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Melanoma: HELP
Articles by Pietro Rubegni
Based on 32 articles published since 2008
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Between 2008 and 2019, P. Rubegni wrote the following 32 articles about Melanoma.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Guideline Spitz/Reed nevi: proposal of management recommendations by the Dermoscopy Study Group of the Italian Society of Dermatology (SIDeMaST). 2014

Broganelli, P / Titli, S / Lallas, A / Alaibac M Annetta, A / Battarra, V / Brunetti, B / Castagno, I / Cavicchini, S / Ferrari, A / Ghigliotti, G / Landi, C / Manganoni, A / Moscarella, E / Pellacani, G / Pizzichetta, M A / Rosina, P / Rubegni, P / Satta, R / Scalvenzi, M / Stanganelli, I / Stinco, G / Zalaudek, I / Zampieri, P / Argenziano, G / Anonymous1410806. ·Department of Oncology and Hematology, Section of Dermatology, City of Health and Science Hospital of Turin, Turin, Italy - paolobroganelli@inwind.it. ·G Ital Dermatol Venereol · Pubmed #25213387.

ABSTRACT: -- No abstract --

2 Review Dermoscopy for the Diagnosis of Conjunctival Lesions. 2018

Cinotti, Elisa / La Rocca, Anna / Labeille, Bruno / Grivet, Damien / Tognetti, Linda / Lambert, Victor / Kaspi, Mathilde / Nami, Niccolò / Fimiani, Michele / Perrot, Jean Luc / Rubegni, Pietro. ·Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria Alle Scotte Hospital, Viale Bracci 16, Siena 53100, Italy. Electronic address: elisacinotti@gmail.com. · Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria Alle Scotte Hospital, Viale Bracci 16, Siena 53100, Italy. · Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne Cedex 2 42055, France. · Department of Ophthalmology, University Hospital of Saint-Etienne, Saint-Etienne Cedex 2 42055, France; Laboratory Biology, Engineering, and Imaging of Corneal Graft, Jean Monnet University, EA2512, Saint-Etienne 42000, France. ·Dermatol Clin · Pubmed #30201153.

ABSTRACT: This article describes the present literature on dermoscopy of conjunctiva and shows the results of a dermoscopy study of 147 conjunctival tumors. Melanomas were characterized by a heavy pigmentation, irregular dots, and a higher prevalence of gray color compared with nevi. Squamous cell carcinomas had peculiar hairpin and glomerular vessels. Primary acquired melanoses were characterized by regularly distributed light brown dots. A large part of nevi had small cysts.

3 Review Dermoscopic patterns of cutaneous melanoma metastases. 2014

Rubegni, Pietro / Lamberti, Arianna / Mandato, Filomena / Perotti, Roberto / Fimiani, Michele. ·Department of Clinical Medicine and Immunological Sciences, Dermatology Section, University of Siena, Siena, Italy. ·Int J Dermatol · Pubmed #24320196.

ABSTRACT: In 2-8% of patients with melanoma, the first clinical manifestation of the disease may be skin metastasis. In these cases, differential diagnosis with the primary melanoma, benign melanocytic lesions, and other malignant and benign skin growths is particularly challenging. For this reason, the dermatologist's approach to cutaneous metastases of malignant melanoma calls for knowledge of the great morphological variety of these lesions. Dermoscopic characteristics associated with CMMMs have not yet been codified. The aim of the present review is to provide additional information about dermoscopic aspects of these skin lesions.

4 Clinical Trial Impact of digital dermoscopy analysis on the decision to follow up or to excise a pigmented skin lesion: a multicentre study. 2011

Burroni, Marco / Wollina, Uwe / Torricelli, Rocco / Gilardi, Stefano / Dell'Eva, Giordana / Helm, Cathrine / Bardey, Wolfgang / Nami, Niccolò / Nobile, Franco / Ceccarini, Massimo / Pomponi, Adriano / Alessandro, Biondi / Rubegni, Pietro. ·Department of Dermatology, Section of Dermatology, University of Siena, Siena, Italy. ·Skin Res Technol · Pubmed #21447065.

ABSTRACT: BACKGROUND: The quality of early malignant melanoma (MM) diagnosis is dependent on the experience of dermatologists, tools like dermoscopy and histopathology, and awareness and education of the studied population. Does a higher rate of excision of pigmented skin lesions (PSL) increase the rate of detected melanomas? MATERIAL AND METHODS: The DB-MIPS objective tool, able to evaluate mathematical defined variables, has been used to verify the variability of measurements among PSL stored by five different centres located in Italy, Switzerland, and Germany. RESULTS: The objective analysis showed low differences in terms of moles' features among the different groups, arguing for robustness of the dermatological patient's PSL inspection. Differences in terms of false positives and predictive positive values have been detected. The tendency to follow up a lesion was proportional to the percentage of thin MM (<0.75 mm tumour thickness), while the interventism was proportional to the percentage of dysplastic moles. Similar percentage of thin melanoma has been observed in all the centres, indicating a standardization in early diagnosing among experienced dermatologists. The main difference among the centres was their mode of action, i.e. to follow up or remove suspicious PSL. CONCLUSION: Interventism depends neither on the geographic site nor on the features of the observed moles. Higher removal rates do not correspond to higher MM detections: this means that an in-depth knowledge of melanoma patterns is required and follow-up of suspicious moles is highly suggested.

5 Article An integrated clinical-dermoscopic risk scoring system for the differentiation between early melanoma and atypical nevi: the iDScore. 2018

Tognetti, L / Cevenini, G / Moscarella, E / Cinotti, E / Farnetani, F / Mahlvey, J / Perrot, J L / Longo, C / Pellacani, G / Argenziano, G / Fimiani, M / Rubegni, P. ·Dermatology Unit, Department of Medical, Surgical and NeuroSciences, University of Siena, Siena, Italy. · Department of Medical Biotechnologies, University of Siena, Siena, Italy. · Dermatology Unit, University of Campania, Naples, Italy. · Skin Cancer Unit Arcispedale S. Maria Nuova-IRCCS, Reggio Emilia, Italy. · Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy. · Melanoma Unit, Department of Dermatology, University of Barcelona, Barcelona, Spain. · Dermatology Unit, University Hospital of St-Etienne, Saint Etienne, France. ·J Eur Acad Dermatol Venereol · Pubmed #29888421.

