Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 21
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Australas J Dermatol ; 2020 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-32017030

RESUMO

BACKGROUND/OBJECTIVES: Basal cell carcinomas (BCCs) and cutaneous squamous cell carcinomas (SCCs) are the most commonly encountered cancers in fair-skinned populations worldwide. Perineural invasion is associated with worse outcomes for patients with BCC or SCC. Estimates of perineural invasion prevalence range widely, likely reflecting non-representative patient samples. We sought to determine the prevalence of perineural invasion in BCC and SCC in the general population, as well as among cancers arising in solid organ transplant recipients. METHODS: We retrospectively analysed histopathology reports of BCC and SCC from patients enrolled in the QSkin Study (a population-based cohort of 43 794 Queensland residents recruited 2010-2011) and the Skin Tumours in Allograft Recipients (STAR) study (a cohort of 509 high-risk kidney or liver transplant recipients at the Princess Alexandra Hospital, Brisbane, recruited 2012-2014.) We estimated the prevalence of perineural invasion (and 95% confidence interval) in BCC and SCC, respectively, and identified clinical factors associated with perineural invasion. RESULTS: In QSkin, we observed 35 instances of perineural invasion in 9850 histopathologically confirmed BCCs (0.36%) and 9 instances of perineural invasion in 3982 confirmed SCC (0.23%) lesions. In the STAR cohort, we identified 4 lesions with perineural invasion in 692 BCCs (0.58%) and 16 reports of perineural invasion in 875 SCC lesions (1.9%). CONCLUSIONS: These data suggest that the overall prevalence of perineural invasion in keratinocyte cancer is low, although perineural invasion prevalence may be slightly higher among organ transplant recipients when compared to the general population.

4.
Australas J Dermatol ; 58(4): 304-307, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29094336

RESUMO

BACKGROUND/OBJECTIVES: The management of dysplastic naevi based on histopathological grading is a contentious issue. Comprehensive management guidelines are lacking and the approach taken varies between clinicians. The authors sought to understand how Australian dermatologists approach the management of biopsy-proven dysplastic naevi, and the impact of grading of dysplasia upon this management. METHODS: In total, 547 Fellows of the Australasian College of Dermatologists were surveyed and 218 responses were collected (40% response rate). RESULTS: Although all dermatologists surveyed would re-excise an incompletely removed severely dysplastic naevus, opinion was divided over whether to treat such a lesion as an in situ melanoma or a dysplastic naevus, with 55% of respondents using a 5-mm margin and the remainder opting for narrow margin re-excision. When the same lesion was reported to be clear of margins by 1 mm after biopsy and the clinical suspicion for melanoma was high, 44% would re-excise with a 5-mm margin. CONCLUSIONS: The approach of Australian dermatologists to the management of dysplastic naevi varies between clinicians, reflecting the problems raised by the validity of histopathological grading.


Assuntos
Síndrome do Nevo Displásico/patologia , Síndrome do Nevo Displásico/cirurgia , Melanoma/patologia , Melanoma/cirurgia , Padrões de Prática Médica , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgia , Austrália , Dermatologia/métodos , Humanos , Margens de Excisão , Reoperação , Inquéritos e Questionários
5.
Australas J Dermatol ; 58(1): 25-29, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26113230

RESUMO

BACKGROUND/OBJECTIVES: Previous studies have shown that sunscreen usage, sun-protection measures and self-examination rates in patients with single primary melanomas (SPM) are similar to that in the general population. This study hypothesises that these rates would be different in a population with multiple primary melanomas (MPM). We further hypothesise that there would be a sex difference in melanoma location in patients with MPM. The objectives of this study were to determine skin protection measures, self-examinations and melanoma location in a cohort of patients with MPM. METHODS: A survey was conducted on 137 patients with MPM examining their sun-protection measures, skin self-examination rates and medical and phenotypic characteristics. These data were combined with a review of their medical records to examine the patients' skin cancer history. RESULTS: Patients with MPM had higher rates of skin self-evaluation (74% vs 22%), sunscreen usage (70% vs 45%) and other sun-protection measures (95% vs 46%) than has been published for patients with a history of a SPM. We have also shown that women have a higher risk of developing melanomas on their arms (p < 0.01) and lower legs (p < 0.05) than men. CONCLUSIONS: This report showed the rates of skin self-examination, sunscreen usage and other sun-protection methods in patients with MPM is higher than in studies of patients with SPM. It also highlighted sex differences in terms of melanoma location for patients with MPM. Further studies to examine the cause of the differences in these forms of protective behaviour could help improve the utilisation of these important preventative measures in all patients.


