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Dermatologie (Heidelberg, Germany) Jun 2024Prurigo pigmentosa is an inflammatory dermatosis that rarely occurs in Europe and mostly affects young women. Here, we describe the typical clinical and dermoscopic...
Prurigo pigmentosa is an inflammatory dermatosis that rarely occurs in Europe and mostly affects young women. Here, we describe the typical clinical and dermoscopic criteria so that therapy can be initiated as early as possible. The 17-year-old patient presented here shows that this disease can also be observed in Western Europe and in men, and that doxycycline is a very effective treatment option.
PubMed: 38935290
DOI: 10.1007/s00105-024-05383-y -
Life (Basel, Switzerland) May 2024The differential diagnosis of atypical melanocytic skin lesions localized on palms and soles represents a diagnostic challenge: indeed, this spectrum encompasses...
Pattern Analysis of Benign and Malignant Atypical Melanocytic Skin Lesions of Palms and Soles: Variations of Dermoscopic Features According to Anatomic Site and Personal Experience.
The differential diagnosis of atypical melanocytic skin lesions localized on palms and soles represents a diagnostic challenge: indeed, this spectrum encompasses atypical nevi (AN) and early-stage melanomas (EN) displaying overlapping clinical and dermoscopic features. This often generates unnecessary excisions or delayed diagnosis. Investigations to date were mostly carried out in specific populations, focusing either on acrolentiginous melanomas or morphologically typical acquired nevi. To investigate the dermoscopic features of atypical melanocytic palmoplantar skin lesions (aMPPLs) as evaluated by variously skilled dermatologists and assess their concordance; to investigate the variations in dermoscopic appearance according to precise location on palms and soles; to detect the features with the strongest association with malignancy/benignity in each specific site. A dataset of 471 aMPPLs-excised in the suspect of malignancy-was collected from 10 European Centers, including a standardized dermoscopic picture (17×) and lesion/patient metadata. An anatomical classification into 17 subareas was considered, along with an anatomo-functional classification considering pressure/friction, (4 macroareas). A total of 156 participants (95 with less than 5 years of experience in dermoscopy and 61 with ≥than 5 years) from 17 countries performed a blinded tele-dermoscopic pattern analysis over 20 cases through a specifically realized web platform. A total of 37,440 dermoscopic evaluations were obtained over 94 (20%) EM and 377 (80%) AN. The areas with the highest density of EM compared to AN were the heel (40.3% EM/aMPPLs) of the sole and the "fingers area" (33%EM/aMPPLs) of the palm, both characterized by intense/chronic traumatism/friction. Globally, the recognition rates of 12 dermoscopic patterns were non statistically different between 95 dermatology residents and 61 specialists: aMPPLs in the plantar arch appeared to be the most "difficult" to diagnose, the was poorly recognized and patterns often misinterpreted. Regarding the aMPPL of the "heel area", the ( = 0.014) and ( = 0.001) significantly discriminated benign cases, while ( = 0.002) and ( = 0.025) malignant ones. In aMPPLs of the "plantar arch", the ( = 0.012) was significant for benignity and , or for malignancy. In palmar lesions, no data were significant in the discrimination between malignant and benign aMPPLs. This study highlights that (i) the pattern analysis of aMPPLs is challenging for both experienced and novice dermoscopists; (ii) the histological distribution varies according to the anatomo-functional classification; and (iii) different dermoscopic patterns are able to discriminate malignant from benign aMPPLs within specific plantar and palmar areas.
PubMed: 38929643
DOI: 10.3390/life14060659 -
Cancers Jun 2024Modern diagnostic procedures, such as three-dimensional total body photography (3D-TBP), digital dermoscopy (DD), and reflectance confocal microscopy (RCM), can improve...
Modern diagnostic procedures, such as three-dimensional total body photography (3D-TBP), digital dermoscopy (DD), and reflectance confocal microscopy (RCM), can improve melanoma diagnosis, particularly in high-risk patients. This study assessed the benefits of combining these advanced imaging techniques in a three-step programme in managing high-risk patients. This study included 410 high-risk melanoma patients who underwent a specialised imaging consultation in addition to their regular skin examinations in outpatient care. At each visit, the patients underwent a 3D-TBP, a DD for suspicious findings, and an RCM for unclear DD findings. The histological findings of excisions initiated based on imaging consultation and outpatient care were compared. Imaging consultation detected sixteen confirmed melanomas (eight invasive and eight in situ) in 39 excised pigmented lesions. Outpatient care examination detected seven confirmed melanomas (one invasive and six in situ) in 163 excised melanocytic lesions. The number needed to excise (NNE) in the imaging consultation was significantly lower than that in the outpatient care (2.4 vs. 23.3). The NNE was 2.6 for DD and 2.3 for RCM. DD, 3D-TBP, or RCM detected melanomas that were not detected by the other imaging methods. The three-step imaging programme improves melanoma detection and reduces the number of unnecessary excisions in high-risk patients.
