Melanoma

Different types of nevi do exist in relation to their epidemiology, morphology, evolution, and associated melanoma risk. The introduction of dermoscopy opened a new dimension of the morphologic universe of nevi and allowed clinicians to observe colors and structures within nevi that are otherwise not visible to the unaided eye. Because most of these colors and structures correspond to well-defined histopathologic correlates, dermoscopy enables clinicians to date to more precisely predict the histopathology diagnosis and thereby improve on their clinical diagnostic accuracy. Besides the diagnostic impact, the in vivo observation of thousands of nevi using dermoscopy and digital dermoscopic follow-up has opened new understanding about the evolution of nevi and factors influencing the nevus pattern. In consequence, a new nevus classification has been proposed, subdividing nevi into 7 categories, which are as follows: (1) globular/cobblestone nevi, (2) reticular nevi, (3) starburst nevi, (4) homogeneous blue nevi, (5) nevi on special body sites, (6) nevi with special features, and (7) and unclassifiable melanocytic proliferations. This article provides an overview on the morphologic classification of nevi and the factors influencing the nevus pattern.

*For a PDF of the full article, click on the link to the left of this introduction.

Different types of nevi do exist in relation to their epidemiology, morphology, evolution, and associated melanoma risk. The introduction of dermoscopy opened a new dimension of the morphologic universe of nevi and allowed clinicians to observe colors and structures within nevi that are otherwise not visible to the unaided eye. Because most of these colors and structures correspond to well-defined histopathologic correlates, dermoscopy enables clinicians to date to more precisely predict the histopathology diagnosis and thereby improve on their clinical diagnostic accuracy. Besides the diagnostic impact, the in vivo observation of thousands of nevi using dermoscopy and digital dermoscopic follow-up has opened new understanding about the evolution of nevi and factors influencing the nevus pattern. In consequence, a new nevus classification has been proposed, subdividing nevi into 7 categories, which are as follows: (1) globular/cobblestone nevi, (2) reticular nevi, (3) starburst nevi, (4) homogeneous blue nevi, (5) nevi on special body sites, (6) nevi with special features, and (7) and unclassifiable melanocytic proliferations. This article provides an overview on the morphologic classification of nevi and the factors influencing the nevus pattern.

*For a PDF of the full article, click on the link to the left of this introduction.

Different types of nevi do exist in relation to their epidemiology, morphology, evolution, and associated melanoma risk. The introduction of dermoscopy opened a new dimension of the morphologic universe of nevi and allowed clinicians to observe colors and structures within nevi that are otherwise not visible to the unaided eye. Because most of these colors and structures correspond to well-defined histopathologic correlates, dermoscopy enables clinicians to date to more precisely predict the histopathology diagnosis and thereby improve on their clinical diagnostic accuracy. Besides the diagnostic impact, the in vivo observation of thousands of nevi using dermoscopy and digital dermoscopic follow-up has opened new understanding about the evolution of nevi and factors influencing the nevus pattern. In consequence, a new nevus classification has been proposed, subdividing nevi into 7 categories, which are as follows: (1) globular/cobblestone nevi, (2) reticular nevi, (3) starburst nevi, (4) homogeneous blue nevi, (5) nevi on special body sites, (6) nevi with special features, and (7) and unclassifiable melanocytic proliferations. This article provides an overview on the morphologic classification of nevi and the factors influencing the nevus pattern.

*For a PDF of the full article, click on the link to the left of this introduction.

The increasing use of dermoscopy in preoperative diagnosis of melanocytic skin neoplasms is impacting on routine histopathology to a relevant extent. We herein present the dermoscopic-pathologic features of 6 cases of histopathologically controversial melanocytic skin neoplasms. By illustrating these cases, we emphasize at least 3 different fields of interest for a combined (clinico-)dermoscopic-pathologic diagnostic approach, namely, information about the evolution of lesions; detection of gross sampling errors; definition of peculiar clinicopathologic entities. The theoretic and practical aspects of a close interaction among dermoscopists and histopathologists are itemized in detail.

*For a PDF of the full article, click on the link to the left of this introduction.