Assuntos
Comportamentos Relacionados com a Saúde , Melanoma/diagnóstico , Melanoma/psicologia , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias Primárias Múltiplas/psicologia , Autoexame , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/psicologia , Idoso , Braço , Cor de Olho , Feminino , Cor de Cabelo , Humanos , Perna (Membro) , Masculino , Melanoma/prevenção & controle , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/prevenção & controle , Roupa de Proteção , Autoexame/estatística & dados numéricos , Fatores Sexuais , Neoplasias Cutâneas/prevenção & controle , Protetores Solares/uso terapêutico , Inquéritos e Questionários
6.
Australas J Dermatol ; 57(1): 29-32, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25970074

RESUMO

BACKGROUND: Patients with a history of non-melanoma skin cancer (NMSC) have a 50% risk of developing subsequent NMSC.(13) Currently there are limited data on the association between multiple squamous cell carcinomas (SCC) and the risk of other cancers, including melanomas. OBJECTIVE: To assess the risk factors in a cohort of 210 Australians with a history of multiple invasive SCC, focusing on the association between multiple SCC and other cancers. METHODS: Data were collected from patients of a private practice in south-east Queensland. RESULTS: A fair complexion and childhood sun exposure were found to be common in this cohort. Approximately half the patients who had their first SCC at or before the age of 30 years subsequently developed a melanoma. There was also an increased risk of internal cancer, prostate cancer being the commonest, followed by bowel and breast cancer. CONCLUSION: Patients with a history of multiple invasive SCC should be aware of their increased risk of future NMSC and of melanomas. The results of thisstudy suggest such patients and their care providers should also consider an appropriate screening for internal malignancies.


Assuntos
Neoplasias da Mama/epidemiologia , Carcinoma de Células Escamosas/patologia , Neoplasias Colorretais/epidemiologia , Melanoma/epidemiologia , Neoplasias Primárias Múltiplas/patologia , Neoplasias da Próstata/epidemiologia , Neoplasias Cutâneas/patologia , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Carcinoma de Células Escamosas/epidemiologia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Neoplasias Primárias Múltiplas/epidemiologia , Fatores de Risco , Neoplasias Cutâneas/epidemiologia , Luz Solar
7.
Australas J Dermatol ; 57(1): 3-13, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25759949

RESUMO

Perineural invasion (PNI) occurring in non-melanoma skin cancers (NMSC) is associated with an increased risk of locoregional recurrence and reduced disease-free survival. This necessitates early and accurate diagnosis, appropriate risk-stratification and a clear management strategy. The diagnosis of PNI is based on careful clinical assessment, imaging and histopathology. Surgery, preferably with margin control, and definitive or adjuvant radiotherapy (ART) are established treatment strategies for PNI. Clinical uncertainty remains over the role of ART in incidental PNI. This review synthesises current literature to ascertain which clinicopathological features impart a higher risk to individuals with PNI in NMSC, in order to provide treatment algorithms, including the identification of patient subsets that are most likely to benefit from ART. This includes those with extratumoural PNI, involvement of larger-calibre nerves, tumour invasion beyond dermis, recurrent tumour or diffuse intratumoural spread. Patients with clinical PNI may be optimally managed by a multidisciplinary head and neck cancer service that is best placed to offer skull base surgery and intensity-modulated radiation therapy (IMRT). The management options presented are stratified by histological subtype and a new classification of PNI into low-risk, medium-risk and high-risk groups.


Assuntos
Carcinoma Basocelular/patologia , Carcinoma Basocelular/cirurgia , Carcinoma de Células Escamosas/cirurgia , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/cirurgia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgia , Algoritmos , Carcinoma Basocelular/radioterapia , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/secundário , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Invasividade Neoplásica , Nervos Periféricos/patologia , Radioterapia Adjuvante , Biópsia de Linfonodo Sentinela , Neoplasias Cutâneas/radioterapia
8.
Arch Dermatol Res ; 307(8): 741-5, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26103950

RESUMO

Melanoma incidence in Australia remains the highest in the world; hence understanding its causation is paramount for future therapeutic developments. Multiple primary melanomas are also common occurrences among the Australian population with identified risk factors such as personal and family history of melanoma, fair skin type, dysplastic naevus syndrome and history of significant ultraviolet exposure. The roles of both environmental and genetic factors have been elucidated in melanoma development, but the synergy of interactions between the two remains complex given the heterogeneous nature of the disease. We present a rare case of a 57-year-old female with 20 cutaneous melanomas and review the role of genetic and environmental factors in development of her multiple primary melanomas.


