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1.
BMJ ; 368: m127, 2020 02 10.
Artigo em Inglês | MEDLINE | ID: mdl-32041693

RESUMO

OBJECTIVE: To examine the validity and findings of studies that examine the accuracy of algorithm based smartphone applications ("apps") to assess risk of skin cancer in suspicious skin lesions. DESIGN: Systematic review of diagnostic accuracy studies. DATA SOURCES: Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, CPCI, Zetoc, Science Citation Index, and online trial registers (from database inception to 10 April 2019). ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Studies of any design that evaluated algorithm based smartphone apps to assess images of skin lesions suspicious for skin cancer. Reference standards included histological diagnosis or follow-up, and expert recommendation for further investigation or intervention. Two authors independently extracted data and assessed validity using QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2 tool). Estimates of sensitivity and specificity were reported for each app. RESULTS: Nine studies that evaluated six different identifiable smartphone apps were included. Six verified results by using histology or follow-up (n=725 lesions), and three verified results by using expert recommendations (n=407 lesions). Studies were small and of poor methodological quality, with selective recruitment, high rates of unevaluable images, and differential verification. Lesion selection and image acquisition were performed by clinicians rather than smartphone users. Two CE (Conformit Europenne) marked apps are available for download. SkinScan was evaluated in a single study (n=15, five melanomas) with 0% sensitivity and 100% specificity for the detection of melanoma. SkinVision was evaluated in two studies (n=252, 61 malignant or premalignant lesions) and achieved a sensitivity of 80% (95% confidence interval 63% to 92%) and a specificity of 78% (67% to 87%) for the detection of malignant or premalignant lesions. Accuracy of the SkinVision app verified against expert recommendations was poor (three studies). CONCLUSIONS: Current algorithm based smartphone apps cannot be relied on to detect all cases of melanoma or other skin cancers. Test performance is likely to be poorer than reported here when used in clinically relevant populations and by the intended users of the apps. The current regulatory process for awarding the CE marking for algorithm based apps does not provide adequate protection to the public. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016033595.


Assuntos
Dermoscopia/métodos , Melanoma/diagnóstico , Aplicativos Móveis , Neoplasias Cutâneas/diagnóstico , Smartphone , Algoritmos , Biópsia , Dermoscopia/instrumentação , Reações Falso-Negativas , Reações Falso-Positivas , Humanos , Melanoma/patologia , Reprodutibilidade dos Testes , Medição de Risco/métodos , Pele/diagnóstico por imagem , Pele/patologia , Neoplasias Cutâneas/patologia
2.
An Bras Dermatol ; 95(1): 1-14, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32001061

RESUMO

These are cutaneous diseases caused by insects, worms, protozoa, or coelenterates which may or may not have a parasitic life. In this review the main ethological agents, clinical aspects, laboratory exams, and treatments of these dermatological diseases will be studied.


Assuntos
Dermatopatias Parasitárias/tratamento farmacológico , Dermatopatias Parasitárias/patologia , Biópsia , Dermoscopia , Diagnóstico Diferencial , Humanos , Reação em Cadeia da Polimerase , Dermatopatias Parasitárias/diagnóstico , Fatores de Tempo
4.
Hautarzt ; 71(2): 101-108, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-31965207

RESUMO

BACKGROUND: Since the establishment of dermoscopy as a routine examination procedure in dermatology, the spectrum of noninvasive, optical devices has further expanded. In difficult-to-diagnose clinical cases, these systems may support dermatologists to arrive at a correct diagnosis without the need for a surgical biopsy. OBJECTIVE: To give an overview about technical background, indications and diagnostic performance regarding four new optical procedures: reflectance confocal microscopy, in vivo multiphoton tomography, dermatofluoroscopy, and systems based on image analysis by artificial intelligence (AI). MATERIALS AND METHODS: This article is based on a selective review of the literature, as well as the authors' personal experience from clinical studies relevant for market approval of the devices. RESULTS: In contrast to standard histopathological slides with vertical cross sections, reflectance confocal microscopy and in vivo multiphoton tomography allow for "optical biopsies" with horizontal cross sections. Dermatofluoroscopy and AI-based image analyzers provide a numerical score, which helps to correctly classify a skin lesion. The presented new optical procedures may be applied for the diagnosis of skin cancer as well as inflammatory skin diseases. CONCLUSION: The presented optical procedures provide valuable additional information that supports dermatologists in making the correct diagnosis. However, a surgical biopsy followed by dermatohistopathological examination remains the diagnostic gold standard in dermatology.


