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Knab A, Anwer AG, Pedersen B, Handley S, Marupally AG, Habibalahi A, Goldys EM. Towards label-free non-invasive autofluorescence multispectral imaging for melanoma diagnosis. J Biophotonics 2024; 17:e202300402. [PMID: 38247053 DOI: 10.1002/jbio.202300402] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/11/2023] [Accepted: 12/31/2023] [Indexed: 01/23/2024]
Abstract
This study focuses on the use of cellular autofluorescence which visualizes the cell metabolism by monitoring endogenous fluorophores including NAD(P)H and flavins. It explores the potential of multispectral imaging of native fluorophores in melanoma diagnostics using excitation wavelengths ranging from 340 nm to 510 nm and emission wavelengths above 391 nm. Cultured immortalized cells are utilized to compare the autofluorescent signatures of two melanoma cell lines to one fibroblast cell line. Feature analysis identifies the most significant and least correlated features for differentiating the cells. The investigation successfully applies this analysis to pre-processed, noise-removed images and original background-corrupted data. Furthermore, the applicability of distinguishing melanomas and healthy fibroblasts based on their autofluorescent characteristics is validated using the same evaluation technique on patient cells. Additionally, the study tentatively maps the detected features to underlying biological processes. This research demonstrates the potential of cellular autofluorescence as a promising tool for melanoma diagnostics.
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Affiliation(s)
- Aline Knab
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Sydney, Australia
- ARC Centre of Excellence for Nanoscale Biophotonics, University of New South Wales, Sydney, Australia
| | - Ayad G Anwer
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Sydney, Australia
- ARC Centre of Excellence for Nanoscale Biophotonics, University of New South Wales, Sydney, Australia
| | - Bernadette Pedersen
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Shannon Handley
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Sydney, Australia
- ARC Centre of Excellence for Nanoscale Biophotonics, University of New South Wales, Sydney, Australia
| | - Abhilash Goud Marupally
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Sydney, Australia
- ARC Centre of Excellence for Nanoscale Biophotonics, University of New South Wales, Sydney, Australia
| | - Abbas Habibalahi
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Sydney, Australia
- ARC Centre of Excellence for Nanoscale Biophotonics, University of New South Wales, Sydney, Australia
| | - Ewa M Goldys
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Sydney, Australia
- ARC Centre of Excellence for Nanoscale Biophotonics, University of New South Wales, Sydney, Australia
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Manolakos D, Patrick G, Geisse JK, Rabinovitz H, Buchanan K, Hoang P, Rodriguez-Diaz E, Bigio IJ, Cognetta AB. Use of an elastic-scattering spectroscopy and artificial intelligence device in the assessment of lesions suggestive of skin cancer: A comparative effectiveness study. JAAD Int 2024; 14:52-58. [PMID: 38143790 PMCID: PMC10746496 DOI: 10.1016/j.jdin.2023.08.019] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 12/26/2023] Open
Abstract
Background Skin cancer is the most common form of cancer worldwide. As artificial intelligence (AI) expands its scope within dermatology, leveraging technology may aid skin cancer detection. Objective To assess the safety and effectiveness of an elastic-scattering spectroscopy (ESS) device in evaluating lesions suggestive of skin cancer. Methods This prospective, multicenter clinical validation study was conducted at 4 US investigational sites. Patients with skin lesions suggestive of melanoma and nonmelanoma skin cancers were clinically assessed by expert dermatologists and evaluated by a device using AI algorithms comparing current ESS lesion readings with training data sets. Statistical analyses included sensitivity, specificity, AUROC, negative predictive value (NPV), and positive predictive value (PPV). Results Overall device sensitivity was 97.04%, with subgroup sensitivity of 96.67% for melanoma, 97.22% for basal cell carcinoma, and 97.01% for squamous cell carcinoma. No statistically significant difference was found between the device and dermatologist performance (P = .8203). Overall specificity of the device was 26.22%. Overall NPV of the device was 89.58% and PPV was 57.54%. Conclusion The ESS device demonstrated high sensitivity in detecting skin cancer. Use of this device may assist primary care clinicians in assessing suspicious lesions, potentially reducing skin cancer morbidity and mortality through expedited and enhanced detection and intervention.
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Affiliation(s)
| | | | - John K. Geisse
- Departments of Dermatology and Pathology, University of California San Francisco, San Francisco, California
| | - Harold Rabinovitz
- Skin and Cancer Associates, Plantation, Florida
- Department of Dermatology, University of Miami School of Medicine, Miami, Florida
- Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Kendall Buchanan
- Medical College of Georgia, Augusta University, Augusta, Georgia
| | | | | | - Irving J. Bigio
- Department of Electrical & Computer Engineering, Boston University, Boston, Massachusetts
| | - Armand B. Cognetta
- Florida State University College of Medicine, Tallahassee, Florida
- Dermatology Associates of Tallahassee, Tallahassee, Florida
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McCaffrey N, Bucholc J, Ng L, Chai K, Livingstone A, Murphy A, Gordon LG. Protocol for a systematic review of reviews on training primary care providers in dermoscopy to detect skin cancers. BMJ Open 2023; 13:e079052. [PMID: 38081669 PMCID: PMC10729275 DOI: 10.1136/bmjopen-2023-079052] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Globally, incidence, prevalence and mortality rates of skin cancers are escalating. Earlier detection by well-trained primary care providers in techniques such as dermoscopy could reduce unnecessary referrals and improve longer term outcomes. A review of reviews is planned to compare and contrast the conduct, quality, findings and conclusions of multiple systematic and scoping reviews addressing the effectiveness of training primary care providers in dermoscopy, which will provide a critique and synthesis of the current body of review evidence. METHODS AND ANALYSIS Four databases (Cochrane, CINAHL, EMBASE and MEDLINE Complete) will be comprehensively searched from database inception to identify published, peer-reviewed English-language articles describing scoping and systematic reviews of the effectiveness of training primary care providers in the use of dermoscopy to detect skin cancers. Two researchers will independently conduct the searches and screen the results for potentially eligible studies using 'Research Screener' (a semi-automated machine learning tool). Backwards and forwards citation tracing will be conducted to supplement the search. A narrative summary of included reviews will be conducted. Study characteristics, for example, population; type of educational programme, including content, delivery method, duration and assessment; and outcomes for dermoscopy will be extracted into a standardised table. Data extraction will be checked by the second reviewer. Methodological quality will be evaluated by two reviewers independently using the Critical Appraisal Tool for Health Promotion and Prevention Reviews. Results of the assessments will be considered by the two reviewers and any discrepancies will be resolved by team consensus. ETHICS AND DISSEMINATION Ethics approval is not required to conduct the planned systematic review of peer-reviewed, published articles because the research does not involve human participants. Findings will be published in a peer-reviewed journal, presented at leading public health, cancer and primary care conferences, and disseminated via website postings and social media channels. PROSPERO REGISTRATION NUMBER CRD42023396276.
