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Richard R Winkelmann - One of the best experts on this subject based on the ideXlab platform.
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negative predictive value of Pigmented Lesion evaluation by multispectral digital skin Lesion analysis in a community practice setting
The Journal of clinical and aesthetic dermatology, 2015Co-Authors: Richard R Winkelmann, Darrell S Rigel, Natalie Tucker, Emily Kollmann, Nicole Swenson, Mark S NestorAbstract:Objective: To determine if the high negative predictive value of a multispectral digital skin Lesion analysis that has been previously found in an academic-based trial would be similar in a community-based setting with its expected different distribution of Pigmented Lesions. Design: Data were collected from patients undergoing routine skin examinations over a one-year period at a community-based practice in Florida. All Lesions that were selected for biopsy to rule out melanoma were also imaged with multispectral digital skin Lesion analysis prior to biopsy. Histopathological diagnoses and multispectral digital skin Lesion analysis results were reviewed and compared with findings from a prior primarily academic center-based multispectral digital skin Lesion analysis trial. Setting/participants: Community-based clinical setting in Florida. Measurements: Negative predictive value, sensitivity, and specificity. Results: One hundred thirty-seven consecutive Lesions were selected for biopsy and also analyzed via multispectral digital skin Lesion analysis. All 21 cases with multispectral digital skin Lesion analysis “Low Disorganization” readings were all histologically benign (100% negative predictive value, 95% lower confidence boundary = 96.9%). The negative predictive value and the sensitivity were not significantly different than what was found in the prior academic-based multispectral digital skin Lesion analysis trial. Multispectral digital skin Lesion analysis also correctly identified all high-risk Lesions, which were subsequently confirmed via histology to be one invasive melanoma and 15 moderately dysplastic nevi (100% sensitivity). Specificity with multispectral digital skin Lesion analysis was significantly higher than reported in the academic-based multispectral digital skin Lesion analysis trial (18% vs. 10%, p=0.02). Conclusion: Because of the high negative predictive value achieved by multispectral digital skin Lesion analysis, Lesions with readings of “Low Disorganization” may be considered for observation versus biopsy. Similar to what was noted in the academic center setting, multispectral digital skin Lesion analysis may help dermatologists reduce the number of unnecessary biopsies while improving diagnostic accuracy.
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comparison of the distribution of morphological disorganization of Pigmented Lesions in a community based practice versus a university based clinical setting as measured by a multispectral digital skin Lesion analysis device impact on diagnosis
The Journal of clinical and aesthetic dermatology, 2015Co-Authors: Richard R Winkelmann, Gregory Nikolaidis, Darrell S Rigel, Natalie Tucker, Laura SpeckAbstract:Objective: To observe how a multispectral digital skin Lesion analysis device was used by dermatologists in a community-based clinical setting and determine differences from a university-based environment. Design: Use of multispectral digital skin Lesion analysis was incorporated into a community-based practice by 12 dermatologists across six clinics over seven consecutive days with the data provided by the device integrated as an adjuvant to their clinical evaluation for their Pigmented Lesion management decisions. Multispectral digital skin Lesion analysis results were collected electronically for Lesions prior to biopsy, and histopathological evaluation was performed for the biopsied Lesions. Multispectral digital skin Lesion analysis and pathology results were then compared to assess the degree of morphological disorganization. Setting/participants: Study of 160 consecutive patients in community-based clinical setting. Measurements: Proportion of “low” and “high” disorganization Lesions identified by multispectral digital skin Lesion analysis. Results: Of the 344 Pigmented skin Lesions analyzed by multispectral digital skin Lesion analysis, 255 were high disorganization, 113 of which were biopsied. Of the 89 Lesions evaluated by multispectral digital skin Lesion analysis to be low disorganization, seven were biopsied and all pathology was benign. Data demonstrate a higher rate of multispectral digital skin Lesion analysis low disorganization readings for Pigmented skin Lesions (32% for single use per patient Lesions, p<0.0001; 26% for all Lesions, p<0.0001) than observed in the Pigmented Lesions clinics providing data for the university-based clinical study (10%). Conclusion: Multispectral digital skin Lesion analysis in the community-based clinical setting may outperform specificity results from the university-based clinical trial study, perhaps because of a higher proportion of subtle Lesions encountered at high-risk Pigmented Lesion clinics of participating major academic centers as compared with those in a community-based practice setting
Paolo Carli - One of the best experts on this subject based on the ideXlab platform.
