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Mylle S, Papeleu J, Hoorens I, Verhaeghe E, Brochez L. The Value of Teledermatology Advice for Skin Toxicity in Oncology: Experience From a Pilot Study. JMIR Dermatol 2024; 7:e40053. [PMID: 38422495 PMCID: PMC10940973 DOI: 10.2196/40053] [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: 06/03/2022] [Revised: 02/20/2023] [Accepted: 02/07/2024] [Indexed: 03/02/2024] Open
Affiliation(s)
- Sofie Mylle
- Dermatology Department, Ghent University Hospital, Ghent, Belgium
- Cancer Research Institute Ghent, Ghent, Belgium
| | - Jorien Papeleu
- Dermatology Department, Ghent University Hospital, Ghent, Belgium
- Cancer Research Institute Ghent, Ghent, Belgium
| | - Isabelle Hoorens
- Dermatology Department, Ghent University Hospital, Ghent, Belgium
- Cancer Research Institute Ghent, Ghent, Belgium
| | - Evelien Verhaeghe
- Dermatology Department, Ghent University Hospital, Ghent, Belgium
- Cancer Research Institute Ghent, Ghent, Belgium
| | - Lieve Brochez
- Dermatology Department, Ghent University Hospital, Ghent, Belgium
- Cancer Research Institute Ghent, Ghent, Belgium
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2
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Laboute E, James-Belin E, Ucay O, Caubere A, Verhaeghe E. Prospective study of functional outcomes and return to sports after anterior cruciate ligament reconstruction in the knee. Int Orthop 2024; 48:455-463. [PMID: 37700201 PMCID: PMC10799780 DOI: 10.1007/s00264-023-05973-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/03/2023] [Indexed: 09/14/2023]
Abstract
PURPOSE Individual factors of low rates of return to sport after anterior cruciate ligament (ACL) reconstruction were unclear. We evaluated the impact of various individual factors after ACL reconstruction for return to sport in athletes. METHODS A prospective study was performed in 1274 athletes, who had undergone ACL autograft reconstruction. Individual factors survey about return to sport was performed during the second year after surgery. Athlete responses were analyzed with a multivariate logistic model adjusted for baseline patient characteristics and an adjusted Cox model. RESULTS Younger age and involvement in higher-level sporting activities were associated with a significantly higher frequency and a significantly shorter time to return to sport (running, training, competition; p = 0.001 to 0.028). Men returned to sport more rapidly than women, for both training (p = 0.007) and competition (p = 0.042). Although there was no difference to return to sport between hamstring (HT) and patellar tendon (PT) autograft. We note that MacFL surgery (Mac Intosh modified with intra- and extra-articular autografts used the tensor fasciae latae muscle) was associated with a higher frequency (p = 0.03) and rapidity (p = 0.025) of return to training than HT. Sports people practicing no weight-bearing sports returned to training (p < 0.001) and competition (p < 0.001) more rapidly than other sports people. By contrast, the practicing pivoting sports with contact started running again sooner (p < 0.001). CONCLUSION Younger age, male sex, higher level of sports, sportspeople practicing no weight-bearing sports, and MacFL surgery reduce time to return to sport after ACL reconstruction.
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Affiliation(s)
- E Laboute
- C.E.R.S., Groupe Ramsay Santé, 83 Av Maréchal de Lattre de Tassigny, 40130, Capbreton, France.
| | - E James-Belin
- C.E.R.S., Groupe Ramsay Santé, 83 Av Maréchal de Lattre de Tassigny, 40130, Capbreton, France
| | - O Ucay
- C.E.R.S., Groupe Ramsay Santé, 83 Av Maréchal de Lattre de Tassigny, 40130, Capbreton, France
| | - A Caubere
- Service de Chirurgie Orthopédique Et Traumatologie, Hôpital d'Instruction Des Armées Sainte-Anne, 2, Bd Sainte Anne, BP 600, 83800, Cedex 9, Toulon, France
| | - E Verhaeghe
- C.E.R.S., Groupe Ramsay Santé, 83 Av Maréchal de Lattre de Tassigny, 40130, Capbreton, France
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3
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Van Molle P, Mylle S, Verbelen T, De Boom C, Vankeirsbilck B, Verhaeghe E, Dhoedt B, Brochez L. Dermatologist versus artificial intelligence confidence in dermoscopy diagnosis: Complementary information that may affect decision-making. Exp Dermatol 2023; 32:1744-1751. [PMID: 37534916 DOI: 10.1111/exd.14892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 07/04/2023] [Accepted: 07/13/2023] [Indexed: 08/04/2023]
Abstract
In dermatology, deep learning may be applied for skin lesion classification. However, for a given input image, a neural network only outputs a label, obtained using the class probabilities, which do not model uncertainty. Our group developed a novel method to quantify uncertainty in stochastic neural networks. In this study, we aimed to train such network for skin lesion classification and evaluate its diagnostic performance and uncertainty, and compare the results to the assessments by a group of dermatologists. By passing duplicates of an image through such a stochastic neural network, we obtained distributions per class, rather than a single probability value. We interpreted the overlap between these distributions as the output uncertainty, where a high overlap indicated a high uncertainty, and vice versa. We had 29 dermatologists diagnose a series of skin lesions and rate their confidence. We compared these results to those of the network. The network achieved a sensitivity and specificity of 50% and 88%, comparable to the average dermatologist (respectively 68% and 73%). Higher confidence/less uncertainty was associated with better diagnostic performance both in the neural network and in dermatologists. We found no correlation between the uncertainty of the neural network and the confidence of dermatologists (R = -0.06, p = 0.77). Dermatologists should not blindly trust the output of a neural network, especially when its uncertainty is high. The addition of an uncertainty score may stimulate the human-computer interaction.
