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1.
JAMA Dermatol ; 157(2): 189-197, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33404623

RESUMO

Importance: Dermoscopy education in US dermatology residency programs varies widely, and there is currently no existing expert consensus identifying what is most important for resident physicians to know. Objectives: To identify consensus-based learning constructs representing an appropriate foundational proficiency in dermoscopic image interpretation for dermatology resident physicians, including dermoscopic diagnoses, associated features, and representative teaching images. Defining these foundational proficiency learning constructs will facilitate further skill development in dermoscopic image interpretation to help residents achieve clinical proficiency. Design, Setting, and Participants: A 2-phase modified Delphi surveying technique was used to identify resident learning constructs in 3 sequential sets of surveys-diagnoses, features, and images. Expert panelists were recruited through an email distributed to the 32 members of the Pigmented Lesion Subcommittee of the Melanoma Prevention Working Group. Twenty-six (81%) opted to participate. Surveys were distributed using RedCAP software. Main Outcomes and Measures: Consensus on diagnoses, associated dermoscopic features, and representative teaching images reflective of a foundational proficiency in dermoscopic image interpretation for US dermatology resident physicians. Results: Twenty-six pigmented lesion and dermoscopy specialists completed 8 rounds of surveys, with 100% (26/26) response rate in all rounds. A final list of 32 diagnoses and 116 associated dermoscopic features was generated. Three hundred seventy-eight representative teaching images reached consensus with panelists. Conclusions and Relevance: Consensus achieved in this modified Delphi process identified common dermoscopic diagnoses, associated features, and representative teaching images reflective of a foundational proficiency in dermoscopic image interpretation for dermatology residency training. This list of validated objectives provides a consensus-based foundation of key learning points in dermoscopy to help resident physicians achieve clinical proficiency in dermoscopic image interpretation.

3.
J Am Board Fam Med ; 33(6): 1022-1024, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33219084

RESUMO

INTRODUCTION: Dermoscopy is a noninvasive, in vivo imaging technique that allows for the visualization of subsurface skin structures. In recent years, several education interventions have incorporated dermoscopy in the primary care setting to improve skin cancer detection. We aim to describe the perspectives, attitudes, and interest of primary care physicians (PCPs) regarding dermoscopy. METHODS: PCPs associated with academic institutions completed an anonymous survey emailed to faculty and resident listservs. The survey consisted of 23 questions related to dermoscopy. RESULTS: A total of 156 PCPs completed the questionnaire. Few PCPs reported having access to a dermatoscope (16%), using it regularly (9%), or having received training (15%). The most common reasons for not using a dermatoscope were the lack of access to the device (85%), followed by the lack of training (76%). However, the majority view dermoscopy as a valuable tool in primary care and are interested in receiving training (87%), particularly with a hands-on approach. CONCLUSION: Our sample of PCPs in the United States showed that although few use dermoscopy, most perceive it as a useful tool, particularly family medicine physicians. The main reported barriers preventing its use included the lack of training and poor access to dermatoscopes. The vast majority of PCPs in our sample want to be trained in dermoscopy, thereby providing an opportunity for educational initiatives that take into account the barriers and preferred learning strategies.

5.
J Am Acad Dermatol ; 82(6): 1551-1552, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32045619
6.
Iatreia ; 32(3): 184-190, Jul-Set. 2019. tab
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1039998