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Affiliation(s)
- Nikki McCaffrey
- IHT, Deakin Health Economics, Deakin University School of Health and Social Development, Burwood, Victoria, Australia
| | - Jessica Bucholc
- IHT, Deakin Health Economics, Deakin University School of Health and Social Development, Burwood, Victoria, Australia
| | - Leo Ng
- Department of Nursing and Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Kevin Chai
- Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Ann Livingstone
- IHT, Deakin Health Economics, Deakin University School of Health and Social Development, Burwood, Victoria, Australia
| | - April Murphy
- IHT, Deakin Health Economics, Deakin University School of Health and Social Development, Burwood, Victoria, Australia
| | - Louisa G Gordon
- Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
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Gellatly ZS, Lagha IB, Ternov NK, Berry E, Nelson KC, Seiverling EV. The Role of Dermoscopy in Provider-to-Provider Store-and-Forward Dermatology eConsults: A Scoping Review of the Recent Literature. Curr Dermatol Rep 2023; 12:169-179. [PMID: 38390375 PMCID: PMC10883069 DOI: 10.1007/s13671-023-00407-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 02/24/2024]
Abstract
Purpose of Review This scoping review maps recent literature on dermatology provider-to-provider asynchronous store-and-forward (SAF) electronic consult (eConsult) platforms with dermoscopy. It offers a descriptive overview, highlighting benefits and challenges. Recent Findings Incorporating dermoscopy into SAF eConsults improves diagnostic accuracy for benign and malignant skin neoplasms. Diagnostic and treatment concordance with traditional face-to-face (FTF) visits is high. SAF eConsults with dermoscopy enhance access to dermatological care by improving triage and reducing wait times for FTF visits. Pediatric patients benefit with improved evaluation of melanocytic and vascular growths. eConsult platforms with dermoscopy serve as a telementoring opportunity for clinicians interested in improving their dermoscopy skills. Summary Adding dermoscopy to SAF eConsults is valuable and results in improved diagnostic accuracy and reduced need for FTF visits. Implementation barriers can be overcome through collaboration between primary care and dermatology. Dermoscopy in SAF eConsults has significant potential for managing skin conditions and reducing the burden caused by unnecessary FTF visit and biopsies.
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Affiliation(s)
| | - Imene B Lagha
- Tufts Medical Center, Department of Dermatology, Boston, MA 02116, USA
| | - Niels Kvorning Ternov
- Department of Plastic Surgery, Herley and Gentofte University Hospital, Copenhagen, Demark
| | - Elizabeth Berry
- OHSU Department of Dermatology Center for Health and Healing, Portland, OR 97239, USA
| | - Kelly C Nelson
- The University of Texas, Department of Dermatology, Division of Internal Medicine, MD Anderson Cancer Center, Houston, TX 77030, USA
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Silver FH, Deshmukh T, Nadiminti H, Tan I. Melanin Stacking Differences in Pigmented and Non-Pigmented Melanomas: Quantitative Differentiation between Pigmented and Non-Pigmented Melanomas Based on Light-Scattering Properties. Life (Basel) 2023; 13:life13041004. [PMID: 37109534 PMCID: PMC10142763 DOI: 10.3390/life13041004] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Cutaneous melanoma is a cancer with metastatic potential characterized by varying amounts of pigment-producing melanocytes, and it is one of the most aggressive and fatal forms of skin malignancy, with several hundreds of thousands of cases each year. Early detection and therapy can lead to decreased morbidity and decreased cost of therapy. In the clinic, this often translates to annual skin screenings, especially for high-risk patients, and generous use of the ABCDE (asymmetry, border irregularity, color, diameter, evolving) criteria. We have used a new technique termed vibrational optical coherence tomography (VOCT) to non-invasively differentiate between pigmented and non-pigmented melanomas in a pilot study. The VOCT results reported in this study indicate that both pigmented and non-pigmented melanomas have similar characteristics, including new 80, 130, and 250 Hz peaks. Pigmented melanomas have larger 80 Hz peaks and smaller 250 Hz peaks than non-pigmented cancers. The 80 and 250 Hz peaks can be used to quantitative characterize differences between different melanomas. In addition, infrared light penetration depths indicated that melanin in pigmented melanomas has higher packing densities than in non-pigmented lesions. Using machine learning techniques, the sensitivity and specificity of differentiating skin cancers from normal skin are shown to range from about 78% to over 90% in this pilot study. It is proposed that using AI on both lesion histopathology and mechanovibrational peak heights may provide even higher specificity and sensitivity for differentiating the metastatic potential of different melanocytic lesions.
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Affiliation(s)
- Frederick H Silver
- Department of Pathology and Laboratory Medicine, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, Piscataway, NJ 08854, USA
- OptoVibronex, LLC, Bethlehem, PA 18015, USA
| | | | - Hari Nadiminti
- Summit Health, Dermatology Department, Berkeley Heights, NJ 07922, USA
| | - Isabella Tan
- Department of Pathology and Laboratory Medicine, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, Piscataway, NJ 08854, USA
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Garrison ZR, Hall CM, Fey RM, Clister T, Khan N, Nichols R, Kulkarni RP. Advances in Early Detection of Melanoma and the Future of At-Home Testing. Life (Basel) 2023; 13:life13040974. [PMID: 37109503 PMCID: PMC10145469 DOI: 10.3390/life13040974] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/17/2023] [Accepted: 03/31/2023] [Indexed: 04/29/2023] Open
Abstract
The past decade has seen numerous advancements in approaches to melanoma detection, each with the common goal to stem the growing incidence of melanoma and its mortality rate. These advancements, while well documented to increase early melanoma detection, have also garnered considerable criticism of their efficacy for improving survival rates. In this review, we discuss the current state of such early detection approaches that do not require direct dermatologist intervention. Our findings suggest that a number of at-home and non-specialist methods exist with high accuracy for detecting melanoma, albeit with a few notable concerns worth further investigation. Additionally, research continues to find new approaches using artificial intelligence which have promise for the future.
