Research

15 pages, 3802 KiB

Open AccessArticle

Diagnosing Melanomas in Dermoscopy Images Using Deep Learning

by Ghadah Alwakid, Walaa Gouda, Mamoona Humayun and N. Z Jhanjhi

Diagnostics 2023, 13(10), 1815; https://doi.org/10.3390/diagnostics13101815 - 22 May 2023

Cited by 9 | Viewed by 1658

When it comes to skin tumors and cancers, melanoma ranks among the most prevalent and deadly. With the advancement of deep learning and computer vision, it is now possible to quickly and accurately determine whether or not a patient has malignancy. This is [...] Read more.

When it comes to skin tumors and cancers, melanoma ranks among the most prevalent and deadly. With the advancement of deep learning and computer vision, it is now possible to quickly and accurately determine whether or not a patient has malignancy. This is significant since a prompt identification greatly decreases the likelihood of a fatal outcome. Artificial intelligence has the potential to improve healthcare in many ways, including melanoma diagnosis. In a nutshell, this research employed an Inception-V3 and InceptionResnet-V2 strategy for melanoma recognition. The feature extraction layers that were previously frozen were fine-tuned after the newly added top layers were trained. This study used data from the HAM10000 dataset, which included an unrepresentative sample of seven different forms of skin cancer. To fix the discrepancy, we utilized data augmentation. The proposed models outperformed the results of the previous investigation with an effectiveness of 0.89 for Inception-V3 and 0.91 for InceptionResnet-V2. Full article

(This article belongs to the Special Issue Imaging Diagnosis for Melanoma 2.0)

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11 pages, 1693 KiB

Open AccessArticle

Impact of [¹⁸F]FDG PET/CT in the Assessment of Immunotherapy-Induced Arterial Wall Inflammation in Melanoma Patients Receiving Immune Checkpoint Inhibitors

by Shaghayegh Ranjbar, Seyed Rasoul Zakavi, Roya Eisazadeh, Seyed Ali Mirshahvalad, Julia Pilz, Zahra Jamshidi-Araghi, Gregor Schweighofer-Zwink, Peter Koelblinger, Christian Pirich and Mohsen Beheshti

Diagnostics 2023, 13(9), 1617; https://doi.org/10.3390/diagnostics13091617 - 03 May 2023

Viewed by 1440

Abstract

We aimed to investigate the role of [¹⁸F]FDG positron emission tomography/computed tomography (PET/CT) in the early detection of arterial wall inflammation (AWI) in melanoma patients receiving immune checkpoint inhibitors (ICIs). Our retrospective study enrolled 95 melanoma patients who had received ICIs. [...] Read more.

We aimed to investigate the role of [¹⁸F]FDG positron emission tomography/computed tomography (PET/CT) in the early detection of arterial wall inflammation (AWI) in melanoma patients receiving immune checkpoint inhibitors (ICIs). Our retrospective study enrolled 95 melanoma patients who had received ICIs. Inclusion criteria were ICI therapy for at least six months and at least three [¹⁸F]FDG PET/CTs, including one pretreatment session plus two scans three and six months after treatment initiation. AWI was assessed using quantitative and qualitative methods in the subclavian artery, thoracic aorta, and abdominal aorta. We found three patients with AWI visual suspicion in the baseline scan, which increased to five in the second and twelve in the third session. Most of these patients’ treatments were terminated due to either immune-related adverse events (irAEs) or disease progression. In the overall population, the ratio of arterial-wall maximum standardized uptake value (SUVmax)/liver-SUVmax was significantly higher three months after treatment than the pretreatment scan in the thoracic aorta (0.83 ± 0.12 vs. 0.79 ± 0.10; p-value = 0.01) and subclavian artery (0.67 ± 0.13 vs. 0.63 ± 0.12; p-value = 0.01), and it remained steady in the six-month follow-up. None of our patients were diagnosed with definite clinical vasculitis on the dermatology follow-up reports. To conclude, our study showed [¹⁸F]FDG PET/CT’s potential to visualise immunotherapy-induced subclinical inflammation in large vessels. This may lead to more accurate prediction of irAEs and better patient management. Full article

(This article belongs to the Special Issue Imaging Diagnosis for Melanoma 2.0)

