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Melanoma: HELP
Articles by Harold S. Rabinovitz
Based on 42 articles published since 2010
(Why 42 articles?)
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Between 2010 and 2020, H. Rabinovitz wrote the following 42 articles about Melanoma.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Review Reflectance confocal microscopy may enhance the accuracy of histopathologic diagnosis: A case series. 2019

Shahriari, Neda / Grant-Kels, Jane M / Rabinovitz, Harold / Oliviero, Margaret / Scope, Alon. ·Department of Dermatology, University of Connecticut, Farmington, Connecticut. · Department of Dermatology, University of Miami Miller School of Medicine, Miami, Florida. · Medical Screening Institute, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. ·J Cutan Pathol · Pubmed #31298761.

ABSTRACT: Although histopathology is the time-honored gold standard diagnostic measure in dermatology, several factors may detract from an accurate microscopic diagnosis. Limiting factors include: human error, suboptimal biopsy-site selection or biopsy technique, and inherent restrictions of vertical tissue sectioning that lead to incomplete microscopic evaluation of the lesion. Reflectance confocal microscopy (RCM) is a non-invasive imaging tool that allows for the cellular-level examination of the lesion, at a horizontal plane, which may complement the subsequent vertical histopathological tissue examination. Herein, we report a case series whereby prebiopsy RCM examination enhanced the accuracy of histopathological diagnosis or allowed for a critical appraisal of initial histopathological misdiagnosis.

2 Review Melanoma on chronically sun-damaged skin: Lentigo maligna and desmoplastic melanoma. 2019

DeWane, Madeline E / Kelsey, Andrew / Oliviero, Margaret / Rabinovitz, Harold / Grant-Kels, Jane M. ·University of Connecticut School of Medicine, Farmington, Connecticut. · Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut. Electronic address: akelsey@uchc.edu. · Dermatology Associates, Plantation, Florida. · Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut. ·J Am Acad Dermatol · Pubmed #30930085.

ABSTRACT: There are multiple, genetically distinct pathways that give rise to melanoma. Melanomas on sun-damaged skin (MSDS), including lentigo maligna and desmoplastic melanoma, have distinct genetic profiles and are uniquely linked to chronic ultraviolet exposure. In this article, we discuss the etiologies of lentigo maligna and desmoplastic melanoma, emerging diagnostic adjuncts that might be helpful for accurately identifying these lesions, and the clinical relevance of their frequent co-occurrence. We present unique and overlapping features of these entities and discuss challenges in MSDS management, including margin assessment, excision, and the potential role of nonsurgical therapy. Last, we address the role of immunotherapy in invasive disease. Understanding MSDS as distinct from melanoma arising on intermittently sun-exposed or sun-protected skin will ultimately help optimize patient outcomes.

3 Review Confocal Microscopy in Skin Cancer. 2018

Ahlgrimm-Siess, Verena / Laimer, Martin / Rabinovitz, Harold S / Oliviero, Margaret / Hofmann-Wellenhof, Rainer / Marghoob, Ashfaq A / Scope, Alon. ·1Abteilung für Dermatologie, Universitätsklinikum Salzburg, Paracelsus Private Medical University of Salzburg, Muellner Hauptstrasse 48, 5020 Salzburg, Austria. · 0000 0004 0523 5263 · grid.21604.31 · Skin and Cancer Associates, 201 NW 82nd Ave #501, Plantation, FL 33324 USA. · 3Medical University of Graz, Graz, Austria. · 0000 0000 8988 2476 · grid.11598.34 · 4Abteilung für Dermatologie, Universitätsklinikum Graz, Auenbruggerplatz 8, 8036 Graz, Austria. · 0000 0000 9937 5566 · grid.411580.9 · Dermatology Service, Memorial Sloan Kettering Skin Cancer Center Hauppauge, 800 Veterans Memorial Highway, 2nd Floor, Hauppauge, New York, 11788 USA. · 6Medical Screening Unit, Sheba Medical Center, Ramat Gan 5262000, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. · 0000 0004 1937 0546 · grid.12136.37 ·Curr Dermatol Rep · Pubmed #29780659.

ABSTRACT: Purpose of Review: Reflectance confocal microscopy (RCM) enables imaging of skin lesions at cellular level resolution at the bedside (in vivo) or in freshly excised tissue (ex vivo). This article provides an overview of strengths and limitations of non-invasive RCM in skin cancer diagnosis. Recent Findings: RCM features of common melanocytic and non-melanocytic skin neoplasms such as melanoma, actinic keratosis/squamous cell carcinoma, basal cell carcinoma, and nevi have been well defined and show good correlation with dermoscopic and histopathologic findings. Due to its technical properties, RCM is especially suitable for the examination of flat skin lesions. Summary: In vivo RCM has been shown to increase the accuracy of non-invasive diagnosis of common skin neoplasms and is a valuable adjunct to dermoscopy, particularly in cosmetically and functionally sensitive areas such as the face or the genital area.

