scholarly journals Accuracy of Store-and-Forward Teledermatology for the Diagnosis of Skin Cancer: The Nouvelle-Aquitaine Experience

Iproceedings ◽  
10.2196/35404 ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. e35404
Author(s):  
Colin Bui ◽  
Marie-Sylvie Doutre ◽  
Alain Taieb ◽  
Marie Beylot-Barry ◽  
Jean-Philippe Joseph ◽  
...  
Keyword(s):  
Skin Cancer ◽  
Conflicts Of Interest ◽  
Precancerous Lesion ◽  
Pathological Finding ◽  
Skin Lesions ◽  
University Hospital ◽  
Median Response ◽  
Day Range ◽  
Intervention Area ◽  
Store And Forward

Background In Nouvelle-Aquitaine (a French region with a population of almost 6 million), the density of dermatologists is less than 3.8/100,000 inhabitants. This lack of dermatological care is delaying diagnosis and management, especially for skin cancer. The SmartDerm Project is a store-and-forward (SAF) teledermatology platform for primary care in Nouvelle-Aquitaine providing dermatological counselling to general practitioners (GPs). Objective The main objective was to determine the concordance between the diagnosis of skin cancer made by dermatologists and the pathologists’ diagnosis. Methods GPs in 3 pilot departments of Nouvelle-Aquitaine (Lot-Et-Garonne, Deux-Sèvres, Creuse) sent their dermatology requests using their smartphone, via an app called PAACO/Globule; dermatologists at the University Hospital of Bordeaux answered within 48-72 hours. Consecutive cases of skin cancer suspected by the referent dermatologists during the intervention were included, if the result of biopsy interpreted by a certified pathologist was available at the time of the study. Results Among the 1727 requests, 163 (9%) concerned a possible diagnosis of skin cancer and were eligible. For 61 cases, the histopathological findings were not available. Eventually, 93 patients with a total of 102 skin lesions were included. Median age was 75 years (range 26-97 years), with 53% women. The skin lesions had progressed for 8 months on average (range 0.5-36 months). The median response time was 1 day (range 0-61 days); 65 days (range 1-667 days) elapsed on average between the SAF opinion and the histological sample. Histopathology diagnosed 83 malignant lesions (57 basal cell carcinomas, 69%; 18 squamous cell carcinomas, 22%; 6 melanomas, 7%; 1 cutaneous lymphoma, 1%; 1 secondary location of a primary cancer, 1%), 1 precancerous lesion, and 18 benign lesions. The concordance between the opinion of the referent dermatologist and the final pathological finding was 83% for nonmelanocytic lesions and 67% for melanocytic lesions. Conclusions This study showed the reliability of SAF teledermatology in the diagnosis of skin cancer, comparable to literature data in the absence of dermatoscopy. The median delay of about two months between request and histology was an improvement compared to the delay of usual appointments in the intervention area. The lack of data for 61 patients showed that SAF telemedicine requires better coordination and follow-up, especially for the management of skin cancer. With this reservation in mind, teledermatology offers an alternative answer for the triage of patients with skin cancer residing in areas with low medical density. Conflicts of Interest None declared.

scholarly journals Accuracy of Store-and-Forward Teledermatology for the Diagnosis of Skin Cancer: The Nouvelle-Aquitaine Experience (Preprint)

2021 ◽  
Author(s):  
Colin Bui ◽  
Marie-Sylvie Doutre ◽  
Alain Taieb ◽  
Marie Beylot-Barry ◽  
Jean-Philippe Joseph ◽  
...  
Keyword(s):  
Skin Cancer ◽  
Precancerous Lesion ◽  
Pathological Finding ◽  
Skin Lesions ◽  
University Hospital ◽  
Median Response ◽  
Day Range ◽  
Intervention Area ◽  
Store And Forward ◽  
The University

