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1.
Clin Cosmet Investig Dermatol ; 13: 837-855, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33223843

RESUMO

Lentigo maligna (LM) is a type of melanoma in situ that has distinctive characteristics regarding epidemiology, risk factors and clinical features. In addition, LM has a potential to progress to an invasive tumor with potentially aggressive behavior: lentigo maligna melanoma (LMM). Overall, LM has a very good prognosis, whereas LMM has the same prognosis as other invasive melanomas with similar Breslow thickness. LM/LMM represents a challenging entity not only regarding the diagnosis but also regarding the management. Diagnostic criteria are not well established, and there is an overlap of clinical, dermoscopic and pathological features with other benign pigmented skin lesions such as lentigines, pigmented actinic keratoses or macular seborrheic keratoses. LM/LMM's common appearance within photodamaged skin makes lesion border identification difficult. Wide excisions are often required, but since LM/LMM typically appears on cosmetically sensitive areas such as the face, sometimes large excisions are not possible nor desirable. In this sense, specialized approaches have been developed such as margin-controlled surgery or image-guided treatment using reflectance confocal microscopy. Other treatments for LM such as cryosurgery, imiquimod, radiotherapy or photodynamic therapy have been proposed, although recurrence/persistence is common. The current manuscript reviews extensively the published data regarding the diagnosis, treatment and management of both complex entities LM and LMM.

2.
Dermatol Online J ; 26(5)2020 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-32621713

RESUMO

Acral purpura is generally a hallmark for severe internal disease. However, exogenous pigmentation related to contact with invertebrates, can induce acral purpura-like lesions. Data regarding the beetle's ability to cause skin hyperpigmentation or purpura-like lesions are scarce. We report a case of exogenous pigmentation caused by accidental contact with a darkling beetle, clinically simulating acral purpuric lesions. The history of recent drug inhalation and abnormal autoimmunity tests made this diagnosis difficult.


Assuntos
Besouros , Hiperpigmentação/etiologia , Dedos do Pé/patologia , Animais , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade
3.
J Am Acad Dermatol ; 83(4): 1057-1063, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31202873

RESUMO

BACKGROUND: Reflectance confocal microscopy (RCM) allows accurate, noninvasive, in vivo diagnosis for skin cancer. However, its impact on physicians' diagnostic confidence and management is unknown. OBJECTIVES: We sought to assess the physicians' diagnostic confidence and management before and after RCM of equivocal skin lesions. METHODS: Prospective, 2-center, observational study. During clinical practice, 7 dermatologists recorded their diagnostic confidence level (measured in a scale from 0 to 10), diagnosis, and management before and after RCM of clinically/dermoscopically equivocal lesions that raised concern for skin cancer. We also evaluated the diagnostic accuracy before and after RCM. RESULTS: We included 272 consecutive lesions from 226 individuals (mean age, 53.5 years). Diagnostic confidence increased from 6.2 to 8.1 after RCM (P < .001) when RCM confirmed or changed the diagnosis. Lesion management changed in 33.5% cases after RCM (to observation in 51 cases and to biopsy/excision in 31 cases). After RCM, the number needed to excise was 1.2. Sensitivity for malignancy before and after RCM was 78.2% and 85.1%, respectively. Specificity before and after RCM was 78.8% and 80%, respectively. LIMITATIONS: Small sample size, real-life environment, and different levels of expertise among RCM users. CONCLUSION: Physicians' diagnostic confidence and accuracy increased after RCM when evaluating equivocal tumors, frequently resulting in management changes while maintaining high diagnostic accuracy.