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6 pages, 241 KiB

Open AccessCommunication

Melanoma Detection by Non-Specialists: An Untapped Potential for Triage?

by Carmen Cantisani, Luca Ambrosio, Carlotta Cucchi, Fanni Adél Meznerics, Norbert Kiss, András Bánvölgyi, Federica Rega, Flavia Grignaffini, Francesco Barbuto, Fabrizio Frezza and Giovanni Pellacani

Diagnostics 2022, 12(11), 2821; https://doi.org/10.3390/diagnostics12112821 - 16 Nov 2022

Cited by 6 | Viewed by 1273

Abstract

Introduction: The incidence of melanoma increased considerably in recent decades, representing a significant public health problem. We aimed to evaluate the ability of non-specialists for the preliminary screening of skin lesions to identify melanoma-suspect lesions. Materials and Methods: A medical student and a [...] Read more.

Introduction: The incidence of melanoma increased considerably in recent decades, representing a significant public health problem. We aimed to evaluate the ability of non-specialists for the preliminary screening of skin lesions to identify melanoma-suspect lesions. Materials and Methods: A medical student and a dermatologist specialist examined the total body scans of 50 patients. Results: The agreement between the expert and the non-specialist was 87.75% (κ = 0.65) regarding the assessment of clinical significance. The four parameters of the ABCD rule were evaluated on the 129 lesions rated as clinically significant by both observers. Asymmetry was evaluated similarly in 79.9% (κ = 0.59), irregular borders in 74.4% (κ = 0.50), color in 81.4% (κ = 0.57), and diameter in 89.9% (κ = 0.77) of the cases. The concordance of the two groups was 96.9% (κ = 0.83) in the case of the detection of the Ugly Duckling Sign. Conclusions: Although the involvement of GPs is part of routine care worldwide, emphasizing the importance of educating medical students and general practitioners is crucial, as many European countries lack structured melanoma screening training programs targeting non-dermatologists. Full article

(This article belongs to the Special Issue Imaging Diagnosis for Melanoma 2.0)

10 pages, 2328 KiB

Open AccessArticle

Dual-Energy Computed Tomography-Based Iodine Concentration Estimation for Evaluating Choroidal Malignant Melanoma Response to Treatment: Optimization and Primary Validation

by Hiroki Tsuchiya, Yasuhiko Tachibana, Riwa Kishimoto, Tokuhiko Omatsu, Eika Hotta, Katsuyuki Tanimoto, Masaru Wakatsuki, Takayuki Obata and Hiroshi Tsuji

Diagnostics 2022, 12(11), 2692; https://doi.org/10.3390/diagnostics12112692 - 04 Nov 2022

Cited by 1 | Viewed by 1114

Abstract

Contrast-enhanced imaging for choroidal malignant melanoma (CMM) is mostly limited to detecting metastatic tumors, possibly due to difficulties in fixing the eye position. We aimed to (1) validate the appropriateness of estimating iodine concentration based on dual-energy computed tomography (DECT) for CMM and [...] Read more.

Contrast-enhanced imaging for choroidal malignant melanoma (CMM) is mostly limited to detecting metastatic tumors, possibly due to difficulties in fixing the eye position. We aimed to (1) validate the appropriateness of estimating iodine concentration based on dual-energy computed tomography (DECT) for CMM and optimize the calculation parameters for estimation, and (2) perform a primary clinical validation by assessing the ability of this technique to show changes in CMM after charged-particle radiation therapy. The accuracy of the optimized estimate (eIC_optimized) was compared to an estimate obtained by commercial software (eIC_commercial) by determining the difference from the ground truth. Then, eIC_optimized, tumor volume, and CT values (80 kVp, 140 kVp, and synthesized 120 kVp) were measured at pre-treatment and 3 months and 1.5–2 years after treatment. The difference from the ground truth was significantly smaller in eIC_optimized than in eIC_commercial (p < 0.01). Tumor volume, CT values, and eIC_optimized all decreased significantly at 1.5–2 years after treatment, but only eIC_commercial showed a significant reduction at 3 months after treatment (p < 0.01). eIC_optimized can quantify contrast enhancement in primary CMM lesions and has high sensitivity for detecting the response to charged-particle radiation therapy, making it potentially useful for treatment monitoring. Full article

