indicators such as classic dermatoscopic regression structures. CONCLUSION pHM could be considered a novel dermatoscopic clue to melanoma.
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Affiliation(s)
- Paweł Pietkiewicz
- General and Oncological Surgery Clinic I, Greater Poland Cancer Centre, Poznań, Poland
- Polish Dermatoscopy Group, Research Workgroup, Poznań, Poland
| | - Piotr Giedziun
- Polish Dermatoscopy Group, Research Workgroup, Poznań, Poland
- Faculty of Information and Communication Technology, Wrocław University of Science and Technology Centre for Scientific and Technical Knowledge and Information, Wrocław, Poland
| | - Jan Idziak
- Polish Dermatoscopy Group, Research Workgroup, Poznań, Poland
| | | | - Michał Lewandowicz
- Polish Dermatoscopy Group, Research Workgroup, Poznań, Poland
- Breast Cancer Unit, Department of Surgical Oncology, Regional Oncology Center, Łódź, Poland
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
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Sun X, Zhang J, Hu J, Han Q, Ge Z. LSM2 is associated with a poor prognosis and promotes cell proliferation, migration, and invasion in skin cutaneous melanoma. BMC Med Genomics 2023; 16:129. [PMID: 37312186 DOI: 10.1186/s12920-023-01564-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 05/31/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Skin cutaneous melanoma (SKCM) is an extremely malignant tumor that is associated with a poor prognosis. LSM2 has been found to be related to different types of tumors; however, its role in SKCM is poorly defined. We aimed to determine the value of LSM2 as a prognostic biomarker for SKCM. METHODS The expression profile of LSM2 mRNA was compared between tumor and normal tissues in public databases, such as TCGA, GEO, and BioGPS. LSM2 protein expression was explored using immunohistochemistry (IHC) on a tissue microarray containing 44 SKCM tissues and 8 normal samples collected at our center. Kaplan-Meier analysis was performed to assess the prognostic value of LSM2 expression in patients with SKCM. SKCM cell lines with LSM2 knockdown were used to determine the effects of LSM2. Cell counting kit-8 (CCK8) and colony formation assays were conducted to assess cell proliferation, whereas wound healing and transwell assays were carried out to assess the migration and invasion abilities of SKCM cells. RESULTS LSM2 was more highly expressed at the mRNA and protein levels in SKCM than that in normal skin. Moreover, elevated expression of LSM2 was associated with shorter survival time and early recurrence in patients with SKCM. The in vitro results revealed that the silencing of LSM2 in SKCM cells significantly inhibited cell proliferation, migration, and invasion. CONCLUSION Overall, LSM2 contributes to malignant status and poor prognosis in patients with SKCM and may be identified as a novel prognostic biomarker and therapeutic target.
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Affiliation(s)
- Xiaofang Sun
- Department of Dermatology, the Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China
- Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Soochow University, Soochow University, Jiangsu, China
| | - Jianping Zhang
- Department of Dermatology, the Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China
| | - Jiayuan Hu
- Department of Dermatology, the Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China
| | - Qingdong Han
- Department of Dermatology, the Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China
| | - Zili Ge
- Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Soochow University, Soochow University, Jiangsu, China.
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Słowińska M, Czarnecka I, Czarnecki R, Tatara P, Nasierowska-Guttmejer A, Lorent M, Cierniak S, Owczarek W. Clinical, Dermoscopic, and Histological Characteristics of Melanoma Patients According to the Age Groups: A Retrospective Observational Study. Life (Basel) 2023; 13:1369. [PMID: 37374151 DOI: 10.3390/life13061369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 05/27/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Although the role of melanoma risk factors is well documented, their correlation with patients' age is less frequently analyzed. METHOD The analysis was performed among 189 melanoma patients in different age groups, including <30 years, 31-60 years, and >60 years, to investigate the risk factors, topography, and coexistence of morphological features of 209 melanomas (dermoscopic and histopathological). RESULTS Among the youngest age group, no correlation with the presence of estimated risk factors was found. The most common dermoscopic pattern was spitzoid and multicomponent asymmetric. The group of middle-aged patients was the most diverse in terms of the occurrence of risk factors, solar lentiginosis, dermoscopic patterns, topography, histological subtypes, and invasiveness of melanomas. The oldest group characterized a strong correlation between solar lentiginosis, NMSC comorbidity, the prevalence of facial melanomas, the dermoscopic pattern of melanoma arising on chronic sun-damaged skin, and regression. CONCLUSION The findings regarding the presence of age-specific features in melanoma patients, especially in the youngest and middle-aged groups, might be helpful for clinicians and to target secondary prevention efforts.
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Affiliation(s)
- Monika Słowińska
- Department of Dermatology, Central Clinical Hospital Ministry of Defense, Military Institute of Medicine-National Research Institute, Szaserow 128, 04-141 Warsaw, Poland
- Evimed Medical Centre Ltd., Private Dermatologic Practice, JP Woronicza 16, 02-625 Warsaw, Poland
| | - Iwona Czarnecka
- Department of Dermatology, Central Clinical Hospital Ministry of Defense, Military Institute of Medicine-National Research Institute, Szaserow 128, 04-141 Warsaw, Poland
| | - Robert Czarnecki
- Department of Cardiology, LUX MED Oncology, Limited Liability Company, St. Elizabeth Hospital, Goszczynskiego 1, 02-616 Warsaw, Poland
| | - Paulina Tatara
- Department of Dermatology, Central Clinical Hospital Ministry of Defense, Military Institute of Medicine-National Research Institute, Szaserow 128, 04-141 Warsaw, Poland
| | - Anna Nasierowska-Guttmejer
- Department of Pathomorphology, Central Clinical Hospital of Ministry of Interior and Administration-National Medical Institute, Woloska 137, 02-507 Warsaw, Poland
- Faculty of Medicine, Lazarski University, Swieradowska 43, 02-662 Warsaw, Poland
| | - Małgorzata Lorent
- Department of Pathomorphology, Central Clinical Hospital Ministry of Defense, Military Institute of Medicine-National Research Institute, Szaserow 128, 04-141 Warsaw, Poland
| | - Szczepan Cierniak
- Department of Pathomorphology, Central Clinical Hospital Ministry of Defense, Military Institute of Medicine-National Research Institute, Szaserow 128, 04-141 Warsaw, Poland
| | - Witold Owczarek
- Department of Dermatology, Central Clinical Hospital Ministry of Defense, Military Institute of Medicine-National Research Institute, Szaserow 128, 04-141 Warsaw, Poland
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Sarró-Fuente C, Gamo-Villegas R, Floristán-Muruzábal U. [Translated article] Dermoscopic Features of Extrafacial Lentigo Maligna. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:T339-T340. [PMID: 36848958 DOI: 10.1016/j.ad.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 03/10/2022] [Indexed: 02/27/2023] Open
Affiliation(s)
- C Sarró-Fuente
- Servicio de Dermatología del Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain.
| | - R Gamo-Villegas
- Servicio de Dermatología del Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - U Floristán-Muruzábal
- Servicio de Dermatología del Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
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Nambisan AK, Maurya A, Lama N, Phan T, Patel G, Miller K, Lama B, Hagerty J, Stanley R, Stoecker WV. Improving Automatic Melanoma Diagnosis Using Deep Learning-Based Segmentation of Irregular Networks. Cancers (Basel) 2023; 15:cancers15041259. [PMID: 36831599 PMCID: PMC9953766 DOI: 10.3390/cancers15041259] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 02/18/2023] Open
Abstract
Deep learning has achieved significant success in malignant melanoma diagnosis. These diagnostic models are undergoing a transition into clinical use. However, with melanoma diagnostic accuracy in the range of ninety percent, a significant minority of melanomas are missed by deep learning. Many of the melanomas missed have irregular pigment networks visible using dermoscopy. This research presents an annotated irregular network database and develops a classification pipeline that fuses deep learning image-level results with conventional hand-crafted features from irregular pigment networks. We identified and annotated 487 unique dermoscopic melanoma lesions from images in the ISIC 2019 dermoscopic dataset to create a ground-truth irregular pigment network dataset. We trained multiple transfer learned segmentation models to detect irregular networks in this training set. A separate, mutually exclusive subset of the International Skin Imaging Collaboration (ISIC) 2019 dataset with 500 melanomas and 500 benign lesions was used for training and testing deep learning models for the binary classification of melanoma versus benign. The best segmentation model, U-Net++, generated irregular network masks on the 1000-image dataset. Other classical color, texture, and shape features were calculated for the irregular network areas. We achieved an increase in the recall of melanoma versus benign of 11% and in accuracy of 2% over DL-only models using conventional classifiers in a sequential pipeline based on the cascade generalization framework, with the highest increase in recall accompanying the use of the random forest algorithm. The proposed approach facilitates leveraging the strengths of both deep learning and conventional image processing techniques to improve the accuracy of melanoma diagnosis. Further research combining deep learning with conventional image processing on automatically detected dermoscopic features is warranted.