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Affiliation(s)
- Pieter Van Molle
- IDLab, Department of Information Technology, Ghent University-IMEC, Ghent, Belgium
| | - Sofie Mylle
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - Tim Verbelen
- IDLab, Department of Information Technology, Ghent University-IMEC, Ghent, Belgium
| | - Cedric De Boom
- IDLab, Department of Information Technology, Ghent University-IMEC, Ghent, Belgium
| | - Bert Vankeirsbilck
- IDLab, Department of Information Technology, Ghent University-IMEC, Ghent, Belgium
| | - Evelien Verhaeghe
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Bart Dhoedt
- IDLab, Department of Information Technology, Ghent University-IMEC, Ghent, Belgium
| | - Lieve Brochez
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
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4
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Van Coile L, Brochez L, Verhaeghe E, Boone B, Meertens A, Ongenae K, Hoorens I. A critical re-evaluation of Mohs micrographic surgery for a facial basal cell carcinoma in older adults: Should we waive this treatment in certain patients? J Eur Acad Dermatol Venereol 2023; 37:1792-1798. [PMID: 37147863 DOI: 10.1111/jdv.19158] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/27/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Skin cancer incidences are increasing. Treatment for basal cell carcinomas (BCCs) can be questioned in certain patients. Treatment options are various, but Mohs micrographic surgery (MMS) has the highest cure rate. It is, however, time-consuming and results in high logistical burden and treatment costs for both patients and society. OBJECTIVES This study critically re-evaluates MMS for facial BCCs in older adults. The main objective is to examine all clinical, tumour and patient characteristics in relation to safety and survival to detect a subgroup in which MMS was not the best choice. The overall aim is to identify characteristics that support clinical decision-making in daily practice. METHODS Patients that received MMS between November 1998 and December 2012 were included. Only patients >75 years with a facial BCC were withheld for analysis. This is a retrospective cohort study, since evaluating the outcome of MMS in accordance with life expectancy is the main objective. Patient charts were evaluated towards comorbidities, complications and survival. RESULTS This cohort comprises 207 patients. Median survival was 7.85 years. The age-adjusted Charlson comorbidity index (aCCI) was divided into low/medium scores (aCCI < 6) and high scores (aCCI ≥ 6). Median survival was 11.58 years in the low aCCI group and 3.60 years in the high aCCI group (p < 0.001). There was a very strong association between high aCCI and survival (HR, 6.25; 95% CI, 3.83-10.21). Other characteristics were not associated with survival. CONCLUSIONS Clinicians should assess the aCCI in older patients presenting with a facial BCC before deciding if MMS is an eligible treatment option. High aCCI has shown to be an indicator for low median survival, even in MMS patients with usually high functional status. MMS should be waived as treatment in older patients with high aCCI scores in favour of other, less intensive and less expensive treatment options.
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Affiliation(s)
- Laura Van Coile
- Department of Dermatology, University Hospital Ghent, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - Lieve Brochez
- Department of Dermatology, University Hospital Ghent, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - Evelien Verhaeghe
- Department of Dermatology, University Hospital Ghent, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - Barbara Boone
- Department of Dermatology, University Hospital Ghent, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - Annick Meertens
- Department of Dermatology, University Hospital Ghent, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - Katia Ongenae
- Department of Dermatology, University Hospital Ghent, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - Isabelle Hoorens
- Department of Dermatology, University Hospital Ghent, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
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5
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Van Coile L, Verhaeghe E, Ongenae K, Destrooper L, Mohamadi Z, Brochez L, Hoorens I. The therapeutic dilemma of basal cell carcinoma in older adults: A review of the current literature. J Geriatr Oncol 2023; 14:101475. [PMID: 36990928 DOI: 10.1016/j.jgo.2023.101475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 01/26/2023] [Accepted: 03/07/2023] [Indexed: 03/29/2023]
Abstract
Skin cancer is known to be a significant health care threat due to the massively increasing numbers of diagnoses. In 2019, 4 million basal cell carcinoma (BCC) cases were diagnosed globally, making BCC the most frequent of all cancers worldwide in fair skinned populations. Given the increasing life-expectancy for all countries worldwide (by 2050, the world's population of people aged 60 years and older will have doubled), the incidence of BCC is expected to keep increasing in the future. Management of BCCs is challenging, especially among older adults, as mortality due to BCCs is extremely rare, whereas locally destructive growth can cause significant morbidity in certain cases. Therapeutic management in this population is further hampered because of the presence of comorbidities, frailty, and the heterogeneity of these aspects in older patients, leading to treatment dilemmas. A literature review was conducted to identify relevant patient, tumour, and treatment related factors that should be considered in the decision making for BCC treatment in older adults. This narrative review synthesizes all aspects concerning BCC treatment in older adults and aims to make some specific suggestions considering BCC treatment in older adults that can be used in daily practice. We found that nodular BCC was found to be the most common subtype in older adults, most frequently located in the head and neck region. In non-facial BCCs, current literature has shown no significant impact on the quality of life (QoL) in older patients. Besides comorbidity scores, functional status should guide clinicians in treatment decisions. Taking all aspects into account when making treatment decisions is of great importance. When treating superficial BCCs on difficult-to-reach lesions in older adults, a clinician-administered treatment should be suggested because of possible impaired mobility in these patients. Based on current literature, we recommend assessing the comorbidities, the functional status, and frailty in older patients with BCC to evaluate life expectancy. In patients with low-risk BCCs and a limited life expectancy (LLE), an active surveillance or watchful waiting strategy can be suggested.
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6
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Janssen L, Van Kelst S, Diricx B, Kimpe T, Papeleu J, Verhaeghe E, Brochez L, Garmyn M. Can Multispectral Dermoscopy Help In Distinguishing Blue Color? Dermatol Pract Concept 2023; 13:dpc.1301a58. [PMID: 36892379 PMCID: PMC9946077 DOI: 10.5826/dpc.1301a58] [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] [Accepted: 05/31/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION The interpretation of colors is essential in the dermoscopic evaluation of skin lesions. The same blue color on white dermoscopy may indicate blood or pigment deep in the dermis. Contrary to white dermoscopy, multispectral dermoscopy uses different wavelengths of light to illuminate a lesion and is able to decompose the dermoscopic image into individual maps that allow to more clearly visualize specific skin structures such as pigment distribution (pigment map) and vasculature (blood map). These maps are called skin parameter maps. OBJECTIVES The aim of this research is to investigate whether skin parameter maps can be used to objectively identify and distinguish the presence of pigment and blood, by using blue naevi and angiomas as models for respectively pigment and blood. METHODS We retrospectively analyzed 24 blue naevi and 79 angiomas. The skin parameter maps of each of the lesions were independently reviewed by 3 expert dermoscopists, in the absence of the regular white-light dermoscopic image. RESULTS All the observers provided high levels of diagnostic accuracy for blue naevus and angioma based on skin parameter maps alone, and the dermoscopic diagnosis was considered substantially reliable because of the 79% of diagnostic K agreement. Percentages of blue naevi and angiomas that showed respectively deep pigment and blood were very high at 95.8% and 97.5%. There was a percentage of lesions that counterintuitively showed blood in blue naevi (37.5%) and deep pigment in angiomas (28.8%). CONCLUSIONS Skin parameter maps based on multispectral images can help to objectify the presence of deep pigment or blood in blue naevi and angiomas. The application of these skin parameter maps could help in the differential diagnosis between pigmented and vascular lesions.