RESUMO

RESUMEN Antecedentes: el cáncer de piel es el más común en humanos y su incidencia continúa en aumento. La radiación ultravioleta (RUV) es el principal factor ambiental asociado con este cáncer. Los deportistas presentan un mayor riesgo para desarrollar cáncer de piel; sin embargo en nuestro país, hasta el momento, no se ha estudiado esta población. Objetivo general: describir las conductas de riesgo del cáncer de piel en deportistas del Valle de Aburrá, a través de una encuesta realizada en los centros más importantes de la región. Materiales y métodos: estudio de corte transversal descriptivo; se evaluaron variables sociodemográficas, clínicas y relacionadas con hábitos de fotoprotección. Según el tipo de variable, se usó media y desviación estándar o conteos absolutos y relativos. Resultados: se incluyeron 122 deportistas, la edad promedio del grupo estudiado fue de 20 años, el 56 % de los incluidos fueron hombres. El 74 % de los deportes se realizaban al aire libre, el fútbol fue el deporte más frecuente. El 75 % de los participantes entrenaba cuatro o más veces por semana y el 55 % lo hacía en horas con muy alta RUV. El 27 % de los deportistas reportó de 1 a 3 insolaciones en la infancia. La fotoprotección química se utilizaba con más frecuencia que la física. Conclusiones: este es el primer estudio realizado en Colombia que evidencia la necesidad de mejorar la educación en prevención primaria y secundaria sobre el cáncer de piel en esta población.


SUMMARY Background: Skin cancer is the most common cancer in humans and its incidence increases. Ultraviolet radiation (UVR) is the main environmental factor associated with this cancer. Athletes have a greater risk to develop skin cancer. Up to date in Colombia, this population has not been studied. Objective: To describe the behaviors and photoprotection measures in athletes of Valle de Aburrá. Materials and methods: Cross sectional study. Sociodemographic, clinical variables and related to photoprotective habits were evaluated. Depending on the type of variable, mean and standard deviation or absolute and relative counts were used. Results: One hundred twenty two athletes were included, 56% were men, the whole group had an average age of 20 years. 74% of sports were played outdoors; soccer was the most frequent sport. 75% of participants trained four or more times per week and 55% did so in hours with very high RUV. 27% of athletes reported between 1 to 3 insolations in childhood. Chemical photoprotection was used more frequently than physical. Conclusions: This is the first study in Colombia that shows the need to improve skin cancer primary and secondary prevention strategies in this population.

7.
J Am Osteopath Assoc ; 119(6): 380-390, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31135866

RESUMO

Melanoma is currently the fifth most common cancer in the United States, resulting in more than 9000 deaths each year. Despite numerous improvements in the management of advanced melanoma, the cornerstone to ensuring a cure remains early detection. Both patient and physician awareness regarding the signs and symptoms of early melanoma remain paramount. As a result, much effort has been and continues to be expended in developing and refining effective diagnostic algorithms to help identify melanomas and differentiate them from nevi, such as the ABCDE rule (A for asymmetry, B for border irregularity, C for color variegation, D for diameter >6 mm, and E for evolution in lesion size, shape, or color). To assist in the detection of more subtle melanomas requires technology to augment a visual examination. Toward this end, a simple instrument called a dermatoscope has transformed not only the appreciation of the morphology of melanoma but also its growth dynamics. The discipline of dermoscopy has improved the detection of melanoma and other skin cancers, has resulted in the detection of thinner melanomas, and has helped improve the ability to differentiate nevi (benign lesions) from melanomas, which, in turn, has resulted in fewer biopsies of benign lesions. Since patients often first present to their primary care physicians for their health-related concerns, it is imperative that primary care physicians be able to recognize the lesions that are suspicious for melanoma. This review is intended to introduce osteopathic physicians to the dermoscopic features associated primarily with melanomas located on nonglabrous skin.


Assuntos
Dermoscopia/métodos , Melanoma/diagnóstico , Neoplasias Cutâneas/diagnóstico , Diagnóstico Diferencial , Humanos , Exame Físico
8.
J Fam Pract ; 67(12): E1-E11, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30566120

RESUMO

Dermoscopy allows you to see deeper into the skin than with the naked eye. Here's how you can make use of it to spot malignant conditions sooner.


