Dermoscopy in Selected Latin American Countries: A Preliminary Look into Current Trends and Future Opportunities Among Dermatology Residency Programs.

INTRODUCTION: Skin cancer remains a global public health burden. Dermoscopy is a useful technique that aids in early detection and increases diagnostic accuracy with adequate training. However, dermoscopy is not uniformly taught to residents worldwide. Dermoscopy training in Latin American dermatology residency programs has not been explored. OBJECTIVES: To assess current dermoscopy training among dermatology residency programs in Latin America (eg training modalities, preferred/most effective modalities per residents, diseases/pathologies taught). METHODS: Cross-sectional survey distributed via e-mail between March and May 2021. Chief residents from Argentina, Brazil, Colombia, Costa Rica, Chile, Ecuador, Guatemala, Mexico, Panama, and Uruguay were invited to participate. RESULTS: 81 chief residents completed the questionnaire (81/126, 64.2%). Seventy-two percent of programs had an established dermoscopy curriculum, with dedicated hours of training varying greatly by program. Institutions commonly utilized sessions with "unknown" dermoscopy images and direct teaching by experts in the clinical setting as supplements to lectures, also described by residents as most effective. The most commonly taught methods included pattern analysis (74.1%), the two-step algorithm (61.7%), and the ABCD rule (59.3%). Almost all respondents reported desiring additional training during residency and believe that dermoscopy training should be a requirement to graduate from residency. CONCLUSIONS: This study highlights a preliminary look into current landscape in dermoscopy training among selected Latin American dermatology residency programs, demonstrating room for improvement and standardization in dermoscopic education and training. Our results serve as a baseline reference and provide valuable information to guide future educational initiatives incorporating successful teaching strategies (eg. spaced education/repetition, flipped classroom model) used in dermatology and other fields.

Birth cohort-specific trends of sun-related behaviors among individuals from an international consortium of melanoma-prone families.

BACKGROUND: Individuals from melanoma-prone families have similar or reduced sun-protective behaviors compared to the general population. Studies on trends in sun-related behaviors have been temporally and geographically limited. METHODS: Individuals from an international consortium of melanoma-prone families (GenoMEL) were retrospectively asked about sunscreen use, sun exposure (time spent outside), sunburns, and sunbed use at several timepoints over their lifetime. Generalized linear mixed models were used to examine the association between these outcomes and birth cohort defined by decade spans, after adjusting for covariates. RESULTS: A total of 2407 participants from 547 families across 17 centers were analyzed. Sunscreen use increased across subsequent birth cohorts, and although the likelihood of sunburns increased until the 1950s birth cohort, it decreased thereafter. Average sun exposure did not change across the birth cohorts, and the likelihood of sunbed use increased in more recent birth cohorts. We generally did not find any differences in sun-related behavior when comparing melanoma cases to non-cases. Melanoma cases had increased sunscreen use, decreased sun exposure, and decreased odds of sunburn and sunbed use after melanoma diagnosis compared to before diagnosis. CONCLUSIONS: Although sunscreen use has increased and the likelihood of sunburns has decreased in more recent birth cohorts, individuals in melanoma-prone families have not reduced their overall sun exposure and had an increased likelihood of sunbed use in more recent birth cohorts. These observations demonstrate partial improvements in melanoma prevention and suggest that additional intervention strategies may be needed to achieve optimal sun-protective behavior in melanoma-prone families.

Characterization of individuals at high risk of developing melanoma in Latin America: bases for genetic counseling in melanoma.

PURPOSE: CDKN2A is the main high-risk melanoma-susceptibility gene, but it has been poorly assessed in Latin America. We sought to analyze CDKN2A and MC1R in patients from Latin America with familial and sporadic multiple primary melanoma (SMP) and compare the data with those for patients from Spain to establish bases for melanoma genetic counseling in Latin America. METHODS: CDKN2A and MC1R were sequenced in 186 Latin American patients from Argentina, Brazil, Chile, Mexico, and Uruguay, and in 904 Spanish patients. Clinical and phenotypic data were obtained. RESULTS: Overall, 24 and 14% of melanoma-prone families in Latin America and Spain, respectively, had mutations in CDKN2A. Latin American families had CDKN2A mutations more frequently (P = 0.014) than Spanish ones. Of patients with SMP, 10% of those from Latin America and 8.5% of those from Spain had mutations in CDKN2A (P = 0.623). The most recurrent CDKN2A mutations were c.-34G>T and p.G101W. Latin American patients had fairer hair (P = 0.016) and skin (P < 0.001) and a higher prevalence of MC1R variants (P = 0.003) compared with Spanish patients. CONCLUSION: The inclusion criteria for genetic counseling of melanoma in Latin America may be the same criteria used in Spain, as suggested in areas with low to medium incidence, SMP with at least two melanomas, or families with at least two cases among first- or second-degree relatives.Genet Med 18 7, 727-736.

Near-visible light and UV photoprotection in the treatment of melasma: a double-blind randomized trial.

