Accuracy of a smartphone application using fractal image analysis of pigmented moles compared to clinical diagnosis and histological result.

BACKGROUND: Lately, various smartphone applications have been introduced as diagnostic self-monitoring tools in the evaluation of pigmented moles, but most of these techniques have not been evaluated systematically. OBJECTIVES: The purpose of this study was to evaluate prospectively the sensitivity and specificity of a recently developed smartphone application using fractal image analysis for the risk evaluation algorithm in the diagnosis of malignant melanoma compared to clinical diagnosis and histopathological result. METHODS: Consecutive patients with melanocytic lesions were recruited and clinical and dermoscopical diagnosis was documented by two dermatologists independently. Imaging and analysis with the smartphone application was performed prior to excision of lesions. The findings were compared to the histological results as gold standard. RESULTS: Of 195 included lesions histopathological analysis revealed 40 melanomas, 42 dysplastic nevi and 113 benign nevi. The sensitivity of the diagnosis melanoma by fractal image analysis using smartphone images was 73%, the specificity was 83% compared to a sensitivity of 88% and specificity of 97% regarding the clinical diagnosis by the dermatologists. CONCLUSION: The smartphone application using fractal analysis might be a promising tool in the pre-evaluation of pigmented moles by laypersons, while it is to date inferior to the diagnostic evaluation by a dermatologist.

[Skin changes as signs of gastrointestinal disorders]. / Hautmanifestationen bei gastrointestinalen Erkrankungen.

In many gastrointestinal disorders associated skin diseases and cutaneous signs can be seen as first manifestations and make a diagnosis of the internal disease possible. Gastrointestinal disorders with characteristic skin lesions include various tumors, inflammatory and vascular diseases. Knowledge of the clinical presentations and their associations is important both for dermatologists and gastroenterologists.

Ex vivo high-definition optical coherence tomography of basal cell carcinoma compared to frozen-section histology in micrographic surgery: a pilot study.

BACKGROUND: Micrographic surgery is an established, but time-consuming operating procedure for facial basal cell carcinoma (BCC). A new high-definition (HD) optical coherence tomography (OCT) with high lateral and axial resolution in a horizontal (en-face) and vertical (slice) imaging mode allows a fast and non-invasive in vivo examination of BCC. OBJECTIVES: To compare the diagnosis of BCC in excised tissue ex vivo by high-definition optical coherence tomography (HD-OCT) with the findings of frozen-section histology in micrographic surgery. METHODS: Twenty freshly excised BCC were examined by HD-OCT in the en-face and slice imaging mode divided into four sections each in concordance with the four excision margins of histography, and subsequently processed for conventional micrographic evaluation. RESULTS: A total of 80 HD-OCT images of 20 BCCs were evaluated and in 45% (9/20) HD-OCT correlated perfectly with the histography results. The sensitivity and specificity for the 80 evaluated HD-OCT images were 74% and 64% respectively. CONCLUSIONS: High-definition optical coherence tomography allows the postoperative identification of BCC in excised tissue ex vivo, but has still limitations in the recognition of tumour margins in comparison with the micrographic evaluation of frozen sections.

[Perioperative antibiotic prophylaxis in dermatologic surgery. Update 2009]. / Perioperative Antibiotikaprophylaxe in der Dermatochirurgie. Update 2009.

As specific data and studies concerning perioperative antibiotic prophylaxis in dermatologic surgery are scarce, recommendations to date mainly draw on findings from other medical disciplines and use them analogously. Three main factors are essential in the decision process: 1st How contaminated is the wound (or will it be)? 2nd Where is the lesion located and what kind of procedure is intended? 3rd Is the patient among the highest risk group for endocarditis? An algorithm is presented incorporating these key features. The preferred antibiotic for perioperative prophylaxis is a first generation or second generation oral cephalosporin, a beta-lactamase resistant penicillin (isoxazolyl penicillin) or amoxicillin/clavulanic acid. The prophylaxis is administered in the highest possible single dose within 2 hours before and 3 hours after surgery. Penicillin or cephalosporin can be substituted with clindamycin or erythromycin in case of known drug allergies. There is insufficient data on the pros and cons of preoperative hair removal. Should hair removal be necessary, clipping is preferred to shaving.