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Melanoma: HELP
Articles by Harald J. Kittler
Based on 39 articles published since 2008
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Between 2008 and 2019, H. Kittler wrote the following 39 articles about Melanoma.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Editorial Early recognition at last. 2008

Kittler, Harald. · ·Arch Dermatol · Pubmed #18427049.

ABSTRACT: -- No abstract --

2 Review Dermatoscopy of amelanotic and hypomelanotic melanoma. 2014

Stojkovic-Filipovic, Jelena / Kittler, Harald. ·Clinic of Dermatovenereology, Clinical Center of Serbia, Department of Dermatovenereology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia. ·J Dtsch Dermatol Ges · Pubmed #24825465.

ABSTRACT: Amelanotic melanoma is a subtype of cutaneous melanoma without pigment. The clinical diagnosis is challenging because it may mimic benign or malignant melanocytic and non-melanocytic neoplasms and inflammatory skin diseases. In synchrony with the improvement of the diagnosis of pigmented lesions, dermatoscopy may assist the clinician in the diagnosis of non-pigmented skin neoplasms in general and of amelanotic melanoma in particular. We have searched the literature to extract the most relevant dermatoscopic clues to diagnose amelanotic and hypomelanotic melanomas by dermatoscopy. In addition we present eight consecutive cases and discuss their clinical and dermatoscopic characteristics in the light of published data.

3 Review Dysplastic nevus: why this term should be abandoned in dermatoscopy. 2013

Kittler, Harald / Tschandl, Philipp. ·Department of Dermatology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria. Electronic address: harald.kittler@meduniwien.ac.at. ·Dermatol Clin · Pubmed #24075546.

ABSTRACT: The term "dysplastic nevus" is a misnomer and should be abandoned. Dysplastic nevus is not just a name, it is the root of the concept that histomorphology (or any morphologic examination including dermatoscopy) is able to predict the fate of a benign melanocytic proliferation. There is no evidence that this hypothesis is true but there are observations that falsify it. Preferably a specific diagnosis should be made based on dermatoscopic pattern and, if this is not possible, on clinical or dermatoscopic grounds alone the term "nevus, not otherwise specified" should be used.

4 Review A clinico-dermoscopic approach for skin cancer screening: recommendations involving a survey of the International Dermoscopy Society. 2013

Argenziano, Giuseppe / Giacomel, Jason / Zalaudek, Iris / Blum, Andreas / Braun, Ralph P / Cabo, Horacio / Halpern, Allan / Hofmann-Wellenhof, Rainer / Malvehy, Josep / Marghoob, Ashfaq A / Menzies, Scott / Moscarella, Elvira / Pellacani, Giovanni / Puig, Susana / Rabinovitz, Harold / Saida, Toshiaki / Seidenari, Stefania / Soyer, H Peter / Stolz, Wilhelm / Thomas, Luc / Kittler, Harald. ·Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS, Viale Risorgimento 80, Reggio Emilia 42100, Italy. Electronic address: g.argenziano@gmail.com. ·Dermatol Clin · Pubmed #24075542.

ABSTRACT: Dermoscopy is useful for skin cancer screening, but a detailed approach is required that integrates this tool into a rational clinical work flow. To investigate clinician perceptions and behavior in approaching patients with skin tumors, a survey was launched by electronic mail through the International Dermoscopy Society. After 4 months, the responses were analyzed and significant findings calculated. Considering the current approach of study participants in examining patients for skin cancer, an up-to-date system of triage is presented in this review, which aims to promote an improved diagnostic accuracy and more timely management of skin malignancy.

5 Article Process Mining and Conformance Checking of Long Running Processes in the Context of Melanoma Surveillance. 2018

Rinner, Christoph / Helm, Emmanuel / Dunkl, Reinhold / Kittler, Harald / Rinderle-Ma, Stefanie. ·Center for Medical Statistics, Informatics, and Intelligent Systems (CeMSIIS), Medical University of Vienna, Spitalgasse 23, 1010 Vienna, Austria. christoph.rinner@meduniwien.ac.at. · Research Department of Advanced Information Systems and Technology, University of Applied Sciences Upper Austria, Softwarepark 13, 4232 Hagenberg, Austria. emmanuel.helm@fh-hagenberg.at. · Faculty of Computer Science, University of Vienna, Währinger Strasse 29, 1010 Vienna, Austria. reinhold.dunkl@gmail.com. · Department of Dermatology, Medical University of Vienna, Währinger Gürtel 18-20, 1010 Vienna, Austria. harald.kittler@meduniwien.ac.at. · Faculty of Computer Science, University of Vienna, Währinger Strasse 29, 1010 Vienna, Austria. stefanie.rinderle-ma@univie.ac.at. ·Int J Environ Res Public Health · Pubmed #30544735.

ABSTRACT: BACKGROUND: Process mining is a relatively new discipline that helps to discover and analyze actual process executions based on log data. In this paper we apply conformance checking techniques to the process of surveillance of melanoma patients. This process consists of recurring events with time constraints between the events. OBJECTIVES: The goal of this work is to show how existing clinical data collected during melanoma surveillance can be prepared and pre-processed to be reused for process mining. METHODS: We describe an approach based on time boxing to create process models from medical guidelines and the corresponding event logs from clinical data of patient visits. RESULTS: Event logs were extracted for 1023 patients starting melanoma surveillance at the Department of Dermatology at the Medical University of Vienna between January 2010 and June 2017. Conformance checking techniques available in the ProM framework and explorative applied process mining techniques were applied. CONCLUSIONS: The presented time boxing enables the direct use of existing process mining frameworks like ProM to perform process-oriented analysis also with respect to time constraints between events.

6 Article The significance of blue color in dermatoscopy. 2017

Popadić, Mirjana / Sinz, Christoph / Kittler, Harald. ·Department of Dermatovenereology, Medical University of Belgrade, Clinic of Dermatovenereology, Clinical Center of Serbia, Belgrade, Serbia. · Department of Dermatology, Division of General Dermatology, Medical University of Vienna, Austria. ·J Dtsch Dermatol Ges · Pubmed #28240407.