BACKGROUND In Nouvelle-Aquitaine (a French region with a population of almost 6 million), the density of dermatologists is less than 3.8/100,000 inhabitants. This lack of dermatological care is delaying diagnosis and management, especially for skin cancer. The SmartDerm Project is a store-and-forward (SAF) teledermatology platform for primary care in Nouvelle-Aquitaine providing dermatological counselling to general practitioners (GPs). OBJECTIVE The main objective was to determine the concordance between the diagnosis of skin cancer made by dermatologists and the pathologists’ diagnosis. METHODS GPs in 3 pilot departments of Nouvelle-Aquitaine (Lot-Et-Garonne, Deux-Sèvres, Creuse) sent their dermatology requests using their smartphone, via an app called PAACO/Globule; dermatologists at the University Hospital of Bordeaux answered within 48-72 hours. Consecutive cases of skin cancer suspected by the referent dermatologists during the intervention were included, if the result of biopsy interpreted by a certified pathologist was available at the time of the study. RESULTS Among the 1727 requests, 163 (9%) concerned a possible diagnosis of skin cancer and were eligible. For 61 cases, the histopathological findings were not available. Eventually, 93 patients with a total of 102 skin lesions were included. Median age was 75 years (range 26-97 years), with 53% women. The skin lesions had progressed for 8 months on average (range 0.5-36 months). The median response time was 1 day (range 0-61 days); 65 days (range 1-667 days) elapsed on average between the SAF opinion and the histological sample. Histopathology diagnosed 83 malignant lesions (57 basal cell carcinomas, 69%; 18 squamous cell carcinomas, 22%; 6 melanomas, 7%; 1 cutaneous lymphoma, 1%; 1 secondary location of a primary cancer, 1%), 1 precancerous lesion, and 18 benign lesions. The concordance between the opinion of the referent dermatologist and the final pathological finding was 83% for nonmelanocytic lesions and 67% for melanocytic lesions. CONCLUSIONS This study showed the reliability of SAF teledermatology in the diagnosis of skin cancer, comparable to literature data in the absence of dermatoscopy. The median delay of about two months between request and histology was an improvement compared to the delay of usual appointments in the intervention area. The lack of data for 61 patients showed that SAF telemedicine requires better coordination and follow-up, especially for the management of skin cancer. With this reservation in mind, teledermatology offers an alternative answer for the triage of patients with skin cancer residing in areas with low medical density.

scholarly journals Activity of Skin Cancer Clinic at Martin University Hospital in 2017

2018 ◽  
Vol 18 (1) ◽  
pp. 21-29
Author(s):  
E Minarikova ◽  
M Smolarova ◽  
M Minarik
Keyword(s):  
Skin Cancer ◽  
Malignant Melanoma ◽  
Skin Lesions ◽  
Common Type ◽  
Upper Extremities ◽  
Breslow Thickness ◽  
University Hospital ◽  
Superficial Spreading ◽  
The University ◽  
Cancer Clinic

Abstract The authors present new cases of malignant melanoma seen at the Skin Cancer Clinic of the University Hospital in Martin in the year 2017. There have been 112 new cases of malignant melanoma, 66 in men and 46 in women, diagnosed in 2017. We have recorded a occurence of two melanomas in one person in 3 patients, two men and one women. One patient had metastatic melanoma found in lymph nodes without corresponding skin lesions. The most common tumor body localisation in both men and women was on the back (51 melanomas, 45 %). In women, the most common localisation was upper extremities (13 melanomas, 29 %), followed by lower extremities and the back at the same rate (11 melanomas, 24 %). In men, the most common localisation was on the back (40 melanomas, 60 %). Histologically, the most common type was superficial spreading malignant melanoma (50 melanomas), the second most common was non specific type of malignant melanoma (19 melanomas). The majority of cases were low risk lesions with histological Breslow thickness in the range from 0,1 mm to 1 mm (47 melanomas). High risk lesions with histological Breslow thickness more than 4 mm were the second most common type (24 melanomas).

scholarly journals Assessing Generalizability of Deep Learning Models Trained on Standardized and Nonstandardized Images and Their Performance Against Teledermatologists

Iproceedings ◽  
10.2196/35391 ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. e35391
Author(s):  
Ibukun Oloruntoba ◽  
Toan D Nguyen ◽  
Zongyuan Ge ◽  
Tine Vestergaard ◽  
Victoria Mar
Keyword(s):  
Skin Cancer ◽  
Conflicts Of Interest ◽  
Area Under The Curve ◽  
Image Data ◽  
Skin Lesions ◽  
Training Image ◽  
Data Sets ◽  
Image Capture ◽  
Data Set ◽  
Unseen Data

