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Melanoma: HELP
Articles by Pascale Guitera
Based on 35 articles published since 2010
(Why 35 articles?)
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Between 2010 and 2020, P. Guitera wrote the following 35 articles about Melanoma.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Editorial Diagnosing melanoma: the method matters. 2019

Rtshiladze, Michael A / Stretch, Jonathan R / Scolyer, Richard A / Guitera, Pascale. ·Melanoma Institute Australia, Sydney, NSW. · Sydney Medical School, University of Sydney, Sydney, NSW. · Royal Prince Alfred Hospital, Sydney, NSW. ·Med J Aust · Pubmed #31414490.

ABSTRACT: -- No abstract --

2 Review Evidence-Based Clinical Practice Guidelines for the Management of Patients with Lentigo Maligna. 2019

Robinson, Mitchell / Primiero, Clare / Guitera, Pascale / Hong, Angela / Scolyer, Richard A / Stretch, Jonathan R / Strutton, Geoffrey / Thompson, John F / Soyer, H Peter. ·Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Queensland, Australia. · Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia. · Cancer Council Australia Melanoma Guidelines Working Party, Sydney, New South Wales, Australia. · Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia. · Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia. · Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia. · Department of Anatomical Pathology, Princess Alexandra Hospital, Brisbane, Queensland, Australia. · Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Queensland, Australia, p.soyer@uq.edu.au. · Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia, p.soyer@uq.edu.au. · Cancer Council Australia Melanoma Guidelines Working Party, Sydney, New South Wales, Australia, p.soyer@uq.edu.au. ·Dermatology · Pubmed #31639788.

ABSTRACT: INTRODUCTION: Lentigo maligna (LM) is a subtype of melanoma in situ that usually occurs in sun-damaged skin and is characterised by an atypical proliferation of melanocytes within the basal epidermis. If left untreated, LM can develop into invasive melanoma, termed lentigo maligna melanoma, which shares the same prognosis as other types of invasive melanoma. The incidence rates of LM are steadily increasing worldwide, in parallel with increases in the incidence rates of invasive melanoma, and establishing appropriate guidelines for the management of LM is therefore of great importance. METHODS: A multidisciplinary working party established by Cancer Council Australia has recently produced up-to-date, evidence-based clinical practice guidelines for the management of melanoma and LM. Following selection of the most relevant clinical questions, a comprehensive literature search for relevant studies was conducted, followed by systematic review of these studies. Data were summarised and the evidence was assessed, leading to the development of recommendations. After public consultation and approval by the full guidelines working party, these recommendations were published on the Cancer Council Australia wiki platform (https://wiki.cancer.org.au/australia/Clinical_question:Effective_interventions_to_improve_outcomes_in_lentigo_maligna%3F). Main Recommendations: Surgical removal of LM remains the standard treatment, with 5- to 10-mm clinical margins when possible. While yet to be fully validated, the use of peri-operative reflectance confocal microscopy to assess margins should be considered where available. There is a lack of high-quality evidence to infer the most effective non-surgical treatment. When surgical removal of LM is not possible or refused, radiotherapy is recommended. When both surgery and radiotherapy are not appropriate or refused, topical imiquimod is the recommended treatment. Cryotherapy and laser therapy are not recommended for the treatment of LM.

3 Review Advances in the use of reflectance confocal microscopy in melanoma. 2018

Waddell, Andréanne / Star, Phoebe / Guitera, Pascale. ·Melanoma Institute Australia, The Poche Centre, North Sydney, New South Wales, Australia. · Department of Medicine/Division of Dermatology, Université de Sherbrooke, Sherbrooke, Quebec, Canada. · Sydney Medical School, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia. · Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia. ·Melanoma Manag · Pubmed #30190930.

ABSTRACT:

4 Review Lentigo Maligna, Macules of the Face, and Lesions on Sun-Damaged Skin: Confocal Makes the Difference. 2016

Star, Phoebe / Guitera, Pascale. ·Department of Dermatology, Melanoma Institute Australia, 40 Rocklands Road, North Sydney, New South Wales 2060, Australia. · Dermatology, Sydney Melanoma Diagnostic Centre (SMDC), Royal Prince Alfred Hospital, Melanoma Institute Australia, Central Clinical School, Sydney University, Missenden Road, Camperdown, New South Wales 2050, Australia. Electronic address: pascale.guitera@melanoma.org.au. ·Dermatol Clin · Pubmed #27692448.

ABSTRACT: Distinguishing lentigo maligna (LM) and lentigo maligna melanoma (LMM) from background pigmented non-melanoma lesions is challenging. The field of solar damage can obscure clinical assessment, and diagnostic ambiguities are created due to the overlap of the clinical features of LM with other benign lesions. Moreover, margin assessment on histology is limited by the resemblance between melanocytic hyperplasia of actinically damaged skin and scattered atypical melanocytes of LM/LMM. Dermoscopy has made a significant contribution but is often not sufficient for diagnosis and margin assessment. Confocal microscopy has become an important complementary tool in enhancing the management of these complex lesions.

5 Review In vivo confocal microscopy for the oral cavity: Current state of the field and future potential. 2016

Maher, N G / Collgros, H / Uribe, P / Ch'ng, S / Rajadhyaksha, M / Guitera, P. ·The Melanoma Institute Australia, Sydney, Australia; The University of Sydney, Sydney, Australia. · Hospital Universitari, Germans Trias i Pujol, Badalona (Barcelona), Spain. · Department of Dermatology, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile; Melanoma and Skin Cancer Unit, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile. · The Melanoma Institute Australia, Sydney, Australia; The University of Sydney, Sydney, Australia; Institute of Academic Surgery at Royal Prince Alfred Hospital, University of Sydney, New South Wales, Australia. · Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, USA. · The Melanoma Institute Australia, Sydney, Australia; The University of Sydney, Sydney, Australia; Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, Australia. Electronic address: pascale.guitera@melanoma.org.au. ·Oral Oncol · Pubmed #26786962.

ABSTRACT: Confocal microscopy (CM) has been shown to correlate with oral mucosal histopathology in vivo. The purposes of this review are to summarize what we know so far about in vivo CM applications for oral mucosal pathologies, to highlight some current developments with CM devices relevant for oral applications, and to formulate where in vivo CM could hold further application for oral mucosal diagnosis and management. Ovid Medline® and/or Google® searches were performed using the terms 'microscopy, confocal', 'mouth neoplasms', 'mouth mucosa', 'leukoplakia, oral', 'oral lichen planus', 'gingiva', 'cheilitis', 'taste', 'inflammatory oral confocal', 'mucosal confocal' and 'confocal squamous cell oral'. In summary, inclusion criteria were in vivo use of any type of CM for the human oral mucosa and studies on normal or pathological oral mucosa. Experimental studies attempting to identify proteins of interest and microorganisms were excluded. In total 25 relevant articles were found, covering 8 main topics, including normal oral mucosal features (n=15), oral dysplasia or neoplasia (n=7), inflamed oral mucosa (n=3), taste impairment (n=3), oral autoimmune conditions (n=2), pigmented oral pathology/melanoma (n=1), delayed type hypersensitivity (n=1), and cheilitis glandularis (n=1). The evidence for using in vivo CM in these conditions is poor, as it is limited to mainly small descriptive studies. Current device developments for oral CM include improved probe design. The authors propose that future applications for in vivo oral CM may include burning mouth syndrome, intra-operative mapping for cancer surgery, and monitoring and targeted biopsies within field cancerization.

