Clinical techniques in veterinary dermatology: Dermoscopy.

Dermoscopy is a noninvasive, painless, easy-to-perform technique used in human and veterinary medicine for rapid and magnified in vivo observation of dermatological lesions and disease. Dermoscopy can lead to a swifter diagnosis and may eliminate the need to perform more invasive diagnostic testing such as skin biopsies. To perform dermoscopy, the clinician needs a dermoscope and a software program equipped with image capture for pattern identification. Two techniques exist for dermoscopy: standard contact, where the dermoscope is applied directly to the patient's skin with the use of a liquid interface, or noncontact, where there is no direct contact between the skin and the dermoscope. The most important criteria to be considered when using dermoscopy are the morphology/arrangement of vascular structures, scaling patterns, colours, follicular abnormalities and specific disease features. Application of dermoscopic findings should always be correlated with the patient's history, clinical signs and the morphology of the skin lesions. Dermoscopy does require an initial financial and time investment by the clinician, yet this technique can quickly and easily help to identify patterns of disease that correlate with clinical diagnosis of dermatological disease.

La dermoscopie est une technique non invasive, indolore et facile à réaliser utilisée en médecine humaine et vétérinaire pour l'observation in vivo rapide et agrandie des lésions et maladies dermatologiques. La dermoscopie peut conduire à un diagnostic plus rapide et peut éliminer la nécessité d'effectuer des tests de diagnostic plus invasifs tels que des biopsies cutanées. Pour effectuer une dermoscopie, le clinicien a besoin d'un dermoscope et d'un logiciel équipé d'une capture d'image pour l'identification des motifs. Deux techniques existent pour la dermoscopie : contact standard, où le dermoscope est appliqué directement sur la peau du patient à l'aide d'une interface liquide, ou sans contact, où il n'y a pas de contact direct entre la peau et le dermoscope. Les critères les plus importants à prendre en compte lors de l'utilisation de la dermoscopie sont la morphologie/l'arrangement des structures vasculaires, les schémas de desquamation, les couleurs, les anomalies folliculaires et les caractéristiques spécifiques de la maladie. L'application des résultats dermoscopiques doit toujours être corrélée avec les antécédents du patient, les signes cliniques et la morphologie des lésions cutanées. La dermoscopie nécessite un investissement initial en argent et en temps de la part du clinicien, mais cette technique peut rapidement et facilement aider à identifier les schémas de la maladie en corrélation avec le diagnostic clinique de la maladie dermatologique.

La dermatoscopia es una técnica no invasiva, indolora y fácil de realizar utilizada en medicina humana y veterinaria para la observación in vivo rápida y ampliada de lesiones y enfermedades dermatológicas. La dermatoscopia puede conducir a un diagnóstico más rápido y puede eliminar la necesidad de realizar pruebas de diagnóstico más invasivas, como biopsias de piel. Para realizar la dermatoscopia, el clínico necesita un dermatoscopio y un programa de software equipado con captura de imágenes para la identificación de patrones. Existen dos técnicas para la dermatoscopia: contacto estándar, donde el dermatoscopio se aplica directamente a la piel del paciente con el uso de una interfase líquida, o sin contacto, donde no hay contacto directo entre la piel y el dermatoscopio. Los criterios más importantes que deben tenerse en cuenta al utilizar la dermatoscopia son la morfología/disposición de las estructuras vasculares, los patrones de descamación, los colores, las anomalías foliculares y las características específicas de la enfermedad. La aplicación de los hallazgos dermatoscópicos siempre debe correlacionarse con la historia del paciente, los signos clínicos y la morfología de las lesiones cutáneas. La dermatoscopia requiere una inversión financiera y de tiempo inicial por parte del médico, pero esta técnica puede ayudar rápida y fácilmente a identificar patrones de enfermedad que se correlacionan con el diagnóstico clínico de la enfermedad dermatológica.

