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Giuseppe Argenziano - One of the best experts on this subject based on the ideXlab platform.
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dermoscopy for the diagnosis of porokeratosis
Journal of The European Academy of Dermatology and Venereology, 2004Co-Authors: Mario Delfino, Giuseppe Argenziano, Massimiliano NinoAbstract:Dermoscopy is a non-invasive diagnostic technique, which is performed by means of different incident light magnification systems using an oil immersion technique. It allows to observe pigmented and vascular structures, from the stratum corneum to the papillary dermis. Dermoscopy is therefore particularly useful in those skin disorders in which the stratum corneum, epidermis and papillary dermis are involved. It is mostly used for the diagnosis of pigmented skin tumours, but its usefulness has also been reported for the in vivo detection of Sarcoptes scabiei. Additionally, this technique may be used for the diagnosis of verrucae vulgaris, psoriasis and other diseases with epidermal involvement. Porokeratoses are a group of disorders of keratinization characterized by annular lesions surrounded by a characteristic keratotic border which corresponds to a typical histopathologic feature, namely, the cornoid lamella. The cornoid lamella is a column of parakeratotic cells placed on a depression of the epidermis where the granular layer is absent. Though nonpathognomonic, the cornoid lamella is the most distinctive feature of the various types of porokeratosis. These varieties include the plaque type originally described by Mibelli (few lesions located on the extremities with a cornoid lamella which could be thick up to 10 mm); the superficial disseminated and superficial actinic forms, the punctate variant of palms and soles and the linear type all sharing similar histopathologic features. We report a case of disseminated superficial porokeratosis and describe the morphologic features that can be evidenced by Epiluminescence Microscopy examination.
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amelanotic hypomelanotic melanoma is dermatoscopy useful for diagnosis
Journal Der Deutschen Dermatologischen Gesellschaft, 2003Co-Authors: Iris Zalaudek, Helmut Kerl, H. Peter Soyer, Giuseppe Argenziano, Rainer HofmannwellenhofAbstract:Background: Amelanotic/hypomelanotic melanoma often leads to delayed clinical diagnosis because its clinical appearance can mimic other hypopigmented skin conditions. Dermatoscopy (dermoscopy, Epiluminescence Microscopy) is thought to be a helpful diagnostic tool in pigmented skin lesions, but it can be used also in non-pigmented skin tumors due to the recognition of vascular structures not visible to the naked eye. Objective: 7 amelanotic/hypomelanotic melanomas in 6 patients were analyzed in order to define their dermatoscopic findings using standard pattern analysis. Methods: Clinical and dermoscopic images of each lesion were obtained using Dermaphot (Heine Optotechnik, Herrsching, Germany), with 10-fold magnification of the lesion and the color slides were converted to digital format using a Kodak Photo CD system. Results: All 7 amelanotic/hypomelanotic melanomas revealed peculiar dermatoscopic findings, namely, atypical vessels, dotted vessels, and a central pink to white veil. In addition, in 2 patients a slight brownish homogenous pigmentation at the periphery of the lesion was observed. In one case the correct diagnosis was done by an experienced dermatologist using dermatoscopy, whereas in the remaining 6 cases the clinical diagnoses included squamous cell carcinoma, Bowen disease, pyogenic granuloma and basal cell carcinoma. In 2 of 6 patients amelanotic/hypomelanotic melanoma was associated with a previous history of melanoma. Conclusion: Amelanotic/hypomelanotic melanoma exhibits as a common dermatoscopic denominator atypical vessels, varying in size and shape, usually associated with a central pink to white veil.
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clinical and dermatoscopic criteria for the preoperative evaluation of cutaneous melanoma thickness
Journal of The American Academy of Dermatology, 1999Co-Authors: Giuseppe Argenziano, Vincenzo De Giorgi, Paolo Carli, Gabriella Fabbrocini, M DelfinoAbstract:Abstract Background : Melanoma thickness measured according to the Breslow method is used to determine surgical margin and in patient selection for sentinel node biopsy. Previous studies did not confirm the reliability of melanoma palpability for clinical prediction of tumor thickness. Recently we reported the usefulness of Epiluminescence Microscopy (dermatoscopy) for in vivo detection of the phases of melanoma progression, as well as tumor depth. Objective : Our purpose was to determine whether the combination of clinical and dermatoscopic criteria could increase the accuracy in preoperative evaluation of melanoma thickness with respect to the clinical elevation and dermatoscopic assessments considered separately. Methods : In a blind retrospective study, 122 cutaneous melanomas were studied to evaluate the presence of several clinical and dermatoscopic criteria and their relation with the histologic thickness. An algorithm of combined criteria was constructed and statistically assessed. Results : Combinations of palpability, diameter of more than 15 mm, pigment network, gray-blue areas, and atypical vascular pattern allowed correct prediction of thickness in 89% of melanomas when categorized in two groups of less than 0.76 mm and more than 0.75 mm thickness, compared with 75% using palpability, and 80% using dermatoscopic criteria. Lower values were obtained in the further subdivision of melanomas into groups of 0.76 to 1.5 mm and more than 1.5 mm thickness. Conclusion : The combination of clinical and dermatoscopic criteria is a more precise guide for the preoperative evaluation of melanoma thickness than either is alone. However, further studies are needed to verify its applicability in establishing the surgical approach to cutaneous melanoma. (J Am Acad Dermatol 1999;40:61-8.)