Assuntos
Dermatologia , Dermatopatias , Neoplasias Cutâneas , Dermoscopia , Humanos , Microscopia Confocal , Pele , Dermatopatias/diagnóstico , Neoplasias Cutâneas/diagnóstico
5.
An Bras Dermatol ; 95(1): 78-81, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31889590

RESUMO

The number of individuals with tattoos has been increasing worldwide, alongside with reports of complications varying from reactions to the injected pigments to infections caused by agents inoculated in the pigmentation process. The diagnosis of such unwanted events can be obtained through complementary non-invasive methods, preserving the maximum of the tattoo design. The authors present two cases of patients with warts on tattooing, and correlate their clinical aspects to in vivo and ex vivo dermoscopy, and to the findings in the histopathological examination, aiming to determine patterns that aid the diagnosis of these lesions without performing biopsy.


Assuntos
Infecções por Papillomavirus/diagnóstico por imagem , Infecções por Papillomavirus/patologia , Tatuagem/efeitos adversos , Verrugas/diagnóstico por imagem , Verrugas/patologia , Adulto , Biópsia , Corantes/efeitos adversos , Dermoscopia/métodos , Epiderme/patologia , Epiderme/virologia , Humanos , Masculino , Infecções por Papillomavirus/virologia , Verrugas/virologia
6.
An Bras Dermatol ; 95(1): 71-74, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31899063

RESUMO

Spitz nevus is a benign melanocytic lesion, which presents in several ways: solitary, agminated, or disseminated. The disseminated variant is uncommon; it may have a rapid evolution (the eruptive form) and be difficult to manage. This report presents the case of a 24-year-old patient with multiple papules on his limbs, which had appeared four years previously. On physical examination, 120 pink and skin-colored papules were seen, which under dermoscopy were observed to be homogeneous, pink vascular lesions. Histopathologic study revealed epithelioid cells arranged in groups or singly in the dermis and dermo-epidermal junction. They were HMB-45 positive in the superficial dermis, and Ki-67<1%. Given these findings, a diagnosis of eruptive disseminated Spitz nevi was made.


Assuntos
Nevo de Células Epitelioides e Fusiformes/patologia , Neoplasias Cutâneas/patologia , Biópsia , Dermoscopia , Humanos , Imuno-Histoquímica , Masculino , Melanócitos/patologia , Adulto Jovem
8.
An Bras Dermatol ; 95(1): 95-97, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31932162

RESUMO

The Borst-Jadassohn phenomenon is a morphological finding that consists of the presence of well-defined nests of cells located in the spiny stratum of an acanthotic epidermis. One of the neoplasms where this phenomenon is found is hidroacanthoma simplex. This neoplasm is considered the intraepidermal form of the eccrine poroma. Despite its benign nature, malignant transformations are reported. The present article reports a case of hidroacanthoma simplex and discusses the dermoscopy of this phenomenon.


Assuntos
Acantoma/diagnóstico por imagem , Acantoma/patologia , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/patologia , Idoso de 80 Anos ou mais , Biópsia , Dermoscopia/métodos , Epiderme/diagnóstico por imagem , Epiderme/patologia , Feminino , Humanos
13.
An Bras Dermatol ; 94(6): 637-657, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31789244

RESUMO

Actinic keratoses are dysplastic proliferations of keratinocytes with potential for malignant transformation. Clinically, actinic keratoses present as macules, papules, or hyperkeratotic plaques with an erythematous background that occur on photoexposed areas. At initial stages, they may be better identified by palpation rather than by visual inspection. They may also be pigmented and show variable degrees of infiltration; when multiple they then constitute the so-called field cancerization. Their prevalence ranges from 11% to 60% in Caucasian individuals above 40 years. Ultraviolet radiation is the main factor involved in pathogenesis, but individual factors also play a role in the predisposing to lesions appearance. Diagnosis of lesions is based on clinical and dermoscopic examination, but in some situations histopathological analysis may be necessary. The risk of transformation into squamous cell carcinoma is the major concern regarding actinic keratoses. Therapeutic modalities for actinic keratoses include topical medications, and ablative and surgical methods; the best treatment option should always be individualized according to the patient.