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Affiliation(s)
- Anand K. Nambisan
- Electrical and Computer Engineering Department, Missouri University of Science and Technology, Rolla, MO 65409, USA
| | - Akanksha Maurya
- Electrical and Computer Engineering Department, Missouri University of Science and Technology, Rolla, MO 65409, USA
| | - Norsang Lama
- Electrical and Computer Engineering Department, Missouri University of Science and Technology, Rolla, MO 65409, USA
| | - Thanh Phan
- Department of Biological Sciences, College of Arts, Sciences, and Education, Missouri University of Science and Technology, Rolla, MO 65409, USA
| | - Gehana Patel
- College of Health Sciences, University of Missouri—Columbia, Columbia, MO 65211, USA
| | - Keith Miller
- Electrical and Computer Engineering Department, Missouri University of Science and Technology, Rolla, MO 65409, USA
| | - Binita Lama
- Electrical and Computer Engineering Department, Missouri University of Science and Technology, Rolla, MO 65409, USA
| | - Jason Hagerty
- S&A Technologies, 10101 Stoltz Drive, Rolla, MO 65401, USA
| | - Ronald Stanley
- Electrical and Computer Engineering Department, Missouri University of Science and Technology, Rolla, MO 65409, USA
- Correspondence:
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Sarró-Fuente C, Gamo-Villegas R, Floristán-Muruzábal U. Dermoscopic Features of Extrafacial Lentigo Maligna. ACTAS DERMO-SIFILIOGRAFICAS 2022; 114:339-340. [PMID: 36584885 DOI: 10.1016/j.ad.2022.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/05/2022] [Accepted: 03/10/2022] [Indexed: 12/28/2022] Open
Affiliation(s)
- C Sarró-Fuente
- Servicio de Dermatología del Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
| | - R Gamo-Villegas
- Servicio de Dermatología del Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - U Floristán-Muruzábal
- Servicio de Dermatología del Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
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A cross-sectional study of clinical, dermoscopic, histopathological, and molecular patterns of scalp melanoma in patients with or without androgenetic alopecia. Sci Rep 2022; 12:15096. [PMID: 36064728 PMCID: PMC9445057 DOI: 10.1038/s41598-022-17108-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 07/20/2022] [Indexed: 11/08/2022] Open
Abstract
Scalp melanoma (SM) has a worse prognosis than melanoma in other locations likely because of late diagnosis due to hair coverage, difficulties in interpreting dermoscopy findings, and its unique molecular profile. We aimed to describe the clinical, histopathological, molecular, and dermoscopic patterns of SM and its relation to androgenetic alopecia/elastosis at the tumor site. Through a retrospective cross-sectional study, we identified all SM diagnosed at the A.C.Camargo Cancer Center between 2008 and 2018. In all, 48 SM were analyzed: 45.8% of which exhibited moderate/severe androgenetic alopecia and 54.1% exhibited elastosis. Androgenetic alopecia/elastosis at the site of the SM was associated with older age (p < 0.001), chronic sun damage (p < 0.001), lentigo maligna subtype (p = 0.029), and photodamaged dermoscopic pattern (p < 0.001). Additionally, 41 cases were evaluated with a 14-gene panel: 53.7% displayed mutations and 46.3% were wild-type. BRAF mutations were most common (77%), with BRAF V600K being more frequent (50%) than BRAF V600E (31.2%). The NF1 gene was evaluated in 40 samples, of which 20% exhibited mutations. SM presents differently in areas covered by hair compared to in areas with androgenetic alopecia. Patients without alopecia may have higher Breslow thickness due to late diagnosis because of hair concealment. The high frequency of detrimental mutations can also explain the poor prognosis of SM.
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Lesion- and Patient-Related Variables May Provide Additional Clues during Dermoscopic Assessment of Blue Nevi—A Retrospective Cohort Study. Cancers (Basel) 2022; 14:cancers14081920. [PMID: 35454827 PMCID: PMC9024686 DOI: 10.3390/cancers14081920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 03/15/2022] [Accepted: 03/29/2022] [Indexed: 11/22/2022] Open
Abstract
Simple Summary Blue nevi (BN) are dermal dendritic melanocytic proliferations which may be congenital or acquired. Due to wide clinical and dermoscopic presentation, their diagnosis may sometimes be difficult, especially if the history of lesion occurrence is unknown. Little is known about the correlation between lesion- and patient-related variables and dermoscopic features of blue nevi. The aim of the study was to analyze dermoscopic features of blue nevi, with particular regard to structures whose prevalence has not been previously reported, and to investigate the possible influence of selected clinical variables on dermoscopic presentation. Our findings provide new insights into the dermoscopic structures observed in blue nevi and their variability according to patient’s phototype and lesion size/localization. Abstract Background: Little is known about the correlation between lesion- and patient-related variables and the dermoscopic features of blue nevi. The aim of the study was dermoscopic analysis of blue nevi in association with patient- and lesion-related variables, with a special interest in structures whose prevalence has not been previously reported. Methods: This was a double-center, retrospective study, which included the analysis of histopathologically confirmed blue nevi (n = 93). Results: There was no difference in the frequency of the observed dermoscopic features according to patients’ gender and age. Pink structureless areas were more common in patients with I/II Fitzpatrick skin phototypes as well as in the patients with photodamaged skin, while blue prominent skin markings over brownish/blue-gray background occurred exclusively in patients with phototype III. Structures of previously unreported prevalence in blue nevi were skin-colored circles (present in 32.3%), gray circles (2.2%), follicular ostia with no pigmentation (18.4%; present exclusively on the face), blue skin markings over brownish background (present in 18.2%; detected only on the limbs) and dark brown polygons (one lesion located on the lower extremity). Conclusion: Dermoscopic presentation of blue nevi may vary according to the patient’s phototype and lesion size/localization rather than gender and age.
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Kittler H. Evolution of the Clinical, Dermoscopic and Pathologic Diagnosis of Melanoma. Dermatol Pract Concept 2021; 11:e2021163S. [PMID: 34447612 DOI: 10.5826/dpc.11s1a163s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 10/31/2022] Open
Abstract
The conventional narrative states that the steadily rising incidence of melanoma among fair-skinned Caucasian populations during the last decades is caused by excessive UV-exposure. There is, however, no doubt that other factors had a significant impact on the rising incidence of melanoma. Pre-1980s the clinical diagnosis of melanoma was based on gross criteria such as ulceration or bleeding. Melanomas were often diagnosed in advanced stages when the prognosis was grim. In the mid-1980s education campaigns such as the propagation of the ABCD criteria, which addressed health care professionals and the public alike, shifted the focus towards early recognition. Dermatoscopy, which became increasingly popular in the mid-1990s, improved the accuracy for the diagnosis of melanoma in comparison to inspection with the unaided eye, especially for flat and small lesions lacking ABCD criteria. At the same time, pathologists began to lower their thresholds, particularly for the diagnosis of melanoma in situ. The melanoma epidemic that followed was mainly driven by an increase in the number of in situ or microinvasive melanomas. In a few decades, the landscape shifted from an undercalling to an overcalling of melanomas, a development that is now met with increased criticism. The gold standard of melanoma diagnosis is still conventional pathology, which is faced with low to moderate interobserver agreement. New insights in the molecular landscape of melanoma did not translate into techniques for the reliable diagnosis of gray zone lesions including small lesions. The aim of this review is to put our current view of melanoma diagnosis in historical context and to provide a narrative synthesis of its evolution. Based on this narrative I will provide suggestions on how to rebuild the trust in melanoma diagnosis accuracy and in the benefit of early recognition.