ABSTRACT: BACKGROUND AND OBJECTIVES: Skin lesions with blue color are frequently excised to rule out malignancy. The objective of the present study was to investigate the significance of blue color. METHODS: We retrospectively scanned dermatoscopic images for blue color and classified them according to pattern analysis. RESULTS: Of 1,123 pigmented skin lesions, 144 (12.8 %) showed blue color, 92 of which (63.9 %) were malignant. Among lesions with blue color, the most common benign diagnoses were nevi (n = 35, 24.3 %) and seborrheic keratoses (n = 8, 5.6 %). Of 103 (71.5 %) lesions with a structureless blue pattern, eight (7.8 %) were entirely blue and 95 (92.2 %) were partly blue, of which 81 (78.6 %) showed peripheral or patchy and 14 (13.6 %) central blue color. Most lesions with peripheral or patchy blue color were melanomas (n = 47, 58 %), whereas most lesions with central blue color were nevi (n = 9, 64.3 %). Of 28 lesions with blue clods, 17 (60.7 %) were basal cell carcinomas. With respect to malignancy, the positive predictive value of blue color was 63.9 % (95 % CI: 56.0-71.8 %). CONCLUSIONS: Among malignant lesions with blue color, structureless peripheral or patchy blue color is a clue for melanoma, while blue clods point to basal cell carcinoma. Pitfalls include seborrheic keratoses, which may show blue color, as well as some nevi, especially combined nevi.

7 Article Melanomas vs. nevi in high-risk patients under long-term monitoring with digital dermatoscopy: do melanomas and nevi already differ at baseline? 2017

Tschandl, P / Hofmann, L / Fink, C / Kittler, H / Haenssle, H A. ·Department of Dermatology, Medical University of Vienna, Vienna, Austria. · Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany. · Department of Dermatology, Venereology and Allergology, University Medical Center, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany. ·J Eur Acad Dermatol Venereol · Pubmed #27896853.

ABSTRACT: BACKGROUND: What lesions to select for a most efficient dermatoscopic monitoring of patients with multiple nevi remains an unresolved issue. OBJECTIVE: To compare the grade of atypia of melanomas and nevi of the same patient at baseline. METHODS: Prospective observational study using 236 dermatoscopic baseline images (59 quartets from 59 patients, each including one melanoma detected during follow-up and three nevi). Dermatologists (n = 26) were asked to assess the 'grade of dermatoscopic atypia' on a numerical scale and to identify the melanomas. RESULTS: On average, each dermatologist identified 24 of 59 melanomas (40%, range: 11-37). The number of correct picks was greater for dermatologists with moderate (mean: 28) or high (mean: 28) experience compared to beginners (mean 17; P < 0.001). In three of the 59 sets, none of the 26 dermatologists identified the melanoma. The mean grade of dermatoscopic atypia was 2.5 for nevi (95% CI: 2.4-2.6) and 3.0 for melanomas (95% CI: 2.9-3.1, P < 0.001). LIMITATIONS: Rating dermatologists were informed that each quartet of images included one melanoma creating substantial deviation from a real-life situation. CONCLUSION: A significant proportion of melanomas detected during follow-up cannot be differentiated from nevi at baseline. This necessitates the additional inclusion of less atypical lesions for monitoring.

8 Article Clinical and dermoscopic clues to differentiate pigmented nail bands: an International Dermoscopy Society study. 2017

Benati, E / Ribero, S / Longo, C / Piana, S / Puig, S / Carrera, C / Cicero, F / Kittler, H / Deinlein, T / Zalaudek, I / Stolz, W / Scope, A / Pellacani, G / Moscarella, E / Piraccini, B M / Starace, M / Argenziano, G. ·Skin Cancer Unit, Arcispedale S. Maria Nuova-IRCCS, Reggio Emilia, Italy. · Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy. · Pathology Unit, Arcispedale S. Maria Nuova-IRCCS, Reggio Emilia, Italy. · Melanoma Unit, Dermatology and Pathology Departments, Hospital Clínic Barcelona, Universitat de Barcelona, Barcelona, Spain. · CIBER of Rare Diseases, Instituto de Salud Carlos III, Barcelona, Spain. · Department of Dermatology, Division of General Dermatology, Medical University of Vienna, Vienna, Austria. · Non-Melanoma Skin Cancer Unit, Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria. · Clinic for Dermatology, Allergology, and Environmental Medicine, Klinik Thalkirchner Straße Städt, Klinikum München GmbH, Munich, Germany. · Department of Dermatology, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. · Department of Dermatology, University of Modena, Reggio Emilia, Italy. · Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy. · Dermatology Unit, Second University of Naples, Naples, Italy. ·J Eur Acad Dermatol Venereol · Pubmed #27696528.

ABSTRACT: BACKGROUND: Longitudinal melanonychia might be difficult to differentiate and the use of dermoscopy can be useful for the preoperative evaluation and management decision. OBJECTIVES: The aim of our study was to investigate clinical and dermoscopic criteria of acquired longitudinal melanonychia in adults to identify the best predictors of melanoma using a multivariate analysis and to explore eventual new dermoscopic criteria for nail melanoma diagnosis. METHODS: In this retrospective observational study, 82 histopathologically diagnosed, acquired nail pigmented bands were collected and examined. All variables were included in the analysis and examined as possible predictors of nail melanoma. Both univariate and multivariable analyses have been performed. RESULTS: Among 82 cases, 25 were diagnosed as nail melanoma and 57 as benign lesions (including 32 melanocytic nevi and 25 benign melanocytic hyperplasia). Melanoma cases were significantly associated with a width of the pigmented band higher than 2/3 of the nail plate, grey and black colours, irregularly pigmented lines, Hutchinson and micro-Hutchinson signs, and nail dystrophy. Granular pigmentation, a newly defined dermoscopic criterion, was found in 40% of melanomas and only in 3.51% of benign lesions. CONCLUSIONS: Dermoscopic examination of longitudinal melanonychia provides useful information that could help clinicians to improve melanoma recognition.

9 Article Validity and Reliability of Dermoscopic Criteria Used to Differentiate Nevi From Melanoma: A Web-Based International Dermoscopy Society Study. 2016

Carrera, Cristina / Marchetti, Michael A / Dusza, Stephen W / Argenziano, Giuseppe / Braun, Ralph P / Halpern, Allan C / Jaimes, Natalia / Kittler, Harald J / Malvehy, Josep / Menzies, Scott W / Pellacani, Giovanni / Puig, Susana / Rabinovitz, Harold S / Scope, Alon / Soyer, H Peter / Stolz, Wilhelm / Hofmann-Wellenhof, Rainer / Zalaudek, Iris / Marghoob, Ashfaq A. ·Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York2Melanoma Unit, Department of Dermatology, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona. · Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. · Dermatology Unit, Second University of Naples, Naples, Italy. · Department of Dermatology, University Hospital Zürich, Zürich, Switzerland. · Dermatology Service, Aurora Skin Cancer Center, Universidad Pontificia Bolivariana, Medellín, Colombia. · Department of Dermatology, Medical University of Vienna, Vienna, Austria. · Melanoma Unit, Department of Dermatology, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Centro de Investigacion Biomedica en red de enfermedades raras, Barcelona, Spain. · Sydney Melanoma Diagnostic Centre, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, Australia8Discipline of Dermatology, The University of Sydney, New South Wales, Australia. · Center for Environmental, Genetic, and Nutritional Epidemiology, Department of Diagnostic, Clinical, and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy. · Skin and Cancer Associates, Plantation, Florida. · Department of Dermatology, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. · Dermatology Research Centre, The University of Queensland, Brisbane, Queensland, Australia13School of Medicine, Translational Research Institute, Brisbane, Queensland, Australia. · Clinic for Dermatology, Allergology, and Environmental Medicine, Klinik Thalkirchner Straße Städt, Klinikum München GmbH, Munich, Germany. · Department of Dermatology, Medical University of Graz, Graz, Austria. ·JAMA Dermatol · Pubmed #27074267.

