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Wang LF, Ni N, Hou JJ, Wang S, Wang JY, Wang Q, Zhu AQ, Zhang YQ, Ren WW, Chen ZT, Shan DD, Zhao YJ, Guo LH, Xu HX. Assessment of the Diagnostic Performance of Clinical Examinations and High-Frequency Ultrasound in Patients With Pigmented Skin Tumors. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:151-160. [PMID: 37812196 DOI: 10.1002/jum.16348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 09/14/2023] [Accepted: 09/23/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVES To investigate whether the integration of high-frequency ultrasound (HFUS) to routine clinical examinations could improve diagnostic performance and management decision for pigmented skin tumors. METHODS Three general practitioners trained previously and a dermatologist independently assessed pigmented skin tumors and rendered management decision based on clinical examinations alone or clinical examinations integrating HFUS. RESULTS After integrating HFUS, the diagnostic area under the curve (AUC) (0.658-0.693 versus 0.848, all P < .05) and specificity (46.6-58.6% versus 89.7%, all P < .05) for pigmented skin malignancies were improved for general practitioners, meanwhile unnecessary biopsy rate reduced (42.9-53.6% versus 10.7%, P < .001). To the dermatologist, the diagnostic AUC (0.822 versus 0.949, P < .001), sensitivity (81.7% versus 96.7%, P = .012) and specificity (0.828 versus 0.931, P = .031) improved significantly, meanwhile both missed biopsy rate (14.5% versus 4.8%, P = .031) and unnecessary biopsy rate (19.6% versus 7.1%, P = .016) decreased. Additionally, the diagnostic performance of the general practitioner with integrating HFUS could be comparable with the dermatologist based on clinical examinations alone (all P > .05). CONCLUSIONS As a complementary tool of clinical examinations, HFUS could help physicians differentiate pigmented skin malignancies and manage decision.
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Affiliation(s)
- Li-Fan Wang
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Na Ni
- Department of Dermatologic Surgery, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jing-Jing Hou
- School of Medicine, Tongji University, Shanghai, China
| | - Sha Wang
- School of Medicine, Tongji University, Shanghai, China
| | - Jing-Yi Wang
- School of Medicine, Tongji University, Shanghai, China
| | - Qiao Wang
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - An-Qi Zhu
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Ya-Qin Zhang
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei-Wei Ren
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Zi-Tong Chen
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Dan-Dan Shan
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Yu-Jing Zhao
- Department of Medical Imaging, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Le-Hang Guo
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Hui-Xiong Xu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
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Owida HA. Developments and Clinical Applications of Noninvasive Optical Technologies for Skin Cancer Diagnosis. J Skin Cancer 2022; 2022:9218847. [PMID: 36437851 PMCID: PMC9699785 DOI: 10.1155/2022/9218847] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/29/2022] [Accepted: 11/09/2022] [Indexed: 04/03/2024] Open
Abstract
Skin cancer has shown a sharp increase in prevalence over the past few decades and currently accounts for one-third of all cancers diagnosed. The most lethal form of skin cancer is melanoma, which develops in 4% of individuals. The rising prevalence and increased number of fatalities of skin cancer put a significant burden on healthcare resources and the economy. However, early detection and treatment greatly improve survival rates for patients with skin cancer. Since the rising rates of both the incidence and mortality have been particularly noticeable with melanoma, significant resources have been allocated to research aimed at earlier diagnosis and a deeper knowledge of the disease. Dermoscopy, reflectance confocal microscopy, optical coherence tomography, multiphoton-excited fluorescence imaging, and dermatofluorescence are only a few of the optical modalities reviewed here that have been employed to enhance noninvasive diagnosis of skin cancer in recent years. This review article discusses the methodology behind newly emerging noninvasive optical diagnostic technologies, their clinical applications, and advantages and disadvantages of these techniques, as well as the potential for their further advancement in the future.
