The daily use of dermoscopy in the Netherlands

Background: Dermoscopy is a well-established tool for the diagnosis of skin diseases and skin cancer. Data on the use of dermoscopy by Dutch dermatologists is lacking. Objectives: To identify factors influencing the use of dermoscopy in daily dermatology practice and compare the results with those from other European countries. Materials & Methods: As a part of a pan-European study, all registered dermatologists in the Netherlands were asked to complete an online survey regarding questions about training and attitude towards dermoscopy. Results: Valid answers were collected from 213 respondents (out of 475 registered dermatologists), of whom 99% reported using dermoscopy. Of those, 41% reported dermoscopy training during residency. A high level of dermoscopy use for different types of skin diseases was reported by 28.9%. Users considered dermoscopy useful for pigmented lesions, especially for the early diagnosis of melanoma, but less advantageous for inflammatory diagnoses. Seventy-three percent reported that dermoscopy increased the number of melanomas detected compared to naked eye diagnosis, and two-thirds reported a decrease in unnecessary biopsies of benign lesions. Almost one third reported that on at least one occasion, a lesion that appeared benign on dermoscopy proved to be a melanoma after excision. Conclusion: This study reveals that nearly all Dutch dermatologists use dermoscopy, particularly for melanocytic lesions, but less so for inflammatory diagnoses. Most believe that they detected more melanomas as a result of using dermoscopy compared to the naked eye. A high level of dermoscopy use was significantly associated with seeing more skin cancer patients each month compared to infrequent use.

[Micrographic surgery of lentigo maligna 5 years later]. / Micrografisch gecontroleerde chirurgie volgens Breuninger.

Lentigo maligna is an in situ melanoma which usually affects sun-damaged skin on the head and neck. In patients with lentigo maligna, the clinically visible demarcation often correlates poorly with the histopathologically confirmed demarcation. Micrograhic surgery of lentigo maligna offers certainty of the presence of clear histological margins and is at the same time tissue sparing. Because of the clear margins after micrographic surgery, this technique leads to fewer recurrences than standard excision.

Increasing time trends of thin melanomas in The Netherlands: What are the explanations of recent accelerations?

BACKGROUND: A disproportional increase in in situ or thin melanomas may point at underlying causes such as increased melanoma awareness, as well as 'overdiagnosis' of melanoma in diagnostically equivocal small lesions. OBJECTIVES: The purposes of this study were to estimate trends in melanoma incidence by sex, Breslow thickness (thin melanomas subdivided into four subgroups: <0.25 mm, 0.25-0.49 mm, 0.50-0.74 mm, and 0.75-1.0 mm), age and location, and to compare these with trends in subgroups of thicker melanomas. METHODS: Data on all histologically confirmed in situ and invasive melanomas diagnosed between 1994 and 2010 were retrieved from the Netherlands Cancer Registry. Trends in European standardised rates (ESRs) were assessed using joinpoint analysis, and expressed as estimated annual percentage change (EAPC). RESULTS: Between 1994 and 2010, 34,156 persons were diagnosed with an in situ or thin melanoma. The ESR of in situ melanomas doubled for males and females with a recent steeper rise in incidence (EAPC 12% (95% confidence interval [CI]: 8.1-16) and 13% (95% CI: 5.9-20), respectively). ESR for thin melanomas amongst males approximately doubled with a steep, but non-significant acceleration compared to other thickness categories since 2006 for <0.25 mm melanomas (EAPC 26% (95% CI: 2.1-35)). For female patients with thin melanomas the ESRs increased almost two-fold, except for <0.25 mm melanomas. CONCLUSIONS: The incidence rates of in situ, thin and thick melanomas increased similarly between 1994 and 2010. Recently steep increases were found for in situ melanomas and thin melanomas in men. Explanations are 'overdiagnosis' in conjunction with increased ultraviolet exposure (natural and artificial) and therefore a 'true' increase, increased awareness, early detection, diagnostic drift and changed market forces in the Dutch health care system.