Clinical and dermoscopic variation of basal cell carcinoma according to age of onset and anatomic location: a multicenter, retrospective study.

Basal cell carcinoma (BCC) is rare in young individuals and reported to possess different pathogenetic, clinical and histological features from late-onset BCC. However, the dermoscopic variability of BCC according to age of onset has not been investigated. Anatomic location was revealed to be associated with dermoscopic variation of BCC in Western population, but whether it applies to Asian population remains unknown. We evaluated the clinical and dermoscopic features of 448 BCCs and compared each feature by age of onset (age < 50/ > 50 years) and anatomic location. Early-onset BCCs occurred more frequently on non-sun-exposed sites (OR 3.28, P = 0.001) and were less pigmented than late-onset BCCs (P = 0.003). Blue-gray globules (OR 1.74, P = 0.037) and no vessels (OR 2.04, P = 0.021) were independently associated with early-onset BCCs, whereas arborizing telangiectasia (OR 0.30, P < 0.001), large blue-gray ovoid nests (OR 0.38, P < 0.001) and ulceration (OR 0.33, P < 0.001) were less common in early-onset BCCs. Scalp BCCs were significantly more pigmented than BCCs located elsewhere (P = 0.022). Superficial subtype (OR 5.90, P < 0.001), spoke-wheel areas (OR 4.78, P = 0.034), superficial erosions (OR 4.69, P = 0.003) and polymorph vessels (OR 6.86, P = 0.001) were independently associated with trunk BCCs, whereas nodular subtype (OR 5.48, P < 0.001) and arborizing telangiectasias (OR 3.64, P < 0.001) with BCCs on face and neck. Our findings suggest that age of onset and anatomic location are independent factors affecting the dermoscopic appearance of BCC.

Summarization and comparison of dermoscopic features on different subtypes of rosacea.

BACKGROUND: The dermoscopic features of rosacea have already been reported. However, the current findings are incomplete, and little is known about phymatous rosacea. Hence, this study aimed to summarize and compare the dermoscopic features and patterns of three rosacea subtypes (erythematotelangiectatic [ETR], papulopustular [PPR], and phymatous [PHR]) in the Chinese Han population and to evaluate whether these features differ with patients' genders, ages, and durations. METHODS: Dermoscopic images of 87 rosacea patients were collected in non-polarized and polarized dermoscopy contact modes at 20-fold magnification. Dermoscopic features, including vessels, scales, follicular findings, and other structures, were summarized and evaluated. RESULTS: The reticular linear vessels and red diffuse structureless areas of ETR were distinctive. For PPR, red diffuse structureless areas, reticular linear vessels, yellow scales, follicular plugs, and follicular pustules were typical dermoscopic criteria. The common dermoscopic features of PHR were: orange diffuse structureless areas, linear vessels with branches, perifollicular white color, orange focal structureless areas, and white lines. The following features statistically differed among the three rosacea subtypes: reticular linear vessels ( P  < 0.001), unspecific linear vessels ( P  = 0.005), linear vessels with branches ( P  < 0.001), yellow scales ( P  = 0.001), follicular plugs ( P  < 0.001), perifollicular white color ( P  < 0.001), red diffuse structureless areas ( P  = 0.022), orange diffuse structureless areas ( P  < 0.001), red focal structureless areas ( P  = 0.002), orange focal structureless areas ( P  = 0.003), white lines ( P  < 0.001), follicular pustules ( P  < 0.001), and black vellus hairs ( P  < 0.001). CONCLUSIONS: The dermoscopic patterns of ETR are red diffuse structureless areas and reticular linear vessels. For PPR, the pattern comprehends combinations of red diffuse structureless areas, reticular linear vessels, yellow scales, follicular plugs, and follicular pustules. Meanwhile, PHR is characterized by remarkable orange diffuse structureless areas, linear vessels with branches, perifollicular white color, orange focal structureless areas, and white lines.

Diagnostic capacity of skin tumor artificial intelligence-assisted decision-making software in real-world clinical settings.