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Affiliation(s)
- Hamza Abu Owida
- Medical Engineering Department, Faculty of Engineering, Al Ahliyya Amman University, Amman 19328, Jordan
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Szyc Ł, Scharlach C, Haenssle H, Fink C. In vivo two-photon-excited cellular fluorescence of melanin, NAD(P)H, and keratin enables an accurate differential diagnosis of seborrheic keratosis and pigmented cutaneous melanoma. JOURNAL OF BIOMEDICAL OPTICS 2021; 26:JBO-210130RR. [PMID: 34263578 PMCID: PMC8278779 DOI: 10.1117/1.jbo.26.7.075002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/29/2021] [Indexed: 06/13/2023]
Abstract
SIGNIFICANCE Seborrheic keratoses (SKs) are harmless pigmented skin lesions (PSLs) that may be confused clinically not only with other benign conditions but also with cutaneous melanoma (CM). As SKs are one of the most common neoplasms in adults, the importance of their correct diagnosis is high. Misclassifying SK as malignant is not rare and leads to a high number of unnecessary biopsies. On the other hand, misdiagnosing CM as SK may have a large impact on prognosis or therapy. AIM In the non-invasive technique of dermatofluoroscopy, the fluorophores in melanocytes and keratinocytes are excited in vivo with nanosecond laser pulses and the resulting spectrally resolved, melanin-dominated fluorescence signals are used to differentiate between pigmented benign lesions and CM. APPROACH In this single-center, non-interventional study, 33 PSLs of 20 patients were scanned with dermatofluoroscopy in vivo. For all included cases, dermatofluoroscopic signals were compared to pathology classification. RESULTS The characteristic spectral features of SK were identified, where the signals are dominated by keratin, NAD(P)H, and melanin. The fluorescence spectra of SKs differed substantially from those of CM: a characteristic spectrum of SK has been identified in 27 of 28 SKs. CONCLUSIONS The high-accuracy differential diagnosis between CM and SK is possible with dermatofluoroscopy.
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Affiliation(s)
| | | | - Holger Haenssle
- University of Heidelberg, Department of Dermatology, Heidelberg, Germany
| | - Christine Fink
- University of Heidelberg, Department of Dermatology, Heidelberg, Germany
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Leupold D, Pfeifer L, Hofmann M, Forschner A, Wessler G, Haenssle H. From Melanocytes to Melanoma Cells: Characterization of the Malignant Transformation by Four Distinctly Different Melanin Fluorescence Spectra (Review). Int J Mol Sci 2021; 22:ijms22105265. [PMID: 34067690 PMCID: PMC8156265 DOI: 10.3390/ijms22105265] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 12/22/2022] Open
Abstract
The melanin fluorescence emitted by pigment cells of the human skin has been a central research topic for decades, because melanin, on the one hand, protects against (solar) radiation in the near-UV range, whereas on the other hand, melanocytes are the starting point for the malignant transformation into melanoma. Until recently, however, melanin fluorescence was not accessible in the context of conventional spectroscopy, because it is ultraweak and is overshadowed by the more intense so-called autofluorescence of endogenous fluorophores. The advent of a new method of laser spectroscopy has made this melanin fluorescence measurable in vivo. A stepwise two-photon absorption with 800 nm photons is used, which more selectively excites melanin (dermatofluoroscopy). Our review summarizes the experimental results on melanin fluorescence of the four types of cutaneous pigment cells from healthy and malignant tissues. Outstanding is the finding that different types of melanocytes (i.e., melanocytes of common nevi, versus dysplastic nevi or versus melanoma cells) show characteristically different fluorescence spectra. The possibilities of using this melanin fluorescence for melanoma diagnosis are shown. Moreover, the uniform fluorescence spectra emitted by different melanoma subtypes are essential. Conclusions are drawn about the molecular processes in the melanosomes that determine fluorescence. Finally, experimental suggestions for further investigations are given.
