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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
4.
J Prim Health Care ; 11(1): 54-63, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31039990

RESUMO

INTRODUCTION No research has been found regarding outcomes of dermoscope-guided surgical procedures in primary care. AIM To establish whether outcomes of dermoscope-guided procedures performed in primary care settings differ from outcomes for similar procedures, performed without the use of a dermoscope. METHODS A retrospective case-control study design was used. All records of dermoscope-guided procedures performed over a 6-month period were retrieved. For each study procedure, the record of the most recent control procedure without dermoscopy guidance performed on a sex-and-age matched patient was retrieved from before we began performing dermoscope-guided procedures. Primary outcomes were: local inflammation and infections within 2 weeks' post procedure; relapse in 6 months; and obvious scars in 6 months. Pain affecting activities of daily living in the first week after the procedure was the secondary outcome. RESULTS Records of 39 dermoscope-guided procedures and 39 control procedures were retrieved. No significant difference in local inflammation and infections in 2 weeks was found; relapse in 6 months after the study procedures was significantly lower for dermoscope-guided than control procedures (risk ratio (RR): 0.22; 95% confidence interval (CI): 0.05-0.95), and there were fewer obvious scars for dermoscope-guided procedures than control procedures (RR: 0.52; 95% CI: 0.32-0.83), with the number of small lesions (<4 mm) leaving scars in study procedures particularly less than that for control procedures (RR: 0.30; 95% CI: 0.13-0.67). There was no difference in the secondary outcome of pain affecting activities of daily living in the first week following the procedure. CONCLUSION In primary care, dermoscope-guided procedures achieved better outcomes than similar procedures without dermoscope guidance. Performing dermoscope-guided procedures in primary care might lower medical costs.


Assuntos
Dermoscopia/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Criança , Cicatriz/etiologia , Dermoscopia/efeitos adversos , Feminino , Humanos , Inflamação/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Dermatopatias/etiologia , Adulto Jovem
5.
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
6.
Libyan J Med ; 13(1): 1479600, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29943665

RESUMO

Ultrasonic and digital dermatoscopy diagnostic methods are used in order to estimate the changes of structure, as well as to non-invasively measure the changes of parameters of lesions of human tissue. These days, it is very actual to perform the quantitative analysis of medical data, which allows to achieve the reliable early-stage diagnosis of lesions and help to save more lives. The proposed automatic statistical post-processing method based on integration of ultrasonic and digital dermatoscopy measurements is intended to estimate the parameters of malignant tumours, measure spatial dimensions (e.g. thickness) and shape, and perform faster diagnostics by increasing the accuracy of tumours differentiation. It leads to optimization of time-consuming analysis procedures of medical images and could be used as a reliable decision support tool in the field of dermatology.


Assuntos
Técnicas de Apoio para a Decisão , Dermoscopia/estatística & dados numéricos , Processamento de Imagem Assistida por Computador/métodos , Melanoma/diagnóstico por imagem , Neoplasias Cutâneas/diagnóstico por imagem , Ultrassonografia/estatística & dados numéricos , Dermoscopia/métodos , Detecção Precoce de Câncer/métodos , Humanos , Modelos Logísticos , Melanócitos/patologia , Melanoma/patologia , Curva ROC , Neoplasias Cutâneas/patologia , Ultrassonografia/métodos
7.
J Eur Acad Dermatol Venereol ; 32(2): 236-241, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28750138