(This article belongs to the Special Issue Imaging Diagnosis for Melanoma 2.0)

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19 pages, 4353 KiB

Open AccessArticle

Development of a Hybrid-Imaging-Based Prognostic Index for Metastasized-Melanoma Patients in Whole-Body 18F-FDG PET/CT and PET/MRI Data

by Thomas Küstner, Jonas Vogel, Tobias Hepp, Andrea Forschner, Christina Pfannenberg, Holger Schmidt, Nina F. Schwenzer, Konstantin Nikolaou, Christian la Fougère and Ferdinand Seith

Diagnostics 2022, 12(9), 2102; https://doi.org/10.3390/diagnostics12092102 - 30 Aug 2022

Cited by 5 | Viewed by 1945

Abstract

Besides tremendous treatment success in advanced melanoma patients, the rapid development of oncologic treatment options comes with increasingly high costs and can cause severe life-threatening side effects. For this purpose, predictive baseline biomarkers are becoming increasingly important for risk stratification and personalized treatment [...] Read more.

Besides tremendous treatment success in advanced melanoma patients, the rapid development of oncologic treatment options comes with increasingly high costs and can cause severe life-threatening side effects. For this purpose, predictive baseline biomarkers are becoming increasingly important for risk stratification and personalized treatment planning. Thus, the aim of this pilot study was the development of a prognostic tool for the risk stratification of the treatment response and mortality based on PET/MRI and PET/CT, including a convolutional neural network (CNN) for metastasized-melanoma patients before systemic-treatment initiation. The evaluation was based on 37 patients (19 f, 62 ± 13 y/o) with unresectable metastasized melanomas who underwent whole-body 18F-FDG PET/MRI and PET/CT scans on the same day before the initiation of therapy with checkpoint inhibitors and/or BRAF/MEK inhibitors. The overall survival (OS), therapy response, metastatically involved organs, number of lesions, total lesion glycolysis, total metabolic tumor volume (TMTV), peak standardized uptake value (SULpeak), diameter (Dmlesion) and mean apparent diffusion coefficient (ADCmean) were assessed. For each marker, a Kaplan–Meier analysis and the statistical significance (Wilcoxon test, paired t-test and Bonferroni correction) were assessed. Patients were divided into high- and low-risk groups depending on the OS and treatment response. The CNN segmentation and prediction utilized multimodality imaging data for a complementary in-depth risk analysis per patient. The following parameters correlated with longer OS: a TMTV < 50 mL; no metastases in the brain, bone, liver, spleen or pleura; ≤4 affected organ regions; no metastases; a Dmlesion > 37 mm or SULpeak < 1.3; a range of the ADCmean < 600 mm²/s. However, none of the parameters correlated significantly with the stratification of the patients into the high- or low-risk groups. For the CNN, the sensitivity, specificity, PPV and accuracy were 92%, 96%, 92% and 95%, respectively. Imaging biomarkers such as the metastatic involvement of specific organs, a high tumor burden, the presence of at least one large lesion or a high range of intermetastatic diffusivity were negative predictors for the OS, but the identification of high-risk patients was not feasible with the handcrafted parameters. In contrast, the proposed CNN supplied risk stratification with high specificity and sensitivity. Full article

(This article belongs to the Special Issue Imaging Diagnosis for Melanoma 2.0)

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Review

Jump to: Research, Other

12 pages, 965 KiB

Open AccessReview

Artificial Intelligence and Radiomics: Clinical Applications for Patients with Advanced Melanoma Treated with Immunotherapy

by Jeremy McGale, Jakob Hama, Randy Yeh, Laetitia Vercellino, Roger Sun, Egesta Lopci, Samy Ammari and Laurent Dercle

Diagnostics 2023, 13(19), 3065; https://doi.org/10.3390/diagnostics13193065 - 27 Sep 2023

Cited by 1 | Viewed by 1032

Abstract

Immunotherapy has greatly improved the outcomes of patients with metastatic melanoma. However, it has also led to new patterns of response and progression, creating an unmet need for better biomarkers to identify patients likely to achieve a lasting clinical benefit or experience immune-related [...] Read more.