A dermatoscopia é uma técnica não invasiva, indolor e de fácil execução utilizada na medicina humana e veterinária para observação in vivo rápida e ampliada de lesões e doenças dermatológicas. A dermatoscopia pode levar a um diagnóstico mais rápido e pode eliminar a necessidade de realizar testes diagnósticos mais invasivos, como biópsias de pele. Para realizar a dermatoscopia, o clínico precisa de um dermatoscópio e um programa de software equipado com captura de imagem para identificação do padrão. Existem duas técnicas de dermatoscopia: contato padrão, onde o dermatoscópio é aplicado diretamente na pele do paciente com o uso de uma interface líquida, ou sem contato, onde não há contato direto entre a pele e o dermatoscópio. Os critérios mais importantes a serem considerados ao utilizar a dermatoscopia são a morfologia/arranjo das estruturas vasculares, padrões de descamação, cores, anormalidades foliculares e características específicas da doença. A aplicação dos achados dermatoscópicos deve sempre ser correlacionada com a história do paciente, os sinais clínicos e a morfologia das lesões cutâneas. A dermatoscopia requer um investimento inicial financeiro e de tempo por parte do clínico, mas esta técnica pode ajudar rápida e facilmente a identificar padrões de doenças que se correlacionam com o diagnóstico clínico de doenças dermatológicas.

Development of a Checklist Tool to Assess the Quality of Skin Lesion Images Acquired by Consumers Using Sequential Mobile Teledermoscopy.

BACKGROUND: Mobile teledermoscopy is an emerging technology that involves imaging and digitally sending dermoscopic images of skin lesions to a clinician for assessment. High-quality, consistent images are required for accurate telediagnoses when monitoring lesions over time. To date there are no tools to assess the quality of sequential images taken by consumers using mobile teledermoscopy. The purpose of this study was to develop a tool to assess the quality of images acquired by consumers. METHODS: Participants imaged skin lesions that they felt were concerning at baseline, 1-, and 2-months. A checklist to assess the quality of consumer sequential imaging of skin lesions was developed based on the International Skin Imaging Collaboration guidelines. A scale was implemented to grade the quality of the images: 0 (low) to 18 (very high). Intra- and inter-reliability of the checklist was assessed using Bland-Altman analysis. Using this checklist, the consistency with which 85 sets of images were scored by 2 evaluators were compared using Kappa statistics. Items with a low Kappa value <0.4 were removed. RESULTS: After reliability testing, 5 of the items were removed due to low Kappa values (<0.4) and the final checklist included 13 items surveying: lesion selection; image orientation; lighting; field of view; focus and depth of view. Participants had a mean age of 41 years (range 19-73), and 67% were female. Most participants (84%, n = 71/85) were able to select and image the correct lesion over time for both the dermoscopic and overview images. Younger participants (<40 years old) scored significantly higher (8.1 ± 2.1) on the imaging checklist compared to older participants (7.1 ± 2.4; p = 0.037). Participants had most difficulty with consistent image orientation. CONCLUSIONS: This checklist could be used as a triage tool to filter images acquired by consumers prior to telediagnosis evaluation, which would improve the efficiency and accuracy of teledermatology and teledermoscopy processes. It may also be used to provide feedback to the consumers to improve image acquisition over time.

Evaluation of dermoscopic criteria for seborrheic keratosis on non-polarized versus polarized dermoscopy.

BACKGROUND: The two dermoscopic methods, polarized dermoscopy (PD) and non-polarized dermoscopy (NPD), use different types of light sources. Here, we aimed to explore the differences between these two methods in the diagnosis of seborrheic keratosis (SK). MATERIALS AND METHODS: The images of 121 cases of SK taken by a digital camera equipped with NPD and PD were evaluated against 14 dermoscopic criteria of SK. RESULTS: The agreement levels between NPD and PD were fair to perfect against the dermoscopic criteria of SK. Perfect agreement was observed in fingerprint-like structures (κ = 0.812) and linear irregular vessels (κ = 0.807). Substantial agreement was determined in comedo-like openings (κ = 0.640), hairpin vessels (κ = 0.609), a moth-eaten border (κ = 0.642), sharp demarcation (κ = 0.637), network-like structures (κ = 0.662), and a mica-like pattern (κ = 0.639). Moderate agreement was found in milia-like cysts (κ = 0.550), fissures and ridges (κ = 0.554), dotted vessels (κ = 0.496), and color variability (κ = 0.438). Fair agreement was obtained only in comma vessels (κ = 0.340). CONCLUSION: Based on our results, we cannot recommend an absolute dermoscopic method for the diagnosis of SK; rather, we suggest that the methods are complementary.