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Epiluminescence Microscopy for the diagnosis of doubtful melanocytic skin lesions comparison of the abcd rule of dermatoscopy and a new 7 point checklist based on pattern analysis
Archives of Dermatology, 1998Co-Authors: Giuseppe Argenziano, Vincenzo De Giorgi, Paolo Carli, Gabriella Fabbrocini, Elena Sammarco, Mario DelfinoAbstract:Objective To compare the reliability of a new 7-point checklist based on simplified Epiluminescence Microscopy (ELM) pattern analysis with the ABCD rule of dermatoscopy and standard pattern analysis for the diagnosis of clinically doubtful melanocytic skin lesions. Design In a blind study, ELM images of 342 histologically proven melanocytic skin lesions were evaluated for the presence of 7 standard criteria that we called the "ELM 7-point checklist." For each lesion, "overall" and "ABCD scored" diagnoses were recorded. From a training set of 57 melanomas and 139 atypical non-melanomas, odds ratios were calculated to create a simple diagnostic model based on identification of major and minor criteria for the "7-point scored" diagnosis. A test set of 60 melanomas and 86 atypical non-melanomas was used for model validation and was then presented to 2 less experienced ELM observers, who recorded the ABCD and 7-point scored diagnoses. Settings University medical centers. Patients A sample of patients with excised melanocytic lesions. Main Outcome Measures Sensitivity, specificity, and accuracy of the models for diagnosing melanoma. Results From the total combined sets, the 7-point checklist gave a sensitivity of 95% and a specificity of 75% compared with 85% sensitivity and 66% specificity using the ABCD rule and 91% sensitivity and 90% specificity using standard pattern analysis (overall ELM diagnosis). Compared with the ABCD rule, the 7-point method allowed less experienced observers to obtain higher diagnostic accuracy values. Conclusions The ELM 7-point checklist provides a simplification of standard pattern analysis because of the low number of features to identify and the scoring diagnostic system. As with the ABCD rule, it can be easily learned and easily applied and has proven to be reliable in diagnosing melanoma.
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Epiluminescence Microscopy a new approach to in vivo detection of sarcoptes scabiei
Archives of Dermatology, 1997Co-Authors: Giuseppe Argenziano, Gabriella Fabbrocini, Mario DelfinoAbstract:Background: The usual methods of scabies diagnosis include microscopic identification of the mites and their eggs and feces in skin scrapings. In many cases, the results of microscopic examination can be negative owing to the low number of parasites present in the cornified layer. Epiluminescence Microscopy (ELM) is an in vivo technique that allows a detailed inspection of the skin, from the surface to the superficial papillary dermis. This is where the scabies mite lives. In this study, we evaluate the applicability and the usefulness of ELM for in vivo diagnosis of scabies. Observations: Sixty-five (93%) of 70 cases of scabies showed small, dark, triangular structures at the sites examined with ELM. A subtle linear segment seen below the base of the triangle was made visible by the presence of small air bubbles. Together, both structures resembled a jet with contrail. On traditional microscopic examination of the scrapings, we verified that the triangular structure corresponded to the pigmented anterior section of the mite in all cases. The linear segment observed on ELM was thought to be the burrow of the mite along with its eggs and fecal pellets. The cases in which the results of a first ELM examination were negative demonstrated positive results on a second ELM examination carried out 20 days later. Conclusion: Epiluminescence Microscopy is a very useful tool for in vivo diagnosis of scabies because it permits Sarcoptes scabiei detection in only a few minutes, with no discomfort to the patient and with a very low number of false-negative results. Arch Dermatol. 1997;133:751-753
Argenziano G. - One of the best experts on this subject based on the ideXlab platform.
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Modified dermoscopic algorithm for the differentiation between melanocytic and nonmelanocytic skin tumors
2006Co-Authors: Blum A, Clemens J, Argenziano G.Abstract:Background: The use of dermoscopy (dermatoscopy, Epiluminescence Microscopy, surface Microscopy) improves the clinical diagnostic accuracy of skin tumors by applying different algorithms or scores. The first step in the dermoscopic evaluation is the differentiation between melanocytic and nonmelanocytic skin tumors. Objective: To evaluate the diagnostic accuracy of the established dermoscopic algorithm (EDA) and the modified dermoscopic algorithm (MDA) for melanocytic versus nonmelanocytic skin tumors. Methods: Two hundred forty-nine patients with melanocytic and nonmelanocytic skin lesions were included. Dermoscopic images of the tumors were taken with 10-fold magnification, followed by surgery and histopathology at the departments of Dermatology at the universities of Tuebingen, in Germany, and Naples, in Italy. Each lesion was classified using the EDA and MDA. In the MDA, accessory nipples and dermatofibromas were considered in particular. Results: With the EDA, 225 of 249 (90.4%) skin tumors were correctly classified in one of the six groups. With the MDA, 237 of 249 (95.2%) were correctly classified. Improvement was achieved in 12 (4.8%) better classified skin tumors. In both algorithms, no melanoma was classified as a nonmalignant melanocytic tumor. All melanomas were classified in the group of melanocytic tumors and one melanoma was classified in the group of basal cell carcinomas. Conclusion: Both dermoscopic algorithms for the differentiation between melanocytic and nonmelanocytic skin tumors were simple and effective when applied step by step. The MDA is an improvement on the EDA with the classification of accessory nipples and dermatofibromas
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Amelanotic/Hypomelanotic Melanoma – Is Dermatoscopy Useful For Diagnosis? : Amelanotisches/Hypopigmentiertes Melanom – Ist die Auflichtmikroskopie hilfreich für die Diagnose?
