| 1. |
- 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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| 2. |
- Dahlén Gyllencreutz, Johan
(författare)
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Benefits and risks with digital dermoscopy and teledermoscopy
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The increasing incidence of malignant melanoma and non-melanoma skin cancer (NMSC) makes it necessary to optimize the management of patients with suspicious skin lesions, from triaging, to establishing a diagnosis and planning treatment. The purpose of this thesis is to investigate the use of teledermoscopy (TDS) as a way of achieving such an optimization, as well as to study safety aspects of digital dermoscopy and teledermoscopy while pointing out risks and pitfalls so that they can be avoided. In study I, smartphone TDS was compared with traditional paper referrals. The outcome of 772 patients referred by TDS from 20 primary health care (PHC) centres to two dermatology departments was compared to that of 746 patients referred without images. TDS provided faster management of patients with skin cancer and more accurate prioritisation. In study II, 80 TDS referrals and 77 paper referrals were evaluated by six dermatologists resulting in moderate interobserver concordance. The diagnostic agreement with TDS was higher for several diagnoses. It also proved easier to plan for surgery at the first visit and to resend referrals with clearly benign lesions. However, a few referrals with malignant lesions were incorrectly resent. In study III, two dermatologists compared the image quality of 172 dermoscopic images acquired in PHC with images of the same tumours obtained at the department of dermatology. The PHC images were of slightly lower quality but the difference was not statistically significant. No difference was found in the ability to correctly diagnose the lesions. In study IV, dermoscopic images of skin lesions, obtained before and after the use of a sunless tanning product containing dihydroxyacetone (DHA) were compared. For facial lesions, there were significantly more equivocal lesions after the use of DHA. A follicular pigmentation was often found, somewhat mimicking that of lentigo maligna. In conclusion, TDS can result in safer, more efficient management of patients with skin lesions of concern, earlier treatment of patients with malignant lesions and decreasing the need for unnecessary visits to a dermatologist. TDS images obtained in PHC are of similar quality to those obtained by trained dermatologists. When triaging TDS referrals, dermatologists should avoid resending referrals for clinically atypical melanocytic lesions and take into consideration the use of pigment-altering substances such as DHA.
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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. |
- Dahlén Gyllencreutz, Johan, et al.
(författare)
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Teledermoscopy images acquired in primary health care and hospital settings - a comparative study of image quality.
- 2018
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Ingår i: Journal of the European Academy of Dermatology and Venereology : JEADV. - : Wiley. - 1468-3083 .- 0926-9959. ; 32:6, s. 1038-1043
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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.
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| 5. |
- 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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| 6. |
- Johansson Backman, Eva, et al.
(författare)
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Basal cell carcinoma: Epidemiological impact of clinical versus histopathological diagnosis.
- 2023
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Ingår i: Journal of the European Academy of Dermatology and Venereology : JEADV. - : Wiley. - 1468-3083 .- 0926-9959. ; 37:3, s. 521-527
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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.
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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. |
- 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. |
- 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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| 10. |
- 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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| 11. |
- 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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