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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article reviews existing noninvasive technologies in dermatology, including imaging and nonimaging tools. The speakers presented data on these technologies and discussed their clinical applicability, as well as new technology concepts from preclinical research.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ESkin Cancer\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ESoft Tissue Cancers\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EDermatology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ESkin Cancer\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ESoft Tissue Cancers\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EThis session reviewed existing noninvasive technologies in dermatology, including imaging and nonimaging tools. The speakers presented data on these technologies and discussed their clinical applicability, as well as new technology concepts from preclinical research.\u003C\/p\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EMORE EVIDENCE NEEDED ON QUALITY AND CONSISTENCY OF NONINVASIVE DIAGNOSTIC TOOLS\u003C\/h2\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EThe diagnosis of melanoma by simple visual examination using the ABCD method is incorrect in almost 1 of every 3 invasive melanoma diagnoses. A number of new techniques have improved the noninvasive diagnosis of slow-growing superficial spreading melanoma. Early diagnosis of fast-growing nodular melanoma may not be possible (or practical), however, using these costly diagnostic technologies. Josep Malvehy, MD, Hospital Clinic of Barcelona, Barcelona, Spain, reviewed the utility of available noninvasive methods for early melanoma diagnosis.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EQualitative imaging methods for melanoma diagnosis include dermoscopy, total body photography, multiphoton tomography, reflectance confocal microscopy (RCM), and optical coherence tomography (OCT). Quantitative methods using automated analysis include multispectral imaging, electrical impedance spectroscopy, and Raman spectroscopy. The features and key study results of the first 3 qualitative methods and the first 3 quantitative methods are shown in \u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E. RCM and OCT were discussed in the subsequent presentations.\u003C\/p\u003E\n         \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/12123\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/12123\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12123\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-5\u0022 class=\u0022first-child\u0022\u003ENoninvasive Qualitative and Quantitative Methods for Melanoma Diagnosis\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EA study of a new noninvasive adhesive patch test for evaluation of pigmented lesions using a 2-gene (CMIP and LINC00518) signature assay for differentiating melanomas from pigmented lesions reported a sensitivity of 97.6% and specificity of 72.7% [Gerami P et al. \u003Cem\u003EJ Am Acad Dermatol\u003C\/em\u003E. 2014]. Limitations of this study included the loss of cases due to messenger RNA insufficiency, inclusion of limited melanoma subtypes, and a minimum lesion diameter of 4 mm.\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EProf Malvehy concluded that new technologies for noninvasive detection of skin cancer will be developed and others will disappear. The optimal method for diagnosis depends on the physician, patient population, technical issues, and stage of development. Important questions remain about the clinical benefit, cost, and evidence for quality and consistency of noninvasive tools for diagnosing skin cancer.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ENEAR HISTOLOGIC RESOLUTION OF MELANOMA WITH RCM\u003C\/h2\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EGiovanni Pellacani, MD, University of Modena, Modena, Italy, spoke about in vivo imaging of the skin with RCM in clinical practice and research. RCM provides lateral resolution of 0.5 to 1 \u03bcm and axial resolution of 3 to 4 \u03bcm. The technique is noninvasive and painless, and it takes 7 minutes to acquire an image, providing an optical biopsy with cellular resolution. The confocal technology produces a composite grayscale image that is formed by consecutive confocal frames and mounted together to form a horizontal section of an area up to 8 \u00d7 8 mm to a maximum depth of 300 \u03bcm.\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EMelanoma is diagnosed on an RCM image by looking for the same features observed on histopathology, including large round pagetoid cells and nonhomogeneous junctional nests of atypical cells. Nevi, on the other hand, are characterized by a ringed, meshwork, or clod pattern without the large atypical cells seen in melanoma.\u003C\/p\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EGuitera and colleagues [\u003Cem\u003EJ Invest Dermatol\u003C\/em\u003E. 2009] demonstrated superior specificity with RCM (68%; 95% CI, 61.1% to 74.3%) vs dermoscopy (32%; 95% CI, 25.9% to 38.7%) and similar sensitivity with RCM (91%; 95% CI, 84.6% to 95.5%) and dermoscopy (88%; 95% CI, 80.7% to 92.6%) in the secondary evaluation of melanocytic lesions (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/37\/23\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Sensitivity and Specificity of Reflectance Ccnfocal Microscopy vs Dermoscopy in Secondary Evaluation of Melanocytic Lesions\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1200273190\u0022 data-figure-caption=\u0022Sensitivity and Specificity of Reflectance Ccnfocal Microscopy vs Dermoscopy in Secondary Evaluation of Melanocytic Lesions\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/37\/23\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/37\/23\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/37\/23\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12122\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-12\u0022 class=\u0022first-child\u0022\u003ESensitivity and Specificity of Reflectance Ccnfocal Microscopy vs Dermoscopy in Secondary Evaluation of Melanocytic Lesions\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003ERCM, reflectance confocal microscopy.