RESUMO

BACKGROUND: The role of general practitioners (GPs) in skin cancer care is increasing. Previous, hospital-based studies suggest that GPs might not have the capabilities to gain responsibility concerning skin cancer care. OBJECTIVES: To evaluate the current approach of GPs towards skin lesions suspected of malignancy in the Netherlands. METHODS: In three general practices, all consultations in 2015 concerning skin lesions suspected of malignancy were identified and reviewed. Patients demographics, circumstances of consultation, evaluation of skin lesion(s), presumed diagnosis, diagnostic accuracy and policy were evaluated. RESULTS: Five hundred and eighty consultations were identified. Patient took initiative for encounter in 90%. Case-finding occurred in 2%. Diagnostic tools were used in 22%; dermoscopy was used in 8% and a diagnostic excision in 10%. The GP diagnosed a benign lesion in 69%. Therapeutic interventions were applied in 31% and a wait-and-see policy in 40%. The diagnosis after referral was a benign tumour in 39% of the cases, a malignancy in 29% and a premalignant lesion in 17%. The positive predictive value (PPV) of the presumed benign, malignant and premalignant diagnoses was 86%, 54% and 18%, respectively. CONCLUSIONS: Most lesions that are presented to the GP with a suspicion of a malignancy appear to be benign lesions. In the examined practices, the diagnosis of the GP is mainly based on clinical examination and little use is made of available diagnostic tools. The use of a diagnostic tool like a biopsy might prevent unnecessary referrals.


Assuntos
Medicina Geral/métodos , Papel do Médico , Padrões de Prática Médica , Lesões Pré-Cancerosas/diagnóstico , Neoplasias Cutâneas/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia/estatística & dados numéricos , Criança , Pré-Escolar , Dermoscopia/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Anamnese , Pessoa de Meia-Idade , Países Baixos , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos , Dermatopatias/diagnóstico , Dermatopatias/terapia , Neoplasias Cutâneas/terapia , Conduta Expectante/estatística & dados numéricos , Adulto Jovem
8.
Artigo em Inglês | MEDLINE | ID: mdl-29185439

RESUMO

INTRODUCTION AND BACKGROUND: Dermoscopy is being increasingly used for improving dermatological diagnosis. Use of dermoscopy in the early recognition of skin malignancies, especially melanoma, is well established. Of late, its use in general clinical dermatology is growing with the recognition of new and specific patterns in conditions such as hair disorders, inflammatory disorders, and infections/infestations. This cross-sectional survey aims to assess the common patterns of dermoscopy use by Indian dermatologists. METHODS: This was across-sectional survey. An online questionnaire was used to collect data. The questionnaire focused on the frequency of dermoscopy use by Indian dermatologists, reasons for using it or not, and the training they had received on dermoscopy. RESULTS: Of the total 150 valid responses, eighty two (54.7%) participants reported that they were using dermoscopy routinely in their clinical practice. Lack of familiarity and lack of proper training were the important reasons cited for not using dermoscopy regularly. Among the dermatologists using dermoscopy, consensus on effectiveness was highest for hair disorders. CONCLUSIONS: Dermoscopy use by dermatologists in India is mainly in the context of inflammatory dermatosis and hair disorders rather than skin tumors. Lack of familiarity with the technique appears to be main factor limiting the use of dermoscopy in India. LIMITATIONS: Small sample size is the major limitation of this study. It is possible that a large number of dermatologists who do not use dermoscopy might not have responded to the survey, there by affecting the results and their interpretation.


Assuntos
Dermatologistas/tendências , Dermoscopia/estatística & dados numéricos , Dermoscopia/tendências , Inquéritos e Questionários , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Dermatopatias/diagnóstico , Dermatopatias/epidemiologia
9.
J Dtsch Dermatol Ges ; 15(5): 517-522, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28485882

RESUMO

BACKGROUND AND OBJECTIVES: We examined the value of monitoring patients with multiple nevi using sequential digital dermatoscopy imaging at a tertiary referral center. PATIENTS AND METHODS: This is a retrospective cohort study including 2,824 patients and 23,241 monitored lesions. We calculated trends in key parameters such as the number of melanomas and nevi monitored and excised. RESULTS: During follow-up, we excised 1,266 lesions in 709 patients, including 146 (11.5 %) melanomas. The percentage of in situ melanomas detected at follow-up was significantly higher than at baseline (46.6 % versus 23.4 %, p ≤ 0.001). The risk of detecting a melanoma during follow-up was higher for patients with a melanoma at baseline, compared to those without (relative risk: 3.59, 95 % CI: 2.15 to 6.00). The number of documented lesions showed a positive correlation with the benign/malignant ratio, and excisions at baseline decreased significantly over the course of the study period. CONCLUSION: Digital dermatoscopy monitoring improves the detection of thin melanomas in patients with multiple nevi. Patients with a melanoma at baseline are at an increased risk of developing a melanoma during follow-up and should therefore be a target group for sequential dermatoscopy imaging.


