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Importance: Convolutional neural networks (CNNs) achieve expert-level accuracy in the diagnosis of pigmented melanocytic lesions. However, the most common types of skin cancer are nonpigmented and nonmelanocytic, and are more difficult to diagnose. Objective: To compare the accuracy of a CNN-based classifier with that of physicians with different levels of experience. Design, Setting, and Participants: A CNN-based classification model was trained on 7895 dermoscopic and 5829 close-up images of lesions excised at a primary skin cancer clinic between January 1, 2008, and July 13, 2017, for a combined evaluation of both imaging methods. The combined CNN (cCNN) was tested on a set of 2072 unknown cases and compared with results from 95 human raters who were medical personnel, including 62 board-certified dermatologists, with different experience in dermoscopy. Main Outcomes and Measures: The proportions of correct specific diagnoses and the accuracy to differentiate between benign and malignant lesions measured as an area under the receiver operating characteristic curve served as main outcome measures. Results: Among 95 human raters (51.6% female; mean age, 43.4 years; 95% CI, 41.0-45.7 years), the participants were divided into 3 groups (according to years of experience with dermoscopy): beginner raters (10 years). The area under the receiver operating characteristic curve of the trained cCNN was higher than human ratings (0.742; 95% CI, 0.729-0.755 vs 0.695; 95% CI, 0.676-0.713; P

BACKGROUND: Nonpigmented skin cancer is common, and diagnosis with the unaided eye is error prone. OBJECTIVE: To investigate whether dermatoscopy improves the diagnostic accuracy for nonpigmented (amelanotic) cutaneous neoplasms. METHODS: We collected a sample of 2072 benign and malignant neoplastic lesions and inflammatory conditions and presented close-up images taken with and without dermatoscopy to 95 examiners with different levels of experience. RESULTS: The area under the curve was significantly higher with than without dermatoscopy (0.68 vs 0.64, P < .001). Among 51 possible diagnoses, the correct diagnosis was selected in 33.1% of cases with and 26.4% of cases without dermatoscopy (P < .001). For experts, the frequencies of correct specific diagnoses of a malignant lesion improved from 40.2% without to 51.3% with dermatoscopy. For all malignant neoplasms combined, the frequencies of appropriate management strategies increased from 78.1% without to 82.5% with dermatoscopy. LIMITATIONS: The study deviated from a real-life clinical setting and was potentially affected by verification and selection bias. CONCLUSIONS: Dermatoscopy improves the diagnosis and management of nonpigmented skin cancer and should be used as an adjunct to examination with the unaided eye.

Introduction Les cancers cutanes ont une incidence croissante amplifiee par le vieillissement de la population. La demographie medicale baisse, augmentant les delais d’acces au dermatologue. La telemedecine par smartphone a montre sa fiabilite, sa securite et son interet dans l’amelioration du pronostic et la diminution du cout de prise en charge des cancers cutanes. Notre but est de raccourcir le delai de prise en charge des cancers cutanes en ville grâce a la tele-expertise par smartphone. Materiel et methodes Elaboration d’un projet pilote de tele-expertise, finance par l’ARS Ile-de-France reposant sur le developpement d’une application mobile adossee a la plateforme ORTIF (Outil regional de telemedecine d’Ile-de-France). Cette application est destinee aux medecins generalistes qui prennent en photo toute suspicion de cancer cutane et remplissent un tele-dossier, succinct, envoye instantanement et de facon securisee, au dermatologue de proximite qui juge du degre d’urgence et du type de prise en charge la plus adaptee. Conception de l’application smartphone avec le GCS SESAN developpee sur IOS et Android et utilisable en mode deconnecte. Dix dermatologues experts ont ete recrutes, dans les departements du 77, 93 et 94. 100 medecins generalistes soit 10 autour de chaque dermatologue ont ete sollicites afin d’etre formes fin 2017 au depistage des cancers cutanes et a l’utilisation de l’application pour debuter en janvier 2018. Resultats Quatre-vingt-onze medecins generalistes ont ete recrutes, 71 ont ete formes et 42 se sont inscrits sur la plateforme ORTIF. Depuis janvier 2018, 75 demandes de tele-expertises ont ete envoyees dont 1 melanome, 2 carcinomes epidermoides, 1 maladie de Bowen, 5 carcinomes basocellulaires, 6 carcinomes non encore confirmes histologiquement, 1 cancer du sein, 4 keratoses pre-carcinomateuses et 30 lesions benignes essentiellement naevus et keratoses seborrheiques. Le delai de prise en charge des cancers cutanes grâce a l’application Ortif est en moyenne de 13 jours contre 3 mois actuellement. Conclusion Notre experience mixte, liberale et hospitaliere, en oncodermatologie nous a conduit a construire ce projet. Cette premiere evaluation montre que cette application mobile a deja permis de depister des cancers cutanes a un stade precoce. Elle represente une reponse aux deserts medicaux. Nous utilisons tous quotidiennement notre smartphone pour echanger des donnees de sante. Il est urgent que cette activite soit organisee de facon securisee avec une cotation CCAM.

Background Dermoscopy improves melanoma recognition, but most criteria were described in the context of superficial spreading melanoma.

