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| 2. |
- Börve, Alexander, et al.
(författare)
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Smartphone Teledermoscopy Referrals: A Novel Process for Improved Triage of Skin Cancer Patients.
- 2015
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Ingår i: Acta dermato-venereologica. - : Medical Journals Sweden AB. - 1651-2057 .- 0001-5555. ; 95:2, s. 186-190
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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.
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| 3. |
- Dahlén Gyllencreutz, Johan, et al.
(författare)
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Diagnostic agreement and interobserver concordance with teledermoscopy referrals
- 2017
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Ingår i: Journal of the European Academy of Dermatology and Venereology. - : Wiley. - 0926-9959 .- 1468-3083. ; 31:5, s. 898-903
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundMalignant melanoma and non-melanoma skin cancers are among the fastest increasing malignancies in many countries. With the help of new tools, such as teledermoscopy referrals between primary health care and dermatology clinics, the management of these patients could be made more efficient. ObjectiveTo evaluate the diagnostic agreement and interobserver concordance achieved when assessing referrals sent through a mobile teledermoscopic referral system as compared to referrals sent via the current paper-based system without images. MethodsThe referral information from 80 teledermoscopy referrals and 77 paper referrals were evaluated by six Swedish dermatologists. They were asked to answer questions about the probable diagnosis, the priority, and a management decision. ResultsTeledermoscopy generally resulted in higher diagnostic agreement, better triaging and more malignant tumours being booked directly to surgery. The largest difference between the referral methods was seen for invasive melanomas. Referrals for benign lesions were significantly more often correctly resent to primary health care with teledermoscopy. However, referrals for cases of melanoma in situ were also incorrectly resent five times. The interobserver concordance was moderate with both methods. ConclusionBy adding clinical and dermoscopic images to referrals, the triage process for both benign and dangerous skin tumours can be improved. With teledermoscopy, patients with melanoma especially can receive treatment more swiftly.
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| 4. |
- Ericson, Marica B, 1974, et al.
(författare)
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Fluorescence contrast and threshold limit: implications for photodynamic diagnosis of basal cell carcinoma
- 2003
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Ingår i: Journal of Photochemistry and Photobiology. B: Biology. - 1011-1344. ; 69:2, s. 121-7
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Tidskriftsartikel (refereegranskat)abstract
- This study was designed to evaluate what application time of delta-5-aminolaevulinic acid (ALA) results in highest contrast between tumour and normal skin, in the interval 1-4 h, when using photodynamic diagnosis (PDD) of basal cell carcinomas (BCC) located on the face. Moreover, a value of the demarcation limit has been derived based on the fluorescence variation in normal skin adjacent to the tumour. Forty patients were included in the study, randomly allocated to four different groups with varying ALA application time in the range 1-4 h. The contrast, defined as the ratio between the fluorescence intensity in ALA-treated tumour tissue and normal skin, was calculated for each patient, and the mean values in each group were evaluated as a function of ALA application time. In addition, the fluorescence intensity variation in ALA-treated normal skin adjacent to the tumour was assessed. The results from this study show a peak of the mean contrast values after 3 h ALA application, but due to large interpatient variation, the mean contrast did not differ significantly in the interval 2-4 h. After 2 h ALA application, the fluorescence intensity variation in the normal ALA-treated skin was found to be at a maximum, which suggests that 2 h ALA application is not preferable when using PDD. Based on data of the fluorescence variation in ALA-treated normal skin after 3 and 4 h ALA application, a tolerance interval was calculated implying that values above 1.4 times the mean normal fluorescence indicate an abnormal condition. This tolerance limit agrees well with results obtained in a former study.
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| 5. |
- Ericson, Marica, 1974, et al.
