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Importance:
Subungual melanoma (SM) is a rare subtype of cutaneous melanoma but carries a worse prognosis than similarly staged cutaneous melanomas. Assessing patient knowledge of melanonychia is integral to early diagnosis of SM.
Objectives:
The aim of this paper is to determine patient knowledge of longitudinal melanonychia (LM) and warning si...
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Background and objectives
Spain is in a situation of indefinite lockdown due to the ongoing coronavirus disease 2019 (COVID-19) pandemic. One of the consequences of this lockdown is delays in medical and surgical procedures for common diseases. The aim of this study was to model the impact on survival of tumor growth caused by such delays in patien...
Citations
... Only 18.2% of dermatologists surveyed reported performing nail examinations at each visit, and 58% performed them only as a component of a total body skin examination [32]. In a study surveying 363 patients in outpatient clinics, only 5% of patients had heard of the ABCDEF mnemonic for NUM in contrast to 9.9% having heard of the ABCD mnemonic for cutaneous melanoma; only 1.4% of patients reported being counseled about the ABCDEF mnemonic for NUM by their physicians compared to 13.8% of patients that were advised about the ABCD mnemonic for cutaneous melanoma [33]. Additionally, only 31.4% of patients stated they assessed their nails for color changes; 10.2% of patients reported having LM, with only 45.9% of those patients seeking medical attention [33]. ...
... In a study surveying 363 patients in outpatient clinics, only 5% of patients had heard of the ABCDEF mnemonic for NUM in contrast to 9.9% having heard of the ABCD mnemonic for cutaneous melanoma; only 1.4% of patients reported being counseled about the ABCDEF mnemonic for NUM by their physicians compared to 13.8% of patients that were advised about the ABCD mnemonic for cutaneous melanoma [33]. Additionally, only 31.4% of patients stated they assessed their nails for color changes; 10.2% of patients reported having LM, with only 45.9% of those patients seeking medical attention [33]. In a study designed to assess and score the accuracy of 27 internet sources relating to NUM, websites varied in accountability and quality while readability was poor overall (mean overall score 16.1/40, range 7-25) [34]. ...
Nail unit melanoma (NUM) is an uncommon form of melanoma and is often diagnosed at later stages. Approximately two-thirds of NUMs are present clinically as longitudinal melanonychia, but longitudinal melanonychia has a broad differential diagnosis. Clinical examination and dermoscopy are valuable for identifying nail findings concerning malignancy, but a biopsy with histopathology is necessary to confirm a diagnosis of NUM. Surgical treatment options for NUM include en bloc excision, digit amputation, and Mohs micrographic surgery. Newer treatments for advanced NUM include targeted and immune systemic therapies. NUM in pediatric patients is extremely rare and diagnosis is challenging since both qualitative and quantitative parameters have only been studied in adults. There is currently no consensus on management in children; for less concerning melanonychia, some physicians recommend close follow-up. However, some dermatologists argue that the “wait and see” approach can cause delayed diagnosis. This article serves to enhance the familiarity of NUM by highlighting its etiology, clinical presentations, diagnosis, and treatment options in both adults and children.
... Одно из новых направлений в медицине -применение мультиагентных систем, которые представляют собой совместную работу ряда агентов (компонентов, процессов, групп людей). Они характеризуются определённой автономностью в принятии решений с обязательным использованием искусственного интеллекта [12][13][14][15]. Поскольку в процессе функционирования системы свойства агентов постоянно меняются, необходима непрерывная коррекция параметров их взаимодействия в интересах общего конечного результата [7][8][9]. ...
Introduction. The most significant problem is the early diagnosis of skin melanoma (SM). In many countries of the world, there is a constant increase in the incidence rate, and the organization of population screening can help solve this problem. Purpose of the study. Evaluation of the use of multi-agent technology in the diagnosis of SM. Material and methods. Study design: at the 1st stage, primary medical documentation was studied - Charts No. 090/y; 027-2/y, statistical reports of the Samara Regional Clinical Oncological Dispensary - Charts No. 7, No. 35, according to the results revealed at stage 2. There was developed and implemented multi-agent technology for SM diagnostics, including various agents of both qualified and specialized levels, these were both individuals and teams of departments who worked in close contact: a public relations agent; artificial intelligence secondary prevention planning agent; agent for training doctors and nurses, patients in the basics of early diagnosis and assessing their level of training; an agent for evaluating performance indicators. Results. After introducing the multi-agent system, the indicator of the share of 1-2 stages of MC in 2010-2019. increased by 48.3% compared to the period 2000-2009 and outpaced the growth in the total number of patients with SM by 6.96%; from 2010 to 2019 the proportion of patients with SM who were actively identified began to increase; one-year mortality rate from 2010 to 2019 decreased in waves (y = 0.0003x5 - 0.0104x4 - 0.2647x3 + 1.4818x2 - 1.8942x + 10.585; R2 = 0.554). Conclusion. The use of multi-agent technology makes it possible to reduce the one-year mortality rate, to achieve a faster growth rate of the newly detected number of patients with an early stage of SM (stage 1-2) compared to the increase in the number of cases, to improve the indicators of early diagnosis, active detection of skin melanoma, which is a positive result.
