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1.
An Bras Dermatol ; 95(3): 379-382, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32276794

RESUMO

In situations in when a dermoscopic record of a large lesion is desirable, the resulting images are usually restricted to a small field of view due to the limited diameter of dermatoscope lenses. This limitation often produces several photographs separately, thus losing the possibility of a single-image global evaluation. In these case reports, we show examples of a recently published image montage technique called Wide Area Digital Dermoscopy, in this case, applied to basal cell carcinomas.


Assuntos
Carcinoma Basocelular/diagnóstico por imagem , Dermoscopia/métodos , Processamento de Imagem Assistida por Computador/métodos , Neoplasias Cutâneas/diagnóstico por imagem , Carcinoma Basocelular/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Neoplasias Cutâneas/patologia , Software
2.
Cient. dent. (Ed. impr.) ; 17(1): 49-55, ene.-abr. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-189749

RESUMO

El síndrome de Gorlin-Goltz (SGG) es también conocido como síndrome névico basocelular o síndrome del carcinoma nevoide basocelular. Fue mencionado por primera vez en 1894 por los doctores Jarish y White y fue descrito en 1960 por Robert J. Gorlin. Es un raro trastorno autosómico dominante, ocasionado por una mutación sufrida en el gen Patched 1 (PTCH1) ubicado en el cromosoma 9q223 (este gen desempeña un papel en la supresión tumoral, la estructuración embrionaria y el ciclo celular), que se caracteriza por defectos en el desarrollo y por elevar de manera significativa la predisposición a padecer algún tipo de cáncer. Su prevalencia es variable según el país, pero está aceptada una media de 1:60.000 habitantes/año, siendo la relación hombre/mujer de 1: 0,621. El diagnóstico del SGG puede resultar complejo debido a la variabilidad en la expresividad del síndrome y en la edad de presentación. La manifestación más común en la cavidad oral son los queratoquistes, lesiones que aparecen hasta en el 90% de los pacientes


Gorlin-Goltz Syndrome (GGS) is also known as basal cell nevus syndrome or nevoid basal cell carcinoma syndrome. It was first mentioned in 1894 by Doctors Jarish and White and described in 1960 by Robert J. Gorlin. It is a rare autosomal dominant condition, caused by a mutation suffered in the PTCH1 gene (Patched 1) located on chromosome 9q223 (this gene plays a role in tumour suppression, embryonic structuring and the cell cycle). It is characterised by defects in development and a significantly increased predisposition to suffering from some type of cancer. Its prevalence varies according to the country, but an average of 1 per 60,000 population/year is accepted, with the male/female ratio being 1:0.621. Diagnosing GGS can be complex due to the variability in the expressiveness of the syndrome and the age of presentation. The most common manifestation is the appearance of keratocysts in the oral cavity, which appear in up to 90% of patients


Assuntos
Humanos , Feminino , Criança , Síndrome do Nevo Basocelular/diagnóstico por imagem , Síndrome do Nevo Basocelular/cirurgia , Carcinoma Basocelular/diagnóstico por imagem , Carcinoma Basocelular/complicações , Carcinoma Basocelular/cirurgia , Cistos Odontogênicos/diagnóstico por imagem , Cistos Odontogênicos/patologia , Radiografia Panorâmica , Regeneração Óssea
3.
J Craniofac Surg ; 31(1): e92-e95, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31592843

