Strategien zur nichtinvasiven Diagnostik des Melanoms

Abstract

The diagnosis of advanced cutaneous melanoma may easily be made by the unaided eye, followed by excisional biopsy and histopathological examination. However, in the setting of melanoma screening examinations in high-risk patients with many nevi, dermatologists are challenged with the differentiation of atypical but benign nevi and early invasive or in situ melanomas. In this situation, there is a real need for additional, noninvasive examination techniques that may serve as an aide to decide for or against an excisional biopsy. Conventional dermoscopy is a well-established examination procedure and an increase in sensitivity was confirmed by two independent meta-analyses. Moreover, dynamic changes or newly developed pigmented lesions may be detected by sequential digital dermoscopy or (automated) total body photography, respectively. Over the past years, a number of medicinal products gained market access after licensing by American and European agencies for the noninvasive diagnosis of cutaneous neoplasms. These devices are based on technologies including in vivo reflectance confocal microscopy, multispectral analysis, electrical impedance spectroscopy, or Raman spectroscopy. Other technologies are still on the verge of becoming less experimental but more clinically applicable for diagnosing melanoma (in vivo multiphoton tomography, stepwise two-photon laser spectroscopy, infrared thermal image analysis, epidermal genetic information retrieval). This review provides a concise overview of general principles and sheds light on indication and added value for dermatologists.

Detection of cutaneous malignant melanoma by tape stripping of pigmented skin lesions – A systematic review

“…hits were scoping reviews, and TS of MM was only mentioned in short. 5,7,[12][13][14][15][16][17][18][19][20][21][22][23][24][25] Five articles had other outcomes where sensitivity and specificity were not examined. [26][27][28][29][30] Three articles were "response letters" to other articles with no relevant data.…”

“…Fourteen hits were meeting, or conference abstracts and no articles were found. Sixteen hits were scoping reviews, and TS of MM was only mentioned in short 5,7,12–25 . Five articles had other outcomes where sensitivity and specificity were not examined 26–30 .…”

From Melanocytes to Melanoma Cells: Characterization of the Malignant Transformation by Four Distinctly Different Melanin Fluorescence Spectra (Review)

“…This stepwise two-photon excitation as schematically shown in Figure 1 b is the principle of dermatofluoroscopy [ 13 , 14 , 15 ]. In the experimental setting of dermatofluoroscopy, laser pulses with a wavelength of 800 nm and pulse duration of 2 ns are used.…”

“…A breakthrough in terms of the measurability of melanin fluorescence in tissue came with a special technique of non-linear spectroscopy, the stepwise two-photon excitation of fluorescence [ 7 , 8 , 9 , 10 , 11 , 12 ]. Its specialized version for measurements in tissue is called dermatofluoroscopy [ 13 , 14 , 15 ].…”

Non-invasive diagnostic techniques for skin tumors and their potential for use in skin melanoma screening: a systematic literature review

“…Следует отметить, что интерпретация изображений, получаемых с помощью конфокальной лазерной микроскопии, требует подготовки специалиста, а результаты могут варьировать в зависимости от опыта исследователя. Неинвазивной методикой, предназначенной для оценки клеточных и внеклеточных структур со сверх высо кой субклеточной разрешающей способностью, является мультифотонная флюоресцентная томография [134][135][136][137]. В системе используется фемтосекундный лазер с двумя или более длинноволновыми, низкоэнергетическими фотонами, предназначенными для возбуждения эндогенных флуоресцентных молекул, таких как NAD(P)H, флавинов, порфиринов и меланина [138].…”