How transparent film applied on dermatologic imaging devices in order to prevent infections affects image quality?

BACKGROUND: In the clinical practice, transparent films are used as sterile interfaces in in vivo dermatologic imaging in order to prevent the transmissions of infections. However, in our experience, the use of a transparent film can alter skin images. Our study aimed to compare the optical quality of a series of different plastic films used as interfaces in order to understand if some might be more suitable for imaging. MATERIALS AND METHODS: We tested the optical properties of 11 different protective transparent films that are marketed in France with a transparency meter and a spectrophotometer. RESULTS: Transmission, minimal diffusion, amount of gray, and contrast were obtained for each transparent film. Transmission ranged from 93.24% to 96.88% (mean 95.36; standard deviation SD 1.02), minimal diffusion from 88.28% to 123.87% (mean 101.04; standard deviation SD 10.02) and contrast from 11.01 to 15.88 (mean 13.93 and SD 1.3). For some films, the transmission was lower at lower wavelengths. CONCLUSION: All tested films had excellent optical properties. However, some of them had better optical qualities and seemed more suitable for their use in dermatologic imaging.

Accuracy of dermoscopy in distinguishing erythroplasia of Queyrat from common forms of chronic balanitis: results from a multicentric observational study.

BACKGROUND: Clinical differentiation of erythroplasia of Queyrat (EQ) and chronic forms of balanitis may be challenging, especially in early phases or in overlapping cases. Dermoscopy has been shown to be a useful supportive tool in facilitating the distinction between tumoral and inflammatory skin conditions; yet, data on EQ and balanitis are scarce or sparse. OBJECTIVES: To systematically assess the dermoscopic features of both EQ and common forms of chronic balanitis and to investigate the accuracy of dermoscopy in distinguishing these conditions. METHODS: Subjects with EQ or chronic balanitis confirmed histologically or microbiologically (for infectious forms) were recruited. A representative dermoscopic image of a target lesion was retrospectively assessed for the presence of specific morphological findings. A correlation matrix was created using Spearman's rho. Proportions of dermoscopic variables scoring among different conditions were compared with the non-parametric Pearson's chi-square test. RESULTS: A total of 81 lesions (14 EQ, 23 psoriasis, 31 Zoon plasma cell balanitis and 13 candidal balanitis) from 81 patients were included in the study. Glomerular vessels (both clustered and diffusely distributed) were highly predictive for the diagnosis of EQ, while diffuse dotted vessels were strongly associated with psoriatic balanitis. Finally, Zoon plasma cell balanitis was characterized by orange structureless areas (focal or diffuse) and focused linear curved vessels, whereas cottage cheese-like structures (sparse white coating corresponding to Candida yeast colonies growth) showed a strong correlation with candidal balanitis. CONCLUSIONS: Erythroplasia of Queyrat and balanitis may display different dermoscopic patterns, thereby bearing the usefulness of dermoscopy as a supportive non-invasive tool for the recognition and differential diagnosis of such conditions.

Computer-assisted diagnosis techniques (dermoscopy and spectroscopy-based) for diagnosing skin cancer in adults.

