Micromelanomas identified with time-lapse total body photography and dermoscopy

Drugge, Elizabeth D.; Volpicelli, Elgida R.; Sarac, Rebecca; Strang, Sophie R.; Elston, Dirk M.; Drugge, Rhett J.

doi:10.1016/j.jaad.2017.07.049

Cited by 16 publications

(24 citation statements)

References 5 publications

(5 reference statements)

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“…As stated in the study by Drudge et al . [ 33 ], some early diagnoses were possible because many of these high risk patients had total body photos and new lesions were found by comparing the images and checking all of the pigmented lesions with dermoscopy.…”

Section: Discussionmentioning

confidence: 99%

“…For some authors, when we remove suspicious small lesions, we would be preventing these lesions from progressing to unmistakable melanomas [22]. As stated in the study by Drudge et al [33], some early diagnoses were possible because many of these high risk patients had total body photos and new lesions were found by comparing the images and checking all of the pigmented lesions with dermoscopy.…”

Section: Plos Onementioning

confidence: 99%

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Melanocytic lesions ≤ 6mm: Prospective series of 481 melanocytic trunk and limb lesions in Brazil

Campos-do-Carmo¹,

Nobre

Cuzzi

et al. 2021

PLoS ONE

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Early diagnosis when melanoma is still small and thin is essential for improving mortality and morbidity. However, the diagnosis of small size melanoma might be particularly difficult, not only clinically but also dermoscopically. This study aimed to define clinical and dermatoscopic parameters in the diagnosis of suspicious pigmented cutaneous lesions with a diameter of ≤ 6mm and determine the sensitivity, specificity, positive and negative predictive values as well as the accuracy of each clinical and dermatoscopic criterion. This is a transversal, descriptive and analytical study of dermatoscopic analysis with the gold standard being the pathologic examination obtained from the excisional biopsy of suspicious melanocytic lesions with a diameter of ≤ 6mm. Trunk and limb lesion data from a public health service and a private clinic were prospectively collected from 2011 to 2017 by a unique observer. In total, 481 melanocytic lesions were included, with 73.8% being ≤ 4mm in diameter. Overall, 123 were diagnosed as melanoma, 56.0% in situ and 22.0% as thin melanomas (Breslow index 0.1 to 1.0mm). Melanoma presented symmetry in 53.7% of cases, regular borders in 54.5% and a single color in 60.2%. Regarding evolution, 13.8% of melanomas versus 10.9% of benign lesions (p = 0.116) were new by comparing photos from baseline with photos from the follow-up. The majority of melanomas (65%) were found on the limbs compared to 37.2% of the benign lesions at this location (p<0.001). A multiple logistic regression model adjusted for age, gender and location was created. The independent variables associated with the diagnosis of melanoma ≤ 6mm, adjusted for age, gender and location, were: streaks (adjusted Odds Ratio [aOR] 2.5; 95% CI 1.3–4.7; p = 0.006), and the presence of a structureless area (aOR 2.2, 95% CI 1.2–4.0, p = 0.011). Conversely, a symmetric typical pigment network was a protection variable (aOR 0.4, 95% 0.7–0.9, p = 0.040). In conclusion, dermatoscopic criteria have been identified which help to diagnose cases of small size melanoma. These include streaks and structureless areas that can be taken, particularly in consideration for the diagnosis of this subset of small difficult melanomas.

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Section: Discussionmentioning

confidence: 99%

Section: Plos Onementioning

confidence: 99%

Melanocytic lesions ≤ 6mm: Prospective series of 481 melanocytic trunk and limb lesions in Brazil

Campos-do-Carmo¹,

Nobre

Cuzzi

et al. 2021

PLoS ONE

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“…The first publication describing the dermoscopic diagnosis of microM was carried out by Bono et al, 1999 [ 5 ]. To date, seventeen other studies have been published showing significant differences in the sizes of samples (8–123 microM; median 27.5) and methodologies [ 2 , 3 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ] ( Table S1 ).…”

Section: Introductionmentioning

confidence: 99%

Dermoscopy of Small Diameter Melanomas with the Diagnostic Feasibility of Selected Algorithms—A Clinical Retrospective Multicenter Study

