Excised melanocytic lesions in children and adolescents - a 10-year survey

Background Early recognition and prompt excision is to date the only available strategy for reducing mortality from melanoma. Little is known about the accuracy of melanoma detection in children and adolescents. Objectives To assess the accuracy of melanoma detection in a paediatric population. Methods From the Department of Dermatology, Medical University of Graz, Austria, we reviewed the dermatopathology reports of naevi and melanomas excised in patients younger than 20 years over a 10‐year period (1998–2007). Patients were subdivided into four age groups: 0–4, 5–9, 10–14 and 15–19 years. Results Accuracy in melanoma detection was tested using the number needed to excise (NNE) value that is obtained by dividing the total number of excised lesions by the number of melanomas. A total of 22 564 lesions were reviewed, disclosing 22 526 naevi and 38 melanomas, for an overall NNE value of 593·8. Five melanomas were excised in children aged 10–14 years (NNE 1141) and 33 in children aged 15–19 years (NNE 479·8), whereas no melanomas were found among 1026 lesions excised in children younger than 10 years. In children aged 0–4 years, congenital and Spitz/Reed naevi accounted for 34·5% and 20% of lesions, respectively. These percentages decreased progressively when moving to older age groups (P < 0·0001). In contrast, the percentage of dermal and compound naevi rose in direct proportion with age, being 3·4% and 20·7%, respectively, in the youngest age group, and 36·7% and 31·9%, respectively, among the oldest patients (P < 0·0001). Conclusions The overall NNE value in paediatric patients over the 10‐year study period was 593·8, meaning that about 594 lesions were excised to find one melanoma. This value is 20 times higher than the rates found in adult patients.     

Two hundred ninety-six cases of onychomycosis in children and teenagers: a 10-year laboratory survey

There is still little data available about the epidemiology of childhood onychomycosis. Looking at our laboratory figures over a 10-year period provided us with some useful information. Nail keratin samples were taken by dermatologists from 21,557 patients with nail conditions, mainly in the Brussels region. The specimens were examined by direct microscopy and/or histology, and cultured on Sabouraud medium agar. Only patients less than 17 years of age were considered as children. Clinical information was gathered about age, sex, and the location of the infected nail. Nine hundred sixty-three of the samples were from children, and 296 of those children had proven onychomycosis. More than three-fourths of the cases were found in children more than 6 years old, and boys were more frequently affected than girls. Toenails were the predominant location of infection. Trichophyton rubrum was the main pathogen, followed by Candida spp. and Trichophyton interdigitale. One case was caused by Scopulariopsis spp. As in adults, onychomycosis is probably the main nail disease in children. After the age of 6 years, the presentation is very similar to that in adults: toenails are mostly involved, and T. rubrum, the main pathogen, is responsible for distal and lateral subungual onychomycosis.     

Camptodactyly: a 10-year series

Camptodactyly is a non-traumatic, painless, non-neurogenic flexion deformity at the proximal interphalangeal joint of the little finger, which may occur in isolation or in various developmental dysmorphology syndromes. In a ten-year survey of almost 10,000 consecutive neurology outpatient referrals, using a passive case finding strategy, camptodactyly was observed with a frequency of 0.43%. All were cases of isolated camptodactyly, and all but one were asymptomatic. Camptodactyly was more often bilateral, often asymmetric, than unilateral. A family history was common, sometimes with intrafamilial heterogeneity (symmetry, degree of angulation). The pattern of inheritance was not certain, but the predominance of female cases (both directly observed and reported in families) and a paucity of father-to-daughter cases suggested the possibility of either sex-linked dominant transmission or mitochondrial DNA point mutation. There was no evidence for aminoaciduria or taurinuria, as previously reported in some cases. Hence, camptodactyly is relatively common as an incidental finding in patients referred to general neurological outpatient clinics, and thus possibly also in the general population. It is possible that camptodactyly is a heterogeneous disorder. Further studies are required to ascertain whether this is the case, and to probe further the inheritance and pathogenesis of the disorder.     

