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2.
Cutis ; 105(3): 138-142;E5, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32352432

RESUMO

Nonmelanoma skin cancer (NMSC) is the most common malignancy worldwide, and the incidence continues to increase. Originally, treatment options for NMSCs largely relied on destructive and surgical methods. Basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) commonly are treated with cryosurgery, electrodesiccation and curettage, or more definitive surgical options. Over time, topical agents such as 5-fluorouracil, imiquimod, ingenol mebutate, and various forms of aminolevulinic acid (ALA) for photodynamic therapy (PDT) were included for superficial lesions as well as field treatment. The development of oral hedgehog (Hh) inhibitors such as vismodegib offered a promising alternative to patients with advanced disease. Each treatment has its own specific indications and side effects, thus there is always room for novel therapeutic approaches. We review new and potential treatments for NMSCs since 2018 including topical sonidegib, cemiplimab, taladegib, posaconazole, radiation therapy (RT), combination RT with vismodegib, PDT, and laser therapies.

3.
Cutis ; 105(1): 28-31, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32074153

RESUMO

The use of computers or machines in medicine dates back to the 1960s. Deep learning software programming is a subset of artificial intelligence (AI) based on the ability of a machine to learn from data and adaptively change. Deep learning is creating the next industrial revolution across the economy by replacing repetitive low-skilled tasks with learning algorithms. In medicine, image-based fields such as radiology, dermatology, and pathology have seen an increase in the number of studies using deep learning. However, given the current lack of standardized data sets to train these machines, it is difficult to predict if the present results eventually will be translated to real-life clinical settings.

5.
Cutis ; 103(5): 292-297;E1;E2;E3, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31233573

RESUMO

Although Mohs micrographic surgery (MMS) is the gold standard for treatment of nonmelanoma skin cancers (NMSCs), laser management has been an emerging treatment option that continues to be studied. Nonablative laser therapy is a noninvasive alternative. This study used a combined pulsed dye laser (PDL) and fractional laser approach to treat basal cell carcinomas (BCCs) in conjunction with noninvasive imaging such as reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) to enhance efficacy rates.


Assuntos
Carcinoma Basocelular/radioterapia , Neoplasias Faciais/radioterapia , Lasers de Corante/uso terapêutico , Terapia com Luz de Baixa Intensidade , Recidiva Local de Neoplasia/diagnóstico por imagem , Neoplasias Cutâneas/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Basocelular/diagnóstico por imagem , Carcinoma Basocelular/patologia , Dermoscopia , Neoplasias Faciais/diagnóstico por imagem , Neoplasias Faciais/patologia , Humanos , Microscopia Confocal , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Neoplasia Residual , Estudos Retrospectivos , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/patologia , Tomografia de Coerência Óptica , Resultado do Tratamento
7.
Cutis ; 103(4): 208-211, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31116817

RESUMO

With the implementation of the new Medicare Physician Fee Schedule on January 1, 2019, it can be beneficial for all practitioners to grasp an understanding of how reimbursement is determined. With the new Physician Fee Schedule also came new relative value units (RVUs) and new billing codes. Biopsy codes, in particular, were changed to reflect the complexity of the sampling technique (ie, tangential, punch, incisional). In this article, we explain RVUs and how they determine reimbursement. This article also highlights changes and additions to billing codes, specifically for biopsies and telemedicine services.


Assuntos
Current Procedural Terminology , Dermatologia , Grupos Diagnósticos Relacionados , Tabela de Remuneração de Serviços , Humanos , Estados Unidos
8.
Cutis ; 104(6): 345-348;350;351;E1;E2, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31939924

RESUMO

The increasing incidence of nonmelanoma skin cancer (NMSC) poses a serious public health concern. Standard care for basal cell carcinoma (BCC) requires patients to attend multiple visits for diagnosis and treatment. This pilot study describes a model of care that aims to alleviate some of the demand placed both on the specialty and on patients by utilizing a novel same-day approach to BCC management with noninvasive diagnosis, same-day treatment, and noninvasive imaging follow-up. This study evaluates the efficacy of the 1064-nm Nd:YAG laser for treating BCC while leveraging noninvasive imaging technology for diagnosis and confirmation of clearance.