Assuntos
Dermoscopia/normas , Medicina de Família e Comunidade/métodos , Dermatopatias/diagnóstico , Neoplasias Cutâneas/diagnóstico , Humanos , Melanoma/diagnóstico , Melanoma/patologia , Nevo Pigmentado/diagnóstico , Exame Físico/métodos , Dermatopatias/patologia , Neoplasias Cutâneas/patologia
9.
Int J Dermatol ; 57(12): 1447-1453, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30168850

RESUMO

BACKGROUND: The incidence of basal cell carcinoma (BCC) in younger individuals has increased in recent decades. However, the characteristics of BCCs in this population, especially in Ibero-Latin American countries, have not been completely defined. OBJECTIVE: To describe the demographic, clinical, and histopathological characteristics of BCCs in patients younger than 40 treated with Mohs Micrographic Surgery (MMS). MATERIALS AND METHODS: A multicenter, retrospective study conducted between January 2009 and December 2014, in five Ibero-American countries, included biopsy-proven BCCs in patients younger than 40 that were treated with MMS. Demographic, clinical, histopathological, and surgical characteristics were described. RESULTS: The study included 301 tumors in 241 patients, of whom 61% were female. The most common Fitzpatrick phototype was III. The most common histological subtypes were nodular (37.5%) and infiltrative (18.9%). Perineural invasion was encountered in 1.7%, and tumor clearance was achieved in 87.4% within two stages of MMS. CONCLUSIONS: This is the first Ibero-Latin American transnational study describing the characteristics of BCCs in young patients treated with MMS. Despite darker skin phototypes in this population, BCCs can occur in early ages and may present with aggressive features. Therefore, MMS may be considered an appropriate first-line treatment option in this population.


Assuntos
Carcinoma Basocelular/cirurgia , Neoplasias Faciais/cirurgia , Cirurgia de Mohs , Recidiva Local de Neoplasia , Neoplasias Cutâneas/cirurgia , Adolescente , Adulto , Argentina , Brasil , Carcinoma Basocelular/patologia , Carcinoma Basocelular/terapia , Criança , Pré-Escolar , Colômbia , Neoplasias Faciais/patologia , Neoplasias Faciais/terapia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , México , Invasividade Neoplásica , Recidiva Local de Neoplasia/patologia , Estudos Retrospectivos , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/terapia , Pigmentação da Pele , Espanha , Adulto Jovem
10.
Dermatol Pract Concept ; 8(3): 180-183, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30116660

RESUMO

Lichen planus-like keratosis (LPLK) is an involuting cutaneous lesion often presenting between the fifth and seventh decades of life. These lesions typically appear abruptly as a solitary macule, papule, or plaque that continuously evolves as it undergoes regression. Clinical and dermoscopic features of LPLK can mimic both benign and malignant lesions, often prompting biopsy for accurate diagnosis. We describe a case of LPLK developing in a patient with a history of multiple skin cancers, including melanoma. Dermoscopy revealed peripheral granules and a central area with pinkish-brown pigmentation and a disorganized pattern with shiny white structures and rosettes. Handheld reflectance confocal microscopy (RCM) showed a typical honeycomb pattern with millia-like cysts and comedo-like openings, and lacked pagetoid and dendritic cells. Based on the benign features seen with RCM, the lesion was followed until complete regression was observed. In conclusion, we describe a case of LPLK with clinically and dermoscopically indeterminate features that was successfully monitored with RCM. We intend to highlight the utility of RCM as a diagnostic aid in equivocal lesions in order to prevent unnecessary excisional procedures.