4.
Pharm Pract (Granada) ; 17(3): 1455, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31592287

RESUMO

Background: Skin cancer incidence is increasing alarmingly, despite current efforts trying to improve its early detection. Community pharmacists have proven success in implementing screening protocols for a number of diseases because of their skills and easy access. Objective: To evaluate the prevalence of skin cancer risk factors and the photoprotection habits with a questionnaire in community pharmacy users. Methods: A research group consisting of pharmacists and dermatologists conducted a descriptive cross-sectional study to assess photoprotection habits and skin cancer risk factors by using a validated questionnaire in 218 community pharmacies in Barcelona from May 23rd to June 13th 2016. All participants received health education on photoprotection and skin cancer prevention. Patients with ≥1 skin cancer risk factor were referred to their physician, as they needed further screening of skin cancer. Results: A total of 5,530 participants were evaluated. Of those, only 20.2% participants had received a total body skin examination for skin cancer screening in the past by a physician and 57.1% reported using a SPF 50+ sunscreen. 53.9% participants presented ≥1 skin cancer risk factor: 11.8% participants reported having skin cancer familial history and 6.2% reported skin cancer personal history; pharmacists found ≥10 melanocytic nevi in 43.8% participants and chronically sun-damaged skin in 21.4%. Lesions suspicious for melanoma were reported in 10.9% of the participants and urgent dermatological evaluation was recommended. Conclusions: Pharmacists can detect people with skin cancer risk factors amongst their users. This intervention can be considered in multidisciplinary strategies of skin cancer screening.

5.
Pharm. pract. (Granada, Internet) ; 17(3): 0-0, jul.-sept. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-188112

RESUMO

Background: Skin cancer incidence is increasing alarmingly, despite current efforts trying to improve its early detection. Community pharmacists have proven success in implementing screening protocols for a number of diseases because of their skills and easy access. Objective: To evaluate the prevalence of skin cancer risk factors and the photoprotection habits with a questionnaire in community pharmacy users. Methods: A research group consisting of pharmacists and dermatologists conducted a descriptive cross-sectional study to assess photoprotection habits and skin cancer risk factors by using a validated questionnaire in 218 community pharmacies in Barcelona from May 23rd to June 13th 2016. All participants received health education on photoprotection and skin cancer prevention. Patients with ≥1 skin cancer risk factor were referred to their physician, as they needed further screening of skin cancer. Results: A total of 5,530 participants were evaluated. Of those, only 20.2% participants had received a total body skin examination for skin cancer screening in the past by a physician and 57.1% reported using a SPF 50+ sunscreen. 53.9% participants presented ≥1 skin cancer risk factor: 11.8% participants reported having skin cancer familial history and 6.2% reported skin cancer personal history; pharmacists found ≥10 melanocytic nevi in 43.8% participants and chronically sun-damaged skin in 21.4%. Lesions suspicious for melanoma were reported in 10.9% of the participants and urgent dermatological evaluation was recommended. Conclusions: Pharmacists can detect people with skin cancer risk factors amongst their users. This intervention can be considered in multidisciplinary strategies of skin cancer screening


No disponible


Assuntos
Humanos , Serviços Comunitários de Farmácia/organização & administração , Neoplasias Cutâneas/epidemiologia , Proteção Radiológica/estatística & dados numéricos , Protetores Solares/farmacocinética , Radiação Solar/efeitos adversos , Detecção Precoce de Câncer/métodos , Estudos Transversais , Fatores de Risco , Variação Biológica da População
6.
J Am Acad Dermatol ; 81(4): 984-988, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31202871

RESUMO

BACKGROUND: Basal cell carcinoma (BCC) treatment modalities can be stratified by tumor subtype and recurrence risk. The main limitation of nonsurgical treatment modalities is the lack of histopathologic confirmation. Reflectance confocal microscopy (RCM) is a noninvasive imaging device that provides quasihistologic images. OBJECTIVE: To evaluate the feasibility and efficacy of RCM-guided carbon dioxide (CO2) laser ablation of low-risk BCCs. METHODS: Prospective study with biopsy specimen-proven low-risk BCCs imaged with RCM. RCM was performed on these sites before and after ablation. If residual tumor was found, a new series of laser passes were performed. The patients were then monitored for recurrence clinically and with RCM. RESULTS: Twenty-two tumor sites in 9 patients (5 men, 4 women) were imaged and treated. Median age was 59 ± 12.9 years (range, 30-74 years). Mean tumor size was 7.7 mm (range, 5-10 mm). Residual tumor was identified in 5 of 22 cases (22.7%) under RCM on immediate first-pass postablation sites, prompting additional laser passes. Median follow-up was 28.5 months (range, 22-32 months) with no recurrences found. CONCLUSIONS: Addition of RCM to laser ablation workflow can detect subclinical persistent tumor after initial ablation and may serve as an aid to increase the efficacy of laser ablation.