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7
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Hilhorst N, Verhaeghe E, Brochez L. Angiosarcoma Mimicking Rhinophyma. JAMA Dermatol 2023; 159:95. [PMID: 36383347 DOI: 10.1001/jamadermatol.2022.4503] [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] [Indexed: 11/17/2022]
Abstract
This case report describes a man in his 60s who was referred to the department of dermatology for further evaluation of a lesion on the nose.
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Affiliation(s)
- Niels Hilhorst
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium.,Dermatology Research Unit, Ghent University, Ghent, Belgium
| | - Evelien Verhaeghe
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium.,Dermatology Research Unit, Ghent University, Ghent, Belgium
| | - Lieve Brochez
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium.,Dermatology Research Unit, Ghent University, Ghent, Belgium
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8
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Van Coile L, Verhaeghe E, Ongenae K, Brochez L, Hoorens I. Study protocol of the BASINEL Study: a pragmatic randomised controlled trial investigating treatment versus no treatment of low-risk basal cell carcinomas in older persons. BMJ Open 2022; 12:e063526. [PMID: 36356999 PMCID: PMC9660619 DOI: 10.1136/bmjopen-2022-063526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Basal cell carcinomas (BCCs) represent 70% of all skin cancers. These tumours do not metastasise but are locally invasive if left untreated. There is a high incidence of BCC in the elderly, and clinicians frequently face important treatment dilemmas. The approach to BCC in the elderly should be investigated thoroughly. METHODS AND ANALYSIS Data on health-related quality of life (HrQoL), survival and complication rate will be examined in a treatment and a non-treatment arm (1:1 allocation). In the non-treatment arm, in vivo biological behaviour of low-risk BCCs in elderly patients will be examined. The main objective is to combine tumour characteristics with demographic data, in order to determine whether treatment will positively affect the patients' HrQoL within a predetermined time frame. A monocentric randomised controlled trial (RCT) was designed at the Ghent University Hospital. The study population consists of patients with the minimum age of 75 years and a new diagnosis of (a) low-risk BCC(s). Patients in the treatment arm will receive standard care. Patients in the non-treatment arm will be closely monitored: the tumour will be intensively evaluated using multispectral dermoscopy, reflectance confocal microscopy and high-definition optical coherence tomography. All patients will be asked to fill in a questionnaire concerning their HrQoL at consecutive time points. Patient-reported side effects will be evaluated via an additional questionnaire.Primary outcomes will include the difference in HrQoL and the difference in complication risks (treatment vs non-treatment) at different time points of the study. Secondary endpoints are the evolution of the BCCs in the non-treatment arm and the long-term survival in both study arms. Tertiary endpoint is the treatment effectiveness in the treatment arm. The sample size calculation was performed and resulted in a target sample size of 272 patients in this study with a 1:1 allocation. ETHICS AND DISSEMINATION Subjects can withdraw from participating in this study at any time for any reason without any consequences. Approval for this study was received from the Ethics Committee of the Ghent University Hospital on 26 August 2021.The results of this RCT will be submitted for publication in one or more international, peer-reviewed medical journals, regardless of the nature of the study results. TRIAL REGISTRATION NUMBER ClinicalTrials.gov (NCT05110924).
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Affiliation(s)
| | | | - Katia Ongenae
- Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Lieve Brochez
- Dermatology, Ghent University Hospital, Ghent, Belgium
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9
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Hoorens I, Waalboer-Spuij R, Van Coile L, Debaveye M, Shen A, Verhaeghe E, Brochez L. Health state utility instruments in patients with keratinocyte cancer and actinic keratosis: a cross-sectional study. J Eur Acad Dermatol Venereol 2022; 36:e906-e907. [PMID: 35734826 DOI: 10.1111/jdv.18349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- I Hoorens
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium.,CRIG, Cancer Research Institute Ghent, Ghent, Belgium
| | - R Waalboer-Spuij
- Department of Dermatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - L Van Coile
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium.,CRIG, Cancer Research Institute Ghent, Ghent, Belgium
| | - M Debaveye
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - A Shen
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - E Verhaeghe
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium.,CRIG, Cancer Research Institute Ghent, Ghent, Belgium
| | - L Brochez
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium.,CRIG, Cancer Research Institute Ghent, Ghent, Belgium
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10
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Van Coile L, Verhaeghe E, Ongenae K, Brochez L, Hoorens I. Basal cell carcinoma in older adults: how to decide when active surveillance or watchful waiting are appropriate? Br J Dermatol 2022; 187:244-245. [PMID: 35157305 DOI: 10.1111/bjd.21056] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Laura Van Coile
- Department of Dermatology, University Hospital Ghent, Belgium.,Cancer Research Institute Ghent (CRIG), Belgium
| | - Evelien Verhaeghe
- Department of Dermatology, University Hospital Ghent, Belgium.,Cancer Research Institute Ghent (CRIG), Belgium
| | - Katia Ongenae
- Department of Dermatology, University Hospital Ghent, Belgium
| | - Lieve Brochez
- Department of Dermatology, University Hospital Ghent, Belgium.,Cancer Research Institute Ghent (CRIG), Belgium
| | - Isabelle Hoorens
- Department of Dermatology, University Hospital Ghent, Belgium.,Cancer Research Institute Ghent (CRIG), Belgium
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11
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Hoorens I, Van Coile L, Jacobs C, Saerens M, Verhaeghe E, Brochez L. Systemic treatment of advanced basal cell carcinoma: how to critically evaluate value for patient and society? Ther Adv Med Oncol 2022; 14:17588359221141762. [DOI: 10.1177/17588359221141762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/09/2022] [Indexed: 12/14/2022] Open
Affiliation(s)
- Isabelle Hoorens
- Department of Dermatology, University Hospital Ghent, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - Laura Van Coile
- Department of Dermatology, University Hospital Ghent, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - Celine Jacobs
- Department of Medical Oncology, University Hospital Ghent, Ghent, Belgium
| | - Michael Saerens
- Department of Medical Oncology, University Hospital Ghent, Ghent, Belgium
| | - Evelien Verhaeghe
- Department of Dermatology, University Hospital Ghent, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - Lieve Brochez
- Department of Dermatology, University Hospital Ghent, Corneel Heymanslaan 10, Ghent 9000, Belgium
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12
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De Vylder J, Kimpe T, Janssen L, Van Kelst S, Mylle S, Verhaeghe E, Desmedt J, Garmyn M, Brochez L. 26915 Steps towards trustworthy AI: Detecting unsupported lesions. J Am Acad Dermatol 2021. [DOI: 10.1016/j.jaad.2021.06.129] [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: 11/28/2022]
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13
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Mylle S, Verhaeghe E, Van Coile L, Van de Maele B, Hoorens I, Brochez L. Lesion-directed screening to optimize skin cancer detection in dermatology practice: an observational study. J Eur Acad Dermatol Venereol 2021; 35:1309-1314. [PMID: 33480073 PMCID: PMC8248046 DOI: 10.1111/jdv.17129] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/04/2020] [Indexed: 12/23/2022]
Abstract
Background Early detection of skin cancer is still a major challenge in dermatology practice today. While surveillance programs are offered to high‐risk patients, systematic total‐body examination (TBE) in the general population is not cost‐effective. In the past, we demonstrated that a lesion‐directed screening (LDS) in the general population delivered similar detection rates to TBE and was less time‐consuming. Objectives To study whether a lesion‐directed early‐access consultation can optimize skin cancer detection in dermatology practice. Methods In this observational study, we offered an early‐access consultation in patients contacting the dermatology department concerning 1 or 2 lesions of concern meeting predefined criteria. Results 342 persons were seen at the dermatology department after triage by phone. Skin cancer detection rate was 13.2% (4.1% for melanoma). If advised/referred by a doctor skin cancer detection rate was 23.6% (9% for melanoma). With a history of skin cancer, detection rate was 24.3% (4.3% for melanoma). In patients with no referral and a negative history of skin cancer, detection rate was 7.7% (1.7% for melanoma), which is at least triple the rates reported by population‐based screening programs. In patients in whom the index lesion was benign, worry of having skin cancer had decreased significantly by the end of the consultation. Additional total‐body examination in these patients had low additional detection rate (0.5%) and a high number of unnecessary excisions (number needed to excise 13). Conclusions An early‐access dermatology consultation for LDS after triage by phone resulted in high overall skin cancer and melanoma detection rates. Our data indicate that performing TBE is especially useful if the index lesion is suspicious. In addition to surveillance programs in high‐risk patients, LDS may be a way to optimize skin cancer detection in the general population and use available time more efficiently in daily dermatology practice.