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Affiliation(s)
- Dieter Leupold
- LTB Lasertechnik Berlin, Am Studio 2c, 12483 Berlin, Germany;
- Correspondence:
| | - Lutz Pfeifer
- LTB Lasertechnik Berlin, Am Studio 2c, 12483 Berlin, Germany;
| | - Maja Hofmann
- Klinik für Dermatologie, Venerologie und Allergologie, Charité-Universitätsmedizin, Charitéplatz 1, 10115 Berlin, Germany;
| | - Andrea Forschner
- Hautklinik, Universitäts-Klinikum Tübingen, Liebermeisterstraße 25, 72076 Tübingen, Germany;
| | - Gerd Wessler
- Hautarztpraxis Berlin, Linderhofstrasse 20, 12623 Berlin, Germany;
| | - Holger Haenssle
- Hautklinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany;
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Hofmann MA, Keim U, Jagoda A, Forschner A, Fink C, Spänkuch I, Tampouri I, Eigentler T, Weide B, Haenssle HA, Garbe C. Die Dermatofluoroskopie als Diagnoseverfahren bei verschiedenen pigmentierten Hautläsionen: Stärken und Schwächen. J Dtsch Dermatol Ges 2020; 18:682-691. [DOI: 10.1111/ddg.14163_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 10/17/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Maja Ann Hofmann
- Klinik für Dermatologie Venerologie und Allergologie Charité – Universitätsmedizin Berlin
| | - Ulrike Keim
- Zentrum für Dermatoonkologie Universitäts‐Hautklinik Eberhard Karls Universität Tübingen
| | - Agata Jagoda
- Klinik für Dermatologie Venerologie und Allergologie Charité – Universitätsmedizin Berlin
| | - Andrea Forschner
- Zentrum für Dermatoonkologie Universitäts‐Hautklinik Eberhard Karls Universität Tübingen
| | - Christine Fink
- Universitäts‐Hautklinik Heidelberg Ruprecht‐Karls‐Universität Heidelberg
| | - Iris Spänkuch
- Zentrum für Dermatoonkologie Universitäts‐Hautklinik Eberhard Karls Universität Tübingen
| | - Ioanna Tampouri
- Zentrum für Dermatoonkologie Universitäts‐Hautklinik Eberhard Karls Universität Tübingen
| | - Thomas Eigentler
- Zentrum für Dermatoonkologie Universitäts‐Hautklinik Eberhard Karls Universität Tübingen
| | - Benjamin Weide
- Zentrum für Dermatoonkologie Universitäts‐Hautklinik Eberhard Karls Universität Tübingen
| | - Holger A. Haenssle
- Universitäts‐Hautklinik Heidelberg Ruprecht‐Karls‐Universität Heidelberg
| | - Claus Garbe
- Zentrum für Dermatoonkologie Universitäts‐Hautklinik Eberhard Karls Universität Tübingen
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Hofmann MA, Keim U, Jagoda A, Forschner A, Fink C, Spänkuch I, Tampouri I, Eigentler T, Weide B, Haenssle HA, Garbe C. Dermatofluoroscopy diagnostics in different pigmented skin lesions: Strengths and weaknesses. J Dtsch Dermatol Ges 2020; 18:682-690. [PMID: 32657017 DOI: 10.1111/ddg.14163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 10/17/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND The melanin fluorescence of skin lesions is measurable with two-photon excitation, a process termed dermatofluoroscopy, which has shown a shift from the green spectra in benign melanocytic lesions to the red spectra in melanoma. This study addressed the question as to which kind of pigmented lesions can be correctly diagnosed as melanin-bearing malignant tumors. METHODS 476 pigmented lesions including 101 cutaneous melanomas were analyzed with dermatofluoroscopy, measuring the melanin fluorescence in a grid-like fashion with a separation of measurement points of 0.2 mm. The results of the dermatofluoroscopy are presented as a diagnostic score with a cut-off score of ≥ 28 for the diagnosis of melanin-bearing malignant tumors, and were compared to the gold standard of histopathology. RESULTS A highly significant difference (p < 0.0001) between the diagnostic scores of different skin tumors was found. Dermatofluoroscopy scores showed the highest sensitivity for melanomas (92.1 %). Interestingly, most pigmented basal cell carcinomas (BCCs, 88.9 %) were diagnosed as melanin-bearing malignant tumors. A higher sensitivity for the correct diagnosis was observed in older patients (≥ 53 years, p = 0.003), in patients with skin tanning (p = 0.025), and in patients with freckles during childhood (p = 0.046). CONCLUSIONS Two-photon fluorescence is an innovative technique for the diagnosis of pigmented skin lesions, and shows a high sensitivity for detection of melanomas and pigmented BCCs.