Immunotherapy has greatly improved the outcomes of patients with metastatic melanoma. However, it has also led to new patterns of response and progression, creating an unmet need for better biomarkers to identify patients likely to achieve a lasting clinical benefit or experience immune-related adverse events. In this study, we performed a focused literature survey covering the application of artificial intelligence (AI; in the form of radiomics, machine learning, and deep learning) to patients diagnosed with melanoma and treated with immunotherapy, reviewing 12 studies relevant to the topic published up to early 2022. The most commonly investigated imaging modality was CT imaging in isolation (n = 9, 75.0%), while patient cohorts were most frequently recruited retrospectively and from single institutions (n = 7, 58.3%). Most studies concerned the development of AI tools to assist in prognostication (n = 5, 41.7%) or the prediction of treatment response (n = 6, 50.0%). Validation methods were disparate, with two studies (16.7%) performing no validation and equal numbers using cross-validation (n = 3, 25%), a validation set (n = 3, 25%), or a test set (n = 3, 25%). Only one study used both validation and test sets (n = 1, 8.3%). Overall, promising results have been observed for the application of AI to immunotherapy-treated melanoma. Further improvement and eventual integration into clinical practice may be achieved through the implementation of rigorous validation using heterogeneous, prospective patient cohorts. Full article

(This article belongs to the Special Issue Imaging Diagnosis for Melanoma 2.0)

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11 pages, 846 KiB

Open AccessReview

Minimally Invasive Treatment Options for Hepatic Uveal Melanoma Metastases

by Abin Sajan, Samuel Fordyce, Andrew Sideris, Connie Liou, Zeeshan Toor, John Filtes, Venkatesh Krishnasamy, Noor Ahmad, Stephen Reis, Sidney Brejt, Asad Baig, Shaheer Khan, Michael Caplan, David Sperling and Joshua Weintraub

Diagnostics 2023, 13(11), 1836; https://doi.org/10.3390/diagnostics13111836 - 24 May 2023

Cited by 2 | Viewed by 2292

Abstract

Uveal melanoma is one of the most common primary intraocular malignancies that accounts for about 85% of all ocular melanomas. The pathophysiology of uveal melanoma is distinct from cutaneous melanoma and has separate tumor profiles. The management of uveal melanoma is largely dependent [...] Read more.

Uveal melanoma is one of the most common primary intraocular malignancies that accounts for about 85% of all ocular melanomas. The pathophysiology of uveal melanoma is distinct from cutaneous melanoma and has separate tumor profiles. The management of uveal melanoma is largely dependent on the presence of metastases, which confers a poor prognosis with a one-year survival reaching only 15%. Although a better understanding of tumor biology has led to the development of novel pharmacologic agents, there is increasing demand for minimally invasive management of hepatic uveal melanoma metastases. Multiple studies have already summarized the systemic therapeutic options available for metastatic uveal melanoma. This review covers the current research for the most prevalent locoregional treatment options for metastatic uveal melanoma including percutaneous hepatic perfusion, immunoembolization, chemoembolization, thermal ablation, and radioembolization. Full article

(This article belongs to the Special Issue Imaging Diagnosis for Melanoma 2.0)

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20 pages, 8271 KiB

Open AccessReview

More than Just Skin-Deep: A Review of Imaging’s Role in Guiding CAR T-Cell Therapy for Advanced Melanoma

by Conor M. Prendergast, Kathleen M. Capaccione, Egesta Lopci, Jeeban P. Das, Alexander N. Shoushtari, Randy Yeh, Daniel Amin, Laurent Dercle and Dorine De Jong

Diagnostics 2023, 13(5), 992; https://doi.org/10.3390/diagnostics13050992 - 05 Mar 2023

Cited by 3 | Viewed by 3148

Abstract

Advanced melanoma is one of the deadliest cancers, owing to its invasiveness and its propensity to develop resistance to therapy. Surgery remains the first-line treatment for early-stage tumors but is often not an option for advanced-stage melanoma. Chemotherapy carries a poor prognosis, and [...] Read more.

