John Paoli

Nerve blocks enable adequate pain relief during topical photodynamic therapy of field cancerization on the forehead and scalp.

Background  Topical photodynamic therapy (PDT) is an effective method when treating extensive areas of sun‐damaged skin with multiple actinic keratoses (AKs) (field cancerization) on areas such as the forehead and scalp, and offers excellent cosmetic outcome. The major side‐effect of PDT is the pain experienced during treatment.

The Euromelanoma skin cancer prevention campaign in Europe: Characteristics and results of 2009 and 2010

Background  Euromelanoma is a skin cancer education and prevention campaign that started in 1999 in Belgium as ‘Melanoma day’. Since 2000, it is active in a large and growing number of European countries under the name Euromelanoma.

Multiphoton Laser Scanning Microscopy—A Novel Diagnostic Method for Superficial Skin Cancers

The increasing incidence of skin cancer and the importance of early diagnosis is a challenge, which requires the development of reliable, cost-effective, noninvasive, diagnostic techniques. Several such methods based on optical imaging techniques are available and currently being investigated. A novel method in this field is multiphoton laser scanning microscopy (MPLSM). This technique is based on the nonlinear process of 2-photon excitation of endogenous fluorophores, which can be used to acquire horizontal optical sectioning of intact biological tissue samples. When studying human skin, MPLSM provides high-resolution fluorescence imaging, allowing visualization of cellular and subcellular structures of the epidermis and upper dermis. This review covers the application of MPLSM as a diagnostic tool for superficial skin cancers, such as basal cell carcinomas, squamous cell carcinoma in situ, and melanomas. MPLSM has also been applied in other research areas related to skin, which will be mentioned briefly. The morphologic features observed in MPLSM images of skin tumors are comparable to traditional histopathology. Safety issues, limitations, and further improvements are discussed. Although further investigations are required to make MPLSM a mainstream clinical diagnostic tool, MPLSM has the potential of becoming a noninvasive, bedside, histopathologic technique for the diagnosis of superficial skin cancers.

Euromelanoma: A dermatology-led European campaign against nonmelanoma skin cancer and cutaneous melanoma. Past, present and future

Euromelanoma is a dermatologist‐led skin cancer prevention programme conducting an annual screening and public education campaign in over 20 European countries. Within its 10‐year history, Euromelanoma has screened over 260 000 individuals across Europe, detecting a significant number of cutaneous melanomas and nonmelanoma skin cancers, identifying high‐risk individuals for further surveillance and promoting awareness on the suspicious features of melanoma and the hazardous effects of ultraviolet exposure. In this review article, we summarize the history of the Euromelanoma campaign, present its organizational structure and discuss the results of the campaign in individual countries and on a European scale. Euromelanoma has had a significant impact on melanoma prevention and early diagnosis in participating countries and, despite many challenges, has positively influenced public health attitudes towards regular mole examination and the implementation of preventive measures against skin cancer.

Mobile teledermoscopy—there's an app for that!

Background: The introduction of the smartphone with high-quality, built-in digital cameras and easy-to-install software may make it more convenient to perform teledermatology. In this study we looked at the feasibility of using a smartphone (iPhone 4®) with an installed application especially developed for teledermatology (iDoc24®) and a dermoscope (FotoFinder Handyscope®) that is customized to attach to the smartphone to be able to carry out mobile teledermoscopy. Objectives: To study the diagnostic accuracy of this mobile teledermoscopy solution, to determine the interobserver concordance between teledermoscopists (TDs) and a dermatologist meeting the patient face-to-face (FTF), and to assess the adequacy of the TDs’ management decisions and to evaluate the image quality obtained. Patients/Methods: During a 16-week period, patients with one or more suspicious skin lesions deemed to need a biopsy or excision were included. The smartphone app was used to send a clinical image, a dermoscopy image and relevant clinical information to a secure Internet platform (Tele-Dermis®). Two TDs assessed the incoming cases, providing a specific primary diagnosis and a management decision. They also graded the image quality. The histopathological diagnosis was used as the gold standard. Results: Sixty-nine lesions were included. The FTF dermatologist’s diagnostic accuracy was 66.7%, which was statistically higher than TD 1 (50.7%, P=0.04) but similar to TD 2 (60.9%, P=0.52). The interobserver concordances between the FTF dermatologist and the two TDs and between the respective TDs showed moderate to substantial agreement. The TDs provided adequate management decisions for 68 (98.6%) and 69 (100%) lesions, respectively. The image quality was rated as excellent or sufficient in 94% and 84% of the cases by the respective TDs. Conclusion: This novel mobile teledermoscopy solution may be useful as a triage tool for patients referred to dermatologists for suspicious skin lesions.