ABSTRACT: BACKGROUND: Dermoscopy revealed to be extremely useful in the diagnosis of early melanoma, the most important limitation being its subjectivity in giving a final diagnosis. To overcome this problem, several algorithms and checklists have been proposed. However, they generally demonstrated modest level of diagnostic accuracy, unsatisfactory concordance between dermoscopists and/or poor specificity. OBJECTIVE: To test a new methodological approach for the differentiation between early melanoma and atypical nevi, based on an integrated clinical-anamnestic dermoscopic risk scoring system (iDScore). METHODS: We selected a total of 435 standardized dermoscopic images of clinically atypical melanocytic skin lesion (MSL) excised in the suspect of malignancy (i.e. 134 early melanomas - MM - and 301 atypical nevi). Data concerning patient age and sex and lesion dimension and site were collected. A scoring classifier was designed based on this data set integrated with the dermoscopic evaluations performed by three experts blinded to histological diagnosis. RESULTS: A total of seven dermoscopic structures, three age groups (30-40 years, 41-60 years and >60 years), two maximum diameter categories (5-10 mm and >10 mm) and three body areas (i.e. frequently, chronically and seldom photoexposed sites) were selected by the scoring classifier as interdependently significant variables. The total risk score (S) of a lesion resulted from the simple sum of partial scores assigned to each selected variable. The iDScore-aided diagnosis showed an high accuracy (receiver operating characteristic-area under the curve = 0.903; IC: 95% = 0.887-0.918). A risk-based criticality scale corresponding to different S ranges was proposed. CONCLUSION: The iDScore checklist is proposed as a feasible and efficient tool to support dermatologists in non-invasive differentiation between atypical nevi and early MM on the basis of few selected clinical-anamnestic data and standardized dermoscopic features.

6 Article Benign and malignant collision tumors of melanocytic skin lesions with hemangioma: Dermoscopic and reflectance confocal microscopy features. 2018

Tognetti, L / Cinotti, E / Perrot, J L / Campoli, M / Fimiani, M / Rubegni, P. ·Division of Dermatology - Department of Medical, Surgical and Neuro Sciences, University of Siena, Siena, Italy. · Department of Medical Biotechnologies, University of Siena, Siena, Italy. · Dermatology Unit, University of St. Etienne, Saint Etienne, France. ·Skin Res Technol · Pubmed #29388348.

ABSTRACT: BACKGROUND: Though the combination/collision of nevi or lentigo simplex and hemangiomas is frequent, the malignant collision tumor melanoma-hemangioma is exceptional and can sometime clinically simulate a benign collision. To date, a series of collision tumors of hemangiomas associated with either benign or malignant melanocytic skin lesions (MSL) has yet to be studied by non-invasive imaging and clinico-pathologic correlates. METHODS: We present 10 cases of patients with collision tumors of hemangioma with different MSL including: 2 in situ lentigo-maligna melanoma, 1 invasive melanoma, 5 melanocytic nevi, and 2 lentigo simplex. The clinical aspect along with the dermoscopic and reflectance confocal microscopy (RCM) features is described and compared with histopathologic findings. RESULTS: Dermoscopic examination allows to recognize a dark ring in malignant collision melanoma-hemangioma and a jelly ring sign in benign collision of nevi/lentigo simplex-hemangioma. These peculiar features were confirmed by RCM and histopathologic findings. CONCLUSION: Two simple dermoscopic clues confirmed by RCM features can be proposed to help distinguish between benign and malignant collisions tumors.

7 Article Melanoma arising from a plaque-type blue naevus with subcutaneous cellular nodules of the scalp. 2018

Yan, L / Tognetti, L / Nami, N / Lamberti, A / Miracco, C / Sun, L / Fimiani, M / Rubegni, P. ·Department of Dermatology, Zhujiang Hospital, Southern Medical University, Guangzhou, China. · Section of Dermatology, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy. · Department of Medical Biotechnologies, University of Siena, Siena, Italy. · Section of Plastic Surgery Dermatology, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy. ·Clin Exp Dermatol · Pubmed #29034495.

ABSTRACT: Plaque-type blue naevus (PTBN) is a very rare variant of blue naevus (BN). The potential malignancy of subcutaneous cellular nodules (SCN) in PTBN was discovered in 2012, and there is currently no clear consensus on prognostic factors or management guidelines of such lesions. PTBN on the scalp have not been described in the literature. We report the clinical, histopathological and immunohistological features of a 50-year-old man who presented with a 30-year history of scalp PTBN, with malignant proliferation of nodular elements and fatal outcome 8 years later. This case suggests that long-term monitoring of patients with PTBN is required. Early surgical removal of such lesions should be considered, especially in the presence of any case of enlargement or change.

8 Article Clinical and dermoscopic characterization of pediatric and adolescent melanomas: Multicenter study of 52 cases. 2018

Carrera, Cristina / Scope, Alon / Dusza, Stephen W / Argenziano, Giuseppe / Nazzaro, Gianluca / Phan, Alice / Tromme, Isabelle / Rubegni, Pietro / Malvehy, Josep / Puig, Susana / Marghoob, Ashfaq A. ·Melanoma Unit, Department of Dermatology, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Centro de Investigacion Biomedica en red de enfermedades raras (CIBERER), Barcelona, Spain; Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. · Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; 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, New York. · Dermatology Unit, University of Campania, Naples, Italy. · Dipartimento di Fisiopatologia e dei Trapianti, Università degli Studi di Milano-UOC Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy. · Department of Dermatology, Centre Hospitalier Lyon Sud, Université Claude Bernard Lyon 1, Pierre Bénite Cedex, France. · Department of Dermatology, King Albert II Institute, Cliniques Universitaires St Luc, Université catholique de Louvain, Brussels, Belgium. · Dipartimento di Scienze Mediche, Chirurgiche e Neuroscienze, Sezione di Dermatologia, Università di Siena, Siena, Italy. · Melanoma Unit, Department of Dermatology, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Centro de Investigacion Biomedica en red de enfermedades raras (CIBERER), Barcelona, Spain. · Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. Electronic address: marghooa@mskcc.org. ·J Am Acad Dermatol · Pubmed #29024734.

