Evaluation of the Diagnostic Accuracy of an Online Artificial Intelligence Application for Skin Disease Diagnosis.

Artificial intelligence (AI) algorithms for automated classification of skin diseases are available to the consumer market. Studies of their diagnostic accuracy are rare. We assessed the diagnostic accuracy of an open-access AI application (Skin Image Search™) for recognition of skin diseases. Clinical images including tumours, infective and inflammatory skin diseases were collected at the Department of Dermatology at the Sahlgrenska University Hospital and uploaded for classification by the online application. The AI algorithm classified the images giving 5 differential diagnoses, which were then compared to the diagnoses made clinically by the dermatologists and/or histologically. We included 521 images portraying 26 diagnoses. The diagnostic accuracy was 56.4% for the top 5 suggested diagnoses and 22.8% when only considering the most probable diagnosis. The level of diagnostic accuracy varied considerably for diagnostic groups. The online application demonstrated low diagnostic accuracy compared to a dermatologist evaluation and needs further development.

Treatment of basal cell carcinoma in Scandinavia: evidence or eminence based?

BACKGROUND: Basal cell carcinoma (BCC) is a locally destructive form of skin cancer, mainly affecting Caucasians. There are multiple treatment options for BCC, with excisional surgery being most widely used. Choice of treatment may be dependent on clinical guidelines, local therapeutic traditions, and/or personal experience. Sweden is the only Scandinavian country with treatment guidelines for BCC. METHODS: Eighty-six dermatologists from Sweden, Denmark, and Norway that were attending a meeting on photodynamic therapy were presented case history and clinical photographs of nine different BCCs and asked to select their treatment of choice among multiple options by the use of an electronic audience response system. RESULTS: Treatment of choice differed substantially between dermatologists from the three countries. Swedish dermatologists more often chose excisional surgery (median 50%, range 0-90%) than their Danish (median 19%, range 0-44%) and Norwegian (median 35%, range 0-65%) colleagues. Very few Swedish dermatologists chose radiation therapy in the four cases where this was an option. Photodynamic therapy was more often selected by Norwegian dermatologists compared to Swedish and Danish dermatologists. CONCLUSIONS: The treatment choices of Swedish dermatologists in cases of BCC are generally in line with Swedish treatment guidelines. National treatment guidelines for BCC should be established in all countries, including Denmark and Norway.

Topical methyl aminolaevulinate photodynamic therapy versus cryotherapy for superficial basal cell carcinoma: a 5 year randomized trial.

This multicentre, randomized study compared photodynamic therapy using topical methyl aminolaevulinate (MAL PDT), a non-invasive modality, with cryotherapy for treatment of superficial basal cell carcinoma. Sixty patients with 114 lesions were treated with MAL cream (160 mg/g) applied for 3 hours before illumination (570-670 nm, light dose 75 J/cm) (1 session), and 58 with 105 lesions received cryotherapy (2 freeze-thaw cycles). Patients with an incomplete response at 3 months received 2 further MAL PDT sessions (n = 20) or repeat cryotherapy (n = 16). 100 lesions treated with MAL PDT and 93 lesions treated with cryotherapy were in complete response at 3 months after the last treatment and evaluable for recurrence over 5 years. There was no difference in 5-year recurrence rates with either treatment (20% with cryotherapy vs. 22% with MAL PDT, p = 0.86). However, more patients had an excellent cosmetic outcome with MAL PDT (60% vs. 16% with cryotherapy, p = 0.00078). These results provide support for the use of MAL PDT as a non-invasive, selective treatment alternative for primary superficial basal cell carcinoma.

A randomized multicenter study to compare two treatment regimens of topical methyl aminolevulinate (Metvix)-PDT in actinic keratosis of the face and scalp.

Photodynamic therapy (PDT) with topical methyl aminolevulinate (MAL) administered in two treatment sessions separated by 1 week is an effective treatment for actinic keratoses. This open prospective study compared the efficacy and safety of MAL-PDT given as a single treatment with two treatments of MAL-PDT 1 week apart. Two hundred and eleven patients with 413 thin to moderately thick actinic keratoses were randomized to either a single treatment with PDT using topical MAL (regimen I; n=105) or two treatments 1 week apart (regimen II; n=106). Each treatment involved surface debridement, application of Metvix cream (160 mg/g) for 3 h, followed by illumination with red light using a light-emitting diode system (peak wavelength 634+/-3 nm, light dose 37 J/cm2). Thirty-seven lesions (19%) with a non-complete response 3 months after a single treatment were re-treated. All patients were followed up 3 months after the last treatment. A total of 400 lesions, 198 initially treated once and 202 treated twice, were evaluable. Complete response rate for thin lesions after a single treatment was 93% (95% CI=87-97%), which was similar to 89% (82-96%) after repeated treatment. Response rates were lower after single treatment of thicker lesions (70% (60-78%) vs 84% (77-91%)), but improved after repeated treatment (88% (82-94%)). The conclusion of this study is that single treatment with topical MAL-PDT is effective for thin actinic keratosis lesions; however, repeated treatment is recommended for thicker or non-responding lesions.

[Increasing number of skin cancer cases--also among the younger]. / Antalet hudcancerfall ökar--även bland yngre. Allt fler behandlingsalternativ ger möjlighet till mindre destruktiva ingrepp.

The incidence of skin cancer has been increasing for several years. This is the case in malignant melanoma as well as in squamous cell carcinoma and basal cell carcinoma. Skin cancer is most common among the elderly, but is now also more frequently found in younger people. Surgery is often the treatment of choice and this is still the case in malignant melanoma and most cases of squamous cell carcinoma. For basal cell carcinoma, Bowen's disease and actinic keratoses, however, alternative treatments should be considered. Today, dermatologists can offer patients with skin cancer several new treatments besides surgery. These new treatments seem to have the same efficacy but better cosmetic results compared to earlier treatments.

Nd:YAG laser for effective treatment of multiple cylindroma of the scalp.

The case presented illustrates the successful effect of the Nd:YAG laser in the treatment of multiple giant scalp tumours in a patient who would not accept surgical excisions. A 60-year-old woman with multiple cylindroma covering the whole scalp area was treated with a Nd:YAG laser in a cutting continuous mode. Postoperative healing by second intention within 3-4 weeks left limited superficial scars. No tendency to relapse was noted during a follow-up of 4 years.