To the Editor: Patient and County-Level Factors Associated with Late Stage Merkel Cell Carcinoma at Diagnosis
Melanoma surveillance for high-risk patients via telemedicine: Examination of real-world data from an integrated store-and-forward total body photography and dermoscopy service
Dermoscopy of acquired pigmentary disorders: a comprehensive review
Dermoscopy has traditionally been used for the diagnosis of neoplasms and more recently in the evaluation of inflammatory conditions. Recent observational studies have suggested a role for dermoscopy in identifying and differentiating acquired pigmentary disorders. This comprehensive review will summarize the growing literature on the use of dermoscopy for pigmentary disorders. A literature review was performed on PubMed dating from inception to October 2020. The following pigmentary disorders were included in this study: melasma, solar lentigines, poikiloderma of Civatte, exogenous ochronosis, lichen planus pigmentosus, erythromelanosis follicularis faciei et colli, pigmented contact dermatitis, Riehl's melanosis, postinflammatory hyperpigmentation, erythema dyschromicum perstans, ashy dermatosis, confluent and reticulated papillomatosis, acanthosis nigricans, pityriasis versicolor, tinea versicolor, idiopathic guttate hypomelanosis, and vitiligo. Search terms used included each pigmentary disorder along with the terms "dermoscopy" or "dermatoscopy." Relevant case reports and case series were included. Many pigmentary disorders have unique and distinguishable features on dermoscopy. Given that these disorders can be clinically challenging for clinicians and emotionally distressing for patients, dermoscopy provides an additional, useful tool in the evaluation and assessment process.
Revisiting Solitary Pedunculated Lipofibromas
OBJECTIVES/OBJECTIVE:Pedunculated lipofibromas are soft, compressible, skin-colored nodules that typically present as an acquired solitary lesion, predominantly located on the buttocks and thighs. We aimed to differentiate between pedunculated lipofibromas and nevus lipomatosus superficialis. Although benign, this may be important as treatment options vary. METHODS:We describe 3 cases of solitary pedunculated lipofibromas occurring in older, obese adults that required clinicopathologic correlation for the correct diagnosis. RESULTS:The histopathologic features of pedunculated lipofibromas include a broad-based lesion with aggregates of mature adipocytes extending upwards into the dermis without an associated inflammatory infiltrate. The primary histopathologic differential diagnoses include fibroepithelial polyps with adipocytes and nevus lipomatosus superficialis, which is more frequently found in children or young adults and is typically characterized clinically by multiple lesions with a cerebriform to verrucoid surface. CONCLUSIONS:While the precise relationship between pedunculated lipofibromas and nevus lipomatosus is still unknown, we propose using pedunculated lipofibroma as a more specific clinical term to refer to solitary pedunculated or broad-based fatty lesions with a smooth surface that occur in older patients and in a wide anatomic distribution.
Real world outcomes of melanoma surveillance using the MoleMap NZ telemedicine platform
BACKGROUND:MoleMap NZ is a novel New Zealand based store-and-forward telemedicine service to detect melanoma. It utilizes expert review of total body photography and close-up and dermoscopic images of skin lesions suspicious for malignancy. OBJECTIVE:The purpose of this study was to assess the effectiveness of MoleMap NZ as a melanoma early detection program. METHODS:We conducted a review of 2,108 melanocytic lesions recommended for biopsy/excision by MoleMap NZ dermoscopists from January 2015-December 2016. RESULTS:Pathologic diagnoses were available for 1,571 lesions. Of these, 1,303 (83%) lesions were benign and 260 (17%) lesions were diagnosed as melanoma, for a melanoma-specific benign-to-malignant ratio of 5.0 to 1. The number-needed-to-biopsy one melanoma was 6. Among melanomas with available tumor thickness data (n=137), 92% were <0.8mm (range: in situ - 3.1mm), with in-situ melanomas comprising 74%. LIMITATIONS/CONCLUSIONS:Only lesions recommended for excision were analyzed. Pathology results were available for 75% of these cases. Tumor thickness data was available for 53% of melanomas diagnosed. CONCLUSION/CONCLUSIONS:This real-world study of MoleMap NZ, a community-based teledermoscopy program, suggests that it has the potential to increase patients' access to specialist expertise via telemedicine. Additional studies are needed to more accurately define its efficacy.