Background Convolutional neural networks (CNNs) are a type of artificial intelligence that show promise as a diagnostic aid for skin cancer. However, the majority are trained using retrospective image data sets of varying quality and image capture standardization. Objective The aim of our study is to use CNN models with the same architecture, but different training image sets, and test variability in performance when classifying skin cancer images in different populations, acquired with different devices. Additionally, we wanted to assess the performance of the models against Danish teledermatologists when tested on images acquired from Denmark. Methods Three CNNs with the same architecture were trained. CNN-NS was trained on 25,331 nonstandardized images taken from the International Skin Imaging Collaboration using different image capture devices. CNN-S was trained on 235,268 standardized images, and CNN-S2 was trained on 25,331 standardized images (matched for number and classes of training images to CNN-NS). Both standardized data sets (CNN-S and CNN-S2) were provided by Molemap using the same image capture device. A total of 495 Danish patients with 569 images of skin lesions predominantly involving Fitzpatrick skin types II and III were used to test the performance of the models. Four teledermatologists independently diagnosed and assessed the images taken of the lesions. Primary outcome measures were sensitivity, specificity, and area under the curve of the receiver operating characteristic (AUROC). Results A total of 569 images were taken from 495 patients (n=280, 57% women, n=215, 43% men; mean age 55, SD 17 years) for this study. On these images, CNN-S achieved an AUROC of 0.861 (95% CI 0.830-0.889; P<.001), and CNN-S2 achieved an AUROC of 0.831 (95% CI 0.798-0.861; P=.009), with both outperforming CNN-NS, which achieved an AUROC of 0.759 (95% CI 0.722-0.794; P<.001; P=.009). When the CNNs were matched to the mean sensitivity and specificity of the teledermatologists, the model’s resultant sensitivities and specificities were surpassed by the teledermatologists. However, when compared to CNN-S, the differences were not statistically significant (P=.10; P=.05). Performance across all CNN models and teledermatologists was influenced by the image quality. Conclusions CNNs trained on standardized images had improved performance and therefore greater generalizability in skin cancer classification when applied to an unseen data set. This is an important consideration for future algorithm development, regulation, and approval. Further, when tested on these unseen test images, the teledermatologists clinically outperformed all the CNN models; however, the difference was deemed to be statistically insignificant when compared to CNN-S. Conflicts of Interest VM received speakers fees from Merck, Eli Lily, Novartis and Bristol Myers Squibb. VM is the principal investigator for a clinical trial funded by the Victorian Department of Health and Human Services with 1:1 contribution from MoleMap.

scholarly journals Are We Missing Something? The Skin Lesions Not Seen in Teledermatology

Iproceedings ◽  
10.2196/35393 ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. e35393
Author(s):  
Leah Jones ◽  
Amanda Oakley
Keyword(s):  
Skin Cancer ◽  
Conflicts Of Interest ◽  
Skin Lesions ◽  
Similar Time ◽  
Additional Lesion ◽  
Melanoma In Situ ◽  
Cancer Group ◽  
Skin Cancers ◽  
Virtual Lesion ◽  
Full Body

Background The suspected skin cancer electronic referral pathway was introduced in 2017. It requires general practitioners to add regional, close-up, and dermoscopic images to a lesion-specific referral template for a teledermatologist to review and advise on management. The virtual lesion clinic is a nurse-led clinic used since 2010 to obtain high-quality images for teledermoscopy assessment. A limitation of both services is the absence of a full-body examination. Objective This study aims to evaluate the number of skin cancers missed during teledermatology assessment. Methods This is a retrospective review of skin lesion referrals to dermatology. Suspected skin cancer referrals made in the latter half of 2020 were compared with referrals to the virtual lesion clinic during a similar time period in 2016. Results The study included 481 patients with 548 lesions in the 2020 suspected skin cancer cohort that were matched for age, sex, and ethnicity to 400 patients with 682 lesions in the 2016 virtual lesion clinic cohort. A total of 41 patients underwent subsequent specialist review in the suspected skin cancer cohort compared to 91 in the virtual lesion clinic cohort. A total of 20% of the suspected skin cancer cohort and 24% of the virtual lesion clinic cohort were found to have at least one additional lesion of concern. The majority of these were keratinocytic skin cancers; there were 2 and 0 additional melanomas or melanoma-in-situ, respectively. The virtual lesion clinic nurses identified additional lesions for imaging in 78 of 400 (20%) patients assessed in the virtual lesion clinic. The teledermatologist determined (author AO) that 73% of these additional lesions were malignant. Of the 548 lesions, 10 (2%) in the suspected skin cancer group were rereferred, none of which had a change in diagnosis. Out of 682 lesions, 16 (2%) in the virtual lesion clinic cohort were rereferred, 6 (1%) of which had a change in diagnosis. Conclusions Patients diagnosed with skin cancer often have multiple lesions of concern. Single-lesion teledermoscopy diagnoses have high concordance with in-person evaluation and histology; however, we have shown that in-person examination may reveal other suspicious lesions. The importance of a full-body skin examination should be emphasized to the referrer. Acknowledgments The Waikato Medical Research Foundation provided financial support for the study. Conflicts of Interest None declared.

