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Stojkovic-Filipovic J, Tiodorovic D, Lallas A, Akay BN, Longo C, Rosendahl C, Dobrosavljevic D, Nazzaro G, Argenziano G, Zalaudek I, Tromme I, Tschandl P, Puig S, Lanssens S, Kittler H. Dermatoscopy of combined blue nevi: a multicentre study of the International Dermoscopy Society. J Eur Acad Dermatol Venereol 2020; 35:900-905. [PMID: 33274487 DOI: 10.1111/jdv.17059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 11/13/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Combined blue nevi (CBN) may mimic melanoma and are relatively often biopsied for diagnostic reasons. OBJECTIVE To better characterize CBN and to compare it with melanoma. METHODS We collected clinical and dermatoscopic images of 111 histologically confirmed CBN and contrasted their dermatoscopic characteristics with 132 partly blue coloured melanomas. Furthermore, we compared the accuracy of human experts using pattern analysis with a computer algorithm based on deep learning. RESULTS Combined blue nevi are usually flat or slightly elevated and, in comparison with melanoma, more frequent on the head and neck. Dermatoscopically, they are typified by a blue structureless part in combination with either brown clods (n = 52, 46.8%), lines (n = 28, 25.2%) or skin-coloured or brown structureless areas (n = 31, 27.9%). In contrast with melanoma, the blue part of CBN is more often well defined (18.9% vs. 4.5%, P < 0.001) and more often located in the centre (22.5% vs. 5.3%, P < 0.001). Melanomas are more often chaotic (OR: 28.7, 95% CI: 14.8-55.7, P < 0.001), have at least one melanoma clue (OR: 10.8, 95% CI: 5.2-22.2 P < 0.001) in particular white lines (OR: 37.1, 95% CI: 13.4-102.9, P < 0.001). Using simplified pattern analysis (chaos and clues), two raters reached sensitivities of 93.9% (95% CI: 88.4-97.3%) and 92.4% (95% CI: 86.5-96.3%) at corresponding specificities of 59.5% (95% CI: 49.7-68.7%) and 65.8% (95% CI: 56.2-74.5%). The human accuracy with pattern analysis was on par with a state-of-the-art computer algorithm based on deep learning that achieved an area under the curve of (0.92, 95% CI: 0.87-0.96) and a specificity of 85.3% (95% CI: 76.5-91.7%) at a given sensitivity of 83.6% (95% CI: 72.5-91.5%). CONCLUSION CBN usually lack melanoma clues, in particular white lines. The accuracy of pattern analysis for combined nevi is acceptable, and histopathologic confirmation may not be necessary in exemplary cases.
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Affiliation(s)
- J Stojkovic-Filipovic
- Clinic of Dermatology and Venereology, Clinical Center of Serbia, Department of Dermatology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - D Tiodorovic
- Clinic of Dermatovenereology, Clinical Center of Nis, Medical Faculty, University of Nis, Nis, Serbia
| | - A Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - B N Akay
- Medicine Faculty, Department of Dermatology, Ankara University, Ankara, Turkey
| | - C Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.,Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
| | - C Rosendahl
- Faculty of Medicine, The University of Queensland, Capalaba, QLD, Australia
| | - D Dobrosavljevic
- Clinic of Dermatology and Venereology, Clinical Center of Serbia, Department of Dermatology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - G Nazzaro
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - G Argenziano
- Dermatology Unit, University of Campania, Naples, Italy
| | - I Zalaudek
- Department of Dermatology, University of Trieste, Trieste, Italy
| | - I Tromme
- Dermatology Department, King Albert II Institute, Cliniques Universitaires St Luc, Brussels, Belgium
| | - P Tschandl
- Department of Dermatology, Division of General Dermatology, Medical University of Vienna, Vienna, Austria
| | - S Puig
- Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III, Barcelona, Spain
| | - S Lanssens
- Dermatologie Maldegem, Maldegem, Belgium
| | - H Kittler
- Department of Dermatology, Division of General Dermatology, Medical University of Vienna, Vienna, Austria
