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Khattab SY, Hijaz BA, Semenov YR. Cutaneous Imaging Techniques. Hematol Oncol Clin North Am 2024; 38:907-919. [PMID: 39079790 DOI: 10.1016/j.hoc.2024.05.011] [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] [Indexed: 09/03/2024]
Abstract
Cutaneous imaging is a central tenant to the practice of dermatology. In this article, the authors explore various noninvasive and invasive skin imaging techniques, as well as the latest deployment of these technologies in conjunction with the use artificial intelligence and machine learning. The authors also provide insight into the benefits, limitations, and challenges around integrating these technologies into dermatologic practice.
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Affiliation(s)
- Sara Yasmin Khattab
- Department of Dermatology, Massachusetts General Hospital, 40 Blossom Street, Bartlett Hall 6R, Room 626, Boston, MA 02114, USA
| | - Baraa Ashraf Hijaz
- Department of Dermatology, Massachusetts General Hospital, 40 Blossom Street, Bartlett Hall 6R, Room 626, Boston, MA 02114, USA; Harvard Medical School, Boston, MA 02115, USA
| | - Yevgeniy Romanovich Semenov
- Department of Dermatology, Massachusetts General Hospital, 40 Blossom Street, Bartlett Hall 6R, Room 626, Boston, MA 02114, USA; Harvard Medical School, Boston, MA 02115, USA.
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2
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Winkler JK, Kommoss KS, Toberer F, Enk A, Maul LV, Navarini AA, Hudson J, Salerni G, Rosenberger A, Haenssle HA. Performance of an automated total body mapping algorithm to detect melanocytic lesions of clinical relevance. Eur J Cancer 2024; 202:114026. [PMID: 38547776 DOI: 10.1016/j.ejca.2024.114026] [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: 01/18/2024] [Revised: 03/11/2024] [Accepted: 03/14/2024] [Indexed: 04/21/2024]
Abstract
IMPORTANCE Total body photography for skin cancer screening is a well-established tool allowing documentation and follow-up of the entire skin surface. Artificial intelligence-based systems are increasingly applied for automated lesion detection and diagnosis. DESIGN AND PATIENTS In this prospective observational international multicentre study experienced dermatologists performed skin cancer screenings and identified clinically relevant melanocytic lesions (CRML, requiring biopsy or observation). Additionally, patients received 2D automated total body mapping (ATBM) with automated lesion detection (ATBM master, Fotofinder Systems GmbH). Primary endpoint was the percentage of CRML detected by the bodyscan software. Secondary endpoints included the percentage of correctly identified "new" and "changed" lesions during follow-up examinations. RESULTS At baseline, dermatologists identified 1075 CRML in 236 patients and 999 CRML (92.9%) were also detected by the automated software. During follow-up examinations dermatologists identified 334 CRMLs in 55 patients, with 323 (96.7%) also being detected by ATBM with automated lesions detection. Moreover, all new (n = 13) or changed CRML (n = 24) during follow-up were detected by the software. Average time requirements per baseline examination was 14.1 min (95% CI [12.8-15.5]). Subgroup analysis of undetected lesions revealed either technical (e.g. covering by clothing, hair) or lesion-specific reasons (e.g. hypopigmentation, palmoplantar sites). CONCLUSIONS ATBM with lesion detection software correctly detected the vast majority of CRML and new or changed CRML during follow-up examinations in a favourable amount of time. Our prospective international study underlines that automated lesion detection in TBP images is feasible, which is of relevance for developing AI-based skin cancer screenings.
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Affiliation(s)
- Julia K Winkler
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany.
| | | | - Ferdinand Toberer
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Alexander Enk
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Lara V Maul
- Department of Dermatology, University Hospital of Basel, Basel, Switzerland
| | | | - Jeremy Hudson
- North Queensland Skin Centre, Townsville, Queensland, Australia
| | - Gabriel Salerni
- Department of Dermatology, Hospital Provincial del Centenario de Rosario- Universidad Nacional de Rosario, Rosario, Argentina
| | - Albert Rosenberger
- Institute of Genetic Epidemiology, University Medical Center, Georg-August University of Goettingen, Goettingen, Germany
| | - Holger A Haenssle
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
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Primiero CA, Betz-Stablein B, Ascott N, D’Alessandro B, Gaborit S, Fricker P, Goldsteen A, González-Villà S, Lee K, Nazari S, Nguyen H, Ntouskos V, Pahde F, Pataki BE, Quintana J, Puig S, Rezze GG, Garcia R, Soyer HP, Malvehy J. A protocol for annotation of total body photography for machine learning to analyze skin phenotype and lesion classification. Front Med (Lausanne) 2024; 11:1380984. [PMID: 38654834 PMCID: PMC11035726 DOI: 10.3389/fmed.2024.1380984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 03/25/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction Artificial Intelligence (AI) has proven effective in classifying skin cancers using dermoscopy images. In experimental settings, algorithms have outperformed expert dermatologists in classifying melanoma and keratinocyte cancers. However, clinical application is limited when algorithms are presented with 'untrained' or out-of-distribution lesion categories, often misclassifying benign lesions as malignant, or misclassifying malignant lesions as benign. Another limitation often raised is the lack of clinical context (e.g., medical history) used as input for the AI decision process. The increasing use of Total Body Photography (TBP) in clinical examinations presents new opportunities for AI to perform holistic analysis of the whole patient, rather than a single lesion. Currently there is a lack of existing literature or standards for image annotation of TBP, or on preserving patient privacy during the machine learning process. Methods This protocol describes the methods for the acquisition of patient data, including TBP, medical history, and genetic risk factors, to create a comprehensive dataset for machine learning. 500 patients of various risk profiles will be recruited from two clinical sites (Australia and Spain), to undergo temporal total body imaging, complete surveys on sun behaviors and medical history, and provide a DNA sample. This patient-level metadata is applied to image datasets using DICOM labels. Anonymization and masking methods are applied to preserve patient privacy. A two-step annotation process is followed to label skin images for lesion detection and classification using deep learning models. Skin phenotype characteristics are extracted from images, including innate and facultative skin color, nevi distribution, and UV damage. Several algorithms will be developed relating to skin lesion detection, segmentation and classification, 3D mapping, change detection, and risk profiling. Simultaneously, explainable AI (XAI) methods will be incorporated to foster clinician and patient trust. Additionally, a publicly released dataset of anonymized annotated TBP images will be released for an international challenge to advance the development of new algorithms using this type of data. Conclusion The anticipated results from this protocol are validated AI-based tools to provide holistic risk assessment for individual lesions, and risk stratification of patients to assist clinicians in monitoring for skin cancer.
