William V Stoecker

• Missouri University of Science and Technology

In recent years, deep learning (DL) has been used extensively and successfully to diagnose different cancers in dermoscopic images. However, most approaches lack clinical inputs supported by dermatologists that could aid in higher accuracy and explainability. To dermatologists, the presence of telangiectasia, or narrow blood vessels that typically...

A critical clinical indicator for basal cell carcinoma (BCC) is the presence of telangiectasia (narrow, arborizing blood vessels) within the skin lesions. Many skin cancer imaging processes today exploit deep learning (DL) models for diagnosis, segmentation of features, and feature analysis. To extend automated diagnosis, recent computational intel...

Deep learning implemented with convolutional network architectures can exceed specialists' diagnostic accuracy. However, whole-image deep learning trained on a given dataset may not generalize to other datasets. The problem arises because extra-lesional features - ruler marks, ink marks, and other melanoma correlates - may serve as information leak...

Background The removal of hair and ruler marks is critical in handcrafted image analysis of dermoscopic skin lesions. No other dermoscopic artifacts cause more problems in segmentation and structure detection. Purpose The aim of the work is to detect both white and black hair, artifacts and finally inpaint correctly the image. Method We introduce...

Simple Summary Supervised deep learning techniques can now automatically process whole dermoscopic images and obtain a diagnostic accuracy for melanoma that exceeds that of specialists. These automatic diagnosis systems are now appearing in clinics. However, the computational techniques used cannot be easily interpreted by the experts using the sys...

Hair and ruler mark structures in dermoscopic images are an obstacle preventing accurate image segmentation and detection of critical network features. Recognition and removal of hairs from images can be challenging, especially for hairs that are thin, overlapping, faded, or of similar color as skin or overlaid on a textured lesion. This paper prop...

Deep learning (DL) applied to whole dermoscopic images has shown unprecedented accuracy in differentiating images of melanoma from benign lesions. We hypothesize that accuracy in whole-image deep learning suffers because whole lesion analysis lacks an evaluation of dermoscopic structures. DL also suffers a “black box” characterization because it of...

In prior research, the authors introduced an automated, localized, fusion-based approach for classifying squamous epithelium into Normal, CIN1, CIN2, and CIN3 grades of cervical intraepithelial neoplasia (CIN) from digitized histology image analysis. The image analysis approach partitioned the epithelium along the medial axis into ten vertical segm...

Cervical cancer is the second most common cancer affecting women worldwide but is curable if diagnosed early. Routinely, expert pathologists visually examine histology slides for assessing cervix tissue abnormalities. A localized, fusion-based, hybrid imaging and deep learning approach is explored to classify squamous epithelium into cervical intra...

Purpose Blood vessels called telangiectasia are visible in skin lesions with the aid of dermoscopy. Telangiectasia are a pivotal identifying feature of basal cell carcinoma. These vessels appear thready, serpiginous, and may also appear arborizing, that is, wide vessels branch into successively thinner vessels. Due to these intricacies, their detec...

Optical oxygen sensors based on photoluminescence quenching have gained increasing attention as a superior method for continuous monitoring of oxygen in a growing number of applications. A simple and low-cost fabrication technique was developed to produce sensor arrays capable of two-dimensional oxygen tension measurement. Sensor patches were print...

Cervical intraepithelial neoplasia (CIN) is regarded as a potential precancerous state of the uterine cervix. Timely and appropriate early treatment of CIN can help reduce cervical cancer mortality. Accurate estimation of CIN grade correlated with human papillomavirus (HPV) type, which is the primary cause of the disease, helps determine the patien...

Cervical cancer is one of the deadliest cancers affecting women globally. Cervical intraepithelial neoplasia (CIN) assessment using histopathological examination of cervical biopsy slides is subject to interobserver variability. Automated processing of digitized histopathology slides has the potential for more accurate classification for CIN grades...

Cervical cancer is the second most common cancer affecting women worldwide but is curable if diagnosed early. Routinely, expert pathologists visually examine histology slides for assessing cervix tissue abnormalities. A localized, fusion-based, hybrid imaging and deep learning approach is explored to classify squamous epithelium into cervical intra...

