Browsing by Author "Marghoob, Ashfaq A."

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    Applications of Ultraviolet and Sub-ultraviolet Dermatoscopy in Neoplastic and Non-neoplastic Dermatoses: A Systematic Review
    (2024) Pietkiewicz, Paweł; Navarrete Dechent, Cristián Patricio; Togawa, Yaei; Szlązak, Piotr; Salwowska, Natalia; Marghoob, Ashfaq A.; Leszczyńska-Pietkiewicz, Agnieszka; Errichetti, Enzo
    Dermatoscopy is a non-invasive and cost-efficient imaging technique augmenting clinical examination in neoplastic and non-neoplastic dermatoses. Recently, novel dermatoscopic techniques based on principles of reflectance/absorption and excited fluorescence have been developed. However, comprehensive data on their applications are sparse, and terminology is inconsistent. In this systematic review, we addressed the principles of ultraviolet (UV) imaging and proposed categorization based on spectral characteristics and signal acquisition, as well as discussed documented and potential clinical applications, safety measures during examination, and limitations associated with reflectance and fluorescence dermatoscopy. A literature search was conducted in the PubMed medical database until 2 December 2023 according to PRISMA guidelines, and 28 papers fit the scope of this review, whereas additional relevant articles were included to provide broader context regarding the chosen terminology, chromophores described, safety of sub-UV/UV, and regulations for light-emitting devices. UV and sub-UV dermatoscopy, categorized into different methods on the basis of the emitted wavelength and signal acquisition process (reflectance versus fluorescence), augment conventional dermatoscopy by optimizing safety margins in melanoma, facilitating early detection of tumor recurrence, and enhancing visualization in non-neoplastic conditions, including pigmentation disorders, intertrigo, papulo-desquamative dermatoses, and beyond. The review highlights the limitations of these techniques, including difficulty in differentiating melanin from hemoglobin, challenges in evaluating uneven surfaces, and artifacts. Although UV dermatoscopy complements conventional dermatoscopy, clinicians should be aware of their peculiarities, artifacts, limitations, and safety concerns to optimize their diagnostic accuracy and ensure patient’s safety.
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    Assessment of the Safety Risk of Dermatoscope Magnets in Patients With Cardiovascular Implanted Electronic Devices
    (2018) Rishpon, Ayelet; Braun, Ralph; Weinstock, Martin A.; Kulju, Stephen; Grenga, Andrea; Navarrete Dechent, Cristián Patricio; Marghoob, Nadeem G.; Steffel, Jan; Marghoob, Ashfaq A.
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    Automated Dermatological Diagnosis: Hype or Reality?
    (2018) Navarrete Dechent, Cristián Patricio; Dusza, Stephen W.; Liopyris, Konstantinos; Marghoob, Ashfaq A.; Halpern, Allan C.; Marchetti, Michael A.
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    Bilateral diffuse uveal melanocytic proliferation with multifocal diffuse integumentary melanocytic proliferation paraneoplastic syndrome: A case report
    (2021) Navarrete-Dechent, Cristian; Monnier, Jilliana; Marghoob, Nadeem G.; Liopyris, Konstantinos; Busam, Klaus J.; Francis, Jasmine H.; Marghoob, Ashfaq A.
    Bilateral diffuse uveal melanocytic proliferation (B-DUMP) is a rare paraneoplastic syndrome typically presenting with bilateral visual loss. B-DUMP is associated with extraocular systemic malignancies with the most common being lung cancer in males and uro-gynaecological cancer in females (mainly ovarian cancer). Cutaneous and/or mucosal involvement in patients with B-DUMP has been reported but it is not well characterised. Herein, we present a female in her 70s with diagnosis of stage IV vaginal clear-cell carcinoma and metastatic melanoma of unknown primary that developed progressive bilateral loss of visual acuity compatible with `B-DUMP'. Simultaneously, she developed multifocal bilateral bluish-greyish patches on the skin that were shown to have a proliferation of dermal melanocytes. We propose that the clinical and histopathologic cutaneous findings seen in patients with B-DUMP be termed 'diffuse integumentary melanocytic proliferation (DIMP)'.
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    Clinical and dermoscopic features associated with lichen planus-like keratoses that undergo skin biopsy: A single-center, observational study
    (2019) Liopyris, Konstantinos; Cristian Navarrete-Dechent; Dusza, Stephen W.; Marghoob, Ashfaq A.; Deng, Liang; Wilson, Barbara B.; Marchetti, Michael A.
