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Melanoma: HELP
Articles by Stefania Seidenari
Based on 34 articles published since 2008
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Between 2008 and 2019, S. Seidenari wrote the following 34 articles about Melanoma.
 
+ Citations + Abstracts
Pages: 1 · 2
1 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.

2 Article Multiple primary melanomas versus single melanoma of the head and neck: a comparison of genetic, diagnostic, and therapeutic implications. 2014

Pollio, Annamaria / Tomasi, Aldo / Pellacani, Giovanni / Ruini, Cristel / Mandel, Victor D / Fortuna, Giulio / Seidenari, Stefania / Ponti, Giovanni. ·aDepartment of Neurosciences, University of Padua, Padua bDepartment of Diagnostic and Clinical Medicine and Public Health cDepartment of Dermatology, University of Modena and Reggio Emilia, Modena, Italy dDepartment of Oral Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA. ·Melanoma Res · Pubmed #24638154.

ABSTRACT: Single primary and multiple primary melanomas (MPMs) of the head and neck region may be confused at first glance because of the common clinical and dermoscopic patterns. An inaccurate diagnosis may lead the clinician to a wrong diagnostic and therapeutic pathway because MPMs occurring in familial or sporadic settings are often involved in individual cancer susceptibility. We investigated the clinical, demographic, histological, and survival differences between MPMs and single melanoma occurring in the head and neck region. A retrospective analysis of medical and histologic records from 217 melanomas of the head and neck region was carried out. Malignant neoplasms affecting MPMs patients were also reported. Mutational analysis of specific genes was carried out when clinical data and family history were suggestive for a familial/hereditary setting. Two hundred and five out of 217 (94.5%) patients were affected by single primary melanoma and 12 (5.5%) by MPMs of the head and neck region. Individuals affected by MPMs were distinguished by a significantly higher mutation frequency and a higher prevalence of malignant neoplasms such as renal cancer. Genetic testing showed germline mutations affecting MITF E318K, CDKN2A genes. Our data highlight the importance of strict cancer surveillance in individuals with MPMs and the role of appropriate genetic counseling and testing in selected patients. Finally, personalized clinical and instrumental screening and follow-up strategies should also be based on mutational status. A heightened level of suspicion is required in the clinical management of mutation carriers.

3 Article Dermoscopic features of cutaneous melanoma are associated with clinical characteristics of patients and tumours and with MC1R genotype. 2014

Fargnoli, M C / Sera, F / Suppa, M / Piccolo, D / Landi, M T / Chiarugi, A / Pellegrini, C / Seidenari, S / Peris, K. ·Department of Dermatology, University of L'Aquila, L'Aquila, Italy. ·J Eur Acad Dermatol Venereol · Pubmed #24588892.

ABSTRACT: BACKGROUND: Several algorithms are available for the dermoscopic diagnosis of pigmented skin lesions. The MC1R gene is a key determinant of pigmentation characteristics that are established host-related melanoma risk factors. OBJECTIVES: To investigate the association of dermoscopic features of sporadic cutaneous melanomas with clinical characteristics of patients and corresponding tumours and with genetic changes in the MC1R and BRAF genes. METHODS: A total of 64 dermoscopic images of 62 patients were scored by ABCD rule and modified pattern analysis. Detailed patients' and melanomas' characteristics were collected. Patients were screened for germline MC1R variants and related melanomas for somatic V600 BRAF mutations. RESULTS: A lower total dermoscopic score (TDS) was observed in melanomas of patients with red hair (P = 0.019), due to reduced dermoscopic structures (P < 0.0001). Thicker melanomas showed higher TDS values (P = 0.021) due to sharper borders (P < 0.0001) and higher number of colors (P = 0.004). An atypical pigment network was prevalent in superficial spreading melanomas (P = 0.010), in individuals with dark skin (P = 0.043) and hair color (P = 0.001). An atypical vascular pattern was more frequent in nodular (P < 0.0001) and thick (P < 0.0001) melanomas, in individuals with skin type I-II (P = 0.037), blond or red hair color (P = 0.032) and blue or green eyes (P = 0.014). Melanomas of MC1R R carriers showed lower TDS value (P = 0.037), reduced dermoscopic structures (P = 0.001) and lower prevalence of atypical pigment network (P = 0.001). No differences were identified between BRAF-mutated or wild-type melanomas. CONCLUSIONS: We suggest a phenotypic/MC1R profile for melanoma patients and their tumours. Melanomas of MC1R R carriers show a significant lower TDS value, with reduced dermoscopic structures, and a lower prevalence of an atypical pigment network. Non-carriers of MC1R R variants develop melanomas dermoscopically characterized by an atypical pigment network which is prevalent in superficial spreading melanomas, in patients with dark complexion and less frequent in red-haired individuals.

4 Article Dermoscopy of small melanomas: just miniaturized dermoscopy? 2014

Seidenari, S / Ferrari, C / Borsari, S / Fabiano, A / Bassoli, S / Giusti, F / Ponti, G / Magnoni, C. ·Department of Dermatology and Venereology, University of Modena and Reggio Emilia, Modena, Italy. ·Br J Dermatol · Pubmed #23909951.