Assuntos
Dermoscopia/estatística & dados numéricos , Interpretação de Imagem Assistida por Computador/métodos , Nevo/diagnóstico por imagem , Nevo/cirurgia , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/cirurgia , Adulto , Áustria/epidemiologia , Dermoscopia/métodos , Feminino , Humanos , Estudos Longitudinais , Masculino , Nevo/epidemiologia , Prevalência , Encaminhamento e Consulta/estatística & dados numéricos , Reprodutibilidade dos Testes , Medição de Risco , Sensibilidade e Especificidade , Vigilância de Evento Sentinela , Processamento de Sinais Assistido por Computador , Neoplasias Cutâneas/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos
11.
Medicine (Baltimore) ; 96(10): e6278, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28272243

RESUMO

Skin cancer screening has undoubted potential to reduce cancer-specific morbidity and mortality. Total-body exams remain the prevailing concept of skin cancer screening even if effectiveness and value of this method are controversial. Meanwhile, store and forward teledermatology was shown to be a reliable instrument for several diagnostic purposes mostly in specialized dermatology settings. The objective of this study was to evaluate most convenient mobile teledermatology interventions as instruments for skin cancer screening in a representative population.Prospective diagnostic study with visitors of a skin cancer screening campaign in Switzerland. Histopathology was used as reference standard. Mobile teledermatology with or without dermoscopic images was assessed for performance as a screening test (i.e., rule-in or rule-out the need for further testing). Outcomes were sensitivity, specificity, and predictive values.Seven cases of skin cancer were present among 195 skin lesions. All skin cancers were ruled-in by teledermatology with or without dermoscopic images (sensitivity and negative predictive value 100%). The addition of dermoscopic images to conventional images resulted in higher specificity (85% vs. 77%), allowing reduction of unnecessary further testing in a larger proportion of skin lesions.Store and forward mobile teledermatology could serve as an instrument for population-based skin cancer screening because of favorable test performance.


Assuntos
Dermatologia/estatística & dados numéricos , Dermoscopia/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
13.
J Dermatol ; 44(6): 681-689, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28191661

RESUMO

Digital dermoscopy (DD) follow up is a useful strategy for monitoring patients at high risk of melanoma. Reflectance confocal microscopy (RCM) is a valuable second-level examination after dermoscopy for the evaluation of difficult to diagnose lesions. The aim of this study was to assess the value of RCM in routine DD monitoring of patients at high risk of melanoma. In this prospective study, performed over 22 months, changing melanocytic lesions were detected by DD and excised. RCM imaging was performed before surgical excision of all the lesions, and histopathology used as the gold standard diagnostic test. Eighty-seven lesions, including 11 thin melanomas, were studied. Dermoscopic evaluation at follow up revealed a significant association between melanoma and asymmetry in two axes (P = 0.035). Enlargement and other changes in structure or color did not significantly differ between nevi and melanomas. Widespread pagetoid cells, non-edged papillae, irregular and dishomogeneous junctional clusters, and sheet-like structures were significantly associated with malignancy (P < 0.001). RCM allowed accurate diagnosis of melanoma in 10 of 11 cases (90.9%). The remaining case was classified as a dysplastic nevus. Forty-six lesions (52.8%) in which RCM revealed no atypia were deemed unnecessarily removed. This study was limited by sample size. In conclusion, combined DD and RCM facilitates the recognition of thin malignant melanomas and reduces unnecessary excisions.


