856 Commentaries
Conflicts of interest None declared. Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Dr Gessler-Str. 17, 93051 Regensburg, Germany E-mail: [email protected]
C.J. APFELBACHER
References 1 Visser MJ, Verberk MM, van Dijk FJ et al. Wet work and hand eczema in apprentice nurses; part I of a prospective cohort study. Contact Dermatitis 2014; 70:44–55. 2 Apfelbacher CJ, Funke U, Radulescu M, Diepgen TL. Determinants of current hand eczema: results from case–control studies nested in the PACO follow-up study (PACO II). Contact Dermatitis 2010; 62:363–70. 3 Lysdal SH, Johansen JD, Flyvholm MA, Søsted H. A quantification of occupational skin exposures and the use of protective gloves among hairdressers in Denmark. Contact Dermatitis 2012; 66:323–34. 4 Committee on Hazardous Substances. TRGS 401. Risks resulting from skin contact – identification, assessment, measures. Available at: http://www.baua.de/en/Topics-from-A-to-Z/Hazardous-Substances/ TRGS/pdf/TRGS-401.pdf (last accessed 6 January 2015). 5 Weistenhofer W, Wacker M, Bernet F et al. Occlusive gloves and skin conditions: is there a problem? Results of a cross-sectional study in a semiconductor company. Br J Dermatol 2015; 172:1058– 65. 6 Weistenh€ ofer W, Baumeister T, Drexler H, K€ utting B. How to quantify skin impairment in primary and secondary prevention? HEROS: a proposal of a hand eczema score for occupational screenings Br J Dermatol 2011; 164:807–13.
Mobile teledermatology is here to stay
front camera (for video conferencing, ‘selfies’ and facial closeups), touch screen and low energy consumption. Image analysis software can recognize faces and objects – and, potentially, diagnose skin conditions. Sharing edited images is easy via multimedia messaging services, e-mail or one of numerous smartphone apps. Mobile teledermatology is convenient and speedy. It enhances access, data collection, diagnosis, health information, treatment adherence and follow-up. Vigorous debate, evidence-based research and guidelines are urgently needed to ensure safe and effective practice, patient confidentiality and consent, and data security.3 Massone et al.4 predicted in 2007 that mobile teledermoscopy would soon be used ‘for enhanced self-monitoring for skin cancer screening’. Manahan et al.5, in this issue of the BJD, have investigated whether patients with multiple naevi selected similar skin lesions to monitor as their dermatologists. The authors found that patients can take high-quality dermatoscopic images, enabling accurate telediagnosis and supplementing in-person total-body examinations. Primary-care physicians increasingly use smartphones with dermatoscopic attachments for referral.6 Patients are also imaging lesions that concern them, sometimes risking the perils of social networks and automated diagnostic apps.7,8 Low-cost dermatoscopic attachments intended for use by patients are imminent (personal communication). The next step is to establish pathways so that people at high risk of skin cancer and the worried well send their images to their usual health practitioners.9 Some will have melanoma. Others with benign lesions can avoid unnecessary surgical procedures and worry. Conflicts of interest None declared. Department of Dermatology, Waikato Hospital, Hamilton, New Zealand E-mail: [email protected]
A. M. OAKLEY
DOI: 10.1111/bjd.13722 ORIGINAL ARTICLE, p 1072 My first sight of a cellular phone – a ‘brick’ – was in 1990. Twenty-five years later, almost every reader has at least one mobile phone with a camera and broadband connection. The International Telecommunications Union estimates that there are 7 billion mobile phone subscriptions worldwide, almost as many as there are people on earth. Mobile cellular penetration is > 90%, even in developing countries. In developed countries, mobile broadband penetration is 84%.1 The first camera phone was sold in Japan in 2000; within 10 years there were more than 1 billion worldwide.2 Highend devices now produce excellent images. Benefits over standard digital cameras include their availability, low weight, British Journal of Dermatology (2015) 172, pp844–860
References 1 International Telecommunications Union. The world in 2014. ICT facts and figures. Available at: http://www.itu.int/en/ITU-D/Statistics/Documents/facts/ICTFactsFigures2014-e.pdf (last accessed 24 February 2015). 2 Wikipedia. Camera phone. Available at: http://en.wikipedia.org/ wiki/Camera_phone (last accessed 24 February 2015). 3 Boulos MN, Brewer AC, Karimkhani C et al. Mobile medical and health apps: state of the art, concerns, regulatory control and certification. Online J Public Health Inform 2014; 5:229. 4 Massone C, Hofmann-Wellenhof R, Ahlgrimm-Siess V et al. Melanoma screening with cellular phones. PLoS ONE 2007; 2:e483. 5 Manahan MN, Soyer HP, Loescher LJ et al. A pilot trial of mobile, patient-performed teledermoscopy. Br J Dermatol 2015; 172:1072– 80.
