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2.
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.

4.
J Am Acad Dermatol ; 84(1): 102-119, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32454102

RESUMO

BACKGROUND: There is lack of uniformity in the reflectance confocal microscopy (RCM) terminology for melanocytic lesions. OBJECTIVE: To review published RCM terms for melanocytic lesions and identify redundant, synonymous terms. METHODS: A systematic review of original research articles adhering to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines was conducted until August 15, 2018. Two investigators gathered all published RCM terms used to describe melanoma and melanocytic nevi. Synonymous terms were grouped based on similarity in definition and in histopathologic correlation. RESULTS: Out of 156 full-text screened articles, 59 studies met the inclusion criteria. We identified 209 terms; 191 (91.4%) corresponding to high-magnification/cellular-level terms and 18 (8.6%) corresponding to low-magnification/architectural patterns terms. The overall average use frequency of RCM terms was 3.1 times (range, 1-31). By grouping of individual RCM terms based on likely synonymous definitions and by eliminating terms lacking clear definition, the total number of RCM terms could be potentially reduced from 209 to 40 terms (80.8% reduction). LIMITATIONS: Non-English and non-peer-reviewed articles were excluded. CONCLUSIONS: This systematic review of published RCM terms identified significant terminology redundancy. It provides the basis for subsequent terminology consensus on melanocytic neoplasms.

5.
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.

6.
J Biomed Opt ; 25(11)2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33247560

RESUMO

SIGNIFICANCE: Melanoma is a deadly cancer that physicians struggle to diagnose early because they lack the knowledge to differentiate benign from malignant lesions. Deep machine learning approaches to image analysis offer promise but lack the transparency to be widely adopted as stand-alone diagnostics. AIM: We aimed to create a transparent machine learning technology (i.e., not deep learning) to discriminate melanomas from nevi in dermoscopy images and an interface for sensory cue integration. APPROACH: Imaging biomarker cues (IBCs) fed ensemble machine learning classifier (Eclass) training while raw images fed deep learning classifier training. We compared the areas under the diagnostic receiver operator curves. RESULTS: Our interpretable machine learning algorithm outperformed the leading deep-learning approach 75% of the time. The user interface displayed only the diagnostic imaging biomarkers as IBCs. CONCLUSIONS: From a translational perspective, Eclass is better than convolutional machine learning diagnosis in that physicians can embrace it faster than black box outputs. Imaging biomarkers cues may be used during sensory cue integration in clinical screening. Our method may be applied to other image-based diagnostic analyses, including pathology and radiology.

7.
J Cutan Pathol ; 2020 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-32989842

RESUMO

BACKGROUND: Accurate basal cell carcinoma (BCC) subtyping is requisite for appropriate management, but non-representative sampling occurs in 18% to 25% of biopsies. By enabling non-invasive diagnosis and more comprehensive sampling, integrated reflectance confocal microscopy-optical coherence tomography (RCM-OCT) may improve the accuracy of BCC subtyping and subsequent management. We evaluated RCM-OCT images and histopathology slides for the presence of two key features, angulation and small nests and cords, and calculated (a) sensitivity and specificity of these features, combined and individually, for identifying an infiltrative BCC subtype and (b) agreement across modalities. METHODS: Thirty-three RCM-OCT-imaged, histopathologically-proven BCCs (17 superficial and/or nodular; 16 containing an infiltrative component) were evaluated. RESULTS: The presence of angulation or small nests and cords was sufficient to identify infiltrative BCC on RCM-OCT with 100% sensitivity and 82% specificity, similar to histopathology (100% sensitivity, 88% specificity, kappa = 0.82). When both features were present, the sensitivity for identifying infiltrative BCC was 100% using either modality and specificity was 88% on RCM-OCT vs 94% on histopathology, indicating near-perfect agreement between non-invasive and invasive diagnostic modalities (kappa = 0.94). CONCLUSIONS: RCM-OCT can non-invasively identify key histopathologic features of infiltrative BCC offering a possible alternative to traditional invasive biopsy.