Advanced melanoma is one of the deadliest cancers, owing to its invasiveness and its propensity to develop resistance to therapy. Surgery remains the first-line treatment for early-stage tumors but is often not an option for advanced-stage melanoma. Chemotherapy carries a poor prognosis, and despite advances in targeted therapy, the cancer can develop resistance. CAR T-cell therapy has demonstrated great success against hematological cancers, and clinical trials are deploying it against advanced melanoma. Though melanoma remains a challenging disease to treat, radiology will play an increasing role in monitoring both the CAR T-cells and response to therapy. We review the current imaging techniques for advanced melanoma, as well as novel PET tracers and radiomics, in order to guide CAR T-cell therapy and manage potential adverse events. Full article

(This article belongs to the Special Issue Imaging Diagnosis for Melanoma 2.0)

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Other

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6 pages, 1075 KiB

Open AccessCase Report

Intrathymic Localization of Melanoma: A Brief Report of Two Cases and a Review of the Literature

by Giorgio Cannone, Vincenzo Verzeletti, Francesco Fortarezza, Federica Pezzuto, Roberta Polverosi, Eleonora Faccioli, Giovanni Maria Comacchio, Andrea Dell’Amore, Federico Rea, Marco Schiavon and Fiorella Calabrese

Diagnostics 2023, 13(12), 2017; https://doi.org/10.3390/diagnostics13122017 - 09 Jun 2023

Viewed by 775

Abstract

Intrathymic localizations of melanoma represent a very rare entity, with fewer than ten cases of intrathymic melanoma described in the literature. Herein, we describe two cases of patients who underwent surgical removal of a thymic mass at our thoracic surgery department between 2015 [...] Read more.

Intrathymic localizations of melanoma represent a very rare entity, with fewer than ten cases of intrathymic melanoma described in the literature. Herein, we describe two cases of patients who underwent surgical removal of a thymic mass at our thoracic surgery department between 2015 and 2022. The final pathological examination revealed a malignant melanoma in both cases; we therefore carried out a literature review to identify such rare and similar cases. In the first case, the intrathymic localization of melanoma was the first manifestation of the disease, posing a dilemma regarding the metastatic and primitive nature of the neoplasm. The second case described a thymic metastasis from a known previous cutaneous melanoma, for which the patient had successfully been treated six years earlier. After carefully reviewing the literature, we identified only six cases of verified primary intrathymic melanomas and one case of intrathymic metastasis resulting from melanoma previously described. Pathologists should be aware of the occurrence of this rare entity and mindful of the differential diagnoses. Several tools, including immunostaining of melanocytic markers and molecular investigations, are mandatory for final pathological diagnosis. Full article

(This article belongs to the Special Issue Imaging Diagnosis for Melanoma 2.0)

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4 pages, 7875 KiB

Open AccessInteresting Images

Polymorphic Malignant Melanoma (PMM) of the Left Helix: Case Report with Clinical-Pathological Correlations

by Gerardo Cazzato, Anna Colagrande, Michele Maruccia, Eleonora Nacchiero, Carmelo Lupo, Nadia Casatta, Giuseppe Ingravallo, Eugenio Maiorano, Andrea Marzullo, Giuseppe Giudice and Leonardo Resta

Diagnostics 2022, 12(11), 2713; https://doi.org/10.3390/diagnostics12112713 - 06 Nov 2022

Viewed by 1407

Abstract

Malignant melanoma (MM) is known to be the great mimic in dermatopathology. Over time, several variants have been described, not all of which have repercussions on the clinical/oncological management of the affected patient. The existence, however, of these alternative forms of MM is [...] Read more.

Malignant melanoma (MM) is known to be the great mimic in dermatopathology. Over time, several variants have been described, not all of which have repercussions on the clinical/oncological management of the affected patient. The existence, however, of these alternative forms of MM is of great interest to the pathologist, as they are potentially capable of inducing diagnostic errors affecting the diagnostic-therapeutic care pathway (PDTC). In this paper, we present a very rare case of polymorphic MM, in which five different morphological aspects coexisted in the same lesion, confirmed by immunohistochemical investigation and by RT-PCR for mutation of the BRAF gene and discuss the importance of correct recognition of these different morphological features to avoid misdiagnosis. Full article

(This article belongs to the Special Issue Imaging Diagnosis for Melanoma 2.0)

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