By Marilynn Larkin
NEW YORK (Reuters Health) - Dermoscopy can help identify seborrheic keratosis (SK)-like melanomas that are challenging to detect otherwise, researchers say.
Dr. Cristina Carrera of the University of Barcelona in Spain and colleagues asked two collaborators to evaluate dermoscopic images of skin lesions from 134 patients treated in nine skin cancer centers in Spain, France, Italy, and Austria.
Image and data from patients (72 men; mean age, 57) were collected from 2013 through 2014.
The evaluators weren’t told that all lesions were histopathologically proven melanomas. They assessed clinical descriptions and 48 dermoscopic features of the 134 images and classified each dermoscopically as SK or not SK. The total dermoscopy score and the seven-point checklist score (https://www.dermoscopy.org/consensus/2d.asp) - a measure of dermoscopic melanoma criteria - were also assessed.
As reported in JAMA Dermatology, online March 29, 82% of the lesions had dermoscopic features suggestive of melanoma, including pigment network (55.2%), blue-white veil (53.7%), globules and dots (50.7%), pseudopods or streaks (35.1%) and blue-black sign (32.3%).
The other 18% were considered likely SKs. Overall, those lesions showed a scaly and hyperkeratotic surface (33.6%), yellowish keratin (31.3%), comedo-like openings (30.5%), and milia-like cysts (22.4%).
The entire sample had a mean total dermoscopy score of 4.7 and a seven-point checklist score of 4.4. Dermoscopically SK-like melanomas had a dermoscopy score of 4.2 and a checklist score of 2.0, indicating they were likely benign.
Criteria most helpful in correctly diagnosing SK-like melanomas were the presence of a blue-white veil, pseudopods or streaks, and pigment network. Further analysis showed only the blue-black sign was significantly associated with a correct diagnosis, while hyperkeratosis and fissures and ridges were independent risk markers.
Dr. Carrera told Reuters Health, “Dermoscopy definitely aids in making a clinically correct diagnosis of skin lesions, and is strongly recommended to any professional before treating skin tumors.”
“Today, no melanoma should be mistreated or misdiagnosed,” she said by email.
Problems arise when clinicians don’t suspect melanoma, she added. “SKs are so frequent and generally easy to diagnose clinically that sometimes they lead us to treat them directly, without paying attention to (certain) features that should be looked at before ablation or cryotherapy.”
Dr. Carrera also noted that cosmeticians and general practitioners may be consulted about skin spots, tumors and verrucas. “These non-dermatologists should be aware of the existence of difficult melanomas that can simulate benign tumors such as SK,” she concluded.
Dr. Delphine Lee, a dermatologist at Providence Saint John’s Health Center in Santa Monica, California, told Reuters Health, “While the study defines key features observed under dermoscopy to distinguish SK-looking melanomas from actual SKs, a key finding is that only 82% of lesions which looked like SKs were correctly detected to be melanoma by dermoscopy.”
“This leaves 18% incorrectly judged,” she said by email. “While dermoscopy can be helpful, like most of our tools in medicine, it is not foolproof.”
“What is most important is for patients to see a board-certified dermatologist who can clinically follow any suspicious lesion, and monitor all lesions, using all our tools including a careful history, physical examination, and proper photography,” she concluded. “In the future, newer emerging technologies such as confocal microscopy might allow us to monitor at even higher magnification without a biopsy.”
SOURCE: https://bit.ly/2nYAtc2
JAMA Dermatol 2017.
(c) Copyright Thomson Reuters 2017. Click For Restrictions - https://about.reuters.com/fulllegal.asp
By Marilynn Larkin
NEW YORK (Reuters Health) - Dermoscopy can help identify seborrheic keratosis (SK)-like melanomas that are challenging to detect otherwise, researchers say.
Dr. Cristina Carrera of the University of Barcelona in Spain and colleagues asked two collaborators to evaluate dermoscopic images of skin lesions from 134 patients treated in nine skin cancer centers in Spain, France, Italy, and Austria.
Image and data from patients (72 men; mean age, 57) were collected from 2013 through 2014.
The evaluators weren’t told that all lesions were histopathologically proven melanomas. They assessed clinical descriptions and 48 dermoscopic features of the 134 images and classified each dermoscopically as SK or not SK. The total dermoscopy score and the seven-point checklist score (https://www.dermoscopy.org/consensus/2d.asp) - a measure of dermoscopic melanoma criteria - were also assessed.
As reported in JAMA Dermatology, online March 29, 82% of the lesions had dermoscopic features suggestive of melanoma, including pigment network (55.2%), blue-white veil (53.7%), globules and dots (50.7%), pseudopods or streaks (35.1%) and blue-black sign (32.3%).
The other 18% were considered likely SKs. Overall, those lesions showed a scaly and hyperkeratotic surface (33.6%), yellowish keratin (31.3%), comedo-like openings (30.5%), and milia-like cysts (22.4%).
The entire sample had a mean total dermoscopy score of 4.7 and a seven-point checklist score of 4.4. Dermoscopically SK-like melanomas had a dermoscopy score of 4.2 and a checklist score of 2.0, indicating they were likely benign.
Criteria most helpful in correctly diagnosing SK-like melanomas were the presence of a blue-white veil, pseudopods or streaks, and pigment network. Further analysis showed only the blue-black sign was significantly associated with a correct diagnosis, while hyperkeratosis and fissures and ridges were independent risk markers.