6 Review Radiotherapy for lentigo maligna: a literature review and recommendations for treatment. 2014

Fogarty, G B / Hong, A / Scolyer, R A / Lin, E / Haydu, L / Guitera, P / Thompson, J. ·Melanoma Institute Australia, Poche Centre, 40 Rocklands Road, North Sydney, NSW, 2060, Australia; Genesis Cancer Care, Mater Sydney Radiation Oncology Centre, Mater Hospital, 25 Rocklands Road, North Sydney, NSW, 2060, Australia. ·Br J Dermatol · Pubmed #24032599.

ABSTRACT: Lentigo maligna (LM) incidence is increasing. LM frequently involves the face near critical anatomical structures and as a consequence clinical management is challenging. Nonsurgical therapies, including radiotherapy (RT), are increasingly used. Evidenced-based treatment guidelines are lacking. We conducted a review of previously published data analysing RT treatment of LM. A search of PubMed, Embase and Medline databases to June 2012 identified nine clinical studies that examined the use of RT for LM treatment in at least five patients. Nine studies described 537 patients with LM treated with definitive primary RT, between 1941 and 2009, with a median reported follow-up time of 3 years. Eight articles could be reviewed for oncological outcome data. There were 18 recurrences documented in a total of 349 assessable patients (5%). Salvage was successful in the majority of recurrent LM cases by using further RT, surgery or other therapies. Progression to LM melanoma (LMM) occurred in five patients (five out of 349, 1.4%) who all had poor outcomes. There were five marginal recurrences documented out of 123 assessable patients (4%). There were eight in-field recurrences documented with either LM (five) or LMM (three) out of 171 assessable patients (5%). A series of recommendations were then developed for RT parameters for treatment of LM. These parameters include treatment volume, dose, dose per fraction and outcome measures. These may be of use in prospective data collection.

7 Review State of the art of diagnostic technology for early-stage melanoma. 2011

Guitera, Pascale / Menzies, Scott W. ·Melanoma Institute Australia, Sydney, NSW, Australia. pascale.guitera@melanoma.org.au ·Expert Rev Anticancer Ther · Pubmed #21554047.

ABSTRACT: In the past few decades, rapid improvements in noninvasive optical technologies have revolutionized the diagnosis of early-stage melanoma. Current knowledge and limitations of these tools will be reviewed in this article. Dermoscopy has been recognized as the 'gold standard' in the screening phase. Digital dermoscopy monitoring and total-body photography are used to identify so-called 'featureless' melanoma only on the criteria of change over time. Automated instruments, as well as optical and nonmorphological methods, are still under development, and offer many opportunities to improve the speed and accuracy of the diagnosis of melanoma and/or to reduce the need for expertise. Despite a penetration depth limited to the upper dermis, the quasi-histological imaging achieved by in vivo reflectance confocal microscopy has been demonstrated to significantly aid diagnostic accuracy for selected melanocytic lesions. Future perspectives on diagnostic instrumentation will also be explored.

8 Article Reflectance confocal microscopy made easy: The 4 must-know key features for the diagnosis of melanoma and nonmelanoma skin cancers. 2019

Pellacani, Giovanni / Scope, Alon / Gonzalez, Salvador / Guitera, Pascale / Farnetani, Francesca / Malvehy, Josep / Witkowski, Alexander / De Carvalho, Nathalie / Lupi, Omar / Longo, Caterina. ·Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy. · The Kittner Skin Cancer Screening & Research Institute, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: scopea1@gmail.com. · Medicine and Medical Specialties Department, Alcalá University Madrid, Madrid, Spain. · Melanoma Institute Australia, The University of Sydney Discipline of Dermatology and Sydney Melanoma Diagnostic Centre, Sydney, Australia. · Melanoma Unit, Department of Dermatology, Hospital Clínic de Barcelona, IDIBAPS, Barcelona University, Centre for Biomedical Research on Rare Diseases (CIBERER), ISCIII, Barcelona, Spain. · Department of Dermatology, 4 WSK Hospital Wroclaw, Wroclaw, Poland. · Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy; Department of Dermatology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil. · Department of Dermatology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil. · Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy; Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy. ·J Am Acad Dermatol · Pubmed #30954581.

ABSTRACT: BACKGROUND: Reflectance confocal microscopy (RCM)-based skin cancer diagnosis requires proficiency. OBJECTIVE: To identify a short list of key RCM features of skin cancers and test their diagnostic utility. METHODS: We identified key RCM features through consensus among 6 experts using a modified Delphi method. To test the diagnostic utility of these RCM key features, 10 novice RCM readers evaluated a subset of 100 RCM cases from a retrospective data set of benign and malignant skin neoplasms. RESULTS: From 56 features reported in the literature, the experts identified 18 RCM features as highly valuable for skin cancer diagnosis. On the basis of consensus definitions, these RCM features were further clustered into 2 melanoma-specific key features (atypical cells and dermoepidermal junction disarray), 1 basal cell carcinoma-specific key feature (basaloid cords/islands), and 1 squamous cell carcinoma-specific key feature (keratinocyte disarray). The novice reading study showed that the presence of at least 1 of the 4 key features was associated with an overall sensitivity for skin cancer diagnosis of 91%, with a sensitivity for melanoma of 93%, a sensitivity for basal cell carcinoma of 92%, and a sensitivity for squamous cell carcinoma of 67%, and an overall specificity of 57%. LIMITATIONS: The consensus was based on only six RCM experts and the validation study was retrospective. CONCLUSIONS: A consensus terminology short list identifying the 4 RCM key features for skin cancer diagnosis may facilitate dissemination of RCM to novice users.

9 Article Methods of melanoma detection and of skin monitoring for individuals at high risk of melanoma: new Australian clinical practice. 2019

Adler, Nikki R / Kelly, John W / Guitera, Pascale / Menzies, Scott W / Chamberlain, Alex J / Fishburn, Paul / Button-Sloan, Alison E / Heal, Clinton / Soyer, H Peter / Thompson, John F. ·Victorian Melanoma Service, Alfred Hospital, Melbourne, VIC. · Armadale Dermatology, Melbourne, VIC. · Melanoma Institute Australia, Sydney, NSW. · University of Sydney, Sydney, NSW. · Royal Prince Alfred Hospital, Sydney, NSW. · Sydney Melanoma Diagnostic Centre, University of Sydney, Sydney, NSW. · Victorian Melanoma Service, Alfred Health, Melbourne, VIC. · Glenferrie Dermatology, Melbourne, VIC. · Norwest Skin Cancer Centre, Sydney, NSW. · Melanoma Patients Australia, Brisbane, QLD. · MelanomaWA, Perth, WA. · Dermatology Research Centre, Diamantina Institute, University of Queensland, Brisbane, QLD. · Princess Alexandra Hospital, Brisbane, QLD. ·Med J Aust · Pubmed #30636296.