Malignant melanoma: a 20 year survey

A review of eighty-three patients with malignant melanoma seen over the last 20 years at one hospital has been carried out. The overall survival rate was 46.8% at 5 years and 29.5% at 10 years. Some aetiological factors which may influence the prognosis are discussed and the methods of treatment reviewed.     

Reliability of prognostic models in malignant melanoma. A 10-year follow-up study

Certain histologic and clinical features of malignant melanoma have been shown to be indicators of prognosis, both collectively and individually. Even though the predictive value of these features is well established, long-term survival is occasionally seen in individuals with multiple poor prognostic factors. To further examine this phenomenon, histologic sections from 53 patients with malignant melanoma excised between the years 1977 and 1980 in whom reliable clinical follow-up data were obtained were evaluated for the presence of features associated with a poor prognosis (thickness greater than 1.7 mm, Clark level greater than or equal to III, vertical growth phase, high mitotic index, marked cytologic atypia, minimal tumor inflammatory infiltrate, presence of regression, presence of plasma cells, male sex, age greater than or equal to 45 years, and axial anatomic location). Sixty-eight percent of the patients survived for greater than or equal to 10 years. Of these, 26% had lesions greater than or equal to 1.7 thick. Multivariate discriminant analysis of all features provide a model that was 76% accurate in predicting outcome over a 10-year period. Although the predictive value of these prognostic variables is generally reliable, there is a significant population of long-term survivors in whom prognosis could not be accurately predicted using these features.     

Accuracy of computer diagnosis of melanoma: a quantitative meta-analysis

BACKGROUND: Recent developments in computer technology have raised expectations that fully automated diagnostic instruments will become available to diagnose cutaneous melanoma without the need of human expertise. OBJECTIVES: To critically review the contemporary literature on computer diagnosis of melanoma, evaluate the accuracy of such computer diagnosis, analyze the influence of study characteristics, and compare the accuracy of computer diagnosis of melanoma with human diagnosis. METHODS: Quantitative meta-analysis of published reports. DATA SOURCES: Eligible studies were identified by a MEDLINE search covering the period from January 1991 to March 2002, by manual searches of the reference lists of retrieved articles, and by direct communication with experts. RESULTS: Thirty studies with substantial differences in methodological quality were deemed eligible for meta-analysis. Five of these complied with the predetermined list of "good quality" requirements, but none met all methodological quality requirements. Ten of these studies compared the performance of computer diagnosis with human diagnosis. The diagnostic accuracy achieved with computer diagnosis was statistically not different from that of human diagnosis (log odds ratios, 3.36 vs 3.51; P =.80). The diagnostic performance of the computer diagnosis was better for studies that used dermoscopic images than for studies that used clinical images (log odds ratios, 4.2 vs 3.4; P =.08). Other study characteristics did not significantly influence the accuracy of the computer diagnosis. CONCLUSIONS: The computer diagnosis of melanoma is accurate under experimental conditions, but the practical value of automated diagnostic instruments under real-world conditions is currently unknown. We suggest minimum requirements for methodological quality in future experimental studies or, ideally, randomized controlled trials.     

Epidemiology and microbiology of cellulitis and bacterial soft tissue infection during HIV disease: a 10-year survey

BACKGROUND: Cellulitis and soft tissue infection are underestimated complications of HIV disease. PATIENTS AND METHODS: Sixty-seven bacteriologically proven consecutive episodes were identified among 2221 HIV-infected patients hospitalized in a 10-year period, and assessed according to several epidemiological, microbiological and clinical variables. RESULTS: Staphylococcus aureus was the most frequently cultured pathogen (50% of 92 isolates), followed by Pseudomonas spp., Escherichia coli and Streptococcus pyogenes; a polymicrobial infection was present in 38.1% of episodes. Drug addiction (p < 0.003) and male gender (p < 0.04) were significantly associated with the occurrence of these complications, which were community-acquired in 83.6% of cases. While a remarkable variation in the severity of underlying immunodeficiency was shown, hematogenous dissemination occurred in 25.4% of episodes, and proved significantly related to a low CD4+ lymphocyte count, and neutropenia. A 21.7% methicillin-resistance rate was shown among S. aureus isolates. All episodes were favorably treated in 5-16 days, in over 60% of cases with associated beta-lactam-aminglycoside antibiotics; a recurrence of staphylococcal cellulitis occurred in four patients only. CONCLUSION: Skin and soft tissue infections are continuing causes of morbidity in HIV-infected patients, even in the highly active antiretroviral therapy era.     