Assuntos
Carcinoma Basocelular/cirurgia , Terapia a Laser/métodos , Lasers de Gás/uso terapêutico , Recidiva Local de Neoplasia/diagnóstico por imagem , Neoplasias Cutâneas/cirurgia , Adulto , Idoso , Biópsia , Carcinoma Basocelular/diagnóstico por imagem , Carcinoma Basocelular/patologia , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Terapia a Laser/instrumentação , Masculino , Microscopia Confocal , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/prevenção & controle , Neoplasia Residual , Estudos Prospectivos , Medição de Risco , Pele/diagnóstico por imagem , Pele/patologia , Pele/efeitos da radiação , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/patologia , Resultado do Tratamento
7.
J Am Board Fam Med ; 32(1): 96-102, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30610147

RESUMO

INTRODUCTION: Dermoscopy aids family physicians (FPs) in skin cancer detection. The triage amalgamated dermoscopic algorithm (TADA) was created to simplify the dermoscopic evaluation of a skin growth. The purpose of this image-based study was to evaluate the effect of teaching the clinical and dermoscopic features of benign skin lesions on the diagnostic accuracy of skin cancer identification using TADA. We also sought to determine the best method to teach benign neoplasms. METHODS: In this cross-sectional study of an educational intervention, FPs participated in dermoscopy training. Participants were divided into 3 groups for teaching of common benign neoplasms (dermatofibroma, angioma, and seborrheic keratosis/lentigo): didactic + interactive, didactic + heuristic, and didactic. For each group, the benign teaching was followed by skin cancer identification training with TADA. All participants took a 30 image pre-test and 30 image post-test. RESULTS: Fifty-nine participants completed the study. The mean preintervention score (out of 30 correct responses) was 17.9 (SD, 4.5) and increased to 23.5 (SD, 3.0) on the postintervention evaluation (P < .001). Sensitivity for skin cancer increased from 62.5% to 88.1% following the intervention. Postintervention specificity for skin cancer was 87.8%. Sensitivity and specificity increased following the intervention for all 3 types of benign neoplasms. Diagnostic accuracy was not impacted by the method of benign teaching. CONCLUSION: Short dermoscopy training sessions with dedicated time for benign growths followed by TADA training for malignant growths are an effective means of teaching FPs dermoscopy and result in a high sensitivity and specificity for the identification of benign and malignant skin neoplasms.


Assuntos
Dermoscopia/educação , Médicos de Família/educação , Pele/diagnóstico por imagem , Ensino/organização & administração , Triagem/métodos , Algoritmos , Competência Clínica/estatística & dados numéricos , Estudos Transversais , Dermoscopia/estatística & dados numéricos , Diagnóstico Diferencial , Feminino , Heurística , Humanos , Ceratose Seborreica/diagnóstico , Lentigo/diagnóstico , Masculino , Médicos de Família/organização & administração , Médicos de Família/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Melhoria de Qualidade , Treinamento por Simulação/métodos , Treinamento por Simulação/organização & administração , Treinamento por Simulação/estatística & dados numéricos , Neoplasias Cutâneas/diagnóstico , Ensino/estatística & dados numéricos , Triagem/organização & administração
8.
J Am Acad Dermatol ; 80(2): 341-363, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30321581

RESUMO

Dermoscopy is increasingly used by clinicians (dermatologists, family physicians, podiatrists, doctors of osteopathic medicine, etc) to inform clinical management decisions. Dermoscopic findings or images provided to pathologists offer important insight into the clinician's diagnostic and management thought process. However, with limited dermoscopic training in dermatopathology, dermoscopic descriptions and images provided in the requisition form provide little value to pathologists. Most dermoscopic structures have direct histopathologic correlates, and therefore dermoscopy can act as an excellent communication bridge between the clinician and the pathologist. In the first article in this continuing medical education series, we review dermoscopic features and their histopathologic correlates.


