scholarly journals A 9-Year Teledermoscopy Service: Retrospective Service Review

Iproceedings ◽  
10.2196/35401 ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. e35401
Author(s):  
Novell Shu Chyng Teoh ◽  
Amanda Oakley
Keyword(s):  
Waiting Time ◽  
Conflicts Of Interest ◽  
Significant Risk ◽  
Patient Characteristics ◽  
Skin Lesions ◽  
Number Needed To Treat ◽  
Melanoma In Situ ◽  
Male Sex

Background A teledermoscopy service was established in January 2010, where patients attended nurse-led clinics for imaging of lesions of concern and remote diagnosis by a dermatologist. Objective The study aimed to review the number of visits, patient characteristics, the efficiency of the service, and the diagnoses made. Methods We evaluated the waiting time and diagnosis of skin lesions for all patient visits from January 1, 2010, to May 31, 2019. The relationships between patient characteristics and the diagnosis of melanoma were specifically analyzed. Results The teledermoscopy clinic was attended by 6479 patients for 11,005 skin lesions on 8805 occasions. Statistically significant risk factors for the diagnosis of melanoma/melanoma in situ were male sex, European ethnicity, and Fitzpatrick skin type 2. Attendance was maximal during 2015 and 2016. The seasonal variation in visits 2011-2018 revealed a consistent peak at the end of summer and a dip at the end of winter. In the year 2010, 306 patients attended; 76% (233/306) of these were discharged to primary care and 24% (73/306) were referred to hospital for specialist assessment. For patients diagnosed by the dermatologist with suspected melanoma from January 1, 2010, to May 31, 2019, the median waiting time for an imaging appointment was 44.5 days (average 57.9 days, range 8-218 days). The most common lesions diagnosed were benign naevus (2933/11,005, 27%), benign keratosis (2576/11,005, 23%), and keratinocytic cancer (1707/11,005, 15%); melanoma was suspected in 5% (507/11,005) of referred lesions (Multimedia Appendix 1). The positive predictive value of melanoma/melanoma in situ was 61.1% (320 true positives and 203 false positives). The number needed to treat (ie, the ratio of the total number of excisions to the number with a histological diagnosis of melanoma/melanoma in situ) was 2.02. Conclusions Diagnoses were comparable to the experience of other teledermoscopy services. Teledermoscopy using a nurse-led imaging clinic can provide efficient and convenient access to dermatology by streamlining referrals to secondary care and prioritizing patients with skin cancer for treatment. Conflicts of Interest None declared.

scholarly journals A 9-Year Teledermoscopy Service: Retrospective Service Review (Preprint)

2021 ◽  
Author(s):  
Novell Shu Chyng Teoh ◽  
Amanda Oakley
Keyword(s):  
Waiting Time ◽  
Significant Risk ◽  
Patient Characteristics ◽  
Skin Lesions ◽  
Number Needed To Treat ◽  
Melanoma In Situ ◽  
Supplementary Material ◽  
Male Sex

BACKGROUND A teledermoscopy service was established in January 2010, where patients attended nurse-led clinics for imaging of lesions of concern and remote diagnosis by a dermatologist. OBJECTIVE The study aimed to review the number of visits, patient characteristics, the efficiency of the service, and the diagnoses made. METHODS We evaluated the waiting time and diagnosis of skin lesions for all patient visits from January 1, 2010, to May 31, 2019. The relationships between patient characteristics and the diagnosis of melanoma were specifically analyzed. RESULTS The teledermoscopy clinic was attended by 6479 patients for 11,005 skin lesions on 8805 occasions. Statistically significant risk factors for the diagnosis of melanoma/melanoma in situ were male sex, European ethnicity, and Fitzpatrick skin type 2. Attendance was maximal during 2015 and 2016. The seasonal variation in visits 2011-2018 revealed a consistent peak at the end of summer and a dip at the end of winter. In the year 2010, 306 patients attended; 76% (233/306) of these were discharged to primary care and 24% (73/306) were referred to hospital for specialist assessment. For patients diagnosed by the dermatologist with suspected melanoma from January 1, 2010, to May 31, 2019, the median waiting time for an imaging appointment was 44.5 days (average 57.9 days, range 8-218 days). The most common lesions diagnosed were benign naevus (2933/11,005, 27%), benign keratosis (2576/11,005, 23%), and keratinocytic cancer (1707/11,005, 15%); melanoma was suspected in 5% (507/11,005) of referred lesions (<xref ref-type="supplementary-material" rid="app1">Multimedia Appendix 1</xref>). The positive predictive value of melanoma/melanoma in situ was 61.1% (320 true positives and 203 false positives). The number needed to treat (ie, the ratio of the total number of excisions to the number with a histological diagnosis of melanoma/melanoma in situ) was 2.02. CONCLUSIONS Diagnoses were comparable to the experience of other teledermoscopy services. Teledermoscopy using a nurse-led imaging clinic can provide efficient and convenient access to dermatology by streamlining referrals to secondary care and prioritizing patients with skin cancer for treatment.