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Affiliation(s)
- Harald Kittler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
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14
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Massone C, Hofman-Wellenhof R, Chiodi S, Sola S. Dermoscopic Criteria, Histopathological Correlates and Genetic Findings of Thin Melanoma on Non-Volar Skin. Genes (Basel) 2021; 12:1288. [PMID: 34440462 PMCID: PMC8391530 DOI: 10.3390/genes12081288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 08/19/2021] [Accepted: 08/19/2021] [Indexed: 11/23/2022] Open
Abstract
Dermoscopy is a non-invasive, in vivo technique that allows the visualization of subsurface skin structures in the epidermis, at the dermoepidermal junction, and in the upper dermis. Dermoscopy brought a new dimension in evaluating melanocytic skin neoplasms (MSN) also representing a link between clinical and pathologic examination of any MSN. However, histopathology remains the gold standard in diagnosing MSN. Dermoscopic-pathologic correlation enhances the level of quality of MSN diagnosis and increases the level of confidence of pathologists. Melanoma is one of the most genetically predisposed among all cancers in humans. The genetic landscape of melanoma has been described in the last years but is still a field in continuous evolution. Melanoma genetic markers play a role not only in melanoma susceptibility, initiation, and progression but also in prognosis and therapeutic decisions. Several studies described the dermoscopic specific criteria and predictors for melanoma and their histopathologic correlates, but only a few studies investigated the correlation among dermoscopy, pathology, and genetic of MSN. The aim of this work is to review the published data about dermoscopic features of melanoma, their histopathological correlates with regards also to genetic alterations. Particularly, this review will focus on low-CSD (cumulative sun damage) melanoma or superficial spreading melanoma, high-CSD melanoma, and nevus-associated melanoma.
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Affiliation(s)
| | | | | | - Simona Sola
- Surgical Pathology, Galliera Hospital, 16128 Genoa, Italy;
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15
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LALLAS A, PASCHOU E, MANOLI SM, PAPAGEORGIOU C, SPYRIDIS I, LIOPYRIS K, BOBOS M, MOUTSOUDIS A, LAZARIDOU E, APALLA Z. Dermatoscopy of melanoma according to type, anatomic site and stage. Ital J Dermatol Venerol 2021; 156:274-288. [DOI: 10.23736/s2784-8671.20.06784-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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16
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Michalak-Stoma A, Małkińska K, Krasowska D. Usefulness of Dermoscopy to Provide Accurate Assessment of Skin Cancers. Clin Cosmet Investig Dermatol 2021; 14:733-746. [PMID: 34234499 PMCID: PMC8254521 DOI: 10.2147/ccid.s305924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/13/2021] [Indexed: 11/23/2022]
Abstract
Seborrheic keratosis (SK) is the most common benign tumour of epidermal origin. In most cases, it is simple to recognize in the clinical examination. However, sometimes SK can be a problematic lesion. We present the cases of two patients with seborrheic keratosis in whom we diagnosed the skin cancer through dermoscopic and histopathological examinations. The article aims to draw attention to the need for dermoscopic examinations to be included for an accurate assessment of the nevi not only by dermatologists but also not-specialized doctors. We would like to underline that many skin cancers share the similar features of malignancy, and competence and capability to interpret the dermoscopic pictures correctly are important for early recognition of malignant lesion. Very often malignant skin cancers can be hidden among benign lesions like seborrheic keratosis or they can be imitators of benign lesions. Amongst all cases of imposing SK, basal cell carcinoma, squamous cell carcinoma, melanoma is the most important differential diagnosis, of which their dermoscopic features will be discussed in this article.
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Affiliation(s)
- Anna Michalak-Stoma
- Department of Dermatology, Venereology and Paediatric Dermatology, Medical University of Lublin, Lublin, 20-080, Poland
| | - Katarzyna Małkińska
- Department of Dermatology, Venereology and Paediatric Dermatology, Samodzielny Publiczny Szpital Kliniczny No 1, Lublin, 20-080, Poland
| | - Dorota Krasowska
- Department of Dermatology, Venereology and Paediatric Dermatology, Medical University of Lublin, Lublin, 20-080, Poland
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17
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Jitian Mihulecea CR, Frățilă S, Rotaru M. Clinical-dermoscopic similarities between atypical nevi and early stage melanoma. Exp Ther Med 2021; 22:854. [PMID: 34178127 PMCID: PMC8220634 DOI: 10.3892/etm.2021.10286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/05/2021] [Indexed: 11/05/2022] Open
Abstract
Atypical (Clark) nevi are benign tumors that may be considered precursors of melanoma. Many studies acknowledge a linear progression from typical to atypical nevi that eventually transform into melanoma. It is often challenging to differentiate a Clark nevus from melanoma, especially in its early stages, due to their clinical, dermoscopic, and histological resemblance. Dermoscopy is a powerful tool in early melanoma diagnosis, but it is a subjective method of examination. Therefore, the use of dermoscopic algorithms and checklists can overcome this issue. In the case of a difficult diagnosis, since both dermoscopy and histopathological exam are subjective methods of examination, modern molecular biology techniques can be used to distinguish between benign and malignant tumors. This study aimed to test the accuracy of specific clinical and dermoscopic criteria in order to distinguish between benign and malignant tumors, with a secondary objective to provide an overview of the clinical and dermoscopic features of atypical nevi and melanoma. In the present study, dermoscopic algorithms did not necessarily help distinguish benign and malignant tumors but demonstrated that nevi and melanoma have similar characteristics.
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Affiliation(s)
- Cristina-Raluca Jitian Mihulecea
- Dermatology Clinic, Emergency Clinical County Hospital of Sibiu, 550245 Sibiu, Romania.,Doctoral Studies, 'Victor Babeș' University of Medicine and Pharmacy of Timișoara, 300041 Timișoara, Romania
| | - Simona Frățilă
- Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania.,Dermatology Department, Emergency Clinical County Hospital of Oradea, 410169 Oradea, Romania
| | - Maria Rotaru
- Dermatology Clinic, Emergency Clinical County Hospital of Sibiu, 550245 Sibiu, Romania.,Doctoral Studies, 'Victor Babeș' University of Medicine and Pharmacy of Timișoara, 300041 Timișoara, Romania.,Dermatology Department, Faculty of Medicine, 'Lucian Blaga' University of Sibiu, 550169 Sibiu, Romania
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18
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Álvarez-Salafranca M, Sánchez-Bernal J, Ara Martín M. Prominent Skin Markings: A New Reason to Suspect Melanoma. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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19
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Álvarez-Salafranca M, Sánchez-Bernal J, Ara Martín M. Prominent Skin Markings: A New Reason to Suspect Melanoma. ACTAS DERMO-SIFILIOGRAFICAS 2020; 112:451-452. [PMID: 33220306 DOI: 10.1016/j.ad.2019.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 06/17/2019] [Accepted: 07/22/2019] [Indexed: 10/23/2022] Open
Affiliation(s)
- M Álvarez-Salafranca
- Servicio de Dermatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
| | - J Sánchez-Bernal
- Servicio de Dermatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - M Ara Martín
- Servicio de Dermatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
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20
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Iznardo H, Garcia-Melendo C, Yélamos O. Lentigo Maligna: Clinical Presentation and Appropriate Management. Clin Cosmet Investig Dermatol 2020; 13:837-855. [PMID: 33223843 PMCID: PMC7671473 DOI: 10.2147/ccid.s224738] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/15/2020] [Indexed: 01/12/2023]
Abstract
Lentigo maligna (LM) is a type of melanoma in situ that has distinctive characteristics regarding epidemiology, risk factors and clinical features. In addition, LM has a potential to progress to an invasive tumor with potentially aggressive behavior: lentigo maligna melanoma (LMM). Overall, LM has a very good prognosis, whereas LMM has the same prognosis as other invasive melanomas with similar Breslow thickness. LM/LMM represents a challenging entity not only regarding the diagnosis but also regarding the management. Diagnostic criteria are not well established, and there is an overlap of clinical, dermoscopic and pathological features with other benign pigmented skin lesions such as lentigines, pigmented actinic keratoses or macular seborrheic keratoses. LM/LMM's common appearance within photodamaged skin makes lesion border identification difficult. Wide excisions are often required, but since LM/LMM typically appears on cosmetically sensitive areas such as the face, sometimes large excisions are not possible nor desirable. In this sense, specialized approaches have been developed such as margin-controlled surgery or image-guided treatment using reflectance confocal microscopy. Other treatments for LM such as cryosurgery, imiquimod, radiotherapy or photodynamic therapy have been proposed, although recurrence/persistence is common. The current manuscript reviews extensively the published data regarding the diagnosis, treatment and management of both complex entities LM and LMM.
