Rainer Hofmann-Wellenhof

Dermoscopy in general dermatology

Dermoscopy improves the diagnostic accuracy in the clinical evaluation of pigmented skin lesions, but it is also useful for the assessment of vascular structures that are not visible to the naked eye. As a consequence, dermoscopy has been employed more and more for the differential diagnosis of nonpigmented skin disorders, including tumors but also inflammatory and infectious diseases. This article provides a review of the dermoscopic features seen in various nonpigmented tumoral and nontumoral skin lesions as well as the dermoscopic criteria used for monitoring skin reactions to various treatments.

Dermoscopy of Bowen's disease.

Background  Dermoscopy improves the diagnostic accuracy in pigmented skin lesions, but it is also useful in the evaluation of nonpigmented skin tumours as it allows the recognition of vascular structures that are not visible to the naked eye. Bowens disease (BD) or squamous cell carcinoma in situ is usually nonpigmented, but may also rarely be pigmented.

Mobile teledermatology for skin tumour screening: Diagnostic accuracy of clinical and dermoscopic image tele-evaluation using cellular phones

Background  The ability to diagnose malignant skin tumours accurately and to distinguish them from benign lesions is vital in ensuring appropriate patient management. Little is known about the effects of mobile teledermatology services on diagnostic accuracy and their appropriateness for skin tumour surveillance.

Teledermoscopy - results of a multicentre study on 43 pigmented skin lesions

We performed a multicentre study to evaluate the agreement between the direct clinical diagnosis and the telediagnosis of 43 cutaneous pigmented lesions. Digital clinical and dermoscopic images of the 43 pigmented skin lesions (11 melanomas, 23 melanocytic naevi, three basal cell carcinomas, three lentigines, two seborrhoeic keratoses and one angiokeratoma) were sent by email to 11 colleagues (six dermatologists, two residents in dermatology, one oncologist, one specialist in internal medicine and one general practitioner) in 10 centres. These 11 colleagues had different degrees of experience in dermoscopy. With histopathology as the gold standard, an average of 85% of the telediagnoses were correct, with results varying from 77% to 95%, whereas face-to-face diagnosis by an expert dermatologist was correct in 91% of cases. The kappa value for all participants ranged from 0.35 to 0.87. The results confirm that teledermoscopy can be a reliable technique for the diagnosis of pigmented skin lesions but one that will depend on the expertise of the observer.

Dermoscopy of facial nonpigmented actinic keratosis

Background  The accuracy of clinical diagnosis of nonpigmented, facial actinic keratosis (AK) is often suboptimal, even for experienced clinicians.

Teledermatology : An Update

Dermatology is perhaps the most visual specialty in medicine, making it ideally suited for modern telemedicine techniques, as has been shown in a number of recent studies investigating feasibility and reliability of teledermatology. It has generally demonstrated high levels of concordance in diagnosis and management plans compared with face-to-face consultations. Teledermatology also has been used for various purposes, including triage, diagnostic and management services, and second-opinion services for primary care practitioners. It has been set up in a number of ways: (1) direct referral for primary care using images and clinical history sent to secondary care dermatology services for second opinion and for triage referrals and (2) facilitating community-based clinics led by nurses or general practitioners. Moreover, in the last years new fields in teledermatology have grown up. Teledermoscopy is a promising area for melanoma screening as well as for the diagnosis and management of equivocal pigmented skin lesions. The feasibility of mobile teledermatology and mobile teledermoscopy recently has been proven, and these new facilities have the potential to become an easy applicable tool for everyone and may open the door for a new flexible triage system for detection of skin cancer in general and melanoma in particular. The implementation of virtual slide systems for teledermatopathology has allowed avoiding the limitations imposed by conventional microphotography. Finally, web consultations in dermatology are a rather new tool that became available in the last years and teledermatologic services through the Internet offer many possibilities, including continuing medical education, on-line atlases and databases, and specific web application suited for teledermatology (ie, www.telederm.org).