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003E*\u003Cem\u003EP\u003C\/em\u003E \u0026lt; .001.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-3\u0022\u003EData source: Guitera P et al. \u003Cem\u003EJ Invest Dermatol\u003C\/em\u003E. 2009.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-4\u0022\u003EReproduced with permission from G Pellacani, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-13\u0022\u003EAn analysis of 710 consecutive clinically equivocal lesions found that RCM had 87.6% sensitivity and 70.8% specificity for melanoma [Guitera P et al. \u003Cem\u003EJ Invest Dermatol\u003C\/em\u003E. 2012].\u003C\/p\u003E\n         \u003Cp id=\u0022p-14\u0022\u003EA 10-year study of the accuracy of melanoma detection found that the number needed to excise a melanoma was 8.7 in specialized centers and 29.4 in nonspecialized centers [Argenziano G et al. \u003Cem\u003EJ Am Acad Dermatol\u003C\/em\u003E. 2011]. Pellacani and colleagues [\u003Cem\u003EBr J Dermatol\u003C\/em\u003E. 2014] recently reported that the number needed to excise a melanoma with RCM examination at a melanoma clinic was 6.8.\u003C\/p\u003E\n         \u003Cp id=\u0022p-15\u0022\u003EA study correlating melanoma biomarker levels with RCM found that melanomas with higher Bak serum levels had more junctional activity on RCM, whereas those with weak Bak expression had sparse dermal nests on RCM [Longo C et al. \u003Cem\u003EExp Dermatol\u003C\/em\u003E. 2011]. Another study reported that distinct melanoma subtypes were identified by RCM analysis of cell morphology [Pellacani G et al. \u003Cem\u003EExp Dermatol\u003C\/em\u003E. 2014]. Furthermore, melanoma risk identification and early diagnosis were improved with both RCM and dermoscopy when combined with genetic studies [Bassoli S et al. \u003Cem\u003EExp Dermatol\u003C\/em\u003E. 2013].\u003C\/p\u003E\n         \u003Cp id=\u0022p-16\u0022\u003ERCM analyzes skin lesions in vivo with similar resolution as observed with histology. According to Prof Pellacani, in vivo morphology may represent the missing link to bridge clinical and laboratory research.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EOCT IMPROVES DIAGNOSTIC ACCURACY AND SPECIFICITY IN NONMELANOMA SKIN CANCER\u003C\/h2\u003E\n         \u003Cp id=\u0022p-17\u0022\u003EMartina Ulrich, MD, Collegium Medicum Berlin, Berlin, Germany, discussed the use of OCT for diagnosing nonmelanoma skin cancer. OCT provides up to 60 images per scan of vertical and horizontal skin sections with a resolution of 7.5 \u03bcm up to 2 mm deep. High-resolution OCT combines horizontal and vertical imaging and has a 1.6 \u00d7 1.8 mm imaging field, 3 \u03bcm resolution, and 570 \u03bcm penetration. Multibeam OCT also combines horizontal and vertical imaging, and it has a 6 \u00d7 6 mm imaging field, 7.5 \u03bcm resolution, and 1 to 2 mm penetration.\u003C\/p\u003E\n         \u003Cp id=\u0022p-18\u0022\u003EOCT is used for differentiating nonmelanoma skin cancers from benign lesions, defining tumor thickness, and assessing tumor margins. A study of basal cell carcinoma diagnosis with OCT vs clinical evaluation and dermoscopy in 235 lesions demonstrated a diagnostic accuracy of 65.8% for histology, 76.2% for dermoscopy, and 87.4% for OCT. The positive predictive value and negative predictive value were greatest with OCT.\u003C\/p\u003E\n         \u003Cp id=\u0022p-19\u0022\u003EIn the same study, OCT significantly improved specificity vs clinical and vs dermoscopy (\u003Cem\u003EP\u003C\/em\u003E \u0026lt; .0001 for both) but not sensitivity vs clinical evaluation (\u003Cem\u003EP\u003C\/em\u003E = .099) and dermoscopy (\u003Cem\u003EP\u003C\/em\u003E = .121). \u003Ca id=\u0022xref-table-wrap-2-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T2\u0022\u003ETable 2\u003C\/a\u003E shows the results of additional studies of OCT for the diagnosis and evaluation of nonmelanoma skin cancers.\u003C\/p\u003E\n         \u003Cdiv id=\u0022T2\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/12124\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/12124\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12124\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 2.\u003C\/span\u003E \n               \u003Cp id=\u0022p-20\u0022 class=\u0022first-child\u0022\u003EStudies of OCT for Diagnosis of Nonmelanoma Skin Cancer\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-22\u0022\u003EOCT is applicable for the primary diagnosis of non-melanoma skin cancer. It may prove to be a useful tool for determining vertical tumor thickness. OCT also allows monitoring of lesions throughout time, and improves the diagnostic accuracy when evaluating pink patches. OCT increases diagnostic specificity in equivocal lesions compared with dermoscopy and clinical examination.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/37\/23.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzops2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzops2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzops2\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}