The increasing use of dermoscopy in preoperative diagnosis of melanocytic skin neoplasms is impacting on routine histopathology to a relevant extent. We herein present the dermoscopic-pathologic features of 6 cases of histopathologically controversial melanocytic skin neoplasms. By illustrating these cases, we emphasize at least 3 different fields of interest for a combined (clinico-)dermoscopic-pathologic diagnostic approach, namely, information about the evolution of lesions; detection of gross sampling errors; definition of peculiar clinicopathologic entities. The theoretic and practical aspects of a close interaction among dermoscopists and histopathologists are itemized in detail.

*For a PDF of the full article, click on the link to the left of this introduction.

The increasing use of dermoscopy in preoperative diagnosis of melanocytic skin neoplasms is impacting on routine histopathology to a relevant extent. We herein present the dermoscopic-pathologic features of 6 cases of histopathologically controversial melanocytic skin neoplasms. By illustrating these cases, we emphasize at least 3 different fields of interest for a combined (clinico-)dermoscopic-pathologic diagnostic approach, namely, information about the evolution of lesions; detection of gross sampling errors; definition of peculiar clinicopathologic entities. The theoretic and practical aspects of a close interaction among dermoscopists and histopathologists are itemized in detail.

*For a PDF of the full article, click on the link to the left of this introduction.

Dermoscopy increases the clinician’s diagnostic accuracy by as much as 30% over that of unaided visual clinical inspection alone and has been confirmed in 3 separate evidencebased publications using a meta-analysis of the literature. It can be viewed as an in vivo bridge between clinical morphology and histopathology. This “bridge” has provided clinician researchers with many new insights into morphology and tumor biology. In this article, we provide the reader with an overview of the different aspects of dermoscopy as a research tool. We cover different aspects, such as the new equipment, new structures, the importance of blood vessels, etc.

*For a PDF of the full article, click on the link to the left of this introduction.

Dermoscopy increases the clinician’s diagnostic accuracy by as much as 30% over that of unaided visual clinical inspection alone and has been confirmed in 3 separate evidencebased publications using a meta-analysis of the literature. It can be viewed as an in vivo bridge between clinical morphology and histopathology. This “bridge” has provided clinician researchers with many new insights into morphology and tumor biology. In this article, we provide the reader with an overview of the different aspects of dermoscopy as a research tool. We cover different aspects, such as the new equipment, new structures, the importance of blood vessels, etc.

*For a PDF of the full article, click on the link to the left of this introduction.

Dermoscopy increases the clinician’s diagnostic accuracy by as much as 30% over that of unaided visual clinical inspection alone and has been confirmed in 3 separate evidencebased publications using a meta-analysis of the literature. It can be viewed as an in vivo bridge between clinical morphology and histopathology. This “bridge” has provided clinician researchers with many new insights into morphology and tumor biology. In this article, we provide the reader with an overview of the different aspects of dermoscopy as a research tool. We cover different aspects, such as the new equipment, new structures, the importance of blood vessels, etc.

*For a PDF of the full article, click on the link to the left of this introduction.

Reflectance confocal microscopy (RCM) enables in vivo imaging of human skin at a quasi histologic resolution. The black-and-white RCM images show horizontal sections of the skin, at a maximum depth of 350 m. To date, the RCM features of a significant number of skin conditions have been described. The main focus of the research community investigating RCM, however, lies on describing and diagnosing melanocytic skin lesions. Taking into account all RCM studies dealing with diagnostic accuracy in melanocytic skin lesions, sensitivity and specificity of approximately 90% and 86% could be found. Improvement of diagnostic accuracy, improved assessment of dermoscopic-histologic correlation, in vivo biopsy side selection, surgical margin assessment, and response control of conservative therapies in skin diseases are some of the major advantages of this novel imaging method. Additionally, RCM holds inherent potential for teledermatologic application and automated image analyzing. This article describes morphologic features of diverse skin lesions and features of “normal skin,” summarizes diagnostic advances of RCM, compares studies dealing with diagnostic applicability, and discusses further research goals of this exciting new imaging technique.

*For a PDF of the full article, click on the link to the left of this introduction.