ABSTRACT: INTRODUCTION: The evidence-based national clinical practice guidelines for the management of cutaneous melanoma published in 2008 are currently being updated. This article summarises the findings from multiple chapters of the guidelines on different methods of melanoma detection and of monitoring the skin for patients at high risk of melanoma. Early detection of melanoma is critical, as thinner tumours are associated with enhanced survival; therefore, strategies to improve early detection are important to reduce melanoma-related mortality. MAIN RECOMMENDATIONS: Clinicians who perform skin examinations for the purpose of detecting skin cancer should be trained in and use dermoscopy. The use of short term sequential digital dermoscopy imaging to detect melanomas that lack dermoscopic features of melanoma is recommended to assess individual melanocytic lesions of concern. The use of long term sequential digital dermoscopy imaging to detect melanomas that lack dermoscopic features of melanoma is recommended to assess individual or multiple melanocytic lesions for routine surveillance of high risk patients. The use of total body photography should be considered in managing patients at increased risk for melanoma, particularly those with high naevus counts and dysplastic naevi. There is insufficient evidence to recommend the routine use of automated instruments for the clinical diagnosis of primary melanoma. MANAGEMENT OVERVIEW: Determining the relative indications for each diagnostic method and how each method should be introduced into the surveillance of a patient requires careful consideration and an individualised approach.

10 Article The steadily growing problem of lentigo maligna and lentigo maligna melanoma in Australia: Population-based data on diagnosis and management. 2019

Guitera, Pascale / Collgros, Helena / Madronio, Christine M / Goumas, Christopher / Mann, Graham J / Watts, Caroline G / Pereira, Amanda R / Armstrong, Bruce K / Drummond, Martin / Morton, Rachael L / Scolyer, Richard A / Menzies, Scott W / Thompson, John F / Cust, Anne E. ·Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia. · Discipline of Dermatology, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia. · Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia. · Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia. · Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia. · Surveillance, Evaluation & Research Program, Kirby Institute, The University of New South Wales, Sydney, New South Wales, Australia. · Department of Dermatology, Federal University of Sao Paulo, Sao Paulo, Brazil. · NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia. · Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia. · Discipline of Surgery, The University of Sydney and Royal Prince Alfred Hospital, Sydney, New South Wales, Australia. ·Australas J Dermatol · Pubmed #30302753.

ABSTRACT: BACKGROUND/OBJECTIVES: There are limited population-based data documenting the incidence and management of lentigo maligna (LM) and invasive lentigo maligna melanoma (LMM). We report the data on occurrence and management of LM and LMM in an Australian population. METHODS: Prospective collection of incidence and clinician-reported management of melanoma in situ (MIS; n = 450, capped) and localised invasive melanoma (n = 3251) notified to the New South Wales Cancer Registry over 12-months in 2006-2007. RESULTS: The estimated annual incidence of all MIS was 27.0 per 100 000 (LM 12.2, non-LM MIS 5.9 and unclassified MIS 9.0). Patients with LM or LMM were on average approximately 10 years older than those with other melanoma subtypes (P < 0.001). The head and neck was the location of 59% of LM, 44% of LMM and <20% of other melanoma subtypes (P < 0.001). The majority of LM and LMM were treated only by specialists. Diagnostic partial biopsies were more frequent for LM and LMM than for other melanoma subtypes, and primary care physicians were more likely than specialists to do a punch partial biopsy than a shave biopsy. The reported median definitive excision margin for LM was 5.0 mm compared with 7.2 mm for non-LM MIS (P = 0.001). CONCLUSIONS: In this Australian population, LM was twice as frequent as other types of MIS. Improved strategies for diagnosis and management are required.

11 Article Use of shared care and routine tests in follow-up after treatment for localised cutaneous melanoma. 2018

Lim, Wei-Yin / Turner, Robin M / Morton, Rachael L / Jenkins, Marisa C / Irwig, Les / Webster, Angela C / Dieng, Mbathio / Saw, Robyn P M / Guitera, Pascale / Low, Donald / Low, Cynthia / Bell, Katy J L. ·Clinical Research Centre Perak, Ministry of Health Malaysia, Ipoh, Perak, Malaysia. · School of Public Health, The University of Sydney, Sydney, NSW, Australia. · Dunedin School of Medicine, University of Otago, Dunedin, New Zealand. · NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia. · Melanoma Institute Australia, Sydney, NSW, Australia. · Discipline of Surgery, The University of Sydney, Sydney, NSW, Australia. · Division of Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia. · Discipline of Dermatology, The University of Sydney, Sydney, NSW, Australia. · The Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia. · Cancer Voices NSW, Sydney, NSW, Australia. · School of Public Health, The University of Sydney, Sydney, NSW, Australia. katy.bell@sydney.edu.au. · Centre for Evidence Based Practice, Bond University, Gold Coast, QLD, Australia. katy.bell@sydney.edu.au. · The University of Sydney, Rm 333 Edward Ford Building (A27), Sydney, NSW, 2006, Australia. katy.bell@sydney.edu.au. ·BMC Health Serv Res · Pubmed #29925350.

ABSTRACT: BACKGROUND: Patients may decide to undertake shared care with a general practitioner (GP) during follow-up after treatment for localised melanoma. Routine imaging tests for surveillance may be commonly used despite no evidence of clinical utility. This study describes the frequency of shared care and routine tests during follow-up after treatment for localised melanoma. METHODS: We randomly sampled 351 people with localised melanoma [American Joint Cancer Committee (AJCC) substages 0 - II] who had not had recurrent or new primary melanoma diagnosed from a total of 902 people diagnosed and treated for localised melanoma at a specialist centre in 2014. We interviewed participants by telephone about their experience of follow-up in the past year, and documented the proportion of patients who were undertaking shared care follow-up with a GP. We also recorded the frequency and type of investigations during follow-up. We calculated weighted estimates that are representative of the full inception cohort. RESULTS: Of the 351 people who were invited to participate, 230 (66%) people consented to the telephone interview. The majority undertook shared care follow-up with a GP (61%). People who choose to have shared care follow-up with a GP are more likely to be male (p = 0.006), have lower AJCC stage (p for trend = 0.02), reside in more remote areas (p for trend< 0.001), and are less likely to have completed secondary school (p < 0.001). Few people saw a non-doctor health practitioner as part of their follow-up (9%). Many people report undergoing tests for melanoma, much of which may be routine tests for surveillance (37%). CONCLUSIONS: The majority of people treated for a first primary localised melanoma at a specialist centre, without recurrent or new melanoma, choose to undertake shared care follow-up with a GP. Many appear to have routine diagnostic imaging as part of their melanoma surveillance.

