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Background: Survey on the current status of dermoscopy in Germany. Methods: In the context of a pan-European internet-based study (n = 7,480) conducted by the International Dermoscopy Society, 880 German dermatologists were asked to answer questions with respect to their level of training as well as their use and perceived benefit of dermoscopy. Results: Seven hundred and sixty-two (86.6 %) participants practiced dermatology in a publicly funded health care setting; 98.4 % used a dermoscope in routine clinical practice. About 93 % (n = 814) stated to have had more than five years of experience in the use of dermoscopy. Dermoscopy was considered useful in the diagnosis of melanoma by 93.6 % (n = 824); for pigmented skin tumors, by 92.4 % (n = 813); in the follow-up of melanocytic lesions, by 88.6 % (n = 780); for non-pigmented lesions, by 71.4 % (n = 628), in the follow-up of non-melanocytic lesions, by 52.7 % (n = 464); and for inflammatory skin lesions, by 28.5 % (n = 251). Overall, 86.5 % (n = 761) of participants felt that-compared to naked-eye examination-dermoscopy increased the number of melanomas diagnosed; 77,7 % (n = 684) considered the number of unnecessary excisions of benign lesions to be decreased. Participants who personally felt that dermoscopy improved their ability to diagnose melanoma were significantly i) younger, ii) had been practicing dermatology for a shorter period of time, iii) were less commonly employed by a university-affiliated dermatology department, iv) were more frequently working in an office-based public health care setting, and v) had more frequently been trained in dermoscopy during their dermatology residency. Conclusions: The findings presented herein ought to be integrated into future residency and continuing medical education programs with the challenge to improve dermato-oncological care and to expand the diagnostic spectrum of dermoscopy to include inflammatory skin diseases.

Background Survey on the current status of dermoscopy in Germany. Methods In the context of a pan-European internet-based study (n = 7,480) conducted by the International Dermoscopy Society, 880 German dermatologists were asked to answer questions with respect to their level of training as well as their use and perceived benefit of dermoscopy. Results Seven hundred and sixty-two (86.6 %) participants practiced dermatology in a publicly funded health care setting; 98.4 % used a dermoscope in routine clinical practice. About 93 % (n = 814) stated to have had more than five years of experience in the use of dermoscopy. Dermoscopy was considered useful in the diagnosis of melanoma by 93.6 % (n = 824); for pigmented skin tumors, by 92.4 % (n = 813); in the follow-up of melanocytic lesions, by 88.6 % (n = 780); for non-pigmented lesions, by 71.4 % (n = 628), in the follow-up of non-melanocytic lesions, by 52.7 % (n = 464); and for inflammatory skin lesions, by 28.5 % (n = 251). Overall, 86.5 % (n = 761) of participants felt that - compared to naked-eye examination - dermoscopy increased the number of melanomas diagnosed; 77,7 % (n = 684) considered the number of unnecessary excisions of benign lesions to be decreased. Participants who personally felt that dermoscopy improved their ability to diagnose melanoma were significantly i) younger, ii) had been practicing dermatology for a shorter period of time, iii) were less commonly employed by an university-affiliated dermatology department, iv) were more frequently working in an office-based public health care setting, and v) had more frequently been trained in dermoscopy during their dermatology residency. Conclusions The findings presented herein ought to be integrated into future residency and continuing medical education programs with the challenge to improve dermato-oncological care and to expand the diagnostic spectrum of dermoscopy to include inflammatory skin diseases.

Background: Collision lesions as two independent and unrelated skin tumors often manifest an atypical morphology. Objective: To determine the combinations of collision skin lesions (CSLs). Methods: Twenty-one pigmented lesion clinics in nine countries included 77 histopathologically proven CSLs in this retrospective observational study. Results: Seventy-seven CSLs from 75 patients (median age 59.8 years) were analyzed; 24.7% of CSLs were located on the head and neck area, 5.2% on the upper extremities, 48.1% on the trunk, and 11.7% on the lower extremities; 40.3% revealed a melanocytic component (median age 54.7 years), followed by 45.5% with a basal cell carcinoma (BCC) (median age 62.4 years) and 11.7% with a seborrheic keratosis (median age 64.7 years). CSLs with a BCC component were more often found on the head and neck area compared to tumors with a melanocytic component (34.3% versus 16.1%). Lesions with a melanocytic component were more often detected on the trunk compared to lesions with a BCC (64.5% versus 37.1%). Patients with CSLs with epidermal-epidermal cell combination were older than patients with epidermal-dermal cell combination (63 versus 55.2 years), were more often male than female (63% versus 43.3%), more often had the lesion on the head and neck area (32.6% versus 13.3%), and less often on the upper (2.2 % versus 10%) or lower extremities (8.7% versus 16.6%). Conclusions: CSLs consist of a heterogeneous group of lesions of varying cell types. They are associated with advancing age and cumulative UV-exposure. CSLs manifest a complex morphology making it challenging to diagnose correctly.