ABSTRACT: BACKGROUND: Knowledge regarding the morphologic spectrum of pediatric melanoma (PM) is sparse, and this may in part contribute to delay in detection and thicker tumors. OBJECTIVE: To analyze the clinicodermoscopic characteristics of PM. METHODS: Retrospective study of 52 melanomas diagnosed in patients before the age of 20 years. RESULTS: On the basis of its clinical, dermoscopic, and histopathologic characteristics, PM can be classified as spitzoid or nonspitzoid. The nonspitzoid melanomas (n = 37 [72.3%]) presented in patients with a mean age of 16.3 years (range, 8-20) and were associated with a high-risk phenotype and a pre-existing nevus (62.2%). The spitzoid melanomas (n = 15 [27.7%]) were diagnosed in patients at a mean age of 12.5 years (range, 2-19) and were mostly de novo lesions (73.3%) located on the limbs (73.3%). Whereas less than 25% of PMs fulfilled the modified clinical ABCD criteria (amelanotic, bleeding bump, color uniformity, de novo at any diameter), 40% of spitzoid melanomas did. Dermoscopic melanoma criteria were found in all cases. Nonspitzoid melanomas tended to be multicomponent (58.3%) or have nevus-like (25%) dermoscopic patterns. Spitzoid melanomas revealed atypical vascular patterns with shiny white lines (46.2%) or an atypical pigmented spitzoid pattern (30.8%). There was good correlation between spitzoid subtype histopathologically and dermoscopically (κ = 0.66). LIMITATIONS: A retrospective study without re-review of pathologic findings. CONCLUSION: Dermoscopy in addition to conventional and modified clinical ABCD criteria helps in detecting PM. Dermoscopy assists in differentiating spitzoid from nonspitzoid melanomas.

9 Article Clinicopathological predictors of recurrence in nodular and superficial spreading cutaneous melanoma: a multivariate analysis of 214 cases. 2017

Pizzichetta, Maria A / Massi, Daniela / Mandalà, Mario / Queirolo, Paola / Stanganelli, Ignazio / De Giorgi, Vincenzo / Ghigliotti, Giovanni / Cavicchini, Stefano / Quaglino, Pietro / Corradin, Maria T / Rubegni, Pietro / Alaibac, Mauro / Astorino, Stefano / Ayala, Fabrizio / Magi, Serena / Mazzoni, Laura / Manganoni, Maria Ausilia / Talamini, Renato / Serraino, Diego / Palmieri, Giuseppe / Anonymous1471021. ·Division of Oncology B, CRO Aviano National Cancer Institute, Via Franco Gallini 2, 33081, Aviano, Italy. pizzichetta@cro.it. · Division of Pathological Anatomy, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy. · Unit of Medical Oncology, Papa Giovanni XXIII Hospital, Bergamo, Italy. · Department of Medical Oncology, National Institute for Cancer Research, IRCCS San Martino, Genoa, Italy. · Skin Cancer Unit, Istituto Tumori Romagna (IRST), Meldola, Italy. · Department of Dermatology, University of Parma, Parma, Italy. · Department of Dermatology, University of Florence, Florence, Italy. · Clinic of Dermatology, IRCCS San Martino-IST, Genoa, Italy. · Department of Dermatology, Fondazione Ospedale Maggiore Policlinico IRCCS, Milan, Italy. · Dermatologic Clinic, Dept Medical Sciences, University of Torino, Turin, Italy. · Division of Dermatology, Pordenone Hospital, Pordenone, Italy. · Department of Dermatology, University of Siena, Siena, Italy. · Department of Dermatology, University of Padova, Padua, Italy. · Division of Dermatology, Celio Hospital, Rome, Italy. · National Cancer Institute, "Fondazione G. Pascale"-IRCCS, Naples, Italy. · Department of Dermatology, ASST degli Spedali Civili di Brescia, Brescia, Italy. · Unit of Epidemiology and Biostatistics, CRO Aviano National Cancer Institute, Aviano, Italy. · Unit of Cancer Genetics, Institute of Biomolecular Chemistry (ICB), National Research Council (CNR), Sassari, Italy. ·J Transl Med · Pubmed #29115977.

ABSTRACT: BACKGROUND: Nodular melanoma (NM) accounts for most thick melanomas and because of their frequent association with ulceration, fast growth rate and high mitotic rate, contribute substantially to melanoma-related mortality. In a multicentric series of 214 primary melanomas including 96 NM and 118 superficial spreading melanoma (SSM), histopathological features were examined with the aim to identify clinicopathological predictors of recurrence. METHODS: All consecutive cases of histopathologically diagnosed primary invasive SSM and NM during the period 2005-2010, were retrieved from the 12 participating Italian Melanoma Intergroup (IMI) centers. Each center provided clinico-pathological data such as gender, age at diagnosis, anatomical site, histopathological conventional parameters, date of excision and first melanoma recurrence. RESULTS: Results showed that NM subtype was significantly associated with Breslow thickness (BT) at multivariate analysis: [BT 1.01-2 mm (OR 7.22; 95% CI 2.73-19.05), BT 2.01-4 mm (OR 7.04; 95% CI 2.54-19.56), and BT > 4 mm (OR 51.78; 95% CI 5.65-474.86) (p < 0.0001)]. Furthermore, mitotic rate (MR) was significantly correlated with NM histotype: [(MR 3-5 mitoses/mm CONCLUSIONS: We found that NM subtype was significantly associated with higher BT and MR but it was not a prognostic factor since it did not significantly correlate with melanoma recurrence rate. Conversely, increased BT and MR as well as SNLB positivity were significantly associated with a higher risk of melanoma recurrence.