Reflectance confocal microscopy (RCM) enables in vivo imaging of human skin at a quasi histologic resolution. The black-and-white RCM images show horizontal sections of the skin, at a maximum depth of 350 m. To date, the RCM features of a significant number of skin conditions have been described. The main focus of the research community investigating RCM, however, lies on describing and diagnosing melanocytic skin lesions. Taking into account all RCM studies dealing with diagnostic accuracy in melanocytic skin lesions, sensitivity and specificity of approximately 90% and 86% could be found. Improvement of diagnostic accuracy, improved assessment of dermoscopic-histologic correlation, in vivo biopsy side selection, surgical margin assessment, and response control of conservative therapies in skin diseases are some of the major advantages of this novel imaging method. Additionally, RCM holds inherent potential for teledermatologic application and automated image analyzing. This article describes morphologic features of diverse skin lesions and features of “normal skin,” summarizes diagnostic advances of RCM, compares studies dealing with diagnostic applicability, and discusses further research goals of this exciting new imaging technique.

*For a PDF of the full article, click on the link to the left of this introduction.

Reflectance confocal microscopy (RCM) enables in vivo imaging of human skin at a quasi histologic resolution. The black-and-white RCM images show horizontal sections of the skin, at a maximum depth of 350 m. To date, the RCM features of a significant number of skin conditions have been described. The main focus of the research community investigating RCM, however, lies on describing and diagnosing melanocytic skin lesions. Taking into account all RCM studies dealing with diagnostic accuracy in melanocytic skin lesions, sensitivity and specificity of approximately 90% and 86% could be found. Improvement of diagnostic accuracy, improved assessment of dermoscopic-histologic correlation, in vivo biopsy side selection, surgical margin assessment, and response control of conservative therapies in skin diseases are some of the major advantages of this novel imaging method. Additionally, RCM holds inherent potential for teledermatologic application and automated image analyzing. This article describes morphologic features of diverse skin lesions and features of “normal skin,” summarizes diagnostic advances of RCM, compares studies dealing with diagnostic applicability, and discusses further research goals of this exciting new imaging technique.

*For a PDF of the full article, click on the link to the left of this introduction.

Reflectance confocal microscopy (RCM) allows noninvasive imaging of the epidermis and superficial dermis. Like dermoscopy, RCM acquires images in the horizontal plane (en face), allowing assessment of tissue pathology underlying dermoscopic structures of interest at a cellular-level resolution. Thus, clinicians using dermoscopy may find RCM to be particularly useful. Our aim was to show the value of RCM for diagnosis and management decisions related to pigmented and nonpigmented skin neoplasms seen in daily practice. Six cases of clinically and dermoscopically equivocal skin lesions, for which RCM facilitated making the correct diagnosis, are presented. Final diagnoses were made based on histopathologic analysis. Three flat pigmented skin lesions with dermoscopic signs of regression showed distinct RCM features that allowed their correct classification as pigmented basal cell carcinoma, pigmented actinic keratosis, and melanoma on sundamaged skin. A flat nonpigmented skin lesion on the face, which did not show distinct clinical or dermoscopic features, was correctly diagnosed as basal cell carcinoma based on RCM findings. In addition, the response of a pigmented actinic keratosis and a melanoma in situ on sun-damaged skin to noninvasive topical treatment was monitored using RCM. RCM is a promising and practical imaging tool for the diagnosis and follow-up of pigmented and nonpigmented skin lesions. 

*For a PDF of the full article, click on the link to the left of this introduction.