RESUMO

INTRODUCTION: An increasing number of skin cancer arising over vascular anomaly has been reported in literature. In such cases, the oncologic radicality required to threat skin malignancies may be in contrast with the safety needed when dealing with vascular malformation. As a result, treatment of this association may be insidious and treacherous and imposes a sound knowledge and carefulness. MATERIALS AND METHODS: The authors report on a case of a 77-years-old woman affected by a basal cell carcinoma (BCC) arising over a vascular malformation of forehead. Preoperative radiological imaging revealed an underlying venous malformation (VM) communicating with intracranial district. Patient underwent sclerotherapy of the VM with gelified ethanol in order to reduce potentially fatal bleeding during surgery and, on the other hand, any leakage of the sclerosant in the intracranial veins. Excision of the BCC was then performed without complications. RESULTS: Neither intra-operative nor post-operative complications were observed. Current 3-years follow-up shows no recurrence of BCC whilst the residual VM is stable and clinically silent. CONCLUSIONS: Mechanisms leading to the onset of skin cancers over venous malformations are still unclear. However, association between these 2 conditions may be underestimated with possible catastrophic consequences. Thorough knowledge of vascular malformations and a multidisciplinary approach is of the uttermost importance when dealing with such clinical challenges.


Assuntos
Carcinoma Basocelular/cirurgia , Testa/cirurgia , Neoplasias Cutâneas/cirurgia , Malformações Vasculares/cirurgia , Veias/cirurgia , Idoso , Carcinoma Basocelular/irrigação sanguínea , Carcinoma Basocelular/diagnóstico por imagem , Feminino , Testa/irrigação sanguínea , Testa/diagnóstico por imagem , Humanos , Procedimentos Cirúrgicos Reconstrutivos , Soluções Esclerosantes/uso terapêutico , Escleroterapia , Neoplasias Cutâneas/diagnóstico por imagem , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/tratamento farmacológico , Veias/diagnóstico por imagem
4.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 44(9): 1063-1070, 2019 Sep 28.
Artigo em Chinês | MEDLINE | ID: mdl-31645498

RESUMO

OBJECTIVE: To construct an intelligent assistant diagnosis model based on the clinical images of basal cell carcinoma (BCC) and pigmented nevi in Chinese by using the advanced convolutional neural network (CNN).
 Methods: Based on the Xiangya Medical Big Data Platform, we constructed a large-scale clinical image dataset of skin diseases according to Chinese ethnicity and the Xiangya Skin Disease Dataset. We evaluated the performance of 5 mainstream CNN models (ResNet50, InceptionV3, InceptionResNetV2, DenseNet121, and Xception) on a subset of BCC and pigmented nevi of this dataset. We also analyzed the basis of the diagnosis results in the form of heatmaps. We compared the optimal CNN classification model with 30 professional dermatologists.
 Results: The Xiangya Skin Disease Dataset contains 150 223 clinical images with lesion annotations, covering 543 skin diseases, and each image in the dataset contains support for pathological gold standards and the patient's overall medical history. On the test set of 349 BCC and 497 pigmented nevi, the optimal CNN model was Xception, and its classification accuracy can reach 93.5%, of which the area under curve (AUC) values were 0.974 and 0.969, respectively. The results of the heatmap showed that the CNN model can indeed learn the characteristics associated with disease identification. The ability of the Xception model to identify clinical images of BCC and Nevi was basically comparable to that of professional dermatologists.
 Conclusion: This study is the first assistant diagnosis study for skin tumor based on Chinese ethnic clinical dataset. It proves that CNN model has the ability to distinguish between Chinese ethnicity's BCC and Nevi, and lays a solid foundation for the following application of artificial intelligence in the diagnosis and treatment for skin tumors.


Assuntos
Carcinoma Basocelular/diagnóstico por imagem , Redes Neurais de Computação , Nevo Pigmentado/diagnóstico por imagem , Neoplasias Cutâneas/diagnóstico por imagem , Área Sob a Curva , Humanos
5.
Comput Methods Programs Biomed ; 178: 201-218, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31416550