Assuntos
Carcinoma Basocelular/diagnóstico por imagem , Carcinoma Basocelular/terapia , Terapia a Laser , Lasers de Estado Sólido/uso terapêutico , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/terapia , Idoso , Idoso de 80 Anos ou mais , Carcinoma Basocelular/patologia , Dermoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Retrospectivos , Neoplasias Cutâneas/patologia , Tomografia de Coerência Óptica , Resultado do Tratamento
9.
Cutis ; 102(4): 252-256, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30489561

RESUMO

As technology continues to advance, so too does its accessibility to the general population. Mobile applications (apps) have become a part of the medical field, with dermatology being no exception. There are various types of dermatology apps, including teledermatology, self-surveillance, disease guide, reference, dermoscopy, conference, education, photograph storage and sharing, and journal apps, and others. In this study, we examined the types of dermatology apps targeting patients and physicians that are most popular by analyzing their rankings in the Apple App Store. We also delved deeper into the perceived benefits of the ranked apps targeting patients and the impact of physician-targeted apps on the field of dermatology.


Assuntos
Dermatologia , Aplicativos Móveis , Padrões de Prática Médica , Telemedicina , Assistência à Saúde , Humanos , Estados Unidos
10.
JAAD Case Rep ; 4(10): 1014-1023, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30456275

RESUMO

Reflectance confocal microscopy (RCM) is a novel technology that provides noninvasive, in vivo imaging of the skin at nearly histologic resolution. In 2016, the US Centers for Medicare and Medicaid Services (CMS) established reimbursement codes for RCM image acquisition and for the reading and interpretation of images. The combination of RCM imaging with dermoscopy has improved the accuracy of skin cancer diagnosis while reducing the number of biopsies of benign skin lesions. With that, we are starting to see more dermatologists and dermatopathologists using RCM in clinical practice. This editorial is to serve as an introduction on RCM imaging with a focus on its usefulness in both the diagnosis and management of skin cancers. We end by briefly describing the characteristic RCM features of normal skin to serve as a building block for later cases that will explore both the benefits and drawbacks of incorporating RCM imaging for benign and malignant lesions.

11.
Cutis ; 102(2): 102-105, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30235368

RESUMO

Digital dermoscopy refers to the acquisition and storage of digital images from a dermoscopic examination. In this article, we delve into the innovative world of digital dermoscopy with a review of its potential uses as well as some nuances of adapting this technology in a clinical setting, including sequential monitoring, teledermoscopy, and machine learning. We also discuss the acquisition and storage of dermoscopy images in accordance with the Health Insurance Portability and Accountability Act (HIPAA).


Assuntos
Dermoscopia/métodos , Processamento de Imagem Assistida por Computador/métodos , Neoplasias Cutâneas/diagnóstico , Health Insurance Portability and Accountability Act , Humanos , Aprendizado de Máquina , Telemedicina/métodos , Estados Unidos
14.
G Ital Dermatol Venereol ; 153(1): 43-55, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28895667

RESUMO

Dermoscopy is a non-invasive diagnostic technique that facilitates the visualization of surface and subsurface structures of the skin. It has been proven to be an essential tool in the diagnosis of both malignant and benign cutaneous lesions. In this article, we review some of the most recent and noteworthy advances in dermoscopy. In addition, we discuss Reflectance Confocal Microscopy (RCM) and Optical Coherence Topography (OCT), two non-invasive imaging devices that may be used alongside dermoscopy to improve diagnostic accuracy.


Assuntos
Dermoscopia/métodos , Dermatopatias/diagnóstico , Neoplasias Cutâneas/diagnóstico , Humanos , Microscopia Confocal/métodos , Reprodutibilidade dos Testes , Pele/patologia , Dermatopatias/patologia , Neoplasias Cutâneas/patologia , Tomografia de Coerência Óptica/métodos
15.
Cutis ; 100(3): 163-166, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29121130

RESUMO

Optical coherence tomography (OCT), an emerging noninvasive imaging modality, recently received category III Current Procedural Terminology (CPT) codes from the American Medical Association, enabling tracking of its use in the medical community. In this article, we review OCT imaging and its variant systems, discussing its applications and limitations for clinical use. Future directions of OCT technology and goals for obtaining category I CPT codes and reimbursement also are discussed.


Assuntos
Dermatologia , Tomografia de Coerência Óptica , American Medical Association , Current Procedural Terminology , Humanos , Estados Unidos
16.
Future Oncol ; 13(26): 2329-2340, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29121782

RESUMO

Skin cancer is the most commonly diagnosed cancer in the USA. Mohs micrographic surgery is a microscopically controlled surgical technique that excises lateral and deep surgical margins while also sparing function and achieving a good cosmetic outcome. Given the increasing incidence in skin cancer worldwide and its associated treatment costs, techniques are being developed to improve the time and cost efficacy of this procedure. The use of noninvasive imaging, both in vivo and ex vivo, has the potential to increase efficiency of diagnosis and surgical management of skin cancers. These devices are useful in delineating lateral and deep tumor margins prior to surgery in vivo as well as to detect residual tumor ex vivo virtually in real time.


