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Observation |

Dermoscopy in Skin Self-examination:  A Useful Tool for Select Patients FREE

Jacqueline M. Goulart, BA; Josep Malvehy, MD; Susana Puig, MD; George Martin, MD; Ashfaq A. Marghoob, MD
[+] Author Affiliations

Author Affiliations: Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, New York (Ms Goulart and Dr Marghoob); Dermatology Department, Melanoma Unit, Hospital Clinic of Barcelona, Barcelona, Spain (Drs Malvehy and Puig). Dr Martin is in private practice in Kihei, Hawaii.


Arch Dermatol. 2011;147(1):53-58. doi:10.1001/archdermatol.2010.387.
Text Size: A A A
Published online

Background  Education for patients on the technique of skin self-examination is important for improving the rate of early detection of melanoma. Strategies to improve skills in skin self-examination include the use of mnemonics to facilitate the recognition of melanoma features and photography to assist in the detection of change.

Observation  We describe 2 patients who used dermoscopy on their own initiative to help identify suspicious pigmented lesions during skin self-examination.

Conclusions  Dermoscopy has not yet been evaluated for patient use. We were intrigued by this concept and suggest that dermoscopy, with appropriate training, may improve the ability for early detection of melanoma in skin self-examination for select patients.

Figures in this Article

The best outcomes for patients with melanoma are achieved through early detection. Cutaneous melanomas are amenable to early detection, because most are visible and localized to the skin before gaining the ability to metastasize. To that end, periodic whole-body skin examinations performed by physicians, trained physician extenders, and patients have been demonstrated to be helpful. Campaigns with both public and physician education components are structured to increase awareness of the signs of melanoma.1 These efforts have resulted in increased detection of thinner tumors. A whole-body skin examination performed within the past 3 years is associated with a 38% increased chance of detecting thin melanoma.2 It is speculated that detection rates for thin melanoma have doubled every 8 to 9 years, with the average thickness of the melanomas identified reduced by nearly half throughout a 25-year period.3,4

Skin self-examination (SSE) is important because patients and their spouses, friends, or relatives detect the majority (61%-86%) of melanomas.510 Depending on how regularly and thoroughly SSE is performed, it can result in the detection of melanomas that are roughly 0.2- to 0.6-mm thinner than those identified in patients who do not perform SSE.7,11 It follows that SSE has the potential to reduce mortality from melanoma, with 1 study predicting a reduction in mortality by as much as 63%.11 Although patients are good at detecting their own melanomas, physicians are more likely to identify thinner tumors, as shown in the Table.58,10 Several strategies to improve skills for melanoma self-detection have been developed. Mnemonics can be helpful; knowledge of the ABCD(E) criteria is associated with increased likelihood of self-detection of melanomas and the ability for individuals to make better decisions about suspicious lesions.1214 Identification of the ABCD features can be made more conspicuous with the use of magnification.13 Differential recognition can simplify skin screening; for example, the “ugly duckling” sign emphasizes that melanomas often appear different from other moles on the same individual.15 These outlier lesions may or may not manifest any of the ABCD features of melanoma but can still be reliably identified as suspicious.16 The ABCD criteria may also be complemented by education on the cognitive method, which has been successful in teaching patients how to recognize melanoma by simply showing classic examples of benign and malignant lesions.17 Despite the aforementioned techniques, differences between physicians and patients in accuracy of skin examination and thickness of detected melanomas suggest there is room for improvement.

Table Graphic Jump LocationTable. Comparison of Physician and Patient Melanoma Detection Rates and Depths

Dermatologists have the obvious advantage of experience and training, but they also benefit from the use of diagnostic aids that facilitate the detection of melanoma.18 Photography and dermoscopy are examples of 2 diagnostic aids that are increasingly used by dermatologists.1921 Photographs, whether of individual lesions or the entire skin surface (ie, total-body photography), serve as a baseline against which serial comparisons can be made to enhance the ability to detect new and changing lesions.22 Change is one of the most sensitive features for melanoma and has been reported as the sole identifying feature in up to 35% of melanomas.18 Unfortunately, change is not highly specific for melanoma since many benign nevi also appear as new or changing lesions (≤17% of changing lesions will be melanoma).2331 Expertise in dermoscopy involves the recognition of patterns that separate benign from suspicious lesions. Dermoscopy improves diagnostic accuracy by increasing sensitivity and specificity for recognition of melanoma and helps to identify change on sequential follow-up of lesions.29,3133 The combination of photography to observe relative changes and dermoscopy to identify patterns specific for melanoma has led to earlier detection of melanoma, lower biopsy rates, and reduction in the benign to malignant biopsy ratio.27