4 Review In vivo reflectance confocal microscopy image interpretation for the dermatopathologist. 2018

Shahriari, Neda / Grant-Kels, Jane M / Rabinovitz, Harold / Oliviero, Margaret / Scope, Alon. ·Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut. · Department of Dermatology, University of Miami Miller School of Medicine, Miami, Florida. · Department of Dermatology, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. ·J Cutan Pathol · Pubmed #29178501.

ABSTRACT: Reflectance confocal microscopy (RCM) is a technology utilized for bedside diagnosis of cutaneous pathology by non-invasive, in vivo, cellular-level imaging. With the recent establishment of reimbursement codes by the US Centers for Medicaid and Medicare Services, RCM is now likely to be employed by clinical dermatologists and impact decision making on skin cancer management. Dermatopathologists, therefore, would benefit from learning how to interpret RCM images and how RCM findings correlate with histopathological criteria of diagnosis. This review briefly explains the principles behind RCM image acquisition, describes the key RCM features of normal skin, and delineates the RCM characteristics of frequently observed benign and malignant neoplasms.

5 Review Assessing Skin Cancer Using Epidermal Genetic Information Retrieved by Adhesive Patch Skin Surface Sampling. 2017

Lee, Nayoung / Scope, Alon / Rabinovitz, Harold. ·Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1600 NW 10th Avenue, Miami, FL 33136, USA. · Department of Dermatology, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Hashomer 5262000, Israel. · Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1600 NW 10th Avenue, Miami, FL 33136, USA; Private Practice, Skin and Cancer Associates, Plantation, FL 33324, USA. Electronic address: harold@admcorp.com. ·Dermatol Clin · Pubmed #28886808.

ABSTRACT: The detection of melanoma can be challenging. Many patients have clinically equivocal lesions in cosmetically sensitive areas or have multiple suspicious lesions. Epidermal genetic information retrieval is a noninvasive diagnostic method involving the application of adhesive tape onto the skin's surface to recover genomic material from the epidermis. This genomic material can then be used in assays to determine gene expression profiles. Studies have shown the potential of this technology to aid clinicians in differentiating between melanomas and nevi. Although this technology is not meant to replace a biopsy, it can help guide the decision whether to biopsy.

6 Review Application of Handheld Confocal Microscopy for Skin Cancer Diagnosis: Advantages and Limitations Compared with the Wide-Probe Confocal. 2016

Que, Syril Keena T / Grant-Kels, Jane M / Rabinovitz, Harold S / Oliviero, Margaret / Scope, Alon. ·Department of Dermatology, University of Connecticut Health Center, 263 Farmington Avenue, MC 6231, Farmington, CT 06030-6231, USA. Electronic address: keenaq@gmail.com. · Department of Dermatology, University of Connecticut Health Center, 263 Farmington Avenue, MC 6231, Farmington, CT 06030-6231, USA. · Department of Dermatology, University of Miami School of Medicine, 1295 NW 14th St., University of Miami South Bldg., Suites K-M, Miami, FL 33125, USA. · Department of Dermatology, Sheba Medical Center, Tel Hashomer, Ramat Gan 5262000, Affiliated with the Sackler School of Medicine, Tel Aviv University, Ramat Gan 52621, Israel. ·Dermatol Clin · Pubmed #27692452.

ABSTRACT: The clinical diagnosis of tumors on the curved surfaces of the face, around the eyes, and on the mucosal surfaces can be difficult, while biopsies and excisions can have functional and aesthetic consequences. To avoid unnecessary surgery, clinicians have been aiming to attain accurate noninvasive diagnosis of lesions at these sites. However, acquisition of high-quality images with dermoscopy and with traditional wide-probe reflectance confocal microscopy (WP-RCM) have been hampered with technical difficulties. This article discusses the technical parameters of the handheld reflectance confocal microscope and discusses its advantages and limitations compared with the WP-RCM.

7 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.

8 Review Through the looking glass: Basics and principles of reflectance confocal microscopy. 2015

Que, Syril Keena T / Fraga-Braghiroli, Naiara / Grant-Kels, Jane M / Rabinovitz, Harold S / Oliviero, Margaret / Scope, Alon. ·Department of Dermatology at the University of Connecticut Health Center, Farmington, Connecticut. Electronic address: keenaq@gmail.com. · Department of Dermatology, University of Miami Miller School of Medicine, Miami, Florida. · Department of Dermatology at the University of Connecticut Health Center, Farmington, Connecticut. · Department of Dermatology, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York. ·J Am Acad Dermatol · Pubmed #26051696.