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cutaneous collision tumour melanocytic naevus basal cell carcinoma seborrhoeic keratosis a clinical dermoscopic and pathological case report
British Journal of Dermatology, 2005Co-Authors: V De Giorgi, D Massi, Serena Sestini, Arbara Alfaioli, Giovanna Carelli, Paolo CarliAbstract:The association of contiguous or 'collision' tumours in the same biopsy specimen is not uncommon and is often reported in the literature. The most common association, basal cell carcinoma (BCC) and naevus, is very difficult to diagnose clinically. We describe a 38-year-old woman with a previous history of melanoma, who presented with a modified Pigmented Lesion of the hip that had begun to change 6 months earlier. Histologically, the Lesion was a melanocytic compound naevus and a BCC with a seborrhoeic keratosis. The case was investigated clinically and by focusing on the dermoscopic features and their pathological correlates. Cutaneous collision tumours are extremely difficult to diagnose preoperatively, even with the help of dermoscopy, in particular when one of the Lesions is melanocytic.
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frequency and characteristics of melanomas missed at a Pigmented Lesion clinic a registry based study
Melanoma Research, 2004Co-Authors: Paolo Carli, Vincenzo De Giorgi, Paolo Nardini, Emanuele Crocetti, B GiannottiAbstract:To ensure the removal of all melanomas at an early phase, a number of benign Lesions are currently excised for diagnostic evaluation. Nevertheless, little is known about the frequency of melanomas missed (neither recognized nor excised for diagnostic verification) by early detection practices. This
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dermoscopic features of mucosal melanosis
Dermatologic Surgery, 2004Co-Authors: Francesca Mannone, Vincenzo De Giorgi, A Cattaneo, Daniela Massi, Angelina De Magnis, Paolo CarliAbstract:BACKGROUNDMelanosis (lentiginosis, labial melanotic macula) is a benign Pigmented Lesion of mucosa characterized by pigmentation of basal keratinocytes with melanocytic normal or slightly increased in number. Melanosis, particularly when occurring on genitalia, can clinically mimic mucosal melanoma
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addition of dermoscopy to conventional naked eye examination in melanoma screening a randomized study
Journal of The American Academy of Dermatology, 2004Co-Authors: Paolo Carli, Vincenzo De Giorgi, Paolo Nardini, Alessandra Chiarugi, Martin A Weinstock, Emanuele Crocetti, Marcello Stante, B GiannottiAbstract:Abstract Objective We sought to assess the difference in Lesion management between combined examination (naked-eye and dermoscopy) and conventional naked-eye examination in evaluations for melanoma; and to assess the impact on patient treatment of facilities for digital follow-up of diagnostically equivocal Lesions. Methods We conducted a randomized, controlled trial at a Pigmented Lesion clinic in a university hospital. A total of 938 consecutive subjects presenting between November 1, 2001, and March 31, 2002, were eligible and 25 were excluded because they were younger than 12 years of age; hence 913 subjects were enrolled. Participants were randomized to combined examination with mandatory excision of equivocal Lesion (arm B) and with possibility of digital follow-up according to the clinician's decision (arm C), or to conventional naked-eye examination (mandatory excision of equivocal Lesion) (arm A). The same Pigmented Lesion clinic staff examined all subjects. Results Combined examination determined a significant reduction in the percentage of patients referred for operation (9.0% vs 15.6%) ( P = .013). When facilities for digital follow-up of equivocal Lesions were available, the percentage of patients classified as harboring Lesions difficult to diagnose increased (group C, 35.8%; group B, 17.8%; P Conclusions the addition of dermoscopy to conventional naked-eye examination is associated with a significant reduction of number of Pigmented skin Lesions excised for diagnostic verification. The possibility of digital follow-up of equivocal Lesions is associated with a not negligible occurrence of initial melanomas left unexcised until the second consultation.