Dr. Carrera told Reuters Health, “Dermoscopy definitely aids in making a clinically correct diagnosis of skin lesions, and is strongly recommended to any professional before treating skin tumors.”
“Today, no melanoma should be mistreated or misdiagnosed,” she said by email.
Problems arise when clinicians don’t suspect melanoma, she added. “SKs are so frequent and generally easy to diagnose clinically that sometimes they lead us to treat them directly, without paying attention to (certain) features that should be looked at before ablation or cryotherapy.”
Dr. Carrera also noted that cosmeticians and general practitioners may be consulted about skin spots, tumors and verrucas. “These non-dermatologists should be aware of the existence of difficult melanomas that can simulate benign tumors such as SK,” she concluded.
Dr. Delphine Lee, a dermatologist at Providence Saint John’s Health Center in Santa Monica, California, told Reuters Health, “While the study defines key features observed under dermoscopy to distinguish SK-looking melanomas from actual SKs, a key finding is that only 82% of lesions which looked like SKs were correctly detected to be melanoma by dermoscopy.”
“This leaves 18% incorrectly judged,” she said by email. “While dermoscopy can be helpful, like most of our tools in medicine, it is not foolproof.”
“What is most important is for patients to see a board-certified dermatologist who can clinically follow any suspicious lesion, and monitor all lesions, using all our tools including a careful history, physical examination, and proper photography,” she concluded. “In the future, newer emerging technologies such as confocal microscopy might allow us to monitor at even higher magnification without a biopsy.”
SOURCE: https://bit.ly/2nYAtc2
JAMA Dermatol 2017.
(c) Copyright Thomson Reuters 2017. Click For Restrictions - https://about.reuters.com/fulllegal.asp
By Marilynn Larkin
NEW YORK (Reuters Health) - Dermoscopy can help identify seborrheic keratosis (SK)-like melanomas that are challenging to detect otherwise, researchers say.
Dr. Cristina Carrera of the University of Barcelona in Spain and colleagues asked two collaborators to evaluate dermoscopic images of skin lesions from 134 patients treated in nine skin cancer centers in Spain, France, Italy, and Austria.
Image and data from patients (72 men; mean age, 57) were collected from 2013 through 2014.
The evaluators weren’t told that all lesions were histopathologically proven melanomas. They assessed clinical descriptions and 48 dermoscopic features of the 134 images and classified each dermoscopically as SK or not SK. The total dermoscopy score and the seven-point checklist score (https://www.dermoscopy.org/consensus/2d.asp) - a measure of dermoscopic melanoma criteria - were also assessed.
As reported in JAMA Dermatology, online March 29, 82% of the lesions had dermoscopic features suggestive of melanoma, including pigment network (55.2%), blue-white veil (53.7%), globules and dots (50.7%), pseudopods or streaks (35.1%) and blue-black sign (32.3%).
The other 18% were considered likely SKs. Overall, those lesions showed a scaly and hyperkeratotic surface (33.6%), yellowish keratin (31.3%), comedo-like openings (30.5%), and milia-like cysts (22.4%).
The entire sample had a mean total dermoscopy score of 4.7 and a seven-point checklist score of 4.4. Dermoscopically SK-like melanomas had a dermoscopy score of 4.2 and a checklist score of 2.0, indicating they were likely benign.
Criteria most helpful in correctly diagnosing SK-like melanomas were the presence of a blue-white veil, pseudopods or streaks, and pigment network. Further analysis showed only the blue-black sign was significantly associated with a correct diagnosis, while hyperkeratosis and fissures and ridges were independent risk markers.
Dr. Carrera told Reuters Health, “Dermoscopy definitely aids in making a clinically correct diagnosis of skin lesions, and is strongly recommended to any professional before treating skin tumors.”
“Today, no melanoma should be mistreated or misdiagnosed,” she said by email.
Problems arise when clinicians don’t suspect melanoma, she added. “SKs are so frequent and generally easy to diagnose clinically that sometimes they lead us to treat them directly, without paying attention to (certain) features that should be looked at before ablation or cryotherapy.”
Dr. Carrera also noted that cosmeticians and general practitioners may be consulted about skin spots, tumors and verrucas. “These non-dermatologists should be aware of the existence of difficult melanomas that can simulate benign tumors such as SK,” she concluded.
Dr. Delphine Lee, a dermatologist at Providence Saint John’s Health Center in Santa Monica, California, told Reuters Health, “While the study defines key features observed under dermoscopy to distinguish SK-looking melanomas from actual SKs, a key finding is that only 82% of lesions which looked like SKs were correctly detected to be melanoma by dermoscopy.”
“This leaves 18% incorrectly judged,” she said by email. “While dermoscopy can be helpful, like most of our tools in medicine, it is not foolproof.”
“What is most important is for patients to see a board-certified dermatologist who can clinically follow any suspicious lesion, and monitor all lesions, using all our tools including a careful history, physical examination, and proper photography,” she concluded. “In the future, newer emerging technologies such as confocal microscopy might allow us to monitor at even higher magnification without a biopsy.”
SOURCE: https://bit.ly/2nYAtc2
JAMA Dermatol 2017.
(c) Copyright Thomson Reuters 2017. Click For Restrictions - https://about.reuters.com/fulllegal.asp