'Wiley', 2003Co-Authors: Argenziano G., Soyer H. P., Kerl H, Hofmann-wellenhof R.Abstract:Background: Amelanotic/hypomelanotic melanoma often leads to delayed clinical diagnosis because its clinical appearance can mimic other hypopigmented skin conditions. Dermatoscopy (dermoscopy, Epiluminescence Microscopy) is thought to be a helpful diagnostic tool in pigmented skin lesions, but it can be used also in non-pigmented skin tumors due to the recognition of vascular structures not visible to the naked eye. Objective: 7 amelanotic/hypomelanotic melanomas in 6 patients were analyzed in order to define their dermatoscopic findings using standard pattern analysis. Methods: Clinical and dermoscopic images of each lesion were obtained using Dermaphot (Heine Optotechnik, Herrsching, Germany), with 10-fold magnification of the lesion and the color slides were converted to digital format using a Kodak Photo CD system. Results: All 7 amelanotic/hypomelanotic melanomas revealed peculiar dermatoscopic findings, namely, atypical vessels, dotted vessels, and a central pink to white veil. In addition, in 2 patients a slight brownish homogenous pigmentation at the periphery of the lesion was observed. In one case the correct diagnosis was done by an experienced dermatologist using dermatoscopy, whereas in the remaining 6 cases the clinical diagnoses included squamous cell carcinoma, Bowen disease, pyogenic granuloma and basal cell carcinoma. In 2 of 6 patients amelanotic/hypomelanotic melanoma was associated with a previous history of melanoma. Conclusion: Amelanotic/hypomelanotic melanoma exhibits as a common dermatoscopic denominator atypical vessels, varying in size and shape, usually associated with a central pink to white veil
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Melanocytic nevi of palms and soles
'Ovid Technologies (Wolters Kluwer Health)', 2003Co-Authors: Ferrara G., Argenziano G., Soyer H. P.Abstract:The macroscopic sampling of melanocytic skin lesions may represent an underestimated source of diagnostic problems. 1 In this context, the article by Signoretti et al. 5 on melanocytic nevi of palms and soles (MNPS) is of particular interest. Their suggestion of dissecting MNPS along a plane perpendicular to the skin markings is strongly supported by recently refined diagnostic criteria using dermoscopy (dermatoscopy, Epiluminescence Microscopy) for the in vivo evaluation of melanocytic skin lesions
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Dermoscopic and histopathologic diagnosis of equivocal melanocytic skin lesions - An interdisciplinary study on 107 cases
2002Co-Authors: Ferrara G., Brunetti B, Argenziano G., Cerroni L, Chimenti S, Corona R, Sera F, El Shabrawi-caelen L, Ferrari AAbstract:BACKGROUND. Dermoscopy (dermatoscopy, Epiluminescence Microscopy) is increasingly employed for the preoperative detection of cutaneous melanoma; dermoscopic features of pigmented skin lesions have been previously defined using histopathology as the key to the code. In a preliminary study on 10 cases evaluated by nine dermoscopists and nine histopathologists, the authors experienced that when at least two dermoscopists disagree in evaluating a melanocytic lesion, even histopathologic consultations may give equivocal results. METHODS. One hundred seven melanocytic skin lesions, consecutively excised because of equivocal clinical and/or dermoscopic features, were retrospectively examined by eight dermoscopists and eight histopathologists; the diagnostic interobserver agreement was calculated by means of the Schouten k statistics. After histopathologic consultations, all 107 lesions underwent unblinded dermoscopic re-evaluation in order to find which dermoscopic features had given rise to histopathologic diagnostic difficulties. RESULTS. The interobserver ageement was good for both dermoscopy (k = 0.53) and histopathology (k = 0.74). Out of 48 cases evaluated by the dermoscopists in complete accordance, only 8 (16.7%) received at least one conflicting histopathologic diagnosis. Instead, among the remaining 59 cases with at least one disagreeing dermoscopic diagnosis, 21 (35.6%) received at least one disagreeing histopathologic diagnosis. The unblinded dermoscopic re-evaluation showed that five out of seven lesions with clear-cut regression structures were histopathologically controversial. CONCLUSIONS. At least for selected and reasonably difficult lesions, a diagnostic discrepancy among formally trained dermoscopists seems to be predictive for a diagnostic disagreement among histopathologists. Lesions showing clear-cut regression structures are prone to give some histopathologic disagreement
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Pre-operative diagnosis of pigmented skin lesions: in vivo dermoscopy performs better than dermoscopy on photographic images