BACKGROUND: Youzhi artificial intelligence (AI) software is the AI-assisted decision-making system for diagnosing skin tumors. The high diagnostic accuracy of Youzhi AI software was previously validated in specific datasets. The objective of this study was to compare the performance of diagnostic capacity between Youzhi AI software and dermatologists in real-world clinical settings. METHODS: A total of 106 patients who underwent skin tumor resection in the Dermatology Department of China-Japan Friendship Hospital from July 2017 to June 2019 and were confirmed as skin tumors by pathological biopsy were selected. Dermoscopy and clinical images of 106 patients were diagnosed by Youzhi AI software and dermatologists at different dermoscopy diagnostic levels. The primary outcome was to compare the diagnostic accuracy of the Youzhi AI software with that of dermatologists and that measured in the laboratory using specific data sets. The secondary results included the sensitivity, specificity, positive predictive value, negative predictive value, F-measure, and Matthews correlation coefficient of Youzhi AI software in the real-world. RESULTS: The diagnostic accuracy of Youzhi AI software in real-world clinical settings was lower than that of the laboratory data (P < 0.001). The output result of Youzhi AI software has good stability after several tests. Youzhi AI software diagnosed benign and malignant diseases by recognizing dermoscopic images and diagnosed disease types with higher diagnostic accuracy than by recognizing clinical images (P = 0.008, P = 0.016, respectively). Compared with dermatologists, Youzhi AI software was more accurate in the diagnosis of skin tumor types through the recognition of dermoscopic images (P = 0.01). By evaluating the diagnostic performance of dermatologists under different modes, the diagnostic accuracy of dermatologists in diagnosing disease types by matching dermoscopic and clinical images was significantly higher than that by identifying dermoscopic and clinical images in random sequence (P = 0.022). The diagnostic accuracy of dermatologists in the diagnosis of benign and malignant diseases by recognizing dermoscopic images was significantly higher than that by recognizing clinical images (P = 0.010). CONCLUSION: The diagnostic accuracy of Youzhi AI software for skin tumors in real-world clinical settings was not as high as that of using special data sets in the laboratory. However, there was no significant difference between the diagnostic capacity of Youzhi AI software and the average diagnostic capacity of dermatologists. It can provide assistant diagnostic decisions for dermatologists in the current state.

Web-based study on Chinese dermatologists' attitudes towards artificial intelligence.

BACKGROUND: Artificial intelligence (AI) has become a powerful tool and is attracting more attention in the field of medicine. There are a number of AI studies focusing on skin diseases, and there are many AI products that have been applied in dermatology. However, the attitudes of dermatologists, specifically those from China, towards AI, is not clear as few, if any studies have focused on this issue. METHODS: A web-based questionnaire was designed by experts from the Chinese Skin Image Database (CSID) and published on the UMER Doctor platform (an online learning platform for dermatologists developed by the Shanghai Wheat Color Intelligent Technology Company, China). A total of 1,228 Chinese dermatologists were recruited and provided answers to the questionnaire online. The differences of dermatologists' attitudes towards AI among the different groups (stratified by age, gender, hospital level, education degree, professional title, and hospital ownership) were compared by using the Mann-Whitney U test and the Kruskal-Wallis H test. The correlations between stratified factors and dermatologists' attitudes towards AI were calculated by using the Spearman's rank correlation test. SPSS (version 22.0) was utilized for all analyses. A two-sided P value <0.05 was considered statistically significant in all analyses. RESULTS: A total of 1,228 Chinese dermatologists from 30 provinces, autonomous regions, municipalities, and other regions (including Hong Kong, Macau, and Taiwan) participated in this survey. The dermatologists who participated acquired AI-related information mainly through the Internet, meetings or forums, and 70.51% of participated dermatologists acquired AI-related information by two or more approaches. In total, 99.51% of participated dermatologists pay attention (general, passive-active, and active attention) to information pertaining to AI. Stratified analyses revealed statistically significant differences in their attention levels (unconcerned, general, passive-active, and active attention) to AI-related information by gender, hospital level, education degree, and professional title (P values ≤1.79E-02). In total, 95.36% of the participated dermatologists thought the role of AI to be in "assisting the daily diagnosis and treatment activities for dermatologists". Stratified analyses about the thought of AI roles (unconcerned, useless, assist, and replace) showed that there was no statistically significant difference except for the hospital level (P value =4.09E-03). The correlations between stratified factors with attention levels and the opinions of AI roles showed extremely weak correlations. Furthermore, 64.17% of participated dermatologists thought secondary hospitals in China are in most need of the application AI, and 91.78% of participated dermatologists thought the priority implementation of AI should be in skin tumors. CONCLUSIONS: The majority of Chinese dermatologists are interested in AI information and acquired information about AI through a variety of approaches. Nearly all dermatologists are attentive to information on AI and think the role of AI is in "assisting the daily diagnosis and treatment activities for dermatologists". Future AI implementation should be primarily focused on skin tumors and utilized in in secondary hospitals.