(författare)
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Photodynamic therapy of actinic keratosis at varying fluence rates : Assessment of photobleaching, pain and primary clinical outcome
- 2004
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Ingår i: British Journal of Dermatology. - : Oxford University Press (OUP). - 0007-0963 .- 1365-2133. ; 151, s. 1204-1212
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Tidskriftsartikel (refereegranskat)abstract
- Background: Although photodynamic therapy (PDT) is becoming an important treatment method for skin lesions such as actinic keratosis (AK) and superficial basal cell carcinoma, there are still discussions about which fluence rate and light dose are preferable. Recent studies in rodents have shown that a low fluence rate is preferable due to depletion of oxygen at high fluence rates. However, these results have not yet been verified in humans. Objectives: The objective was to investigate the impact of fluence rate and spectral range on primary treatment outcome and bleaching rate in AK using aminolaevulinic acid PDT. In addition, the pain experienced by the patients has been monitored during treatment. Patients/methods Thirty-seven patients (mean age 71 years) with AK located on the head, neck and upper chest were treated with PDT, randomly allocated to four groups: two groups with narrow filter (580-650 nm) and fluence rates of 30 or 45 mW cm-2, and two groups with broad filter (580-690 nm) and fluence rates of 50 or 75 mW cm-2. The total cumulative light dose was 100 J cm-2 in all treatments. Photobleaching was monitored by fluorescence imaging, and pain experienced by the patients was registered by using a visual analogue scale graded from 0 (no pain) to 10 (unbearable pain). The primary treatment outcome was evaluated at a follow-up visit after 7 weeks. Results: Our data showed a significant correlation between fluence rate and initial treatment outcome, where lower fluence rate resulted in favourable treatment response. Moreover, the photo-bleaching dose (1/e) was found to be related to fluence rate, ranging from 4.5 ± 1.0 J cm -2 at 30 mW cm-2, to 7.3 ± 0.7 J cm-2 at 75 mW cm-2, indicating higher oxygen levels in tissue at lower fluence rates. After a cumulative light dose of 40 J cm-2 no further photobleaching took place, implying that higher doses are excessive. No significant difference in pain experienced by the patients during PDT was observed in varying the fluence rate from 30 to 75 mW cm-2. However, the pain was found to be most intense up to a cumulative light dose of 20 J cm-2. Conclusions: Our results imply that the photobleaching rate and primary treatment outcome are dependent on fluence rate, and that a low fluence rate (30 mW cm-2) seems preferable when performing PDT of AK using noncoherent light sources.
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| 6. |
- Halldin, Christina, 1957, et al.
(författare)
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Nerve blocks enable adequate pain relief during topical photodynamic therapy of field cancerization on the forehead and scalp
- 2009
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Ingår i: British Journal of Dermatology. - 1365-2133. ; 160:4, s. 795-800
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Topical photodynamic therapy (PDT) is an effective method when treating extensive areas of sun-damaged skin with multiple actinic keratoses (AKs) (field cancerization) on areas such as the forehead and scalp, and offers excellent cosmetic outcome. The major side-effect of PDT is the pain experienced during treatment. OBJECTIVES: To investigate whether nerve blocks could provide adequate pain relief during PDT of AKs on the forehead and scalp. METHODS: Ten men with symmetrically distributed and extensive AKs on the forehead and scalp were included in the study. Prior to PDT one side of the forehead and scalp was anaesthetized by nerve blocks while the other side served as control. RESULTS: The mean visual analogue scale (VAS) score on the anaesthetized side was 1 compared with 6.4 on the nonanaesthetized side during PDT. This difference was significant (P<0.0001), implying that nerve blocks reduce VAS scores during PDT. CONCLUSIONS: The results of the study support the use of nerve blocks as pain relief during PDT of field cancerization on the forehead and scalp, although individual considerations must be taken into account to find the most adequate pain-relieving method for each patient.
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| 7. |
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| 8. |
- Paoli, John, 1975, et al.
(författare)
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Response to the letter by Leitch et al.
- 2015
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Ingår i: Acta dermato-venereologica. - 1651-2057. ; 95:7, s. 870-1
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 9. |
- Paoli, John, 1975, et al.
(författare)
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Teaching peripheral nerve blocks for the head and neck area to dermatologists.
