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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Wallingford CK, Maas EJ, Howard A, DeBortoli E, Bhanja D, Lee K, Mothershaw A, Jagirdar K, Willett R, Betz-Stablein B, Sturm RA, Soyer HP, McInerney-Leo AM. MITF E318K: A rare homozygous case with multiple primary melanoma. Pigment Cell Melanoma Res 2024; 37:68-73. [PMID: 37635363 DOI: 10.1111/pcmr.13122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/26/2023] [Accepted: 08/16/2023] [Indexed: 08/29/2023]
Abstract
MITF E318K moderates melanoma risk. Only five MITF E318K homozygous cases have been reported to date, one in association with melanoma. This novel report uses 3D total-body-photography (TBP) to describe the dermatological phenotype of a homozygous MITF E318K individual. The case, a 32-year-old male, was diagnosed with his first of six primary melanomas at 26 years of age. Five melanomas were located on the back and one in the groin. Two were superficial spreading. Three arose from pre-existing naevi and one was a rare naevoid melanoma. 3D-TBP revealed a high naevus count (n = 162) with pigmentation varying from light to dark. Most naevi generally (n = 90), and large (>5 mm diameter) and clinically atypical naevi specifically were located on the back where sun damage was mild. In contrast, naevi count was low (n = 25 total) on the head/neck and lower limbs where sun damage was severe. Thus, melanoma location correlated with naevi density, rather than degree of sun damage. In addition to the MITF E318K homozygosity, there was heterozygosity for four other moderate-risk variants, which may contribute to melanoma risk. Further research is warranted to explore whether melanomas in E318K heterozygous and other homozygotes coincide with regions of high naevi density as opposed to sun damage. This could inform future melanoma screening/surveillance.
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Affiliation(s)
- Courtney K Wallingford
- Dermatology Research Centre, Frazer Institute, The University of Queensland, Brisbane, Queensland, Australia
- Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Ellie J Maas
- Dermatology Research Centre, Frazer Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Antonia Howard
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Emily DeBortoli
- Dermatology Research Centre, Frazer Institute, The University of Queensland, Brisbane, Queensland, Australia
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Deboshmita Bhanja
- Dermatology Research Centre, Frazer Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Katie Lee
- Dermatology Research Centre, Frazer Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Adam Mothershaw
- Dermatology Research Centre, Frazer Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Kasturee Jagirdar
- Dermatology Research Centre, Frazer Institute, The University of Queensland, Brisbane, Queensland, Australia
- Biochemistry and Molecular Biology Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rod Willett
- Jimboomba Junction Family Practice and Skin Cancer Clinic, Jimboomba, Queensland, Australia
| | - Brigid Betz-Stablein
- Dermatology Research Centre, Frazer Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Richard A Sturm
- Dermatology Research Centre, Frazer Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - H Peter Soyer
- Dermatology Research Centre, Frazer Institute, The University of Queensland, Brisbane, Queensland, Australia
- Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Aideen M McInerney-Leo
- Dermatology Research Centre, Frazer Institute, The University of Queensland, Brisbane, Queensland, Australia
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Jayasinghe D, Nufer KL, Betz-Stablein B, Soyer HP, Janda M. Body Site Distribution of Acquired Melanocytic Naevi and Associated Characteristics in the General Population of Caucasian Adults: A Scoping Review. Dermatol Ther (Heidelb) 2022. [PMID: 36180760 DOI: 10.1007/s13555-022-00806-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/30/2022] [Indexed: 11/26/2022] Open
Abstract
The number of melanocytic naevi is a major risk factor for melanoma. The divergent pathway hypothesis proposes that the propensity for naevus proliferation and malignant transformation may differ by body site and exposure to ultraviolet (UV) radiation. This scoping review aimed to summarise the evidence on the number and distribution of naevi (≥ 2 mm) on the body overall and by individual anatomical sites in Caucasian adults, and to assess whether studies used the International Agency for Research on Cancer (IARC) protocol to guide naevus counting processes. Systematic searches of Embase and PubMed identified 661 potentially relevant studies, and 12 remained eligible after full-text review. Studies varied widely in their counting protocols, reporting of naevus counts overall and by body sites, and used counting personnel with differing qualifications. Only one study used the IARC protocol. Studies reported that the highest number of naevi was on the trunk in males and on the arms in females. Body sites which receive intermittent exposure to UV radiation had higher density of naevi. Larger naevi (≥ 5 mm) were detected mostly on body sites intermittently exposed to UV radiation, and smaller naevi (< 5 mm) on chronically exposed sites. Studies reported that environmental and behavioural aspects related to UV radiation exposure, as well as genetic factors, all impact body site and size distribution of naevi. This review found that to overcome limitations of the current evidence, future studies should use consistent naevus counting protocols. Skin surface imaging could improve the reliability of findings. An updated IARC protocol is required that integrates these emerging standards and technologies to guide reliable and reproducible naevus counting in the future.
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Lee KJ, Betz-Stablein B, Stark MS, Janda M, McInerney-Leo AM, Caffery LJ, Gillespie N, Yanes T, Soyer HP. The Future of Precision Prevention for Advanced Melanoma. Front Med (Lausanne) 2022; 8:818096. [PMID: 35111789 PMCID: PMC8801740 DOI: 10.3389/fmed.2021.818096] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 12/22/2021] [Indexed: 12/16/2022] Open
Abstract
Precision prevention of advanced melanoma is fast becoming a realistic prospect, with personalized, holistic risk stratification allowing patients to be directed to an appropriate level of surveillance, ranging from skin self-examinations to regular total body photography with sequential digital dermoscopic imaging. This approach aims to address both underdiagnosis (a missed or delayed melanoma diagnosis) and overdiagnosis (the diagnosis and treatment of indolent lesions that would not have caused a problem). Holistic risk stratification considers several types of melanoma risk factors: clinical phenotype, comprehensive imaging-based phenotype, familial and polygenic risks. Artificial intelligence computer-aided diagnostics combines these risk factors to produce a personalized risk score, and can also assist in assessing the digital and molecular markers of individual lesions. However, to ensure uptake and efficient use of AI systems, researchers will need to carefully consider how best to incorporate privacy and standardization requirements, and above all address consumer trust concerns.
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Affiliation(s)
- Katie J. Lee
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Brigid Betz-Stablein
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Mitchell S. Stark
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Monika Janda
- Centre for Health Services Research, School of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Aideen M. McInerney-Leo
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Liam J. Caffery
- Centre for Health Services Research, School of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Nicole Gillespie
- The University of Queensland Business School, Faculty of Business, Economics and Law, The University of Queensland, Brisbane, QLD, Australia
| | - Tatiane Yanes
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, QLD, Australia
| | - H. Peter Soyer
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, QLD, Australia
- Department of Dermatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
- *Correspondence: H. Peter Soyer
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