ABSTRACT: Reflectance confocal microscopy (RCM) offers high-resolution, noninvasive skin imaging and can help avoid obtaining unnecessary biopsy specimens. It can also increase efficiency in the surgical setting by helping to delineate tumor margins. Diagnostic criteria and several RCM algorithms have been published for the differentiation of benign and malignant neoplasms. We provide an overview of the basic principles of RCM, characteristic RCM features of normal skin and cutaneous neoplasms, and the limitations and future directions of RCM.

9 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.

10 Clinical Trial The performance of MelaFind: a prospective multicenter study. 2011

Monheit, Gary / Cognetta, Armand B / Ferris, Laura / Rabinovitz, Harold / Gross, Kenneth / Martini, Mary / Grichnik, James M / Mihm, Martin / Prieto, Victor G / Googe, Paul / King, Roy / Toledano, Alicia / Kabelev, Nikolai / Wojton, Maciej / Gutkowicz-Krusin, Dina. ·Total Skin and Beauty Dermatology, Birmingham, Alabama, USA. ·Arch Dermatol · Pubmed #20956633.

ABSTRACT: OBJECTIVE: To demonstrate the safety and effectiveness of MelaFind, a noninvasive and objective computer-vision system designed to aid in detection of early pigmented cutaneous melanoma. DESIGN: A prospective, multicenter, blinded study. The diagnostic performance of MelaFind and of study clinicians was evaluated using the histologic reference standard. Standard images and patient information for a subset of 50 randomly selected lesions (25 melanomas) were used in a reader study of 39 independent dermatologists to estimate clinicians' biopsy sensitivity to melanoma. SETTING: Three academic and 4 community practices in the United States with expertise in management of pigmented skin lesions. PATIENTS: A total of 1383 patients with 1831 lesions enrolled from January 2007 to July 2008; 1632 lesions (including 127 melanomas-45% in situ-with median Breslow thickness of invasive lesions, 0.36 mm) were eligible and evaluable for the study end points. MAIN OUTCOME MEASURES: Sensitivity of MelaFind; specificities and biopsy ratios for MelaFind and the study investigators; and biopsy sensitivities of independent dermatologists in the reader study. RESULTS: The measured sensitivity of MelaFind was 98.4% (125 of 127 melanomas) with a 95% lower confidence bound at 95.6% and a biopsy ratio of 10.8:1; the average biopsy sensitivity of dermatologists was 78% in the reader study. Including borderline lesions (high-grade dysplastic nevi, atypical melanocytic proliferations, or hyperplasias), MelaFind's sensitivity was 98.3% (172 of 175), with a biopsy ratio of 7.6:1. On lesions biopsied mostly to rule out melanoma, MelaFind's average specificity (9.9%) was superior to that of clinicians (3.7%) (P=.02). CONCLUSION: MelaFind is a safe and effective tool to assist in the evaluation of pigmented skin lesions. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00434057.

11 Article Consensus Recommendations for the Use of Non-Invasive Melanoma Detection Techniques Based on Results of an International DELPHI Process. 2019

Waldman, Reid A / Grant-Kels, Jane M / Curiel, Clara N / Curtis, Julia / Rodríguez, Salvador González / Hu, Shasa / Kerr, Philip / Marghoob, Ashfaq / Markowitz, Orit / Pellacani, Giovanni / Rabinovitz, Harold / Rao, Babar / Scope, Alon / Stein, Jennifer A / Swetter, Susan M. ·University of Connecticut Department of Dermatology, Farmington, CT 06032. · University of Connecticut Department of Dermatology, Farmington, CT 06032. Electronic address: grant@uchc.edu. · University of Arizona College of Medicine Department of Dermatology. · Department of Dermatology University of Utah School of Medicine. · Department of Medicine and Medical Specialties Alcalá University. · Department of Dermatology University of Miami Miller School of Medicine. · Department of Dermatology Memorial Sloan Kettering Cancer Center. · Department of Dermatology SUNY Downstate Medical Center. · Department of Dermatology University of Modena and Reggio Emilia. · Dermatology Associates. · Department of Dermatology Rutgers-Robert Wood Johnson Medical School. · The Kittner Skin Cancer Screening & Research Institute Sheba Medical Center and Sackler School of Medicine. · The Ronald O. Perelman Department of Dermatology New York University School of Medicine. · Department of Dermatology Stanford University Medical Center. ·J Am Acad Dermatol · Pubmed #31563644.