Assuntos
Carcinoma Basocelular/patologia , Carcinoma de Células Escamosas/patologia , Dermoscopia/métodos , Neoplasias Cutâneas/patologia , Adulto , Idoso , Biópsia por Agulha , Carcinoma Basocelular/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Diagnóstico Diferencial , Educação Médica Continuada , Feminino , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Neoplasias Cutâneas/diagnóstico
9.
J Am Acad Dermatol ; 80(2): 365-377, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30321580

RESUMO

Multiple studies have shown that dermoscopy increases the sensitivity and specificity for the detection of skin cancers compared with examination by the naked eye. Dermoscopy can also lead to the detection of thinner and smaller cancers. In addition, dermoscopy leads to the more precise selection of lesions requiring excision. In essence, dermoscopy helps clinicians differentiate benign from malignant lesions through the presence or absence of specific dermoscopic structures. Therefore, because most dermoscopic structures have direct histopathologic correlates, dermoscopy can allow the prediction of certain histologic findings present in skin cancers, thus helping select management and treatment options for select types of skin cancers. Visualizing dermoscopic structures in the ex vivo specimens can also be beneficial. It can improve the histologic diagnostic accuracy by targeted step-sectioning in areas of concern, which can be marked by the clinician before sending the specimen to the pathologist, or by the pathologist on the excised specimen in the laboratory. In addition, ex vivo dermoscopy can also be used to select tumor areas with genetic importance because some dermoscopic structures have been related to mutations with theragnostic relevance. In the second article in this continuing medical education series, we review the impact of dermoscopy on the diagnostic accuracy of skin cancer, how dermoscopy can affect the histopathologic examination, and which dermoscopic features may be more relevant in terms of histologic and genetic prediction.


Assuntos
Carcinoma Basocelular/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Dermoscopia/métodos , Melanoma/diagnóstico , Neoplasias Cutâneas/diagnóstico , Biópsia por Agulha , Carcinoma Basocelular/patologia , Carcinoma de Células Escamosas/patologia , Diagnóstico Diferencial , Educação Médica Continuada , Feminino , Humanos , Imuno-Histoquímica , Masculino , Melanoma/patologia , Estadiamento de Neoplasias , Sensibilidade e Especificidade , Neoplasias Cutâneas/patologia
10.
J Am Acad Dermatol ; 80(6): 1585-1593, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30244062

RESUMO

BACKGROUND: Multiple BRCA1-associated protein 1 (BAP1)-inactivated melanocytic tumors (BIMTs) have been associated with a familial cancer syndrome involving germline mutations in BAP1. OBJECTIVES: We sought to describe the clinical and dermoscopic features of BIMTs. METHODS: This was a retrospective, multicenter, case-control study. Participating centers contributed clinical data, dermoscopic images, and histopathologic data of biopsy-proven BIMTs. We compared the dermoscopic features between BIMTs and control patients. RESULTS: The dataset consisted of 48 BIMTs from 31 patients (22 women; median age 37 years) and 80 control patients. Eleven patients had a BAP1 germline mutation. Clinically, most BIMTs presented as pink, dome-shaped papules (n = 24). Dermoscopically, we identified 5 patterns: structureless pink-to-tan with irregular eccentric dots/globules (n = 14, 29.8%); structureless pink-to-tan with peripheral vessels (n = 10, 21.3%); structureless pink-to-tan (n = 7, 14.9%); a network with raised, structureless, pink-to-tan areas (n = 7, 14.9%); and globular pattern (n = 4, 8.5%). The structureless with eccentric dots/globules pattern and network with raised structureless areas pattern were only identified in BIMT and were more common in patients with BAP1 germline mutations (P < .0001 and P = .001, respectively). LIMITATIONS: Limitations included our small sample size, retrospective design, the absence of germline genetic testing in all patients, and inclusion bias toward more atypical-looking BIMTs. CONCLUSIONS: Dome-shaped papules with pink-to-tan structureless areas and peripheral irregular dots/globules or network should raise the clinical suspicion for BIMT.


Assuntos
Melanoma/patologia , Nevo Pigmentado/patologia , Neoplasias Cutâneas/patologia , Proteínas Supressoras de Tumor/genética , Ubiquitina Tiolesterase/genética , Adolescente , Adulto , Idoso , Biópsia , Estudos de Casos e Controles , Criança , Bases de Dados Factuais , Dermoscopia , Feminino , Mutação em Linhagem Germinativa , Humanos , Masculino , Melanoma/genética , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/genética , Neoplasias Primárias Múltiplas/patologia , Síndromes Neoplásicas Hereditárias/genética , Nevo de Células Epitelioides e Fusiformes/genética , Nevo de Células Epitelioides e Fusiformes/patologia , Nevo Pigmentado/genética , Variações Dependentes do Observador , Estudos Retrospectivos , Tamanho da Amostra , Método Simples-Cego , Neoplasias Cutâneas/genética , Adulto Jovem
11.
Rev. chil. dermatol ; 35(4): 166-169, 2019. ilus, tab
Artigo em Inglês | LILACS | ID: biblio-1120282