Photography, although initially used only by physicians, has made its way into the hands of patients to enhance skin examination and surveillance. Photography overcomes a major barrier to an effective SSE because detecting new or changing lesions is limited by a person's ability to remember the presence or appearance of the original lesions.34 Patient use of baseline photography has been shown to improve diagnostic accuracy by increasing sensitivity and specificity for the detection of new or changed lesions.35,36 Dynamic features, such as change in size or color, have been shown to be useful for patients when discriminating between benign and malignant lesions; 71% to 88% of patients had noted change in their melanoma and sought care, resulting in removal of the lesion.37,38 Photography is beneficial in SSE; however, other interventions must be developed and studied as well to further improve self-detection of melanoma. The experience of 2 patients has prompted us to contemplate whether dermoscopy used by motivated patients can assist in SSE.

A 45-year-old man's profession requires setting up and coordinating the audiovisual equipment for lectures at different venues. One such venue was hosting a dermatology seminar with a focus on skin cancer and dermoscopy. While listening to the lectures, the man realized that he was at increased risk for developing melanoma. This concerning notion prompted him to examine his nevi. Although he did not see any concerning lesions, he decided to borrow a dermatoscope from one of the vendors to further examine the nevi. During the dermoscopic self-examination he noticed 1 pigmented lesion on his right forearm (Figure 1A). This lesion appeared to manifest dermoscopic criteria for melanoma based on the lecture he had just heard (Figure 1B). With this newly acquired knowledge, he approached the lecturer, who confirmed the patient's impression regarding the lesion. The patient was directed to a local dermatologist who excised the lesion; testing confirmed the diagnosis of a microinvasive melanoma (Figure 1C).

Place holder to copy figure label and caption
Figure 1.

Patient 1. A, This patient identified a suspicious melanocytic lesion on his arm. B, Dermoscopic results revealed a lesion that did not manifest one of the benign nevus patterns. In addition, it had an irregular (atypical) blotch, which is one of the melanoma-specific structures. C, Findings from the biopsy revealed that the lesion was a microinvasive melanoma (hematoxylin-eosin, original magnification ×10).

Graphic Jump Location

A 50-year-old male truck driver had a history of melanoma and multiple nevi. He was very anxious about the risk of developing an additional melanoma, as well as worried that one of his family members might develop melanoma. He sought information on melanoma detection to enhance their routine skin surveillance. After learning about dermoscopy through the Internet and by reading publications written by the physicians involved in his care, he purchased a dermatoscope and incorporated dermoscopy into SSE of his skin and the skin of his family members. He identified a suspicious lesion on the abdomen of his wife (aged 47 years), which was then inspected by a dermatologist at his suggestion (Figure 2A and B). The lesion was biopsied, and testing revealed a dysplastic nevus with regression. One year later, the man identified a new lesion on his arm (Figure 2C and D) and, based on the dermoscopic pattern, he brought it to the attention of his dermatologist. The lesion was inspected and removed; testing showed a dysplastic nevus with severe atypia.

Place holder to copy figure label and caption
Figure 2.

Patient 2. A, The patient identified a suspicious-appearing melanocytic neoplasm on the abdomen of his wife. B, The lesion had a concerning dermoscopic pattern with regression structures; biopsy revealed a dysplastic nevus with regression. C, The man later discovered a new pigmented lesion on his arm. D, The lesion had a focal irregular network on dermoscopy; findings from the biopsy were consistent with a dysplastic nevus with severe atypia.

Graphic Jump Location

Dermoscopy has not yet been explored for patient use; however, it shares features with tools that have been demonstrated to be valuable in SSE.39 It may improve sensitivity and specificity for detecting melanoma by enhancing the ability of patients to identify changing or suspicious lesions and separate them from benign lesions. Furthermore, tools that increase patients' sensitivity for detecting new or changing lesions provide a means for active, as opposed to passive, surveillance, which may improve confidence in and adherence to SSE. For example, adherence to SSE improves after patients are educated on how to perform SSE and use photographs as an adjunct, which is mediated in part by improving self-efficacy.40,41 Based on the potential benefits of adding dermoscopy to SSE, we propose 2 models for its practical implementation.