12 Article The smart approach: feasibility of lentigo maligna superficial margin assessment with hand-held reflectance confocal microscopy technology. 2018

Pellacani, G / De Carvalho, N / Ciardo, S / Ferrari, B / Cesinaro, A M / Farnetani, F / Bassoli, S / Guitera, P / Star, P / Rawson, R / Rossi, E / Magnoni, C / Gualdi, G / Longo, C / Scope, A. ·Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy. · Department of Pathology, University of Modena and Reggio Emilia, Modena, Italy. · Melanoma Institute Australia, Sydney, NSW, Australia. · The University of Sydney, Sydney, NSW, Australia. · Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia. · Department of Dermatolgy, Spedali Civili di Brescia, Brescia, Italy. · Skin Cancer Unit, IRCCS - Santa Maria Nuova, Reggio Emilia, Italy. · Medical Screening Institute, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. ·J Eur Acad Dermatol Venereol · Pubmed #29704275.

ABSTRACT: BACKGROUND: Lentigo maligna may be challenging to clear surgically. OBJECTIVE: To evaluate feasibility of using superficial skin cuts as RCM imaging anchors for attaining negative surgical margins in lentigo maligna. METHODS: Included patients presented with lentigo maligna near cosmetically sensitive facial structures. We evaluated, with hand-held-RCM, microscopic clearance of melanoma beyond its dermoscopically detected edges. Evaluated margins were annotated using shallow skin cuts. If a margin was positive at 'first-step' RCM evaluation, we sequentially advanced the margin radially outward at that segment by 2-mm intervals until an RCM-negative margin was identified. Prior to final surgical excision, we placed sutures at the outmost skin cuts to allow comparison of RCM and histopathological margin assessments. Primary outcome measure was histopathological verification that RCM-negative margins were clear of melanoma. RESULTS: The study included 126 first-step margin evaluations in 23 patients, median age 70 years (range: 43-91). Seventeen patients (74%) had primary in-situ melanoma and six (26%) invasive melanoma, mean thickness 0.3 mm (range 0.2-0.4 mm). Six cases (26%) showed complete negative RCM margins on 'first-step', 11 (48%) were negative at 'second-step', and four (17%) at 'third-step'. In two additional cases (9%), margins clearance could not be determined via RCM due to widespread dendritic cells proliferation. The RCM-negative margins in all 21 cases proved clear of melanoma on histopathology. Of the 15 cases that returned at 1-year follow-up, none showed any residual melanoma on dermoscopic and RCM examinations. Interobserver reproducibility showed fair agreement between bedside RCM reader and blinded remote-site reader, with Spearman's rho of 0.48 and Cohen's kappa of 0.43; using bedside reader as reference, the remote reader's sensitivity was 92% and specificity 57% in positive margin detection. CONCLUSIONS: Margin mapping of lentigo maligna with hand-held-RCM, using superficial skin cuts, appears feasible. This approach needs validation by larger studies.

13 Article Patient Preferences for Follow-up After Recent Excision of a Localized Melanoma. 2018

Lim, Wei-Yin / Morton, Rachael L / Turner, Robin M / Jenkins, Marisa C / Guitera, Pascale / Irwig, Les / Webster, Angela C / Dieng, Mbathio / Saw, Robyn P M / Low, Donald / Low, Cynthia / Bell, Katy J L. ·Clinical Research Centre Perak, Ministry of Health Malaysia, Ipoh, Perak, Malaysia. · School of Public Health, The University of Sydney, Sydney, New South Wales, Australia. · NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia. · School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia. · Melanoma Institute Australia, Sydney, New South Wales, Australia. · Discipline of Dermatology, The University of Sydney, Sydney, New South Wales, Australia. · The Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia. · Discipline of Surgery, The University of Sydney, Sydney, New South Wales, Australia. · Division of Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia. · Cancer Voices NSW, Sydney, New South Wales, Australia. · Centre for Evidence Based Practice, Bond University, Gold Coast, Queensland, Australia. ·JAMA Dermatol · Pubmed #29490373.

ABSTRACT: Importance: The standard model of follow-up posttreatment of localized melanoma relies on clinician detection of recurrent or new melanoma, through routinely scheduled clinics (clinician-led surveillance). An alternative model is to increase reliance on patient detection of melanoma, with fewer scheduled visits and increased support for patients' skin self-examination (SSE) (eg, using smartphone apps to instruct, prompt and record SSE, and facilitate teledermatology; patient-led surveillance). Objective: To determine the proportion of adults treated for localized melanoma who prefer the standard scheduled visit frequency (as per Australian guideline recommendations) or fewer scheduled visits (adapted from the Melanoma Follow-up [MELFO] study of reduced follow-up). Design, Setting, and Participants: This survey study used a telephone interview for surveillance following excision of localized melanoma at an Australian specialist center. We invited a random sample of 400 patients who had completed treatment for localized melanoma in 2014 to participate. They were asked about their preferences for scheduled follow-up, and experience of follow-up in the past 12 months. Those with a recurrent or new primary melanoma diagnosed by the time of interview (0.8-1.7 years since first diagnosis) were asked about how it was first detected and treated. SSE practices were also assessed. Main Outcomes and Measures: Proportion preferring standard vs fewer scheduled clinic visits, median delay between detection and treatment of recurrent or new primary melanoma, and SSE practices. Results: Of the 262 people who agreed to be interviewed, the mean (SD) age was 64.3 (14.3) years, and 93 (36%) were women. Among the 230 people who did not have a recurrent or new primary melanoma, 149 vs 81 preferred the standard vs fewer scheduled clinic visits option (70% vs 30% after adjusting for sampling frame). Factors independently associated with preferring fewer visits were a higher disease stage, melanoma on a limb, living with others, not having private health insurance, and seeing a specialist for another chronic condition. The median delay between first detection and treatment of recurrent or new primary melanoma was 7 and 3 weeks, respectively. Only 8% missed a scheduled visit, while 40% did not perform SSE or did so at greater than 3-month intervals. Conclusions and Relevance: Some patients with melanoma may prefer fewer scheduled visits, if they are supported to do SSE and there is rapid clinical review of anything causing concern (patient-led surveillance).

14 Article Germline BAP1-positive patients: the dilemmas of cancer surveillance and a proposed interdisciplinary consensus monitoring strategy. 2018

Star, Phoebe / Goodwin, Annabel / Kapoor, Rony / Conway, R Max / Long, Georgina V / Scolyer, Richard A / Guitera, Pascale. ·Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia. · Cancer Genetics, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; The University of Sydney, Sydney, Australia. · Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; The Mater Hospital, Sydney, Australia. · The University of Sydney, Sydney, Australia; Ocular Oncology Unit, Save Sight Institute, Australia. · Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Royal North Shore Hospital, Sydney, Australia. · Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; The University of Sydney, Sydney, Australia; Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia. · Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; The University of Sydney, Sydney, Australia; Sydney Melanoma Diagnostic Centre (SMDC), Royal Prince Alfred Hospital, Camperdown, NSW, Australia. Electronic address: pascale.guitera@melanoma.org.au. ·Eur J Cancer · Pubmed #29413689.