© 2015 British Association of Dermatologists
Commentaries 6 Chao JT 2nd, Loescher LJ, Soyer HP, Curiel-Lewandrowski C. Barriers to mobile teledermoscopy in primary care. J Am Acad Dermatol 2013; 69:821–4. 7 Most smartphone apps for melanoma detection are inaccurate. Health Devices 2013; 42:135. 8 Wolf JA, Moreau J, Akilov O et al. Diagnostic inaccuracy of smartphone applications for melanoma detection. JAMA Dermatol 2013; 149:422–6. 9 Hall S, Murchie P. Can we use technology to encourage self-monitoring by people treated for melanoma? A qualitative exploration of the perceptions of potential recipients. Support Care Cancer 2014; 22:1663–71.
Association between genetic factors, naevus count and dermoscopic pattern DOI: 10.1111/bjd.13578 ORIGINAL ARTICLE, p 1081 It is well known that naevogenesis is a complex process that has its critical periods in childhood and adolescence.1 Moreover, the development of naevi is influenced not only by age but also by factors such as sex, sun exposure, skin type and freckling, to name just a few.2 A growing body of evidence has suggested that naevi have a strong heritable component in which gene variants implicated in naevus development include those involved in pigmentation, cell cycle regulation, telomere function and senescence. A deep understanding of the dynamic process of naevogenesis has been offered by dermoscopy and in vivo confocal microscopy. These methods have provided new insights into the growing pattern of some naevi (lesions with peripheral globules) and the stability of other naevi typified by a reticular pattern, suggesting that dermoscopically defined subsets of acquired naevi are biologically distinct.1,3 The study by Orlow et al.4, in this issue of the BJD, evaluates the potential associations between genetics and both melanocytic naevus count and dermoscopic naevus patterns in early life. In total 853 naevi located on the backs of 290 children were dermoscopically classified and correlated with their genetic profile. Interestingly, the IRF4 rs12203952 polymorphism was very strongly associated with high naevus count, and the rs12203952 T allele was associated with increased counts of flat naevi and decreased counts of raised naevi. SNPs in IRF4 and TERT showed significant associations with globular patterns, while SNPs in CDKN1B, MTAP and PARP1 showed significant associations with reticular-patterned naevi (compared with homogeneous naevi). A SNP in CDK6 showed borderline significance with reticular-patterned naevi.
