Melanoma: Menzies SW

Menzies SW. · No affiliation provided · Med J Aust. · Pubmed #17115962 links to  free full text

Abstract: There is now an inexpensive first-line approach for diagnosing pigmented skin lesions.

Menzies SW, Zalaudek I. · No affiliation provided · Arch Dermatol. · Pubmed #16983009 No free full text.

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Menzies SW. · No affiliation provided · Arch Dermatol. · Pubmed #10606065 No free full text.

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Vestergaard ME, Menzies SW. · Department of Dermatology, Sydney Cancer Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia. · Semin Cutan Med Surg. · Pubmed #18486022 No free full text.

Abstract: 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 reviewed.

Menzies SW. · Sydney Melanoma Diagnostic Center, Cancer Center, University of Sydney, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia. · Dermatol Ther. · Pubmed #16405568 No free full text.

Abstract: The minimum requirement for the general dermatologist for clinically assessing pigmented skin lesions is dermoscopy. In expert hands, this technique has been shown to improve both the sensitivity and specificity for the diagnosis of melanoma. This is also reflected by lower benign melanoma excision ratios and decreased excision rates. Evidence is mounting for the routine use of total body skin photography for patients with a very high risk of developing cutaneous melanoma. Both long-term (12 months) and short-term (3 months) digital dermoscopy monitoring has been shown to allow the detection of dermoscopically featureless melanoma and is central for the clinical assessment of melanocytic lesions at the Sydney Melanoma Diagnostic Center. The use of automated instruments for the diagnosis of cutaneous melanoma is still in an experimental phase, and its utility is dependent on the evidence that such instruments give a clinically useful expert second opinion. Currently, other noninvasive diagnostic techniques, such as in vivo confocal scanning laser microscopy, are reserved for clinical research settings.

Crotty KA, Menzies SW. · Melanoma and Skin Cancer Research Institute, University of Sydney, NSW, Australia. · Pathology. · Pubmed #15370118 No free full text.

Abstract: Dermoscopy (surface microscopy) is a clinical technique which uses a hand-held magnifying instrument, usually with liquid at the skin-instrument interface, to examine pigmented lesions on the skin surface. A magnification of x 10 is usually used. Dermoscopy assists in deciding if the lesion should be excised or biopsied, requires monitoring or can be safely left in situ. The technique provides a bridge between the naked eye appearance of a lesion and the histopathological examination. Multiple dermoscopic features have been described and many of their histological correlates have been determined. Dermoscopic diagnosis usually involves a two-step procedure. The first step is to decide if the lesion is melanocytic or not. If melanocytic, the second step is to decide if the lesion is benign or malignant. Multiple algorithms have been developed to help in this decision. Dermoscopic criteria have been developed for melanoma and naevi. Several non-melanocytic pigmented lesions can be diagnosed with dermoscopy, including pigmented basal cell carcinoma, seborrhoeic keratoses, haemangioma and lichen planus-like keratosis.

Argenziano G, Soyer HP, Chimenti S, Talamini R, Corona R, Sera F, Binder M, Cerroni L, De Rosa G, Ferrara G, Hofmann-Wellenhof R, Landthaler M, Menzies SW, Pehamberger H, Piccolo D, Rabinovitz HS, Schiffner R, Staibano S, Stolz W, Bartenjev I, Blum A, Braun R, Cabo H, Carli P, De Giorgi V, Fleming MG, Grichnik JM, Grin CM, Halpern AC, Johr R, Katz B, Kenet RO, Kittler H, Kreusch J, Malvehy J, Mazzocchetti G, Oliviero M, Ozdemir F, Peris K, Perotti R, Perusquia A, Pizzichetta MA, Puig S, Rao B, Rubegni P, Saida T, Scalvenzi M, Seidenari S, Stanganelli I, Tanaka M, Westerhoff K, Wolf IH, Braun-Falco O, Kerl H, Nishikawa T, Wolff K, Kopf AW. · Department of Dermatology, Second University of Naples, Italy. · J Am Acad Dermatol. · Pubmed #12734496 No free full text.

