Grimaldi Luca, Silvestri Alessandro, Brandi Cesare, Nisi Giuseppe, Brafa Anna, Calabrò Massimiliano, Campa Alessandra, D'Aniello Carlo
Unit of Plastic Surgery, University of Siena, Italy.
J Plast Reconstr Aesthet Surg. 2009 Aug;62(8):1054-8. doi: 10.1016/j.bjps.2008.01.011. Epub 2008 Jun 10.
Digital epiluminescence dermoscopy is a relatively recent tool, based on the acquisition of high-definition digital images, for the diagnosis of pigmented cutaneous lesions.
To verify the usefulness of digital dermoscopy in detecting pigmented lesions with features which may lead to suspicion of malignancy, when the examination is carried out by primary care physicians (PCP), not expert in that kind of diagnosis. Another target was an appraisal of the effectiveness and safety of telediagnosis based on epiluminescence digital dermoscopy on pigmented lesions.
Digital images from some peripheral centres (235 lesions) have been forwarded in real time to the reference centre (Unit of Plastic Surgery, University of Siena, Italy), with a double judgement by each primary care physician ('benign' or 'suspicious of malignancy') on the basis of anamnesis and clinical examination at first step, and dermoscopy as second step. The image analysis carried out from the reference centre identified every lesion examined as 'to be controlled' (219 lesions) or 'to be removed' (16 lesions).
Regarding the patients with dermoscopic examination (197 subjects, 235 lesions), the investigation reduced the number of lesions suspected of malignancy from 68 to 29 after the first dermoscopy, and from 29 to 16 after the re-examination of the image by the central unit researchers. Fourteen lesions suspected of malignancy when examined in the peripheral centres were then evaluated as benign by the central unit researchers, while one lesion, judged as benign at first (always labelled as 'benign' by the PCP), was then revealed as a dysplastic naevus.
Digital dermoscopy can be enhanced by telediagnosis, which provides a better control of cutaneous pigmented lesions in the peripheral areas, thus reducing the number of consultations in specialised centres.
数字偏振光皮肤镜检查是一种基于获取高清晰度数字图像的相对较新的工具，用于诊断色素性皮肤病变。
验证当由非此类诊断专家的初级保健医生（PCP）进行检查时，数字皮肤镜检查在检测具有可能导致怀疑恶性特征的色素性病变方面的有用性。另一个目标是评估基于偏振光数字皮肤镜检查对色素性病变进行远程诊断的有效性和安全性。
来自一些外围中心的数字图像（235个病变）已实时转发至参考中心（意大利锡耶纳大学整形外科单元），每位初级保健医生首先根据病史和临床检查，然后根据皮肤镜检查进行双重判断（“良性”或“怀疑恶性”）。参考中心进行的图像分析将每个检查的病变确定为“需复查”（219个病变）或“需切除”（16个病变）。
对于接受皮肤镜检查的患者（197名受试者，235个病变），在首次皮肤镜检查后，怀疑恶性的病变数量从68个减少到29个，在中央单元研究人员对图像进行复查后，从29个减少到16个。在外围中心检查时怀疑恶性的14个病变随后被中央单元研究人员评估为良性，而一个最初被判断为良性的病变（初级保健医生一直标记为“良性”）随后被发现是发育异常痣。
远程诊断可增强数字皮肤镜检查，从而更好地控制周边地区的皮肤色素性病变，减少专科中心的会诊数量。
