Diagnosis of pigmented skin lesions by dermoscopy: web-based training improves diagnostic performance of non-experts

Summary Background Dermoscopy has been shown to enhance the diagnosis of melanoma. However, use of dermoscopy requires training and expertise to be effective. Objectives To determine whether an Internet-based course is a suitable tool in teaching dermoscopy, and to evaluate the diagnostic value of pattern analysis and diagnostic algorithms in colleagues not yet familiar with this technique. Methods Sixteen colleagues who were not experts in dermoscopy were asked to evaluate the dermoscopic images of 20 pigmented skin lesions using different diagnostic methods (i.e. pattern analysis, ABCD rule, seven-point checklist and Menzies' method), before and after an Internet-based training course on dermoscopy. Mean ± SEM sensitivity, specificity and diagnostic accuracy, and kappa (κ) intraobserver agreement were evaluated for each diagnostic method before and after training for the 16 participants. Differences between mean values were assessed by means of two-tailed Wilcoxon rank-sum tests. Results There was a considerable improvement in the dermoscopic melanoma diagnosis after the Web-based training vs. before. Improvements in sensitivity and diagnostic accuracy were significant for the ABCD rule and Menzies' method. Improvements in sensitivity were also significant for pattern analysis, whereas the sensitivity values were high for the seven-point checklist in evaluations both before and after training. No significant difference was found for specificity before and after training for any method. There was a significant improvement in the κ intraobserver agreement after training for pattern analysis and the ABCD rule. For the seven-point checklist and Menzies' method there was already good agreement before training, with no significant improvement after training. Conclusions We demonstrated that Web-based training is an effective tool for teaching dermoscopy

Landscape structure in the northern coast of Paraná state, a hotspot for the brazilian Atlantic Forest conservation

The "Serra do Mar" region comprises the largest remnant of the Brazilian Atlantic Forest. The coast of the Paraná State is part of the core area of the "Serra do Mar" corridor and where actions for biodiversity conservation must be planned. In this study we aimed at characterizing the landscape structure in the APA-Guaraqueçaba, the largest protected area in this region, in order to assist environmental policies of this region. Based on a supervised classification of a mosaic of LANDSAT-5-TM satellite images (from March 2009), we developed a map (1:75,000 scale) with seven classes of land use and land cover and analyzed the relative quantities of forests and modified areas in slopes and lowlands. The APA-Guaraqueçaba is comprised mainly by the Dense Ombrophilous Forest (68.6% of total area) and secondary forests (9.1%), indicating a forested landscape matrix; anthropogenic and bare soil areas (0.8%) and the Pasture/Grasslands class (4.2%) were less representative. Slopes were less fragmented and more preserved (96.3% of Dense Ombrophilous Forest and secondary forest) than lowlands (71.3%), suggesting that restoration initiatives in the lowlands must be stimulated in this region. We concluded that most of the region sustains well-conserved ecosystems, highlighting the importance of Paraná northern coast for the biodiversity maintenance of the Atlantic Forest