Assuntos
Inibidor p16 de Quinase Dependente de Ciclina/genética , Melanoma/genética , Neoplasias Primárias Múltiplas/genética , Receptor Tipo 1 de Melanocortina/genética , Neoplasias Cutâneas/genética , Austrália/epidemiologia , Feminino , Predisposição Genética para Doença , Humanos , Melanoma/epidemiologia , Melanoma/patologia , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/patologia , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/patologia
9.
Australas J Dermatol ; 56(4): e99-101, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24689840

RESUMO

We present a case of verruciform xanthoma ((VX) of the penis in an elderly man in whom an asymptomatic papule on his foreskin was noted during a routine clinical examination. VX is a rare, benign condition with a predilection for the oral cavity and clinically presents as isolated, painless mucosal lesions with a verrucoid surface. Accurate diagnosis is important in avoiding aggressive surgical management of this relatively rare condition.


Assuntos
Doenças do Pênis/diagnóstico , Dermatopatias/diagnóstico , Xantomatose/diagnóstico , Idoso , Austrália , Humanos , Masculino , Doenças do Pênis/patologia , Dermatopatias/patologia , Xantomatose/patologia
10.
Australas J Dermatol ; 55(2): 107-10, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24372092

RESUMO

This article by the Perineural Invasion (PNI) Registry Group aims to clarify clinical and histopathological ambiguities surrounding PNI in non-melanoma skin cancer (NMSC). PNI is reportedly present in approximately 2-6% of cases of NMSC and is associated with greater rates of morbidity and mortality. The distinction between clinical PNI and incidental PNI is somewhat unclear, especially in regard to management and prognosis. One important objective of the PNI Registry is to develop a standardised method of classifying perineural invasion. Hence, in this article we propose a definition for PNI and for its sub-classification. This article also provides a critical analysis of the current literature on the treatment of incidental PNI by evaluating the key cohort studies that have investigated the use of surgery or radiotherapy in the management of incidental PNI. At present, there are no universal clinical guidelines that specify the acceptable treatment of NMSC exhibiting incidental PNI. Consequently, patients often receive surgery with varying wider margins, or radiotherapy despite the limited evidence substantiating such management options. It is evident from the existing literature that current opinion is divided over the benefit of adjuvant radiotherapy. Certain prognostic factors have been proposed, such as the size and depth of tumour invasion, nerve diameter, the presence of multifocal PNI and the type of tumour. The PNI Registry is a web-based registry that has been developed to assist in attaining further data pertaining to incidental PNI in NMSC. It is envisaged that this information will provide the foundation for identifying and defining best practice in managing incidental PNI.


Assuntos
Carcinoma Basocelular/patologia , Carcinoma de Células Escamosas/patologia , Nervos Periféricos/patologia , Sistema de Registros , Neoplasias Cutâneas/patologia , Austrália , Carcinoma Basocelular/terapia , Carcinoma de Células Escamosas/terapia , Humanos , Invasividade Neoplásica/patologia , Pele/inervação , Neoplasias Cutâneas/terapia
11.
Australas J Dermatol ; 55(2): 142-4, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-23573958

RESUMO

Regions with high solar UV levels and high skin cancer rates may experience a greater incidence of malignancy in association with seborrhoeic keratoses (SebK) than in low UV regions. Previous reports have indicated that basal cell carcinoma is the most common neoplasm with reported rates of up to 4 per cent of excised SebK. The rates of such compound lesions occurring in our practice were reviewed, indicating that Bowen's disease was the most frequently observed neoplasm with a rate of 7 per cent. In total, 10 per cent of all excised specimens showed either frank malignancy or some degree of atypia.


