Background Ultrasound imaging has recently benefited from the introduction of a new 70 MHz transd... more Background Ultrasound imaging has recently benefited from the introduction of a new 70 MHz transducer able to provide high-resolution images, i.e.: ultra-high-frequency ultrasound (UHFUS). Objectives To study the morphological features of Basal Cell Carcinoma (BCC) and measure BCC thickness by means of UHFUS examination. Methods This retrospective multicentric study included 171 consecutive patients that underwent UHFUS examination between November 2018 and May 2019 for suspeted BCC. Diagnosis was confirmed by histopathology. A series of morphologic parameters including echogenicity, structure, borders, shape composition (i.e., presence of intralesional structures) were investigated along with objective measurements such as thickness (i.e., maximum distance between the surface of the epidermis and the deepest part of the tumor) and wideness. Results A total of 117 BCC of superficial (n = 13; 11.1%), nodular (n = 64; 54.5%), infiltrative (n = 17; 14.5%), mixed subtype (n = 18; 16.1%)...
Background Line-field confocal optical coherence tomography (LC-OCT) is a new in vivo emerging te... more Background Line-field confocal optical coherence tomography (LC-OCT) is a new in vivo emerging technique that provides cellular resolution, allows deep imaging (400 μm) and produces real-time images in both the horizontal and vertical plane and in three dimensions. No previous description of different subtypes of melanocytic lesions and their correlation with histopathology and reflectance confocal microscopy has been reported. Aim To describe the features of melanocytic lesions by LC-OCT and their correlation with histopathology and reflectance confocal microscopy (RCM) findings. Methods Selected melanocytic benign lesions and melanomas were imaged in vivo with RCM and LC-OCT at the Fundación Hospital Clinic (Barcelona, Spain). A minimum area of 4 × 4 mm (block image) at four depths (stratum granulosum, suprabasal, layer dermoepidermal junction and upper dermis) were acquired with RCM and a minimum of three cubes with LC-OCT. Horizontal, vertical sections and three-dimensional (3D)...
This open-label study takes aim at the valutation of the efficacy and safety of facial injections... more This open-label study takes aim at the valutation of the efficacy and safety of facial injections of an Polyacrilamide Hydrogel (PAIG), in HIV-positive people that showed different level (severe, moderate and mild) of facial lipoatrophy. This is a typical AIDS-related pathology that involve a loss of subcutaneous fat in the face, especially in cheeks, temples and nasolabial folds, and other parts of the body, and often it consequently cause some mental rebound (lack of self-interest or loose of self-esteem). 36 HIV-positive subjects with facial lipoatrophy were enrolled. Every treatment consisted of the injection of 1 to 2 vials of PAIG on the first day, and every 4 weeks for some months, according to the level of facial lipoatrophy. We previously advised each one of the subjects to avoid sunburn in the injection's area. Patient's valuation has been done by facial ecosonography, along with clinical examination. Withal we took standard photographs before and after the treatme...
Italian journal of dermatology and venereology, 2021
Born in 1995, teledermatology (TD) turns 25 years old today. Since then, TD evolved according to ... more Born in 1995, teledermatology (TD) turns 25 years old today. Since then, TD evolved according to patients and physicians needs. The present review aimed to summarize all the efforts and experiences carried out in the field of TD and its subspecialties, the evolution and the future perspectives. A literature search was conducted in PubMed and Google Scholar. The state of the art of the "tele-dermo research" included TD and clinical trials, TD/TDS web platforms, TDS and artificial intelligence studies. Finally, the future perspective of TD/TDS in the era of social distancing was discussed. Using TD in specific situations adds several benefits including time-effectiveness of intervention and reduction in the waiting time for the first visit, reduced travel-costs, reduced sanitary costs, equalization of access from patient to specialistic consult. The communication technologies devices currently available can adequately support the growing needs of tele-assistance. A main limi...
Journal of the European Academy of Dermatology and Venereology, 2019
Although live and teledermoscopic examination has been successfully used to achieve non‐invasive ... more Although live and teledermoscopic examination has been successfully used to achieve non‐invasive diagnosis of melanocytic skin lesions (MSLs), early melanoma (EM) and atypical nevi (AN) continue to be a challenge, and none of the various algorithms proposed have been sufficiently accurate. We designed a scoring classifier diagnostic method, the iDScore that combines clinical data of the patient with dermoscopic features of the MSL.