BACKGROUND: Early accurate detection of all skin cancer types is essential to guide appropriate management and to improve morbidity and survival. Melanoma and cutaneous squamous cell carcinoma (cSCC) are high-risk skin cancers which have the potential to metastasise and ultimately lead to death, whereas basal cell carcinoma (BCC) is usually localised with potential to infiltrate and damage surrounding tissue. Anxiety around missing early curable cases needs to be balanced against inappropriate referral and unnecessary excision of benign lesions. Computer-assisted diagnosis (CAD) systems use artificial intelligence to analyse lesion data and arrive at a diagnosis of skin cancer. When used in unreferred settings ('primary care'), CAD may assist general practitioners (GPs) or other clinicians to more appropriately triage high-risk lesions to secondary care. Used alongside clinical and dermoscopic suspicion of malignancy, CAD may reduce unnecessary excisions without missing melanoma cases. OBJECTIVES: To determine the accuracy of CAD systems for diagnosing cutaneous invasive melanoma and atypical intraepidermal melanocytic variants, BCC or cSCC in adults, and to compare its accuracy with that of dermoscopy. SEARCH METHODS: We undertook a comprehensive search of the following databases from inception up to August 2016: Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; Embase; CINAHL; CPCI; Zetoc; Science Citation Index; US National Institutes of Health Ongoing Trials Register; NIHR Clinical Research Network Portfolio Database; and the World Health Organization International Clinical Trials Registry Platform. We studied reference lists and published systematic review articles. SELECTION CRITERIA: Studies of any design that evaluated CAD alone, or in comparison with dermoscopy, in adults with lesions suspicious for melanoma or BCC or cSCC, and compared with a reference standard of either histological confirmation or clinical follow-up. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted all data using a standardised data extraction and quality assessment form (based on QUADAS-2). We contacted authors of included studies where information related to the target condition or diagnostic threshold were missing. We estimated summary sensitivities and specificities separately by type of CAD system, using the bivariate hierarchical model. We compared CAD with dermoscopy using (a) all available CAD data (indirect comparisons), and (b) studies providing paired data for both tests (direct comparisons). We tested the contribution of human decision-making to the accuracy of CAD diagnoses in a sensitivity analysis by removing studies that gave CAD results to clinicians to guide diagnostic decision-making. MAIN RESULTS: We included 42 studies, 24 evaluating digital dermoscopy-based CAD systems (Derm-CAD) in 23 study cohorts with 9602 lesions (1220 melanomas, at least 83 BCCs, 9 cSCCs), providing 32 datasets for Derm-CAD and seven for dermoscopy. Eighteen studies evaluated spectroscopy-based CAD (Spectro-CAD) in 16 study cohorts with 6336 lesions (934 melanomas, 163 BCC, 49 cSCCs), providing 32 datasets for Spectro-CAD and six for dermoscopy. These consisted of 15 studies using multispectral imaging (MSI), two studies using electrical impedance spectroscopy (EIS) and one study using diffuse-reflectance spectroscopy. Studies were incompletely reported and at unclear to high risk of bias across all domains. Included studies inadequately address the review question, due to an abundance of low-quality studies, poor reporting, and recruitment of highly selected groups of participants.Across all CAD systems, we found considerable variation in the hardware and software technologies used, the types of classification algorithm employed, methods used to train the algorithms, and which lesion morphological features were extracted and analysed across all CAD systems, and even between studies evaluating CAD systems. Meta-analysis found CAD systems had high sensitivity for correct identification of cutaneous invasive melanoma and atypical intraepidermal melanocytic variants in highly selected populations, but with low and very variable specificity, particularly for Spectro-CAD systems. Pooled data from 22 studies estimated the sensitivity of Derm-CAD for the detection of melanoma as 90.1% (95% confidence interval (CI) 84.0% to 94.0%) and specificity as 74.3% (95% CI 63.6% to 82.7%). Pooled data from eight studies estimated the sensitivity of multispectral imaging CAD (MSI-CAD) as 92.9% (95% CI 83.7% to 97.1%) and specificity as 43.6% (95% CI 24.8% to 64.5%). When applied to a hypothetical population of 1000 lesions at the mean observed melanoma prevalence of 20%, Derm-CAD would miss 20 melanomas and would lead to 206 false-positive results for melanoma. MSI-CAD would miss 14 melanomas and would lead to 451 false diagnoses for melanoma. Preliminary findings suggest CAD systems are at least as sensitive as assessment of dermoscopic images for the diagnosis of invasive melanoma and atypical intraepidermal melanocytic variants. We are unable to make summary statements about the use of CAD in unreferred populations, or its accuracy in detecting keratinocyte cancers, or its use in any setting as a diagnostic aid, because of the paucity of studies. AUTHORS' CONCLUSIONS: In highly selected patient populations all CAD types demonstrate high sensitivity, and could prove useful as a back-up for specialist diagnosis to assist in minimising the risk of missing melanomas. However, the evidence base is currently too poor to understand whether CAD system outputs translate to different clinical decision-making in practice. Insufficient data are available on the use of CAD in community settings, or for the detection of keratinocyte cancers. The evidence base for individual systems is too limited to draw conclusions on which might be preferred for practice. Prospective comparative studies are required that evaluate the use of already evaluated CAD systems as diagnostic aids, by comparison to face-to-face dermoscopy, and in participant populations that are representative of those in which the test would be used in practice.