Dermoscopy in China: current status and future prospective.

OBJECTIVE: Dermoscopy is a useful technique for improving the diagnostic accuracy of various types of skin disorders. In China, dermoscopy has been widely accepted, and domestic researchers have made tremendous progress in the field of dermoscopy. The main purpose of this review is to summarize the current status of dermoscopy in China and identify its future directions. DATA SOURCES: Articles included in this review were obtained by searching the following databases: Wanfang, China National Knowledge Infrastructure, PubMed, and the Web of Science. We focused on research published before 2019 with keywords including dermoscopy, dermoscopic, dermoscope and trichoscopy. STUDY SELECTION: A total of 50 studies were selected. Of these studies, 20 studies were in Chinese and 30 in English, research samples of all the studies were collected from Chinese populations. RESULTS: Since 2000, more than 380 articles about dermoscopy have been published in domestic or foreign journals. Dermoscopy can improve the diagnostic accuracy of neoplastic diseases, evaluating the therapeutic effect of treatment, and determining the treatment endpoint, and it can also assist in the differential diagnosis of inflammatory diseases and in the assessment of the severity of the disease. In addition, researches about the applications of dermoscopy during surgical treatment have been published. Training courses aiming to improve the diagnostic ability of dermatologists, either face-to-face or online, have been offered. The Chinese Skin Image Database, launched in 2017 as a work platform for dermatologists, has promoted the development of dermoscopy in China. Computer-aided diagnostic systems based on the Chinese population are ready for use. In the future, cooperation, resource sharing, talent development, image management, and computer-aided diagnosis will be important directions for the development of dermoscopy in China. CONCLUSION: Dermoscopy has been widely used and developed in China, however, it still needs to address more challenges in the future.

Melanoma Classification on Dermoscopy Images Using a Neural Network Ensemble Model.

We develop a novel method for classifying melanocytic tumors as benign or malignant by the analysis of digital dermoscopy images. The algorithm follows three steps: first, lesions are extracted using a self-generating neural network (SGNN); second, features descriptive of tumor color, texture and border are extracted; and third, lesion objects are classified using a classifier based on a neural network ensemble model. In clinical situations, lesions occur that are too large to be entirely contained within the dermoscopy image. To deal with this difficult presentation, new border features are proposed, which are able to effectively characterize border irregularities on both complete lesions and incomplete lesions. In our model, a network ensemble classifier is designed that combines back propagation (BP) neural networks with fuzzy neural networks to achieve improved performance. Experiments are carried out on two diverse dermoscopy databases that include images of both the xanthous and caucasian races. The results show that classification accuracy is greatly enhanced by the use of the new border features and the proposed classifier model.

Application-Driven No-Reference Quality Assessment for Dermoscopy Images With Multiple Distortions.