BACKGROUND: Melasma is an acquired hyperpigmentation on sun-exposed areas. Multiple approaches are used to treat it, but all include broad ultraviolet (UV)-spectrum sunscreens. Visible light (VL) can induce pigmentary changes similar to those caused by UV radiation on darker-skinned patients. OBJECTIVE: To assess the efficacy of sunscreen with broad-spectrum UV protection that contains iron oxide as a VL-absorbing pigment (UV-VL) compared with a regular UV-only broad-spectrum sunscreen for melasma patients exposed to intense solar conditions. METHODS: Sixty-eight patients with melasma were randomized in two groups to receive either UV-VL sunscreen or UV-only sunscreen, both with sun protection factor ≥ 50, over 8 weeks. All patients received 4% hydroquinone as a depigmenting treatment. At onset and at conclusion of the study, they were assessed by the Melasma Activity and Severity Index (MASI; a subjective scale), colorimetry (L*) and histological analysis of melanin. RESULTS: Sixty-one patients concluded the study. At 8 weeks, the UV-VL group showed 15%, 28% and 4% greater improvements than the UV-only group in MASI scores, colorimetric values and melanin assessments, respectively. CONCLUSIONS: UV-VL sunscreen enhances the depigmenting efficacy of hydroquinone compared with UV-only sunscreen in treatment of melasma. These findings suggest a role for VL in melasma pathogenesis.

Influence of time on dermoscopic diagnosis and management.

BACKGROUND/OBJECTIVES: Dermoscopy aids in clinical decision-making. However, time pressure is a common reason precluding its use. We evaluated the effect of time on lesion recognition and management decisions utilising clinical and dermoscopic images. METHOD: In all, 100 dermoscopic images were presented to 15 dermatologists with experience in dermoscopy and seven non-experts (dermatology residents). Each lesion was displayed thrice in succession. The dermoscopic image was initially presented for 1 s (t1). The same dermoscopic image was shown again without time constraints (t2) and then a final time with additional images of the clinical context (t3). Participants provided a diagnosis, their level of confidence and biopsy predilection after evaluating each image. RESULTS: For benign lesions, both groups rarely changed their diagnosis. However, an improvement in the number of correct benign diagnoses was observed when the lesion was shown in a clinical context. For malignant lesions, both groups improved when more time and clinical context was given; nevertheless, non-experts were more likely to change the diagnosis towards the correct one as more time was given and tended to perform more biopsies, in particular of benign lesions. Limitations were a small number of participants and an artificial study setting. CONCLUSION: Dermoscopy uses analytical and non-analytical reasoning approaches. We suggest that non-analytical reasoning is employed when rapid clinical decisions need to be made, especially during the evaluation of benign lesions. We conclude that dermoscopy is relatively rapid and non-time-consuming technique that adds relevant information and guides clinicians towards appropriate management decisions.

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.

[Dermoscopy findings in malignant skin melanoma with metastases. A case report]. / Dermatoscopia de las metástasis de melanoma maligno cutáneo. Informe de caso.

Melanoma is the result of the malignant transformation of normal melanocytes of the skin, which are responsible for the synthesis of melamine. It occupies the third place in frequency of skin cancer. Its incidence shows an annual increment of 3 to 7 % which varies in different populations. In our country the mortality is higher than the incidence due to the delayed diagnosis. We are reporting a case of a patient with fair skin who developed blue metastases that were indistinguishable from the characteristic pattern of blue nevi.

[The impact of dermoscopy in clinical practice]. / Impacto de la dermatoscopia en la práctica clínica.

For a long time, visual exploration has been the main strategy in dermatology. Melanoma diagnosis is established with symptoms like pruritus, scars and bleeding. The incidence of melanoma and its high mortality led to the use of dermoscopy, which has shown good results for identification, prevention and diagnosis of malign melanoma.

[Correlation among simple observation and dermoscopy in the study of pigmented lesions of the skin]. / Diagnóstico de lesiones pigmentadas de piel. Correlación entre observación simple y dermatoscopia.

INTRODUCTION: Dermoscopy began in 1663, and until 1971 was used to diagnose skin lesions. OBJECTIVE: To measure the correlation between simple observation and dermoscopy to diagnose pigmented skin lesions. METHODS: The study was conducted in Centro Médico Nacional La Raza. Sixty-eight patients with pigmented skin lesions were included. Participants were randomly examined by two dermatologists blinded to the study. Both dermatologists did simple observations and dermoscopy. Every participant was diagnosed using both procedures and by both doctors. A skin biopsy was obtained for pathological study. RESULTS: Kappa index of agreement to diagnose malignancy of the skin lesion between simple observation and histology was 0.69 (95 % CI 0.44, 0.93); the dermoscopy/histology Kappa index was 0.73 (95 % CI 0.60, 0.87). 75 % of positive results were obtained by using dermoscopy, compared to 63.9 % obtained by simple observation (p = 0.12). Simple observation and dermoscopy showed 94.44 % and 90.38 % sensitivity, specificity was 73.33 and 82.92 % and test accuracy was 84.84 and 87.09 % respectively. CONCLUSIONS: Dermoscopy is a non-invasive technique with acceptable specificity and superior than simple observation to diagnose pigmented skin lesions.

Ganglio centinela. Nuevo concepto en el manejo del melanoma maligno cutáneo / Sentinel lymph node in the malignant melanoma management

El tratamiento quirúrgico de pacientes con melanoma se ha revolucionado con el advenimiento del mapeo linfático y biopsia del ganglio centinela. Este procedimiento se lleva a cabo mediante la inyección de un marcador en el sitio del melanoma primario antes de su extirpación, el marcador llega vía linfática hasta el primer ganglio de drenaje o nodo centinela. El nodo es removido y evaluado para descartar la presencia de metástasis de melanoma. En este sentido, los pacientes serán seleccionados para una linfadenectomía regional. Además, la exactitud y mínima morbilidad de esta técnica permite identificar aquellos pacientes que serán beneficiados con terapia adyuvante. Nosotros reportamos los resultados obtenidos de un estudio clínico preliminar con este nuevo procedimiento.