Background: In a pilot study, the three-point checklist of dermoscopy has been shown to represent a valid and reproducible tool with high sensitivity for the diagnosis of skin cancer in the hands of a small group of n...Background: In a pilot study, the three-point checklist of dermoscopy has been shown to represent a valid and reproducible tool with high sensitivity for the diagnosis of skin cancer in the hands of a small group of nonexperts. Objectives: To reevaluate these preliminary results in a large number of observers independently from their profession and expertise in dermoscopy. Methods: The study was conducted via the internet to provide worldwide access for participants. After a short webbased tutorial, the participants evaluated dermoscopic images of 165 (116 benign and 49 malignant) skin lesions (15 training and 150 test lesions). For each lesion participants scored the presence of the three-point checklist criteria (asymmetry, atypical network and blue-white structures). Kappa values, odds ratios, sensitivity, specificity and likelihood ratios were estimated. Results: Overall, 150 participants joined the study. The three-point checklist showed good interobserver reproducibility (kappa value: 0.53). Sensitivity for skin cancer (melanoma and basal cell carcinoma) was 91.0%and this value remained basically uninfluenced by the observers’professional profile. Only 20 participants lacking any experience in dermoscopy performed significantly more poorly, but the sensitivity was still remarkably high (86.7%) when considering that they were untrained novices in dermoscopy. The specificity was 71.9%and was significantly influenced by the profession, with dermatologists performing best. Conclusions: Our study confirms that the three-point checklist is a feasible, simple, accurate and reproducible skin cancer screening tool.展开更多
Objective: To achieve a clinicopathologic classification of Spitz nevi by comparing their clinical, dermoscopic, and histopathologic features. Design: Eighty- three cases were independently reviewed by 3 histopatholog...Objective: To achieve a clinicopathologic classification of Spitz nevi by comparing their clinical, dermoscopic, and histopathologic features. Design: Eighty- three cases were independently reviewed by 3 histopathologists and preliminarily classified into classic or desmoplastic Spitz nevus (CDSN, n=11), pigmented Spitz nevus (PSN, n=14), Reed nevus (RN, n=16), or atypical Spitz nevus (ASN, n=14); the remaining 28 cases were then placed into an intermediate category (pigmented Spitz- Reed nevus, PSRN) because a unanimous diagnosis of either PSN or RN was not reached. Setting: University dermatology and pathology departments and general hospital pathology departments. Patients: A sample of subjects with excised melanocytic lesions. Main Outcome Measure: Frequency of dermoscopic patterns within the different histopathologic subtypes of Spitz nevi. Results: Overlapping clinical, dermoscopic, and histopathologic findingswere observed among PSN, RN, and PSRN, thereby justifying their inclusion into the single PSRN diagnostic category. Asymmetry was the most frequent indicator of histopathologic ASN (79% ; n=11); in only 4 cases did dermoscopic asymmetry show no histopathologic counterpart, and in those cases the discrepancy was probably the result of an artifact of the gross sampling technique carried out with no attention to the dermoscopic features. Conclusions: Among Spitz nevi, histopathologic distinction between PSN and RN is difficult, not reproducible, and may be clinically useless. A simple clinicopathologic classification of these neoplasms might therefore be structured as CDSN, PSRN, andASN.Asymmetry should be assessed using both dermoscopic and histopathologic analysis, and reliability in histopathologic diagnosis may be enhanced by the simultaneous evaluation of the corresponding dermoscopic images.展开更多
There is a need to improve the early detection of melanoma of the scalp because it is characterized by a poorer prognosis compared with melanoma on other body sites.Dermoscopy is a useful tool for the early detection ...There is a need to improve the early detection of melanoma of the scalp because it is characterized by a poorer prognosis compared with melanoma on other body sites.Dermoscopy is a useful tool for the early detection of melanoma but no previous reports on dermoscopic features of scalp melanoma have been published.We describe the first case of melanoma of the scalp seen by dermoscopy exhibiting a multicomponent global pattern with atypical pigment network, irregular streaks, and regression structures.In contrast to the dermoscopic features usually seen in melanoma occurring on the face, the same morphologic type of pigment network usually seen in melanoma of the trunk was observed in our case of scalp melanoma.展开更多