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Affiliation(s)
- S Mylle
- Department of Dermatology, University Hospital Ghent, Ghent, Belgium.,Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - E Verhaeghe
- Department of Dermatology, University Hospital Ghent, Ghent, Belgium.,Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - L Van Coile
- Department of Dermatology, University Hospital Ghent, Ghent, Belgium
| | - B Van de Maele
- Department of Dermatology, University Hospital Ghent, Ghent, Belgium.,Department of Dermatology, General Hospital Sint-Lucas, Bruges, Belgium
| | - I Hoorens
- Department of Dermatology, University Hospital Ghent, Ghent, Belgium.,Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - L Brochez
- Department of Dermatology, University Hospital Ghent, Ghent, Belgium.,Cancer Research Institute Ghent (CRIG), Ghent, Belgium
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14
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Bogaert DJ, Verlinden L, Vandecruys E, Laureys G, Verhaeghe E, Bauters T. Severe phototoxicity associated with concomitant use of methotrexate and voriconazole, an overlooked drug-drug interaction. Pediatr Blood Cancer 2020; 67:e28246. [PMID: 32207558 DOI: 10.1002/pbc.28246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Delfien J Bogaert
- Primary Immunodeficiency Research Lab, Center for Primary Immunodeficiency Ghent, Jeffrey Modell Diagnosis and Research Center, Ghent University Hospital, Ghent, Belgium.,Department of Pediatrics, Ghent University Hospital, Ghent, Belgium
| | - Louisa Verlinden
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Els Vandecruys
- Department of Pediatrics, Division of Pediatric Hemato-Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Geneviève Laureys
- Department of Pediatrics, Division of Pediatric Hemato-Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Evelien Verhaeghe
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Tiene Bauters
- Department of Pediatrics, Division of Pediatric Hemato-Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium.,Department of Pharmacy, Ghent University Hospital, Ghent, Belgium
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Abstract
Background: Teledermatology, the application of telemedicine in the field of dermatology, can be a valuable tool to improve the efficiency of care in general practice.Objectives: In this pilot study, we implemented a teledermatology programme in Belgian context to assess the effect on referral rate and to evaluate the acceptability of teledermatology by clinicians and patients.Material and methods: A store-and-forward teledermatology service between 12 general practitioners (GPs) and 3 academic dermatologists was evaluated for a period of 3-6 months. Clinicians and patients were questioned about satisfaction, benefits and barriers.Results: In total, 54 teledermatologic consultations were performed. The referral rate was reduced. Thirty-one teleconsulations were performed instead of physical referral, of which nine patients were actually referred. In 23 cases, performed for a second opinion, two more patients were referred on the dermatologist's advice.All clinicians want to continue working with teledermatology. GPs highlighted the educational benefit, whereas dermatologists were interested in the triage effect and reduced referral rate. Patients indicated that teledermatology would encourage them to consult a GP sooner when experiencing dermatologic problems.Conclusion: Teledermatology proved to be a feasible and acceptable tool for both clinicians and patients. It also shows to be a valuable for triage and reducing unnecessary referrals. Considering the emergent pressure on health care in the next decades, teledermatology following GP selection could be useful for the Belgian health care system and deserves further elaboration in the search for effective tools to strengthen first line health care and streamline referral to secondary care.
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Affiliation(s)
- Julie Kips
- General practitioner, Ghent University, Ghent, Belgium
| | - Jo Lambert
- Department of Dermatology, Ghent University, Ghent, Belgium
| | - Katia Ongenae
- Department of Dermatology, Ghent University, Ghent, Belgium
| | - An De Sutter
- Department of General practice and primary health care, Ghent University, Ghent, Belgium
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Janssen L, Mylle S, Van Kelst S, De Smedt J, Diricx B, Kimpe T, Boone M, Verhaeghe E, Brochez L, Garmyn M. Enhanced visualization of blood and pigment in multispectral skin dermoscopy. Skin Res Technol 2020; 26:708-712. [PMID: 32227367 DOI: 10.1111/srt.12859] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 02/29/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Dermoscopy has proven its value in the diagnosis of skin cancer and, therefore, is well established in daily dermatology practice. Up until now, analogue white light dermoscopy is the standard. Multispectral dermoscopy is based on illumination of the skin with narrowband light sources with different wavelengths. Each of these wavelengths is differently absorbed by skin chromophores, such as pigment or (de)oxygenated blood. Multispectral dermoscopy could be a way to enhance the visualization of vasculature and pigment. We illustrate possible additional information by such "skin parameter maps" in some cases of basal cell carcinoma and Bowen's disease. METHODS Using a new digital multispectral dermatoscope, skin images at multiple wavelengths are collected from different types of skin lesions. These particular images together with the knowledge on skin absorption properties, result in so called "skin parameter maps". RESULTS A "pigment contrast map," which shows the relative concentration of primarily pigment, and a "blood contrast map" which shows the relative concentration of primarily blood were created. Especially, the latter is of importance in diagnosing keratinocyte skin cancer hence vascular structures are a characteristic feature, as further illustrated in the study. CONCLUSIONS Skin parameter maps based on multispectral images can give better insight in the inner structures of lesions, especially in lesions with characteristic blood vessels such as Bowen's disease and basal cell carcinoma. Skin parameter maps can be used complementary to regular dermoscopy and could potentially facilitate diagnosing skin lesions.
