| 1. |
- Fougelberg, Julia, et al.
(författare)
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Cryosurgery versus curettage for intraepidermal carcinoma: A randomized controlled trial
- 2023
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Ingår i: Journal of the European Academy of Dermatology and Venereology. - 0926-9959. ; 37:11, s. 2370-2377
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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.
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| 2. |
- Fougelberg, Julia, et al.
(författare)
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Decreased sexual risk behaviour after the diagnosis of HIV and initiation of antiretroviral treatment - a study of patients in Johannesburg : prevention
- 2006
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Ingår i: Southern African Journal of HIV Medicine. ; :25, s. 12-15
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. An extended programme for free antiretroviral treatment (ART) of HIV was launched in South Africa in April 2004. It is essential to assess the effects on sexual risk behaviour. Design and setting. A questionnaire was distributed to patients on ART at Helen Joseph Hospital, Johannesburg, between 17 January and 22 February 2005. Results. The percentage of men who had sexual contacts outside their relationship decreased from 48% before HIV diagnosis to 11% after starting ART. Condom use with casual partners increased from 53% among the men and 46% among the women before the diagnosis of HIV to 87% and 81% respectively on ART. The majority of patients were tested for HIV because they presented with symptoms of illness. We noted no significant difference in disclosure rate after the start of ART. All participants were positive about the treatment and felt physically better. The majority of the patients experienced a better quality of life. Conclusions. The ART had an overall positive effect on health with no increase of sexual risk behaviour.
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| 3. |
- Fougelberg, Julia, et al.
(författare)
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Dermoscopic Findings in Intraepidermal Carcinoma: an Interobserver Agreement Study
- 2023
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Ingår i: Dermatology Practical & Conceptual. - : Mattioli1885. - 2160-9381. ; 13:1
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: A wide range of descriptive terms have been used for dermoscopic findings in intraepidermal carcinoma (IEC) and the clinical diagnostic accuracy of IEC can be challenging. Furthermore, dermoscopic findings in IEC have only rarely been evaluated in fair-skinned populations.Objectives: To measure the interobserver agreement between dermatologists for dermoscopic findings in IEC. Furthermore, to describe the frequency of these findings in a predominantly fair-skinned population. Methods: One hundred dermoscopic images of histopathologically verified IECs were collected. The 11 most common dermoscopic findings described in previous studies were re-defined in a new terminology in a pre-study consensus meeting. Images were assessed by eight experienced international dermoscopists. The frequency of findings and the interobserver agreement was analyzed.Results: Scales (83%), dotted/glomerular vessels (77%), pinkish-white areas (73%) and hemorrhage (46%) were the most commonly present dermoscopic findings. Pigmented structures were found in 32% and shiny white structures (follicular or stromal) in 54% of the IEC. Vascular structures (vessels and/or hemorrhage) could be seen in 89% of the lesions. Overall, the interobserver agreement for the respective dermoscopic findings was poor to moderate, with the highest kappa values noted for scales (0.55) and hemorrhage (0.54) and the lowest for pinkish-white areas (0.015).Conclusion: Our results confirm those of previous studies on dermoscopy in IEC, including the frequency of pigmented structures despite the fair-skinned population. The interobserver agreement was relatively low. The proposed new terminology and our findings can hopefully serve as a guideline for researchers, teachers and students on how to identify IEC.
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| 4. |
- Fougelberg, Julia
(författare)
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On the diagnosis and treatment of intraepidermal carcinoma
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Abstract: Intraepidermal carcinoma (IEC), also known as Bowen disease (BD) or squamous cell carcinoma (SCC) in situ, is a precursor to SCC. The incidence of IEC is increasing rapidly in fair-skinned populations with a subsequent increase in patient morbidity. This calls for optimized patient management through improving diagnosis and choosing the most advantageous treatment. A key step is making a correct diagnosis, which is best accomplished using dermoscopy prior to histopathological confirmation. Several treatment options are available for IEC, e.g. photodynamic therapy (PDT), surgical excision and destructive methods like cryosurgery and curettage. The purpose of this thesis was to evaluate the agreement between dermatologists on the dermoscopic findings of IEC as well as the effectiveness of PDT, surgical excisions and a comparison between cryosurgery and curettage. In Paper I, we measured the interobserver agreement between international dermatologists on dermoscopic findings in IEC. The frequency of pre-defined dermoscopic findings were: scales (83%), dotted/glomerular vessels (77%), pinkish-white areas (73%), and hemorrhage (46%). The interobserver agreement ranged from poor to moderate with the highest Kappa values noted for scales (0.55) and hemorrhage (0.54), while pinkish- white areas showed the lowest Kappa value (0.015). In Paper II, we assessed the effectiveness, recurrence risk, and factors affecting the response rate of PDT for IEC. PDT is a relatively effective treatment modality with an overall clearance rate of 63.4%. Larger lesions (>20 mm) and a single PDT session were risk factors for unsuccessful treatment. In Paper III, we aimed to evaluate the clinicopathological risk factors for incomplete excision of IEC. Less surgical experience was independently associated with incomplete surgical excisions using a less strict definition (mild to moderate dysplasia at the resection margin), whereas less experience and location on the head and neck area or upper extremities was independently associated with incomplete excision using a strict definition (no dysplasia at the resection margin). In Paper IV, we performed a randomized controlled trial to compare the effectiveness of cryosurgery and curettage for IEC. The overall clearance rate 1 year after cryosurgery was significantly higher than with curettage (94.6% vs 78.9%). Nevertheless, wound healing times were significantly shorter with curettage. In conclusion, the interobserver agreement for dermoscopic findings of IEC is poor to moderate. PDT provides clearance in approximately two-thirds of the treated IECs. Risk factors for incomplete excisions of IEC are less experienced surgeons and location on the head and neck area or upper extremities. Cryosurgery and curettage both show high clearance rates, with cryosurgery being significantly more effective and wound healing times being shorter with curettage.