... A previous survey-based study found a paucity of patient knowledge on longitudinal melanonychia and the warning signs for subungual melanomas. 3 Only 31% of patients assessed their nails for color changes, and only 13% of patients responded that their doctors asked about nail changes. Another study found that only 8% of physicians asked their patients to remove nail polish at every visit, yet 44% of physicians responded that they encounter melanonychia at least once a month and 23% once a week. ...
... 1,2 A survey-based study of patients' knowledge of longitudinal melanonychia and warning signs of subungual melanoma found that patients' knowledge was very limited, with only 31% of participants examining their nails regularly and 12% of subjects stating that their physician (dermatologist or internist in an outpatient setting) asked them about nail changes. 3 Our study aimed to assess patients' knowledge of the components of a complete skin examination, specifically, nail examinations. ...
Background:
Longitudinal melanonychia (LM) is a common dermatologic finding in clinical practice with a broad differential diagnosis. Melanocytic activation is the most common LM etiology.
Objective:
To investigate clinical and dermoscopic differences of benign LM based on Fitzpatrick skin type and in biopsied vs. non-biopsied patients.
Methods:
A 10-year retrospective cohort of 248 benign LM cases at Weill Cornell Dermatology was identified and analyzed.
Results:
Darker-skinned vs. lighter-skinned patients had higher band width percentage (p=0.0125), lower band brightness (p<0.001), more band changes (p=0.0071), and received more biopsies (p=0.032). Biopsied (n=47) vs. non-biopsied patients (n=201) had less multidigit band involvement (p=0.0008), higher band width percentage (p=0.0213), lower band brightness (p=0.0003), and more band changes (p<0.0001). Darker skin types more often had brown vs. grey coloration on dermoscopy (p=0.0232). Mean band width percentage for all biopsied patients was 30.81% (range: 5.80%-100%).
Limitations:
Single-center retrospective design. Subungual melanoma and other benign LM etiologies were not analyzed. Only 18.95% of patients received a biopsy.
Conclusion:
Darker vs. lighter skin types more often present with darker and wider bands, brown vs. grey coloration on dermoscopy, and receive more biopsies. Multi-institutional studies on LM are needed to determine nail matrix biopsy criteria in different skin types.
Subungual melanoma (SUM) is subset of acral melanoma that develops within the nail unit and is associated with a poor prognosis. Nail biopsy is the only way to definitively diagnosis SUM. To analyze the Medicare database for nail biopsy utilization and to compare the annual nail biopsy rate with the estimated incidence of SUM in the United States (US). A retrospective study on nail biopsy data was performed using the Medicare Provider Utilization and Payment Database 2012‐2017. The number of nail biopsies performed per 100 000 people was compared to SUM incidence per 100 000 people. Podiatrists, dermatologists, other physicians, and NP/PAs respectively performed 12.12, 0.42, 0.08, 0.07 nail biopsies per 100 000 people annually. Dermatologists performed adequate nail biopsies to cover the minimum (0.7%), but not the maximum (3.5%) estimated incidence of SUM. Only 0.28% and 1.01% of general dermatologists and Mohs surgeons, respectively, performed nail biopsies in 19/50 (38.00%) states and 69/929 (7.42%) zip codes. Limitations Nail biopsies on patients less than 65 years, and those with no or commercial health insurance were not analyzed. Very few dermatologists performed nail biopsies in the Medicare database. Increased efforts are needed to educate dermatologists on nail surgery. This article is protected by copyright. All rights reserved.
Background
Dermoscopy is undoubtedly a useful tool to improve diagnostic accuracy and minimize unnecessary biopsies. However, much of the literature on dermoscopy focuses on findings in lighter skin phototypes, leaving potential gaps of knowledge regarding its use in skin of color (SOC). As the clinical applications of dermoscopy continue to increase, it is imperative to understand dermoscopic patterns in SOC. Objectives: This review will discuss the literature on dermoscopic findings of neoplasms in SOC, highlighting unique and characteristic dermoscopic features. Methods: A literature review was performed using PubMed database. Case reports, case-series, case-control studies, and systematic reviews were included. Results: A total of 8326 studies were identified based on search terms, and 41 were included in this review based on relevance. Conclusion: There are specific dermoscopic characteristics in SOC for benign nevi, acral lentiginous melanoma, ethnic melanonychia and dermatofibroma; however, there is a lack of published data about specific features of cutaneous melanoma, subungual melanoma, pigmented basal cell carcinoma, and pigmented squamous cell carcinoma in SOC. As pigmented basal cell carcinoma, pigmented squamous cell carcinoma, ethnic melanonychia and acral lentiginous melanoma are diagnosed at later stages in this population, it is important to understand their dermoscopic features. Further descriptive studies are needed to better characterize unique dermoscopic features in neoplasms in SOC.