Assuntos
Doença de Bowen/patologia , Carcinoma Basocelular/patologia , Transformação Celular Neoplásica , Ceratose Seborreica/patologia , Neoplasias Induzidas por Radiação/patologia , Neoplasias Cutâneas/patologia , Raios Ultravioleta/efeitos adversos , Doença de Bowen/etiologia , Carcinoma Basocelular/etiologia , Transformação Celular Neoplásica/efeitos da radiação , Humanos , Ceratose Actínica/patologia , Queensland , Estudos Retrospectivos , Neoplasias Cutâneas/etiologia
12.
Arch Dermatol Res ; 305(9): 851-6, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23740369

RESUMO

Melanoma is a multifactorial disease with a strong genetic component and known risk factors such as excessive ultraviolet exposure, intermittent sunburns and fair skin type. The prognosis is poor if diagnosis is delayed, in spite of recent treatment advances. Evidence is mounting that the incidence of melanoma is higher in the immunosuppressed and individuals with highly stressful occupations. We present a case series of individuals diagnosed with multiple cutaneous melanomas over a few months to 1 year. All had encountered psychological stressors in their lives, and the melanomas were diagnosed briefly after encountering these stressors. No known causes of immunosuppression were detected to explain the sporadic occurrence of melanomas in these individuals. There is evidence in the current literature that stress can lead to immune disregulation, predisposing an individual to various disease states including melanoma. Stress hormones such as norepinephrine have been shown to cause upregulation of cytokines such as Interleukin 6 and 8, which are proangiogenic and support tumour progression. Coupled with genetic and environmental factors, stress appears to play a role in melanoma formation and progression. Large prospective studies are required to study the link between stress and melanoma and gain further insight into the etiology of melanoma.


Assuntos
Síndrome do Nevo Displásico/etiologia , Melanoma/etiologia , Neoplasias Cutâneas/etiologia , Estresse Psicológico , Ansiedade , Síndrome do Nevo Displásico/imunologia , Feminino , Humanos , Interleucina-6/biossíntese , Interleucina-6/metabolismo , Interleucina-8/biossíntese , Interleucina-8/metabolismo , Masculino , Melanoma/imunologia , Pessoa de Meia-Idade , Fatores de Risco , Neoplasias Cutâneas/imunologia , Fator A de Crescimento do Endotélio Vascular/biossíntese , Fator A de Crescimento do Endotélio Vascular/metabolismo
13.
Cutis ; 85(6): 318-24, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20666194

RESUMO

We conducted a prospective, multicenter, phase 3, open-label study to assess long-term sustained clearance of superficial basal cell carcinomas (sBCCs) treated with imiquimod cream 5%. A biopsy-confirmed tumor (area > or = 0.5 cm2 and diameter < or = 2.0 cm) was treated once daily 7 times per week for 6 weeks. Participants with initial clinical clearance at 12 weeks posttreatment were followed for 60 months. Tumor recurrence, serious adverse events (AEs), local skin reactions (LSRs), and skin quality assessments (SQAs) were measured. The initial clearance rate was 94.1% (159/169). Estimated sustained clearance (proportion of participants who achieved initial clearance at the 12-week posttreatment visit and remained clinically clear at each time point during the long-term follow-up period; N=157) was 85.4% at 60 months (life-table method: 95% confidence interval [CI], 79.3%-91.6%). The overall estimate of treatment success was 80.4% at 60 months (N=169; 95% CI, 74.4%-86.4%). Of 20 recurrent tumors, 74 (70%) occurred within the first 24 months of follow-up. Local skin reactions and application site reactions, the AEs reported by the most participants, occurred predominantly during the treatment period and resolved posttreatment. Compared to baseline, investigator-assessed SQA scores for the target tumor site improved for skin surface abnormalities and hyperpigmentation, and worsened for hypopigmentation. For low-risk sBCCs, daily application of imiquimod for 6 weeks had high initial and 5-year sustained clearance rates.


Assuntos
Aminoquinolinas/uso terapêutico , Antineoplásicos/uso terapêutico , Carcinoma Basocelular/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Administração Cutânea , Aminoquinolinas/administração & dosagem , Aminoquinolinas/efeitos adversos , Antineoplásicos/administração & dosagem , Antineoplásicos/efeitos adversos , Carcinoma Basocelular/patologia , Seguimentos , Humanos , Imiquimode , Recidiva Local de Neoplasia , Estudos Prospectivos , Neoplasias Cutâneas/patologia , Resultado do Tratamento
14.
Australas J Dermatol ; 51(4): 254-7, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21198521

RESUMO

BACKGROUND: There are various known familial and environmental risk factors that influence the risk for melanoma. This study sought to define the risk factors for multiple primary melanoma. METHODS: A telephone survey of patients with multiple primary melanomas was conducted from a private practice in south-east Queensland, in order to examine various risk factors in this cohort. RESULTS: Our findings of high rates of family history of melanoma (37%), and of dysplastic naevi (42%) support the influence of genotype in this high-risk group. A family history of multiple primary melanomas, seen in 17% of our patients, is a risk factor not previously reported in similar cohort studies. Sixty-eight per cent of patients had an equal or lesser degree of invasive malignancy in subsequent melanomas. Most multiple primary melanoma patients in this group (86.6%) were conducting self skin examination at least once per month. With regards to sun-protective behaviour, 85% reported regular sunscreen use and 92% reported regular use of sun-protective clothing; however, fewer had done this in childhood. CONCLUSIONS: Enhanced knowledge of the genetic and environmental risk factors for multiple primary melanomas can assist clinicians in assessing risk and planning surveillance of patients.