ABSTRACT: -- No abstract --

12 Article Deep Learning and Handcrafted Method Fusion: Higher Diagnostic Accuracy for Melanoma Dermoscopy Images. 2019

Hagerty, Jason R / Stanley, R Joe / Almubarak, Haidar A / Lama, Norsang / Kasmi, Reda / Guo, Peng / Drugge, Rhett J / Rabinovitz, Harold S / Oliviero, Margaret / Stoecker, William V. · ·IEEE J Biomed Health Inform · Pubmed #30624234.

ABSTRACT: This paper presents an approach that combines conventional image processing with deep learning by fusing the features from the individual techniques. We hypothesize that the two techniques, with different error profiles, are synergistic. The conventional image processing arm uses three handcrafted biologically inspired image processing modules and one clinical information module. The image processing modules detect lesion features comparable to clinical dermoscopy information-atypical pigment network, color distribution, and blood vessels. The clinical module includes information submitted to the pathologist-patient age, gender, lesion location, size, and patient history. The deep learning arm utilizes knowledge transfer via a ResNet-50 network that is repurposed to predict the probability of melanoma classification. The classification scores of each individual module from both processing arms are then ensembled utilizing logistic regression to predict an overall melanoma probability. Using cross-validated results of melanoma classification measured by area under the receiver operator characteristic curve (AUC), classification accuracy of 0.94 was obtained for the fusion technique. In comparison, the ResNet-50 deep learning based classifier alone yields an AUC of 0.87 and conventional image processing based classifier yields an AUC of 0.90. Further study of fusion of conventional image processing techniques and deep learning is warranted.

13 Article Reflectance confocal microscopy terminology glossary for nonmelanocytic skin lesions: A systematic review. 2019

Navarrete-Dechent, Cristian / DeRosa, Antonio P / Longo, Caterina / Liopyris, Konstantinos / Oliviero, Margaret / Rabinovitz, Harold / Marghoob, Ashfaq A / Halpern, Allan C / Pellacani, Giovanni / Scope, Alon / Jain, Manu. ·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. · Samuel J. Wood Library, Weill Cornell Medical College, New York, New York. · Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy; Azienda Unità Sanitaria Locale, Istituto di Ricovero e Cura a Carattere Scientifico di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy. · Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. · Dermatology Associates, Plantation, Florida. · Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy. · Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Medical Screening Institute, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. · Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. Electronic address: jainm@mskcc.org. ·J Am Acad Dermatol · Pubmed #30529706.

ABSTRACT: BACKGROUND: There is lack of uniformity in reflectance confocal microscopy (RCM) terminology for nonmelanocytic lesions (NMLs). OBJECTIVE: To review published RCM terms for NMLs and identify likely synonymous terms. METHODS: We conducted a systematic review of original research articles published up to August 19, 2017, adhering to Preferred Reporting Items for Systemic Reviews and Meta-Analyses guidelines. Two investigators gathered all published RCM terms used to describe basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and seborrheic keratosis/solar lentigo/lichen planus-like keratosis (SK/SL/LPLK). Synonymous terms were grouped on the basis of similarity in definition and histopathologic correlates. RESULTS: The inclusion criteria was met by 31 studies. Average frequency of use per term was 1.6 (range 1-8). By grouping synonymous terms, the number of terms could be reduced from 58 to 18 for BCC, 58 to 36 for SCC, 23 to 12 for SK/SL/LPLK, and from 139 to 66 terms (52.5% reduction) in total. The frequency of term usage stratified by anatomic layer (suprabasal epidermis vs epidermal basal layer, dermoepidermal junction, and superficial dermis) was 27 (25.7%) versus 78 (74.2%) for BCC; 60 (64.5%) versus 33 (34.5%) for SCC, and 15 (45.4%) versus 18 (54.5%) for SK/SL/LPLK, respectively. LIMITATIONS: Articles that were not peer reviewed were excluded. CONCLUSION: Systematic review of published RCM terms provides the basis for future NMLs terminology consensus.

14 Article Accuracy of tele-consultation on management decisions of lesions suspect for melanoma using reflectance confocal microscopy as a stand-alone diagnostic tool. 2019

Scope, A / Dusza, S W / Pellacani, G / Gill, M / Gonzalez, S / Marchetti, M A / Rabinovitz, H S / Marghoob, A A / Alessi-Fox, C / Halpern, A C. ·Medical Screening Institute, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. · Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA. · Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy. · SkinMedical Research and Diagnostics, Dobbs Ferry, NY, USA. · SUNY Downstate, Brooklyn, NY, USA. · Department of Medicine and Medical Specialties, University de Alcalà, Madrid, Spain. · Skin and Cancer Associates, Plantation, FL, USA. · Caliber Imaging and Diagnostics, Rochester, NY, USA. ·J Eur Acad Dermatol Venereol · Pubmed #30242916.

