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Harald Kittler - One of the best experts on this subject based on the ideXlab platform.
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Dermatoscopy of Neoplastic Skin Lesions: Recent Advances, Updates, and Revisions
Current Treatment Options in Oncology, 2018Co-Authors: Philipp Weber, Christoph Sinz, Philipp Tschandl, Harald KittlerAbstract:Dermatoscopy (dermoscopy) improves the diagnosis of benign and malignant cutaneous neoplasms in comparison with examination with the unaided eye and should be used routinely for all pigmented and non-pigmented cutaneous neoplasms. It is especially useful for the early stage of melanoma when melanoma-specific criteria are invisible to the unaided eye. Preselection by the unaided eye is therefore not recommended. The increased availability of polarized dermatoscopes, and the extended use of Dermatoscopy in non-pigmented lesions led to the discovery of new criteria, and we recommend that lesions should be examined with polarized and non-polarized Dermatoscopy. The “chaos and clues algorithm” is a good starting point for beginners because it is easy to use, accurate, and it works for all types of pigmented lesions not only for those melanocytic. Physicians, who use Dermatoscopy routinely, should be aware of new clues for acral melanomas, nail matrix melanomas, melanoma in situ, and nodular melanoma. Dermatoscopy should also be used to distinguish between different subtypes of basal cell carcinoma and to discriminate highly from poorly differentiated squamous cell carcinomas to optimize therapy and management of non-melanoma skin cancer. One of the most exciting areas of research is the use of dermatoscopic images for machine learning and automated diagnosis. Convolutional neural networks trained with dermatoscopic images are able to diagnose pigmented lesions with the same accuracy as human experts. We humans should not be afraid of this new and exciting development because it will most likely lead to a peaceful and fruitful coexistence of human experts and decision support systems.
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long term evaluation of the efficacy of digital Dermatoscopy monitoring at a tertiary referral center
Journal Der Deutschen Dermatologischen Gesellschaft, 2017Co-Authors: Christoph Rinner, Christoph Sinz, Philipp Tschandl, Harald KittlerAbstract:SummaryBackground 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.
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teaching Dermatoscopy of pigmented skin tumours to novices comparison of analytic vs heuristic approach
Journal of The European Academy of Dermatology and Venereology, 2015Co-Authors: Philipp Tschandl, Harald Kittler, Iris Zalaudek, Karin Schmid, G ArgenzianoAbstract:Background There are two strategies to approach the dermatoscopic diagnosis of pigmented skin tumours, namely the verbal-based analytic and the more visual-global heuristic method. It is not known if one or the other is more efficient in teaching Dermatoscopy. Objective To compare two teaching methods in short-term training of Dermatoscopy to medical students. Methods Fifty-seven medical students in the last year of the curriculum were given a 1-h lecture of either the heuristic- or the analytic-based teaching of Dermatoscopy. Before and after this session, they were shown the same 50 lesions and asked to diagnose them and rate for chance of malignancy. Test lesions consisted of melanomas, basal cell carcinomas, nevi, seborrhoeic keratoses, benign vascular tumours and dermatofibromas. Performance measures were diagnostic accuracy regarding malignancy as measured by the area under the curves of receiver operating curves (range: 0–1), as well as per cent correct diagnoses (range: 0–100%). Results Diagnostic accuracy as well as per cent correct diagnoses increased by +0.21 and +32.9% (heuristic teaching) and +0.19 and +35.7% (analytic teaching) respectively (P for all <0.001). Neither for diagnostic accuracy (P = 0.585), nor for per cent correct diagnoses (P = 0.298) was a difference between the two groups. Conclusions Short-term training of Dermatoscopy to medical students allows significant improvement in diagnostic abilities. Choosing a heuristic or analytic method does not have an influence on this effect in short training using common pigmented skin lesions.