Assuntos
Síndrome do Nevo Displásico/epidemiologia , Exposição Ambiental/prevenção & controle , Melanoma/epidemiologia , Linhagem , Lesões Pré-Cancerosas/epidemiologia , Neoplasias Cutâneas/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Basocelular/epidemiologia , Carcinoma de Células Escamosas/epidemiologia , Vestuário , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Prevalência , Queensland/epidemiologia , Fatores de Risco , Luz Solar , Protetores Solares , Adulto Jovem
16.
Australas J Dermatol ; 50(4): 261-5, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19916969

RESUMO

Currently, the National Health and Medical Research Council do not have any recommendations about the frequency of follow up after treatment of primary cutaneous invasive squamous cell cancer (SCC), due to a lack of data. The present study aimed to establish appropriate follow-up times and to determine the long-term risk of subsequent non-melanoma skin cancers and melanoma. Patients who had a primary invasive cutaneous SCC excised during 1996 were retrospectively identified from the databases of a dermatologist in private practice in south-east Queensland. Data on size, site, depth, differentiation, perineural involvement, lymphovascular involvement of the index SCC were obtained. The patients were regularly followed up and lymph-node involvement, patient immunocompetence, and the presence of local recurrences and subsequent SCC, basal cell carcinomas and melanoma were recorded. Forty patients were identified, comprising 25 men and 15 women with a mean age of 65 years. The majority (60%) of primary incident SCC were in the low-risk category. The median follow-up time was 7.5 years. One in two developed a second SCC within 5 years, a significant number had a second SCC detected only in 5-10 year follow up, and 72.5% had a BCC within 5 years, and 82.5% at 10 years. One in eight had a subsequent melanoma detected.


Assuntos
Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/patologia , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/patologia , Idoso , Feminino , Humanos , Masculino , Invasividade Neoplásica , Estudos Retrospectivos
17.
Australas J Dermatol ; 50(1): 64-5, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19178497

RESUMO

Primary cutaneous angioplasmocellular hyperplasia is a plasma-cellular infiltrate that has been reported only once previously in the literature, in a report of a case affecting two Latin American patients. In the present case, a systemically well 62-year-old Caucasian man presented with a nodule on the back of the neck. Histology showed a vascular proliferative process with an abundance of plasma cells in the stroma. There has been no recurrence of the lesion 2 years following curettage and diathermy. The clinicopathological presentation is consistent with primary cutaneous angioplasmocellular hyperplasia.


Assuntos
Vasos Sanguíneos/patologia , Pescoço/patologia , Plasmócitos/patologia , Dermatopatias Vasculares/diagnóstico , Dermatopatias Vasculares/terapia , Diagnóstico Diferencial , Diatermia/métodos , Epiderme/patologia , Fibrose , Humanos , Hiperplasia , Ceratose/patologia , Masculino , Pessoa de Meia-Idade , Dermatopatias Vasculares/patologia , Dermatopatias Vasculares/cirurgia , Resultado do Tratamento
18.
Australas J Dermatol ; 49(4): 242-4, 2008 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-18855792

RESUMO

We report a case of complex regional pain syndrome developing in a 57-year-old woman after minor skin surgery in the sole of her right foot. This was diagnosed and treated in its early phase with sympathetic blockade using guanethedine with complete recovery of symptoms.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Dermatologia , Pé/cirurgia , Distrofia Simpática Reflexa/etiologia , Bloqueio Nervoso Autônomo/métodos , Feminino , Guanetidina , Humanos , Injeções Intravenosas , Pessoa de Meia-Idade , Distrofia Simpática Reflexa/diagnóstico , Distrofia Simpática Reflexa/tratamento farmacológico , Simpatolíticos , Resultado do Tratamento
19.
Australas J Dermatol ; 47(2): 106-8, 2006 May.
Artigo em Inglês | MEDLINE | ID: mdl-16637805