One model for incorporating dermoscopy into SSE is to provide patients with baseline dermoscopic images of their lesions so that they feel more confident making a comparison and monitoring individual nevi. Including baseline dermoscopic images could be easily integrated into the currently accepted practice of providing patients with photobooks containing their baseline total-body skin clinical images. Needless to say, significant effort would be required to ensure that patients are educated on the proper technique of using baseline clinical and dermoscopic images. This in turn will enable patients to effectively use photobooks containing dermoscopic and clinical images to enhance SSE. We acknowledge that performing SSE with dermoscopy could be a time-consuming endeavor; however, highly anxious patients might find comfort in the knowledge gained. A second model for including dermoscopy in SSE is to incorporate simple dermoscopic algorithms and criteria into educational materials designed for patients. The 3-point checklist simplifies dermoscopy by focusing on criteria with high sensitivity for melanoma detection: (1) asymmetry of pattern, (2) atypical network, and (3) presence of blue-white structures. It has been shown that the 3-point checklist can improve the ability for nonexperts to correctly identify lesions that should be evaluated by a dermatologist.42,43 Patients may also benefit from learning dermoscopic patterns of benign nevi. Detecting benign patterns is facilitated by the fact that the majority of an individual's nevi will share common dermoscopic patterns.44 An understanding of the common benign patterns facilitates the recognition of lesions with differing patterns that are suggestive of melanoma.45

Before offering dermoscopy to patients, the potential ramifications of such a suggestion must be considered. By empowering patients, dermoscopy may increase adherence to SSE, which has the added benefit of having patients spend more time scrutinizing their skin. Another positive outcome is that patients may improve their ability to recognize new or changing lesions and, as a result, improve their sensitivity for melanoma detection. Educating patients to recognize common dermoscopic patterns of benign nevi and simple dermoscopic criteria for melanoma has the potential to improve specificity as well. In addition to improving performance in SSE, some patients may find relief of their concerns through the use of dermoscopy. One advantage of using dermoscopy is that it can alleviate anxiety for patients with a high level of concern regarding their lesions.46,47 Finally, given the advances in telemedicine, specifically teledermoscopy, patients ultimately might be able to use dermoscopy attachments for mobile phone cameras to send images of lesions that concern them to their physicians, thereby allowing for faster and potentially more efficient care.48,49

Negative outcomes of having patients use dermoscopy, ranging from bothersome to grave, must be weighed as well. Some patients may become hypervigilant. The perception of several changing lesions as well as new worrisome dermoscopic features may be overwhelming for patients and paradoxically increase rather than relieve anxiety. Heightened awareness of changing nevi that are benign could translate to a dramatic increase in unnecessary calls and office visits to physicians. Alternatively, inadequate understanding of what constitutes a benign dermoscopic pattern may lead to a false sense of security such that suspicious lesions are erroneously dismissed and not brought to a physician's attention. This has been demonstrated in untrained dermatologists who had inferior diagnostic accuracy using dermoscopy compared with unaided visual examination.50 Furthermore, the diagnosis of melanoma is complex; pigmented lesions may exhibit subtle features of melanoma and can pose diagnostic conundrums for dermatologists and pathologists, let alone for patients.33 Finally, since the purchase of a dermatoscope is not covered by insurance, the cost may be prohibitive for many patients.

In conclusion, the experiences of 2 patients have prompted us to consider the role for dermoscopy in SSE. If dermoscopy is integrated into SSE, patients should be carefully selected and provided with ample education regarding the instrument and its potential benefits and pitfalls. Future research will need to focus on identifying subsets of patients who would benefit most from this screening method. Furthermore, to avoid the liabilities of overconfidence associated with patient use of dermoscopy, patients who engage in this practice must maintain routine follow-up visits with a dermatologist. Perhaps, in motivated and reliable patients, the provision of a dermatoscope could increase adherence to SSE and result in the detection of thinner melanomas. Regardless of whether patient use of dermoscopy is promoted by dermatologists, patients may do so on their own initiative. Thus, we hope to bring to light the possibility of an emerging role for dermoscopy in the realm of the patient and to advise physicians that some patients may already be pursuing this option.

Correspondence: Ashfaq A. Marghoob, MD, Dermatology Service, Memorial Sloan-Kettering Cancer Center, 160 E 53rd St, New York, NY 10022 (marghooa@mskcc.org).

Accepted for Publication: August 29, 2010.

Author Contributions: Ms Goulart and Drs Malvehy, Puig, and Marghoob had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Malvehy, Puig, and Marghoob. Acquisition of data: Malvehy, Puig, Martin, and Marghoob. Analysis and interpretation of data: Goulart and Marghoob. Drafting of the manuscript: Goulart. Critical revision of the manuscript for important intellectual content: Malvehy, Puig, Martin, and Marghoob. Administrative, technical, or material support: Goulart, Malvehy, Puig, and Marghoob. Study supervision: Martin and Marghoob.

Financial Disclosure: Dr Martin is a consultant for Dusa Pharmaceuticals Inc and an advisor for Galderma, sanofi-aventis, Abbott Laboratories, and LEO Pharma Inc.