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Teaching Dermatoscopy of pigmented skin tumours to novices: comparison of analytic vs. heuristic approach
Journal of The European Academy of Dermatology and Venereology, 2014Co-Authors: Philipp Tschandl, Harald Kittler, Iris Zalaudek, Karin Schmid, G ArgenzianoAbstract:Background There are two strategies to approach the dermatoscopic diagnosis of pigmented skin tumours, namely the verbal-based analytic and the more visual-global heuristic method. It is not known if one or the other is more efficient in teaching Dermatoscopy. Objective To compare two teaching methods in short-term training of Dermatoscopy to medical students. Methods Fifty-seven medical students in the last year of the curriculum were given a 1-h lecture of either the heuristic- or the analytic-based teaching of Dermatoscopy. Before and after this session, they were shown the same 50 lesions and asked to diagnose them and rate for chance of malignancy. Test lesions consisted of melanomas, basal cell carcinomas, nevi, seborrhoeic keratoses, benign vascular tumours and dermatofibromas. Performance measures were diagnostic accuracy regarding malignancy as measured by the area under the curves of receiver operating curves (range: 0–1), as well as per cent correct diagnoses (range: 0–100%). Results Diagnostic accuracy as well as per cent correct diagnoses increased by +0.21 and +32.9% (heuristic teaching) and +0.19 and +35.7% (analytic teaching) respectively (P for all
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Dermatoscopy of amelanotic and hypomelanotic melanoma
Journal Der Deutschen Dermatologischen Gesellschaft, 2014Co-Authors: Jelena Stojkovicfilipovic, Harald KittlerAbstract:Summary Amelanotic melanoma is a subtype of cutaneous melanoma without pigment. The clinical diagnosis is challenging because it may mimic benign or malignant melanocytic and non-melanocytic neoplasms and inflammatory skin diseases. In synchrony with the improvement of the diagnosis of pigmented lesions, Dermatoscopy may assist the clinician in the diagnosis of non-pigmented skin neoplasms in general and of amelanotic melanoma in particular. We have searched the literature to extract the most relevant dermatoscopic clues to diagnose amelanotic and hypomelanotic melanomas by Dermatoscopy. In addition we present eight consecutive cases and discuss their clinical and dermatoscopic characteristics in the light of published data.
Antonella Tosti - One of the best experts on this subject based on the ideXlab platform.
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Hair and Scalp Dermatoscopy (Trichoscopy)
Alopecia, 2019Co-Authors: Rodrigo Pirmez, Antonella TostiAbstract:Abstract Dermatoscopy has been widely used in dermatology for the evaluation of pigmented skin lesions. More recently, Dermatoscopy has been used in the evaluation of hair and scalp disorders, allowing visualization of morphologic structures not readily visible to the naked eye, including changes to hair shaft thickness and shape, as well as perifollicular and interfollicular features. When used for such purposes, hair and scalp Dermatoscopy is also known as trichoscopy. In this chapter, we discuss the technique itself, the various uses of trichoscopy, and the main trichoscopic structures.
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ex vivo Dermatoscopy of scalp specimens and slides
Journal of The European Academy of Dermatology and Venereology, 2014Co-Authors: Mariya Miteva, Emma Lanuti, Antonella TostiAbstract:Background Correct evaluation of horizontal scalp biopsies requires accurate gross sectioning and embedding of the tissue. The most common issue during processing includes incorrect specimen bisection. Objectives To verify if (i) ex vivo assessment of scalp biopsies by contact Dermatoscopy can identify the correct plane of transverse bisection as well as (ii) if using contact Dermatoscopy on the glass slides can be useful to control the tissue processing and expedite sign-out. Materials and methods For the first aim, dermatoscopic pictures of 43 scalp biopsies were printed and shown to 10 dermatology residents not involved in the study, who were asked to identify and highlight the dermo-epidermal junction. For the second aim, dermatoscopic captions of 40 horizontal sections were evaluated in a blinded way for the size of the specimen as well as the level and plane of bisection. The agreement was investigated using Cohen's κ statistics. Results Ten independent observers were able to correctly identify the dermo-epidermal junction as a brownish wavy line in 95.3% cases. The Cohen's κ statistics showed almost perfect agreement. Two independent pathologists agreed on the specimen size in all cases, on the specimen plane in 39 cases and on the specimen level on 35 cases. The Cohen's κ statistics showed almost complete agreement for the size and plane of bisection and substantial agreement for the level of section. Conclusion Ex vivo Dermatoscopy of scalp biopsies may be a new way to decrease laboratory costs and improve turnaround time in hair pathology as this technique optimally guides the correct bisection at 1–1.5 mm below the junction. Ex vivo Dermatoscopy on the slides may expedite sign out after the initial bisection.
