Ultrasound-based follow-up does not increase survival in early-stage melanoma patients: A comparative cohort study

PubMed

Ultrasound-based follow-up does not increase survival in early-stage melanoma patients: A comparative cohort study

https://www.ncbi.nlm.nih.gov/pubmed/28888850

INTRODUCTION:

Different protocols have been used to follow up melanoma patients in stage I-II. However, there is no consensus on the complementary tests that should be requested or the appropriate intervals between visits. Our aim is to compare an ultrasound-based follow-up with a clinical follow-up.

PATIENTS AND METHODS:

Analysis of two prospectively collected cohorts of melanoma patients in stage IB-IIA from two tertiary referral centres in Barcelona (clinical-based follow-up [C-FU]) and Turin (ultrasound-based follow-up [US-FU]). Kaplan-Meier curves were used to evaluate distant metastases-free survival (DMFS), disease-free interval (DFI), nodal metastases-free survival (NMFS) and melanoma-specific survival (MSS).

RESULTS:

A total of 1149 patients in the American Joint Committee on Cancer stage IB and IIA were included in this study, of which 554 subjects (48%) were enrolled for a C-FU, and 595 patients (52%) received a protocolised US-FU. The median age was 53.8 years (interquartile range [IQR] 41.5-65.2) with a median follow-up time of 4.14 years (IQR 1.2-7.6). During follow-up, 69 patients (12.5%) in C-FU and 72 patients (12.1%) in US-FU developed disease progression. Median time to relapse for the first metastatic site was 2.11 years (IQR 1.14-4.04) for skin metastases, 1.32 (IQR 0.57-3.29) for lymph node metastases and 2.84 (IQR 1.32-4.60) for distant metastases. The pattern of progression and the total proportion of metastases were not significantly different (P = .44) in the two centres. No difference in DFI, DMFS, NMFS and MSS was found between the two cohorts.

CONCLUSION:

Ultrasound-based follow-up does not increase the survival of melanoma patients in stage IB-IIA.

#melanoma #josepmalvehy #malvehy   #americanjointcommitteeoncancer #metastases, #susanapuig #aliciabarreiro  #cristinacarrera #skincancer #dermatologiabarcelona #dermatologobarcelona #centrodermatologico #dermatologicalcenter #topdoctors #aad18

A proposed scoring system for assessing the severity of actinic keratosis on the head: actinic keratosis area and severity index

PubMed

A proposed scoring system for assessing the severity of actinic keratosis on the head: actinic keratosis area and severity index

BACKGROUND:

Actinic keratosis (AK) severity is currently evaluated by subjective assessment of patients.

OBJECTIVES:

To develop and perform an initial pilot validation of a new easy-to-use quantitative tool for assessing AK severity on the head.

METHODS:

The actinic keratosis area and severity index (AKASI) for the head was developed based on a review of other severity scoring systems in dermatology, in particular the psoriasis area and severity index (PASI). Initial validation was performed by 13 physicians assessing AK severity in 18 AK patients and two controls using a physician global assessment (PGA) and AKASI. To determine an AKASI score, the head was divided into four regions (scalp, forehead, left/right cheek ear, chin and nose). In each region, the percentage of the area affected by AKs was estimated, and the severities of three clinical signs of AK were assessed: distribution, erythema and thickness.

RESULTS:

There was a strong correlation between AKASI and PGA scores (Pearson correlation coefficient: 0.86). AKASI was able to discriminate between different PGA categories: mean (SD) AKASI increased from 2.88 (1.18) for 'light' to 5.33 (1.48) for 'moderate', 8.28 (1.89) for 'severe', and 8.73 (3.03) for 'very severe' PGA classification. The coefficient of variation for AKASI scores was low and relatively constant across all PGA categories.

CONCLUSIONS:

Actinic keratosis area and severity index is proposed as a new quantitative tool for assessing AK severity on the head. It may be useful in the future evaluation of new AK treatments in clinical studies and the management of AK in daily practice.

https://www.ncbi.nlm.nih.gov/pubmed/28401585

 

#josepmalvehy #erythema #psoriasis #dermatoscopy #dermatology #dermatologiabarcelona #dermatologobarcelona #doctormalvehy #cedilp

 

Dermoscopic Clues for Diagnosing Melanomas That Resemble Seborrheic Keratosis.

PubMed

Abstract

Importance:

Melanomas that clinically mimic seborrheic keratosis (SK) can delay diagnosis and adequate treatment. However, little is known about the value of dermoscopy in recognizing these difficult-to-diagnose melanomas.

Objective:

To describe the dermoscopic features of SK-like melanomas to understand their clinical morphology.