8.
J Cancer ; 11(20): 6019-6024, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32922542

RESUMO

The increasing rate of incidence and prevalence of basal cell carcinomas (BCCs) worldwide, combined with the morbidity associated with conventional surgical treatment has led to the development and use of alternative minimally invasive non-surgical treatments. Biopsy and pathology are used to guide BCC diagnosis and assess margins and subtypes, which then guide the decision and choice of surgical or non-surgical treatment. However, alternatively, a noninvasive optical approach based on combined reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) imaging may be used. Optical imaging may be used to guide diagnosis and margin assessment at the bedside, and potentially facilitate non-surgical management, along with long-term monitoring of treatment response. Noninvasive imaging may also complement minimally invasive treatments and help further reduce morbidity. In this paper, we highlight the current state of an integrated RCM/OCT imaging approach for diagnosis and triage of BCCs, as well as for assessing margins, which therefore may be ultimately used for guiding therapy.

9.
JAMA Dermatol ; 2020 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-32936222

RESUMO

Importance: The development of new primary cutaneous melanoma (CM) after starting immune checkpoint inhibitor (ICI) therapy is poorly characterized. Objective: To determine the incidence of new CM in patients treated with ipilimumab, nivolumab, and/or pembrolizumab for metastatic melanoma. Design, Setting, and Participants: Single-center, retrospective, observational cohort study using an institutional database to identify patients diagnosed with melanoma at a tertiary care cancer hospital in New York, New York. Exposures: Ipilimumab, nivolumab, and/or pembrolizumab treatment for metastatic melanoma. Main Outcomes and Measures: Primary outcomes were the incidence proportion, the incidence rate, and the 5-year cause-specific cumulative risk. Results: A total of 2251 patients were included in the study; mean (SD) age at the time of ICI start was 62.8 (14.4) years. The majority were male (63.8%, n = 1437), White (92.7%, n = 2086), and non-Hispanic (92.1%, n = 2073). Forty-two of 2251 patients who received ipilimumab, nivolumab, and/or pembrolizumab were diagnosed with 48 new CMs at a median (range) of 397.5 (39-2409) days after ICI initiation. The median age of affected patients at the time of ICI first dose was 66.5 years. The majority were male (66.7%, n = 28), White (92.9%, n = 39), and non-Hispanic (100.0%, n = 42). There were no differences in age, sex, race, and ethnicity among patients who did and did not develop a new CM. Patients who developed a new CM were more likely to have a family history of melanoma (23.8% vs 16.3%, P = .02). Most new CMs (n = 30, 62.5%) were diagnosed after the last date of ICI administration. Twenty-seven (56.3%) new CMs were in situ and 21 (43.8%) were invasive. Of the invasive CMs with a reported Breslow thickness (n = 20), the median (range) thickness was 0.4 (0.1-8.4) mm. The overall incidence proportion of new CM was 1.9% (95% CI, 1.4%-2.5%) and the incidence rate was 1103 cases per 100 000 person-years (95% CI, 815-1492). The 5-year cumulative cause-specific risk of new CM was 4.9% (95% CI, 3.3%-7.4%). Conclusions and Relevance: Patients treated with ICI therapy for metastatic melanoma remain at risk for the development of new CM.

10.
Arch Dermatol Res ; 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32978676

RESUMO

Fibroepithelioma of Pinkus (FEP) is a subtype of basal cell carcinoma (BCC) that can clinically resemble intradermal nevi (IDN) and fibromas. We performed a retrospective review of consecutively biopsied lesions confirmed to be FEP on histopathology diagnosed from January 1, 2008 to April 8, 2019. Clinical (n = 48), contact non-polarized dermoscopy (NPD) (n = 44), and contact polarized dermoscopy (PD) (n = 22) images from 36 patients were reviewed. Mean age was 64.5 years (SD 15.1 years, range 24-86 years) at diagnosis of first FEP lesion. Most lesions were located on the torso (n = 28, 58.3%), followed by the lower extremity (n = 9, 18.8%). The most common differential diagnoses at the time of biopsy included BCC (n = 40) and nevus (other than IDN, n = 5). Clinically, FEP were pink (95.8%), scaly (66.7%) papules (77.1%) displaying disrupted skin markings (62.5%) and absence of hair follicles (87.5%). NPD revealed serpentine (97.7%), dotted (81.8%), or polymorphous vessels (86.4%), and hypopigmented to pink lines intersecting at acute angles (HPLA) (52.3%). PD demonstrated serpentine (95.5%), dotted (86.4%), or polymorphous vessels (81.8%), shiny white lines (50.0%), and HPLA (59.1%). Classic features of BCC such as arborizing vessels (n = 2), ulceration (n = 1), shiny white blotches and strands (n = 1), blue-gray ovoid nest (n = 1), and leaf-like areas (n = 1) were uncommon. FEP often presents as scaly, erythematous papules with disrupted skin markings and absence of hair follicles. Dermoscopy reveals polymorphous vessels with shiny white lines and HPLA.

