{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T14:39:32Z","timestamp":1771339172094,"version":"3.50.1"},"reference-count":34,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2024,11,15]],"date-time":"2024-11-15T00:00:00Z","timestamp":1731628800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Facial pigmented skin lesions are extremely common, starting from the fourth to fifth decades, especially in South-European countries, often located in the periorbital region. These include malignant forms, Lentigo maligna (LM) and lentigo maligna melanoma (LMM), characterized by growing incidence, and a series of benign simulators, including solar lentigo (SL), pigmented actinic keratosis (PAK), seborrheic keratosis (SK) and lichen planus-like keratosis (LPK). The clinical differential diagnosis of atypical pigmented skin lesions (aPFLs) can be difficult, even for dermatologists, leading to inappropriate skin biopsies with consequent aesthetic impacts. Dermoscopy of the facial area is a specific dermoscopic field that requires dedicated training and proved to increase diagnostic accuracy in dermatologists. Since these lesions are often seen by ophthalmologists at first, we aimed to evaluate the effect of a focused dermoscopy training course on a group of ophthalmologists na\u00efve to the use of a dermatoscope. Methods: A set of 80 periorbital pigmented skin lesions with both clinical and dermoscopic images was selected and evaluated by six ophthalmologists before and after a one-day intensive dermoscopic training course. They were required to evaluate 80 periorbital lesions one month before and after a one-day intensive dermoscopic training course, illustrating second-level diagnostic options such as reflectance confocal microscopy (RCM), obtaining a total of 480 evaluations. Specifically, they had to provide, for each case, a punctual diagnosis and a management option among dermoscopic follow-up\/skin biopsy\/RCM\/LC-OCT. Descriptive statistics were carried out, and the accuracy (ACC), sensitivity (SE), and specificity (SP), with their 95% confidence interval (95% CI), were estimated. Results: In the pre-course test, ophthalmologists achieved 84.0% SP, 33.3% SE and 63.7% ACC, while after the course, SE increased by +9% (i.e., 41.7%), SP decreased by 4%, and ACC remained comparable, i.e., 64.6%. In the management study, the percentage of benign lesions for which a close dermoscopic follow-up was suggested significantly decreased (51.6% versus 22.2%), in parallel with an increase in the number of lesions referred for RCM. As for malignant cases, the reduction in responses \u201cclose dermoscopic follow-up\u201d decreased from 37.0% to 9.9%, (\u221227%), in favor of RCM (+15%) and skin biopsy (+12%). Conclusions: The ophthalmologists proved to be very receptive in quickly metabolizing and putting into practice the concepts learned during the one-day intensive dermoscopy training course. Indeed, after only a one-day lesson, they were able to increase their SE by 9% and to improve their management strategy. The present findings highlight the importance of providing training ophthalmologists in dermoscopy during residency programs, in terms of benefits for the correct patient care.<\/jats:p>","DOI":"10.3390\/diagnostics14222571","type":"journal-article","created":{"date-parts":[[2024,11,18]],"date-time":"2024-11-18T07:45:27Z","timestamp":1731915927000},"page":"2571","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Dermoscopy Training Course Improves Ophthalmologists\u2019 Accuracy in Diagnosing Atypical Pigmented Periorbital Skin Lesions"],"prefix":"10.3390","volume":"14","author":[{"given":"Giovanni","family":"Rubegni","sequence":"first","affiliation":[{"name":"Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1818-6275","authenticated-orcid":false,"given":"Alessandra","family":"Cartocci","sequence":"additional","affiliation":[{"name":"Dermatology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6691-4310","authenticated-orcid":false,"given":"Linda","family":"Tognetti","sequence":"additional","affiliation":[{"name":"Dermatology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matteo","family":"Orione","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University of Catania, 95123 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caterina","family":"Gagliano","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University of Catania, 95123 Catania, Italy"},{"name":"Department of Medicine and Surgery, University of Enna \u201cKore\u201d, 94100 Enna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7477-2263","authenticated-orcid":false,"given":"Tommaso","family":"Bacci","sequence":"additional","affiliation":[{"name":"Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Tarantello","sequence":"additional","affiliation":[{"name":"Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicola","family":"Lo Russo","sequence":"additional","affiliation":[{"name":"Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3869-8593","authenticated-orcid":false,"given":"Mario","family":"Fruschelli","sequence":"additional","affiliation":[{"name":"Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niccol\u00f2","family":"Castellino","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University of Catania, 95123 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8139-1204","authenticated-orcid":false,"given":"Ernesto","family":"De