10 Article [Contribution of reflectance confocal microscopy in the diagnosis of uterine cervix melanoma: First case report]. 2017

Perrot, J L / Labeille, B / Richard Coulet, E / Cochin, S / Biron Schneider, A-C / Rubegni, P / Cambazard, F / Cinotti, E / Anonymous5980911. ·Service de dermatologie, hôpital universitaire de Saint-Étienne, 42055 Saint-Étienne cedex 2, France. · SIPATH-anatomie et cytopathologie pathologique, 73, rue Général-Giraud, 42300 Roanne, France. · Clinique du Renaison, 75, rue Général-Giraud, 42300 Roanne, France. · Service de dermatologie, hôpital universitaire S. Maria alle Scotte, 16, viale Bracci, 53100 Siena, Italie. · Service de dermatologie, hôpital universitaire S. Maria alle Scotte, 16, viale Bracci, 53100 Siena, Italie. Electronic address: elisa.cinotti@gmail.com. ·Ann Dermatol Venereol · Pubmed #28668262.

ABSTRACT: -- No abstract --

11 Article Handheld In Vivo Reflectance Confocal Microscopy for the Diagnosis of Eyelid Margin and Conjunctival Tumors. 2017

Cinotti, Elisa / Singer, Aurélie / Labeille, Bruno / Grivet, Damien / Rubegni, Pietro / Douchet, Catherine / Cambazard, Frédéric / Thuret, Gilles / Gain, Philippe / Perrot, Jean Luc. ·Department of Medical, Surgical, and Neurological Science, Dermatology Section, University of Siena, S Maria alle Scotte Hospital, Siena, Italy. · Department of Ophthalmology, University Hospital of Saint-Etienne, Saint-Etienne, France. · Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France. · Biology, Engineering and Imaging of Corneal Graft Laboratory, EA2521, Jean Monnet University, Saint-Etienne, France. · Department of Pathology, University Hospital of Saint-Etienne, Saint-Etienne, France. · French University Institute, Paris, France. ·JAMA Ophthalmol · Pubmed #28654937.

ABSTRACT: Importance: The clinical diagnosis of conjunctival and eyelid margin tumors is challenging, and new noninvasive imaging techniques could be valuable in this field. Objective: To assess the diagnostic accuracy of handheld in vivo reflectance confocal microscopy (IVCM) for the diagnosis of eyelid margin and conjunctival tumors. Design: A prospective observational study was conducted at University Hospital of Saint-Etienne from January 2, 2011, to December 31, 2016 (inclusion of patients until December 31, 2015, and follow-up until December 31, 2016). A total of 278 consecutive patients with eyelid margin or conjunctival lesions were included. Conjunctival lesions were diagnosed with a conventional clinical examination using a slitlamp and by handheld IVCM. Final diagnoses were established by histopathologic examination for 155 neoformations suspicious for being malignant through clinical and/or IVCM examination that were excised and on follow-up of 12 months or longer for the remaining 140 lesions. Main Outcomes and Measures: Sensitivity, specificity, and positive and negative predictive values for malignant tumors of the conjunctiva and eyelid margin were calculated using clinical examination with slitlamp and handheld IVCM. Results: In the 278 patients (136 [48.9%] females; mean [SD] age, 59 [21] years), a total of 166 eyelid margin and 129 conjunctival lesions were included in the analysis. Of the 155 excised neoformations with a histopathologic diagnosis, IVCM showed higher sensitivity compared with clinical examination conducted with the slitlamp for malignant tumors of the eyelid margin (98% vs 92%) and conjunctiva (100% vs 88%). The specificity for malignant eyelid margin tumors was higher for IVCM than for slitlamp examination (74% vs 46%), but slightly less for malignant conjunctival tumors (78% vs 88%). Analysis of all neoformations (155 excised and 140 in follow-up) confirmed these differences in the diagnostic accuracy of the clinical examination and IVCM. The presence of hyperreflective Langerhans cells mimicking malignant melanocytes was the main cause for misdiagnosis of malignant conjunctival tumors with IVCM. Conclusions and Relevance: Handheld IVCM could be a useful tool for the identification of malignant conjunctival tumors. Further studies are required to confirm the usefulness of this device and identify possible features that can differentiate Langerhans cells from malignant melanocytes to prevent the misdiagnosis of melanoma using IVCM.

12 Article Mucosal melanoma: clinical, histological and c-kit gene mutational profile of 86 French cases. 2017

Cinotti, E / Chevallier, J / Labeille, B / Cambazard, F / Thomas, L / Balme, B / Leccia, M T / D'Incan, M / Vercherin, P / Douchet, C / Rubegni, P / Perrot, J L. ·Department of Dermatology, University Hospital of Saint Etienne, Saint Etienne, France. · Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy. · Dermatology Department, University Hospital of Lyon Sud, Pierre Bénite, France. · Dermatopathology Department, University Hospital of Lyon Sud, Pierre Bénite, France. · Department of Dermatology, University Hospital of Grenoble, Grenoble, France. · Dermatology Department, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France. · Department of Public Health and Medical Information, University Hospital of Saint Etienne, Saint Etienne, France. · Department of Pathology, University Hospital of Saint Etienne, Saint Etienne, France. ·J Eur Acad Dermatol Venereol · Pubmed #28543798.