ABSTRACT: IMPORTANCE: The comparative diagnostic performance of dermoscopic algorithms and their individual criteria are not well studied. OBJECTIVES: To analyze the discriminatory power and reliability of dermoscopic criteria used in melanoma detection and compare the diagnostic accuracy of existing algorithms. DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective, observational study of 477 lesions (119 melanomas [24.9%] and 358 nevi [75.1%]), which were divided into 12 image sets that consisted of 39 or 40 images per set. A link on the International Dermoscopy Society website from January 1, 2011, through December 31, 2011, directed participants to the study website. Data analysis was performed from June 1, 2013, through May 31, 2015. Participants included physicians, residents, and medical students, and there were no specialty-type or experience-level restrictions. Participants were randomly assigned to evaluate 1 of the 12 image sets. MAIN OUTCOMES AND MEASURES: Associations with melanoma and intraclass correlation coefficients (ICCs) were evaluated for the presence of dermoscopic criteria. Diagnostic accuracy measures were estimated for the following algorithms: the ABCD rule, the Menzies method, the 7-point checklist, the 3-point checklist, chaos and clues, and CASH (color, architecture, symmetry, and homogeneity). RESULTS: A total of 240 participants registered, and 103 (42.9%) evaluated all images. The 110 participants (45.8%) who evaluated fewer than 20 lesions were excluded, resulting in data from 130 participants (54.2%), 121 (93.1%) of whom were regular dermoscopy users. Criteria associated with melanoma included marked architectural disorder (odds ratio [OR], 6.6; 95% CI, 5.6-7.8), pattern asymmetry (OR, 4.9; 95% CI, 4.1-5.8), nonorganized pattern (OR, 3.3; 95% CI, 2.9-3.7), border score of 6 (OR, 3.3; 95% CI, 2.5-4.3), and contour asymmetry (OR, 3.2; 95% CI, 2.7-3.7) (P < .001 for all). Most dermoscopic criteria had poor to fair interobserver agreement. Criteria that reached moderate levels of agreement included comma vessels (ICC, 0.44; 95% CI, 0.40-0.49), absence of vessels (ICC, 0.46; 95% CI, 0.42-0.51), dark brown color (ICC, 0.40; 95% CI, 0.35-0.44), and architectural disorder (ICC, 0.43; 95% CI, 0.39-0.48). The Menzies method had the highest sensitivity for melanoma diagnosis (95.1%) but the lowest specificity (24.8%) compared with any other method (P < .001). The ABCD rule had the highest specificity (59.4%). All methods had similar areas under the receiver operating characteristic curves. CONCLUSIONS AND RELEVANCE: Important dermoscopic criteria for melanoma recognition were revalidated by participants with varied experience. Six algorithms tested had similar but modest levels of diagnostic accuracy, and the interobserver agreement of most individual criteria was poor.

10 Article Dermoscopic clues to differentiate facial lentigo maligna from pigmented actinic keratosis. 2016

Lallas, A / Tschandl, P / Kyrgidis, A / Stolz, W / Rabinovitz, H / Cameron, A / Gourhant, J Y / Giacomel, J / Kittler, H / Muir, J / Argenziano, G / Hofmann-Wellenhof, R / Zalaudek, I. ·Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS, Viale Risorgimento 80, 42100, Reggio Emilia, Italy. · Department of Dermatology, Medical University of Vienna, Vienna, Austria. · Department of Dermatology, Allergology and Environmental Medicine II, Hospital Thalkirchner Straße, Städtisches Klinikum Munich, Munich, Germany. · Skin and Cancer Associates, Plantation, FL, U.S.A. · School of Medicine, University of Queensland, Brisbane, Qld, Australia. · Dermatology Practice, Nemours, France. · Skin Spectrum Medical Services, Como, WA, Australia. · School of Medicine, The University of Queensland, Brisbane, Qld, Australia. · Dermatology Unit, Second University of Naples, Naples, Italy. · Department of Dermatology and Venerology, Non-Melanoma Skin Cancer Unit, Medical University of Graz, Graz, Austria. ·Br J Dermatol · Pubmed #26784739.

ABSTRACT: BACKGROUND: Dermoscopy is limited in differentiating accurately between pigmented lentigo maligna (LM) and pigmented actinic keratosis (PAK). This might be related to the fact that most studies have focused on pigmented criteria only, without considering additional recognizable features. OBJECTIVES: To investigate the diagnostic accuracy of established dermoscopic criteria for pigmented LM and PAK, but including in the evaluation features previously associated with nonpigmented facial actinic keratosis. METHODS: Retrospectively enrolled cases of histopathologically diagnosed LM, PAK and solar lentigo/early seborrhoeic keratosis (SL/SK) were dermoscopically evaluated for the presence of predefined criteria. Univariate and multivariate regression analyses were performed and receiver operating characteristic curves were used. RESULTS: The study sample consisted of 70 LMs, 56 PAKs and 18 SL/SKs. In a multivariate analysis, the most potent predictors of LM were grey rhomboids (sixfold increased probability of LM), nonevident follicles (fourfold) and intense pigmentation (twofold). In contrast, white circles, scales and red colour were significantly correlated with PAK, posing a 14-fold, eightfold and fourfold probability for PAK, respectively. The absence of evident follicles also represented a frequent LM criterion, characterizing 71% of LMs. CONCLUSIONS: White and evident follicles, scales and red colour represent significant diagnostic clues for PAK. Conversely, intense pigmentation and grey rhomboidal lines appear highly suggestive of LM.

11 Article Impact of oncogenic BRAF mutations and p16 expression on the growth rate of early melanomas and naevi in vivo. 2016

Tschandl, P / Berghoff, A S / Preusser, M / Pammer, J / Pehamberger, H / Kittler, H. ·Department of Dermatology, Medical University of Vienna, Währinger Güurtel 18-20, 1090, Vienna, Austria. · Institute of Neurology, Medical University of Vienna, Währinger Güurtel 18-20, 1090, Vienna, Austria. · Department of Internal Medicine I, Medical University of Vienna, Währinger Güurtel 18-20, 1090, Vienna, Austria. · Department of Pathology, Medical University of Vienna, Währinger Güurtel 18-20, 1090, Vienna, Austria. ·Br J Dermatol · Pubmed #26613644.

