Accuracy in melanoma detection: a 10-year multicenter survey.

BACKGROUND: Early excision is the only strategy to reduce melanoma mortality, but unnecessary excision of benign lesions increases morbidity and healthcare costs. OBJECTIVE: To assess accuracy in melanoma detection based on number-needed-to-excise (NNE) values over a 10-year period. METHODS: Information was retrieved on all histopathologically confirmed cutaneous melanomas or melanocytic nevi that were excised between 1998 and 2007 at participating clinics. NNE values were calculated by dividing the total number of excised lesions by the number of melanomas. Analyses included changes in NNE over time, differences in NNE between specialized clinical settings (SCS) versus non-specialized clinical settings (NSCS), and patient factors influencing NNE. RESULTS: The participating clinics contributed a total of 300,215 cases, including 17,172 melanomas and 283,043 melanocytic nevi. The overall NNE values achieved in SCS and NSCS in the 10-year period were 8.7 and 29.4, respectively. The NNE improved over time in SCS (from 12.8 to 6.8), but appeared unchanged in NSCS. Most of the effect on NNE in SCS was due to a greater number of excised melanomas. Higher NNE values were observed in patients younger than 40 years and for lesions located on the trunk. LIMITATIONS: No data concerning the use of dermatoscopy and digital monitoring procedures were collected from the participating centers. CONCLUSION: Over the 10-year study period, accuracy in melanoma detection improved only in specialized clinics maybe because of a larger use of new diagnostic techniques such as dermatoscopy.

The results of treatment of basoceltular carcinomas of the head skin.

INTRODUCTION: Basocellular skin carcinoma (BCC) is the most common cancer in the human population. BCC almost appeared at adult's people, but it can be found at children, too. THE AIM: The aim of this study was to determine which the position of BCC on the head skin is the most difficult for the treatment and what the reasons are for it. METHODS: With the prospective study, from June 2004 to June 2011, were compared the results of treatment of basocellular carcinomas (BCC) of the head skin. The examinees were divided into 3 groups. The first group, the group A (38 patients) was consisted of examinees treated of BCC on the nose. In the second group, the group B (42 patients) was classified of examinees treated of BCC on the face, temple, eyelids and forehead, while the third group, group C (35 patients) was classified of examinees treated of BCC on the scalp. The parameters for comparison the results of treatment were the method of treatment, number of the relapse, elapsed time from surgery to relapse and consequently defacement. RESULTS: There was found a statistical significant difference in terms of choice of methods of operative treatment for the significantly higher number of operations on the scalp operated with cutaneous transplants. It was confirmed that the localization of the tumors on the scalp, and then on the nose are with the highest incidence of the relapse, whereas the postoperative defacement is mostly on the scalp after skin graft placement. Key

Teledermoscopy for Skin Cancer Prevention: a Comparative Study of Clinical and Teledermoscopic Diagnosis.

INTRODUCTION: The number of newly diagnosed skin cancers per year is greater than the sum of the four most common cancers: breast, prostate, lung, and colon. The implementation of primary and secondary prevention measures, over the last 2 to 3 decades, has made a major contribution to successful treatment. AIM: Evaluate the accuracy and reliability of teledermoscopic versus clinical diagnosis for skin cancers when diagnostic algorithms are used, and when GPs and surgical specialties are involved in the clinical procedure. METHODS: Digital dermoscope (TS-DD, by Teleskin company) was used for the acquisition of teledermoscopic photographs and specialized teledermoscopic software was used for clinical examination and teledermoscopic consultation. The teledermoscopic procedure itself was performed in two steps. The first step was a clinical examination using the ABCDE rule with digital dermoscopic photography of the suspected lesion. The second step was a 2-step dermoscopic evaluation using the second step ABCD algorithm for the second step. Accuracy and diagnostic reliability were calculated for: teledermoscopic diagnosis versus histopathological diagnosis; clinical diagnosis versus histopathological diagnosis and teledermoscopic diagnosis versus clinical diagnosis. RESULTS: The study included 120 patients with 121 Pigmented Skin Lesions, of which 75 (62%) were benign and 46 (38%) were malignant lesions (6 melanomas and 40 NonMelanoma Skin Cancers). Diagnostic accuracy between teledermoscopic and histopathologic diagnosis was 90.91% and reliability k=0.81; between clinical and histopathological diagnosis the diagnostic accuracy was 82.64% and the reliability k=0.64 and between the clinical and teledermoscopic diagnosis the diagnostic accuracy was 81.82% and the reliability k=0.62. CONCLUSION: The achieved diagnostic accuracy between clinical and teledermoscopic diagnosis, when using diagnostic algorithms, establishes a feasible screening path for skin cancers and indicates that general practitioners and specialized surgeons may equally be involved in prevention.

Discrimination among melanoma, nevi, and normal skin by using synchronous luminescence spectroscopy.

Novel optical spectroscopy and imaging methods may be valuable in the early detection of cancer. This paper reports differences in the luminescence responses of pigmented skin lesions (melanomas and nevi) and apparently normal non-pigmented human skin, based on analyses of synchronous luminescence spectroscopy measurements. Measurements were performed in the excitation range of 330-545 nm, with synchronous intervals varying from 30-120 nm. Normal skin, nevi, and melanomas differ in the way they fluoresce, and these differences are more distinct in the synchronous fluorescence spectra than in the conventional emission and excitation spectra. The differences in the fluorescence characteristics of pigmented and normal skin samples were ascribed to differences in concentrations of endogenous fluorophores and chromophores. Principal component and linear discriminant analysis of the synchronous spectra measured at different synchronous intervals showed that the greatest variance among the sample groups was at the 70 nm interval spectra. These spectra were then used to create partial least squares discriminant analysis-based classification models. Evaluation of the quality of these models from the receiver operating characteristic curves showed they performed well, with a maximum value of 1 for the area under the curve for melanoma detection. Hence, synchronous luminescence spectroscopy coupled with statistical methods may be advantageous in the early detection of skin cancer.

The analysis of reasons for malignant skin tumors late diagnosis.

INTRODUCTION: Timely diagnosis is a prerequisite for the successful treatment of malignant skin tumors. Late diagnosis leads a patient into a situation of losing valuable time and chance for cure. MATERIAL AND METHODS: A prospective study was conducted from February 2006 until August 2011 which analyzed the reasons that led to establishing the diagnosis of malignant skin tumors in 220 patients. Patients were divided into two groups: Group A (102 patients), patients with diagnosed melanoma, and group B (118 patients) of patients suffering from basocellular (BCC) and planocellular cell (PCC) skin cancer. Parameters for comparison of analysis results were the reasons for coming to examination and reasons for not coming to the examination, because of which skin cancers were not diagnosed in time. GOAL: To determine the factors that influences the establishment of late diagnosis and treatment of skin tumors. RESULTS: It was confirmed that the prejudices of patients that tumors of the skin "should not be operated because it is dangerous" is the main reason for late diagnosis. At the same time it is confirmed that the belief that it is unnecessary to operate congenital changes of the skin is the second most important reason for delayed diagnosis of malignant skin tumors.