| 1. |
|
|
| 2. |
- Berglund, Sofia, et al.
(författare)
-
Incomplete Excisions of Melanocytic Lesions: Rates and Risk Factors.
- 2021
-
Ingår i: Acta dermato-venereologica. - : Medical Journals Sweden AB. - 1651-2057. ; 101:3
-
Tidskriftsartikel (refereegranskat)abstract
- Incomplete excisions of melanocytic lesions occur despite the intention of complete removal. The aim of this study was to determine the incomplete excision rates for benign and malignant melanocytic lesions and the associated risk factors. Demographic, clinical, and histo-pathological data possibly associated with incomplete excision were collected from 2,782 consecutive excisions between 2014 and 2015. Of these, 269 melanocytic lesions (9.7%) were incompletely excised. Multivariate analysis revealed the following risk factors for significantly higher incomplete excision rates: lesions located in the head and neck area (odds ratio (OR) 3.95, 95% confidence interval (95% CI) 2.35-6.65), surgery performed by general practitioners (OR 3.01, 95% CI 2.16-4.19), the use of a punch excision technique (OR 2.83, 95% CI 1.96-4.08), and excision of non-dysplastic naevi (OR 1.58, 95% CI 1.11-2.23). In conclusion, more caution should be taken when excising melanocytic lesions in the head and neck area, general practitioners require more surgical training, and punch excisions of melanocytic lesions should be avoided.
|
|
| 3. |
|
|
| 4. |
- Börve, Alexander, et al.
(författare)
-
Smartphone Teledermoscopy Referrals: A Novel Process for Improved Triage of Skin Cancer Patients.
- 2015
-
Ingår i: Acta dermato-venereologica. - : Medical Journals Sweden AB. - 1651-2057 .- 0001-5555. ; 95:2, s. 186-190
-
Tidskriftsartikel (refereegranskat)abstract
- In this open, controlled, multicentre and prospective observational study, smartphone teledermoscopy referrals were sent from 20 primary healthcare centres to 2 dermatology departments for triage of skin lesions of concern using a smartphone application and a compatible digital dermoscope. The outcome for 816 patients referred via smartphone teledermoscopy was compared with 746 patients referred via the traditional paper-based system. When surgical treatment was required, the waiting time was significantly shorter using teledermoscopy for patients with melanoma, melanoma in situ, squamous cell carcinoma, squamous cell carcinoma in situ and basal cell carcinoma. Triage decisions were also more reliable with teledermoscopy and over 40% of the teledermoscopy patients could potentially have avoided face-to-face visits. Only 4 teledermoscopy referrals (0.4%) had to be excluded due to poor image quality. Smartphone teledermoscopy referrals allow for faster and more efficient management of patients with skin cancer as compared to traditional paper referrals.
|
|
| 5. |
- Dahlén Gyllencreutz, Johan, et al.
(författare)
-
Teledermoscopy images acquired in primary health care and hospital settings - a comparative study of image quality.
- 2018
-
Ingår i: Journal of the European Academy of Dermatology and Venereology : JEADV. - : Wiley. - 1468-3083 .- 0926-9959. ; 32:6, s. 1038-1043
-
Tidskriftsartikel (refereegranskat)abstract
- The incidence of melanoma and non-melanoma skin cancer is increasing, which has also lead to an increase in referrals between primary health care (PHC) and dermatology departments, putting a strain on healthcare services. Teledermoscopy (TDS) referrals from PHC can improve the triage process for patients with suspicious skin tumours, but the quality of the images included could potentially affect its usefulness.To critically appraise the quality of the dermoscopic images of a smartphone TDS system, by comparing the TDS referral images with images of the same tumours acquired at the department of dermatology.Two dermatologists rated the image quality of two image sets from 172 skin tumours separately. The dermatologists also decided on a main diagnosis, differential diagnoses and described the visible dermoscopic structures.The images acquired in PHC were rated as having slightly lower quality, but there was no significant difference. PHC images and dermatology images were of intermediate-to-high quality in 95.5%-97.7% and 96.5%-98.8%, respectively. There was no difference in agreement between the TDS diagnosis based on the two image sets with the final clinical or histopathological diagnosis. Most image pairs (81.4% and 83.7%) received the same main diagnosis by the two evaluators. When this was not the case, the most common reasons were poor focus, excessive pressure applied when acquiring the image or inadequate amount of zoom.TDS performed in PHC with a smartphone-based system does not seem to negatively affect the usefulness of TDS referrals. Thus, physicians at PHC do not necessarily need to be trained photographers to ensure adequate TDS image quality. Knowledge about technical difficulties could however be used when training PHC staff, to improve the image quality further.
|
|
| 6. |
- Fougelberg, Julia, et al.