ABSTRACT: BACKGROUND: It is important to know what drives and arrests melanocytic growth in vivo but observations linking oncogenic mutations to growth rates of melanocytic neoplasms in vivo are sparse. OBJECTIVES: To clarify the relationship between BRAF(V) (600E) mutations and p16 expression and the growth rate of melanocytic neoplasms in vivo. METHODS: We measured the growth rate of 54 melanocytic lesions (26 melanomas, 28 naevi) in vivo with digital dermatoscopy and correlated it with BRAF(V) (600E) and p16 expression, and with dermatoscopic and histological patterns. RESULTS: Melanomas grew faster than naevi (mean 2·7 vs. 0·8 mm(2) /year; P < 0·001) and the growth rate was faster in lesions with more nests (> 25% nests: 2·0 mm(2) /year vs. < 25% nests: 1·0 mm(2) /year; P = 0·036). Melanomas with the BRAF(V) (600E) mutation grew significantly faster than melanomas without the mutation (mean 3·36 vs. 1·60 mm(2) /year, P = 0·018). This effect of the BRAF(V) (600E) mutation on the growth rate was not observed in melanocytic naevi (mean 1·01 vs. 0·47 mm(2) /year, P = 0·274). Histopathologically, extensive nesting, larger nests and larger cell sizes were more common in melanocytic neoplasms with the BRAF(V) (600E) mutation than in those without the mutation. Melanomas expressing p16 had a slower growth rate than melanomas without p16 expression (2·27 vs. 4·34 mm(2) /year, P = 0·047). This effect was not observed in naevi (0·81 vs. 0·68 mm(2) /year, P = 0·836). CONCLUSIONS: The expression of BRAF(V) (600E) and the loss of p16 accelerate the growth rate of early melanomas in vivo but not in melanocytic naevi. In comparison to melanocytic proliferations that lack the mutation, the epidermal melanocytes in lesions that harbour BRAF(V) (600E) mutations are larger and more frequently arranged in large nests.

12 Article The BRAAFF checklist: a new dermoscopic algorithm for diagnosing acral melanoma. 2015

Lallas, A / Kyrgidis, A / Koga, H / Moscarella, E / Tschandl, P / Apalla, Z / Di Stefani, A / Ioannides, D / Kittler, H / Kobayashi, K / Lazaridou, E / Longo, C / Phan, A / Saida, T / Tanaka, M / Thomas, L / Zalaudek, I / Argenziano, G. ·Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS, Viale Risorgimento 80, 42100, Reggio Emilia, Italy. · Department of Dermatology, Shinshu University School of Medicine, Matsumoto, Japan. · Division of General Dermatology, Department of Dermatology, Medical University, Vienna, Austria. · First Department of Dermatology, Medical School, Aristotle University, Thessaloniki, Greece. · Division of Dermatology, Complesso Integrato Columbus, Rome, Italy. · Department of Dermatology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan. · Kobayashi Clinic, Tokyo, Japan. · Department of Dermatology, Claude Bernard - Lyon 1 University, Centre Hospitalier Lyon-Sud, Pierre Bénite, France. · Department of Dermatology and Venereology, Medical University, Graz, Austria. · Dermatology Unit, Second University of Naples, Naples, Italy. ·Br J Dermatol · Pubmed #26211689.

ABSTRACT: BACKGROUND: The parallel ridge pattern (PRP) is considered the dermoscopic hallmark of acral melanoma (AM). However, it was recently shown that approximately one-third of AMs do not display a PRP dermoscopically, rendering their detection more troublesome. OBJECTIVES: To investigate the diagnostic accuracy of dermoscopic criteria for the diagnosis of AM. METHODS: Dermoscopic images of consecutive cases of histopathologically diagnosed AMs and acral naevi with histopathological diagnosis or with at least 1 year of follow-up were evaluated by three independent investigators for the presence of predefined criteria. Crude and adjusted odds ratios and their corresponding 95% confidence intervals were calculated by univariate and multivariate logistic regression, respectively. Receiver operating characteristic curves were used to choose among competing classification schemes. RESULTS: In total 603 lesions (472 naevi and 131 AMs) were included in the study. A scoring system (named BRAAFF) composed of six variables was associated with optimal area under the curve and sensitivity for the diagnosis of AM. This method includes four positive (irregular blotches, ridge pattern, asymmetry of structures and asymmetry of colours) and two negative predictors (furrow pattern and fibrillar pattern). CONCLUSIONS: The BRAAFF checklist significantly improves the diagnostic accuracy of dermoscopy for the diagnosis of AM.

13 Article Pigmented nodular melanoma: the predictive value of dermoscopic features using multivariate analysis. 2015

Pizzichetta, M A / Kittler, H / Stanganelli, I / Bono, R / Cavicchini, S / De Giorgi, V / Ghigliotti, G / Quaglino, P / Rubegni, P / Argenziano, G / Talamini, R / Anonymous1690828. ·Division of Medical Oncology - Preventive Oncology, Centro di Riferimento Oncologico, National Cancer Institute, Via Franco Gallini, 2, 33081, Aviano, Italy. · Department of Dermatology, University of Vienna, Vienna, Austria. · Skin Cancer Unit, Istituto Tumori Romagna (IRST), Meldola, Italy. · Istituto Dermopatico Immacolata, IRCCS, Rome, Italy. · Department of Dermatology, Fondazione Ospedale Maggiore Policlinico IRCCS, Milan, Italy. · Department of Dermatology, University of Florence, Florence, Italy. · Clinic of Dermatology, IRCCS San Martino - Ist, Genoa, Italy. · Dermatologic Clinic, Department of Medical Sciences, University of Turin, Turin, Italy. · Department of Dermatology, University of Siena, Siena, Italy. · Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy. · Unit of Epidemiology and Biostatistics, Centro di Riferimento Oncologico, National Cancer Institute, Via Franco Gallini, 2, 33081, Aviano, Italy. ·Br J Dermatol · Pubmed #25916655.