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Affiliation(s)
- Maja Ann Hofmann
- University Department of Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrike Keim
- Center of Dermatooncology, Department of Dermatology, Eberhard Karls University, Tübingen, Germany
| | - Agata Jagoda
- University Department of Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andrea Forschner
- Center of Dermatooncology, Department of Dermatology, Eberhard Karls University, Tübingen, Germany
| | - Christine Fink
- Department of Dermatology, University of Heidelberg, Germany
| | - Iris Spänkuch
- Center of Dermatooncology, Department of Dermatology, Eberhard Karls University, Tübingen, Germany
| | - Ioanna Tampouri
- Center of Dermatooncology, Department of Dermatology, Eberhard Karls University, Tübingen, Germany
| | - Thomas Eigentler
- Center of Dermatooncology, Department of Dermatology, Eberhard Karls University, Tübingen, Germany
| | - Benjamin Weide
- Center of Dermatooncology, Department of Dermatology, Eberhard Karls University, Tübingen, Germany
| | | | - Claus Garbe
- Center of Dermatooncology, Department of Dermatology, Eberhard Karls University, Tübingen, Germany
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Leupold D, Szyc L, Stankovic G, Hofmann M, Scholz M, Forschner A. Dermatofluoroscopy Is Also for Redheads a Sensitive Method of Early Melanoma Detection. Dermatology 2020; 236:508-516. [PMID: 32541152 DOI: 10.1159/000507614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 03/29/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Caucasians with red hair and fair skin have a remarkably increased risk of malignant melanoma compared to non-redhead Caucasians. OBJECTIVES With the aim of a reliable melanoma diagnosis in redheads, the application of dermatofluoroscopy was analyzed in 16 patients with red hair. Most of them had been included in a clinical dermatofluoroscopy study for patients with the suspicion of melanoma. We examined whether the 25 lesions of the redheads showed the same characteristic melanin fluorescence spectra for dysplastic nevi and melanomas as those of non-redhead Caucasians or whether there was a different fluorescence pattern. This is important in view of the known significantly altered ratio of eumelanin to pheomelanin in the skin of redheads. METHODS More than 8,000 spatially resolved fluorescence spectra of 25 pigmented lesions were measured and analysed. The spectra were excited by the stepwise absorption of two 800-nm photons (principle of dermatofluoroscopy). Furthermore, the fluorescence spectra of eumelanin and pheomelanin in hair samples were determined in the same way. RESULTS The evaluation revealed that the melanin fluorescence spectra of dysplastic nevi and melanomas of redheads have the same spectral characteristics as those of non-redhead Caucasians. An accompanying result is that dermatofluoroscopy shows identical fluorescence spectra for eumelanin and pheomelanin. CONCLUSIONS Dermatofluoroscopy proves to be a reliable diagnostic method also for redheads. Our results also explain our recent finding that there is a uniform fluorescence spectroscopic fingerprint for melanomas of all subtypes, which is of particular interest for hypomelanotic and apparently amelanotic melanomas containing pheomelanin.
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Affiliation(s)
| | | | | | - Maja Hofmann
- University Department of Dermatology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Andrea Forschner
- Center of Dermatooncology, Department of Dermatology, University Hospital Tübingen, Eberhard-Karls-University, Tübingen, Germany,
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Diagnostic Performance of a Support Vector Machine for Dermatofluoroscopic Melanoma Recognition: The Results of the Retrospective Clinical Study on 214 Pigmented Skin Lesions. Diagnostics (Basel) 2019; 9:diagnostics9030103. [PMID: 31450697 PMCID: PMC6787620 DOI: 10.3390/diagnostics9030103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 08/20/2019] [Accepted: 08/22/2019] [Indexed: 11/17/2022] Open
Abstract
The need for diagnosing malignant melanoma in its earliest stages results in an increasing number of unnecessary excisions. Objective criteria beyond the visual inspection are needed to distinguish between benign and malignant melanocytic tumors in vivo. Fluorescence spectra collected during the prospective, multicenter observational study (“FLIMMA”) were retrospectively analyzed by the newly developed machine learning algorithm. The formalin-fixed paraffin-embedded (FFPE) tissue samples of 214 pigmented skin lesions (PSLs) from 144 patients were examined by two independent pathologists in addition to the first diagnosis from the FLIMMA study, resulting in three histopathological results per sample. The support vector machine classifier was trained on 17,918 fluorescence spectra from 49 lesions labeled as malignant (1) and benign (0) by three histopathologists. A scoring system that scales linearly with the number of the “malignant spectra” was designed to classify the lesion as malignant melanoma (score > 28) or non-melanoma (score ≤ 28). Finally, the scoring algorithm was validated on 165 lesions to ensure model prediction power and to estimate the diagnostic accuracy of dermatofluoroscopy in melanoma detection. The scoring algorithm revealed a sensitivity of 91.7% and a specificity of 83.0% in diagnosing malignant melanoma. Using additionally the image segmentation for normalization of lesions’ region of interest, a further improvement of sensitivity of 95.8% was achieved, with a corresponding specificity of 80.9%.