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Affiliation(s)
| | - Sofie Mylle
- Department of Dermatology, UZ Gent, Gent, Belgium
| | | | | | | | | | | | | | | | - Marjan Garmyn
- Department of Dermatology, KU Leuven, Leuven, Belgium
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17
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Laboute E, Verhaeghe E, Ucay O, Minden A. Evaluation kinaesthetic proprioceptive deficit after knee anterior cruciate ligament (ACL) reconstruction in athletes. J Exp Orthop 2019; 6:6. [PMID: 30729340 PMCID: PMC6367489 DOI: 10.1186/s40634-019-0174-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 01/17/2019] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The objective of this study was to evaluate kinaesthetic proprioceptive deficit after knee anterior cruciate ligament (ACL) reconstruction in two populations of athletes, those in the post-surgery period and those in re-training during the intensive program-training phase. METHODS We performed a prospective study in ACL-operated athletes without previous knee injuries, with 32 athletes in each group. Time since surgery in the operated athletes in the post-surgery group was 21 to 35 days, and between three and 9 months in the re-training group. We also analysed a control group of 32 uninjured non-operated subjects with a similar sporting level. Proprioception was evaluated using the threshold to detection of passive motion (TDPM) test with Biodex-type isokinetic equipment comparing operated knees, non-operated knees and control uninjured non-operated group. The control group was tested twice, 1 day apart to control reproducibility, using the intraclass correlation coefficient (ICC). The p-value threshold for statistical significance between different groups in hypothesis testing was <.05. RESULTS TDPM reproducibility was excellent (right knee: ICC = 0.80, left knee: ICC =0.72). We found a bilateral kinaesthetic deficit in post-surgery patients compared to the control group (p < 0.001 and p = 0.011), which was significantly higher on the operated side (p = 0.001). Re-training patients had no significant difference between operated and uninjured knees, but had a kinaesthetic deficit on operated limbs (p = 0.036) compared to the control group. CONCLUSION There was a bilateral deficit in post-surgery athletes with a significant difference between injured and healthy knees, which could be explained by a change in the central nervous system. Compared to the control group, a proprioceptive deficit was only seen for re-training patients on the operated side and not in the healthy limb. Kinaesthetic recovery may be faster for the uninjured side as initial deficit is lower. Level of evidence II.
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Affiliation(s)
- E Laboute
- C.E.R.S, Ramsay Générale de Santé, 83 av Maréchal de Lattre de Tassigny, 40130 Capbreton, Capbreton, France.
| | - E Verhaeghe
- C.E.R.S, Ramsay Générale de Santé, 83 av Maréchal de Lattre de Tassigny, 40130 Capbreton, Capbreton, France
| | - O Ucay
- C.E.R.S, Ramsay Générale de Santé, 83 av Maréchal de Lattre de Tassigny, 40130 Capbreton, Capbreton, France
| | - A Minden
- Université Catholique de Louvain, Place P. de Coubertin, 1348, Louvain-la-Neuve, Belgium
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18
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Genouw E, Verheire B, Ongenae K, De Schepper S, Creytens D, Verhaeghe E, Boone B. Laser‐assisted photodynamic therapy for superficial basal cell carcinoma and Bowen's disease: a randomized intrapatient comparison between a continuous and a fractional ablativeCO2laser mode. J Eur Acad Dermatol Venereol 2018; 32:1897-1905. [DOI: 10.1111/jdv.14989] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 03/14/2018] [Indexed: 12/14/2022]
Affiliation(s)
- E. Genouw
- Faculty of Medicine and Health Sciences Ghent University Ghent Belgium
| | - B. Verheire
- Faculty of Medicine and Health Sciences Ghent University Ghent Belgium
| | - K. Ongenae
- Department of Dermatology Ghent University Hospital Ghent Belgium
| | - S. De Schepper
- Department of Dermatology Ghent University Hospital Ghent Belgium
| | - D. Creytens
- Department of Pathology Ghent University Hospital Ghent Belgium
- CRIG, Cancer Research Institute Ghent Ghent University Ghent Belgium
| | - E. Verhaeghe
- Department of Dermatology Ghent University Hospital Ghent Belgium
| | - B. Boone
- Department of Dermatology Ghent University Hospital Ghent Belgium
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19
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Speeckaert R, Dugardin J, Lambert J, Lapeere H, Verhaeghe E, Speeckaert MM, van Geel N. Critical appraisal of the oxidative stress pathway in vitiligo: a systematic review and meta-analysis. J Eur Acad Dermatol Venereol 2018; 32:1089-1098. [PMID: 29341310 DOI: 10.1111/jdv.14792] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 12/13/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND The pathogenesis of vitiligo remains a topic of extensive debate. This is partly due to the moderate efficacy of current treatments. The role of the oxidative stress pathway in vitiligo is a popular although controversial research topic. OBJECTIVE To clarify the role of the oxidative stress pathway in vitiligo compared to other inflammatory skin disorders and to assess the therapeutic role of antioxidants. METHODS We conducted a systematic search of the existing literature on the aberrancies of the oxidative stress pathway in vitiligo. Subsequently, the efficacy of both topical and oral antioxidants in clinical trials was investigated. RESULTS A deregulated oxidative pathway is clearly evident with elevated superoxide dismutase, decreased catalase and increased lipid peroxidation. However, similar results have been obtained in other inflammatory skin diseases such as psoriasis, atopic dermatitis, lichen planus and urticaria. This questions the unique role of oxidative stress in the development of vitiligo. Some isolated successes have been reported with oral ginkgo biloba, polypodium leucotomos and vitamin C and E preparations, while other clinical trials have failed to show reproducible results. The use of topical antioxidants delivers in general no beneficial results. CONCLUSION The oxidative pathway is affected in vitiligo, but its unique initiating or contributory role in the pathogenesis is less evident. Interesting data support the added value of oral antioxidants in vitiligo although confirmatory studies are missing.
