Validity of ABCD Rule of Dermoscopy in Clinical Practice.

The ABCD rule of dermoscopy was developed to facilitate the dermoscopic differentiation between benign and malignant melanocytic lesions. However, there is a lack of studies on its validity in clinical practice. The aim of this study was to evaluate the accuracy of the algorithm used bedside, compared with the accuracy of the preliminary preoperative diagnosis, and to rate physicians' level of confidence in the diagnosis. Melanocytic tumours were preoperatively scored bedside, according to the ABCD algorithm; 309 cases (46 melanomas and 263 naevi) were included. A sensitivity of 83% and specificity of 45% were found for the ABCD algorithm. A comparable sensitivity (74%), but a significantly higher specificity (91%), was found for the preliminary diagnosis. Interestingly, there was a considerable percentage (19.6%) of early melanomas for which a malignant diagnosis was not preoperatively expected, indicating that it is important to maintain generous indications for excision or to practise short-term follow-up of ambiguous lesions in order to detect early melanomas.

Diagnosis of pigmented skin tumours in a dermatological setting: different aspects of the number needed to excise as a measure of efficiency.

The increasing incidence of melanoma prompts a need for efficient management of this patient group. In this study, we use the number needed to excise (NNE), as a measurement of the efficiency of diagnosing melanoma. From January 2009 to December 2012, postoperative records from all patients were prospectively registered. All excised tumours with the histopathological diagnosis of naevus, melanoma or seborrhoeic keratosis were included. NNE values, both excluding and including seborrhoeic keratosis, changes over time, as well as patient- and tumour-related factors influencing NNE were determined. In total, 1,717 cases were included. The overall NNE value was 6.5, and the value fell significantly (r = 0.959, p = 0.041) during the 4-year study period from 8.2 to 4.8. NNE values decreased with increasing patient age to 1.8 in patients ≥ 80 years of age. The overall NNE value including seborrhoeic keratosis was 6.8.

Accuracy of clinical skin tumour diagnosis in a dermatological setting.

The aim of this study was to evaluate the accuracy of preoperative diagnosis of skin tumours in a dermatological setting. Patients undergoing skin surgery at the Department of Dermatology without preoperative biopsy were prospectively enrolled. Preoperatively, a single clinical diagnosis was registered. The histopathological diagnosis, performed after excision, was registered as the correct diagnosis. The sensitivity and positive predictive value of the clinical diagnosis were calculated. A total of 2,953 tumours were included. Altogether, 55.1% of the excised lesions were malignant. Excision margins for malignant tumours were free from tumour cells in 96.0% of cases. The sensitivity for diagnosis of malignant tumour was 98.0% and the positive predictive value was 85.3%. In line with previous studies, the sensitivity and positive predictive value were highest for basal cell carcinoma, 95.4% and 85.9%, respectively. For squamous cell carcinoma, the corresponding values were 68.0% and 67.3%, and for melanoma, 70.6% and 51.3%.

[Treatment of venous leg ulcers can be better and cheaper. Annual costs calculation based on an inquiry study]. / Venösa bensår kan behandlas både bättre och billigare. Beräkning av årliga kostnader baserad på en enkätstudie.

Weekly resource use data for local wound treatment was collected from a clinical survey (138 patients). Annual costs were calculated from the weekly resource usage multiplied by unit costs and published epidemiological prevalence data for Sweden. The average weekly cost was 101 euro, though it differed depending by ulcer size. The total direct annual cost of venous leg ulcers in Sweden could be estimated at 73 million euro (2002 prices, 1 euro = SEK 9.16) based on a point prevalence of 0.3 percent and 45 percent venous ulcers. Treatment of leg ulcers seems to have improved compared with previous reports, resulting in slightly decreased costs. Nevertheless, the costs are still substantial and the management of these patients requires large resources. A more structured management, more careful selection of dressing products and decreased frequency of dressing changes imply further improvements in wound healing and quality of life for patients and decreased costs for the health care system and for society.

Novel method for training skin flap surgery: polyurethane foam dressing used as a skin equivalent.

BACKGROUND: With a substantial rise in the incidence of skin cancer, skin surgery has become an increasingly large part of dermatology. Skin surgery is best performed by dermatologists. This demands effective training in dermatologic surgery, including flap surgery. OBJECTIVE: To find a modern alternative to traditional training on pig's feet skin in teaching flap surgery to residents in dermatology. MATERIALS AND METHODS: A face with expression lines printed on a nonadhesive hydrocellular polyurethane dressing (Allevyn, #66007638, 20 x 20 cm, Smith & Nephew Medical Limited, Hull, England). Tumors were marked in suitable locations, necessitating the use of transposition, advancement, and rotation flaps. Twenty-two residents were trained in flap construction, excision, and closure. RESULTS: Training on Allevyn was rated high by participants. CONCLUSION: Allevyn has unlimited storing qualities and skinlike qualities when incised, extended, and sutured. Sutures stay tight without the help of an assistant. Training on Allevyn gives students a good understanding of the mechanics of skin flaps, including transposition, advancement, and rotational flaps. The Allevyn is kept by the student after the course and can be studied afterward. Skin surgery training on Allevyn is superior to traditional training in pig's feet skin.

The role of vascular surgery in chronic leg ulcers: report from a specialized ulcer clinic.

Experience gained from cooperation between dermatologists and vascular surgeons in 177 patients evaluated at a joint leg ulcer clinic is reported. Patients were divided into two subgroups: (i) 86 patients with healed ulcers and (ii) 91 patients with ongoing therapy-resistant ulcers. Venous insufficiency was the most common etiology in both subgroups (87% and 55%, respectively). Of previous therapy-resistant ulcers, 71% were healed after the combined effort. The pattern of venous incompetence differed between the two subgroups; patients with isolated superficial disease constituting 68% and 26% of patients, respectively. In patients with therapy-resistant ulcers, those with isolated superficial venous insufficiency were found to have a better prognosis than those with deep venous insufficiency. Cooperation between the dermatologist and vascular surgeon is a mainstay in order to take advantage of the possibilities offered by modern vascular surgery.

Pinch grafting of chronic leg ulcers in primary care: fourteen years' experience.

Pinch grafting for treatment of chronic leg ulcers has been evaluated mainly in hospitalized and immobilized patients. This study describes the results of 199 pinch graft operations of 126 chronic leg and foot ulcers in 85 patients in primary care between 1987 and 2001. The aetiology of the ulcers was venous insufficiency in 43% and multi-factorial in 25% (77% with venous insufficiency as the main determinant). The mean ulcer size was 13.5 cm2 and the mean ulcer duration was 15.9 months. The overall healing rate within 3 months was 33%, ranging from 19% for multi-factorial or combined venous and arterial ulcers to 48% for venous ulcers. Within 12 months the overall healing rate was 60%, with 67% healed venous ulcers. The results from our study suggest that pinch grafting is suitable for treating chronic leg ulcers, especially venous ulcers, in primary care.