(författare)
-
Cryosurgery versus curettage for intraepidermal carcinoma: A randomized controlled trial
- 2023
-
Ingår i: Journal of the European Academy of Dermatology and Venereology. - 0926-9959. ; 37:11, s. 2370-2377
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundCryosurgery is a common destructive treatment method for intraepidermal carcinoma (IEC) above the knee. Curettage alone is a simple, non-aggressive and inexpensive treatment method commonly used on benign skin lesions. However, only one study has assessed curettage for treatment of IEC. ObjectiveWe aimed to (1) compare the effectiveness of cryosurgery (standard method) to curettage (experimental method) for treatment of IEC in regard to overall clearance rates at 1-year follow-up, and (2) investigate whether wound healing times differed between the treatment groups. MethodsIn this randomized and controlled, non-inferiority trial, adult patients with one or more IEC with a diameter of 5-20 mm, located above the knee and suitable for destructive treatment were recruited from Sahlgrenska University Hospital (Gothenburg, Sweden). Lesions were randomized to treatment with either cryosurgery or curettage. Wound healing was assessed by a nurse after 4-6 weeks and through self-report forms. Overall clearance was assessed by a dermatologist after 1 year. ResultsIn total, 183 lesions in 147 patients were included, with 93 lesions randomized to cryosurgery and 90 to curettage. Eighty-eight (94.6%) of the lesions in the cryosurgery group and 71 (78.9%) in the curettage group showed an overall clearance at the 1-year follow-up visit (p = 0.002). The non-inferiority analysis was inconclusive. Curettage resulted in both shorter self-reported wound healing times (mean time 3.1 vs. 4.8 weeks, p < 0.001) and a larger proportion of healed wounds after 4-6 weeks (p < 0.001). ConclusionsCryosurgery and curettage both result in high clearance rates for treatment of IEC, but cryosurgery is significantly more effective. On the other hand, curettage may result in shorter wound healing times.
|
|
| 7. |
- Gillstedt, Martin, 1977, et al.
(författare)
-
Evaluation of Melanoma Thickness with Clinical Close-up and Dermoscopic Images Using a Convolutional Neural Network
- 2022
-
Ingår i: Acta dermato-venereologica. - : Medical Journals Sweden AB. - 0001-5555 .- 1651-2057. ; 102
-
Tidskriftsartikel (refereegranskat)abstract
- Convolutional neural networks (CNNs) have shown promise in discriminating between invasive and in situ melanomas. The aim of this study was to analyse how a CNN model, integrating both clinical close-up and dermoscopic images, performed compared with 6 in-dependent dermatologists. The secondary aim was to address which clinical and dermoscopic features derma-tologists found to be suggestive of invasive and in situ melanomas, respectively. A retrospective investigation was conducted including 1,578 cases of paired images of invasive (n = 728, 46.1%) and in situ melanomas (n = 850, 53.9%). All images were obtained from the Department of Dermatology and Venereology at Sahl-grenska University Hospital and were randomized to a training set (n = 1,078), a validation set (n = 200) and a test set (n = 300). The area under the receiver operating characteristics curve (AUC) among the der-matologists ranged from 0.75 (95% confidence in-terval 0.70-0.81) to 0.80 (95% confidence interval 0.75-0.85). The combined dermatologists' AUC was 0.80 (95% confidence interval 0.77-0.86), which was significantly higher than the CNN model (0.73, 95% confidence interval 0.67-0.78, p = 0.001). Three of the dermatologists significantly outperformed the CNN. Shiny white lines, atypical blue-white structures and polymorphous vessels displayed a moderate interob-server agreement, and these features also correlated with invasive melanoma. Prospective trials are needed to address the clinical usefulness of CNN models in this setting.
|
|
| 8. |
- Johansson Backman, Eva, et al.