Geller  ACSwetter  SMBrooks  KDemierre  MFYaroch  AL Screening, early detection, and trends for melanoma: current status (2000-2006) and future directions. J Am Acad Dermatol 2007;57 (4) 555- 576
PubMed
Aitken  JFElwood  MBaade  PDYoul  PEnglish  D Clinical whole-body skin examination reduces the incidence of thick melanomas. Int J Cancer 2010;126 (2) 450- 458
PubMed
Coory  MBaade  PAitken  JSmithers  MMcLeod  GRRing  I Trends for in situ and invasive melanoma in Queensland, Australia, 1982-2002. Cancer Causes Control 2006;17 (1) 21- 27
PubMed
Buettner  PGLeiter  UEigentler  TKGarbe  C Development of prognostic factors and survival in cutaneous melanoma over 25 years: an analysis of the Central Malignant Melanoma Registry of the German Dermatological Society. Cancer 2005;103 (3) 616- 624
PubMed
Koh  HKMiller  DRGeller  ACClapp  RWMercer  MBLew  RA Who discovers melanoma? patterns from a population-based survey. J Am Acad Dermatol 1992;26 (6) 914- 919
PubMed
Brady  MSOliveria  SAChristos  PJ  et al.  Patterns of detection in patients with cutaneous melanoma. Cancer 2000;89 (2) 342- 347
PubMed
Carli  PDe Giorgi  VPalli  D  et al. Italian Multidisciplinary Group on Melanoma, Dermatologist detection and skin self-examination are associated with thinner melanomas: results from a survey of the Italian Multidisciplinary Group on Melanoma. Arch Dermatol 2003;139 (5) 607- 612
PubMed
Epstein  DSLange  JRGruber  SBMofid  MKoch  SE Is physician detection associated with thinner melanomas? JAMA 1999;281 (7) 640- 643
PubMed
McPherson  MElwood  MEnglish  DRBaade  PDYoul  PHAitken  JF Presentation and detection of invasive melanoma in a high-risk population. J Am Acad Dermatol 2006;54 (5) 783- 792
PubMed
Schwartz  JLWang  TSHamilton  TALowe  LSondak  VKJohnson  TM Thin primary cutaneous melanomas: associated detection patterns, lesion characteristics, and patient characteristics. Cancer 2002;95 (7) 1562- 1568
PubMed
Berwick  MBegg  CBFine  JARoush  GCBarnhill  RL Screening for cutaneous melanoma by skin self-examination. J Natl Cancer Inst 1996;88 (1) 17- 23
PubMed
Carli  PDe Giorgi  VPalli  D  et al.  Self-detected cutaneous melanomas in Italian patients. Clin Exp Dermatol 2004;29 (6) 593- 596
PubMed
Robinson  JKTurrisi  R Skills training to learn discrimination of ABCDE criteria by those at risk of developing melanoma. Arch Dermatol 2006;142 (4) 447- 452
PubMed
Bränström  RHedblad  MAKrakau  IUllén  H Laypersons' perceptual discrimination of pigmented skin lesions. J Am Acad Dermatol 2002;46 (5) 667- 673
PubMed
Grob  JJBonerandi  JJ The ‘ugly duckling’ sign: identification of the common characteristics of nevi in an individual as a basis for melanoma screening. Arch Dermatol 1998;134 (1) 103- 104
PubMed
Scope  ADusza  SWHalpern  AC  et al.  The “ugly duckling” sign: agreement between observers. Arch Dermatol 2008;144 (1) 58- 64
PubMed
Girardi  SGaudy  CGouvernet  JTeston  JRichard  MAGrob  JJ Superiority of a cognitive education with photographs over ABCD criteria in the education of the general population to the early detection of melanoma: a randomized study. Int J Cancer 2006;118 (9) 2276- 2280
PubMed
Psaty  ELHalpern  AC Current and emerging technologies in melanoma diagnosis: the state of the art. Clin Dermatol 2009;27 (1) 35- 45
PubMed
Scheinfeld  NSFlanigan  KMoshiyakhov  MWeinberg  JM Trends in the use of cameras and computer technology among dermatologists in New York City 2001-2002. Dermatol Surg 2003;29 (8) 822- 826
PubMed
Hubbard  VGGoddard  DJWalker  SL An online survey of the use of digital cameras by members of the British Association of Dermatologists. Exp Dermatol 2009;34 (4) 492- 494
Terushkin  VOliveria  SAMarghoob  AAHalpern  AC Use of and beliefs about total body photography and dermoscopy among US dermatology training programs: an update [published online ahead of print March 12, 2010]. J Am Acad Dermatol 2010;62 (5) 794- 803
PubMed
Feit  NEDusza  SWMarghoob  AA Melanomas detected with the aid of total cutaneous photography. Br J Dermatol 2004;150 (4) 706- 714
PubMed
Schiffner  RSchiffner-Rohe  JLandthaler  MStolz  W Long-term dermoscopic follow-up of melanocytic naevi: clinical outcome and patient compliance. Br J Dermatol 2003;149 (1) 79- 86
PubMed
Bauer  JBlum  AStrohhäcker  UGarbe  C Surveillance of patients at high risk for cutaneous malignant melanoma using digital dermoscopy. Br J Dermatol 2005;152 (1) 87- 92
PubMed
Robinson  JKNickoloff  BJ Digital epiluminescence microscopy monitoring of high-risk patients. Arch Dermatol 2004;140 (1) 49- 56
PubMed
Kittler  HSeltenheim  MDawid  MPehamberger  HWolff  KBinder  M Frequency and characteristics of enlarging common melanocytic nevi. Arch Dermatol 2000;136 (3) 316- 320