Background Little is known about the dermoscopic features of scalp tumours. Objective To determine the dermoscopic features of scalp tumours. Methods Retrospective analysis of dermoscopic images of histopathologically diagnosed scalp tumours from International Dermoscopy Society members. Results A total of 323 tumours of the scalp from 315 patients (mean age: 52 years; range 388 years) were analysed. Scalp nevi were significantly associated with young age ( 65 years and sun damage. Atypical network and regression were predictive for thin (=1 mm) melanomas, whereas advanced melanomas (tumour thickness > 1 mm) revealed blue white veil, unspecific patterns and irregular black blotches or dots. Conclusions The data collected provide a new knowledge regarding the clinical and dermoscopy features of pigmented scalp tumours.

P>Although dermoscopy has been primarily designed for aiding the in vivo diagnosis of skin tumors, recent advances indicate it is also useful in the diagnosis of common skin infections and infestations. As such, dermoscopy connects the research fields of dermatology and entomology into one field of "entomodermoscopy". In this article we give an overview on the current applications of entomodermoscopy.

SummaryBackground Dermoscopy is limited in differentiating accurately between pigmented lentigo maligna (LM) and pigmented actinic keratosis (PAK). This might be related to the fact that most studies have focused on pigmented criteria only, without considering additional recognizable features. Objectives To investigate the diagnostic accuracy of established dermoscopic criteria for pigmented LM and PAK, but including in the evaluation features previously associated with nonpigmented facial actinic keratosis. Methods Retrospectively enrolled cases of histopathologically diagnosed LM, PAK and solar lentigo/early seborrhoeic keratosis (SL/SK) were dermoscopically evaluated for the presence of predefined criteria. Univariate and multivariate regression analyses were performed and receiver operating characteristic curves were used. Results The study sample consisted of 70 LMs, 56 PAKs and 18 SL/SKs. In a multivariate analysis, the most potent predictors of LM were grey rhomboids (sixfold increased probability of LM), nonevident follicles (fourfold) and intense pigmentation (twofold). In contrast, white circles, scales and red colour were significantly correlated with PAK, posing a 14-fold, eightfold and fourfold probability for PAK, respectively. The absence of evident follicles also represented a frequent LM criterion, characterizing 71% of LMs. Conclusions White and evident follicles, scales and red colour represent significant diagnostic clues for PAK. Conversely, intense pigmentation and grey rhomboidal lines appear highly suggestive of LM.

A case of a predominantly yellow primary superficial spreading melanoma arising on the back of a 44-year-old woman is presented. Possible causes of the clinical and dermatoscopic yellow color are discussed. Staining with the histochemical stain, Sudan Black, revealed a differential uptake compared to a closely matched control melanoma. We speculate that the clinical and dermatoscopic yellow color could be due to the presence of increased amounts of the pigment lipofuscin, which is known to produce subtle orange color in some choroidal melanomas.

Background Several common inflammatory dermatoses, such as rosacea, seborrheic dermatitis (SD), discoid lupus erythematosus (DLE) and granulomatous skin diseases manifest as erythematous macules or plaques on the facial skin. Although clinical examination represents the cornerstone of diagnosis, the broad variety of clinical features and uncommon presentations of these diseases may cause at times diagnostic and therapeutic uncertainty. Dermoscopy, in addition to its well-documented value in evaluation of skin tumours, is continuously gaining appreciation also in the field of general dermatology. Objective To describe and compare the dermoscopic patterns of common facial inflammatory skin diseases including SD, erythematotelangiectatic rosacea (ER), sarcoidosis, lupus vulgaris (LV), DLE and granuloma faciale (GF). Methods Dermoscopic images of lesions from patients with histopathologically confirmed diagnosis of SD, ER, sarcoidosis, LV, DLE or GF were retrospectively evaluated for the presence of several criteria. Selection of the dermoscopic variables included in the evaluation process was based on the data available in the literature and on our preliminary observations. Results One hundred and fifteen dermoscopic images were included in the study. SD was dermoscopically characterized by dotted vessels and yellow scales, whereas ER was typified by a characteristic pattern of vascular polygons. Sarcoidosis and LV very commonly exhibited orange-yellowish areas and linear branching vessels. Features related to follicle abnormalities and linear branching vessels were the most common dermoscopic criteria of DLE and GF. Conclusions This study provides new insights into the dermoscopic variability in common facial inflammatory dermatoses.

Granuloma annulare (GA) and necrobiosis lipoidica (NL) are the most common granulomatous skin diseases (GSD). Although GA usually follows a self-limiting course, it has been reported to occur in association with haematologic neoplasias and solid tumours. 1,2 The aetio- pathogenesis of NL is strongly associated with diabetes mellitus, and nonhealing ulcers and squamous cell carcinoma have been reported to develop occasionally on chronic NL lesions.

Background: The clinical variability of cutaneous sarcoidosis (CS) often makes its correct diagnosis challenging. Although traditionally employed for the diagnosis of skin tumors, during the past years dermoscopy also gained increasing interest as an aid in the clinical diagnosis of inflammatory and infectious skin manifestations in general dermatology. Objective: Our purpose was to evaluate the usefulness of dermoscopy in the differential diagnosis of CS. Methods: This was a retrospective analysis of 7 clinical and dermoscopic images of CS that were collected at dermatology clinics in France and Italy between 2005 and 2009. Results: Retrospective dermoscopic evaluation revealed small grouped, translucent orange globular structures associated with linear vessels of variable diameter in all 7 cases. In 5 cases, additional central scar-like areas were seen. Conclusion: Lesions showing dermoscopically translucent yellow to orange globular-like or structureless areas associated with linear vessels should raise the suspicion of a granulomatous skin disease, including CS.