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Affiliation(s)
- Helena Iznardo
- Dermatology Service, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Garcia-Melendo
- Dermatology Service, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Oriol Yélamos
- Dermatology Service, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Dermatology Service, Centro Médico Teknon - Quirónsalud, Barcelona, Spain
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21
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Maskalane J, Salijuma E, Lallas K, Papageorgiou C, Gkentsidi T, Manoli MS, Spyridis I, Papadimitriou I, Lazaridou E, Sotiriou E, Vakirlis E, Ioannides D, Apalla Z, Lallas A. Distribution of the dermoscopic features of melanoma of trunk and extremities according to the anatomic sublocation. J Am Acad Dermatol 2020; 84:1717-1719. [PMID: 32822796 DOI: 10.1016/j.jaad.2020.08.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/25/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
Affiliation(s)
| | - Eliza Salijuma
- Aesthetic Dermatology Clinic of Prof. Janis Kisis, Riga, Latvia
| | | | | | | | | | - Ioannis Spyridis
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | | | - Elizabeth Lazaridou
- Second Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Elena Sotiriou
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | | | | | - Zoe Apalla
- State Clinic of Dermatology, Hippokration General Hospital, Thessaloniki, Greece
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
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22
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Durgarao N, Sudhavani G. Detection of skin cancer with adaptive fuzzy classifier using improved whale optimization. BIOMED ENG-BIOMED TE 2020; 65:605-619. [DOI: 10.1515/bmt-2018-0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 02/14/2020] [Indexed: 11/15/2022]
Abstract
AbstractSkin cancer is considered as a well-known type of cancer globally, and its occurrence has been found to be raised in current days. Researchers state that the disease requires early prediction so that the identification of precise signs will make it simple for the dermatologists and clinicians. This disorder has been established to be unpredictable. Hence, this paper intends to develop an efficient skin cancer detection scheme, which classifies the nature of cancer, whether it is normal, benign or malignant. Accordingly, the skin image which is given as input is segmented using k-means clustering model and the features are extracted from segmented image using Local Vector Pattern (LVP). Moreover, the extracted features are subjected to fuzzy classifier for recognizing the cancer. In addition, the limits of membership functions are optimally selected by improved Whale Optimization Algorithm (WOA). Thus, the proposed scheme is termed as Improved Selection of Encircling and Spiral updating position of WO-based Fuzzy Classifier (ISESW-FC). From the optimized output, the type of skin cancer image can be determined, whether it is normal, benign or malignant. The performance of proposed model is compared over other conventional methods, and its efficiency is proved by means of Type I and Type II measures.
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Affiliation(s)
- Nagayalanka Durgarao
- Department of ECE, R.V.R. & J.C. College of Engineering, Guntur, Andhra Pradesh, India
| | - Ghanta Sudhavani
- Department of ECE, R.V.R. & J.C. College of Engineering, Guntur, Andhra Pradesh, India
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23
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Marghoob NG, Liopyris K, Jaimes N. Dermoscopy: A Review of the Structures That Facilitate Melanoma Detection. J Osteopath Med 2020; 119:380-390. [PMID: 31135866 DOI: 10.7556/jaoa.2019.067] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Melanoma is currently the fifth most common cancer in the United States, resulting in more than 9000 deaths each year. Despite numerous improvements in the management of advanced melanoma, the cornerstone to ensuring a cure remains early detection. Both patient and physician awareness regarding the signs and symptoms of early melanoma remain paramount. As a result, much effort has been and continues to be expended in developing and refining effective diagnostic algorithms to help identify melanomas and differentiate them from nevi, such as the ABCDE rule (A for asymmetry, B for border irregularity, C for color variegation, D for diameter >6 mm, and E for evolution in lesion size, shape, or color). To assist in the detection of more subtle melanomas requires technology to augment a visual examination. Toward this end, a simple instrument called a dermatoscope has transformed not only the appreciation of the morphology of melanoma but also its growth dynamics. The discipline of dermoscopy has improved the detection of melanoma and other skin cancers, has resulted in the detection of thinner melanomas, and has helped improve the ability to differentiate nevi (benign lesions) from melanomas, which, in turn, has resulted in fewer biopsies of benign lesions. Since patients often first present to their primary care physicians for their health-related concerns, it is imperative that primary care physicians be able to recognize the lesions that are suspicious for melanoma. This review is intended to introduce osteopathic physicians to the dermoscopic features associated primarily with melanomas located on nonglabrous skin.
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24
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Borsari S, Pampena R, Raucci M, Mirra M, Piana S, Pellacani G, Longo C. Neck Melanoma: Clinical, Dermoscopic and Confocal Features. Dermatology 2019; 236:241-247. [PMID: 31707398 DOI: 10.1159/000503284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 09/10/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The head and neck are considered one single anatomical unit. No data on clinical, dermoscopic and confocal aspects of neck melanoma are currently available. OBJECTIVES To identify clinical, dermoscopic and confocal diagnostic features of neck melanomas. METHODS Consecutive malignant (cases) and benign (controls) melanocytic skin lesions located on the neck, excised as suspected of being melanoma from March 2011 to February 2018, were retrospectively retrieved. Dermoscopic criteria of the 7-point checklist, integrated by other melanoma features (such as grey colour and irregular hyperpigmented areas) were assessed. Reflectance confocal microscopy (RCM) images were examined when available. RESULTS 282 lesions located to the head and neck area were biopsied to rule out melanoma. Thirty-one out of 282 (11%) lesions were located on the neck: 21 melanomas and 10 naevi. Melanoma patients were older than patients with naevi (mean age: 60.4 vs. 37.9 years, p < 0.001). Neck melanomas were more frequently located on sun-damaged skin compared to naevi (76.2 vs. 30%, p = 0.02). Dermoscopically, neck melanomas were characterized by irregular dots/globules, grey colour and regression (76.2, 81 and 46.7% of cases) and showed criteria of lentigo maligna melanoma (LMM) in 52.4% of cases. Regression, grey colour, irregular hyperpigmented areas and criteria of LMM typified melanomas on sun-damaged skin, whereas tumours located on non-sun-damaged areas were often characterized by irregular pigmentation (blotches). RCM, implemented to dermoscopy, correctly diagnosed 10/12 melanomas and 3/5 naevi. CONCLUSION Neck melanoma has peculiar clinical and dermoscopic aspects that could help clinicians to distinguish it from naevi and to diagnose melanoma earlier.
