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The coronavirus disease 2019 (COVID-19) pandemic and subsequent physical distancing recommendations created major gaps in traditional dermatologic undergraduate and postgraduate medical education delivery. Nevertheless, the educational consequences of various public health restrictions have indirectly set aside the inertia, resistance, and risk averse approach to pedagogical change in medicine. In Canada, rapid collaboration and innovation in dermatologic education has led to novel programs including the implementation of a range of internet-facilitated group learning activities and a dramatic expansion of digital telehealth and virtual care. Going forward, three key issues arising from these developments will need to be addressed: the ongoing assessment of these innovations for efficacy; sustaining the momentum and creativity that has been achieved; and, determining which of these activities are worth maintaining when traditional "tried and true" learning activities can be resumed. [ABSTRACT FROM AUTHOR]

In a recent study, we have demonstrated that real-time Raman spectroscopy could be used for skin cancer diagnosis. As a translational study, the objective of this study is to validate previous findings through a completely independent clinical test. In total, 645 confirmed cases were included in the analysis, including a cohort of 518 cases from a previous study, and an independent cohort of 127 new cases. Multi-variant statistical data analyses including principal component with general discriminant analysis (PC-GDA) and partial least squares (PLS) were used separately for lesion classification, which generated similar results. When the previous cohort ( n = 518) was used as training and the new cohort ( n = 127) was used as testing, the area under the receiver operating characteristic curve (ROC AUC) was found to be 0.889 (95 % CI 0.834-0.944; PLS); when the two cohorts were combined, the ROC AUC was 0.894 (95 % CI 0.870-0.918; PLS) with the narrowest confidence intervals. Both analyses were comparable to the previous findings, where the ROC AUC was 0.896 (95 % CI 0.846-0.946; PLS). The independent study validates that real-time Raman spectroscopy could be used for automatic in vivo skin cancer diagnosis with good accuracy. [ABSTRACT FROM AUTHOR]

The article presents a case study of 65-year-old woman with unwanted pigmented lesions on the face for 10 years, with a history of kidney transplantation 15 years before for treatment of idiopathic renal failure and was on low-dose prednisone, mycophenolate mofetil, cyclosporine and diltiazem. The patient undergone laser surgery using Q-switched alexandrite laser resulting to the darkening of skin colored camouflage tattoo, which was corrected using carbon dioxide laser surgery.

This issue of Photodermatology, Photoimmunology, and Photomedicine commemorates the contributions and legacy of Dr Nikiforos Kollias, an outstanding skin biophysicist affectionately known as "Nik" to those who worked and trained with and under him. Nik championed the use of noninvasive optical techniques such as spectroscopy of the skin to probe basic physiologic processes such as pigmentation and inflammation. More than just trying to understand how and why the skin could change its appearance and behavior following exposure to light, Nik actively sought to improve and advance practical biophotonic medical applications including sunscreens, photodynamic therapy, and optical imaging. [Extracted from the article]

The article offers information on the 2015 World Congress of Dermatology (WCD) to be held in Vancouver, British Columbia in June 2015 on topics including new treatments techniques for skin diseases, clinical practice guidelines to dermatologists and patient care.

Background: Studies have shown disparities in the perception of skin disease burden between patients and physicians, with patients often feeling that the severity, emotional impact, and social repercussions of their skin condition are underestimated. Although physician's professional behavior is guided by documents such as the Hippocratic Oath, there are no patient-driven principles to guide healthcare interactions involving skin concerns. Objective: To develop a concise and practical charter for patients based on their perceptions of unmet needs with the goals of helping patients express their needs and exercise their rights to accessing and utilizing the healthcare system for conditions, diseases, or traumas involving the skin. Methods: An initial literature review examined healthcare delivery concerns of patients with skin conditions. Results were used to draft a charter that was reviewed by a Canadian patient focus group representing various skin condition advocacy groups. A revised charter was reviewed by Canadian dermatologists before being formally approved by the Canadian Skin Patient Alliance Board and endorsed by the Canadian Dermatology Association. Results: The Patient Charter comprises 8 principles for providing and receiving professional services for the skin in the healthcare setting. Conclusions: This Patient Charter provides direct insights into patient priorities and will be used as an educational and advocacy tool in healthcare, occupational, and social settings. The intended goal is for the Patient Charter to empower patients and to educate health professions, government, industry, and society at large. Accordingly, the charter will be disseminated through print materials, informational videos, and social media campaigns. [ABSTRACT FROM AUTHOR]