Reflectance confocal microscopy (RCM) allows noninvasive imaging of the epidermis and superficial dermis. Like dermoscopy, RCM acquires images in the horizontal plane (en face), allowing assessment of tissue pathology underlying dermoscopic structures of interest at a cellular-level resolution. Thus, clinicians using dermoscopy may find RCM to be particularly useful. Our aim was to show the value of RCM for diagnosis and management decisions related to pigmented and nonpigmented skin neoplasms seen in daily practice. Six cases of clinically and dermoscopically equivocal skin lesions, for which RCM facilitated making the correct diagnosis, are presented. Final diagnoses were made based on histopathologic analysis. Three flat pigmented skin lesions with dermoscopic signs of regression showed distinct RCM features that allowed their correct classification as pigmented basal cell carcinoma, pigmented actinic keratosis, and melanoma on sundamaged skin. A flat nonpigmented skin lesion on the face, which did not show distinct clinical or dermoscopic features, was correctly diagnosed as basal cell carcinoma based on RCM findings. In addition, the response of a pigmented actinic keratosis and a melanoma in situ on sun-damaged skin to noninvasive topical treatment was monitored using RCM. RCM is a promising and practical imaging tool for the diagnosis and follow-up of pigmented and nonpigmented skin lesions. 

*For a PDF of the full article, click on the link to the left of this introduction.

Reflectance confocal microscopy (RCM) allows noninvasive imaging of the epidermis and superficial dermis. Like dermoscopy, RCM acquires images in the horizontal plane (en face), allowing assessment of tissue pathology underlying dermoscopic structures of interest at a cellular-level resolution. Thus, clinicians using dermoscopy may find RCM to be particularly useful. Our aim was to show the value of RCM for diagnosis and management decisions related to pigmented and nonpigmented skin neoplasms seen in daily practice. Six cases of clinically and dermoscopically equivocal skin lesions, for which RCM facilitated making the correct diagnosis, are presented. Final diagnoses were made based on histopathologic analysis. Three flat pigmented skin lesions with dermoscopic signs of regression showed distinct RCM features that allowed their correct classification as pigmented basal cell carcinoma, pigmented actinic keratosis, and melanoma on sundamaged skin. A flat nonpigmented skin lesion on the face, which did not show distinct clinical or dermoscopic features, was correctly diagnosed as basal cell carcinoma based on RCM findings. In addition, the response of a pigmented actinic keratosis and a melanoma in situ on sun-damaged skin to noninvasive topical treatment was monitored using RCM. RCM is a promising and practical imaging tool for the diagnosis and follow-up of pigmented and nonpigmented skin lesions. 

*For a PDF of the full article, click on the link to the left of this introduction.

The increasing incidence of skin cancer and the importance of early diagnosis is a challenge, which requires the development of reliable, cost-effective, noninvasive, diagnostic techniques. Several such methods based on optical imaging techniques are available and currently being investigated. A novel method in this field is multiphoton laser scanning microscopy (MPLSM). This technique is based on the nonlinear process of 2-photon excitation of endogenous fluorophores, which can be used to acquire horizontal optical sectioning of intact biological tissue samples. When studying human skin, MPLSM provides high-resolution fluorescence imaging, allowing visualization of cellular and subcellular structures of the epidermis and upper dermis. This review covers the application of MPLSM as a diagnostic tool for superficial skin cancers, such as basal cell carcinomas, squamous cell carcinoma in situ, and melanomas. MPLSM has also been applied in other research areas related to skin, which will be mentioned briefly. The morphologic features observed in MPLSM images of skin tumors are comparable to traditional histopathology. Safety issues, limitations, and further improvements are discussed. Although further investigations are required to make MPLSM a mainstream clinical diagnostic tool, MPLSM has the potential of becoming a noninvasive, bedside, histopathologic technique for the diagnosis of superficial skin cancers.

*For a PDF of the full article, click on the link to the left of this introduction.

The increasing incidence of skin cancer and the importance of early diagnosis is a challenge, which requires the development of reliable, cost-effective, noninvasive, diagnostic techniques. Several such methods based on optical imaging techniques are available and currently being investigated. A novel method in this field is multiphoton laser scanning microscopy (MPLSM). This technique is based on the nonlinear process of 2-photon excitation of endogenous fluorophores, which can be used to acquire horizontal optical sectioning of intact biological tissue samples. When studying human skin, MPLSM provides high-resolution fluorescence imaging, allowing visualization of cellular and subcellular structures of the epidermis and upper dermis. This review covers the application of MPLSM as a diagnostic tool for superficial skin cancers, such as basal cell carcinomas, squamous cell carcinoma in situ, and melanomas. MPLSM has also been applied in other research areas related to skin, which will be mentioned briefly. The morphologic features observed in MPLSM images of skin tumors are comparable to traditional histopathology. Safety issues, limitations, and further improvements are discussed. Although further investigations are required to make MPLSM a mainstream clinical diagnostic tool, MPLSM has the potential of becoming a noninvasive, bedside, histopathologic technique for the diagnosis of superficial skin cancers.