Does Shave Biopsy Accurately Predict the Final Breslow Depth of Primary Cutaneous Melanoma?

2009 ◽  
Vol 75 (5) ◽  
pp. 369-373 ◽  
Author(s):  
Phillip Moore ◽  
Jon Hundley ◽  
Jennifer Hundley ◽  
Edward A. Levine ◽  
Phillip Williford ◽  
...  
Keyword(s):  
Retrospective Review ◽  
Residual Disease ◽  
Tumor Stage ◽  
Skin Lesions ◽  
Tumor Depth ◽  
Primary Cutaneous Melanoma ◽  
Tumor Registry ◽  
Melanoma In Situ ◽  
Additional Surgery

Shave biopsy (SB) is used for the diagnosis of suspicious skin lesions, including melanoma. Its accuracy for melanoma has not been confirmed. We examined our experience with SB to determine its ability to predict true Breslow depth (BD). We performed a retrospective review of the tumor registry for all patients diagnosed with melanoma by SB from 1995 to 2004. Site and depth of lesion, tumor stage, correlation of BD between SB and wide local excision (WLE), and changes in surgical management due to discordance were examined. Melanoma-in-situ was defined as a depth of 0 for this analysis. One hundred thirty-nine patients were diagnosed with melanoma by SB. Pathology after WLE were as follows: 54 (39%) patients had no residual disease, 67 (48%) had a BD equal to or less than the SB, and 18 (13%) had a thicker BD compared with the SB. For these 18 patients, the median BD by SB and WLE was 1.1 mm (range 0-6.5) and 3.5 mm (range 0.5-20.5), respectively ( P = 0.0017). Upstaging of final BD from SB to WLE was significantly associated with increasing tumor depth and higher stage of melanoma ( P < 0.0001). Only seven of the 139 patients (5%) required further surgery because of the increased depth of the WLE. SB underestimated the final BD of melanoma in 13 per cent of patients, but changed the management of few patients. SB is a valuable tool for practitioners in the diagnosis of melanoma. Nevertheless, patients diagnosed with melanoma by SB should be counseled about the rare need for additional surgery.

Distinctive Dermatoscopic Features of Acral Lentiginous Melanoma in Situ from Plantar Melanocytic Nevi and Their Histopathologic Correlation

1998 ◽  
Vol 2 (4) ◽  
pp. 199-204 ◽  
Author(s):  
Yasuhiro Kawabata ◽  
Kunihiko Tamaki
Keyword(s):  
Skin Lesions ◽  
Melanocytic Nevus ◽  
Entire Surface ◽  
Acral Lentiginous Melanoma ◽  
Melanocytic Nevi ◽  
Melanoma In Situ ◽  
Technical Advances ◽  
Surface Profiles ◽  
Histopathologic Findings

Background: An acral lentiginous melanoma in situ on the sole is often difficult to differentiate with the naked eye from an acquired plantar melanocytic nevus. Recent technical advances in epiluminescence microscopy have contributed to the differentiation of these two pigmented skin lesions. Objective: In this study, the correlation between dermatoscopic and histopathologic findings of acral lentiginous melanoma in situ on the sole are compared to those of acquired plantar melanocytic nevi. Methods: Three acral lentiginous melanomas in situ on the sole, and two cases of acral lentiginous melanoma were compared with 50 acquired plantar melanocytic nevi by means of dermatoscopy and histopathology. Results: The dermatoscopic surface profiles of acquired melanocytic nevi were composed of linear pigmentation accentuated mainly on the sulcus superficialis. Histologically, some areas of the sulcus superficialis corresponded to rete ridges of the epidermis, and nests of nevus cells were also often located there. In contrast, the acral lentiginous melanomas in situ showed diffuse, irregularly shaped pigmentation distributed in a disorderly fashion over the entire surface. Histologically, isolated areas of proliferation and small nest formations of atypical melanocytes were irregularly distributed in the epidermis. Conclusion: A distinctive dermatoscopic feature of acral lentiginous melanoma in situ is diffuse and irregular pigmentation over the entire surface of the lesion. This feature is helpful for differentiating acral lentiginous melanoma in situ from acquired plantar melanocytic nevi.