ABSTRACT: BACKGROUND: Small malignant melanomas (MMs) are usually MMs in an initial growth phase, deserving attention by the clinician aiming at an early diagnosis. OBJECTIVES: To identify clues for early diagnosis of small MMs, by comparing the dermoscopic features of MMs < 4 mm (micromelanomas) with those of larger MMs. METHODS: Our database consists of dermoscopic images of 482 MMs, which have been retrieved and measured digitally. The ABCD (asymmetry, border, colour, dimension) and 7-point criteria were evaluated for the whole database by three expert dermoscopists, whereas the main dermoscopic pattern was assessed only for micromelanomas. The dermoscopic aspects were correlated to clinical and histological features. RESULTS: Most 7-point and ABCD scores, and criteria referring to micromelanomas, differed from those of the MM database as a whole. Lesion asymmetry, number of colours, blue-whitish veil, atypical vessels, irregular globules/dots and regression increased according to MM diameter. An inverse trend was observed for atypical network and irregular pigmentation, which were more frequently observed in micromelanomas than in larger ones. Among the 22 micromelanomas, 12 lesions were in situ, whereas the other 10 were 0·2-2 mm thick. The clinical and dermoscopic characteristics of the two groups were similar. CONCLUSIONS: Micromelanomas are not a rarity. However, the clinician should be aware of the fact that the majority of them lack most of the dermoscopic features presented by larger lesions.

5 Article Stem cell properties in cell cultures from different stage of melanoma progression. 2014

Magnoni, Cristina / Giudice, Stefania / Pellacani, Giovanni / Bertazzoni, Giorgia / Longo, Caterina / Veratti, Eugenia / Morini, Daria / Benassi, Luisa / Vaschieri, Cristina / Azzoni, Paola / De Pol, Anto / Seidenari, Stefania / Tomasi, Aldo / Pollio, Annamaria / Ponti, Giovanni. ·Departments of *Dermatology ‡Clinical and Diagnostic Medicine and Public Health, University Hospital of Modena and Reggio Emilia, University of Modena and Reggio Emilia, Modena †1st Medical Department, Dermatology Unit, Arcispedale Santa Maria Nuova, Reggio Emilia §Department of Odontostomatological and Maxillofacial Sciences, Oral Medicine Unit, School of Medicine and Surgery, Federico II University of Naples, Naples, Italy. ·Appl Immunohistochem Mol Morphol · Pubmed #23702651.

ABSTRACT: Cutaneous melanoma is an extremely heterogenous human cancer. The most aggressive melanoma may contain deregulated cells with undifferentiated/stem cell-like phenotype. A critical mechanism by which melanoma cells enhance their invasive capacity is the dissolution of the intercellular adhesion and the acquisition of mesenchymal features as a part of an epithelial-to-mesenchymal transition. The aim of this study was to clarify the role of a stem cell-like population in human melanomas by means of melanocytic cell culture analysis obtained from distinct histotypes of primary and metastatic malignant melanoma. Patients with advanced melanoma >2 cm in diameter and/or >300 mm surface were enrolled. The melanoma cells were isolated from skin biopsies of lentigo maligna melanoma, superficial spreading melanoma, nodular melanoma, and metastatic melanoma. The colony forming unit assay and alkaline phosphatase stain were evaluated. Cells were subsequently cultured and maintained in different media to evaluate their ability to differentiate into osteogenic and adipogenic lineages. Immunohistochemistry and flow cytometry analysis were performed to evaluate antigenic markers CD90, CD73, CD105, CD146, CD20, CD166, and Nestin. This study confirms that melanoma can include heterogenous cell populations with the ability both to self-renew and to a give rise to differentiated progeny. Melanoma cells displayed intratumoral heterogeneity and dynamic antigen phenotypes. Histologically, transitions from normal skin to melanoma were associated with a gradual increase in the expression of CD146, CD20, CD133, Nestin, and CD73. These molecular profiles could be further analyzed and, in the future, used for the development of novel biomolecular targeted-therapy approaches.

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

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

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

7 Article Fluorescence in-situ hybridization and dermoscopy in the assessment of controversial melanocytic tumors. 2013

Ponti, Giovanni / Ruini, Cristel / Massi, Daniela / Pellacani, Giovanni / Tomasi, Aldo / Paglierani, Milena / Loschi, Pietro / Seidenari, Stefania. ·Departments of aHead and Neck Surgery bPlastic and Reconstructive Surgery cClinical and Diagnostic Medicine and Public Health, Division of Clinical Pathology, University Hospital of Modena and Reggio Emilia, University of Modena and Reggio Emilia, Modena dDepartment of Critical Care Medicine and Surgery, Division of Pathological Anatomy, Florence, Italy. ·Melanoma Res · Pubmed #24077512.

ABSTRACT: Although the 'gold standard' for melanoma diagnosis remains histopathological analysis, presently dermoscopists play a significant role in the diagnostic process. However, even a combined approach may not allow a clear-cut judgment on equivocal melanocytic lesions. Fluorescence in-situ hybridization (FISH) can offer assistance in the evaluation of chromosome abnormalities associated with malignancies, and its role is emerging in melanoma diagnosis. The aim of this study was to evaluate the diagnostic role of the FISH in the assessment of controversial lesions, defined as those lesions showing discrepancies between dermatoscopic and histological evaluations. Twenty clinically and histologically ambiguous melanocytic lesions were selected. After the first histopathologic diagnosis, a second pathologist examined the specimens in a blinded review for a second opinion and to identify the most suitable areas to hybridize using probes specific to RREB1, MYB, and CCND1 genes and the centromere of chromosome 6. The first histopathological evaluation led to the diagnosis of melanoma in seven cases, whereas the second identified eight cases of malignant melanoma and was in agreement with the first in 65% of cases and with dermoscopy in 40% of cases. Cytogenetic abnormalities detected by FISH are markers of malignancy that can be useful in the characterization of difficult-to-diagnose melanocytic tumors, when the dermatologist and the pathologist have a different opinions.