ABSTRACT: The germline BAP1 (BRCA1-associated protein-1) mutation and associated cancer pre-disposition syndrome was first described in 2011. Since then, physicians have considered this diagnosis for patients with a characteristic personal or family history of BAP1-associated tumours (mainly uveal and cutaneous melanoma, pleural/peritoneal mesothelioma, renal cell carcinoma and BAP1-deficient melanocytic lesions). However, a positive germline BAP1 mutation detection creates significant uncertainty in terms of appropriate cancer surveillance. A number of groups have proposed surveillance plans but important management dilemmas remain unresolved. The lifetime risk of developing cancer is not known and it is not clear if surveillance would lead to detecting cancer at an earlier stage or change survival outcomes. A consensus monitoring strategy was initially proposed at the Melanoma Institute Australia Melanoma Multidisciplinary Team meeting and later discussed with specialists in the field of cancer genetics, pathology, radiology, medical oncology, ophthalmology and dermatology. The objectives were to facilitate early diagnosis, incorporating where possible, clinically based and low/non-ionising radiation imaging modalities, applying the principles of a good screening test and a multidisciplinary focus.

15 Article Dermoscopy vs. reflectance confocal microscopy for the diagnosis of lentigo maligna. 2018

Cinotti, E / Labeille, B / Debarbieux, S / Carrera, C / Lacarrubba, F / Witkowski, A M / Moscarella, E / Arzberger, E / Kittler, H / Bahadoran, P / Gonzalez, S / Guitera, P / Agozzino, M / Farnetani, F / Hofmann-Wellenhof, R / Ardigò, M / Rubegni, P / Tognetti, L / Łudzik, J / Zalaudek, I / Argenziano, G / Longo, C / Ribero, S / Malvehy, J / Pellacani, G / Cambazard, F / Perrot, J L. ·Department of Dermatology, University Hospital of St-Etienne, Saint-Etienne, France. · Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy. · Departments of Dermatology, Centre Hospitalier Lyon Sud, Pierre Benite, France. · Melanoma Unit, Department of Dermatology, Hospital Clínic de Barcelona, IDIBAPS, Barcelona University, Barcelona, Spain. · Dermatology Clinic, University of Catania, Catania, Italy. · Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy. · Dermatology Unit, Second University of Naples, Nuovo Policlinico, Naples, Italy. · Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria. · Department of Dermatology, Medical University of Vienna, Vienna, Austria. · Department of Dermatology, Clinical Research Center, Hopital Archet 2, Nice, France. · Medicine and Medical Specialities Department, Madrid and Dermatology Department, Alcalá University, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. · Department of Dermatology, The University of Sydney, Sydney Melanoma Diagnostic Centre and Melanoma Institute Australia, Sydney, NSW, Australia. · Clinical Dermatology, San Gallicano Dermatological Institute, Rome, Italy. · Department of Medical Biotechnologies, University of Siena, Siena, Italy. · Department of Bioinformatics and Telemedicine, Jagiellonian University Medical College, Krakow, Poland. · Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy. · Department of Medical Sciences, University of Turin, Turin, Italy. ·J Eur Acad Dermatol Venereol · Pubmed #29341263.

ABSTRACT: BACKGROUND: Several dermoscopic and in vivo reflectance confocal microscopy (RCM) diagnostic criteria of lentigo maligna (LM)/lentigo maligna melanoma (LMM) have been identified. However, no study compared the diagnostic accuracy of these techniques. OBJECTIVE: We evaluated the diagnostic accuracy of dermoscopy and RCM for LM/LMM using a holistic assessment of the images. METHODS: A total of 223 facial lesions were evaluated by 21 experts. Diagnostic accuracy of the clinical, dermoscopic and RCM examination was compared. Interinvestigator variability and confidence level in the diagnosis were also evaluated. RESULTS: Overall diagnostic accuracy of the two imaging techniques was good (area under the curve of the sROC function: 0.89). RCM was more sensitive (80%, vs. 61%) and less specific (81% vs. 92%) than dermoscopy for LM/LMM. In particular, RCM showed a higher sensitivity for hypomelanotic and recurrent LM/LMM. RCM had a higher interinvestigator agreement and a higher confidence level in the diagnosis than dermoscopy. CONCLUSION: Reflectance confocal microscopy and dermoscopy are both useful techniques for the diagnosis of facial lesions and in particular LM/LMM. RCM is particularly suitable for the identification of hypomelanotic and recurrent LM/LMM.

16 Article A National Budget Impact Analysis of a Specialised Surveillance Programme for Individuals at Very High Risk of Melanoma in Australia. 2018

Watts, Caroline G / Wortley, Sally / Norris, Sarah / Menzies, Scott W / Guitera, Pascale / Askie, Lisa / Mann, Graham J / Morton, Rachael L / Cust, Anne E. ·Sydney School of Public Health, The University of Sydney, The Lifehouse, Level 6-North, 119-143 Missenden Road, Camperdown, NSW, 2050, Australia. caroline.watts@sydney.edu.au. · Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia. caroline.watts@sydney.edu.au. · Sydney School of Public Health, The University of Sydney, The Lifehouse, Level 6-North, 119-143 Missenden Road, Camperdown, NSW, 2050, Australia. · Menzies Centre for Health Policy, The University of Sydney, Sydney, NSW, Australia. · Sydney Melanoma Diagnostic Centre, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia. · Dermatology Department, Royal Prince Alfred Hospital, The University of Sydney, Sydney, NSW, Australia. · Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia. · NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia. · Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney, Westmead, NSW, Australia. ·Appl Health Econ Health Policy · Pubmed #29305821.

ABSTRACT: BACKGROUND: Specialised surveillance using total body photography and digital dermoscopy to monitor people at very high risk of developing a second or subsequent melanoma has been reported as cost effective. OBJECTIVES: We aimed to estimate the 5-year healthcare budget impact of providing specialised surveillance for people at very high risk of subsequent melanoma from the perspective of the Australian healthcare system. METHODS: A budget impact model was constructed to assess the costs of monitoring and potential savings compared with current routine care based on identification of patients at the time of a melanoma diagnosis. We used data from a published cost-effectiveness analysis of specialised surveillance, and Cancer Registry data, to estimate the patient population and healthcare costs for 2017-2021. RESULTS: When all eligible patients, estimated at 18% of patients with melanoma diagnosed annually in Australia, received specialised surveillance rather than routine care, the cumulative 5-year cost was estimated at $93.5 million Australian dollars ($AU) ($US 64 million) for specialised surveillance compared with $AU 120.7 million ($US 82.7 million) for routine care, delivering savings of $AU 27.2 million ($US 18.6 million). With a staggered introduction of 60% of eligible patients accessing surveillance in year 1, increasing to 90% in years 4 and 5, the cumulative cost over 5 years was estimated at $AU 98.1 million ($US 67.2 million), amounting to savings of $AU 22.6 million ($US 15.5 million) compared with routine care. CONCLUSIONS: Specialised melanoma surveillance is likely to provide substantial cost savings for the Australian healthcare system.

17 Article Punch 'scoring': a technique that facilitates melanoma diagnosis of clinically suspicious pigmented lesions. 2018

Grogan, Judith / Cooper, Caroline L / Dodds, Tristan J / Guitera, Pascale / Menzies, Scott W / Scolyer, Richard A. ·Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia. · Sydney Medical School, The University of Sydney, Sydney, NSW, Australia. · Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia. · Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia. ·Histopathology · Pubmed #28796900.

