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1.
Nat Med ; 26(6): 900-908, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32424212

RESUMO

Skin conditions affect 1.9 billion people. Because of a shortage of dermatologists, most cases are seen instead by general practitioners with lower diagnostic accuracy. We present a deep learning system (DLS) to provide a differential diagnosis of skin conditions using 16,114 de-identified cases (photographs and clinical data) from a teledermatology practice serving 17 sites. The DLS distinguishes between 26 common skin conditions, representing 80% of cases seen in primary care, while also providing a secondary prediction covering 419 skin conditions. On 963 validation cases, where a rotating panel of three board-certified dermatologists defined the reference standard, the DLS was non-inferior to six other dermatologists and superior to six primary care physicians (PCPs) and six nurse practitioners (NPs) (top-1 accuracy: 0.66 DLS, 0.63 dermatologists, 0.44 PCPs and 0.40 NPs). These results highlight the potential of the DLS to assist general practitioners in diagnosing skin conditions.


Assuntos
Aprendizado Profundo , Diagnóstico Diferencial , Dermatopatias/diagnóstico , Acne Vulgar/diagnóstico , Adulto , Afro-Americanos , Americanos Asiáticos , Carcinoma Basocelular/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Dermatite Seborreica/diagnóstico , Dermatologistas , Eczema/diagnóstico , Grupo com Ancestrais do Continente Europeu , Feminino , Foliculite/diagnóstico , Hispano-Americanos , Humanos , Índios Norte-Americanos , Ceratose Seborreica/diagnóstico , Masculino , Melanoma/diagnóstico , Pessoa de Meia-Idade , Profissionais de Enfermagem , Grupo com Ancestrais Oceânicos , Fotografação , Médicos de Atenção Primária , Psoríase/diagnóstico , Neoplasias Cutâneas/diagnóstico , Telemedicina , Verrugas/diagnóstico
3.
J Am Acad Dermatol ; 82(3): 622-627, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31306724

RESUMO

BACKGROUND: Computer vision has promise in image-based cutaneous melanoma diagnosis but clinical utility is uncertain. OBJECTIVE: To determine if computer algorithms from an international melanoma detection challenge can improve dermatologists' accuracy in diagnosing melanoma. METHODS: In this cross-sectional study, we used 150 dermoscopy images (50 melanomas, 50 nevi, 50 seborrheic keratoses) from the test dataset of a melanoma detection challenge, along with algorithm results from 23 teams. Eight dermatologists and 9 dermatology residents classified dermoscopic lesion images in an online reader study and provided their confidence level. RESULTS: The top-ranked computer algorithm had an area under the receiver operating characteristic curve of 0.87, which was higher than that of the dermatologists (0.74) and residents (0.66) (P < .001 for all comparisons). At the dermatologists' overall sensitivity in classification of 76.0%, the algorithm had a superior specificity (85.0% vs. 72.6%, P = .001). Imputation of computer algorithm classifications into dermatologist evaluations with low confidence ratings (26.6% of evaluations) increased dermatologist sensitivity from 76.0% to 80.8% and specificity from 72.6% to 72.8%. LIMITATIONS: Artificial study setting lacking the full spectrum of skin lesions as well as clinical metadata. CONCLUSION: Accumulating evidence suggests that deep neural networks can classify skin images of melanoma and its benign mimickers with high accuracy and potentially improve human performance.


Assuntos
Aprendizado Profundo , Dermoscopia/métodos , Interpretação de Imagem Assistida por Computador/métodos , Melanoma/diagnóstico , Neoplasias Cutâneas/diagnóstico , Colômbia , Estudos Transversais , Dermatologistas/estatística & dados numéricos , Dermoscopia/estatística & dados numéricos , Diagnóstico Diferencial , Humanos , Cooperação Internacional , Internato e Residência/estatística & dados numéricos , Israel , Ceratose Seborreica/diagnóstico , Melanoma/patologia , Nevo/diagnóstico , Curva ROC , Pele/diagnóstico por imagem , Pele/patologia , Neoplasias Cutâneas/patologia , Espanha , Estados Unidos
5.
Pan Afr Med J ; 37: 98, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33425131