Purpose We present a classifier for automatically selecting a lesion border for dermoscopy skin lesion images, to aid in computer‐aided diagnosis of melanoma. Variation in photographic technique of dermoscopy images makes segmentation of skin lesions a difficult problem. No single algorithm provides an acceptable lesion border to allow further proc...

This paper presents an approach that combines conventional image processing with deep learning by fusing the features from the individual techniques. We hypothesize that the two techniques, with different error profiles, are synergistic. The conventional image processing arm uses three handcrafted biologically inspired image processing modules and...

We present four entropy-based methods for colour segmentation within a lesion in a dermoscopy image for classification of the image as melanoma or benign. Four entropy segmentation methods are based on Tsallis, Havrda and Charvat, Renyi and Kapur entropy measures. Segmentation through Six Sigma threshold as preprocessor is also evaluated by this as...

We review recent findings on medical aspects of marijuana use in order to identify those who are at greatest risk of marijuana-related medical problems. We analyze the impact of medical marijuana laws on health, in particular the disproportionate effects on adolescents and children. Chronic marijuana use predominantly affects certain areas of the b...

In prior research, the authors introduced an automated, localized, fusion-based approach for classifying squamous epithelium into Normal, CIN1, CIN2, and CIN3 grades of cervical intraepithelial neoplasia (CIN) from digitized histology image analysis. The image analysis approach partitioned the epithelium along the medial axis into ten vertical segm...

Objective: Inexpensive methods for more rapid healing of secondary intention wounds are sought. This pilot study measured the wound healing rate for a new zinc oxide structured dressing technique. Method: In this study, we included the three patients with the largest wounds with onset during a one month period. A 3-ply gauze was cut and placed in...

A fuzzy logic-based color histogram analysis technique is presented for discriminating benign skin lesions from malignant melanomas in dermoscopy images. The approach extends previous research for utilizing a fuzzy set for skin lesion color for a specified class of skin lesions, using alpha-cut and support set cardinality for quantifying a fuzzy ra...

The report by Khosla et al.(1) highlights a critical gap in osteoporosis management: patients who need pharmacological therapy are either not being prescribed these medications or fail to take them, especially bisphosphonates. We suggest three changes to the paths proposed by the authors to further improve osteoporosis treatment: new ways to guide...

The notoriety of the brown recluse spider, Loxosceles reclusa, has resulted in many dermatological conditions beingmisdiagnosedasthebiteofthisarachnid.ThesemisdiagnosesoccurthroughoutNorthAmericaandareofconcernespeciallyinAmericanstatesandCanadianprovinces where no brownrecluse populations are knownto exist. About40medical conditions have been or c...

A vision-based measurement approach for pill shape detection is presented along with other applications. Rapid and accurate pill identification is needed by medical and law enforcement personnel during emergencies. But real-world pill identification is challenging due to varied lighting conditions, minor manufacturing defects, and subsequent pill w...

Misidentified or unidentified prescription pills are an increasing challenge for all caregivers, both families and professionals. Errors in pill identification may lead to serious or fatal adverse events. To respond to this challenge, a fast and reliable automated pill identification technique is needed. The first and most critical step in pill ide...

We analyze 25 accidental childhood fentanyl exposures reported to FDA, 2004-2013. These exposures had a case-fatality rate = 48%; male:female ratio = 7.3; 76% were within the 2-4 age range. The ability of fentanyl to kill children so quickly is explained by fentanyl's ability to suppress respiration-as quantified by the antinociceptive potency per...

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Background: Pink blush is a common feature in basal cell carcinoma (BCC). A related feature, semitranslucency, appears as smooth pink or orange regions resembling skin color. We introduce an automatic method for detection of these features based on smoothness and brightness. We also introduce a neighborhood correction method for texture area corre...

Background: Evolving dermoscopic terminology motivated us to initiate a new consensus. Objective: We sought to establish a dictionary of standardized terms. Methods: We reviewed the medical literature, conducted a survey, and convened a discussion among experts. Results: Two competitive terminologies exist, a more metaphoric terminology that...