Melanozytare Navi, also gutartige Proliferationen melanozytarer Zellen der Haut gehoren zu den haufigsten Diagnosen in einer Hautarztpraxis. Die Ahnlichkeit und Verwechslungsmoglichkeit mit einem Melanom ist fur viele Patienten der primare Konsultationsgrund („Ist das was Schlimmes?“). Besondere Aufmerksamkeit erfordern rasch entstandene Pigmentmale.

Haare, Haut und Nagel pragen entscheidend den asthetischen Gesamteindruck einer Person. Durch die Moglichkeiten der Dermatoskopie als nicht invasive morphologische Untersuchungsmethode wird die Lucke zwischen klinischer Blickdiagnose und histologischer Befunderhebung am Schnittpraparat geschlossen. Dem Untersucher erschliesen sich durch diese Technik mikroanatomische Strukturen lebender Haut in dreidimensionaler Perspektive.

Nach dem Ausstieg aus der Atomkraftnutzung wird die Entsorgung der hoch radioaktiven Abfalle in Deutschland vermehrt diskutiert. Im Standortauswahlgesetz ist die Entsorgungsoption „Endlagerung“ festgelegt. Erfahrungsgemas kommen jedoch immer wieder Diskussionen daruber auf, welche Entsorgungsoption die Richtige ist, und zur Umsetzung einer Entsorgungsoption konnen verschiedene Entsorgungspfade beschritten weren. Daher sind neue Ansatze gefragt, um die Sicherheit von Entsorgungspfaden zu beurteilen und vergleichend zu bewerten.

Die Entsorgung hoch radioaktiver Abfalle ist ein anspruchsvolles Vorhaben. Sicherheit muss uber sehr lange Zeiraume gewahrleistet werden. Angesichts der damit verbundenen Ungewissheiten wird immer wieder gefordert, ein End- oder Tiefenlager uber langere Zeitraume kontrollieren zu konnen. Monitoring und Ruckholbarkeit sollen es erlauben, Abweichungen vom erwarteten Verhalten des Lagers fruhzeitig zu erkennen und ggf. Korrekturen am Entsorgungspfad vorzunehmen.

Mit der Entsorgung hoch radioaktiver Abfalle wird vorrangig das Ziel verfolgt, Mensch und Umwelt vor den Gefahren zu schutzen, die von den Abfallen ausgehen. Dazu mussen Risiken uber sehr lange Zeitraume kontrolliert und Vorsorge gegenuber Ungewissheiten getroffen werden. Ungewissheiten sind nicht nur in Bezug auf die Langzeitentwicklung der Lager von Bedeutung, sondern auch in Bezug auf die Standortauswahl, den Bau und Betrieb von End-, Tiefen- und Oberflachenlagern, die voraussichtlich viele Jahrzehnte beanspruchen werden. Wichtige Grundsatze, die dem Ziel der Sicherheit nachgelagert sind, sind Gerechtigkeit und Wirtschaftlichkeit.

International werden heute vor allem drei Entsorgungsoptionen naher in Betracht gezogen oder in nationalen Entsorgungsprogrammen umgesetzt, die Endlagerung, die Tiefenlagerung und die Oberflachenlagerung. Als Entsorgungspfad werden alle Schritte bezeichnet, die erforderlich sind, bis die Abfalle auf Dauer passiv sicher entsorgt worden sind bzw. so behandelt wurden, dass von ihnen kein unzulassiges Risiko mehr fur Mensch und Umwelt ausgeht. Die Risiken der Entsorgung variieren mit dem gewahlten Entsorgungspfad und der gewahlten Entsorgungsoption.