8 Article Multiphoton laser tomography and fluorescence lifetime imaging of melanoma: morphologic features and quantitative data for sensitive and specific non-invasive diagnostics. 2013

Seidenari, Stefania / Arginelli, Federica / Dunsby, Christopher / French, Paul M W / König, Karsten / Magnoni, Cristina / Talbot, Clifford / Ponti, Giovanni. ·Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy. ·PLoS One · Pubmed #23923016.

ABSTRACT: Multiphoton laser tomography (MPT) combined with fluorescence lifetime imaging (FLIM) is a non-invasive imaging technique, based on the study of fluorescence decay times of naturally occurring fluorescent molecules, enabling a non-invasive investigation of the skin with subcellular resolution. The aim of this retrospective observational ex vivo study, was to characterize melanoma both from a morphologic and a quantitative point of view, attaining an improvement in the diagnostic accuracy with respect to dermoscopy. In the training phase, thirty parameters, comprising both cytological descriptors and architectural aspects, were identified. The training set included 6 melanomas with a mean Breslow thickness±S.D. of 0.89±0.48 mm. In the test phase, these parameters were blindly evaluated on a test data set consisting of 25 melanomas, 50 nevi and 50 basal cell carcinomas. Melanomas in the test phase comprised 8 in situ lesions and had a mean thickness±S.D. of 0.77±1.2 mm. Moreover, quantitative FLIM data were calculated for special areas of interest. Melanoma was characterized by the presence of atypical short lifetime cells and architectural disorder, in contrast to nevi presenting typical cells and a regular histoarchitecture. Sensitivity and specificity values for melanoma diagnosis were 100% and 98%, respectively, whereas dermoscopy achieved the same sensitivity, but a lower specificity (82%). Mean fluorescence lifetime values of melanocytic cells did not vary between melanomas and nevi, but significantly differed from those referring to basal cell carcinoma enabling a differential diagnosis based on quantitative data. Data from prospective preoperative trials are needed to confirm if MPT/FLIM could increase diagnostic specificity and thus reduce unnecessary surgical excisions.

9 Article Negative pigment network identifies a peculiar melanoma subtype and represents a clue to melanoma diagnosis: a dermoscopic study of 401 melanomas. 2013

Bassoli, Sara / Ferrari, Chiara / Borsari, Stefania / Giusti, Francesca / Magnoni, Cristina / Pellacani, Giovanni / Seidenari, Stefania. ·Department of Dermatology and Venereology, University of Modena and Reggio Emilia, IT-41124 Modena, Italy. sarabassoli79@gmail.com. ·Acta Derm Venereol · Pubmed #23695965.

ABSTRACT: The dermoscopic descriptor "negative pigment network" (NPN) has been reported in several types of melanocytic and non-melanocytic lesions, although it has a higher frequency of association with melanoma and Spitz naevus. In a study of 401 consecutive melanomas, excluding facial, acral and mucosal locations, the frequency and variability of NPN were investigated, and the results of NPN correlated with clinical and histopathological data. NPN of any extension was found in 27% of melanomas, most frequently invasive and arising from a naevus on the trunk of young subjects. Seven percent of melanomas in the study population showed presence of NPN in more than half of the lesion area; most of these did not show typical dermoscopic melanoma features. The authors propose a new melanoma subtype, in which extensive NPN should be considered as a diagnostic indicator.

10 Article Small-diameter melanocytic lesions: morphological analysis by means of in vivo confocal microscopy. 2013

Pupelli, G / Longo, C / Veneziano, L / Cesinaro, A M / Ferrara, G / Piana, S / Moscarella, E / Ricci, C / Zalaudek, I / Seidenari, S / Argenziano, G / Pellacani, G. ·Department of Dermatology, University of Modena and Reggio Emilia, Italy. ·Br J Dermatol · Pubmed #23301553.

ABSTRACT: BACKGROUND: Small-diameter melanocytic lesions represent a diagnostic challenge for clinicians, as they do not follow the ABCD rule for diagnosis and do not always display reliable histopathological criteria. OBJECTIVES: To analyse the confocal features of small-diameter lesions (naevi and melanomas with diameter ≤ 5 mm) to determine whether they show specific morphological criteria. METHODS: Twenty-four melanomas and 72 naevi were subjected to dermoscopic and confocal evaluation along with histopathology. Significant dermoscopic and confocal differences between melanomas and naevi were evaluated by means of the Pearson χ(2) test. Odds ratios and 95% confidence intervals were calculated for each parameter. Binary logistic regression was performed to identify the reflectance confocal microscopy (RCM) independently significant features for melanoma diagnosis. RESULTS: The seven-point checklist dermoscopic score was ≥ 3 in 22 melanomas and in 33 naevi. The combination of cells' pleomorphism and architectural disorder (i.e. nonspecific pattern or irregular junctional nests upon confocal examination) are the most striking criteria for consistent diagnosis of small melanoma. The presence of atypical cells, more than five atypical cells per mm(2) , and roundish atypical cells at the dermoepidermal junction showed the highest odds ratios. From logistic regression, the presence of at least five pagetoid cells per mm(2) , tangled lines within the epidermis, and atypical roundish cells at the dermoepidermal junction resulted in the three independent confocal parameters that characterized small melanomas. CONCLUSIONS: Small melanomas frequently reveal specific dermoscopic and confocal features. Moreover, the combination of dermoscopy and RCM can lead to a correct diagnosis of a number of naevi that share some morphological aspects with melanomas.

11 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.