RESUMO

El molusco contagioso (MC) es una infección viral frecuente, generalmente fácil de diagnosticar gracias a sus manifestaciones clínicas características. Sin embargo, las presentaciones clínicas atípicas pueden suponer un desafío diagnóstico. La dermatoscopia ha ayudado en estos casos complejos, al mostrar un patrón dermatoscópico característico compuesto por un poro central o umbilicación junto con estructuras amorfas polilobulares de color blanco a amarillo, rodeadas de vasos lineales o ramificados ('vasos en corona"). Sin embargo, se pueden encontrar patrones dermatoscópicos adicionales. Presentamos dos casos de MC donde se observaron rosetas en la dermatoscopia.


Molluscum contagiosum (MC), a frequent viral infection, is generally easy to diagnose because of its characteristic clinical features. However, atypical presentations can be a diagnostic challenge for clinicians. Dermoscopy has helped in this cases by showing a characteristic dermoscopic pattern composed of a central pore or umbilication in conjunction with polylobular white to yellow amorphous structures, surrounded by linear or branched vessels ('red crown"). However, additional dermoscopic patterns can be found. Herein we present two MC cases where rosettes were seen on dermoscopy


Assuntos
Humanos , Feminino , Criança , Adolescente , Adulto , Pele/patologia , Dermoscopia/métodos , Molusco Contagioso/diagnóstico
12.
JAMA Dermatol ; 154(10): 1175-1183, 2018 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-30140851

RESUMO

Importance: The limited tissue sampling of a biopsy can lead to an incomplete assessment of basal cell carcinoma (BCC) subtypes and depth. Reflectance confocal microscopy (RCM) combined with optical coherence tomography (OCT) imaging may enable real-time, noninvasive, comprehensive three-dimensional sampling in vivo, which may improve the diagnostic accuracy and margin assessment of BCCs. Objective: To determine the accuracy of a combined RCM-OCT device for BCC detection and deep margin assessment. Design, Setting, and Participants: This pilot study was carried out on 85 lesions from 55 patients referred for physician consultation or Mohs surgery at Memorial Sloan Kettering Skin Cancer Center in Hauppauge, New York. These patients were prospectively and consecutively enrolled in the study between January 1, 2017, and December 31, 2017. Patients underwent imaging, with the combined RCM-OCT probe, for previously biopsied, histopathologically confirmed BCCs and lesions clinically or dermoscopically suggestive of BCC. Only patients with available histopathologic examination after imaging were included. Main Outcomes and Measures: Improvements in sensitivity, specificity, and diagnostic accuracy for BCC using the combined RCM-OCT probe as well as the correlation between OCT-estimated depth and histopathologically measured depth were investigated. Results: In total, 85 lesions from 55 patients (27 [49%] were female and 28 [51%] were male with a median [range] age of 59 [21-90] years) were imaged. Imaging was performed on 25 previously biopsied and histopathologically confirmed BCCs and 60 previously nonbiopsied but clinically or dermoscopically suspicious lesions. Normal skin and BCC features were correlated and validated with histopathologic examination. In previously biopsied lesions, residual tumors were detected in 12 of 25 (48%) lesions with 100% sensitivity (95% CI, 73.5%-100%) and 23.1% specificity (95% CI, 5.0%-53.8%) for combined RCM-OCT probe. In previously nonbiopsied and suspicious lesions, BCCs were diagnosed in 48 of 60 (80%) lesions with 100% sensitivity (95% CI, 92.6%-100%) and 75% specificity (95% CI, 42.8%-94.5%). Correlation was observed between depth estimated with OCT and depth measured with histopathologic examination: the coefficient of determination (R2) was 0.75 (R = 0.86; P < .001) for all lesions, 0.73 (R = 0.85; P < .001) for lesions less than 500 µm deep, and 0.65 (R = 0.43; P < .001) for lesions greater than 500 µm deep. Conclusions and Relevance: Combined RCM-OCT imaging may be prospectively used to comprehensively diagnose lesions suggestive of BCC and triage for treatment. Further validation of this device must be performed on a larger cohort.