Assuntos
Dermoscopia/métodos , Ceratose Actínica/diagnóstico por imagem , Ceratose Actínica/terapia , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/patologia , Humanos , Ceratose Actínica/patologia , Fatores de Risco , Índice de Gravidade de Doença , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/patologia
14.
An Bras Dermatol ; 94(6): 747-750, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31789261

RESUMO

Melanoacanthoma is a rare variant of seborrheic keratosis, which is notable for dark pigmentation and fast radial growth, making it difficult to distinguish from melanoma. Histologically, it is characterized by proliferation of keratinocytes and dendritic melanocytes. The authors report a scalp lesion, fast growing, suspected by dermoscopy and confocal microscopy examination, with dendritic cells distributed throughout the lesion. Based on these findings, it was not possible to classify this lesion as clearly benign, so it was excised. Histopathologic evaluation and immunostain were consistent with melanoacanthoma.


Assuntos
Acantoma/patologia , Ceratose Seborreica/patologia , Dermatoses do Couro Cabeludo/patologia , Neoplasias Cutâneas/patologia , Idoso , Células Dendríticas/patologia , Dermoscopia , Humanos , Masculino , Melanócitos/patologia , Microscopia Confocal/métodos
15.
An Bras Dermatol ; 94(6): 671-676, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31789269

RESUMO

BACKGROUND: Mohs micrographic surgery is a surgical technique for the treatment of nonmelanoma skin cancer. Surgery begins by removing the visible tumor before excision of the tissue specimens for evaluation of the tumor margins. OBJECTIVES: To present a new way to evaluate the material obtained from debulking, by horizontal histological analysis of the fragment. METHODS: Descriptive retrospective cross-sectional study based on the medical records and histological lamellae of patients with primary basal cell carcinomas smaller than 1.5cm submitted to Mohs micrographic surgery and who had the visible tumor analyzed by horizontal histological sections. RESULTS: The sample evaluated included 16 patients with lesions located on the face. Comparing the histopathological examinations of incisional biopsy in vertical sections and debulking in horizontal sections, there was agreement in seven cases. The histological analysis performed in horizontal sections allowed identification of the tumor site in 13 cases, and the relation between tumor and margin showed that in 11 cases, the lateral margin was compromised. STUDY LIMITATIONS: The technique was better-applied in lesions smaller than 2cm. CONCLUSION: Horizontal histological analysis of debulking has advantages for Mohs surgery, since it allows visualization of almost all tumor extension in the same view plane of the dermatoscopy, allowing better definition of the histological subtype, tumor site, and tumor/margin of lesions less than 1.5cm.


Assuntos
Carcinoma Basocelular/patologia , Carcinoma Basocelular/cirurgia , Cirurgia de Mohs/métodos , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Biópsia , Estudos Transversais , Dermoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Carga Tumoral
16.
Rev Med Liege ; 74(12): 650-654, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31833275

RESUMO

Since decades the incidence of skin cancer is clearly rising. This alarming trend also applies to melanoma. It represents the 4th most common cancer in women and 6th in men in 2015. Early recognition and treatment reduce both morbidity and mortality. Screening is the cornerstone of secondary prevention. However, access to reliable and rapid diagnosis is hampered by several factors, including accessibility to specialized medicine. One of the solutions to this problem is to collaborate with the first-line medical care through a teledermatology system. The TeleSPOT project, Teledermoscopy Smartphone-based Pigmented lesion diagnosis Online Taskforce, aims to provide a remote diagnostic aid by dermatologists to distinguish suspect pigmented skin lesions and accelerate their management.


Assuntos
Dermoscopia , Medicina Geral , Melanoma , Neoplasias Cutâneas , Telemedicina , Detecção Precoce de Câncer , Feminino , Humanos , Masculino , Melanoma/diagnóstico , Neoplasias Cutâneas/diagnóstico
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