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Experimental Dermatology Jul 2022Differential diagnosis of extrafacial flat pigmented lesions with dermoscopic reticular and/or homogeneous pattern is challenging. Dendritic cells upon reflectance...
Differential diagnosis of extrafacial flat pigmented lesions with dermoscopic reticular and/or homogeneous pattern is challenging. Dendritic cells upon reflectance confocal microscopy (RCM) still represent a pitfall. This study aims to determine the role of dendritic cells upon RCM in the epidermis and dermo-epidermal junction (DEJ), together with common RCM features for melanoma and nevi, in dermoscopically equivocal extrafacial flat pigmented lesions. A retrospective evaluation of RCM images of melanocytic extrafacial flat pigmented lesions with reticular and/or homogeneous dermoscopic pattern and with histopathological diagnosis, was performed. A multivariate model of RCM features was used to obtain a score of independent risk factors. A total of 698 lesions were included. Increasing patient age, epidermal dendritic cells, many dendritic cells in the DEJ (>30%) and many (>5/mm ) round atypical cells were independent risk factors for melanoma. Edged papillae and melanophages were indicative of nevus. A score based on these features was developed to assist in melanoma differential diagnosis. The RCM observation of abundant (>30%) dendritic cells in the DEJ is highly suggestive of malignity. This independent risk factor should also be considered for improved differential diagnosis of extrafacial melanoma.
Topics: Dendritic Cells; Dermoscopy; Diagnosis, Differential; Humans; Melanoma; Microscopy, Confocal; Nevus; Retrospective Studies; Skin Neoplasms
PubMed: 35220636
DOI: 10.1111/exd.14553 -
PloS One 2022Some melanocytic lesions do not present enough clinical and dermoscopic features to allow ruling out a possible melanoma diagnosis. These "doubtful melanocytic lesions"...
Some melanocytic lesions do not present enough clinical and dermoscopic features to allow ruling out a possible melanoma diagnosis. These "doubtful melanocytic lesions" pose a very common and challenging scenario in clinical practice and were selected at this study for reflectance confocal microscopy evaluation and subsequent surgical excision for histopathological diagnosis. The study included 110 lesions and three confocal features were statistically able to distinguish benign melanocytic lesions from melanomas: "peripheral hotspot at dermo-epidermal junction", "nucleated roundish cells at the dermo-epidermal junction" and "sheet of cells". The finding of a peripheral hotspot (atypical cells in 1mm2) at the DEJ is highlighted because has not been previously reported in the literature as a confocal feature related to melanomas.
Topics: Diagnosis, Differential; Humans; Melanoma; Microscopy, Confocal; Nevus, Pigmented; Retrospective Studies; Sensitivity and Specificity
PubMed: 35157706
DOI: 10.1371/journal.pone.0263819 -
Dermatology and Therapy Feb 2022Topical imiquimod is an off-label alternative treatment for lentigo maligna used when surgery cannot be performed. Severe inflammatory response induced by this drug may...
Topical imiquimod is an off-label alternative treatment for lentigo maligna used when surgery cannot be performed. Severe inflammatory response induced by this drug may generate many complaints and force patients to discontinue use. We present a case in which interval treatment with 5% topical imiquimod was implemented for severe inflammatory response. An 82-year-old Caucasian woman presented with a large, irregularly pigmented lesion on her left cheek within the scar of a previously excised melanocytic lesion diagnosed as junctional nevus. Based on dermatoscopical examination confirmed by histopathological description, lentigo maligna was diagnosed. Since the lesion was large and covered the lower left eyelid and due to the risk of disfigurement, the patient refused surgical excision. Therefore, treatment with imiquimod 5% once daily, five times per week, was offered. After 5 weeks, the treatment was stopped because of intense inflammatory reaction and ulceration. On the follow-up visit after 3 months, videodermatoscopical examination revealed changes in the pigmentation of the lentigo maligna including the presence of residual gray dots and fading of the previous dark brown and black colors. The inflammatory response had almost resolved. The second course of treatment with imiquimod five times a week was implemented again for 5 weeks, and after a 2-month interval the third course with the same regimen was started. Total clearance of the lesion was achieved, which was confirmed by videodermatoscopical examination. During the 2-year follow-up, no relapse was observed based on dermatoscopical examination. We propose interval treatment with topical imiquimod 5% lentigo maligna for severe inflammatory reactions in patients with contraindications to surgery. This could help patients overcome this typical response effect and decrease their cessation of treatment.