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Dermatoscopy of hair shaft disorders
Journal of The American Academy of Dermatology, 2013Co-Authors: Mariya Miteva, Antonella TostiAbstract:Until a few years ago the diagnosis of hair shaft disorders was based on light microscopy or scanning electron microscopy on plucked or cut samples of hair. Dermatoscopy is a new fast, noninvasive, and cost-efficient technique for easy in-office diagnosis of all hair shaft abnormalities including conditions such as pili trianguli and canaliculi that are not recognizable by examining hair shafts under the light microscope. It can also be used to identify disease limited to the eyebrows or eyelashes. Dermatoscopy allows for fast examination of the entire scalp and is very helpful to identify the affected hair shafts when the disease is focal.
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Dermatoscopy of hair shaft disorders
Journal of the American Academy of Dermatology, 2013Co-Authors: Mariya Miteva, Antonella TostiAbstract:Until a few years ago the diagnosis of hair shaft disorders was based on light microscopy or scanning electron microscopy on plucked or cut samples of hair. Dermatoscopy is a new fast, noninvasive, and cost-efficient technique for easy in-office diagnosis of all hair shaft abnormalities including conditions such as pili trianguli and canaliculi that are not recognizable by examining hair shafts under the light microscope. It can also be used to identify disease limited to the eyebrows or eyelashes. Dermatoscopy allows for fast examination of the entire scalp and is very helpful to identify the affected hair shafts when the disease is focal. © 2011 by the American Academy of Dermatology, Inc.
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hair and scalp Dermatoscopy
Journal of The American Academy of Dermatology, 2012Co-Authors: Mariya Miteva, Antonella TostiAbstract:Dermatoscopy is a noninvasive diagnostic tool that allows the recognition of morphologic structures not visible by the naked eye. Trichoscopy (scalp Dermatoscopy and videoDermatoscopy) is useful for the diagnosis and follow-up of hair and scalp disorders. However, it is not widely used in the management of hair disorders. This review provides updated information from the literature and our experience on the dermoscopic features of the most common hair and scalp disorders. This will enable dermatologists to make fast diagnoses of tinea capitis and alopecia areata, distinguish early androgenetic alopecia from telogen effluvium, and differentiate scarring from nonscarring alopecia.
Iris Zalaudek - One of the best experts on this subject based on the ideXlab platform.
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Two Controversies Confronting Dermoscopy or Dermatoscopy: Nomenclature and Results
Clinics in Dermatology, 2019Co-Authors: Claudio Conforti, Roberta Giuffrida, Chiara Retrosi, Iris ZalaudekAbstract:Abstract Dermatoscopy is a noninvasive diagnostic technique that was used mostly for diagnosing pigmented lesions, [1] , [2] but more recently, it has been employed in the diagnosis of infectious and inflammatory skin lesions, also known as entomodermoscopy and inflammoscopy, 3 as well as for hair 4 and scalp disorders, called trichoscopy. 5 The initial name of epiluminescence microscopy has evolved into Dermatoscopy and dermoscopy but not without controversy.