Abstract: BACKGROUND: There is a need for better standardization of the dermoscopic terminology in assessing pigmented skin lesions. OBJECTIVE: The virtual Consensus Net Meeting on Dermoscopy was organized to investigate reproducibility and validity of the various features and diagnostic algorithms. METHODS: Dermoscopic images of 108 lesions were evaluated via the Internet by 40 experienced dermoscopists using a 2-step diagnostic procedure. The first-step algorithm distinguished melanocytic versus nonmelanocytic lesions. The second step in the diagnostic procedure used 4 algorithms (pattern analysis, ABCD rule, Menzies method, and 7-point checklist) to distinguish melanoma versus benign melanocytic lesions. kappa Values, log odds ratios, sensitivity, specificity, and positive likelihood ratios were estimated for all diagnostic algorithms and dermoscopic features. RESULTS: Interobserver agreement was fair to good for all diagnostic methods, but it was poor for the majority of dermoscopic criteria. Intraobserver agreement was good to excellent for all algorithms and features considered. Pattern analysis allowed the best diagnostic performance (positive likelihood ratio: 5.1), whereas alternative algorithms revealed comparable sensitivity but less specificity. Interobserver agreement on management decisions made by dermoscopy was fairly good (mean kappa value: 0.53). CONCLUSION: The virtual Consensus Net Meeting on Dermoscopy represents a valid tool for better standardization of the dermoscopic terminology and, moreover, opens up a new territory for diagnosing and managing pigmented skin lesions.

Menzies SW. · Sydney Melanoma Unit, Royal Prince Alfred Hospital, Camperdown, Australia. · Clin Dermatol. · Pubmed #12074864 No free full text.

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Menzies SW. · Department of Surgery, University of Sydney, Sydney Melanoma Unit, Melanoma and Skin Cover Research Institute, Royal Prince Alfred Hospital, New South Wales, Australia. · Dermatol Clin. · Pubmed #11556238 No free full text.

Abstract: For a melanoma to be diagnosed, it must have neither of two morphological negative features and one or more of nine positive features. The negative features are symmetry of pattern and a single color. The positive features are blue-white veil, multiple brown dots, pseudopods, radial streaming, scar-like pigmentation, peripheral black dots or globules, five or six colors, multiple blue-gray dots, and a broadened network. This method gives a 92% sensitivity and 71% specificity for the diagnosis of melanoma.

Hersey P, Halliday GM, Farrelly ML, DeSilva C, Lett M, Menzies SW. · Oncology and Immunology Unit, Room 443, David Maddison Clinical Sciences Building, Cnr. King & Watt Streets, Newcastle, NSW 2300, Australia. · Cancer Immunol Immunother. · Pubmed #18157724 No free full text.

Abstract: BACKGROUND: In the present study, we have examined whether treatment of patients with metastatic melanoma with matured dendritic cell (DC) vaccines with or without low dose IL-2 may improve treatment outcomes. METHODS: Sixteen patients received DC vaccines (DCs) sensitized with autologous melanoma lysates and 18 patients received DCs sensitized with peptides from gp100, MART-1, tyrosinase, MAGE-3.A2, MAGE-A10 and NA17. IL-2 was given subcutaneously (sc) at 1 MU/m2 on the second day after each injection for 5-14 days in half of each group. DCs were given by intranodal injection. RESULTS: There were 2 partial responses (PR) and 3 with stable disease (SD) in the nine patients receiving DCs + peptides + IL-2, and 1 PR and 1 SD in nine patients treated with DCs + peptides without IL-2. There were only two patients with SD in the group receiving DCs + autologous lysates and no IL-2. Median overall survival for all patients was very good at 18.5 months but this was most probably due to selection of a favourable group of patients for the study. There was no significant difference in survival between the groups by log rank analysis. Treatment was not associated with significant side effects. The quality and yield of the DCs in the preparations were generally good. CONCLUSIONS: We conclude that mature DC preparations may be superior to immature DC preparations for presentation of melanoma peptides and that IL-2 may increase clinical responses to the DCs plus peptides. However, in our view the low response rates do not justify the cost and complexity of this treatment approach.