12 Article A case-control study of the risk of cutaneous melanoma associated with three selenium exposure indicators. 2012

Vinceti, Marco / Crespi, Catherine M / Malagoli, Carlotta / Bottecchi, Ilaria / Ferrari, Angela / Sieri, Sabina / Krogh, Vittorio / Alber, Dorothea / Bergomi, Margherita / Seidenari, Stefania / Pellacani, Giovanni. ·Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Public Health Sciences, University of Modena and Reggio Emilia, Reggio Emilia, Italy. marco.vinceti@unimore.it ·Tumori · Pubmed #22825502.

ABSTRACT: AIMS AND BACKGROUND: A direct association between exposure to the metalloid selenium and risk of cutaneous melanoma has been suggested by some observational and experimental cohort studies, whereas other studies have yielded inconsistent results. Since some of the inconsistencies may be due to exposure misclassification arising from the use of exposure indicators that do not adequately reflect body tissue selenium content or the levels of the biologically relevant species of this metalloid, we examined this issue using multiple indicators of exposure. METHODS: We analyzed the relation of selenium exposure with risk of cutaneous melanoma using two different biomarkers, plasma and toenail selenium concentration, and estimated dietary selenium intake in a population-based case-control series (54 cases, 56 controls) from an Italian community. RESULTS: In unmatched and matched logistic regression models as well as nonparametric generalized additive models, higher plasma selenium levels were strongly associated with excess disease risk. In contrast, toenail and dietary selenium exhibited little relation with melanoma risk. The pattern of correlation among indicators of exposure differed by disease status, with dietary intake associated with plasma selenium levels in patients but not in controls. CONCLUSIONS: Our data showed that different selenium exposure indicators can yield different inferences about melanoma risk. Although the series was small, our results are consistent with a positive association between circulating levels of selenium and melanoma risk. Further investigation of the exposure classification performance of various selenium biomarkers and of metabolic patterns of the metalloid and of its speciation are needed to help elucidate the relation between selenium exposure and human health.

13 Article Variegated dermoscopy of in situ melanoma. 2012

Seidenari, Stefania / Bassoli, Sara / Borsari, Stefania / Ferrari, Chiara / Giusti, Francesca / Ponti, Giovanni / Tomasini, Carlo / Magnoni, Cristina. ·Department of Dermatology, University of Modena, Modena, Italy. seidenari.stefania@unimore.it ·Dermatology · Pubmed #22653091.

ABSTRACT: BACKGROUND: Melanomas in situ (MIS) are difficult to diagnose, lacking well-established dermoscopic descriptors. OBJECTIVE: The aim of this study was to improve the identification of early melanomas describing the variegated dermoscopic features of MIS and their correlation with demographic and clinical aspects. METHODS: Dermoscopic images of 114 histologically proven MIS were evaluated by 3 expert dermoscopists and classified into their main dermoscopic patterns. Dermoscopic features were also considered for their correlation with clinical parameters. RESULTS: Eight different dermoscopic subtypes of MIS were identified: reticular grey-blue (27.2%), reticular (21.1%), multicomponent (20.2%), island (10.5%), spitzoid (7%), inverse network (6.1%), 'net-blue globules' (5.3%) and globular (2.6%). Clinical characteristics of lesions and patients varied according to the different dermoscopic groups. CONCLUSION: We hypothesize that the different dermoscopic subgroups of MIS correspond to lesions with a different origin and, possibly, various patterns of growth and a different biological behaviour.

14 Article The dermoscopic variability of pigment network in melanoma in situ. 2012

Seidenari, Stefania / Ferrari, Chiara / Borsari, Stefania / Bassoli, Sara / Cesinaro, Anna Maria / Giusti, Francesca / Pellacani, Giovanni / Ponti, Giovanni / Zalaudek, Iris / Argenziano, Giuseppe. ·Department of Dermatology and Venereology, Medical University of Modena and Reggio Emilia, Modena, Italy. stefania.seidenari@unimore.it ·Melanoma Res · Pubmed #22395417.

ABSTRACT: To define the dermoscopic aspects of the network in melanoma in situ (MIS), using both standard and newly introduced network descriptors. Fifty-four histologically confirmed MIS with a reticular pattern, 108 atypical reticular naevi and 108 typical reticular naevi were evaluated for the presence of 11 network descriptors. The ABCD-score and the seven-point score were calculated, and the diameter of the lesions was measured by means of a dedicated software. Clinical data including age, sex and skin site were also considered. The prevalence of different dermoscopic features was calculated to allow (i) the identification of lesions to be excised and (ii) the distinction between MIS and dermoscopically atypical naevi. In dermoscopically atypical lesions (MIS and atypical naevi), the frequency of all descriptors significantly differed from those of typical naevi. With respect to atypical naevi, MIS more frequently showed larger size, an atypical network involving more than half of the lesion, the contemporary presence of more than one type of network and more extended reticular grey-blue regression areas located both in the centre and at the periphery of the lesion. The list of network descriptors proposed by us can be used for the identification of lesions that should be subjected to surgery. For the distinction between MIS and atypical naevi, the extension of an atypical network, the presence of more than one type of network, the distribution of reticular grey-blue areas and the lesion diameter must be considered.

15 Article Value and prognostic significance of mitotic rate in a retrospective series of pT1 cutaneous malignant melanoma patients. 2012

Ponti, G / Pollio, A / Cesinaro, A M / Pellacani, G / Magnoni, C / Seidenari, S. ·Department of Internal Medicine, Division of Dermatology, University of Modena and Reggio Emilia, via del Pozzo 71, Modena, Italy. giovanni.ponti@unimore.it ·Cancer Epidemiol · Pubmed #22153914.