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Tognetti L, Cartocci A, Cinotti E, Moscarella E, Farnetani F, Lallas A, Tiodorovic D, Carrera C, Longo C, Puig S, Perrot JL, Argenziano G, Pellacani G, Cataldo G, Balistreri A, Cevenini G, Rubegni P. The impact of anatomical location and sun exposure on the dermoscopic recognition of atypical nevi and early melanomas: usefulness of an integrated clinical-dermoscopic method (iDScore). J Eur Acad Dermatol Venereol 2020; 35:650-657. [PMID: 32743829 DOI: 10.1111/jdv.16847] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 07/09/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND The anatomical location of atypical melanocytic skin lesion (aMSL) was never combined into an algorithm for discriminating early melanomas (EM) from atypical nevi (AN). AIMS To investigate the impact of body location on the intuitive diagnosis performed in teledermoscopy by dermatologists of different skill levels. A further aim was to evaluate how the integration of the body location could improve an algorithm-aided diagnosis. METHODS We retrospectively collected 980 standardized dermoscopic images of aMSL cases (663 AN, 317 EM): data on the anatomical location were collected according to 15 body sites classified into 4 macro-areas of chronically/frequently/seldom/rarely exposure. Through a teledermatology web platform, 111 variously skilled dermoscopists performed either the intuitive diagnosis and 3 algorithm-assisted diagnostic tests (i.e. iDScore, 7-point checklist, ABCD rule) on each case, for a total of 3330 examinations. RESULTS In the rarely photoexposed area (side, bottom, abdomen), AN were the most tricky (i.e. highest quote of false positives), due to a frequent recognition of dermoscopic features usually considered as suggestive for melanoma in these lesions; the EM at these sites received the highest quote of false negatives, being generally interpreted as 'featureless' according to these traditional parameters, that were more frequently displayed on the chronically photoexposed area. In rarely and seldom photoexposed area, intuitive diagnosis fails to achieve adequate accuracy for all aMSLs, as the ABCD rule and the 7-point checklist; by applying the iDScore algorithm the diagnostic performance was increased by 15% in young and 17% in experts. CONCLUSIONS The body location of an aMSL can affect the quality of intuitive dermoscopic diagnosis, especially in sun-protected areas. Accuracy can be improved by using the iDScore algorithm that assigns a different partial score of each body site.
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Affiliation(s)
- L Tognetti
- Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
| | - A Cartocci
- Bioengineering & Biomedical Data Science Lab, Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - E Cinotti
- Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
| | - E Moscarella
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - F Farnetani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - A Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - D Tiodorovic
- Dermatology Clinic, Medical Faculty, Nis University, Nis, Serbia
| | - C Carrera
- Melanoma Unit, Department of Dermatology, University of Barcelona, Barcelona, Spain
| | - C Longo
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - S Puig
- Melanoma Unit, Department of Dermatology, University of Barcelona, Barcelona, Spain
| | - J L Perrot
- Dermatology Unit, University Hospital of St-Etienne, Saint Etienne, France
| | - G Argenziano
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - G Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - G Cataldo
- Bioengineering & Biomedical Data Science Lab, Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - A Balistreri
- Bioengineering & Biomedical Data Science Lab, Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - G Cevenini
- Bioengineering & Biomedical Data Science Lab, Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - P Rubegni
- Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
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Damiani G, Bragazzi N, Garbarino S, Chattu VK, Shapiro CM, Pacifico A, Malagoli P, Pigatto PDM, Conic RR, Tiodorovic D, Watad A, Adawi M. Psoriatic and psoriatic arthritis patients with and without jet-lag: does it matter for disease severity scores? Insights and implications from a pilot, prospective study. Chronobiol Int 2019; 36:1733-1740. [PMID: 31645138 PMCID: PMC6832868 DOI: 10.1080/07420528.2019.1678629] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 10/04/2019] [Indexed: 12/13/2022]
