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Melanoma: HELP
Articles by Harald J. Kittler
Based on 45 articles published since 2010
(Why 45 articles?)
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Between 2010 and 2020, H. Kittler wrote the following 45 articles about Melanoma.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Review Dermatoscopy of Neoplastic Skin Lesions: Recent Advances, Updates, and Revisions. 2018

Weber, Philipp / Tschandl, Philipp / Sinz, Christoph / Kittler, Harald. ·Department of Dermatology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. · Department of Dermatology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. harald.kittler@meduniwien.ac.at. ·Curr Treat Options Oncol · Pubmed #30238167.

ABSTRACT: OPINION STATEMENT: Dermatoscopy (dermoscopy) improves the diagnosis of benign and malignant cutaneous neoplasms in comparison with examination with the unaided eye and should be used routinely for all pigmented and non-pigmented cutaneous neoplasms. It is especially useful for the early stage of melanoma when melanoma-specific criteria are invisible to the unaided eye. Preselection by the unaided eye is therefore not recommended. The increased availability of polarized dermatoscopes, and the extended use of dermatoscopy in non-pigmented lesions led to the discovery of new criteria, and we recommend that lesions should be examined with polarized and non-polarized dermatoscopy. The "chaos and clues algorithm" is a good starting point for beginners because it is easy to use, accurate, and it works for all types of pigmented lesions not only for those melanocytic. Physicians, who use dermatoscopy routinely, should be aware of new clues for acral melanomas, nail matrix melanomas, melanoma in situ, and nodular melanoma. Dermatoscopy should also be used to distinguish between different subtypes of basal cell carcinoma and to discriminate highly from poorly differentiated squamous cell carcinomas to optimize therapy and management of non-melanoma skin cancer. One of the most exciting areas of research is the use of dermatoscopic images for machine learning and automated diagnosis. Convolutional neural networks trained with dermatoscopic images are able to diagnose pigmented lesions with the same accuracy as human experts. We humans should not be afraid of this new and exciting development because it will most likely lead to a peaceful and fruitful coexistence of human experts and decision support systems.

2 Review [Dermatoscopic-pathological correlation of melanocytic skin lesions]. 2018

Kittler, H. ·Universitätsklinik für Dermatologie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich. harald.kittler@meduniwien.ac.at. ·Hautarzt · Pubmed #29876611.

ABSTRACT: There is no doubt that dermatopathology is the most important method to decide if a melanocytic lesion is benign or malignant; however, like most morphologic examinations, dermatopathology is subjective. A recent study demonstrated that the pathologic diagnosis of melanocytic skin lesions has a high variability. Reports with false-positive or false-negative diagnoses are relatively common. The pathologic examination of melanocytic lesions also has observer-independent limitations and one has to accept that some melanocytic lesions cannot be classified as benign or malignant with confidence by dermatopathology alone. If a confident diagnosis is not possible a dermatoscopic-pathologic correlation may be helpful. This, however, is only possible if dermatoscopic images are available and if the dermatopathologist knows how to interpret dermatoscopic structures. A dermatoscopic-pathologic correlation is not useful in all difficult melanocytic lesions but it should be considered in difficult flat pigmented lesions. In these cases dermatoscopy may provide even more important additional information than molecular findings.

3 Review Standardization of terminology in dermoscopy/dermatoscopy: Results of the third consensus conference of the International Society of Dermoscopy. 2016

