Amelanotic metastatic cutaneous melanoma

Dermatoscopy of melanocytic lesions has guided the decision of when or not to biopsy a lesion. The use of this tool has increased clinical examination''s sensitivity and specificity in 89% and 96% respectively. However, dermatoscopic evaluation of amelanotic or hypomelanotic melanomas, as well as metastases, can be difficult. There is still no standardization for the analysis of these pathologies, which relies mostly on their vascular pattern. We describe the dermatoscopy of acral metastatic amelanotic melanoma.     

Dysplastic nevus associated with seborrheic keratosis

Seborrheic keratosis is a common skin lesion which may coincidentally be associated melanocytic nevi. The authors describe a case of dysplastic nevus associated with seborrheic keratosis and discuss the clinical, dermoscopic, and histological findings of this association. They also discuss the association between seborrheic keratosis and other benign and malignant tumours.     

Dermoscopic features of thin melanomas: a comparative study of melanoma in situ and invasive melanomas smaller than or equal to 1mm

BACKGROUND

Dermoscopy allows the early detection of melanomas. The preoperative determination of Breslow index by dermoscopy could be useful in planning the surgical approach and in selecting patients for sentinel lymph node biopsy.

OBJECTIVES

This study aims at describing the dermoscopic features of thin melanomas and comparing melanomas in situ with invasive melanomas less than or equal to 1 mm thick.

METHODS

This was an observational retrospective study in which the dermoscopy photographs of 41 thin melanomas were evaluated. Three observers evaluated together 14 dermoscopic criteria.

RESULTS

Among thin melanomas, the most frequent criteria were presence of asymmetry in two axes in 95% of cases (39 cases), 3 or more colors in 80.4% of cases (33 cases), atypical dots or globules in 58.5% of cases (24 cases) and atypical network or streaks in 53.6% of cases (22 cases). The group of invasive melanomas presented with a higher frequency and statistical significance (p <0.05) 3 or more colors (OR: 16.1), milky red areas (OR: 4.8) and blue-white veil (OR: 20.4), and a greater tendency to have streaks or atypical network (OR: 3.66).

CONCLUSIONS

Thin melanomas tend to have asymmetry in the two axes, 3 or more colors, atypical dots or globules and atypical network or streaks. Melanomas in situ tend to have up to 2 colors, no blue-white veil and no milky red area. Invasive melanomas tend to have 3 or more colors, a milky red area, blue-white veil, and atypical network or streaks. Further studies are needed to confirm these findings.     

Biopsy guided by dermoscopy in cutaneous pigmented lesion - Case report

It may be clinically difficult to differentiate early-stage melanoma from benign tumors, specially pigmented seborrheic keratosis. Dermoscopy can help; however, the findings are not always conclusive. Therefore, histopathology may be necessary for a correct diagnosis. We describe a melanocytic lesion with dubious clinic and dermoscopic findings. An incisional biopsy of a suspicious area, guided by dermoscopy, was performed to clarify the findings.     

Polypoid melanoma and superficial spreading melanoma different subtypes in the same lesion

Melanoma is a malignant melanocytic neoplasm with high mortality rate, andsteadily and universally increasing incidence rates. Polypoid melanoma isconsidered an exophytic variant of the nodular subtype. The incidence ofpolypoid melanoma is extremely variable, most likely because of the differentcriteria used for its characterization. We presented a rare case of polypoidmelanoma and superficial spreading melanoma in the same lesion.     

Consensus on melanonychia nail plate dermoscopy

This statement, focused on melanonychia and nail plate dermoscopy, is intended to guide medical professionals working with melanonychia and to assist choosing appropriate management for melanonychia patients. The International Study Group on Melanonychia was founded in 2007 and currently has 30 members, including nail experts and dermatopathologists with special expertise in nails. The need for common definitions of nail plate dermoscopy was addressed during the Second Meeting of this Group held in February 2008. Prior to this meeting and to date (2010) there have been no evidence-based guidelines on the use of dermoscopy in the management of nail pigmentation.     

Parallel ridge pattern on dermoscopy: observation in non-melanoma cases

The acral melanoma is the most prevalent type of melanoma in the non-Caucasianpopulation, and dermoscopy is a useful tool for earlier diagnosis and differentiationfrom benign lesions. The dermoscopic pattern often associated with melanoma on thevolar skin is the parallel ridge, with 99% specificity according to the literature.However, this pattern can also occur in several benign acral lesions, so it isimportant to make a good interpretation of this pattern, along with the clinicalhistory and evolution.     