PubMed
Banky  JPKelly  JWEnglish  DRYeatman  JMDowling  JP Incidence of new and changed nevi and melanomas detected using baseline images and dermoscopy in patients at high risk for melanoma. Arch Dermatol 2005;141 (8) 998- 1006
Menzies  SWGutenev  AAvramidis  MBatrac  AMcCarthy  WH Short-term digital surface microscopic monitoring of atypical or changing melanocytic lesions. Arch Dermatol 2001;137 (12) 1583- 1589
PubMed
Altamura  DAvramidis  MMenzies  SW Assessment of the optimal interval for and sensitivity of short-term sequential digital dermoscopy monitoring for the diagnosis of melanoma. Arch Dermatol 2008;144 (4) 502- 506
PubMed
Haenssle  HAVente  CBertsch  HP  et al.  Results of a surveillance programme for patients at high risk of malignant melanoma using digital and conventional dermoscopy. Eur J Cancer Prev 2004;13 (2) 133- 138
PubMed
Malvehy  JPuig  S Follow-up of melanocytic skin lesions with digital total-body photography and digital dermoscopy: a two-step method. Clin Dermatol 2002;20 (3) 297- 304
PubMed
Kittler  HPehamberger  HWolff  KBinder  M Follow-up of melanocytic skin lesions with digital epiluminescence microscopy: patterns of modifications observed in early melanoma, atypical nevi, and common nevi. J Am Acad Dermatol 2000;43 (3) 467- 476
PubMed
Puig  SArgenziano  GZalaudek  I  et al.  Melanomas that failed dermoscopic detection: a combined clinicodermoscopic approach for not missing melanoma. Dermatol Surg 2007;33 (10) 1262- 1273
PubMed
Hanrahan  PFHersey  PMenzies  SWWatson  ABD’Este  CA Examination of the ability of people to identify early changes of melanoma in computer-altered pigmented skin lesions. Arch Dermatol 1997;133 (3) 301- 311
PubMed
Oliveria  SAChau  DChristos  PJCharles  CAMushlin  AIHalpern  AC Diagnostic accuracy of patients in performing skin self-examination and the impact of photography. Arch Dermatol 2004;140 (1) 57- 62
PubMed
Chiu  VWon  EMalik  MWeinstock  MA The use of mole-mapping diagrams to increase skin self-examination accuracy. J Am Acad Dermatol 2006;55 (2) 245- 250
PubMed
Liu  WHill  DGibbs  AF  et al.  What features do patients notice that help to distinguish between benign pigmented lesions and melanomas? the ABCD(E) rule versus the seven-point checklist. Melanoma Res 2005;15 (6) 549- 554
PubMed
Abbasi  NRShaw  HMRigel  DS  et al.  Early diagnosis of cutaneous melanoma: revisiting the ABCD criteria. JAMA 2004;292 (22) 2771- 2776
PubMed
Hamidi  RPeng  DCockburn  M Efficacy of skin self-examination for the early detection of melanoma. Int J Dermatol 2010;49 (2) 126- 134
PubMed
Oliveria  SADusza  SWPhelan  DLOstroff  JSBerwick  MHalpern  AC Patient adherence to skin self-examination: effect of nurse intervention with photographs. Am J Prev Med 2004;26 (2) 152- 155
PubMed
Hay  JLOliveria  SADusza  SWPhelan  DLOstroff  JSHalpern  AC Psychosocial mediators of a nurse intervention to increase skin self-examination in patients at high risk for melanoma. Cancer Epidemiol Biomarkers Prev 2006;15 (6) 1212- 1216
PubMed
Soyer  HPArgenziano  GZalaudek  I  et al.  Three-point checklist of dermoscopy: a new screening method for early detection of melanoma. Dermatology 2004;208 (1) 27- 31
PubMed
Argenziano  GPuig  SZalaudek  I  et al.  Dermoscopy improves accuracy of primary care physicians to triage lesions suggestive of skin cancer. J Clin Oncol 2006;24 (12) 1877- 1882
PubMed
Scope  ABurroni  MAgero  AL  et al.  Predominant dermoscopic patterns observed among nevi. J Cutan Med Surg 2006;10 (4) 170- 174
PubMed
Marghoob  AAKorzenko  AJChangchien  LScope  ABraun  RPRabinovitz  H The beauty and the beast sign in dermoscopy. Dermatol Surg 2007;33 (11) 1388- 1391
PubMed
Nehal  KSOliveria  SAMarghoob  AA  et al.  Use of and beliefs about dermoscopy in the management of patients with pigmented lesions: a survey of dermatology residency programmes in the United States. Melanoma Res 2002;12 (6) 601- 605
PubMed
Noor  O  IINanda  ARao  BK A dermoscopy survey to assess who is using it and why it is or is not being used. Int J Dermatol 2009;48 (9) 951- 952
PubMed
Massone  CBrunasso  AMCampbell  TMSoyer  HP Mobile teledermoscopy—melanoma diagnosis by one click? Semin Cutan Med Surg 2009;28 (3) 203- 205
PubMed
Piccolo  DSmolle  JArgenziano  G  et al.  Teledermoscopy—results of a multicentre study on 43 pigmented skin lesions. J Telemed Telecare 2000;6 (3) 132- 137
PubMed
Binder  MSchwarz  MWinkler  A  et al.  Epiluminescence microscopy: a useful tool for the diagnosis of pigmented skin lesions for formally trained dermatologists. Arch Dermatol 1995;131 (3) 286- 291
PubMed