Hersey P, Menzies SW, Coventry B, Nguyen T, Farrelly M, Collins S, Hirst D, Johnson H. · Oncology and Immunology Unit, Room 443, David Maddison Clinical Sciences Building, King & Watt Streets, Newcastle, NSW, 2300, Australia. · Cancer Immunol Immunother. · Pubmed #15449035 No free full text.

Abstract: Previous studies in small groups of patients suggested that immunization of melanoma patients with peptide epitopes recognized by T cells could induce regression of melanoma. This approach was tested in 36 patients with stage IV melanoma. The (MHC class I-restricted) peptides were from gp100, MART-1, tyrosinase, and MAGE-3. The gp100 and MART-1 peptides had been modified to increase their immunogenicity. In half the patients (groups 3 and 4) the peptides were given in the adjuvant Montanide-ISA-720, and half the patients in both groups were given GM-CSF s.c. for 4 days following each injection. Treatment was well tolerated except for two severe erythematous responses to Montanide-ISA-720 and marked inflammatory responses at sites of GM-CSF administration in three patients. There were no objective clinical responses but stabilization of disease for periods from 3 to 12 months were seen in seven patients. Five of these were patients given the peptides in Montanide-ISA-720. Delayed-type hypersensitivity (DTH) skin test responses were also seen mainly in the patients given the peptides in Montanide-ISA-720. GM-CSF did not increase DTH responses in patients in the latter group but may have increased DTH responses in those not given peptides in Montanide-ISA-720. Inflammatory responses around s.c. metastases or regional lymph nodes were observed in two patients. These results suggest that the peptides are more effective when given in the adjuvant Montanide-ISA-720. Nevertheless, results from this study, together with those from a number of comparable studies, indicate that peptide vaccines are currently of minimal benefit to patients and support the need for ongoing development of new strategies in treatment of this disease.

Hersey P, Menzies SW, Halliday GM, Nguyen T, Farrelly ML, DeSilva C, Lett M. · Oncology and Immunology Unit, Room 443, David Maddison Clinical Sciences Building, Cnr. King & Watt Streets, 2300, Newcastle, NSW, Australia. · Cancer Immunol Immunother. · Pubmed #14600790 No free full text.

Abstract: Previous studies have suggested that immunotherapy with dendritic cell (DC) vaccines may be effective in treatment of patients with AJCC stage IV melanoma. We examined this treatment in phase I/II studies in 33 patients with good performance status and low volume disease. Nineteen patients received DCs plus autologous lysates and 14 patients DCs plus peptides from the melanoma antigens MAGE-3.A2, tyrosinase, gp100, and MART-1. Keyhole limpet hemocyanin (KLH) was used as a helper protein and influenza peptide was given as a positive control. DCs were produced from adherent cells in blood lymphocytes (monocytic DCs), grown in IL-4 and GM-CSF without a maturation step. The DCs were injected into inguinal lymph nodes at weekly intervals (x4), 2 weeks (x1), and 4-weekly intervals (x2). There were 3 responses (3 partial responses) and 1 mixed response in the 19 patients treated with DCs plus autologous lysates. No responses were seen in the group treated with DCs plus peptides. Stable disease (defined as no progression over a period of 3 months) was seen in 4 patients in group 1 and 5 patients in group 2. Treatment was not associated with significant side effects. We examined whether DTH skin tests or assays of IFN-gamma cytokine production may be useful predictors of clinical responses. Twenty-two of 30 patients had DTH responses to KLH and 12 of 13 patients had DTH responses to the influenza peptide. Five of 15 DTH responses were seen against autologous lysates. This was strongly correlated with clinical responses. Approximately half the patients had responses to MART-1 peptide and a third to the other melanoma peptides. Similarly, cytokine production assays showed responses to influenza in 7 of 13 patients, and approximately one third of patients had responses to the other peptides. No IFN-gamma responses were seen in 5 patients against their autologous lysates. There was no correlation between assays of IFN-gamma production and clinical responses. The present studies suggest that autologous lysates may be more effective than the melanoma peptides used in the study as the source of antigen for DC vaccines. DTH responses to autologous lysates appear useful predictors of clinical responses, but further work is needed to identify other measures associated with clinical responses.