ABSTRACT: BACKGROUND: Nodular melanoma (NM), representing 10-30% of all melanomas, plays a major role in global mortality related to melanoma. Nonetheless, the literature on dermoscopy of NM is scanty. OBJECTIVES: To assess odds ratios (ORs) to quantify dermoscopic features of pigmented NM vs. pigmented superficial spreading melanoma (SSM), and pigmented nodular nonmelanocytic and benign melanocytic lesions. METHODS: To assess the presence or absence of global patterns and dermoscopic criteria, digitized images of 457 pigmented skin lesions from patients with a histopathological diagnosis of NM (n = 75), SSM (n = 93), and nodular nonmelanocytic and benign melanocytic lesions (n = 289; namely, 39 basal cell carcinomas, 85 seborrhoeic keratoses, 81 blue naevi, and 84 compound/dermal naevi) were retrospectively collected and blindly evaluated by three observers. RESULTS: Multivariate analysis showed that ulceration (OR 4.07), homogeneous disorganized pattern (OR 10.76), and homogeneous blue pigmented structureless areas (OR 2.37) were significantly independent prognostic factors for NM vs. SSM. Multivariate analysis of dermoscopic features of NM vs. nonmelanocytic and benign melanocytic lesions showed that the positive correlating features leading to a significantly increased risk of NM were asymmetric pigmentation (OR 6.70), blue-black pigmented areas (OR 7.15), homogeneous disorganized pattern (OR 9.62), a combination of polymorphous vessels and milky-red globules/areas (OR 23.65), and polymorphous vessels combined with homogeneous red areas (OR 33.88). CONCLUSIONS: Dermoscopy may be helpful in improving the recognition of pigmented NM by revealing asymmetric pigmentation, blue-black pigmented areas, homogeneous disorganized pattern and abnormal vascular structures, including polymorphous vessels, milky-red globules/areas and homogeneous red areas.

14 Article Teaching dermatoscopy of pigmented skin tumours to novices: comparison of analytic vs. heuristic approach. 2015

Tschandl, P / Kittler, H / Schmid, K / Zalaudek, I / Argenziano, G. ·Department of Dermatology, Medical University of Vienna, Vienna, Austria. · Department of Psychology, Karl Franzens University Graz, Graz, Austria. · Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy. ·J Eur Acad Dermatol Venereol · Pubmed #25370214.

ABSTRACT: BACKGROUND: There are two strategies to approach the dermatoscopic diagnosis of pigmented skin tumours, namely the verbal-based analytic and the more visual-global heuristic method. It is not known if one or the other is more efficient in teaching dermatoscopy. OBJECTIVE: To compare two teaching methods in short-term training of dermatoscopy to medical students. METHODS: Fifty-seven medical students in the last year of the curriculum were given a 1-h lecture of either the heuristic- or the analytic-based teaching of dermatoscopy. Before and after this session, they were shown the same 50 lesions and asked to diagnose them and rate for chance of malignancy. Test lesions consisted of melanomas, basal cell carcinomas, nevi, seborrhoeic keratoses, benign vascular tumours and dermatofibromas. Performance measures were diagnostic accuracy regarding malignancy as measured by the area under the curves of receiver operating curves (range: 0-1), as well as per cent correct diagnoses (range: 0-100%). RESULTS: Diagnostic accuracy as well as per cent correct diagnoses increased by +0.21 and +32.9% (heuristic teaching) and +0.19 and +35.7% (analytic teaching) respectively (P for all <0.001). Neither for diagnostic accuracy (P = 0.585), nor for per cent correct diagnoses (P = 0.298) was a difference between the two groups. CONCLUSIONS: Short-term training of dermatoscopy to medical students allows significant improvement in diagnostic abilities. Choosing a heuristic or analytic method does not have an influence on this effect in short training using common pigmented skin lesions.

15 Article Dermatoscopy of flat pigmented facial lesions. 2015

Tschandl, P / Rosendahl, C / Kittler, H. ·Department of Dermatology, Division of General Dermatology, Medical University of Vienna, Vienna, Austria. ·J Eur Acad Dermatol Venereol · Pubmed #24661420.

ABSTRACT: BACKGROUND: The diagnosis of flat pigmented lesions on the face is challenging because of the morphologic overlap of biologically different lesions and the unknown significance of dermatoscopic patterns. OBJECTIVE: To better characterize dermatoscopic patterns of various types of flat pigmented facial lesions and to analyse their significance by calculating their relative risks and diagnostic values. METHODS: We prospectively analysed dermatoscopic images of 240 flat pigmented facial skin lesions collected consecutively from 195 patients (41.5% females, mean age: 61 ± 14 years) between 2007 and March 2012 in a primary skin cancer practice situated in Queensland, Australia. RESULTS: Histopathologically 114 (47.5%) lesions were malignant (24 lentigo maligna, 21 basal cell carcinomas and 69 pigmented actinic keratoses). Compared with all other patterns the positive predictive value for lentigo maligna was highest for a pattern of circles (31.3%, 95% CI: 11.1-58.6%). A pattern of clods was associated with basal cell carcinoma. If grey structures were present the relative risk for malignancy was 2.2 (95%CI: 1.4-3.4). The best clues to differentiate pigmented actinic keratosis from other lesions were the presence of scale (positive predictive value: 72.2%, specificity: 94.2%), white circles (positive predictive value: 68.8%, specificity: 94.2%) and a sharply demarcated border (positive predictive value: 44.2%, specificity: 86.0%). CONCLUSIONS: In flat lesions a pattern of circles bears the highest risk for facial melanoma but other patterns do not exclude it. Scale, white circles and a sharply demarcated border are clues to pigmented actinic keratoses. The presence of grey colour is a clue to malignancy regardless of pattern.

16 Article IL28B polymorphism cannot predict response to interferon alpha treatment in patients with melanoma. 2014

Probst, Martin / Hoeller, Christoph / Ferenci, Peter / Staettermayer, Albert F / Beinhardt, Sandra / Pehamberger, Hubert / Kittler, Harald / Grabmeier-Pfistershammer, Katharina. ·Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology, Medical University Vienna, Vienna, Austria. · Division of General Dermatology, Department of Dermatology, Medical University Vienna, Vienna, Austria. · Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria. ·PLoS One · Pubmed #25389973.

ABSTRACT: BACKGROUND: Recent genome-wide association studies revealed the rs12979860 single nucleotide polymorphism (SNP) of the IL28B gene (CC genotype) to be the strongest pre-therapeutic predictor of therapy response to interferon alpha in patients with chronic hepatitis C infection. The favorable CC genotype is associated with significantly higher rates of sustained virologic response. No data exist on the role of IL28B polymorphism in interferon therapy of diseases other than viral hepatitis. METHODS: A retrospective study involving 106 patients with melanoma who received low- or high-dose interferon therapy was performed. The CC and non-CC genotype of IL28B rs12979860 SNP were correlated with progression-free and overall survival. RESULTS: 44 (41.5%) patients were CC and 62 (58.5%) non-CC. There was no statistically significant difference in age at diagnosis, melanoma type or localization, Breslow level or AJCC stage between CC and non-CC patients. During the observation period (6.43±4.66 years) disease progression occurred in 36 (34%) patients after 5.5±4.3 years. 43.2% (19) of patients with CC and 27.4% (17) of patients with non-CC genotype were affected (p = 0.091). Disease progression was more frequent in patients on high dose interferon therapy and with a worse AJCC stage. CONCLUSION: In contrast to classical risk factors like tumor thickness and clinical stage, IL28B polymorphism was not associated with progression-free or overall survival in patients with melanoma treated with interferon alpha.