ABSTRACT: BACKGROUND: Diagnostic accuracy of reflectance confocal microscopy (RCM) as a stand-alone diagnostic tool for suspect skin lesions has not been extensively studied. OBJECTIVE: Primary aim was to measure experts' accuracy in RCM-based management decisions. Secondary aim was to identify melanoma-specific RCM features. METHODS: The study enrolled patients ≥18 years that underwent biopsy of skin lesions clinically suspected to be melanoma. One hundred lesions imaged by RCM were randomly selected from 439 lesions prospectively collected at four pigmented lesion clinics. The study data set included 23 melanomas, three basal cell and two squamous cell carcinomas, 11 indeterminate melanocytic lesions and 61 benign lesions including 50 nevi. Three expert RCM evaluators were blinded to clinical or dermoscopic images, and to the final histopathological diagnosis. Evaluators independently issued a binary RCM-based management decision, 'biopsy' vs. 'observation'; these decisions were scored against histopathological diagnosis, with 'biopsy' as the correct management decision for malignant and indeterminate lesions. A subset analysis of 23 melanomas and 50 nevi with unequivocal histopathological diagnosis was performed to identify melanoma-specific RCM features. RESULTS: Sensitivity, specificity and diagnostic accuracy were 74%, 67% and 70% for reader 1, 46%, 84% and 69% for reader 2, and 72%, 46% and 56% for reader 3, respectively. The overall kappa for management decisions was 0.34. Readers had unanimous agreement on management for 50 of the 100 lesions. Non-specific architecture, non-visible papillae, streaming of nuclei, coarse collagen fibres and abnormal vasculature showed a significant association with melanoma in the evaluation of at least two readers. CONCLUSIONS: Reflectance confocal microscopy tele-consultation of especially challenging lesions, based on image review without benefit of clinical or dermoscopy images, may be associated with limited diagnostic accuracy and interobserver agreement. Architectural and stromal criteria may emerge as potentially useful and reproducible criteria for melanoma diagnosis.

15 Article Reflectance confocal microscopy features of melanomas on the body and non-glabrous chronically sun-damaged skin. 2018

Shahriari, Neda / Grant-Kels, Jane M / Rabinovitz, Harold / Oliviero, Margaret / Scope, Alon. ·Department of Internal Medicine, St. Mary's Hospital, Waterbury, Connecticut. · Department of Dermatology, UCONN Health Center, Farmington, Connecticut. · Department of Dermatology, University of Miami Miller School of Medicine, Miami, Florida. · Sheba Medical Center and Sackler Faculty of Medicine, Medical Screening Institute, Tel Aviv University, Tel Aviv, Israel. ·J Cutan Pathol · Pubmed #29971811.

ABSTRACT: BACKGROUND: Melanoma remains a challenge to diagnose, especially when appearing on the background of chronically sun-damaged skin (CSDS). Our goal was to identify and quantify the reflectance confocal microscopy (RCM) features of melanoma on non-facial CSDS. METHODS: Included lesions were biopsy-proven melanomas, from anatomic sites other than the face, neck, scalp and acral skin, with histopathologic finding of solar elastosis in the underlying dermis. All included lesions underwent clinical, dermoscopic and RCM imaging, obtained in a standardized fashion, prior to biopsy. All images were retrospectively analyzed by four observers. RESULTS: We identified 33 melanomas from 33 patients with 63.6% male patients and overall mean age of 72.8 years. The salient RCM features included an atypical honeycomb or disarranged epidermal pattern (81.8%), pagetoid infiltration of the epidermis by both round and/or dendritic melanocytes (100%), focal proliferation of predominantly dendritic melanocytes as sheets (78.8%), foci with non-edged papillae (84.8%), junctional thickening (60.6%), areas of irregular ring or meshwork pattern (78.8%), and underlying thickened collagen bundles (51.5%). CONCLUSION: Non-facial CSDS melanomas share features similar to other melanoma types including pagetoid cells and non-edged papillae. The focal proliferation of dendritic pagetoid cells in sheets is similar to that seen in facial CSDS melanomas.

16 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.

17 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.

18 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.

