Siete características no melanoma para descartar el melanoma facial.

Tschandl P1, Gambardella A, Boespflug A, Deinlein T, de Giorgi V, Kittler H, Lallas A, Malvehy J, Moscarella E, Puig S, Scalvenzi M, Thomas L, Zalaudek I, Alfano R, Argenziano G.

Resumen:

El melanoma facial es difícil de diagnosticar y las características dermatoscópicas a menudo son sutiles. Los patrones dermatoscópicos "no melanoma" pueden tener un valor diagnóstico comparable. En este estudio piloto, las lesiones faciales se recolectaron retrospectivamente, lo que resultó en un conjunto de casos de 339 melanomas y 308 no melanomas. 

Las lesiones se evaluaron para determinar la prevalencia (> 50% de la superficie lesional) de 7 características dermatoscópicas no melanoma: 

escamas, folículos blancos, eritema / vasos reticulares, líneas reticulares y / o curvas / huellas dactilares, color marrón sin estructura, demarcación aguda y clásicos criterios de queratosis seborreica. Los melanomas tuvieron un número menor de patrones no melanoma (p <0,001). La puntuación de una lesión sospechosa cuando no se encontró un patrón "no melanoma" prevaleciente, resultó en una sensibilidad del 88,5% y una especificidad del 66,9% para el diagnóstico de melanoma. La especificidad fue mayor para léntigo solar (78.8%) y queratosis seborreica (74.3%) y menor para queratosis actínica (61.4%) y queratosis liquenoide (25.6%). 

La evaluación de los patrones prevalentes de "no melanoma" puede proporcionar una sensibilidad ligeramente menor y una mayor especificidad en la detección de melanoma facial en comparación con las características malignas ya conocidas.

Fuente: PubMed

https://www.ncbi.nlm.nih.gov/pubmed/28761960

Seven Non-melanoma Features to Rule Out Facial Melanoma.

Abstract

Facial melanoma is difficult to diagnose and dermatoscopic features are often subtle. Dermatoscopic non-melanoma patterns may have a comparable diagnostic value. In this pilot study, facial lesions were collected retrospectively, resulting in a case set of 339 melanomas and 308 non-melanomas. Lesions were evaluated for the prevalence (> 50% of lesional surface) of 7 dermatoscopic non-melanoma features: scales, white follicles, erythema/reticular vessels, reticular and/or curved lines/fingerprints, structureless brown colour, sharp demarcation, and classic criteria of seborrhoeic keratosis. Melanomas had a lower number of non-melanoma patterns (p< 0.001). Scoring a lesion suspicious when no prevalent non-melanoma pattern is found resulted in a sensitivity of 88.5% and a specificity of 66.9% for the diagnosis of melanoma. Specificity was higher for solar lentigo (78.8%) and seborrhoeic keratosis (74.3%) and lower for actinic keratosis (61.4%) and lichenoid keratosis (25.6%). Evaluation of prevalent non-melanoma patterns can provide slightly lower sensitivity and higher specificity in detecting facial melanoma compared with already known malignant features.

Ugly Duckling Sign as a Major Factor of Efficiency in Melanoma Detection

Importance:

Understanding the contribution of the ugly duckling sign (a nevus that is obviously different from the others in a given individual) in intrapatient comparative analysis (IPCA) of nevi may help improve the detection of melanoma.

Objectives:

To assess the agreement of dermatologists on identification of the ugly duckling sign and estimate the contribution of IPCA to the diagnosis of melanoma.

Design, Setting, and Participants:

The same 2089 digital images of the nevi of a sample of 80 patients (mean age, 42 years [range, 19-80 years]; 33 men and 47 women), as well as 766 dermoscopic images from a subset of 30 patients (mean age, 40 years [range, 21-75 years]; 12 men and 18 women), were randomly presented to the same 9 dermatologists for blinded assessment from September 22, 2011, to April 1, 2013. The first experiment was designed to mimic an IPCA situation, with images of all nevi of each patient shown to the dermatologists, who were asked to identify ugly duckling nevi (UDN). The second experiment was designed to mimic a lesion-focused analysis to identify morphologically suspicious nevi. Data analysis was conducted from November 1, 2012, to June 1, 2013.

Main Outcomes and Measures:

Number of nevi labeled UDN and morphologically suspicious nevi, specificity of lesion-focused analysis and IPCA, and number of nevi identified for biopsy.

Results:

Of the 2089 clinical images of nevi from 80 patients (median number of nevi per patient, 26 [range, 8-81]) and 766 dermoscopic images (median number of nevi per patient, 19 [range, 8-81]), all melanomas were labeled UDN and as morphologically suspicious nevi by the 9 dermatologists. The median number of UDN detected per patient was 0.8 among the clinical images of nevi (mean, 1.0; range, 0.48-2.03) and 1.26 among the dermoscopic images (mean, 1.4; range, 1.00-2.06). The propensity to consider more or fewer nevi as having ugly duckling signs was independent of the presentation (clinical or dermoscopic). The agreement among the dermatologists regarding UDN was lower with dermoscopic images (mean pairwise agreement, 0.53 for clinical images and 0.50 for dermoscopic images). The specificity of IPCA was 0.96 for clinical images and 0.95 for dermoscopic images vs 0.88 and 0.85, respectively, for lesion-focused analysis. When both IPCA and lesion-focused analyses were used, the number of nevi considered for biopsy was reduced by a factor of 6.9 compared with lesion-focused analysis alone.

Conclusions and Relevance:

Intrapatient comparative analysis is of major importance to the effectiveness of the diagnosis of melanoma. Introducing IPCA using the ugly duckling sign in computer-assisted diagnosis systems would be expected to improve performance.

#josepmalvehy #clinicadermatologica #dermatologobarcelona #melanoma #cancerdepiel #diagnosismelanoma #canceruña #skincancer #dermatologabarcelona #bestdoctor #topdoctors #nevus #confocal #susanapuig

Transforming Dermatologic Imaging for the Digital Era: Metadata and Standards.

Abstract

Imaging is increasingly being used in dermatology for documentation, diagnosis, and management of cutaneous disease. The lack of standards for dermatologic imaging is an impediment to clinical uptake. Standardization can occur in image acquisition, terminology, interoperability, and metadata. This paper presents the International Skin Imaging Collaboration position on standardization of metadata for dermatologic imaging. Metadata is essential to ensure that dermatologic images are properly managed and interpreted. There are two standards-based approaches to recording and storing metadata in dermatologic imaging. The first uses standard consumer image file formats, and the second is the file format and metadata model developed for the Digital Imaging and Communication in Medicine (DICOM) standard. DICOM would appear to provide an advantage over using consumer image file formats for metadata as it includes all the patient, study, and technical metadata necessary to use images clinically. Whereas, consumer image file formats only include technical metadata and need to be used in conjunction with another actor-for example, an electronic medical record-to supply the patient and study metadata. The use of DICOM may have some ancillary benefits in dermatologic imaging including leveraging DICOM network and workflow services, interoperability of images and metadata, leveraging existing enterprise imaging infrastructure, greater patient safety, and better compliance to legislative requirements for image retention.

https://www.ncbi.nlm.nih.gov/pubmed/29344752

#josepmalvehy #skinimaging #dermoscopic #dermatologic #teledermatology #dicom