11.
BMC Cancer ; 20(1): 721, 2020 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-32746799

RESUMO

BACKGROUND: Hematopoietic cell transplantation (HCT) is a curative option for a growing number of patients with hematologic diseases and malignancies. However, HCT-related factors, such as total body irradiation used for conditioning, graft-versus-host disease, and prolonged exposure to immunosuppressive therapy, result in very high risk for melanoma and non-melanoma skin cancer (NMSC). In fact, skin cancer is the most common subsequent neoplasm in HCT survivors, tending to develop at a time when survivors' follow-up care has largely transitioned to the primary care setting. The goal of this study is to increase skin cancer screening rates among HCT survivors through patient-directed activation alone or in combination with physician-directed activation. The proposed intervention will identify facilitators of and barriers to risk-based screening in this population and help reduce the burden of cancer-related morbidity after HCT. METHODS/DESIGN: 720 HCT survivors will be enrolled in this 12-month randomized controlled trial. This study uses a comparative effectiveness design comparing (1) patient activation and education (PAE, N = 360) including text messaging and print materials to encourage and motivate skin examinations; (2) PAE plus primary care physician activation (PAE + Phys, N = 360) adding print materials for the physician on the HCT survivors' increased risk of skin cancer and importance of conducting a full-body skin exam. Patients on the PAE + Phys arm will be further randomized 1:1 to the teledermoscopy (PAE + Phys+TD) adding physician receipt of a portable dermatoscope to upload images of suspect lesions for review by the study dermatologist and an online course with descriptions of dermoscopic images for skin cancers. DISCUSSION: When completed, this study will provide much-needed information regarding strategies to improve skin cancer detection in other high-risk (e.g. radiation-exposed) cancer survivor populations, and to facilitate screening and management of other late effects (e.g. cardiovascular, endocrine) in HCT survivors. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04358276 . Registered 24 April 2020.

12.
Arch Dermatol Res ; 2020 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-32844312

RESUMO

Dermoscopy and reflectance confocal microscopy (RCM) are two noninvasive, optical imaging tools used to facilitate clinical diagnosis. A biopsy technique that produces exact correlation with optical imaging features is not previously reported. To evaluate the applications of a novel feature-focused 'precision biopsy' technique that correlates clinical-dermoscopy-RCM findings with histopathology. This was a prospective case-series performed during August 2017 and June 2019 at a tertiary care cancer. We included consecutive patients requiring a precise dermoscopy-RCM-histopathologic correlation. We performed prebiopsy dermoscopy and both wide probe and handheld RCM of suspicious lesions. Features of interest were isolated with the aid of paper rings and a 2 mm punch biopsy was performed in the dermoscopy- or RCM-highlighted area. Tissue was processed either en face or with vertical sections. One-to-one correlation with histopathology was obtained. Twenty-three patients with 24 lesions were included in the study. The mean age was 64.6 years (range 22-91 years); there were 16 (69.6%) males, 14 (58.3%) lesions biopsied were on head and neck region. We achieved tissue-conservation diagnosis in 100% (24/24), 13 (54.2%) were clinically equivocal lesions, six (25%) were selected for 'feature correlation' of structures on dermoscopy or RCM, and five (20.8%) for 'correlation of new/unknown' RCM features seen on follow-up. The precision biopsy technique described herein is a novel method that facilitates direct histopathological correlation of dermoscopy and RCM features. With the aids of optical imaging devices, accurate diagnosis may be achieved by minimally invasive tissue extraction.

13.
J Am Acad Dermatol ; 2020 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-32827607

RESUMO

BACKGROUND: Radiation therapy (RT) is a treatment option for selected skin cancers. The histologic effects of RT on normal skin or skin cancers are not well-characterized. Dermoscopy, high frequency ultrasonography (HFUS), and reflectance confocal microscopy (RCM) are non-invasive imaging modalities that may help characterize RT response. OBJECTIVES: To describe changes in the tumor and surrounding skin of basal cell carcinoma (BCC) patients treated with RT. METHODS: The study was conducted between 2014-2018. Patients with biopsy-proven BCCs were treated with 42 Gy in 6 fractions using a commercially available brachytherapy device. Dermoscopy, HFUS, RCM were performed before treatment, 6 weeks, 3 months and 12 months after RT. RESULTS: 137 imaging assessments (RCM + dermoscopy + HFUS) were performed in 12 patients. Presence of BCC-specific features were present in 81.8%, 91% and 17% of patients imaged with dermoscopy, RCM and HFUS at baseline, prior to treatment. After treatment, resolution of these features was noted in 33.4%, 91.7%, and 100% of patients imaged with the respective modalities. No recurrences were seen after 31.7 months mean follow-up. LIMITATIONS: Small sample size and no histopathological correlation. CONCLUSION: Dermoscopy and HFUS were not as reliable as RCM at characterizing BCCs RT response.

