Effectiveness of an image analyzing AI-based Digital Health Technology to identify Non-Melanoma Skin Cancer and other skin lesions: results of the DERM-003 study.

Introduction: Identification of skin cancer by an Artificial Intelligence (AI)-based Digital Health Technology could help improve the triage and management of suspicious skin lesions. Methods: The DERM-003 study (NCT04116983) was a prospective, multi-center, single-arm, masked study that aimed to demonstrate the effectiveness of an AI as a Medical Device (AIaMD) to identify Squamous Cell Carcinoma (SCC), Basal Cell Carcinoma (BCC), pre-malignant and benign lesions from dermoscopic images of suspicious skin lesions. Suspicious skin lesions that were suitable for photography were photographed with 3 smartphone cameras (iPhone 6S, iPhone 11, Samsung 10) with a DL1 dermoscopic lens attachment. Dermatologists provided clinical diagnoses and histopathology results were obtained for biopsied lesions. Each image was assessed by the AIaMD and the output compared to the ground truth diagnosis. Results: 572 patients (49.5% female, mean age 68.5 years, 96.9% Fitzpatrick skin types I-III) were recruited from 4 UK NHS Trusts, providing images of 611 suspicious lesions. 395 (64.6%) lesions were biopsied; 47 (11%) were diagnosed as SCC and 184 (44%) as BCC. The AIaMD AUROC on images taken by iPhone 6S was 0.88 (95% CI: 0.83-0.93) for SCC and 0.87 (95% CI: 0.84-0.91) for BCC. For Samsung 10 the AUROCs were 0.85 (95% CI: 0.79-0.90) and 0.87 (95% CI, 0.83-0.90), and for the iPhone 11 they were 0.88 (95% CI, 0.84-0.93) and 0.89 (95% CI, 0.86-0.92) for SCC and BCC, respectively. Using pre-determined diagnostic thresholds on images taken on the iPhone 6S the AIaMD achieved a sensitivity and specificity of 98% (95% CI, 88-100%) and 38% (95% CI, 33-44%) for SCC; and 94% (95% CI, 90-97%) and 28% (95 CI, 21-35%) for BCC. All 16 lesions diagnosed as melanoma in the study were correctly classified by the AIaMD. Discussion: The AIaMD has the potential to support the timely diagnosis of malignant and premalignant skin lesions.

Menopause, skin and common dermatosis. Part 3: genital disorders.

Oestrogen plays a vital role in maintaining a normal vulvovaginal epithelium, vaginal lubrication, as well as a healthy microbiome to ensure an acidic pH. The decrease in oestrogen levels in women going through menopause results in both physiological and physical changes of the genitourinary system, and more specifically the vulva. We conducted a literature review on the effects of low oestrogen levels on the physiology and function of the vulva and the vulvovaginal epithelium. 'Genitourinary syndrome of menopause' (GSM) is the term used to describe the signs and symptoms of a low oestrogen state. The symptoms and signs of GSM can overlap or coexist with other vulval dermatoses. Expert opinion is needed to diagnose and manage vulval dermatoses in menopause. This article will discuss the signs and symptoms of GSM, as well as the different management options available. Other vulval dermatoses that can be affected by hypo-oestrogenism are also reviewed.

Menopause, skin and common dermatoses. Part 4: oral disorders.

The physiological impact of declining oestrogen levels during menopause has been well documented. We conducted a literature review to assess the impact of menopause on oral health. Falling oestrogen levels are associated with adverse effects on the gingival, oral and buccal epithelia. The symptoms prevalent in perimenopausal and postmenopausal women range from dry mouth to immune-mediated mucocutaneous disease and burning mouth syndrome. Our review has highlighted the need for further research into potential treatments for oral symptoms in menopause, particularly with regard to hormone replacement therapy.

Menopause, skin and common dermatoses. Part 1: hair disorders.

Menopause, which usually occurs between the age of 45 and 55 years, is associated with falling oestrogen levels due to ovarian follicle depletion. The impact on the cardiovascular system and bone density are well documented; however, further research required to establish the impact on the skin and hair. In this first part of a four-part review, we examine the effect of menopause on the hair. We performed a literature review on dermatology and hair in menopause. Androgens and oestrogens are involved with regulation of the hair cycle, with a reduction in anagen hairs seen in postmenopausal women. Female pattern hair loss and frontal fibrosing alopecia have both been associated with the perimenopausal and postmenopausal states. It is clear that menopause and the change in hormone levels have an impact on the hair cycle and common hair conditions. However, further research is required, particularly to understand the therapeutic targets and role of hormonal therapy.

Menopause, skin and common dermatoses. Part 2: skin disorders.

In this second part of a four-part review, we examine the effect of menopause on the skin. Menopause and the associated hypo-oestrogenic state have implications for the structure and function of the skin. We performed a literature review to investigate the impact of the menopause on common dermatoses. There is evidence that oestrogen is implicated in transepidermal water loss and reduction in dermal collagen. There are associations with menopause and multiple common dermatoses, including xerosis and pruritus, hidradenitis suppurativa and psoriasis. Menopause has a clear impact on the skin and common dermatological conditions. Further research to understand the mechanisms and explore therapeutic options is needed.

"DLQI Seems to be 'Action', and Skindex-29 Seems to be 'Emotion'": Qualitative Study of the Perceptions of Patients with Psoriasis or Eczema on Two Common Dermatology-specific Quality of Life Measures.

Little is known about which quality of life measure best captures the lived experience of people with a chronic skin condition. The purpose of this study was to explore patients' views on the Dermatology Life Quality Index (DLQI) and Skindex-29. Participants were adults (n = 28) with a diagnosis of eczema or psoriasis who completed the DLQI and the Skindex-29 before being interviewed about the content and format of these questionnaires. Interviews were analysed using content analysis. Participants were generally satisfied with length and layout of both questionnaires. However, the majority preferred the Skindex-29 for its ease of understanding, use of a longer recall period and incorporation of items on a variety of emotions. Participants reported both questionnaires failing to incorporate important aspects of their lives, for instance impact on professional relationships. Participants voiced limitations in both measures but overall felt Skindex-29 better captured their lived experience.

Dermatologic Surgery and Reconstruction Photograph Booklet as a Tool to Improve Informed Consent Before Skin Surgery.

BACKGROUND: Skin surgery is a high-risk area of litigation and tools to improve consent are welcomed. OBJECTIVE: This project aimed to strengthen the consenting process for dermatological surgery by introducing a photograph booklet. MATERIALS AND METHODS: The authors designed a booklet containing skin surgery images. Patients attending surgery completed an anonymous questionnaire immediately after their procedures before the booklet introduction (Group 1). The questionnaire was then repeated (Group 2) with the introduction of the photograph booklet during consent. The authors looked for changes in the following: understanding of procedure, scar, and postoperative care as well as addressing of patients' concerns using a subjective scale of 1 to 5 (1 = poor, 2 = fair, 3 = okay, 4 = good, and 5 = great). RESULTS: Results indicated greater patient satisfaction among patients in Group 2 who had been shown relevant surgical images compared with Group 1, with improvements from ratings of 3 and 4 on the scale to 5. The difference in the 2 groups for the highest ratings of 5/5 was significant (p < .05) for understanding of procedure and resulting scars. CONCLUSION: The use of photograph booklets containing simple and relevant images to support the consent process for dermatologic surgery improves patients' understanding, expectations, and experience of skin surgery.