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Affiliation(s)
- R Speeckaert
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - J Dugardin
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - J Lambert
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - H Lapeere
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - E Verhaeghe
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - M M Speeckaert
- Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - N van Geel
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
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20
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Lambert J, André J, Boone M, Boonen H, Bouffioux B, Dedonder B, de la Brassinne M, del Marmol V, Lambert J, Lapeere H, Snauwaert J, Vandaele M, Vanhooteghem O, Van Staey A, Verhaeghe E. Profile of the Belgian dermatologist: results of an online survey. J Eur Acad Dermatol Venereol 2014; 28:667-8. [DOI: 10.1111/jdv.12227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 06/30/2013] [Accepted: 07/03/2013] [Indexed: 11/28/2022]
Affiliation(s)
- J.L.W. Lambert
- Department of Dermatology; Ghent University Hospital; Ghent Belgium
| | - J. André
- Interhospital Department of Dermatology; Université Libre de Bruxelles; Belgium
| | - M. Boone
- Department of Dermatology; CHU Brugmann; Brussels Belgium
| | - H. Boonen
- Department of Dermatology; Erica Hospital; Geel-Mol Belgium
| | - B. Bouffioux
- Department of Dermatology; Clinique St Pierre; Ottignies Belgium
| | | | - M. de la Brassinne
- Department of Dermatology; Clinique Sainte Elisabeth de Namur; Namur Belgium
| | - V. del Marmol
- Interhospital Department of Dermatology; Université Libre de Bruxelles; Belgium
| | - J. Lambert
- Department of Dermatology; Antwerp University Hospital; Antwerp Belgium
| | - H. Lapeere
- Department of Dermatology; Ghent University Hospital; Ghent Belgium
| | | | - M. Vandaele
- Department of Dermatology; City Hospital; Roeselare Belgium
| | - O. Vanhooteghem
- Department of Dermatology; Clinique Sainte Elisabeth de Namur; Namur Belgium
| | - A. Van Staey
- Department of Dermatology; Zus van Barmh Hospital; Ronse Belgium
| | - E. Verhaeghe
- Department of Dermatology; Ghent University Hospital; Ghent Belgium
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Lapeere H, Boone B, Verhaeghe E, Ongenae K, Lambert J. Contact dermatitis caused by lovage (Levisticum officinalis) essential oil. Contact Dermatitis 2014; 69:181-2. [PMID: 23948036 DOI: 10.1111/cod.12082] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 02/22/2013] [Accepted: 02/28/2013] [Indexed: 12/11/2022]
Affiliation(s)
- Hilde Lapeere
- Department of Dermatology, Ghent University Hospital, Ghent, 9000, Belgium.
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Lapeere H, Brochez L, Verhaeghe E, Stichele RHV, Remon JP, Lambert J, Leybaert L. Efficacy of products to remove eggs of Pediculus humanus capitis (Phthiraptera: Pediculidae) from the human hair. J Med Entomol 2014; 51:400-407. [PMID: 24724290 DOI: 10.1603/me13106] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Head lice infestations are very common in children aged between 3 and 12 yr old. The eggs of the head louse are difficult to remove and remain firmly attached to the hair even after any head louse treatment. Solid in vitro and in vivo evidence to support the use of any of the proposed products to facilitate nit removal is scarce. The objective of the current study was to determine the efficacy of several products to remove eggshells from human hair using an objective measurement procedure. Water and ordinary hair conditioner significantly facilitated the removal of nits in vitro. We found no difference between ordinary conditioner and products specifically marketed for the purpose of nit removal. Other products such as formic acid solution and almond oil did not have a beneficial effect.
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Wierckx K, Van de Peer F, Verhaeghe E, Dedecker D, Van Caenegem E, Toye K, Kaufman JM, T'Sjoen G. Short‐ and Long‐Term Clinical Skin Effects of Testosterone Treatment in Trans Men. J Sex Med 2014; 11:222-9. [DOI: 10.1111/jsm.12366] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Van Caenegem E, Verhaeghe E, Taes Y, Wierckx K, Toye K, Goemaere S, Zmierczak HG, Hoebeke P, Monstrey S, T'Sjoen G. Long-term evaluation of donor-site morbidity after radial forearm flap phalloplasty for transsexual men. J Sex Med 2013; 10:1644-51. [PMID: 23534878 DOI: 10.1111/jsm.12121] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Phalloplasty using the radial forearm flap is currently the most frequently used technique to create the neophallus in transsexual men (formerly described as female-to-male transsexual persons). Although it is considered the gold standard, its main disadvantage is the eventual donor-site morbidity in a young, healthy patient population. AIM The study aims to examine the long-term effects of radial forearm flap phalloplasty in transsexual men and to evaluate aesthetic outcome, scar acceptance, bone health, and daily functioning. MAIN OUTCOME MEASURES Scars were evaluated with the patient and observer scar assessment scale, the Vancouver Scar Scale, and self-reported satisfaction. Bone health was assessed using dual X-ray absorptiometry and peripheral quantitative computed tomography, and daily functioning using a physical activity questionnaire (Baecke). These measurements were compared with 44 age-matched control women. METHODS This is a cross-sectional study of 44 transsexual, a median of 7 years after radial forearm flap phalloplasty, recruited from the Center for Sexology and Gender Problems at the Ghent University Hospital, Belgium. RESULTS We observed no functional limitations on daily life activities, a pain-free and rather aesthetic scar, and unaffected bone health a median of 7 years after radial foreram flap phalloplasty. Over 75% of transsexual men were either satisfied or neutral with the appearance of the scar. CONCLUSIONS Transsexual men, despite scarring the forearm, consider the radial forearm flap phalloplasty as worthwhile.
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Affiliation(s)
- Eva Van Caenegem
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium.