ABSTRACT: AIMS: Early recognition and accurate diagnosis underpins melanoma survival. Identifying early melanomas arising in association with pre-existing lesions is often challenging. Clinically suspicious foci, however small, must be identified and examined histologically. This study assessed the accuracy of punch biopsy 'scoring' of suspicious foci in excised atypical pigmented skin lesions to identify early melanomas. METHODS AND RESULTS: Forty-one excised pigmented skin lesions with a clinically/dermoscopically focal area of concern for melanoma, with the suspicious focus marked prior to excision with a punch biopsy 'score' (a partial incision into the skin surface), were analysed. Melanoma was diagnosed in nine of 41 cases (22%). In eight of nine cases (89%) the melanoma was associated with a naevus, and in seven of nine (88%) cases the melanoma was identified preferentially by the scored focus. In six of nine cases (67%), the melanoma was entirely encompassed by the scored focus. In one case of melanoma in situ, the diagnostic material was identified only on further levelling through the scored focus. In 28 of 32 of non-melanoma cases (88%), the scored focus identified either diagnostic features of a particular lesion or pathological features that correlated with the clinical impression of change/atypia including altered architecture or distribution of pigmentation, features of irritation or regression. CONCLUSIONS: The 'punch scoring technique' allows direct clinicopathological correlation and facilitates early melanoma diagnosis by focusing attention on clinically suspicious areas. Furthermore, it does not require special expertise in ex-vivo clinical techniques for implementation. Nevertheless, in some cases examination of the lesion beyond the scored focus is also necessary to make a diagnosis of melanoma.

18 Article Detection of desmoplastic melanoma with dermoscopy and reflectance confocal microscopy. 2017

Maher, N G / Solinas, A / Scolyer, R A / Puig, S / Pellacani, G / Guitera, P. ·Melanoma Institute Australia, Sydney, NSW, Australia. · The University of Sydney, Sydney, NSW, Australia. · Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia. · Melanoma Unit, Dermatology Department, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain. · Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy. · Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia. ·J Eur Acad Dermatol Venereol · Pubmed #28573666.

ABSTRACT: BACKGROUND: Desmoplastic melanoma (DM) is frequently misdiagnosed clinically and often associated with melanoma in situ (MIS). OBJECTIVE: To improve the detection of DM using dermoscopy and reflectance confocal microscopy (RCM). METHODS: A descriptive analysis of DM dermoscopy features and a case-control study within a melanoma population for RCM feature evaluation was performed blindly, using data obtained between 2005 and 2015. After retrospectively identifying all DM cases with RCM data over the study period (n = 16), a control group of non-DM melanoma patients with RCM data, in a ratio of at least 3 : 1, was selected. The control group was matched by age and primary tumour site location, divided into non-DM invasive melanomas (n = 27) and MIS (n = 27). Invasive melanomas were selected according to the melanoma subtypes associated with the DM cases. The main outcomes were the frequency of melanoma-specific features on dermoscopy for DM; and the odds ratios of RCM features to distinguish DM from MIS and/or other invasive melanomas; or MIS from the combined invasive melanoma group. RESULTS: At least one of the 14 melanoma-specific features evaluated on dermoscopy was found in 100% of DMs (n = 15 DM with dermoscopy). Known RCM melanoma predictors were commonly found in the DMs, such as pagetoid cells (100%) and cell atypia (100%). The RCM feature of spindle cells in the superficial dermis was more common in DM compared with the entire melanoma control group (OR 3.82, 95% CI 1.01-14.90), and particularly compared to MIS (OR 5.48, 95% CI 1.11-32.36). Nucleated cells in the dermis and the RCM correlate of dermal inflammation were also significant RCM features favouring DM over MIS, as well as invasive melanoma over MIS. CONCLUSION: Dermoscopy and RCM may be useful tools for the identification of DM. Certain RCM features may help distinguish DM from MIS and other invasive melanomas. Larger studies are warranted.

19 Article In Vivo Reflectance Confocal Microscopy for the Diagnosis of Melanoma and Melanotic Macules of the Lip. 2017

Uribe, Pablo / Collgros, Helena / Scolyer, Richard A / Menzies, Scott W / Guitera, Pascale. ·Department of Dermatology, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile. · Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, Australia. · Melanoma Institute Australia, Sydney, New South Wales, Australia. · Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, Australia. · The University of Sydney, Sydney, New South Wales, Australia. ·JAMA Dermatol · Pubmed #28467525.

ABSTRACT: Importance: Benign melanotic macules (MAC) are the most frequent cause of lip pigmentation and sometimes difficult to differentiate from lip melanoma (MEL). Objectives: To report in vivo reflectance confocal microscopy (RCM) features of normal lips of different phototypes and to identify features that assist in distinguishing MEL from MAC using dermoscopy and RCM. Design, Setting, and Participants: For this retrospective observational study, 2 groups of patients from 2 tertiary referral centers for melanoma (Sydney Melanoma Diagnostic Centre and Melanoma Institute Australia) were recruited between June 2007 and January 2015. Group 1 included patients with normal lips and different phototypes, and Group 2 consisted of patients with MAC and MEL; RCM and dermoscopy were used for lips analysis. Main Outcomes and Measures: Overall, 92 RCM features were correlated with clinical history, dermoscopic images, and histopathology in all patients with MEL and 5 patients with MAC. Results: Images from the vermillion and/or mucosal part of the lip were recorded from 10 patients with clinically normal lips (mean [SD] age, 34.5 [6.1] years), 16 patients with MAC (mean [SD] age, 49.6 [17.9] years), and 5 patients with 6 cases of MEL (1 patient had a recurrent lesion; mean [SD] age, 56.2 [15.5] years). In normal lips, the draped pattern-a previously described MAC RCM feature-was identified in all cases. In MEL, the following findings were frequent and significantly different from MAC: epidermal disarray; pagetoid infiltration of dendritic and/or round cells; a nonspecific architectural pattern at the dermoepidermal junction (DEJ); nonhomogenously distributed papillae; continuous (lentiginous) proliferation of cells with marked atypia at the DEJ, especially in interpapillary spaces; a higher number of dendritic cells (especially roundish); and atypical round cells at the DEJ. The cellular body area of dendritic cells was about the double in MEL compared with MAC. An RCM lip algorithm was developed that provided 100% sensitivity and 88% specificity for the diagnosis of MEL of the vermillion and mucosal part of the lip. With dermoscopy, MAC were correctly classified as benign in 13 of 16 cases (81%) and MEL were classified as equivocal or malignant in 5 of 6 cases (83%). Conclusions and Relevance: Reflectance confocal microscopy can assist in the differential diagnosis of lip MEL and MAC. An RCM Lip Score that we developed based on study results is proposed and needs to be validated on an independent data set.