17 Article Twenty nevi on the arms: a simple rule to identify patients younger than 50 years of age at higher risk for melanoma. 2014

Argenziano, Giuseppe / Giacomel, Jason / Zalaudek, Iris / Apalla, Zoe / Blum, Andreas / De Simone, Paola / Lallas, Aimilios / Longo, Caterina / Moscarella, Elvira / Tiodorovic-Zivkovic, Danica / Tiodorovic, Jelica / Jovanovic, Dragan L / Kittler, Harald. ·aSkin Cancer Unit bDermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia cDepartment of Dermato-Oncology, San Gallicano Dermatological Institute, IFO of Rome, Rome, Italy dSkin Spectrum Medical Services, Como, Western Australia, Australia eDepartment of Dermatology, Medical University of Graz, Graz fDepartment of Dermatology, Division of General Dermatology, Medical University of Vienna, Vienna, Austria gState Clinic of Dermatology, Hospital of Skin and Venereal Diseases, Thessaloniki, Greece hPublic, Private and Teaching Practice of Dermatology, Konstanz, Germany iClinic of Dermatovenereology Medical University of Nis, Nis, Serbia. ·Eur J Cancer Prev · Pubmed #25068806.

ABSTRACT: Patients with a high total nevus count (TNC) merit a total-body examination, but a simple strategy to identify these high-risk individuals is essentially missing. The aim of this study was to investigate the correlation between the number of melanocytic nevi on both arms and the TNC, and to evaluate patient variables that may have an effect on this association. In this multicenter, cross-sectional study, 2175 patients were examined and the mean number of arm nevi in relation to TNC was calculated. A mean value of fewer than 10 arm nevi was found in patients with TNC lower than 51 and a mean value of greater than 19 arm nevi was scored in patients with TNC greater than 50. These values remained unchanged after adjustment for various patient variables. In relation to TNC greater than 50, the presence of 20 or more arm nevi had specificity and negative predictive values of 95.2 and 89.6%, respectively. The sensitivity was 65.5% in patients younger than 50 years of age and 37.5% in the older age group. The number of arm nevi was significantly higher in individuals with a history of melanoma and in those with a melanoma detected during the study period. The presence of 20 or more nevi on the arms is an independent predictor of a high TNC and risk of melanoma. This sign thus represents a simple and rapid screening tool for either the primary care physician or the dermatologist to help identify high-risk patients.

18 Article Palmar and plantar melanomas differ for sex prevalence and tumor thickness but not for dermoscopic patterns. 2014

Lallas, Aimilios / Sgouros, Dimitrios / Zalaudek, Iris / Tanaka, Masaru / Saida, Toshiaki / Thomas, Luc / Kittler, Harald / Kobayashi, Ken / Koga, Hiroshi / Phan, Alice / Longo, Caterina / Moscarella, Elvira / Katoulis, Alexandros / Argenziano, Giuseppe. ·aSkin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy bSecond Department of Dermatology, 'Attikon' General University Hospital, University of Athens, Athens, Greece cDepartment of Dermatology, Medical University, Graz dDepartment of Dermatology, Division of General Dermatology, Medical University, Vienna, Austria eDepartment of Dermatology, Tokyo Women's Medical University Medical Center East fKobayashi Clinic, Tokyo gDepartment of Dermatology, Shinshu University School of Medicine, Matsumoto, Japan hDepartment of Dermatology, Centre Hospitalier Lyon-Sud, Claude Bernard - Lyon 1 University, Pierre Bénite, France. ·Melanoma Res · Pubmed #24276365.

ABSTRACT: The specific anatomy of the glabrous skin, characterized by marked orthokeratosis and the presence of furrows and ridges, results in peculiar dermoscopic patterns of acral melanocytic lesions. Most frequently, acral nevi are typified by a parallel furrow pattern and acral melanoma (AM) by a parallel ridge pattern (PRP). Although the dermoscopic patterns of AM have been extensively investigated, little attention has been paid to site-related differences between palmar and plantar AM. The current study aimed to compare patients' characteristics, melanoma thickness, and the morphologic variability of AM depending on the localization on palms or soles. Patients demographics and dermoscopic images of 118 AM, including 99 (83.9%) plantar and 19 (16.1%) palmar lesions (mean thickness, 2.1 mm), were extracted from the databases of seven pigmented skin lesion clinics and were evaluated for the presence of predefined criteria. Palmar melanomas were remarkably more frequent in women (male-to-female ratio, 1/3.8) and thinner than plantar melanomas (1.3 vs. 2.2 mm). Dermoscopically, no significant differences were found between plantar and palmar melanomas, with PRP scored in 64.6 and 68.4% of plantar and palmar lesions, respectively. Non-site-specific melanoma criteria were detected in 83.9% of lesions and, among melanomas not exhibiting a PRP, 95.1% showed at least one non-site-specific melanoma criterion. In conclusion, plantar and palmar AMs show sex-related and thickness-related differences, but do not differ with respect to their dermoscopic features. For cases lacking the PRP, non-site-specific melanoma criteria may be considered as helpful additional clues for the correct diagnosis.

19 Article Recurrent melanocytic nevi and melanomas in dermoscopy: results of a multicenter study of the International Dermoscopy Society. 2014

Blum, Andreas / Hofmann-Wellenhof, Rainer / Marghoob, Ashfaq A / Argenziano, Giuseppe / Cabo, Horacio / Carrera, Cristina / Costa Soares de Sá, Bianca / Ehrsam, Eric / González, Roger / Malvehy, Josep / Manganoni, Ausilia Maria / Puig, Susana / Simionescu, Olga / Tanaka, Masaru / Thomas, Luc / Tromme, Isabelle / Zalaudek, Iris / Kittler, Harald. ·Public, Private, and Teaching Practice of Dermatology, Konstanz, Germany. · Medical University of Graz, Graz, Austria. · Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York. · Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy. · Medical Research Institute "A. Lanari," University of Buenos Aires, Buenos Aires, Argentina. · Melanoma Unit, Department of Dermatology, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigacion Biomedica en red de enfermedades raras (CIBERER) Enfermedades rara, Barcelona, Spain. · Skin Cancer and Dermatology Center, Hospital AC Camargo São Paulo, Brazil. · Public and Private Practice of Dermatology, Lille, France. · Departamento de Introducción a la Clínica, Facultad de Medicina, UANL, Monterrey, México. · Department of Dermatology, University of Brescia, Brescia, Italy. · First Dermatological Clinic, Carol Davila University of Medicine and Pharmacy, Colentina Hospital, Bucharest, Romania. · Department of Dermatology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan. · Department of Dermatology, Lyon 1 University Centre Hospitalier Lyon Sud, Pierre Bénite, France. · Department of Dermatology, Centre du Cancer, Cliniques Universitaires St Luc, Université Catholique de Louvain, Brussels, Belgium. · Department of Dermatology, Medical University of Vienna, Vienna, Austria. ·JAMA Dermatol · Pubmed #24226788.