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Verhaeghe E, Ongenae K, Bostoen J, Lambert J. Nonablative Fractional Laser Resurfacing for the Treatment of Hypertrophic Scars: A Randomized Controlled Trial. Dermatol Surg 2013; 39:426-34. [DOI: 10.1111/dsu.12059] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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26
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Laboute E, Bealu A, Verhaeghe E, Puig P, Trouve P. Risques de récidives et reprise du sport après chirurgie pour instabilité de l’épaule. Ann Phys Rehabil Med 2012. [DOI: 10.1016/j.rehab.2012.07.1046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Laboute E, Bealu A, Verhaeghe E, Puig P, Trouve P. Risk of recurrence and return to sport after surgery for anterior shoulder instability. Ann Phys Rehabil Med 2012. [DOI: 10.1016/j.rehab.2012.07.1053] [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: 11/15/2022]
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28
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Verhaeghe E, Ongenae K, Dierckxsens L, Bostoen J, Lambert J. Nonablative fractional laser resurfacing for the treatment of scars and grafts after Mohs micrographic surgery: a randomized controlled trial. J Eur Acad Dermatol Venereol 2012; 27:997-1002. [DOI: 10.1111/j.1468-3083.2012.04639.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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van Geel N, Mollet I, Brochez L, Dutré M, De Schepper S, Verhaeghe E, Lambert J, Speeckaert R. New insights in segmental vitiligo: case report and review of theories. Br J Dermatol 2011; 166:240-6. [DOI: 10.1111/j.1365-2133.2011.10650.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Verhaeghe E, Lodewick E, van Geel N, Lambert J. Intrapatient Comparison of 308-nm Monochromatic Excimer Light and Localized Narrow-Band UVB Phototherapy in the Treatment of Vitiligo: A Randomized Controlled Trial. Dermatology 2011; 223:343-8. [DOI: 10.1159/000335272] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Accepted: 11/22/2011] [Indexed: 11/19/2022] Open
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Caekelbergh K, Nikkels AF, Leroy B, Verhaeghe E, Lamotte M, Vincent R. Photodynamic therapy using methyl aminolevulinate in the management of primary superficial basal cell carcinoma: clinical and health economic outcomes. J Drugs Dermatol 2009; 8:992-996. [PMID: 19894366] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Basal cell carcinoma (BCC) is the most common form of skin cancer worldwide. Different treatment options exist. The efficacy of photodynamic therapy with methyl aminolevulinate (MAL-PDT) has been established in several randomized controlled trials (RCTs). Real life data can differ greatly from data derived from randomized controlled trials (RCTs). OBJECTIVES To describe the results of a Belgian observational study concerning superficial BCC (sBCC) vis-a-vis clinical and health economic outcomes in order to evaluate the real-life practice of MAL-PDT. METHODS This study was a prospective, single-arm, open study conducted at eight dermatological institutions during six months after the first MAL-PDT treatment. Eligible patients had to present with lesions, suitable for MAL-PDT according to Belgian reimbursement criteria. Resource use was collected during the study period. Clinical Response (CR) and Cosmetic Outcome (CO), as well as cost of care were evaluated. A subset analysis of patients with sBCC only was conducted. RESULTS Ninety patients were identified for the analysis (mean age 65 years; 61% female). The mean number of lesions per patient was 1.6, mostly located on the face, the back and the chest. For the entire period, the mean number of visits to a dermatologist was 4 per patient including two MAL-PDT sessions. The average, cumulative amount of MAL used per treatment was 1,256 mg. Two patients experienced adverse events at the application site, none of them serious; all resolved completely. The CR rate was 89% at the end of the study. The CO was "excellent" or "good" in 96% of the patients. Total cost of care was Euro 289 ($414 U.S.) per patient. Cost per lesion was Euro 195 ($280 U.S.). CONCLUSION The results from the real-life practice study confirm the efficacy found in prior, prospective randomized trials. About four visits and less than one tube of MAL are needed for the full treatment of sBCC in one patient.
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Affiliation(s)
- Karin Caekelbergh
- Health Economics and Outcomes Research, IMS Health, Brussels, Belgium.
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Kaufmann R, Spelman L, Weightman W, Reifenberger J, Szeimies RM, Verhaeghe E, Kerrouche N, Sorba V, Villemagne H, Rhodes LE. Multicentre intraindividual randomized trial of topical methyl aminolaevulinate-photodynamic therapy vs. cryotherapy for multiple actinic keratoses on the extremities. Br J Dermatol 2008; 158:994-9. [PMID: 18341663 DOI: 10.1111/j.1365-2133.2008.08488.x] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Methyl aminolaevulinate-photodynamic therapy (MAL-PDT) is an effective treatment in facial/scalp actinic keratosis (AK). OBJECTIVES The aims of this study were to compare efficacy, safety, cosmetic outcome and patient preference of MAL-PDT vs. cryotherapy in patients with AK at other locations. METHODS A multicentre, controlled, randomized, open, intraindividual, right-left comparison was performed. Patients with nonhyperkeratotic AK were treated once with MAL-PDT and cryotherapy on either side of the body. At week 12, lesions showing noncomplete response were retreated. The primary efficacy variable was the lesion response at week 24. Investigator's assessment of cosmetic outcome, patient's preference in terms of cosmetic outcome and a patient preference questionnaire were also analysed at week 24. RESULTS In total, of 121 patients with 1343 lesions (98% located on the extremities and the remainder on the trunk and neck) were included. Both treatments provided a high mean percentage reduction in lesion count at week 24 with significantly higher efficacy for cryotherapy: 78% for MAL-PDT and 88% for cryotherapy (P=0.002, per protocol population). Investigator's assessment of cosmetic outcome was significantly better for MAL-PDT than cryotherapy (P<0.001), 79% of lesions having an excellent cosmetic outcome with MAL-PDT vs. 56% with cryotherapy at week 24. The cosmetic outcome achieved by MAL-PDT compared with cryotherapy was also preferred by patients (50% vs. 22%, respectively, P<0.001), and 59% of patients would prefer to have any new lesions treated with MAL-PDT compared with 25% with cryotherapy (P<0.001). Both treatment regimens were safe and well tolerated. CONCLUSIONS MAL-PDT showed inferior efficacy for treatment of non-face/scalp AK compared with cryotherapy. However, both treatments showed high efficacy, and MAL-PDT conveyed the advantages of better cosmesis and higher patient preference.
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Affiliation(s)
- R Kaufmann
- Johann-Wolfgang-Goethe-Universität-Hautklinik, Frankfurt, Germany
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Abstract
Hemangiomas can present a difficult problem in management. Much controversy exists over whether it is better to watch and wait for natural involution or to be more aggressive and attempt to prevent some of the potential negative sequelae. Different modalities have been employed in the treatment of hemangiomas, including systemic therapy - antiangiogenic drugs, i.e. systemic corticosteroids and alpha-interferon - and local therapy - surgical procedures, arterial embolization and cryotherapy. Overall, a very conservative approach to therapy has been recommended because of treatment risks, treatment inadequacy and lack of evidence showing superiority over natural involution. Recently laser treatment has been used in the therapeutic approach of hemangiomas. This review discusses the pros and contras of early laser treatment of hemangiomas. For superficial hemangiomas, the flashlamp pumped pulsed dye laser in particular has proven itself in numerous studies. In the treatment of hemangiomas with subcutaneous components, the Nd:YAG laser is the treatment of choice.