14.
JAMA Dermatol ; 156(9): 1004-1011, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32725204

RESUMO

Importance: Use of prognostic gene expression profile (GEP) testing in cutaneous melanoma (CM) is rising despite a lack of endorsement as standard of care. Objective: To develop guidelines within the national Melanoma Prevention Working Group (MPWG) on integration of GEP testing into the management of patients with CM, including (1) review of published data using GEP tests, (2) definition of acceptable performance criteria, (3) current recommendations for use of GEP testing in clinical practice, and (4) considerations for future studies. Evidence Review: The MPWG members and other international melanoma specialists participated in 2 online surveys and then convened a summit meeting. Published data and meeting abstracts from 2015 to 2019 were reviewed. Findings: The MPWG members are optimistic about the future use of prognostic GEP testing to improve risk stratification and enhance clinical decision-making but acknowledge that current utility is limited by test performance in patients with stage I disease. Published studies of GEP testing have not evaluated results in the context of all relevant clinicopathologic factors or as predictors of regional nodal metastasis to replace sentinel lymph node biopsy (SLNB). The performance of GEP tests has generally been reported for small groups of patients representing particular tumor stages or in aggregate form, such that stage-specific performance cannot be ascertained, and without survival outcomes compared with data from the American Joint Committee on Cancer 8th edition melanoma staging system international database. There are significant challenges to performing clinical trials incorporating GEP testing with SLNB and adjuvant therapy. The MPWG members favor conducting retrospective studies that evaluate multiple GEP testing platforms on fully annotated archived samples before embarking on costly prospective studies and recommend avoiding routine use of GEP testing to direct patient management until prospective studies support their clinical utility. Conclusions and Relevance: More evidence is needed to support using GEP testing to inform recommendations regarding SLNB, intensity of follow-up or imaging surveillance, and postoperative adjuvant therapy. The MPWG recommends further research to assess the validity and clinical applicability of existing and emerging GEP tests. Decisions on performing GEP testing and patient management based on these results should only be made in the context of discussion of testing limitations with the patient or within a multidisciplinary group.

15.
J Am Acad Dermatol ; 83(5): 1274-1281, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32622142

RESUMO

BACKGROUND: Pediatric melanoma is rare and diagnostically challenging. OBJECTIVE: To characterize clinical and histopathologic features of fatal pediatric melanomas. METHODS: Multicenter retrospective study of fatal melanoma cases in patients younger than 20 years diagnosed between 1994 and 2017. RESULTS: Of 38 cases of fatal pediatric melanoma identified, 57% presented in white patients and 19% in Hispanic patients. The average age at diagnosis was 12.7 years (range, 0.0-19.9 y), and the average age at death was 15.6 years (range, 1.2-26.2 y). Among cases with known identifiable subtypes, 50% were nodular (8/16), 31% were superficial spreading (5/16), and 19% were spitzoid melanoma (3/16). One fourth (10/38) of melanomas arose in association with congenital melanocytic nevi. LIMITATIONS: Retrospective nature, cohort size, and potential referral bias. CONCLUSIONS: Pediatric melanoma can be fatal in diverse clinical presentations, including a striking prevalence of Hispanic patients compared to adult disease, and with a range of clinical subtypes, although no fatal cases of spitzoid melanoma were diagnosed during childhood.