scholarly journals Artificial Intelligence Support for Skin Lesion Triage in Primary Care and Dermatology

Iproceedings ◽  
10.2196/35395 ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. e35395
Author(s):  
Harmony Thompson ◽  
Amanda Oakley ◽  
Michael B Jameson ◽  
Adrian Bowling
Keyword(s):  
Artificial Intelligence ◽  
Primary Care ◽  
Health Care ◽  
Skin Cancer ◽  
Sensitivity And Specificity ◽  
Conflicts Of Interest ◽  
Real Life ◽  
Primary Care Providers ◽  
Skin Lesions ◽  
Care Providers

Background Primary care providers, dermatology specialists, and health care access are key components of primary prevention, early diagnosis, and treatment of skin cancer. Artificial intelligence (AI) offers the promise of diagnostic support for nonspecialists, but real-world clinical validation of AI in primary care is lacking. Objective We aimed to (1) assess the reliability of an AI-based clinical triage algorithm in classifying benign and malignant skin lesions and (2) evaluate the quality of images obtained in primary care using the study camera (3Gen DermLite Cam v4 or similar). Methods This was a single-center, prospective, double-blinded observational study with a predetermined study design. We recruited participants with suspected skin cancer in 20 primary care practices who were referred for assessment via teledermatology. A second set of photographs taken using a standardized camera was processed by the AI algorithm. We evaluated the image quality and compared two teledermatologists’ diagnoses by consensus (the “gold standard”) with AI and histology where applicable. Results Our primary outcome assessment stratified 391 skin lesions by management as benign, uncertain, or malignant. Uncertain lesions were not included in the sensitivity and specificity analyses. Uncertain lesions included lesions that had either diagnostic or management uncertainties. For the remaining 242 lesions, the sensitivity was 97.26% (95% CI 93.13%-99.25%) and the specificity was 97.92% (95% CI 92.68%-99.75%). The AI algorithm was compared with the histological diagnoses for 123 lesions. The sensitivity was 100% (95% CI 95.85%-100%) and the specificity was 72.22% (95% CI 54.81%-85.80%). Conclusions The AI algorithm demonstrates encouraging results, with high sensitivity and specificity, concordant with previous AI studies. It shows potential as a triage tool in conjunction with teledermatology to augment health care and improve access to dermatology. Further real-life studies need to be conducted on a larger scale to assess the reliability, usability, and cost-effectiveness of the algorithm in primary care. Acknowledgments MoleMap NZ, who developed the AI algorithm, provided some funding for this study. HT's salary was partially sponsored by MoleMap NZ, who developed the AI algorithm. AB is a shareholder and consultant to Molemap Ltd provider of the AI algorithm. Conflicts of Interest None declared.

scholarly journals Non-Melanoma Skin Cancer in Outdoor Workers: A Study on Actinic Keratosis in Italian Navy Personnel

2020 ◽  
Vol 17 (7) ◽  
pp. 2321 ◽  
Author(s):  
Luigi Vimercati ◽  
Luigi De Maria ◽  
Antonio Caputi ◽  
Enza Sabrina Silvana Cannone ◽  
Francesca Mansi ◽  
...  
Keyword(s):  
Skin Cancer ◽  
Squamous Cell ◽  
Actinic Keratosis ◽  
Precancerous Lesion ◽  
Skin Lesions ◽  
Outdoor Workers ◽  
Exposed Skin ◽  
Non Melanoma Skin Cancer ◽  
Navy Personnel ◽  
Melanoma Skin