© 2015 British Association of Dermatologists
857
The present study demonstrated in a selected population of white non-Hispanic children that genetics are associated with distinct dermoscopic patterns (reticular/globular/homogeneous), as well as the number of naevi. This opens the possibility to understand better the pathways implied in naevogenesis and potentially to improve the current knowledge of melanoma development. Furthermore, this study underlines the need to correlate clinical dermoscopic findings that represent a dynamic view of naevi, including the genetic background, to have a complete overview of pathogenetic process such as naevogenesis. In our opinion this study opens the door to the research of new risk factors that can justify the frequent development of melanomas in patients lacking clinically identifiable risk factors, also considering that some nodular melanomas arising in youth are not related to predictable risk factors, but may depend on the genetic background.5 Thus, deep understanding of the polymorphisms responsible for characteristic naevus patterns may increase our knowledge of the genetic background responsible for different melanoma subtypes.6 It may also help in early identification of groups of patients needing screening programmes and dedicated education on primary and secondary prevention for melanoma. Conflicts of interest None declared. 1
Dermatology and Skin Cancer Unit, ASMN-IRCCS, Reggio Emilia, Italy 2 Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy E-mail: [email protected]
C. LONGO1 G. PELLACANI2
References 1 Zalaudek I, Ferrara G, Argenziano G. Dermoscopy insights into nevogenesis: ‘Abtropfung’ versus ‘Hochsteigerung’. Arch Dermatol 2007; 143:284. 2 Bataille V, Snieder H, MacGregor AJ et al. Genetics of risk factors for melanoma: an adult twin study of nevi and freckles. J Natl Cancer Inst 2000; 92:457–63. 3 Pellacani G, Scope A, Ferrari B et al. New insights into nevogenesis: in vivo characterization and follow-up of melanocytic nevi by reflectance confocal microscopy. J Am Acad Dermatol 2009; 61:1001–13. 4 Orlow I, Satagopan JM, Berwick M et al. Genetic factors associated with naevus count and dermoscopic patterns: preliminary results from the Study of Nevi in Children (SONIC). Br J Dermatol 2015; 172:1081–89. 5 Sturm RA, Fox C, McClenahan P et al. Phenotypic characterization of nevus and tumor patterns in MITF E318K mutation carrier melanoma patients. J Invest Dermatol 2014; 134:141–9. 6 Pellacani G, De Pace B, Reggiani C et al. Distinct melanoma types based on reflectance confocal microscopy. Exp Dermatol 2014; 23:414–18.
British Journal of Dermatology (2015) 172, pp844–860
This document is a scanned copy of a printed document. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material.
Conflicts of interest None declared. Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Dr Gessler-Str. 17, 93051 Regensburg, Germany E-mail: [email protected]
C.J. APFELBACHER
References 1 Visser MJ, Verberk MM, van Dijk FJ et al. Wet work and hand eczema in apprentice nurses; part I of a prospective cohort study. Contact Dermatitis 2014; 70:44–55. 2 Apfelbacher CJ, Funke U, Radulescu M, Diepgen TL. Determinants of current hand eczema: results from case–control studies nested in the PACO follow-up study (PACO II). Contact Dermatitis 2010; 62:363–70. 3 Lysdal SH, Johansen JD, Flyvholm MA, Søsted H. A quantification of occupational skin exposures and the use of protective gloves among hairdressers in Denmark. Contact Dermatitis 2012; 66:323–34. 4 Committee on Hazardous Substances. TRGS 401. Risks resulting from skin contact – identification, assessment, measures. Available at: http://www.baua.de/en/Topics-from-A-to-Z/Hazardous-Substances/ TRGS/pdf/TRGS-401.pdf (last accessed 6 January 2015). 5 Weistenhofer W, Wacker M, Bernet F et al. Occlusive gloves and skin conditions: is there a problem? Results of a cross-sectional study in a semiconductor company. Br J Dermatol 2015; 172:1058– 65. 6 Weistenh€ ofer W, Baumeister T, Drexler H, K€ utting B. How to quantify skin impairment in primary and secondary prevention? HEROS: a proposal of a hand eczema score for occupational screenings Br J Dermatol 2011; 164:807–13.