Pediatric tinea faciei in southern Spain: a 30-year survey

Tinea faciei (TF) is a common clinical form of tinea in children that is frequently misdiagnosed and treated with corticosteroids. No large case series of TF focusing on children have been published. The aim of this study was to analyze the main epidemiologic, clinical, and microbiologic features of TF in children over a period of 30 years and compare these features with those of other tineas. We undertook a retrospective study of 818 cases of tinea in children at a referral hospital in southern Spain, diagnosed between 1977 and 2006, concentrating for this study on TF. Of the 73 cases of TF diagnosed, 50.7% were in girls. Most children (46.6%) were 4 to 9 years old. At the time of diagnosis, 29.2% of the cases had been treated with topical steroids. The most frequently isolated dermatophyte was Trichophyton mentagrophytes, which was isolated significantly more frequently in TF than in the other tineas. Cases of TF in children were not extremely unusual, emphasizing that TF must be considered in children with inflammatory facial eruptions. This consideration and the more-frequent use of mycologic tests can help achieve the correct diagnosis, when present.     

Recurrent epithelioid angiosarcoma of the scalp simulating melanoma. A 10-year follow-up

We present a case of an intriguing mesenchymal neoplasm of the scalp that recurred several times over 10 years before a final diagnosis was possible. The case was sent for expert opinions to various international dermatopathological authorities and was, for a long time, unanimously interpreted as malignant melanoma. This diagnosis was supported by immunohistochemical examinations demonstrating S-100 positivity. Nevertheless, the clinical behaviour, as well as some histopathological features raised doubt regarding the diagnosis. Only after the last recurrence, followed by a repeat extensive immunohistochemical study, the diagnosis of epithelioid angiosarcoma was made. Histologically malignant melanoma can be highly misleading and in literature, reports of misinterpreted cases of melanoma are published. In contrast, tumours that can simulate melanoma are also not infrequent and it is essential to perform immunohistochemistry to confirm diagnosis and exclude a melanocytic lesion.     

Two feet–one hand syndrome: a retrospective multicenter survey

Background The two feet-one hand syndrome is not uncommon; however, there have only been a few reports on this condition. This study was undertaken to obtain a better understanding of the epidemiology of the two feet-one hand syndrome. Methods A retrospective chart review was conducted of all the patients seen in our practices over the past 15 years with the diagnosis of two feet-one hand syndrome. Results A total of 80 patients with mycologically confirmed disease were identified (men, 72 (90%); women, 8 (10%); 77 (96%) Caucasian; 3 (4%) African-American; age (mean ± standard error (SE)), 55.9 ± 2.1 years). The mean age of the patients when the physician was first seen for the condition was 51.3 ± 2.0 years. The mean ages when the symptoms first developed on the feet and hand were 37.1 ± 2.4 years and 45.7 ± 2.2 years, respectively. Tinea pedis was found to occur at an earlier age than tinea manuum (t(65)=6.92, P<0.01). There was a significant relationship between the hand in which tinea manuum developed, the hand used to excoriate the soles of feet (Ch²(4)=14.82, P<0.01), and the hand used to pick toenails (χ²(4) = 14.82, P<0.01); however, there was no significant relationship between handedness and the development of tinea manuum in the dominant hand. The occupation of the patient at the time of development of the two feet-one hand syndrome was categorized according to whether the intensity of hand use was high, moderate, or low. Patients with a high intensity of hand use in their jobs were significantly more likely to develop tinea pedis/onychomycosis (r=-0.27, F(1,61)=4.77, P<0.05) and tinea manuum (r=-0.30, F(1,62)=6.31, P<0.05) at an earlier age. The best multiple predictors of the age at which medical attention was sought were the age of onset of tinea manuum and a family history of tinea infection (r=0.86, F(2,59)=86.9, P<0.01). The age of onset of tinea manuum was the best single predictor, with a correlation of 0.85. Conclusions In the two feet-one hand syndrome, the development of tinea pedis/onychomycosis generally preceded the development of tinea manuum. Tinea manuum usually developed in the hand used to excoriate the feet or pick toenails. Patients whose occupation involved a high intensity of use of the hands were more likely to develop the disease at an earlier age. Patients were more likely to seek attention once tinea manuum had developed, particularly if there was a family history of tinea infection.     