RESUMO

BACKGROUND AND OBJECTIVE: Skin cancer is the commonest form of cancer in the worldwide population. Non-invasive and non-contact imaging modalities are being used for the screening of melanoma and other cutaneous malignancies to endorse early detection and prevention of the disease. Traditionally it has been a problem for medical personnel to differentiate melanoma, dysplastic nevi and basal cell carcinoma (BCC) diseases from one another due to the confusing appearance and similarity in the characteristics of the pigmented lesions. The paper reports an integrated method developed for identifying these skin diseases from the dermoscopic images. METHODS: The proposed integrated computer-aided method has been employed for the identification of each of these diseases using recursive feature elimination (RFE) based layered structured multiclass image classification technique. Prior to the classification, different quantitative features have been extracted by analyzing the shape, the border irregularity, the texture and the color of the skin lesions, using different image processing tools. Primarily, a combination of gray level co-occurrence matrix (GLCM) and a proposed fractal-based regional texture analysis (FRTA) algorithm has been used for the quantification of textural information. The performance of the framework has been evaluated using a layered structure classification model using support vector machine (SVM) classifier with radial basis function (RBF). RESULTS: The performance of the morphological skin lesion segmentation algorithm has been evaluated by estimating the pixel level sensitivity (Sen) of 0.9172, 0.9788 specificity (Spec), 0.9521 accuracy (ACU), along with the image similarity measuring indices as Jaccard similarity index (JSI) of 0.8562 and Dice similarity coefficient (DSC) of 0.9142 with respect to the corresponding ground truth (GT) images. The quantitative features extracted from the proposed feature extraction algorithms have been employed for the proposed multi-class skin disease identification. The proposed layered structure identifies all the three classes of skin diseases with a highly acceptable classification accuracy of 98.99%, 97.54% and 99.65% for melanoma, dysplastic nevi and BCC respectively. CONCLUSION: To overcome the difficulties of proper diagnosis of diseases based on visual evaluation, the proposed integrated system plays an important role by quantifying the effective features and identifying the diseases with higher degree of accuracy. This combined approach of quantitative and qualitative analysis not only increases the diagnostic accuracy, but also provides some important information not obtainable from qualitative assessment alone.


Assuntos
Carcinoma Basocelular/diagnóstico por imagem , Fractais , Processamento de Imagem Assistida por Computador/métodos , Melanoma/diagnóstico por imagem , Nevo/diagnóstico por imagem , Adulto , Algoritmos , Dermoscopia , Diagnóstico por Computador , Detecção Precoce de Câncer , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reconhecimento Automatizado de Padrão , Pigmentação , Reprodutibilidade dos Testes , Máquina de Vetores de Suporte
6.
Chin Med J (Engl) ; 132(17): 2021-2026, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31460903

RESUMO

BACKGROUND: Due to advances in high-frequency ultrasound technology, it is easier to detect fine structures of skin lesions. The aim of this study was to examine the ultrasonographic features and use recurrence risk stratification to assess the diagnostic performance of pre-operative ultrasound examination of basal cell carcinoma (BCC). METHODS: This was a retrospective study. Forty-six BCC lesions underwent pre-operative ultrasound examination using 50- and 20-MHz probes. Ultrasonographic shape, margin, internal echoes, hyper-echoic spots, posterior echoes, and depth of the lesion were evaluated and correlated with the risk of recurrence based on histological features. RESULTS: Forty-two patients had 46 skin lesions in total. The high-risk (n = 6) and low-risk (n = 40) groups exhibited considerable overlap in the ultrasonographic manifestations and no significant difference in margin (χ = 3.231, P = 0.072), internal echo (χ = 1.592, P = 0.207), or posterior echo (P = 0.169). However, high-risk BCCs tended to be irregular in shape than low-risk lesions (χ = 4.313, P = 0.038). Both types presented hyper-echoic spots (χ = 1.850, P = 0.174). Additionally, 78% of low-risk lesions were confined to the dermis (31/40), and 100% of high-risk lesions infiltrated into the sub-cutaneous tissue, resulting in a significant difference between the two groups (χ = 10.951, P = 0.001). Ultrasound detected sub-clinical lesions in five patients. CONCLUSIONS: High-frequency ultrasound can provide important information for pre-operative evaluation of risk in BCC foci and reveal hidden lesions. The technique may play a crucial role in guiding therapeutic options for BCC.