Abstract
Background: Jet-lag may affect air-travelers crossing at least two time-zones and has several health-care implications. It occurs when the human biological rhythms are out of synch with respect to the day-night cycle at the country destination. Its effect in psoriasis is missing. We aimed to evaluate the effect of Jet-lag in psoriatic patients' management. Methods: This is a prospective observational study that enrolled psoriatic patients that underwent a flight: patients who experienced jet-lag were compared to patients who did not experience jet-lag. Before the flight, a dermatologist recorded clinical and demographical data with particular attention to Psoriasis Area Severity Index (PASI) and Disease Activity in Psoriatic Arthritis (DAPSA). Patients performed Self-Administered Psoriasis Area Severity Index (SAPASI), the Dermatology Life Quality Index (DLQI) and the pruritus Visual Analog Scale (VAS) scores. After the flight, patients completed the SAPASI, DLQI and pruritus-VAS scores. Results: The sample recruited comprised of 70 psoriatic patients aged 42.4 ± 9.7 years (median 42.5 years). Thirty (42.9%) were males, mean BMI was 25.5 ± 2.2 kg/m2. Average disease duration was 15.2 ± 7.1 years, and 20 (28.6%) subjects had developed PsA. Average hours of flight were 5.4 ± 3.5 (median 3.5 h), with 34 (48.6%) subjects reporting jet-lag. At the multivariate regression analysis, the change in the SAPASI score resulted correlated with jet-lag (regression coefficient 1.63, p = .0092), as well the change in the DLQI score (regression coefficient = 1.73, p = .0009), but no change on the pruritus VAS scale was found. Conclusions: The present study suggests that jet-lag may influence disease severity and DLQI scores, but not itch in psoriatic patients.
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Affiliation(s)
- G. Damiani
- Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Department of Dermatology, Case Western Reserve University, Cleveland, OH, USA
- Young Dermatologists Italian Network, Centro Studi GISED, Bergamo, Italy
| | - N.L. Bragazzi
- Young Dermatologists Italian Network, Centro Studi GISED, Bergamo, Italy
- Postgraduate School of Public Health, Department of Health Sciences, University of Genoa, Genoa, Italy
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, Ontario, Canada
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences (DINOGMI), University of Genoa, Genoa, Italy
| | - S. Garbarino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences (DINOGMI), University of Genoa, Genoa, Italy
| | - V. K. Chattu
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Youthdale Child and Adolescent Sleep Centre, Toronto, Ontario, Canada
| | - C. M. Shapiro
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Youthdale Child and Adolescent Sleep Centre, Toronto, Ontario, Canada
| | - A. Pacifico
- San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - P. Malagoli
- Dermatology Unit, Azienda Ospedaliera San Donato Milanese, Milan, Italy
| | - P. D. M. Pigatto
- Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - R. R.Z. Conic
- Department of Surgery, University of Maryland, Baltimore, MD, USA
| | - D. Tiodorovic
- Dermatology Clinic, Medical Faculty, Nis University, Nis, Serbia
| | - A. Watad
- Department of Medicine B and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M. Adawi
- Padeh and Ziv Hospitals, Azrieli Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel
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Tognetti L, Cevenini G, Moscarella E, Cinotti E, Farnetani F, Lallas A, Tiodorovic D, Carrera C, Puig S, Perrot J, Longo C, Argenziano G, Pellacani G, Smargiassi E, Cataldo G, Cartocci A, Balistreri A, Rubegni P. Validation of an integrated dermoscopic scoring method in an European teledermoscopy web platform: the
iDScore
project for early detection of melanoma. J Eur Acad Dermatol Venereol 2019; 34:640-647. [DOI: 10.1111/jdv.15923] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 08/07/2019] [Indexed: 01/13/2023]
Affiliation(s)
- L. Tognetti
- Dermatology Unit Department of Medical, Surgical and Neurosciences University of Siena Siena Italy