文摘Background: In a pilot study, the three-point checklist of dermoscopy has been shown to represent a valid and reproducible tool with high sensitivity for the diagnosis of skin cancer in the hands of a small group of nonexperts. Objectives: To reevaluate these preliminary results in a large number of observers independently from their profession and expertise in dermoscopy. Methods: The study was conducted via the internet to provide worldwide access for participants. After a short webbased tutorial, the participants evaluated dermoscopic images of 165 (116 benign and 49 malignant) skin lesions (15 training and 150 test lesions). For each lesion participants scored the presence of the three-point checklist criteria (asymmetry, atypical network and blue-white structures). Kappa values, odds ratios, sensitivity, specificity and likelihood ratios were estimated. Results: Overall, 150 participants joined the study. The three-point checklist showed good interobserver reproducibility (kappa value: 0.53). Sensitivity for skin cancer (melanoma and basal cell carcinoma) was 91.0%and this value remained basically uninfluenced by the observers’professional profile. Only 20 participants lacking any experience in dermoscopy performed significantly more poorly, but the sensitivity was still remarkably high (86.7%) when considering that they were untrained novices in dermoscopy. The specificity was 71.9%and was significantly influenced by the profession, with dermatologists performing best. Conclusions: Our study confirms that the three-point checklist is a feasible, simple, accurate and reproducible skin cancer screening tool.
文摘Objective: To achieve a clinicopathologic classification of Spitz nevi by comparing their clinical, dermoscopic, and histopathologic features. Design: Eighty- three cases were independently reviewed by 3 histopathologists and preliminarily classified into classic or desmoplastic Spitz nevus (CDSN, n=11), pigmented Spitz nevus (PSN, n=14), Reed nevus (RN, n=16), or atypical Spitz nevus (ASN, n=14); the remaining 28 cases were then placed into an intermediate category (pigmented Spitz- Reed nevus, PSRN) because a unanimous diagnosis of either PSN or RN was not reached. Setting: University dermatology and pathology departments and general hospital pathology departments. Patients: A sample of subjects with excised melanocytic lesions. Main Outcome Measure: Frequency of dermoscopic patterns within the different histopathologic subtypes of Spitz nevi. Results: Overlapping clinical, dermoscopic, and histopathologic findingswere observed among PSN, RN, and PSRN, thereby justifying their inclusion into the single PSRN diagnostic category. Asymmetry was the most frequent indicator of histopathologic ASN (79% ; n=11); in only 4 cases did dermoscopic asymmetry show no histopathologic counterpart, and in those cases the discrepancy was probably the result of an artifact of the gross sampling technique carried out with no attention to the dermoscopic features. Conclusions: Among Spitz nevi, histopathologic distinction between PSN and RN is difficult, not reproducible, and may be clinically useless. A simple clinicopathologic classification of these neoplasms might therefore be structured as CDSN, PSRN, andASN.Asymmetry should be assessed using both dermoscopic and histopathologic analysis, and reliability in histopathologic diagnosis may be enhanced by the simultaneous evaluation of the corresponding dermoscopic images.
文摘There is a need to improve the early detection of melanoma of the scalp because it is characterized by a poorer prognosis compared with melanoma on other body sites.Dermoscopy is a useful tool for the early detection of melanoma but no previous reports on dermoscopic features of scalp melanoma have been published.We describe the first case of melanoma of the scalp seen by dermoscopy exhibiting a multicomponent global pattern with atypical pigment network, irregular streaks, and regression structures.In contrast to the dermoscopic features usually seen in melanoma occurring on the face, the same morphologic type of pigment network usually seen in melanoma of the trunk was observed in our case of scalp melanoma.
