Transcript Document

" New methods to diagnose
changing moles"
Zsolt B. Argenyi, M.D.
Professor of Pathology & Dermatology
Director of the Pigmented Lesion Clinic
and Dermatopathology
University of Washington Medical Center
Seattle, WA, USA
Why to Strive for an Early Diagnosis?
… and some more statistics
1. Long term survival is greater than 90% with
thin (<1mm) melanoma.
2. Long term survival is 50-90% with thick
(>1mm) melanoma
3. Long term survival is 20-60% with lymph
node involvement
4. Long term survival is less than 10% with
distant metastasis.
Diagnosis in early stages  good survival
Some Encouraging News
65% of patients are diagnosed with localized disease
Goal
Better patient
profiling
Improved identification
techniques
Earliest possible diagnosis
The Good News
(cont.)
Improved identification techniques
Skin self-examination
Total body skin
photography
Dermoscopy
Traditional Clinical Examination
A:
B:
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D:
E:
Asymmetry
Border irregularity
Colors
Diameter > 6 mm
Evolving lesions
Why Dermoscopy?
1. ABCD criteria are not always reliable
2. Common atypical looking, but benign
lesions
3. Poor discrimination between pigmented
melanocytic and pigmented nonmelanocytic lesions
4. Unnecessary biopsies and surgeries
Dermatoscopy – Epiluminescence
Microscopy
• Non-invasive, in-vivo microscopic technique
using incident light, immersion oil, and low-tomedium power magnifying optics
• Helpful to differentiate pigmented melanocytic
from pigmented non-melanocytic lesions
• Increases diagnostic accuracy of pigmented
lesions
• Widely used in Europe
• Becoming routine use in the USA
Principles of Dermoscopy
• New morphology appears with features
that cannot be perceived by the naked
eye
Dermoscopic Diagnosis of
Melanocytic Tumors
1. High sensitivity 75-96%
2. High specificity 79-98%
This improves with experience and far exceeds
the rate by clinical examination alone
Recently Introduced Application of
Dermoscopy on Equivocal Lesions
“Short Term Mole Monitoring”
1. Low concern lesions on clinical exam
2. Newly developed lesions
3. More of a concerns for the patient
3-4 months dermoscopic monitoring
Lesions are removed if further changes occur
. The diagnostic software of this computer
analyzes the images by comparing to a large
data bank and provides a diagnostic score. The
diagnostic score correlates with the biologic
behavior of the lesion benign vs. malignant.
Based on the biopsy report, your
Dermatologist will advise you if further
treatments are needed.
Skin Surface Microscopy
Image Analysis
Colors
Structures
Patterns
Criteria
Clinico-pathologic correlation
Diagnosis
Algorithmic Approach of
Pigmented Skin Lesions
The Patient - Physician Team Work
Periodic Exams with Multiple Techniques
Skin self-examination
Total body skin
photography
Dermoscopy
The Importance of Total Body
Photography
1. High-resolution digital overview photos of
the entire skin surface
2. Standardized technique, lighting, distance,
topography, etc.
3. Baseline record used for follow-up
examination for comparison to detect new
or changing lesions
4. One set for patient clinic records, another
set for patient’s own records for self-exams
Total Body Photography
Marghoob te al. J Am Acad Dermatol 2003; 777-97.
Patients Who Benefit from TBP
1. Personal or family history of
melanoma
2. “Atypical mole syndrome”
3. Multiple normal appearing nevi
4. Large congenital nevi
5. Genetic abnormalities (p16 gene)
6. High anxiety
Advantages of TBP
1. Help to identify new or changing
lesions
2. Increase the efficiency of biopsying
the right lesion
3. May save the life by earlier detection
Additional Advantages of TBP
1. Encouraging participation by involving
self-screening
2. Reducing unnecessary biopsy rates
for benign nevi
3. Reassuring patients that stable lesions
are benign
Maximazing Positive Outcome
Goal
Better patient
profiling
Improved identification
techniques
Earliest possible diagnosis
Combination of Approaches
1. Optimize knowledge, resources, and
techniques.
2. Select the high risk patient population
3. Combining techniques
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Total body photography
Dermoscopy
4. Invest and develop new techniques
In vivo confocal scanning microscopy
Teledermatology
Melanoma
in situ
Margins !
Mobile Teledermatology
C.Ebner et al. J.Telemed. Telecare 2008
Combination of Approaches
(cont.)
5. Collaborate with the full scale of
multidisciplinary specialists:
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Dermatologists
Surgeons
Clinical oncologists
Pathologists, dermatopathologists
Psychiatrists
Researchers
Social Workers and
Survivors and their relatives
Beyond the Hard Core Science
Pearls from Real Survivors
1. Emotional commitment to keep going
despite ups and downs
2. Utilize all internal and external resources
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Positive thinking
Goal setting, being creative
Find humor and playfulness
Share experiences and learn from others
3. Comply with Doctor’s instructions
4. Appreciate life
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Living everyday in the fullest sense