Sensitization to palladium chloride: a 10-year evaluation.

BACKGROUND: Palladium is increasingly used in industry, jewelry, and dentistry and is becoming more common since the European directive restricting the use of nickel in all products placed in direct and prolonged contact with the skin. OBJECTIVE: The role of palladium sensitization is still unclear, and the aim of our study is to evaluate the trend of sensitization in a contact dermatitis clinic population during a 10-year period. METHODS: We report our experience with 4,446 patients (3,077 female, 1,369 male; mean age, 40.1 +/-13.7 years) with suspected contact dermatitis patch-tested during the period of 1991 to 2000. RESULTS: A positive patch-test result to palladium chloride 1% was indicated in 236 patients (5.3%), with a higher percentage in females (6.7%) than in males (2.3%), and the sensitization to this metal has increased over the specified period, to a maximum in the year 2000 (9.7%). In the majority of cases, subjects were polysensitized (92.8%), but 7.2% of subjects were patch-test positive only to palladium. Of palladium-sensitized patients, 40.5% complained of hand dermatitis, 47.4% complained of body dermatitis, and 1.7% complained of burning mouth syndrome. Palladium sensitization is significantly related to female sex (OR = 3.08; 95% CI, 2.07-4.61) and to sensitization to other metals, with a maximum for nickel sulfate (OR = 32.9; 95% CI, 21.3-51.5). CONCLUSION: Sensitization to palladium is increasing by the year, reaching high values, but its role in reducing sensitization and symptoms is still unclear because of the frequent cosensitization with nickel and the low number of monosensitized patients with relevant sensitizations. We need to follow palladium sensitization in future years to verify an increase of sensitization due to the increasing use of this metal.     

Bullous pemphigoid in Liguria: A 2-year survey

BACKGROUND: The epidemiology of bullous pemphigoid (BP) is not clear because of the heterogeneity of the disease, and its possible association with internal malignancies has been under debate for many years. We report the findings of a 2-year study on incident BP cases in the Liguria region of Italy. SUBJECTS AND METHODS: Thirty-two patients with BP were collected over the 2-year period. Diagnosis was made based on clinical findings and confirmed by histology, direct immunofluorescence (DIF) and indirect immunofluorescence (IIF) with salt-split skin and monkey oesophagus, and immunoblotting (IB). All patients were thoroughly investigated for possible malignancies and all were followed up for 6 months to monitor the response to treatment. RESULTS: DIF showed linear deposits at the dermoepidermal junction in all but one patient. IIF gave positive findings for 15 sera tested with monkey oesophagus and 20 tested with salt-split skin. IB gave positive findings in 19 cases. There was a malignancy in six cases, but no clinical or immunological features that could be considered to predict this occurrence. CONCLUSIONS: The findings of this study are in accordance with most of the data found in the literature, including the fact that IgG serum levels did not predict the course of the disease. Contrary to previous indications, IgE levels were not indicative of disease course either. Mucosal lesions, erythema multiform-like lesions, negative IIF findings and antibodies to AgPB2 were not a prediction for the development of malignancy.     