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the use of Dermatoscopy in diagnosis and therapy of nonmelanocytic skin cancer
Journal Der Deutschen Dermatologischen Gesellschaft, 2016Co-Authors: Teresa Deinlein, Georg Richtig, Christoph Schwab, Federica Scarfi, Edith Arzberger, Ingrid H Wolf, Rainer Hofmannwellenhof, Iris ZalaudekAbstract:Summary Today, Dermatoscopy is an integral part of every clinical skin examination, as it markedly enhances the early detection of melanocytic and nonmelanocytic skin cancer (NMSC) compared to naked-eye inspection. Besides its diagnostic use, this noninvasive method is increasingly important in the selection of as well as the response assessment to various therapies used for NMSC, including basal cell carcinoma, actinic keratoses, squamous cell carcinoma, and also rare tumors such as Merkel cell carcinoma, angiosarcoma, or dermatofibrosarcoma protuberans. Thus, Dermatoscopy is a valid tool for the preoperative assessment of tumor margins in basal cell carcinoma, but also for follow-up of actinic keratoses after topical treatment. The present article presents an overview on the use of Dermatoscopy in the diagnosis and therapy of various types of NMSC.
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teaching Dermatoscopy of pigmented skin tumours to novices comparison of analytic vs heuristic approach
Journal of The European Academy of Dermatology and Venereology, 2015Co-Authors: Philipp Tschandl, Harald Kittler, Iris Zalaudek, Karin Schmid, G ArgenzianoAbstract:Background There are two strategies to approach the dermatoscopic diagnosis of pigmented skin tumours, namely the verbal-based analytic and the more visual-global heuristic method. It is not known if one or the other is more efficient in teaching Dermatoscopy. Objective To compare two teaching methods in short-term training of Dermatoscopy to medical students. Methods Fifty-seven medical students in the last year of the curriculum were given a 1-h lecture of either the heuristic- or the analytic-based teaching of Dermatoscopy. Before and after this session, they were shown the same 50 lesions and asked to diagnose them and rate for chance of malignancy. Test lesions consisted of melanomas, basal cell carcinomas, nevi, seborrhoeic keratoses, benign vascular tumours and dermatofibromas. Performance measures were diagnostic accuracy regarding malignancy as measured by the area under the curves of receiver operating curves (range: 0–1), as well as per cent correct diagnoses (range: 0–100%). Results Diagnostic accuracy as well as per cent correct diagnoses increased by +0.21 and +32.9% (heuristic teaching) and +0.19 and +35.7% (analytic teaching) respectively (P for all <0.001). Neither for diagnostic accuracy (P = 0.585), nor for per cent correct diagnoses (P = 0.298) was a difference between the two groups. Conclusions Short-term training of Dermatoscopy to medical students allows significant improvement in diagnostic abilities. Choosing a heuristic or analytic method does not have an influence on this effect in short training using common pigmented skin lesions.
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Teaching Dermatoscopy of pigmented skin tumours to novices: comparison of analytic vs. heuristic approach
Journal of The European Academy of Dermatology and Venereology, 2014Co-Authors: Philipp Tschandl, Harald Kittler, Iris Zalaudek, Karin Schmid, G ArgenzianoAbstract:Background There are two strategies to approach the dermatoscopic diagnosis of pigmented skin tumours, namely the verbal-based analytic and the more visual-global heuristic method. It is not known if one or the other is more efficient in teaching Dermatoscopy. Objective To compare two teaching methods in short-term training of Dermatoscopy to medical students. Methods Fifty-seven medical students in the last year of the curriculum were given a 1-h lecture of either the heuristic- or the analytic-based teaching of Dermatoscopy. Before and after this session, they were shown the same 50 lesions and asked to diagnose them and rate for chance of malignancy. Test lesions consisted of melanomas, basal cell carcinomas, nevi, seborrhoeic keratoses, benign vascular tumours and dermatofibromas. Performance measures were diagnostic accuracy regarding malignancy as measured by the area under the curves of receiver operating curves (range: 0–1), as well as per cent correct diagnoses (range: 0–100%). Results Diagnostic accuracy as well as per cent correct diagnoses increased by +0.21 and +32.9% (heuristic teaching) and +0.19 and +35.7% (analytic teaching) respectively (P for all