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Affiliation(s)
- Zachary R Garrison
- Department of Dermatology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Connor M Hall
- Department of Dermatology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Rosalyn M Fey
- Department of Dermatology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Terri Clister
- Department of Dermatology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Nabeela Khan
- Department of Dermatology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Rebecca Nichols
- Department of Dermatology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Rajan P Kulkarni
- Department of Dermatology, Oregon Health & Science University, Portland, OR 97239, USA
- Cancer Early Detection Advanced Research Center (CEDAR), Portland, OR 97239, USA
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR 97239, USA
- Operative Care Division, U.S. Department of Veterans Affairs Portland Health Care System, Portland, OR 97239, USA
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7
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Bucchi L, Mancini S, Zamagni F, Crocetti E, Dal Maso L, Ferretti S, Baldacchini F, Giuliani O, Ravaioli A, Vattiato R, Brustolin A, Candela G, Carone S, Carrozzi G, Cavallo R, Dinaro YM, Ferrante M, Iacovacci S, Mazzoleni G, Musolino A, Rizzello RV, Serraino D, Biggeri A, Stanganelli I, Falcini F. Patient presentation, skin biopsy utilization and cutaneous malignant melanoma incidence and mortality in northern Italy: Trends and correlations. J Eur Acad Dermatol Venereol 2023; 37:293-302. [PMID: 36181283 PMCID: PMC10092783 DOI: 10.1111/jdv.18635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/14/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND The global increase in incidence of cutaneous malignant melanoma (CMM) occurring in the past decades has been partly attributed to increased diagnostic scrutiny of early lesions, with a potential phenomenon of overdiagnosis. The reported positive linear relation between skin biopsy rate and incidence of early CMM is compatible with this hypothesis. OBJECTIVES We explored the ecological association between the trends in annual dermatologic office visit rates, skin biopsy rates, incidence rates of in situ and invasive CMM by tumour thickness category, and CMM mortality rates in the Emilia-Romagna Region (northern Italy). METHODS Four cancer registries covering a population of 2,696,000 provided CMM incidence data for the years 2003-2017. Dermatologic office visit rates and skin biopsy rates were calculated using the Regional outpatient care database. All rates were age-standardized. Trends were described with the estimated average annual per cent change (EAAPC). Correlations were tested with the Spearman correlation coefficient. RESULTS Incidence increased significantly. The increase was steeper for in situ CMM (EAAPC: men, 10.2; women, 6.9) followed by CMM <0.8 mm thick (9.1; 5.2), but the rates grew significantly for most subgroups of CMMs ≥0.8 mm thick. Mortality decreased significantly among women (-2.3) and non-significantly among men. For dermatologic office visit rate and skin biopsy rate the EAAPC were, respectively, 1.7 and 1.8 for men and 1.2 and 0.9 for women. Annual dermatologic office visit rate correlated with skin biopsy rate in both sexes. However, the proportion of skin biopsies out of dermatologic office visits was constant across the years (range: men, 0.182-0.216; women, 0.157-0.191). CONCLUSIONS In Italy, the increasing CMM incidence trend is, at least in part, genuine. Overdiagnosis-if any-is due to an increased patient presentation at dermatologic offices and not to a lower dermatologic threshold to perform biopsy.
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Affiliation(s)
- Lauro Bucchi
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Silvia Mancini
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Federica Zamagni
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Emanuele Crocetti
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Luigino Dal Maso
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Stefano Ferretti
- Romagna Cancer Registry, section of Ferrara, Local Health Authority and University of Ferrara, Ferrara, Italy
| | - Flavia Baldacchini
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Orietta Giuliani
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Alessandra Ravaioli
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Rosa Vattiato
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Angelita Brustolin
- UOSD Epidemiologia e Registro Tumori (Dip. di Prevenzione ASL VT) c/o Cittadella della Salute, Viterbo, Italy
| | - Giuseppa Candela
- Trapani Cancer Registry, Dipartimento di Prevenzione della Salute, Servizio Sanitario Regionale Sicilia, Azienda Sanitaria Provinciale (ASP), Trapani, Italy
| | - Simona Carone
- Registro Tumori di Taranto, Unità Operativa Complessa di Statistica ed Epidemiologia, Azienda Sanitaria Locale, Taranto, Italy
| | - Giuliano Carrozzi
- Modena Cancer Registry, Public Health Department, Local Health Authority, Modena, Italy
| | | | | | - Margherita Ferrante
- Integrated Cancer Registry of Catania-Messina-Enna, Azienda Ospedaliero-Universitaria Policlinico "Rodolico-San Marco", Catania, Italy
| | | | | | - Antonino Musolino
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Medical Oncology Unit and Cancer Registry, University Hospital of Parma, Parma, Italy
| | - Roberto Vito Rizzello
- Trento Province Cancer Registry, Unit of Clinical Epidemiology, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Diego Serraino
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Annibale Biggeri
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Ignazio Stanganelli
- Skin Cancer Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy.,Department of Dermatology, University of Parma, Parma, Italy
| | - Fabio Falcini
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy.,Local Health Authority, Cancer Prevention Unit, Forlì, Italy
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Becevic M, Ge B, Braudis K, Cintrón C, Fleming D, Shyu CR, Edison K. Diagnostic and treatment concordance in primary care participants and dermatologists utilizing Extension for Community Health Outcomes (ECHO). J Telemed Telecare 2023:1357633X221147074. [PMID: 36654477 DOI: 10.1177/1357633x221147074] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Suboptimal access to dermatologic care is dependent on patient location and insurance type. Although there have been attempts to address access issues, barriers to providing excellent dermatologic care to all patients at the right time still exist. The objective of this study was to investigate the clinical impact of Dermatology Extension for Community Healthcare Outcomes (ECHO) project participation on primary care providers' diagnostic and treatment tendencies and accuracy. METHODS This was a retrospective cohort study constructed using Dermatology Extension for Community Healthcare Outcomes case and recommendation data from November 2015 to June 2021. The University of Missouri-based Dermatology Extension for Community Healthcare Outcomes specialty hub team offers regularly scheduled live interactive tele-mentoring sessions for primary care providers who practice in rural and underserved areas. 524 patient cases presented by 25 primary care providers were included in the analysis. Of those, 449 cases were included in diagnostic concordance, and 451 in treatment concordance analysis. RESULTS Less than 40% of all diagnoses were fully concordant with an expert panel. Over 33% of patients were misdiagnosed, and over 26% received partially correct diagnosis. Only 16% of all treatment recommendations were fully concordant with an expert panel. DISCUSSION Diagnostic and treatment accuracy of participants is low, and Dermatology Extension for Community Healthcare Outcomes platform ensured patients received correct diagnosis and treatment quickly. Although tele-dermatology models are effective, they continue to be underutilized. Dermatologists in practice and training should be encouraged to adopt innovative clinical educational models, like Dermatology ECHO, to expand access to dermatologic expertise for the most marginalized populations.
