rolex replica | fake audemars piguet | hublot replica sale | rolex replica sale

Molescreening - State of the art Technology

Dr. Dagmar Whitaker, Dermatologist, Cape Town - President of Melanoma Advisory Board S.A.

Invasive primary melanoma in whites shows the greatest and most rapid increase of all cancer worldwide. The incidence in South Africa is unknown but what is known is that the incidence in the Cape Town area is similar to that in Australia (24,4 per 100:000). Epidemiological studies to determine the exact incidence are in progress but it would appear from current statistics that at least 850 people continue to die from melanoma each year in South Africa.

Many of these deaths occur at a younger age than for solid tumours so the number of years of life lost due to melanoma exceeds that of many other cancers. Prevention of melanoma has not yet been achieved and there are no conclusive data to show that current promotion of sun avoidance has substantially altered its incidence.

What makes matters worse is that even today there is no effective treatment for late stage disease. To alter the outcome and prognosis there is only one promising strategy and that is early diagnosis. So far diagnosis is based mainly on clinical assessment of changes in colour, diameter, elevation and border (irregularity of outline) of a skin lesion, asymmetry of a lesion or a lesion different from other nevi.

Common nevi (moles) are a benign nest of melanocytic cells and must be differentiated from atypical or dysplastic nevi. The melanoma risk increases accumulative with an increased number of nevi (>50) plus the presence of one or more dysplastic nevi. It is therefore imperative that the clinician should recognize features of a dysplastic nevus and to differentiate between a nevus and an early malignant melanoma. While the normal clinical examination with the naked eye could be described as inadequate to detect early changes diagnostic accuracy has improved with the introduction of skin surface microscopy. Most if not all Dermatologists had specific training in the use of the Dermoscope, or hand held skin surface microscope developed in 1990. This offers the visualisation of subsurface structures of the skin providing a 10 X magnification.

Following the rising pressure to diagnose melanomas earlier and earlier the first Computerised Digital Epiluminecence was developed in. the mid 1990's in form of the Mole Max.

This system includes handheld macro- and micro imaging devices, a computer screen, storage systems and a printer. It offers a 90 X magnification which can reveal the pigment in the epidermis and superficial dermis. The pigment pattern and colour can be correlated with pigment distribution in the corresponding histopathological structures.

For the interpretation of these findings it is of course imperative to have profound understanding of the morphology of pigmented lesions. The software also offers an Expertizer programme where the lesion observed can be compared to reference lesions i.e. junctional nevi, dysplastic nevi or early melanomas.

Furthermore it can analyse the lesion through the ABCD rule and measure pigment density to arrive at a specific score given to the mole examined. The score determines how suspicious this lesion is whether and at what intervals it can be followed up or whether it needs to be excised for histological examination. Another great advantage is the effective storage of date. Up to 60000 macro- and micro images can be stored and called up at follow up. In such a way one can detect the slightest changes in a suspicious lesion.

It is obvious that such a system offers advantages over an unaided clinical examination and follow-up. One has to however emphasize that any machine - and even computer - can only be as good as its operator. Like in all techniques it is essential to be able to assess the features seen and classify them in order to make an accurate diagnosis.

Melanoma is a cancer to be concerned about because if missed in the early stages it carries an extremely high mortality rate. So any aid to alter the outcome of this disease should be welcomed. Unfortunately awareness campaigns still carry mixed messages and have not influenced the incidence of melanoma. Only early diagnosis has and will continue to alter the prognosis. It may be worthwhile offering Molescreening programmes to school children to identify individuals at risk. Sun exposure in the first 20 years of your life is known to contribute significantly to the development of malignant melanoma (and other forms of skin cancer).

Maybe the institution of "walk-in" skin-clinics like they have in Le. Australia would also improve the early diagnosis. The population needs to be educated and clinicians need to be trained and equipped to take on the task of a "Mole-patrol". High risk individuals should be followed up by a specialist with an interest in melanoma management and patients with an existing melanoma should ideally be managed with the support from a melanoma centre.

COPYRIGHT (C) CAPETOWNDERMATOLOGISTS.CO.ZA. ALL RIGHTS RESERVED
Email Dr Whitaker