Assuntos
Carcinoma Basocelular/diagnóstico por imagem , Neoplasias Cutâneas/diagnóstico por imagem , Tomografia de Coerência Óptica , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Carcinoma Basocelular/patologia , Feminino , Humanos , Masculino , Microscopia Confocal , Pessoa de Meia-Idade , Imagem Multimodal , Projetos Piloto , Estudos Prospectivos , Sensibilidade e Especificidade , Pele/patologia , Neoplasias Cutâneas/patologia , Adulto Jovem
13.
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
16.
Dermatol Pract Concept ; 7(4): 13-16, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29214103

RESUMO

The majority of oral pigmentations are benign lesions such as nevi, melanotic macules, melanoacanthomas or amalgam tattoos. Conversely, mucosal melanomas are rare but often lethal; therefore, excluding oral melanomas in this setting is crucial. Reflectance confocal microscopy is a non-invasive, in vivo imaging system with cellular resolution that has been used to distinguish benign from malignant pigmented lesions in the skin, and more recently in the mucosa. However, lesions located posteriorly in the oral cavity are difficult to assess visually and difficult to biopsy due to their location. Herein we present a patient with previous multiple melanomas presenting with an oral amalgam tattoo in the buccal mucosa, which was imaged using an intraoral telescopic probe attached to a commercially available handheld RCM. In this case report we describe this novel probe, the first RCM description of an amalgam tattoo and we discuss its differences with the findings described in oral melanomas.

17.
JAMA Dermatol ; 153(12): 1278-1284, 2017 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-29049429

RESUMO

Importance: The management of lentigo maligna (LM) and LM melanoma (LMM) is challenging because of extensive subclinical spread and its occurrence on cosmetically sensitive areas. Reflectance confocal microscopy (RCM) improves diagnostic accuracy for LM and LMM and can be used to delineate their margins. Objectives: To evaluate whether handheld RCM with radial video mosaicing (HRCM-RV) offers accurate presurgical assessment of LM and LMM margins. Design, Setting, and Participants: This prospective study included consecutive patients with biopsy-proven LM and LMM located on the head and neck area who sought consultation for surgical management from March 1, 2016, through March 31, 2017, at the Dermatology Service of the Memorial Sloan Kettering Cancer Center. Thirty-two patients underwent imaging using HRCM-RV, and 22 patients with 23 LM or LMM lesions underwent staged surgery and contributed to the analysis. Main Outcomes and Measures: Clinical lesion size and area, LM and LMM area based on HRCM-RV findings, surgical defect area estimated by HRCM-RV, and observed surgical defect area. In addition, the margins measured in millimeters estimated for tumor clearance in each quadrant based on HRCM-RV findings were calculated and compared with the surgical margins. Results: Among the 22 patients (12 men and 10 women; mean [SD] age, 69.0 [8.6] years [range, 46-83 years]) with 23 lesions included in the final analysis, the mean (SD) surgical defect area estimated with HRCM-RV was 6.34 (4.02) cm2 and the mean (SD) area of surgical excision with clear margins was 7.74 (5.28) cm2. Overall, controlling for patient age and previous surgery, surgical margins were a mean of 0.76 mm (95% CI, 0.67-0.84 mm; P < .001) larger than the HRCM-RV estimate. Conclusions and Relevance: Mapping of LM and LMM with HRCM-RV estimated defects that were similar to but slightly smaller than those found in staged excision. Thus, mapping of LM using HRCM-RV can help spare healthy tissue by reducing the number of biopsies needed in clinically uncertain areas and may be used to plan treatment of LM and LMM and counsel patients appropriately.


Assuntos
Sarda Melanótica de Hutchinson/diagnóstico , Margens de Excisão , Melanoma/diagnóstico , Microscopia Confocal/métodos , Neoplasias Cutâneas/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Biópsia , Feminino , Humanos , Sarda Melanótica de Hutchinson/patologia , Sarda Melanótica de Hutchinson/cirurgia , Masculino , Melanoma/patologia , Melanoma/cirurgia , Pessoa de Meia-Idade , Estudos Prospectivos , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgia , Gravação em Vídeo
18.
Sci Rep ; 7(1): 10759, 2017 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-28883434