Kittler, Harald / Marghoob, Ashfaq A / Argenziano, Giuseppe / Carrera, Cristina / Curiel-Lewandrowski, Clara / Hofmann-Wellenhof, Rainer / Malvehy, Josep / Menzies, Scott / Puig, Susana / Rabinovitz, Harold / Stolz, Wilhelm / Saida, Toshiaki / Soyer, H Peter / Siegel, Eliot / Stoecker, William V / Scope, Alon / Tanaka, Masaru / Thomas, Luc / Tschandl, Philipp / Zalaudek, Iris / Halpern, Allan. ·Department of Dermatology, Medical University of Vienna, Vienna, Austria. Electronic address: harald.kittler@meduniwien.ac.at. · Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, New York. · Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Reggio Emilia, Italy. · Melanoma Unit, Department of Dermatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER ER), Instituto de Salud Carlos III, Barcelona, Spain. · University of Arizona Cancer Center, Tucson, Arizona. · Department of Dermatology and Venerology, Nonmelanoma Skin Cancer Unit, Medical University of Graz, Graz, Austria. · Sydney Melanoma Diagnostic Center, Sydney Cancer Center, Royal Prince Alfred Hospital, Camperdown, Australia. · Skin and Cancer Associates, Plantation, Florida. · Department of Dermatology, Klinikum München, Munich, Germany. · Department of Dermatology, Shinshu University School of Medicine, Matsumoto, Japan. · Dermatology Research Center, University of Queensland, School of Medicine, Translational Research Institute, Brisbane, Australia. · University of Maryland Medical Center, Baltimore Department of Veterans Affairs Medical Center, Baltimore, Maryland. · Department of Dermatology, University of Missouri Health Sciences Center, Columbia, Missouri. · Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Dermatology, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. · Department of Dermatology, Keio University, Tokyo, Japan. · Service de Dermatologie, Center Hospitalier Universitaire de Lyon, Lyon, France. · Department of Dermatology, Medical University of Vienna, Vienna, Austria. ·J Am Acad Dermatol · Pubmed #26896294.

ABSTRACT: BACKGROUND: Evolving dermoscopic terminology motivated us to initiate a new consensus. OBJECTIVE: We sought to establish a dictionary of standardized terms. METHODS: We reviewed the medical literature, conducted a survey, and convened a discussion among experts. RESULTS: Two competitive terminologies exist, a more metaphoric terminology that includes numerous terms and a descriptive terminology based on 5 basic terms. In a survey among members of the International Society of Dermoscopy (IDS) 23.5% (n = 201) participants preferentially use descriptive terminology, 20.1% (n = 172) use metaphoric terminology, and 484 (56.5%) use both. More participants who had been initially trained by metaphoric terminology prefer using descriptive terminology than vice versa (9.7% vs 2.6%, P < .001). Most new terms that were published since the last consensus conference in 2003 were unknown to the majority of the participants. There was uniform consensus that both terminologies are suitable, that metaphoric terms need definitions, that synonyms should be avoided, and that the creation of new metaphoric terms should be discouraged. The expert panel proposed a dictionary of standardized terms taking account of metaphoric and descriptive terms. LIMITATIONS: A consensus seeks a workable compromise but does not guarantee its implementation. CONCLUSION: The new consensus provides a revised framework of standardized terms to enhance the consistent use of dermoscopic terminology.

4 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.

5 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.

6 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.

7 Article Number Needed to Biopsy (NNB) Ratio and Diagnostic Accuracy for Melanoma Detection. 2020

Marchetti, Michael A / Yu, Ashley / Nanda, Japbani / Tschandl, Philipp / Kittler, Harald / Marghoob, Ashfaq A / Halpern, Allan C / Dusza, Stephen W. ·Dermatology Service, Department of Medicine; Memorial Sloan Kettering Cancer Center, New York, New York, United States. Electronic address: marchetm@mskcc.org. · Dermatology Service, Department of Medicine; Memorial Sloan Kettering Cancer Center, New York, New York, United States. · Department of Dermatology, Medical University of Vienna, Austria. ·J Am Acad Dermatol · Pubmed #32360723.

ABSTRACT: BACKGROUND: The number needed to biopsy (NNB) ratio for melanoma diagnosis is calculated by dividing the total number of biopsies by the number of biopsied melanomas. It is the inverse of positive predictive value (PPV), which is calculated by dividing the number of biopsied melanomas by the total number of biopsies. NNB is increasingly used as a metric to compare the diagnostic accuracy of health care practitioners (HCPs). OBJECTIVE: To investigate the association of NNB with the standard statistical measures of sensitivity and specificity. METHODS: We extracted published diagnostic accuracy data from 5 cross-sectional skin cancer reader studies [median (min-max) readers/study was 29 (8-511)]. As NNB is a ratio, we converted it to PPV. RESULTS: Four studies showed no association and one showed a negative association between PPV and sensitivity. All five studies showed a positive association between PPV and specificity. LIMITATIONS: Reader study data. CONCLUSION: An individual HCP with a lower NNB is likely to have a higher specificity than one with a higher NNB, assuming they practice under similar conditions; no conclusions can be made about their relative sensitivity. We advocate for additional research to define quality metrics for melanoma detection and caution when interpreting NNB.