*For a PDF of the full article, click on the link to the left of this introduction.

The increasing incidence of skin cancer and the importance of early diagnosis is a challenge, which requires the development of reliable, cost-effective, noninvasive, diagnostic techniques. Several such methods based on optical imaging techniques are available and currently being investigated. A novel method in this field is multiphoton laser scanning microscopy (MPLSM). This technique is based on the nonlinear process of 2-photon excitation of endogenous fluorophores, which can be used to acquire horizontal optical sectioning of intact biological tissue samples. When studying human skin, MPLSM provides high-resolution fluorescence imaging, allowing visualization of cellular and subcellular structures of the epidermis and upper dermis. This review covers the application of MPLSM as a diagnostic tool for superficial skin cancers, such as basal cell carcinomas, squamous cell carcinoma in situ, and melanomas. MPLSM has also been applied in other research areas related to skin, which will be mentioned briefly. The morphologic features observed in MPLSM images of skin tumors are comparable to traditional histopathology. Safety issues, limitations, and further improvements are discussed. Although further investigations are required to make MPLSM a mainstream clinical diagnostic tool, MPLSM has the potential of becoming a noninvasive, bedside, histopathologic technique for the diagnosis of superficial skin cancers.

*For a PDF of the full article, click on the link to the left of this introduction.

Optical coherence tomography (OCT) is an emerging imaging technology based on light reflection. It provides real-time images with up to 2-mm penetration into the skin and a resolution of approximately 10 m. It is routinely used in ophthalmology. The normal skin and its appendages have been studied, as have many diseases. The method can provide accurate measures of epidermal and nail changes in normal tissue. Skin cancer and other tumors, as well as inflammatory diseases, have been studied and good agreement found between OCT images and histopathological architecture. OCT also allows noninvasive monitoring of morphologic changes in skin diseases and may have a particular role in the monitoring of medical treatment of nonmelanoma skin cancer. The technology is however still evolving and continued technological development will necessitate an ongoing evaluation of its diagnostic accuracy. Several technical solutions are being pursued to further improve the quality of the images and the data provided, and OCT is being integrated in multimodal imaging devices that would potentially be able to provide a quantum leap to the imaging of skin in vivo.

*For a PDF of the full article, click on the link to the left of this introduction.

Optical coherence tomography (OCT) is an emerging imaging technology based on light reflection. It provides real-time images with up to 2-mm penetration into the skin and a resolution of approximately 10 m. It is routinely used in ophthalmology. The normal skin and its appendages have been studied, as have many diseases. The method can provide accurate measures of epidermal and nail changes in normal tissue. Skin cancer and other tumors, as well as inflammatory diseases, have been studied and good agreement found between OCT images and histopathological architecture. OCT also allows noninvasive monitoring of morphologic changes in skin diseases and may have a particular role in the monitoring of medical treatment of nonmelanoma skin cancer. The technology is however still evolving and continued technological development will necessitate an ongoing evaluation of its diagnostic accuracy. Several technical solutions are being pursued to further improve the quality of the images and the data provided, and OCT is being integrated in multimodal imaging devices that would potentially be able to provide a quantum leap to the imaging of skin in vivo.

*For a PDF of the full article, click on the link to the left of this introduction.

Optical coherence tomography (OCT) is an emerging imaging technology based on light reflection. It provides real-time images with up to 2-mm penetration into the skin and a resolution of approximately 10 m. It is routinely used in ophthalmology. The normal skin and its appendages have been studied, as have many diseases. The method can provide accurate measures of epidermal and nail changes in normal tissue. Skin cancer and other tumors, as well as inflammatory diseases, have been studied and good agreement found between OCT images and histopathological architecture. OCT also allows noninvasive monitoring of morphologic changes in skin diseases and may have a particular role in the monitoring of medical treatment of nonmelanoma skin cancer. The technology is however still evolving and continued technological development will necessitate an ongoing evaluation of its diagnostic accuracy. Several technical solutions are being pursued to further improve the quality of the images and the data provided, and OCT is being integrated in multimodal imaging devices that would potentially be able to provide a quantum leap to the imaging of skin in vivo.

