Melanoma diagnosis: predictive value of macroscopic changes observed by the patient.

About half of the melanomas are detected by patients but the mean thickness of such melanomas is higher than when diagnosed by physicians. Symptoms and signs described by patients are dynamic changes and pruritus, the appearance of a new lesion having been rarely investigated. These observations are documented for melanomas but not for benign naevi. To the best of our knowledge, this is the first study in which both melanomas and suspected excised naevi were included. The main objectives were to (a) analyse the value of the anamnestic predictors for melanoma versus non-melanoma and (b) calculate the influence of age on the most significant anamnestic predictors. In order to reach these objectives, we prospectively collected data on symptoms (pruritus, anxiety) and signs (de novo appearance, dynamic changes and bleeding) described by patients undergoing the excision of lesions clinically diagnosed as melanocytic and considered as suspicious by 46 Belgian dermatologists. Among 1865 lesions, dynamic changes and de novo appearance were significant predictors for melanoma versus non-melanoma diagnosis in all patients and patients older than 50, respectively. More precisely, dynamic changes and de novo appearance occurred to be strong predictors for melanoma diagnosis in patients greater than 41.5 and greater than 44.5 years, respectively. Pruritus was not significant for melanoma diagnosis. As a conclusion, when mid-age or older patients observe melanocytic lesions as recently changed or newly appeared, such lesions should be considered more carefully than when observed by young patients.

Selective use of sequential digital dermoscopy imaging allows a cost reduction in the melanoma detection process: a belgian study of patients with a single or a small number of atypical nevi.

BACKGROUND: Dermoscopy is a technique which improves melanoma detection. Optical dermoscopy uses a handheld optical device to observe the skin lesions without recording the images. Sequential digital dermoscopy imaging (SDDI) allows storage of the pictures and their comparison over time. Few studies have compared optical dermoscopy and SDDI from an economic perspective. OBJECTIVE: The present observational study focused on patients with one-to-three atypical melanocytic lesions, i.e. lesions considered as suspicious by optical dermoscopy. It aimed to calculate the "extra-costs" related to the process of melanoma detection. These extra-costs were defined as the costs of excision and pathology of benign lesions and/or the costs of follow-up by SDDI. The objective was to compare these extra-costs when using optical dermoscopy exclusively versus optical dermoscopy with selective use of SDDI. METHODS: In a first group of patients, dermatologists were adequately trained in optical dermoscopy but worked without access to SDDI. They excised all suspicious lesions to rule out melanoma. In a second group, the dermatologists were trained in optical and digital dermoscopy. They had the opportunity of choosing between immediate excision or follow-up by SDDI (with delayed excision if significant change was observed). The comparison of extra-costs in both groups was made possible by a decision tree model and by the division of the extra-costs by the number of melanomas diagnosed in each group. Belgian official tariffs and charges were used. RESULTS: The extra-costs in the first and in the second group were respectively €1,613 and €1,052 per melanoma excised. The difference was statistically significant. CONCLUSIONS: Using the Belgian official tariffs and charges, we demonstrated that the selective use of SDDI for patients with one-to-three atypical melanocytic lesions resulted in a significant cost reduction.

Real-time PCR and DNA sequencing for detection and identification of Trichophyton rubrum as a cause of culture negative chronic granulomatous dermatophytosis.

A 31-year-old patient presented with a diagnosis of granulomatous dermatophytosis based on the clinical aspect of the lesions and the rare presence of hyphae on direct microscopic examination of clinical material. A chronic evolution and progression of the disease, its resistance to a wide range of antifungal agents, the occasional presence of hyphae on direct examination but consistently negative cultures over a 5-year period prompted the use of amplification-based DNA analyses of several successive swab samples or skin biopsies. DNA was extracted using a combination of two semi-automated DNA isolation methods (FastPrep preparation and NucliSENS lysis magnetic extraction method). Identification relied both on sequence analysis of amplicons after SYBR Green real-time PCR of the panfungal internal transcribed spacer 1 (ITS1) genetic target, as well as the unique amplicon melting curve profile of positive samples. Accordingly, Trichophyton rubrum was unambiguously identified in several clinical samples collected over a 7-month period. This case illustrates the contribution of DNA-based assays applied directly to sample biopsies for identifying causative agents in cases in which fungal pathogens are highly suspected but culture are repeatedly negative. It also pinpoints the benefit of combining semi-automated DNA preparation methods, analysis of ITS1 amplicon melting curve profiles and sequence analysis on repeated skin biopsy samples for unambiguous identification of the causative fungal species.