(författare)
-
Basal cell carcinoma: Epidemiological impact of clinical versus histopathological diagnosis.
- 2023
-
Ingår i: Journal of the European Academy of Dermatology and Venereology : JEADV. - : Wiley. - 1468-3083 .- 0926-9959. ; 37:3, s. 521-527
-
Tidskriftsartikel (refereegranskat)abstract
- Low-risk basal cell carcinomas (BCCs) are to an increasing extent diagnosed by dermatologists through dermoscopic examination only and treated with non-surgical methods. Reports on increasing incidence as well as trends regarding subtypes, anatomical sites and differences related to gender are based solely on histopathologically verified tumours. How unreported clinically diagnosed BCCs affect the epidemiological data has not been sufficiently investigated.To analyse the tumour and patient characteristics of clinically diagnosed versus histopathologically confirmed primary BCCs and to make a gross estimate on how unreported BCCs could influence the total number of new cases.We retrospectively reviewed all primary BCCs diagnosed in 2016 at the Department of Dermatology, Sahlgrenska University Hospital in Gothenburg, Sweden. We also reviewed all histopathologically verified primary BCCs at the two largest pathology laboratories in Western Sweden during the same year to estimate the proportion of BCCs diagnosed by dermatologists.In total, 2365 primary BCCs were diagnosed at our centre. More than half of these tumours were clinically diagnosed (55.8%). Superficial subtype (41.7%), location on the trunk (46.3%) and destructive treatment methods (60.0%) were most common. The reports from the two pathology laboratories showed that histopathologically verified BCCs (n=5837) were more commonly of the infiltrative or nodular subtype and located in the head and neck area. Dermatologists managed 56.0% of them.This study indicates that a substantial number of BCCs are not visualized in the official statistics which are solely based on reports from pathology laboratories. When taking clinically diagnosed tumours into account, truncal location and superficial subtype are more common than previously believed. Further, based on the regional calculations, the real burden of BCC in Sweden might be up to 70% higher than what is reported in official statistics.
|
|
| 9. |
- Johansson Backman, Eva
(författare)
-
Basal cell carcinoma: real-life burden on healthcare and simplified destructive treatments
- 2023
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Basal cell carcinoma (BCC) is the most common cancer in humans. With steadily increasing incidence rates, there is a constant need to evaluate current diagnostic methods and treatment alternatives to achieve effective care for the patients while considering available healthcare funding. This thesis consists of four original papers and addresses potential changes concerning the burden of BCC but also evaluates whether destructive treatment methods can be further simplified with maintained effectiveness and patient satisfaction. Paper I compared clinically diagnosed BCCs with histopathologically confirmed BCCs to make an estimation of how well official statistics reflect real-world data. The study indicated that the burden of BCC in Sweden may be up to 70% higher than reported in official statistics and that BCCs with truncal location and superficial subtype were more prevalent than previously reported, especially among males. Papers II to IV are components of a larger research project, with randomized controlled trials, comparing different destructive treatment protocols for various subtypes of low-risk BCCs. In Paper II, the effectiveness of curettage alone vs cryosurgery in a single freeze-thaw cycle for superficial BCCs was compared. The 1-year clinical clearance rates were 95.7 vs 100%, respectively (P=0.060). Oozing wounds lasted 0.8 weeks after curettage and 1.6 weeks after cryosurgery (P<0.0001). Paper III evaluated the effectiveness of curettage followed by cryosurgery in one or two freeze-thaw cycles for nodular BCCs. The 1-year clearance rates were 99% vs 100%, respectively (P=1). The average duration of oozing wounds was 1.0 week for one cycle and 1.2 weeks for two cycles (P=0.062). Paper IV employed a mixed methods design to investigate cosmetic outcomes and patients' preferences when deciding upon BCC treatment. The objective evaluation of cosmetic outcome was not comparable to patients’ satisfaction with their scars. For non-facial BCCs, most patients reported little concern about scarring. Their primary consideration was the expected clearance rates of the available treatments. Taken together, the results indicate that official statistics based on histopathologically confirmed BCCs significantly underestimate the true number of BCCs and that low-risk BCCs are more common than described. These low-risk lesions can be safely treated with simplified destructive treatments and patients seem to value an effective treatment more than an excellent cosmetic outcome.
|
|
| 10. |
|
|
