In vivo epiluminescence microscopy of pigmented skin lesions. II. Diagnosis of small pigmented skin lesions and early detection of malignant melanoma

The need for diagnosing malignant melanoma in its earliest stages results in an increasing number of unnecessary excisions. Objective criteria beyond the visual inspection are needed to distinguish between benign and malignant melanocytic tumors in vivo. Fluorescence spectra collected during the prospective, multicenter observational study (“FLIMMA”) were retrospectively analyzed by the newly developed machine learning algorithm. The formalin-fixed paraffin-embedded (FFPE) tissue samples of 214 pigmented skin lesions (PSLs) from 144 patients were examined by two independent pathologists in addition to the first diagnosis from the FLIMMA study, resulting in three histopathological results per sample. The support vector machine classifier was trained on 17,918 fluorescence spectra from 49 lesions labeled as malignant (1) and benign (0) by three histopathologists. A scoring system that scales linearly with the number of the “malignant spectra” was designed to classify the lesion as malignant melanoma (score > 28) or non-melanoma (score ≤ 28). Finally, the scoring algorithm was validated on 165 lesions to ensure model prediction power and to estimate the diagnostic accuracy of dermatofluoroscopy in melanoma detection. The scoring algorithm revealed a sensitivity of 91.7% and a specificity of 83.0% in diagnosing malignant melanoma. Using additionally the image segmentation for normalization of lesions’ region of interest, a further improvement of sensitivity of 95.8% was achieved, with a corresponding specificity of 80.9%.

Download Full-text

MALIGNANT MELANOMA AND PREGNANCY

Romanian Medical Journal ◽

10.37897/rmj.2021.2.2 ◽

2021 ◽

Vol 68 (2) ◽

pp. 143-146

Author(s):

Delia Cudalbă ◽

◽

Nicolae Gică ◽

Radu Botezatu ◽

Corina Gică ◽

...

Keyword(s):

Malignant Melanoma ◽

Poor Prognosis ◽

Skin Lesions ◽

Fetal Medicine ◽

Treatment Need ◽

Pigmented Skin Lesions ◽

Pregnant State ◽

State Diagnosis ◽

Patients With Poor Prognosis ◽

In Pregnancy

Malignant melanoma is one of the most frequent cancers diagnosed during pregnancy. Any pigmented skin lesions that change the color should be examined by an experienced dermatologist and if suspected, should be biopsied. Recent studies showed that malignant melanoma in pregnancy has not a worse outcome compared with non-pregnant state. Diagnosis of melanoma does not require an early delivery excepted pregnant patients with poor prognosis that need more aggressive treatment. Diagnosis and treatment need to be established in specialized centers with a multidisciplinary team. Pregnancy monitoring should be performed by team consisting of an obstetrician, a neonatologist and a specialist in fetal medicine.

Download Full-text

Malignant melanoma

InnovAiT Education and inspiration for general practice ◽

10.1177/1755738019836450 ◽

2019 ◽

Vol 12 (6) ◽

pp. 297-303

Author(s):

Charlotte Sidebotham

Keyword(s):

Public Health ◽

Malignant Melanoma ◽

Skin Lesions ◽

Health Concern ◽

Public Health Concern ◽

Favourable Prognosis ◽

Younger Age ◽

Pigmented Skin Lesions ◽

Early Primary

Melanoma affects people at a younger age than other cancers, and can rapidly become fatal if not detected. Thus, pigmented skin lesions can cause concern in both doctors and patients. If discovered in the early primary stages, melanomas have a favourable prognosis. Over the last few decades, the incidence of melanoma has significantly increased, and is fast becoming an urgent public health concern. This article aims to shine a light on this dangerous adversary.

Download Full-text

Does the initial biopsy type affect clinically important outcomes in malignant melanoma? A meta-analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e21041 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e21041-e21041

Author(s):

Fatima Fayyaz ◽

Richard A Shellenberger

Keyword(s):

Malignant Melanoma ◽

Early Detection ◽

Risk Ratio ◽

Meta Analysis ◽

Excisional Biopsy ◽

Skin Lesions ◽

Pigmented Lesions ◽

Significant Rate ◽

All Cause Mortality ◽

Specific Mortality

e21041 Background: Malignant melanoma continues to have an increasing incidence worldwide without a decline in mortality, despite advances in treatment and early detection which have led to improved mortality outcomes for most malignancies. Early detection is particularly favorable for melanoma localized to the site of disease, which confers a five year survival rate of 98.4 %. Guidelines from the American Academy of Dermatology (AAD) give three acceptable options for the initial management of pigmented lesions suspicious for melanoma: elliptical excision, wide punch excision and a deep shave or saucerization. Methods: We performed a systematic review and meta-analysis to better define the evidence for differences between punch incisional and excisional biopsy with regard to clinically important outcomes in the evaluation of skin lesions suspicious for melanoma. These were melanoma specific mortality, all-cause mortality, Breslow tumor thickness, and melanoma recurrence. The comparison groups were punch incisional and excisional biopsy; there was insufficient data to include shave biopsies. Results: The result of pooling the studies that track melanoma specific mortality finds that there is a higher, but non-significant rate of death among those in the punch incisional group. The pooled risk ratio is 1.21, p = 0.153. The results of pooling the all-cause mortality studies also finds a higher, but non-significant, rate of death among the punch incisional group, RR = 1.03, p = 0.390. Pooling the two studies that examine Breslow thickness found that values in the punch incisional group are significantly lower, with a standardized mean difference of -0.17, p = 0.006. Finally, the pooled risk ratio for recurrence was not significant, RR = 1.161, p = 0.198. Conclusions: Until further data is available, there is no evidence to suggest a preferred diagnostic procedure in the initial evaluation of pigmented lesions suspected of cutaneous melanoma related to clinically important outcomes. To our knowledge, this is the first meta-analysis done on this important question regarding melanoma epidemiology and public health.

Download Full-text

Dermoscopic Features of Pigmented Bowen's Disease in a Japanese Female Mimicking Malignant Melanoma

Dermatology Research and Practice ◽

10.1155/2010/543091 ◽

2010 ◽

Vol 2010 ◽

pp. 1-3 ◽

Cited By ~ 8

Author(s):

Takayuki Inoue ◽

Ken Kobayashi ◽

Mizuki Sawada ◽

Sumiko Ishizaki ◽

Haruo Ito ◽

...

Keyword(s):

Malignant Melanoma ◽

Skin Lesions ◽

Japanese Woman ◽

Bowen’S Disease ◽

Seborrheic Keratosis ◽

Bowen's Disease ◽

Pathologic Features ◽

Old Japanese ◽

History Of ◽

Pigmented Skin Lesions

Various structures have been reported for dermoscopic features of pigmented Bowen's disease (BD), which could be a mimic of various pigmented skin lesions. A 79-year-old Japanese woman presented with a 3-year history of brown-black macule on her right upper arm without symptom. Dermoscopic examination demonstrated irregular flossy streaks, irregular brown dots/globules, blue-whitish regression structures, and overlaying whitish scaly areas. We suspected pigmented skin lesions including seborrheic keratosis, pigmented eccrine poroma, and malignant melanoma and excised completely with a 5 mm margin. Histopathological features were consistent with a diagnosis of pigmented BD. Although similar dermoscopic features might be revealed in pigmented skin lesions and it may occasionally be difficult to distinguish between pigmented BD and other pigmented skin lesions, dermoscopy would be useful in speculating pathologic features of pigmented BD.

Download Full-text