Baseline factors influencing decisions on digital follow-up of melanocytic lesions in daily practice: An Italian multicenter survey - 09/08/11
, Giovanni Ghigliotti, MD b, Matteo Gnone, MD c, Alessandra Chiarugi, MD a, Emanuele Crocetti, MD d, Stefano Astorino, MD e, Ugo A. Berti, MD f, Paolo Broganelli, MD g, Antonio Carcaterra, MD h, Maria Teresa Corradin, MD i, Giovanni Pellacani, MD j, Domenico Piccolo, MD k, Massimiliano Risulo, MD l, Ignazio Stanganelli, MD m, Vincenzo De Giorgi, MD a
Reprint requests: Paolo Carli, MD, Department of Dermatology, University of Florence, Via della Pergola 60–50121, Florence, Italy.Florence, Genoa, Sestri Levante, Rome, Carrara, Turin, Lecco, Pordenone, Modena, L’Aquila, Siena, and Ravenna, Italy
Abstract |
Background |
Guidelines for optimized use of digital follow-up of melanocytic lesions are not yet available, and little is known about inclusion criteria adopted in clinical practice.
Objective |
Our purpose was to describe the frequency of digital follow-up adoption in melanoma screening, the characteristics of patients and lesions selected, and the predictors of duration of the intervals of digital follow-up.
Methods |
Baseline characteristics of patients and lesions selected for digital follow-up in 12 Italian pigmented lesion clinics were examined. Predictors of a short follow-up interval (≤3 months) compared with a 6-month interval were investigated by means of logistic regression analysis.
Results |
Out of 2116 subjects consecutively examined, 409 were submitted to digital follow-up (19.3%), with 1.6 mean lesions found per patient (range, 1-9; median, 1). According to an a posteriori analysis, 15.2% of the lesions were diagnostically equivocal and 7.8% of lesions had a total dermoscopy score (TDS) suggestive of malignancy. However, large differences in the TDS were found among the participating centers. Determinants of a short follow-up interval, adopted in 40.8% of patients, were the personal history of melanoma (odds ratio [OR] 2.56, 95% confidence interval [CI] 1.09-5.99) and the presence of atypical nevi (at least one atypical nevus (OR 4.54, 95% CI 2.45-8.42). Unexpectedly, the dermoscopic atypia of the lesion (TDS >4.75) was associated only with a marginal effect on the scheduled duration of follow-up interval (OR 1.34, 95% CI 0.97-1.86). These findings were confirmed by a multivariate analysis.
Limitations |
The adoption of different digital dermoscopy systems in the participating centers may have limited the reliability of the TDS assigned by a central group to dermoscopy images.
Conclusions |
Practicing dermatologists who use digital epiluminescence microscopy in screening for melanoma decided to submit at least one melanocytic lesion to digital follow-up for approximately 1 patient for every 5 examined. This implies costs and time spent that need to be evaluated together with the benefits of this procedure from a large-scale perspective. The lack of well-defined guidelines for inclusion and exclusion criteria may hamper optimized use of digital follow-up in daily practice.
Le texte complet de cet article est disponible en PDF.Abbreviations used : CI, D-ELM, MM, OR, PLC, TDS
Plan
| Funding sources: None. Conflicts of interest: None identified. |
Vol 55 - N° 2
P. 256-262 - août 2006 Retour au numéro
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