Background: Venous leg ulcers generally take manyweeks to heal. Novel therapies that shorten healingtime and require less complex care are needed. Purpose: The purpose of this report is to presenta pilot study for a new method that can result ina faster healing time for venous leg ulcers usinginexpensive materials. Methods: A central-gauzeprot...

Cervical cancer, which has been affecting women worldwide as the second most common cancer, can be cured if detected early and treated well. Routinely, expert pathologists visually examine histology slides for cervix tissue abnormality assessment. In previous research, we investigated an automated, localized, fusion-based approach for classifying s...

Background/Purpose: Computer-aided diagnosis of skin cancer requires accurate lesion segmentation, which must overcome noise such as hair, skin color variations, and ambient light variability. Methods: A biologically inspired geodesic active contour (GAC) technique is used for lesion segmentation. The algorithm presented here employs automatic cont...

History and physical examination remain the primary sources of information for the clinical decision of skin cancer diagnosis, even with in-vivo diagnostic aids.(1,2) Marghoob and Scope(3) identified six components for a decision to biopsy: five arise from visual examination, while the sixth relates to "history, e.g. patient concerns." Patient conc...

Early detection of malignant melanoma is an important public health challenge. In the USA, dermatologists are seeing more melanomas at an early stage, before classic melanoma features have become apparent. Pink color is a feature of these early melanomas. If rapid and accurate automatic detection of pink color in these melanomas could be accomplish...

Importance Bites from the brown recluse spider (BRS) can cause extreme pain. We propose cytokine release as a cause of the discomfort and a central mechanism through glial cell upregulation to explain measured pain levels and time course.Observations Twenty-three BRS bites were scored at a probable or documented level clinically, and an enzyme-li...

This is the first part of a two-part article on personal details revealed by the hand examination. Daily activities revealed by hand examination are the focus of Part 1, while personal details including nutrition and psychological assessment are presented in Part 2. These clues enable the examiner to discern hobbies, vocation, sporting activities,...

Fuzzy logic image analysis techniques were used to analyze three shades of blue (lavender blue, light blue, and dark blue) in dermoscopic images for melanoma detection. A logistic regression model provided up to 82.7% accuracy for melanoma discrimination for 866 images. With a support vector machines (SVM) classifier, lower accuracy was obtained fo...

Background: Telangiectasia, tiny skin vessels, are important dermoscopy structures used to discriminate basal cell carcinoma (BCC) from benign skin lesions. This research builds off of previously developed image analysis techniques identified vessels automatically to discriminate benign lesions from BCCs. Methods: A biologically-inspired reinforcem...

We report an atypical course of a likely brown recluse spider bite in a 79-year-old male. The Rader scale and Loxosceles reclusa venom detection by ELISA provide supporting evidence for a loxoscelism diagnosis. Obtundation and myocardial infarction occurred following a drop in hemoglobin to 6.5g/dL. The rapid loss of blood volume was considered a s...

Background Telangiectasia, tiny skin vessels, are important dermoscopy structures used to discriminate basal cell carcinoma (BCC) from benign skin lesions. This research builds off of previously developed image analysis techniques to identify vessels automatically to discriminate benign lesions from BCCs. MethodsA biologically inspired reinforcemen...

Background. In dermoscopic images, multiple shades of pink have been described in melanoma without specifying location of these areas within the lesion. Objective. The purpose of this study was to determine the statistics for the presence of centrally and peripherally located pink melanoma and benign melanocytic lesions. Methods. Three observers, u...

Background Basal cell carcinoma (BCC) is the most commonly diagnosed cancer in the USA. In this research, we examine four different feature categories used for diagnostic decisions, including patient personal profile (patient age, gender, etc.), general exam (lesion size and location), common dermoscopic (blue‐gray ovoids, leaf‐structure dirt trail...