Figures

Place holder to copy figure label and caption
Figure 1.

Patient 1. A, This patient identified a suspicious melanocytic lesion on his arm. B, Dermoscopic results revealed a lesion that did not manifest one of the benign nevus patterns. In addition, it had an irregular (atypical) blotch, which is one of the melanoma-specific structures. C, Findings from the biopsy revealed that the lesion was a microinvasive melanoma (hematoxylin-eosin, original magnification ×10).

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

Patient 2. A, The patient identified a suspicious-appearing melanocytic neoplasm on the abdomen of his wife. B, The lesion had a concerning dermoscopic pattern with regression structures; biopsy revealed a dysplastic nevus with regression. C, The man later discovered a new pigmented lesion on his arm. D, The lesion had a focal irregular network on dermoscopy; findings from the biopsy were consistent with a dysplastic nevus with severe atypia.

Graphic Jump Location

Tables

Table Graphic Jump LocationTable. Comparison of Physician and Patient Melanoma Detection Rates and Depths

References

Geller  ACSwetter  SMBrooks  KDemierre  MFYaroch  AL Screening, early detection, and trends for melanoma: current status (2000-2006) and future directions. J Am Acad Dermatol 2007;57 (4) 555- 576
PubMed
Aitken  JFElwood  MBaade  PDYoul  PEnglish  D Clinical whole-body skin examination reduces the incidence of thick melanomas. Int J Cancer 2010;126 (2) 450- 458
PubMed
Coory  MBaade  PAitken  JSmithers  MMcLeod  GRRing  I Trends for in situ and invasive melanoma in Queensland, Australia, 1982-2002. Cancer Causes Control 2006;17 (1) 21- 27
PubMed
Buettner  PGLeiter  UEigentler  TKGarbe  C Development of prognostic factors and survival in cutaneous melanoma over 25 years: an analysis of the Central Malignant Melanoma Registry of the German Dermatological Society. Cancer 2005;103 (3) 616- 624
PubMed
Koh  HKMiller  DRGeller  ACClapp  RWMercer  MBLew  RA Who discovers melanoma? patterns from a population-based survey. J Am Acad Dermatol 1992;26 (6) 914- 919
PubMed
Brady  MSOliveria  SAChristos  PJ  et al.  Patterns of detection in patients with cutaneous melanoma. Cancer 2000;89 (2) 342- 347
PubMed
Carli  PDe Giorgi  VPalli  D  et al. Italian Multidisciplinary Group on Melanoma, Dermatologist detection and skin self-examination are associated with thinner melanomas: results from a survey of the Italian Multidisciplinary Group on Melanoma. Arch Dermatol 2003;139 (5) 607- 612
PubMed
Epstein  DSLange  JRGruber  SBMofid  MKoch  SE Is physician detection associated with thinner melanomas? JAMA 1999;281 (7) 640- 643
PubMed
McPherson  MElwood  MEnglish  DRBaade  PDYoul  PHAitken  JF Presentation and detection of invasive melanoma in a high-risk population. J Am Acad Dermatol 2006;54 (5) 783- 792
PubMed
Schwartz  JLWang  TSHamilton  TALowe  LSondak  VKJohnson  TM Thin primary cutaneous melanomas: associated detection patterns, lesion characteristics, and patient characteristics. Cancer 2002;95 (7) 1562- 1568
PubMed
Berwick  MBegg  CBFine  JARoush  GCBarnhill  RL Screening for cutaneous melanoma by skin self-examination. J Natl Cancer Inst 1996;88 (1) 17- 23
PubMed
Carli  PDe Giorgi  VPalli  D  et al.  Self-detected cutaneous melanomas in Italian patients. Clin Exp Dermatol 2004;29 (6) 593- 596
PubMed
Robinson  JKTurrisi  R Skills training to learn discrimination of ABCDE criteria by those at risk of developing melanoma. Arch Dermatol 2006;142 (4) 447- 452