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Affiliation(s)
- Stefania Borsari
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Riccardo Pampena
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy,
| | - Margherita Raucci
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Marica Mirra
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Simonetta Piana
- Pathology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giovanni Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Caterina Longo
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
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25
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DeWane ME, Kelsey A, Oliviero M, Rabinovitz H, Grant-Kels JM. Melanoma on chronically sun-damaged skin: Lentigo maligna and desmoplastic melanoma. J Am Acad Dermatol 2019; 81:823-833. [DOI: 10.1016/j.jaad.2019.03.066] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 03/17/2019] [Accepted: 03/22/2019] [Indexed: 02/01/2023]
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26
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Shahriari N, Grant‐Kels JM, Rabinovitz H, Oliviero M, Scope A. Reflectance confocal microscopy may enhance the accuracy of histopathologic diagnosis: A case series. J Cutan Pathol 2019; 46:830-838. [DOI: 10.1111/cup.13548] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 06/08/2019] [Accepted: 07/09/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Neda Shahriari
- Department of DermatologyUniversity of Connecticut Farmington Connecticut
| | - Jane M. Grant‐Kels
- Department of DermatologyUniversity of Connecticut Farmington Connecticut
| | - Harold Rabinovitz
- Department of DermatologyUniversity of Miami Miller School of Medicine Miami Florida
| | - Margaret Oliviero
- Department of DermatologyUniversity of Miami Miller School of Medicine Miami Florida
| | - Alon Scope
- Medical Screening Institute, Sheba Medical Center and Sackler School of MedicineTel Aviv University Tel Aviv Israel
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27
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Moreno A, Manrique-Silva E, Virós A, Requena C, Sanmartín O, Traves V, Nagore E. Histologic Features Associated With an Invasive Component in Lentigo Maligna Lesions. JAMA Dermatol 2019; 155:782-788. [PMID: 31066867 PMCID: PMC6506897 DOI: 10.1001/jamadermatol.2019.0467] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 02/21/2019] [Indexed: 11/14/2022]
Abstract
Importance Lentigo maligna (LM) presents an invasive component in up to 20% of biopsied cases, but to date the histologic features useful in detecting this invasive component have not been described. Some histologic characteristics are hypothesized to contribute to the progression of LM invasion. Objective To identify the histologic characteristics associated with lentigo maligna melanoma (LMM) in patients with LM diagnosed by a partial diagnostic biopsy. Design, Setting, and Participants A retrospective cross-sectional study of patients treated between January 1, 2000, and December 31, 2017, was conducted in a referral oncology center in València, Spain. Data and specimens of patients (n = 96) with a diagnosis of primary cutaneous melanoma in the form of either LM or LMM who had undergone surgical treatment, a complete histologic examination of the whole tumor, and an initial diagnostic partial biopsy of LM were included in the study. Histologic assessment was blinded to the presence of an invasive component. Interventions All biopsy specimens were evaluated for the presence of certain histologic characteristics. Main Outcomes and Measures Comparisons between invasive samples and samples without an invasive component were performed. The differences in the distribution of variables between the groups were assessed using the χ2 and Fisher exact tests, and the degree of association of the relevant variables was quantified by logistic regression models. A classification and regression tree analysis was performed to rank the variables by importance. Results In total, 96 patients had sufficient histologic material that could be evaluated. The patients were predominantly male (56 [58.3%]) and had a mean (SD) age at diagnosis of 72 (12) years. Of these patients, 63 (65.6%) had an LM diagnosis and 33 (34.4%) had an LMM diagnosis (an invasive component). The histologic variables associated with the presence of an invasive component were melanocytes forming rows (odds ratio [OR], 11.5; 95% CI, 1.4-94.1; P = .02), subepidermal clefts (OR, 2.8; 95% CI, 1.0-7.9; P = .049), nests (OR, 3.0; 95% CI, 1.1-8.6; P = .04), and a lesser degree of solar elastosis (OR, 0.4; 95% CI, 0.1-1.1; P = .07). A classification and regression tree analysis of the relevant histologic features was able to accurately identify lentigo maligna with an invasive component (LMM) in more than 60% of patients. Conclusions and Relevance These findings may be useful in classifying early LM specimens at higher risk of invasion, which may eventually be relevant in identifying the most appropriate management for LM.
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Affiliation(s)
- Angela Moreno
- School of Medicine, Universidad Católica de Valencia San Vicente Mártir, València, Spain
| | - Esperanza Manrique-Silva
- Department of Dermatology, Instituto Valenciano de Oncología, València, Spain
- Escuela de Doctorado, Universidad Católica de Valencia San Vicente Mártir, València, Spain
| | - Amaya Virós
- Skin Cancer and Ageing Laboratory, CRUK Manchester Institute, The University of Manchester, Manchester, United Kingdom
| | - Celia Requena
- Department of Dermatology, Instituto Valenciano de Oncología, València, Spain
| | - Onofre Sanmartín
- Department of Dermatology, Instituto Valenciano de Oncología, València, Spain
| | - Víctor Traves
- Department of Pathology, Instituto Valenciano de Oncología, València, Spain
| | - Eduardo Nagore
- School of Medicine, Universidad Católica de Valencia San Vicente Mártir, València, Spain
- Department of Dermatology, Instituto Valenciano de Oncología, València, Spain
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Carapeba MDOL, Alves Pineze M, Nai GA. Is dermoscopy a good tool for the diagnosis of lentigo maligna and lentigo maligna melanoma? A meta-analysis. Clin Cosmet Investig Dermatol 2019; 12:403-414. [PMID: 31239744 PMCID: PMC6556474 DOI: 10.2147/ccid.s208717] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 04/26/2019] [Indexed: 01/26/2023]
Abstract
Introduction: Dermoscopy is a low-cost examination performed by a dermatologist and good for the diagnosis of pigmented lesions. However, dermoscopy diagnosis of lentigo maligna (LM) and lentigo maligna melanoma (LMM) is still questionable. The objective of this study was to evaluate whether dermoscopy is an effective diagnostic method to diagnose LM/LMM from other pigmented skin lesions, and to identify which are the most frequent dermoscopic criteria associated with LM/LMM Methods: For this systematic review and meta-analysis, we used the following descriptors: dermoscopy, lentigo maligna, lentigo maligna melanoma, histopathology; and the following databases to search for articles: Cochrane Collaboration, MEDLINE; PMC (PubMed Central) - NIH (National Institutes of Health), EMBASE (The Excerpt Medical Database), and SCISEARCH, from inception to March 30, 2018. The evaluation of studies was performed using the QUADAS (Quality Assessment of Diagnostic Accuracy Studies)-2 tool. The PRISMA (Preferred Reporting Itens for Systematic Reviews and Meta-Analyses) and MOOSE (Meta-analysis Of Observational Studies in Epidemiology) guidelines were followed for data extraction. Also, we extracted from each study the dermoscopic criteria most commonly found in the lesions of LM/LMM. Results: This systematic review included 15 articles for qualitative analysis (a total of 2,012 lesions evaluated) and 7 for meta-analysis. In the bivariate model the mean sensitivity was 0.824 and the mean specificity was 0.835. The area under the curve was 0.889. Rhomboid structures, pseudonetwork, and homogeneous areas were the most frequent dermoscopic criteria associated with LM/LMM. Conclusion: These findings suggest that dermoscopy has good accuracy in the diagnosis of LM/LMM. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/QGHCmdQ8Q04
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Affiliation(s)
- Murilo de Oliveira Lima Carapeba
- Department of Dermatology, Universidade do Oeste Paulista (UNOESTE), Presidente Prudente, SP 19050-680, Brazil.,Medical School, Universidade do Oeste Paulista (UNOESTE), Presidente Prudente, SP, 19050-680, Brazil