Diagnostic accuracy of reflectance confocal microscopy using VivaScope for detecting and monitoring skin lesions: a systematic review.

BACKGROUND: Skin cancer is one of the most common cancers in the UK. Patients with suspicious skin lesions are assessed clinically with/without dermoscopy, and lesions still considered suspicious are then surgically removed or have the diagnosis confirmed by a punch biopsy. AIM: To evaluate the diagnostic accuracy of the in vivo VivaScope© reflective confocal microscopy (RCM) system, a noninvasive technology designed to provide a more accurate presurgical diagnosis, leading to fewer biopsies of benign lesions, or to provide greater accuracy for lesion margins. METHODS: MEDLINE, EMBASE and the Cochrane Library were searched to identify studies evaluating dermoscopy plus RCM, or RCM alone, with histopathology as the reference test. Clinical experts were also contacted for information on unpublished studies. RESULTS: Eleven studies met the inclusion criteria but were too heterogeneous to be combined by meta-analysis. Results indicated that VivaScope subsequent to dermoscopy may improve diagnostic accuracy of malignant melanomas compared with dermoscopy. For margin delineation, the data suggest that mapping using VivaScope 1500 for lentigo maligna (LM) and LM melanoma may improve accuracy in terms of complete excision of lesions compared with dermoscopically determined margins. For basal cell carcinoma, the limited data show high diagnostic accuracy with both VivaScope 1500 and VivaScope 3000. Evidence on the effectiveness of VivaScope in diagnosing cutaneous squamous cell carcinomas was very limited. CONCLUSION: The use of VivaScope 1500 following dermoscopy may improve patient care and management of suspicious skin lesions, although the generalizability of these results to the UK population remains unclear.

[Dermoscopy for malignant and benign skin tumors : Indication and standardized terminology]. / Dermatoskopie bei malignen und benignen Hauttumoren : Indikation und standardisierte Terminologie.

Dermoscopy has a high diagnostic accuracy in pigmented and nonpigmented malignant and benign skin tumors. These microscopic in vivo examinations with polarized and nonpolarized light are effective in the early detection of malignant skin tumors and reduce the number of unnecessary excisions of benign skin tumors. The selection of the skin lesions is crucial for the diagnostic accuracy of the dermoscopic examination. Not only large pigmented skin lesions, but also small hypo-, de-, or nonpigmented skin lesions, should be examined dermatoscopically as well as skin lesions that have changed in shape and/or color. In clinical routine, research and teaching, the dermoscopic diagnosis should be performed by describing the visible structures, their distribution and colors by means of descriptive and/or metaphoric terminology. Optionally, a diagnostic algorithm can also be used. Especially in benign lesions, the dermatoscopic diagnosis should be uniform for the complete area. Comparison with other nearby skin tumors of the same patient (comparative approach) is helpful in the evaluation of numerous melanocytic skin tumors. If it is unclear whether the lesion is malignant, a biopsy or complete excision should be performed with subsequent histopathological examination.

Preoperative prediction of histopathological outcome in basal cell carcinoma: flat surface and multiple small erosions predict superficial basal cell carcinoma in lighter skin types.

BACKGROUND: Prediction of the histopathological subtype of basal cell carcinoma (BCC) is important for tailoring optimal treatment, especially in patients with suspected superficial BCC (sBCC). OBJECTIVES: To assess the accuracy of the preoperative prediction of subtypes of BCC in clinical practice, to evaluate whether dermoscopic examination enhances accuracy and to find dermoscopic criteria for discriminating sBCC from other subtypes. MATERIALS AND METHODS: The main presurgical diagnosis was compared with the histopathological, postoperative diagnosis of routinely excised skin tumours in a predominantly fair-skinned patient cohort of northern Europe during a study period of 3 years (2011-13). The study period was split in two: during period 1, dermoscopy was optional (850 cases with a pre- or postoperative diagnosis of BCC), while during period 2 (after an educational dermoscopic update) dermoscopy was mandatory (651 cases). A classification tree based on clinical and dermoscopic features for prediction of sBCC was applied. RESULTS: For a total of 3544 excised skin tumours, the sensitivity for the diagnosis of BCC (any subtype) was 93·3%, specificity 91·8%, and the positive predictive value (PPV) 89·0%. The diagnostic accuracy as well as the PPV and the positive likelihood ratio for sBCC were significantly higher when dermoscopy was mandatory. A flat surface and multiple small erosions predicted sBCC. CONCLUSIONS: The study shows a high accuracy for an overall diagnosis of BCC and increased accuracy in prediction of sBCC for the period when dermoscopy was applied in all cases. The most discriminating findings for sBCC, based on clinical and dermoscopic features in this fair-skinned population, were a flat surface and multiple small erosions.