PubMed
Bränström  RHedblad  MAKrakau  IUllén  H Laypersons' perceptual discrimination of pigmented skin lesions. J Am Acad Dermatol 2002;46 (5) 667- 673
PubMed
Grob  JJBonerandi  JJ The ‘ugly duckling’ sign: identification of the common characteristics of nevi in an individual as a basis for melanoma screening. Arch Dermatol 1998;134 (1) 103- 104
PubMed
Scope  ADusza  SWHalpern  AC  et al.  The “ugly duckling” sign: agreement between observers. Arch Dermatol 2008;144 (1) 58- 64
PubMed
Girardi  SGaudy  CGouvernet  JTeston  JRichard  MAGrob  JJ Superiority of a cognitive education with photographs over ABCD criteria in the education of the general population to the early detection of melanoma: a randomized study. Int J Cancer 2006;118 (9) 2276- 2280
PubMed
Psaty  ELHalpern  AC Current and emerging technologies in melanoma diagnosis: the state of the art. Clin Dermatol 2009;27 (1) 35- 45
PubMed
Scheinfeld  NSFlanigan  KMoshiyakhov  MWeinberg  JM Trends in the use of cameras and computer technology among dermatologists in New York City 2001-2002. Dermatol Surg 2003;29 (8) 822- 826
PubMed
Hubbard  VGGoddard  DJWalker  SL An online survey of the use of digital cameras by members of the British Association of Dermatologists. Exp Dermatol 2009;34 (4) 492- 494
Terushkin  VOliveria  SAMarghoob  AAHalpern  AC Use of and beliefs about total body photography and dermoscopy among US dermatology training programs: an update [published online ahead of print March 12, 2010]. J Am Acad Dermatol 2010;62 (5) 794- 803
PubMed
Feit  NEDusza  SWMarghoob  AA Melanomas detected with the aid of total cutaneous photography. Br J Dermatol 2004;150 (4) 706- 714
PubMed
Schiffner  RSchiffner-Rohe  JLandthaler  MStolz  W Long-term dermoscopic follow-up of melanocytic naevi: clinical outcome and patient compliance. Br J Dermatol 2003;149 (1) 79- 86
PubMed
Bauer  JBlum  AStrohhäcker  UGarbe  C Surveillance of patients at high risk for cutaneous malignant melanoma using digital dermoscopy. Br J Dermatol 2005;152 (1) 87- 92
PubMed
Robinson  JKNickoloff  BJ Digital epiluminescence microscopy monitoring of high-risk patients. Arch Dermatol 2004;140 (1) 49- 56
PubMed
Kittler  HSeltenheim  MDawid  MPehamberger  HWolff  KBinder  M Frequency and characteristics of enlarging common melanocytic nevi. Arch Dermatol 2000;136 (3) 316- 320
PubMed
Banky  JPKelly  JWEnglish  DRYeatman  JMDowling  JP Incidence of new and changed nevi and melanomas detected using baseline images and dermoscopy in patients at high risk for melanoma. Arch Dermatol 2005;141 (8) 998- 1006
Menzies  SWGutenev  AAvramidis  MBatrac  AMcCarthy  WH Short-term digital surface microscopic monitoring of atypical or changing melanocytic lesions. Arch Dermatol 2001;137 (12) 1583- 1589
PubMed
Altamura  DAvramidis  MMenzies  SW Assessment of the optimal interval for and sensitivity of short-term sequential digital dermoscopy monitoring for the diagnosis of melanoma. Arch Dermatol 2008;144 (4) 502- 506
PubMed
Haenssle  HAVente  CBertsch  HP  et al.  Results of a surveillance programme for patients at high risk of malignant melanoma using digital and conventional dermoscopy. Eur J Cancer Prev 2004;13 (2) 133- 138
PubMed
Malvehy  JPuig  S Follow-up of melanocytic skin lesions with digital total-body photography and digital dermoscopy: a two-step method. Clin Dermatol 2002;20 (3) 297- 304
PubMed