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relationship between cause of referral and diagnostic outcome in Pigmented Lesion clinics a multicentre survey of the italian multidisciplinary group on melanoma gipme
Melanoma Research, 2003Co-Authors: Paolo Carli, Vincenzo De Giorgi, R Betti, Raffaella Vergani, Caterina Catricala, Giustino Mariani, Marco Simonacci, Alberta Bettacchi, Ugo Bottoni, Giovanni Lo ScoccoAbstract:Pigmented Lesion clinics (PLCs) are permanent units to which subjects presenting with suspicious Pigmented skin Lesions can be rapidly referred and which can provide a prompt response to an individual's concern about melanoma. However, little is known about the melanoma detection rate in these clinics, in particular with regard to intermediate risk populations. We report a survey involving more than 1000 subjects consecutively referred by family doctors to six Italian PLCs. Using a histological diagnosis of melanoma as the endpoint, the pooled melanoma detection rate at these PLCs was 1.5% (one melanoma for diagnosed every 64 subjects examined), and the ratio between the number of melanomas and benign Lesions excised for diagnostic verification was 1: 5.8 (16 melanomas and 93 benign Lesions). Almost all the melanomas (15 out of 16) were detected in subjects who had requested referral for a specific doubtful Lesion (group A) or for the presence of melanoma risk factors (previous melanoma, large number of common and atypical naevi, family history of melanoma) (group B). Only one melanoma was detected amongst the 418 subjects seeking consultation for concern about their moles (group C) (P = 0.004). The positive and negative predictive values of the referral groups A and B combined were 2.5% and 99.7%, respectively. Since the probability of detecting a melanoma in subjects referred only for reassurance about their moles, which nevertheless represented 43% of the subjects examined, is very low, an optimized role for PLCs in melanoma prevention would be to limit consultation to subjects who present for examination of a specific Lesion or who have one or more risk factors for melanoma.
Mark S Nestor - One of the best experts on this subject based on the ideXlab platform.
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negative predictive value of Pigmented Lesion evaluation by multispectral digital skin Lesion analysis in a community practice setting
The Journal of clinical and aesthetic dermatology, 2015Co-Authors: Richard R Winkelmann, Darrell S Rigel, Natalie Tucker, Emily Kollmann, Nicole Swenson, Mark S NestorAbstract:Objective: To determine if the high negative predictive value of a multispectral digital skin Lesion analysis that has been previously found in an academic-based trial would be similar in a community-based setting with its expected different distribution of Pigmented Lesions. Design: Data were collected from patients undergoing routine skin examinations over a one-year period at a community-based practice in Florida. All Lesions that were selected for biopsy to rule out melanoma were also imaged with multispectral digital skin Lesion analysis prior to biopsy. Histopathological diagnoses and multispectral digital skin Lesion analysis results were reviewed and compared with findings from a prior primarily academic center-based multispectral digital skin Lesion analysis trial. Setting/participants: Community-based clinical setting in Florida. Measurements: Negative predictive value, sensitivity, and specificity. Results: One hundred thirty-seven consecutive Lesions were selected for biopsy and also analyzed via multispectral digital skin Lesion analysis. All 21 cases with multispectral digital skin Lesion analysis “Low Disorganization” readings were all histologically benign (100% negative predictive value, 95% lower confidence boundary = 96.9%). The negative predictive value and the sensitivity were not significantly different than what was found in the prior academic-based multispectral digital skin Lesion analysis trial. Multispectral digital skin Lesion analysis also correctly identified all high-risk Lesions, which were subsequently confirmed via histology to be one invasive melanoma and 15 moderately dysplastic nevi (100% sensitivity). Specificity with multispectral digital skin Lesion analysis was significantly higher than reported in the academic-based multispectral digital skin Lesion analysis trial (18% vs. 10%, p=0.02). Conclusion: Because of the high negative predictive value achieved by multispectral digital skin Lesion analysis, Lesions with readings of “Low Disorganization” may be considered for observation versus biopsy. Similar to what was noted in the academic center setting, multispectral digital skin Lesion analysis may help dermatologists reduce the number of unnecessary biopsies while improving diagnostic accuracy.
Natalie Tucker - One of the best experts on this subject based on the ideXlab platform.