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Affiliation(s)
- Clare A. Primiero
- Dermatology Department, Hospital Clinic and Fundació Clínic per la Recerca Biomèdica—IDIBAPS, Barcelona, Spain
- Frazer Institute, The University of Queensland, Dermatology Research Centre, Brisbane, QLD, Australia
| | - Brigid Betz-Stablein
- Frazer Institute, The University of Queensland, Dermatology Research Centre, Brisbane, QLD, Australia
| | | | | | | | - Paul Fricker
- Torus Actions & Belle.ai, Ramonville-Saint-Agne, France
| | | | | | - Katie Lee
- Frazer Institute, The University of Queensland, Dermatology Research Centre, Brisbane, QLD, Australia
| | - Sana Nazari
- Computer Vision and Robotics Group, University of Girona, Girona, Spain
| | - Hang Nguyen
- Torus Actions & Belle.ai, Ramonville-Saint-Agne, France
| | - Valsamis Ntouskos
- Remote Sensing Lab, National Technical University of Athens, Athens, Greece
| | | | - Balázs E. Pataki
- HUN-REN Institute for Computer Science and Control, Budapest, Hungary
| | | | - Susana Puig
- Dermatology Department, Hospital Clinic and Fundació Clínic per la Recerca Biomèdica—IDIBAPS, Barcelona, Spain
- Medicine Department, University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades raras, Instituto de Salud Carlos III, Barcelona, Spain
| | - Gisele G. Rezze
- Dermatology Department, Hospital Clinic and Fundació Clínic per la Recerca Biomèdica—IDIBAPS, Barcelona, Spain
| | - Rafael Garcia
- Computer Vision and Robotics Group, University of Girona, Girona, Spain
| | - H. Peter Soyer
- Frazer Institute, The University of Queensland, Dermatology Research Centre, Brisbane, QLD, Australia
- Dermatology Department, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Josep Malvehy
- Dermatology Department, Hospital Clinic and Fundació Clínic per la Recerca Biomèdica—IDIBAPS, Barcelona, Spain
- Medicine Department, University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades raras, Instituto de Salud Carlos III, Barcelona, Spain
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Brown H, De'Ambrosis B, Yong-Gee S, Griffin A, Muir J. Melanoma diagnosis at a specialist dermatology practice without the use of photographic surveillance. Australas J Dermatol 2023; 64:234-241. [PMID: 36774586 DOI: 10.1111/ajd.14008] [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: 09/01/2022] [Revised: 01/28/2023] [Accepted: 02/01/2023] [Indexed: 02/13/2023]
Abstract
BACKGROUND/OBJECTIVE Photographic aides are increasingly used in melanoma surveillance. We report melanoma characteristics detected using traditional surveillance without photographic technologies. METHODS Retrospective study of melanomas diagnosed by three dermatologists at a private dermatology practice over 7 years. Patients underwent full skin examinations with dermoscopy and suspect lesions were excised or biopsied. Total body photography (TBP) and serial digital dermoscopic imaging (SDDI) were not used. Patient demographics, melanoma subtype and thickness, location, biopsy technique and keratinocyte cancers diagnosed at the same visit were recorded. Ratio of in situ to invasive melanomas was calculated. Melanoma risk factors were recorded for 69 randomly-selected patients. RESULTS 492 patients were diagnosed with 615 melanomas during 579 visits. 505 (82%) were in situ (in situ to invasive ratio of 4.6:1). Of the invasive melanomas, 85.5% had a Breslow thickness <0.8 mm, 10 (9.1%) 0.8-1 mm and 6 (5.5%) >1 mm. 43.3% of in situ melanomas were lentiginous or lentigo maligna and 41.6% were superficial spreading melanomas (SSM). Of invasive melanomas, 24.3% were lentigo maligna melanoma and 59.5% were SSM. 48.4% of melanomas were diagnosed by shave procedures. Where risk factors were known, 25% were very-high-risk and 43% had a history of melanoma. Keratinocyte carcinoma was diagnosed by biopsy at 26.1% of visits. Studies using TBP and/or SDDI report in situ to invasive ratios of 0.59:1 to 2.17:1. CONCLUSION Tradiational melanoma surveillance with immediate biopsy of suspect lesions results in high in situ to invasive ratios. Studies using photographic surveillance show lower ratios of in situ to invasive disease.
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Affiliation(s)
- Hilary Brown
- Mater Hospital, South Brisbane, Queensland, Australia
- South East Dermatology, Annerley, Queensland, Australia
| | - Brian De'Ambrosis
- South East Dermatology, Annerley, Queensland, Australia
- Medical Faculty, University of Queensland, Brisbane, Queensland, Australia
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Simon Yong-Gee
- South East Dermatology, Annerley, Queensland, Australia
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Alison Griffin
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - James Muir
- Mater Hospital, South Brisbane, Queensland, Australia
- South East Dermatology, Annerley, Queensland, Australia
- Medical Faculty, University of Queensland, Brisbane, Queensland, Australia
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Ahmedt-Aristizabal D, Nguyen C, Tychsen-Smith L, Stacey A, Li S, Pathikulangara J, Petersson L, Wang D. Monitoring of Pigmented Skin Lesions Using 3D Whole Body Imaging. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 232:107451. [PMID: 36893580 DOI: 10.1016/j.cmpb.2023.107451] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/23/2023] [Accepted: 02/26/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Advanced artificial intelligence and machine learning have great potential to redefine how skin lesions are detected, mapped, tracked and documented. Here, we propose a 3D whole-body imaging system known as 3DSkin-mapper to enable automated detection, evaluation and mapping of skin lesions. METHODS A modular camera rig arranged in a cylindrical configuration was designed to automatically capture images of the entire skin surface of a subject synchronously from multiple angles. Based on the images, we developed algorithms for 3D model reconstruction, data processing and skin lesion detection and tracking based on deep convolutional neural networks. We also introduced a customised, user-friendly, and adaptable interface that enables individuals to interactively visualise, manipulate, and annotate the images. The interface includes built-in features such as mapping 2D skin lesions onto the corresponding 3D model. RESULTS The proposed system is developed for skin lesion screening, the focus of this paper is to introduce the system instead of clinical study. Using synthetic and real images we demonstrate the effectiveness of the proposed system by providing multiple views of a target skin lesion, enabling further 3D geometry analysis and longitudinal tracking. Skin lesions are identified as outliers which deserve more attention from a skin cancer physician. Our detector leverages expert annotated labels to learn representations of skin lesions, while capturing the effects of anatomical variability. It takes only a few seconds to capture the entire skin surface, and about half an hour to process and analyse the images. CONCLUSIONS Our experiments show that the proposed system allows fast and easy whole body 3D imaging. It can be used by dermatological clinics to conduct skin screening, detect and track skin lesions over time, identify suspicious lesions, and document pigmented lesions. The system can potentially save clinicians time and effort significantly. The 3D imaging and analysis has the potential to change the paradigm of whole body photography with many applications in skin diseases, including inflammatory and pigmentary disorders. With reduced time requirements for recording and documenting high-quality skin information, doctors could spend more time providing better-quality treatment based on more detailed and accurate information.