Hanrahan PF, D'Este CA, Menzies SW, Plummer T, Hersey P. · Oncology & Immunology Unit, Newcastle Mater Misericordiae Hospital, New South Wales, Australia. · J Med Screen. · Pubmed #12370325 No free full text.

Abstract: OBJECTIVES: We have previously shown that photographs assist in detection of change in skin lesions and designed the present randomised population based trial to assess the feasibility of photographs as an aid to management of skin cancers in older men. SETTING: 1899 men over fifty, identified from the electoral roll in two regions in New South Wales (NSW), Australia, were invited by mail to participate. METHODS: A total of 973 of 1037 respondents were photographed and randomised into intervention (participants given their photographs) or control groups (photographs withheld by investigators). At one and two years from the time of photography, all participants were advised to see their primary care practitioner for a skin examination. Those in the intervention group were examined with their photographs and those in the control group without their photographs. RESULTS: The results indicated that the practitioners were more likely to leave suspicious lesions in place for follow up observation (37% v 29%) (p=0.006) and less likely to excise benign non pigmented lesions (20 v 32%). There was little difference in excision rates for benign pigmented lesions (21% v 23%). Lesions excised were more likely to be non-melanoma skin cancer (58% v 42%) from patients who had photographs compared to those without photographs (p=0.005). The use of skin photography resulted in a substantial savings due to the reduced excision of benign lesions. CONCLUSIONS: These results suggest that it would be feasible to conduct a large scale randomised trial to evaluate the value of photography in early detection of melanoma and that such a trial could be cost effective due to the reduced excision of benign skin lesions.

Hanrahan PF, Menzies SW, D'Este CA, Plummer T, Hersey P. · Oncology & Immunology Unit, Newcastle Mater Misericordiae Hospital, New South Wales. · Aust N Z J Public Health. · Pubmed #11215011 No free full text.

Abstract: OBJECTIVE: To examine the acceptability of photography as an aid to skin examinations in men over 50 years of age. METHODS: A randomised trial of men selected from the electoral roll. All participants were photographed, but only half received their photographs. Skin examinations by GPs at years one and two. RESULTS: 55% of men consented to have photographs taken and 51% did so. 86% of respondents had risk factors for melanoma (compared to 68% of non-responders) and 47% had two or more risk factors (compared to 23% of non-responders). At year one, 91% of participants remaining in study regions had been examined. Photographs were lost by only six participants. CONCLUSIONS: Men over 50 years of age respond to personalised health messages about melanoma and respondents include a high proportion of males with risk factors for melanoma. IMPLICATIONS: These initial results suggest that photography may be a logistically acceptable approach for assisting in the early detection of melanoma.

Westerhoff K, McCarthy WH, Menzies SW. · Sydney Melanoma Unit, Melanoma and Skin Cancer Research Institute, Department of Surgery, University of Sydney, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia. · Br J Dermatol. · Pubmed #11069512 No free full text.

Abstract: BACKGROUND: Skin surface microscopy (oil epiluminescence microscopy, dermoscopy, dermatoscopy) has been shown to increase the diagnostic accuracy of melanoma. However, all studies to date have been in an expert setting. OBJECTIVES: To determine whether primary care physicians (PCP) (general practitioners) could improve their melanoma diagnosis using surface microscopy after a short education intervention. METHODS: Seventy-four practising PCP completed a pretest of 50 melanomas and 50 atypical non-melanoma pigmented skin lesions (PSL) containing matched clinical and surface microscopy photographs. PCP were randomized between a surface microscopy education intervention or control group, followed by an identical post-test. RESULTS: Following training there was a significant improvement in the post-test vs. pretest in both clinical melanoma diagnosis (62.7% vs. 54.6%; P = 0.007) and surface microscopy melanoma diagnosis (75.9% vs. 57.8%; P = 0.000007). No difference was found in the control group between the post-test vs. pretest clinical melanoma diagnosis (53.7% vs. 50.6%; P = 0.21) or the surface microscopy melanoma diagnosis (54.8% vs. 52.9%; P = 0.56). Following training there was a significant improvement in the diagnosis of melanoma using surface microscopy vs. clinical diagnosis (75.9% vs. 62.7%; P = 0.000007), which was absent in the control group (54.8% vs. 53.7%; P = 0.59). No significant difference was found in clinical vs. surface microscopy post-test results for non-melanoma PSL in either the intervention group or control group. Improvement in the sensitivity for the diagnosis of melanoma with surface microscopy was seen without a decrease in specificity; this indicated that the effect should occur without increasing the number of needless excisions. CONCLUSIONS: All PCP in countries where melanoma leads to significant mortality should be trained in skin surface microscopy.