17.
Dermatol Pract Concept ; 10(2): e2020035, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32363097

RESUMO

Background: Accurate identification of cutaneous lesions is an essential skill for family medicine physicians (FMPs). Studies show significant improvement in skin cancer detection with dermoscopy use. Frontline FMPs are an ideal target group for dermoscopy training. The 3-step Triage Amalgamated Dermoscopic Algorithm (TADA) facilitates high sensitivity and specificity for pigmented and nonpigmented skin lesions. Step I requires unequivocal identification of dermoscopic features for 1 of 3 benign skin lesions: angioma, dermatofibroma, or seborrheic keratosis. If absent, steps II and III are applied assessing for features of architectural disorder and malignancies with organized, symmetric patterns, respectively. Objective: To assess FMPs' diagnostic accuracy of benign and malignant skin lesions before and after training in TADA step I. Methods: In this repeated-measures observational study, 33 dermoscopy-naive FMPs attending an introductory dermoscopy workshop each assessed gross and corresponding dermoscopic photographic images of 50 pigmented and nonpigmented skin lesions (23 benign, 27 malignant) for features of TADA step I lesions before and after training. Analyses compared diagnostic accuracy in relation to training and baseline physician characteristics. Results: Diagnostic accuracy improved from 76.4% to 90.8% (P < 0.001) and from 85.0% to 90.0% (P = 0.01), respectively, for all lesions and for all TADA I lesions. Female sex was significant as a predictor of individual posttraining performance (all lesions combined, P = 0.02). Conclusions: Results show significant improvement in diagnostic accuracies for benign and malignant skin lesions with introductory dermoscopy training using TADA step I. This will reduce unnecessary benign lesion excision and enhance referral sensitivity, conserving specialist resources.

18.
J Am Acad Dermatol ; 83(3): 780-787, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32360723

RESUMO

BACKGROUND: The number needed to biopsy (NNB) ratio for melanoma diagnosis is calculated by dividing the total number of biopsies by the number of biopsied melanomas. It is the inverse of positive predictive value (PPV), which is calculated by dividing the number of biopsied melanomas by the total number of biopsies. NNB is increasingly used as a metric to compare the diagnostic accuracy of health care practitioners. OBJECTIVE: To investigate the association of NNB with the standard statistical measures of sensitivity and specificity. METHODS: We extracted published diagnostic accuracy data from 5 cross-sectional skin cancer reader studies (median [min-max] readers/study was 29 [8-511]). Because NNB is a ratio, we converted it to PPV. RESULTS: Four studies showed no association and 1 showed a negative association between PPV and sensitivity. All 5 studies showed a positive association between PPV and specificity. LIMITATIONS: Reader study data. CONCLUSIONS: An individual health care practitioner with a lower NNB is likely to have a higher specificity than one with a higher NNB, assuming they practice under similar conditions; no conclusions can be made about their relative sensitivities. We advocate for additional research to define quality metrics for melanoma detection and caution when interpreting NNB.

19.
JAMA Dermatol ; 156(8): 882-890, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32459294

RESUMO

Importance: Basal cell carcinoma (BCC) is the most common skin cancer. Dermoscopic imaging has improved diagnostic accuracy; however, diagnosis of nonpigmented BCC remains limited to arborizing vessels, ulceration, and shiny white structures. Objective: To assess multiple aggregated yellow-white (MAY) globules as a diagnostic feature for BCC. Design, Setting, and Participants: In this retrospective, single-center, case-control study, nonpigmented skin tumors, determined clinically, were identified from a database of lesions consecutively biopsied during a 7-year period (January 1, 2009, to December 31, 2015). A subset of tumors was prospectively diagnosed, and reflectance confocal microscopy, optical coherence tomography, and histopathologic correlation were performed. Data analysis was conducted from July 1 to September 31, 2019. Exposures: Investigators evaluated for the presence or absence of known dermoscopic criteria. MAY globules were defined as aggregated, white-yellow structures visualized in polarized and nonpolarized light. Main Outcomes and Measures: The primary outcome was the diagnostic accuracy of MAY globules for the diagnosis of BCC. Secondary objectives included the association with BCC location and subtype. Interrater agreement was estimated. Results: A total of 656 nonpigmented lesions from 643 patients (mean [SD] age, 63.1 [14.9] years; 381 [58.1%] male) were included. In all, 194 lesions (29.6%) were located on the head and neck. A total of 291 (44.4%) were BCCs. MAY globules were seen in 61 of 291 BCC cases (21.0%) and in 3 of 365 other diagnoses (0.8%) (P < .001). The odds ratio for diagnosis of BCC was 32.0 (96% CI, 9.9-103.2). The presence of MAY globules was associated with a diagnosis of histologic high-risk BCC (odds ratio, 6.5; 95% CI, 3.1-14.3). The structure was never seen in cases of superficial BCCs. Conclusions and Relevance: The findings suggest that MAY globules may have utility as a new BCC dermoscopic criterion with a high specificity. MAY globules were negatively associated with superficial BCC and positively associated with deeper-seated, histologic, higher-grade tumor subtypes.

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