ABSTRACT: IMPORTANCE Differentiating recurrent nevi from recurrent melanoma is challenging. OBJECTIVE To determine dermoscopic features to differentiate recurrent nevi from melanomas. DESIGN, SETTING, AND PARTICIPANTS Retrospective observational study of 15 pigmented lesion clinics from 12 countries; 98 recurrent nevi (61.3%) and 62 recurrent melanomas (38.8%) were collected from January to December 2011. MAIN OUTCOMES AND MEASURES Scoring the dermoscopic features, patterns, and colors in correlation with the histopathologic findings. RESULTS In univariate analysis, radial lines, symmetry, and centrifugal growth pattern were significantly more common dermoscopically in recurrent nevi; in contrast, circles, especially if on the head and neck area, eccentric hyperpigmentation at the periphery, a chaotic and noncontinuous growth pattern, and pigmentation beyond the scar's edge were significantly more common in recurrent melanomas. Patients with recurrent melanomas were significantly older than patients with recurrent nevi (mean [SD] age, 63.1 [17.5] years vs 30.2 [12.4] years) (P<.001), and there was a significantly longer time interval between the first procedure and the second treatment (median time interval, 25 vs 8 months) (P<.001). In a multivariate analysis, pigmentation beyond the scar's edge (P=.002), age (P<.001), and anatomic site (P=.002) were significantly and independently associated with the diagnosis of recurrent melanoma in dermoscopy. CONCLUSIONS AND RELEVANCE Dermoscopically, pigmentation beyond the scar's edge is the strongest clue for melanoma. Dermoscopy is helpful in evaluating recurrent lesions, but final interpretation requires taking into account the patient age, anatomic site, time to recurrence, growth pattern, and, if available, the histopathologic findings of the first excision.

20 Article Dermoscopy of acral melanoma: a multicenter study on behalf of the international dermoscopy society. 2013

Braun, Ralph P / Thomas, L / Dusza, S W / Gaide, O / Menzies, S / Dalle, S / Blum, A / Argenziano, G / Zalaudek, I / Kopf, A / Rabinovitz, H / Oliviero, M / Perrinaud, A / Cabo, H / Pizzichetta, M / Pozo, L / Langford, D / Tanaka, M / Saida, T / Perusquia Ortiz, A M / Kreusch, J / De Giorgi, V / Piccolo, D / Grichnik, J M / Kittler, H / Puig, S / Malvehy, J / Seidenari, S / Stanganelli, I / French, L / Marghoob, A A. ·Department of Dermatology, University Hospital Zürich, Zürich, Switzerland. ·Dermatology · Pubmed #24296632.

ABSTRACT: BACKGROUND: Most studies on dermoscopy of acral lesions were conducted in Asian populations. In this study, we analyzed these features in a predominantly Caucasian population. OBJECTIVE: Estimate the prevalence of dermoscopic features in acral lesions, and assess their level of agreement between observers. METHODS: In this retrospective multicenter study, 167 acral lesions (66 melanomas) were evaluated for 13 dermoscopic patterns by 26 physicians, via a secured Internet platform. RESULTS: Parallel furrow pattern, bizarre pattern, and diffuse pigmentation with variable shades of brown had the highest prevalence. The agreement for lesion patterns between physicians was variable. Agreement was dependent on the level of diagnostic difficulty. CONCLUSION: Lesions with a diameter >1 cm were more likely to be melanoma. We found as well that a benign pattern can be seen in parts of melanomas. For this reason one should evaluate an acral lesion for the presence of malignant patterns first.

21 Article Melanoma epidemiology of Austria reveals gender-related differences. 2013

Duschek, Nikolaus / Skvara, Hans / Kittler, Harald / Delir, Golnaz / Fink, Astrid / Pinkowicz, Anja / Waldhör, Thomas. ·Department of Vascular and Endovascular Surgery. · Department of Dermatology, Division of Immunology, Allergy and Infectious Diseases. · Department of Dermatology, Division of General Dermatology, University of Vienna Medical School, Austria. · Department of Dermatology, Wilhelminenspital, Montleartstrasse 37, 1160 Vienna, Austria. · Department of Epidemiology, Centre of Public Health, Medical University of Vienna, Austria. ·Eur J Dermatol · Pubmed #24184485.

ABSTRACT: BACKGROUND: Cutaneous melanoma shows gender-specific trends worldwide, with highest rates in older men. In Austria, women show greater knowledge about the early detection of skin cancer by screening. Our aim was to analyse national melanoma incidence and mortality rates with regard to gender to improve our prevention efforts. METHODS: Population-based incidence (1983-2008) and mortality (1970-2010) data were retrieved from the Austrian cancer registry. ICD 9/10 Codes (172/C43) were used for melanoma. Stages were defined by the TNM classification. Age-standardized rates were calculated using the direct method (2000 WHO standard population) and linear regression models were used to estimate trends. RESULTS: Age-standardized incidence rates of melanoma increased for both genders from 4.9 in 1983 to 10.5 in 2008 (P<0.001), for men more than women (P<0.005). In 2006-2008 the lifetime risk of developing a melanoma was 1:123 (women: 1:128, men 1:117). In-situ and local stages were more common in women, men presented with regional and distant disease. In 2008-2010 male mortality was 1.7 times higher than female (P<0.005) and the lifetime risk of death from melanoma amounted to 1:570 (women 1:705, men 1:434; P<0.05). Comparatively, men over 75 faced the highest risk of presenting with or dying from melanoma. CONCLUSION: In Austria, melanoma epidemiology showed gender-specific differences. Efforts in early detection need to be increased in elderly men. As shown in the female population, a change in the melanoma-related epidemiology is feasible, most likely by means of secondary prevention.

