Strategies for early melanoma detection: Approaches to the patient with nevi

Department of Dermatology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA.
Journal of the American Academy of Dermatology (Impact Factor: 4.45). 06/2009; 60(5):719-35; quiz 736-8. DOI: 10.1016/j.jaad.2008.10.065
Source: PubMed


Given its propensity to metastasize and the lack of effective therapies for most patients with advanced disease, early detection of melanoma is a clinical imperative. Although there are no noninvasive techniques for the definitive diagnosis of melanoma, and the "gold standard" remains biopsy with histologic examination, a variety of modalities may facilitate early melanoma diagnosis and the detection of new and changing nevi. This article reviews the general clinical principles of early melanoma detection and various modalities that are currently available or on the horizon, providing the clinician with an up to date understanding of management strategies for their patients with numerous or atypical nevi. LEARNING OBJECTIVE: After completing this learning activity, participants should understand the clinical importance of early melanoma detection, appreciate the challenges of early melanoma diagnosis and which patients are at highest risk, know the general principles of early melanoma detection, be familiar with current and emerging modalities that may facilitate early melanoma diagnosis and the detection of new and changing nevi, know the advantages and limitations of each modality, and be able to practice a combined approach to the patient with numerous or clinically atypical nevi.

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    • "Despite the fact that early melanoma identification is linked to improved survival rates (e.g., Geller et al. 2011; Kasparian et al. 2009; Rigel and Carucci 2000), existing technology for promoting early detection appears to be fairly ineffective (e.g., Goodson and Grossman 2008; McWhirter and Hoffman- Goetz 2013; Pollitt et al. 2009). There is clearly a need for new perspectives on this problem. "
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    ABSTRACT: Early detection is critical to successful treatment of melanoma, and at-risk individuals often are educated about melanoma by showing them examples of symptom-free and highly symptomatic lesions. We explain why, according to principles of stimulus control, this common practice could discourage the detection of newly developed symptoms and present an experiment modeling the predicted effects. Using images depicting a continuum of melanoma symptom severity, we familiarized participants with a symptomatic lesion (S+), and then conducted generalization tests to determine how often they would label other degrees of symptom severity as the same as (unchanged from) S+. During training for a group that was modeled after typical melanoma education efforts, S- was an asymptomatic lesion. For passive and active control groups, respectively, S- was either absent or a more severely symptomatic lesion. In generalization tests, gradient shift occurred such that stimuli similar to S- were especially unlikely to be called “same.” For the target group, this resulted in reduced labeling of mildly symptomatic lesions as symptomatic. We discuss the implications of these findings for melanoma education efforts.
    The Psychological record 04/2015; 65(2):323-335. DOI:10.1007/s40732-014-0108-x · 0.96 Impact Factor
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    • "It also allows reproducibility in the diagnosis, as well as the use of digital image processing techniques. There are also new encouraging techniques other than dermoscopy [4] [5] [6] [7] [8]; notwithstanding, given its facility for image acquisition, its good results and its high degree of utilization among medical experts, its use for a long period of time is ensured; in fact, dermoscopy has been recognized as the " gold standard " in the screening phase [8]. "
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    ABSTRACT: By means of this study, a detection algorithm for the "pigment network" in dermoscopic images is presented, one of the most relevant indicators in the diagnosis of melanoma. The design of the algorithm consists of two blocks. In the first one, a machine learning process is carried out, allowing the generation of a set of rules which, when applied over the image, permit the construction of a mask with the pixels candidates to be part of the pigment network. In the second block, an analysis of the structures over this mask is carried out, searching for those corresponding to the pigment network and making the diagnosis, whether it has pigment network or not, and also generating the mask corresponding to this pattern, if any. The method was tested against a database of 220 images, obtaining 86% sensitivity and 81.67% specificity, which proves the reliability of the algorithm.
    Computers in Biology and Medicine 11/2013; 44(1). DOI:10.1016/j.compbiomed.2013.11.002 · 1.24 Impact Factor
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    • "In this study, we focused on melanoma, which has doubled over the past decades and the incidence is increasing more rapidly than any other cancer [17]. Although melanoma skin cancer can be cured by surgical excision and efforts have been carried out to develop new therapies, the prognosis of patients are poor and the 5-year survival rates range from merely 10% to 50% [17,18]. "
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    ABSTRACT: Oncolytic virotherapy is an attractive drug platform of cancer gene therapy, but efficacy and specificity are important prerequisites for success of such strategies. Previous studies determined that Apoptin is a p53 independent, bcl-2 insensitive apoptotic protein with the ability to specifically induce apoptosis in tumor cells. Here, we generated a conditional replication-competent adenovirus (CRCA), designated Ad-hTERT-E1a-Apoptin, and investigated the effectiveness of the CRCA a gene therapy agent for further clinical trials. The observation that infection with Ad-hTERT-E1a-Apoptin significantly inhibited growth of the melanoma cells, protecting normal human epidermal melanocytes from growth inhibition confirmed cancer cell selective adenoviral replication, growth inhibition, and apoptosis induction of this therapeutic approach. The in vivo assays performed by using C57BL/6 mice containing established primary or metastatic tumors expanded the in vitro studies. When treated with Ad-hTERT-E1a-Apoptin, the subcutaneous primary tumor volume reduction was not only observed in intratumoral injection group but in systemic delivery mice. In the lung metastasis model, Ad-hTERT-E1a-Apoptin effectively suppressed pulmonary metastatic lesions. Furthermore, treatment of primary and metastatic models with Ad-hTERT-E1a-Apoptin increased mice survival. These data further reinforce the previously research showing that an adenovirus expressing Apoptin is more effective and advocate the potential applications of Ad-hTERT-E1a-Apoptin in the treatment of neoplastic diseases in future clinical trials.
    Molecular Cancer 01/2010; 9(1):10. DOI:10.1186/1476-4598-9-10 · 4.26 Impact Factor
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