Die wissenschaftlichen Arbeiten zur Dermatoskopie (Auflichtmikroskopie, Epilumineszenzmikroskopie) in den Bereichen der klinischen Forschung, der Lehre und der technischen Entwicklungen von zahlreichen deutschsprachigen Dermatoskopikern/innen haben in den letzten 30 Jahren einen wichtigen Grundstein fur die tagliche Versorgung von dermatoonkologischen Patienten nicht nur national, sondern auch international gelegt.

Gesellschaftliche Rahmenbedingungen entscheiden daruber mit, welche Entsorgungsoption und welcher Entsorgungspfad in einer spezifischen Situation die jeweils besten sind. Die Sicherheit einer Entsorgungsoption folgt einem komplexen Muster von Risiken und Ungewissheiten, das sich im Verlauf des Entsorgungspfades wandelt. Monitoring und Ruckholbarkeit bewegen sich im Spannungsfeld von Risiko, Ungewissheit und Akzeptanz. Zwischen diesen Anspruchen muss im Dialog mit der Zivilgesellschaft eine Optimierung angestrebt werden.

Background: Deep learning convolutional neural networks (CNN) may facilitate melanoma detection, but data comparing a CNN's diagnostic performance to larger groups of dermatologists are lacking.Methods: Google's Inception v4 CNN architecture was trained and validated using dermoscopic images and corresponding diagnoses. In a comparative cross-sectional reader study a 100-image test-set was used (level-I: dermoscopy only; level-II: dermoscopy plus clinical information and images). Main outcome measures were sensitivity, specificity and area under the curve (AUC) of receiver operating characteristics (ROC) for diagnostic classification (dichotomous) of lesions by the CNN versus an international group of 58 dermatologists during level-I or -II of the reader study. Secondary end points included the dermatologists' diagnostic performance in their management decisions and differences in the diagnostic performance of dermatologists during level-I and -II of the reader study. Additionally, the CNN's performance was compared with the top-five algorithms of the 2016 International Symposium on Biomedical Imaging (ISBI) challenge.Results: In level-I dermatologists achieved a mean (±standard deviation) sensitivity and specificity for lesion classification of 86.6% (±9.3%) and 71.3% (±11.2%), respectively. More clinical information (level-II) improved the sensitivity to 88.9% (±9.6%, P = 0.19) and specificity to 75.7% (±11.7%, P < 0.05). The CNN ROC curve revealed a higher specificity of 82.5% when compared with dermatologists in level-I (71.3%, P < 0.01) and level-II (75.7%, P < 0.01) at their sensitivities of 86.6% and 88.9%, respectively. The CNN ROC AUC was greater than the mean ROC area of dermatologists (0.86 versus 0.79, P < 0.01). The CNN scored results close to the top three algorithms of the ISBI 2016 challenge.Conclusions: For the first time we compared a CNN's diagnostic performance with a large international group of 58 dermatologists, including 30 experts. Most dermatologists were outperformed by the CNN. Irrespective of any physicians' experience, they may benefit from assistance by a CNN's image classification.Clinical trial number: This study was registered at the German Clinical Trial Register (DRKS-Study-ID: DRKS00013570; https://www.drks.de/drks_web/). (Less)

BACKGROUND: Survey on the current status of dermoscopy in Germany. METHODS: In the context of a pan-European internet-based study (n = 7,480) conducted by the International Dermoscopy Society, 880 German dermatologists were asked to answer questions with respect to their level of training as well as their use and perceived benefit of dermoscopy. RESULTS: Seven hundred and sixty-two (86.6 %) participants practiced dermatology in a publicly funded health care setting; 98.4 % used a dermoscope in routine clinical practice. About 93 % (n = 814) stated to have had more than five years of experience in the use of dermoscopy. Dermoscopy was considered useful in the diagnosis of melanoma by 93.6 % (n = 824); for pigmented skin tumors, by 92.4 % (n = 813); in the follow-up of melanocytic lesions, by 88.6 % (n = 780); for non-pigmented lesions, by 71.4 % (n = 628), in the follow-up of non-melanocytic lesions, by 52.7 % (n = 464); and for inflammatory skin lesions, by 28.5 % (n = 251). Overall, 86.5 % (n = 761) of participants felt that - compared to naked-eye examination - dermoscopy increased the number of melanomas diagnosed; 77,7 % (n = 684) considered the number of unnecessary excisions of benign lesions to be decreased. Participants who personally felt that dermoscopy improved their ability to diagnose melanoma were significantly i) younger, ii) had been practicing dermatology for a shorter period of time, iii) were less commonly employed by an university-affiliated dermatology department, iv) were more frequently working in an office-based public health care setting, and v) had more frequently been trained in dermoscopy during their dermatology residency. CONCLUSIONS: The findings presented herein ought to be integrated into future residency and continuing medical education programs with the challenge to improve dermato-oncological care and to expand the diagnostic spectrum of dermoscopy to include inflammatory skin diseases.