PubMed: 35083713
DOI: 10.1007/s13555-021-00667-w -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Nov 2021To explore the effectiveness and safety of Pacman flap for repair of eyelid and periocular soft tissue defects.
OBJECTIVE
To explore the effectiveness and safety of Pacman flap for repair of eyelid and periocular soft tissue defects.
METHODS
The clinical data of 12 patients who underwent repair of eyelid and periocular soft tissue defects with Pacman flap between April 2015 and September 2020 was retrospectively reviewed. There were 5 males and 7 females, aged from 18 to 87 years, with a median age of 63 years. The disease duration ranged from 6 months to 50 years, with a median time of 3 years. The defect was located on the lateral eyelid in 5 cases, inferior eyelid in 3 cases, inferior and medial eyelid in 2 cases, inferior and lateral eyelid in 2 cases, and lateral eyebrow in 1 case. Pathological diagnosis included 4 cases of basal cell carcinoma, 4 cases of squamous cell carcinoma, 1 case of junction nevus, 1 case of intradermal nevus, 1 case of seborrheic keratosis, and 1 case of keratoacanthoma. The size of defects ranged from 1.4 cm×1.2 cm to 5.5 cm×5.0 cm. According to the skin mobility and toughness around the defects, Pacman flaps with the size of 1.6 cm×1.4 cm to 10.0 cm×6.0 cm were designed and advanced to repair the defects.
RESULTS
All flaps survived completely with no necrosis. One patient had infection, and another patient had partial wound dehiscence, but the wounds healed after dressing change without further debridement. Other patients all recovered successfully. The follow-up time ranged from4 to 51 months, with a median time of 12 months. No recurrence and metastasis occurred, and the scars were invisible without deformity of eyelid and brow. All patients were satisfied with the aesthetic and functional outcomes of the eyes.
CONCLUSION
Pacman flap is a simple and feasible technique for repair of eyelid and periocular soft tissue defects, with satisfactory effectiveness.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Eyelids; Female; Humans; Male; Middle Aged; Perforator Flap; Plastic Surgery Procedures; Retrospective Studies; Skin Transplantation; Soft Tissue Injuries; Treatment Outcome; Young Adult
PubMed: 34779174
DOI: 10.7507/1002-1892.202106066 -
Acta Dermato-venereologica Nov 2021BRAF/V600E mutation and other cell growth/growth-control mechanisms are involved in naevogenesis and melanomagenesis. Immunoexpression of BRAF/V600E and other molecules...
Differential Immunoexpression of BRAF/V600E, Senescence Markers, PTEN, and T-type Calcium Channels in Acquired Naevi According to their Histopathological and Dermoscopic Classification.
BRAF/V600E mutation and other cell growth/growth-control mechanisms are involved in naevogenesis and melanomagenesis. Immunoexpression of BRAF/V600E and other molecules (p16, phosphatase and tensin homologue (PTEN), Ki67, hTERT and Cav3.1 and 3.2 calcium channels) were investigated in 80 histopatho-logically and dermoscopically classified acquired naevi. Regarding BRAF/V600E, dysplastic naevi showed lower immunostaining than common naevi, which was significant in comparison with intradermal naevi, which showed the highest BRAF/V600E histoscore. Junctional naevi showed the lowest BRAF/V600E levels. Globular/cobblestone and reticular dermoscopic patterns were consistently associated with high and low BRAF/V600E immunoexpression, respectively, but Zalaudek's peripheral globule pattern (CR/PG) showed the highest BRAF/V600E immunoexpression. Among global patterns, the previously not investigated multicomponent pattern showed the lowest BRAF/V600E immunoexpression. Regarding the remaining biomarkers, new immunohistochemical features were found, in particular p16 and PTEN low expression in multicomponent pattern; and Ki67, hTERT and Cav.3.1 high expression in CR/PG. In conclusion, histopathology and dermoscopy provide complementary information regarding the biology of melanocytic naevi.