ABSTRACT: BACKGROUND: Mucosal melanomas are rare and highly aggressive tumours. Few studies evaluated mucosal melanomas of locations other than the head and neck region, and other than those of the Asian population. OBJECTIVES: The objective of this study was to analyse the clinical and histological features, as well as the mutational status of c-kit and b-raf gene of mucosal melanoma in any localization in a French series. METHODS: We investigated clinical (sex, age, performance status, survival, treatment of the patients and lack of pigmentation of the tumours) and histopathological features (ulceration, Breslow's index, mitotic rate), as well as the mutational status of c-kit and b-raf of 86 mucosal melanomas diagnosed in 15 years in four French University Hospitals. RESULTS: Most melanomas affected women (72%) and the genital region (46.5%). A fifth of melanomas were amelanotic. 81% of melanomas had a Breslow's index ≥1, whereas all glans melanomas, and most vulvar melanomas had a Breslow index ≤1 mm. Overall survival was 54% at 3 years; 11.6% of the 43 tested mucosal melanomas were c-kit-mutated while the 15 tested genital melanomas were not. The c-kit gene mutation did not influence the overall survival. Age ≥ 50, amelanotic type and performance status ≥1 were not poor prognostic factors in our series. CONCLUSION: This study confirmed that mucosal melanomas are rare and could be difficult to diagnose being often amelanotic and in hidden sites. Most melanomas were thick at the diagnosis, but glans and vulvar melanomas were thinner probably because of their greater visibility. The frequency of the c-kit mutation varied depending on the initial tumour site. In our series, the prognosis was poor, independently from c-kit mutations and the patient's general health and age. The presence of metastasis at diagnosis was associated with a worse prognosis indicating the importance of an early diagnosis.

13 Article A risk scoring system for the differentiation between melanoma with regression and regressing nevi. 2016

Rubegni, P / Tognetti, L / Argenziano, G / Nami, N / Brancaccio, G / Cinotti, E / Miracco, C / Fimiani, M / Cevenini, G. ·Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, AOUS "Le Scotte", Siena, Italy. · Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, AOUS "Le Scotte", Siena, Italy. Electronic address: linda.tognetti@gmail.com. · Dermatology Unit, Department of Mental and Physic Health and Preventive Medicine, Second University of Naples, Naples, Italy. · Dermatology Department-University Hospital of Saint-Etienne, Saint-Etienne, France. · Section of Human Patology, University of Siena, Siena, Italy. · Department of Medical Biotechnologies, University of Siena, Siena, Italy. ·J Dermatol Sci · Pubmed #27157925.

ABSTRACT: BACKGROUND: Spontaneous regression of melanomas is relatively common, its prevalence ranging from 10 to 35%. However, regressing nevi can exhibit worrisome feature and simulate melanoma both clinically and dermoscopically. Thus, the presence of regression can represent a confounding factor. OBJECTIVE: To investigate the frequency of dermoscopic patterns of "regression" in a series of benign and malignant melanocytic skin lesions, and to design an integrated scoring system. Scoring classifiers are very effective in selecting the significant parameters for discriminating two clinical conditions, thus can rapidly calculate a patient's risk for a given disease. METHODS: We selected a series of 95 regressing melanocytic lesions, including 50 regressing nevi and 45 melanomas with regression. For each lesion, 12 dermoscopic variables (i.e. five types of regression structures, five atypical pigmentation structures, atypical vascular pattern and pink areas) were examined by three expert in dermoscopy (blinded to the histological diagnosis). The dermoscopic evaluation was then combined with patient age, gender, body site and the maximum diameter of lesion. Concordance analysis with Cohen's kappa was performed between the three clinicians. A risk scoring system was designed by the leave-one-out cross-validation procedure to ensure model prediction power. RESULTS: The predictive score model revealed a sensitivity of 97.8% and a specificity of 75.5% in discriminating nevi and melanomas with regression. Using the score model, the diagnostic performance of the examiners increased by an average of 23.7% in sensitivity and 5.9% in specificity, compared with standard dermoscopic pattern analysis. CONCLUSIONS: We assessed the validity of an integrated risk scoring model as a new methodological approach that could help the dermatologist in the differentiation between melanoma with regression and regressing nevus. Future studies could test the setting up of a score model over an even more complex pool of data obtained from different skin lesions with various diagnostic devices.

14 Article Computer-assisted melanoma diagnosis: a new integrated system. 2015

Rubegni, Pietro / Feci, Luca / Nami, Niccolò / Burroni, Marco / Taddeucci, Paolo / Miracco, Clelia / Munezero Butorano, Marie A G / Fimiani, Michele / Cevenini, Gabriele. ·aDepartment of Medical, Surgical and Neurological Science, Dermatology Section, Siena University Hospital bDepartment of Medicine, Surgery and Neurosurgery, Section of Pathological Anatomy, Policlinico Santa Maria alle Scotte cDepartment of Medical Biotechnologies, University of Siena, Siena, Italy. ·Melanoma Res · Pubmed #26426763.

ABSTRACT: In dermatology, attempts at synergy between man and machine have mainly been made to improve melanoma diagnosis. The aim of the present study was to test an 'integrated digital dermoscopy analysis' (i-DDA) system with a series of melanocytic lesions that were benign and malignant in nature, and to evaluate its discriminating power with respect to histological diagnosis. In a retrospective study we used an i-DDA system to evaluate a series of 856 excised, clinically atypical pigmented skin lesions (584 benign and 272 malignant). The system evaluated 48 parameters to be studied as possible discriminant variables, grouped into four categories (geometries, colours, textures and islands of colour) integrated with three personal metadata items (sex, age and site of lesion) and presence/absence of three dermoscopic patterns (regression structures, blue-white veil and polymorphic vascular structures). Stepwise multivariate logistic regression of i-DDA data selected nine variables with the highest possible discriminant power. At the end of the stepwise procedure the percentage of cases correctly classified by i-DDA was 89.2% (100% sensitivity and 40.8% specificity). The limitations of the study included those associated with a retrospective design and the 'a priori' exclusion of nonmelanocytic skin lesions. By incorporating numerical digital features with personal data and some dermoscopic patterns into the learning process, the proposed i-DDA improved the performance of assisted melanoma diagnosis, with the advantage that our results can be objectively repeated in any other clinical setting.