8 Article Analysis of Collective Human Intelligence for Diagnosis of Pigmented Skin Lesions Harnessed by Gamification Via a Web-Based Training Platform: Simulation Reader Study. 2020

Rinner, Christoph / Kittler, Harald / Rosendahl, Cliff / Tschandl, Philipp. ·Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria. · Department of Dermatology, Medical University of Vienna, Vienna, Austria. · Faculty of Medicine, University of Queensland, Brisbane, Australia. ·J Med Internet Res · Pubmed #32012058.

ABSTRACT: BACKGROUND: The diagnosis of pigmented skin lesion is error prone and requires domain-specific expertise, which is not readily available in many parts of the world. Collective intelligence could potentially decrease the error rates of nonexperts. OBJECTIVE: The aim of this study was to evaluate the feasibility and impact of collective intelligence for the detection of skin cancer. METHODS: We created a gamified study platform on a stack of established Web technologies and presented 4216 dermatoscopic images of the most common benign and malignant pigmented skin lesions to 1245 human raters with different levels of experience. Raters were recruited via scientific meetings, mailing lists, and social media posts. Education was self-declared, and domain-specific experience was tested by screening tests. In the target test, the readers had to assign 30 dermatoscopic images to 1 of the 7 disease categories. The readers could repeat the test with different lesions at their own discretion. Collective human intelligence was achieved by sampling answers from multiple readers. The disease category with most votes was regarded as the collective vote per image. RESULTS: We collected 111,019 single ratings, with a mean of 25.2 (SD 18.5) ratings per image. As single raters, nonexperts achieved a lower mean accuracy (58.6%) than experts (68.4%; mean difference=-9.4%; 95% CI -10.74% to -8.1%; P<.001). Collectives of nonexperts achieved higher accuracies than single raters, and the improvement increased with the size of the collective. A collective of 4 nonexperts surpassed single nonexperts in accuracy by 6.3% (95% CI 6.1% to 6.6%; P<.001). The accuracy of a collective of 8 nonexperts was 9.7% higher (95% CI 9.5% to 10.29%; P<.001) than that of single nonexperts, an improvement similar to single experts (P=.73). The sensitivity for malignant images increased for nonexperts (66.3% to 77.6%) and experts (64.6% to 79.4%) for answers given faster than the intrarater mean. CONCLUSIONS: A high number of raters can be attracted by elements of gamification and Web-based marketing via mailing lists and social media. Nonexperts increase their accuracy to expert level when acting as a collective, and faster answers correspond to higher accuracy. This information could be useful in a teledermatology setting.

9 Article Clinical and dermoscopic features of cutaneous BAP1-inactivated melanocytic tumors: Results of a multicenter case-control study by the International Dermoscopy Society. 2019

Yélamos, Oriol / Navarrete-Dechent, Cristián / Marchetti, Michael A / Rogers, Tova / Apalla, Zoe / Bahadoran, Philippe / Blázquez-Sánchez, Nuria / Busam, Klaus / Carrera, Cristina / Dusza, Stephen W / de la Fouchardière, Arnaud / Ferrara, Gerardo / Gerami, Pedram / Kittler, Harald / Lallas, Aimilios / Malvehy, Josep / Millán-Cayetano, José F / Nelson, Kelly C / Quan, Victor Li / Puig, Susana / Stevens, Howard / Thomas, Luc / Marghoob, Ashfaq A. ·Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Dermatology Department, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, and CIBER de Enfermedades Raras, Instituto de Salud Carlos III, Barcelona, Spain. Electronic address: oyelamos@gmail.com. · Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Dermatology, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. · Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. · First Department of Dermatology, Aristotle University, Thessaloniki, Greece. · Dermatology Department, Centre Hospitalier Universitaire de Nice, Nice, France. · Dermatology Department, Hospital Costa del Sol, Marbella, Spain. · Pathology Department, Memorial Sloan Kettering Cancer Center, New York, New York. · Dermatology Department, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, and CIBER de Enfermedades Raras, Instituto de Salud Carlos III, Barcelona, Spain. · Département de Biopathologie, Centre Léon Bérard, Lyon, France. · Anatomic Pathology Unit, Hospital of Macerata, Macerata, Italy. · Dermatology Department, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. · Department of Dermatology, Medical University of Vienna, Vienna, Austria. · Dermatology Department, The University of Texas MD Anderson Cancer Center, Houston, Texas. · Skin Care Network, Barnet, London, United Kingdom. · Department of Dermatology, Lyon 1 University, Centre Hospitalier Lyon Sud and Lyon's Cancer Research Center INSERM U1052 - CNRS UMR5286, Lyon, France. ·J Am Acad Dermatol · Pubmed #30244062.