Assuntos
Carcinoma Basocelular/diagnóstico por imagem , Dermatopatias/diagnóstico por imagem , Pele/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estudos Retrospectivos , Neoplasias Cutâneas/diagnóstico por imagem , Ultrassonografia
7.
Dermatol Clin ; 37(4): 527-536, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31466592

RESUMO

Skin cancer is the most common malignancy in the United States. Health care providers and patients alike are tasked with identifying suspicious skin lesions in order to diagnose skin cancers early and treat them quickly. The normal pathway to skin cancer diagnosis is visual, with dermoscopic assessment of the lesion followed by biopsy and histopathologic evaluation. Recently, many innovative skin cancer detection technologies have been developed to increase diagnostic accuracy for skin cancers. These noninvasive technologies offer benefits over biopsy but are limited by expense, training, and poor specificity. The skin cancer detection techniques are reviewed in this article.


Assuntos
Carcinoma Basocelular/patologia , Carcinoma de Células Escamosas/patologia , Melanoma/patologia , Neoplasias Cutâneas/patologia , Carcinoma Basocelular/diagnóstico , Carcinoma Basocelular/diagnóstico por imagem , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/diagnóstico por imagem , Dermoscopia , Espectroscopia Dielétrica , Humanos , Melanoma/diagnóstico , Melanoma/diagnóstico por imagem , Microscopia Confocal , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/diagnóstico por imagem , Análise Espectral Raman , Tomografia de Coerência Óptica , Ultrassonografia
8.
J Appl Clin Med Phys ; 20(9): 78-85, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31454148

RESUMO

PURPOSE: This case series represents an initial experience with implementing 3-dimensional (3D) surface scanning, digital design, and 3D printing for bolus fabrication for patients with complex surface anatomy where traditional approaches are challenging. METHODS AND MATERIALS: For 10 patients requiring bolus in regions with complex contours, bolus was designed digitally from 3D surface scanning data or computed tomography (CT) images using either a treatment planning system or mesh editing software. Boluses were printed using a fused deposition modeling printer with polylactic acid. Quality assurance tests were performed for each printed bolus to verify density and shape. RESULTS: For 9 of 10 patients, digitally designed boluses were used for treatment with no issues. In 1 case, the bolus was not used because dosimetric requirements were met without the bolus. QA tests revealed that the bulk density was within 3% of the reference value for 9 of 12 prints, and with more judicious selection of print settings this could be increased. For these 9 prints, density uniformity was as good as or better than our traditional sheet bolus material. The average shape error of the pieces was less than 0.5 mm, and no issues with fit or comfort were encountered during use. CONCLUSIONS: This study demonstrates that new technologies such as 3D surface scanning, digital design and 3D printing can be safely and effectively used to modernize bolus fabrication.


Assuntos
Impressão Tridimensional/instrumentação , Garantia da Qualidade dos Cuidados de Saúde/normas , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia de Intensidade Modulada/instrumentação , Radioterapia de Intensidade Modulada/métodos , Neoplasias Cutâneas/radioterapia , Idoso , Idoso de 80 Anos ou mais , Carcinoma Basocelular/diagnóstico por imagem , Carcinoma Basocelular/radioterapia , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/radioterapia , Desenho de Equipamento , Feminino , Humanos , Processamento de Imagem Assistida por Computador/métodos , Masculino , Pessoa de Meia-Idade , Órgãos em Risco/efeitos da radiação , Prognóstico , Dosagem Radioterapêutica , Neoplasias Cutâneas/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos
9.
Int J Dermatol ; 58(11): 1270-1276, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31347153