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Leupold D, Szyc L, Stankovic G, Strobel S, Völker HU, Fleck U, Müller T, Scholz M, Riederer P, Monoranu CM. Melanin and Neuromelanin Fluorescence Studies Focusing on Parkinson's Disease and Its Inherent Risk for Melanoma. Cells 2019; 8:cells8060592. [PMID: 31208049 PMCID: PMC6627191 DOI: 10.3390/cells8060592] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/07/2019] [Accepted: 06/13/2019] [Indexed: 12/19/2022] Open
Abstract
Parkinson’s disease is associated with an increased risk of melanoma (and vice versa). Several hypotheses underline this link, such as pathways affecting both melanin and neuromelanin. For the first time, the fluorescence of melanin and neuromelanin is selectively accessible using a new method of nonlinear spectroscopy, based on a stepwise two-photon excitation. Cutaneous pigmentation and postmortem neuromelanin of Parkinson patients were characterized by fluorescence spectra and compared with controls. Spectral differences could not be documented, implying that there is neither a Parkinson fingerprint in cutaneous melanin spectra nor a melanin-associated fingerprint indicating an increased melanoma risk. Our measurements suggest that Parkinson’s disease occurs without a configuration change of neuromelanin. However, Parkinson patients displayed the same dermatofluorescence spectroscopic fingerprint of a local malignant transformation as controls. This is the first comparative retrospective fluorescence analysis of cutaneous melanin and postmortem neuromelanin based on nonlinear spectroscopy in patients with Parkinson’s disease and controls, and this method is a very suitable diagnostic tool for melanoma screening and early detection in Parkinson patients. Our results suggest a non-pigmentary pathway as the main link between Parkinson’s disease and melanoma, and they do not rule out the melanocortin-1-receptor gene as an additional bridge between both diseases.
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Affiliation(s)
- Dieter Leupold
- LTB Lasertechnik Berlin GmbH, 12489 Berlin, Germany.
- Magnosco GmbH, 12489 Berlin, Germany.
| | | | | | - Sabrina Strobel
- Institute of Pathology, Department of Neuropathology, University of Wuerzburg, Comprehensive Cancer Center (CCC) Mainfranken Wuerzburg, 97080 Wuerzburg, Germany.
| | - Hans-Ullrich Völker
- Pathology, Leopoldina Krankenhaus GmbH, Gustav-Adolf-Str 8, D-97422 Schweinfurt, Germany.
| | | | - Thomas Müller
- Department of Neurology, St. Joseph Hospital Berlin-Weißensee, 13088 Berlin, Germany.
| | | | - Peter Riederer
- Center of Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, Margarete-Hoeppel-Platz 1, 97080 Wuerzburg, Germany.
- Department and Research Unit of Psychiatry, University of Southern Denmark, Odense, Odense C - DK-5000, Denmark.
| | - Camelia-Maria Monoranu
- Institute of Pathology, Department of Neuropathology, University of Wuerzburg, Comprehensive Cancer Center (CCC) Mainfranken Wuerzburg, 97080 Wuerzburg, Germany.
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Stolz W. Wie schätzen unsere Patienten die Melanomfrüherkennung mit Hilfe des Computers und von hochentwickelten technischen Systemen ein? J Dtsch Dermatol Ges 2018; 16:819-820. [DOI: 10.1111/ddg.13567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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