Journal Der Deutschen Dermatologischen Gesellschaft最新文献

Background and objectives: Integration of artificial intelligence in healthcare, particularly ChatGPT, is transforming medical diagnostics and may benefit teledermatology. This exploratory study compared image description and differential diagnosis generation by a ChatGPT-4 based chatbot with human teledermatologists.

Patients and methods: This retrospective study compared 154 teledermatology consultations (December 2023-February 2024) with ChatGPT-4's performance in image descriptions and diagnoses. Diagnostic concordance was classified as "Top1" (exact match with the teledermatologist's diagnoses), "Top3" (correct diagnosis within one the top three diagnoses), and "Partial" (similar but not identical diagnoses). Image descriptions were rated and compared for quality parameters (location, color, size, morphology, and surrounding area), and accuracy (Yes, No, and Partial).

Results: Out of 154 cases, ChatGPT-4 achieved a Top1 diagnostic concordance in 108 (70.8%), Top3 concordance in 137 (87.7%), partial concordance in four (2.6%), and was discordant in 15 (9.7%) cases. The quality of ChatGPT-4's image descriptions significantly surpassed teledermatologists in all five parameters. ChatGPT-4's descriptions were accurate in 130 (84.4%), partially accurate in 22 (14.3%), and inaccurate in two (1.3%) cases.

Conclusions: The preliminary findings of this study indicate that ChatGPT-4 demonstrates potential in generating accurate image descriptions and differential diagnoses. These results highlight the promise of integrating artificial intelligence into asynchronous teledermatology workflows.

Papulonodular mucinosis (PNM) is a rare cutaneous mucinosis recognized as a rare variant of lupus erythematosus. There are no large-scale cohort studies characterizing its clinicopathological features or evaluating the effectiveness of various treatment options. This study aimed to review the literature on PNMs to identify its clinical and histological features and treatment outcomes. The search includes studies from the PubMed, Embase, and Cochrane Library databases up to the March 1, 2024. A total of 37 studies, encompassing 44 patients, were included in the review. Of these, 20 were males and 24 females, with a mean age at diagnosis of 34.9 ± 1.92 years. PNM lesions are characterized by generalized papules, plaques, and nodules, and histopathologically, they show abundant mucin deposition throughout the dermis. The temporal relationship between PNM and SLE is variable. There is no evidence that SLE patients with PNM are more prone to organ involvement or increased disease activity. A combination of medical history, clinical features, and histopathological findings is essential for diagnosis; however, misdiagnosis is possible until lupus erythematosus (LE) becomes evident. Hydroxychloroquine and systemic glucocorticoids are the current mainstays of treatment for PNM, with most patients achieving partial or complete remission.

Background: Up to now, the optimal duration of immune checkpoint inhibitors (ICI) has not been evaluated in prospective studies. However, current clinical practice requires decisions to be made regarding the duration of ICI in complete responders.

Material and methods: A survey was sent to 80 DeCOG skin cancer centers to assess how decisions are made on treatment duration of ICI in melanoma after having reached complete response, and staging intervals after ICI discontinuation. All responses received by March 10, 2024 (51 centers) were included.

Results: The duration of ICI after having achieved complete remission varies between centers from three to 36 months. In total, 66% of the DeCOG centers continue treatment for up to 6 months, after having achieved complete remission (CR) with ICI. In the first year after discontinuation of ICI, most centers perform staging intervals (CT/MRI) every 3 months. More than 60% of centers continue staging at least once per year even in the 4th and 5th year after discontinuation.

Conclusions: There are significant differences between the centers regarding staging intervals and duration of ICI upon CR. Prospective studies are necessary to determine the optimal time point of ICI discontinuation and follow-up.