20 Article Analysis of an electrical impedance spectroscopy system in short-term digital dermoscopy imaging of melanocytic lesions. 2017

Rocha, L / Menzies, S W / Lo, S / Avramidis, M / Khoury, R / Jackett, L / Guitera, P. ·Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia. · The University of Sydney, Sydney Medical School, Discipline of Dermatology, Camperdown, NSW, Australia. · Melanoma Institute Australia, North Sydney, NSW, Australia. · Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia. · The University of Sydney, Sydney Medical School, Camperdown, NSW, Australia. · Discipline of Dermatology, University of Sydney and Sydney Melanoma Diagnostic Centre, Camperdown, NSW, Australia. ·Br J Dermatol · Pubmed #28421597.

ABSTRACT: BACKGROUND: Electrical impedance spectroscopy (EIS) is a noninvasive diagnostic technique that measures tissue impedance. OBJECTIVES: To evaluate the effect of adding an EIS measurement at baseline to suspicious melanocytic lesions undergoing routine short-term sequential digital dermoscopy imaging (SDDI). METHODS: Patients presented with suspicious melanocytic lesions that were eligible for short-term SDDI (with no clear feature of melanoma on dermoscopy). EIS measurement was performed at the first visit following dermoscopic photography. Normally, an EIS score of ≥ 4 is considered positive; however, this protocol investigated a higher cut-off in combination with SDDI. When the EIS score was ≥ 7 the lesion was excised immediately owing to the high risk of melanoma. Lesions with a score < 7 were monitored with standard SDDI over a 3-month period. RESULTS: From a total of 160 lesions analysed, 128 of 154 benign lesions received an EIS score of 0-6, giving a specificity of the EIS method for the diagnosis of melanoma of 83·1% [95% confidence interval (CI) 76·3-88·7]. Five of the six melanomas found in this study had an EIS score ≥ 7, with a sensitivity for melanoma diagnosis of 83·3% (95% CI 35·9-99·6). When EIS 0-6 lesions were subsequently followed up with SDDI, one additional melanoma was detected (EIS = 6) giving a sensitivity for the diagnosis of melanoma overall of 100% (95% CI 54·1-100; six of six malignant melanomas excised) and a specificity of 69·5% (95% CI 61·5-76·6; 107 of 154 benign lesions not excised). CONCLUSIONS: If utilizing a protocol where an EIS score ≤ 3 requires no SDDI and ≥ 7 requires immediate excision, it reduced the need for SDDI by 46·9% (n = 75/160; 95% CI 39·0-54·9).

21 Article Fear of new or recurrent melanoma after treatment for localised melanoma. 2017

Bell, Katy J L / Mehta, Yachna / Turner, Robin M / Morton, Rachael L / Dieng, Mbathio / Saw, Robyn / Guitera, Pascale / McCaffery, Kirsten / Low, Donald / Low, Cynthia / Jenkins, Marisa / Irwig, Les / Webster, Angela C. ·The School of Public Health, The University of Sydney, Sydney, New South Wales, Australia. · Center for Evidence Based Practice, Bond University, Gold Coast, Queensland, Australia. · Australia New Zealand Melanoma Trials Group, Melanoma Institute Australia, Sydney, New South Wales, Australia. · School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia. · NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia. · Macquarie University, Sydney, New South Wales, Australia. · Melanoma Institute Australia, Sydney, New South Wales, Australia. · Discipline of Surgery, The University of Sydney, Sydney, New South Wales, Australia. · Division of Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia. · Discipline of Dermatology, The University of Sydney, Sydney, New South Wales, Australia. · The Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia. · Cancer Voices NSW, Sydney, New South Wales, Australia. ·Psychooncology · Pubmed #28052599.

ABSTRACT: OBJECTIVE: To estimate the amount of fear of new or recurrent melanoma among people treated for localised melanoma in an Australian specialist centre. METHODS: We randomly selected 400 potential participants from all those treated for localised melanoma at the Melanoma Institute Australia during 2014 (n = 902). They were asked to complete an adapted version of the Fear of Cancer Recurrence Inventory (FCRI). We calculated summary statistics for demographics, clinical variables and total FCRI and subscale scores. RESULTS: Two hundred fifteen people (54%) completed the FCRI questionnaire. The overall mean severity subscale score was 15.0 (95% CI 14.0-16.1). A high proportion of participants had scores above a proposed threshold to screen for clinical fear of cancer recurrence (77% and 63% of participants with and without new or recurrent melanoma had severity subscale scores ≥13). Most participants also had scores above a threshold found to have high specificity for clinical fear of cancer recurrence (65% and 48% of participants with and without new or recurrent melanoma had severity subscale scores ≥16). The severity subscale appeared to discriminate well between groups with differing levels of risk of new or recurrent melanoma. CONCLUSIONS: There is a substantial amount of fear of new or recurrent melanoma among this population, despite most having a very good prognosis.

22 Article Melanoma diagnosis may be a pitfall for optical coherence tomography assessment of equivocal amelanotic or hypomelanotic skin lesions. 2017

Maher, N G / Blumetti, T P / Gomes, E E / Cheng, H M / Satgunaseelan, L / Lo, S / Rezze, G G / Scolyer, R A / Guitera, P. ·Melanoma Institute Australia, Sydney, Australia. · The University of Sydney, Sydney, Australia. · AC Camargo Cancer Center, Cutaneous Oncology Department, São Paulo, Brazil. · Tissue Pathology and Diagnostic Oncology, Sydney, Australia. · Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, Australia. ·Br J Dermatol · Pubmed #27861726.

ABSTRACT: -- No abstract --

23 Article In vivo reflectance confocal microscopy for evaluating melanoma of the lip and its differential diagnoses. 2017

Maher, Nigel G / Solinas, Annalisa / Scolyer, Richard A / Guitera, Pascale. ·The Melanoma Institute Australia, Sydney, Australia; Sydney Medical School, The University of Sydney, Sydney, Australia. · Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, Australia. · The Melanoma Institute Australia, Sydney, Australia; Sydney Medical School, The University of Sydney, Sydney, Australia; Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, Australia. · The Melanoma Institute Australia, Sydney, Australia; Sydney Medical School, The University of Sydney, Sydney, Australia; Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, Australia. Electronic address: Pascale.guitera@melanoma.org.au. ·Oral Surg Oral Med Oral Pathol Oral Radiol · Pubmed #27720652.

ABSTRACT: OBJECTIVE: To improve prebiopsy diagnostic accuracy and surgical management of pigmented appearing lesions on the lips, particularly melanoma, using in vivo reflectance confocal microscopy (RCM). STUDY DESIGN: Prospective case series over a 12-month period between 2015 and 2016. The setting was two specialist dermatology referral centers with expertise in confocal microscopy. The study population was a consecutive sample of patients with pigmentation of the lip for which the cause was uncertain clinically, whose differential diagnosis included melanoma, and who had undergone both in vivo RCM and subsequent biopsy. The outcome measures were RCM features, dermoscopy features, and histopathological diagnosis. Results were reported by descriptive analysis and correlations made between RCM features and histopathology. RESULTS: Eight patients were recruited for the study. In vivo RCM facilitated the targeting of small biopsies to identify two in situ oral melanoma recurrences and successfully mapped an in situ oral melanoma before wide excision. Suprabasal dendritic pagetoid cells and epidermal disarray on RCM were useful indicators for in situ melanoma of the lip. Previously described dermoscopy features for mucosal melanoma were not very helpful in diagnosing melanoma in our series. Challenges included evaluating inflamed lesions with pigment incontinence. CONCLUSIONS: RCM can assist in the diagnosis and management of pigmented lip lesions, but additional studies are required to further evaluate these initial observations.