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Affiliation(s)
| | - Chuong Nguyen
- Imaging and Computer Vision group, CSIRO Data61, Australia.
| | | | | | - Shenghong Li
- Imaging and Computer Vision group, CSIRO Data61, Australia.
| | | | - Lars Petersson
- Imaging and Computer Vision group, CSIRO Data61, Australia.
| | - Dadong Wang
- Imaging and Computer Vision group, CSIRO Data61, Australia.
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Hona TWPT, Horsham C, Silva CV, Lawn C, Sanjida S, Gillespie N, Soyer HP, Janda M. Consumer views of melanoma early detection using 3D total-body photography: cross-sectional survey. Int J Dermatol 2023; 62:524-533. [PMID: 36707877 DOI: 10.1111/ijd.16578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/31/2022] [Accepted: 12/28/2022] [Indexed: 01/29/2023]
Abstract
BACKGROUND Three-dimensional (3D) total-body photography is a recent advance in melanoma early detection that can aid in monitoring and identifying new and changing skin lesions over time. METHODS A cross-sectional survey of adults living in metropolitan and rural areas of Australia was conducted to assess perceptions of 3D total-body photography. Participants completed a survey detailing their previous use of skin cancer photography, personal skin checking history, perceptions of 3D total-body photography, and willingness to pay. Participants were also asked to describe the potential barriers and facilitators of 3D total-body photography in their own words. RESULTS A total of 1056 participants completed the survey, with 739 (70%) from metropolitan areas of Australia and 317 (30%) from rural areas. Most participants (95%, n = 1004/1056) indicated they would consider using 3D total-body photography if it became commercially available at their regular medical practice. Most participants indicated 3D total-body photography would be effective to identify suspicious skin spots (94%, n = 995/1056), monitor lesion changes (94%, n = 997/1056), and reduce skin cancer related anxiety (90%, n = 950/1055). In open-ended feedback, participants (87%, n = 918/1056) identified perceived benefits, including more comprehensive screenings, earlier detection, and less human error. Participants (84%, n = 889/1056) also identified potential barriers to 3D total-body photography, including cost, accessibility and availability, trust in the technology, and digital security concerns. CONCLUSIONS Participant feedback indicated a high level of acceptance and confidence in the technology. To facilitate clinical translation, addressing consumer-identified barriers to 3D total-body photography will be vital.
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Affiliation(s)
- Te Wai Pounamu T Hona
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Caitlin Horsham
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Carina V Silva
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Craig Lawn
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Saira Sanjida
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Nicole Gillespie
- School of Business, Faculty of Business, Economics and Law, The University of Queensland, Brisbane, QLD, Australia
| | - H Peter Soyer
- Dermatology Research Centre, Frazer Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Monika Janda
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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Rashid S, Gupta S, McCormick SR, Tsao H. New Insights into Melanoma Tumor Syndromes. JID INNOVATIONS 2022; 2:100152. [DOI: 10.1016/j.xjidi.2022.100152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 06/08/2022] [Accepted: 06/13/2022] [Indexed: 10/14/2022] Open
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Horsham C, O'Hara M, Sanjida S, Ma S, Jayasinghe D, Green AC, Schaider H, Aitken JF, Sturm RA, Prow T, Soyer HP, Janda M. The Experience of 3D Total-Body Photography to Monitor Nevi: Results From an Australian General Population-Based Cohort Study. JMIR DERMATOLOGY 2022; 5:e37034. [PMID: 37632874 PMCID: PMC10334884 DOI: 10.2196/37034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/28/2022] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Digital 3D total-body photography of the skin surface is an emerging imaging modality that can facilitate the identification of new and changing nevi. OBJECTIVE We aimed to describe the experiences of study participants drawn from the general population who were provided 3D total-body photography and dermoscopy for the monitoring of nevi. METHODS A population-based prospective study of adults aged 20-70 years from South East Queensland, Australia was conducted. Participants underwent 3D total-body photography and dermoscopy every 6 months over a 3-year period. Participants were asked to provide closed and open-ended feedback on their 3D total-body photography and dermoscopy experience (eg, comfort, trust, intended future use, and willingness to pay) at the halfway study time point (18 months) and final study time point (36 months). We assessed changes in participants' reported experience of 3D total-body photography, and patient characteristics associated with patient experience at the end of the study (36 months) were analyzed. RESULTS A total of 149 participants completed the surveys at both the 18- and 36-month time points (median age 55, range 23-70 years; n=94, 63.1% were male). At the 18-month time point, most participants (n=103, 69.1%) stated they completely trusted 3D total-body imaging for the diagnosis and monitoring of their nevi, and this did not change at the 36-month (n=104, 69.8%) time point. The majority of participants reported that they were very comfortable or comfortable with the technology at both the 18- (n=138, 92.6%) and 36-month (n=140, 94%) time points, respectively; albeit, the number of participants reporting that they were very comfortable reduced significantly between the 18- and 36-month time points, from 71.1% (n=106) to 61.1% (n=91; P=.01). Almost all participants (n=140, 94%) would consider using this technology if it were to become commercially available, and this did not change during the two study time points. Half of the participants (n=74) cited barriers to participating in 3D total-body photography, including trust in the ability of this technology to detect and monitor suspicious lesions, digital privacy, cost, and travel requirements. CONCLUSIONS The majority of participants expressed positive attitudes toward 3D total-body photography for the monitoring of their moles. Half of the participants identified potential barriers to uptake.