| | - Mariana Alves Pineze
- Medical School, Universidade do Oeste Paulista (UNOESTE), Presidente Prudente, SP, 19050-680, Brazil
| | - Gisele Alborghetti Nai
- Medical School, Universidade do Oeste Paulista (UNOESTE), Presidente Prudente, SP, 19050-680, Brazil.,Department of Pathology, Universidade do Oeste Paulista (UNOESTE), Presidente Prudente, SP, 19050-680, Brazil
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Lallas A, Longo C, Manfredini M, Benati E, Babino G, Chinazzo C, Apalla Z, Papageorgiou C, Moscarella E, Kyrgidis A, Argenziano G. Accuracy of Dermoscopic Criteria for the Diagnosis of Melanoma In Situ. JAMA Dermatol 2019; 154:414-419. [PMID: 29466542 DOI: 10.1001/jamadermatol.2017.6447] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The accuracy of melanoma-specific dermoscopic criteria has been tested mainly in studies including invasive tumors. Scarce evidence exists on the usefulness of these criteria for the diagnosis of melanoma in situ (MIS). Objective To investigate the diagnostic accuracy of dermoscopic criteria for the diagnosis of MIS. Design, Setting, and Participants A diagnostic accuracy study with retrospective patient enrollment was conducted in 3 centers specializing in skin cancer diagnosis and management. A total of 1285 individuals with histopathologically diagnosed MIS or other flat, pigmented skin tumors that were histopathologically diagnosed or monitored for at least 1 year were included. Dermoscopic images of MIS and other flat, pigmented skin tumors were evaluated by 3 independent investigators for the presence of predefined criteria. Evaluators were blinded to the clinic dermoscopic and histopathologic diagnosis. Main Outcomes and Measures Frequencies of dermoscopic criteria per diagnosis were calculated. Crude odds ratios, adjusted odds ratios, and corresponding 95% CIs were calculated by univariate and multivariate logistic regression, respectively. Results A total of 1285 patients were included in the study (642 [50%] male); mean age was 45.9 years (range, 9-91 years). Of a total of 1285 lesions obtained from these patients, 325 (25.3%) were MIS; 574 (44.7%) were nevi (312 [24.3%] excised and 262 [20.4%] not excised); 67 (5.2%) were seborrheic keratoses, solar lentigines, or lichen planus-like keratoses; 91 (7.1%) were pigmented superficial basal cell carcinomas; 26 (2.0%) were pigmented intraepithelial carcinomas; 100 (7.8%) were Reed nevi; and 102 (7.9%) were invasive melanomas with a Breslow thickness less than 0.75 mm. The most frequent dermoscopic criteria for MIS were regression (302 [92.9%]), atypical network (278 [85.5%]), and irregular dots and/or globules (163 [50.2%]). The multivariate analysis revealed 5 main positive dermoscopic indicators of MIS: atypical network (3.7-fold; 95% CI, 2.5-5.4), regression (4.7-fold; 95% CI, 2.8-8.1), irregular hyperpigmented areas (5.4-fold; 95% CI, 3.7-8.0), prominent skin markings (3.4-fold; 95% CI, 1.9-6.1), and angulated lines (2.2-fold; 95% CI, 1.2-4.1). When compared only with excised nevi, 2 of these criteria remained potent MIS indicators, namely, irregular hyperpigmented areas (4.3-fold; 95% CI, 2.7-6.8) and prominent skin markings (2.7-fold; 95% CI, 1.3-5.7). Conclusions and Relevance Clinicians should take into consideration the aforementioned dermoscopic indicators for the diagnosis of MIS.
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Affiliation(s)
- Aimilios Lallas
- First Department of Dermatology, School of Medicine, Aristotle University, Thessaloniki, Greece
| | - Caterina Longo
- Skin Cancer Unit, Arcispedale Santa Maria Nuova Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy
| | | | - Elisa Benati
- Skin Cancer Unit, Arcispedale Santa Maria Nuova Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy
| | - Graziella Babino
- Department of Dermatology, University of Campania, Naples, Italy
| | - Chiara Chinazzo
- Department of Dermatology, University of Campania, Naples, Italy
| | - Zoe Apalla
- First Department of Dermatology, School of Medicine, Aristotle University, Thessaloniki, Greece
| | - Chryssoula Papageorgiou
- First Department of Dermatology, School of Medicine, Aristotle University, Thessaloniki, Greece
| | | | - Athanassios Kyrgidis
- Skin Cancer Unit, Arcispedale Santa Maria Nuova Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy
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Yélamos O, Braun RP, Liopyris K, Wolner ZJ, Kerl K, Gerami P, Marghoob AA. Dermoscopy and dermatopathology correlates of cutaneous neoplasms. J Am Acad Dermatol 2019; 80:341-363. [DOI: 10.1016/j.jaad.2018.07.073] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 07/01/2018] [Accepted: 07/04/2018] [Indexed: 12/21/2022]
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31
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Apalla Z, Nikolaidou C, Lallas A, Sotiriou E, Lazaridou E, Venizelos I, Bobos M, Vakirlis E, Ioannides D, Ferrara G. Clinicopathologically problematic melanocytic tumors: a case-based review. Dermatol Pract Concept 2018; 8:306-313. [PMID: 30479862 PMCID: PMC6246059 DOI: 10.5826/dpc.0804a12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/31/2018] [Indexed: 01/31/2023] Open
Abstract
Background In spite of recent advances in the histopathological and molecular diagnosis of melanocytic neoplasms, a certain proportion of these lesions remain a daunting challenge for both the clinician and the pathologist. Objectives To emphasize the importance of close collaboration between clinicians and pathologists in case of problematic melanocytic lesions. Patients We report and discuss 5 problematic scenarios of melanocytic lesions, including tumoral melanosis, nevoid melanoma, lentiginous melanoma, spitzoid melanoma and BAPoma that may pose diagnostic difficulties in our practice. Conclusions Clinico-dermoscopic-pathological correlation, with incorporation of all the available data, in problematic melanocytic skin neoplasms is of paramount importance for accurate diagnosis.
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Affiliation(s)
- Zoe Apalla
- First Dermatology Department, Aristotle University of Thessaloniki, Greece
| | - Christina Nikolaidou
- First Dermatology Department, Aristotle University of Thessaloniki, Greece.,Anatomic Pathology Unit, Hippokration Hospital, Thessaloniki, Greece
| | - Aimilios Lallas
- First Dermatology Department, Aristotle University of Thessaloniki, Greece
| | - Elena Sotiriou
- First Dermatology Department, Aristotle University of Thessaloniki, Greece
| | | | - Ioannis Venizelos
- Anatomic Pathology Unit, Hippokration Hospital, Thessaloniki, Greece
| | - Mattheos Bobos
- Microdiagnostics Pathology Laboratory, Thessaloniki, Greece
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32
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Shahriari N, Grant-Kels JM, Rabinovitz H, Oliviero M, Scope A. Reflectance confocal microscopy features of melanomas on the body and non-glabrous chronically sun-damaged skin. J Cutan Pathol 2018; 45:754-759. [PMID: 29971811 DOI: 10.1111/cup.13318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 06/16/2018] [Accepted: 06/28/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Melanoma remains a challenge to diagnose, especially when appearing on the background of chronically sun-damaged skin (CSDS). Our goal was to identify and quantify the reflectance confocal microscopy (RCM) features of melanoma on non-facial CSDS. METHODS Included lesions were biopsy-proven melanomas, from anatomic sites other than the face, neck, scalp and acral skin, with histopathologic finding of solar elastosis in the underlying dermis. All included lesions underwent clinical, dermoscopic and RCM imaging, obtained in a standardized fashion, prior to biopsy. All images were retrospectively analyzed by four observers. RESULTS We identified 33 melanomas from 33 patients with 63.6% male patients and overall mean age of 72.8 years. The salient RCM features included an atypical honeycomb or disarranged epidermal pattern (81.8%), pagetoid infiltration of the epidermis by both round and/or dendritic melanocytes (100%), focal proliferation of predominantly dendritic melanocytes as sheets (78.8%), foci with non-edged papillae (84.8%), junctional thickening (60.6%), areas of irregular ring or meshwork pattern (78.8%), and underlying thickened collagen bundles (51.5%). CONCLUSION Non-facial CSDS melanomas share features similar to other melanoma types including pagetoid cells and non-edged papillae. The focal proliferation of dendritic pagetoid cells in sheets is similar to that seen in facial CSDS melanomas.