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Affiliation(s)
- Mirna Becevic
- Department of Dermatology, 14716University of Missouri, Columbia, MO, USA
- Missouri Telehealth Network, 14716University of Missouri, Columbia, MO, USA
- Institute for Data Science and Informatics, 14716University of Missouri, Columbia, MO, USA
| | - Bin Ge
- Family and Community Medicine, 14716University of Missouri, Columbia, MO, USA
| | - Kara Braudis
- Department of Dermatology, 14716University of Missouri, Columbia, MO, USA
| | - Coralys Cintrón
- Calle San Antonio Rosales, 7165Universidad del Sagrado Corazón, San Juan, Puerto Rico
| | - David Fleming
- Department of Medicine and Center for Health Ethics, 14716University of Missouri, Columbia, MO, USA
| | - Chi-Ren Shyu
- Institute for Data Science and Informatics, 14716University of Missouri, Columbia, MO, USA
- Department of Electrical Engineering and Computer Science, 14716University of Missouri, Columbia, MO, USA
| | - Karen Edison
- Department of Dermatology, 14716University of Missouri, Columbia, MO, USA
- Missouri Telehealth Network, 14716University of Missouri, Columbia, MO, USA
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Zhang X, Xie Z, Xiang Y, Baig I, Kozman M, Stender C, Giancardo L, Tao C. Issues in Melanoma Detection: Semisupervised Deep Learning Algorithm Development via a Combination of Human and Artificial Intelligence. JMIR Dermatol 2022; 5:e39113. [PMID: 37632881 PMCID: PMC10334941 DOI: 10.2196/39113] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 09/01/2022] [Accepted: 10/12/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Automatic skin lesion recognition has shown to be effective in increasing access to reliable dermatology evaluation; however, most existing algorithms rely solely on images. Many diagnostic rules, including the 3-point checklist, are not considered by artificial intelligence algorithms, which comprise human knowledge and reflect the diagnosis process of human experts. OBJECTIVE In this paper, we aimed to develop a semisupervised model that can not only integrate the dermoscopic features and scoring rule from the 3-point checklist but also automate the feature-annotation process. METHODS We first trained the semisupervised model on a small, annotated data set with disease and dermoscopic feature labels and tried to improve the classification accuracy by integrating the 3-point checklist using ranking loss function. We then used a large, unlabeled data set with only disease label to learn from the trained algorithm to automatically classify skin lesions and features. RESULTS After adding the 3-point checklist to our model, its performance for melanoma classification improved from a mean of 0.8867 (SD 0.0191) to 0.8943 (SD 0.0115) under 5-fold cross-validation. The trained semisupervised model can automatically detect 3 dermoscopic features from the 3-point checklist, with best performances of 0.80 (area under the curve [AUC] 0.8380), 0.89 (AUC 0.9036), and 0.76 (AUC 0.8444), in some cases outperforming human annotators. CONCLUSIONS Our proposed semisupervised learning framework can help with the automatic diagnosis of skin disease based on its ability to detect dermoscopic features and automate the label-annotation process. The framework can also help combine semantic knowledge with a computer algorithm to arrive at a more accurate and more interpretable diagnostic result, which can be applied to broader use cases.
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Affiliation(s)
- Xinyuan Zhang
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Ziqian Xie
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Yang Xiang
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Imran Baig
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Mena Kozman
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Carly Stender
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Luca Giancardo
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Cui Tao
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, United States
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Sangers TE, Wakkee M, Moolenburgh FJ, Nijsten T, Lugtenberg M. Towards successful implementation of artificial intelligence in skin cancer care: a qualitative study exploring the views of dermatologists and general practitioners. Arch Dermatol Res 2022; 315:1187-1195. [PMID: 36477587 PMCID: PMC9734890 DOI: 10.1007/s00403-022-02492-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 06/09/2022] [Revised: 10/17/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
Abstract
Recent studies show promising potential for artificial intelligence (AI) to assist healthcare providers (HCPs) in skin cancer care. The aim of this study is to explore the views of dermatologists and general practitioners (GPs) regarding the successful implementation of AI when assisting HCPs in skin cancer care. We performed a qualitative focus group study, consisting of six focus groups with 16 dermatologists and 17 GPs, varying in prior knowledge and experience with AI, gender, and age. An in-depth inductive thematic content analysis was deployed. Perceived benefits, barriers, and preconditions were identified as main themes. Dermatologists and GPs perceive substantial benefits of AI, particularly an improved health outcome and care pathway between primary and secondary care. Doubts about accuracy, risk of health inequalities, and fear of replacement were among the most stressed barriers. Essential preconditions included adequate algorithm content, sufficient usability, and accessibility of AI. In conclusion, dermatologists and GPs perceive significant benefits from implementing AI in skin cancer care. However, to successfully implement AI, key barriers need to be addressed. Efforts should focus on ensuring algorithm transparency, validation, accessibility for all skin types, and adequate regulation of algorithms. Simultaneously, improving knowledge about AI could reduce the fear of replacement.
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Affiliation(s)
- Tobias E. Sangers
- Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Marlies Wakkee
- Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Folkert J. Moolenburgh
- Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Tamar Nijsten
- Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Marjolein Lugtenberg
- Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
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11
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Harkemanne E, Duyver C, Leconte S, Sawadogo K, Baeck M, Tromme I. Short- and Long-Term Evaluation of General Practitioners' Competences After a Training in Melanoma Diagnosis: Refresher Training Sessions May Be Needed. J Cancer Educ 2022; 37:1928-1941. [PMID: 34704171 PMCID: PMC8547729 DOI: 10.1007/s13187-021-02063-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/27/2021] [Indexed: 06/13/2023]
Abstract
General practitioners (GPs) are first-line clinicians in melanoma diagnosis. It is, therefore, important to ensure that they maintain their melanoma diagnostic accuracy over time. The objective of this study was to assess the short- and long-term competences of GPs after a training session in naked-eye melanoma diagnosis. An interventional prospective study was conducted whereby, over a 6-month period, GPs attended a 1-h melanoma diagnostic training session. To assess their acquired competences, GPs were asked to fill in a questionnaire on basic melanoma knowledge and to evaluate 10 clinical images of pigmented skin lesions prior to training, immediately after and 1 year later. In total, 89 GPs completed the questionnaire prior and immediately after training. As expected, the number of GPs who appropriately managed [Formula: see text] 50% of the melanoma cases increased after training (P < 0.001). One year after training, only 27 (30%) of the 89 GPs completed the questionnaire. This number of participants was too low to obtain significant figures but the GPs' mean overall score of appropriately managed clinical cases was much lower than in the immediate post-test. In conclusion, although this short training improved the GPs' diagnostic accuracy and management of melanoma in the short-term, participating GPs do not seem to have maintained these competences in the long-term. Further studies are needed to assess whether refresher training sessions are able to sustain acquired diagnostic and management skills.
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Affiliation(s)
- Evelyne Harkemanne
- Dermatology Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, B-1200, Brussels, Belgium.