Celebi ME, Kingravi HA, Iyatomi H, Aslandogan YA, Stoecker WV, Moss RH, Malters JM, Grichnik JM, Marghoob AA, Rabinovitz HS, Menzies SW. · Department of Computer Science, Louisiana State University in Shreveport, Shreveport, LA 71115, USA. · Skin Res Technol. · Pubmed #19159382 No free full text.

Abstract: BACKGROUND: As a result of advances in skin imaging technology and the development of suitable image processing techniques, during the last decade, there has been a significant increase of interest in the computer-aided diagnosis of melanoma. Automated border detection is one of the most important steps in this procedure, because the accuracy of the subsequent steps crucially depends on it. METHODS: In this article, we present a fast and unsupervised approach to border detection in dermoscopy images of pigmented skin lesions based on the statistical region merging algorithm. RESULTS: The method is tested on a set of 90 dermoscopy images. The border detection error is quantified by a metric in which three sets of dermatologist-determined borders are used as the ground-truth. The proposed method is compared with four state-of-the-art automated methods (orientation-sensitive fuzzy c-means, dermatologist-like tumor extraction algorithm, meanshift clustering, and the modified JSEG method). CONCLUSION: The results demonstrate that the method presented here achieves both fast and accurate border detection in dermoscopy images.

Pellacani G, Longo C, Ferrara G, Cesinaro AM, Bassoli S, Guitera P, Menzies SW, Seidenari S. · Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy. · J Am Acad Dermatol. · Pubmed #19091443 No free full text.

Abstract: BACKGROUND: Spitz nevi are benign melanocytic tumors, sometimes misdiagnosed as malignant melanoma (MM). OBJECTIVE: We sought identification of characteristic in vivo microscopic features of Spitz nevi, their histopathologic correlates, and diagnostic usefulness. METHODS: Forty Spitz nevi were studied by in vivo confocal microscopy and dermatoscopy, evaluating histopathologic correlates, and compared with 40 MMs and 40 Clark nevi. RESULTS: Some histologic aspects characteristic for Spitz nevus diagnosis were correlated with confocal features, comprising some that can be useful for atypical Spitz nevus classification. The most striking features for differentiating Spitz nevi from MMs were the presence of sharp border cut-off, junctional nests, and melanophages. LIMITATIONS: No correlates were found for other aspects, such as Kamino bodies, hyperkeratosis, acanthosis, mitoses, and maturation with depth. The impossibility of exploring deeper aspects hampered an accurate distinction from MMs in some cases. CONCLUSION: Confocal and dermatoscopic examination enabled the identification of different Spitz categories with different histologic substrates.

Menzies SW, Kreusch J, Byth K, Pizzichetta MA, Marghoob A, Braun R, Malvehy J, Puig S, Argenziano G, Zalaudek I, Rabinovitz HS, Oliviero M, Cabo H, Ahlgrimm-Siess V, Avramidis M, Guitera P, Soyer HP, Ghigliotti G, Tanaka M, Perusquia AM, Pagnanelli G, Bono R, Thomas L, Pellacani G, Langford D, Piccolo D, Terstappen K, Stanganelli I, Llambrich A, Johr R. · Faculty of Medicine, University of Sydney, Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia. · Arch Dermatol. · Pubmed #18794455 No free full text.

Abstract: OBJECTIVE: To determine the predictive dermoscopic features of amelanotic and hypomelanotic melanoma. DESIGN: A total of 105 melanomas (median Breslow thickness, 0.76 mm), 170 benign melanocytic lesions, and 222 nonmelanocytic lesions lacking significant pigment (amelanotic, partially pigmented, and light colored) were imaged using glass-plate dermoscopy devices and scored for 99 dermoscopic features. Diagnostic models were derived from and tested on independent randomly selected lesions. SETTING: Predominantly hospital-based clinics from 5 continents. MAIN OUTCOME MEASURES: Sensitivity, specificity, and odds ratios for individual features and models for the diagnosis of melanoma and malignancy. RESULTS: The most significant negative predictors of melanoma were having multiple (>3) milialike cysts (odds ratio, 0.09; 95% confidence interval, 0.01-0.64), comma vessels with a regular distribution (0.10; 0.01-0.70), comma vessels as the predominant vessel type (0.16; 0.05-0.52), symmetrical pigmentation pattern (0.18; 0.09-0.39), irregular blue-gray globules (0.20; 0.05-0.87), and multiple blue-gray globules (0.28; 0.10-0.81). The most significant positive predictors were having a blue-white veil (odds ratio,13; 95% confidence interval, 3.9-40.0), scarlike depigmentation (4.4; 2.4-8.0), multiple blue-gray dots (3.5; 1.9-6.4), irregularly shaped depigmentation (3.3; 2.0-5.3), irregular brown dots/globules (3.2; 1.8-5.6), 5 to 6 colors (3.2; 1.6-6.3), and predominant central vessels (3.1; 1.6-6.0). A simple model distinguishing melanomas from all nonmelanomas had a sensitivity of 70% and a specificity of 56% in the test set. A model distinguishing all malignant lesions from benign lesions had a sensitivity of 96% and a specificity of 37%. Conclusion Although the diagnostic accuracy of dermoscopy for melanoma lacking significant pigment is inferior to that of more pigmented lesions, features distinguishing the former from benign lesions can be visualized on dermoscopic evaluation.

Menzies SW. · University of Sydney, Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, 2050 NSW, Australia. · BMJ. · Pubmed #18647765 No free full text.

This publication has no abstract.

Guitera P, Pellacani G, Longo C, Seidenari S, Avramidis M, Menzies SW. · Sydney Melanoma Diagnostic Centre, Sydney Cancer Centre and Dermatology Department, Royal Prince Alfred Hospital, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia. · J Invest Dermatol. · Pubmed #18633444 No free full text.

Abstract: We recently described an in vivo reflectance confocal microscopy (RCM) method and our aim was to evaluate a possible additive value of this type of analysis in the management of melanocytic lesions. In two referral centers (Sydney and Modena), lesions (203 nevi and 123 melanomas (MMs) with a median Breslow thickness of 0.54 mm) were excised on the basis of clinical suspicion (history, dermoscopy examination, and/or digital monitoring). The RCM method was also trialed on a non-biopsied population of 100 lesions, which were clinically and dermoscopically diagnosed as benign nevi. All RCM and dermoscopy diagnoses were performed blinded to the histopathological diagnosis. Firstly, in the study population, a high interobserver agreement (on a subset of 90 lesions) was seen with the RCM method, which had superior specificity (68%, 95% confidence interval (95% CI): 61.1-74.3) for the diagnosis of MM compared with dermoscopy (32%, 95% CI: 25.9-38.7), while showing no difference in sensitivity (91%, 95% CI: 84.6-95.5, RCM; 88%, 95% CI: 80.7-92.6 dermoscopy). The two techniques had a weak correlation, resulting in only 2.4% of MMs being misclassified by both techniques. Diagnosis of light-colored lesions is improved by RCM (specificity 84%, 95% CI: 66.3-94.5) compared with dermoscopy (specificity 39%, 95% CI: 23.7-56.2). Secondly, the RCM method classified 100% of the non-biopsied control nevi population as benign.

Vestergaard ME, Macaskill P, Holt PE, Menzies SW. · The Sydney Melanoma Diagnostic Centre and The Department of Dermatology, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia. · Br J Dermatol. · Pubmed #18616769 No free full text.

Abstract: BACKGROUND: Dermoscopy is a noninvasive technique that enables the clinician to perform direct microscopic examination of diagnostic features, not seen by the naked eye, in pigmented skin lesions. Diagnostic accuracy of dermoscopy has previously been assessed in meta-analyses including studies performed in experimental and clinical settings. OBJECTIVES: To assess the diagnostic accuracy of dermoscopy for the diagnosis of melanoma compared with naked eye examination by performing a meta-analysis exclusively on studies performed in a clinical setting. METHODS: We searched for publications from 1987 to January 2008 and found nine eligible studies. The selected studies compare diagnostic accuracy of dermoscopy with naked eye examination using a valid reference test on consecutive patients with a defined clinical presentation, performed in a clinical setting. Hierarchical summary receiver operator curve analysis was used to estimate the relative diagnostic accuracy for clinical examination with, and without, the use of dermoscopy. RESULTS: We found the relative diagnostic odds ratio for melanoma, for dermoscopy compared with naked eye examination, to be 15.6 [95% confidence interval (CI) 2.9-83.7, P = 0.016]; removal of two outlier studies changed this to 9.0 (95% CI 1.5-54.6, P = 0.03). CONCLUSIONS: Dermoscopy is more accurate than naked eye examination for the diagnosis of cutaneous melanoma in suspicious skin lesions when performed in the clinical setting.

Guitera P, Li LX, Crotty K, Fitzgerald P, Mellenbergh R, Pellacani G, Menzies SW. · Department of Dermatology, Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia. · Br J Dermatol. · Pubmed #18565186 No free full text.

Abstract: BACKGROUND: Ultrasound at 20 MHz tends to overestimate melanoma Breslow thickness due to lymphocytic infiltration or naevus remnant. Objectives To determine the efficacy of 75-MHz ultrasound for estimating melanoma thickness and to assess its reliability to predict surgical requirement. METHODS: One hundred and twelve suspicious skin lesions were imaged prospectively with the 75-MHz ultrasound in A and B mode. This instrument has a penetration of 3 mm and a lateral resolution of 21 mum. Measurements were performed by two observers and the mean was compared with the histological Breslow thickness. RESULTS: Forty-five of 52 melanomas and 22 of 36 naevi had clear hypoechogenicity boundaries. The median histological Breslow thickness of melanomas was 0.4 mm and 22 were in situ. The median percentage error of the machine was 13% of the histological Breslow thickness, with a high correlation (Pearson's r = 0.908, P < 0.001). Measurement was highly reliable for invasive melanoma, even in the presence of lymphocytic infiltration or naevus. CONCLUSIONS: In this series, 75-MHz measurement was highly reliable for predicting invasive melanoma thickness.

Altamura D, Avramidis M, Menzies SW. · Sydney Melanoma Diagnostic Centre, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia. · Arch Dermatol. · Pubmed #18427044 links to  free full text

Abstract: OBJECTIVE: To determine whether 6 weeks could replace 3 months for short-term sequential digital dermoscopy imaging (ST-SDDI) of suspicious melanocytic lesions and determine the proportion of melanomas missed. DESIGN: Consecutive lesions (n = 2602) undergoing ST-SDDI monitored from 1859 patients were included. Half of the patients underwent 6-week monitoring followed by 3-month monitoring (range, 2.5-4.5 months) if changes were not seen. The remainder underwent 3-month monitoring only. Any change during this time led to excision. Lesions unchanged were then followed up over time. SETTING: A tertiary referral institution. MAIN OUTCOME MEASURES: The proportion of changed melanomas (sensitivity) and odds ratios (ORs) for melanoma of changed lesions. RESULTS: Eighty-one melanomas were detected using ST-SDDI (Breslow thickness: median, in situ; maximum, 0.8 mm). Of 39 melanomas detected using ST-SDDI in the 6-week monitored lesions, 27 (69%) were detected at 6 weeks and 12 (31%) at 3 months. The OR for melanoma for a lesion changing at 6 weeks was 19 (95% confidence interval [CI], 10-35), and the overall OR for melanoma for a lesion changing during the short-term monitoring period (6 weeks to 4.5 months) was 47 (95% CI, 23-94). For lesions remaining unchanged at 3 months, 99.2% (1118 of 1127 lesions) were shown to be benign as defined by an unremarkable further follow-up. Seventy-five percent (15 of 20) of the lentigo maligna melanomas, 93% (40 of 43) of other in situ melanomas, and 96% (26 of 27) of the invasive melanomas were detected using ST-SDDI. Conclusion Three months remains the standard interval for ST-SDDI, where the sensitivity for the diagnosis of melanoma for changed (non-lentigo maligna) lesions is high but not 100%.