15 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.

16 Article Differences in clinicopathological features and distribution of risk factors in Italian melanoma patients. 2015

Fava, P / Astrua, C / Chiarugi, A / Crocetti, E / Pimpinelli, N / Fargnoli, M C / Maurichi, A / Rubegni, P / Manganoni, A M / Bottoni, U / Catricalà, C / Cavicchini, S / Santinami, M / Alaibac, M / Annetta, A / Borghi, A / Calzavara Pinton, P / Capizzi, R / Clerico, R / Colombo, E / Corradin, M T / De Simone, P / Fantini, F / Ferreli, C / Filosa, G / Girgenti, V / Giulioni, E / Guarneri, C / Lamberti, A / Lisi, P / Nardini, P / Papini, M / Peris, K / Pizzichetta, M A / Salvini, C / Savoia, P / Strippoli, D / Tolomio, E / Tomassini, M A / Vena, G A / Zichichi, L / Patrizi, A / Argenziano, G / Simonacci, M / Quaglino, P. ·Dermatologic Clinic, Department of Medical Sciences, University of Turin, Turin, Italy. ·Dermatology · Pubmed #25659983.

ABSTRACT: BACKGROUND: No studies are available in the literature on the distribution of different melanoma features and risk factors in the Italian geographical areas. OBJECTIVE: To identify the differences in clinical-pathological features of melanoma, the distribution of risk factors and sun exposure in various Italian macro-areas. METHODS: Multicentric-observational study involving 1,472 melanoma cases (713 north, 345 centre, 414 south) from 26 referral centres belonging to the Italian Multidisciplinary Group for Melanoma. RESULTS: Melanoma patients in northern regions are younger, with thinner melanoma, multiple primaries, lower-intermediate phototype and higher counts of naevi with respect to southern patients; detection of a primary was mostly connected with a physician examination, while relatives were more involved in the south. Northern patients reported a more frequent use of sunbeds and occurrence of sunburns before melanoma despite sunscreen use and a lower sun exposure during the central hours of the day. CONCLUSIONS: The understanding of differences in risk factors distribution could represent the basis for tailored prevention programmes.

17 Article Negative pigment network: an additional dermoscopic feature for the diagnosis of melanoma. 2013

Pizzichetta, Maria A / Talamini, Renato / Marghoob, Ash A / Soyer, H Peter / Argenziano, Giuseppe / Bono, Riccardo / Corradin, M Teresa / De Giorgi, Vincenzo / Gonzalez, Marian A / Kolm, Isabel / Kopf, Andrew W / Malvehy, Joseph / Nami, Niccolò / Oliviero, Margaret / Pellacani, Giovanni / Puig, Susana / Rabinovitz, Harold / Rubegni, Pietro / Seidenari, Stefania / Stanganelli, Ignazio / Veronesi, Andrea / Zalaudek, Iris / Zampieri, Pierfrancesco / Menzies, Scott W. ·Centro di Riferimento Oncologico, National Cancer Institute, Aviano, Italy. Electronic address: pizzichetta@cro.it. · Centro di Riferimento Oncologico, National Cancer Institute, Aviano, Italy. · Dermatology Section, Memorial Sloan Kettering Cancer Center, New York, New York. · Dermatology Research Center, University of Queensland, School of Medicine, Princess Alexandra Hospital, Brisbane, Australia. · Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico(IRCCS), Reggio Emilia, Italy. · Istituto Dermopatico Immacolata, IRCCS, Rome, Italy. · Division of Dermatology, Pordenone Hospital, Pordenone, Italy. · Department of Dermatology, University of Florence, Florence, Italy. · Division of Dermatology, Merano Hospital, Merano, Italy. · Department of Dermatology, University of Miami, Miami, Florida. · New York University School of Medicine, New York, New York. · Melanoma Unit, Department of Dermatology, Hospital Clinic, Institut d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain. · Department of Dermatology, University of Siena, Siena, Italy. · Department of Dermatology, University of Modena and Reggio Emilia, Modena and Reggio Emilia, Italy. · Skin Cancer Unit, Istituto Tumori Romagna, Meldola, Italy. · Medical University of Graz, Graz, Austria. · Sydney Melanoma Diagnostic Center, Royal Prince Alfred Hospital and Discipline of Dermatology, University of Sydney, Sydney, Australia. ·J Am Acad Dermatol · Pubmed #23062610.

ABSTRACT: BACKGROUND: The negative pigment network (NPN) is seen as a negative of the pigmented network and it is purported to be a melanoma-specific structure. OBJECTIVES: We sought to assess the frequency, sensitivity, specificity, and odds ratios (ORs) of NPN between melanoma cases and a group of control lesions. METHODS: Digitalized images of skin lesions from 679 patients with histopathological diagnosis of dermatofibroma (115), melanocytic nevus (220), Spitz nevus (139), and melanoma (205) were retrospectively collected and blindly evaluated to assess the presence/absence of NPN. RESULTS: The frequency of occurrence of NPN was higher in the melanoma group (34.6%) than in Spitz nevus (28.8%), melanocytic nevus (18.2%), and dermatofibroma (11.3%) groups. An OR of 1.8 emerged for the diagnosis of melanoma in the presence of NPN as compared with nonmelanoma diagnosis. Conversely, for melanocytic nevi and dermatofibromas the OR was very low (0.5 and 0.3, respectively). For Spitz nevi the OR of 1.1 was not statistically significant. When comparing melanoma with dermatofibroma, melanocytic nevus, and Spitz nevus, we observed a significantly higher frequency of multicomponent pattern (68.1%), asymmetric pigmentation (92.9%), irregularly distributed NPN (87.3%), and peripheral location of NPN (66.2%) in melanomas. LIMITATIONS: Further studies can provide the precise dermoscopic-histopathologic correlation of NPN in melanoma and other lesions. CONCLUSIONS: The overall morphologic pattern of NPN, such as the irregular distribution and the peripheral location of NPN, along with the multicomponent pattern and the asymmetric pigmentation could be used as additional features in distinguishing melanoma from Spitz nevus and other benign lesions.