Kittler  HPehamberger  HWolff  KBinder  M Follow-up of melanocytic skin lesions with digital epiluminescence microscopy: patterns of modifications observed in early melanoma, atypical nevi, and common nevi. J Am Acad Dermatol 2000;43 (3) 467- 476
PubMed
Puig  SArgenziano  GZalaudek  I  et al.  Melanomas that failed dermoscopic detection: a combined clinicodermoscopic approach for not missing melanoma. Dermatol Surg 2007;33 (10) 1262- 1273
PubMed
Hanrahan  PFHersey  PMenzies  SWWatson  ABD’Este  CA Examination of the ability of people to identify early changes of melanoma in computer-altered pigmented skin lesions. Arch Dermatol 1997;133 (3) 301- 311
PubMed
Oliveria  SAChau  DChristos  PJCharles  CAMushlin  AIHalpern  AC Diagnostic accuracy of patients in performing skin self-examination and the impact of photography. Arch Dermatol 2004;140 (1) 57- 62
PubMed
Chiu  VWon  EMalik  MWeinstock  MA The use of mole-mapping diagrams to increase skin self-examination accuracy. J Am Acad Dermatol 2006;55 (2) 245- 250
PubMed
Liu  WHill  DGibbs  AF  et al.  What features do patients notice that help to distinguish between benign pigmented lesions and melanomas? the ABCD(E) rule versus the seven-point checklist. Melanoma Res 2005;15 (6) 549- 554
PubMed
Abbasi  NRShaw  HMRigel  DS  et al.  Early diagnosis of cutaneous melanoma: revisiting the ABCD criteria. JAMA 2004;292 (22) 2771- 2776
PubMed
Hamidi  RPeng  DCockburn  M Efficacy of skin self-examination for the early detection of melanoma. Int J Dermatol 2010;49 (2) 126- 134
PubMed
Oliveria  SADusza  SWPhelan  DLOstroff  JSBerwick  MHalpern  AC Patient adherence to skin self-examination: effect of nurse intervention with photographs. Am J Prev Med 2004;26 (2) 152- 155
PubMed
Hay  JLOliveria  SADusza  SWPhelan  DLOstroff  JSHalpern  AC Psychosocial mediators of a nurse intervention to increase skin self-examination in patients at high risk for melanoma. Cancer Epidemiol Biomarkers Prev 2006;15 (6) 1212- 1216
PubMed
Soyer  HPArgenziano  GZalaudek  I  et al.  Three-point checklist of dermoscopy: a new screening method for early detection of melanoma. Dermatology 2004;208 (1) 27- 31
PubMed
Argenziano  GPuig  SZalaudek  I  et al.  Dermoscopy improves accuracy of primary care physicians to triage lesions suggestive of skin cancer. J Clin Oncol 2006;24 (12) 1877- 1882
PubMed
Scope  ABurroni  MAgero  AL  et al.  Predominant dermoscopic patterns observed among nevi. J Cutan Med Surg 2006;10 (4) 170- 174
PubMed
Marghoob  AAKorzenko  AJChangchien  LScope  ABraun  RPRabinovitz  H The beauty and the beast sign in dermoscopy. Dermatol Surg 2007;33 (11) 1388- 1391
PubMed
Nehal  KSOliveria  SAMarghoob  AA  et al.  Use of and beliefs about dermoscopy in the management of patients with pigmented lesions: a survey of dermatology residency programmes in the United States. Melanoma Res 2002;12 (6) 601- 605
PubMed
Noor  O  IINanda  ARao  BK A dermoscopy survey to assess who is using it and why it is or is not being used. Int J Dermatol 2009;48 (9) 951- 952
PubMed
Massone  CBrunasso  AMCampbell  TMSoyer  HP Mobile teledermoscopy—melanoma diagnosis by one click? Semin Cutan Med Surg 2009;28 (3) 203- 205
PubMed
Piccolo  DSmolle  JArgenziano  G  et al.  Teledermoscopy—results of a multicentre study on 43 pigmented skin lesions. J Telemed Telecare 2000;6 (3) 132- 137
PubMed
Binder  MSchwarz  MWinkler  A  et al.  Epiluminescence microscopy: a useful tool for the diagnosis of pigmented skin lesions for formally trained dermatologists. Arch Dermatol 1995;131 (3) 286- 291
PubMed

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