GOAL: Dermoscopy images often suffer from blur and uneven illumination distortions that occur during acquisition, which can adversely influence consequent automatic image analysis results on potential lesion objects. The purpose of this paper is to deploy an algorithm that can automatically assess the quality of dermoscopy images. Such an algorithm could be used to direct image recapture or correction. METHODS: We describe an application-driven no-reference image quality assessment (IQA) model for dermoscopy images affected by possibly multiple distortions. For this purpose, we created a multiple distortion dataset of dermoscopy images impaired by varying degrees of blur and uneven illumination. The basis of this model is two single distortion IQA metrics that are sensitive to blur and uneven illumination, respectively. The outputs of these two metrics are combined to predict the quality of multiply distorted dermoscopy images using a fuzzy neural network. Unlike traditional IQA algorithms, which use human subjective score as ground truth, here ground truth is driven by the application, and generated according to the degree of influence of the distortions on lesion analysis. RESULTS: The experimental results reveal that the proposed model delivers accurate and stable quality prediction results for dermoscopy images impaired by multiple distortions. CONCLUSION: The proposed model is effective for quality assessment of multiple distorted dermoscopy images. SIGNIFICANCE: An application-driven concept for IQA is introduced, and at the same time, a solution framework for the IQA of multiple distortions is proposed.

No-reference hair occlusion assessment for dermoscopy images based on distribution feature.

The presence of hair is a common quality problem for dermoscopy images, which may influence the accuracy of lesion analysis. In this paper, a novel no-reference hair occlusion assessment method is proposed according to the distribution feature of hairs in the dermoscopy image. Firstly, the image is adaptively enhanced by simple linear iterative clustering (SLIC) combined with isotropic nonlinear filtering (INF). Then, hairs are extracted from the image by an automatic threshold and meanwhile the postprocessing is used to refine the hair through re-extracting omissive hairs and filtering false hairs. Finally, the degree of hair occlusion is evaluated by an objective metric based on the hair distribution. A series of experiments was carried out on both simulated images and real images. The result shows that the proposed local adaptive hair detection method can work well on both sparse hair and dense hair, and the designed metric can effectively evaluate the degree of hair occlusion.

Cutis laxa: analysis of metalloproteinases and extracellular matrix expression by immunohistochemistry and histochemistry.

Upregulation of matrix metalloproteinases (MMPs) and downregulation of tissue inhibitors of metalloproteinases (TIMP) have been reported in cultured fibroblasts from patients with congenital cutis laxa (CL) or anetoderma. We determined the protein expressions of MMP-1, MMP-2, MMP-3, MMP-9, MMP-12, TIMP-1 and collagen I, collagen III in vivo, to confirm their roles in the pathogenesis of cutis laxa. The protein expression of the MMPs and collagens from skin lesions of CL were detected by immunohistochemistry and analyzed by image analysis software. Markedly increased MMP-1, MMP-2, MMP-3, MMP-9, MMP-12, TIMP-1 associated with alteration of elastic and collagen fibers were found in two cases of CL, whereas increased MMP-3, MMP-9, MMP-12 accompanying a degradation of elastic fibers were detected in the third case. These results suggest an elevated expression of MMPs may play a role in the evolution or genesis of CL.

Effects of intense pulsed light and ultraviolet A on metalloproteinases and extracellular matrix expression in human skin.

OBJECTIVE: The aim of this study was to evaluate the effects of intense pulsed light (IPL) and ultraviolet A (UVA) irradiation on the expression of matrix metalloproteases (MMPs), tissue inhibitor of metalloproteinase 1 (TIMP-1), and extracellular matrix (ECM) in human skin, and to confirm the relative mechanism. BACKGROUND DATA: IPL has been widely used to treat photoaged skin but the underlying mechanism remains unknown. METHODS: Human buttock skin was irradiated by repetitive suberythemal doses of UVA and therapeutic doses of IPL. Skin biopsies were taken and the protein/mRNA expression of MMP-1, -3, -9, and -12 and TIMP-1 was examined by immunohistochemistry, image analysis, and real-time quantitative polymerase chain reaction (qRT-PCR). RESULTS: Compared with normal control skin, both IPL and UVA irradiation induced a general elevation of MMP-1, -3, -9, and -12 and TIMP-1 at protein/mRNA levels, with some differences in the MMP expression patterns, e.g., a remarkable increase of MMP-1, -3, and -12 in UVA-exposed skin, while lower MMP-1, -3, and -12 (p < 0.01, p < 0.01, p < 0.01) but higher MMP-9 (p < 0.05) levels in IPL-irradiated skin. Meanwhile, increased collagen I fibers (p < 0.05) were observed in IPL-irradiated skin, whereas fragments of elastic fibers were found in UVA-exposed skin. CONCLUSION: These findings demonstrated that IPL has similar effects on the expression of MMPs/TIMP-1 in human skin to UVA, but the expression pattern differed from that in UVA-exposed skin, which may account for IPL's photorejuvenation effects.

