Teledermoscopic triage of melanoma-suspicious skin lesions is safe: A retrospective comparative diagnostic accuracy study with multiple assessors.

BACKGROUND: The rising incidence of melanoma and the high number of benign lesions excised due to diagnostic uncertainty highlight the need for effective patient triage. This study assesses the safety and accuracy of teledermoscopic triage on a high-prevalence case set with pre-triaged, challenging, melanoma-suspicious lesions. METHODS: Five dermatologists independently reviewed 250 retrospectively extracted patient cases. Teledermoscopy assessments were simulated for panels of 1, 2, 3 and 5 assessors using two distinct consensus strategies, Caution Protocol and Majority Vote, and the sensitivity and specificity of the patient triages were calculated. RESULTS: Triage by a single teledermatologist showed a sensitivity of 92.3% and a specificity of 58.7%. Sensitivity improved with the number of assessors, particularly when using the Caution Protocol, though with a considerable drop in specificity. The Majority Vote showed a more balanced improvement in sensitivity and specificity. Safety analyses indicated that diagnostic accuracy decreased with poor image quality and increased case difficulty. DISCUSSION: Expert teledermoscopic triage of melanocytic skin lesions is highly sensitive and lowers the need for unnecessary excision procedures by half while dismissing as few as 0.4% (95% confidence interval 0-0.6%) of melanomas, even when applied to a high-prevalence pre-triaged subpopulation. Implementation of safety procedures increases accuracy. Using multiple teledermatologists increases sensitivity but at the cost of specificity unless a Majority Vote consensus strategy is applied. Future teledermoscopy guidelines should encompass safety procedures and protocols for disagreement between assessors.

Treatment of postgestational rectus diastasis.

Rectus diastasis is defined by thinning and widening of linea alba and is a part of pregnancy. In some patients, the diastasis persists giving symptoms such as core instability, and cosmetic complaints. Treatment consists of exercise and surgery by either a plastic surgeon or a general surgeon. Lately, rectus diastasis has gained both national and international attention but it is not clear which patients will benefit from surgery or which operative technique has the best outcome. This review describes postgestational rectus diastasis and summarizes treatment possibilities based on the latest literature.

Improving Skin Cancer Diagnostics Through a Mobile App With a Large Interactive Image Repository: Randomized Controlled Trial.

BACKGROUND: Skin cancer diagnostics is challenging, and mastery requires extended periods of dedicated practice. OBJECTIVE: The aim of the study was to determine if self-paced pattern recognition training in skin cancer diagnostics with clinical and dermoscopic images of skin lesions using a large-scale interactive image repository (LIIR) with patient cases improves primary care physicians' (PCPs') diagnostic skills and confidence. METHODS: A total of 115 PCPs were randomized (allocation ratio 3:1) to receive or not receive self-paced pattern recognition training in skin cancer diagnostics using an LIIR with patient cases through a quiz-based smartphone app during an 8-day period. The participants' ability to diagnose skin cancer was evaluated using a 12-item multiple-choice questionnaire prior to and 8 days after the educational intervention period. Their thoughts on the use of dermoscopy were assessed using a study-specific questionnaire. A learning curve was calculated through the analysis of data from the mobile app. RESULTS: On average, participants in the intervention group spent 2 hours 26 minutes quizzing digital patient cases and 41 minutes reading the educational material. They had an average preintervention multiple choice questionnaire score of 52.0% of correct answers, which increased to 66.4% on the postintervention test; a statistically significant improvement of 14.3 percentage points (P<.001; 95% CI 9.8-18.9) with intention-to-treat analysis. Analysis of participants who received the intervention as per protocol (500 patient cases in 8 days) showed an average increase of 16.7 percentage points (P<.001; 95% CI 11.3-22.0) from 53.9% to 70.5%. Their overall ability to correctly recognize malignant lesions in the LIIR patient cases improved over the intervention period by 6.6 percentage points from 67.1% (95% CI 65.2-69.3) to 73.7% (95% CI 72.5-75.0) and their ability to set the correct diagnosis improved by 10.5 percentage points from 42.5% (95% CI 40.2%-44.8%) to 53.0% (95% CI 51.3-54.9). The diagnostic confidence of participants in the intervention group increased on a scale from 1 to 4 by 32.9% from 1.6 to 2.1 (P<.001). Participants in the control group did not increase their postintervention score or their diagnostic confidence during the same period. CONCLUSIONS: Self-paced pattern recognition training in skin cancer diagnostics through the use of a digital LIIR with patient cases delivered by a quiz-based mobile app improves the diagnostic accuracy of PCPs. TRIAL REGISTRATION: ClinicalTrials.gov NCT05661370; https://classic.clinicaltrials.gov/ct2/show/NCT05661370.

Christmas article: Have your cake and eat it too: a comparison of temptations in the confectionery and the operating room.

Introduction The use and consumption of "products", such as cosmetic procedures and confectionery, is on a rise in the Danish population. However, it has never been evaluated if the same tendency can be observed among the providers of these products. In view of the upcoming Christmas, we decided to investigate this delicate matter. Methods This study was a survey-based cross-sectional study examining demographics, professional backgrounds, as well as frequency and preferences regarding confectionery and cosmetic procedures among confectioners and plastic surgeons. Results A total of 90 persons answered the questionnaire. Results showed that consumption of confectionery was high among both confectioners and plastic surgeons, and that the use of cosmetic procedures was higher among both confectioners and plastic surgeons than among the background population. Both groups preferred to know the person who provided "the product" within their respective area. Conclusion Most plastic surgeons do not need to know their confectioner but would like to know their cosmetic procedure provider. So, if you, as part of the department management, or simply as a well-meaning colleague, want to treat your staff/colleagues, you can safely order cake from a random confectioner but not cosmetic procedures from a random surgeon! Funding none. Trial registration not relevant.

[Chainsaw lacerations of the face].

This is a case report of two patients, who had accidental self-inflicted chainsaw lacerations of the face. The injuries were remarkably similar with jagged soft tissue lacerations and soft tissue parts of questionable vitality. These cases and their treatment are presented to show examples of the handling of soft tissue injuries of the face in an emergency department setting and to show, that very conservative debridement of these injuries is the recommended approach.

[The effect on mold formation when leaving the first slice in situ in white sliced bread].

INTRODUCTION: To study the effect on mold formation when leaving the first slice in situ in white sliced bread (WSB). MATERIAL AND METHODS: We randomized 20 bags of WSB from a single production batch to either have the first slice removed or left in situ and compared mold formation and dryness on day ten. We removed two slices of bread from each bag daily and used blinded outcome assessors. RESULTS: We found mold in seven vs. six bags in the groups (p = 1.00). Results on dryness were inconsistent. The study may have been underpowered. CONCLUSION: Leaving the end slice in situ may not affect mold formation in WSB.