Background/Purpose: A recent direction in skin disease classification is to develop quantitative diagnostic techniques. Skin relief, colloquially known as roughness, is an important clinical feature. The aim of this study is to demonstrate a novel polarization speckle technique to quantitatively measure roughness on skin lesions in vivo. We then calculate the average roughness of different types of skin lesions to determine the extent to which polarization speckle roughness measurements can be used to identify skin cancer. Methods: The experimental conditions were set to target the fine relief structure on the order of ten microns within a small field of view of 3 mm. The device was tested in a clinical study on patients with malignant and benign skin lesions that resemble cancer. The cancer group includes 37 malignant melanomas (MM), 43 basal cell carcinomas (BCC), and 26 squamous cell carcinomas (SCC), all categories confirmed by gold standard biopsy. The benign group includes 109 seborrheic keratoses (SK), 79 nevi, and 11 actinic keratoses (AK). Normal skin roughness was obtained for the same patients (301 different body sites proximal to the lesion). Results: The average root mean squared (rms) roughness ± standard error of the mean for MM and nevus was equal to 19 ± 5 μm and 21 ± 3 μm, respectively. Normal skin has rms roughness of 31 ± 3 μm, other lesions have roughness of 35 ± 10 μm (AK), 35 ± 7 μm (SCC), 31 ± 4 μm (SK), and 30 ± 5 μm (BCC). Conclusion: An independent‐samples Kruskal–Wallis test indicates that MM and nevus can be separated from each of the tested types of lesions, except each other. These results quantify clinical knowledge of lesion roughness and could be useful for optical cancer detection. [ABSTRACT FROM AUTHOR]

Background: Biases inherent in self‐assessment of sun exposure and sun‐safe behavior may lead to inaccurate conclusions about the effectiveness of sun‐safety educational programs. Objectives: We aimed to compare self‐reports to objective measures of sun exposure, when examining the effectiveness of passive versus active educational interventions. Methods: From May to June 2018, 73 participants recruited at a dermatology clinic were sequentially assigned to receive sun‐safety education through one of 3 modes: interactive online module, video, or no education. A baseline Sun Exposure and Behavior Inventory (SEBI) questionnaire was administered, and spectrophotometric measurements of sun‐exposed and sun‐protected areas were taken and reported in the CIE L*a*b* color space. Participants were followed 4–8 and 16 weeks after the initial visit where the SEBI was re‐administered, and serial measurements of skin color were taken. The change in SEBI scores and L*a*b values, as calculated by the individual typology angle (ITA°), was analyzed. Results: There was a significant increase in skin darkening in all the groups at 4–8 and 16 weeks follow‐up. There was no statistically significant difference between the groups in the magnitude of color change. However, subjectively at 4‐8 weeks post‐intervention, participants in the interactive module and video groups had significantly improved self‐reported SEBI scores compared to control (p <.05, Kruskal‐Wallis). By 16 weeks, only the interactive module group showed significant improvement in SEBI scores compared to control (p <.05, ANOVA). Conclusion: In determining the effectiveness of sun‐safety programs, spectrophotometric evaluation of sun‐induced skin pigmentation can allow for a more complete evaluation of self‐reported sun exposure and sun‐protective behavior. [ABSTRACT FROM AUTHOR]

Background: Although many hair disorders can be readily diagnosed based on their clinical appearance, their progression and response to treatment are often difficult to monitor, particularly in quantitative terms. We introduce an innovative technique utilizing a smartphone and computerized image analysis to expeditiously and automatically measure and compute hair density and diameter in patients in real time. Methods: A smartphone equipped with a dermatoscope lens wirelessly transmits trichoscopy images to a computer for image processing. A black‐and‐white binary mask image representing hair and skin is produced, and the hairs are thinned into single‐pixel‐thick fiber skeletons. Further analysis based on these fibers allows morphometric characteristics such as hair shaft number and diameters to be computed rapidly. The hair‐bearing scalps of fifty participants were imaged to assess the precision of our automated smartphone‐based device in comparison with a specialized trichometry device for hair shaft density and diameter measurement. The precision and operation time of our technique relative to manual trichometry, which is commonly used by hair disorder specialists, is determined. Results: An equivalence test, based on two 1‐sided t tests, demonstrates statistical equivalence in hair density and diameter values between this automated technique and manual trichometry within a 20% margin. On average, this technique actively required 24 seconds of the clinician's time whereas manual trichometry necessitated 9.2 minutes. Conclusion: Automated smartphone‐based trichometry is a rapid, precise, and clinically feasible technique which can significantly facilitate the assessment and monitoring of hair loss. Its use could be easily integrated into clinical practice to improve standard trichoscopy. [ABSTRACT FROM AUTHOR]