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Affiliation(s)
- Neda Shahriari
- Department of Internal Medicine, St. Mary's Hospital, Waterbury, Connecticut
- Department of Dermatology, UCONN Health Center, Farmington, Connecticut
| | - Jane M Grant-Kels
- Department of Dermatology, UCONN Health Center, Farmington, Connecticut
| | - Harold Rabinovitz
- Department of Dermatology, University of Miami Miller School of Medicine, Miami, Florida
| | - Margaret Oliviero
- Department of Dermatology, University of Miami Miller School of Medicine, Miami, Florida
| | - Alon Scope
- Sheba Medical Center and Sackler Faculty of Medicine, Medical Screening Institute, Tel Aviv University, Tel Aviv, Israel
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Weber P, Tschandl P, Sinz C, Kittler H. Dermatoscopy of Neoplastic Skin Lesions: Recent Advances, Updates, and Revisions. Curr Treat Options Oncol 2018; 19:56. [PMID: 30238167 PMCID: PMC6153581 DOI: 10.1007/s11864-018-0573-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OPINION STATEMENT Dermatoscopy (dermoscopy) improves the diagnosis of benign and malignant cutaneous neoplasms in comparison with examination with the unaided eye and should be used routinely for all pigmented and non-pigmented cutaneous neoplasms. It is especially useful for the early stage of melanoma when melanoma-specific criteria are invisible to the unaided eye. Preselection by the unaided eye is therefore not recommended. The increased availability of polarized dermatoscopes, and the extended use of dermatoscopy in non-pigmented lesions led to the discovery of new criteria, and we recommend that lesions should be examined with polarized and non-polarized dermatoscopy. The "chaos and clues algorithm" is a good starting point for beginners because it is easy to use, accurate, and it works for all types of pigmented lesions not only for those melanocytic. Physicians, who use dermatoscopy routinely, should be aware of new clues for acral melanomas, nail matrix melanomas, melanoma in situ, and nodular melanoma. Dermatoscopy should also be used to distinguish between different subtypes of basal cell carcinoma and to discriminate highly from poorly differentiated squamous cell carcinomas to optimize therapy and management of non-melanoma skin cancer. One of the most exciting areas of research is the use of dermatoscopic images for machine learning and automated diagnosis. Convolutional neural networks trained with dermatoscopic images are able to diagnose pigmented lesions with the same accuracy as human experts. We humans should not be afraid of this new and exciting development because it will most likely lead to a peaceful and fruitful coexistence of human experts and decision support systems.
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Affiliation(s)
- Philipp Weber
- Department of Dermatology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Philipp Tschandl
- Department of Dermatology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Christoph Sinz
- Department of Dermatology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Harald Kittler
- Department of Dermatology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Bassoli S, Kyrgidis A, Ciardo S, Casari A, Losi A, De Pace B, Babino G, De Col E, Marchetti Cautela J, Ferrari F, Moscarella E, Lallas A, Argenziano G, Pellacani G, Longo C. Uncovering the diagnostic dermoscopic features of flat melanomas located on the lower limbs. Br J Dermatol 2018; 178:e217-e218. [DOI: 10.1111/bjd.16030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S. Bassoli
- Dermatology Department; University of Modena and Reggio Emilia; Modena Italy
| | - A. Kyrgidis
- Skin Cancer Unit; Arcispedale S. Maria Nuova-IRCCS; Reggio Emilia Italy
| | - S. Ciardo
- Dermatology Department; University of Modena and Reggio Emilia; Modena Italy
| | - A. Casari
- Dermatology Department; University of Modena and Reggio Emilia; Modena Italy
| | - A. Losi
- Dermatology Department; University of Modena and Reggio Emilia; Modena Italy
| | - B. De Pace
- Dermatology Department; University of Modena and Reggio Emilia; Modena Italy
| | - G. Babino
- Dermatology Unit; II University of Naples; Naples Italy
| | - E. De Col
- Dermatology Unit; II University of Naples; Naples Italy
| | | | - F. Ferrari
- Dermatology Department; University of Modena and Reggio Emilia; Modena Italy
| | - E. Moscarella
- Skin Cancer Unit; Arcispedale S. Maria Nuova-IRCCS; Reggio Emilia Italy
| | - A. Lallas
- First Department of Dermatology; Aristotle University; Thessaloniki Greece
| | - G. Argenziano
- Dermatology Unit; II University of Naples; Naples Italy
| | - G. Pellacani
- Dermatology Department; University of Modena and Reggio Emilia; Modena Italy
| | - C. Longo
- Skin Cancer Unit; Arcispedale S. Maria Nuova-IRCCS; Reggio Emilia Italy
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35
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Papageorgiou V, Apalla Z, Sotiriou E, Papageorgiou C, Lazaridou E, Vakirlis S, Ioannides D, Lallas A. The limitations of dermoscopy: false-positive and false-negative tumours. J Eur Acad Dermatol Venereol 2018; 32:879-888. [PMID: 29314288 DOI: 10.1111/jdv.14782] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 12/13/2017] [Indexed: 12/25/2022]
Abstract
Dermoscopy has been documented to increase the diagnostic accuracy of clinicians evaluating skin tumours, improving their ability to detect skin cancer and better recognize benign moles. However, dermoscopically 'false-positive' and 'false-negative' tumours do exist. False-positive diagnosis usually leads to unnecessary excisions. False-negative diagnosis is much more dangerous, as it might result in overlooking a cancer, with severe undesirable consequences for the patient and the physician. Therefore, management strategies should mainly focus on addressing the risk of dermoscopically false-negative tumours. The most frequent benign tumours that might acquire dermatoscopic characteristics suggestive of malignancy are seborrhoeic keratosis (SK), including solar lentigo, melanoacanthoma, irritated, clonal and regressive SK, angioma (mainly thrombosed angioma and angiokeratoma), dermatofibroma, benign adnexal tumours and naevi (Clark, Spitz, recurrent, combined, sclerosing). The most useful clues to recognize these tumours are the following: solar lentigo - broad network; melanoacanthoma - sharp border; irritated SK - regularly distributed white perivascular halos; clonal SK - classic SK criteria; regressive SK - remnants of SK; targetoid haemosiderotic haemangioma - dark centre and reddish periphery; thrombosed angioma - sharp demarcation; angiokeratoma - dark lacunae; atypical dermatofibromas - palpation; follicular tumours - white colour; sebaceous tumours - yellow colour; Clark naevi - clinical context; Spitz/Reed naevi - age; combined naevi - blue central area; recurrent naevi - pigmentation within the scar; sclerosing naevi - age and location on the upper back; blue naevi - history. Malignant tumours that might mimic benign ones and escape detection are melanoma (in situ, nevoid, spitzoid, verrucous, regressive, amelanotic), squamous cell carcinoma (mainly well-differentiated variants) and rarely basal cell carcinoma (non-pigmented variants). The most useful clues to recognize the peculiar melanoma subtypes are as follows: melanoma in situ - irregular hyperpigmented areas; nevoid melanoma - history of growth; spitzoid melanoma - age; verrucous melanoma - blue-black sign; regressive melanoma - peppering or scar-like depigmentation; amelanotic melanoma - pink colour, linear irregular vessels, dotted vessels. In this article, we summarized the most frequent dermoscopic variations of common skin tumours that are often misinterpreted, aiming to assist clinicians to reduce the number of false diagnoses.
