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

4. Skin self-examination
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;

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 Science Pearls 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