Diagnosis based on histopathology for skin cancer detection is today’s gold standard and relies o... more Diagnosis based on histopathology for skin cancer detection is today’s gold standard and relies on the presence or absence of biomarkers and cellular atypia. However it suffers drawbacks: it requires a strong expertise and is time-consuming. Moreover the notion of atypia or dysplasia of the visible cells used for diagnosis is very subjective, with poor inter-rater agreement reported in the literature. Lastly, histology requires a biopsy which is an invasive procedure and only captures a small sample of the lesion, which is insufficient in the context of large fields of cancerization. Here we demonstrate that the notion of cellular atypia can be objectively defined and quantified with a non-invasive in-vivo approach in three dimensions (3D). A Deep Learning (DL) algorithm is trained to segment keratinocyte (KC) nuclei from Line-field Confocal Optical Coherence Tomography (LC-OCT) 3D images. Based on these segmentations, a series of quantitative, reproducible and biologically relevant...
Introduction La jonction dermo-epidermique (JDE) n’est pas similaire sur l’ensemble des different... more Introduction La jonction dermo-epidermique (JDE) n’est pas similaire sur l’ensemble des differentes parties du corps a l’instar des autres constituant de la peau, du fait d’une specialisation liee a la topographie et a la fonctionnalite attenante. La JDE a ete evaluee initialement ex vivo au moyen des coupes histologiques, puis in vivo en microscopie confocale. Dans les 2 cas il s’agissait d’imagerie 2 D alors que la JDE est une structure complexe tridimensionnelle. Or la nature de la JDE n’est pas sans consequence dans la pratique dermatologique. Ainsi les criteres dermatoscopiques des tumeurs pigmentees du visage sont en partie expliques par une JDE aplatie a la difference de celle du tronc, ondulee. La tomographie confocale a coherence optique en ligne (LC-OCT, DAMAE Medical®, Paris, France) est une nouvelle technique capable de combiner les avantages techniques de la microscopie confocale a reflectance et de l’OCT. La toute derniere camera de LC-OCT permet d’acquerir des images in vivo tridimensionnelles. Nous avons cherche a mesurer in vivo les caracteristiques tridimensionnelles de la JDE du visage de la peau saine. Materiel et methodes Trois zones differentes du visage ont ete explorees : la partie centrale du front, la joue G et la pointe du nez, chez 5 femmes âgees de 20 a 30 ans et de phototype II et III et 3 femmes âgees de 50 a 60 ans et de phototype II. Nous avons mesure l’index d’interdigitation 3D, exprime en pourcentage, au moyen du logiciel Skin Analysis v0.7.2® (DAMAE Medical, Paris, France) : il s’agit d’un index representant le niveau d’ondulation de la JDE, il s’etablit au moyen de la surface de l’aire de la nappe que forme la JDE et de la surface de l’aire planaire de la zone d’interet : (aire JDE- aire planaire de la zone exploree)/aire planaire de la zone d’interet. Resultats L’index d’interdigitation du nez presentait une valeur moyenne de 18,9 %, avec un maximum de 37,3 % et un minimum de 10,1 %. L’index d’interdigitation du front median presentait une valeur moyenne de 19,6 % avec un maximum de 36,2 % et un minimum de 4,4 %. L’index d’interdigitation de la joue presentait une valeur moyenne de 7,9 % avec un maximum de 10,3 % et un minimum de 6,0 %. Discussion Independamment de l’âge du volontaire, la JDE reste plate (index bas) au niveau de la joue, contrairement aux autres zones du visage, qui peuvent etre plus ondulees. L’ondulation de la JDE chez le volontaire jeune n’est pas systematiquement plus marquee que chez le volontaire âge. Il s’agit de la premiere etude decrivant les caracteristiques in vivo tridimensionnelle avec une resolution spatiale de 1 μm dans les 3 axes de l’espace. Manifestement si la JDE de la joue est plate, ce n’est pas le cas de toutes les autres zones du visage. Il parait donc logique d’envisager de rediscuter des signes dermatoscopiques en fonction de l’ondulation moyenne des differents sites du visage etudie en dermatoscopie.
Journal of the European Academy of Dermatology and Venereology
Dermoscopy revealed to be extremely useful in the diagnosis of early melanoma, the most important... more Dermoscopy revealed to be extremely useful in the diagnosis of early melanoma, the most important limitation being its subjectivity in giving a final diagnosis. To overcome this problem, several algorithms and checklists have been proposed. However, they generally demonstrated modest level of diagnostic accuracy, unsatisfactory concordance between dermoscopists and/or poor specificity.
Wound closure after post‐traumatic injuries and/or localized at peculiar body sites (head‐and‐nec... more Wound closure after post‐traumatic injuries and/or localized at peculiar body sites (head‐and‐neck, oral cavity, legs) are particularly challenging and can often be delayed due to local and systemic factors. In case of deep wounds and/or hard‐to‐heal wounds, grafting of dermal acellular matrices (ADM) is often needed. Though a great variety of synthetic and semisynthetic dermal and skin equivalents are available, viable human dermis, is still considered the most physiological alternative to replace the loss of autologous dermis, by acting as a physiological scaffold that add structural support to soft tissues. To date, human ADMs (hADMs) have been employed in the reconstruction of skin defects affecting almost all body sites, ranging from visceral sites to the skin and subcutaneous tissues. This review aims to investigate the use of hADM at different body sites and their peculiar advantages. A literature search was using the search terms “acellular dermal matrices”, “dermal regenera...
BACKGROUND Basal cell carcinoma can simulate melanoma and specific dermoscopic criteria have not ... more BACKGROUND Basal cell carcinoma can simulate melanoma and specific dermoscopic criteria have not yet been defined in a large cohort. OBJECTIVE To identify dermoscopic "trump" characteristics for differential diagnosis, identify cluster groups and assess the clinical impact of this study's findings. METHODS Retrospective, multicentric comparative study of atypical, non-facial basal cell carcinoma (≥ 1 seven-point checklist criteria) and melanoma (with at least one BCC criteria) at dermoscopy. Observed dermoscopic features were used to develop a proposed score. Lesion clusters were defined with hierarchical analysis. Clinical impact was assessed with a blinded reader study following this study's results. RESULTS A total of 146 basal cell carcinoma and 76 melanoma were included. Atypical vascular pattern was common to most lesions (74.5%). Twelve trump features were included in the proposed score (sensitivity 94.1% and specificity 79.5%). Cluster analysis identified 3 basal cell carcinoma and 3 melanoma clusters. Findings improved overall diagnostic accuracy and confidence (26.8% and 13.8% respectively; p<0.001). CONCLUSIONS These findings support the notion that atypical vascular pattern should be considered a shared feature of both melanoma and atypical basal cell carcinoma. Our proposed score improves diagnostic accuracy and confidence. Absence of pigmented features were associated with lower diagnostic accuracy and confidence.
Background Ultrasound imaging has recently benefited from the introduction of a new 70 MHz transd... more Background Ultrasound imaging has recently benefited from the introduction of a new 70 MHz transducer able to provide high-resolution images, i.e.: ultra-high-frequency ultrasound (UHFUS). Objectives To study the morphological features of Basal Cell Carcinoma (BCC) and measure BCC thickness by means of UHFUS examination. Methods This retrospective multicentric study included 171 consecutive patients that underwent UHFUS examination between November 2018 and May 2019 for suspeted BCC. Diagnosis was confirmed by histopathology. A series of morphologic parameters including echogenicity, structure, borders, shape composition (i.e., presence of intralesional structures) were investigated along with objective measurements such as thickness (i.e., maximum distance between the surface of the epidermis and the deepest part of the tumor) and wideness. Results A total of 117 BCC of superficial (n = 13; 11.1%), nodular (n = 64; 54.5%), infiltrative (n = 17; 14.5%), mixed subtype (n = 18; 16.1%)...
Background Line-field confocal optical coherence tomography (LC-OCT) is a new in vivo emerging te... more Background Line-field confocal optical coherence tomography (LC-OCT) is a new in vivo emerging technique that provides cellular resolution, allows deep imaging (400 μm) and produces real-time images in both the horizontal and vertical plane and in three dimensions. No previous description of different subtypes of melanocytic lesions and their correlation with histopathology and reflectance confocal microscopy has been reported. Aim To describe the features of melanocytic lesions by LC-OCT and their correlation with histopathology and reflectance confocal microscopy (RCM) findings. Methods Selected melanocytic benign lesions and melanomas were imaged in vivo with RCM and LC-OCT at the Fundación Hospital Clinic (Barcelona, Spain). A minimum area of 4 × 4 mm (block image) at four depths (stratum granulosum, suprabasal, layer dermoepidermal junction and upper dermis) were acquired with RCM and a minimum of three cubes with LC-OCT. Horizontal, vertical sections and three-dimensional (3D)...
This open-label study takes aim at the valutation of the efficacy and safety of facial injections... more This open-label study takes aim at the valutation of the efficacy and safety of facial injections of an Polyacrilamide Hydrogel (PAIG), in HIV-positive people that showed different level (severe, moderate and mild) of facial lipoatrophy. This is a typical AIDS-related pathology that involve a loss of subcutaneous fat in the face, especially in cheeks, temples and nasolabial folds, and other parts of the body, and often it consequently cause some mental rebound (lack of self-interest or loose of self-esteem). 36 HIV-positive subjects with facial lipoatrophy were enrolled. Every treatment consisted of the injection of 1 to 2 vials of PAIG on the first day, and every 4 weeks for some months, according to the level of facial lipoatrophy. We previously advised each one of the subjects to avoid sunburn in the injection's area. Patient's valuation has been done by facial ecosonography, along with clinical examination. Withal we took standard photographs before and after the treatme...
Italian journal of dermatology and venereology, 2021
Born in 1995, teledermatology (TD) turns 25 years old today. Since then, TD evolved according to ... more Born in 1995, teledermatology (TD) turns 25 years old today. Since then, TD evolved according to patients and physicians needs. The present review aimed to summarize all the efforts and experiences carried out in the field of TD and its subspecialties, the evolution and the future perspectives. A literature search was conducted in PubMed and Google Scholar. The state of the art of the "tele-dermo research" included TD and clinical trials, TD/TDS web platforms, TDS and artificial intelligence studies. Finally, the future perspective of TD/TDS in the era of social distancing was discussed. Using TD in specific situations adds several benefits including time-effectiveness of intervention and reduction in the waiting time for the first visit, reduced travel-costs, reduced sanitary costs, equalization of access from patient to specialistic consult. The communication technologies devices currently available can adequately support the growing needs of tele-assistance. A main limi...
Journal of the European Academy of Dermatology and Venereology, 2019
Although live and teledermoscopic examination has been successfully used to achieve non‐invasive ... more Although live and teledermoscopic examination has been successfully used to achieve non‐invasive diagnosis of melanocytic skin lesions (MSLs), early melanoma (EM) and atypical nevi (AN) continue to be a challenge, and none of the various algorithms proposed have been sufficiently accurate. We designed a scoring classifier diagnostic method, the iDScore that combines clinical data of the patient with dermoscopic features of the MSL.
Diagnosis based on histopathology for skin cancer detection is today’s gold standard and relies o... more Diagnosis based on histopathology for skin cancer detection is today’s gold standard and relies on the presence or absence of biomarkers and cellular atypia. However it suffers drawbacks: it requires a strong expertise and is time-consuming. Moreover the notion of atypia or dysplasia of the visible cells used for diagnosis is very subjective, with poor inter-rater agreement reported in the literature. Lastly, histology requires a biopsy which is an invasive procedure and only captures a small sample of the lesion, which is insufficient in the context of large fields of cancerization. Here we demonstrate that the notion of cellular atypia can be objectively defined and quantified with a non-invasive in-vivo approach in three dimensions (3D). A Deep Learning (DL) algorithm is trained to segment keratinocyte (KC) nuclei from Line-field Confocal Optical Coherence Tomography (LC-OCT) 3D images. Based on these segmentations, a series of quantitative, reproducible and biologically relevant...
Introduction La jonction dermo-epidermique (JDE) n’est pas similaire sur l’ensemble des different... more Introduction La jonction dermo-epidermique (JDE) n’est pas similaire sur l’ensemble des differentes parties du corps a l’instar des autres constituant de la peau, du fait d’une specialisation liee a la topographie et a la fonctionnalite attenante. La JDE a ete evaluee initialement ex vivo au moyen des coupes histologiques, puis in vivo en microscopie confocale. Dans les 2 cas il s’agissait d’imagerie 2 D alors que la JDE est une structure complexe tridimensionnelle. Or la nature de la JDE n’est pas sans consequence dans la pratique dermatologique. Ainsi les criteres dermatoscopiques des tumeurs pigmentees du visage sont en partie expliques par une JDE aplatie a la difference de celle du tronc, ondulee. La tomographie confocale a coherence optique en ligne (LC-OCT, DAMAE Medical®, Paris, France) est une nouvelle technique capable de combiner les avantages techniques de la microscopie confocale a reflectance et de l’OCT. La toute derniere camera de LC-OCT permet d’acquerir des images in vivo tridimensionnelles. Nous avons cherche a mesurer in vivo les caracteristiques tridimensionnelles de la JDE du visage de la peau saine. Materiel et methodes Trois zones differentes du visage ont ete explorees : la partie centrale du front, la joue G et la pointe du nez, chez 5 femmes âgees de 20 a 30 ans et de phototype II et III et 3 femmes âgees de 50 a 60 ans et de phototype II. Nous avons mesure l’index d’interdigitation 3D, exprime en pourcentage, au moyen du logiciel Skin Analysis v0.7.2® (DAMAE Medical, Paris, France) : il s’agit d’un index representant le niveau d’ondulation de la JDE, il s’etablit au moyen de la surface de l’aire de la nappe que forme la JDE et de la surface de l’aire planaire de la zone d’interet : (aire JDE- aire planaire de la zone exploree)/aire planaire de la zone d’interet. Resultats L’index d’interdigitation du nez presentait une valeur moyenne de 18,9 %, avec un maximum de 37,3 % et un minimum de 10,1 %. L’index d’interdigitation du front median presentait une valeur moyenne de 19,6 % avec un maximum de 36,2 % et un minimum de 4,4 %. L’index d’interdigitation de la joue presentait une valeur moyenne de 7,9 % avec un maximum de 10,3 % et un minimum de 6,0 %. Discussion Independamment de l’âge du volontaire, la JDE reste plate (index bas) au niveau de la joue, contrairement aux autres zones du visage, qui peuvent etre plus ondulees. L’ondulation de la JDE chez le volontaire jeune n’est pas systematiquement plus marquee que chez le volontaire âge. Il s’agit de la premiere etude decrivant les caracteristiques in vivo tridimensionnelle avec une resolution spatiale de 1 μm dans les 3 axes de l’espace. Manifestement si la JDE de la joue est plate, ce n’est pas le cas de toutes les autres zones du visage. Il parait donc logique d’envisager de rediscuter des signes dermatoscopiques en fonction de l’ondulation moyenne des differents sites du visage etudie en dermatoscopie.
Journal of the European Academy of Dermatology and Venereology
Dermoscopy revealed to be extremely useful in the diagnosis of early melanoma, the most important... more Dermoscopy revealed to be extremely useful in the diagnosis of early melanoma, the most important limitation being its subjectivity in giving a final diagnosis. To overcome this problem, several algorithms and checklists have been proposed. However, they generally demonstrated modest level of diagnostic accuracy, unsatisfactory concordance between dermoscopists and/or poor specificity.
Wound closure after post‐traumatic injuries and/or localized at peculiar body sites (head‐and‐nec... more Wound closure after post‐traumatic injuries and/or localized at peculiar body sites (head‐and‐neck, oral cavity, legs) are particularly challenging and can often be delayed due to local and systemic factors. In case of deep wounds and/or hard‐to‐heal wounds, grafting of dermal acellular matrices (ADM) is often needed. Though a great variety of synthetic and semisynthetic dermal and skin equivalents are available, viable human dermis, is still considered the most physiological alternative to replace the loss of autologous dermis, by acting as a physiological scaffold that add structural support to soft tissues. To date, human ADMs (hADMs) have been employed in the reconstruction of skin defects affecting almost all body sites, ranging from visceral sites to the skin and subcutaneous tissues. This review aims to investigate the use of hADM at different body sites and their peculiar advantages. A literature search was using the search terms “acellular dermal matrices”, “dermal regenera...
BACKGROUND Basal cell carcinoma can simulate melanoma and specific dermoscopic criteria have not ... more BACKGROUND Basal cell carcinoma can simulate melanoma and specific dermoscopic criteria have not yet been defined in a large cohort. OBJECTIVE To identify dermoscopic "trump" characteristics for differential diagnosis, identify cluster groups and assess the clinical impact of this study's findings. METHODS Retrospective, multicentric comparative study of atypical, non-facial basal cell carcinoma (≥ 1 seven-point checklist criteria) and melanoma (with at least one BCC criteria) at dermoscopy. Observed dermoscopic features were used to develop a proposed score. Lesion clusters were defined with hierarchical analysis. Clinical impact was assessed with a blinded reader study following this study's results. RESULTS A total of 146 basal cell carcinoma and 76 melanoma were included. Atypical vascular pattern was common to most lesions (74.5%). Twelve trump features were included in the proposed score (sensitivity 94.1% and specificity 79.5%). Cluster analysis identified 3 basal cell carcinoma and 3 melanoma clusters. Findings improved overall diagnostic accuracy and confidence (26.8% and 13.8% respectively; p<0.001). CONCLUSIONS These findings support the notion that atypical vascular pattern should be considered a shared feature of both melanoma and atypical basal cell carcinoma. Our proposed score improves diagnostic accuracy and confidence. Absence of pigmented features were associated with lower diagnostic accuracy and confidence.
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