RESUMO

Seborrheic keratoses (SKs) are benign tumor of the skin. They can occur anywhere, except the palms and soles. SKs commonly present as multiple, pigmented papules which is classically described as verrucous stuck-on papules or plaques. A case with multiple nodular appearance is a rare case and to our knowledge has never been reported. Here we report a rare case of multiple SKs on the scalp. On clinical evaluation, multiple, erythematous hyperkeratotic nodules were present. Dermoscopic and histopathological examination supported SKs. The patient was successfully treated with topical application of 80% TCA solution.


Assuntos
Fármacos Dermatológicos/administração & dosagem , Ceratose Seborreica/diagnóstico , Couro Cabeludo/patologia , Ácido Tricloroacético/administração & dosagem , Administração Cutânea , Adulto , Dermoscopia , Humanos , Ceratose Seborreica/tratamento farmacológico , Masculino , Resultado do Tratamento
7.
Pan Afr Med J ; 34: 54, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31762920

RESUMO

Seborrheic keratosis is a benign epidermal neoplasm, representing one of the most common skin tumors. Clonal seborrheic keratosis is one of the histological subtypes of this entity. It is an uncommon lesion which may resemble other benign or malignant lesion. We report a case of a 60-year-old woman presented with a 7 year history of a gradually growing, cutaneous lesion on her left arm. On physical examination, the lesion was elevated, well-circumscribed, measuring 5 cm in maximum diameter. The tumor was biopsied. Histopathological examination revealed the presence of well-defined nests of clear-looking or basaloid keratinocytes within an acanthotic epidermis, corresponding to the Borst-Jadassohn phenomenon. The tumor cells were small and monomorphic. We diagnosed this tumor as clonal seborrheic keratosis. Although surgical excision was recommended, our patient refused an operation. This case of clonal seborrheic keratosis is presented for its rarity and for differential diagnosis.


Assuntos
Queratinócitos/patologia , Ceratose Seborreica/diagnóstico , Neoplasias Cutâneas/diagnóstico , Biópsia , Diagnóstico Diferencial , Feminino , Humanos , Ceratose Seborreica/patologia , Pessoa de Meia-Idade , Neoplasias Cutâneas/patologia
8.
F1000Res ; 82019.
Artigo em Inglês | MEDLINE | ID: mdl-31508199

RESUMO

Seborrheic keratosis (SK) is a common benign epidermal tumor with predominance in adult patients. Whereas common SKs are more frequent in Caucasians, dermatosis papulosa nigra is more prevalent in patients with a Fitzpatrick skin type of at least 3. There seems to be a link between extrinsic skin aging and the occurrence of SK. Mutations of fibroblast growth factor receptor 3 and other signaling molecules are a frequent finding in SK lesions. However, this does not translate into any malignant potential. Viral infections are particularly common in genital lesions, although their pathogenetic relevance for SK is questionable. Different histologic and clinical subtypes have been identified. The great variability of SKs raises some difficulties in diagnosis. Dermoscopy is the preferred non-invasive diagnostic method, in particular to differentiate pigmented SKs from other pigment tumors, including cutaneous melanoma. Eruptive SKs can be a paraneoplastic condition known as the Leser-Trélat sign. New targeted cancer treatments can cause a pseudo-Leser-Trélat sign. The treatment in practice is mainly minor surgery, including cryosurgery, shave excisions, and laser-assisted removal. The medical approaches have only limited effects. Recently, two formulations for topical therapy have been evaluated: a product with 40% hydrogen peroxide (HP40) and an aqueous nitric-zinc complex. Based on clinical trials, HP40 seems to be a promising alternative to surgery, in particular for facial lesions.