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

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

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

20 Article Clinical and dermoscopic characteristics of melanomas on nonfacial chronically sun-damaged skin. 2015

Jaimes, Natalia / Marghoob, Ashfaq A / Rabinovitz, Harold / Braun, Ralph P / Cameron, Alan / Rosendahl, Cliff / Canning, Greg / Keir, Jeffrey. ·Dermatology Service, Aurora Skin Cancer Center and Universidad Pontificia Bolivariana, Medellín, Colombia. · Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, New York. · Skin and Cancer Associates, Plantation, Florida. · Department of Dermatology, University Hospital Zürich, Zürich, Switzerland. · School of Medicine, The University of Queensland, Brisbane, Australia. · Hermit Park Clinic and Skin Cancer Care, Townsville, Australia. · Northern Rivers Skin Cancer Clinic, Ballina, Australia. Electronic address: jkballina@gmail.com. ·J Am Acad Dermatol · Pubmed #25824275.

ABSTRACT: BACKGROUND: Melanomas on chronically sun-damaged skin (CSDS) can be difficult to identify and often manifest morphologic features that overlap with benign lesions. OBJECTIVE: We describe and analyze the clinical and dermoscopic characteristics of melanomas on nonfacial CSDS. METHODS: Melanoma cases on nonfacial CSDS were retrospectively identified from the biopsy specimen logs of 6 melanoma clinics. Clinical and dermoscopic images were combined into 1 database. Demographics, clinical, dermoscopic, and histopathologic information were analyzed. Descriptive frequencies were calculated. RESULTS: One hundred eighty-six cases met the inclusion criteria: 142 melanomas in situ (76%) and 39 invasive (21%; mean thickness, 0.49 mm). Lentigo maligna was the most common histopathologic subtype (n = 76; 40.9%). The most frequent dermoscopic structures were granularity (n = 126; 67.7%) and angulated lines (n = 82; 44%). Vascular structures were more frequent in invasive melanomas (56% vs 12% of in situ melanomas). Most manifested 1 of 3 dermoscopic patterns: patchy peripheral pigmented islands, angulated lines, and tan structureless with granularity pattern. LIMITATIONS: This was a retrospective study, and evaluators were not blinded to the diagnosis. In addition, interobserver concordance and sensitivity and specificity for dermoscopic structures were not evaluated. CONCLUSION: Outlier lesions manifesting dermoscopic structures, such as granularity, angulated lines, or vessels and any of the 3 described dermoscopic patterns should raise suspicion for melanoma.

21 Article Age, gender, and topography influence the clinical and dermoscopic appearance of lentigo maligna. 2015

Tiodorovic-Zivkovic, Danica / Argenziano, Giuseppe / Lallas, Aimilios / Thomas, Luc / Ignjatovic, Aleksandra / Rabinovitz, Harold / Moscarella, Elvira / Longo, Caterina / Hofmann-Wellenhof, Rainer / Zalaudek, Iris. ·Clinic of Dermatovenereology, Clinical Center of Nis Medical Faculty, University of Nis, Nis, Serbia. · Skin Cancer Unit, Arcispedale S. Maria Nuova, IRCCS (Istituto Di Ricovero e Cura a Carattere Scientifico), Reggio Emilia, Italy. · Lyon 1 University, Dermatology Department, Centre Hospitalier Lyon Sud, Lyon, France. · Department of Medical Statistics, Faculty of Medicine, University of Nis, Nis, Serbia. · Skin and Cancer Associates, Plantation, Florida. · Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria. · Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria. Electronic address: iris.zalaudek@gmail.com. ·J Am Acad Dermatol · Pubmed #25774013.

ABSTRACT: BACKGROUND: Little is known about the frequency of clinical and dermoscopic patterns of lentigo maligna (LM) in relation to specific anatomic subsites and patients characteristics. OBJECTIVE: We sought to assess the frequency of clinical and dermoscopic features of LM and to correlate them to specific anatomic subsites, and patients' age and gender. METHODS: This was a retrospective analysis of clinical and dermoscopic images of a series of consecutive, histopathologically diagnosed, facial and extrafacial LM. RESULTS: A total of 201 cases from 200 patients (mean age 69.51 ± 12.26 years) including 120 women were collected. Most cases were located on the face (n = 192, 95.5%). In 102 cases, LM presented as clinically solitary facial macule (s/LM), whereas it was associated with multiple surrounding freckles in the remaining cases. s/LM were significantly smaller (<10 vs >10 mm; P = .020) and associated with younger age compared with LM associated with multiple surrounding freckles (mean age 67.73 ± 12.68 years vs 71.34 ± 11.59 years, respectively; P = .036). Dermoscopically, gray color irrespective of a specific pattern was the most prevalent finding seen in 178 (88.6%) cases. LIMITATIONS: This was a retrospective study. CONCLUSIONS: The knowledge about patient age, patient gender, and site-related clinical features of LM associated with gray color upon dermoscopy may enhance the clinical recognition of LM.