- Institute of Experimental and Clinical Research (IREC), UCLouvain, Brussels, Belgium.
| | - Corentin Duyver
- Centre Académique de Médecine Générale (CAMG), UCLouvain, Brussels, Belgium
| | - Sophie Leconte
- Centre Académique de Médecine Générale (CAMG), UCLouvain, Brussels, Belgium
| | - Kiswendsida Sawadogo
- Statistical Support Unit, King Albert II Cancer and Hematology Institute, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Marie Baeck
- Dermatology Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, B-1200, Brussels, Belgium
- Institute of Experimental and Clinical Research (IREC), UCLouvain, Brussels, Belgium
| | - Isabelle Tromme
- Dermatology Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, B-1200, Brussels, Belgium
- King Albert II Cancer and Hematology Institute, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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12
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Fee JA, McGrady FP, Hart ND. Dermoscopy use in primary care: a qualitative study with general practitioners. BMC Prim Care 2022; 23:47. [PMID: 35291937 PMCID: PMC8925058 DOI: 10.1186/s12875-022-01653-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/25/2022] [Indexed: 11/26/2022]
Abstract
Background Skin assessments constitute a significant proportion of consultations with family physicians (commonly called general practitioners or GPs in the UK), and referrals to hospital dermatology departments have risen significantly in recent years. Research has shown that dermoscopy use may help GPs to assess and triage skin lesions, including suspected skin cancers, more accurately. However, dermoscopy is used by a small minority of GPs in the UK. Previous questionnaire studies have aimed to establish in a limited way some perceptions of dermoscopy among GPs: this study aimed to explore more deeply the factors influencing the use of dermoscopy among GPs. Methods This was a qualitative interview study set in UK general practice. A purposive sample was taken of GPs who were established dermoscopy users, GPs who had recently adopted dermoscopy, and those who did not use dermoscopy. A total of twelve semi-structured interviews were conducted. Audio-recordings were transcribed verbatim and analysed using a thematic analysis (Braun and Clarke). Results GPs’ capability to use dermoscopy necessitated receiving adequate training, while previous dermatology experience and support from colleagues were also considered factors that enabled dermoscopy use. The impact of dermoscopy on patient consultations about skin complaints was generally considered to be positive, as was having an ‘in-house’ dermoscopy user within a GP practice to refer patients to. However, training in dermoscopy was not considered a priority for many GPs either due to other more pressing concerns within their practices or the perceived complexity of dermoscopy, alongside barriers such as equipment costs. Significant ethical concerns with posting patient photographs online for training and teaching purposes were also highlighted. Conclusions Both GPs who use dermoscopy, and those who do not, consider it to have an important role in improving skin assessments within primary care. However the need for adequate training in dermoscopy and dermatology more generally was highlighted as a key barrier to its wider use. The development of competency standards for the use of dermoscopy could allow the adequacy of training to be assessed and developed.
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13
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Alonso-Belmonte C, Montero-Vilchez T, Arias-Santiago S, Buendía-Eisman A. [Translated article] Current State of Skin Cancer Prevention: A Systematic Review. Actas Dermo-Sifiliográficas 2022. [DOI: 10.1016/j.ad.2022.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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14
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Alonso-belmonte C, Montero-vilchez T, Arias-santiago S, Buendía-eisman A. Situación actual de la prevención del cáncer de piel: una revisión sistemática. Actas Dermo-Sifiliográficas 2022; 113:781-791. [DOI: 10.1016/j.ad.2022.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/03/2022] [Accepted: 04/12/2022] [Indexed: 11/20/2022] Open
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15
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Bridgewater K, Levene A, Lun A, Keith D. The LED Loupe Magnifier: A cost-effective method of dermoscopic examination and photography of skin lesions in primary care and beyond. J Eur Acad Dermatol Venereol 2022; 36:e1058-e1060. [PMID: 35857406 DOI: 10.1111/jdv.18448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- K Bridgewater
- Department of Dermatology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - A Levene
- Department of Dermatology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - A Lun
- Department of Dermatology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - D Keith
- Department of Dermatology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
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16
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Rogers T, McCrary MR, Yeung H, Krueger L, Chen SC. Dermoscopic Photographs Impact Confidence and Management of Remotely Triaged Skin Lesions. Dermatol Pract Concept 2022; 12:e2022129. [PMID: 36159122 PMCID: PMC9464534 DOI: 10.5826/dpc.1203a129] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 12/14/2022] Open
Abstract
Introduction Improving remote triage is crucial given expansions in tele-dermatology and with limited in-person care during COVID-19. In addition to clinical pictures, dermoscopic images may provide utility for triage. Objectives To determine if dermoscopic images enhance confidence, triage accuracy, and triage prioritization for tele-dermatology. Methods In this preliminary parallel convergent mixed-methods study, a cohort of dermatologists and residents assessed skin lesions using clinical and dermoscopic images. For each case, participants viewed a clinical image and determined diagnostic category, management, urgency, and decision-making confidence. They subsequently viewed the associated dermoscopy and answered the same questions. A moderated focus group discussion followed to explore perceptions on the role of dermoscopy in tele-dermatology. Results Dermoscopy improved recognition of malignancies by 23% and significantly reduced triage urgency measures for non-malignant lesions. Participants endorsed specific utilities of tele-dermoscopy, such as for evaluating pigmented lesions, with limitations including poor image quality. Conclusions Dermoscopic images may be useful when remotely triaging skin lesions. Standardized imaging protocols are needed.
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Affiliation(s)
- Tova Rogers
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Howa Yeung
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia, USA,Regional Telehealth Service, VISN 7, Duluth, Georgia, USA
| | - Loren Krueger
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Suephy C Chen
- Regional Telehealth Service, VISN 7, Duluth, Georgia, USA,Department of Dermatology, Duke University, Durham, North Carolina, USA
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17
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Rojas KD, Perez ME, Marchetti MA, Nichols AJ, Penedo FJ, Jaimes N. Skin Cancer: Primary, Secondary, and Tertiary Prevention. Part II. J Am Acad Dermatol 2022; 87:271-288. [DOI: 10.1016/j.jaad.2022.01.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/12/2022] [Accepted: 01/26/2022] [Indexed: 10/19/2022]
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18
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Hardy V, Yue A, Archer S, Merriel SWD, Thompson M, Emery J, Usher-Smith J, Walter FM. Role of primary care physician factors on diagnostic testing and referral decisions for symptoms of possible cancer: a systematic review. BMJ Open 2022; 12:e053732. [PMID: 35074817 PMCID: PMC8788239 DOI: 10.1136/bmjopen-2021-053732] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 12/23/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Missed opportunities for diagnosing cancer cause patients harm and have been attributed to suboptimal use of tests and referral pathways in primary care. Primary care physician (PCP) factors have been suggested to affect decisions to investigate cancer, but their influence is poorly understood. OBJECTIVE To synthesise evidence evaluating the influence of PCP factors on decisions to investigate symptoms of possible cancer. METHODS We searched MEDLINE, Embase, Scopus, CINAHL and PsycINFO between January 1990 and March 2021 for relevant citations. Studies examining the effect or perceptions and experiences of PCP factors on use of tests and referrals for symptomatic patients with any cancer were included. PCP factors comprised personal characteristics and attributes of physicians in clinical practice. DATA EXTRACTION AND SYNTHESIS Critical appraisal and data extraction were undertaken independently by two authors. Due to study heterogeneity, data could not be statistically pooled. We, therefore, performed a narrative synthesis. RESULTS 29 studies were included. Most studies were conducted in European countries. A total of 11 PCP factors were identified comprising modifiable and non-modifiable factors. Clinical judgement of symptoms as suspicious or 'alarm' prompted more investigations than non-alarm symptoms. 'Gut feeling' predicted a subsequent cancer diagnosis and was perceived to facilitate decisions to investigate non-specific symptoms as PCP experience increased. Female PCPs investigated cancer more than male PCPs. The effect of PCP age and years of experience on testing and referral decisions was inconclusive. CONCLUSIONS PCP interpretation of symptoms as higher risk facilitated testing and referral decisions for possible cancer. However, in the absence of 'alarm' symptoms or 'gut feeling', PCPs may not investigate cancer. PCPs require strategies for identifying patients with non-alarm and non-specific symptoms who need testing or referral. PROSPERO REGISTRATION NUMBER CRD420191560515.
