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

2021 ◽  
Author(s):  
Leah Jones ◽  
Amanda Oakley
Keyword(s):  
Skin Cancer ◽  
Skin Lesions ◽  
Similar Time ◽  
Additional Lesion ◽  
Melanoma In Situ ◽  
Cancer Group ◽  
Skin Cancers ◽  
Virtual Lesion ◽  
Electronic Referral ◽  
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.

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.

Dermatology

2019 ◽  
pp. 213-230
Keyword(s):  
Skin Cancer ◽  
Acne Vulgaris ◽  
Systemic Disease ◽  
Skin Lesions ◽  
Punch Biopsy ◽  
Stevens Johnson Syndrome ◽  
Clinical Approach ◽  
Dermatology Clinic ◽  
Skin Cancers ◽  
Johnson Syndrome

Dermatology is the study of the skin, hair, nails, and oral and genital mucus membranes and the diseases affecting them. It is predominantly an outpatient specialty. This chapter explains the common terminology used to describe skin lesions and dermatoses. The commonest conditions encountered in the dermatology clinic are described: eczema, psoriasis, pyoderma gangrenosum, skin cancers (basal cell skin cancer, squamous cell skin cancer, malignant melanoma), acne vulgaris and bullous disorders, in addition to dermatological manifestations of systemic disease such as vasculitis. Emergency presentations such as Stevens–Johnson syndrome/toxic epidermal necrolysis, anaphylaxis, and necrotizing fasciitis are outlined. A practical guide to common dermatological procedures such as punch biopsy, and a clinical approach to the dermatological patient are included.

Recognising skin cancers in the dental patient

2012 ◽  
Vol 3 (3) ◽  
pp. 158-165 ◽  
Author(s):  
Carrie Newlands
Keyword(s):  
At Risk ◽  
Skin Cancer ◽  
Skin Lesions ◽  
Facial Skin ◽  
Older Population ◽  
Skin Cancers ◽  
Dental Patient ◽  
The Face ◽  
Fair Skin

Skin cancer is increasing in incidence and the face is the commonest site for skin cancers to occur. Patients who are at risk from skin cancers include those who have fair skin and who have had long-term exposure to sunshine.1 While facial skin cancers are more common in the older population, greater numbers of younger people are developing these cancers.2-4 Facial skin lesions are common. This article aims to help members of the dental team recognise the features of those lesions which may indicate malignancy or pre-malignancy.

scholarly journals ANN-based diagnosis method for skin cancers using dermoscopic images

2021 ◽  
pp. bs202108
Author(s):  
Hamidreza Khezri ◽  
Mojtaba Farzaneh ◽  
Zeinab Ghasemishahrestani ◽  
Ali Moghadam
Keyword(s):  
Skin Cancer ◽  
Accurate Result ◽  
Low Cost ◽  
Skin Lesions ◽  
Multi Layer Perceptron ◽  
Skin Cancers ◽  
The World ◽  
Diagnosis Method ◽  
Artificial Neural Network Ann ◽  
Melanoma Skin

Melanoma is one of the most dangerous skin cancers in the world. It accounts for 55% of all deaths associated with skin cancer. Researchers believe that skin cancer increases the risk of other cancers if not diagnosed early. Therefore, prompt and timely diagnosis of this disease is very important for the successful treatment of the patient. This system can detect melanoma lethal carcinoma from other skin lesions without the need for surgery, with a low cost, accuracy of about 98.88% and specificity 99%. In this article, a new, intelligent and accurate software (Delphi) system has been used to diagnose melanoma skin cancer. To detect malignant melanoma, the ABCDT rule, asymmetry (A), boundary (B), color (C), diameter (D) and textural variation (T) of the lesion are calculated and finally, an artificial neural network (ANN) is used to obtain an accurate result. The ANN with Multi-Layer Perceptron (MLP) contains the five extraction Characteristics (ABCDT) of lesions is used as inputs, two hidden layers, and two outputs. Very good results were obtained using this method. It was observed that for a dataset of 180 dermoscopic lesion images including 80 malignant melanomas, 20 benign melanomas and 80 nevus lesions. Due to its automatic recognition and ability to be installed on a computer, this system can be very useful for dermatologists as well as the general public.

scholarly journals Remote Skin Cancer Diagnosis: Adding Images to Electronic Referrals Is More Efficient Than Wait-Listing for a Nurse-Led Imaging Clinic