*For a PDF of the full article, click on the link to the left of this introduction.

Mobile telemedicine integrates wireless communications for different telemedical applications, such as mobile phones and personal digital assistants, and with the implementation of modern wireless telecommunication, wireless local area network and satellite communication is a reality. New generation cellular phones or personal digital assistants have overcome limitations of image quality seen in older devices and, with dermatology being a visual profession, mobile teledermatology is perhaps the most recent development in this field. Mobile teledermatology may provide a triage service aimed toward management of patients with emergent skin disease or for follow-up with patients requiring systemic treatment. Teledermoscopy enables rapid transmission of dermoscopic images via e-mail or specific web-application and studies have demonstrated a high, 91%, concordance between face-to-face diagnosis and remote diagnosis of such images. Further to this, telediagnosis of melanocytic skin neoplasms achieved a diagnostic accuracy of 83% versus the conventional histopathologic diagnosis. Mobile teledermoscopy is the combination of such approaches enabling transfer of images captured with cellular phones coupled with a pocket dermatoscope and preliminary studies have demonstrated the feasibility and potential of its use in triage of pigmented lesions. Such applications are of benefit to physicians in enabling easy storage of data for follow-up or referral of images for expert second opinion and may facilitate a “person-centered health system” for patients with numerous moles and pigmented skin lesions who could forward images for evaluation. The incidence of skin cancers has reached epidemic proportions among whites and the trend is still going upward. Mobile teledermatology and teledermoscopy may be implemented as a triage or screening tool for malignant tumors to facilitate early detection and diagnosis, which is crucial for improved patient outcomes. While the legal aspects concerning teleconsultations need to be evaluated, the communications technologies provide a unique opportunity for physicians and patients alike and we foresee a place for these tools in dermatology soon.

*For a PDF of the full article, click on the link to the left of this introduction.

Mobile telemedicine integrates wireless communications for different telemedical applications, such as mobile phones and personal digital assistants, and with the implementation of modern wireless telecommunication, wireless local area network and satellite communication is a reality. New generation cellular phones or personal digital assistants have overcome limitations of image quality seen in older devices and, with dermatology being a visual profession, mobile teledermatology is perhaps the most recent development in this field. Mobile teledermatology may provide a triage service aimed toward management of patients with emergent skin disease or for follow-up with patients requiring systemic treatment. Teledermoscopy enables rapid transmission of dermoscopic images via e-mail or specific web-application and studies have demonstrated a high, 91%, concordance between face-to-face diagnosis and remote diagnosis of such images. Further to this, telediagnosis of melanocytic skin neoplasms achieved a diagnostic accuracy of 83% versus the conventional histopathologic diagnosis. Mobile teledermoscopy is the combination of such approaches enabling transfer of images captured with cellular phones coupled with a pocket dermatoscope and preliminary studies have demonstrated the feasibility and potential of its use in triage of pigmented lesions. Such applications are of benefit to physicians in enabling easy storage of data for follow-up or referral of images for expert second opinion and may facilitate a “person-centered health system” for patients with numerous moles and pigmented skin lesions who could forward images for evaluation. The incidence of skin cancers has reached epidemic proportions among whites and the trend is still going upward. Mobile teledermatology and teledermoscopy may be implemented as a triage or screening tool for malignant tumors to facilitate early detection and diagnosis, which is crucial for improved patient outcomes. While the legal aspects concerning teleconsultations need to be evaluated, the communications technologies provide a unique opportunity for physicians and patients alike and we foresee a place for these tools in dermatology soon.

*For a PDF of the full article, click on the link to the left of this introduction.