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classifying distinct basal cell carcinoma subtype by means of Dermatoscopy and reflectance confocal microscopy
Journal of The American Academy of Dermatology, 2014Co-Authors: Caterina Longo, Iris Zalaudek, Aimilios Lallas, Elvira Moscarella, Athanassios Kyrgidis, Harold S Rabinovitz, Silvana Ciardo, Margaret Oliviero, A Losi, Salvador GonzalezAbstract:Background The current guidelines for the management of basal cell carcinoma (BCC) suggest a different therapeutic approach according to histopathologic subtype. Although dermatoscopic and confocal criteria of BCC have been investigated, no specific studies were performed to evaluate the distinct reflectance confocal microscopy (RCM) aspects of BCC subtypes. Objectives To define the specific dermatoscopic and confocal criteria for delineating different BCC subtypes. Methods Dermatoscopic and confocal images of histopathologically confirmed BCCs were retrospectively evaluated for the presence of predefined criteria. Frequencies of dermatoscopic and confocal parameters are provided. Univariate and adjusted odds ratios were calculated. Discriminant analyses were performed to define the independent confocal criteria for distinct BCC subtypes. Results Eighty-eight BCCs were included. Dermatoscopically, superficial BCCs (n = 44) were primarily typified by the presence of fine telangiectasia, multiple erosions, leaf-like structures, and revealed cords connected to the epidermis and epidermal streaming upon RCM. Nodular BCCs (n = 22) featured the classic dermatoscopic features and well outlined large basaloid islands upon RCM. Infiltrative BCCs (n = 22) featured structureless, shiny red areas, fine telangiectasia, and arborizing vessels on Dermatoscopy and dark silhouettes upon RCM. Limitations The retrospective design. Conclusion Dermatoscopy and confocal microscopy can reliably classify different BCC subtypes.
Andreas Blum - One of the best experts on this subject based on the ideXlab platform.
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accuracy of Dermatoscopy for the diagnosis of nonpigmented cancers of the skin
Journal of The American Academy of Dermatology, 2017Co-Authors: Christoph Sinz, Andreas Blum, Cliff Rosendahl, Philipp Tschandl, Bengu Nisa Akay, Giuseppe Argenziano, Ralph P Braun, Horacio Cabo, Jeanyves GourhantAbstract:Background Nonpigmented skin cancer is common, and diagnosis with the unaided eye is error prone. Objective To investigate whether Dermatoscopy improves the diagnostic accuracy for nonpigmented (amelanotic) cutaneous neoplasms. Methods We collected a sample of 2072 benign and malignant neoplastic lesions and inflammatory conditions and presented close-up images taken with and without Dermatoscopy to 95 examiners with different levels of experience. Results The area under the curve was significantly higher with than without Dermatoscopy (0.68 vs 0.64, P P Limitations The study deviated from a real-life clinical setting and was potentially affected by verification and selection bias. Conclusions Dermatoscopy improves the diagnosis and management of nonpigmented skin cancer and should be used as an adjunct to examination with the unaided eye.
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tape Dermatoscopy constructing a low cost dermatoscope using a mobile phone immersion fluid and transparent adhesive tape
Dermatology practical & conceptual, 2015Co-Authors: Andreas Blum, Jason GiacomelAbstract:Importance: Medical professionals and indeed the general public have an increasing interest in the acquisition of dermatoscopic images of suspect or ambiguous skin lesions. To this end, good dermatoscopic image quality and low costs are important considerations.
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"Tape Dermatoscopy": constructing a low-cost dermatoscope using a mobile phone, immersion fluid and transparent adhesive tape.