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Affiliation(s)
- V Papageorgiou
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece.,Cosmetic Derma Medicine Medical Group, Athens, Greece
| | - Z Apalla
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - E Sotiriou
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - C Papageorgiou
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - E Lazaridou
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - S Vakirlis
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - D Ioannides
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - A Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
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Wollina U, Hansel G, Schmidt N, Schönlebe J, Kittner T, Nowak A. Very Rare Amelanotic Lentigo Maligna Melanoma with Skull Roof Invasion. Open Access Maced J Med Sci 2017; 5:458-461. [PMID: 28785332 PMCID: PMC5535657 DOI: 10.3889/oamjms.2017.113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 05/04/2017] [Accepted: 05/05/2017] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Lentigo malignant melanoma is a melanoma subtype of chronic sun-damaged skin in elderly Caucasians. Amelanotic variants of lentigo malignant are extremely rare. CASE PRESENTATION This is a case report of an 80-year-old male patient who presented with a non-pigmented exophytic tumour of his bald head. After complete surgical excision under the suspicion of squamous cell carcinoma, three-dimensional histologic examination confirmed an amelanotic lentigo malignant melanoma with a tumour thickness of 1.76 mm, resected R0. Five years later he developed the first relapse, the other year a satellite metastasis was surgically removed. One year later, this patient had developed a large relapsing lentigo malignant melanoma with skull roof invasion. There was no evidence of distant metastatic spread. Amelanotic lentigo malignant melanoma is a very rare tumour. CONCLUSIONS Serial excision or slow Mohs and Mohs micrographic surgery are the treatments of choice especially in the head and neck area. These tumours may be locally very aggressive as it is shown by skull invasion in the present case.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt in Dresden, Dresden, Germany
| | - Gesina Hansel
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt in Dresden, Dresden, Germany
| | - Nadine Schmidt
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt in Dresden, Dresden, Germany
| | - Jacqueline Schönlebe
- Städtisches Klinikum Dresden - Institute of Pathology "Georg Schmorl", Dresden, Germany
| | - Thomas Kittner
- Stadtisches Klinikum Dresden, Department of Radiology, Dresden, Sachsen, Germany
| | - Andreas Nowak
- Department of Anesthesiology & Intensive Care Medicine, Emergency Medicine & Pain Management, Hospital Dresden-Friedrichstadt, Academic Teaching Hospital of the Technical University of Dresden, Friedrichstrasse 41, 01067, Dresden, Germany
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Lentigo maligno. Claves en el diagnóstico dermatoscópico. ACTAS DERMO-SIFILIOGRAFICAS 2016; 107:489-97. [DOI: 10.1016/j.ad.2016.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 12/15/2015] [Accepted: 01/03/2016] [Indexed: 11/20/2022] Open
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38
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Bollea-Garlatti L, Galimberti G, Galimberti R. Lentigo Maligna: Keys to Dermoscopic Diagnosis. ACTAS DERMO-SIFILIOGRAFICAS 2016. [DOI: 10.1016/j.adengl.2016.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Scope A, Marchetti MA, Marghoob AA, Dusza SW, Geller AC, Satagopan JM, Weinstock MA, Berwick M, Halpern AC. The study of nevi in children: Principles learned and implications for melanoma diagnosis. J Am Acad Dermatol 2016; 75:813-823. [PMID: 27320410 PMCID: PMC5030195 DOI: 10.1016/j.jaad.2016.03.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 03/17/2016] [Accepted: 03/19/2016] [Indexed: 10/21/2022]
Abstract
Melanocytic nevi are a strong phenotypic marker of cutaneous melanoma risk. Changes in nevi during childhood and adolescence make these prime periods for studying nevogenesis. Insights gained by the study of nevi in childhood have implications for melanoma detection in both adults and children. A more comprehensive understanding of the morphologic characteristics of nevi in different anatomic locations, in association with the patient's age and pigmentary phenotype may aid in the identification of melanomas. When monitoring melanocytic lesions over time, it is essential to differentiate normal from abnormal change. This review summarizes the rapidly expanding body of literature relevant to nevus phenotype, particularly in the context of our experience with the Study of Nevi in Children (SONIC) Project.
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Affiliation(s)
- Alon Scope
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Dermatology, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael A Marchetti
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ashfaq A Marghoob
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stephen W Dusza
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alan C Geller
- Harvard School of Public Health, Social and Behavioral Sciences, Boston, Massachusetts
| | - Jaya M Satagopan
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Martin A Weinstock
- Dermatoepidemiology Unit, Veteran's Affairs Medical Center, Providence, Rhode Island; Department of Dermatology, Rhode Island Hospital, Providence, Rhode Island; Departments of Dermatology and Epidemiology, Brown University, Providence, Rhode Island
| | - Marianne Berwick
- Division of Epidemiology and Biostatistics, University of New Mexico, Albuquerque, New Mexico
| | - Allan C Halpern
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
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Kittler H, Marghoob AA, Argenziano G, Carrera C, Curiel-Lewandrowski C, Hofmann-Wellenhof R, Malvehy J, Menzies S, Puig S, Rabinovitz H, Stolz W, Saida T, Soyer HP, Siegel E, Stoecker WV, Scope A, Tanaka M, Thomas L, Tschandl P, Zalaudek I, Halpern A. Standardization of terminology in dermoscopy/dermatoscopy: Results of the third consensus conference of the International Society of Dermoscopy. J Am Acad Dermatol 2016; 74:1093-106. [PMID: 26896294 DOI: 10.1016/j.jaad.2015.12.038] [Citation(s) in RCA: 162] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 12/15/2015] [Accepted: 12/20/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Evolving dermoscopic terminology motivated us to initiate a new consensus. OBJECTIVE We sought to establish a dictionary of standardized terms. METHODS We reviewed the medical literature, conducted a survey, and convened a discussion among experts. RESULTS Two competitive terminologies exist, a more metaphoric terminology that includes numerous terms and a descriptive terminology based on 5 basic terms. In a survey among members of the International Society of Dermoscopy (IDS) 23.5% (n = 201) participants preferentially use descriptive terminology, 20.1% (n = 172) use metaphoric terminology, and 484 (56.5%) use both. More participants who had been initially trained by metaphoric terminology prefer using descriptive terminology than vice versa (9.7% vs 2.6%, P < .001). Most new terms that were published since the last consensus conference in 2003 were unknown to the majority of the participants. There was uniform consensus that both terminologies are suitable, that metaphoric terms need definitions, that synonyms should be avoided, and that the creation of new metaphoric terms should be discouraged. The expert panel proposed a dictionary of standardized terms taking account of metaphoric and descriptive terms. LIMITATIONS A consensus seeks a workable compromise but does not guarantee its implementation. CONCLUSION The new consensus provides a revised framework of standardized terms to enhance the consistent use of dermoscopic terminology.
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Affiliation(s)
- Harald Kittler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria.
| | - Ashfaq A Marghoob
- Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Giuseppe Argenziano
- Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Reggio Emilia, Italy
| | - Cristina Carrera
- Melanoma Unit, Department of Dermatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER ER), Instituto de Salud Carlos III, Barcelona, Spain
| | | | - Rainer Hofmann-Wellenhof
- Department of Dermatology and Venerology, Nonmelanoma Skin Cancer Unit, Medical University of Graz, Graz, Austria
| | - Josep Malvehy
- Melanoma Unit, Department of Dermatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER ER), Instituto de Salud Carlos III, Barcelona, Spain
| | - Scott Menzies
- Sydney Melanoma Diagnostic Center, Sydney Cancer Center, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Susana Puig
- Melanoma Unit, Department of Dermatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER ER), Instituto de Salud Carlos III, Barcelona, Spain
| | | | - Wilhelm Stolz
- Department of Dermatology, Klinikum München, Munich, Germany
| | - Toshiaki Saida
- Department of Dermatology, Shinshu University School of Medicine, Matsumoto, Japan
| | - H Peter Soyer
- Dermatology Research Center, University of Queensland, School of Medicine, Translational Research Institute, Brisbane, Australia
| | - Eliot Siegel
- University of Maryland Medical Center, Baltimore Department of Veterans Affairs Medical Center, Baltimore, Maryland
| | - William V Stoecker
- Department of Dermatology, University of Missouri Health Sciences Center, Columbia, Missouri
| | - Alon Scope
- Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Dermatology, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Masaru Tanaka
- Department of Dermatology, Keio University, Tokyo, Japan
| | - Luc Thomas
- Service de Dermatologie, Center Hospitalier Universitaire de Lyon, Lyon, France
| | - Philipp Tschandl
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Iris Zalaudek
- Department of Dermatology and Venerology, Nonmelanoma Skin Cancer Unit, Medical University of Graz, Graz, Austria
| | - Allan Halpern
- Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, New York
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