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    Contemporary management of actinic keratosis
    (2021) Navarrete-Dechent, Cristian; Marghoob, Ashfaq A.; Marchetti, Michael A.
    Actinic keratosis (AK) is a skin lesion characterized by itraepithelial keratinocyte dysplasia and molecular alterations shared with normal chronically sun-damaged skin and squamous cell carcinoma (SCC). AK can undergo spontaneous regression, stable existence, or malignant transformation to cutaneous SCC with progression rates to SCC ranging from 0% to 0.5% per lesion-year and AK spontaneous regression of 15-63%. As AK is a potential precursor of invasive SCC, it is commonly treated to mitigate the risk of malignant progression, including metastasis and death. There is a myriad of available spots (e.g. cryotherapy) and field (e.g. 5-fluorouracil, imiquimod photodynamic therapy) treatments for AK. Recently published randomized clinical trials have helped bridge the gap on AK management. In this viewpoint, we sought to summarize the most up-to-date evidence in the management of AK.
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    Delphi Consensus Among International Experts on the Diagnosis, Management, and Surveillance for Lentigo Maligna
    (2023) Longo, Caterina; Navarrete-Dechent, Cristian; Tschandl, Philipp; Apalla, Zoe; Argenziano, Giuseppe; Braun, Ralph P.; Bataille, Veronique; Cabo, Horacio; Hoffmann-Wellhenhof, Rainer; Forsea, Ana Maria; Garbe, Claus; Guitera, Pascale; Raimond, Karls; Marghoob, Ashfaq A.; Malvehy, Josep; Del Marmol, Veronique; Moreno, David; Nehal, Kishwer S.; Nagore, Eduardo; Paoli, John; Pellacani, Giovanni; Peris, Ketty; Puig, Susana; Soyer, H. Peter; Swetter, Susan; Stratigos, Alexander; Stolz, Wilhelm; Thomas, Luc; Tiodorovic, Danica; Zalaudek, Iris; Kittler, Harald; Lallas, Aimilios
    Introduction: Melanoma of the lentigo maligna (LM) type is challenging. There is lack of consensus on the optimal diagnosis, treatment, and follow-up.
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    Dermoscopy of elastosis perforans serpiginosa : a useful tool to distinguish it from granuloma annulare
    (2015) Navarrete Dechent, Cristián Patricio; Del Puerto Troncoso, Constanza; Bajaj, Shirin; Marghoob, Ashfaq A.; González Bombardiere, Sergio; Jaque Silva, Ana Alejandra; Navarrete Dechent, Cristián Patricio; Del Puerto Troncoso, Constanza; Bajaj, Shirin; Marghoob, Ashfaq A.; González Bombardiere, Sergio; Jaque Silva, Ana Alejandra
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    Evaluation of a Combined Reflectance Confocal Microscopy-Optical Coherence Tomography Device for Detection and Depth Assessment of Basal Cell Carcinoma
    (2018) Sahu, Aditi; Yélamos, Oriol; Iftimia, Nicusor; Córdova, Miguel; Alessi Fox, Christi; Gill, Melissa; Maguluri, Gopi; Dusza, Stephen; Navarrete Dechent, Cristián Patricio; González, Salvador; Rossi, Anthony M.; Marghoob, Ashfaq A.; Rajadhyaksha, Milind; Chen, C-S J.
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    Expert Agreement on the Presence and Spatial Localization of Melanocytic Features in Dermoscopy
    (2024) Liopyris, Konstantinos; Navarrete-Dechent, Cristian; Marchetti, Michael A.; Rotemberg, Veronica; Apalla, Zoe; Argenziano, Giuseppe; Blum, Andreas; Braun, Ralph P.; Carrera, Cristina; Codella, Noel C. F.; Combalia, Marc; Dusza, Stephen W.; Gutman, David A.; Helba, Brian; Hofmann-Wellenhof, Rainer; Jaimes, Natalia; Kittler, Harald; Kose, Kivanc; Lallas, Aimilios; Longo, Caterina; Malvehy, Josep; Menzies, Scott; Nelson, Kelly C.; Paoli, John; Puig, Susana; Rabinovitz, Harold S.; Rishpon, Ayelet; Russo, Teresa; Scope, Alon; Soyer, H. Peter; Stein, Jennifer A.; Stolz, Willhelm; Sgouros, Dimitrios; Stratigos, Alexander J.; Swanson, David L.; Thomas, Luc; Tschandl, Philipp; Zalaudek, Iris; Weber, Jochen; Halpern, Allan C.; Marghoob, Ashfaq A.
