Christoph Sinz

Accuracy of dermatoscopy for the diagnosis of nonpigmented cancers of the skin

Background Nonpigmented skin cancer is common, and diagnosis with the unaided eye is error prone. Objective To investigate whether dermatoscopy improves the diagnostic accuracy for nonpigmented (amelanotic) cutaneous neoplasms. Methods We collected a sample of 2072 benign and malignant neoplastic lesions and inflammatory conditions and presented close‐up images taken with and without dermatoscopy to 95 examiners with different levels of experience. Results The area under the curve was significantly higher with than without dermatoscopy (0.68 vs 0.64, P < .001). Among 51 possible diagnoses, the correct diagnosis was selected in 33.1% of cases with and 26.4% of cases without dermatoscopy (P < .001). For experts, the frequencies of correct specific diagnoses of a malignant lesion improved from 40.2% without to 51.3% with dermatoscopy. For all malignant neoplasms combined, the frequencies of appropriate management strategies increased from 78.1% without to 82.5% with dermatoscopy. Limitations The study deviated from a real‐life clinical setting and was potentially affected by verification and selection bias. Conclusions Dermatoscopy improves the diagnosis and management of nonpigmented skin cancer and should be used as an adjunct to examination with the unaided eye.

Combined multi-modal photoacoustic tomography, optical coherence tomography (OCT) and OCT angiography system with an articulated probe for in vivo human skin structure and vasculature imaging

Cutaneous blood flow accounts for approximately 5% of cardiac output in human and plays a key role in a number of a physiological and pathological processes. We show for the first time a multi-modal photoacoustic tomography (PAT), optical coherence tomography (OCT) and OCT angiography system with an articulated probe to extract human cutaneous vasculature in vivo in various skin regions. OCT angiography supplements the microvasculature which PAT alone is unable to provide. Co-registered volumes for vessel network is further embedded in the morphologic image provided by OCT. This multi-modal system is therefore demonstrated as a valuable tool for comprehensive non-invasive human skin vasculature and morphology imaging in vivo.

The value of reflectance confocal microscopy in diagnosis of flat pigmented facial lesions: a prospective study

Flat pigmented facial lesions are difficult to diagnose even with dermatoscopy. It is controversial how additional information obtained by in vivo reflectance confocal microscopy (RCM) impacts the diagnosis and management.

The significance of blue color in dermatoscopy

Skin lesions with blue color are frequently excised to rule out malignancy. The objective of the present study was to investigate the significance of blue color.

Die Bedeutung der blauen Farbe in der Dermatoskopie

Hautläsionen mit blauer Färbung werden häufig chirurgisch entfernt, um Malignität auszuschließen zu können. Das Ziel der vorliegenden Studie war es, die Bedeutung der blauen Färbung zu untersuchen.

Long-term evaluation of the efficacy of digital dermatoscopy monitoring at a tertiary referral center

We examined the value of monitoring patients with multiple nevi using sequential digital dermatoscopy imaging at a tertiary referral center.

Comprehensive vascular imaging using optical coherence tomography-based angiography and photoacoustic tomography

Abstract. Studies have proven the relationship between cutaneous vasculature abnormalities and dermatological disorders, but to image vasculature noninvasively in vivo, advanced optical imaging techniques are required. In this study, we imaged a palm of a healthy volunteer and three subjects with cutaneous abnormalities with photoacoustic tomography (PAT) and optical coherence tomography with angiography extension (OCTA). Capillaries in the papillary dermis that are too small to be discerned with PAT are visualized with OCTA. From our results, we speculate that the PA signal from the palm is mostly from hemoglobin in capillaries rather than melanin, knowing that melanin concentration in volar skin is significantly smaller than that in other areas of the skin. We present for the first time OCTA images of capillaries along with the PAT images of the deeper vessels, demonstrating the complementary effective imaging depth range and the visualization capabilities of PAT and OCTA for imaging human skin in vivo. The proposed imaging system in this study could significantly improve treatment monitoring of dermatological diseases associated with cutaneous vasculature abnormalities.