Predictors of pain associated with photodynamic therapy: a retrospective study of 658 treatments.

Pain is the most common side-effect of photodynamic therapy (PDT). Our main objective was to identify pain predictors in PDT. In total, we performed 658 treatments on 377 patients at our department during 2004. Larger sized treatment areas were the strongest pain predictor, and actinic keratoses were more painful to treat than basal cell carcinomas and Bowens disease. The most sensitive areas to treat were the face and scalp. Gender and age did not influence pain. Although treatment outcome was not our primary objective, 62% of 95 superficial basal cell carcinomas that were followed for 3 years showed complete clearance. Also, perforation of nodular basal cell carcinomas did not lead to better clinical results. In conclusion, the size of the treatment area, the diagnosis and the lesion location influence pain during PDT. Nevertheless, there is a large variance in visual analogue scale assessment within each group, thereby limiting the ability to predict pain.

Electrical impedance spectroscopy as a potential adjunct diagnostic tool for cutaneous melanoma

Previous studies have shown statistically significant differences in electrical impedance between various cutaneous lesions. Electrical impedance spectroscopy (EIS) may therefore be able to aid clinicians in differentiating between benign and malignant skin lesions.

Smartphone Teledermoscopy Referrals: A Novel Process for Improved Triage of Skin Cancer Patients

In this open, controlled, multicentre and prospective observational study, smartphone teledermoscopy referrals were sent from 20 primary healthcare centres to 2 dermatology departments for triage of skin lesions of concern using a smartphone application and a compatible digital dermoscope. The outcome for 816 patients referred via smartphone teledermoscopy was compared with 746 patients referred via the traditional paper-based system. When surgical treatment was required, the waiting time was significantly shorter using teledermoscopy for patients with melanoma, melanoma in situ, squamous cell carcinoma, squamous cell carcinoma in situ and basal cell carcinoma. Triage decisions were also more reliable with teledermoscopy and over 40% of the teledermoscopy patients could potentially have avoided face-to-face visits. Only 4 teledermoscopy referrals (0.4%) had to be excluded due to poor image quality. Smartphone teledermoscopy referrals allow for faster and more efficient management of patients with skin cancer as compared to traditional paper referrals.

5-year Recurrence Rates of Mohs Micrographic Surgery for Aggressive and Recurrent Facial Basal Cell Carcinoma

Mohs micrographic surgery allows for complete microscopic examination of the surgical margin when treating aggressive and recurrent facial basal cell carcinomas. This leads to the highest cure rates and maximal preservation of healthy tissue. The 5-year recurrence rates of 587 aggressive and/or recurrent facial basal cell carcinomas treated during 1993 to 2003 at our centre were studied retrospectively. The resulting 5-year recurrence rates using Kaplan-Meier survival analysis were 2.1% for primary (previously untreated) tumours, 5.2% for recurrent basal cell carcinomas and 3.3% overall. In total, 87.9% of the tumours required at least two stages of Mohs micrographic surgery. The surgical defects size after complete excision was, on average, approximately twice the size of the defect after excision of the clinically visible tumour with a 2-3 mm margin. Mohs micro-graphic surgery is underused in Scandinavia despite being the treatment of choice for aggressive and recurrent facial basal cell carcinomas.

Transcutaneous electrical nerve stimulation for pain relief during photodynamic therapy of actinic keratoses.

Topical photodynamic therapy (PDT) is an effective treatment for actinic keratoses (AKs) on the face and scalp (1, 2). The major side-effect of PDT is pain during treatment (3). Patients receiving PDT for AKs on the face and scalp often experience severe pain during treatment. The difficulty of finding a pain-relieving strategy has been highlighted in earlier studies (4, 5). Untreated AK lesions may increase the risk of developing squamous cell carcinoma (SCC) (6). Since PDT can be used to treat field cancerization, has good cure rates and gives excellent cosmetic results (7), it is necessary to find new strategies to reduce the pain experienced to an acceptable level. Transcutaneous electrical nerve stimulation (TENS) is used as pain relief in acute and chronic pain (8). The mechanism behind TENS is based on the gate control theory (9, 10). A TENS unit consists of an external stimulator and electrodes applied directly to the skin. TENS has been investigated to treat different kinds of pain, e.g. procedural pain, with varying results (11, 12). The aim of this pilot study was to investigate whether TENS can reduce the amount of pain experienced by patients undergoing PDT of AKs located on the face and scalp.PATIENTS AND METHODS