ABSTRACT: INTRODUCTION: Patients affected by thin melanomas (≤1mm) generally have a good prognosis; however, some have a recurrence and eventually die of the disease. The seventh edition of the American Joint Committee on Cancer (AJCC) melanoma staging system, introduced mitotic rate (MR) as one of the primary criteria for staging thin melanoma. MATERIALS AND METHODS: In this study, we sought to determine the prognostic value of mitotic rate in a retrospective cohort of localized primary cutaneous melanoma patients. RESULTS: In total, 286 cases of pT1 primary malignant melanoma occurring in the period 2003-2008 were evaluated. Mitotic counts were re-assessed on standard sections of cases without mitosis and with at least 1 mitosis at diagnosis; 5-year follow-up and recurrence-free survival were available for all patients. Of the 56 radically treated pT1b melanoma patients, 4 (7.1%) had recurrent disease. These data support the efficacy of the incorporation of mitogenicity into AJCC staging for localized cutaneous melanoma and indicate the difficulties in the accuracy and reproducibility of the mitotic count system.

16 Article Italian Euromelanoma Day Screening Campaign (2005-2007) and the planning of melanoma screening strategies. 2012

Seidenari, Stefania / Benati, Elisa / Ponti, Giovanni / Borsari, Stefania / Ferrari, Chiara / Albertini, Giuseppe / Altomare, Gianfranco / Arcangeli, Fabio / Aste, Nicola / Bernengo, Maria Grazia / Bongiorno, Maria Rita / Borroni, Giovanni / Calvieri, Stefano / Chimenti, Sergio / Cusano, Francesco / Fracchiolla, Claudio / Gaddoni, Giuseppe / Girolomoni, Giampiero / Guarneri, Biagio / Lanzoni, Anna / Lombardi, Mara / Lotti, Torello / Mariotti, Antonio / Marsili, Franco / Micali, Giuseppe / Parodi, Aurora / Peris, Ketty / Peserico, Andrea / Quaglino, Pietro / Santini, Marcello / Schiavon, Sergio / Tonino, Camillo / Trevisan, Giusto / Tribuzi, Paola / Valentini, Paolo / Vena, Gino A / Virgili, Annarosa. ·Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy. ·Eur J Cancer Prev · Pubmed #22001916.

ABSTRACT: Although no study has definitively shown that unfocused screening of skin cancer is effective, many campaigns have been organized with the aim of increasing awareness on melanoma risk factors. The objective of this study was to analyse the results of the Skin Cancer Screening Day in Italy during the period 2005-2007, to determine the priorities for melanoma control plans in a Mediterranean country. A total of 5002 patients were screened by dermatologists in 31 cities. Individuals who considered themselves to have many naevi and those with a family history of melanoma showed a higher number of common and atypical naevi. Ten melanomas, 20 basal cell carcinomas and two squamous cell carcinomas were histopathologically confirmed. Our observations provide the following suggestions for melanoma prevention strategies: (a) an unfocused campaign is suitable to inform the public about the importance of self-examination of the skin, but is not useful to identify a larger number of melanomas; and (b) melanoma screening campaigns should focus on a selected population, which meets rigorous risk criteria to maintain higher cost-effectiveness. The financial support to effective melanoma screening programmes could be increased, especially in southern populations where lower levels of self-surveillance and socioeconomic conditions represent risk factors for late identification of melanoma.

17 Article Accuracy in melanoma detection: a 10-year multicenter survey. 2012

Argenziano, Giuseppe / Cerroni, Lorenzo / Zalaudek, Iris / Staibano, Stefania / Hofmann-Wellenhof, Rainer / Arpaia, Nicola / Bakos, Renato Marchiori / Balme, Brigitte / Bandic, Jadran / Bandelloni, Roberto / Brunasso, Alexandra M G / Cabo, Horacio / Calcara, David A / Carlos-Ortega, Blanca / Carvalho, Ana Carolina / Casas, Gabriel / Dong, Huiting / Ferrara, Gerardo / Filotico, Raffaele / Gómez, Guillermo / Halpern, Allan / Ilardi, Gennaro / Ishiko, Akira / Kandiloglu, Gulsen / Kawasaki, Hiroshi / Kobayashi, Ken / Koga, Hiroshi / Kovalyshyn, Ivanka / Langford, David / Liu, Xin / Marghoob, Ashfaq A / Mascolo, Massimo / Massone, Cesare / Mazzoni, Laura / Menzies, Scott / Minagawa, Akane / Nugnes, Loredana / Ozdemir, Fezal / Pellacani, Giovanni / Seidenari, Stefania / Siamas, Katherine / Stanganelli, Ignazio / Stoecker, William V / Tanaka, Masaru / Thomas, Luc / Tschandl, Philipp / Kittler, Harald. ·Dermatology Unit, Medical Department, Arcispedale Santa Maria Nuova, Viale Risorgimento 80 - 42100 Reggio Emilia, Italy. g.argenziano@gmail.com ·J Am Acad Dermatol · Pubmed #21982636.