Standardization of terminology in dermoscopy/dermatoscopy: Results of the third consensus conference of the International Society of Dermoscopy.

BACKGROUND: Evolving dermoscopic terminology motivated us to initiate a new consensus. OBJECTIVE: We sought to establish a dictionary of standardized terms. METHODS: We reviewed the medical literature, conducted a survey, and convened a discussion among experts. RESULTS: Two competitive terminologies exist, a more metaphoric terminology that includes numerous terms and a descriptive terminology based on 5 basic terms. In a survey among members of the International Society of Dermoscopy (IDS) 23.5% (n = 201) participants preferentially use descriptive terminology, 20.1% (n = 172) use metaphoric terminology, and 484 (56.5%) use both. More participants who had been initially trained by metaphoric terminology prefer using descriptive terminology than vice versa (9.7% vs 2.6%, P < .001). Most new terms that were published since the last consensus conference in 2003 were unknown to the majority of the participants. There was uniform consensus that both terminologies are suitable, that metaphoric terms need definitions, that synonyms should be avoided, and that the creation of new metaphoric terms should be discouraged. The expert panel proposed a dictionary of standardized terms taking account of metaphoric and descriptive terms. LIMITATIONS: A consensus seeks a workable compromise but does not guarantee its implementation. CONCLUSION: The new consensus provides a revised framework of standardized terms to enhance the consistent use of dermoscopic terminology.

Standardisation of minimal erythematous dose reading and assessment: a new system.

BACKGROUND/PURPOSE: Sunscreen efficacy is usually expressed by the sun protection factor (SPF) which is calculated by establishing the minimum erythematous dose (MED), i.e. the smallest amount of energy required to trigger erythema. Efforts have been made to harmonise SPF testing but in vivo SPF methodology could still be improved to reduce its variability. This article proposes a means of standardising MED evaluations through the development and validation of an MED assessment system based on image analysis. METHODS: The MED assessment system comprises a camera combined with a black tube for acquiring pictures of the skin surface. Specific software was then developed to analyse these pictures to determine the MED based on the shape, size and colour of the exposed zones. The MED assessment system was validated through two studies. The first study was designed to assess the correlation between three expert graders who visually determined the MEDs in five subjects on whom three different suncare products (SPF 6, SPF 30 and SPF 50+) were tested. The second study correlated results obtained from one expert grader with those from a grader assisted by the new MED assessment system. RESULTS: Results of the first study showed substantial variation between graders, with kappa agreement as low as 0.59 (percentage error 19.7%). Results of the study assessing correlation between the expert grader and the grader facilitated by the new MED assessment device showed better correlation, with a kappa value of 0.75 and percentage error of 9.61%. CONCLUSION: A high degree of inter-grader variability was seen when MED was assessed by expert graders. The new MED assessment system provides background colour correction and standardisation to enable accurate MED determination. A high level of correlation was seen between the expert grader and the new MED assessment system, thus demonstrating its potential utility in more accurate and homogenous MED evaluations. Future multicentre studies are required to improve and validate the standardised MED determination for suncare products and to further evaluate the role of this new MED assessment system. However, these preliminary results are encouraging and may set the scene for this new MED assessment system to become the standard of the future.

German guidelines for the diagnosis and therapy of localized scleroderma.

Localized scleroderma designates a heterogeneous group of sclerotic skin disorders. Depending on the subtype, severity, and site affected, adjacent structures such as adipose tissue, muscles, joints, and bones may be involved. This is an update of the existing German AWMF (Association of the Scientific Medical Societies in Germany) guidelines (classification: S2k). These guidelines provide an overview of the definition, epidemiology, classification, pathogenesis, laboratory workup, histopathology, clinical scoring systems, as well as imaging and device-based workup of localized scleroderma. Moreover, consensus-based recommendations are given on the management of localized scleroderma depending on its clinical subtype. Treatment recommendations are presented in a therapeutic algorithm. No financial support was given by any pharmaceutical company. The guidelines are valid until July 2019.

