Lesion Clinics (lesion + clinic)

Distribution by Scientific Domains

Selected Abstracts

Dermoscopic patterns of superficial basal cell carcinoma

Massimiliano Scalvenzi MD
Background, Superficial basal cell carcinoma (BCC) presents as a scaly, pink to red,brown patch and is predominantly located on the trunk. Clinical diagnosis may not be always easy and implicates a variety of differential diagnoses; in this situation dermoscopy has been reported improving the diagnostic accuracy. This study investigated dermoscopic patterns of superficial BCC focalizing the most specific and frequent structures in order to improve the diagnostic accuracy. Limitations, Study population referred to skin lesion clinic. Methods, Dermoscopic patterns of 42 superficial BCCs were analyzed and photographed. These cases represented the 8% of all BCCs excised in our Department between 2005 and 2006. Results, Dermoscopic structures observed in the 42 superficial BCCs consisted of shiny white to red areas (100%), "erosions" (78.6%), short fine telangiectasias (SFTs) (66.6%), leaf-like areas (16.6%), arborizing telangiectasias (14.3%), blue,gray globules (14.3%) and large blue,gray ovoid nests (4.7%). Conclusions, Our study identifies the presence of shiny white to red areas, SFTs and "erosions" as main dermoscopic criteria of superficial BCC. Other dermoscopic features, such as leaf-like areas, arborizing telangiectasias, blue,gray globules and large blue,gray ovoid nests, are not strongly associated with the diagnosis of superficial BCC but they are useful in the differential diagnosis from other pigmented and nonpigmented skin lesions. [source]

Comparison of diagnostic accuracy for cutaneous malignant melanoma between general dermatology, plastic surgery and pigmented lesion clinics

J.E. Osborne
SummaryBackground Since the 1980s there have been dedicated pigmented lesion clinics (PLCs) in the U.K. Important considerations when comparing the efficacy of the PLC with other referral clinics include diagnostic accuracy. Objectives To compare the false-negative rate of clinical diagnosis (FNR) in the PLC with that in the other clinics of primary referral of malignant melanoma (MM) in the same geographical area. We have previously shown that certain clinical features are risk factors for diagnostic failure of MM. A further aim of this study was to correct for any differences in frequency of these factors in the melanoma populations between clinics and to estimate the false-positive diagnostic rate (FPR) in the PLC. Methods To compare the FNR between clinics, the case notes of all patients presenting with histologically proven cutaneous MM in Leicestershire between 1987 and 1997 were examined retrospectively. A false-negative diagnosis was defined as documentation of another diagnosis and/or evidence in the case notes that the diagnosis was not considered to be MM. The FNR was estimated as the number of false-negative clinical diagnoses/number of true-positive histological diagnoses. To estimate the diagnostic FPR, which was defined as the number of false-positive clinical diagnoses of MM/total number of positive clinical diagnoses, in the PLC, the outcome of 500 consecutive patients attending the PLC was surveyed. Results The case notes of 731 patients were available, of whom approximately two-thirds initially attended the PLC, one-fifth the General Dermatology clinics (D) and the remainder were divided approximately equally (one-twentieth each) between Plastic Surgery clinics (P), other clinics (O) and the surgery of the general practitioner (GP). The last was regarded as the primary referral clinic if the lesion were excised there prior to any referral. The FNR was lowest for the PLC, at 10%, compared with 29% (D), 19% (P), 55% (O) and 54% (GP) (P < 0·0001). Lesions with risk factors for diagnostic failure were under-represented in the PLC (P < 0·0001), the mean frequencies of the risk factors being 20% (PLC), 25% (D), 22% (P), 31% (O) and 30% (GP). Differences were not large but still could partially explain the lower FNR of the PLC. However, when the FNR was estimated for lesions exhibiting each of these risk factors, the PLC was found to have the lowest rate in every case (PLC vs. all clinics combined, P = 0·04 to P < 0·0001). The mean FNR for the risk factors combined was 18% (PLC), 45% (D), 50% (P), 68% (O) and 71% (GP). Also on logistic multivariable analysis of the PLC vs. all the other clinics on FNR and the above factors, the higher FNR of the other clinics retained significance (odds ratio 5·9, P < 0·0001). In the 500 patients surveyed separately in the PLC, the MM pick-up rate on biopsy was 32% and the diagnostic FPR was 41%. Conclusions The FNR of MM was lower in the PLC than in the other clinics, while the pick-up rate for MM on biopsy and the FPR were acceptably low. [source]

Correlation with digital dermoscopic images can help dermatopathologists to diagnose equivocal skin tumours

J. Bauer
Summary Background, A variety of pigmented skin tumours can lead to diagnostic difficulties in dermatopathology. Objectives, To investigate whether the interobserver agreement between histopathological diagnoses of equivocal pigmented tumours made by two referral centres can be improved by additional use of dermoscopic images. Material and methods, Retrospective study using 160 tumours excised in the pigmented skin lesions clinic in Graz and 141 from Tübingen. Tumours were diagnosed in the referring centres using clinical data, histopathology and, if required, immunohistochemistry. The tumours were initially diagnosed as 74 melanomas, 218 melanocytic naevi and nine nonmelanocytic tumours. Haematoxylin and eosin sections, patients' age and sex, tumour localization and digital dermoscopic images were then exchanged between the participating centres. Then, diagnoses were made initially based solely on dermatopathology and clinical information. After a washout phase, the same sections were reevaluated with the additional use of dermoscopic images. The main outcome measures were the Cohen's , -coefficients of the initial diagnoses of the centre submitting the cases and the diagnoses of the other centre without and with dermoscopy. Results, The , -coefficient between the initial diagnoses with those made by the second centre without dermoscopy was 0·90 in Graz, 0·73 in Tübingen, and 0·81 overall. With the additional use of dermoscopy the , -value was invariably high with 0·89 in Graz, and improved to 0·87 in Tübingen, and to 0·88 overall. Conclusions, The additional use of digital dermoscopic images further improved the overall very good agreement of histopathological diagnoses between two referral centres. [source]