    Dermoscopy aids in melanoma detection; however, agreement on dermoscopic features, including those of high clinical relevance, remains poor. In this study, we attempted to evaluate agreement among experts on exemplar images not only for the presence of melanocytic-specific features but also for spatial localization. This was a cross-sectional, multicenter, observational study. Dermoscopy images exhibiting at least 1 of 31 melanocytic-specific features were submitted by 25 world experts as exemplars. Using a web-based platform that allows for image markup of specific contrast-defined regions (superpixels), 20 expert readers annotated 248 dermoscopic images in collections of 62 images. Each collection was reviewed by five independent readers. A total of 4,507 feature observations were performed. Good-to-excellent agreement was found for 14 of 31 features (45.2%), with eight achieving excellent agreement (Gwet's AC >0.75) and seven of them being melanomaspecific features. These features were peppering/granularity (0.91), shiny white streaks (0.89), typical pigment network (0.83), blotch irregular (0.82), negative network (0.81), irregular globules (0.78), dotted vessels (0.77), and blue-whitish veil (0.76). By utilizing an exemplar dataset, a good-to-excellent agreement was found for 14 features that have previously been shown useful in discriminating nevi from melanoma. All images are public (www.isic-archive.com) and can be used for education, scientific communication, and machine learning experiments.
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    In vivo imaging characterization of basal cell carcinoma and cutaneous response to high-dose ionizing radiation therapy: A prospective study of reflectance confocal microscopy, dermoscopy, and ultrasonography
    (2021) Navarrete-Dechent, Cristian; Cordova, Miguel; Liopyris, Konstantinos; Aleissa, Saud; Rajadhyaksha, Milind; Cohen, Gil'ad; Marghoob, Ashfaq A.; Rossi, Anthony M.; Barker, Christopher A.
    Background: Radiation therapy (RT) is a treatment option for select skin cancers. The histologic effects of RT on normal skin or skin cancers are not well characterized. Dermoscopy, high-frequency ultrasonography (HFUS), and reflectance confocal microscopy (RCM) are noninvasive imaging modalities that may help characterize RT response.
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    Incidence of New Primary Cutaneous Melanoma in Patients With Metastatic Melanoma Treated With Immune Checkpoint Inhibitors A Single-Center Cohort Study
    (2021) Nanda, Japbani K.; Dusza, Stephen W.; Navarrete-Dechent, Cristian; Liopyris, Konstantinos; Marghoob, Ashfaq A.; Marchetti, Michael A.
    Question What is the incidence of new primary cutaneous melanoma (CM) after initiating immune checkpoint inhibitor therapy for metastatic melanoma? Findings In this single-center observational cohort study, 42 of 2251 patients (1.9%) who received immune checkpoint inhibitors were diagnosed with 48 melanomas. The incidence rate was approximately 1100 cases per 100000 person-years, and the cumulative cause-specific risk of new CM after 5 years was 4.9%; patients diagnosed with a new primary CM were more likely to have a family history of melanoma. Meaning Patients who receive checkpoint inhibitors for treatment of metastatic melanoma remain at risk for the development of new primary CMs.
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    International Skin Imaging Collaboration-Designated Diagnoses (ISIC-DX): Consensus terminology for lesion diagnostic labeling
    (2024) Scope, Alon; Liopyris, Konstantinos; Weber, Jochen; Barnhill, Raymond L.; Braun, Ralph P.; Curiel-Lewandrowski, Clara N.; Elder, David E.; Ferrara, Gerardo; Grant-Kels, Jane M.; Jeunon, Thiago; Lallas, Aimilios; Lin, Jennifer Y.; Marchetti, Michael A.; Marghoob, Ashfaq A.; Navarrete-Dechent, Cristian; Pellacani, Giovanni; Soyer, Hans Peter; Stratigos, Alexander; Thomas, Luc; Kittler, Harald; Rotemberg, Veronica; Halpern, Allan C.
