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      Smartphone applications for triaging adults with skin lesions that are suspicious for melanoma

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            In 2003, the QUADAS tool for systematic reviews of diagnostic accuracy studies was developed. Experience, anecdotal reports, and feedback suggested areas for improvement; therefore, QUADAS-2 was developed. This tool comprises 4 domains: patient selection, index test, reference standard, and flow and timing. Each domain is assessed in terms of risk of bias, and the first 3 domains are also assessed in terms of concerns regarding applicability. Signalling questions are included to help judge risk of bias. The QUADAS-2 tool is applied in 4 phases: summarize the review question, tailor the tool and produce review-specific guidance, construct a flow diagram for the primary study, and judge bias and applicability. This tool will allow for more transparent rating of bias and applicability of primary diagnostic accuracy studies.
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              To revise the staging system for cutaneous melanoma on the basis of data from an expanded American Joint Committee on Cancer (AJCC) Melanoma Staging Database. The melanoma staging recommendations were made on the basis of a multivariate analysis of 30,946 patients with stages I, II, and III melanoma and 7,972 patients with stage IV melanoma to revise and clarify TNM classifications and stage grouping criteria. Findings and new definitions include the following: (1) in patients with localized melanoma, tumor thickness, mitotic rate (histologically defined as mitoses/mm(2)), and ulceration were the most dominant prognostic factors. (2) Mitotic rate replaces level of invasion as a primary criterion for defining T1b melanomas. (3) Among the 3,307 patients with regional metastases, components that defined the N category were the number of metastatic nodes, tumor burden, and ulceration of the primary melanoma. (4) For staging purposes, all patients with microscopic nodal metastases, regardless of extent of tumor burden, are classified as stage III. Micrometastases detected by immunohistochemistry are specifically included. (5) On the basis of a multivariate analysis of patients with distant metastases, the two dominant components in defining the M category continue to be the site of distant metastases (nonvisceral v lung v all other visceral metastatic sites) and an elevated serum lactate dehydrogenase level. Using an evidence-based approach, revisions to the AJCC melanoma staging system have been made that reflect our improved understanding of this disease. These revisions will be formally incorporated into the seventh edition (2009) of the AJCC Cancer Staging Manual and implemented by early 2010.

                Author and article information

                Cochrane Database of Systematic Reviews
                December 04 2018
                [1 ]University of Birmingham; Institute of Applied Health Research; Birmingham UK B15 2TT
                [2 ]University Hospitals Birmingham NHS Foundation Trust and University of Birmingham; NIHR Birmingham Biomedical Research Centre; Birmingham UK
                [3 ]Churchill Hospital; Department of Dermatology; Old Road Headington Oxford UK OX3 7LE
                [4 ]Addenbrooke's Hospital; Plastic Surgery; Hills Road Cambridge UK CB2 0QQ
                [5 ]University of Pittsburgh Medical Center; Internal Medicine; Department of Medicine, Office of Education UPMC Montefiore Hospital, N715 Pittsburgh USA PA, 15213
                [6 ]The University of Nottingham; c/o Cochrane Skin Group; Nottingham UK
                [7 ]Cardiff and Vale University Health Board; CEDAR Healthcare Technology Research Centre; Cardiff Medicentre, University Hospital of Wales, Heath Park Campus Cardiff Wales UK CF144UJ
                [8 ]Imperial College Healthcare NHS trust, St Mary’s Hospital; Department of Plastic and Reconstructive Surgery; London UK W2 1NY
                [9 ]University of Cambridge; Public Health & Primary Care; Strangeways Research Laboratory, Worts Causeway Cambridge UK CB1 8RN
                [10 ]University of Nottingham; Centre of Evidence Based Dermatology; Queen's Medical Centre Derby Road Nottingham UK NG7 2UH
                © 2018


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