Mobile telemedicine integrates wireless communications for different telemedical applications, such as mobile phones and personal digital assistants, and with the implementation of modern wireless telecommunication, wireless local area network and satellite communication is a reality. New generation cellular phones or personal digital assistants have overcome limitations of image quality seen in older devices and, with dermatology being a visual profession, mobile teledermatology is perhaps the most recent development in this field. Mobile teledermatology may provide a triage service aimed toward management of patients with emergent skin disease or for follow-up with patients requiring systemic treatment. Teledermoscopy enables rapid transmission of dermoscopic images via e-mail or specific web-application and studies have demonstrated a high, 91%, concordance between face-to-face diagnosis and remote diagnosis of such images. Further to this, telediagnosis of melanocytic skin neoplasms achieved a diagnostic accuracy of 83% versus the conventional histopathologic diagnosis. Mobile teledermoscopy is the combination of such approaches enabling transfer of images captured with cellular phones coupled with a pocket dermatoscope and preliminary studies have demonstrated the feasibility and potential of its use in triage of pigmented lesions. Such applications are of benefit to physicians in enabling easy storage of data for follow-up or referral of images for expert second opinion and may facilitate a “person-centered health system” for patients with numerous moles and pigmented skin lesions who could forward images for evaluation. The incidence of skin cancers has reached epidemic proportions among whites and the trend is still going upward. Mobile teledermatology and teledermoscopy may be implemented as a triage or screening tool for malignant tumors to facilitate early detection and diagnosis, which is crucial for improved patient outcomes. While the legal aspects concerning teleconsultations need to be evaluated, the communications technologies provide a unique opportunity for physicians and patients alike and we foresee a place for these tools in dermatology soon.

*For a PDF of the full article, click on the link to the left of this introduction.

Antioxidant supplements do not appear to increase the risk of melanoma, according to a large, population-based study.

None of the exposure variables examined—overall antioxidant use, duration of use over the past 10 years, total dosage expressed in pill-years, or years of adult use during adulthood—correlated with melanoma risk in either men or women, said Dr. Maryam M. Asgari of Kaiser Permanente Northern California, Oakland, and her associates.

They undertook this study because the Supplementation in Vitamins and Mineral Antioxidants (SUVIMAX) study, a primary prevention trial published in 2007, found that daily oral supplementation with a combination of antioxidants raised the incidence of melanoma in women. The SUVIMAX findings were alarming, given that an estimated 48%–55% of American adults use supplements regularly, Dr. Asgari and her colleagues wrote.

They further examined the issue in a cohort of 69,671 adults who answered a 24-page questionnaire regarding health history, lifestyle factors, diet, supplement use, and cancer risk factors. They focused on the five antioxidants assessed in the SUVIMAX trial: vitamin C, vitamin E, zinc, beta carotene, and selenium.

Most of the study subjects (66%) were either current or former users of multivitamins. During 7 years of follow-up there were 461 incident cases of cutaneous melanoma.

Antioxidants were not associated with the disease. “Specifically, in the highest dose category of multivitamins … there was no increased risk of melanoma. Results were similar in men and women,” the investigators wrote (Arch. Dermatol. 2009;145:879–82).

Moreover, since many people take multivitamins plus additional beta carotene and selenium supplements, comparably high doses of these two nutrients were tested in a separate analysis. Again, no increased risk of melanoma was found and the results were the same for women and men.

It is likely that the SUVIMAX findings “could be explained by methodological shortcomings,” Dr. Asgari and her associates wrote.

In that study, subjects answered only a single question pertaining to their lifetime sun exposure, and “the analysis was based on only 16 cases” of melanoma. In addition, the incidence of melanoma in the SUVIMAX population was only 25 cases per 100,000 person-years—one-fifth the rate in the current study.

The work of Dr. Asgari and her associates was supported in part by the National Institute of Arthritis, Musculoskeletal and Skin Diseases and the National Cancer Institute. No financial conflicts of interest were reported.

Antioxidant supplements do not appear to increase the risk of melanoma, according to a large, population-based study.

None of the exposure variables examined—overall antioxidant use, duration of use over the past 10 years, total dosage expressed in pill-years, or years of adult use during adulthood—correlated with melanoma risk in either men or women, said Dr. Maryam M. Asgari of Kaiser Permanente Northern California, Oakland, and her associates.