22 Article Accuracy of in vivo confocal microscopy for diagnosis of basal cell carcinoma: a comparative study between handheld and wide-probe confocal imaging. 2015

Castro, R P / Stephens, A / Fraga-Braghiroli, N A / Oliviero, M C / Rezze, G G / Rabinovitz, H / Scope, A. ·Department of Cutaneous Oncology, A.C. Camargo Cancer Center, São Paulo, SP, Brazil. · Skin and Cancer Associations, Plantation, FL, USA. · Dermatology Department, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel. · Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA. ·J Eur Acad Dermatol Venereol · Pubmed #25338750.

ABSTRACT: BACKGROUND: Reflectance confocal microscopy (RCM) increases specificity of identification of basal cell carcinoma (BCC). A smaller-diameter handheld RCM (HH-RCM) allows better access to limited anatomic locations. OBJECTIVE: To compare accuracy of HH-RCM in identification of BCC to that of traditional wide-probe RCM (TWP-RCM). METHODS: Patients presenting at least one lesion clinically and dermoscopically suspicious for BCC, were recruited from two dermatology skin cancer clinics. Prior to excision, we attempted to image all lesions with HH-RCM and TWP-RCM using a standardized protocol. RCM images were retrospectively evaluated, jointly by two blinded readers. For purposes of comparative RCM, sensitivity and specificity analysis, we used a threshold of ≥3 RCM criteria to identify BCC, whereby at least one criterion had to be presence of 'dark silhouettes' or 'bright tumor islands'. RESULTS: Among 54 lesions imaged with both RCM devices, 45 were biopsy-proven BCCs. Comparison between TWP-RCM vs. HH-RCM was as follows: sensitivity (100% vs. 93%), specificity (78% for both probes), positive predictive value (96% vs. 95%), and negative predictive value (100% vs. 70%) respectively. Notably, both TWP-RCM and HH-RCM demonstrated the presence of 'dark silhouettes' or 'bright tumor islands' in all 45 BCCs. CONCLUSION: Both RCM probes demonstrate high PPV. TWP-RCM shows higher NPV, since its broader field-of-view probably allows more exhaustive search for BCC criteria. The RCM criteria threshold for BCC identification should be further tested.

23 Article Clinical performance of the Nevisense system in cutaneous melanoma detection: an international, multicentre, prospective and blinded clinical trial on efficacy and safety. 2014

Malvehy, J / Hauschild, A / Curiel-Lewandrowski, C / Mohr, P / Hofmann-Wellenhof, R / Motley, R / Berking, C / Grossman, D / Paoli, J / Loquai, C / Olah, J / Reinhold, U / Wenger, H / Dirschka, T / Davis, S / Henderson, C / Rabinovitz, H / Welzel, J / Schadendorf, D / Birgersson, U. ·Department of Dermatology, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain. ·Br J Dermatol · Pubmed #24841846.

ABSTRACT: BACKGROUND: Even though progress has been made, the detection of melanoma still poses a challenge. In light of this situation, the Nevisense electrical impedance spectroscopy (EIS) system (SciBase AB, Stockholm, Sweden) was designed and shown to have the potential to be used as an adjunct diagnostic tool for melanoma detection. OBJECTIVES: To assess the effectiveness and safety of the Nevisense system in the distinction of benign lesions of the skin from melanoma with electrical impedance spectroscopy. METHODS: This multicentre, prospective, and blinded clinical study was conducted at five American and 17 European investigational sites. All eligible skin lesions in the study were examined with the EIS-based Nevisense system, photographed, removed by excisional biopsy and subjected to histopathological evaluation. A postprocedure clinical follow-up was conducted at 7 ± 3 days from the initial measurement. A total of 1951 patients with 2416 lesions were enrolled into the study; 1943 lesions were eligible and evaluable for the primary efficacy end point, including 265 melanomas - 112 in situ and 153 invasive melanomas with a median Breslow thickness of 0·57 mm [48 basal cell carcinomas (BCCs) and seven squamous cell carcinomas (SCCs)]. RESULTS: The observed sensitivity of Nevisense was 96·6% (256 of 265 melanomas) with an exact one-sided 95% lower confidence bound estimated at 94·2% and an observed specificity of 34·4%, and an exact two-sided 95% confidence bound estimated at 32·0-36·9%. The positive and negative predictive values of Nevisense were 21·1% and 98·2%, respectively. The observed sensitivity for nonmelanoma skin cancer was 100% (55 of 48 BCCs and seven SCCs) with an exact two-sided 95% confidence bound estimated at 93·5-100·0%. CONCLUSIONS: Nevisense is an accurate and safe device to support clinicians in the detection of cutaneous melanoma.