2002Co-Authors: Carli P, Argenziano G., De Giorgi, Palli D, Giannotti BAbstract:Background Epiluminescence Microscopy (ELM) (dermoscopy, dermatoscopy) is a technique for non-invasive diagnosis of pigmented skin lesions that improves the diagnostic performance of dermatologists. Little is known about the possible influence of associated clinical features on the reliability of dermoscopic diagnosis during in vivo examination. Objective To compare diagnostic performance of in vivo dermoscopy (combined clinical and dermoscopic examination) with that of dermoscopy performed on photographic slides (pure dermoscopy). Design This case series comprised 256 pigmented skin lesions consecutively identified as suspicious or equivocal during examination in a general dermatological clinic. Clinical examination and in vivo dermoscopy were performed before excision by two trained dermatologists. The same observers carried out dermoscopy on photographic slides at a later time, and these three diagnostic classifications were reviewed together with the histological findings for the individual lesions. This was carried out in a university hospital. Results In vivo dermoscopy performed better than dermoscopy on photographic slides for classification of pigmented skin lesions compared with histological diagnosis, and both performed better than general clinical diagnosis. In vivo dermoscopic diagnosis of melanoma showed 98.1% sensitivity, 95.5% specificity and 96.1% diagnostic accuracy while dermoscopic diagnosis of melanoma on photographic slides was less reliable with 81.5% sensitivity, 86.7% specificity and 85.2% diagnostic accuracy. In particular, diagnosis of melanoma based on photographic slides led to nine false negative cases (three in situ, six invasive; thickness ranges 0.2-1.5 mm). Conclusions In vivo dermoscopy, i.e. combined clinical and dermoscopic examination, is more reliable than dermoscopy on photographic slides. In clinical practice, therefore, in vivo dermoscopy cannot be considered independent from associated clinical characteristics of the lesions, which help the trained observer to reach a more precise classification. This may have implications on the reliability of ELM diagnosis made by an observer not fully trained in the clinical diagnosis of pigmented skin lesions or by a remote observer during digital ELM teleconsultation
Paolo Carli - One of the best experts on this subject based on the ideXlab platform.
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Multiple pigmented trichoblastomas and syringocystadenoma papilliferum in naevus sebaceous mimicking a malignant melanoma: a clinical dermoscopic-pathological case study.
The British journal of dermatology, 2003Co-Authors: V. De Giorgi, Daniela Massi, E. Trez, Barbara Alfaioli, Paolo CarliAbstract:We report a case of three distinct adnexal neoplasms associated with a naevus sebaceous of the scalp: a nodular pigmented trichoblastoma, a smaller flat pigmented trichoblastoma and a syringocystadenoma papilliferum, and discuss the clinical and histological features of these neoplasms. The clinical manifestation was suggestive of malignant melanoma, a feature that has never been reported before. For the first time in the literature we describe the case also by means of a noninvasive analysis, i.e. Epiluminescence Microscopy. In our experience, Epiluminescence Microscopy does not appear to be more diagnostically accurate than simple clinical examination when diagnosing lesions of the scalp, contrary to other regions.
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dermatoscopy in the diagnosis of pigmented skin lesions a new semiology for the dermatologist
Journal of The European Academy of Dermatology and Venereology, 2000Co-Authors: Paolo Carli, Marcello Stante, Vincenzo De Giorgi, H. Peter Soyer, Francesca Mannone, B. GiannottiAbstract:Dermatoscopy or Epiluminescence Microscopy (ELM), is a noninvasive method that enables clinicians to evaluate fully - by means of a magnified oil immersion diascopy - numerous morphological features, not visible with the naked eye, which enhance the diagnosis of nearly all pigmented skin lesions. In recent years, a burst of research activity in this topic has been carried out, dealing with different aspects, and new frontiers, of this technique. First, a continuous refinement of dermatoscopic terminology is undertaken, paying particular attention to the diagnostic performance of dermatoscopy at peculiar anatomical sites and to the building of different dermatoscopic algorithms aimed at a simplified diagnosis of melanoma, even for less experienced observers. Another point of interest concerns the possible role of dermatoscopy in the pre-operative assessment of melanoma thickness. Finally, promising data about the role of digital equipment in the follow up of melanocytic skin lesions as well as in the automated diagnosis of pigmented skin lesions have been recently reported. This paper should enable readers to become familiar with the procedure and terminology of ELM in the diagnosis of pigmented skin lesions encouraging a greater understanding of different methods (pattern analysis, algorithms) in the diagnosis of melanoma using ELM.