Acanthosis nigricans (AN) is so closely linked with insulin resistance (IR) that it has been called a clinical surrogate for laboratory-determined hyperinsulinemia.1 The presence of AN can therefore indicate patients with IR, allowing implementation of interventions that may prevent progression to type 2 diabetes mellitus.2 We report 30 patients wh...

To the Editor The study by Wolf et al1 highlights the low accuracy of smartphone applications for melanoma self-detection, and correctly concludes that these applications could harm patients by delaying melanoma treatment through incorrect diagnosis. The article also found 98% sensitivity with 30.4% specificity for pigmented lesion evaluation by st...

Blue-gray ovoids (B-GOs) are critical dermoscopic structures in basal cell carcinomas (BCCs) that pose a challenge for automatic detection. Due to variation in size and color, B-GOs can be easily mistaken for similar structures in benign lesions. Analysis of these structures could help further accomplish the goal of automatic BCC detection. This st...

Abstract While there are limited options for chemical-free Arachnid pest control, glue-traps are one suitable alternative to pesticides. The effectiveness of several three-dimensional glue-trap shapes for trapping the brown recluse spider, Loxosceles reclusa Gertsch and Mulaik (Araneae: Sicariidae), was investigated using four novel glue-trap shape...

How far are we away from a Star-Trek-like device that can analyze a lesion and assess its malignancy? We review the main challenges in this field in light of the Blois paradigm of clinical judgment and computers. The research community has failed to adequately address several challenges ripe for the application of digital technology: 1) early detec...

Early detection of melanoma by magnified visible-light imaging (dermoscopy) is hindered by lesions which mimic melanoma. Automatic discrimination of melanoma from mimics could allow detection of melanoma at an earlier stage. Seborrheic keratoses are common mimics; these have distinctive bright structures: starry milia-like cysts (MLCs). We report d...

Detection of melanoma remains an empirical clinical science. New tools for automatic discrimination of melanoma from benign lesions in digitized dermoscopy images may allow an improvement in early detection of melanoma. This research implements a fast version of the median split algorithm in an open source format and applied to four-color splitting...

There is a vital need for fast and accurate recognition of medicinal tablets and capsules. Efforts to date have centered on automatic segmentation, color and shape identification. Our system combines these with preprocessing before imprint recognition. Using the National Library of Medicine Pillbox database, regression analysis applied to automatic...

Black-spot poison ivy is an uncommon presentation of poison ivy (Toxicodendron) allergic contact dermatitis. A 78-year-old sought evaluation of a black spot present on her right hand amid pruritic vesicles. The presentation of a black spot on the skin in a clinical context suggesting poison ivy is indicative of black-spot poison ivy. Dermoscopy rev...

Telangiectasia, tiny skin vessels, are important dermoscopy structures used to discriminate basal cell carcinoma (BCC) from benign skin lesions. This research builds off of previously developed image analysis techniques to identify vessels automatically to discriminate benign lesions from BCCs. A biologically inspired reinforcement learning approac...

Scale-crust, also termed "keratin crust", appears as yellowish-to-tan scale on the skin's surface. It is caused by hyperkeratosis and parakeratosis in inflamed areas of squamous cell carcinoma in situ (SCCIS, Bowen's disease) and is a critical dermoscopy feature for detecting this skin cancer. In contrast, scale appears as a white-to-ivory detachin...

Blue-gray ovoids (B-GOs), a critical dermoscopic structure for basal cell carcinoma (BCC), offer an opportunity for automatic detection of BCC. Due to variation in size and color, B-GOs can be easily mistaken for similar structures in benign lesions. Analysis of these structures could afford accurate characterization and automatic recognition of B-...

Background: Basal cell carcinoma (BCC) is the most commonly diagnosed cancer in the USA. In this research, we examine four different feature categories used for diagnostic decisions, including patient personal profile (patient age, gender, etc.), general exam (lesion size and location), common dermoscopic (blue-gray ovoids, leaf-structure dirt tra...

Ulcers are frequently visible in magnified, cross-polarized, dermoscopy images of basal cell carcinoma. An ulcer without a history of trauma, a so-called 'atraumatic' ulcer, is an important sign of basal cell carcinoma, the most common skin cancer. Distinguishing such ulcers from similar features found in benign lesions is challenging. In this rese...