Słowińska

Kamińska‐Winciorek

Kowalska-Olędzka³

et al. 2021

Cancers

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Objective: The aim of the study was to verify two hypotheses. The first concerned the possibility of diagnostic dermoscopic differentiation between cutaneous melanomas of the histopathological category in situ (pTis) and thin melanomas (pT1a) in terms of their diameter. The second assessed the diagnostic feasibility of two dermoscopic algorithms aiming to detect ≤ 5.0 mm-sized melanomas histopathologically confirmed as pTis and pT1a. Methods: Dermoscopic images of consecutive cases of histopathologically confirmed melanomas were evaluated by three independent investigators for the presence of the predefined criteria. The melanomas were subdivided according to their diameter into small melanomas, so-called micromelanomas (microM)—sized ≤ 5.0 mm and >5.0 mm, according to published definitions of small melanocytic lesions. The Triage Amalgamated Dermoscopic Algorithm (TADA) and the revisited 7-point checklist of dermoscopy (7-point) algorithm were chosen for the diagnostic feasibility. Odds ratios and corresponding 95% confidence limits (CL) were calculated using the logistic regression adjusted for age for the melanoma-specific dermoscopic structures, the dermoscopic patterns and the diagnostic feasibility of the 7-point checklist and TADA algorithms. The p-values of the results were corrected using the Bonferroni method. Results: In total, 106 patients with 109 melanomas, 50 sized ≤ 5.0 mm and 59 exceeding the diameter of 5.0 mm, were retrospectively analyzed. The prevalent general pattern of microM was the spitzoid one (48% vs. 11.86%, p = 0.0013). Furthermore, 40% of microM vs. 6.78% melanomas sized > 5.0 mm (p = 0.0023) did not present melanoma-specific patterns. The asymmetric multicomponent pattern was present in 64.41% melanomas sized > 5.0 mm and in 26.00% microM (p = 0.0034). The asymmetry of structures or colors was detected in 56% microM vs. 89.83% (p = 0.0020) and 56% microM and 94.92% (p = 0.000034) melanoma sized > 5.0 mm, respectively. The differences in frequency of the detected dermoscopic structures specific to melanomas revealed that microM are almost deprived of negative networks (p = 0.04), shiny white structures (p = 0.0027) and regression features (p = 0.00003). Neither prominent skin markings nor angulated lines were found in the entire study group. Out of the vascular structures, microM presented only dotted (32%) or polymorphous (28%) vessels, although more rarely than melanomas sized > 5.0 mm (66.1% p = 0.017 and 49% p > 0.05, respectively). The diagnostic feasibility revealed a score ≥ 3 of the 7-point algorithm (indicative for malignancy) in 60% microM and 98.31% melanomas sized > 5.0 mm (p = 0.000006). The TADA algorithm revealed melanoma-specific patterns in 64% microM and 96.61% > 5.0 mm-sized melanomas (p = 0.00006) and melanoma-specific structures in 72% and 91.53% (p > 0.05), respectively. Conclusion: In the dermoscopy, 40% of micromelanomas histopathologically staged as pTis and pT1a did not reveal melanoma-specific patterns. Among the general melanocytic patterns, the spitzoid one was the most frequently found in melanomas sized ≤ 5.0 mm. The 7-point checklist and TADA dermoscopic algorithms were helpful in the identification of the majority of melanomas sized ≤ 5.0 mm.

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“…No studies had a contemporaneous control group, and only one study attempted comparison with a historical cohort 13 . We did not evaluate studies assessing the benefits of TBP for patient‐related outcomes 10,35–37 or disease‐related outcomes 6,18,38 . Finally, access to TBP systems remains limited in developing countries, limiting the applicability of our findings to resource‐rich settings 39 …”

Section: Discussionmentioning

confidence: 99%

Total body photography for the diagnosis of cutaneous melanoma in adults: a systematic review and meta‐analysis*

2021

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Summary Background Early detection of melanoma is essential to reduce mortality. Total body photography (TBP) can facilitate the detection of melanoma in high‐risk individuals. However, the accuracy of TBP in diagnosing melanoma remains unclear. Objectives To determine the diagnostic accuracy of TBP for the detection of melanoma in adults. Methods MEDLINE, Embase, Cochrane and Centre for Reviews databases were searched from inception to 26 May 2020. Studies that included TBP for diagnosing melanoma with at least one follow‐up appointment were eligible for inclusion in the systematic review if they provided data to calculate at least one diagnostic accuracy measure. Two authors independently screened articles, extracted data and assessed quality. Disagreements were resolved by a third reviewer. Results In total, 10 studies were included, comprising 41 703 patients who underwent TBP and 6203 biopsies. Melanoma in situ (MIS) was diagnosed in 315 (5·1%) lesions and invasive melanoma was diagnosed in 187 (3·0%) lesions biopsied. Summary estimates for TBP in diagnosing melanoma were calculated as follows: mean percentage of biopsies positive for MIS or melanoma was 15% [95% confidence interval (CI) 10–21], number needed to biopsy (NNB) was 8·6 (range 2·3–19·6), naevus : melanoma ratio was 7·6 (range 1·3–18·6), and MIS : melanoma ratio was 1·7 (1·0–3·5). Regression analysis showed a negative correlation between NNB and MIS : melanoma ratio. Conclusions Available data regarding the diagnostic accuracy of TBP are heterogeneous, owing to variability in the risk profile of cohorts and TBP protocols. Best current estimates suggest that TBP for diagnosing melanoma has an acceptable NNB in high‐risk patients. However, prospective diagnostic test accuracy studies are needed to gauge the diagnostic accuracy of TBP.

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Micromelanomas identified with time-lapse total body photography and dermoscopy

Abstract: is the inventor and holder of the intellectual property rights (US patent 7,359,748) of the Melanoscan system. E. Drugge is a firstdegree relative of Dr Drugge. The other authors have no conflicts of interest to declare.

Cited by 16 publications

References 5 publications

Melanocytic lesions ≤ 6mm: Prospective series of 481 melanocytic trunk and limb lesions in Brazil

Melanocytic lesions ≤ 6mm: Prospective series of 481 melanocytic trunk and limb lesions in Brazil

Dermoscopy of Small Diameter Melanomas with the Diagnostic Feasibility of Selected Algorithms—A Clinical Retrospective Multicenter Study

Total body photography for the diagnosis of cutaneous melanoma in adults: a systematic review and meta‐analysis*

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