MITF-siRNA formulation is a safe and effective therapy for human melasma.

It is unclear whether siRNA-based agents can be a safe and effective therapy for diseases. In this study, we demonstrate that microphthalmia-associated transcription factor-siRNA (MITF-siR)-silenced MITF gene expression effectively induced a significant reduction in tyrosinase (TYR), tyrosinase-related protein 1, and melanocortin 1 receptor (MC1R) levels. The siRNAs caused obvious inhibition of melanin synthesis and melanoma cell apoptosis. Using a novel type of transdermal peptide, we developed the formulation of an MITF-siR cream. Results demonstrated that hyperpigmented facial lesions of siRNA-treated subjects were significantly lighter after 12 weeks of therapy than before treatment (P < 0.001); overall improvement was first noted after 4 weeks of siRNA treatment. At the end of treatment, clinical and colorimetric evaluations demonstrated a 90.4% lightening of the siRNA-treated lesions toward normal skin color. The relative melanin contents in the lesions and adjacent normal skin were decreased by 26% and 7.4%, respectively, after treatment with the MITF-siR formulation. Topical application of siRNA formulation significantly lightens brown facial hypermelanosis and lightens normal skin in Asian individuals. This treatment represents a safe and effective therapy for melasma, suggesting that siRNA-based agents could be developed for treating other diseases such as melanoma.

PDE-based unsupervised repair of hair-occluded information in dermoscopy images of melanoma.

The repair of hair-occluded information is one of the key problems for the precise segmentation and analysis of the skin malignant melanoma image with hairs. Aimed at dermoscopy images of pigmented skin lesions, an unsupervised repair algorithm for the hair-occluded information is proposed in this paper. This algorithm includes three steps: first, the melanoma image with hairs are enhanced by morphologic closing-based top-hat operator and then segmented through statistic threshold; second, the hairs are extracted based on the elongate of connected region; third, the hair-occluded information is repaired by the PDE-based image inpainting. As a matter of fact, with the morphologic closing-based top-hat operator both strong and weak hairs can be enhanced simultaneously, and the elongate state of band-like connected region can be correctly described by the elongate function proposed in this paper so as to measure the hair effectively. Therefore, the unsupervised repair problem of the hair-occluded information can be resolved very well through combining the hair extracting with the image inpainting technology. The experiment results show that the repaired images can satisfy the requirement of medical diagnosis by the proposed algorithm and the segmentation veracity is effectively improved after repairing the hair-occluded information.

Cutaneous and systemic plasmacytosis: a Chinese case.

Cutaneous and systemic plasmacytosis (CSP) is an exceedingly rare condition arising primarily in patients of Japanese descent. Herein, we describe a patient of mainland Chinese origin suffering CSP. A 49-year-old Chinese male had asymptomatic brownish-red plaques and papules of the face and trunk for 6 years. Physical examination revealed innumerable symmetric red-brownish macules on face and trunk with fewer red-brownish papules scattered among the macules. Chemical analysis revealed hypergammaglobulinemia. Computerized tomography scan discovered some lymphadenopathy in the axillary, paratracheal and pulmonary regions. Histological examination showed focal perivascular and periadnexal infiltrate of mainly plasma cells in the superficial and deep dermis. Immunohistochemical study showed that a great number of the infiltrating cells were CD20-positive. The infiltrated polyclonal plasma cells expressed both kappa and lambda light chains. Topical therapy with tacrolimus 0.1% ointment for 2 months reduced the thickness and pigmentation of the facial skin lesions. The lesions resumed the original appearance 3 weeks after discontinuing the therapy. To the best of our knowledge, this is the first case of CSP from mainland China.