Photosensitivity to sitagliptin, a dipeptidyl peptidase-4 (DPP-4) inhibitor, is reported. No previous reports of photosensitivity to any DPP-4 inhibitors are known. Physical examination of the patient revealed edematous plaques confined to sun-exposed areas of the skin. An unusual finding in this case was the spongy sensation upon palpation of the...

Basal cell carcinoma (BCC) is the most common cancer in the US. Dermatoscopes are devices used by physicians to facilitate the early detection of these cancers based on the identification of skin lesion structures often specific to BCCs. One new lesion structure, referred to as dirt trails, has the appearance of dark gray, brown or black dots and c...

Studies have shown that the incidence of melanoma in situ (MIS) is increasing significantly. This study analyzes selected clinical and demographic characteristics of MIS cases observed in private dermatology practices in the United States. This study collected 257 MIS cases from 4 private dermatology practices in the United States from January 2005...

Early excision is the only strategy to reduce melanoma mortality, but unnecessary excision of benign lesions increases morbidity and healthcare costs. To assess accuracy in melanoma detection based on number-needed-to-excise (NNE) values over a 10-year period. Information was retrieved on all histopathologically confirmed cutaneous melanomas or mel...

Seborrheic keratoses are the most common skin lesions known to contain small white or yellow structures called milia-like cysts (MLCs). Varied appearances can sometimes make it difficult to differentiate benign lesions from malignant lesions such as melanoma, the deadliest form of skin cancer found in humans. The purpose of this study was to determ...

Background: Telangiectasia, dilated blood vessels near the surface of the skin of small, varying diameter, are critical dermoscopy structures used in the detection of basal cell carcinoma (BCC). Distinguishing these vessels from other telangiectasia, that are commonly found in sun-damaged skin, is challenging. Methods: Image analysis techniques...

In this work, a dermoscopic image analysis technique is proposed. A novel approach, based on the detection of gray areas using image analysis techniques is explored. To this aim, a statistical histogram analysis is carried out using the HSB color space to derive the relationship between the skewness and the mean of the brightness color plane histog...

Dermoscopy, also known as dermatoscopy or epiluminescence microscopy (ELM), permits visualization of features of pigmented melanocytic neoplasms that are not discernable by examination with the naked eye. White areas, prominent in early malignant melanoma and melanoma in situ, contribute to early detection of these lesions. An adaptive detection me...

Background: Dermoscopy is one of the major imaging modalities used in the diagnosis of melanoma and other pigmented skin lesions. Due to the difficulty and subjectivity of human interpretation, computerized analysis of dermoscopy images has become an important research area. One of the most important steps in dermoscopy image analysis is the automa...

In previous research, a watershed-based algorithm was shown to be useful for automatic lesion segmentation in dermoscopy images, and was tested on a set of 100 benign and malignant melanoma images with the average of three sets of dermatologist-drawn borders used as the ground truth, resulting in an overall error of 15.98%. In this study, to reduce...

Granularity, also called peppering and multiple blue-grey dots, is defined as an accumulation of tiny, blue-grey granules in dermoscopy images. Granularity is most closely associated with a diagnosis of malignant melanoma. This study analyzes areas of granularity with color and texture measures to discriminate granularity in melanoma from similar a...

Background: Dermoscopy is one of the major imaging modalities used in the diagnosis of melanoma and other pigmented skin lesions. Due to the difficulty and subjectivity of human interpretation, automated analysis of dermoscopy images has become an important research area. Border detection is often the first step in this analysis. Methods: In this a...

Dermoscopy is a non-invasive skin imaging technique, which permits visualization of features of pigmented melanocytic neoplasms that are not discernable by examination with the naked eye. One of the most important features for the diagnosis of melanoma in dermoscopy images is the blue-white veil (irregular, structureless areas of confluent blue pig...

Background: Dermoscopy is one of the major imaging modalities used in the diagnosis of melanoma and other pigmented skin lesions. Due to the difficulty and subjectivity of human interpretation, dermoscopy image analysis has become an important research area. One of the most important steps in dermoscopy image analysis is the automated detection of...