    Background: A common terminology for diagnosis is critically important for clinical communication, education, research and artificial intelligence. Prevailing lexicons are limited in fully representing skin neoplasms. Objectives: To achieve expert consensus on diagnostic terms for skin neoplasms and their hierarchical mapping. Methods: Diagnostic terms were extracted from textbooks, publications and extant diagnostic codes. Terms were hierarchically mapped to super-categories (e.g. 'benign') and cellular/tissue-differentiation categories (e.g. 'melanocytic'), and appended with pertinent-modifiers and synonyms. These terms were evaluated using a modified-Delphi consensus approach. Experts from the International-Skin-Imaging-Collaboration (ISIC) were surveyed on agreement with terms and their hierarchical mapping; they could suggest modifying, deleting or adding terms. Consensus threshold was >75% for the initial rounds and >50% for the final round. Results: Eighteen experts completed all Delphi rounds. Of 379 terms, 356 (94%) reached consensus in round one. Eleven of 226 (5%) benign-category terms, 6/140 (4%) malignant-category terms and 6/13 (46%) indeterminate-category terms did not reach initial agreement. Following three rounds, final consensus consisted of 362 terms mapped to 3 super-categories and 41 cellular/tissue-differentiation categories. Conclusions: We have created, agreed upon, and made public a taxonomy for skin neoplasms and their hierarchical mapping. Further study will be needed to evaluate the utility and completeness of the lexicon.
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    Melanocytic Lesions. Other Melanoma Subtypes
    (CRC Press, 2022) Navarrete Dechent, Cristián Patricio; Liopyris, Konstantinos; Jaimes, Natalia; Marghoob, Ashfaq A.
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    Nonmelanocytic Lesions
    (CRC Press, 2022) Navarrete Dechent, Cristián Patricio; Liopyris, Konstantinos; Marghoob, Ashfaq A.
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    Paradoxical effect of epinephrine on lesion redness and vascularity
    (2023) Nazir, Zaeem H.; Rishpon, Ayelet; Kose, Kivanc; Marghoob, Nadeem G.; Liopyris, Konstantinos; Navarrete-Dechent, Cristian; Dusza, Stephen W.; Daoud, Alexander; Marghoob, Ashfaq A.
    IntroductionEpinephrine is commonly used in combination with local anesthetic (lidocaine/epinephrine) due to its beneficial vasoconstrictive properties. Typically, pallor is appreciated after injection as a sign of effect; however, we observed that some cutaneous malignancies paradoxically revealed increased redness and vascularity after injection of lidocaine/epinephrine. In this study, we investigate this phenomenon among a series of biopsied lesions to identify characteristics of lesions associated with increased redness and/or vascularity.ObjectivesTo determine characteristics of lesions which become redder or more vascular after injection with lidocaine/epinephrine prior to biopsy.MethodsThis cross-sectional study consisted of a convenience sample of lesions scheduled for biopsy. Lesions were photographed prior to and 7 min after injection of lidocaine/epinephrine as a part of standard care. Two readers blinded to study objectives and histopathological diagnosis assessed lesions for changes in redness and vascular features.ResultsFifty-four lesions from 47 patients-61.7% male, mean age 64.8 years, age-range 24-91 were included. Thirty-six lesions were biopsy confirmed malignant, with 5 in situ and 31 invasive malignancies; the remaining 18 lesions were benign. In comparison with non-malignant lesions, malignant lesions were associated with an increase in clinically appreciable vascular features after injection of lidocaine/epinephrine, X-2 (1) = 21.600, p < 0.001. Further stratification into benign, in situ, and invasive lesions strengthened the association, X-2 (1) = 23.272, p < 0.001.ConclusionsCombination lidocaine/epinephrine has been shown to paradoxically increase the visibility of vessels seen in cutaneous malignancies. This is consistent with prior literature suggesting aberrant adrenergic signaling in neoangiogenic vessels.
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    Perifollicular linear projections: A dermatoscopic criterion for the diagnosis of lentigo maligna on the face
    (2024) Navarrete-Dechent, Cristian; Jaimes, Natalia; Dusza, Stephen W.; Liopyris, Konstantinos; Marchetti, Michael A.; Cordova, Miguel; Oliviero, Margaret; Villaseca, Miguel A.; Pulitzer, Melissa; Busam, Klaus J.; Rossi, Anthony M.; Rabinovitz, Harold S.; Nehal, Kishwer S.; Scope, Alon; Marghoob, Ashfaq A.