Dermatoscopy of Neoplastic Skin Lesions: Recent Advances, Updates, and Revisions

Opinion statementDermatoscopy (dermoscopy) improves the diagnosis of benign and malignant cutaneous neoplasms in comparison with examination with the unaided eye and should be used routinely for all pigmented and non-pigmented cutaneous neoplasms. It is especially useful for the early stage of melanoma when melanoma-specific criteria are invisible to the unaided eye. Preselection by the unaided eye is therefore not recommended. The increased availability of polarized dermatoscopes, and the extended use of dermatoscopy in non-pigmented lesions led to the discovery of new criteria, and we recommend that lesions should be examined with polarized and non-polarized dermatoscopy. The “chaos and clues algorithm” is a good starting point for beginners because it is easy to use, accurate, and it works for all types of pigmented lesions not only for those melanocytic. Physicians, who use dermatoscopy routinely, should be aware of new clues for acral melanomas, nail matrix melanomas, melanoma in situ, and nodular melanoma. Dermatoscopy should also be used to distinguish between different subtypes of basal cell carcinoma and to discriminate highly from poorly differentiated squamous cell carcinomas to optimize therapy and management of non-melanoma skin cancer. One of the most exciting areas of research is the use of dermatoscopic images for machine learning and automated diagnosis. Convolutional neural networks trained with dermatoscopic images are able to diagnose pigmented lesions with the same accuracy as human experts. We humans should not be afraid of this new and exciting development because it will most likely lead to a peaceful and fruitful coexistence of human experts and decision support systems.

Non-invasive multimodal optical coherence and photoacoustic tomography for human skin imaging

The cutaneous vasculature is involved in many diseases. Current clinical examination techniques, however, cannot resolve the human vasculature with all plexus in a non-invasive manner. By combining an optical coherence tomography system with angiography extension and an all optical photoacoustic tomography system, we can resolve in 3D the blood vessels in human skin for all plexus non-invasively. With a customized imaging unit that permits access to various parts of patients’ bodies, we applied our multimodality imaging system to investigate several different types of skin conditions. Quantitative vascular analysis is given for each of the dermatological conditions to show the potential diagnostic value of our system in non-invasive examination of diseases and physiological processes. Improved performance of our system over its previous generation is also demonstrated with an updated characterization.

Combined multimodal photoacoustic tomography, optical coherence tomography (OCT) and OCT based angiography system for in vivo imaging of multiple skin disorders in human(Conference Presentation)

All optical photoacoustic tomography (PAT) using a planar Fabry-Perot interferometer polymer film sensor has been demonstrated for in vivo human palm imaging with an imaging penetration depth of 5 mm. The relatively larger vessels in the superficial plexus and the vessels in the dermal plexus are visible in PAT. However, due to both resolution and sensitivity limits, all optical PAT cannot reveal the smaller vessels such as capillary loops and venules. Melanin absorption also sometimes causes difficulties in PAT to resolve vessels. Optical coherence tomography (OCT) based angiography, on the other hand, has been proven suitable for microvasculature visualization in the first couple millimeters in human. In our work, we combine an all optical PAT system with an OCT system featuring a phase stable akinetic swept source. This multimodal PAT/OCT/OCT-angiography system provides us co-registered human skin vasculature information as well as the structural information of cutaneous. The scanning units of the sub-systems are assembled into one probe, which is then mounted onto a portable rack. The probe and rack design gives six degrees of freedom, allowing the multimodal optical imaging probe to access nearly all regions of human body. Utilizing this probe, we perform imaging on patients with various skin disorders as well as on healthy controls. Fused PAT/OCT-angiography volume shows the complete blood vessel network in human skin, which is further embedded in the morphology provided by OCT. A comparison between the results from the disordered regions and the normal regions demonstrates the clinical translational value of this multimodal optical imaging system in dermatology.