11.
J Am Acad Dermatol ; 78(2): 270-277.e1, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28969863

RESUMO

BACKGROUND: Computer vision may aid in melanoma detection. OBJECTIVE: We sought to compare melanoma diagnostic accuracy of computer algorithms to dermatologists using dermoscopic images. METHODS: We conducted a cross-sectional study using 100 randomly selected dermoscopic images (50 melanomas, 44 nevi, and 6 lentigines) from an international computer vision melanoma challenge dataset (n = 379), along with individual algorithm results from 25 teams. We used 5 methods (nonlearned and machine learning) to combine individual automated predictions into "fusion" algorithms. In a companion study, 8 dermatologists classified the lesions in the 100 images as either benign or malignant. RESULTS: The average sensitivity and specificity of dermatologists in classification was 82% and 59%. At 82% sensitivity, dermatologist specificity was similar to the top challenge algorithm (59% vs. 62%, P = .68) but lower than the best-performing fusion algorithm (59% vs. 76%, P = .02). Receiver operating characteristic area of the top fusion algorithm was greater than the mean receiver operating characteristic area of dermatologists (0.86 vs. 0.71, P = .001). LIMITATIONS: The dataset lacked the full spectrum of skin lesions encountered in clinical practice, particularly banal lesions. Readers and algorithms were not provided clinical data (eg, age or lesion history/symptoms). Results obtained using our study design cannot be extrapolated to clinical practice. CONCLUSION: Deep learning computer vision systems classified melanoma dermoscopy images with accuracy that exceeded some but not all dermatologists.


Assuntos
Algoritmos , Dermatologistas , Dermoscopia , Lentigo/diagnóstico por imagem , Melanoma/diagnóstico , Nevo/diagnóstico por imagem , Neoplasias Cutâneas/diagnóstico por imagem , Congressos como Assunto , Estudos Transversais , Diagnóstico por Computador , Humanos , Aprendizado de Máquina , Melanoma/patologia , Curva ROC , Neoplasias Cutâneas/patologia
12.
Malar J ; 16(1): 270, 2017 07 04.
Artigo em Inglês | MEDLINE | ID: mdl-28676092

RESUMO

BACKGROUND: Understanding how mosquitoes respond to long lasting insecticide treated nets (LLINs) is fundamental to sustaining the effectiveness of this essential control tool. We report on studies with a tracking system to investigate behaviour of wild anophelines at an LLIN, in an experimental hut at a rural site in Mwanza, Tanzania. METHODS: Groups of adult female mosquitoes (n = 10 per replicate) reared from larvae of a local population, identified as predominantly (95%) Anopheles arabiensis, were released in the hut. An infrared video tracking system recorded flight and net contact activity over 1 h as the mosquitoes attempted to reach a supine human volunteer within a bed net (either a deltamethrin-treated LLIN or an untreated control net). A range of activities, including flight path, position in relation to the bed net and duration of net contact, were quantified and compared between treatments. RESULTS: The total time that female An. arabiensis spent in flight around LLINs was significantly lower than at untreated nets [F(1,10) = 9.26, p = 0.012], primarily due to a substantial reduction in the time mosquitoes spent in persistent 'bouncing' flight [F(1,10) = 18.48, p = 0.002]. Most activity occurred at the net roof but significantly less so with LLINs (56.8% of total) than untreated nets [85.0%; Χ2 (15) = 234.69, p < 0.001]. Activity levels at the bed net directly above the host torso were significantly higher with untreated nets (74.2%) than LLINs [38.4%; Χ2 (15) = 33.54, p = 0.004]. 'Visiting' and 'bouncing' rates were highest above the volunteer's chest in untreated nets (39.9 and 50.4%, respectively) and LLINs [29.9 and 42.4%; Χ2 (13) = 89.91, p < 0.001; Χ2 (9) = 45.73, p < 0.001]. Highest resting rates were above the torso in untreated nets [77%; Χ2 (9) = 63.12, p < 0.001], but in LLINs only 33.2% of resting occurred here [Χ2 (9) = 27.59, p = 0.001], with resting times spread between the short vertical side of the net adjacent to the volunteer's head (21.8%) and feet (16.2%). Duration of net contact by a single mosquito was estimated at 204-290 s on untreated nets and 46-82 s on LLINs. While latency to net contact was similar in both treatments, the reduction in activity over 60 min was significantly more rapid for LLINs [F(1,10) = 6.81, p = 0.026], reiterating an 'attract and kill' rather than a repellent mode of action. CONCLUSIONS: The study has demonstrated the potential for detailed investigations of behaviour of wild mosquito populations under field conditions. The results validate the findings of earlier laboratory studies on mosquito activity at LLINs, and reinforce the key role of multiple brief contacts at the net roof as the critical LLIN mode of action.