24 Article Dermoscopy and in vivo confocal microscopy are complementary techniques for diagnosis of difficult amelanotic and light-coloured skin lesions. 2016

Guitera, P / Menzies, S W / Argenziano, G / Longo, C / Losi, A / Drummond, M / Scolyer, R A / Pellacani, G. ·Sydney Melanoma Diagnostic Centre and Dermatology Department, Royal Prince Alfred Hospital, Camperdown, NSW, Australia. · Discipline of Dermatology, Sydney Medical School, University of Sydney, Sydney, NSW, Australia. · Melanoma Institute Australia, 40 Rocklands Road, North Sydney, NSW, Australia. · Dermatology Unit, Second University of Naples, Naples, Italy. · Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova, University of Modena and Reggio Emilia, Modena, Italy. · Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy. · Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia. · Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia. · Discipline of Pathology, Sydney Medical School, University of Sydney, Sydney, NSW, Australia. ·Br J Dermatol · Pubmed #27177158.

ABSTRACT: BACKGROUND: Amelanotic melanomas are often difficult to diagnose. OBJECTIVES: To find and test the best methods of diagnosis using dermoscopy and reflectance confocal microscopy (RCM) tools. METHODS: We selected consecutive, difficult-to-diagnose, light-coloured and amelanotic skin lesions from three centres (in Australia and Italy). Dermoscopy and RCM diagnostic utility were evaluated under blinded conditions utilizing 45 melanomas (16 in situ, 29 invasive), 68 naevi, 48 basal cell carcinomas (BCCs), 10 actinic keratoses, 10 squamous cell carcinomas (SCCs) and 13 other benign lesions. RESULTS: Sensitivity and specificity for melanoma with dermoscopy pattern analysis by two blinded observers and their 'confidence in diagnosis' were low. The amelanotic dermoscopy method had the highest sensitivity (83%) for a diagnosis of malignancy (melanoma, BCC or SCC), but specificity was only 18%. Multivariate analysis confirmed the utility of RCM features previously identified for the diagnosis of BCC and melanoma (highest odds ratio for melanoma: epidermal disarray, dark and/or round pagetoid cells). RCM sensitivity was 67% and 73% for melanoma and BCC diagnosis, respectively, and its specificity for nonmalignant lesion diagnosis was 56%. RCM reader confidence was higher than for dermoscopy; 84% of melanomas would have been biopsied and biopsy avoided in 47% of benign lesions. All melanomas misclassified by either dermoscopy or RCM were detected by the other tool. CONCLUSIONS: Dermoscopy and RCM represent complementary/synergistic methods for diagnosis of amelanotic/light-coloured skin lesions.

25 Article Skin Cancer Diagnosis With Reflectance Confocal Microscopy: Reproducibility of Feature Recognition and Accuracy of Diagnosis. 2015

Farnetani, Francesca / Scope, Alon / Braun, Ralph P / Gonzalez, Salvador / Guitera, Pascale / Malvehy, Josep / Manfredini, Marco / Marghoob, Ashfaq A / Moscarella, Elvira / Oliviero, Margaret / Puig, Susana / Rabinovitz, Harold S / Stanganelli, Ignazio / Longo, Caterina / Malagoli, Carlotta / Vinceti, Marco / Pellacani, Giovanni. ·Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy. · Sheba Medical Center, Department of Dermatology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel3Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York. · Department of Dermatology, University Hospital Zurich, Zurich, Switzerland. · Internal Medicine Department, Alcala University, Madrid, Spain. · Melanoma Institute Australia, The University of Sydney, Sydney7Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, Australia. · Melanoma Unit, Dermatology Department, Hospital Clinic and University of Barcelona, Institut de Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain9Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III. · Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York. · Dermatology and Skin Cancer Unit, Arcispedale S. Maria Nuova-Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy. · Department of Dermatology and Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida. · Skin Cancer Unit-Istituto di Ricovero e Cura a Carattere Scientifico Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Forlì-Cesena, Italy. · Center for Environmental, Genetic, and Nutritional Epidemiology, Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy. ·JAMA Dermatol · Pubmed #25993262.

ABSTRACT: IMPORTANCE: Reflectance confocal microscopy (RCM) studies have been performed to identify criteria for diagnosis of skin neoplasms. However, RCM-based diagnosis is operator dependent. Hence, reproducibility of RCM criteria needs to be tested. OBJECTIVE: To test interobserver reproducibility of recognition of previously published RCM descriptors and accuracy of RCM-based skin cancer diagnosis. DESIGN, SETTING, AND PARTICIPANTS: Observational retrospective web-based study of a set of RCM images collected at a tertiary academic medical center. Nine dermatologists (6 of whom had ≥3 years of RCM experience) from 6 countries evaluated an RCM study set from 100 biopsy-proven lesions, including 55 melanocytic nevi, 20 melanomas, 15 basal cell carcinomas, 7 solar lentigines or seborrheic keratoses, and 3 actinic keratoses. Between June 15, 2010, and October 21, 2010, participanting dermatologists, blinded to histopathological diagnosis, evaluated 3 RCM mosaic images per lesion for the presence of predefined RCM descriptors. MAIN OUTCOMES AND MEASURES: The main outcome was identification of RCM descriptors with fair to good interrater agreement (κ statistic, ≥0.3) and independent correlation with malignant vs benign diagnosis on discriminant analysis. Additional measures included sensitivity and specificity for diagnosis of malignant vs benign for each evaluator, for majority diagnosis (rendered by ≥5 of 9 evaluators), and for experienced vs recent RCM users. RESULTS: Eight RCM descriptors showed fair to good reproducibility and were independently associated with a specific diagnosis. Of these, the presence of pagetoid cells, atypical cells at the dermal-epidermal junction, and irregular epidermal architecture were associated with melanoma. Aspecific junctional pattern, basaloid cords, and ulceration were associated with basal cell carcinomas. Ringed junctional pattern and dermal nests were associated with nevi. The mean sensitivity for the group of evaluators was 88.9% (range, 82.9%-100%), and the mean specificity was 79.3% (range, 69.2%-90.8%). Majority diagnosis showed sensitivity of 100% and specificity of 80.0%. Sensitivity was higher for experienced vs recent RCM users (91.0% vs. 84.8%), but specificity was similar (80.0% vs. 77.9%). CONCLUSIONS AND RELEVANCE: The study highlights key RCM diagnostic criteria for melanoma and basal cell carcinoma that are reproducibly recognized among RCM users. Diagnostic accuracy increases with experience. The higher accuracy of majority diagnosis suggests that there is intrinsically more diagnostic information in RCM images than is currently used by individual evaluators.

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