Topics: Biomarkers; Calcium Channels, T-Type; Dermoscopy; Humans; Nevus, Pigmented; PTEN Phosphohydrolase; Proto-Oncogene Proteins B-raf; Skin Neoplasms
PubMed: 34643739
DOI: 10.2340/actadv.v101.361 -
Genes Aug 2021Dermoscopy is a non-invasive, in vivo technique that allows the visualization of subsurface skin structures in the epidermis, at the dermoepidermal junction, and in the... (Review)
Review
Dermoscopy is a non-invasive, in vivo technique that allows the visualization of subsurface skin structures in the epidermis, at the dermoepidermal junction, and in the upper dermis. Dermoscopy brought a new dimension in evaluating melanocytic skin neoplasms (MSN) also representing a link between clinical and pathologic examination of any MSN. However, histopathology remains the gold standard in diagnosing MSN. Dermoscopic-pathologic correlation enhances the level of quality of MSN diagnosis and increases the level of confidence of pathologists. Melanoma is one of the most genetically predisposed among all cancers in humans. The genetic landscape of melanoma has been described in the last years but is still a field in continuous evolution. Melanoma genetic markers play a role not only in melanoma susceptibility, initiation, and progression but also in prognosis and therapeutic decisions. Several studies described the dermoscopic specific criteria and predictors for melanoma and their histopathologic correlates, but only a few studies investigated the correlation among dermoscopy, pathology, and genetic of MSN. The aim of this work is to review the published data about dermoscopic features of melanoma, their histopathological correlates with regards also to genetic alterations. Particularly, this review will focus on low-CSD (cumulative sun damage) melanoma or superficial spreading melanoma, high-CSD melanoma, and nevus-associated melanoma.
Topics: Dermoscopy; Humans; Melanoma; Skin; Skin Neoplasms; Melanoma, Cutaneous Malignant
PubMed: 34440462
DOI: 10.3390/genes12081288 -
Annals of the Royal College of Surgeons... Oct 2021Malignant melanoma of the gastrointestinal tract is usually a metastasis from a cutaneous source. Primary gastric melanoma is an extremely rare clinical entity, with few...
Malignant melanoma of the gastrointestinal tract is usually a metastasis from a cutaneous source. Primary gastric melanoma is an extremely rare clinical entity, with few reported cases worldwide. It is often advanced at the time of diagnosis and is associated with a poor outcome. We report a case of a 57-year-old male who presented to the emergency department with complaints of fatigue, haematemesis and melena. Laboratory investigation indicated a haemoglobin level of 7.4g/dl, for which the patient received a transfusion. Upper gastrointestinal endoscopy revealed a bleeding mass in the body of stomach which provisional histology was suggestive of a malignant mesenchyimal tumour but subsequent cytomorphology and immunophenotyping were consistent with malignant melanoma, with positive S-100, HMB-45 and Melan-A. Dermatological exam indicated two lesions suspicious for the primary site of metastasis but were ultimately diagnosed as benign lesions, one junctional nevus and other one seborrheic keratosis, on biopsies. Ophthalmologic exam showed no other probable sites of origin. PET/CT showed accumulation of tracer in the stomach, jejunum and perigastric lymph nodes. For this reason, primary advanced gastric melanoma was suspected in this patient. Since the patient had recurrent upper gastrointestinal bleeding that required frequent blood transfusion, a total gastrectomy with partial small bowel resection was performed. We report this case to present initial diagnostic challange and discuss performing surgery for recurrent tumour bleeding.
Topics: Gastrointestinal Hemorrhage; Humans; Male; Melanoma; Middle Aged; Recurrence; Stomach Neoplasms; Upper Gastrointestinal Tract
PubMed: 34431710
DOI: 10.1308/rcsann.2020.7139 -
Acta Dermatovenerologica Alpina,... Mar 2021We report the case of an adolescent girl that presented with an atypical melanocytic lesion on the left gluteal region, suspicious for melanoma. She was healthy with no... (Review)
Review
We report the case of an adolescent girl that presented with an atypical melanocytic lesion on the left gluteal region, suspicious for melanoma. She was healthy with no associated diseases, and there was no history of skin cancer in the family. The nevus had been present for several years, but she had noted a change and growth of it in the last few months. She reported that the nevus was injured about 2 years earlier and it had appeared different ever since. Although dermoscopic examination showed the lesion to be highly suspicious for melanoma and it was therefore surgically excised on the same day, pathohistological examination showed a compound melanocytic nevus with extensive dermal fibrosis/regression and overlying atypical junctional hyperplasia of melanocytes consistent with pseudomelanoma, also known as recurrent melanocytic nevus.
