Mario Cristofolini

Dermatoscopy: usefulness in the differential diagnosis of cutaneous pigmentary lesions.

Dermatoscopy has been reported to give valid Information in the differential diagnosis of cutaneous pigmentary lesions. Using a dermatoscopy Delta 10 Heine optotechnique, we evaluated 220 pigmented lesions during a health campaign for the early diagnosis of cutaneous melanoma and compared clinical and dermatoscopic diagnosis. Histologic diagnosis was carried out after removal of the lesions. Sensitivity, specificity, positive predictive value, negative predictive value and overall agreement were evaluated. In our experience clinical and dermatoscopic diagnosis gave similar results; sensitivity and specificity were slightly better for dermatoscopy than for clinical diagnosis. The agreement between clinical and dermatoscopic diagnosis was better in histologically negative lesions. Dermatoscopy Is useful in the diagnosis of pigmentary lesions, but clinical diagnosis by experienced dermatological staff, is unreplaceable, especially during a health campaign for the early diagnosis of cutaneous melanoma.

Analysis of the cost‐effectiveness ratio of the health campaign for the early diagnosis of cutaneous melanoma in Trentino, Italy

Background. The cost‐effectiveness ratio of a health campaign for the early diagnosis of cutaneous melanoma (CM), currently the only means to reduce mortality from this melanoma, was calculated for the Trentino region in Italy.

A gigantic, metastasizing keratoacanthoma: report of a case and discussion on classification

A case of a gigantic metastasizing keratoacanthoma in a woman who had impaired cellular immunity and autoimmune hemolytic anemia is described. The case suggests that disorders of humoral and cellular immunity may be responsible for development of recurrent and metastasizing keratoacanthomas.

Digital epiluminescence microscopy: usefulness in the differential diagnosis of cutaneous pigmentary lesions. A statistical comparison between visual and computer inspection.

Epiluminescence light microscopy (ELM) has been confirmed to be a useful tool for the diagnosis of pigmented skin lesions. The application of digital systems to epiluminescence represents the latest attempt to improve the diagnosis of cutaneous melanoma. The aim of this study was to compare the diagnostic accuracy of one of these systems, the DB-Dermo MIPS, with the accuracy of well-trained dermatologists using the ELM technique in order to establish the real usefulness of this instrument and to verify how much it can help the clinician make a diagnosis in a clinical setting. During a campaign for the early diagnosis of cutaneous melanoma, 311 patients with non-melanocytic lesions, common naevi, dysplastic naevi and melanomas underwent clinical diagnosis using ELM, computerized evaluation with DB-Dermo MIPS and skin biopsy. Sensitivity, specificity, true and negative predictive value were evaluated for epiluminescence and digital epiluminescence. Our study revealed that the inspection of pigmented skin lesions by digital epiluminescence has a better diagnostic accuracy than that of a trained dermatologist using the epiluminescence technique only. In our experience, this computerized system can play an essential role in the detection of early melanomas.

Epidemiology of skin tumors: data from the cutaneous cancer registry in Trentino, Italy.

Background: A Skin Cancer Registry was established in the province of Trento in northeast Italy in 1992 with the aim of collecting data on all cutaneous tumors affecting residents. These neoplasms are responsible for considerable morbidity and utilization of the Health Service because of their high frequency and, therefore, knowledge of the exact incidence is very important in planning health policies. Registry data are also very helpful in performing studies of analytical and descriptive epidemiology. Methods: For each patient, we collected personal data, phenotypical characteristics, professional history, concurrent diseases, previous therapy or trauma, and all data regarding the tumors. Patients were interviewed in person or, less frequently, by phone. All data were verified and put in a computerized file, in a protected room. The Statistics Institute of Trento University analyzed the data. Comparison among means was performed using the analysis of variance and differences among proportions were tested by chi-squared analysis. Poisson regression and the likelihood ratio test were used to compare incidence rates. We analyze here the data regarding epiteliomas and melanoma. Results: During the study period we registered 3435 primary skin tumors in 2868 individuals. Crude incidence rates, calculated using the number of subjects (not the number of tumors), were 87.9 for basal cell carcinoma (BCC), 28.9 for squamous cell carcinoma (SCC), and 14.2 for cutaneous melanoma (CM), per 100,000 per annum. We also calculated the same figures in females and males and specific incidence rates in both sexes and evaluated the distribution of skin cancer according to sex and anatomical site. Conclusion: We report the analysis of the data collected by the Skin Cancer registry in a 6 year period and compare the data with published data in literature and with data of a previously registered melanoma file. Our results confirm the high incidence of nonmelanoma skin cancers and the variation in the histological patterns of CM.SommaireAntécédents: En 1992, un registre de cancer de la peau a été établi dans la province de Trento, nord-est de l’Italie, dans l’objectif de collecter toutes les tumeurs malignes affectant les résidents. Vu leur fréquence élevée, ces néoplasmes sont la cause d’une forte morbidité et d’une grande utilisation du système de santé. Donc, connaÑtre leur incidence exacte contribue à une meilleure planification des politiques en matière de santé. Les données du registre sont également très utiles dans les études d’pidémiologie analytique et descriptive. Méthodes: Nous avons recueilli, pour chaque patient, des données personnelles, les caractéristiques phénotypiques, les antécédents professionels, les maladies actuelles, les thérapies ou les traumatismes précédents ainsi que toutes les données relatives aux tumeurs. Une entrevue a été effectuée auprès de chaque patient en personne, plus rarement par téléphone. Toutes les données ont été vérifiées, consignées dans un fichier informatique et gardées dans une chambre protégée. L’institut des statistiques de l’université de Trento a analysé les données. Une comparaison des moyens a été effectuée par analyse de la variance et les différences entre les proportions ont été évaluées par Khi carré. La régression Poisson et le taux de probabilité ont servi à comparer les taux d’incidence. Nous analysons dans le présent article les données relatives aux tumeurs épithéliales et aux mélanomes. Résultats: Durant l’étude, nous avons enregistré 3 435 tumeurs cutanées primaires chez 2 868 personnes. Les taux d’incidence bruts, calculés en utilisant le nombre de sujets (et non le nombre de tumeurs), étaient de 87,9 dans les cas de carcinomes basocellulaires, de 28,9 dans les cas de carcinomes spinocellulaires et de 14,2 dans les cas de mélanomes, par 100 000 sujets par an. Nous avons également effectué les mémes calculs pour les femmes et pour les hommes séparément, avec les taux d’incidence selon le sexe et une évaluation de la distribution du cancer de la peau selon le sexe. Conclusion: Nous présentons les données recueillies par le registre de cancer de la peau durant une période de six ans et les comparons aux données publiées dans les revues spécialisées et aux données tirées d’un registre précédent. Nos résultats confirment une incidence élevée de cancers non mélaniques et une variation des tendances histologiques des mélanomes.