- 2012
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Ingår i: Journal of the European Academy of Dermatology and Venereology : JEADV. - : Wiley. - 1468-3083 .- 0926-9959. ; 26:8, s. 1035-1037
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Tidskriftsartikel (refereegranskat)abstract
- Background Peripheral nerve blocks in the head and neck region can be useful for a large number of surgical or otherwise painful procedures carried out by dermatologists. As anaesthesiologists cannot always be available to help dermatologists place nerve blocks in outpatient settings, training courses for these physicians are warranted. Objectives To present a method of teaching nerve blocks for the face and scalp to dermatologists during residency and/or continuing medical education programmes. Methods Half-day courses with theoretical education, video demonstrations and supervised 'hands-on' training were organized to teach supraorbital/supratrochlear, infraorbital, mental and occipital nerve blocks. The outcome and effects of these training courses were analysed with a survey amongst participants 1-2years after the course. Results All the 20 participants who responded the survey successfully placed at least one type of nerve block during the course. Thirteen of 20 participants (65%) reported to be able to perform all the nerve block techniques at follow-up. Conclusions Dermatologists can learn how to perform nerve blocks for the face and scalp in a safe and controlled manner through half-day courses, including theory, video demonstrations and supervised 'hands-on' training.
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| 10. |
- Sandberg, Carin, 1969
(författare)
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Aspects of Fluorescence diagnostics and photodynamic therapy of non-melanoma skin cancer
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aspects of fluorescence diagnostics and photodynamic therapy in non-melanoma skin cancer. Carin Sandberg Department of Dermatology and Venereology, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. ABSTRACT Photodynamic therapy (PDT) is now an established method to treat superficial basal cell carcinoma (BCC), Bowen’s disease (BD) and actinic keratosis (AK). The main advantage of PDT is that it is non-invasive and gives excellent cosmetic results; although the majority of the patients do experience some degree of pain, which can sometimes be extreme. Fluorescence diagnostics (FD) is a method to diagnose mainly BCC, which is the most common type of tumour within the class of non-melanoma skin cancer (NMSC) and accounts for about 80% of all skin tumours. This technique can be used as an in vivo pre-surgical diagnostic tool, which can help to detect occult tumour borders of ill-defined BCCs. In the first study (Paper I), the impact of fluence rate and spectral range on the primary treatment outcome and bleaching rate in AKs using aminolaevulinic acid (ALA)-PDT was studied. Pain during treatment was also registered. The results imply that the photobleaching rate and primary treatment outcome were dependent on the fluence rate and that a low fluence rate (30 mW/cm2) appears preferable. In the second study (Paper II), risk factors related to pain during PDT for AK were investigated. The most important factors relating to the experience of pain seem to be the size and “redness” of the lesion. No significant pain relief with capsaicin was seen. In the third study (Paper III), the transdermal penetration of ALA and methyl-aminolaevulinate (MAL) in vivo were investigated using a microdialysis technique. The results imply that there is no significant difference in transdermal penetration of ALA and MAL in tumour tissue. Detectable levels of the drug were not obtained in almost 50% of the lesions where catheters were inserted 1-1.9 mm into the lesion. Curettage was not found to affect the interstitial concentration, indicating that penetration of the drug might indeed be a problem when treating BCCs thicker than 1 mm. In the final study presented within this thesis (Paper IV), the fluorescence contrast in patients undergoing MAL-PDT for superficial BCCs was evaluated. The MAL fluorescence contrast obtained between the tumour and normal skin was also compared to that obtained in a previous study using ALA. In both cases it was possible to identify areas in the fluorescence images corresponding to a tumour and to surrounding normal skin. The mean fluorescence contrast with MAL, however, was significantly higher than the mean fluorescence contrast after application of ALA. Thus, MAL generally renders a higher tumour contrast compared to ALA in superficial BCCs. No correlation between fluorescence and treatment response could be observed. The results of this thesis prove that PDT, using either ALA or MAL, is effective in the treatment of thin non-melanoma skin cancer and pre-cancer. These results further suggest that lower fluence rate should be considered as a precaution to minimise pain response when treating large and inflammatory lesions, although more study is needed. When performing FD, MAL is the best option and lack of treatment response cannot be connected to fluorescence but maybe due to the fact that the pro-drug does not successfully penetrate into the deeper parts of the tumour. Key words: actinic keratosis, aminolaevulinic acid, fluorescence contrast, methyl-aminolaevulinic acid, microdialysis, non-melanoma skin cancer, pain, photodynamic therapy ISBN 978-91-628-7874-0, http://hdl.handle.net/2077/21192 Gothenburg 2009
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