Assuntos
Dermoscopia/estatística & dados numéricos , Melanoma/diagnóstico , Microscopia Confocal/estatística & dados numéricos , Neoplasias Cutâneas/diagnóstico , Adulto , Assistência ao Convalescente , Feminino , Humanos , Masculino , Melanoma/patologia , Estudos Prospectivos , Pele/patologia , Neoplasias Cutâneas/patologia
14.
J Am Osteopath Assoc ; 117(3): 158-164, 2017 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-28241327

RESUMO

CONTEXT: Osteopathic physicians (ie, DOs) in primary care may play a critical role in the early detection of skin cancer. Dermoscopy improves diagnostic accuracy; however, its use among primary care DOs remains understudied. OBJECTIVES: To document dermascope use among DOs in primary care, to examine physician and practice characteristics associated with having used and having heard of a dermascope, and to examine the barriers to dermascope use. METHODS: Osteopathic physicians were recruited to complete an anonymous survey assessing demographic factors, physician and practice characteristics, confidence in differentiating skin lesions, knowledge and dermascope use, and barriers to dermascope use. Bivariate analyses were conducted, and the significant factors were entered into 2 separate logistic regressions. RESULTS: A total of 768 participants were included in the study. Four hundred ten (54%) had heard of a dermascope, and 123 (15%) had used one. The statistically significant multivariate predictors for having used a dermascope (model 1) were graduating from medical school after 1989 and having greater confidence in differentiating skin lesions (OR, 2.2; 95% CI, 1.66-2.79). Those who graduated after 2009 were 9.5 times more likely and those graduating between 2000 and 2009 were 4.3 times more likely to have used a dermascope than those graduating before 1990 (95% CI, 4.29-20.90 and 95% CI, 2.04-9.23, respectively). Ever having heard of a dermascope (model 2) was associated with being female (OR, 1.4; 95% CI, 1.02-1.87); practicing in a group (OR, 1.6; 95% CI, 1.05-2.36), academic (OR, 2.2; 95% CI, 1.26-3.86), or community center (OR, 2.2; 95% CI, 1.20-4.00); and having greater confidence in differentiating skin lesions (OR, 1.3; 95% CI, 1.15-1.55). Both models were statistically significant and correctly classified 605 (84.1%) (model 1) and 444 (58.4%) participants (model 2). CONCLUSION: Dermascope use could help primary care DOs improve their diagnostic accuracy for skin cancer and reduce unnecessary referrals to specialists. Efforts to disseminate knowledge about the benefits of using a dermascope to primary care DOs are needed.


Assuntos
Dermoscopia/estatística & dados numéricos , Médicos Osteopáticos/estatística & dados numéricos , Atenção Primária à Saúde/métodos , Neoplasias Cutâneas/diagnóstico , Intervalos de Confiança , Estudos Transversais , Detecção Precoce de Câncer , Feminino , Humanos , Modelos Logísticos , Masculino , Razão de Chances , Padrões de Prática Médica , Neoplasias Cutâneas/prevenção & controle , Inquéritos e Questionários , Estados Unidos
15.
J Eur Acad Dermatol Venereol ; 31(7): 1148-1156, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28109068

RESUMO

BACKGROUND: Dermoscopy is a widely used technique that can increase the sensitivity and specificity of melanoma detection. Information is lacking on the impact of dermoscopy use on the detection of melanoma in the real-life practice of European dermatologists. OBJECTIVE: To identify factors that influence the benefit of using dermoscopy for increasing melanoma detection and lowering the number of unnecessary biopsies in the practice of European dermatologists. METHODS: We conducted a survey of dermatologists registered in 32 European countries regarding the following: the demographic and practice characteristics, dermoscopy training and use, opinions on dermoscopy and the self-estimated impact of dermoscopy use on the number of melanomas detected and the number of unnecessary biopsies performed in practice. RESULTS: Valid answers were collected for 7480 respondents, of which 6602 reported using dermoscopy. Eighty-six per cent of dermoscopy users reported that dermoscopy increased the numbers of melanomas they detected, and 70% reported that dermoscopy decreased the number of unnecessary biopsies of benign lesions they performed. The dermatologists reporting these benefits were more likely to have received dermoscopy training during residency, to use dermoscopy frequently and intensively, and to use digital dermoscopy systems and pattern analysis compared to dermatologists who did not perceive any benefit of dermoscopy for the melanoma recognition in their practice. CONCLUSIONS: Improving dermoscopy training, especially during residency and increasing access to digital dermoscopy equipment are important paths to enhance the benefit of dermoscopy for melanoma detection in the practice of European dermatologists.