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Affiliation(s)
- H Al Buainian
- Department of Dermatology, Ghent University Hospital, Belgium
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Brochez L, Verhaeghe E, Grosshans E, Haneke E, Piérard G, Ruiter D, Naeyaert JM. Inter-observer variation in the histopathological diagnosis of clinically suspicious pigmented skin lesions. J Pathol 2002; 196:459-66. [PMID: 11920743 DOI: 10.1002/path.1061] [Citation(s) in RCA: 106] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
When a biopsy is taken of a suspicious pigmented skin lesion, histological examination is expected to establish the definitive diagnosis. This study evaluated the inter-observer variation of 20 pathologists in the histological diagnosis of a randomly selected set of suspicious pigmented skin lesions (PSLs), by comparing their diagnoses to a reference diagnosis. Overall sensitivity for melanoma was 87%, ranging from 55% to 100% between the observers. Sensitivity was significantly lower for thin (Breslow thickness <1 mm) than for thick melanomas (83% versus 97%, p=0.005). Overall melanoma specificity was 94%, ranging from 83% to 100% between observers. Dysplastic naevus was the most important source of false-positive diagnoses, mainly in situ melanomas. Positive and negative predictive values in the given test set were 75% and 97%, respectively. In the case of melanoma, there was quite some variation in measured Breslow thickness. This would have led to a different therapeutic approach in 12% of the readings. Some of the variation seemed to be due to a different interpretation of the presence of a co-existent naevus. In 9% (3/35) of the readings, participants did not agree on the presence of ulceration. These results reflect a tendency to overdiagnose mainly thin melanomas in general histopathological practice. They also demonstrate variation in the assessment of major prognostic factors of melanoma.
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Brochez L, Verhaeghe E, Bleyen L, Naeyaert JM. Diagnostic ability of general practitioners and dermatologists in discriminating pigmented skin lesions. J Am Acad Dermatol 2001; 44:979-86. [PMID: 11369910 DOI: 10.1067/mjd.2001.113442] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Early recognition of melanoma is the key in preventing metastatic disease. OBJECTIVE The aim of this study was to evaluate diagnostic ability of general practitioners (GPs) and dermatologists concerning pigmented skin lesions in general and melanoma in particular. We also investigated whether the diagnostic ability of GPs changed after a lecture on melanoma. METHODS A test set of 13 pigmented skin lesions on 35-mm color slides was presented to 160 GPs and 60 dermatologists during educational courses. RESULTS GPs correctly evaluated biologic behavior of the pigmented skin lesions in 72% of the evaluations. In 71% of these evaluations they correctly identified the lesions. The proportion of lesions correctly identified was positively correlated with the frequency of pigmented skin lesions in everyday practice. Dermatologists made a correct identification of the lesions in 88% of all evaluations, and they correctly evaluated biologic behavior in 94% of these. Recognition of melanoma was proportional to melanoma exposure in everyday practice. Thick melanomas were better recognized than thin melanomas in both physician groups. After a lecture on melanoma, sensitivity of GPs to recognize malignant disease increased from 72% to 84%, without a significant decrease in specificity. The proportion of lesions correctly identified also rose significantly (66% vs 52%).
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Affiliation(s)
- L Brochez
- Department of Dermatology, University Hospital Gent, Belgium
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Abstract
Delay in melanoma diagnosis was investigated in a population-based sample of 130 patients. The median time elapsing from the first notice of the lesion to excision was 110.5 days. There was no linear correlation between total delay time and Breslow-thickness of the diagnosed melanomas (P=0.19). Patient delay, defined as the time from first notice of a (change in a) lesion to the first observation by a physician, exceeded 2 months in half of all patients. Only 41% of the patients consulted a doctor because they were worried about the lesion. Colour change and itch were associated with a longer patient delay. There was no correlation with age, gender, socio-economic factors, localisation of the lesion and the person who first noticed the lesion. In one quarter of all patients, the time from first observation by a physician to excision of the lesion exceeded 2.5 months. This physician delay seemed to be attributed to misdiagnosis and to a delay occurring during referral.
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Affiliation(s)
- L Brochez
- Fund for Scientific Research-Flanders, Egmontstraat 5, B-1000, Brussels, Belgium
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Beele H, Verhaeghe E, Stockman A, Janssens A, Noens L, Geerts ML, Huys I, Naeyaert J. Pyoderma gangrenosum as an early revelator of acute leukemia. Dermatology 2000; 200:176-8. [PMID: 10773715 DOI: 10.1159/000018360] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Bullous pyoderma gangrenosum is an atypical, more superficial variety of the classical pyoderma and is often associated with myeloproliferative disorders. We present the case of a patient who presented initially with subcutaneous nodules and who developed bullous lesions afterwards. Histological evaluation showed the presence of neutrophilic infiltrates in both lesions. A few months after the diagnosis of bullous pyoderma gangrenosum, an underlying leukemia was revealed. Our case illustrates the importance of regular blood and bone marrow examinations in patients with atypical bullous pyoderma gangrenosum, resulting in a rapid diagnosis of the underlying disease.
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Affiliation(s)
- H Beele
- Department of Dermatology, University Hospital Gent, Belgium
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Brochez L, Verhaeghe E, Sales F, Del Marmol V, Deraemaecker R, Vossaert K, Naeyaert JM. Current guidelines in melanoma treatment. Melanoma Working Group of Gent and Bordet. Dermatology 2000; 200:160-6. [PMID: 10773711 DOI: 10.1159/000018356] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
This article focuses on the actual management of cutaneous melanoma, dealing both with established, internationally well-accepted standard procedures and interventions which are still being investigated. It wants to offer a global picture to the dermatologist of what is currently available in the therapeutic arsenal against melanoma.
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Affiliation(s)
- L Brochez
- Dermatology Department, University Hospital Ghent, Belgium
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Abstract
The overall underestimation of incident cancer cases in the Belgian National Cancer Registry is estimated at about 20-25%, with a probable larger under-registration among males. Melanoma incidence is suspected to be underestimated even further because of the hospital-based reporting system of the National Cancer Registry. To investigate the suspected underestimation of melanoma in Belgium, the official data were compared with international data on melanoma incidence and the results of a melanoma registration programme launched in the province of East Flanders. The Eindhoven Cancer Registry, which covers a registration area near the Belgian border, was used as a reference to calculate the expected number of melanomas in East Flanders for 1995. The results indicate an ongoing under-registration of melanoma cases by the National Cancer Registry. Based on the Eindhoven Cancer Registry data, the under-registration in East Flanders is estimated at 43% for males and 36% for females. The East Flanders registration programme apparently obtains a better registration in females. This is mainly due to a higher registration in the younger age groups. In these groups a higher proportion of in situ melanomas and a thinner median Breslow thickness of the invasive melanomas is observed.
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Affiliation(s)
- L Brochez
- Fund for Scientific Research-Flanders, Brussels, Belgium
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