ABSTRACT: BACKGROUND: Early excision is the only strategy to reduce melanoma mortality, but unnecessary excision of benign lesions increases morbidity and healthcare costs. OBJECTIVE: To assess accuracy in melanoma detection based on number-needed-to-excise (NNE) values over a 10-year period. METHODS: Information was retrieved on all histopathologically confirmed cutaneous melanomas or melanocytic nevi that were excised between 1998 and 2007 at participating clinics. NNE values were calculated by dividing the total number of excised lesions by the number of melanomas. Analyses included changes in NNE over time, differences in NNE between specialized clinical settings (SCS) versus non-specialized clinical settings (NSCS), and patient factors influencing NNE. RESULTS: The participating clinics contributed a total of 300,215 cases, including 17,172 melanomas and 283,043 melanocytic nevi. The overall NNE values achieved in SCS and NSCS in the 10-year period were 8.7 and 29.4, respectively. The NNE improved over time in SCS (from 12.8 to 6.8), but appeared unchanged in NSCS. Most of the effect on NNE in SCS was due to a greater number of excised melanomas. Higher NNE values were observed in patients younger than 40 years and for lesions located on the trunk. LIMITATIONS: No data concerning the use of dermatoscopy and digital monitoring procedures were collected from the participating centers. CONCLUSION: Over the 10-year study period, accuracy in melanoma detection improved only in specialized clinics maybe because of a larger use of new diagnostic techniques such as dermatoscopy.

18 Article Biological evaluation of MR36, a novel non-polyglutamatable thymidylate synthase inhibitor that blocks cell cycle progression in melanoma cell lines. 2012

Giudice, Stefania / Benassi, Luisa / Bertazzoni, Giorgia / Veratti, Eugenia / Morini, Daria / Azzoni, Paola / Costi, Maria P / Venturelli, Alberto / Pirondi, Silvia / Seidenari, Stefania / Magnoni, Cristina. ·Department of Dermatology, University of Modena and Reggio Emilia, Via del Pozzo, 71-41126 Modena, Italy. ·Invest New Drugs · Pubmed #21881917.

ABSTRACT: Melanoma is one of the most common cancers, and its incidence has continued to increase over the past few decades. Chemotherapy resistance and related defects in apoptotic signaling are critical for the high mortality of melanoma. Effective drugs are lacking because apoptosis regulation in this tumor type is not well understood. The folate pathway has been considered an interesting target for anticancer therapies, and approaches targeting this pathway have recently been extended to melanoma treatment. In this study, the intracellular apoptosis signaling pathways of two melanoma cells lines (SK-MEL-2 and SK-MEL-28) were investigated after treatment with a new experimental antifolate substance (MR36) that targets thymidylate synthase. In both melanoma cell lines, apoptosis induction was triggered by a p53-independent mechanism. MR36-induced apoptosis was associated with a loss of both mitochondrial membrane potential and caspase-3 activation. Induction of cell cycle arrest by MR36 was associated with changes in the expression of key cell cycle regulators, such as p21 and cyclin D1, and the hypophosphorylation of pRb. In addition, Fas signaling was also analyzed. These findings suggest that, unlike classical antifolates, MR36 exerted an inhibitory effect on both the enzymatic function and expression of thymidylate synthase, thereby inducing apoptosis through the activation of the extrinsic and intrinsic pathways in the melanoma cell lines. MR36 showed a different mechanism of action from the known antifolates (Nolatrexed and Pemetrexed) that resulted in higher anticancer activity. Therefore, MR36 should be included as a potential new therapeutic treatment in melanoma research.

19 Article In vivo confocal microscopy for detection and grading of dysplastic nevi: a pilot study. 2012

Pellacani, Giovanni / Farnetani, Francesca / Gonzalez, Salvador / Longo, Caterina / Cesinaro, Anna Maria / Casari, Alice / Beretti, Francesca / Seidenari, Stefania / Gill, Melissa. ·Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy. pellacani.giovanni@unimore.it ·J Am Acad Dermatol · Pubmed #21742408.

ABSTRACT: BACKGROUND: Dysplastic nevi are thought to be precursors of melanoma during a stepwise process. However, this concept is still controversial and precise correlation between clinical and histopathologic features is lacking. In vivo confocal microscopy represents a noninvasive imaging technique producing horizontal sections at nearly histopathologic resolution. OBJECTIVE: We sought to determine whether specific histologic features in dysplastic nevi have reliable correlates on confocal microscopy and to develop an in vivo microscopic grading system. METHODS: Sixty melanocytic lesions with equivocal dermatoscopic aspects, corresponding to 19 nondysplastic nevi, 27 dysplastic nevi, and 14 melanomas, were analyzed by confocal microscopy and histopathology, using the Duke grading criteria. RESULTS: All architectural and cytologic features of the Duke grading score had significant reflectance confocal microscopy correlates. Confocally, dysplastic nevi were characterized by a ringed pattern, in association with a meshwork pattern in a large proportion of cases, along with atypical junctional cells in the center of the lesion, and irregular junctional nests with short interconnections. A simplified algorithm was developed to distinguish dysplastic nevi from melanoma and nondysplastic nevi. The contemporary presence of cytologic atypia and of atypical junctional nests (irregular, with short interconnections, and/or with nonhomogeneous cellularity) was suggestive of histologic dysplasia, whereas a widespread pagetoid infiltration, widespread cytologic atypia at the junction, and nonedged papillae suggested melanoma diagnosis. LIMITATIONS: A small number of cases were evaluated because of the necessity to analyze numerous histopathologic and confocal features. CONCLUSION: The possibility to detect dysplastic nevi in vivo may lead to an appropriate management decision.

20 Article De novo melanoma and melanoma arising from pre-existing nevus: in vivo morphologic differences as evaluated by confocal microscopy. 2011

Longo, Caterina / Rito, Cintia / Beretti, Francesca / Cesinaro, Anna Maria / Piñeiro-Maceira, Juan / Seidenari, Stefania / Pellacani, Giovanni. ·Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy. · Department of Pathology, University Federal of Rio de Janeiro, Rio de Janeiro, Brazil. · Department of Anatomy and Histology, University of Modena and Reggio Emilia, Modena, Italy. · Department of Pathology, University of Modena and Reggio Emilia, Modena, Italy. · Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy. Electronic address: pellacani.giovanni@unimore.it. ·J Am Acad Dermatol · Pubmed #21715047.