脂溢性角化病的皮肤高频超声及皮肤镜特征分析

目的 描述脂溢性角化病（SK）的常见皮肤高频超声及皮肤镜特征。方法 收集2017年8 - 12月在北京协和医院皮肤科门诊就诊的46例SK患者,对其50处SK皮损行50 MHz和20 MHz皮肤高频超声和皮肤镜检查。对SK皮肤高频超声和皮肤镜特征进行总结分析。采用χ2检验比较50 MHz和20 MHz超声对SK的评估结果差异,并对SK皮肤高频超声和皮肤镜下特征的对应关系通过简单匹配系数进行分析。结果 SK皮损特征自上而下50 MHz和20 MHz超声表现分别为增强高回声（48处和39处,P = 0.007）、角质层块状或点状增强高回声（22处和11处,P = 0.019）、伴后方声影（34处和13处,P < 0.001）、皮损形态规则且边界清晰（46处和41处,P = 0.137）、皮损内不均质低回声（50处和47处,P = 0.079）和点状高回声（25处和2处,P < 0.001）、基底位于同一水平面（40处和36处,P = 0.349）、皮损下方真皮回声减低（50处和28处,P < 0.001）。50 MHz超声对SK皮损的8个皮肤高频超声特征整体评价显著优于20 MHz超声（P = 0.002）。50处SK皮损常见皮肤镜下特征为边界清楚（50处）,粉刺样开口（45处）,沟嵴/脑回状模式（31处）,发卡样血管（30处）,多发粟粒样囊肿（24处）,虫蚀状边缘（21处）和亮白色条纹（3处）。50 MHz和20 MHz超声下,SK皮损角质层块状或点状增强高回声与皮肤镜下粉刺样开口的简单匹配系数分别为42%（21处）和20%（10处）,皮损内点状高回声与皮肤镜下多发粟粒样囊肿（> 3个）的简单匹配系数分别为58%（29处）和48%（24处）。结论 皮肤高频超声和皮肤镜对SK皮损评估具有较好的应用价值,且50 MHz超声比20 MHz超声对SK的皮损成像更具优势。     

Dermoscopic clues in the diagnosis of amelanotic and hypomelanotic malignant melanoma

The clinical identification of amelanotic malignant melanoma (AMM) and hypomelanoticmalignant melanoma (HMM) becomes difficult due to the lack of pigmentation and to thediverse clinical presentations. Dermoscopy is very useful in these cases, increasingthe level of suspicion of malignancy. We report 4 cases of amelanotic malignantmelanoma and hypomelanotic malignant melanoma with characteristic dermoscopicfindings. Dermoscopy under polarized light demonstrates vascular polymorphism,globules and milky-red areas, in addition to chrysalis and multiple blue-graydots.     

Reflectance confocal microscopy of cutaneous melanoma. Correlation with dermoscopy and histopathology

In vivo Confocal Microscopy is a method for non-invasive, real-time visualization of microscopic structures and cellular details of the epidermis and dermis, which has a degree of resolution similar to that obtained with histology. We present a case of cutaneous melanoma in which diagnosis was aided by confocal microscopy examination. We also correlate the observed features with the dermoscopic and histopathological findings. Confocal microscopy proved to be an useful adjunct to dermoscopy, playing an important role as a method ''between clinical evaluation and histopathology''.     

日光性雀斑样痣、脂溢性角化病及扁平苔藓样角化病皮肤镜特征专家共识

【摘要】 日光性雀斑样痣、脂溢性角化病及扁平苔藓样角化病是常见的良性表皮增生性疾病,其皮肤镜特征对于明确诊断、与其他皮肤肿瘤相鉴别、避免不必要的活检和手术以及动态监测皮损变化等都有一定帮助。本共识对这3种疾病的皮肤镜特征进行了总结。日光性雀斑样痣的皮肤镜特征主要为皮损边界清晰、虫蚀状边缘、模糊的色素网、指纹模式、棕色均质模式、假性网络。脂溢性角化病的皮肤镜特征主要为皮损边界清晰、粟粒样囊肿、粉刺样开口、脑回状模式、发夹样血管、摇晃试验中皮损整体移动。扁平苔藓样角化病的皮肤镜特征主要为胡椒粉样或颗粒模式以及周围可见日光性雀斑样痣、脂溢性角化病或光线性角化病的皮肤镜特征。     

脂溢性角化病的病因与治疗进展

脂溢性角化病是一种良性表皮角质形成细胞肿瘤.其病因尚不清楚,可能与遗传因素密切相关,流行病学研究显示年龄和紫外线暴露是本病独立的危险因素,细胞因子及感染可能与其发病有一定的关系.脂溢性角化病的治疗以冷冻、激光为主,但近年来也出现一些新的疗法,如局部外用三氯乙酸,系统应用阿维A等.     

Lack of compliance: a challenge for digital dermoscopy follow-up

BACKGROUND

Digital dermoscopy is the gold standard follow-up method for patients with high risk for developing cutaneous malignant melanoma. By comparing the same lesion at different moments, it allows early detection of subtle changes that could suggest the diagnosis of melanoma. Thus, it is clear that the test must be repeated after a period of time, according to time intervals determined by the evaluator.

OBJECTIVES

To evaluate adherence of patients to follow-up examinations using digital dermoscopy.