22 Article NRAS and BRAF mutations in melanoma-associated nevi and uninvolved nevi. 2013

Tschandl, Philipp / Berghoff, Anna Sophie / Preusser, Matthias / Burgstaller-Muehlbacher, Sebastian / Pehamberger, Hubert / Okamoto, Ichiro / Kittler, Harald. ·Department of Dermatology, Medical University of Vienna, Vienna, Austria. ·PLoS One · Pubmed #23861977.

ABSTRACT: According to the prevailing multistep model of melanoma development, oncogenic BRAF or NRAS mutations are crucial initial events in melanoma development. It is not known whether melanocytic nevi that are found in association with a melanoma are more likely to carry BRAF or NRAS mutations than uninvolved nevi. By laser microdissection we were able to selectively dissect and genotype cells either from the nevus or from the melanoma part of 46 melanomas that developed in association with a nevus. In 25 cases we also genotyped a control nevus of the same patients. Available tissue was also immunostained using the BRAF(V600E)-mutation specific antibody VE1. The BRAF(V600E) mutation was found in 63.0% of melanomas, 65.2% of associated nevi and 50.0% of control nevi. No significant differences in the distribution of BRAF or NRAS mutations could be found between melanoma and associated nevi or between melanoma associated nevi and control nevi. In concordant cases immunohistochemistry showed a higher expression (intensity of immunohistochemistry) of the mutated BRAF(V600E)-protein in melanomas compared to their associated nevi. In this series the presence of a BRAF- or NRAS mutation in a nevus was not associated with the risk of malignant transformation. Our findings do not support the current traditional model of stepwise tumor progression.

23 Article Meta-analysis of digital dermoscopy follow-up of melanocytic skin lesions: a study on behalf of the International Dermoscopy Society. 2013

Salerni, G / Terán, T / Puig, S / Malvehy, J / Zalaudek, I / Argenziano, G / Kittler, H. ·Department of Dermatology, Hospital Provincial del Centenario de Rosario, Universidad Nacional de Rosario, Rosario, Argentina. gabrielsalerni@hotmail.com ·J Eur Acad Dermatol Venereol · Pubmed #23181611.

ABSTRACT: It has been demonstrated that dermoscopic monitoring of melanocytic lesions allows for the recognition of melanoma in early stages while minimizing the excision of benign lesions. However, it is still pending to determine the real impact of digital follow-up in the clinical management of pigmented lesions. To assess the evidence of follow-up of melanocytic skin lesions with digital dermoscopy in the management of individuals at risk for melanoma by performing a meta-analysis. Medline database was screened, no limits in terms of date or language were applied. Original studies were selected when the following criteria were met: performed in clinical setting with clinical and dermoscopic evaluation made by physicians, data regarding population characteristics included, follow-up strategy used described. Fourteen of 145 retrieved references were retained. Included studies account for a total of 5787 patients (mean 445 per study) and 52,739 lesions monitored (mean per study 4057; range 272-11,396) with a mean of 12 lesions monitored per patient; a total of 4388 lesions (8.3%) were excised. The mean length of follow-up was 30 months. A mean of <1 lesion was excised per patient along the surveillance period. The number needed to monitor (NNM) ranged from 31 to 1008 (mean: 348) among eligible studies. For every additional month of monitoring, 1additional melanoma was detected. Using digital dermoscopy follow-up, the proportion of in situ melanoma and thin melanomas are higher than expected in general population. Chances to detect a melanoma during surveillance increase as the length of follow-up extends.

24 Article Trends in the diagnosis of melanoma at a university center over time. 2013

Tschandl, Philipp / Pehamberger, Hubert / Kittler, Harald. ·Department of Dermatology, Division of General Dermatology, Medical University of Vienna, Austria. philipp.tschandl@meduniwien.ac.at ·J Dtsch Dermatol Ges · Pubmed #23078407.

ABSTRACT: BACKGROUND AND OBJECTIVES: The aim of this study is to show data regarding trends in the diagnosis of melanoma over the last ten years by looking at the University Clinic of Dermatology in Vienna as an example. PATIENTS AND METHODS: All excised melanocytic lesions from 1998 to 2008 were included. RESULTS: The ratio of excisions of benign to malignant lesions fell from 7:1 (1998) to 4:1 (2008). The mean percentage of in situ melanomas was 39% in 1998 and did not change significantly over time and no change was seen in tumor thickness of invasive melanomas. The median invasion depth was 0.7 mm in 1998 and 0.65 mm in 2008. The absolute number of diagnosed melanomas did not change significantly over time. CONCLUSION: The proportion of in situ melanomas was consistently high. Tumor thickness stayed at a low level, whereas the number of excised benign melanocytic lesions decreased significantly.

25 Article Changes observed in slow-growing melanomas during long-term dermoscopic monitoring. 2012

Terushkin, V / Dusza, S W / Scope, A / Argenziano, G / Bahadoran, P / Cowell, L / De Giorgi, V / Ferrara, G / Kittler, H / Malvehy, J / Menzies, S / Piccolo, D / Puig, S / Rubegni, P / Stanganelli, I / Thomas, L / Zalaudek, I / Marghoob, A A. ·Dermatology Service, Memorial Sloan-Kettering Cancer Center, 160 East 53rd Street, New York, NY 10022, USA. ·Br J Dermatol · Pubmed #22283805.

ABSTRACT: BACKGROUND: Melanomas vary in growth rate from rapidly developing nodular melanomas to slow-growing melanomas (SGM) that hardly change over years. OBJECTIVES: To evaluate longitudinal changes in dermoscopic findings of SGM. METHODS: We retrospectively analysed a dermoscopic image dataset from 15 pigmented lesion clinics, of SGM that were followed sequentially by digital dermoscopy for at least 1 year. We evaluated baseline and follow-up images for changes in global pattern, organization, colours, structure and size. RESULTS: Our series consisted of 92 SGM. On follow-up, these melanomas developed the following dermoscopic findings: more homogeneous and less reticular global dermoscopic pattern; more frequent disorganization of pattern (baseline, 67% vs. follow-up, 79%); decreased prominence of light brown colour, increased prominence of dark brown colour, and increased frequency of the colours red, white, grey, blue and black (baseline: 29%, 3%, 18%, 6% and 33% vs. follow-up: 41%, 10%, 31%, 13% and 45%, respectively); decrease in prominence of dermoscopic structure of pigmented network, with a concomitant increase in prominence of structureless areas; and increased prominence or new appearance of melanoma-specific dermoscopic structures, including negative network, blue-white structures and blotches. The majority of lesions (75%) remained the same size or grew by < 2 mm in diameter. An increase in lesion size was associated with change in the total number of colours and structures (χ(2) = 14·3, P = 0·027) at follow-up. CONCLUSIONS: While their diameter changed minimally over time, most SGM became more disorganized, revealed loss of network in favour of structureless areas, and developed new colours.

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