ABSTRACT: BACKGROUND: Although in the majority of melanomas there is no evidence of pre-existing melanocytic nevus, it is believed that malignant transformation may sometimes occur within a benign precursor. OBJECTIVES: We sought to describe the morphologic features of de novo melanoma and melanoma arising from nevi by means of in vivo confocal microscopy, and to correlate them with their corresponding histopathologic features. METHODS: A total of 113 consecutive, histopathologically proven melanoma cases, 33 arising from a nevus and 80 occurring de novo, were imaged by confocal microscopy and retrospectively evaluated. Cyto-architectural features preferentially expressed in melanomas arising from nevi and in de novo melanomas were defined. RESULTS: By confocal microscopy, abrupt transition, localized distribution of junctional atypical cells, and the presence of dense dermal nests were the most helpful criteria for categorizing a melanoma as arising from a nevus. Melanomas arising from common and congenital nevi were predominantly composed of roundish, monomorphous cells, whereas melanomas arising either de novo or from dysplastic nevi were characterized by markedly pleomorphic cells. LIMITATIONS: The study is retrospective. CONCLUSION: Confocal microscopy is effective in identifying melanoma even when a nevus is simultaneously present, confirming the clinical usefulness of this methodology. Moreover, distinctive features were observed in de novo melanomas and melanomas arising from nevi, permitting accurate distinction between the two groups. Finally, differences in cell morphology, easily detectable by confocal microscopy, seemed to characterize different melanoma types.

21 Article Inverse association between dietary vitamin D and risk of cutaneous melanoma in a northern Italy population. 2011

Vinceti, Marco / Malagoli, Carlotta / Fiorentini, Chiara / Longo, Caterina / Crespi, Catherine M / Albertini, Giuseppe / Ricci, Cinzia / Lanzoni, Anna / Reggiani, Maurizio / Virgili, Annarosa / Osti, Federica / Lombardi, Mara / Santini, Marcello / Fanti, Pier Alessandro / Dika, Emi / Sieri, Sabina / Krogh, Vittorio / Seidenari, Stefania / Pellacani, Giovanni. ·Center for Environmental, Genetic, and Nutritional Epidemiology CREAGEN, Department of Public Health Sciences, University of Modena and Reggio Emilia, Modena, Italy. marco.vinceti@unimore.it ·Nutr Cancer · Pubmed #21541899.

ABSTRACT: The possibility of an inverse association between vitamin D and risk of cancer and, in particular, of cutaneous malignant melanoma has been suggested, but results of epidemiologic studies are still conflicting. We examined the relation between dietary vitamin D intake and melanoma risk through a population-based case-control study (380 cases, 719 controls) in a northern region of Italy, a country with an average vitamin D intake lower than that in northern Europe or the United States. We assessed average daily intake of vitamin D from foodstuffs using the European Prospective Investigation into Cancer and Nutrition (EPIC) semiquantitative food frequency questionnaire. In this population, levels of vitamin D intake were considerably lower than those observed in recent U.S. studies. We found an inverse relation between dietary vitamin D and melanoma risk in the sample as a whole, in both crude and adjusted analyses. In sex- and age-specific analyses, this association appeared to be stronger among males and among older subjects. These findings suggest that, at the relatively low levels of intake observed in this sample, an inverse relation between dietary vitamin D and risk of cutaneous malignant melanoma may exist.

22 Article Dermoscopic island: a new descriptor for thin melanoma. 2010

Borsari, Stefania / Longo, Caterina / Ferrari, Chiara / Benati, Elisa / Bassoli, Sara / Schianchi, Simona / Giusti, Francesca / Cesinaro, Anna Maria / Pellacani, Giovanni / Seidenari, Stefania. ·Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy. ·Arch Dermatol · Pubmed #21079063.

ABSTRACT: OBJECTIVES: To determine the frequency and the features of the dermoscopic island (DI) in melanocytic lesions and to assess its specificity for the diagnosis of melanoma. Dermoscopy improves the diagnostic accuracy of melanoma, but only a few dermoscopic descriptors specific for thin melanomas have been identified. We defined a new descriptor, the dermoscopic island, a well-circumscribed area showing a uniform dermoscopic pattern that differs from the rest of the pigmented lesion. DESIGN: Dermoscopic images of 96 in situ melanomas, 266 invasive melanomas, and 612 dermoscopic atypical nevi were evaluated to establish the presence and the main pattern of the DI. Also, clinical and histologic characteristics were analyzed. SETTING: Dermoscopic images were collected from lesions excised between 2003 and 2008 at the Department of Dermatology, University of Modena and Reggio Emilia. MAIN OUTCOME MEASURES: Specificity and odds ratio for melanoma; dermoscopic and histologic characteristics of lesions with a DI. RESULTS: The DI was present in 10.4% of in situ melanomas, 4.1% of invasive melanomas, and 3.1% of dermoscopic atypical nevi. The odds ratio for melanoma was 1.922, and specificity was 96.9%. Invasive melanomas with a DI were thinner than those lacking this descriptor. In addition, more than half of the melanomas with a DI arose on a nevus. The DI appeared mainly reticular on a reticular background. CONCLUSION: The DI is characteristic of thin melanoma arising in a nevus; thus, it can be considered a potential early sign of transformation of a nevus into a melanoma.