ABSTRACT: BACKGROUND: Multiple BRCA1-associated protein 1 (BAP1)-inactivated melanocytic tumors (BIMTs) have been associated with a familial cancer syndrome involving germline mutations in BAP1. OBJECTIVES: We sought to describe the clinical and dermoscopic features of BIMTs. METHODS: This was a retrospective, multicenter, case-control study. Participating centers contributed clinical data, dermoscopic images, and histopathologic data of biopsy-proven BIMTs. We compared the dermoscopic features between BIMTs and control patients. RESULTS: The dataset consisted of 48 BIMTs from 31 patients (22 women; median age 37 years) and 80 control patients. Eleven patients had a BAP1 germline mutation. Clinically, most BIMTs presented as pink, dome-shaped papules (n = 24). Dermoscopically, we identified 5 patterns: structureless pink-to-tan with irregular eccentric dots/globules (n = 14, 29.8%); structureless pink-to-tan with peripheral vessels (n = 10, 21.3%); structureless pink-to-tan (n = 7, 14.9%); a network with raised, structureless, pink-to-tan areas (n = 7, 14.9%); and globular pattern (n = 4, 8.5%). The structureless with eccentric dots/globules pattern and network with raised structureless areas pattern were only identified in BIMT and were more common in patients with BAP1 germline mutations (P < .0001 and P = .001, respectively). LIMITATIONS: Limitations included our small sample size, retrospective design, the absence of germline genetic testing in all patients, and inclusion bias toward more atypical-looking BIMTs. CONCLUSIONS: Dome-shaped papules with pink-to-tan structureless areas and peripheral irregular dots/globules or network should raise the clinical suspicion for BIMT.

10 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.

11 Article [Image-based computer diagnosis of melanoma]. 2018

Dick, V / Tschandl, P / Sinz, C / Blum, A / Kittler, H. ·Abteilung für Allgemeine Dermatologie, Universitätsklinik für Dermatologie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich. · Hautarzt- und Lehrpraxis Konstanz, Konstanz, Deutschland. · Abteilung für Allgemeine Dermatologie, Universitätsklinik für Dermatologie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich. harald.kittler@meduniwien.ac.at. ·Hautarzt · Pubmed #29845364.

ABSTRACT: The use of automated diagnostic systems for the diagnosis of melanomas is becoming increasingly more established. These are based on the following four steps: 1) preprocessing, to ensure that disturbing factors are eliminated, 2) segmentation, the separation of the image and the background, 3) extraction and selection of features that provide the highest measure of accuracy for the diagnosis and 4) classification, in which the lesion is assigned to a diagnostic class. Recently, the computer-assisted diagnosis of melanoma has focused on algorithms based on transfer learning, which can make steps 2 and 3 obsolete and provides better results. In this article we also review smartphone applications in the field of melanoma screening and recognition. These applications should be considered with caution as they are available to lay persons although the diagnostic accuracy of these applications has not usually been tested in clinical trials.

12 Article Morphologic characteristics of nevi associated with melanoma: a clinical, dermatoscopic and histopathologic analysis. 2018

Alendar, Temeida / Kittler, Harald. ·Department of Dermatology, Medical University Vienna, Vienna, Austria. ·Dermatol Pract Concept · Pubmed #29785326.

ABSTRACT: Background: The aim of this retrospective study was to determine the frequency of nevus-associated melanomas and to better characterize the preexisting nevus from a histopathologic, clinical and dermatoscopic point of view. Methods: We reviewed the histopathologic slides of a consecutive series of 357 melanomas and corresponding clinical and dermatoscopic images, if available. Results: We found that 31 (8.7%) melanomas were associated with a preexisting nevus, 284 (79.5%) melanomas developed de novo, and in 42 (11.8%) a preexisting nevus could not be excluded, although the alternative explanation that the entire lesion represented a melanoma was also possible. The preexisting nevus was a "superficial" or "superficial and deep" congenital nevus in 27 cases (87%) and a Clark nevus in 4 cases (13%). Clinical or dermatoscopic images were available in 149 (41.7%) cases. The preexisting nevus, if visible, looked inconspicuous clinically or dermatoscopically. The median invasion thickness of nevus-associated melanoma was not significantly different from "de novo" melanomas but the frequency of in situ melanomas was higher in the "de novo" group (40.1% versus 16.1%). Patients with melanoma in association with a nevus were significantly younger (mean age=55 years, SD: 16 years) than patients with "de novo" melanomas (mean age=68 years SD: 15 years, p<0.001). When controlled for age and invasion thickness overall, survival did not differ significantly between patients with nevus-associated melanomas and patients with de novo melanomas. Conclusions: From a histomorphologic point of view, the majority of melanomas arise de novo. If melanomas develop in a preexisting nevus, they usually occur in association with a "superficial" or "superficial and deep" congenital nevus.