Blum A, Ingvar C, Avramidis M, von Kannen A, Menzies SW, Olsson H, Rezze GG, Wennberg AM, Westerhoff K. · Department of Dermatology, University of Tuebingen, Tuebingen, Germany. · J Cutan Med Surg. · Pubmed #17601421 No free full text.

Abstract: BACKGROUND: Patients and physicians both play an important role in the diagnosis of malignant melanoma. OBJECTIVE: The purpose of this study was to assess important factors of delay in diagnosis at different centers and on three continents. METHODS: Between October 2001 and October 2002, patients with histologically confirmed invasive melanoma were included in the study and given an established questionnaire. Recorded patients and tumor characteristics included age, sex, anatomic location, Breslow thickness, patients' awareness of the lesion and time with suspicion, and physicians' time (delay) before the operation. RESULTS: The study included 985 patients (486 males, 499 females): 253 from Germany, 464 from Sweden, 58 from Brazil, and 210 from Australia. More females detected their lesions by themselves. The change to a darker color (21%) and enlargement of the area of the lesion (19%) were the major signs. The highest knowledge among patients that early detection may improve the outcome was found in Sweden and Australia. At each center, the media (newspaper, magazine, radio, and television) provided the best sources of information about melanoma. Twenty to 33% of all physicians initially consulted missed the melanoma diagnosis, independent of their specialty. CONCLUSIONS: There are still factors for the delay in melanoma diagnosis in different countries and continents, but the differences are rather small. The results should be included in planning prevention campaigns in this specific field and in the education of medical students, physicians of all specialties, and other health professionals.

Zalaudek I, Argenziano G, Soyer HP, Corona R, Sera F, Blum A, Braun RP, Cabo H, Ferrara G, Kopf AW, Langford D, Menzies SW, Pellacani G, Peris K, Seidenari S, Anonymous00570. · Department of Dermatology, Medical University of Graz, Austria. · Br J Dermatol. · Pubmed #16445771 No free full text.

Abstract: BACKGROUND: In a pilot study, the three-point checklist of dermoscopy has been shown to represent a valid and reproducible tool with high sensitivity for the diagnosis of skin cancer in the hands of a small group of nonexperts. OBJECTIVES: To re-evaluate these preliminary results in a large number of observers independently from their profession and expertise in dermoscopy. METHODS: The study was conducted via the internet to provide worldwide access for participants. After a short web-based tutorial, the participants evaluated dermoscopic images of 165 (116 benign and 49 malignant) skin lesions (15 training and 150 test lesions). For each lesion participants scored the presence of the three-point checklist criteria (asymmetry, atypical network and blue-white structures). Kappa values, odds ratios, sensitivity, specificity and likelihood ratios were estimated. RESULTS: Overall, 150 participants joined the study. The three-point checklist showed good interobserver reproducibility (kappa value: 0.53). Sensitivity for skin cancer (melanoma and basal cell carcinoma) was 91.0% and this value remained basically uninfluenced by the observers' professional profile. Only 20 participants lacking any experience in dermoscopy performed significantly more poorly, but the sensitivity was still remarkably high (86.7%) when considering that they were untrained novices in dermoscopy. The specificity was 71.9% and was significantly influenced by the profession, with dermatologists performing best. CONCLUSIONS: Our study confirms that the three-point checklist is a feasible, simple, accurate and reproducible skin cancer screening tool.