ABSTRACT
BACKGROUND: Although live and teledermoscopic examination has been successfully used to achieve non-invasive diagnosis of melanocytic skin lesions (MSLs), early melanoma (EM) and atypical nevi (AN) continue to be a challenge, and none of the various algorithms proposed have been sufficiently accurate. We designed a scoring classifier diagnostic method, the iDScore that combines clinical data of the patient with dermoscopic features of the MSL. OBJECTIVE: To test the accuracy of the iDScore in differentiating EM from AN in a teledermoscopy setting and to compare it with intuitive diagnosis, the ABCD rule and the seven-point checklist. MATERIALS AND METHODS: A dedicated teledermoscopy web platform was designed. This involved the following: (i) collecting a large integrated clinical-historical-dermoscopic data set of difficult MSLs from eight European dermatology centres; (ii) online testing, education and training in using the iDScore. A total of 904 images were combined with age, sex, lesion diameter and body site data and evaluated on the platform by 111 participants with four levels of skill in dermoscopy. Each testing session consisted of 30 blind cases to examine consecutively by the above four methods. 'Management decisions' and personal participant data were also recorded. RESULTS: iDScore-aided diagnosis achieved satisfactory diagnostic accuracy for all lesions, irrespective of centre of affiliation, showing an average AUC of 0.776 in all participant testing sessions. All skill groups improved their accuracy by 10-16% with respect to intuitive diagnosis and the other methods, showing high concordance and avoiding wrong management decisions. CONCLUSION: We demonstrated the validity of the iDScore method for managing suspicious MSLs in a large multicentric data set and a teledermoscopic setting. The platform designed for the iDScore project provides ready support for physicians of any dermoscopy skill level and is useful for education and training.
Subject(s)
Dermoscopy/methods , Early Detection of Cancer/methods , Internet , Melanoma/pathology , Skin Neoplasms/pathology , Telepathology , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Europe , Female , Humans , Infant , Male , Middle Aged , Reproducibility of Results , Retrospective Studies , Young AdultABSTRACT
Forty-eight patients with oncologic prosthetic devices (modular rotatory shoulder, Kotz, custom made) and metallic means of fixation (Sherman's plates, Ender's rods, etc.) underwent MRI in order to: 1) assess possible physical changes in the magnetic field or the alloys under examination; 2) detect the presence and type of artifacts, and 3) verify the onset of eventual noxious effects of the alloy on the patient. The diagnostic investigation was preceded by an experimental phase which was characterized by: A) a study of the temperature fluctuations of the alloys when submitted to the magnetic field and to radiofrequency; B) the identification and characterization of the artifacts, as well as C) their physical interpretation. During examination, there was no evidence of any mobilization of the means of fixation, sensation of endogenous heat, or other subjective complaints on the part of the patient. The authors observed that, even in the presence of artifacts, MRI provided good evaluation of the soft tissues around the devices by identifying tumor recurrences in the presence of an oncological prosthesis. MRI was also capable of showing trophic changes in the tissues surrounding the means of fixation. Thus, the method exhibits no contraindications in the study of these patients but, on the other hand, does not allow the evaluation of the integrity or mobilization of the prosthetic devices.