- Department of Medical Biotechnologies University of Siena Siena Italy
| | - G. Cevenini
- Department of Medical Biotechnologies University of Siena Siena Italy
| | - E. Moscarella
- Dermatology Unit University of Campania Luigi Vanvitelli Naples Italy
| | - E. Cinotti
- Dermatology Unit Department of Medical, Surgical and Neurosciences University of Siena Siena Italy
| | - F. Farnetani
- Department of Dermatology University of Modena and Reggio Emilia Modena Italy
| | - A. Lallas
- First Department of Dermatology Aristotele University Thessaloniki Greece
| | - D. Tiodorovic
- Dermatology Clinic Medical Faculty Nis University Nis Serbia
| | - C. Carrera
- Dermatology Clinic Medical Faculty Nis University Nis Serbia
| | - S. Puig
- Dermatology Clinic Medical Faculty Nis University Nis Serbia
- Melanoma Unit Department of Dermatology University of Barcelona Barcelona Spain
| | - J.L. Perrot
- Dermatology Unit University Hospital of St‐Etienne Saint Etienne France
| | - C. Longo
- Department of Dermatology University of Modena and Reggio Emilia Modena Italy
- Centro Oncologico ad Alta Tecnologia Diagnostica Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia Reggio Emilia Italy
| | - G. Argenziano
- Dermatology Unit University of Campania Luigi Vanvitelli Naples Italy
| | - G. Pellacani
- First Department of Dermatology Aristotele University Thessaloniki Greece
| | - E. Smargiassi
- Department of Medical Biotechnologies University of Siena Siena Italy
| | - G. Cataldo
- Department of Medical Biotechnologies University of Siena Siena Italy
| | - A. Cartocci
- Department of Medical Biotechnologies University of Siena Siena Italy
| | - A. Balistreri
- Department of Medical Biotechnologies University of Siena Siena Italy
| | - P. Rubegni
- Dermatology Unit Department of Medical, Surgical and Neurosciences University of Siena Siena Italy
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Kocic H, Arsic I, Stankovic M, Tiodorovic D, Ciric V, Kocic G. Proliferative, anti-apoptotic and immune-enhancing effects of L-arginine in culture of skin fibroblasts. J BIOL REG HOMEOS AG 2017; 31:667-672. [PMID: 28954469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Semi-essential amino acid L-arginine may be of fundamental importance in various intracellular and intercellular pathways related to skin repair and wound healing. Our current study was aimed to explore the effect of L-arginine on skin fibroblast (L929) signaling pathways involved in cell proliferation (Akt-pAkt kinase, Erk/pErk1/2 kinase, JNK/pJNK kinase and pStat-1), apoptosis (Bcl2 and Bax) and immune defense (NF-κB and CD26). Significant upregulation of Erk (p<0.011), pErk (p<0.017) and JNK (p<0.002) was documented, while the rise was not significant for pJNK kinase. The Akt/pAkt signaling pathway did not change significantly for the above-mentioned time and dose, while pStat-1 was significantly down regulated (p<0.011). The exposure of skin fibroblasts to L-arginine increased anti-apoptotic Bcl2/Bax stoichiometry ratio (p<0.05), obtained by calculation of their individual quantities. L-arginine was able to elicit NF-κB signaling through the increase of p65 active subunit level (p<0.004), while CD26 surface antigen level was not significantly changed. In conclusion, the exposure of skin fibroblasts to L-arginine may help in maintaining and stimulating skin fibroblast proliferative, anti-apoptotic and immune defense function. Therefore, the proposed L-arginine dose may be used for tissue regeneration application, which would be of importance in regenerative medicine, skin rejuvenation approaches and wound healing.
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Affiliation(s)
- H Kocic
- Medical Faculty, Maribor University, Maribor, Slovenia
| | - I Arsic
- Department for Pharmacy, Medical Faculty, Nis University, Nis, Serbia
| | - M Stankovic
- Department for Pharmacy, Medical Faculty, Nis University, Nis, Serbia
| | - D Tiodorovic
- Dermatology Clinic, Medical Faculty, Nis University, Nis, Serbia
| | - V Ciric
- Clinic for Endocrinology, Clinical Center, Nis, Serbia
| | - G Kocic
- Institute of Biochemistry, Faculty of Medicine, Nis University, Nis, Serbia
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