RESUMO

A retrospective study of 813 histological specimens reported as seborrhoeic keratoses included 43 (5.3%) associated with non-melanoma skin cancer. Intraepidermal carcinoma (squamous cell carcinoma in situ) was the most common of these (36). There were five basal cell carcinomas (one with intraepidermal carcinoma also) and two invasive squamous cell carcinomas. No melanomas were reported. Twenty-seven of the intraepidermal carcinomas appeared to arise within the seborrhoeic keratosis as did one of the invasive squamous cell carcinomas. Of these 28 lesions, the head was the most common site. Fourteen were clinically diagnosed as a non-melanoma skin cancer with only nine clinically felt to be a seborrhoeic keratosis. These lesions may represent malignant transformation within the seborrhoeic keratosis. Twelve specimens reported adjacent dual pathologies, with the trunk and limbs the most common sites. Seven were diagnosed clinically as a skin malignancy, whereas three were thought to be solar keratoses. Clinically, the remaining two were seborrhoeic keratoses. The origin of the malignancy in these cases is less obvious and may represent collision tumours. Three curette specimens could not be assessed for architecture.


Assuntos
Ceratose Seborreica/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Basocelular/epidemiologia , Carcinoma Basocelular/etiologia , Carcinoma Basocelular/patologia , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/etiologia , Carcinoma de Células Escamosas/patologia , Transformação Celular Neoplásica , Feminino , Cabeça , Humanos , Ceratose Seborreica/etiologia , Ceratose Seborreica/patologia , Masculino , Registros Médicos , Pessoa de Meia-Idade , Lesões Pré-Cancerosas , Queensland/epidemiologia , Estudos Retrospectivos , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/etiologia , Neoplasias Cutâneas/patologia
20.
Arch Dermatol ; 141(11): 1388-96, 2005 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-16301386

RESUMO

OBJECTIVE: To describe the diagnostic performance of SolarScan (Polartechnics Ltd, Sydney, Australia), an automated instrument for the diagnosis of primary melanoma. DESIGN: Images from a data set of 2430 lesions (382 were melanomas; median Breslow thickness, 0.36 mm) were divided into a training set and an independent test set at a ratio of approximately 2:1. A diagnostic algorithm (absolute diagnosis of melanoma vs benign lesion and estimated probability of melanoma) was developed and its performance described on the test set. High-quality clinical and dermoscopy images with a detailed patient history for 78 lesions (13 of which were melanomas) from the test set were given to various clinicians to compare their diagnostic accuracy with that of SolarScan. SETTING: Seven specialist referral centers and 2 general practice skin cancer clinics from 3 continents. Comparison between clinician diagnosis and SolarScan diagnosis was by 3 dermoscopy experts, 4 dermatologists, 3 trainee dermatologists, and 3 general practitioners. PATIENTS: Images of the melanocytic lesions were obtained from patients who required either excision or digital monitoring to exclude malignancy. MAIN OUTCOME MEASURES: Sensitivity, specificity, the area under the receiver operator characteristic curve, median probability for the diagnosis of melanoma, a direct comparison of SolarScan with diagnoses performed by humans, and interinstrument and intrainstrument reproducibility. RESULTS: The melanocytic-only diagnostic model was highly reproducible in the test set and gave a sensitivity of 91% (95% confidence interval [CI], 86%-96%) and specificity of 68% (95% CI, 64%-72%) for melanoma. SolarScan had comparable or superior sensitivity and specificity (85% vs 65%) compared with those of experts (90% vs 59%), dermatologists (81% vs 60%), trainees (85% vs 36%; P =.06), and general practitioners (62% vs 63%). The intraclass correlation coefficient of intrainstrument repeatability was 0.86 (95% CI, 0.83-0.88), indicating an excellent repeatability. There was no significant interinstrument variation (P = .80). CONCLUSIONS: SolarScan is a robust diagnostic instrument for pigmented or partially pigmented melanocytic lesions of the skin. Preliminary data suggest that its performance is comparable or superior to that of a range of clinician groups. However, these findings should be confirmed in a formal clinical trial.


Assuntos
Dermoscopia/métodos , Melanoma/diagnóstico , Nevo Pigmentado/diagnóstico , Neoplasias Cutâneas/diagnóstico , Algoritmos , Austrália , Florida , Alemanha , Humanos , Processamento de Imagem Assistida por Computador/métodos , Registros Médicos , Melanoma/patologia , Nevo Pigmentado/patologia , Valor Preditivo dos Testes , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade , Neoplasias Cutâneas/patologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA