Skin cancer screening

  • 文章类型: Journal Article
    第二原发性恶性肿瘤的发生在癌症幸存者中变得越来越重要。黑色素瘤,一种起源于黑素细胞的侵袭性肿瘤,是大多数皮肤癌相关死亡的原因。这篇综述旨在探讨黑色素瘤作为最常见的血液肿瘤亚型之后的第二原发癌的发生风险。起源于髓系或淋巴细胞谱系的恶性疾病。慢性淋巴细胞白血病(CLL)和非霍奇金淋巴瘤(NHL)是与黑色素瘤发展最相关的亚型之一。我们还讨论了可能解释这些恶性肿瘤与黑色素瘤对生存影响之间关联的潜在假设。该综述强调了提高血液肿瘤幸存者对黑色素瘤风险认识的重要性。因为它可以导致迅速的识别,改善皮肤监测,和更好的生存结果。
    The occurrence of second primary malignancies is becoming increasingly important among cancer survivors. Melanoma, an aggressive neoplasm originating from the melanocytes, is responsible for most skin cancer-related deaths. This review aims to explore the risk of melanoma occurrence as a second primary cancer after the most common subtypes of hematologic neoplasia, a malignant disease originating from myeloid or lymphocytic cell lineages. Chronic lymphocytic leukemia (CLL) and non-Hodgkin lymphoma (NHL) are among the most associated subtypes with melanoma development. We also discuss the underlying hypotheses that may explain the associations between these malignancies and the impact of melanoma on survival. The review emphasizes the importance of increasing awareness of melanoma risk in hematologic cancer survivors, as it can lead to prompt recognition, improved skin surveillance, and better survival outcomes.
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  • 文章类型: Letter
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  • 文章类型: Journal Article
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  • 文章类型: Journal Article
    现代诊断程序,例如三维全身摄影(3D-TBP),数字皮肤镜(DD),和反射共聚焦显微镜(RCM),可以改善黑色素瘤的诊断,特别是高危患者。这项研究评估了将这些先进的成像技术结合在三步程序中管理高危患者的好处。这项研究包括410名高危黑色素瘤患者,他们除了在门诊护理中定期进行皮肤检查外,还接受了专门的影像学咨询。每次访问,患者接受了3D-TBP,可疑发现的DD,以及不清楚DD发现的RCM。比较了基于影像学咨询和门诊护理开始切除的组织学发现。影像学咨询在39个切除的色素性病变中发现了16个确诊的黑色素瘤(8个侵袭性和8个原位)。门诊检查在163个切除的黑素细胞病变中发现了7个确诊的黑素瘤(1个侵袭性和6个原位)。影像学会诊中需要切除的人数(NNE)明显低于门诊(2.4vs.23.3).DD的NNE为2.6,RCM为2.3。DD,3D-TBP,或RCM检测到其他成像方法未检测到的黑色素瘤。三步成像程序改善了黑色素瘤的检测,并减少了高危患者不必要的切除次数。
    Modern diagnostic procedures, such as three-dimensional total body photography (3D-TBP), digital dermoscopy (DD), and reflectance confocal microscopy (RCM), can improve melanoma diagnosis, particularly in high-risk patients. This study assessed the benefits of combining these advanced imaging techniques in a three-step programme in managing high-risk patients. This study included 410 high-risk melanoma patients who underwent a specialised imaging consultation in addition to their regular skin examinations in outpatient care. At each visit, the patients underwent a 3D-TBP, a DD for suspicious findings, and an RCM for unclear DD findings. The histological findings of excisions initiated based on imaging consultation and outpatient care were compared. Imaging consultation detected sixteen confirmed melanomas (eight invasive and eight in situ) in 39 excised pigmented lesions. Outpatient care examination detected seven confirmed melanomas (one invasive and six in situ) in 163 excised melanocytic lesions. The number needed to excise (NNE) in the imaging consultation was significantly lower than that in the outpatient care (2.4 vs. 23.3). The NNE was 2.6 for DD and 2.3 for RCM. DD, 3D-TBP, or RCM detected melanomas that were not detected by the other imaging methods. The three-step imaging programme improves melanoma detection and reduces the number of unnecessary excisions in high-risk patients.
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  • 文章类型: Letter
    目的:在过去的四十年中,黑色素瘤的发病率急剧增加,而总死亡率保持稳定。这种发病率的增加而没有总死亡率的变化可能是由于皮肤癌筛查的过度诊断。尽管USPSTF没有足够的证据支持或反对在平均风险的成年人中进行专业皮肤癌筛查,美国皮肤癌筛查实践可能导致皮肤癌的过度诊断。
    方法:两名评审人员审查了由癌症委员会认可的1113个美国癌症中心进行皮肤癌筛查的在线建议,包括国家癌症研究所(NCI)指定的66个。关于皮肤癌筛查的建议,比如年龄,频率,和患者群体(即患皮肤癌的高风险,“有色人种”)被记录下来。
    结果:我们发现18%的中心(202)建议对平均风险的成年人进行专业筛查,35.8%(399)建议定期自我检查,只有3.4%(38)的人提到筛查实践的证据不足;49%的NCI中心(32/66)建议在高风险成人中进行筛查,而13%的非NCI中心(135/1047;p=0.0004);0.45%的中心(5)提到了筛查的潜在危害,而3.5%(39)特别建议对有色人种进行筛查。
    结论:我们的研究表明,许多美国癌症中心建议进行某种形式的皮肤癌筛查,尽管缺乏支持或反对这些做法的证据。很少有中心提到筛查的潜在危害,包括过度诊断。这表明有必要为特定的筛查指南提供更强有力的证据,并提高公众对常规皮肤癌筛查的潜在益处和危害的认识。
    OBJECTIVE: The incidence of melanoma has increased dramatically over the past four decades, while overall mortality has remained stable. This increase in incidence without a change in overall mortality may be due to overdiagnosis through skin cancer screening. Despite the USPSTF citing insufficient evidence for or against professional skin cancer screening in average-risk adults, U.S. skin cancer screening practices may be leading to overdiagnosis of skin cancers.
    METHODS: Two reviewers examined the online recommendations for skin cancer screening of 1113 U.S. cancer centers accredited by the Commission on Cancer, including 66 designated by the National Cancer Institute (NCI). Recommendations on skin cancer screening, such as age, frequency, and patient population (i.e. high-risk of developing skin cancer, \"people of color\") were documented.
    RESULTS: We found that 18% of centers (202) recommended professional screening in average-risk adults, 35.8% (399) advised regular self-examination, and only 3.4% (38) cited insufficient evidence for screening practices; 49% of NCI centers (32/66) recommended screening in high-risk adults compared to 13% of non-NCI centers (135/1047; p = 0.0004); 0.45% of centers (5) mentioned the potential harms of screening, while 3.5% (39) specifically recommended screening for people of color.
    CONCLUSIONS: Our study reveals that many U.S. cancer centers advise some form of skin cancer screening despite a lack of evidence for or against these practices. Few centers mentioned the potential harms of screening, including overdiagnosis. This indicates a need for stronger evidence for specific screening guidelines and for greater public awareness of the potential benefits and harms of routine skin cancer screening.