RESUMO

BACKGROUND: Primary cutaneous lymphomas (PCLs) and pseudolymphomas presenting as single pink-red nodules/tumors are highly unspecific and include a wide differential diagnosis. OBJECTIVE: To describe the dermoscopic characteristics of PCL/pseudolymphoma. METHODS: In this retrospective, case-control study, we evaluated the dermoscopic features of patients with solitary PCL/pseudolymphoma tumors and compared them to a control group of non-lymphomatous, nonpigmented, solitary tumors (e.g., basal cell carcinoma, amelanotic melanoma, etc). RESULTS: We included 14 patients with PCL/pseudolymphomas and 35 controls. T-cell and B-cell lymphoma proportions were 28.6% (n = 4) and 71.4% (n = 10), respectively. Compared to controls, most lymphomas presented dermoscopically with orange color (71.4% vs. 14.2%, P < 0.001), follicular plugs (85% vs. 2.8%, P < 0.001), and as  organized lesions (85% vs. 31.4%, P = 0.001). Coexistence of orange color and follicular plugs had an odds ratio (OR) of 2.8 (P < 0.001), highly suggestive of PCL . The kappa index for independent observers was 0.66, 0.49, 0.43 for orange background, follicular plugs, and organized lesion, respectively. Histopathologic correlation was performed in six PCL cases and showed dense diffuse and perifollicular lymphocytic infiltrate in all cases and keratin plugs in five of six cases, possibly correlating with the orange color and the follicular plugs, respectively. CONCLUSION: Primary cutaneous lymphomas/pseudolymphomas present with characteristic dermoscopic findings irrespective of immunohistochemical subtype.


Assuntos
Linfoma de Células B/diagnóstico por imagem , Linfoma Cutâneo de Células T/diagnóstico , Pseudolinfoma/diagnóstico por imagem , Neoplasias Cutâneas/diagnóstico por imagem , Pele/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Carcinoma Basocelular/diagnóstico por imagem , Estudos de Casos e Controles , Dermoscopia , Diagnóstico Diferencial , Feminino , Humanos , Linfoma de Células B/patologia , Linfoma Cutâneo de Células T/patologia , Masculino , Melanoma Amelanótico/diagnóstico por imagem , Pessoa de Meia-Idade , Pseudolinfoma/patologia , Estudos Retrospectivos , Pele/diagnóstico por imagem , Neoplasias Cutâneas/patologia
10.
J Eur Acad Dermatol Venereol ; 33(10): 1837-1846, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31166040

RESUMO

The differential diagnosis of nipple and areola complex (NAC) lesions encompasses a large spectrum of conditions from benign tumours to inflammatory diseases that could be challenging to recognize on clinical ground. While melanoma (MM) of the NAC is exceedingly rare, benign lesions are more frequent but could be difficult to distinguish from MM. Besides MM, other malignant tumours can affect this area and in particular Paget's disease (PD). For clinically doubtful lesions, biopsy is required, with possible functional and aesthetic consequences in this sensitive area. Dermoscopy and reflectance confocal microscopy (RCM) are widely used techniques for the diagnosis of many skin lesions, but their use for NAC lesions is not well established. The objective of this study was to evaluate current literature on these imaging techniques for NAC lesions. We searched in Medline, PubMed and Cochrane database all studies up to November 2018 dealing with dermoscopy, RCM and this special site. We found that the most described malignant tumour was PD and that only two primary MMs of the NAC have been reported with these imaging techniques. Although there are few data on diagnostic accuracy of non-invasive imaging techniques for NAC lesions, it seems that dermoscopy and RCM can add relevant information to be integrated with clinical examination for the diagnosis of NAC lesions and in particular for the differential diagnosis of PD and eczema.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Dermoscopia , Melanoma/diagnóstico por imagem , Mamilos/diagnóstico por imagem , Doença de Paget Mamária/diagnóstico por imagem , Transtornos da Pigmentação/diagnóstico por imagem , Neoplasias Cutâneas/diagnóstico por imagem , Carcinoma Basocelular/diagnóstico por imagem , Carcinoma de Células Escamosas/diagnóstico por imagem , Diagnóstico Diferencial , Eczema/diagnóstico por imagem , Humanos , Microscopia Confocal
11.
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
12.
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
13.
J Am Acad Dermatol ; 81(2): 417-426, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31227277