METHOD

Retrospective analysis of 36 patients who underwent digital dermoscopic examination and total-body photography in a private medical center between September 2010 and January 2013.

RESULTS

Only 25% of the patients returned for followup evaluations.

CONCLUSIONS

Low adherence to digital dermoscopy follow-up could compromise the efficacy of this valuable method. This lack of adherence represents a challenge for the evaluator.     

Regressing eruptive disseminated pigmented Spitz (Reed) nevi in a young adult

Eruptive disseminated Spitz nevi is a rare clinical presentation that features an abrupt widespread eruption of Spitz nevi. Spontaneous regression of these nevi has been rarely reported in previous literature. The authors of the present study report the case of a 30-year-old man who presented eruptive disseminated Spitz nevi that appeared within a week and started regression in the following years.     

Psoriasiform Keratosis - Case report

Psoriasiform Keratosis is a rare clinic entity. The etiopathogenesis remains unknownand the disease is characterized by a solitary, scaly or keratotic papule, or plaquemainly located on the extremities. Histopathological features closely resemble thoseof psoriasis. We report the case of a 70-year-old woman presenting a solitary andasymptomatic keratotic plaque, located on the back of the left leg, unresponsive totopical corticosteroids. We performed an excisional biopsy and histopathology wasconsistent with psoriasiform keratosis.     

Brazilian guidelines for diagnosis,treatment and follow-up of primary cutaneous melanoma - Part II

The last Brazilian guidelines on melanoma were published in 2002. Development in diagnosis and treatment made updating necessary. The coordinators elaborated ten clinical questions, based on PICO system. A Medline search, according to specific MeSH terms for each of the 10 questions was performed and articles selected were classified from A to D according to level of scientific evidence. Based on the results, recommendations were defined and classified according to scientific strength. The present Guidelines were divided in two parts for editorial and publication reasons. In this second part, the following clinical questions were answered: 1) which patients with primary cutaneous melanoma benefit from sentinel lymph node biopsy? 2) Follow-up with body mapping is indicated for which patients? 3) Is preventive excision of acral nevi beneficious to patients? 4) Is preventive excision of giant congenital nevi beneficious to patients? 5) How should stages 0 and I primary cutaneous melanoma patients be followed?     

Cloudy and starry milia‐like cysts: how well do they distinguish seborrheic keratoses from malignant melanomas?

Background Seborrheic keratoses are the most common skin lesions known to contain small white or yellow structures called milia‐like cysts (MLCs). Varied appearances can sometimes make it difficult to differentiate benign lesions from malignant lesions such as melanoma, the deadliest form of skin cancer found in humans. Objective The purpose of this study was to determine the statistical occurrence of MLCs in benign vs. malignant lesions. Methods A medical student with 10 months experience in examining approximately 1000 dermoscopy images and a dermoscopy‐naïve observer analysed contact non‐polarized dermoscopy images of 221 malignant melanomas and 175 seborrheic keratoses for presence of MLCs. Results The observers found two different types of MLCs present: large ones described as cloudy and smaller ones described as starry. Starry MLCs were found to be prevalent in both seborrheic keratoses and melanomas. Cloudy MLCs, however, were found to have 99.1% specificity for seborrheic keratoses among this group of seborrheic keratoses and melanomas. Conclusion Cloudy MLCs can be a useful tool for differentiating between seborrheic keratoses and melanomas.     

Dermoscopy as an auxiliary tool for the diagnosis of furuncular myiasis

Furuncular myiasis occurs after larvae penetrate on the skin. The disease ischaracterized by the presence of a nodule with a central hole through whichthere is serosanguinous exudate drainage. The authors present a case offuruncular myiasis by Dermatobia hominis in which late diagnosis made itnecessary to have the orifice margins surgically enlarged in order to extractthe larva. They also emphasize that dermoscopy is a useful auxiliary tool inthis diagnosis.     

Dermoscopy assisting the diagnosis of mycetoma: case report and literature review

Mycetomas are a chronic skin infection characterized by perilesional edema, formation of sinus tracts, and discharge of purulent or seropurulent exudate containing grains. This report aims to demonstrate the clinical diagnosis (by dermoscopy) of a skin lesion that initially bared no clinical features of a mycetoma.     

Cauliflower-like exophytic mass on the skin: polypoid melanoma. Clinical,dermoscopic, and histologic features

Polypoid melanoma is a variant of nodular melanoma, whose poor prognosis depends on its thickness and the presence of ulceration at the time of diagnosis. The authors report two cases of polypoid melanoma, presenting as broad, cauliflower-like, polypoid masses. Dermoscopy was characterized by a multicolored pattern, atypical polymorphic vessels, and the fiber sign. Clinical and dermoscopic features can help to diagnose polypoid melanoma and exclude other possible differential diagnoses. However, histology remains mandatory to confirm the diagnostic suspicion.