Discrimination of Actinic Keratoses from Normal Skin with Reflectance Mode Confocal Microscopy

BACKGROUND Recently, a wide range of new noninvasive therapies has been introduced for the treatment of actinic keratoses. As these treatment options do not provide tissue for histopathologic examination, in vivo confocal laser scanning microscopy may become an important method for obtaining a reliable diagnosis. OBJECTIVE The objective was to validate the diagnostic confocal examination of actinic keratoses. METHODS Thirty actinic keratoses and skin fields from the contralateral sides of the patients were consecutively sampled and examined using a confocal microscope. Stored images were rated by four independent observers. RESULTS Distinct diagnostic morphologic features could be visualized. Overall, sensitivity of 93.34% and specificity of 88.34% could be achieved by two clinical dermatooncologists (positive predictive value 88.94%, negative predictive value 93.15%). Assessment of distinct confocal microscopy features showed a moderate interobserver correlation (κ = 0.4–0.6 in five of seven criteria). Classification and regression tree analysis yielded a one-step algorithm based on only one criterion (irregular keratinocyte cell borders), facilitating a correct classification in 86.67% of actinic keratoses and 85% of normal skin. LIMITATIONS Hyperkeratotic actinic keratoses were excluded from the study set. CONCLUSIONS This study provides a set of morphologic confocal microscopy criteria showing promise as a noninvasive monitoring tool in the treatment of actinic keratoses.

Design and development of a mobile computer application to reengineer workflows in the hospital and the methodology to evaluate its effectiveness

This paper describes a new method of collecting additional data for the purpose of skin cancer research from the patients in the hospital using the system Mobile Computing in Medicine Graz (MoCoMed-Graz). This system departs from the traditional paper-based questionnaire data collection methods and implements a new composition of evaluation methods to demonstrate its effectiveness. The patients fill out a questionnaire on a Tablet-PC (or iPad Device) and the resulting medical data is integrated into the electronic patient record for display when the patient enters the doctors examination room. Since the data is now part of the electronic patient record, the doctor can discuss the data together with the patient making corrections or completions where necessary, thus enhancing data quality and patient empowerment. A further advantage is that all questionnaires are in the system at the end of the day - and manual entry is no longer necessary - consequently raising data completeness. The front end was developed using a User Centered Design Process for touch tablet computers and transfers the data in XML to the SAP based enterprise hospital information system. The system was evaluated at the Graz University Hospital - where about 30 outpatients consult the pigmented lesion clinic each day - following Bronfenbrenners three level perspective: The microlevel, the mesolevel and the macrolevel: On the microlevel, the questions answered by 194 outpatients, evaluated with the System Usability Scale (SUS) resulted in a median of 97.5 (min: 50, max: 100) which showed that it is easy to use. On the mesolevel, the time spent by medical doctors was measured before and after the implementation of the system; the medical task performance time of 20 doctors (age median 43 (min: 29; max: 50)) showed a reduction of 90%. On the macrolevel, a cost model was developed to show how much money can be saved by the hospital management. This showed that, for an average of 30 patients per day, on a 250 day basis per year in this single clinic, the hospital management can save up to 40,000 EUR per annum, proving that mobile computers can successfully contribute to workflow optimization.

Telemedicine and teledermatology: Past, present and future

Telemedicine is an emerging field within medicine with potential to revolutionize the delivery of health care.It is defined as the use of telecommunication technologies to transfer medical information.Teledermatology is a category of telemedicine. Early experiments were already made at the beginning of the 20th century, the breakthrough happened in the nineties because of the rapid progress of telecommunication technology. The latest advance is mobile telemedicine which is characterized by the use of mobile devices such as mobile phone and PDA (personal digital assistant).Advantages of telemedicine are the possibility of remote patient‐care as well as the easy and fast access to expert opinions and education.This can either happen through exchange of previously stored data/images (store‐and‐forward method) or in real time.Since our society is increasingly becoming interconnected via technical advances, it is essential that medicine also has an objective understanding of the topic.

Reflectance confocal microscopy for skin diseases

This book focuses on the use and significance of in vivo reflectance confocal microscopy (RCM) for non-invasive high-resolution imaging of the skin. All of the chapters in this hands-on guide are generously illustrated with numerous confocal images and structured in a reader-friendly way. The contents include detailed information on the most relevant and up-to-date aspects of RCM, schematic drawings summarizing and explaining the most important RCM criteria, and a chapter specifically devoted to bridging the gap between dermoscopy, RCM, and histopathology. At the end of each chapter, core messages recapitulate the most pertinent aspects. Reflectance Confocal Microscopy for Skin Diseases will be a valuable resource for all physicians involved in the diagnosis and treatment of neoplastic and inflammatory skin diseases.