RESUMO

BACKGROUND: Biopsy specimens from patients with basal cell carcinoma (BCC) can present to surgery with no clinically residual tumor, complicating treatment decisions. OBJECTIVE: To evaluate reflectance confocal microscopy (RCM) for the assessment of residual BCC following biopsy. METHODS: Consecutive patients with biopsy-proven BCC and no clinical evidence of residual tumor who had been referred for Mohs micrographic surgery were included. Biopsy sites were imaged with a handheld RCM device. On the basis of RCM evaluation, cases were labeled RCM positive or RCM negative. Mohs micrographic surgery was performed in all cases; margins and 15-µm serial vertical sectioning were evaluated. RESULTS: A total of 61 patients were included (mean age, 61.7 years [standard deviation, 12.2 years]; range, 37-87 years); 60.7% were women. The mean lesion size was 5.1 mm (range, 3-12 mm); 73.8% of patients were positive on RCM, and 68.9% had residual BCC on histopathologic examination. The rates of RCM sensitivity, specificity, positive predictive value, and negative predictive value were 92.8%, 68.4%, 86.6%, and 81.2%, respectively. Three cases of BCC (high-risk, infiltrative, and basosquamous) were missed with use of RCM. When high-risk subtypes were excluded (n = 5), sensitivity and negative predictive value were both 100%. LIMITATIONS: RCM can miss deep-seated residual tumor. CONCLUSION: RCM is a valuable tool for the evaluation of residual BCC following biopsy, with the potential to reduce unnecessary surgical procedures.


Assuntos
Carcinoma Basocelular/diagnóstico por imagem , Carcinoma Basocelular/patologia , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Carcinoma Basocelular/cirurgia , Dermoscopia , Reações Falso-Negativas , Feminino , Humanos , Masculino , Microscopia Confocal/métodos , Pessoa de Meia-Idade , Cirurgia de Mohs , Neoplasia Residual , Valor Preditivo dos Testes , Estudos Prospectivos , Pele/patologia , Neoplasias Cutâneas/cirurgia , Carga Tumoral
14.
Skin Res Technol ; 25(5): 662-671, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30932258

RESUMO

BACKGROUND: The increased incidence rate of skin cancers during the last decades is alarming. One of the significant difficulties in the histopathology of skin cancers is appearance variability due to the heterogeneity of diseases or tissue preparation and staining process. This study aims to investigate whether the high-resolution acoustic microscopy has the potential for identifying and quantitatively classifying skin cancers. MATERIAL/METHODS: Unstained standard formalin-fixed skin tissue samples were used for ultrasonic examination. The high-frequency acoustic microscope equipped with the 320 MHz transducer was utilized to visualize skin structure. Fourier transform was performed to calculate the sound speed and attenuation in the tissue. RESULTS: The acoustic images demonstrate good concordance with the traditional histology images. All histological features in the tumour were easily identifiable on acoustic images. Each skin cancer type has its combination of ultrasonic properties significantly different from the healthy skin. CONCLUSIONS: High-resolution acoustic imaging strengthened with quantitative analysis shows a potential to work as an auxiliary imaging modality assisting pathologists to lean to the particular decision in doubtful cases. The method can also assist surgeon to ensure the complete resection of a tumour.


Assuntos
Carcinoma Basocelular/diagnóstico por imagem , Carcinoma de Células Escamosas/diagnóstico por imagem , Melanoma/diagnóstico por imagem , Neoplasias Cutâneas/diagnóstico por imagem , Carcinoma Basocelular/patologia , Carcinoma de Células Escamosas/patologia , Técnicas de Imagem por Elasticidade/métodos , Humanos , Melanoma/patologia , Microscopia Acústica/métodos , Neoplasias Cutâneas/patologia
15.
J Am Acad Dermatol ; 81(2): 520-526, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30954581