Design, Setting, and Participants:

This observational retrospective study used 134 clinical and dermoscopic images of histopathologically proven melanomas in 134 patients treated in 9 skin cancer centers in Spain, France, Italy, and Austria. Without knowledge that the definite diagnosis for all the lesions was melanoma, 2 dermoscopy-trained observers evaluated the clinical descriptions and 48 dermoscopic features (including all melanocytic and nonmelanocytic criteria) of all 134 images and classified each dermoscopically as SK or not SK. The total dermoscopy score and the 7-point checklist score were assessed. Images of the lesions and patient data were collected from July 15, 2013, through July 31, 2014.

Main Outcomes and Measures:

Frequencies of specific morphologic patterns of (clinically and dermoscopically) SK-like melanomas, patient demographics, and interobserver agreement of criteria were evaluated.

Results:

Of the 134 cases collected from 72 men and 61 women, all of whom were white and who had a mean (SD) age of 55.6 (17.5) years, 110 (82.1%) revealed dermoscopic features suggestive of melanoma, including pigment network (74 [55.2%]), blue-white veil (72 [53.7%]), globules and dots (68 [50.7%]), pseudopods or streaks (47 [35.1%]), and blue-black sign (43 [32.3%]). The remaining 24 cases (17.9%) were considered likely SKs, even by dermoscopy. Overall, lesions showed a scaly and hyperkeratotic surface (45 [33.6%]), yellowish keratin (42 [31.3%]), comedo-like openings (41 [30.5%]), and milia-like cysts (30 [22.4%]). The entire sample achieved a mean (SD) total dermoscopy score of 4.7 (1.6) and a 7-point checklist score of 4.4 (2.3), while dermoscopically SK-like melanomas achieved a total dermoscopy score of only 4.2 (1.3) and a 7-point checklist score of 2.0 (1.9), both in the range of benignity. The most helpful criteria in correctly diagnosing SK-like melanomas were the presence of blue-white veil, pseudopods or streaks, and pigment network. Multivariate analysis found only the blue-black sign to be significantly associated with a correct diagnosis, while hyperkeratosis and fissures and ridges were independent risk markers of dermoscopically SK-like melanomas.

Conclusions and Relevance:

Seborrheic keratosis-like melanomas can be dermoscopically challenging, but the presence of the blue-black sign, pigment network, pseudopods or streaks, and/or blue-white veil, despite the presence of other SK features, allows the correct diagnosis of most of the difficult melanoma cases.

https://www.ncbi.nlm.nih.gov/pubmed/28355453

#josepmalvehy  #aliciabarreiro  #aliciabarreiro #susanapuig #paulaaguilera #cristinacarrera, #cutaneousmelanoma #diagnosisofmelanoma #dermoscopic #seborrheickeratosis #keratosis, #dermoscopy #skincancer

Transforming Dermatologic Imaging for the Digital Era: Metadata and Standards.

Abstract

Imaging is increasingly being used in dermatology for documentation, diagnosis, and management of cutaneous disease. The lack of standards for dermatologic imaging is an impediment to clinical uptake. Standardization can occur in image acquisition, terminology, interoperability, and metadata. This paper presents the International Skin Imaging Collaboration position on standardization of metadata for dermatologic imaging. Metadata is essential to ensure that dermatologic images are properly managed and interpreted. There are two standards-based approaches to recording and storing metadata in dermatologic imaging. The first uses standard consumer image file formats, and the second is the file format and metadata model developed for the Digital Imaging and Communication in Medicine (DICOM) standard. DICOM would appear to provide an advantage over using consumer image file formats for metadata as it includes all the patient, study, and technical metadata necessary to use images clinically. Whereas, consumer image file formats only include technical metadata and need to be used in conjunction with another actor-for example, an electronic medical record-to supply the patient and study metadata. The use of DICOM may have some ancillary benefits in dermatologic imaging including leveraging DICOM network and workflow services, interoperability of images and metadata, leveraging existing enterprise imaging infrastructure, greater patient safety, and better compliance to legislative requirements for image retention.

https://www.ncbi.nlm.nih.gov/pubmed/29344752

#josepmalvehy #skinimaging #dermoscopic #dermatologic #teledermatology #dicom

 

Dermoscopy versus reflectance confocal microscopy for the diagnosis of lentigo maligna

PubMed

Dermoscopy versus reflectance confocal microscopy for the diagnosis of lentigo maligna

BACKGROUND:

Several dermoscopic and in vivo reflectance confocal microscopy (RCM) diagnostic criteria of lentigo maligna (LM)/lentigo maligna melanoma (LMM) have been identified. However, no study compared the diagnostic accuracy of these techniques.

OBJECTIVE:

We evaluated the diagnostic accuracy of dermoscopy and RCM for LM/LMM using a holistic assessment of the images.