Assuntos
Dermatologistas , Dermoscopia/estatística & dados numéricos , Melanoma/diagnóstico , Neoplasias Cutâneas/diagnóstico , Adulto , Europa (Continente) , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
16.
J Eur Acad Dermatol Venereol ; 31(2): 247-251, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27422807

RESUMO

BACKGROUND: Digital dermoscopy monitoring (DDM) is an effective strategy for melanoma detection. Two methods are currently employed. Short-term follow-up (STFU) for the evaluation of single, atypical lesions to detect subtle changes over a short period of time (3-6 months). Long-term follow-up (LTFU) is recommended for patients with multiple nevi. Although a study demonstrated that STFU improves the patients' compliance for DDM, little remains known about the impact and reliability of STFU in this setting. OBJECTIVES: The aim of this retrospective, observational study was to evaluate the impact and reliability of a schedule combining STFU and LTFU in patients with multiple atypical nevi. METHODS: We searched our database for all cases of patients with multiple atypical nevi occurring between 2006 and 2014. RESULTS: A total of 3823 lesions in 541 patients were dermoscopically monitored (mean number = 7 lesions per patient; median = 6 lesions; range, 2-51). In all, 264 (6.9%) lesions in 184 (34.4%) patients were excised (mean of 0.5 lesions per patient). In total, 197 (74.6%) lesions were excised at follow-up, with melanomas representing 30.5% of lesions excised after follow-up. A total of 30 (33.3%) melanomas were excised at baseline, 23 (25.6%) after STFU and 37 (41.1%) after LTFU. There was no difference in the number of in situ melanomas detected at baseline with those detected after follow-up. The mean Breslow thickness of melanomas detected at baseline was higher than those detected after STFU (P = 0.038) and LTFU (P = 0.055). CONCLUSIONS: Our study confirm that digital dermoscopy follow-up is a valid management strategy for patients with multiple atypical nevi, with short-term monitoring playing an effective role also in this setting of patients.


Assuntos
Dermoscopia/métodos , Melanoma/diagnóstico , Nevo/diagnóstico , Adolescente , Adulto , Idoso , Criança , Dermoscopia/estatística & dados numéricos , Diagnóstico Diferencial , Seguimentos , Humanos , Pessoa de Meia-Idade , Cooperação do Paciente , Estudos Retrospectivos , Adulto Jovem
18.
Br J Dermatol ; 175(6): 1329-1337, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27469990

RESUMO

BACKGROUND: When used correctly, dermoscopy is an essential tool for helping clinicians in the diagnosis of skin diseases and the early detection of skin cancers. Despite its proven benefits, there is a lack of data about how European dermatologists use dermoscopy in everyday practice. OBJECTIVES: To identify the motivations, obstacles and modifiable factors influencing the use of dermoscopy in daily dermatology practice across Europe. METHODS: All registered dermatologists in 32 European countries were invited to complete an online survey of 20 questions regarding demographic and practice characteristics, dermoscopy training and self-confidence in dermoscopic skills, patterns of dermoscopy use, reasons for not using dermoscopy and attitudes relating to dermoscopy utility. RESULTS: We collected 7480 valid answers, of which 89% reported use of dermoscopy. The main reasons for not using dermoscopy were lack of equipment (58% of nonusers) and lack of training (42%). Dermoscopy training during residency was reported by 41% of dermoscopy users and by 12% of nonusers (P < 0·001). Dermatologists working in public hospitals were the least likely to use dermoscopy. High use of dermoscopy across the spectrum of skin diseases was reported by 62% of dermoscopy users and was associated with dermoscopy training during residency, the use of polarized light and digital dermoscopy devices, longer dermoscopy practice, younger age and female gender. CONCLUSIONS: Expanding access to dermoscopy equipment, especially in public healthcare facilities and establishing dermoscopy training during dermatology residency would further enhance the substantially high dermoscopy use across European countries.