RESUMO

BACKGROUND: Reflectance confocal microscopy (RCM)-based skin cancer diagnosis requires proficiency. OBJECTIVE: To identify a short list of key RCM features of skin cancers and test their diagnostic utility. METHODS: We identified key RCM features through consensus among 6 experts using a modified Delphi method. To test the diagnostic utility of these RCM key features, 10 novice RCM readers evaluated a subset of 100 RCM cases from a retrospective data set of benign and malignant skin neoplasms. RESULTS: From 56 features reported in the literature, the experts identified 18 RCM features as highly valuable for skin cancer diagnosis. On the basis of consensus definitions, these RCM features were further clustered into 2 melanoma-specific key features (atypical cells and dermoepidermal junction disarray), 1 basal cell carcinoma-specific key feature (basaloid cords/islands), and 1 squamous cell carcinoma-specific key feature (keratinocyte disarray). The novice reading study showed that the presence of at least 1 of the 4 key features was associated with an overall sensitivity for skin cancer diagnosis of 91%, with a sensitivity for melanoma of 93%, a sensitivity for basal cell carcinoma of 92%, and a sensitivity for squamous cell carcinoma of 67%, and an overall specificity of 57%. LIMITATIONS: The consensus was based on only six RCM experts and the validation study was retrospective. CONCLUSIONS: A consensus terminology short list identifying the 4 RCM key features for skin cancer diagnosis may facilitate dissemination of RCM to novice users.


Assuntos
Carcinoma Basocelular/diagnóstico por imagem , Carcinoma de Células Escamosas/diagnóstico por imagem , Melanoma/diagnóstico por imagem , Nevo/diagnóstico por imagem , Neoplasias Cutâneas/diagnóstico por imagem , Consenso , Técnica Delfos , Humanos , Microscopia Confocal/métodos , Estudos Retrospectivos , Sensibilidade e Especificidade
18.
J Eur Acad Dermatol Venereol ; 33(6): 1084-1091, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30811707

RESUMO

BACKGROUND: The surgical removal of non-melanoma skin cancers (NMSCs) is guided by the pathologic examination of margins. However, the preparation of histopathology is time consuming, labour-intensive and requires separate laboratory infrastructure. Furthermore, when histopathology indicates positive margins, patients must return for re-excisions. Reflectance confocal microscopy (RCM) with a new video-mosaicking approach can noninvasively delineate margins directly on patients and potentially guide surgery in real-time, augmenting the traditional approaches of histopathology. OBJECTIVE: To assess a new peri-operative RCM video-mosaicking approach for comprehensive delineation of NMSC margins on patients in vivo. METHODS: Thirty-five patients undergoing Mohs micrographic surgery (MMS) in the Mohs surgery unit at Memorial Sloan Kettering Cancer Center, New York, NY were included in the study. RCM imaging was performed before and after the first staged excision by acquiring videos along the surgical margins (epidermal, peripheral and deep dermal) of each wound, which were subsequently processed into video-mosaics. Two RCM evaluators read and assessed video-mosaics, and subsequently compared to the corresponding Mohs frozen histopathology. RESULTS: Reflectance confocal microscopy videos and video-mosaics displayed acceptable imaging quality (resolution and contrast), pre-operatively in 32/35 (91%) NMSC lesions and intra-operatively in 29/35 lesions (83%). Pre-operative delineation of margins correlated with the histopathology in 32/35 (91%) lesions. Intra-operative delineation correlated in 10/14 (71%) lesions for the presence of residual tumour and in 18/21 (86%) lesions for absence. Sensitivity/specificity were 71%/86% and 86%/81% for two RCM video-mosaic evaluators, and overall agreement was 80% and 83% with histopathology, with moderate inter-evaluator agreement (k = 0.59, P ≤ 0.0002). CONCLUSIONS: Peri-operative RCM video-mosaicking of NMSC margins directly on patients may potentially guide surgery in real-time, serve as an adjunct to histopathology, reduce time spent in clinic and reduce the need for re-excisions. Further testing in larger studies is needed.


Assuntos
Carcinoma Basocelular/diagnóstico por imagem , Carcinoma Basocelular/cirurgia , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/cirurgia , Margens de Excisão , Microscopia Confocal/métodos , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/cirurgia , Humanos , Cirurgia de Mohs
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