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preoperative assessment of melanoma thickness by abcd score of dermatoscopy
Journal of The American Academy of Dermatology, 2000Co-Authors: Paolo Carli, Vanni Giannotti, Vincenzo De Giorgi, Domenico Palli, B. GiannottiAbstract:Abstract Background: Epiluminescence Microscopy is a useful tool for the noninvasive diagnosis of malignant melanoma based on criteria that have been correlated with specific histologic characteristics. Previous studies have also shown a good correlation between the frequency of some dermatoscopic criteria based on pattern analysis (pigment network, blue-gray areas, vascular pattern) and tumor thickness. This technique could be useful in the preoperative assessment of tumor thickness as an indication for sentinel node biopsy. Objective: Our purpose was to evaluate the possible role of the total dermatoscopy score (TDS) assigned to a series of lesions in accordance with the ABCD rule of dermatoscopy as a preoperative predictor of melanoma thickness. Methods: For 84 cutaneous melanomas (17 were in situ melanomas; 67 invasive cases with mean thickness 0.93 mm; range, 0.2–3.9 mm; standard deviation, 0.63) consecutively excised at the Department of Dermatology of Florence, TDS was established by two observers blinded as to the tumor thickness. The performance of different cut-off points of TDS in the diagnosis of melanoma with Breslow's thickness more than 0.75 or 1.00 mm was investigated by receiver operating characteristic (ROC) analysis. Accuracy of classification was evaluated in terms of sensitivity, specificity, and area under ROC curves (AUC). Results: The TDS assigned to cutaneous melanomas by the ABCD rule increased with the thickness of the lesions from in situ melanomas to melanomas of intermediate thickness (0.75–1.50 mm). As a preoperative method for the detection of melanomas with a Breslow thickness greater than 0.75 mm, a TDS cut-off point of 6.80 showed 80% sensitivity, 84% specificity, and 82% diagnostic accuracy (AUC value, 0.90). TDS performed better in the diagnosis of a thickness threshold of 0.75 than 1.00 mm (higher AUC value). Conclusion: The TDS calculated by the ABCD rule of dermatoscopy-a simplified approach to dermatoscopic diagnosis of melanoma-provides useful information for the preoperative assessment of melanoma thickness greater than 0.75 mm. (J Am Acad Dermatol 2000;43:459–66.)
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preoperative assessment of melanoma thickness by abcd score of dermatoscopy
Journal of The American Academy of Dermatology, 2000Co-Authors: Paolo Carli, Vanni Giannotti, Vincenzo De Giorgi, Domenico Palli, B. GiannottiAbstract:Abstract Background: Epiluminescence Microscopy is a useful tool for the noninvasive diagnosis of malignant melanoma based on criteria that have been correlated with specific histologic characteristics. Previous studies have also shown a good correlation between the frequency of some dermatoscopic criteria based on pattern analysis (pigment network, blue-gray areas, vascular pattern) and tumor thickness. This technique could be useful in the preoperative assessment of tumor thickness as an indication for sentinel node biopsy. Objective: Our purpose was to evaluate the possible role of the total dermatoscopy score (TDS) assigned to a series of lesions in accordance with the ABCD rule of dermatoscopy as a preoperative predictor of melanoma thickness. Methods: For 84 cutaneous melanomas (17 were in situ melanomas; 67 invasive cases with mean thickness 0.93 mm; range, 0.2–3.9 mm; standard deviation, 0.63) consecutively excised at the Department of Dermatology of Florence, TDS was established by two observers blinded as to the tumor thickness. The performance of different cut-off points of TDS in the diagnosis of melanoma with Breslow's thickness more than 0.75 or 1.00 mm was investigated by receiver operating characteristic (ROC) analysis. Accuracy of classification was evaluated in terms of sensitivity, specificity, and area under ROC curves (AUC). Results: The TDS assigned to cutaneous melanomas by the ABCD rule increased with the thickness of the lesions from in situ melanomas to melanomas of intermediate thickness (0.75–1.50 mm). As a preoperative method for the detection of melanomas with a Breslow thickness greater than 0.75 mm, a TDS cut-off point of 6.80 showed 80% sensitivity, 84% specificity, and 82% diagnostic accuracy (AUC value, 0.90). TDS performed better in the diagnosis of a thickness threshold of 0.75 than 1.00 mm (higher AUC value). Conclusion: The TDS calculated by the ABCD rule of dermatoscopy-a simplified approach to dermatoscopic diagnosis of melanoma-provides useful information for the preoperative assessment of melanoma thickness greater than 0.75 mm. (J Am Acad Dermatol 2000;43:459–66.)
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clinical and dermatoscopic criteria for the preoperative evaluation of cutaneous melanoma thickness
Journal of The American Academy of Dermatology, 1999Co-Authors: Giuseppe Argenziano, Vincenzo De Giorgi, Paolo Carli, Gabriella Fabbrocini, M DelfinoAbstract:Abstract Background : Melanoma thickness measured according to the Breslow method is used to determine surgical margin and in patient selection for sentinel node biopsy. Previous studies did not confirm the reliability of melanoma palpability for clinical prediction of tumor thickness. Recently we reported the usefulness of Epiluminescence Microscopy (dermatoscopy) for in vivo detection of the phases of melanoma progression, as well as tumor depth. Objective : Our purpose was to determine whether the combination of clinical and dermatoscopic criteria could increase the accuracy in preoperative evaluation of melanoma thickness with respect to the clinical elevation and dermatoscopic assessments considered separately. Methods : In a blind retrospective study, 122 cutaneous melanomas were studied to evaluate the presence of several clinical and dermatoscopic criteria and their relation with the histologic thickness. An algorithm of combined criteria was constructed and statistically assessed. Results : Combinations of palpability, diameter of more than 15 mm, pigment network, gray-blue areas, and atypical vascular pattern allowed correct prediction of thickness in 89% of melanomas when categorized in two groups of less than 0.76 mm and more than 0.75 mm thickness, compared with 75% using palpability, and 80% using dermatoscopic criteria. Lower values were obtained in the further subdivision of melanomas into groups of 0.76 to 1.5 mm and more than 1.5 mm thickness. Conclusion : The combination of clinical and dermatoscopic criteria is a more precise guide for the preoperative evaluation of melanoma thickness than either is alone. However, further studies are needed to verify its applicability in establishing the surgical approach to cutaneous melanoma. (J Am Acad Dermatol 1999;40:61-8.)