S1 guidelines on the diagnosis and treatment of scabies - short version.

The goals of this German guideline are the improvement of diagnosis and therapy of scabies, the implementation of a coordinated action in outbreaks of scabies, and the control of this infestation in large migration or refugee flows.Sarcoptes scabiei var. hominis is transmitted by direct skin-to-skin contact of sufficient duration. The infectivity of female mites when removed from patients does not exceed 48 hours at room temperature (21°C) and relative humidity of 40-80%. The risk of infection rises proportionally to the number of mites on the skin and is particularly high in crusted scabies. As elderly persons tend to develop crusted scabies due to disease- or medication-related immunosuppression, there is an increased risk for outbreaks of scabies at nursing homes and extended-care facilities. The guideline contains detailed recommendations for management of such outbreaks. In refugees the prevalence of scabies is higher than in the general population in Germany, but the risk for outbreaks is not high. Scabies infestation should be considered when a recent onset of itching is associated with eczema and presence of burrows or comma-like papules at predilection sites. It is confirmed by dermatoscopic detection of mites or by microscopic identification of mites, mite eggs or fecal matter (scybala) from skin scrapings.The treatment of choice for common scabies is topical permethrin 5% cream applied for 8-12 hours. Permethrin can be considered for off-label use also in infants of less than 3 months of age and pregnant women. For this group crotamiton is another option, which, besides benzyl benzoate, presents a good second line therapy for the other indications. Indications for oral ivermectin, which has just been licensed in Germany, include patients with immunosuppression, severe dermatitis, and low adherence.Crusted scabies is preferentially treated by a combination of topical permethrin and oral ivermectin. Affected patients should be isolated, and all contact persons should be treated. The guideline contains lists for additional measures, including possible treatment of contact persons, clothes, linen and other possibly infested articles.

Dermoscopy structures as predictors of sentinel lymph node positivity in cutaneous melanoma.

BACKGROUND: Histological features such as Breslow thickness, ulceration and mitosis are the main criteria to guide sentinel lymph node biopsy (SLNB) in melanoma. Dermoscopy may add complementary information to these criteria. OBJECTIVES: To evaluate the correlation between dermoscopy structures and SLNB positivity. METHODS: Retrospective analysis of 123 consecutive melanomas with Breslow thickness > 0·75 mm, SLNB performed during follow-up and dermoscopic images. RESULTS: Men were more likely to have a positive SLNB. The presence of ulceration and blotch and the absence of a pigmented network in dermoscopy correlated with positive SLNB. Histological ulceration also correlated with positive SLNB. A dermoscopy SCORE predicted SLN status with a sensitivity of 96·3% and a specificity of 30·2%. When sex and Breslow thickness were added (SCOREBRESEX), the sensitivity remained at 96·3% but the specificity increased to 52·1%. This study is limited by the number of patients and was performed in only one institution. CONCLUSIONS: Dermoscopy allowed a more precise prediction of SLN status. If a combined SCOREBRESEX was used to select patients for SLNB, 41·5% of procedures might be avoided.

The sensitivity and specificity of optical coherence tomography for the assisted diagnosis of nonpigmented basal cell carcinoma: an observational study.

BACKGROUND: The diagnostic criteria for basal cell carcinoma (BCC) using optical coherence tomography (OCT) have been described previously, but the clinical value of these findings remains unknown. OBJECTIVES: To investigate the diagnostic value of OCT for BCC in a typical clinical setting. The primary efficacy end point was a diagnosis of BCC for each lesion. Secondary end points were the diagnosis of other possible conditions. METHODS: This was an observational, prospective, multicentre study in which consecutive patients with nonpigmented pink lesions suspicious for BCC underwent clinical assessment, dermoscopy and OCT, with the diagnosis recorded at each stage. Once all diagnoses had been recorded, the histological results were disclosed. In total 164 patients with 256 lesions were recruited. Histology was missing for 21 lesions, leaving 235 lesions in 155 patients for analysis. RESULTS: Sixty per cent of lesions (141 of 235) were identified as BCC by histology. A slight increase of sensitivity was noted following OCT, which did not reach statistical significance. The specificity increased significantly from 28·6% by clinical assessment to 54·3% using dermoscopy and to 75·3% with the addition of OCT (P < 0·001). The positive predictive value for the diagnosis of BCC using OCT was 85·2% [95% confidence interval (CI) 78·6-90·4], and the negative predictive value was 92·1% (95% CI 83·6-97·0). The accuracy of diagnosis for all lesions increased from 65·8% with clinical evaluation to 76·2% following additional dermoscopy and to 87·4% with the addition of OCT. CONCLUSIONS: OCT significantly improved the diagnostic specificity for BCC compared with clinical assessment and dermoscopy alone.