23 Article The different psychological profiles of subjects attending melanoma screening campaigns and those delaying diagnosis: an aid for designing preventive campaigns? 2010

Forghieri, Matilde / Longo, Caterina / Galeazzi, Gian Maria / Rigatelli, Marco / Seidenari, Stefania / Pellacani, Giovanni. ·Department of Neuroscience, University of Modena and Reggio Emilia, 41124 Modena, Italy. ·Eur J Dermatol · Pubmed #20956101.

ABSTRACT: Patient delay in seeking medical attention for melanoma (MM) constitutes one of the main challenges in designing prevention campaigns. No conclusive studies exploring psychological aspects of those patients, using standardized psychometric instruments, are currently available. We hypothesized that the attitude toward illness of subjects attending the melanoma screening day (EMD) would differ from patients diagnosed with MM following the usual clinical pathways. Five psychometric tests, assessing attitude toward illness, were administered both to EMD and MM groups, this latter further divided into two subgroups (good and bad detectors, GD and BD) considering the histo-clinical characteristics of the lesion. The Mann-Whitney U Test and Pearson Chi Square test were used to compare EMD patients with the other groups and to compare psychometric scores between GD and BD. BD and GD groups showed significant differences. Interestingly, the BD group was characterized by higher scores in Temperament and Character Inventory Fearful subscale, Multidimensional Health Locus of Control Powerful Others scale and Illness Behaviour Questionnaire General Hypochondriasis, Affective Disturbance and Irritability subscales. BD patients tend to react in a phobic manner to medical recommendations and they appear to favour external and more assertive help, which would suggest choosing a more direct approach in proposing a prevention campaign. Although this is a pilot study and further studies are needed, it gives new insight to build up more effective prevention campaigns for those patients.

24 Article Reticular grey-blue areas of regression as a dermoscopic marker of melanoma in situ. 2010

Seidenari, S / Ferrari, C / Borsari, S / Benati, E / Ponti, G / Bassoli, S / Giusti, F / Schianchi, S / Pellacani, G. ·Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy. ·Br J Dermatol · Pubmed #20426776.

ABSTRACT: BACKGROUND: By dermoscopy, regression structures are substantially defined by the presence of white and blue areas in the lesion image. As fibrosis and melanosis are often seen in malignant melanoma (MM), the presence of dermoscopic signs of regression may represent a clue for the diagnosis of malignancy. OBJECTIVES: To assess the frequency and extent of dermoscopic signs of regression in melanoma in situ (MIS) and to describe its dermoscopic features. METHODS: Dermoscopic images of 85 MIS, 85 invasive MMs and 85 dermoscopically equivocal lesions with a histological diagnosis of naevus were evaluated by three dermatologists, who assessed the presence of 11 parameters of regression. RESULTS: The number of regression parameters per lesion increased according to melanoma thickness. White areas, the grey-blue veil and widespread blue areas were more frequent in invasive MMs than in the other two lesion groups, whereas light brown areas and regression of dermoscopic structures were more frequent in MIS. Peppering was observable in the same percentage of MIS and invasive MMs. Blue areas were more frequently structureless in equivocal lesions and invasive MMs, whereas the reticular pattern prevailed in MIS. CONCLUSIONS: Frequency, morphology, extent and distribution of regression vary according to melanoma thickness and diameter. Lesions with reticular blue regression and light brown areas should undergo surgical excision for the suspicion of MIS. Moreover, the identification of the reticular pattern of blue regression can be considered a significant discriminator and a reliable predictor of MIS.

25 Article Reflectance confocal microscopy and features of melanocytic lesions: an internet-based study of the reproducibility of terminology. 2009

Pellacani, Giovanni / Vinceti, Marco / Bassoli, Sara / Braun, Ralph / Gonzalez, Salvador / Guitera, Pascale / Longo, Caterina / Marghoob, Ashfaq A / Menzies, Scott W / Puig, Susana / Scope, Alon / Seidenari, Stefania / Malvehy, Josep. ·Department of Dermatology, University of Modena and Reggio Emilia, Via del Pozzo 71, 41100 Modena, Italy. pellacani.giovanni@unimo.it ·Arch Dermatol · Pubmed #19841401.

ABSTRACT: OBJECTIVE: To test the interobserver and intraobserver reproducibility of the standard terminology for description and diagnosis of melanocytic lesions in in vivo confocal microscopy. DESIGN: A dedicated Web platform was developed to train the participants and to allow independent distant evaluations of confocal images via the Internet. SETTING: Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy. PARTICIPANTS: The study population was composed of 15 melanomas, 30 nevi, and 5 Spitz/Reed nevi. Six expert centers were invited to participate at the study. Intervention Evaluation of 36 features in 345 confocal microscopic images from melanocytic lesions. MAIN OUTCOME MEASURE: Interobserved and intraobserved agreement, by calculating the Cohen kappa statistics measure for each descriptor. RESULTS: High overall levels of reproducibility were shown for most of the evaluated features. In both the training and test sets there was a parallel trend of decreasing kappa values as deeper anatomic skin levels were evaluated. All of the features, except 1, used for melanoma diagnosis, including roundish pagetoid cells, nonedged papillae, atypical cells in basal layer, cerebriform clusters, and nucleated cells infiltrating dermal papillae, showed high overall levels of reproducibility. However, less-than-ideal reproducibility was obtained for some descriptors, such as grainy appearance of the epidermis, junctional thickening, mild atypia in basal layer, plump bright cells, small bright cells, and reticulated fibers in the dermis. Conclusion The standard consensus confocal terminology useful for the evaluation of melanocytic lesions was reproducibly recognized by independent observers.

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