Mario Delfino - One of the best experts on this subject based on the ideXlab platform.
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dermoscopy for the diagnosis of porokeratosis
Journal of The European Academy of Dermatology and Venereology, 2004Co-Authors: Mario Delfino, Giuseppe Argenziano, Massimiliano NinoAbstract:Dermoscopy is a non-invasive diagnostic technique, which is performed by means of different incident light magnification systems using an oil immersion technique. It allows to observe pigmented and vascular structures, from the stratum corneum to the papillary dermis. Dermoscopy is therefore particularly useful in those skin disorders in which the stratum corneum, epidermis and papillary dermis are involved. It is mostly used for the diagnosis of pigmented skin tumours, but its usefulness has also been reported for the in vivo detection of Sarcoptes scabiei. Additionally, this technique may be used for the diagnosis of verrucae vulgaris, psoriasis and other diseases with epidermal involvement. Porokeratoses are a group of disorders of keratinization characterized by annular lesions surrounded by a characteristic keratotic border which corresponds to a typical histopathologic feature, namely, the cornoid lamella. The cornoid lamella is a column of parakeratotic cells placed on a depression of the epidermis where the granular layer is absent. Though nonpathognomonic, the cornoid lamella is the most distinctive feature of the various types of porokeratosis. These varieties include the plaque type originally described by Mibelli (few lesions located on the extremities with a cornoid lamella which could be thick up to 10 mm); the superficial disseminated and superficial actinic forms, the punctate variant of palms and soles and the linear type all sharing similar histopathologic features. We report a case of disseminated superficial porokeratosis and describe the morphologic features that can be evidenced by Epiluminescence Microscopy examination.
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Epiluminescence Microscopy for the diagnosis of doubtful melanocytic skin lesions comparison of the abcd rule of dermatoscopy and a new 7 point checklist based on pattern analysis
Archives of Dermatology, 1998Co-Authors: Giuseppe Argenziano, Vincenzo De Giorgi, Paolo Carli, Gabriella Fabbrocini, Elena Sammarco, Mario DelfinoAbstract:Objective To compare the reliability of a new 7-point checklist based on simplified Epiluminescence Microscopy (ELM) pattern analysis with the ABCD rule of dermatoscopy and standard pattern analysis for the diagnosis of clinically doubtful melanocytic skin lesions. Design In a blind study, ELM images of 342 histologically proven melanocytic skin lesions were evaluated for the presence of 7 standard criteria that we called the "ELM 7-point checklist." For each lesion, "overall" and "ABCD scored" diagnoses were recorded. From a training set of 57 melanomas and 139 atypical non-melanomas, odds ratios were calculated to create a simple diagnostic model based on identification of major and minor criteria for the "7-point scored" diagnosis. A test set of 60 melanomas and 86 atypical non-melanomas was used for model validation and was then presented to 2 less experienced ELM observers, who recorded the ABCD and 7-point scored diagnoses. Settings University medical centers. Patients A sample of patients with excised melanocytic lesions. Main Outcome Measures Sensitivity, specificity, and accuracy of the models for diagnosing melanoma. Results From the total combined sets, the 7-point checklist gave a sensitivity of 95% and a specificity of 75% compared with 85% sensitivity and 66% specificity using the ABCD rule and 91% sensitivity and 90% specificity using standard pattern analysis (overall ELM diagnosis). Compared with the ABCD rule, the 7-point method allowed less experienced observers to obtain higher diagnostic accuracy values. Conclusions The ELM 7-point checklist provides a simplification of standard pattern analysis because of the low number of features to identify and the scoring diagnostic system. As with the ABCD rule, it can be easily learned and easily applied and has proven to be reliable in diagnosing melanoma.
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Epiluminescence Microscopy a new approach to in vivo detection of sarcoptes scabiei
Archives of Dermatology, 1997Co-Authors: Giuseppe Argenziano, Gabriella Fabbrocini, Mario DelfinoAbstract:Background: The usual methods of scabies diagnosis include microscopic identification of the mites and their eggs and feces in skin scrapings. In many cases, the results of microscopic examination can be negative owing to the low number of parasites present in the cornified layer. Epiluminescence Microscopy (ELM) is an in vivo technique that allows a detailed inspection of the skin, from the surface to the superficial papillary dermis. This is where the scabies mite lives. In this study, we evaluate the applicability and the usefulness of ELM for in vivo diagnosis of scabies. Observations: Sixty-five (93%) of 70 cases of scabies showed small, dark, triangular structures at the sites examined with ELM. A subtle linear segment seen below the base of the triangle was made visible by the presence of small air bubbles. Together, both structures resembled a jet with contrail. On traditional microscopic examination of the scrapings, we verified that the triangular structure corresponded to the pigmented anterior section of the mite in all cases. The linear segment observed on ELM was thought to be the burrow of the mite along with its eggs and fecal pellets. The cases in which the results of a first ELM examination were negative demonstrated positive results on a second ELM examination carried out 20 days later. Conclusion: Epiluminescence Microscopy is a very useful tool for in vivo diagnosis of scabies because it permits Sarcoptes scabiei detection in only a few minutes, with no discomfort to the patient and with a very low number of false-negative results. Arch Dermatol. 1997;133:751-753
Vincenzo De Giorgi - One of the best experts on this subject based on the ideXlab platform.