Assuntos
Ceratose Seborreica , Melanoma , Neoplasias Cutâneas , Adulto , Diagnóstico Diferencial , Humanos , Ceratose Seborreica/diagnóstico , Ceratose Seborreica/terapia , Melanoma/diagnóstico , Neoplasias Cutâneas/diagnóstico
9.
J Drugs Dermatol ; 18(7): 615, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31329381

RESUMO

Many cultures associate beauty with an even complexion. It has been shown in many reported references, the major cosmetic concern in patients of color is discoloration. This issue addresses discoloration of individuals of color and the use of a multitude of preparations that can blend the complexion. Authors in Asia, Sweden, France, and Brazil discuss the use of injectable deoxycholic acid in nonsubmental regions and hyaluronic acid for skin boosting, an off-label usage or procedures in the United States. Skin boosting improves hydration and the smoothness of the skin. Additionally, international methods of treating cosmetic patients with multiple modalities are discussed.


Assuntos
Ceratose Seborreica/terapia , Rosácea/terapia , Neoplasias Cutâneas/terapia , Pigmentação da Pele , Grupo com Ancestrais do Continente Africano , Grupo com Ancestrais do Continente Asiático , Técnicas Cosméticas , Feminino , Hispano-Americanos , Humanos , Ceratose Seborreica/diagnóstico , Fatores de Risco , Rosácea/diagnóstico , Pele/efeitos da radiação , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/etiologia , Luz Solar/efeitos adversos
12.
Aust J Gen Pract ; 48(6): 364-367, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31220885

RESUMO

BACKGROUND: Benign pigmented skin lesions are extremely common. Such lesions are seen every day in general practice. OBJECTIVE: The objectives of this paper are to develop a framework that may be used to evaluate pigmented skin lesions and a strategy for dealing with pigmented lesions, outline the conditions that improve the diagnosis of pigmented lesions (eg good lighting, careful inspection and dermoscopy), and increase clinician confidence in identifying pigmented lesions with concerning features. DISCUSSION: Regular assessment of pigmented skin lesions during patient consultations, including in an opportunistic fashion, will increase diagnostic acumen and help to identify potentially problematic lesions, and may improve patient awareness of lesions on their skin.


Assuntos
Transtornos da Pigmentação/diagnóstico , Biópsia/métodos , Doença de Bowen/diagnóstico , Doença de Bowen/diagnóstico por imagem , Humanos , Ceratose Seborreica/diagnóstico , Ceratose Seborreica/diagnóstico por imagem , Nevo/diagnóstico , Nevo/diagnóstico por imagem , Exame Físico/métodos , Transtornos da Pigmentação/diagnóstico por imagem
13.
Actas Dermosifiliogr ; 110(8): 659-665, 2019 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31153547

RESUMO

BACKGROUND AND OBJECTIVE: Skin lesions are a common reason for consulting a primary care physician. Current legislation in Spain states that purely aesthetic skin problems that do not pose a health problem are not to be treated within the National Health Service. The aim of this study was to estimate the proportion of referrals from primary care physicians to dermatologists that were for cystic lesions or benign tumors and could potentially have been avoided. MATERIAL AND METHODS: We consulted cases registered in the DIADERM study dataset, which is representative of dermatology practice in Spain, and collected the main diagnoses given on referring patients from primary care. A referral diagnosis was classified as potentially avoidable if it corresponded to one of the primary care discharge diagnoses listed in a consensus paper of the Andalusian section of the Spanish Academy of Dermatology and Venereology (AEDV). RESULTS: We collected 2171 main reasons for first-visit referrals to dermatologists; 686 of them (31.6%) were for cystic lesions or benign tumors and classified as potentially avoidable. In 478 cases (22%) the patients were discharged on the first visit. The most frequent diagnoses in such cases were seborrheic keratosis (9.3%) and melanocytic nevus (8.6%). CONCLUSIONS: Nearly a third of referrals from primary care to a dermatologist were for cystic lesions and benign tumors and could have been avoided. A clearer understanding of our caseload can be useful for improving planning, training, and health care system management.