Assuntos
Dermoscopia/estatística & dados numéricos , Dermatopatias/diagnóstico por imagem , Adulto , Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Dermatologistas/psicologia , Europa (Continente) , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
19.
Dermatol Clin ; 34(3): 353-62, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27363893

RESUMO

Early detection remains the most important strategy to reduce melanoma mortality. The identification and evaluation of new or changing skin lesions are important components of melanoma screening and are best performed today using complementary noninvasive imaging technologies, such as total body photography (TBP), dermoscopy, sequential digital dermoscopic imaging (SDDI), and reflectance confocal microscopy (RCM). Despite strong evidence showing that these screening techniques improve diagnostic accuracy for melanoma, they are not widely used by dermatologists. In this practice gaps review, the authors highlight the use, evidence, and rationale for TBP, dermoscopy, SDDI, and RCM.


Assuntos
Dermatologia/educação , Dermoscopia/estatística & dados numéricos , Melanoma/diagnóstico por imagem , Fotografação , Neoplasias Cutâneas/diagnóstico por imagem , Competência Clínica , Dermatologia/normas , Dermoscopia/educação , Dermoscopia/métodos , Detecção Precoce de Câncer , Humanos , Melanoma/patologia , Microscopia Confocal , Guias de Prática Clínica como Assunto , Padrões de Prática Médica , Autoeficácia , Neoplasias Cutâneas/patologia
20.
J Am Acad Dermatol ; 74(6): 1107-13, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26826889

RESUMO

BACKGROUND: Dermoscopy allows for visualization of morphologic structures beyond the epidermis, including features that may indicate early malignant transformation. However, dermoscopic features are rarely considered during routine histologic sectioning, and areas of clinical concern may be missed during microscopic evaluation. OBJECTIVE: We assessed the diagnostic impact of a dermoscopy-guided micropunch score for the evaluation of melanocytic lesions. METHODS: In this case-control study, we evaluated 150 scored melanocytic lesions. Original tissue specimens were reprocessed to create a control group, in which a new score was introduced elsewhere in the lesion to guide an alternative plane of section. Slides were reviewed in a randomized, double-blinded manner to assess histologic features and render a diagnosis. Dermoscopy was also reviewed. RESULTS: The proportion of cases with a higher grade in the original, dermoscopy-guided section was statistically significant. Four invasive melanomas were exclusively identified using the scoring protocol. The presence of regression structures, negative pigment network, radial streaming or pseudopods, and irregular blotches were highly specific for a higher diagnostic grade. LIMITATIONS: This study is retrospective and reprocessing tissue does not perfectly mimic routine sectioning. CONCLUSION: Dermoscopy can identify important, histologically high-grade areas, and this information can be used to optimize the sectioning of melanocytic neoplasms.


Assuntos
Dermoscopia/métodos , Síndrome do Nevo Displásico/patologia , Biópsia Guiada por Imagem/métodos , Melanoma/patologia , Nevo Pigmentado/patologia , Neoplasias Cutâneas/patologia , Adulto , Idoso , Estudos de Casos e Controles , Bases de Dados Factuais , Dermoscopia/estatística & dados numéricos , Diagnóstico Diferencial , Síndrome do Nevo Displásico/diagnóstico , Feminino , Humanos , Biópsia Guiada por Imagem/estatística & dados numéricos , Imuno-Histoquímica , Masculino , Melanoma/diagnóstico , Pessoa de Meia-Idade , Nevo Pigmentado/diagnóstico , Neoplasias Cutâneas/diagnóstico
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