Background: In recent studies, convolutional neural networks (CNNs) outperformed dermatologists in distinguishing dermoscopic images of melanoma and nevi. In these studies, dermatologists and artificial intelligence were considered as opponents. However, the combination of classifiers frequently yields superior results, both in machine learning and among humans. In this study, we investigated the potential benefit of combining human and artificial intelligence for skin cancer classification. Methods: Using 11,444 dermoscopic images, which were divided into five diagnostic categories, novel deep learning techniques were used to train a single CNN. Then, both 112 dermatologists of 13 German university hospitals and the trained CNN independently classified a set of 300

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Patient-centered motives and expectations of the treatment of actinic keratoses (AK) have received little attention until now. Hence, we aimed to profile and cluster treatment motivations and expectations among patients with AK in a nationwide multicenter, cross-sectional study including patients from 14 German skin cancer centers. Patients were asked to complete a self-administered questionnaire. Treatment motives and expectations towards AK management were measured on a visual analogue scale from 1–10. Specific patient profiles were investigated with subgroup and correlation analysis. Overall, 403 patients were included. The highest motivation values were obtained for the items “avoid transition to invasive squamous cell carcinoma” (mean ± standard deviation; 8.98 ± 1.46), “AK are considered precancerous lesions” (8.72 ± 1.34) and “treating physician recommends treatment” (8.10 ± 2.37; p < 0.0001). The highest expectation values were observed for the items “effective lesion clearance” (8.36 ± 1.99), “safety” (8.20 ± 2.03) and “treatment-related costs are covered by health insurance” (8.00 ± 2.41; p < 0.0001). Patients aged ≥77 years and those with ≥7 lesions were identified at high risk of not undergoing any treatment due to intrinsic and extrinsic motivation deficits. Heat mapping of correlation analysis revealed four clusters with distinct motivation and expectation profiles. This study provides a patient-based heuristic tool for a personalized treatment decision in patients with AK.

K E Y W O R D S : (meth)acrylates, allergy, bone cement, case report, dental filling, lichen planus, patch test Despite the increasing use of (meth)acrylates both in dentistry and in beauty treatments, allergic reactions may often not be identified as such. We report a patient who developed dermatitis upon use of acrylate fingernails and exposure to paint dust, followed by oral pain and erosive lichen planus caused by acrylate-based dental fillings. Subsequently, the patient sought advice, as dental implants and a cemented arthroplasty were planned. CASE REPORTA 58-year-old woman had undergone replacement of amalgam dental fillings on the right jaw with plastic composite fillings. Subsequently, right-sided oral pain and burning developed. Neurological examination excluded neuritis. Thereafter, painful oral erosions ( Figure 1) and ulcers appeared, and were classified as erosive lichen planus by histology. Careful history-taking showed, apart from itching and eczema caused by jewellery, that the patient had developed dermatitis of the fingertips upon wearing artificial acrylic nails years ago. Furthermore, a pruritic rash on her face and neck had been aggravated by paint dust in the paint division of a hardware store.Because of a suspicion of acrylate allergy, patch testing was performed with the baseline series, and dental metal and dental technician series including acrylate preparations, according to the recommendations of the German Contact Dermatitis Research Group. Patch tests showed + positive reactions to nickel and palladium on day (D) 3, and +++ positive, partly bullous reactions to ethyleneglycol dimethylacrylate, 2-hydroxyethyl methacrylate, triethyleneglycol dimethacrylate, methyl methacrylate, 2-hydroxypropyl methacrylate, 1,4-butanediol dimethacrylate, ethyl methacrylate, tetrahydrofurfuryl methacrylate and diurethane dimethacrylate on D2 and D3 (Supporting Information Figure S1). Erosions partly persisted at the D7 reading. After replacement of plastic composite fillings with "a non-acrylate-releasing material" the patient's symptoms completely resolved. However, some years later, she presented again for evaluation prior to planned dental implantation and arthroplasty. DISCUSSIONThe main elicitors of dental material allergy are palladium, gold, and amalgam. 1 Furthermore, allergy to metals is common in patients with oral lichenoid lesions. 2,3 Acrylate allergy is less common, but may present with cross-reacting compounds. Theoretically, acrylates should be polymerized in dental prostheses and fillings. However, with inadequate polymerization, residual monomers are released and the risk of sensitization or elicitation arises. 4 (Meth)acrylates are contained in various coatings, plastics, dental prostheses, hearing aids, paints, bone cement for arthroplasty, glass substitutes, acrylic nails, printing inks, and adhesives. 5 A consumer may not interpret local eczema, and especially facial/neck dermatitis, as a manifestation of allergy to nail acrylates. However, such allergy is increasing both in occup...

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