Consensus recommendations for the use of noninvasive melanoma detection techniques based on results of an international Delphi process
Utility of confocal microscopy in the management of lentigo maligna and lentigo maligna melanoma
536 Impact of electrical impedance spectroscopy on diagnostic accuracy and clinician confidence in a survey-based evaluation of melanocytic skin lesions suspicious for melanoma [Meeting Abstract]
Nevisense is an FDA-cleared device to aid in diagnosing melanoma. Using a non-invasive probe, the device measures electrical impedance spectroscopy (EIS) of target skin lesions. While EIS has demonstrated high sensitivity in diagnosing melanoma, its impact on a clinician's diagnostic confidence remains unknown. We conducted a pilot study evaluating whether the addition of EIS scores to clinical and dermoscopic images increases diagnostic confidence, accuracy, sensitivity, and specificity for students and dermatologists when evaluating lesions clinically suspicious for melanoma. Three pigmented lesions specialists and three 4th year medical students completed an online survey to evaluate 34 melanocytic lesions suspicious for melanoma. For each lesion, participants provided their diagnosis, biopsy recommendation, and confidence in diagnosing a lesion as benign or malignant based on history and clinical and dermoscopic images, and again after receiving an EIS score. Addition of EIS scores increased mean biopsy sensitivity for melanoma/severe dysplastic nevi (DN) from 70% to 84% (p =.014) and mean diagnostic accuracy from 74% to 86% (p =.005). Mean diagnostic confidence increased for 29/34 lesions, of which 26 were accurately diagnosed by >=4 evaluators. Increases in diagnostic confidence were significant for common melanocytic nevi, DN, and melanoma, for both students and dermatologists (all p <.05). Use of EIS may increase clinicians' confidence to provide greater reassurance regarding dermoscopically equivocal lesions such as DN. EIS thus has the potential to help clinicians better alleviate patients' anxieties during skin exams. EIS may also improve management of melanocytic lesions suspicious for melanoma among novice and expert diagnosticians, though further investigation is needed to determine if these findings translate to clinical settings. NB: All authors except for Ms. Fried are team members for a separate study utilizing a Nevisense device, loaned to NYU by Scibase.
Association between halo nevi and melanoma in adults: A multicenter retrospective case series
Dermoscopic features of neoplasms in skin of color: A review
Background/UNASSIGNED:Dermoscopy is undoubtedly a useful tool to improve diagnostic accuracy and minimize the number of unnecessary biopsies. However, much of the literature on dermoscopy focuses on findings in lighter-skin phototypes, leaving potential gaps of knowledge regarding its use in skin of color (SoC). As the clinical applications of dermoscopy continue to increase, understanding dermoscopic patterns in SoC is imperative. Objective/UNASSIGNED:This review discusses the literature on dermoscopic findings of neoplasms in SoC, highlighting unique and characteristic dermoscopic features. Methods/UNASSIGNED:A literature review was performed using the PubMed database. Case reports, case series, case-control studies, and systematic reviews were included. Results/UNASSIGNED:A total of 8326 studies were identified based on the selected search terms, and 41 were included in this review based on relevance. Conclusion/UNASSIGNED:There are specific dermoscopic characteristics in SoC for benign nevi, acral lentiginous melanoma, ethnic melanonychia, and dermatofibroma; however, there is a lack of published data about specific features of cutaneous melanoma, subungual melanoma, pigmented basal cell carcinoma, and pigmented squamous cell carcinoma in SoC. Because pigmented basal cell carcinoma, pigmented squamous cell carcinoma, ethnic melanonychia, and acral lentiginous melanoma are diagnosed at later stages in this population, it is important to understand their dermoscopic features. Further descriptive studies are needed to better characterize unique dermoscopic features in neoplasms in SoC.