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Affiliation(s)
- Caitlin Horsham
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Montana O'Hara
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Saira Sanjida
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Samantha Ma
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Dilki Jayasinghe
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Adele C Green
- Cancer and Population Studies, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- Cancer Research UK Manchester Institute, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
- Australian Skin and Skin Cancer Research Centre, Brisbane, Queensland, Australia
| | - Helmut Schaider
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Joanne F Aitken
- Viertel Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
- Institute for Resilient Regions, University of Southern Queensland, Brisbane, Queensland, Australia
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Richard A Sturm
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Tarl Prow
- Future Industries Institute, University of South Australia, Adelaide, South Australia, Australia
- Skin Research Centre, York Biomedical Research Institute, Hull York Medical School, York, United Kingdom
| | - H Peter Soyer
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Monika Janda
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Common M, Ehret M, Visseaux L, Colomb M, Renard F, Dutel-Charneux J, Goeldel-Brichet AL, Adnot-Desanlis L, Grange F. The use of digital dermoscopy in the surveillance of melanocytic skin lesions: A real-life retrospective study comparing university hospital and private practices. Ann Dermatol Venereol 2022; 149:251-257. [DOI: 10.1016/j.annder.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 09/09/2021] [Accepted: 03/08/2022] [Indexed: 11/28/2022]
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Skudalski L, Waldman R, Kerr PE, Grant-Kels JM. Melanoma: How and When to Consider Clinical Diagnostic Technologies. J Am Acad Dermatol 2021; 86:503-512. [PMID: 34915058 DOI: 10.1016/j.jaad.2021.06.901] [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: 04/06/2021] [Revised: 06/09/2021] [Accepted: 06/13/2021] [Indexed: 11/26/2022]
Abstract
In response to rising rates of melanoma worldwide, novel non-invasive melanoma detection techniques are emerging to facilitate the early detection of melanoma and decrease unnecessary biopsies of benign pigmented lesions. Because they often report similar study findings, it may be difficult to determine how best to incorporate these technologies into clinical practice based on their supporting studies alone. As an expansion of the recent article by Fried et al.1, which reviewed the clinical data supporting these non-invasive melanoma detection techniques, the first article in this continuing medical education series provides practical advice on how and when to use various non-invasive melanoma detection techniques into clinical practice.
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Affiliation(s)
- Lauren Skudalski
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Reid Waldman
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Philip E Kerr
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT, USA; Department of Dermatology, University of Florida College of Medicine, Gainesville, FL, USA.
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Betz-Stablein B, D'Alessandro B, Koh U, Plasmeijer E, Janda M, Menzies SW, Hofmann-Wellenhof R, Green AC, Soyer HP. Reproducible Naevus Counts Using 3D Total Body Photography and Convolutional Neural Networks. Dermatology 2021; 238:4-11. [PMID: 34237739 DOI: 10.1159/000517218] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/07/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The number of naevi on a person is the strongest risk factor for melanoma; however, naevus counting is highly variable due to lack of consistent methodology and lack of inter-rater agreement. Machine learning has been shown to be a valuable tool for image classification in dermatology. OBJECTIVES To test whether automated, reproducible naevus counts are possible through the combination of convolutional neural networks (CNN) and three-dimensional (3D) total body imaging. METHODS Total body images from a study of naevi in the general population were used for the training (82 subjects, 57,742 lesions) and testing (10 subjects; 4,868 lesions) datasets for the development of a CNN. Lesions were labelled as naevi, or not ("non-naevi"), by a senior dermatologist as the gold standard. Performance of the CNN was assessed using sensitivity, specificity, and Cohen's kappa, and evaluated at the lesion level and person level. RESULTS Lesion-level analysis comparing the automated counts to the gold standard showed a sensitivity and specificity of 79% (76-83%) and 91% (90-92%), respectively, for lesions ≥2 mm, and 84% (75-91%) and 91% (88-94%) for lesions ≥5 mm. Cohen's kappa was 0.56 (0.53-0.59) indicating moderate agreement for naevi ≥2 mm, and substantial agreement (0.72, 0.63-0.80) for naevi ≥5 mm. For the 10 individuals in the test set, person-level agreement was assessed as categories with 70% agreement between the automated and gold standard counts. Agreement was lower in subjects with numerous seborrhoeic keratoses. CONCLUSION Automated naevus counts with reasonable agreement to those of an expert clinician are possible through the combination of 3D total body photography and CNNs. Such an algorithm may provide a faster, reproducible method over the traditional in person total body naevus counts.
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Affiliation(s)
- Brigid Betz-Stablein
- QIMR Berghofer Medical Research Institute, Cancer and Population Studies, Brisbane, Queensland, Australia.,The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia
| | | | - Uyen Koh
- The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia
| | - Elsemieke Plasmeijer
- QIMR Berghofer Medical Research Institute, Cancer and Population Studies, Brisbane, Queensland, Australia.,Netherlands Cancer Institute, Dermatology Department, Amsterdam, The Netherlands
| | - Monika Janda
- Centre of Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Scott W Menzies
- Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia.,Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | | | - Adele C Green
- QIMR Berghofer Medical Research Institute, Cancer and Population Studies, Brisbane, Queensland, Australia.,CRUK Manchester Institute and University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - H Peter Soyer
- The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia.,Dermatology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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12
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Nguyen J, Ting S, Paul E, Smith AL, Watts CG, Kelly J, Cust AE, Mar V. Diagnostic tools used for melanoma: A survey of Australian general practitioners and dermatologists. Australas J Dermatol 2021; 62:300-309. [PMID: 33860932 DOI: 10.1111/ajd.13595] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/16/2021] [Accepted: 02/22/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND/OBJECTIVE Diagnostic tools such as dermoscopy, sequential digital dermoscopy imaging (SDDI), total body photography (TBP) and automated diagnostic tools are available to assist in early melanoma diagnosis. The use, accessibility and barriers of dermoscopy have been well studied; however, there are few similar studies regarding SDDI, TBP and automated diagnostic tools. We aim to understand the use of these diagnostic aids amongst Australian general practitioners (GPs) and dermatologists. METHODS Between June 2019 and January 2020, GPs and dermatologists across Australia were invited to participate in an online survey. Surveys were distributed through GP and dermatology organisations. RESULTS A total of 227 survey responses were received, 175 from GPs and 52 from dermatologists. Amongst GPs, 44.6% worked in a skin cancer clinic. Dermoscopy was used at least occasionally by 98.9% of all GPs. SDDI was used by 93.6% of skin cancer GPs, 80.8% of dermatologists and 45.3% of generalist GPs. TBP was used or recommended by 77.1% of generalist GPs, 82.3% of skin cancer GPs and 86.5% of dermatologists. The most common barriers to the use of TBP were cost, limited accessibility, poor patient compliance, and time required for both patients and doctors. Very few clinicians reported using automated diagnostic tools. There was an interest in future diagnostic aids for melanoma in 88% of GPs and dermatologists. CONCLUSION Dermoscopy, SDDI and TBP were commonly used by responding Australian skin cancer GPs and dermatologists in this survey. Automated diagnostic tools were not reported to be used routinely. Several barriers were identified for use of TBP.