24 Article Fuzzy logic color detection: Blue areas in melanoma dermoscopy images. 2014

Lingala, Mounika / Stanley, R Joe / Rader, Ryan K / Hagerty, Jason / Rabinovitz, Harold S / Oliviero, Margaret / Choudhry, Iqra / Stoecker, William V. ·Department of Electrical and Computer Engineering, Missouri University of Science and Technology, G20 Emerson Electric Company Hall, 301 West 16th Street, Rolla, MO 65409-0040, United States. Electronic address: ml427@mst.edu. · Department of Electrical and Computer Engineering, Missouri University of Science and Technology, 127 Emerson Electric Company Hall, 301 West 16th Street, Rolla, MO 65409-0040, United States. Electronic address: stanleyj@mst.edu. · Stoecker & Associates, LLC 10101 Stoltz Drive Rolla, MO 65401-7714, United States. Electronic address: rkrc5b@health.missouri.edu. · Stoecker & Associates, LLC 10101 Stoltz Drive Rolla, MO 65401-7714, United States. Electronic address: hagerty.jason@gmail.com. · Skin & Cancer Associates, 201 NW 82nd Avenue, Suite 501, Plantation, FL 33324, United States. Electronic address: harold@admcorp.com. · Skin & Cancer Associates, 201 NW 82nd Avenue, Suite 501, Plantation, FL 33324, United States. Electronic address: maggie@admcorp.com. · Stoecker & Associates, LLC 10101 Stoltz Drive Rolla, MO 65401-7714, United States. Electronic address: iqrachowder@live.com. · Stoecker & Associates, LLC 10101 Stoltz Drive Rolla, MO 65401-7714, United States. Electronic address: wvs@mst.edu. ·Comput Med Imaging Graph · Pubmed #24786720.

ABSTRACT: Fuzzy logic image analysis techniques were used to analyze three shades of blue (lavender blue, light blue, and dark blue) in dermoscopic images for melanoma detection. A logistic regression model provided up to 82.7% accuracy for melanoma discrimination for 866 images. With a support vector machines (SVM) classifier, lower accuracy was obtained for individual shades (79.9-80.1%) compared with up to 81.4% accuracy with multiple shades. All fuzzy blue logic alpha cuts scored higher than the crisp case. Fuzzy logic techniques applied to multiple shades of blue can assist in melanoma detection. These vector-based fuzzy logic techniques can be extended to other image analysis problems involving multiple colors or color shades.

25 Article Dark homogeneous streak dermoscopic pattern correlating with specific KIT mutations in melanoma. 2014

Sanchez, Margaret I / Rabinovitz, Harold S / Oliviero, Margaret C / Elgart, George W / Perez, Carmen / Puig, Susana / Malvehy, Josep / Grichnik, James M. ·Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida. · Melanoma Unit, Dermatology Department, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain3CIBER de Enfermedades Raras, Instituto de Salud Carlos III, Barcelona, Spain. ·JAMA Dermatol · Pubmed #24695820.

ABSTRACT: IMPORTANCE: Mutations driving melanoma growth have diagnostic, prognostic, and therapeutic implications. Traditional classification systems do not correlate optimally with underlying melanoma growth-promoting mutations. Our objective was to determine whether unique dermoscopic growth patterns directly correlate with driving mutations. OBSERVATIONS: We evaluated common driving mutations in 4 different dermoscopic patterns (rhomboidal, negative pigmented network, polygonal, and dark homogeneous streaks) of primary cutaneous melanomas; 3 melanomas per pattern were tested. Three of the 4 patterns lacked common mutations in BRAF, NRAS, KIT, GNAQ, and HRAS. One pattern, the dark homogeneous streaks pattern, had unique KIT mutations in the second catalytic domain of KIT in exon 17 for all 3 samples tested. Two tumors with the dark homogeneous streaks pattern turned out to be different primary melanomas from the same patient and had different sequence mutations but had an impact on the same KIT domain. CONCLUSIONS AND RELEVANCE: While future study is required, these results have multiple implications. (1) The underlying melanoma-driving mutations may give rise to specific dermoscopic growth patterns, (2) BRAF/NRAS mutations in early melanomas may not be as common as previously thought, and (3) patients may be predisposed to developing specific driving mutations giving rise to melanomas or nevi of similar growth patterns.

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