Topics: Adolescent; Female; Humans; Melanocytes; Melanoma; Nevus, Pigmented; Precancerous Conditions; Skin Neoplasms
PubMed: 33765760
DOI: No ID Found -
BioMed Research International 2021Giant congenital melanocytic nevi (GCMN) treatment remains controversial. While surgical resection is the best option for complete removal, skin shortage to reconstruct...
BACKGROUND
Giant congenital melanocytic nevi (GCMN) treatment remains controversial. While surgical resection is the best option for complete removal, skin shortage to reconstruct the skin defect remains an issue. We report a novel treatment using a high hydrostatic pressurization (HHP) technique and a cryopreservation procedure. However, cryopreservation may inhibit revascularization of implanted nevus tissue and cultured epidermal autograft (CEA) take. We aimed to investigate the influence of the cryopreservation procedure on the HHP-treated dermis specimen and CEA take on cryopreserved tissue.
METHODS
Nevus tissue harvested from a patient with GCMN was inactivated with HHP of 200 MPa and then cryopreserved at -30°C for 28 days. The cryopreserved specimen was compared with fresh (HHP-treated without cryopreservation) tissue and with untreated (without HHP treatment) tissue to evaluate the extracellular matrix, basal membranes, and capillaries. Cultured epidermis (CE) take on the cryopreserved tissue was evaluated following implantation of the cryopreserved nevus tissue with CE into the subcutis of nude mice.
RESULTS
No difference was observed between cryopreserved and fresh tissue in terms of collagen or elastic fibers, dermal capillaries, or basement membranes at the epidermal-dermal junction. In 4 of 6 samples (67%), applied CE took on the nevus tissues and regenerated the epidermis in the cryopreserved group compared with 5 of 6 samples (83%) in the fresh group.
CONCLUSION
Cryopreservation at -30°C for 28 days did not result in significant damage to inactivated nevus tissue, and applied CE on the cryopreserved nevus tissues took and regenerated the epidermis. Inactivated nevus tissue with HHP can be used as a dermal substitute after 28-day cryopreservation.
Topics: Animals; Cryopreservation; Dermis; Humans; Hydrostatic Pressure; Male; Mice; Mice, Nude; Nevus; Skin Neoplasms; Skin, Artificial
PubMed: 33681354
DOI: 10.1155/2021/3485189 -
Journal of Biomedical Optics Feb 2021Melanocytic nevi represent the most common dermal melanocytic lesions in humans. Nevus is typically diagnosed clinically with the naked eye or with dermoscopy. However,...
SIGNIFICANCE
Melanocytic nevi represent the most common dermal melanocytic lesions in humans. Nevus is typically diagnosed clinically with the naked eye or with dermoscopy. However, it is essential to identify the type of nevus by invasive biopsy for histopathological examination. The use of noninvasive imaging tools can be used to evaluate the types of nevi to reduce unnecessary excisions of benign entities.
AIM
To evaluate the feasibility of using en face and cross-sectional full-field optical coherence tomography (FF-OCT) in differentiation of melanocytic nevi that can facilitate the reduction of unnecessary excisions of benign entities.
APPROACH
Dual-mode Mirau-type FF-OCT for cross-sectional imaging (B-scan) and en face imaging were used to distinguish the types of nevi.
RESULTS
Although the B-scan reveals the distribution of melanosomes, users can set a specific depth of the en face image to explore the morphology of surrounding skin cells instantly. According to the locations of nevus nests, the different types of nevi, including junction nevus and compound nevus, can be identified using this dual-mode FF-OCT system.
CONCLUSIONS
Combining B-scan and en face imaging in vivo FF-OCT enables the examination and navigation of skin tissues in real time and in three dimensions.
Topics: Cell Differentiation; Humans; Melanoma; Nevus, Pigmented; Skin Neoplasms; Tomography, Optical Coherence
PubMed: 33624460
DOI: 10.1117/1.JBO.26.2.020501