Mobile teledermatology is here to stay
front camera (for video conferencing, ‘selfies’ and facial closeups), touch screen and low energy consumption. Image analysis software can recognize faces and objects – and, potentially, diagnose skin conditions. Sharing edited images is easy via multimedia messaging services, e-mail or one of numerous smartphone apps. Mobile teledermatology is convenient and speedy. It enhances access, data collection, diagnosis, health information, treatment adherence and follow-up. Vigorous debate, evidence-based research and guidelines are urgently needed to ensure safe and effective practice, patient confidentiality and consent, and data security.3 Massone et al.4 predicted in 2007 that mobile teledermoscopy would soon be used ‘for enhanced self-monitoring for skin cancer screening’. Manahan et al.5, in this issue of the BJD, have investigated whether patients with multiple naevi selected similar skin lesions to monitor as their dermatologists. The authors found that patients can take high-quality dermatoscopic images, enabling accurate telediagnosis and supplementing in-person total-body examinations. Primary-care physicians increasingly use smartphones with dermatoscopic attachments for referral.6 Patients are also imaging lesions that concern them, sometimes risking the perils of social networks and automated diagnostic apps.7,8 Low-cost dermatoscopic attachments intended for use by patients are imminent (personal communication). The next step is to establish pathways so that people at high risk of skin cancer and the worried well send their images to their usual health practitioners.9 Some will have melanoma. Others with benign lesions can avoid unnecessary surgical procedures and worry. Conflicts of interest None declared. Department of Dermatology, Waikato Hospital, Hamilton, New Zealand E-mail: [email protected]
A. M. OAKLEY
DOI: 10.1111/bjd.13722 ORIGINAL ARTICLE, p 1072 My first sight of a cellular phone – a ‘brick’ – was in 1990. Twenty-five years later, almost every reader has at least one mobile phone with a camera and broadband connection. The International Telecommunications Union estimates that there are 7 billion mobile phone subscriptions worldwide, almost as many as there are people on earth. Mobile cellular penetration is > 90%, even in developing countries. In developed countries, mobile broadband penetration is 84%.1 The first camera phone was sold in Japan in 2000; within 10 years there were more than 1 billion worldwide.2 Highend devices now produce excellent images. Benefits over standard digital cameras include their availability, low weight, British Journal of Dermatology (2015) 172, pp844–860
References 1 International Telecommunications Union. The world in 2014. ICT facts and figures. Available at: http://www.itu.int/en/ITU-D/Statistics/Documents/facts/ICTFactsFigures2014-e.pdf (last accessed 24 February 2015). 2 Wikipedia. Camera phone. Available at: http://en.wikipedia.org/ wiki/Camera_phone (last accessed 24 February 2015). 3 Boulos MN, Brewer AC, Karimkhani C et al. Mobile medical and health apps: state of the art, concerns, regulatory control and certification. Online J Public Health Inform 2014; 5:229. 4 Massone C, Hofmann-Wellenhof R, Ahlgrimm-Siess V et al. Melanoma screening with cellular phones. PLoS ONE 2007; 2:e483. 5 Manahan MN, Soyer HP, Loescher LJ et al. A pilot trial of mobile, patient-performed teledermoscopy. Br J Dermatol 2015; 172:1072– 80.
© 2015 British Association of Dermatologists
Commentaries 6 Chao JT 2nd, Loescher LJ, Soyer HP, Curiel-Lewandrowski C. Barriers to mobile teledermoscopy in primary care. J Am Acad Dermatol 2013; 69:821–4. 7 Most smartphone apps for melanoma detection are inaccurate. Health Devices 2013; 42:135. 8 Wolf JA, Moreau J, Akilov O et al. Diagnostic inaccuracy of smartphone applications for melanoma detection. JAMA Dermatol 2013; 149:422–6. 9 Hall S, Murchie P. Can we use technology to encourage self-monitoring by people treated for melanoma? A qualitative exploration of the perceptions of potential recipients. Support Care Cancer 2014; 22:1663–71.