A short dermoscopy training increases diagnostic performance in both inexperienced and experienced dermatologists.

Dermoscopy is a clinical tool known to improve the early detection of melanoma and other malignancies of the skin, but only for experienced users. Our aim was to evaluate the effect of short (3-hour) dermoscopy training sessions in both residents and practicing dermatologists. The training improved diagnostic accuracy for both melanocytic and nonmelanocytic neoplasms of the skin and the observed effect was the highest for residents but was also significant for more experienced practicing dermatologists.

Screening, early detection, education, and trends for melanoma: current status (2007-2013) and future directions: Part I. Epidemiology, high-risk groups, clinical strategies, and diagnostic technology.

While most cancers have shown both decreased incidence and mortality over the past several decades, the incidence of melanoma has continued to grow, and mortality has only recently stabilized in the United States and in many other countries. Certain populations, such as men >60 years of age and lower socioeconomic status groups, face a greater burden from disease. For any given stage and across all ages, men have shown worse melanoma survival than women, and low socioeconomic status groups have increased levels of mortality. Novel risk factors can help identify populations at greatest risk for melanoma and can aid in targeted early detection. Risk assessment tools have been created to identify high-risk patients based on various factors, and these tools can reduce the number of patients needed to screen for melanoma detection. Diagnostic techniques, such as dermatoscopy and total body photography, and new technologies, such as multispectral imaging, may increase the accuracy and reliability of early melanoma detection.

Screening, early detection, education, and trends for melanoma: current status (2007-2013) and future directions: Part II. Screening, education, and future directions.

New evidence has accumulated over the past several years that supports improved melanoma outcomes associated with both clinician and patient screening. Population-based and workplace studies conducted in Australia and the Unites States, respectively, have shown decreases in the incidence of thick melanoma and overall melanoma mortality, and a year-long statewide screening program in Germany has shown a nearly 50% reduction in mortality 5 years after the screening ended. Current melanoma screening guidelines in the United States are inconsistent among various organizations, and therefore rates of both physician and patient skin examinations are low. As policymaking organizations update national screening recommendations in the United States, the latest research reviewed in part II of this continuing medical education article should be considered to establish the most effective recommendations. Patient and provider education will be necessary to ensure that appropriate patients receive recommended screening.

JPEG vs. JPEG2000: benchmarking with dermatological images.

BACKGROUND: Despite the importance of images in the discipline and the diffusion of digital imaging devices, the issue of image compression in dermatology was discussed only in few studies, which yielded results often not comparable, and left some unanswered questions. OBJECTIVE: To evaluate and compare the performance of the JPEG and JPEG2000 algorithms for compression of dermatological images. METHODS: Nineteen macroscopic and fifteen videomicroscopic images of skin lesions were compressed with JPEG and JPEG2000 at 18 different compression rates, from 90% to 99.5%. Compressed images were shown, next to uncompressed versions, to three dermatologists with different experience, who judged quality and suitability for educational/scientific and diagnostic purposes. Moreover, alterations and quality were evaluated by calculation of mean 'distance' of pixel colors between compressed and original images and by peak signal-to-noise ratio, respectively. RESULTS: JPEG2000 was qualitatively better than JPEG at all compression rates, particularly highest ones, as shown by dermatologists' ratings and objective parameters. Agreement between raters was high, but with some differences in specific cases, showing that different professional experience can influence judgement on images. CONCLUSION: In consideration of its high qualitative performance and wide diffusion, JPEG2000 represents an optimal solution for the compression of digital dermatological images.