Occupational exposure to ultraviolet radiation is one of the main risk factors for non-melanoma skin cancer (NMSC) development. The most common variants of NMSC are basal cell carcinomas, squamous cell carcinomas, and actinic keratosis (AK). The latter is nowadays considered by most authors as an early squamous cell carcinoma rather than a precancerous lesion. Outdoor workers have a higher risk of developing NMSC because they spend most of the working day outside. The aim of this descriptive study was to assess the prevalence of skin lesions, especially AK, in a professional category of individuals exposed to ultraviolet (UV) radiation: the Italian Navy. From January to June 2016, a questionnaire and a total skin examination of 921 military personnel were administered by medical specialists (dermatologists) in seven different Italian Navy centres. AK was detected in 217 of 921 (23.5%) workers. Older age, outdoor occupation, longer working life, and fair skin seem to promote the development of AK. Of the 217 workers with AK, 187 (86.2%) had lesions in chronically sun-exposed skin areas. Italian Navy personnel have a high AK prevalence. Further studies are needed to investigate occupational hazards and their health effects among outdoor workers to promote protective behaviour and raise awareness of skin cancer.

scholarly journals Screening for Melanoma and Other Skin Cancer Shows a Higher Early Melanoma Incidence: Social Educational Program “Life Fear-Free”

2021 ◽  
Vol 8 (1) ◽  
pp. 54-68
Author(s):  
Lev Demidov ◽  
Igor Samoylenko ◽  
Nina Vand ◽  
Igor Utyashev ◽  
Irina Shubina ◽  
...  
Keyword(s):  
Skin Cancer ◽  
Screening Program ◽  
Excisional Biopsy ◽  
Skin Lesions ◽  
Detection Methods ◽  
Non Melanoma Skin Cancer ◽  
The Social ◽  
Educational Campaign ◽  
Skin Cancer Detection ◽  
The Impact

Background: The screening program Life Fear-Free (LFF) aimed at early diagnosis of cutaneous melanoma (CM) was introduced in Samara, Chelyabinsk, Yekaterinburg, and Krasnodar (Russia) in 2019. Objectives: To analyze the impact of the program on early CM and non-melanoma skin cancer (NMSC) detection. Methods: According to the social educational campaign, people were informed about CM risk factors and symptoms and were invited for skin examination. The program planned to involve 3200 participants in total. Participants with suspicious lesions were invited for excisional biopsy. Results: 3143 participants, including 75.4% women, were examined for skin lesions. The average age of the participants was 43.7 years. Mostly skin phototypes II and III were registered (48.2% and 41.0%, respectively); 3 patients had CM, 15 had basal cell carcinoma, and 1 had Bowen’s disease, which were confirmed histologically. All detected melanomas had Breslow’s thickness of 1 mm. Conclusion: The participants showed high interest in early skin cancer detection programs. The incidence rate of CM and NMSCs among the program participants was higher than in general public. The early disease grade was proven for the detected CMs and NMSCs. The study has shown that it is important to continue such programs.

scholarly journals Q-Switched Neodymium-Doped Yttrium Aluminum Garnet Laser Therapy for Pigmented Skin Lesions: Efficacy and Safety

2013 ◽  
Vol 10 (2) ◽  
pp. 46-50 ◽  
Author(s):  
D Karn ◽  
S KC ◽  
A Amatya ◽  
EA Razouria ◽  
M Timalsina ◽  
...  
Keyword(s):  
Recurrence Rate ◽  
Safety Profile ◽  
Yttrium Aluminum Garnet ◽  
Skin Lesions ◽  
University Hospital ◽  
Efficacy And Safety ◽  
Yag Laser ◽  
Pigmentary Disorders ◽  
Yttrium Aluminum ◽  
Pigmented Skin Lesions