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Affiliation(s)
- Jennifer Nguyen
- Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sarajane Ting
- Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia.,The Royal Australian College of General Practitioners, East Melbourne, Victoria, Australia
| | - Eldho Paul
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrea L Smith
- Macquarie University, Sydney, New South Wales, Australia
| | - Caroline G Watts
- The Sydney School of Public Health and Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Kirby Institute, UNSW, Sydney, New South Wales, Australia
| | - John Kelly
- The Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Anne E Cust
- The Sydney School of Public Health and Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Victoria Mar
- Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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13
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Ji‐Xu A, Dinnes J, Matin R. Total body photography for the diagnosis of cutaneous melanoma in adults: a systematic review and meta‐analysis*. Br J Dermatol 2021; 185:302-312. [DOI: 10.1111/bjd.19759] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2020] [Indexed: 01/10/2023]
Affiliation(s)
- A. Ji‐Xu
- Department of Dermatology Oxford University Hospitals NHS Foundation Trust Oxford UK
| | - J. Dinnes
- Test Evaluation Research Group Institute of Applied Health Research University of Birmingham Birmingham UK
- NIHR Birmingham Biomedical Research Centre University Hospitals Birmingham NHS Foundation Trust and University of Birmingham Birmingham UK
| | - R.N. Matin
- Department of Dermatology Oxford University Hospitals NHS Foundation Trust Oxford UK
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14
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Hornung A, Steeb T, Wessely A, Brinker TJ, Breakell T, Erdmann M, Berking C, Heppt MV. The Value of Total Body Photography for the Early Detection of Melanoma: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1726. [PMID: 33578996 PMCID: PMC7916771 DOI: 10.3390/ijerph18041726] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 12/19/2022]
Abstract
Early detection of melanoma is critical to reduce the mortality and morbidity rates of this tumor. Total body photography (TBP) may aid in the early detection of melanoma. To summarize the current evidence on TBP for the early detection of melanoma, we performed a systematic literature search in Medline, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) for eligible records up to 6th August 2020. Outcomes of interest included melanoma incidence, incisional and excisional biopsy rates, as well as the Breslow's index of detected tumors. Results from individual studies were described qualitatively. The risks of bias and applicability of the included studies was assessed using the QUADAS-2 checklist. In total, 14 studies published between 1997 and 2020 with an overall sample size of n = 12082 (range 100-4692) were included in the qualitative analysis. Individuals undergoing TBP showed a trend towards a lower Breslow's thickness and a higher proportion of in situ melanomas compared to those without TBP. The number needed to excise one melanoma varied from 3:1 to 14.3:1 and was better for lesions that arose de novo than for tracked ones. The included studies were judged to be of unclear methodological concern with specific deficiencies in the domains "flow and timing" and "reference standard". The use of TBP can improve the early detection of melanoma in high-risk populations. Future studies are warranted to reduce the heterogeneity of phenotypic risk factor definition and the technical implementation of TBP. Artificial intelligence-assisted analysis of images derived from 3-D TBP systems and digital dermoscopy may further improve the early detection of melanoma.
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Affiliation(s)
- Annkathrin Hornung
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.H.); (T.S.); (A.W.); (T.B.); (M.E.); (C.B.)
- Comprehensive Cancer Center Erlangen—European Metropolitan Region of Nürnberg, 91054 Erlangen, Germany
| | - Theresa Steeb
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.H.); (T.S.); (A.W.); (T.B.); (M.E.); (C.B.)
- Comprehensive Cancer Center Erlangen—European Metropolitan Region of Nürnberg, 91054 Erlangen, Germany
| | - Anja Wessely
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.H.); (T.S.); (A.W.); (T.B.); (M.E.); (C.B.)
- Comprehensive Cancer Center Erlangen—European Metropolitan Region of Nürnberg, 91054 Erlangen, Germany
| | - Titus J. Brinker
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany;
| | - Thomas Breakell
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.H.); (T.S.); (A.W.); (T.B.); (M.E.); (C.B.)
- Comprehensive Cancer Center Erlangen—European Metropolitan Region of Nürnberg, 91054 Erlangen, Germany
| | - Michael Erdmann
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.H.); (T.S.); (A.W.); (T.B.); (M.E.); (C.B.)
- Comprehensive Cancer Center Erlangen—European Metropolitan Region of Nürnberg, 91054 Erlangen, Germany
| | - Carola Berking
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.H.); (T.S.); (A.W.); (T.B.); (M.E.); (C.B.)
- Comprehensive Cancer Center Erlangen—European Metropolitan Region of Nürnberg, 91054 Erlangen, Germany
| | - Markus V. Heppt
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.H.); (T.S.); (A.W.); (T.B.); (M.E.); (C.B.)
- Comprehensive Cancer Center Erlangen—European Metropolitan Region of Nürnberg, 91054 Erlangen, Germany
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15
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Fried L, Tan A, Bajaj S, Liebman TN, Polsky D, Stein JA. Technological advances for the detection of melanoma. J Am Acad Dermatol 2020; 83:983-992. [DOI: 10.1016/j.jaad.2020.03.121] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 03/02/2020] [Accepted: 03/22/2020] [Indexed: 10/24/2022]
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16
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Young AT, Vora NB, Cortez J, Tam A, Yeniay Y, Afifi L, Yan D, Nosrati A, Wong A, Johal A, Wei ML. The role of technology in melanoma screening and diagnosis. Pigment Cell Melanoma Res 2020; 34:288-300. [PMID: 32558281 DOI: 10.1111/pcmr.12907] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 03/31/2020] [Accepted: 06/12/2020] [Indexed: 12/28/2022]
Abstract
Melanoma presents challenges for timely and accurate diagnosis. Expert panels have issued risk-based screening guidelines, with recommended screening by visual inspection. To assess how recent technology can impact the risk/benefit considerations for melanoma screening, we comprehensively reviewed non-invasive visual-based technologies. Dermoscopy increases lesional diagnostic accuracy for both dermatologists and primary care providers; total body photography and sequential digital dermoscopic imaging also increase diagnostic accuracy, are supported by automated lesion detection and tracking, and may be best suited to use by dermatologists for longitudinal follow-up. Specialized imaging modalities using non-visible light technology have unproven benefit over dermoscopy and can be limited by cost, access, and training requirements. Mobile apps facilitate image capture and lesion tracking. Teledermatology has good concordance with face-to-face consultation and increases access, with increased accuracy using dermoscopy. Deep learning models can surpass dermatologist accuracy, but their clinical utility has yet to be demonstrated. Technology-aided diagnosis may change the calculus of screening; however, well-designed prospective trials are needed to assess the efficacy of these different technologies, alone and in combination to support refinement of guidelines for melanoma screening.