Spectrum of autoimmune bullous diseases in Iran: a 10-year review

Background Autoimmune bullous diseases (ABDs) are potentially devastating bullous dermatoses of the skin and mucosae characterized by the presence of tissue‐bound and circulating antibodies directed against disease‐specific target antigens. These diseases comprise two major subgroups of subepidermal autoimmune bullous disorders and pemphigus, based on the level of blister formation. Although they occur worldwide, the relative frequencies of different ABDs show wide geographical variation. Most epidemiological studies on ABDs have focused on single diseases or a group of diseases; published surveys studying the whole spectrum of diseases are scarce. Objectives This study aimed to assess the relative frequencies of different ABDs in patients presenting to the Bullous Diseases Research Center, Tehran, Iran. Methods Medical files for all newly diagnosed patients with ABD presenting to the Center between March 1997 and February 2006 were examined. Patients with dermatitis herpetiformis were not included. Results A total of 1402 patients were diagnosed with ABD during the study period. Pemphigus vulgaris (PV) was the most common ABD (81.2%), followed by bullous pemphigoid (BP) (11.6%), pemphigus foliaceus (PF) (4.4%), pemphigoid gestationis (0.7%), mucous membrane pemphigoid (0.7%), epidermolysis bullosa acquisita (0.5%), linear immunoglobulin A (IgA) disease (0.4%), paraneoplastic pemphigus (0.2%), IgA pemphigus (0.2%), and pemphigus erythematosus (0.1%). The mean age at diagnosis and male : female ratio were 43.4 years and 1 : 1.39, 42.2 years and 1 : 1.34, and 59.4 years and 1 : 1.36 for PV, BP, and PF, respectively. Conclusions Pemphigus vulgaris was the most frequent ABD according to our study; cases of PV outnumbered those of BP by a ratio of almost 8 : 1. This finding contrasts with those of studies conducted in Western European countries, in which BP predominates. There was a female predominance in most subtypes of ABD. Mean age at onset of PV and BP was lower than in Europe. In view of its large population of PV patients, Iran should be considered a suitable field for future clinical trials.     

Accuracy in the clinical diagnosis of malignant melanoma

The computerized database (1955 through 1982) of the Oncology Section of the Skin and Cancer Unit of New York (NY) University Medical Center includes data on 13,878 lesions. Of these lesions, 214 were diagnosed clinically and histologically as malignant melanoma (MM). An additional 51 lesions, diagnosed clinically as other than MMs, were found histologically to be MM. Seventy-nine lesions were clinically diagnosed as MM but were found histologically to be other entities. An analysis of the clinical diagnostic accuracy showed some improvement over the three periods studied (1955 through 1963, 1964 through 1973, and 1974 through 1982). Although the diagnostic accuracy for the best period (1974 through 1982) was only 64%, the diagnosis of MM was made in 84.5% of the histologically proved cases of MM, reflecting a high degree of sensitivity.     

The aetiology of eyelid dermatitis: a 10-year retrospective analysis

Few studies have examined the aetiology of eyelid dermatitis across broad demographics. The objectives of this study were (i) to compare the diagnoses of patients with isolated eyelid dermatitis to the diagnoses of patients with additional sites of involvement and (ii) to determine the relevant allergens among patients with allergic eyelid dermatitis. A retrospective analysis of 1215 patients patch tested over 10 years was conducted in this study. Compared to patients without eyelid dermatitis, patients with this entity were more often female. Of the 105 patients with eyelid dermatitis, 43.8% had allergic contact dermatitis (ACD), 36.2% seborrhoeic dermatitis, 11.4% other dermatitis/dermatoses, 7.6% irritant contact dermatitis, 3.8% psoriasis, and 2.9% atopic eczema. With isolated eyelid dermatitis, seborrhoeic dermatitis was the most frequent diagnosis (46.3%) followed by ACD (35.2%). Allergens commonly causing allergic eyelid dermatitis consisted of fragrances, metals, neomycin, oleamidopropyl dimethylamine, tosylamide formaldehyde resin, benzalkonium chloride, and other preservatives. When evaluated according to sites of involvement, seborrhoeic dermatitis was diagnosed most often in patients with isolated eyelid dermatitis, but when dermatitis was distributed to facial or other sites, ACD was the most frequent diagnosis. A majority of the causative allergens for eyelid dermatitis are not present on the Food and Drug Administration-approved panels available in the USA.     

Clouston Syndrome: 25-year follow-up of a patient

Clouston syndrome is a rare genodermatosis that affects skin and annexes. Itis a form of ectodermal dysplasia characterized by generalizedhypotrichosis, palmoplantar hyperkeratosis and nail dystrophy. This paperreports a 25-year follow-up of a patient with Clouston syndrome, fromchildhood to adulthood, monitoring diagnosis and clinical course of thedisease.