Dermatology practical & conceptual, 2015Co-Authors: Andreas Blum, Jason GiacomelAbstract:IMPORTANCE: Medical professionals and indeed the general public have an increasing interest in the acquisition of dermatoscopic images of suspect or ambiguous skin lesions. To this end, good dermatoscopic image quality and low costs are important considerations.\n\nOBSERVATIONS: Images of seven lesions (seborrheic keratosis, melanoma in-situ, blue and dermal nevus, basal cell carcinoma and two squamous cell carcinomas) were taken. A novel technique of "tape Dermatoscopy" involved: Using immersion fluid (i.e., water, olive oil, disinfectant spray) placed on the flat or slightly elevated lesion;Covering the lesion with transparent adhesive tape with lateral tension;Using ambient indoor or outdoor lighting for illumination (rather than flash photography);Positioning a photographic device at an angle of approximately 45° from the side of the lesion to avoid light reflection;Recording a focused image with a mobile phone or digital camera at a distance of approximately 25-30 cm from the lesion; andEnlarging the image on the screen of the device. Essential dermatoscopic features enabling a correct diagnosis were visible in 6 of the 7 lesions. 'Tape Dermatoscopy" images of the lesions were compared to standard Dermatoscopy (using a Fotofinder handyscope® in combination with a mobile phone). The latter confirmed the dermatoscopic features in six of seven lesions.\n\nCONCLUSIONS AND RELEVANCE: "Tape Dermatoscopy" images can be recorded by medical personnel and even the general public without a dermatoscope. However, the limitations of this method are that images may be unfocused, exophytic tumors may be difficult to assess, excess pressure on tumoral blood vessels may lead to compression artefact, dermatoscopic features that are only visible under polarized light are unable to be detected (particularly "crystalline" or "chrysalis" structures) and tumors in certain anatomic locations may be difficult to assess (e.g., edges of nose, ears [demonstrated in one case], nails). Comparative prospective studies are necessary in order to test reproducibility of these preliminary findings, to establish special indications for the technique, and to develop guidelines for its effective use.
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Dermatoscopy of an invasive melanoma on the upper lip shows possible association with laugier hunziker syndrome
Journal of The American Academy of Dermatology, 2008Co-Authors: Olga Simionescu, Doina Dumitrescu, Mariana Costache, Andreas BlumAbstract:We report mucosal melanoma of the upper lip in a patient affected by the Laugier–Hunziker disease. Using Dermatoscopy, two distinct parts were identified in the same mucosal area: nodular (malignant) and macular (benign). A complete surgical excision was performed and the patient has been free of disease for 16 months.
Cliff Rosendahl - One of the best experts on this subject based on the ideXlab platform.
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accuracy of Dermatoscopy for the diagnosis of nonpigmented cancers of the skin
Journal of The American Academy of Dermatology, 2017Co-Authors: Christoph Sinz, Andreas Blum, Cliff Rosendahl, Philipp Tschandl, Bengu Nisa Akay, Giuseppe Argenziano, Ralph P Braun, Horacio Cabo, Jeanyves GourhantAbstract:Background Nonpigmented skin cancer is common, and diagnosis with the unaided eye is error prone. Objective To investigate whether Dermatoscopy improves the diagnostic accuracy for nonpigmented (amelanotic) cutaneous neoplasms. Methods We collected a sample of 2072 benign and malignant neoplastic lesions and inflammatory conditions and presented close-up images taken with and without Dermatoscopy to 95 examiners with different levels of experience. Results The area under the curve was significantly higher with than without Dermatoscopy (0.68 vs 0.64, P P Limitations The study deviated from a real-life clinical setting and was potentially affected by verification and selection bias. Conclusions Dermatoscopy improves the diagnosis and management of nonpigmented skin cancer and should be used as an adjunct to examination with the unaided eye.
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trichilemmoma in continuity with pigmented basal cell carcinoma with Dermatoscopy and dermatopathology
Dermatology practical & conceptual, 2015Co-Authors: Moayad Al Kaptan, Joseph Kattampallil, Cliff RosendahlAbstract:A case of trichilemmoma in continuity with a pigmented basal cell carcinoma is presented with Dermatoscopy and dermatopathology. The distinction between the two lesions was evident dermatoscopically and was confirmed dermatopathologically. While trichilemmoma has been reported in association with basal cell carcinoma and Dermatoscopy images of four previous cases of trichilemmoma have been published, no previous Dermatoscopy image has been published of trichilemmoma associated with basal cell carcinoma.