Sirolimus Combined with Dexamethasone for the Treatment of a Patient with Interferon Resistant Hydroa Vacciniform-Like Lymphoma

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4992-4992
Author(s):  
Zhigang Liu ◽  
Yongqian Jia ◽  
Yuping Gong ◽  
Yong Guo ◽  
Jiazhuo Liu ◽  
...  
Keyword(s):  
T Cell ◽  
Conflicts Of Interest ◽  
Serum Biochemistry ◽  
Skin Lesions ◽  
Cytotoxic T Cell ◽  
Cell Phenotype ◽  
Ebv Dna ◽  
One Year

Abstract Abstract 4992 Hydroa vacciniform-like lymphoma is an unusual pediatric cutaneous T-cell lymphoma, which rarely involved with adults. Chemotherapy and/or radiotherapy had little or no benefit. Patients may have a response to α-interferon. We report here an adult case with interferon resistant hydroa vacciniform-like lymphoma that has been successfully treated with sirolimus, an mTOR pathway inhibitor. The patient is a thirty-five year old women,she begun with recurrent cutanous rash and small vesicule around her mouth and nose 3 years ago. One year before, the symptoms were exacerbated with obvious vesiculopapular eruption, edematous, blisters, ulcers, scarring and crusts in her face. Scattered vesiculopapular could be seen in her upper chest and extremities accompanied with fever and submandibular lymphadenopathy. Facial skin biopsy showed angiocentric infiltrates from the epidermis to the subjacent dermis. The infiltrate cells showed a cytotoxic T-cell phenotype, with positive TCR gene rearrangement and EBER expression in situ hybridization. EBV serum test showed EBV-IgA and IgG positive, but serum EBV-DNA was negative. Patient was given α-interferon 300 million units, intramuscularlly, two times a week, plus prednisone 30mg per day, orally. Patients' skin lesions were improved, but present recurrent episodes of papulovesicular eruptions. For the past 3 month patient had a recurrent high fever and exacerbated vesiculopapular eruptions and blisters. Laboratory test showed anemia and neutropenia, serum biochemistry and marrow examination confirmed that a lymphoma associated hematophagocytosis was complicated. Sirolimus was started at an initial dose of 1.5mg, orally, every 12 hours, combined with dexamethasone 10mg/day, intravenously. Three days later the fever begun to resolved and the skin lesion gradually subsided. Two weeks later the skin lesions disappeared and the dose of sirolinmus begun to tapered to 1.0mg, orally, every 12 hours, with prednisone 30mg/day, orally. By three month of follow-up the patient still on stable and be observed. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Bone fractures in patients with type 2 diabetes mellitus: prevalence and risk factors

2017 ◽  
Vol 20 (4) ◽  
pp. 4-10
Author(s):  
Tatiana Olegovna Yalochkina ◽  
Janna Evgen'evna Belaya ◽  
Lyudmila Yakovlevna Rozhinskaya ◽  
Michail Borisovich Antsiferov ◽  
Larisa Konstantinovna Dzeranova ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Outpatient Clinic ◽  
Bone Fractures ◽  
Significant Risk ◽  
History Of ◽  
Male Sex

Aim. To estimate the prevalence of and risk factors for low-traumatic fractures in patients with type 2 diabetes mellitus (T2DM).Materials and methods. We questioned 214 patients with T2DM from a single outpatient clinic located in Moscow to evaluate the prevalence of and risk factors for low-traumatic fractures, the duration of and complications from TD2M and HbA1c levels.Results. Of 214 patients, 65 reported low-traumatic bone fractures. Patients with a history of low-traumatic fractures reported falls in the previous year (28%), whereas only 13% of patients without fractures reported falls. The difference was statistically significant, with an odds ratio of 2.34 (1,144,76), P=0,022. Men reported fractures more frequently than women (43.3% vs. 24.7%, respectively, P = 0.01). Patients with bone fractures had a lower body mass index (P = 0.022); however, a multivariate analysis revealed that a history of falls and male sex were the most significant risk factors for fracture.Conclusion. Around 30% of patients with T2DM from a Moscow outpatient clinic reported bone fractures. The most significant risk factors for fracture were a history of falls in the previous year and male sex. The article is the RePrint from the original article inDiabetes Mellitus (2016); 19(5) pp. 359-365. doi: 10.14341/DM7796

scholarly journals Intracorneal Hematoma Showing Clinical and Dermoscopic Features of Acral Lentiginous Melanoma

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Ugur Uslu ◽  
Franz Heppt ◽  
Michael Erdmann
Keyword(s):  
Correct Diagnosis ◽  
Surgical Excision ◽  
Skin Lesions ◽  
Melanocytic Nevus ◽  
Careful Examination ◽  
Acral Lentiginous Melanoma ◽  
Melanoma In Situ ◽  
Malignant Skin ◽  
Rule Out

Intra- and subcorneal hematoma, a skin alteration seen palmar and plantar after trauma or physical exercise, can be challenging to distinguish from in situ or invasive acral lentiginous melanoma. Thus, careful examination including dermoscopic and histologic assessment may be necessary to make the correct diagnosis. We here present a case of a 67-year-old healthy female patient who presented with a pigmented plantar skin alteration. Differential diagnoses included benign skin lesions, for example, hematoma or melanocytic nevus, and also acral lentiginous melanoma or melanoma in situ. Since clinical and dermoscopic examinations did not rule out a malignant skin lesion, surgical excision was performed and confirmed an intracorneal hematoma. In summary, without adequate physical trigger, it may be clinically and dermoscopically challenging to make the correct diagnosis in pigmented palmar and plantar skin alterations. Thus, biopsy or surgical excision of the skin alteration may be necessary to rule out melanoma.