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  • 文章类型: Journal Article
    背景:使用人工智能(AI)筛查皮肤癌引起了极大的兴趣。这是由于皮肤癌发病率上升和训练有素的皮肤科医生日益稀缺。能够识别黑色素瘤的AI系统可以挽救生命,允许立即访问放映,减少不必要的护理和医疗费用。虽然这种基于人工智能的系统从公共卫生的角度来看是有用的,过去的研究表明,个体患者对于接受AI系统检查非常犹豫。
    目的:这项研究的目的是双重的:(1)确定提供者的相对重要性(当面医生,医生通过远程皮肤病学,AI,个性化AI),筛查费用(免费,10€,25€,40欧元;1欧元=1.09美元),和等待时间(立即,1天,1周,4周)作为有助于患者选择特定皮肤癌筛查模式的属性;和(2)调查社会人口统计学特征是否,尤其是年龄,与参与者的个人选择有系统地相关。
    方法:使用基于选择的联合分析从患者的角度检查医学AI对皮肤癌筛查的接受程度。参与者回答了12个选择集,每个包含三个筛选变体,通过提供者的属性描述每个变体,成本,和等待时间。此外,社会人口学特征的影响(年龄,性别,收入,工作状态,和教育背景)对选择进行了评估。
    结果:在调查链接的383次点击中,共有126名(32.9%)受访者完成了在线调查。联合分析表明,这三个属性在促进参与者的选择方面或多或少具有同等的重要性,提供程序是最重要的属性。检查联合属性的各个部分价值表明,医生的治疗是最优选的方式,其次是与医生的电子咨询和个性化AI;在三个AI级别中得分最低。关于社会人口统计学特征和相对重要性之间的关系,只有年龄与属性提供者的重要性呈显著正相关(r=0.21,P=.02),年轻的参与者对提供者的重视程度低于年长的参与者。所有其他相关性均不显著。
    结论:这项研究增加了越来越多的研究,使用基于选择的实验来调查AI在健康环境中的接受度。未来的研究需要探索人工智能被接受或拒绝的原因,以及社会人口统计学特征是否与这一决定相关。
    BACKGROUND: There is great interest in using artificial intelligence (AI) to screen for skin cancer. This is fueled by a rising incidence of skin cancer and an increasing scarcity of trained dermatologists. AI systems capable of identifying melanoma could save lives, enable immediate access to screenings, and reduce unnecessary care and health care costs. While such AI-based systems are useful from a public health perspective, past research has shown that individual patients are very hesitant about being examined by an AI system.
    OBJECTIVE: The aim of this study was two-fold: (1) to determine the relative importance of the provider (in-person physician, physician via teledermatology, AI, personalized AI), costs of screening (free, 10€, 25€, 40€; 1€=US $1.09), and waiting time (immediate, 1 day, 1 week, 4 weeks) as attributes contributing to patients\' choices of a particular mode of skin cancer screening; and (2) to investigate whether sociodemographic characteristics, especially age, were systematically related to participants\' individual choices.
    METHODS: A choice-based conjoint analysis was used to examine the acceptance of medical AI for a skin cancer screening from the patient\'s perspective. Participants responded to 12 choice sets, each containing three screening variants, where each variant was described through the attributes of provider, costs, and waiting time. Furthermore, the impacts of sociodemographic characteristics (age, gender, income, job status, and educational background) on the choices were assessed.
    RESULTS: Among the 383 clicks on the survey link, a total of 126 (32.9%) respondents completed the online survey. The conjoint analysis showed that the three attributes had more or less equal importance in contributing to the participants\' choices, with provider being the most important attribute. Inspecting the individual part-worths of conjoint attributes showed that treatment by a physician was the most preferred modality, followed by electronic consultation with a physician and personalized AI; the lowest scores were found for the three AI levels. Concerning the relationship between sociodemographic characteristics and relative importance, only age showed a significant positive association to the importance of the attribute provider (r=0.21, P=.02), in which younger participants put less importance on the provider than older participants. All other correlations were not significant.
    CONCLUSIONS: This study adds to the growing body of research using choice-based experiments to investigate the acceptance of AI in health contexts. Future studies are needed to explore the reasons why AI is accepted or rejected and whether sociodemographic characteristics are associated with this decision.
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  • 文章类型: Journal Article
    背景:免疫抑制是皮肤鳞状细胞癌(CSCC)发展的已知危险因素,尤其是实体器官移植受者和慢性淋巴细胞白血病。然而,这种风险在自身免疫和炎症中的定义较少.