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Affiliation(s)
- Albert T Young
- Department of Dermatology, University of California, San Francisco, CA, USA.,Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Niki B Vora
- Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Jose Cortez
- Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Andrew Tam
- Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Yildiray Yeniay
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Ladi Afifi
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Di Yan
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Adi Nosrati
- Department of Dermatology, University of California, San Francisco, CA, USA.,Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Andrew Wong
- Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Arjun Johal
- Department of Dermatology, University of California, San Francisco, CA, USA.,Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Maria L Wei
- Department of Dermatology, University of California, San Francisco, CA, USA.,Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
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17
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Deinlein T, Michor C, Hofmann-Wellenhof R, Schmid-Zalaudek K, Fink-Puches R. Die Bedeutung von Ganzkörperfotografie und sequenzieller digitaler Dermatoskopie bei der Überwachung von Patienten mit erhöhtem Melanomrisiko. J Dtsch Dermatol Ges 2020; 18:692-698. [PMID: 32713154 DOI: 10.1111/ddg.14158_g] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/12/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Teresa Deinlein
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Graz, Graz, Österreich
| | - Carina Michor
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Graz, Graz, Österreich
| | - Rainer Hofmann-Wellenhof
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Graz, Graz, Österreich
| | | | - Regina Fink-Puches
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Graz, Graz, Österreich
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18
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Deinlein T, Michor C, Hofmann-Wellenhof R, Schmid-Zalaudek K, Fink-Puches R. The importance of total-body photography and sequential digital dermatoscopy for monitoring patients at increased melanoma risk. J Dtsch Dermatol Ges 2020; 18:692-697. [PMID: 32597015 PMCID: PMC7496451 DOI: 10.1111/ddg.14158] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/12/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES The incidence of melanoma is rising and prevention plays an important role. Multiple nevi as well as a medical history of melanoma are important risk factors. In affected patients, a two-step algorithm consisting of total-body photography (TBP) and sequential digital dermatoscopy (SDD) is a helpful diagnostic tool. PATIENTS AND METHODS This was a retrospective observational study that lasted six years in order to evaluate the significance of the two-step algorithm. Cases were evaluated based on distinct dermoscopic patterns and statistical analyses were performed with the latest version of SPSS. RESULTS 6020 dermoscopic images of 214 patients were included. TBP was performed at a mean interval of 16.9 months (SD ± 1.43 months), while SDD was performed every 9.9 months (SD ± 1.68 months). The number needed to excise was 4.6 and the number needed to monitor was 548. Excisions were mostly performed because dynamic changes were observed. A total of eleven melanomas were detected and had a mean tumor thickness of 0.44 mm (SD ± 0.15 mm; range 0.2-0.6 mm). CONCLUSIONS Invasive melanomas had a tumor thickness of less than 0.6 mm, thus providing evidence of an effective strategy for early melanoma detection. Excisions of benign nevi were minimized as indicated by a low number needed to excise.
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Affiliation(s)
- Teresa Deinlein
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Carina Michor
- Department of Dermatology, Medical University of Graz, Graz, Austria
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19
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Flint ND, Bishop MD, Smart TC, Strunck JL, Boucher KM, Grossman D, Secrest AM. Low accuracy of self-reported family history of melanoma in high-risk patients. Fam Cancer 2020; 20:41-48. [PMID: 32436000 DOI: 10.1007/s10689-020-00187-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Family history of melanoma is a major melanoma risk factor. However, self-reported family histories for some cancers, including melanoma, are commonly inaccurate. We used a unique database, the Utah Population Database (UPDB), as well as the Utah Cancer Registry to determine the accuracy of self-reported family history of melanoma in a large cohort of high-risk patients. Patient charts were reviewed and compared to records in the UPDB and the UCR to confirm personal and family history of melanoma in 1780 patients enrolled in a total body photography monitoring program. Self-reported family history of melanoma in first-degree relatives had an overall sensitivity of 71%, specificity of 79%, PPV of 31%, and NPV of 95%, with decreased accuracy (PPV) for second-degree relatives. A personal history of melanoma was the only factor significantly associated with accuracy in self-reported family history of melanoma. Patient age, sex, estimated nevus count, and number of prior personal melanomas were not significant predictors. Dermatologists should educate patients on the differences between melanomas, keratinocyte carcinomas, and pre-cancers. Confirming self-reported family history of melanoma may improve risk assessment for patients undergoing screening.
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Affiliation(s)
| | | | - Tristan C Smart
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | | | - Kenneth M Boucher
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Douglas Grossman
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA
| | - Aaron M Secrest
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA.
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA.
- Department of Dermatology, University of Utah, 30 N 1900 East, 4A330, Salt Lake City, UT, 84132, USA.
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20
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Greenwald E, Tan A, Stein JA, Liebman TN, Bowling A, Polsky D. Real-world outcomes of melanoma surveillance using the MoleMap NZ telemedicine platform. J Am Acad Dermatol 2020; 85:596-603. [PMID: 32114083 DOI: 10.1016/j.jaad.2020.02.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 01/21/2020] [Accepted: 02/10/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND MoleMap NZ is a novel New Zealand-based store-and-forward telemedicine service to detect melanoma. It uses expert review of total body photography and close-up and dermoscopic images of skin lesions that are suspicious for malignancy. OBJECTIVE The purpose of this study was to assess the effectiveness of MoleMap NZ as a melanoma early detection program. METHODS We conducted a review of 2108 melanocytic lesions recommended for biopsy/excision by MoleMap NZ dermoscopists between January 2015 and December 2016. RESULTS Pathologic diagnoses were available for 1571 lesions. Of these, 1303 (83%) lesions were benign and 260 (17%) lesions were diagnosed as melanoma, for a melanoma-specific benign:malignant ratio of 5.0:1. The number needed to biopsy to obtain 1 melanoma was 6. Among melanomas with available tumor thickness data (n = 137), 92% were <0.8 mm (range in situ to 3.1 mm), with in situ melanomas comprising 74%. LIMITATIONS Only lesions recommended for excision were analyzed. Pathology results were available for 75% of these cases. Tumor thickness data were available for 53% of melanomas diagnosed. CONCLUSIONS This real-world study of MoleMap NZ, a community-based teledermoscopy program, suggests that it has the potential to increase patients' access to specialist expertise via telemedicine. Additional studies are needed to more accurately define its efficacy.
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Affiliation(s)
- Elizabeth Greenwald
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Andrea Tan
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Jennifer A Stein
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Tracey N Liebman
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | | | - David Polsky
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.