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Affiliation(s)
- Victoria Hardy
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Adelaide Yue
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephanie Archer
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Matthew Thompson
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Jon Emery
- Centre for Cancer Research and Department of General Practice, University of Melbourne VCCC, Parkville, Victoria, Australia
| | - Juliet Usher-Smith
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Fiona M Walter
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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19
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Hasan MK, Elahi MTE, Alam MA, Jawad MT, Martí R. DermoExpert: Skin lesion classification using a hybrid convolutional neural network through segmentation, transfer learning, and augmentation. Informatics in Medicine Unlocked 2022. [DOI: 10.1016/j.imu.2021.100819] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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20
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Percival G, Nicholas C, Webb CE, Temple-Oberle CF. Assessing exposure to dermoscopy in plastic surgery training programs. JPRAS Open 2021; 29:178-183. [PMID: 34258367 PMCID: PMC8255500 DOI: 10.1016/j.jpra.2021.05.003] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/07/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Dermoscopy is a noninvasive tool that improves the diagnostic accuracy of melanoma and other cutaneous malignancies; yet, it is not widely used by plastic surgeons, who commonly manage skin lesions. Thus, the purpose of this study was to explore current practice patterns and knowledge of dermoscopy among plastic surgeons and postgraduate plastic surgery trainees. Additionally, interest to establish a formal dermoscopy curriculum as part of plastic surgery residency training was evaluated. METHODS An online electronic questionnaire was developed and distributed through email to practicing plastic surgeons and plastic surgery trainees at two Canadian universities. RESULTS Of the 59 potential participants, 27 (46%) responded. While the majority of participants were familiar with dermoscopy (n = 26; 96%), only one respondent reported using dermoscopy in clinical practice. However, all respondents reported exposure to melanoma clinically (n = 26; one participant did not provide a response). A lack of training, along with lack of access to dermatoscopes, were the most frequently cited reasons for not using dermoscopy. Knowledge scores with regard to dermoscopic features were also low; coupled with a noted propensity toward diagnostic or excisional biopsy, whichcould raise the benign to malignant ratio. Overall, 89% (n = 24) of respondents expressed interest in dermoscopy training in plastic surgery postgraduate training. CONCLUSIONS Few responding plastic surgeons or plastic surgery residents currently use dermoscopy in training or practice but are interested in formal dermoscopy training in residency.
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Affiliation(s)
- Gemma Percival
- Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary Alberta T2N 4N1, Canada
| | - Christine Nicholas
- Department of Surgery, Divisions of Plastic Surgery and Surgical Oncology, University of Calgary, Tom Baker Cancer Centre, 1331 29 Street NW, Calgary, Alberta T2A 4N2, Canada
| | - Carmen E. Webb
- Department of Surgery, Divisions of Plastic Surgery and Surgical Oncology, University of Calgary, Tom Baker Cancer Centre, 1331 29 Street NW, Calgary, Alberta T2A 4N2, Canada
| | - Claire F. Temple-Oberle
- Department of Surgery, Divisions of Plastic Surgery and Surgical Oncology, University of Calgary, Tom Baker Cancer Centre, 1331 29 Street NW, Calgary, Alberta T2A 4N2, Canada
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21
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Parisi R, Huppertz J, Potolski A, Tracey V. Distance to diagnosing dermatology provider as a predictor of multiple melanoma diagnoses. J Am Acad Dermatol 2021; 87:216-218. [PMID: 34358585 DOI: 10.1016/j.jaad.2021.07.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/09/2021] [Accepted: 07/19/2021] [Indexed: 11/17/2022]
Affiliation(s)
| | - John Huppertz
- David D. Reh School of Business, Clarkson University, Schenectady, New York
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22
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Berano Teh J, Abdulla F, Peng K, Atencio L, Echevarria M, Iukuridze A, Geller AC, Wong FL, Forman SJ, Nakamura R, Modi B, Armenian SH. Incidence and Risk Factors for De Novo Cutaneous Squamous Cell Carcinoma in a Contemporary Cohort of Long-Term Hematopoietic Cell Transplantation Survivors. J Invest Dermatol 2021; 141:2073-2076.e5. [PMID: 33609555 PMCID: PMC8316257 DOI: 10.1016/j.jid.2021.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/14/2020] [Accepted: 01/10/2021] [Indexed: 11/23/2022]
Affiliation(s)
| | - Farah Abdulla
- Division of Dermatology, Department of Surgery, City of Hope, Duarte, California, USA
| | - Kelly Peng
- Department of Population Sciences, City of Hope, Duarte, California, USA
| | - Liezl Atencio
- Department of Population Sciences, City of Hope, Duarte, California, USA
| | - Meagan Echevarria
- Department of Population Sciences, City of Hope, Duarte, California, USA
| | - Aleksi Iukuridze
- Department of Population Sciences, City of Hope, Duarte, California, USA
| | - Alan C Geller
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - F Lennie Wong
- Department of Population Sciences, City of Hope, Duarte, California, USA
| | - Stephen J Forman
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, California, USA
| | - Ryotaro Nakamura
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, California, USA
| | - Badri Modi
- Division of Dermatology, Department of Surgery, City of Hope, Duarte, California, USA
| | - Saro H Armenian
- Department of Population Sciences, City of Hope, Duarte, California, USA.
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Abstract
BACKGROUND General practitioners (GPs) play a key role in early melanoma detection. To help GPs deal with suspicious skin lesions, melanoma diagnostic training programmes have been developed. However, it is unclear whether these programmes guarantee the acquisition of skills that will be applied by GPs in their daily clinical practice and maintained over time. OBJECTIVES This scoping review aimed to examine and compare educational programmes designed to train GPs in melanoma diagnosis using clinical (naked eye) examination alone or dermoscopy±clinical examination, and sought to inform on the long-term sustainability of the GPs' acquired skills. ELIGIBILITY CRITERIA Studies eligible for inclusion evaluated educational programmes for teaching diagnosis of melanoma to GPs. MEDLINE, EMBASE and Cochrane databases were searched for relevant articles from 1995 to May 2020. RESULTS Forty-five relevant articles were found assessing 31 educational programmes. Most programmes that improved the diagnostic accuracy and long-term performances of the GPs, that is, increase in confidence, decrease in dermatologist referral for benign skin lesions and improvement in the benign/malignant ratio of excised skin lesions, trained the GPs in clinical diagnosis, followed by dermoscopy. To maintain long-term performances, these programmes provided refresher training material. CONCLUSION This review shows that studies generally report positive outcomes from the training of GPs in melanoma diagnosis. However, refresher training material seemed necessary to maintain the acquired skills. The optimal form and ideal frequency for these updates have yet to be defined.