Cancers ◽  
2021 ◽  
Vol 13 (22) ◽  
pp. 5828
Author(s):  
Leah Jones ◽  
Michael Jameson ◽  
Amanda Oakley
Keyword(s):  
Primary Care ◽  
Skin Cancer ◽  
Time Course ◽  
Skin Lesions ◽  
Primary Objective ◽  
Retrospective Comparison ◽  
Virtual Lesion ◽  
Primary Care Doctors ◽  
Management Advice ◽  
Diagnostic Concordance

We undertook a retrospective comparison of two teledermatology pathways that provide diagnostic and management advice for suspected skin cancers, to evaluate the time from referral to diagnosis and its concordance with histology. Primary Care doctors could refer patients to either the Virtual Lesion Clinic (VLC), a nurse-led community teledermoscopy clinic or, more recently, to the Suspected Skin Cancer (SSC) pathway, which requires them to attach regional, close-up, and dermoscopic images. The primary objective of this study was to determine the comparative time course between the SSC pathway and VLC. Secondary objectives included comparative diagnostic concordance, skin lesion classification, and evaluation of missed skin lesions during subsequent follow-up. VLC referrals from July to December 2016 and 2020 were compared to SSC referrals from July to December 2020. 408 patients with 682 lesions in the VLC cohort were compared with 480 patients with 548 lesions from the 2020 SSC cohort, matched for age, sex, and ethnicity, including histology where available. Median time (SD) from referral to receipt of teledermatology advice was four (2.8) days and 50 (43.0) days for the SSC and VLC cohorts, respectively (p < 0.001). Diagnostic concordance between teledermatologist and histopathologist for benign versus malignant lesions was 70% for 114 lesions in the SSC cohort, comparable to the VLC cohort (71% of 122 lesions). Referrals from primary care, where skin lesions were imaged with variable devices and quality resulted in faster specialist advice with similar diagnostic performance compared to high-quality imaging at nurse-led specialist dermoscopy clinics.

scholarly journals Melanoma Arising after Imiquimod Use

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Sharad P. Paul
Keyword(s):  
Skin Cancer ◽  
De Novo ◽  
Precancerous Lesions ◽  
Antiviral Agents ◽  
Cutaneous Metastases ◽  
First Line Therapy ◽  
Melanoma In Situ ◽  
Skin Cancers

Imiquimod belongs to the class of 1H-imidazo-[4,5-c]quinolones—drugs originally developed as nucleoside analogues with the aim of finding new potential antiviral agents (Harrison et al., 1988). Indeed, Imiquimod was first released as treatment for genital warts before its actions against skin cancer were studied. Imiquimod is a relatively small sized molecule (Mr = 240.3) and is hydrophobic, allowing it to penetrate the skin epidermal barrier and therefore making it suitable for topical formulations (Gerster et al., 2005). Imiquimod has shown itself effective against skin cancers and precancerous lesions, especially basal cell cancers and actinic keratosis (Salasche et al., 2002, Beutner et al., 1999). There have been reports of Imiquimod being used as topical treatment against cutaneous metastases of melanoma and some authors have reported its use as first-line therapy against melanoma in situ (Smyth et al., 2011, Gagnon, 2011). We report a case of an invasive malignant melanoma arising de novo at the specific site of application of Imiquimod (Aldara cream 5%) for a biopsy-proven superficial BCC. Therefore while Imiquimod has added to our topical armamentarium against skin cancer, care must be exercised in prescribing this treatment and it is especially important to follow up patients regularly.

Novel Nanolipoidal Systems for the Management of Skin Cancer

2020 ◽  
Vol 14 (2) ◽  
pp. 108-125
Author(s):  
Apoorva Singh ◽  
Nimisha
Keyword(s):  
Skin Cancer ◽  
Survival Rates ◽  
Cancer Therapeutics ◽  
The Body ◽  
Surgical Removal ◽  
The Novel ◽  
Skin Cancers ◽  
Recent Developments ◽  
Abnormal Cells ◽  
The Stability

