Dermatoscopic asymmetry of melanocytic skin lesion is pivotal in most algorithms assessing the probability of melanoma. Larger lesions cannot be assessed by dermatoscopy and the Dermaphot in a single ...field of vision, but this can be performed using the acrylic globe magnifier. We examined the diagnostic accuracy of the acrylic globe magnifier and compared it with classical dermatoscopy. A total of 119 patients successively referred to our naevus clinics had Dermaphot and acrylic globe magnifier pictures taken. Lesions were excised and assessed by histopathology. Observers blinded to histopathology diagnoses, assessed dermatoscopic and acrylic globe magnifier photo-slides according to the dermoscopic risk stratification. The observed agreement over all categories between acrylic globe magnifier dermatoscopy and classical dermatoscopy was 94% and Cohen's kappa coefficient was 90% (95% confidence interval 83-97%). Sensitivity for melanoma, benign melanocytic naevi and basal cell carcinoma was 100%, 98% and 85%, respectively. Specificity was 95%, 94% and 100% for melanoma, naevi and basal cell carcinoma. Acrylic globe dermatoscopy enables a diagnostic accuracy similar to epiluminescence microscopy.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Picato (ingenol mebutate) was recently marketed for local treatment of actinic keratosis (AK). Compared to alternative creams and gels, Picato is a quick and efficient treatment, which is applied for ...only two to three days. A patient developed a bullous reaction to the gel after a single application. Picato 150 microg/g was applied in the evening to AK in the patient's forehead. The patient experienced a headache during the night, and the next morning big, thin-walled bullae had developed in the treated area.
Breslow thickness and Clark level can be used to determine surgical procedures for cutaneous malignant melanoma and patient eligibility for experimental adjuvant therapy. Efforts to predict the ...thickness of melanomas using dermatoscopy have focused on differences between single dermatoscopic findings. The aim of this study was to develop a method for preoperative identification of melanomas of > or = 1 mm Breslow thickness using the entire range of dermatoscopic findings. Sixty-five melanomas were assessed for the presence of 22 dermatoscopic features. Ten dermatoscopic features showed differences in thick and thin melanomas and were selected for further analysis. A latent trait analysis construct implied that a progression in dermatoscopic features was associated with advancement of melanomas. Early melanomas are characterized by a light brown colour, a pigment network and irregularity or heterogeneity. Gray-blue areas, white scar-like areas and an atypical vascular pattern gradually displace these features. Likelihood ratios were determined for these 6 dermatoscopic findings and an algorithm for calculating the probability of thick malignant melanoma was established.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
The distinction between bacterial colonization and infection relies on clinical judgement. Determining sensitivity and specificity of this judgement are problematic as no gold standard exists. Six ...specialists in wound management independently assessed 120 nonhealing chronic wounds. Sixty-five (54.2%) patients had venous ulcer, 18 (15%) arterial ulcers, 15 (12.5%) ulcerative pyoderma gangraenosum, 12 (10%) neuropathic or pressure ulcers, six (5%) vasculitis ulcers, and four patients had ulcers caused by a primary or metastatic cancer disease. Unrestricted latent class analysis was used for determining sensitivity and specificity in the observer's assessment of hypergranulation, redness, and overall impression of infection. Interrater agreement among observers was determined by restricted latent class analysis. The observers used the diagnoses (redness, hypergranulation, and overall impression of infection with different frequencies (p<0.001, Cochrane's Q test). A two latent class model fitted data. Sensitivity for hypergranulation ranged from 3 to 82%, for redness from 34 to 91% and for overall impression of infection from 37 to 90%. None of the observers were interchangeable. These results indicate that clinical assessment of chronic wounds for the presence of infection are difficult tasks accompanied by great variability and low reliability.
Dynamic dermoscopy Lorentzen, Henrik F; Weismann, Kaare
Ugeskrift for læger,
2006-Nov-20, Letnik:
168, Številka:
47
Journal Article
Dermoscopy of early-stage melanoma can be challenging, and repeated examination at three-month intervals may disclose subtle changes. In patients with atypical nevus syndrome or more than 50 nevi, ...repetitive excision of benign lesions does not guarantee that melanomas will be identified at an early stage and exposes patients to potentially disfiguring surgery. We present the case of a high-risk patient where repeated dermoscopy of an in situ melanoma showed that part of the pigment network had coarsened, even though the lesion had not changed macroscopically.
Imiquimod is an immune system-modifying drug that switches the immune system to a Th1 response, enabling it to defeat virus-infected and neoplastic cells. We report on a 94-year-old woman with a ...large lentigo maligna (LM) on her cheek whom we treated with imiquimod 5% cream. Dermoscopy was used to identify the most suspect areas of the lesion for biopsy and in follow-up. By week 19 the lesion was cleared, and no remnants of the lesion were seen by dermoscopy or histology. Published LM cases treated with imiquimod are reviewed.
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