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Affiliation(s)
- Evelyne Harkemanne
- Service de dermatologie, Cliniques universitaires Saint-Luc, Bruxelles, Belgique
- Pôle de pneumologie et dermatologie, Institut de Recherche Expérimentale et Clinique, UCLouvain, Bruxelles, Belgique
| | - Marie Baeck
- Service de dermatologie, Cliniques universitaires Saint-Luc, Bruxelles, Belgique
- Pôle de pneumologie et dermatologie, Institut de Recherche Expérimentale et Clinique, UCLouvain, Bruxelles, Belgique
| | - Isabelle Tromme
- Service de dermatologie, Cliniques universitaires Saint-Luc, Bruxelles, Belgique
- Clinique du mélanome, Institut Roi Albert II, Cliniques universitaires Saint-Luc, Bruxelles, Belgique
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Guan M, Zhu S, Li S. Recent Progress in Nanomedicine for Melanoma Theranostics With Emphasis on Combination Therapy. Front Bioeng Biotechnol 2021; 9:661214. [PMID: 33777924 PMCID: PMC7991305 DOI: 10.3389/fbioe.2021.661214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 02/19/2021] [Indexed: 11/13/2022] Open
Abstract
Melanoma is an aggressive type of skin cancer with increasing incidence and high mortality rates worldwide. However, there is still a lack of efficient and resolutive treatment strategies, particularly in clinical settings. Currently, nanomedicine, an emerging area in the medical field, is being widely investigated in small animal models to afford melanoma theranostics. However, several problems, such as tumor heterogeneity, and drug resistance treatment with a single therapy, remain unresolved. Previous reviews have primarily focused on monotherapy for melanoma in the context of nanomedicine. In this review article, we summarize the recent progress in the application of nanomedicine for melanoma treatment, with particular attention to combination therapy based on nanomedicine to achieve optimized therapeutic output for melanoma treatment. In addition, we also highlight the fluorescence-guided strategies for intraoperative melanoma detection, especially in the near-infrared imaging window with greatly improved imaging contrast and penetration depth.
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Affiliation(s)
- Mengqi Guan
- Department of Dermatology and Venerology, The First Hospital of Jilin University, Changchun, China
| | - Shoujun Zhu
- Joint Laboratory of Opto-Functional Theranostics in Medicine and Chemistry, The First Hospital of Jilin University, Changchun, China.,State Key Laboratory of Supramolecular Structure and Materials, College of Chemistry, Jilin University, Changchun, China
| | - Shanshan Li
- Department of Dermatology and Venerology, The First Hospital of Jilin University, Changchun, China
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25
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Hasan MK, Alam MA, Elahi MTE, Roy S, Martí R. DRNet: Segmentation and localization of optic disc and Fovea from diabetic retinopathy image. Artif Intell Med 2020; 111:102001. [PMID: 33461693 DOI: 10.1016/j.artmed.2020.102001] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 11/22/2020] [Accepted: 12/06/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVE In modern ophthalmology, automated Computer-aided Screening Tools (CSTs) are crucial non-intrusive diagnosis methods, where an accurate segmentation of Optic Disc (OD) and localization of OD and Fovea centers are substantial integral parts. However, designing such an automated tool remains challenging due to small dataset sizes, inconsistency in spatial, texture, and shape information of the OD and Fovea, and the presence of different artifacts. METHODS This article proposes an end-to-end encoder-decoder network, named DRNet, for the segmentation and localization of OD and Fovea centers. In our DRNet, we propose a skip connection, named residual skip connection, for compensating the spatial information lost due to pooling in the encoder. Unlike the earlier skip connection in the UNet, the proposed skip connection does not directly concatenate low-level feature maps from the encoder's beginning layers with the corresponding same scale decoder. We validate DRNet using different publicly available datasets, such as IDRiD, RIMONE, DRISHTI-GS, and DRIVE for OD segmentation; IDRiD and HRF for OD center localization; and IDRiD for Fovea center localization. RESULTS The proposed DRNet, for OD segmentation, achieves mean Intersection over Union (mIoU) of 0.845, 0.901, 0.933, and 0.920 for IDRiD, RIMONE, DRISHTI-GS, and DRIVE, respectively. Our OD segmentation result, in terms of mIoU, outperforms the state-of-the-art results for IDRiD and DRIVE datasets, whereas it outperforms state-of-the-art results concerning mean sensitivity for RIMONE and DRISHTI-GS datasets. The DRNet localizes the OD center with mean Euclidean Distance (mED) of 20.23 and 13.34 pixels, respectively, for IDRiD and HRF datasets; it outperforms the state-of-the-art by 4.62 pixels for IDRiD dataset. The DRNet also successfully localizes the Fovea center with mED of 41.87 pixels for the IDRiD dataset, outperforming the state-of-the-art by 1.59 pixels for the same dataset. CONCLUSION As the proposed DRNet exhibits excellent performance even with limited training data and without intermediate intervention, it can be employed to design a better-CST system to screen retinal images. Our source codes, trained models, and ground-truth heatmaps for OD and Fovea center localization will be made publicly available upon publication at GitHub.1.
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Affiliation(s)
- Md Kamrul Hasan
- Department of Electrical and Electronic Engineering, Khulna University of Engineering & Technology, Khulna 9203, Bangladesh.
| | - Md Ashraful Alam
- Department of Electrical and Electronic Engineering, Khulna University of Engineering & Technology, Khulna 9203, Bangladesh.
| | - Md Toufick E Elahi
- Department of Electrical and Electronic Engineering, Khulna University of Engineering & Technology, Khulna 9203, Bangladesh.
| | - Shidhartho Roy
- Department of Electrical and Electronic Engineering, Khulna University of Engineering & Technology, Khulna 9203, Bangladesh.
| | - Robert Martí
- Computer Vision and Robotics Institute, University of Girona, Spain.
