" New methods to diagnose changing moles"

1. " 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

2. Why to Strive for an Early Diagnosis?… and some more statistics • Long term survival is greater than 90% with thin (<1mm) melanoma. • Long term survival is 50-90% with thick (>1mm) melanoma • Long term survival is 20-60% with lymph node involvement • Long term survival is less than 10% with distant metastasis. Diagnosis in early stages  good survival

3. Some Encouraging News 65% of patients are diagnosed with localized disease Goal Better patient profiling Improved identification techniques Earliest possible diagnosis

4. The Good News(cont.) Improved identification techniques Skin self-examination Dermoscopy Total body skin photography

5. Traditional Clinical Examination A: Asymmetry B: Border irregularity C: Colors D: Diameter > 6 mm E: Evolving lesions

6. Why Dermoscopy? • ABCD criteria are not always reliable • Common atypical looking, but benign lesions • Poor discrimination between pigmented melanocytic and pigmented non-melanocytic lesions • Unnecessary biopsies and surgeries

7. Dermatoscopy – Epiluminescence Microscopy • Non-invasive, in-vivo microscopic technique using incident light, immersion oil, and low-to-medium 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

8. Principles of Dermoscopy • New morphology appears with features that cannot be perceived by the naked eye

10. Dermoscopic Diagnosis of Melanocytic Tumors • High sensitivity 75-96% • High specificity 79-98% This improves with experience and far exceeds the rate by clinical examination alone

11. Recently Introduced Application of Dermoscopy on Equivocal Lesions“Short Term Mole Monitoring” • Low concern lesions on clinical exam • Newly developed lesions • More of a concerns for the patient 3-4 months dermoscopic monitoring Lesions are removed if further changes occur

13. . 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.

14. Based on the biopsy report, your Dermatologist will advise you if further treatments are needed.

15. Skin Surface Microscopy Image Analysis Colors Structures Patterns Criteria Clinico-pathologic correlation Diagnosis

16. Algorithmic Approach of Pigmented Skin Lesions

17. The Patient - Physician Team Work Periodic Exams with Multiple Techniques Skin self-examination Dermoscopy Total body skin photography

18. The Importance of Total Body Photography • High-resolution digital overview photos of the entire skin surface • Standardized technique, lighting, distance, topography, etc. • Baseline record used for follow-up examination for comparison to detect new or changing lesions • One set for patient clinic records, another set for patient’s own records for self-exams

19. Total Body Photography Marghoob te al. J Am Acad Dermatol 2003; 777-97.

20. Patients Who Benefit from TBP • Personal or family history of melanoma • “Atypical mole syndrome” • Multiple normal appearing nevi • Large congenital nevi • Genetic abnormalities (p16 gene) • High anxiety

21. Advantages of TBP • Help to identify new or changing lesions • Increase the efficiency of biopsying the right lesion • May save the life by earlier detection

22. Additional Advantages of TBP • Encouraging participation by involving self-screening • Reducing unnecessary biopsy rates for benign nevi • Reassuring patients that stable lesions are benign

23. Maximazing Positive Outcome Goal Better patient profiling Improved identification techniques Earliest possible diagnosis

24. Combination of Approaches • Optimize knowledge, resources, and techniques. • Select the high risk patient population • Combining techniques • Total body photography • Dermoscopy • Invest and develop new techniques In vivo confocal scanning microscopy Teledermatology

25. Melanoma in situ Margins !

26. Mobile Teledermatology C.Ebner et al. J.Telemed. Telecare 2008

27. Combination of Approaches(cont.) • Collaborate with the full scale of multidisciplinary specialists: • Dermatologists • Surgeons • Clinical oncologists • Pathologists, dermatopathologists • Psychiatrists • Researchers • Social Workers and • Survivors and their relatives

28. Beyond the Hard Core SciencePearls from Real Survivors Emotional commitment to keep going despite ups and downs Utilize all internal and external resources Positive thinking Goal setting, being creative Find humor and playfulness Share experiences and learn from others Comply with Doctor’s instructions Appreciate life Living everyday in the fullest sense