: Skin cancer, among the various kinds of cancers, is a type that emerges from skin due to the growth of abnormal cells. These cells are capable of spreading and invading the other parts of the body. The occurrence of non-melanoma and melanoma, which are the major types of skin cancers, has increased over the past decades. Exposure to ultraviolet radiations (UV) is the main associative cause of skin cancer. UV exposure can inactivate tumor suppressor genes while activating various oncogenes. The conventional techniques like surgical removal, chemotherapy and radiation therapy lack the potential for targeting cancer cells and harm the normal cells. However, the novel therapeutics show promising improvements in the effectiveness of treatment, survival rates and better quality of life for patients. Different methodologies are involved in the skin cancer therapeutics for delivering the active ingredients to the target sites. Nano carriers are very efficient as they have the ability to improve the stability of drugs and further enhance their penetration into the tumor cells. The recent developments and research in nanotechnology have entitled several targeting and therapeutic agents to be incorporated into nanoparticles for an enhancive treatment of skin cancer. To protect the research works in the field of nanolipoidal systems various patents have been introduced. Some of the patents acknowledge responsive liposomes for specific targeting, nanocarriers for the delivery or co-delivery of chemotherapeutics, nucleic acids as well as photosensitizers. Further recent patents on the novel delivery systems have also been included here.

scholarly journals Systemic Photoprotection in Skin Cancer Prevention: Knowledge among Dermatologists

Biomolecules ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 332
Author(s):  
Luca Fania ◽  
Francesca Sampogna ◽  
Francesco Ricci ◽  
Mariafrancesca Hyeraci ◽  
Andrea Paradisi ◽  
...  
Keyword(s):  
Skin Cancer ◽  
Sampling Procedure ◽  
Skin Cancer Prevention ◽  
Snowball Sampling ◽  
Scientific Publications ◽  
Current State ◽  
Skin Cancers ◽  
Knowledge And Attitude ◽  
Nonmelanoma Skin Cancers

Background: Systemic photoprotection (i.e., administration of substances such as nicotinamide, carotenoids, and vitamin D) may be important to reduce photocarcinogenesis or to support long-term protection against UV irradiation. Clinical trials showed that oral nicotinamide is effective in reducing the onset of new nonmelanoma skin cancers (NMSCs), while other oral photoprotectors failed to achieve the reduction of new melanoma or NMSC formation in humans. The aim of this study was to summarize the current state of knowledge of systemic photoprotection and to evaluate the knowledge and attitude of dermatologists regarding these treatments. Methods: The survey was conducted on a sample of dermatologists recruited according to a snowball sampling procedure. The questionnaire consisted of a first part asking for characteristics of the participant and a second part with 12 specific questions on their knowledge about systemic photoprotection, particularly their knowledge of astaxanthin, β-carotene, nicotinamide, and vitamin D3. Results: One hundred eight dermatologists answered the survey. Most of them (85.2%) stated that oral photoprotectors have a role in the prevention of skin cancer, and responses mainly mentioned nicotinamide. More than half of them (54.6%) had prescribed all the considered oral photoprotectors, but the majority of them had prescribed nicotinamide, mainly for 2 to 3 months during summer, almost invariably (n = 106) associated with topical photoprotectors. Most dermatologists (>80%) were aware of scientific publications demonstrating an effect of systemic photoprotectors on NMSC. Conclusions: Most Italian dermatologists have positive views on oral photoprotection in skin cancer and are aware of the demonstrated potential of nicotinamide in the prevention of NMSCs.

scholarly journals Detailed head localization and incidence of skin cancers

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Marta Fijałkowska ◽  
Mateusz Koziej ◽  
Bogusław Antoszewski
Keyword(s):  
Skin Cancer ◽  
Cell Carcinoma ◽  
Vertical Dimension ◽  
Surgical Department ◽  
Surface Areas ◽  
Common Cancer ◽  
Skin Cancers ◽  
Sex Type ◽  
Cancer Subtype ◽  
The Face

AbstractSkin cancers are the most common neoplasms; frequently, they localize on the face. The aim of paper is to present the incidence of skin tumors in a single center from 2017 to 2019, describe trends in its frequency and find relations between neoplasms and sex, type of cancer, and its size. An analysis of histopathological files from the surgical department between 2017 and 2019 was calculated. These items were selected: sex, age, type of skin cancer, subtype of basal cell carcinoma (BCC), grading of squamous cell carcinoma (SCC), localization and dimensions of the tumor. The study sample consisted of 387 cases. BCC was the most common cancer and its nodular type was the most frequent. In older patients, the vertical dimension of excised carcinoma was significantly larger. Moreover, this connection was detected only in women compared to men. There were statistically significant differences between dimensions of the skin cancer and sex. In men group, skin cancers had statistically higher vertical dimensions and larger surface areas. On the face and head, BCC more often localizes in the nasal area, while SCC on the auricle. It has been demonstrated that the older the patient, the larger the vertical dimension of the tumor. As such, tumor size is larger in men than in women, as women usually see their physicians sooner than men: cosmetic concerns are more important to them.

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