Assuntos
Anopheles/fisiologia , Mosquiteiros Tratados com Inseticida , Inseticidas/farmacologia , Mosquitos Vetores/fisiologia , Nitrilos/farmacologia , Piretrinas/farmacologia , Animais , Anopheles/efeitos dos fármacos , Comportamento Alimentar , Feminino , Controle de Mosquitos , Mosquitos Vetores/efeitos dos fármacos , Tanzânia
13.
JAMA Dermatol ; 152(7): 798-806, 2016 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-27074267

RESUMO

IMPORTANCE: The comparative diagnostic performance of dermoscopic algorithms and their individual criteria are not well studied. OBJECTIVES: To analyze the discriminatory power and reliability of dermoscopic criteria used in melanoma detection and compare the diagnostic accuracy of existing algorithms. DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective, observational study of 477 lesions (119 melanomas [24.9%] and 358 nevi [75.1%]), which were divided into 12 image sets that consisted of 39 or 40 images per set. A link on the International Dermoscopy Society website from January 1, 2011, through December 31, 2011, directed participants to the study website. Data analysis was performed from June 1, 2013, through May 31, 2015. Participants included physicians, residents, and medical students, and there were no specialty-type or experience-level restrictions. Participants were randomly assigned to evaluate 1 of the 12 image sets. MAIN OUTCOMES AND MEASURES: Associations with melanoma and intraclass correlation coefficients (ICCs) were evaluated for the presence of dermoscopic criteria. Diagnostic accuracy measures were estimated for the following algorithms: the ABCD rule, the Menzies method, the 7-point checklist, the 3-point checklist, chaos and clues, and CASH (color, architecture, symmetry, and homogeneity). RESULTS: A total of 240 participants registered, and 103 (42.9%) evaluated all images. The 110 participants (45.8%) who evaluated fewer than 20 lesions were excluded, resulting in data from 130 participants (54.2%), 121 (93.1%) of whom were regular dermoscopy users. Criteria associated with melanoma included marked architectural disorder (odds ratio [OR], 6.6; 95% CI, 5.6-7.8), pattern asymmetry (OR, 4.9; 95% CI, 4.1-5.8), nonorganized pattern (OR, 3.3; 95% CI, 2.9-3.7), border score of 6 (OR, 3.3; 95% CI, 2.5-4.3), and contour asymmetry (OR, 3.2; 95% CI, 2.7-3.7) (P < .001 for all). Most dermoscopic criteria had poor to fair interobserver agreement. Criteria that reached moderate levels of agreement included comma vessels (ICC, 0.44; 95% CI, 0.40-0.49), absence of vessels (ICC, 0.46; 95% CI, 0.42-0.51), dark brown color (ICC, 0.40; 95% CI, 0.35-0.44), and architectural disorder (ICC, 0.43; 95% CI, 0.39-0.48). The Menzies method had the highest sensitivity for melanoma diagnosis (95.1%) but the lowest specificity (24.8%) compared with any other method (P < .001). The ABCD rule had the highest specificity (59.4%). All methods had similar areas under the receiver operating characteristic curves. CONCLUSIONS AND RELEVANCE: Important dermoscopic criteria for melanoma recognition were revalidated by participants with varied experience. Six algorithms tested had similar but modest levels of diagnostic accuracy, and the interobserver agreement of most individual criteria was poor.