Boniface (Bordeaux, France) found that perilesional skin in progressive vitiligo patients reveals upregulation of NKG2D when compared to stable vitiligo and control patients. Patients with active vitiligo had significantly higher serum IL-23 levels than controls, whereas stable vitiligo patients did not have a significant difference in IL-23 levels when compared to controls. Vitiligo treatments Results of clinical trials and studies on vitiligo treatments were presented. Lectures were given by vitiligo experts from different countries regarding tissue and cell transfer surgical approaches to vitiligo treatment. [Extracted from the article]

Summary: Background and Purpose: Although cutaneous autofluorescence has been utilized for evaluation of skin conditions, there is a paucity of data on normal human skin autofluorescence and its dependence on anatomical site. The objective of this study is to use excitation‐emission matrix spectroscopy to quantify and characterize skin autofluorescence at different body sites. Methods: Ten anatomical sites from 30 healthy volunteers were measured with a double‐grating excitation‐emission matrix spectrofluorometer. Results: For the 10 body sites evaluated, there were four overall patterns of autofluorescence: skin from the head and neck exhibits high superficial and low bilayer fluorescence; the dorsal forearm and dorsal hand have both low superficial and bilayer fluorescence; the upper inner arm and back have high superficial and intermediate bilayer fluorescence; while the palm and thumbnail have both high superficial and bilayer fluorescence. The corresponding fluorescence excitation‐emission peaks for these patterns were as follows: head and neck, 3 peaks at 290‐300/330‐350, 360‐380/460‐485, and 380‐420/610‐630 nm; dorsal forearm and dorsal hand, 2 peaks around 295‐300/345‐360 and 385‐395/460‐485 nm; upper inner arm and back, 3 peaks around 295‐300/335‐355, 335‐340/390‐410, and 375‐390/455‐480 nm; palm and thumbnail, 3 peaks around 285‐300/345‐355, 335‐345/390‐410, and 365‐390/450‐480 nm. Conclusion: Cutaneous fluorescence varies in distinct patterns according to anatomical site, due to the component fluorophores present, skin thickness, and the degree of melanization and long term sun exposure. These EEM patterns for normal skin should be accounted for when interpreting fluorescence signals from disease states and can also be used to guide the selection of optimal wavebands when applying this optical modality. [ABSTRACT FROM AUTHOR]

Summary: Background: There is no accepted method to objectively assess the visual appearance of sunscreens on the skin. Methods: We present a method for sunscreen application, digital photography, and computer analysis to quantify the appearance of the skin after sunscreen application. Four sunscreen lotions were applied randomly at densities of 0.5, 1.0, 1.5, and 2.0 mg/cm2 to areas of the back of 29 subjects. Each application site had a matched contralateral control area. High‐resolution standardized photographs including a color card were taken after sunscreen application. After color balance correction, CIE L*a*b* color values were extracted from paired sites. Differences in skin appearance attributed to sunscreen were represented by ΔE, which in turn was calculated from the linear Euclidean distance within the L*a*b* color space between the paired sites. Results: Sunscreen visibility as measured by median ΔE varied across different products and application densities and ranged between 1.2 and 12.1. The visibility of sunscreens varied according to product SPF, composition (organic vs inorganic), presence of tint, and baseline b* of skin (P < .05 for all). Conclusion: Standardized sunscreen application followed by digital photography and indirect computer‐based colorimetry represents a potential method to objectively quantify visibility of sunscreen on the skin. [ABSTRACT FROM AUTHOR]