Assuntos
Dermatologia/estatística & dados numéricos , Mau Uso de Serviços de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Dermatopatias/diagnóstico , Cistos/diagnóstico , Mau Uso de Serviços de Saúde/prevenção & controle , Humanos , Ceratose Seborreica/diagnóstico , Espanha
15.
J Int Adv Otol ; 15(2): 326-329, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31120423

RESUMO

We compare the results of clinical observation and histopathology analysis for developing a differential diagnosis of seborrheic keratosis (SK) of the external auditory canal (EAC). A 46-year-old man with a history of a recurrent lesion in the EAC underwent clinical observation of the skin lesion's appearance, computed tomography (CT) scan, magnetic resonance imaging (MRI), and several biopsies. Initially, a benign form of SK was diagnosed based on several biopsies performed over a 10-year period. The lesion's appearance was consistent with a malignant disease, which led the clinician to perform a CT scan and an MRI scan. The patient underwent partial petrosectomy to completely remove the lesion as CT and MRI scans showed an infiltrative process. Squamous carcinoma was the final histological diagnosis. The patient was disease free at 1 year of follow-up after petrosectomy. In conclusion, if there are inconsistencies between clinical observation and histological report, additional tests should be performed to exclude the malignity of a lesion.


Assuntos
Carcinoma de Células Escamosas/diagnóstico , Neoplasias da Orelha/diagnóstico , Ceratose Seborreica/diagnóstico , Biópsia , Carcinoma de Células Escamosas/cirurgia , Diagnóstico Diferencial , Meato Acústico Externo/cirurgia , Neoplasias da Orelha/cirurgia , Humanos , Ceratose Seborreica/cirurgia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/cirurgia , Exame Físico , Tomografia Computadorizada por Raios X
16.
Dermatol Online J ; 25(3)2019 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-30982311

RESUMO

Pigmented and irritated types of seborrheic keratosis (SK) can be confused with melanoma, basal cell carcinoma, or pigmented actinic keratosis. Dermoscopic examination may give many clues for the diagnosis of SK, but in equivocal cases the accurate diagnosis can only be made by microscopic features. Herein, we report a striking, isolated pigmented and inflamed SK, located on the waist in an elderly man. Although the duration of the lesion was not clear, a recent change in color was reported. The striking dark pigmentation and lack of visible characteristic features for SK led us to consider other pigmented lesions, mainly melanoma, which it closely resembled. Dermoscopic examination was inconclusive with subtle clues for SK, such as brown-gray dots, small brownish clods, a few curved short lines, and few small pinkish round structures. Histopathological and immunohistochemical examinations revealed an inflamed and pigmented SK. In conclusion, pigmented and inflamed SK does not usually tend to show typical dermoscopic features of SK and may mimic other pigmented lesions, including melanoma. All skin lesions that cannot be classified as clearly benign should undergo biopsy.


Assuntos
Hiperpigmentação/diagnóstico , Inflamação/diagnóstico , Ceratose Seborreica/diagnóstico , Melanoma/diagnóstico , Idoso , Biópsia , Dermoscopia , Diagnóstico Diferencial , Humanos , Hiperpigmentação/patologia , Inflamação/patologia , Ceratose Seborreica/patologia , Masculino , Neoplasias Cutâneas
17.
Am J Clin Pathol ; 151(6): 551-560, 2019 05 03.
Artigo em Inglês | MEDLINE | ID: mdl-30852607

RESUMO

OBJECTIVES: We observed keratoses with "clonal" nests present as numerous tiny collections, in which cells in "pagetoid" array are found, a configuration we termed microclonal seborrheic keratosis (MSK). To better distinguish MSK from pagetoid Bowen disease (PBD), we investigated use of immunohistochemical staining. METHODS: Biopsy specimens of 26 MSKs, 17 PBDs, and 11 borderline cases were reviewed for histopathology and stained with p53, Ki-67, and p16. RESULTS: High expression of Ki-67 and p16 was observed in 12 (80%) of 15 PBDs and in one (4%) of 23 MSKs. Low expression of p16 and high expression of Ki-67 were observed in 16 (70%) of 23 MSKs and in two (13%) of 15 PBDs. Expression of p16 was elevated in 12 (80%) of 15 PBDs and in three (13%) of 23 MSKs (P < .0001). CONCLUSIONS: We describe a "microclonal" variant of seborrheic keratosis with morphology sometimes challenging to distinguish from PBD. High expression of p16 and Ki-67 or p16 alone favors the diagnosis of PBD over MSK.