Association between genetic factors, naevus count and dermoscopic pattern DOI: 10.1111/bjd.13578 ORIGINAL ARTICLE, p 1081 It is well known that naevogenesis is a complex process that has its critical periods in childhood and adolescence.1 Moreover, the development of naevi is influenced not only by age but also by factors such as sex, sun exposure, skin type and freckling, to name just a few.2 A growing body of evidence has suggested that naevi have a strong heritable component in which gene variants implicated in naevus development include those involved in pigmentation, cell cycle regulation, telomere function and senescence. A deep understanding of the dynamic process of naevogenesis has been offered by dermoscopy and in vivo confocal microscopy. These methods have provided new insights into the growing pattern of some naevi (lesions with peripheral globules) and the stability of other naevi typified by a reticular pattern, suggesting that dermoscopically defined subsets of acquired naevi are biologically distinct.1,3 The study by Orlow et al.4, in this issue of the BJD, evaluates the potential associations between genetics and both melanocytic naevus count and dermoscopic naevus patterns in early life. In total 853 naevi located on the backs of 290 children were dermoscopically classified and correlated with their genetic profile. Interestingly, the IRF4 rs12203952 polymorphism was very strongly associated with high naevus count, and the rs12203952 T allele was associated with increased counts of flat naevi and decreased counts of raised naevi. SNPs in IRF4 and TERT showed significant associations with globular patterns, while SNPs in CDKN1B, MTAP and PARP1 showed significant associations with reticular-patterned naevi (compared with homogeneous naevi). A SNP in CDK6 showed borderline significance with reticular-patterned naevi.
© 2015 British Association of Dermatologists
857
The present study demonstrated in a selected population of white non-Hispanic children that genetics are associated with distinct dermoscopic patterns (reticular/globular/homogeneous), as well as the number of naevi. This opens the possibility to understand better the pathways implied in naevogenesis and potentially to improve the current knowledge of melanoma development. Furthermore, this study underlines the need to correlate clinical dermoscopic findings that represent a dynamic view of naevi, including the genetic background, to have a complete overview of pathogenetic process such as naevogenesis. In our opinion this study opens the door to the research of new risk factors that can justify the frequent development of melanomas in patients lacking clinically identifiable risk factors, also considering that some nodular melanomas arising in youth are not related to predictable risk factors, but may depend on the genetic background.5 Thus, deep understanding of the polymorphisms responsible for characteristic naevus patterns may increase our knowledge of the genetic background responsible for different melanoma subtypes.6 It may also help in early identification of groups of patients needing screening programmes and dedicated education on primary and secondary prevention for melanoma. Conflicts of interest None declared. 1
Dermatology and Skin Cancer Unit, ASMN-IRCCS, Reggio Emilia, Italy 2 Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy E-mail: [email protected]
C. LONGO1 G. PELLACANI2
References 1 Zalaudek I, Ferrara G, Argenziano G. Dermoscopy insights into nevogenesis: ‘Abtropfung’ versus ‘Hochsteigerung’. Arch Dermatol 2007; 143:284. 2 Bataille V, Snieder H, MacGregor AJ et al. Genetics of risk factors for melanoma: an adult twin study of nevi and freckles. J Natl Cancer Inst 2000; 92:457–63. 3 Pellacani G, Scope A, Ferrari B et al. New insights into nevogenesis: in vivo characterization and follow-up of melanocytic nevi by reflectance confocal microscopy. J Am Acad Dermatol 2009; 61:1001–13. 4 Orlow I, Satagopan JM, Berwick M et al. Genetic factors associated with naevus count and dermoscopic patterns: preliminary results from the Study of Nevi in Children (SONIC). Br J Dermatol 2015; 172:1081–89. 5 Sturm RA, Fox C, McClenahan P et al. Phenotypic characterization of nevus and tumor patterns in MITF E318K mutation carrier melanoma patients. J Invest Dermatol 2014; 134:141–9. 6 Pellacani G, De Pace B, Reggiani C et al. Distinct melanoma types based on reflectance confocal microscopy. Exp Dermatol 2014; 23:414–18.
British Journal of Dermatology (2015) 172, pp844–860
This document is a scanned copy of a printed document. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material.