18 Article Dermoscopy and digital dermoscopy analysis of palmoplantar 'equivocal' pigmented skin lesions in Caucasians. 2012

Rubegni, P / Cevenini, G / Nami, N / Argenziano, G / Saida, T / Burroni, M / Bono, R / Quaglino, P / Barbini, P / Miracco, C / Lamberti, A / Fimiani, M. ·Dermatology Section, Department of Clinical Medicine and Immunological Science, University of Siena, Siena, Italy. rubegni@unisi.it ·Dermatology · Pubmed #23182753.

ABSTRACT: BACKGROUND/AIM: The diagnosis of palmoplantar melanoma is often delayed and misdiagnosis is common, due to frequently unusual clinical presentation. We used a digital dermoscopy analyzer with a series of palmoplantar pigmented skin lesions (PP-PSL), and we compared sensitivity, specificity and diagnostic accuracy obtained with digital dermoscopy analysis (DDA) and classical dermoscopy. METHODS: Digital dermoscopy images of 107 PP-PSL were retrospectively obtained from the database of images of 3 Italian centers. The lesions (25 melanomas and 82 nevi) were all removed because of the presence of clinical and/or dermoscopic suspicious features. All digital images were analyzed using appropriate algorithms, and the diagnostic accuracy of the model was calculated. For comparison, dermoscopic images were clinically evaluated by two dermatologists and the Cohen ĸ concordance with DDA was calculated. RESULTS: The stepwise logistic regression analysis selected only 5 parameters out of 49. The logistic model achieved a sensitivity of 96% and a specificity of 87.8%. The Cohen ĸ concordance, evaluated by the Landis and Koch scale, supplied a substantial agreement between dermoscopy and DDA. CONCLUSIONS: DDA might be a useful diagnostic instrument in the evaluation of preselected PP-PSL. However, these findings should be confirmed in a formal clinical trial.

19 Article A single centre melanoma thickness trend (1985-2009) in relation to skin areas accessible and non-accessible to self-inspection. 2012

Rubegni, Pietro / Rossi, Stefania / Nami, Niccolò / Risulo, Massimiliano / Biagioli, Maurizio / Miracco, Clelia / Fimiani, Michele. ·Department of Clinical Medicine and Immunological Sciences, Dermatology Section, University Hospital of Siena, Italy. rubegni@unisi.it ·Australas J Dermatol · Pubmed #22309328.

ABSTRACT: BACKGROUND/OBJECTIVES: Melanoma has become a major public health problem worldwide and its incidence in individuals of Caucasian origin continues to rise. The objective was to determine historical changes in thickness, melanoma proportions and anatomical site of presentation over a 25-year period in our Department. METHODS: This was a historical retrospective study (January 1985 to December 2009). Only patients born and living in Italy were considered. The following parameters were evaluated: age, gender, year of diagnosis, site of primitive lesion (head, back, chest, anterior and posterior upper limbs, anterior and posterior lower limb, and acral sites) and Breslow thickness of the lesion. RESULTS: In the 25-year period, 993 cases of melanoma were diagnosed. The total number of cases per year tripled between 1985-1989 and 1995-1999 and more than doubled between 1995-1999 and 2005-2009. Our results also revealed that thicker melanomas were more frequent in elderly patients and on parts of the body that cannot be readily self-inspected. CONCLUSION: The importance of observation of the posterior parts of the body is stressed, since not only did most melanomas arise in these sites but the diagnosis of lesions in these sites is often delayed.

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

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

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

21 Article Objective melanoma progression. 2011

Rubegni, Pietro / Burroni, Marco / Nami, Niccolò / Cevenini, Gabriele / Bono, Riccardo / Sbano, Paolo / Fimiani, Michele. ·Department of Clinical Medicine and Immunological Science, Dermatology Section, University of Siena, Siena, Italy. rubegni@unisi.it ·Skin Res Technol · Pubmed #20923468.

ABSTRACT: BACKGROUND/PURPOSE: Many aspects of the natural history of malignant melanoma (MM) are still unclear, specifically its appearance at onset and particularly how it changes in time. The purpose of our study was to retrospectively determine objective changes in melanoma over a 3-24-month observation period. MATERIALS AND METHODS: Our study was carried out in two Italian dermatology centers. Digital dermoscopy analyzers (DB-Mips System) were used to retrospectively evaluate dermoscopic images of 59 MM (with no initial clinical aspects suggesting melanoma) under observation for 3-24 months. The analyzer evaluates 49 parameters grouped into four categories: geometries, colors, textures and islands of color. Multivariate analysis of variance for repeated measures was used to evaluate the statistical significance of the changes in the digital dermoscopy variables of melanomas. RESULTS: Within-lesion analysis indicated that melanomas increased in dimension (Area, Minimum, and Maximum Diameter), manifested greater disorganization of the internal components (Red, Green and Blue Multicomponent, Contrast, and Entropy) and increased in clusters of milky pink color (Light Red Area). CONCLUSION: Analysis of the parameters of our model and statistical analysis enabled us to interpret/identify the most significant factors of melanoma modification, providing quantitative insights into the natural history of this cutaneous malignancy.

22 Article Objective follow-up of atypical melanocytic skin lesions: a retrospective study. 2010

Rubegni, Pietro / Cevenini, Gabriele / Burroni, Marco / Bono, Riccardo / Sbano, Paolo / Biagioli, Maurizio / Risulo, Massimiliano / Nami, Niccolò / Perotti, Roberto / Miracco, Clelia / Fimiani, Michele. ·Department of Clinical Medicine and Immunological Science, Policlinico "Le Scotte", Siena, Italy. rubegni@unisi.it ·Arch Dermatol Res · Pubmed #20411393.