Objective measurements of melanin can provide important information for differentiating melanoma from benign pigmented lesions and in assessing pigmentary diseases. Herein, we evaluate near-infrared (NIR) fluorescence as a possible tool to quantify melanin. Various concentrations of in vitro Sepia melanin in tissue phantoms were measured with NIR fluorescence and diffuse reflectance spectroscopy. Similar optic measurements were conducted in vivo on 161 normal human skin sites. Diffuse reflectance spectroscopy was used to quantify the melanin content via Stamatas-Kollias algorithm. At physiologic concentrations, increasing in vitro melanin concentrations demonstrated higher fluorescence that was linearly correlated (R² = 0.99, p < .001). At higher concentrations, the fluorescence signal plateaued. A linear relationship was also observed with melanin content in human skin (R² = 0.59, p < .001). Comparing the fluorescence and reflectance signals with in vitro and in vivo samples, the estimated melanin concentration in human skin ranged between 0 and 1.25 mg/ml, consistent with previous quantitative studies involving invasive methods. [ABSTRACT FROM AUTHOR]

The Vitiligo Global Issues Consensus Conference ( VGICC), through an international e-Delphi consensus, concluded that 'repigmentation' and 'maintenance of gained repigmentation' are essential core outcome measures in future vitiligo trials. This VGICC position paper addresses these core topics in two sections and includes an atlas depicting vitiligo repigmentation patterns and color match. The first section delineates mechanisms and characteristics of vitiligo repigmentation, and the second section summarizes the outcomes of international meeting discussions and two e-surveys on vitiligo repigmentation, which had been carried out over 3 yr. Treatment is defined as successful if repigmentation exceeds 80% and at least 80% of the gained repigmentation is maintained for over 6 months. No agreement was found on the best outcome measure for assessing target or global repigmentation, therefore highlighting the limitations of e-surveys in addressing clinical measurements. Until there is a clear consensus, existing tools should be selected according to the specific needs of each study. A workshop will be conducted to address the remaining issues so as to achieve a consensus. [ABSTRACT FROM AUTHOR]

Real-time Raman spectroscopy can be used to assist in assessing skin lesions suspicious for cancer. Most of the diagnostic algorithms are based on full band of the Raman spectra, either in the fingerprint region or the high wavenumber region. In this paper we explored wavenumber selection based analysis in Raman spectroscopy for skin cancer diagnosis. Wavenumber selection was implemented using windows of wavenumber and leave-one-out cross-validated stepwise regression or least and shrinkage selection operator (LASSO). The diagnostic algorithms were then generated from the selected windows of wavenumber using multivariate statistical analyses, including principal component and general discriminate analysis (PC-GDA) and partial least squares (PLS). In total a combined cohort of 645 confirmed lesions from 573 patients encompassing skin cancers, precancers and benign skin lesions were included, which were divided into training cohort (n = 518) and testing cohort (n = 127) according to the measurement time. It was found that the area under the receiver operating characteristic curve (ROC) was improved from 0.861–0.891 to 0.891–0.911 and the diagnostic specificity for fixed sensitivity 0.99–0.90 was improved from 0.17–0.65 to 0.20–0.75 with wavenumber selection based analysis. [ABSTRACT FROM AUTHOR]

Real-time Raman spectroscopy can be used to assist in assessing skin lesions suspicious for cancer. Most of the diagnostic algorithms are based on full band of the Raman spectra, either in the fingerprint region or the high wavenumber region. In this paper we explored wavenumber selection based analysis in Raman spectroscopy for skin cancer diagnosis. Wavenumber selection was implemented using windows of wavenumber and leave-one-out cross-validated stepwise regression or least and shrinkage selection operator (LASSO). The diagnostic algorithms were then generated from the selected windows of wavenumber using multivariate statistical analyses, including principal component and general discriminate analysis (PC-GDA) and partial least squares (PLS). In total a combined cohort of 645 confirmed lesions from 573 patients encompassing skin cancers, precancers and benign skin lesions were included, which were divided into training cohort (n = 518) and testing cohort (n = 127) according to the measurement time. It was found that the area under the receiver operating characteristic curve (ROC) was improved from 0.861–0.891 to 0.891–0.911 and the diagnostic specificity for fixed sensitivity 0.99–0.90 was improved from 0.17–0.65 to 0.20–0.75 with wavenumber selection based analysis. [ABSTRACT FROM AUTHOR]