    Background: Lentigo maligna (LM) can mimic benign, flat, pigmented lesions and can be challenging to diagnose. Objective: To describe a new dermatoscopic feature termed "perifollicular linear projections (PLP)"as a diagnostic criterion for LM on the face. Methods: Retrospective study on reflectance confocal microscopy and dermatoscopy images of flat facial pigmented lesions originating from 2 databases. PLP were defined as short, linear, pigmented projections emanating from hair follicles. Dermatoscopy readers were blinded to the final histopathologic diagnosis. Results: From 83 consecutive LMs, 21/83 (25.3%) displayed "bulging of hair follicles"on reflectance confocal microscopy and 18 of these 21 (85.7%), displayed PLP on dermatoscopy. From a database of 2873 consecutively imaged and biopsied lesions, 252 flat-pigmented facial lesions were included. PLP was seen in 47/76 melanomas (61.8%), compared with 7/176 lesions (3.9%) with other diagnosis (P \ .001). The sensitivity was 61.8% (95% CI, 49.9%-72.7%), specificity 96.0% (95% CI, 92.9%-98.4%). PLP was independently associated with LM diagnosis on multivariate analysis (OR 26.1 [95% CI, 9.6%-71.0]). Limitations: Retrospective study. Conclusion: PLP is a newly described dermatoscopic criterion that may add specificity and sensitivity to the early diagnosis of LM located on the face. We postulate that PLP constitutes an intermediary step in the LM progression model. ( J Am Acad Dermatol 2024;90:52-7.)
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    Rapid diagnosis of tinea incognito using handheld reflectance confocal microscopy : a paradigm shift in dermatology?
    (2015) Navarrete Dechent, Cristián Patricio; Bajaj, Shirin; Marghoob, Ashfaq A.; Marchetti, Michael A.
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    Reflectance confocal microscopy terminology for non-melanocytic skin lesions: A Delphi consensus of experts
    (Elsevier Inc., 2025) Navarrete Dechent, Cristian Patricio; Longo, Caterina; Liopyris, Konstantinos; Ardigo, Marco; Ahlgrimm-Siess, Verena; Bahadoran, Phillipe; Carrera, Cristina; Braga, Juliana Casagrande Tavoloni; Chen, Chih-Shan J.; Correa, Lilia; Carvahlo, Nathalie de; Durkin, John; Farnetani, Francesca; Grant-Kels, Jane M.; Gill, Melissa; Gonzalez, Salvador; Hartmann, Daniela; Hoffman-Wellenhof, Rainer; Huho, Albert; Ludzik, Joanna; Malvehy, Josep; Marghoob, Ashfaq A.; Moscarella, Elvira; Oliviero, Margaret; Puig, Susana; Rabinovitz, Harold; Rao, Babar; Rezze, Gisele G.; Rossi, Anthony M.; Rubinstein, Gene; Ruini, Cristel; Sattler, Elke; Soyer, H. Peter; Schwartz, Rodrigo; Thng, Steven; Ulrich, Martina; Witkowski, Alexander; Dusza, Stephen W.; Guitera, Pascale; Pellacani, Giovanni; Scope, Alon; Jain, Manu
    Background There is lack of uniformity in reflectance confocal microscopy (RCM) terminology. Objective To establish expert consensus on a standardized set of RCM terms that describe non-melanocytic lesions (NML). Methods We invited RCM experts to participate in a Delphi-consensus study. Fifty-nine RCM descriptors were extracted from a previous systematic review on RCM terminology for describing NML. Of these, 35 items were presented as 4 groups of synonymous terms and 24 items as single, non-synonymous terms. For the first round, an agreement threshold was set at >70%. Participants could also propose new terms. Terms with ≤70% agreement and newly proposed terms were carried over to the next round. For subsequent rounds, agreement threshold was set at >50%. Results The study was conducted between June 2021 and May 2023. Forty-two of 44 (95%) invited experts participated. Three iterative Delphi rounds were completed, resulting in a consensus list of 36 terms, including 32 synonymous- and 4 non-synonymous- terms for describing NML. Limitations Only experts were included. We did not evaluate definitions of terms in the study. Conclusions We propose a simplified list of RCM terms, vetted by RCM experts, for describing and diagnosing NML. Uniform terminology could benefit clinical practice, research, and education.
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    Response to comments on the Letter to the Editor titled "Differentiating basal cell carcinoma from intradermal nevi along the eyelid margin with dermoscopy: A case series''
    (Mosby-Elsevier, 2021) Williams, Natalie M.; Navarrete Dechent, Cristian Patricio; Marghoob, Ashfaq A.; Abarzua Araya, Álvaro Rodrigo; Salerni, Gabriel; Jaimes, Natalia