Automatic lesion segmentation is an important part of computer-based image analysis of pigmented skin lesions. In this research, a watershed algorithm is developed and investigated for adequacy of skin lesion segmentation in dermoscopy images. Hair, black border and vignette removal methods are introduced as preprocessing steps. The flooding varian...

In this paper, an unsupervised approach based on Evolving Vector Quantization (EVQ) is presented for enhancing dermatology images for skin lesion segmentation. Vector Quantization (VQ) as a famous compression technique has been widely used in image signal compression and speech signal compression. The EVQ algorithm extends the Linde, Buzo, and Gray...

The presence of an atypical (irregular) pigment network (APN) can indicate a diagnosis of melanoma. This study sought to analyze the APN with texture measures. For 106 dermoscopy images including 28 melanomas and 78 benign dysplastic nevi, the areas of APN were selected manually. Ten texture measures in the CVIPtools image analysis system were appl...

Dermoscopy is one of the major imaging modalities used in the diagnosis of melanoma and other pigmented skin lesions. Owing to the difficulty and subjectivity of human interpretation, dermoscopy image analysis has become an important research area. One of the most important steps in dermoscopy image analysis is the automated detection of lesion bor...

To identify and analyze subtypes of globules based on size, shape, network connectedness, pigmentation, and distribution to determine which globule types and globule distributions are most frequently associated with a diagnosis of malignant melanoma. Retrospective case series of dermoscopy images with globules. Private dermatology practices. Patien...

We report here a case of systemic loxoscelism, confirmed by bite-site skin surface swab. Features of systemic loxoscelism present in this case included debilitating symptoms, a classic local bite-site reaction, hemolysis causing loss of approximately 15% of the blood volume within 72 hours, and a symptomatic exanthem. A skin surface ELISA test was...

Semitranslucency, defined as a smooth, jelly-like area with varied, near-skin-tone color, can indicate a diagnosis of basal cell carcinoma (BCC) with high specificity. This study sought to analyze potential areas of semitranslucency with histogram-derived texture and color measures to discriminate BCC from non-semitranslucent areas in non-BCC skin...

Dermoscopy is one of the major imaging modalities used in the diagnosis of melanoma and other pigmented skin lesions. Because of the difficulty and subjectivity of human interpretation, automated analysis of dermoscopy images has become an important research area. Border detection is often the first step in this analysis. In this article, we presen...

Tinea versicolor (TV) is a superficial cutaneous mycosis that is caused by an overgrowth of Malassezia furfur, a dimorphic, lipophilic yeast that is present in normal skin (Figure 1). The pigmentation of TV lesions varies from white or light pink to dark brown (Figure 2). We demonstrate the “evoked scale sign” of TV, in which a visible layer of thi...

Diagnosis of Loxosceles reclusa envenomations is currently based upon clinical presentation. An enzyme-linked immunosorbent assay (ELISA) can detect surface Loxosceles venom at the envenomation site, allowing diagnostic confirmation. The length of time that venom on the skin is recoverable non-invasively is unknown. To investigate duration of recov...

We report here one case of tularemia, one case of human monocytic ehrlichiosis, and one case of febrile illness most consistent with tularemia with titers suggestive of Rocky Mountain spotted fever in residents of three south-central Missouri counties. All three cases had with nonspecific symptoms of a febrile illness. All three patients had a hist...

Dermoscopy is one of the major imaging modalities used in the diagnosis of melanoma and other pigmented skin lesions. Due to the difficulty and subjectivity of human interpretation, computerized analysis of dermoscopy images has become an important research area. One of the most important steps in dermoscopy image analysis is the automated detectio...

The clinical feature semitranslucency, defined as a semiliquid or jellylike appearance, is a useful optical phenomenon for the identification of basal cell carcinoma (BCC).1 Semitranslucent areas in dermoscopic images of BCC also display the smooth, jellylike appearance of the clinical counterpart. The color ranges from reddish pink, usually seen i...