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21
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Strunck JL, Smart TC, Boucher KM, Secrest AM, Grossman D. Improved melanoma outcomes and survival in patients monitored by total body photography: A natural experiment. J Dermatol 2020; 47:342-347. [PMID: 31953873 DOI: 10.1111/1346-8138.15221] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 12/12/2019] [Indexed: 01/28/2023]
Abstract
Total body photography (TBP) facilitates early melanoma detection, but long-term outcomes have not been well studied. Our objectives were to examine melanoma diagnoses, role of TBP-associated follow-up visits, and survival in patients monitored by TBP. A total of 1955 patients meeting inclusion criteria received TBP from 2004-2013 at a single academic center. We compared the melanoma diagnoses and overall survival of 1253 patients with any follow-up visits (median, three visits; range, 1-18) and 702 patients with no follow-up visits. Use of TBP photographs influenced decision to biopsy 66 of 121 (54.5%) melanomas diagnosed after TBP. Lower invasive melanoma Breslow depth was significantly associated with having one or more follow-up visit (median, 0.83 vs 0.33 mm; P = .002) and photographic review (median, 0.31 vs 0.48 mm; P = 0.02). In multivariable analyses, greater overall survival was significantly associated with having one or more follow-up visit after TBP (hazard ratio [HR], 0.36; 95% confidence interval [CI], 0.14-0.91; P < 0.032) and having more than 100 nevi (HR, 0.37; 95% CI, 0.22-0.64; P = 0.004). Worse overall survival was significantly associated with increasing age (HR per year, 1.06; 95% CI, 1.04-1.08; P < 0.001) and male sex (HR, 2.65; 95% CI, 1.48-4.73; P = 0.001). Thus, monitoring by TBP was associated with subsequent melanoma diagnoses of lower stage and depth and greater overall survival.
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Affiliation(s)
| | | | - Kenneth M Boucher
- Huntsman Cancer Institute, Salt Lake City, Utah, USA.,Department of, Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Aaron M Secrest
- Department, Dermatology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA.,Department, Population Health Sciences, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Douglas Grossman
- Huntsman Cancer Institute, Salt Lake City, Utah, USA.,Department, Dermatology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA.,Department, Oncological Sciences, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
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22
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Correlation of total body photography frequency and invasive melanoma depth. J Am Acad Dermatol 2019; 82:768-769. [PMID: 31706932 DOI: 10.1016/j.jaad.2019.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 11/01/2019] [Accepted: 11/01/2019] [Indexed: 11/23/2022]
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23
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Varedi A, Bishop MD, Boucher KM, Kim CC, Grossman D. Powering a prospective melanoma chemoprevention trial in high-risk cohorts. Int J Dermatol 2019; 58:e232-e234. [PMID: 31206619 DOI: 10.1111/ijd.14538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/18/2019] [Accepted: 05/20/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Amir Varedi
- Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Michael D Bishop
- Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Kenneth M Boucher
- Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, UT, USA.,Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Caroline C Kim
- Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Douglas Grossman
- Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, UT, USA.,Department of Dermatology, University of Utah School of Medicine, Salt Lake City, UT, USA.,Department of Oncological Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
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24
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Shrivastava V, Bailin P, Elliott J, Bacnik E, Gastman B, Bergfeld W, Billings SD, Piliang M, Fernandez A, Kovalyshyn I, Ko JS. Histopathologic correlation of high-risk MelaFind TM lesions: a 3-year experience from a high-risk pigmented lesion clinic. Int J Dermatol 2019; 58:569-576. [PMID: 30549001 DOI: 10.1111/ijd.14336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 10/08/2018] [Accepted: 11/14/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND A significant number of pigmented lesions are biopsied to rule out melanoma, but most will be benign. MelaFindTM is a highly sensitive, noninvasive computer-assisted system to aid in clinical diagnosis of melanoma. METHODS A total of 140 high-risk patients were followed by one expert dermatologist. Biopsies were blindly and independently evaluated by two dermatopathologists and given histologic severity scores (HSS, 0-12) based on the histologic features of melanoma/dysplastic nevi and compared to pathologic diagnoses and MelaFindTM scores. RESULTS MelaFindTM reduced the biopsy number of clinically ambiguous lesions (923 scanned to 253 biopsied, 73% reduction). Biopsied cases were usually benign (135/253, 53.4%, HSS = 2.8-3.2). Dysplastic nevi with varying degrees of atypia were observed next most commonly (80/253, 31.6%, HSS = 4.7-5.2 for mild dysplasia and 7-7.6 for moderate to severe dysplasia). Melanomas comprised 11/253 (4.3%) of biopsies (HSS = 9.3-10.7). Twenty-four cases were given miscellaneous diagnoses not within the dysplastic nevus-melanoma spectrum (9.5%, HSS = 1.3). Dermal fibrosis was the most commonly identified worrisome histologic feature (177/253, 70%), closely followed by other known atypical features. Nonthreatening histologic features in benign lesions with high MelaFindTM disorganization scores were common. The HSS differed significantly depending on pathologic diagnosis severity, while the MelaFindTM score did not (benign = 2.2; mildly atypical = 4.8; moderately to severely atypical = 2.3; in-situ or invasive melanoma = 3.1). CONCLUSIONS MelaFindTM unequivocally reduced the number of biopsies, but banal lesions had histologic attributes resulting in high-risk MelaFindTM scores, and MelaFindTM does not correlate with degree of cytologic atypia. Knowledge of these limitations should increase bidirectional confidence when making clinicopathologic correlations in high-risk patients.
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Affiliation(s)
- Vikas Shrivastava
- Department of Dermatology, Naval Medical Center Portsmouth, Portsmouth, VA, USA
| | - Phillip Bailin
- Dermatology and Plastic Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jennifer Elliott
- Dermatology and Plastic Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Elizabeth Bacnik
- Dermatology and Plastic Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Brian Gastman
- Dermatology and Plastic Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Wilma Bergfeld
- Dermatology and Plastic Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
- Pathology and Laboratory Medicine Institute, Cleveland, OH, USA
| | - Steven D Billings
- Dermatology and Plastic Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
- Pathology and Laboratory Medicine Institute, Cleveland, OH, USA
| | - Melissa Piliang
- Dermatology and Plastic Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
- Pathology and Laboratory Medicine Institute, Cleveland, OH, USA
| | - Anthony Fernandez
- Dermatology and Plastic Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
- Pathology and Laboratory Medicine Institute, Cleveland, OH, USA
| | | | - Jennifer S Ko
- Dermatology and Plastic Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
- Pathology and Laboratory Medicine Institute, Cleveland, OH, USA
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25
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Adler NR, Kelly JW, Guitera P, Menzies SW, Chamberlain AJ, Fishburn P, Button-Sloan AE, Heal C, Soyer HP, Thompson JF. Methods of melanoma detection and of skin monitoring for individuals at high risk of melanoma: new Australian clinical practice. Med J Aust 2018; 210:41-47. [PMID: 30636296 DOI: 10.5694/mja2.12033] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION The evidence-based national clinical practice guidelines for the management of cutaneous melanoma published in 2008 are currently being updated. This article summarises the findings from multiple chapters of the guidelines on different methods of melanoma detection and of monitoring the skin for patients at high risk of melanoma. Early detection of melanoma is critical, as thinner tumours are associated with enhanced survival; therefore, strategies to improve early detection are important to reduce melanoma-related mortality. MAIN RECOMMENDATIONS Clinicians who perform skin examinations for the purpose of detecting skin cancer should be trained in and use dermoscopy. The use of short term sequential digital dermoscopy imaging to detect melanomas that lack dermoscopic features of melanoma is recommended to assess individual melanocytic lesions of concern. The use of long term sequential digital dermoscopy imaging to detect melanomas that lack dermoscopic features of melanoma is recommended to assess individual or multiple melanocytic lesions for routine surveillance of high risk patients. The use of total body photography should be considered in managing patients at increased risk for melanoma, particularly those with high naevus counts and dysplastic naevi. There is insufficient evidence to recommend the routine use of automated instruments for the clinical diagnosis of primary melanoma. MANAGEMENT OVERVIEW Determining the relative indications for each diagnostic method and how each method should be introduced into the surveillance of a patient requires careful consideration and an individualised approach.