Assuntos
Doença de Bowen/diagnóstico , Inibidor p16 de Quinase Dependente de Ciclina/análise , Ceratose Seborreica/diagnóstico , Antígeno Ki-67/análise , Neoplasias Cutâneas/diagnóstico , Doença de Bowen/química , Diagnóstico Diferencial , Humanos , Imuno-Histoquímica , Ceratose Seborreica/metabolismo
18.
J Cutan Pathol ; 46(6): 411-417, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30828837

RESUMO

BACKGROUND: At times, distinguishing Bowen disease (BD) and benign seborrheic keratosis (SK) is histologically challenging, especially when SK shows clonal features (clonal seborrheic keratosis [CSK]). While p16 is often reported as positive in BD and negative in SK, p16 expression in CSK is rarely studied. Here we investigate p16 immunohistochemistry in CSK, SK, and BD. METHODS: p16 immunohistochemistry with pattern of expression was noted for 14 CSK, 12 SK, and 18 BD. The degree of inflammation among lesions with respect to p16 expression was also noted. RESULTS: When examining p16 staining in clonal nests of CSK, 57% showed diffuse or patchy/diffuse positivity, 21% showed patchy positivity, and 21% showed clusters of single positive cells. 67% of BD showed diffuse positivity, 11% showed patchy/diffuse positivity, 17% showed patchy positivity, and 6% were negative. 25% of SK showed focal areas of patchy to full thickness positivity, 25% showed moderate number of positive single cells with or without patchy staining, and 50% showed negative/scattered single cell positivity. CONCLUSION: Our findings support that p16 positivity limited to clonal nests in CSK is normal. p16 positivity in clonal nests of CSK in isolation without concurrent atypical histologic features should not be used to support a diagnosis of BD.


Assuntos
Doença de Bowen , Inibidor p16 de Quinase Dependente de Ciclina/biossíntese , Regulação Neoplásica da Expressão Gênica , Ceratose Seborreica , Neoplasias Cutâneas , Doença de Bowen/metabolismo , Doença de Bowen/patologia , Diagnóstico Diferencial , Feminino , Humanos , Ceratose Seborreica/diagnóstico , Ceratose Seborreica/patologia , Masculino , Neoplasias Cutâneas/metabolismo , Neoplasias Cutâneas/patologia
19.
Dermatol Online J ; 25(2)2019 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-30865414

RESUMO

Seborrheic keratosis is a benign condition that can mimic many different non-melanoma and melanoma neoplasms. There have been several case reports of underlying squamous cell carcinomas or intraepidermal carcinomas appearing within lesions that look analogous to seborrheic keratoses. We present a patient with a verrucous melanoma that could be mistaken for a benign skin tumor like an inflamed seborrheic keratosis. In our patient's case, her verrucous plaque was initially clinically suggestive of a benign seborrheic keratosis. However, given the patient's complaint of pain associated with the lesion, a biopsy was performed and revealed a verrucous-keratotic malignant melanoma, which was subsequently removed through surgical excision. It is important to remain vigilant of this diagnosis, as treatment for inflamed seborrheic keratosis often includes a trial of cryotherapy, which potentially could lead to a delayed diagnosis of an underlying malignant lesion.


Assuntos
Ceratose Seborreica/diagnóstico , Melanoma/diagnóstico , Neoplasias Cutâneas/diagnóstico , Idoso , Biópsia , Diagnóstico Diferencial , Feminino , Humanos , Melanoma/complicações , Dor/etiologia , Pele/patologia , Neoplasias Cutâneas/complicações
20.
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
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