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negative predictive value of Pigmented Lesion evaluation by multispectral digital skin Lesion analysis in a community practice setting
The Journal of clinical and aesthetic dermatology, 2015Co-Authors: Richard R Winkelmann, Darrell S Rigel, Natalie Tucker, Emily Kollmann, Nicole Swenson, Mark S NestorAbstract:Objective: To determine if the high negative predictive value of a multispectral digital skin Lesion analysis that has been previously found in an academic-based trial would be similar in a community-based setting with its expected different distribution of Pigmented Lesions. Design: Data were collected from patients undergoing routine skin examinations over a one-year period at a community-based practice in Florida. All Lesions that were selected for biopsy to rule out melanoma were also imaged with multispectral digital skin Lesion analysis prior to biopsy. Histopathological diagnoses and multispectral digital skin Lesion analysis results were reviewed and compared with findings from a prior primarily academic center-based multispectral digital skin Lesion analysis trial. Setting/participants: Community-based clinical setting in Florida. Measurements: Negative predictive value, sensitivity, and specificity. Results: One hundred thirty-seven consecutive Lesions were selected for biopsy and also analyzed via multispectral digital skin Lesion analysis. All 21 cases with multispectral digital skin Lesion analysis “Low Disorganization” readings were all histologically benign (100% negative predictive value, 95% lower confidence boundary = 96.9%). The negative predictive value and the sensitivity were not significantly different than what was found in the prior academic-based multispectral digital skin Lesion analysis trial. Multispectral digital skin Lesion analysis also correctly identified all high-risk Lesions, which were subsequently confirmed via histology to be one invasive melanoma and 15 moderately dysplastic nevi (100% sensitivity). Specificity with multispectral digital skin Lesion analysis was significantly higher than reported in the academic-based multispectral digital skin Lesion analysis trial (18% vs. 10%, p=0.02). Conclusion: Because of the high negative predictive value achieved by multispectral digital skin Lesion analysis, Lesions with readings of “Low Disorganization” may be considered for observation versus biopsy. Similar to what was noted in the academic center setting, multispectral digital skin Lesion analysis may help dermatologists reduce the number of unnecessary biopsies while improving diagnostic accuracy.
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comparison of the distribution of morphological disorganization of Pigmented Lesions in a community based practice versus a university based clinical setting as measured by a multispectral digital skin Lesion analysis device impact on diagnosis
The Journal of clinical and aesthetic dermatology, 2015Co-Authors: Richard R Winkelmann, Gregory Nikolaidis, Darrell S Rigel, Natalie Tucker, Laura SpeckAbstract:Objective: To observe how a multispectral digital skin Lesion analysis device was used by dermatologists in a community-based clinical setting and determine differences from a university-based environment. Design: Use of multispectral digital skin Lesion analysis was incorporated into a community-based practice by 12 dermatologists across six clinics over seven consecutive days with the data provided by the device integrated as an adjuvant to their clinical evaluation for their Pigmented Lesion management decisions. Multispectral digital skin Lesion analysis results were collected electronically for Lesions prior to biopsy, and histopathological evaluation was performed for the biopsied Lesions. Multispectral digital skin Lesion analysis and pathology results were then compared to assess the degree of morphological disorganization. Setting/participants: Study of 160 consecutive patients in community-based clinical setting. Measurements: Proportion of “low” and “high” disorganization Lesions identified by multispectral digital skin Lesion analysis. Results: Of the 344 Pigmented skin Lesions analyzed by multispectral digital skin Lesion analysis, 255 were high disorganization, 113 of which were biopsied. Of the 89 Lesions evaluated by multispectral digital skin Lesion analysis to be low disorganization, seven were biopsied and all pathology was benign. Data demonstrate a higher rate of multispectral digital skin Lesion analysis low disorganization readings for Pigmented skin Lesions (32% for single use per patient Lesions, p<0.0001; 26% for all Lesions, p<0.0001) than observed in the Pigmented Lesions clinics providing data for the university-based clinical study (10%). Conclusion: Multispectral digital skin Lesion analysis in the community-based clinical setting may outperform specificity results from the university-based clinical trial study, perhaps because of a higher proportion of subtle Lesions encountered at high-risk Pigmented Lesion clinics of participating major academic centers as compared with those in a community-based practice setting
Darrell S Rigel - One of the best experts on this subject based on the ideXlab platform.