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Gómez Arias PJ, Arias Blanco MC, Redondo Sánchez J, Escribano Villanueva F, Vélez García-Nieto AJ. [Usefulness and efficiency of teledermoscopy in skin cancer management in primary care]. Semergen 2020; 46:553-559. [PMID: 32826148 DOI: 10.1016/j.semerg.2020.06.026] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/14/2020] [Accepted: 06/26/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the usefulness of teledermoscopy as a diagnostic and triage method for suspected skin cancer lesions between Primary Care and Dermatology. To analyse the reduction in the number of referrals and estimate the savings achieved. MATERIAL AND METHODS Concordance study on a non-randomised case series. Descriptive observational study of teleconsultations sent from two Health Centres (urban and rural) to the reference Dermatology service in Cordoba (Spain) between January 2017 and April 2019. The diagnoses proposed by Primary Care before and after the use of dermatoscopy, and the diagnosis of the Dermatologist, along with other epidemiological variables were collected. Descriptive analysis and concordance study were performed. RESULTS A total of 395 teleconsultations were made. The coefficient of agreement between the diagnoses of both specialists without using dermoscopy was 0.486. Using this technique the concordance was 0.641. A reduction in the number of referrals to Dermatology was 58%. A savings of 2,475€ in transfers by ambulance and 550 working hours were made. The most common diagnoses were basal cell carcinoma (20%; n=79) and seborrheic keratosis (15.2%; n=60). CONCLUSIONS The addition of dermoscopy increases diagnosis concordance. Teledermatology is a useful system for patient triage and for decreasing the demand for hospital care, with an inherent resources saving.
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Affiliation(s)
- P J Gómez Arias
- Unidad de Gestión Clínica de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Reina Sofía, Córdoba, España.
| | - M C Arias Blanco
- Unidad de Gestión Clínica de La Sierra, Consultorio de Villaharta, Distrito Córdoba-Guadalquivir, Villaharta, Córdoba, España
| | - J Redondo Sánchez
- Unidad de Gestión Clínica de Lucano, Centro de Salud Lucano, Distrito Córdoba-Guadalquivir, Córdoba, España
| | - F Escribano Villanueva
- Unidad de Gestión Clínica de La Sierra, Centro de Salud Villaviciosa de Córdoba, Distrito Córdoba-Guadalquivir, Villaviciosa de Córdoba, Córdoba, España
| | - Antonio J Vélez García-Nieto
- Unidad de Gestión Clínica de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Reina Sofía, Córdoba, España; Facultad de Medicina, Universidad de Córdoba, Córdoba, España
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Marra E, van Rijsingen MCJ, Alkemade JAC, Groenewoud JMM, Hueskes KF, Nij Bijvank CHM, van de Laar FA, Lubeek SFK. The effect of a dermato-oncological training programme on the diagnostic skills and quality of referrals for suspicious skin lesions by general practitioners. Br J Dermatol 2020; 184:538-544. [PMID: 32407577 PMCID: PMC7983956 DOI: 10.1111/bjd.19214] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2020] [Indexed: 12/11/2022]
Abstract
Background The rising incidence rates of skin cancer (SC) lead to an enormous burden on healthcare systems. General practitioners (GPs) might play an important part in SC care, but research has shown poor clinical recognition of SC, leading to a high rate of potentially unnecessary referrals. Objectives The aim of this study was to evaluate if a dermato‐oncological training programme (DOTP) for GPs improved their diagnostic skills and quality of referrals. Methods Out of 194 GPs in the Nijmegen area, 83 (42·8%) followed a DOTP on SC. Referrals from both a trained cohort (TC) and two cohorts of untrained GPs [untrained present cohort (UPC) and untrained historical cohort (UHC)] were included. Data on diagnostic skills, quality of referrals and the number of potentially unnecessary referrals were evaluated. Results A total number of 1662 referrals were analysed. The referral diagnosis was correct more often in the TC (70·3%) compared with the UPC (56·2%; P < 0·001) and the UHC (51·6%; P < 0·001). Furthermore, the TC also provided a better lesion description, mentioned a diagnosis more often in their referral letters and more often performed diagnostics before referral. In addition, fewer potentially unnecessary referrals were identified in the TC compared with the UPC (62·7% vs. 73·7%; P < 0·001) and the UHC (75·2%; P < 0·001). Conclusions GPs who followed a DOTP had better diagnostic skills and quality of referrals than untrained GPs, leading to fewer potentially unnecessary referrals. This might enhance a more efficient use of the limited capacity in secondary dermatological care and consequently lead to lower healthcare costs. What is already known about this topic? General practitioners (GPs) play an important part in skin cancer (SC) care and optimal recognition and referral are considered of vital importance to optimize SC care efficacy. Previous research identified a rather poor clinical recognition of (pre)malignant skin tumours by GPs, leading to a high rate of potentially unnecessary referrals to dermatologists.
What does this study add? GPs who followed a dedicated dermato‐oncological training programme had better diagnostic skills and quality of referrals than untrained GPs, leading to fewer potentially unnecessary referrals. This might enhance a more efficient use of the limited capacity in secondary dermatological care and consequently lead to lower healthcare costs.
Plain language summary available online
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Affiliation(s)
- E Marra
- Dermatology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | | | - J A C Alkemade
- Department of Dermatology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - J M M Groenewoud
- Department of, Health Evidence, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - K F Hueskes
- Regional Department of the National Association of General Practitioners, Nijmegen, the Netherlands
| | - C H M Nij Bijvank
- Regional Department of the National Association of General Practitioners, Nijmegen, the Netherlands
| | - F A van de Laar
- Department of, Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands.,Regional Department of the National Association of General Practitioners, Nijmegen, the Netherlands
| | - S F K Lubeek
- Dermatology, Radboud University Medical Centre, Nijmegen, the Netherlands
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Abstract
Skin cancer, including melanoma, basal cell carcinoma and cutaneous squamous cell carcinoma, has one of the highest global incidences of any form of cancer. In 2016 more than 16,000 people were diagnosed with melanoma in the UK. Over the last decade the incidence of melanoma has increased by 50% in the UK, and about one in ten melanomas are diagnosed at a late stage. Among the keratinocyte carcinomas (previously known as non-melanoma skin cancers), basal cell carcinoma is the most common cancer amongst Caucasian populations. The main risk factor for all skin cancer is exposure to ultraviolet radiation-more than 80% are considered preventable. Primary care clinicians have a vital role to play in detecting and managing patients with skin lesions suspected to be skin cancer, as timely diagnosis and treatment can improve patient outcomes, particularly for melanoma. However, detecting skin cancer can be challenging, as common non-malignant skin lesions such as seborrhoeic keratoses share features with less common skin cancers. Given that more than 80% of skin cancers are attributed to ultraviolet (UV) exposure, primary care clinicians can also play an important role in skin cancer prevention. This article is one of a series discussing cancer prevention and detection in primary care. Here we focus on the most common types of skin cancer: melanoma, squamous cell carcinoma and basal cell carcinoma. We describe the main risk factors and prevention advice. We summarise key guidance on the symptoms and signs of skin cancers and their management, including their initial assessment and referral. In addition, we review emerging technologies and diagnostic aids which may become available for use in primary care in the near future, to aid the triage of suspicious skin lesions.
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Affiliation(s)
- Owain T Jones
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
| | | | - Per N Hall
- Addenbrookes Hospital NHS Foundation Trust, Cambridge, UK
| | - Garth Funston
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Fiona M Walter
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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