PubMed: 38927909
DOI: 10.3390/cancers16122204 -
Journal of the European Academy of... Jun 2024Only a small per cent of new melanocytic lesions developing in adults are expected to represent melanomas. Total body photography (TBP) has been widely incorporated in...
BACKGROUND
Only a small per cent of new melanocytic lesions developing in adults are expected to represent melanomas. Total body photography (TBP) has been widely incorporated in clinical practice, especially for follow-up of high-risk individuals with multiple naevi. However, dynamic changes detected with TBP need to be interpreted with caution to avoid unnecessary excisions.
OBJECTIVES
To identify clinical and dermoscopic predictors of malignancy in melanocytic lesions presenting clinically as new lesions on TBP.
METHODS
Melanomas and melanocytic naevi excised from a high-risk cohort and presenting as new lesions on TBP were retrospectively included. Naevi were arbitrarily collected up to approximately twice the number of melanomas. Melanomas were categorized as 'unequivocal' or 'borderline' on histopathology review.
RESULTS
Sixty melanomas and 110 naevi were included. Median age (range) of cases (55; 27-83) was 9 years older than controls (46; 24-77) (p < 0.0001). Median diameter (IQR) of naevi was 2.6 mm (1.8-3.8) and of melanomas 4.2 mm (2.7-7.0) (p < 0.0001). On histopathology, 40% of the melanomas were 'borderline'. A positive 7-point checklist was reported in 12.5% of 'borderline' melanomas and 33.3% of 'unequivocal' melanomas (p = 0.005), while 18.3% of melanomas were completely featureless. Blue-whitish veil, atypical vascular pattern and shiny white lines were exclusively found in melanomas. The main predictors of malignancy were (OR; 95% CI) regression structures (7.13; 1.88-27.06; p = 0.004); hypo/amelanotic colour (6.00; 1.17-30.73; p = 0.03); irregular pigmentation (3.89; 1.36-11.13; p = 0.01); asymmetrical peripheral dots/globules (3.50; 1.11-11.00; p = 0.03); and asymmetry in pattern and/or colour (2.5; 1.3-4.9; p = 0.007). All invasive melanomas detected in patients younger than 50 years presented at least one dermoscopic predictor of malignancy.
CONCLUSIONS
Melanomas presenting as new lesions are frequently featureless or feature poor on dermoscopy and difficult-to-diagnose on histopathology. In high-risk patients, the presence on any of the dermoscopic predictors of malignancy identified should prompt excision; however, the remaining lesions should be closely monitored.
PubMed: 38925576
DOI: 10.1111/jdv.20188 -
International Journal of Dermatology Jun 2024Scabies, caused by the Sarcoptes scabiei var hominis mite burrowing into the skin, is a highly contagious disease characterized by intense nocturnal itching. Its global... (Review)
Review
Scabies, caused by the Sarcoptes scabiei var hominis mite burrowing into the skin, is a highly contagious disease characterized by intense nocturnal itching. Its global impact is considerable, affecting more than 200 million individuals annually and posing significant challenges to healthcare systems worldwide. Transmission occurs primarily through direct skin-to-skin contact, contributing to its widespread prevalence and emergence as a substantial public health concern affecting large populations. This review presents consensus-based clinical practice guidelines for diagnosing and managing scabies, developed through the fuzzy Delphi method by dermatology, parasitology, pediatrics, pharmacology, and public health experts. The presence of burrows containing adult female mites, their eggs, and excreta is the diagnostic hallmark of scabies. Definitive diagnosis typically involves direct microscopic examination of skin scrapings obtained from these burrows, although dermoscopy has become a diagnostic tool in clinical practice. Treatment modalities encompass topical agents, such as permethrin, balsam of Peru, precipitated sulfur, and benzyl benzoate. In cases where topical therapy proves inadequate or in instances of crusted scabies, oral ivermectin is recommended as a systemic treatment option. This comprehensive approach addresses the diagnostic and therapeutic challenges associated with scabies, optimizing patient care, and management outcomes.
PubMed: 38922701
DOI: 10.1111/ijd.17327 -
Understanding the Dermoscopic Patterns of Basal Cell Carcinoma Using Line-Field Confocal Tomography.Tomography (Ann Arbor, Mich.) May 2024Basal cell carcinoma (BCC) is the most frequent malignancy in the general population. To date, dermoscopy is considered a key tool for the diagnosis of BCC;...