Assuntos
Diagnóstico por Imagem , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/cirurgia , Cirurgia Assistida por Computador , Diagnóstico por Imagem/métodos , Humanos , Neoplasia Residual/diagnóstico por imagem , Cirurgia Assistida por Computador/métodos
17.
Dermatol Clin ; 35(4): 465-488, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28886803

RESUMO

Optical coherence tomography (OCT) has emerged as a novel noninvasive imaging device that allows for the real-time, in vivo, cross-sectional imaging of skin morphology. OCT has increased imaging depth and field of view compared with reflectance confocal microscopy, at the cost of decreased cellular resolution. Frequency domain OCT, dynamic OCT (D-OCT), and high-definition OCT (HD-OCT) are useful in the diagnosis, treatment planning, and treatment monitoring of nonmelanoma skin cancers. Research is currently underway to assess the utilization of these devices in distinguishing between malignant and benign melanocytic lesions based on vascular patterns on D-OCT and cellular information on HD-OCT.


Assuntos
Carcinoma Basocelular/diagnóstico por imagem , Carcinoma de Células Escamosas/diagnóstico por imagem , Melanoma/diagnóstico por imagem , Neoplasias Cutâneas/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Humanos , Ceratose Actínica/diagnóstico por imagem
18.
Dermatol Clin ; 35(4): 565-576, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28886814

RESUMO

Early diagnosis and treatment of melanoma improve survival. New technologies are emerging that may augment the diagnosis, assessment, and management of melanoma but penetrance into everyday practice is low. In the current health care climate, greater emphasis will be placed on the incorporation of technology for clinically suspicious pigmented lesions to facilitate better, more cost-effective management.


Assuntos
Algoritmos , Melanoma/diagnóstico , Nevo Pigmentado/diagnóstico , Neoplasias Cutâneas/diagnóstico , Biópsia , Tomada de Decisão Clínica , Dermoscopia , Humanos , Melanoma/genética , Melanoma/patologia , Nevo Pigmentado/genética , Nevo Pigmentado/patologia , Prognóstico , Neoplasias Cutâneas/genética , Neoplasias Cutâneas/patologia , Transcriptoma
19.
Cutis ; 99(6): 399-402, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28686758

RESUMO

Reflectance confocal microscopy (RCM) has recently received Category I Current Procedural Terminology (CPT) codes by the Centers for Medicare & Medicaid Services for reimbursement comparable to a skin biopsy. In this article, we present a review of RCM imaging and its benefits and limitations in diagnosis and treatment planning. We also comment on guidelines for receiving reimbursement for acquiring, reading, and interpreting RCM images.


Assuntos
Microscopia Confocal , Neoplasias Cutâneas/diagnóstico por imagem , Biópsia , Grupos Diagnósticos Relacionados , Humanos , Neoplasias Cutâneas/patologia
20.
J Clin Aesthet Dermatol ; 10(10): 28-33, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29344318

RESUMO

OBJECTIVE: To determine whether actinic keratosis and photodamaged perilesional areas (field cancerization) treated successfully with topical ingenol mebutate gel 0.015% remained clear one year later, and to treat actinic keratosis and perilesional skin not treated one year earlier. DESIGN: Single-center, single-arm, open-label extension of an original clinical study completed one year earlier. SETTING: An outpatient clinic. PARTICIPANTS: Fifteen of the original 28 study patients enrolled in and who completed the extension phase. MEASUREMENTS: All treated and untreated lesions in the original study were evaluated clinically, dermoscopically, and with optical coherence tomography at Day 0 of the extension study. Previously untreated lesions were then treated with ingenol mebutate gel 0.015% for three days and reevaluated at Day 60. RESULTS: There was no significant increase in actinic keratoses over one year. The majority of actinic keratoses not treated in the original study were still present at the beginning of the extension study. Following treatment, 69 percent of these lesions cleared by Day 60 of the extension study, which was not significantly different from the 79 percent clearance observed in the original study. CONCLUSION: Ingenol mebutate 0.015% maintained clearance of lesions treated one year earlier. Optical coherence therapy demonstrated its reliability as a noninvasive mode of diagnosis for actinic keratosis as well as actinic damage in the surrounding areas of field cancerization. Optical coherence therapy also showed that previously untreated lesions exhibited similar clearance rates once treated with the medication.

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