ABSTRACT: Various authors have suggested that information from longitudinal observation (follow-up) of dynamic changes in atypical melanocytic pigmented skin lesions (MPSL) could enable identification of early malignant melanoma escaping initial observation due to an absence of specific clinical and dermoscopic features. The aim of our retrospective study was to determine the existence of numerical variables regarding changes in MPSL that could be useful to differentiate early melanomas and atypical nevi. The study was carried out in two Italian dermatology Centres. Digital dermoscopy analyzers (DB-Mips System) were used to evaluate dermoscopic images of 94 equivocal pigmented skin lesions under observation for 6-12 months and then excised because of changes across time (29 melanomas and 65 nevi). The analyzer evaluates 49 parameters grouped into four categories: geometries, colours, textures and islands of colour. The ROC curve designed on the 49 digital dermoscopy analysis parameters showed good accuracy. At sensitivity (SE) = specificity (SP), it correctly classified 89.3% of cases. When objective pigmented skin lesion parameters were considered together with their objective changes over 6-12 months, a decisive increase in discrimination capacity was obtained. At SE = SP accuracy was 96.3%. Analysis of the parameters of our model and statistical analysis enabled us to interpret/identify the most significant factors of modification and differentiation of lesions, providing quantitative insights into the diagnosis of equivocal MPSL and demonstrating the utility of objective/numerical follow-up.

23 Article Evaluation of cutaneous melanoma thickness by digital dermoscopy analysis: a retrospective study. 2010

Rubegni, Pietro / Cevenini, Gabriele / Sbano, Paolo / Burroni, Marco / Zalaudek, Iris / Risulo, Massimiliano / Dell'Eva, Giordana / Nami, Niccolò / Martino, Antonia / Fimiani, Michele. ·Section of Dermatology, Department of Clinical Medicine and Immunological Sciences, University of Siena, Siena, Italy. rubegni@unisi.it ·Melanoma Res · Pubmed #20375922.

ABSTRACT: Digital dermoscopy analysis (DDA) exploits computerized analysis of digital images and offers the possibility of parametric analysis of morphological aspects of pigmented skin lesions by means of integration with dedicated software. We conducted a study by DDA in 141 melanomas, with the aim assessing whether the numerical variables extrapolated by univariate logistic analysis could be used in a system of multivariate analysis to predict melanoma thickness before surgery. Melanoma images were evaluated for 49 DDA parameters. Logistic analysis was conducted to identify statistically significant variables. The leave-one-out method was used to evaluate the predictive representations of rules for stepwise logistic classification. The percentage of correctly classified cases was calculated by a classification matrix. Melanomas less than 1 mm had a smaller area, faded borders and were more symmetrical than melanomas greater than 1 mm. The latter had a bluer colour and more random disposition of elements. The accuracy was 86.5%. Specifically, 97 of 108 thin melanomas (specificity 89.8%) and 25 of 33 thick melanomas (sensitivity 75.7%) were correctly classified. In conclusion, the predictive value of DDA for melanoma thickness was quite good. Moreover, DDA allowed us to know objectively those dermoscopic features important in the differentiation between thick and thin melanoma. However, further studies should be performed in a prospective setting before the clinical application.

24 Article Slow-growing melanoma: a dermoscopy follow-up study. 2010

Argenziano, G / Kittler, H / Ferrara, G / Rubegni, P / Malvehy, J / Puig, S / Cowell, L / Stanganelli, I / De Giorgi, V / Thomas, L / Bahadoran, P / Menzies, S W / Piccolo, D / Marghoob, A A / Zalaudek, I. ·Department of Dermatology, Second University of Naples, Via S. Pansini, 5-80131 Naples, Italy. g.argenziano@gmail.com ·Br J Dermatol · Pubmed #19785607.

ABSTRACT: BACKGROUND: Recent evidence suggests that melanoma is a family of different tumours with varying abilities to grow and metastasize. Trends in melanoma epidemiology show a strong increase in the incidence of thin melanoma, with no corresponding increase in mortality or incidence of thick melanoma. We initially evaluated five cases and found that none had baseline features suggestive of melanoma; excision was performed based on slight changes visible only in side-by-side comparisons of dermoscopic images. OBJECTIVES: To assess the clinico-dermoscopic features and the growth patterns of melanomas that were excised after a follow-up of 1 year or more due to their inconspicuous features at the baseline consultation. METHODS: In a multicentre, retrospective study of histopathologically confirmed melanomas excised after follow-up, we analysed dermoscopic images obtained at the initial consultation and compared them with images obtained at the last follow-up consultation. Images were analysed and graded using standard algorithms and scored for changes in size, symmetrical or asymmetrical structural change, and development of new melanoma-specific criteria. An overall score reflecting the amount of change was calculated for each lesion. RESULTS: Our series consisted of 103 melanomas. After a median follow-up of 20 months, most lesions were still in situ or early invasive (median Breslow thickness of 0.48 mm), with only three lesions showing tumour thickness of 1 mm or more. The most frequent baseline characteristics were asymmetrical pigmentation (78.6% of lesions), reticular overall pattern (62.1%), and regression features (35.9%). Most melanomas (58.3%) showed minor to moderate changes over time, with < 2 mm size increase, with asymmetrical structural change, and without development of new melanoma-specific criteria. Major changes were visible only after a mean follow-up of 33 months. CONCLUSIONS: This study provides evidence for the existence of a subgroup of slow-growing melanomas, which may explain the increase in the incidence of thin melanoma, despite stable rates of thick melanoma and melanoma-associated mortality.

25 Article Melanoma with halo. 2009

Rubegni, P / Nami, N / Risulo, M / Tataranno, D / Fimiani, M. ·Department of Dermatology, University of Siena, Siena, Italy. rubegni@unisi.it ·Clin Exp Dermatol · Pubmed #19635121.

ABSTRACT: -- No abstract --

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