Basal cell carcinoma (BCC) is the most frequent malignancy in the general population. To date, dermoscopy is considered a key tool for the diagnosis of BCC; nevertheless, line-field confocal optical coherence tomography (LC-OCT), a new non-invasive optical technique, has become increasingly important in clinical practice, allowing for in vivo imaging at cellular resolution. The present study aimed to investigate the possible correlation between the dermoscopic features of BCC and their LC-OCT counterparts. In total, 100 histopathologically confirmed BCC cases were collected at the Dermatologic Clinic of the University of Siena, Italy. Predefined dermoscopic and LC-OCT criteria were retrospectively evaluated, and their frequencies were calculated. The mean (SD) age of our cohort was 65.46 (13.36) years. Overall, BCC lesions were mainly located on the head (49%), and they were predominantly dermoscopically pigmented (59%). Interestingly, all dermoscopic features considered had a statistically significant agreement with the LC-OCT criteria (all < 0.05). In conclusion, our results showed that dermoscopic patterns may be associated with LC-OCT findings, potentially increasing accuracy in BCC diagnosis. However, further studies are needed in this field.
Topics: Humans; Carcinoma, Basal Cell; Dermoscopy; Skin Neoplasms; Aged; Male; Female; Retrospective Studies; Tomography, Optical Coherence; Middle Aged; Aged, 80 and over; Italy; Adult
PubMed: 38921940
DOI: 10.3390/tomography10060063 -
Dermatopathology (Basel, Switzerland) Jun 2024A 74-year-old woman in good general health presented with a 5-year history of progressive hair loss over several years, interpreted as female androgenetic alopecia...
A 74-year-old woman in good general health presented with a 5-year history of progressive hair loss over several years, interpreted as female androgenetic alopecia (AGA), and was treated with topical 5% Minoxidil without improvement. The patient's relevant medical history revealed infiltrating, triple-negative apocrine carcinoma of the right breast four years before, treated by quadrantectomy, radiation, lymphadenectomy and chemotherapy, with no recurrence at the last follow-up. On examination, there was an asymptomatic 15 × 15 cm firm and whitish area of scarring alopecia on the central scalp. Dermoscopy revealed multiple arborizing vessels and many telangiectasia. The clinical considerations included mainly cutaneous metastasis of breast carcinoma (alopecia neoplastica), pseudopelade of Broque and morpheaform basal cell carcinoma (BCC). A histopathologic examination revealed characteristic changes of morpheaform BCC with basaloid islands and cords of atypical basaloid cells diffusely infiltrating the dermis, embedded in a sclerotic and hypervascularized stroma. Secondary alopecia neoplastica due to morpheaform BCC on the scalp is an exceedingly rare entity, possessing subtle clinical features that may mimic both scarring and non-scarring alopecia. Delayed recognition may contribute to aggressive behavior and extensive local destruction. Treatment with hedgehog inhibitors in locally advanced BCC of the scalp, both in adjuvant and neoadjuvant modalities, is promising.
PubMed: 38921053
DOI: 10.3390/dermatopathology11020016 -
Clinical and Experimental Dermatology Jun 2024
PubMed: 38917247
DOI: 10.1093/ced/llae241 -
Archives of Dermatological Research Jun 2024
Topics: Humans; Vitiligo; Skin Pigmentation; Dermoscopy; Female; Adult; Male; Adolescent; Middle Aged; Young Adult; Treatment Outcome; Child; Skin
PubMed: 38916667
DOI: 10.1007/s00403-024-03170-2 -
Melanoma Research Jun 2024Vulvar melanoma is considered rare, but it is the second most frequent vulvar neoplasm; 2% of melanomas in women arise in the vulvar area. It is important to highlight...
Vulvar melanoma is considered rare, but it is the second most frequent vulvar neoplasm; 2% of melanomas in women arise in the vulvar area. It is important to highlight how the characteristics of vulvar melanoma differentiate it from classic cutaneous melanoma. Vulvar melanoma has different risk factors and clinical and dermoscopic characteristics; moreover, it has a higher recurrence rate and a greater likelihood of multifocality. Here, we present a case of a 44-year-old patient with two primary vulvar melanomas located on opposite sides of her vulva. The lesions were both flat, but they had distinct clinical and dermoscopic appearances. Melanoma of the genital tract is likely the result of a multifocal disorder of the melanocytes within the mucosa that inhabit the perineal squamous epithelium. The risk factors of vulvar melanoma differ from those of classical cutaneous melanomas. Vulvar melanoma occurs in an area shielded from ultraviolet radiation; the primary risk factors include chronic inflammatory disease, genetic susceptibility, irritant agents and viral infections. This case study reveals how a close examination of the genital area is important and how dermoscopy can aid in the differential diagnosis of vulvar lesions. Inspections of the genital area should be particularly thorough if a melanoma is detected there, given the higher risk of multifocality in that part of the body.
PubMed: 38913418
DOI: 10.1097/CMR.0000000000000989