Assuntos
Algoritmos , Dermoscopia , Melanoma/diagnóstico por imagem , Nevo/diagnóstico por imagem , Neoplasias Cutâneas/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Internet , Variações Dependentes do Observador , Curva ROC , Distribuição Aleatória , Reprodutibilidade dos Testes , Estudos Retrospectivos
14.
Sci Rep ; 5: 13392, 2015 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-26323965

RESUMO

Long-lasting insecticidal bed nets (LLINs) protect humans from malaria transmission and are fundamental to malaria control worldwide, but little is known of how mosquitoes interact with nets. Elucidating LLIN mode of action is essential to maintain or improve efficacy, an urgent need as emerging insecticide resistance threatens their future. Tracking multiple free-flying Anopheles gambiae responding to human-occupied bed nets in a novel large-scale system, we characterised key behaviours and events. Four behavioural modes with different levels of net contact were defined: swooping, visiting, bouncing and resting. Approximately 75% of all activity occurred at the bed net roof where multiple brief contacts were focussed above the occupant's torso. Total flight and net contact times were lower at LLINs than untreated nets but the essential character of the response was unaltered. LLINs did not repel mosquitoes but impacted rapidly: LLIN contact of less than 1 minute per mosquito during the first ten minutes reduced subsequent activity; after thirty minutes, activity at LLINs was negligible. Velocity measurements showed that mosquitoes detected nets, including unbaited untreated nets, prior to contact. This is the most complete characterisation of mosquito-LLIN interactions to date, and reveals many aspects of LLIN mode of action, important for developing the next generation of LLINs.


Assuntos
Anopheles/efeitos dos fármacos , Inseticidas/toxicidade , Animais , Anopheles/crescimento & desenvolvimento , Anopheles/fisiologia , Feminino , Resistência a Inseticidas , Mosquiteiros Tratados com Inseticida , Larva/efeitos dos fármacos , Larva/fisiologia , Gravação em Vídeo
15.
J Am Acad Dermatol ; 72(6): 1027-35, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25824275

RESUMO

BACKGROUND: Melanomas on chronically sun-damaged skin (CSDS) can be difficult to identify and often manifest morphologic features that overlap with benign lesions. OBJECTIVE: We describe and analyze the clinical and dermoscopic characteristics of melanomas on nonfacial CSDS. METHODS: Melanoma cases on nonfacial CSDS were retrospectively identified from the biopsy specimen logs of 6 melanoma clinics. Clinical and dermoscopic images were combined into 1 database. Demographics, clinical, dermoscopic, and histopathologic information were analyzed. Descriptive frequencies were calculated. RESULTS: One hundred eighty-six cases met the inclusion criteria: 142 melanomas in situ (76%) and 39 invasive (21%; mean thickness, 0.49 mm). Lentigo maligna was the most common histopathologic subtype (n = 76; 40.9%). The most frequent dermoscopic structures were granularity (n = 126; 67.7%) and angulated lines (n = 82; 44%). Vascular structures were more frequent in invasive melanomas (56% vs 12% of in situ melanomas). Most manifested 1 of 3 dermoscopic patterns: patchy peripheral pigmented islands, angulated lines, and tan structureless with granularity pattern. LIMITATIONS: This was a retrospective study, and evaluators were not blinded to the diagnosis. In addition, interobserver concordance and sensitivity and specificity for dermoscopic structures were not evaluated. CONCLUSION: Outlier lesions manifesting dermoscopic structures, such as granularity, angulated lines, or vessels and any of the 3 described dermoscopic patterns should raise suspicion for melanoma.


Assuntos
Dermoscopia/métodos , Sarda Melanótica de Hutchinson/patologia , Melanoma/patologia , Neoplasias Cutâneas/patologia , Luz Solar/efeitos adversos , Adulto , Distribuição por Idade , Idoso , Austrália/epidemiologia , Estudos de Coortes , Detecção Precoce de Câncer/métodos , Feminino , Humanos , Sarda Melanótica de Hutchinson/epidemiologia , Sarda Melanótica de Hutchinson/etiologia , Incidência , Masculino , Melanoma/epidemiologia , Melanoma/etiologia , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Medição de Risco , Distribuição por Sexo , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/etiologia , Raios Ultravioleta/efeitos adversos
16.
JAMA Dermatol ; 151(7): 715-21, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25714607