METHODS:

223 facial lesions were evaluated by 21 experts. Diagnostic accuracy of the clinical, dermoscopic and RCM examination were compared. Inter-investigator variability and confidence level in the diagnosis were also evaluated.

RESULTS:

Overall diagnostic accuracy of the two imaging techniques was good (area under the curve of the sROC function: 0.89). RCM was more sensitive (80%, versus 61%) and less specific (81% versus 92%) than dermoscopy for LM/LMM. In particular RCM showed a higher sensitivity for hypomelanotic and recurrent LM/LMM. RCM had a higher inter-investigator agreement and a higher confidence level in the diagnosis than dermoscopy.

CONCLUSION:

RCM and dermoscopy are both useful techniques for the diagnosis of facial lesions and in particular LM/LMM. RCM is particularly suitable for the identification of hypomelanotic and recurrent LM/LMM. This article is protected by copyright. All rights reserved.

https://www.ncbi.nlm.nih.gov/pubmed/29341263

This article is protected by copyright. All rights reserved.

 

 

#confocal #cristinacarrera #josepmalvehy #susanapuig #skincancer #invivo #confocalinvivo #cutaneousmelanoma #lentigo #reflactanceconfocal #cedilp #pubmed #microscopy

 

Response to "Phase IV head-to-head randomised controlled trial comparing ingenol mebutate 0.015% gel with diclofenac sodium 3% gel for the treatment of actinic keratosis on the face or scalp".

PubMed

Abstract

We read with attention the recent paper by Stockfleth et al¹ on the efficacy and safety of Ingenol Mebutate 0.015% gel (IngMb) vs. diclofenac sodium 3% gel (DS) for the treatment of actinic keratosis (AK). Regarding this interesting study, we would like to address some comments to the authors.In this study, the primary endpoint was complete clearance of AKs (AKCLEAR100) at end of first treatment course (Week8, IngMeb; Week17, DS).
This article is protected by copyright. All rights reserved.

https://www.ncbi.nlm.nih.gov/pubmed/29205276

#susanapuig #josepmalvehy #queratosis #akclear100 #treatmentactinickeratosis #actinickeratosis #keratosis #queratosis #tratamientoqueratosisactinica

Improving diagnostic sensitivity of combined dermoscopy and reflectance confocal microscopy imaging through double reader concordance evaluation in telemedicine settings: A retrospective study of 1000 equivocal cases

PubMed

Improving diagnostic sensitivity of combined dermoscopy and reflectance confocal microscopy imaging through double reader concordance evaluation in telemedicine settings: A retrospective study of 1000 equivocal cases

Abstract

BACKGROUND:

Reflectance confocal microscopy (RCM) is an imaging device that permits non-invasive visualization of cellular morphology and has been shown to improve diagnostic accuracy of dermoscopically equivocal cutaneous lesions. The application of double reader concordance evaluation of dermoscopy-RCM image sets in retrospective settings and its potential application to telemedicine evaluation has not been tested in a large study population.

OBJECTIVE:

To improve diagnostic sensitivity of RCM image diagnosis using a double reader concordance evaluation approach; to reduce mismanagement of equivocal cutaneous lesions in retrospective consultation and telemedicine settings.

METHODS:

1000 combined dermoscopy-RCM image sets were evaluated in blind by 10 readers with advanced training and internship in dermoscopy and RCM evaluation. We compared sensitivity and specificity of single reader evaluation versus double reader concordance evaluation as well as the effect of diagnostic confidence on lesion management in a retrospective setting.

RESULTS:

Single reader evaluation resulted in an overall sensitivity of 95.2% and specificity of 76.3%, with misdiagnosis of 8 melanomas, 4 basal cell carcinomas and 2 squamous cell carcinomas. Combined double reader evaluation resulted in an overall sensitivity of 98.3% and specificity of 65.5%, with misdiagnosis of 1 in-situ melanoma and 2 basal cell carcinomas.

CONCLUSION:

Evaluation of dermoscopy-RCM image sets of cutaneous lesions by single reader evaluation in retrospective settings is limited by sensitivity levels that may result in potential mismanagement of malignant lesions. Double reader blind concordance evaluation may improve the sensitivity of diagnosis and management safety. The use of a second check can be implemented in telemedicine settings where expert consultation and second opinions may be required.

https://www.ncbi.nlm.nih.gov/pubmed/29121636

#josepmalvehy  #carcinomabasocelular  #dermatoscopy #confocal #cancerdepiel #confocalinvivo, #microscopy #cutaneousmelanoma #squamouscellcarcinomas #carcinomas  #melanomas #reflectanceconfocal #telemedicine