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10th
International Inter University Scientific Meeting
Academy of Studenica
PERSPECTIVES
IN MELANOMA MANAGEMENT
& NANOTECHNOLOGY IN BIOMEDICINE
Organizers:
Institute of Oncology
Sremska Kamenica; Union of Cancer Prevention
Societies of Vojvodina, Novi Sad; Clinic of Oncology, Nis; Institute
for Oncology and Radiology of Serbia, Belgrade Center for Bioengineering,
Faculty of Mechanical Engineering, University of Belgrade
President:
Vladimir Baltic Vice-presidents: Zlata
Janjic, Radan Dzodic, Borislava Nikolin; Djuro Koruga
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DIGITAL
EPILUMINESCENCE MICROSCOPY - WORLDWIDE STANDARD IN DIAGNOSTICS
OF CUTANEOUS MELANOMA
Nikolin B.
Institute
of oncology Sremska Kamenica, Clinic for internal oncology, Sremska
Kamenica, Serbia and Montenegro
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ABSTRACT
Early
recognition and prompt excision of primary cutaneous melanoma is
the course of action most likely to improve the patients survival
prospects. If cutaneous melanoma is diagnosed when it is a level
I or "in situ" the cure rate is close to 100%. It is difficult to
achieve this by direct personal experience, because although the
incidence of melanoma is increasing rapidly, no individual has a
great experience unless they work in a specialist center. The incidence
of melanoma is steadily increasing, at a faster rate then any other
human cancer, infect it is doubling in almost all parts of the world
over a 10 years period. Thin melanoma (less than 1 mm thickness)
has been particularly marked in parts of the world where intensive
public and professional early detection education programmes have
been carried out. Extreme need to improve early diagnosis leads
as to digital epiluminescence microscopy (skin surface microscopy,
dermoscopy).
Early detection and diagnosis is probably the most critical factor
accounting for the increase in overall survival of patients with
melanoma during the past few decades. The checklists of value, ABCDE's
(asymmetry, border, color, diameter, elevation, surrounding tissue)
and Glasgow system are a useful reminder of the clinical warning
signs of melanoma, although early melanoma may lack these signs.
Digital epiluminescence microscopy (DELM) or dermoscopy, is an in-vivo
nonivasive diagnostic technique of image analysis with computer
technology for efficient data storage and retrieval, that may improve
the clinical diagnostic capabilities for early melanoma. The principle
behind this technique is the examination of the pigmented skin lesion
(PSL) in vivo on the body surface at moderate magnifications of
x10 to x40, in such a way that color and structure in the epidermis,
dermoepidermal junction and papillary dermis become visible, witch
is not possible with the naked eye or typical magnification used
by clinicians. The use of dermoscopy does allow to decrease the
number of excised benign PSL compared to standard clinical examination.
Significant improvement in diagnosis of melanoma with 10 to 27%
is achieved by training and experience dermoscopy, comparing clinical
examination alone. Allowing visualization of subsurface colors and
structures this potentially life-saving technique is accepted as
a gold standard in diagnostic of cutaneous melanoma. DELM is not
only useful in differential diagnostics of benign or non benign
lesions, but also in diagnostics of non melanocytic lesions, such
as vascular lesions, seborrhoeic keratosis, dermatofibroma, basal
cell carcinoma and pyogenic granuloma.
The 3-point checklist (asymmetry of color and structure, atypical
network and blue-white structures) was designed as a screening method.
The sensitivity is much higher than the specificity to ensure that
melanoma are not misdiagnosed. DELM analysis of PSL is based on
four algorithms: pattern analysis; the ABCD rule; Menzies' 11-point
checklist and Argenziano' 7-point checklist. The basic principle
is that pigmented skin lesions are characterized by global patterns
and combination of local criteria.
Digital epiluminescence microscopy is a bridge between our standard
clinical evaluation of pigmented skin lesions and the histopathological
interpretation of those lesions when biopsied.
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Keywords:
Melanoma; Digital Epiluminescence Microscopy (dermoscopy) |
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