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dermatoscopy in the diagnosis of pigmented skin lesions a new semiology for the dermatologist
Journal of The European Academy of Dermatology and Venereology, 2000Co-Authors: Paolo Carli, Marcello Stante, Vincenzo De Giorgi, H. Peter Soyer, Francesca Mannone, B. GiannottiAbstract:Dermatoscopy or Epiluminescence Microscopy (ELM), is a noninvasive method that enables clinicians to evaluate fully - by means of a magnified oil immersion diascopy - numerous morphological features, not visible with the naked eye, which enhance the diagnosis of nearly all pigmented skin lesions. In recent years, a burst of research activity in this topic has been carried out, dealing with different aspects, and new frontiers, of this technique. First, a continuous refinement of dermatoscopic terminology is undertaken, paying particular attention to the diagnostic performance of dermatoscopy at peculiar anatomical sites and to the building of different dermatoscopic algorithms aimed at a simplified diagnosis of melanoma, even for less experienced observers. Another point of interest concerns the possible role of dermatoscopy in the pre-operative assessment of melanoma thickness. Finally, promising data about the role of digital equipment in the follow up of melanocytic skin lesions as well as in the automated diagnosis of pigmented skin lesions have been recently reported. This paper should enable readers to become familiar with the procedure and terminology of ELM in the diagnosis of pigmented skin lesions encouraging a greater understanding of different methods (pattern analysis, algorithms) in the diagnosis of melanoma using ELM.
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preoperative assessment of melanoma thickness by abcd score of dermatoscopy
Journal of The American Academy of Dermatology, 2000Co-Authors: Paolo Carli, Vanni Giannotti, Vincenzo De Giorgi, Domenico Palli, B. GiannottiAbstract:Abstract Background: Epiluminescence Microscopy is a useful tool for the noninvasive diagnosis of malignant melanoma based on criteria that have been correlated with specific histologic characteristics. Previous studies have also shown a good correlation between the frequency of some dermatoscopic criteria based on pattern analysis (pigment network, blue-gray areas, vascular pattern) and tumor thickness. This technique could be useful in the preoperative assessment of tumor thickness as an indication for sentinel node biopsy. Objective: Our purpose was to evaluate the possible role of the total dermatoscopy score (TDS) assigned to a series of lesions in accordance with the ABCD rule of dermatoscopy as a preoperative predictor of melanoma thickness. Methods: For 84 cutaneous melanomas (17 were in situ melanomas; 67 invasive cases with mean thickness 0.93 mm; range, 0.2–3.9 mm; standard deviation, 0.63) consecutively excised at the Department of Dermatology of Florence, TDS was established by two observers blinded as to the tumor thickness. The performance of different cut-off points of TDS in the diagnosis of melanoma with Breslow's thickness more than 0.75 or 1.00 mm was investigated by receiver operating characteristic (ROC) analysis. Accuracy of classification was evaluated in terms of sensitivity, specificity, and area under ROC curves (AUC). Results: The TDS assigned to cutaneous melanomas by the ABCD rule increased with the thickness of the lesions from in situ melanomas to melanomas of intermediate thickness (0.75–1.50 mm). As a preoperative method for the detection of melanomas with a Breslow thickness greater than 0.75 mm, a TDS cut-off point of 6.80 showed 80% sensitivity, 84% specificity, and 82% diagnostic accuracy (AUC value, 0.90). TDS performed better in the diagnosis of a thickness threshold of 0.75 than 1.00 mm (higher AUC value). Conclusion: The TDS calculated by the ABCD rule of dermatoscopy-a simplified approach to dermatoscopic diagnosis of melanoma-provides useful information for the preoperative assessment of melanoma thickness greater than 0.75 mm. (J Am Acad Dermatol 2000;43:459–66.)