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.

scholarly journals Important risk factors for gallstones after laparoscopic gastrectomy: a retrospective study

BMC Surgery ◽  
2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Shohei Fujita ◽  
Masaru Kimata ◽  
Kenji Matsumoto ◽  
Yuichi Sasakura ◽  
Toshiaki Terauchi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Laparoscopic Cholecystectomy ◽  
Laparoscopic Gastrectomy ◽  
Significant Risk ◽  
Patient Characteristics ◽  
Gallstone Formation ◽  
Abdominal Ultrasonography ◽  
Exact Test ◽  
D2 Lymph Node Dissection ◽  
Male Sex

Abstract Background The frequency of gallstones is higher in patients who have undergone gastrectomy than in the general population. While there have been some studies of gallstone formation after open gastrectomy, there are few reports of gallstones after laparoscopic gastrectomy (LG). Therefore, this study aimed to evaluate the incidence of gallstones after LG. Methods We retrospectively reviewed the records of 184 patients who underwent LG between January 2011 and May 2016 at Saiseikai Utsunomiya Hospital. After gastrectomy, abdominal ultrasonography was generally performed every 6 months for 5 years. Patients who underwent cholecystectomy before LG, underwent simultaneous cholecystectomy, and did not undergo abdominal ultrasonography, with an observation period of < 24 months, were excluded from the study. Finally, 90 patients were analyzed. Laparoscopic cholecystectomy was performed whenever biliary complications occurred. Patient characteristics were compared using the two-tailed Fisher’s exact test or Chi-square test. In addition, the risk factors for postoperative gallstones were analyzed using logistic regression analysis. Results Among the 90 patients included in this study, 60 were men (78%), and the mean age was 65.5 years. Laparoscopic total gastrectomy was performed for 15 patients and laparoscopic distal gastrectomy for 75 patients. D2 lymph node dissection was performed for 8 patients (9%), whereas 68 patients underwent LG with Roux-en-Y reconstruction (76%). Gallstones were detected after LG in 27 of the 90 (30%) patients. Multivariate analysis identified Roux-en-Y reconstruction and male sex as significant risk factors of gallstones after gastrectomy. The incidence of gallstones was significantly higher (53%) in male patients who underwent Roux-en-Y reconstruction. Symptomatic gallstones after laparoscopic cholecystectomy were found in 6 cases (6/27, 22%), and all patients underwent laparoscopic cholecystectomy. Conclusion Roux-en-Y reconstruction and male sex were identified as significant risk factors for gallstones after LG.

scholarly journals Bone fractures in patients with type 2 diabetes mellitus: prevalence and risk factors

2016 ◽  
Vol 19 (5) ◽  
pp. 359-365 ◽  
Author(s):  
Tatiana Olegovna Yalochkina ◽  
Janna Evgen'evna Belaya ◽  
Lyudmila Yakovlevna Rozhinskaya ◽  
Michail Borisovich Antsiferov ◽  
Larisa Konstantinovna Dzeranova ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Outpatient Clinic ◽  
Bone Fractures ◽  
Significant Risk ◽  
History Of ◽  
Male Sex

Aim. To estimate the prevalence of and risk factors for low-traumatic fractures in patients with type 2 diabetes mellitus (T2DM).Materials and methods. We questioned 214 patients with T2DM from a single outpatient clinic located in Moscow to evaluate the prevalence of and risk factors for low-traumatic fractures, the duration of and complications from TD2M and HbA1c levels.Results. Of 214 patients, 65 reported low-traumatic bone fractures. Patients with a history of low-traumatic fractures reported falls in the previous year (28%), whereas only 13% of patients without fractures reported falls. The difference was statistically significant, with an odds ratio of 2.34 (1,14–4,76), P=0,022. Men reported fractures more frequently than women (43.3% vs. 24.7%, respectively, P = 0.01). Patients with bone fractures had a lower body mass index (P = 0.022); however, a multivariate analysis revealed that a history of falls and male sex were the most significant risk factors for fracture.Conclusion. Around 30% of patients with T2DM from a Moscow outpatient clinic reported bone fractures. The most significant risk factors for fracture were a history of falls in the previous year and male sex.

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