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| 5. |
- Fougelberg, Julia, et al.
(författare)
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Surgery for Bowen Disease: Clinicopathological Factors Associated With Incomplete Excision
- 2021
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Ingår i: Dermatology Practical & Conceptual. - : Mattioli1885. - 2160-9381. ; 11:2
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Tidskriftsartikel (refereegranskat)abstract
- Background: One common treatment for Bowen disease (BD) is surgical excision, but there is no international consensus on the appropriate surgical margins. Objectives: This study examined what factors affect the rate of incomplete excision of BD. Methods: Clinicopathological data potentially linked to surgical outcome (complete or incomplete excision) were retrospectively collected from medical and histopathological records on all surgically excised BD lesions diagnosed at Sahlgrenska University Hospital in Gothenburg, Sweden during 2014-2015. Data were analyzed with two definitions of incomplete excision: less strict (ie, BD present at the surgical margin) and strict (ie, dysplasia present at the surgical margin). Results: In total, 463 BD lesions among 408 patients were included. With the less strict definition, 3 factors were associated with significantly higher rates of incomplete excision: surgical margins <3 mm, a less experienced surgeon, and use of punch biopsy excision. The same factors plus a tumor location on the head and neck area or upper extremities were associated with significantly higher rates of incomplete excision using the strict definition. After adjustment for confounders, less experience was independently associated with incomplete excision using the less strict definition, whereas less experience and location on the head and neck area or upper extremities were independently associated with incomplete excision using the strict definition. Surgeon specialty was not associated with incomplete excision regardless of the definition. Conclusions: When removing BD surgically, an elliptical excision with surgical margins >= 3 mm carried out by an experienced surgeon should be recommended. Surgical margins may need to be adjusted depending on body site.
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| 6. |
- Gillstedt, Martin, 1977, et al.
(författare)
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Evaluation of Melanoma Thickness with Clinical Close-up and Dermoscopic Images Using a Convolutional Neural Network
- 2022
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Ingår i: Acta dermato-venereologica. - : Medical Journals Sweden AB. - 0001-5555 .- 1651-2057. ; 102
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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.
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| 7. |
- Paoli, John, 1975, et al.
(författare)
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Nonsurgical Options for the Treatment of Basal Cell Carcinoma.
- 2019
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Ingår i: Dermatology practical & conceptual. - : Mattioli1885. - 2160-9381. ; 9:2, s. 75-81
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this review article is to summarize the effectiveness, potential adverse events, and indications of the main nonsurgical treatment alternatives for basal cell carcinoma.An extensive literature review was carried out. The most relevant articles were discussed and selected by the authors in order to provide a brief but evidence-based overview of the most common nonsurgical methods used for treating basal cell carcinoma.Although surgery and Mohs micrographic surgery are often considered the optimal treatment options for basal cell carcinoma, these tumors can also be treated successfully with destructive techniques (eg, curettage alone, cryosurgery, or electrodesiccation), photodynamic therapy, topical drugs (eg, 5-fluorouracil, imiquimod, or ingenol mebutate), radiotherapy, or hedgehog pathway inhibitors. When choosing between these alternatives, physicians must take into consideration the tumor's size, location, and histopathological subtype. Special care should be taken when treating recurrent tumors. Furthermore, physician experience is of great importance when using destructive techniques. Finally, patient preference, potential adverse events, and cosmetic outcome should also be considered.Dermatologists and physicians treating basal cell carcinoma should have knowledge of and experience with the large arsenal of therapeutic alternatives available for the successful, safe, and individualized management of patients with basal cell carcinoma.
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| 8. |
- Polesie, Sam, et al.
(författare)
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Can Dermoscopy Be Used to Predict if a Melanoma Is In Situ or Invasive?