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Affiliation(s)
- Nikki R Adler
- Victorian Melanoma Service, Alfred Hospital, Melbourne, VIC
| | - John W Kelly
- Victorian Melanoma Service, Alfred Hospital, Melbourne, VIC.,Armadale Dermatology, Melbourne, VIC
| | - Pascale Guitera
- Melanoma Institute Australia, Sydney, NSW.,University of Sydney, Sydney, NSW.,Royal Prince Alfred Hospital, Sydney, NSW
| | - Scott W Menzies
- Sydney Melanoma Diagnostic Centre, University of Sydney, Sydney, NSW
| | - Alex J Chamberlain
- Victorian Melanoma Service, Alfred Health, Melbourne, VIC.,Glenferrie Dermatology, Melbourne, VIC
| | | | | | | | - H Peter Soyer
- Dermatology Research Centre, Diamantina Institute, University of Queensland, Brisbane, QLD.,Princess Alexandra Hospital, Brisbane, QLD
| | - John F Thompson
- Melanoma Institute Australia, Sydney, NSW.,University of Sydney, Sydney, NSW
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26
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Elder DE. Melanoma Screening and Mortality. J Natl Cancer Inst 2018; 110:1135-1136. [PMID: 29618115 DOI: 10.1093/jnci/djy056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 03/06/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- David E Elder
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
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27
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Tschandl P. Sequential digital dermatoscopic imaging of patients with multiple atypical nevi. Dermatol Pract Concept 2018; 8:231-237. [PMID: 30116670 PMCID: PMC6092075 DOI: 10.5826/dpc.0803a16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 03/03/2018] [Indexed: 11/21/2022] Open
Abstract
Patients with multiple atypical nevi are at higher risk of developing melanoma. Among different techniques, sequential digital dermatoscopic imaging (SDDI) is a state-of-the art method to enhance diagnostic accuracy in evaluating pigmented skin lesions. It relies on analyzing digital dermatoscopic images of a lesion over time to find specific dynamic criteria inferring biologic behavior. SDDI can reduce the number of necessary excisions and finds melanomas in an early—and potentially curable—stage, but precautions in selecting patients and lesions have to be met to reach those goals.
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Affiliation(s)
- Philipp Tschandl
- ViDIR Group, Department of Dermatology, Medical University of Vienna, Austria
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28
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Rayner JE, Laino AM, Nufer KL, Adams L, Raphael AP, Menzies SW, Soyer HP. Clinical Perspective of 3D Total Body Photography for Early Detection and Screening of Melanoma. Front Med (Lausanne) 2018; 5:152. [PMID: 29911103 PMCID: PMC5992425 DOI: 10.3389/fmed.2018.00152] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 05/02/2018] [Indexed: 11/28/2022] Open
Abstract
Melanoma incidence continues to increase across many populations globally and there is significant mortality associated with advanced disease. However, if detected early, patients have a very promising prognosis. The methods that have been utilized for early detection include clinician and patient skin examinations, dermoscopy (static and sequential imaging), and total body photography via 2D imaging. Total body photography has recently witnessed an evolution from 2D imaging with the ability to now create a 3D representation of the patient linked with dermoscopy images of individual lesions. 3D total body photography is a particularly beneficial screening tool for patients at high risk due to their personal or family history or those with multiple dysplastic naevi—the latter can make monitoring especially difficult without the assistance of technology. In this perspective, we discuss clinical examples utilizing 3D total body photography, associated advantages and limitations, and future directions of the technology. The optimal system for melanoma screening should improve diagnostic accuracy, be time and cost efficient, and accessible to patients across all demographic and socioeconomic groups. 3D total body photography has the potential to address these criteria and, most importantly, optimize crucial early detection.
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Affiliation(s)
- Jenna E Rayner
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, QLD, Australia.,Dermatology Department, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Antonia M Laino
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, QLD, Australia.,Dermatology Department, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Kaitlin L Nufer
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, QLD, Australia
| | - Laura Adams
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, QLD, Australia
| | - Anthony P Raphael
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, QLD, Australia
| | - Scott W Menzies
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - H Peter Soyer
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, QLD, Australia.,Dermatology Department, Princess Alexandra Hospital, Brisbane, QLD, Australia
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29
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Weyers W. Screening for malignant melanoma-a critical assessment in historical perspective. Dermatol Pract Concept 2018; 8:89-103. [PMID: 29785325 PMCID: PMC5955075 DOI: 10.5826/dpc.0802a06] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 12/19/2017] [Indexed: 12/13/2022] Open
Abstract
Screening for melanoma has been advocated for many years because early detection and excision have been regarded as the most important measure to lower mortality from that neoplasm. In the past decade, concern has been raised by epidemiologists that screening might result in excision chiefly of "inconsequential cancer," i.e., melanomas that would never have progressed into life-threatening tumors, a phenomenon referred to by the misleading term "overdiagnosis." Without any firm evidence, that speculation has been embraced worldwide, and incipient melanomas have been trivialized. At the same time, efforts at early detection of melanoma have continued and have resulted in biopsy of pigmented lesions at a progressively earlier stage, such as lesions with a diameter of only 2, 3, or 4 mm. Those tiny lesions often lack sufficient criteria for clinical and histopathologic diagnosis, the result being true overdiagnoses, i.e., misdiagnoses of melanocytic nevi as melanoma. This is especially true if available criteria for histopathologic diagnosis are diminuished even further by incomplete excision of lesions. The reliability of histopathologic diagnosis is far higher in excisional biopsies of lesions that were given some more time to develop changes that make them recognizable. Biopsy of pigmented lesions with a diameter of 6 mm has been found to result in a far higher yield of melanomas. In addition to better clinical judgment, slight postponement of biopsies bears the promise of substantial improvement of the reliability of histopathologic diagnosis, and of alleviating true overdiagnoses.
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