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preoperative assessment of melanoma thickness by abcd score of dermatoscopy
Journal of The American Academy of Dermatology, 2000Co-Authors: Paolo Carli, Vanni Giannotti, Vincenzo De Giorgi, Domenico Palli, B. GiannottiAbstract:Abstract Background: Epiluminescence Microscopy is a useful tool for the noninvasive diagnosis of malignant melanoma based on criteria that have been correlated with specific histologic characteristics. Previous studies have also shown a good correlation between the frequency of some dermatoscopic criteria based on pattern analysis (pigment network, blue-gray areas, vascular pattern) and tumor thickness. This technique could be useful in the preoperative assessment of tumor thickness as an indication for sentinel node biopsy. Objective: Our purpose was to evaluate the possible role of the total dermatoscopy score (TDS) assigned to a series of lesions in accordance with the ABCD rule of dermatoscopy as a preoperative predictor of melanoma thickness. Methods: For 84 cutaneous melanomas (17 were in situ melanomas; 67 invasive cases with mean thickness 0.93 mm; range, 0.2–3.9 mm; standard deviation, 0.63) consecutively excised at the Department of Dermatology of Florence, TDS was established by two observers blinded as to the tumor thickness. The performance of different cut-off points of TDS in the diagnosis of melanoma with Breslow's thickness more than 0.75 or 1.00 mm was investigated by receiver operating characteristic (ROC) analysis. Accuracy of classification was evaluated in terms of sensitivity, specificity, and area under ROC curves (AUC). Results: The TDS assigned to cutaneous melanomas by the ABCD rule increased with the thickness of the lesions from in situ melanomas to melanomas of intermediate thickness (0.75–1.50 mm). As a preoperative method for the detection of melanomas with a Breslow thickness greater than 0.75 mm, a TDS cut-off point of 6.80 showed 80% sensitivity, 84% specificity, and 82% diagnostic accuracy (AUC value, 0.90). TDS performed better in the diagnosis of a thickness threshold of 0.75 than 1.00 mm (higher AUC value). Conclusion: The TDS calculated by the ABCD rule of dermatoscopy-a simplified approach to dermatoscopic diagnosis of melanoma-provides useful information for the preoperative assessment of melanoma thickness greater than 0.75 mm. (J Am Acad Dermatol 2000;43:459–66.)
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clinical and dermatoscopic criteria for the preoperative evaluation of cutaneous melanoma thickness
Journal of The American Academy of Dermatology, 1999Co-Authors: Giuseppe Argenziano, Vincenzo De Giorgi, Paolo Carli, Gabriella Fabbrocini, M DelfinoAbstract:Abstract Background : Melanoma thickness measured according to the Breslow method is used to determine surgical margin and in patient selection for sentinel node biopsy. Previous studies did not confirm the reliability of melanoma palpability for clinical prediction of tumor thickness. Recently we reported the usefulness of Epiluminescence Microscopy (dermatoscopy) for in vivo detection of the phases of melanoma progression, as well as tumor depth. Objective : Our purpose was to determine whether the combination of clinical and dermatoscopic criteria could increase the accuracy in preoperative evaluation of melanoma thickness with respect to the clinical elevation and dermatoscopic assessments considered separately. Methods : In a blind retrospective study, 122 cutaneous melanomas were studied to evaluate the presence of several clinical and dermatoscopic criteria and their relation with the histologic thickness. An algorithm of combined criteria was constructed and statistically assessed. Results : Combinations of palpability, diameter of more than 15 mm, pigment network, gray-blue areas, and atypical vascular pattern allowed correct prediction of thickness in 89% of melanomas when categorized in two groups of less than 0.76 mm and more than 0.75 mm thickness, compared with 75% using palpability, and 80% using dermatoscopic criteria. Lower values were obtained in the further subdivision of melanomas into groups of 0.76 to 1.5 mm and more than 1.5 mm thickness. Conclusion : The combination of clinical and dermatoscopic criteria is a more precise guide for the preoperative evaluation of melanoma thickness than either is alone. However, further studies are needed to verify its applicability in establishing the surgical approach to cutaneous melanoma. (J Am Acad Dermatol 1999;40:61-8.)
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Epiluminescence Microscopy for the diagnosis of doubtful melanocytic skin lesions comparison of the abcd rule of dermatoscopy and a new 7 point checklist based on pattern analysis
Archives of Dermatology, 1998Co-Authors: Giuseppe Argenziano, Vincenzo De Giorgi, Paolo Carli, Gabriella Fabbrocini, Elena Sammarco, Mario DelfinoAbstract:Objective To compare the reliability of a new 7-point checklist based on simplified Epiluminescence Microscopy (ELM) pattern analysis with the ABCD rule of dermatoscopy and standard pattern analysis for the diagnosis of clinically doubtful melanocytic skin lesions. Design In a blind study, ELM images of 342 histologically proven melanocytic skin lesions were evaluated for the presence of 7 standard criteria that we called the "ELM 7-point checklist." For each lesion, "overall" and "ABCD scored" diagnoses were recorded. From a training set of 57 melanomas and 139 atypical non-melanomas, odds ratios were calculated to create a simple diagnostic model based on identification of major and minor criteria for the "7-point scored" diagnosis. A test set of 60 melanomas and 86 atypical non-melanomas was used for model validation and was then presented to 2 less experienced ELM observers, who recorded the ABCD and 7-point scored diagnoses. Settings University medical centers. Patients A sample of patients with excised melanocytic lesions. Main Outcome Measures Sensitivity, specificity, and accuracy of the models for diagnosing melanoma. Results From the total combined sets, the 7-point checklist gave a sensitivity of 95% and a specificity of 75% compared with 85% sensitivity and 66% specificity using the ABCD rule and 91% sensitivity and 90% specificity using standard pattern analysis (overall ELM diagnosis). Compared with the ABCD rule, the 7-point method allowed less experienced observers to obtain higher diagnostic accuracy values. Conclusions The ELM 7-point checklist provides a simplification of standard pattern analysis because of the low number of features to identify and the scoring diagnostic system. As with the ABCD rule, it can be easily learned and easily applied and has proven to be reliable in diagnosing melanoma.