The mainstays of the clinical diagnosis of melanoma are asymmetry, border irregularity, color variegation, and a diameter >6 mm, and any major progress in diagnostic accuracy will probably be related to the development of additional criteria. Such independent criteria might arise from the study of the geometry of the tumour surface, because this quality has been substantially disregarded until now. Our work is aimed at utilizing the surface topography for the differential diagnosis between malignant melanoma and naevocytic naevus.Dynamically focusing optical profilometry was used to measure the surfaces of negative replicas of melanocytic skin tumours and of the surrounding normal skin. 21 silicone imprints of superficial spreading melanomas and 25 imprints of naevocytic naevi were examined.Melanomas and naevi differed with respect to a variety of statistical surface parameters, and a linear discriminant analysis correctly allocated 19 out of 21 melanomas (90%) and 21 out of 25 naevi (84%). To get an unbiased estimate of the errors to be expected with this classification rule, we calculated bootstrap-corrections to the apparent errors. Estimated probabilities of correct allocation were 84.1% for melanomas and 77.1% for naevi.Our findings suggest that simple statistical parameters of surface topography can differentiate effectively between malignant melanomas and naevocytic naevi.

Typisches dermatoskopisches Merkmal atrophisierender Dermatosen ist die Trias: weise strukturlose Areale (Elastose, Fibrose), Gefasektasien und keratinisierende Follikelatrophien.

Auser bei einigen kleinen initialen Melanomen oder kutanen Melanommetastasen hat sich zur dermatoskopischen Differenzierung maligner melanozytarer Tumore die Kittlersche Faustregel bewahrt: > 1 Muster oder > als eine Farbe und ein zusatzliches Melanomkriterium. Symmetrie bei Muster und Farben ist hoher zu werten als ein zusatzliches Kriterium.

Mit Ausnahme einiger konnataler Pigmentzellnavi, »dysplastischer« Navi und Spitz-Navi mit asymmetrischer Struktur, herrschen bei benignen melanozytaren Tumoren symmetrisch angelegte retikulare, schollige, globulare, unstrukturierte oder kombinierte dermatoskopische Pigmentmuster vor.

Im Vordergrund der dermatoskopischen Tumorarchitektur steht die Neovaskularisation. Polymorphe, ektatische, netz- oder strahlenkranzartig angeordnete Gefase wachsen unkoordiniert und uberschreiten anatomisch vorgegebene Strukturen des Papillarkorpers, oft umgeben von hamorrhagischen Plaques. Fur einige Tumore sind unterschiedlich grose rote bis livide Schollen typisch.

Im Vordergrund des dermatoskopischen Bildes granulomatoser Dermatosen steht die Symptomentrias: typische Gefasanordnung (kranzartig, netzformig, radiar zentripetal), unstrukturierte »apfelgeleefarbene« Areale (Epitheloidzellgranulome) und weisliche Nekrosezonen. Bei papulosen und papillomatosen Lasionen uberschreiten Papillengefase die anatomisch vorgegebenen Grenzen des Papillarkorpers nicht.

Sowohl von Blut-, Haut-, Bindegewebs- oder Tumorzellen produzierte bzw. inkorporierte als auch proteingebundene Pigmente bestimmen im Wesentlichen die Farbtonungen in Hautstrukturen. Zu den wichtigsten korpereigenen Pigmenten zahlen Hamoglobin, Hamoglobin-Abbauprodukte und Melanin.