TECHNOLOGY IN DERMATOLOGY AND DERMATOLOGIC SURGERY
The ability to detect early melanoma remains of paramount importance in our efforts to
curtail deaths related to this malignancy. Fortunately, our clinical skills at recognizing the
varied clinical presentation of early melanomas are continuously improving. Our enhanced
clinical acumen together with improved awareness of the danger signs of melanoma has
resulted in a greater proportion of thin melanomas being diagnosed today as compared to
the past. The implementation and utilization of in vivo imaging technologies in clinical
practice promises to further enhance our ability to detect melanoma while this cancer is
still thin and easily curable. This article describes the utility and application of the in vivo
imaging technologies that are currently in clinical use today including dermoscopy, total
body photography, individual lesion photography, and reflectance confocal microscopy.
Semin Cutan Med Surg 27:2-10 © 2008 Elsevier Inc. All rights reserved.
KEYWORDS melanoma, dermoscopy, total body photography, confocal, short term
Between 1987 and 2007, different groups developed digital image analysis systems for the diagnosis of benign and malignant skin tumors. As the result of significant differences in the technical devices, the number, the nature and benign/malignant ratio of included skin tumors, different variables and statistical methods any comparison of these different systems and their results is difficult. For the use and comparison of the diagnostic performance of different digital image analysis systems in the future, some principle basic conditions are required: All used systems should have a standardized recording system and calibration. First, melanocytic and nonmelanocytic lesions should be included for the development of the diagnostic algorithms. Critical analyses of the results should answer the question if in future only melanocytic lesions should be analyzed or all pigmented and nonpigmented lesions. This will also lead to the answer if only dermatologists or all specialities of medical doctors will use such a system. All artifacts (eg, hairs, air bubbles) should be removed. The number of variables should be chosen according to the number of included melanomas. A high number of benign skin lesions should be included. Of all lesions only 10% or better less should be invasive melanomas. Each system should be developed by a training-set and controlled by an independent test-set. Each system should be controlled by the user with the final decision and responsibility and tested by independent users without any conflict of financial interest.
In recent years, DNA microarray technology has been used for the analysis of gene expression patterns in a variety of skin diseases, including malignant melanoma, psoriasis, lupus erythematosus, and systemic sclerosis. Many of the studies described herein confirmed earlier results on individual genes or functional groups of genes. However, a plethora of new candidate genes, gene patterns, and regulatory pathways have been identified. Major progresses were reached by the identification of a prognostic gene pattern in malignant melanoma, an immune signaling cluster in psoriasis, and a so-called interferon signature in systemic lupus erythematosus. In future, interference with genes or regulatory pathways with the use of different RNA interference technologies or targeted therapy may not only underscore the functional significance of microarray data but also may open interesting therapeutic perspectives. Large-scale gene expression analyses may also help to design more individualized treatment approaches of cutaneous diseases. Semin Cutan Med Surg 27:16-24 © 2008 Elsevier Inc. All rights reserved.
Teledermatopathology can be defined as a telemedicine application related to histological
diagnosis of cutaneous specimens. Its development and implementation around the world
is very heterogeneous due to the wide range of existing geographical, social and healthcare
conditions. This paper reviews the technological bases for static (use of images generated
at one side, stored on a computer, and then transmitted to another site for a second
diagnosis) and dynamic teledermatopathology (interaction between an user located on a
remote area and a histological video image captured from a microscopy which allows
navigation across the slide) as well as for virtual microscopy.
The use of teledematopathology could increase the healthcare standard and the accessibility
to the health care system in developing countries. However, some limitations related
to economic, medico-legal and technical issues still remain, particularly when dealing with
inflammatory skin diseases.
Semin Cutan Med Surg 27:25-31 © 2008 Elsevier Inc. All rights reserved.
The objective of this review is to report and discuss the evidence for fully automated
diagnostic instruments for cutaneous melanoma tested in a real-world clinical setting
directly compared with human diagnosis. A systematic review was performed and articles
excluded when studies did not report sensitivity or specificity for melanoma directly
compared with humans on an independent test set. Only 3 instruments have had their
diagnostic accuracy compared with a human diagnosis in the clinical field with a meaningful
sample size that could allow some generalization with the wider clinical arena. Two
of these instruments showed a significantly inferior specificity for the diagnosis of melanoma
compared with specialists. In one of these studies, the sensitivity for diagnosis,
although superior to the specialist diagnosis, did not reach statistical significance. In
contrast, one instrument had an equivalent specificity and trended superior but not significantly
for sensitivity for the diagnosis of melanoma. Other image based nonclinic studies
and studies comparing clinical management as the endpoint rather than diagnosis are also
Semin Cutan Med Surg 27:32-36 © 2008 Elsevier Inc. All rights reserved.