Background Nepalese population with Fitzpatrick skin types III-V has high prevalence of pigmentary disorders and it is a growing cosmetic concern. Q-Switched Neodymium- Doped Yttrium Aluminum Garnet (QS Nd-YAG) laser is an efficacious tool in the treatment of pigment disorders. Objective To highlight the efficacy and safety profile of various pigment disorders. Methods A prospective study done in Dhulikhel Hospital, Kathmandu University Hospital from January 2009 to January 2011. Patients undergoing laser for pigmented skin lesions were followed for response and safety profile. We included total 270 patients in the study with various disorders especially nevus, tattoos and melasma. Settings were repeated at 3-4 weeks interval and response was evaluated on clinical basis. Efficacy was then evaluated according to various parameters. Results For nevus, total 840 treatment sessions had been performed with an average of 6.88 sessions (range 3-11). Nd: YAG laser was very efficacious in removal of blue and black colored tattoos with an average of 7.9 and 9.5 sessions respectively. However, red mixed with blue and or green tattoos were relatively resistant to treatment and required average 10.33 treatment sessions. Melasma and freckles both responded to the therapy but recurrence rate was high. Conclusion Our results indicate that QS Nd: YAG laser is an effective modality for pigment disorders among Nepalese population. Nevus and melasma respond well but recurrence rate of melasma is high. Blue tattoos respond well while mixed colored tattoos are quite resistant to Nd: YAG laser alone. Transient pain and temporary hyperpigmentation are common side effects. Kathmandu University Medical Journal | Vol.10 | No. 2 | Issue 38 | Apr – June 2012 | Page 46-50 DOI: http://dx.doi.org/10.3126/kumj.v10i2.7343

scholarly journals CD180 Expression in B-Cell Lymphomas: A Multicenter Geil Study

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 1628-1628
Author(s):  
Caroline Mayeur-Rousse ◽  
Julien Guy ◽  
Laurent Miguet ◽  
Sabrina Bouyer ◽  
Franck Genevieve ◽  
...  
Keyword(s):  
Flow Cytometry ◽  
B Cell ◽  
Conflicts Of Interest ◽  
Lymphocytic Leukemia ◽  
University Hospital ◽  
Routine Practice ◽  
Similar Data ◽  
B Cell Lymphomas ◽  
Whitney Test ◽  
Mann Whitney Test

Abstract CD180 is a Toll-Like Receptor homolog strongly expressed on normal human B-cells and involved in innate immune responses. Previous proteomic analyses on microparticles derived from mature B-cell neoplasms allowed us to identify CD180 as a marker of marginal zone lymphomas (MZL)(Miguet, Leukemia, 2013). Using flow cytometry on blood samples we showed that this protein is lost or underexpressed at the plasma membrane for almost all B-cell lymphomas except MZL. In order to confirm its clinical relevance, we conducted a prospective multicenter flow cytometry study in 5 French University Hospital laboratories, on behalf of the GEIL. Blood or bone marrow samples from 236 patients were studied (20 normal controls ; 74 chronic lymphocytic leukemia (CLL); 21 mantle cell lymphoma (MCL); 42 lymphoplasmacytic lymphoma (LPL); 13 follicular lymphoma (FL) ; 58 MZL, 14 of which with numerous villous lymphocytes; 8 hairy cell leukemia (HCL)). Analyses were performed either on FACSCanto II (BD Biosciences, 3 centers) or on Navios (Beckman Coulter, 2 centers) instruments. Harmonization process was performed using Rainbow beads (Spherotech). For the CLL group, CD180 Median fluorescence (MdFI) in each center was not significantly different (Anova test, p>0.05). Instruments’ harmonization was therefore effective enough to obtain similar data from all centres. In the whole cohort, CD180 was significantly less expressed in the group of lymphomas -including CLL, MCL, LPL and FL- than in controls (Mann-Whitney test, p<0.05). Conversely, in the group of MZL and HCL, CD180 MdFI was not different from those of controls (Mann-Whitney test, p>0.05) but significantly higher than in CLL, MCL, LPL and FL (Mann-Whitney test, p<0.0001). Distinction between MZL and lymphomas with numerous villous lymphocytes was possible (Mann-Whitney test, p=0.0012) but not between MZL and HCL. ROC curve analysis determined a CD180 MdFI threshold of 1800 which allow the positive diagnosis of MZL with a sensitivity of 77% and specificity of 92%. These results underline the efficiency of CD180 as a single positive and robust marker for MZL diagnosis, and confirm that between centers and between instruments harmonization is largely feasible in routine practice as published recently (Solly F et al. Cytomery part A, 2013). It should be emphasized that among the group of lymphomas with intense expression of CD180, all interestingly originating from the spleen, those with numerous villous lymphocytes display the highest expression. We described for the first time in this study the strong positivity of CD180 in HCL. Anti-CD180 antibody may be included in diagnosis combination markers in order to improve the diagnosis of chronic B-cell malignancies Disclosures No relevant conflicts of interest to declare.

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