RESUMO

We describe a computer vision-based mosaicking method for in vivo videos of reflectance confocal microscopy (RCM). RCM is a microscopic imaging technique, which enables the users to rapidly examine tissue in vivo. Providing resolution at cellular-level morphology, RCM imaging combined with mosaicking has shown to be highly sensitive and specific for non-invasively guiding skin cancer diagnosis. However, current RCM mosaicking techniques with existing microscopes have been limited to two-dimensional sequences of individual still images, acquired in a highly controlled manner, and along a specific predefined raster path, covering a limited area. The recent advent of smaller handheld microscopes is enabling acquisition of videos, acquired in a relatively uncontrolled manner and along an ad-hoc arbitrarily free-form, non-rastered path. Mosaicking of video-images (video-mosaicking) is necessary to display large areas of tissue. Our video-mosaicking methods addresses this need. The method can handle unique challenges encountered during video capture such as motion blur artifacts due to rapid motion of the microscope over the imaged area, warping in frames due to changes in contact angle and varying resolution with depth. We present test examples of video-mosaics of melanoma and non-melanoma skin cancers, to demonstrate potential clinical utility.


Assuntos
Processamento de Imagem Assistida por Computador/métodos , Microscopia Confocal/métodos , Humanos , Melanoma/diagnóstico por imagem , Melanoma/patologia , Microscopia Confocal/instrumentação , Microscopia de Vídeo/métodos , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/patologia
19.
Dermatol Clin ; 35(4): 417-437, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28886798

RESUMO

Dermoscopy increases the sensitivity for skin cancer detection, decreases the number of benign lesions biopsied for each malignant diagnosis, and enables the diagnosis of thinner melanomas compared with naked eye examination. Multiple meta-analyses have identified that dermoscopy improves the diagnostic accuracy for melanoma when compared with naked eye examination. In addition, studies have established that dermoscopy can aid in the detection of keratinocyte carcinomas. Dermoscopy triage algorithms have been developed to help novices decide when a biopsy or a referral is most appropriate. In this article, the authors illustrate the dermoscopic features that assist in identifying melanoma and keratinocyte carcinomas.


Assuntos
Carcinoma Basocelular/diagnóstico por imagem , Carcinoma de Células Escamosas/diagnóstico por imagem , Dermoscopia , Melanoma/diagnóstico por imagem , Neoplasias Cutâneas/diagnóstico por imagem , Algoritmos , Humanos , Ceratoacantoma/diagnóstico por imagem , Ceratose Actínica/diagnóstico por imagem
20.
J Biomed Opt ; 22(8): 1-13, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28831793

RESUMO

Laser ablation offers a procedure for precise, fast, and minimally invasive removal of superficial and early nodular basal cell carcinomas (BCCs). However, the lack of histopathological confirmation has been a limitation toward widespread use in the clinic. A reflectance confocal microscopy (RCM) imaging-guided approach offers cellular-level histopathology-like feedback directly on the patient, which may then guide and help improve the efficacy of the ablation procedure. Following an ex vivo benchtop study (reported in our earlier papers), we performed an initial study on 44 BCCs on 21 patients in vivo, using a pulsed erbium:ytterbium aluminum garnet laser and a contrast agent (aluminum chloride). In 10 lesions on six patients, the RCM imaging-guided detection of either presence of residual tumor or complete clearance was immediately confirmed with histopathology. Additionally, 34 BCCs on 15 patients were treated with RCM imaging-guided laser ablation, with immediate confirmation for clearance of tumor (no histopathology), followed by longer-term monitoring, currently in progress, with follow-up imaging (again, no histopathology) at 3, 6, and 18 months. Thus far, the imaging resolution appears to be sufficient and consistent for monitoring efficacy of ablation in the wound, both immediately postablation and subsequently during recovery. The efficacy results appear to be promising, with observed clearance in 19 cases of 22 cases with follow-ups ranging from 6 to 21 months. An additional 12 cases with 1 to 3 months of follow-ups has shown clearance of tumor but a longer follow-up time is required to establish conclusive results. Further instrumentation development will be necessary to cover larger areas with a more automatically controlled instrument for more uniform, faster, and deeper imaging of margins.


Assuntos
Carcinoma Basocelular/cirurgia , Terapia a Laser/métodos , Microscopia Confocal/métodos , Neoplasias Cutâneas/cirurgia , Humanos
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