13 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.

14 Article Accuracy of dermatoscopy for the diagnosis of nonpigmented cancers of the skin. 2017

Sinz, Christoph / Tschandl, Philipp / Rosendahl, Cliff / Akay, Bengu Nisa / Argenziano, Giuseppe / Blum, Andreas / Braun, Ralph P / Cabo, Horacio / Gourhant, Jean-Yves / Kreusch, Juergen / Lallas, Aimilios / Lapins, Jan / Marghoob, Ashfaq A / Menzies, Scott W / Paoli, John / Rabinovitz, Harold S / Rinner, Christoph / Scope, Alon / Soyer, H Peter / Thomas, Luc / Zalaudek, Iris / Kittler, Harald. ·Department of Dermatology, Division of General Dermatology, Medical University of Vienna, Vienna, Austria. · Faculty of Medicine, The University of Queensland, Brisbane, Australia; School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. · Department of Dermatology, Ankara University Faculty of Medicine, Ankara, Turkey. · Dermatology Unit, University of Campania, Naples, Italy. · Public, Private and Teaching Practice of Dermatology, Konstanz, Germany. · Department of Dermatology, University Hospital Zurich, Zurich, Switzerland. · Department of Dermatology, Instituto de Investigaciones Médicas "A. Lanari," University of Buenos Aires, Buenos Aires, Argentina. · Centre de Dermatologie, Nemours, France. · Private Dermatology Practice, Lübeck, Germany. · First Department of Dermatology, Aristotle University, Thessaloniki, Greece. · Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden. · Memorial Sloan Kettering Cancer Center, Hauppauge, New York. · Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, and Discipline of Dermatology, University of Sydney, Sydney, Australia. · Department of Dermatology and Venereology, Sahlgrenska University Hospital, Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. · Skin and Cancer Associates, Plantation, Florida. · Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria. · Department of Dermatology, Chaim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. · Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Australia. · Department of Dermatology, Centre Hospitalier Lyon Sud, Lyon 1 University, Lyons Cancer Research Center, Lyon, France. · Department of Dermatology, Medical University of Graz, Graz, Austria. · Department of Dermatology, Division of General Dermatology, Medical University of Vienna, Vienna, Austria. Electronic address: harald.kittler@meduniwien.ac.at. ·J Am Acad Dermatol · Pubmed #28941871.

ABSTRACT: BACKGROUND: Nonpigmented skin cancer is common, and diagnosis with the unaided eye is error prone. OBJECTIVE: To investigate whether dermatoscopy improves the diagnostic accuracy for nonpigmented (amelanotic) cutaneous neoplasms. METHODS: We collected a sample of 2072 benign and malignant neoplastic lesions and inflammatory conditions and presented close-up images taken with and without dermatoscopy to 95 examiners with different levels of experience. RESULTS: The area under the curve was significantly higher with than without dermatoscopy (0.68 vs 0.64, P < .001). Among 51 possible diagnoses, the correct diagnosis was selected in 33.1% of cases with and 26.4% of cases without dermatoscopy (P < .001). For experts, the frequencies of correct specific diagnoses of a malignant lesion improved from 40.2% without to 51.3% with dermatoscopy. For all malignant neoplasms combined, the frequencies of appropriate management strategies increased from 78.1% without to 82.5% with dermatoscopy. LIMITATIONS: The study deviated from a real-life clinical setting and was potentially affected by verification and selection bias. CONCLUSIONS: Dermatoscopy improves the diagnosis and management of nonpigmented skin cancer and should be used as an adjunct to examination with the unaided eye.

15 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.

16 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.

17 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.

18 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.

19 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.

20 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.

21 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.

22 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.

23 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.

24 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.

25 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.

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