Clinical validation of an automated system for supporting the early diagnosis of melanoma

Background: Early diagnosis and surgical excision is the most effective treatment of melanoma. Well‐trained dermatologists reach a high level of diagnostic accuracy with good sensitivity and specificity. Their performances increase using some technical aids as digital epiluminescence microscopy. Several studies describe the development of computerized systems whose aim is supporting dermatologists in the early diagnosis of melanoma. In many cases, the performances of those systems were comparable to those of dermatologists. However, this cannot tell us whether a system is able to support dermatologists. Actually, the computerized system might correctly recognize the same lesions that the dermatologist does, without providing them any useful advice and therefore being useless in recognizing early malignant lesions.

Uselessness of thermography for diagnosis and follow-up of cutaneous malignant melanoma.

Thermography is useless for diagnosis of cutaneous malignant melanomas (CMM). In fact, false negative thermograms (29.9 %) are much more numerous than clinically suspicious cases. Thermography is useless for follow-up of CMM. False-negative and false-positive thermograms of metastatic lymph nodes, subcutaneous nodules and removal site of CMM are much too numerous.

The role of etretinate (Tegison; Tigason) in the management of keratoacanthoma

Four patients with keratoacanthomas 2 to 3 cm in size were treated with etretinate. All the patients demonstrated early response and complete regression of the lesions. Follow-up (of 24 months in one case) did not reveal any recurrence.

Accuracy of epiluminescence microscopy among practical dermatologists: a study from the Emilia-Romagna region of Italy.

Aims and background The accuracy of epiluminescence microscopy (ELM) for pigmented skin lesions (PSLs) is still unclear. The large scale utilization of the technique is generally discouraged. The present study was aimed at comparing the accuracy of ELM with that of clinical examination alone in a group of 20 practical dermatologists. Methods and study design Thirty digital clinical images of benign and malignant PSLs and their digital ELM counterparts were used. A set of cumulative accuracy measures reported in the combined clinical/ELM diagnosis was compared with that reported in the clinical diagnosis alone. Results The proportion of nonmelanocytic lesions (NMLs), melanocytic nevi, and melanomas correctly identified, the predictive value of such diagnoses, and the proportion of melanomas detected by referral for biopsy (irrespective of the diagnosis reported) increased significantly. The cases referred for biopsy despite a “benign” impression decreased significantly among NMLs. Conclusions The observed tendency towards a greater accuracy suggests that even in the routine dermatology practice ELM has the potential to improve the clinical examination of PSLs.

Diagnosis of cutaneous melanoma: accuracy of a computerized image analysis system (Skin View)

Background/aims: Early diagnosis is essential for reducing the high mortality of CM (cutaneous melanoma). An expert dermatologist has a diagnostic accuracy of 85% but, in performing mass screening, the problem is to transfer the experience of a specialized centre to peripheral health clinics. Therefore, some computerized analysis systems were made. The aim of this paper is to compare the diagnostic accuracy of one such system, the Skin View System (SVS), to the accuracy of a well trained dermatologist in order to establish the real usefulness of the instrument and to verify how much it can help the diagnostic accuracy of the clinician in a dermatology setting.