They undertook this study because the Supplementation in Vitamins and Mineral Antioxidants (SUVIMAX) study, a primary prevention trial published in 2007, found that daily oral supplementation with a combination of antioxidants raised the incidence of melanoma in women. The SUVIMAX findings were alarming, given that an estimated 48%–55% of American adults use supplements regularly, Dr. Asgari and her colleagues wrote.

They further examined the issue in a cohort of 69,671 adults who answered a 24-page questionnaire regarding health history, lifestyle factors, diet, supplement use, and cancer risk factors. They focused on the five antioxidants assessed in the SUVIMAX trial: vitamin C, vitamin E, zinc, beta carotene, and selenium.

Most of the study subjects (66%) were either current or former users of multivitamins. During 7 years of follow-up there were 461 incident cases of cutaneous melanoma.

Antioxidants were not associated with the disease. “Specifically, in the highest dose category of multivitamins … there was no increased risk of melanoma. Results were similar in men and women,” the investigators wrote (Arch. Dermatol. 2009;145:879–82).

Moreover, since many people take multivitamins plus additional beta carotene and selenium supplements, comparably high doses of these two nutrients were tested in a separate analysis. Again, no increased risk of melanoma was found and the results were the same for women and men.

It is likely that the SUVIMAX findings “could be explained by methodological shortcomings,” Dr. Asgari and her associates wrote.

In that study, subjects answered only a single question pertaining to their lifetime sun exposure, and “the analysis was based on only 16 cases” of melanoma. In addition, the incidence of melanoma in the SUVIMAX population was only 25 cases per 100,000 person-years—one-fifth the rate in the current study.

The work of Dr. Asgari and her associates was supported in part by the National Institute of Arthritis, Musculoskeletal and Skin Diseases and the National Cancer Institute. No financial conflicts of interest were reported.

Antioxidant supplements do not appear to increase the risk of melanoma, according to a large, population-based study.

None of the exposure variables examined—overall antioxidant use, duration of use over the past 10 years, total dosage expressed in pill-years, or years of adult use during adulthood—correlated with melanoma risk in either men or women, said Dr. Maryam M. Asgari of Kaiser Permanente Northern California, Oakland, and her associates.

They undertook this study because the Supplementation in Vitamins and Mineral Antioxidants (SUVIMAX) study, a primary prevention trial published in 2007, found that daily oral supplementation with a combination of antioxidants raised the incidence of melanoma in women. The SUVIMAX findings were alarming, given that an estimated 48%–55% of American adults use supplements regularly, Dr. Asgari and her colleagues wrote.

They further examined the issue in a cohort of 69,671 adults who answered a 24-page questionnaire regarding health history, lifestyle factors, diet, supplement use, and cancer risk factors. They focused on the five antioxidants assessed in the SUVIMAX trial: vitamin C, vitamin E, zinc, beta carotene, and selenium.

Most of the study subjects (66%) were either current or former users of multivitamins. During 7 years of follow-up there were 461 incident cases of cutaneous melanoma.

Antioxidants were not associated with the disease. “Specifically, in the highest dose category of multivitamins … there was no increased risk of melanoma. Results were similar in men and women,” the investigators wrote (Arch. Dermatol. 2009;145:879–82).

Moreover, since many people take multivitamins plus additional beta carotene and selenium supplements, comparably high doses of these two nutrients were tested in a separate analysis. Again, no increased risk of melanoma was found and the results were the same for women and men.

It is likely that the SUVIMAX findings “could be explained by methodological shortcomings,” Dr. Asgari and her associates wrote.

In that study, subjects answered only a single question pertaining to their lifetime sun exposure, and “the analysis was based on only 16 cases” of melanoma. In addition, the incidence of melanoma in the SUVIMAX population was only 25 cases per 100,000 person-years—one-fifth the rate in the current study.

The work of Dr. Asgari and her associates was supported in part by the National Institute of Arthritis, Musculoskeletal and Skin Diseases and the National Cancer Institute. No financial conflicts of interest were reported.