Piano","sequence":"additional","affiliation":[{"name":"Dermatology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8315-3413","authenticated-orcid":false,"given":"Martina","family":"D\u2019Onghia","sequence":"additional","affiliation":[{"name":"Dermatology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriele","family":"Cevenini","sequence":"additional","affiliation":[{"name":"Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teresio","family":"Avitabile","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University of Catania, 95123 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pietro","family":"Rubegni","sequence":"additional","affiliation":[{"name":"Dermatology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7615-9187","authenticated-orcid":false,"given":"Alessio","family":"Luschi","sequence":"additional","affiliation":[{"name":"Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gian Marco","family":"Tosi","sequence":"additional","affiliation":[{"name":"Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1159\/000502470","article-title":"Evidence-based clinical practice guidelines for the management of patients with lentigo maligna","volume":"236","author":"Robinson","year":"2020","journal-title":"Dermatology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1097\/CMR.0000000000000619","article-title":"Estimated risk of progression of lentigo maligna to lentigo maligna melanoma","volume":"30","author":"Menzies","year":"2020","journal-title":"Melanoma Res."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Ding, Y., Jiang, R., Chen, Y., Jing, J., Yang, X., Wu, X., Zhang, X., Xu, J., Xu, P., and LiuHuang, S.C. (2021). Comparing the characteristics and predicting the survival of patients with head and neck melanoma versus body melanoma: A population-based study. BMC Cancer, 21.","DOI":"10.1186\/s12885-021-08105-y"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1097\/CMR.0b013e3283577b96","article-title":"The prognostic impact of the anatomical sites in the \u2018head and neck melanoma\u2019: Scalp versus face and neck","volume":"22","author":"Rossari","year":"2012","journal-title":"Melanoma Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1007\/s00403-021-02226-x","article-title":"Dermoscopy of early melanomas: Variation according to the anatomic site","volume":"314","author":"Tognetti","year":"2022","journal-title":"Arch. Dermatol. Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1016\/S0161-6420(99)90161-6","article-title":"Epidemiologic characteristics and clinical course of patients with malignant eyelid tumors in an incidence cohort in Olmsted County, Minnesota","volume":"106","author":"Cook","year":"1999","journal-title":"Ophthalmology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"29","DOI":"10.5826\/dpc.0502a04","article-title":"Trends in dermoscopy use in the UK: Results from surveys in 2003 and 2012","volume":"5","author":"Butler","year":"2015","journal-title":"Dermatol. Pract. Concept."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1016\/S1470-2045(00)00422-8","article-title":"Dermoscopy of pigmented skin lesions\u2014A valuable tool for early diagnosis of melanoma","volume":"2","author":"Argenziano","year":"2001","journal-title":"Lancet Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1111\/j.1365-4632.2008.03556.x","article-title":"Dermoscopy: Basic concepts","volume":"47","year":"2008","journal-title":"Int. J. Dermatol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Dinnes, J., Deeks, J.J., Chuchu, N., di Ruffano, L.F., Matin, R.N., Thomson, D.R., Wong, K.Y., Aldridge, R.B., Abbott, R., and Fawzy, M. (2018). Dermoscopy, with and without visual inspection, for diagnosing melanoma in adults. Cochrane Database Syst. Rev.","DOI":"10.1002\/14651858.CD011902.pub2"},{"key":"ref_11","first-page":"CD011901","article-title":"Visual inspection and dermoscopy, alone or in combination, for diagnosing keratinocyte skin cancers in adults","volume":"12","author":"Dinnes","year":"2018","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/S1470-2045(02)00679-4","article-title":"Diagnostic accuracy of dermoscopy","volume":"3","author":"Kittler","year":"2002","journal-title":"Lancet Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1016","DOI":"10.1046\/j.1365-2133.2000.03836.x","article-title":"Increase in the sensitivity for melanoma diagnosis by primary care physicians using skin surface microscopy","volume":"143","author":"Westerhoff","year":"2000","journal-title":"Br. J. Dermatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1007\/s11606-018-4311-3","article-title":"A Randomized Trial on the Efficacy of Mastery Learning for Primary Care Provider Melanoma Opportunistic Screening Skills and Practice","volume":"33","author":"Robinson","year":"2018","journal-title":"J. Gen. Intern. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e027529","DOI":"10.1136\/bmjopen-2018-027529","article-title":"Dermoscopy for melanoma detection and triage in primary care: A systematic review","volume":"9","author":"Jones","year":"2019","journal-title":"BMJ Open"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1016\/j.bjps.2008.01.011","article-title":"Digital epiluminescence dermoscopy for pigmented cutaneous lesions, primary care physicians, and telediagnosis: A useful tool?","volume":"62","author":"Grimaldi","year":"2009","journal-title":"J. Plast. Reconstr. Aesthetic Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e465","DOI":"10.1111\/jdv.15781","article-title":"Dermoscopy use in UK primary care","volume":"33","author":"Fee","year":"2019","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1016\/j.det.2016.05.005","article-title":"Lentigo Maligna, Macules of the Face, and Lesions on Sun-Damaged Skin: Confocal Makes the Difference","volume":"34","author":"Star","year":"2016","journal-title":"Dermatol. Clin."