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negative predictive value of Pigmented Lesion evaluation by multispectral digital skin Lesion analysis in a community practice setting
The Journal of clinical and aesthetic dermatology, 2015Co-Authors: Richard R Winkelmann, Darrell S Rigel, Natalie Tucker, Emily Kollmann, Nicole Swenson, Mark S NestorAbstract:Objective: To determine if the high negative predictive value of a multispectral digital skin Lesion analysis that has been previously found in an academic-based trial would be similar in a community-based setting with its expected different distribution of Pigmented Lesions. Design: Data were collected from patients undergoing routine skin examinations over a one-year period at a community-based practice in Florida. All Lesions that were selected for biopsy to rule out melanoma were also imaged with multispectral digital skin Lesion analysis prior to biopsy. Histopathological diagnoses and multispectral digital skin Lesion analysis results were reviewed and compared with findings from a prior primarily academic center-based multispectral digital skin Lesion analysis trial. Setting/participants: Community-based clinical setting in Florida. Measurements: Negative predictive value, sensitivity, and specificity. Results: One hundred thirty-seven consecutive Lesions were selected for biopsy and also analyzed via multispectral digital skin Lesion analysis. All 21 cases with multispectral digital skin Lesion analysis “Low Disorganization” readings were all histologically benign (100% negative predictive value, 95% lower confidence boundary = 96.9%). The negative predictive value and the sensitivity were not significantly different than what was found in the prior academic-based multispectral digital skin Lesion analysis trial. Multispectral digital skin Lesion analysis also correctly identified all high-risk Lesions, which were subsequently confirmed via histology to be one invasive melanoma and 15 moderately dysplastic nevi (100% sensitivity). Specificity with multispectral digital skin Lesion analysis was significantly higher than reported in the academic-based multispectral digital skin Lesion analysis trial (18% vs. 10%, p=0.02). Conclusion: Because of the high negative predictive value achieved by multispectral digital skin Lesion analysis, Lesions with readings of “Low Disorganization” may be considered for observation versus biopsy. Similar to what was noted in the academic center setting, multispectral digital skin Lesion analysis may help dermatologists reduce the number of unnecessary biopsies while improving diagnostic accuracy.
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comparison of the distribution of morphological disorganization of Pigmented Lesions in a community based practice versus a university based clinical setting as measured by a multispectral digital skin Lesion analysis device impact on diagnosis
The Journal of clinical and aesthetic dermatology, 2015Co-Authors: Richard R Winkelmann, Gregory Nikolaidis, Darrell S Rigel, Natalie Tucker, Laura SpeckAbstract:Objective: To observe how a multispectral digital skin Lesion analysis device was used by dermatologists in a community-based clinical setting and determine differences from a university-based environment. Design: Use of multispectral digital skin Lesion analysis was incorporated into a community-based practice by 12 dermatologists across six clinics over seven consecutive days with the data provided by the device integrated as an adjuvant to their clinical evaluation for their Pigmented Lesion management decisions. Multispectral digital skin Lesion analysis results were collected electronically for Lesions prior to biopsy, and histopathological evaluation was performed for the biopsied Lesions. Multispectral digital skin Lesion analysis and pathology results were then compared to assess the degree of morphological disorganization. Setting/participants: Study of 160 consecutive patients in community-based clinical setting. Measurements: Proportion of “low” and “high” disorganization Lesions identified by multispectral digital skin Lesion analysis. Results: Of the 344 Pigmented skin Lesions analyzed by multispectral digital skin Lesion analysis, 255 were high disorganization, 113 of which were biopsied. Of the 89 Lesions evaluated by multispectral digital skin Lesion analysis to be low disorganization, seven were biopsied and all pathology was benign. Data demonstrate a higher rate of multispectral digital skin Lesion analysis low disorganization readings for Pigmented skin Lesions (32% for single use per patient Lesions, p<0.0001; 26% for all Lesions, p<0.0001) than observed in the Pigmented Lesions clinics providing data for the university-based clinical study (10%). Conclusion: Multispectral digital skin Lesion analysis in the community-based clinical setting may outperform specificity results from the university-based clinical trial study, perhaps because of a higher proportion of subtle Lesions encountered at high-risk Pigmented Lesion clinics of participating major academic centers as compared with those in a community-based practice setting