    目标:评估疾病类型,免疫抑制的持续时间,全身药物对CSCC应计率有影响,定义为患者每年发展的CSCC数量,在自身免疫和炎症条件。
    方法:回顾性回顾94例免疫抑制(类风湿性关节炎(RA):31[33.0%],炎症性肠病(IBD):17[18.1%],银屑病(PsO):11[11.7%],自身免疫性其他(AO):24[25.5%],炎性其他(IO):21[22.3%])和188个免疫活性对照,以确定所有原发性,2010年至2020年诊断为侵袭性CSCC。
    结果:免疫抑制患者的CSCC累积率高于免疫活性对照组(0.44±0.36):总队列(0.82±0.95,p<0.01),RA(0.88±1.10,p<0.01),IBD(0.94±0.88,p<0.01),PSO(1.06±1.58,p<0.01),AO(0.72±0.56,p<0.01),和IO(0.72±0.61,p<0.01)。肿瘤发生率增加与全身药物暴露之间存在关联,包括,免疫调节剂,TNF抑制剂,非TNF抑制剂生物制剂,和皮质类固醇,但与全身性药物类别暴露的次数或免疫抑制的持续时间无关。
    结论:回顾性,单中心研究结论:自身免疫和炎症患者的CSCCs发生率高于免疫功能正常患者。
    BACKGROUND: Immunosuppression is a known risk factor for the development of cutaneous squamous cell carcinoma (CSCC), especially in solid organ transplant recipients and chronic lymphocytic leukemia. However, this risk is less well defined in autoimmune and inflammatory conditions.
    OBJECTIVE: Assess the impact that disease-type, duration of immunosuppression, and systemic medications have on CSCC accrual rates, defined as the number of CSCCs a patient develops per year, in autoimmune and inflammatory conditions.
    METHODS: Retrospective review of 94 immunosuppressed (rheumatoid arthritis: 31[33.0%], inflammatory bowel disease: 17[18.1%], psoriasis: 11[11.7%], autoimmune other (AO): 24[25.5%], inflammatory other: 21[22.3%]) and 188 immunocompetent controls to identify all primary, invasive CSCCs diagnosed from 2010 to 2020.
    RESULTS: Immunosuppressed patients had higher CSCC accrual rates than immunocompetent controls (0.44 ± 0.36): total cohort (0.82 ± 0.95, P < .01), rheumatoid arthritis (0.88 ± 1.10, P < .01), inflammatory bowel disease (0.94 ± 0.88, P < .01), psoriasis (1.06 ± 1.58, P < .01), AO (0.72 ± 0.56, P < .01), and inflammatory other (0.72 ± 0.61, P < .01). There was an association between increased tumor accrual rates and exposure to systemic medications including, immunomodulators, tumor necrosis factor-alpha inhibitors, non-tumor necrosis factor inhibitor biologics, and corticosteroids, but not with number of systemic medication class exposures or duration of immunosuppression.
    CONCLUSIONS: Retrospective, singlecenter study.
    CONCLUSIONS: Patients with autoimmune and inflammatory conditions accrue CSCCs at higher rates than immunocompetent patients.
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  • 文章类型: Journal Article
    这项研究调查了美国两次免费皮肤癌筛查事件参与者的结果和随访行为。这项调查,有296名参与者和31%的回应率,收集了有关参与者人口统计的信息,个人皮肤癌史,皮肤筛查实践的知识,和后续行为。在建议进一步皮肤科会诊的个体中,有92.3%的高随访率,但筛查的初步诊断与患者召回的诊断之间的一致率较低(22%)。此外,约1/6的参与者认为有限的治疗机会是参与筛查的动机.该研究强调需要提高对免费筛查局限性的认识,加强参与者教育,并确保公平获得皮肤癌筛查。未来的研究应集中在影响后续行为的因素上,并制定有针对性的干预措施,以提高对皮肤癌筛查的认识和获取。
    This study investigated the outcomes and follow-up behaviors of participants from two free skin cancer screening events in the United States. This survey, with 296 participants and a 31% response rate, gathered information on participant demographics, personal history of skin cancer, knowledge of skin screening practices, and follow-up behaviors. There was a high follow-up rate of 92.3% among individuals recommended for further dermatological consultation, but a low (22%) concordance rate between the preliminary diagnoses from the screening and patient-recalled diagnoses. Additionally, about one-sixth of participants identified limited access to care as a motivation for participating in the screening. The study emphasizes the need to improve awareness about the limitations of free screenings, enhance participant education, and ensure equitable access to skin cancer screening. Future research should focus on factors influencing follow-up behaviors and the development of targeted interventions to increase awareness and access to skin cancer screening.
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