- 2021
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Ingår i: Dermatology Practical & Conceptual. - : Mattioli1885. - 2160-9381. ; 11:3
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Tidskriftsartikel (refereegranskat)abstract
- Background: The preoperative prediction of whether melanomas are invasive or in situ can influence initial management. Objectives: This study evaluated the accuracy rate, interobserver concordance, sensitivity and specificity in determining if a melanoma is invasive or in situ, as well as the ability to predict invasive melanoma thickness based on clinical and dermoscopic images. Methods: In this retrospective, single-center investigation, 7 dermatologists independently reviewed clinical and dermoscopic images of melanomas to predict if they were invasive or in situ and, if invasive, their Breslow thickness. Fleiss' and Cohen's kappa (kappa) were used for interobserver concordance and agreement with histopathological diagnosis. Results: We included 184 melanomas (110 invasive and 74 in situ). Diagnostic accuracy ranged from 67.4% to 76.1%. Accuracy rates for in situ and invasive melanomas were 57.5% (95% confidence interval [I], 53.1%-61.8%) and 81.7% (95% CI, 78.8%-84.4%), respectively. Interobserver concordance was moderate (kappa = 0.47; 95% CI, 0.44-0.51). Sensitivity for predicting invasiveness ranged from 63.6% to 91.8% for 7 observers, while specificity was 32.4%-82.4%. For all correctly predicted invasive melanomas, agreement between predictions and correct thickness over or under 1.0 mm was moderate (kappa = 0.52; 95% CI, 0.45-0.58). All invasive melanomas incorrectly predicted by any observer as in situ had a thickness <1.0 mm. All 32 melanomas >1.0 mm were correctly predicted to be invasive by all observers. Conclusions: Accuracy rates for predicting thick melanomas were excellent, melanomas inaccurately predicted as in situ were all thin, and interobserver concordance for predicting in situ or invasive melanomas was moderate. Preoperative dermoscopy of suspected melanomas is recommended for choosing appropriate surgical margins.
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| 9. |
- Polesie, Sam, et al.
(författare)
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Discrimination Between Invasive and In Situ Melanomas Using Clinical Close-Up Images and a De Novo Convolutional Neural Network
- 2021
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Ingår i: Frontiers in Medicine. - : Frontiers Media SA. - 2296-858X. ; 8
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Tidskriftsartikel (refereegranskat)abstract
- Background: Melanomas are often easy to recognize clinically but determining whether a melanoma is in situ (MIS) or invasive is often more challenging even with the aid of dermoscopy. Recently, convolutional neural networks (CNNs) have made significant and rapid advances within dermatology image analysis. The aims of this investigation were to create a de novo CNN for differentiating between MIS and invasive melanomas based on clinical close-up images and to compare its performance on a test set to seven dermatologists. Methods: A retrospective study including clinical images of MIS and invasive melanomas obtained from our department during a five-year time period (2016-2020) was conducted. Overall, 1,551 images [819 MIS (52.8%) and 732 invasive melanomas (47.2%)] were available. The images were randomized into three groups: training set (n = 1,051), validation set (n = 200), and test set (n = 300). A de novo CNN model with seven convolutional layers and a single dense layer was developed. Results: The area under the curve was 0.72 for the CNN (95% CI 0.66-0.78) and 0.81 for dermatologists (95% CI 0.76-0.86) (P < 0.001). The CNN correctly classified 208 out of 300 lesions (69.3%) whereas the corresponding number for dermatologists was 216 (72.0%). When comparing the CNN performance to each individual reader, three dermatologists significantly outperformed the CNN. Conclusions: For this classification problem, the CNN was outperformed by the dermatologist. However, since the algorithm was only trained and validated on 1,251 images, future refinement and development could make it useful for dermatologists in a real-world setting.
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| 10. |
- Polesie, Sam, et al.
(författare)
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Interobserver Agreement on Dermoscopic Features and their Associations with In Situ and Invasive Cutaneous Melanomas.
- 2021
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Ingår i: Acta dermato-venereologica. - : Medical Journals Sweden AB. - 1651-2057 .- 0001-5555. ; 101:10
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Tidskriftsartikel (refereegranskat)abstract
- Several melanoma-specific dermoscopic features have been described, some of which have been reported as indicative of in situ or invasive melanomas. To assess the usefulness of these features to differentiate between these 2 categories, a retrospective, single-centre investigation was conducted. Dermoscopic images of melanomas were reviewed by 7 independent dermatologists. Fleiss' kappa (κ) was used to analyse interobserver agreement of predefined features. Logistic regression and odds ratios were used to assess whether specific features correlated with melanoma in situ or invasive melanoma. Overall, 182 melanomas (101 melanoma in situ and 81 invasive melanomas) were included. The interobserver agreement for melanoma-specific features ranged from slight to substantial. Atypical blue-white structures (κ=0.62, 95% confidence interval 0.59-0.65) and shiny white lines (κ=0.61, 95% confidence interval 0.58-0.64) had a substantial interobserver agreement. These 2 features were also indicative of invasive melanomas >1.0 mm in Breslow thickness. Furthermore, regression/peppering correlated with thin invasive melanomas. The overall agreement for classification of the lesions as invasive or melanoma in situ was moderate (κ=0.52, 95% confidence interval 0.49-0.56).
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