RESUMO

IMPORTANCE: The 2-step dermoscopy algorithm aims to guide the decision-making process to biopsy or not biopsy a skin lesion by providing the most probable diagnosis via a systematic approach. OBJECTIVE: To evaluate the diagnostic accuracy and potential limitations of the first step (to differentiate melanocytic from nonmelanocytic lesions) of the 2-step dermoscopy algorithm. DESIGN, SETTING, AND PARTICIPANTS: Retrospective study in a clinical practice of one dermatologist of biopsy data of all skin lesions from one clinic during a 10-year period. The prebiopsy and histopathology diagnoses were classified as melanocytic or nonmelanocytic. MAIN OUTCOMES AND MEASURES: The diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value for the first step were estimated using the histopathological lesion classifications as the standard. RESULTS: The sensitivity of the first step for correctly identifying melanocytic lesions was 85%, and the specificity was 94%. Approximately 7% of all lesions (667 of 9168) had discordant classifications, with 415 (4.5%) being false-positive lesions (clinically classified as melanocytic and histopathologically classified as nonmelanocytic) and 252 (2.7%) being false negatives (clinically classified as nonmelanocytic and histopathologically classified as melanocytic). Common classification errors included intradermal nevus misclassified as basal cell carcinoma and nonmelanocytic lesions (eg, seborrheic keratosis, lichen planus-like keratosis, basal cell carcinomas) misclassified as melanocytic because they mimic melanoma. Clinically, 8 of 381 melanomas were misclassified as nonmelanocytic (primarily as pigmented basal cell carcinomas and squamous cell carcinomas). CONCLUSIONS AND RELEVANCE: The 2-step dermoscopy algorithm, including its first step, has high sensitivity, specificity, and accuracy and can be relied on to provide an accurate and specific prebiopsy diagnosis and to help guide management decisions. Some lesions had a higher chance of being misclassified, with the most common being intradermal nevi. This algorithm helps toward maximizing the detection of skin cancer to ensure that malignant lesions are not missed and aims at making more precise clinical diagnoses.


Assuntos
Algoritmos , Carcinoma Basocelular/patologia , Carcinoma de Células Escamosas/patologia , Dermoscopia/métodos , Melanoma/patologia , Neoplasias Cutâneas/patologia , Biópsia , Técnicas de Apoio para a Decisão , Reações Falso-Negativas , Reações Falso-Positivas , Humanos , Pigmentação , Valor Preditivo dos Testes , Estudos Retrospectivos , Pele/patologia
17.
Cancer ; 121(1): 60-8, 2015 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-25186461

RESUMO

BACKGROUND: The use of BRAF inhibitors may lead to the development of cutaneous toxicities such as rashes, photosensitivity, alopecia, palmoplantar erythrodysesthesia, and proliferative skin lesions, including keratoacanthomas (KAs) and cutaneous squamous cell carcinomas (cuSCCs). The latter are noteworthy for their potential to exhibit malignant features, and they may necessitate invasive treatment. Their prompt identification is of primary importance for directing supportive care efforts and maintaining dose intensity while minimizing the morbidity associated with supportive care interventions. Because such lesions are less familiar to oncologists, this study was designed to characterize their clinico-morphological features, which have not been hitherto described. METHODS: The clinical and dermoscopic characteristics and risk factors of new-onset proliferative skin lesions (benign verrucous lesions and KAs/cuSCCs) developing after the initiation of treatment with vemurafenib, dabrafenib, and XL281 were analyzed; the histopathological diagnoses were ascertained. RESULTS: The majority of the lesions were benign verrucous lesions (78%, n = 87), whereas KAs/cuSCCs represented 22% (n = 25). The median times to biopsy for the initial verrucous lesions and KAs/cuSCCs were 4.8 and 10.5 weeks, respectively. The clinico-morphological features significant for KAs/cuSCCs included a larger size (P < .001), a nodular appearance (P < .001), a central keratin plug (P < .001), a central ulceration or crust (P = .04), an adherent scale (P = .02), an erythematous halo (P = .03), and a scaly ring (collarette; P < .001) at the periphery. CONCLUSIONS: Our findings represent the first detailed description of the clinico-morphological characteristics that permit distinction between the benign and malignant skin lesions induced by BRAF inhibitors. They are valuable for the recognition of lesions that require intervention and/or a dermatology referral versus those that permit provisional monitoring.


