TME15/458: Next Generation Telemedicine Network Service for Counselling on Diagnosis of Pigmented Skin Tumours at the Point of Care

INTRODUCTION: It is estimated that one in every 70 persons born in 2000 will develop malignant melanoma, one of the most deadly forms of cancer, and that the number of cases doubles every 6 years. The progressing sub-specialisation in medicine results in concentration of experts in few medical centres and deficits of expert knowledge in other, predominantly rural areas. The patient has to be sent to an expert in a medical centre for further diagnosis, which means inconvenience for the patient and costs for the medical care system. Contact between physicians and specialists will be strengthened and the transfer of medical knowledge from centres to periphery intensified. METHODS: Teledermoscopy, the combined use of dermoscopy and telemedicine technologies represents a new approach for the diagnosis of pigmented skin tumours including malignant melanomas. Value of new internet technologies to examine the skin of patients with digital cameras, sending the pictures to centres of excellence for diagnoses and returning them to the points of care will be proven. The possibility of the immediate second opinion on diagnoses is a major advantage of this network. RESULTS: A network infrastructure, consisting of computer systems, software and communications equipment to support teledermoscopy services will be installed. Applications based on expertise in medicine as well as information technologies will be developed, allowing multi-lingual, user-friendly and secure access to the network from any computer connected to the Internet. Examination of patients will be performed on a face-to-face basis in centres of excellence and by about thirty general physicians and dermatologists. For the purpose of dermatalogic diagnostics different digital cameras will be evaluated. Digital images will be electronically submitted to the TELDOM Platform, a multi-tier, CORBA-based distributed application framework. An automated system of image analysis in order to analyse size, structure and colours of the lesions together with a diagnostic algorithm using artificial networking techniques will be developed. DISCUSSION: The internet based network will develop an innovative medical system for screening, diagnosis and therapy of skin tumours. It will improve quality of life by providing a user-friendly society and thus increase quality of health by providing easy access to expert medical counselling for individuals with equivocal pigmented skin tumours which will be realised with new generation telemedicine systems for teleconsultation and telecare at the point of need

"Compound blue nevus": a reappraisal of "superficial blue nevus with prominent intraepidermal dendritic melanocytes" with emphasis on dermoscopic and histopathologic features.

We describe 5 cases of "compound blue nevus" (CBN) ("superficial blue nevus with prominent intraepidermal dendritic melanocytes," "Kamino nevus"). Dermoscopically in 2 of 4 cases the bluish pigmentation characteristic of blue nevi was centrally replaced by a black lamella, with black dots and brown globules also observed in one case, thus revealing a structural asymmetry suggestive of melanoma. Histopathologically, pigmented parakeratosis was the underlying histopathologic finding of black lamella and dots/globules. Immunohistochemistry highlighted the unique histopathologic feature of CBN, namely, single dendritic melanocytes at the dermoepidermal junction with striking intraepidermal prolongations. Our findings confirm that CBN is a distinctive variant of blue nevus that may mimic cutaneous melanoma both clinically and dermoscopically

Diagnosis and categorization of acral melanocytic lesions using teledermoscopy

We performed a multicentre study to test the validity of teledermoscopy for diagnosing acral melanoma and to evaluate inter-observer agreement on the classification of acral melanocytic lesions. Dermoscopic images of 77 acral melanocytic lesions (71 common melanocytic naevi and 6 melanomas) were sent by email to 11 dermatologists with different degrees of experience in dermoscopy. The observers analysed the images on a computer monitor to diagnose acral melanoma or atypical lesions and to categorize all lesions. All 11 observers, regardless of their degree of experience, obtained high values for sensitivity (mean 0.91, SD 0.09) and specificity (mean 0.95, SD 0.04) with regard to the diagnosis of melanoma. The inter-observer agreement was good to excellent (kappa 0.49-0.88) for the categorization of acral melanocytic lesions. All six melanomas were correctly classified as 'atypical pattern' and all observers recommended surgical excision. Teledermoscopy represents a useful tool for the diagnosis of acral melanoma and for the categorization of patterns that suggest benign or potentially malignant acral melanocytic lesions

Diagnosis and categorization of acral melanocytic lesions using teledermoscopy

We performed a multicentre study to test the validity of teledermoscopy for diagnosing acral melanoma and to evaluate inter-observer agreement on the classification of acral melanocytic lesions. Dermoscopic images of 77 acral melanocytic lesions (71 common melanocytic naevi and 6 melanomas) were sent by email to 11 dermatologists with different degrees of experience in dermoscopy. The observers analysed the images on a computer monitor to diagnose acral melanoma or atypical lesions and to categorize all lesions. All 11 observers, regardless of their degree of experience, obtained high values for sensitivity (mean 0.91, SD 0.09) and specificity (mean 0.95, SD 0.04) with regard to the diagnosis of melanoma. The inter-observer agreement was good to excellent (kappa 0.49-0.88) for the categorization of acral melanocytic lesions. All six melanomas were correctly classified as 'atypical pattern' and all observers recommended surgical excision. Teledermoscopy represents a useful tool for the diagnosis of acral melanoma and for the categorization of patterns that suggest benign or potentially malignant acral melanocytic lesions

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. Objective To evaluate results of Euromelanoma in 2009 and 2010 in 20 countries, describing characteristics of screenees, rates of clinically suspicious lesions for skin cancer and detection rates of melanomas. Methods Euromelanoma questionnaires were used by 20 countries providing their data in a standardized database (Belgium, Croatia, Cyprus, Czech Republic, FYRO Macedonia, Germany, Greece, Hungary, Italy, Lithuania, Luxembourg, Malta, Moldavia, Portugal, Serbia, Slovenia, Spain, Sweden, Switzerland and Ukraine). Results In total, 59 858 subjects were screened in 20 countries. Most screenees were female (64%), median ages were 43 (female) and 46 (male) and 33% had phototype I or II. The suspicion rates ranged from 1.1% to 19.4% for melanoma (average 2.8%), from 0.0% to 10.7% for basal cell carcinoma (average 3.1%) and from 0.0% to 1.8% for squamous cell carcinoma (average 0.4%). The overall positive predictive value of countries where (estimation of) positive predictive value could be determined was 13.0%, melanoma detection rates varied from 0.1% to 1.9%. Dermoscopy was used in 78% of examinations with clinically suspected melanoma; full body skin examination was performed in 72% of the screenees. Conclusion Although the population screened during Euromelanoma was relatively young, high rates of clinically suspected melanoma were found. The efficacy of Euromelanoma could be improved by targeting high-risk populations and by better use of dermoscopy and full body skin examination. © 2011 European Academy of Dermatology and Venereology

Dermoscopy of pigmented skin lesions: results of a consensus meeting via the Internet

There is a need for better standardization of the dermoscopic terminology in assessing pigmented skin lesions