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e372","DOI":"10.1111\/jdv.15669","article-title":"The integration of dermoscopy and reflectance confocal microscopy improves the diagnosis of lentigo maligna","volume":"33","author":"Cinotti","year":"2019","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Rubegni, G., Zeppieri, M., Tognetti, L., Cinotti, E., De Piano, E., D\u2019Onghia, M., Orione, M., Gagliano, C., Bacci, T., and Tarantello, A. (2024). Comparison of Ophthalmologists versus Dermatologists for the Diagnosis and Management of Periorbital Atypical Pigmented Skin Lesions. J. Clin. Med., 13.","DOI":"10.3390\/jcm13164787"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1356","DOI":"10.1089\/tmj.2022.0456","article-title":"Development and implementation of a web-based international registry dedicated to atypical pigmented skin lesions of the face: Teledermatologic investigation on epidemiology and risk factors","volume":"29","author":"Tognetti","year":"2023","journal-title":"Telemed. e-Health"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"837","DOI":"10.2147\/CCID.S224738","article-title":"Lentigo Maligna: Clinical Presentation and Appropriate Management","volume":"13","author":"Iznardo","year":"2020","journal-title":"Clin. Cosmet. Investig. Dermatol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"7178305","DOI":"10.1155\/2021\/7178305","article-title":"Diagnosis and Management of Lentigo Maligna: Clinical Presentation and Comprehensive Review","volume":"2021","author":"Naik","year":"2021","journal-title":"J. Skin Cancer"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1111\/ijd.16688","article-title":"Surgical margin mapping for lentigo maligna and lentigo maligna melanoma: Traditional technique (visual inspection with dermoscopy) versus combined paper tape and reflectance confocal microscopy technique","volume":"62","author":"Cabrioli","year":"2023","journal-title":"Int. J. Dermatol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"403","DOI":"10.2147\/CCID.S208717","article-title":"Is dermoscopy a good tool for the diagnosis of lentigo maligna and lentigo maligna melanoma? A metaanalysis","volume":"12","author":"Carapeba","year":"2019","journal-title":"Clin. Cosmet. Investig. Dermatol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1684\/ejd.2018.3246","article-title":"A new dermoscopic algorithm for the differentialdiagnosis of facial lentigo maligna and pigmented actinic keratosis","volume":"28","author":"Micantonio","year":"2018","journal-title":"Eur. J. Dermatol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1016\/j.jaad.2020.06.085","article-title":"The dermoscopic inverse approach significantly improves the accuracy of human readers for lentigo maligna diagnosis","volume":"84","author":"Lallas","year":"2021","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2301","DOI":"10.1111\/jdv.19360","article-title":"A risk-scoring model for the differential diagnosis of lentigo maligna and other atypical pigmented facial lesions of the face: The facial iDScore","volume":"37","author":"Tognetti","year":"2023","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2166","DOI":"10.1111\/exd.14941","article-title":"Dermoscopy of atypical pigmented lesions of the face: Variation according to facial areas","volume":"32","author":"Tognetti","year":"2023","journal-title":"Exp. Dermatol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1001\/jamadermatol.2022.1570","article-title":"Effect of reflectance confocal microscopy for suspect lesions on diagnostic accuracy in melanoma: A randomized clinical trial","volume":"158","author":"Pellacani","year":"2022","journal-title":"JAMA Dermatol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"884","DOI":"10.1097\/DAD.0000000000001212","article-title":"Impact of Dermoscopy and Reflectance Confocal Microscopy on the Histopathologic Diagnosis of Lentigo Maligna\/Lentigo Maligna Melanoma","volume":"40","author":"Mataca","year":"2018","journal-title":"Am. J. Dermatopathol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1016\/j.jaad.2020.04.109","article-title":"Number needed to biopsy ratio and diagnostic accuracy for melanoma detection","volume":"83","author":"Marchetti","year":"2020","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1097\/CMR.0000000000000979","article-title":"The number needed to biopsy for cutaneous melanoma in academic dermatology clinics","volume":"34","author":"Kibbie","year":"2024","journal-title":"Melanoma Res."},{"key":"ref_34","first-page":"713","article-title":"OR\u00c1O: RESTful Cloud-Based Ophthalmologic Medical Record for Chromatic Pupillometry","volume":"Volume 73","author":"Iadanza","year":"2020","journal-title":"CMBEBIH 2019, Proceedings of the International Conference on Medical and Biological Engineering, Banja Luka, Bosnia and Herzegovina, 16\u201318 May 2019"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/22\/2571\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:33:14Z","timestamp":1760113994000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/22\/2571"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,15]]},"references-count":34,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2024,11]]}},"alternative-id":["diagnostics14222571"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics14222571","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,15]]}}}