Assuntos
Neoplasias/tratamento farmacológico , Inibidores de Proteínas Quinases/efeitos adversos , Dermatopatias/induzido quimicamente , Dermatopatias/patologia , Adulto , Idoso , Benzimidazóis/efeitos adversos , Carbamatos/efeitos adversos , Feminino , Humanos , Imidazóis/efeitos adversos , Indóis/efeitos adversos , Masculino , Pessoa de Meia-Idade , Oximas/efeitos adversos , Dermatopatias/complicações , Sulfonamidas/efeitos adversos , Vemurafenib
18.
Int J Angiol ; 23(1): 65-8, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24627620

RESUMO

Enteric drainage is the preferred method of exocrine diversion in simultaneous kidney-pancreas transplantation. Because of improvements in immunosuppression, enteric drainage has become the preferred method of pancreas transplantation in general. Although associated with less potential complications than bladder-drained pancreas, potentially lethal arterio-enteric fistulas in the setting of nonfunctioning allografts represent a constant threat. We herein present a case report, a review of the literature, and a call for caution.

19.
Australas J Dermatol ; 55(2): 119-24, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24548383

RESUMO

BACKGROUND/OBJECTIVES: Many melanomas are of a diameter smaller than 6 mm and may lack classical asymmetry, border irregularity and colour variegation (ABCD). The objectives of this article are to characterise the fidelity of melanomas diagnosed in a high-risk clinic to the ABCD and to review potential methods for early clinical detection of melanoma. METHODS: All cases of primary melanoma diagnosed by one clinician at the Memorial Sloan-Kettering Cancer Center over the past 11 years were evaluated for the presence of the ABCD. The melanomas were analysed for asymmetry of contour, unevenness in distribution of colours and textures, border irregularity, number of colours present and diameter. RESULTS: In all, 236 melanomas were analysed. Of these, asymmetry of contour was present in 65% and 94% demonstrated unevenness in the distribution of colours and textures. The borders were regular in 12% of the melanomas and colour variegation was present in 63%. In total, 28% of the lesions were small, with a diameter less than 6 mm. This study was limited by the subjectivity of clinical lesion analysis. CONCLUSION: We put forward for your consideration a new mnemonic: 'Do UC (different, uneven, changing) the melanoma?' This mnemonic encompasses differential, analytical and comparative cognition strategies for an enhanced early detection of melanoma.


Assuntos
Detecção Precoce de Câncer , Melanoma/patologia , Neoplasias Cutâneas/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pigmentação , Estudos Retrospectivos
20.
Dermatol Clin ; 31(4): 599-613, viii-ix, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24075548

RESUMO

Differentiating dysplastic nevi from melanoma remains one of the main objectives of dermoscopy. Melanomas tend not to manifest any of the benign patterns described for nevi and instead usually display chaotic dermoscopic morphologies. Melanomas located on the face, chronically sun-damaged skin, volar surfaces, nails, and mucosal surfaces have additional features that can assist in their identification. However, some melanomas lack any defined dermoscopic structures. These so-called featureless melanomas can be identified via digital surveillance. This article reviews the melanoma-specific structures as a function of anatomic location (ie, melanomas on nonglabrous skin, face, volar surfaces, mucosae, and nails).


Assuntos
Dermoscopia , Sarda Melanótica de Hutchinson/diagnóstico , Melanoma/diagnóstico , Doenças da Unha/diagnóstico , Neoplasias Cutâneas/diagnóstico , Diagnóstico Diferencial , Humanos , Sarda Melanótica de Hutchinson/patologia , Melanoma/patologia , Doenças da Unha/patologia , Neoplasias Cutâneas/patologia
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