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the impact of subspecialization and Dermatoscopy use on accuracy of melanoma diagnosis among primary care doctors in australia
Journal of The American Academy of Dermatology, 2012Co-Authors: Cliff Rosendahl, Ian Mccoll, Gail M Williams, Diann Eley, Tobias Wilson, Greg Canning, Jeffrey Keir, David WilkinsonAbstract:Background Dermatoscopy improves accuracy of melanoma diagnosis, but the impact of subspecialization in skin cancer practice among general practitioners on melanoma diagnostic accuracy is not known. Objective To assess the impact of Dermatoscopy use and subspecialization on the accuracy of melanoma diagnosis by general practitioners. Methods We did a prospective study on the Skin Cancer Audit Research Database and measured melanoma ‘number needed to treat' (NNT), with 21,900 lesions excised to diagnose 2367 melanomas. Results Melanoma NNT fell from a high of 17.0 (95% confidence interval [CI] 14.5-20.7) among general practitioners with a generalist practice to 9.4 (CI 8.9-10.1) among those with a specific interest in skin cancer, and 8.5 (CI 8.1-9.0) among those practicing only skin cancer medicine ( P P P P = .41) when adjusted for practice type and other variables. Limitations There is selection bias with respect to participating doctors and completeness and accuracy of data are not independently verified in the Skin Cancer Audit Research Database (SCARD). Conclusions General practitioners who subspecialize in skin cancer have a higher use of Dermatoscopy and diagnose melanoma with greater accuracy than their generalist counterparts.
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Dermatoscopy in routine practice chaos and clues
Australian Family Physician, 2012Co-Authors: Cliff Rosendahl, Alan Cameron, Ian Mccoll, David WilkinsonAbstract:Background: Skin cancer is a major cause of mortality and morbidity in Australia, and primary care doctors can, and should, treat most cases. Objective: In this article we outline one method for the effective use of Dermatoscopy in diagnosing melanoma and other skin malignancies in general practice. Discussion: The use of a dermatoscope in clinical practice has been shown to increase diagnostic accuracy and is considered the standard of care in assessing patients with pigmented skin lesions. Its use is also being increasingly applied to the diagnosis of nonpigmented skin lesions. Like any clinical tool, training is required for effective use. 'Chaos and clues' is a straightforward method of rapidly assessing suspicious pigmented skin lesions using a dermatoscope; its use can lead to improved diagnosis of melanoma and other skin malignancies.
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diagnostic accuracy of Dermatoscopy for melanocytic and nonmelanocytic pigmented lesions
Journal of The American Academy of Dermatology, 2011Co-Authors: Cliff Rosendahl, Alan Cameron, Philipp Tschandl, Harald KittlerAbstract:Background It is unknown whether Dermatoscopy improves the diagnostic accuracy for all types of pigmented skin lesions or only for those that are melanocytic. Objective We sought to assess if the addition of Dermatoscopy to clinical examination with the unaided eye improves diagnostic accuracy for all types of pigmented lesions. Methods We analyzed 463 consecutively excised pigmented skin lesions collected during a period of 30 months in a primary care skin cancer practice in Queensland, Australia. Results Of 463 lesions, 217 (46.9%) were nonmelanocytic. Overall 30% (n = 138) were malignant including 29 melanomas, 72 basal cell carcinomas, and 37 squamous cell carcinomas. The diagnostic accuracy for malignant neoplasms measured as area under receiver operating characteristic curves was 0.89 with Dermatoscopy and 0.83 without it ( P Limitations Estimates of diagnostic accuracy are influenced by verification bias. Conclusions Dermatoscopy improves the diagnostic accuracy for nonmelanocytic lesions. A simple algorithm based on pattern analysis is suitable for the detection of melanoma and nonmelanoma skin cancer.