Background Recent advances in biomedical optics have enabled dermal and epidermal components to be visualized at subcellular resolution and assessed noninvasively. Multiphoton microscopy ( MPM) and reflectance confocal microscopy ( RCM) are noninvasive imaging modalities that have demonstrated promising results in imaging skin micromorphology, and which provide complementary information regarding skin components. This study assesses whether combined MPM/ RCM can visualize intracellular and extracellular melanin granules in the epidermis and dermis of normal human skin. Methods We perform MPM and RCM imaging of in vivo and ex vivo skin in the infrared domain. The inherent three-dimensional optical sectioning capability of MPM/ RCM is used to image high-contrast granular features across skin depths ranging from 50 to 90 μm. The optical images thus obtained were correlated with conventional histologic examination including melanin-specific staining of ex vivo specimens. Results MPM revealed highly fluorescent granular structures below the dermal-epidermal junction ( DEJ) region. Histochemical staining also demonstrated melanin-containing granules that correlate well in size and location with the granular fluorescent structures observed in MPM. Furthermore, the MPM fluorescence excitation wavelength and RCM reflectance of cell culture-derived melanin were equivalent to those of the granules. Conclusion This study suggests that MPM can noninvasively visualize and quantify subepidermal melanin in situ. [ABSTRACT FROM AUTHOR]

One challenge in facing the application of biomedical Raman spectroscopy is that the Raman signal is acquired in a dark operation room. It is inconvenient for both the operator and the patient because it is difficult for the operator to accurately and precisely locate the target in the dark environment, and the patient feels uncomfortable in such a setting. In this note, we propose a method to implement biomedical Raman measurement with an illumination source, by multiple filtering of the illumination and the collection optics. Experimental results are demonstrated on skin Raman measurement under 785-nm excitation. [ABSTRACT FROM AUTHOR]

• Developed a novel polarization speckle system that incorporates deep learning. • Polarization speckle data lends itself to augmentation for machine learning and deep learning. • In a clinical validation study, multiple types of skin cancers are separated from benign skin lesions. • Deep learning enables improved detection performance over machine learning and previous speckle analysis methods. Polarization speckle is a growing research field, especially for the purposes of biomedical imaging and diagnostics. The statistical uniformity of speckle creates novel opportunities for AI methods to analyze speckle patterns, as they are difficult for a human to interpret. We employed deep learning and traditional machine learning methods (Support Vector Machine, K Nearest Neighbor, and Random Forests) to analyze polarization speckle images generated from the general categories of malignant and benign lesions, a classification task previously found to be very difficult. Their performance in classifying the patterns were compared both to each other and to the previous statistical methods of speckle analysis. A collection of 122 malignant and 196 benign skin lesion speckle images were augmented for deep learning using patch cropping, an advantageous method given the patterns' statistical homogeneity. The machine learning technique performed with a diagnostic accuracy of less than 65%, a result comparable to those of previous statistical methods, despite the fact that the same machine learning technique could achieve a high 90% accuracy in the simpler classification task of differentiating malignant melanoma and the benign lookalike seborrheic keratosis. However, ResNet, our chosen deep learning architecture, achieved the best performance of 82% diagnostic accuracy in the general classification task of malignant and benign. These results show that deep learning extracts previously hidden information from polarization speckle, which further develops towards a rapid, real-time, analysis technique for an automatic skin cancer detection system. [ABSTRACT FROM AUTHOR]

Significance: Management of skin cancer worldwide is often a challenge of scale, in that the number of potential cases presented outweighs the resources available to detect and treat skin cancer. Aim: This project aims to develop a polarimetry probe to create an accessible skin cancer detection tool. Approach: An optical probe was developed to perform bulk tissue Stokes polarimetry, a technique in which a laser of known polarization illuminates a target, and the altered polarization state of the backscattered light is measured. Typically, measuring a polarization state requires four sequential measurements with different orientations of polarization filters; however, this probe contains four spatially separated detectors to take four measurements in one shot. The probe was designed to perform at a lower cost and higher speed than conventional polarimetry methods. The probe uses photodiodes and linear and circular film polarizing filters as detectors, and a low-coherence laser diode as its illumination source. The probe design takes advantage of the statistical uniformity of the polarization speckle field formed at the detection area. Results: Tests of each probe component, and the complete system put together, were performed to evaluate error and confirm the probe's performance despite its low-cost components. This probe's potential is demonstrated in a pilot clinical study on 71 skin lesions. The degree of polarization was found to be a factor by which malignant melanoma could be separated from other types of skin lesions. [ABSTRACT FROM AUTHOR]