Preliminary results of DERMATEL: prospective randomized study comparing synchronous and asynchronous modalities of teledermatology

IntroductionThere is considerable variability in the results of studies that evaluate diagnostic reliability in teledermatology. There are only two studies that compare the synchronous and asynchronous modalities of teleconsult in the same sample. We present the results of the pilot project DERMATEL, a study of diagnostic concordance that aims to increase the evidence of these aspects.Material and methodsOne-hundred-fifty.nine patients referred by the general practitioner in the first consult were randomized (algorithm 3:2:1) in three arms: asyncronous teledermatology (store-and-forward or SAF), synchronous teldermatology (real-time or VTC), and conventional consult (CC). We used high-quality, fixed digital images in all cases. The patients on the VTC teledermatology arm were also evaluated by videoconference. Finally all patients attended a face-to-face consult, considered the gold standard of patient care. A second dermatologist evaluated the diagnostic and management concordance between the teleconsults and the face-to-face consults.ResultsOne-hundred.forty-seven patients completed the study as follows: 74 in the SAF teledermatology arm, 47 in the VTC teledermatology arm and 26 in the conventional consult (control group). The teledermatological (SAF and VTC) and face-to-face evaluations were identical in 100 of 121 patients (82.6 %). The errors were mild in 14 cases (11.6 %) and severe in 7 (5,8 %). The diagnostic concordance was very high (kappa = 0,813). The errors grouped by diseases were as follows: 6/54 (11 %) for tumors, 10/30 (33.3 %) for inflammatory conditions, 1/20 (5 %) for infectious diseases, 3/12 (25 %) for alopecia/acne and 1/5 (20 %) for others. There were 15 errors in the SAF teledermatology arm (20.3 %) and 6 in the VTC teledermatology arm (12.8 %); these differences were not statistically significant (χ² 1.12; p = 0.288).ConclusionThe reliability of dermatological teleconsult is very high, especially for tumoral or infectious diseases. The synchronous interaction with audio requires more resources, is difficult to coordinate and its diagnostic efficacy is not superior to SAF teledermatology.     

Teledermatología. Capacidad para reducir consultas presenciales según el grupo de enfermedad

IntroductionTeledermatology was initially considered useful and cost-effective, especially when distances to the reference hospital were significant. It is currently gaining importance as a more specific tool that can evaluate the need for a rapid referral or to decrease medical costs. The aim of this study was to assess the capacity of teledermatology for resolving cases in different groups of disease.Material and methodsTeleconsultations received in our Department of Dermatology between May 2011 and April 2014 were evaluated according to the virtual diagnosis, the indication given by the dermatologist who evaluated the teleconsultation (discharge/referral), reasons for attending to hospital, reasons for more than one virtual consultation, final face-to-face diagnosis, and diagnostic agreement between the virtual and face-to-face diagnoses.ResultsAn assessment was made on 1163 virtual consultations. Inflammatory diseases were the most frequent diagnosis group (45%). A total of 50.82% of virtual consultations were discharged. The highest resolution rate was achieved by the infectious diseases group, followed by inflammatory diseases (78.4% and 62.8%, respectively). Malignant lesions were referred in nearly all cases (96.7%). The main reason for a referral was the need for diagnostic confirmation or complementary studies (59.8% of all cases). A total of 102 patients received more than one teleconsultation, principally due to incomplete clinical data or poor-quality images. The agreement rate between virtual and face-to-face diagnosis was 88.95%.ConclusionTeledermatology avoids around 50% of the primary care referrals. The highest resolution rate is achieved in the infectious diseases group, followed by the inflammatory diseases group and, secondly, by benign tumours and benign melanocytic lesions.     

Differentiation of Benign Pigmented Skin Lesions with the Aid of Computer Image Analysis: A Novel Approach

Background

The differential diagnosis of common pigmented skin lesions is important in cosmetic dermatology. The computer aided image analysis would be a potent ancillary diagnostic tool when patients are hesitant to undergo a skin biopsy.

Objective

We investigated the numerical parameters discriminating each pigmented skin lesion from another with statistical significance.

Methods

For each of the five magnified digital images containing clinically diagnosed nevus, lentigo and seborrheic keratosis, a total of 23 parameters describing the morphological, color, texture and topological features were calculated with the aid of a self-developed image analysis software. A novel concept of concentricity was proposed, which represents how closely the color segmentation resembles a concentric circle.

Results

Morphologically, seborrheic keratosis was bigger and spikier than nevus and lentigo. The color histogram revealed that nevus was the darkest and had the widest variation in tone. In the aspect of texture, the surface of the nevus showed the highest contrast and correlation. Finally, the color segmented pattern of the nevus and lentigo was far more concentric than that of seborrheic keratosis.

Conclusion

We found that the subtle distinctions between nevus, lentigo and seborrheic keratosis, which are likely to be unrecognized by ocular inspection, are well emphasized and detected with the aid of software.     

Minor cutaneous ambulatory surgery and cryotherapy. Comparative study between a dermatologist and family physicians

IntroductionLack of diagnostic skill in cutaneous surgery may lead to erroneous and potentially detrimental therapies. This study compares the diagnosis and treatment in cutaneous surgery, including cryotherapy, between a dermatologist and family physicians.MethodsIt is an observational, prospective study on a random sample of patients that consulted the dermatologist for candidate lesions. Each lesion was independently evaluated by a dermatologist and a family physician, both of whom assigned the clinical diagnosis and therapeutic advice. Concordance for diagnosis, recommended treatment and indication for cryotherapy was calculated by Cohen's kappa coefficient.ResultsSix hundred forty-six lesions were evaluated. Global kappa indexes were 0.69 (95 % CI, 0.65-0.73) for diagnostic concordance, 0.62 (95% CI, 0.56-0.67) for recommended treatment and 0.73 (95 % CI, 0.67-0.78) for indication of cryotherapy. Diagnostic concordance was significantly better for melanocytic nevus, achrocordon and for lesions with multiple and monomorphous presentation, and worse for isolated pigmented lesions. For recommended treatment concordance was better for multiple and monomorphous lesions and worse for skin cancer and seborrheic keratosis. For indication of cryotherapy concordance was worse for skin cancer, melanocytic nevus, acrochordon and seborrheic keratosis. Family physicians made an erroneous indication for cryotherapy in 5.88 % of cases, including 3 non melanoma skin cancers.ConclusionsConcordance between dermatologists and family physicians for minor cutaneous surgery is generally good. Family physicians should be more careful in evaluating solitary pigmented lesions and patients at risk for skin cancer.     

Contribution to characterization of skin field cancerization activity: morphometric,chromatin texture,proliferation, and apoptosis aspects

BackgroundA skin field cancerization is a cutaneous area with subclinical changes resultant from chronic sun exposure, with a higher predisposition to development of pre-neoplastic and neoplastic lesions. So far, there are no well-defined objective parameters that can indicate their degree of activity.ObjectivesTo describe and compare morphometric aspects and expression of factors related to apoptosis and cell proliferation in actinic keratosis (AK), in both photoexposed and photoprotected epidermis.MethodsA cross-sectional study of patients with actinic keratosis in the forearms, biopsied at two points: the actinic keratosis and the axillary region. The biopsies of the actinic keratosis, perilesional area, and axilla were evaluated through keratinocyte intraepithelial neoplasia (KIN), and immunohistochemistry of p53, survivin, and Ki67. Nuclear morphometry of basal layer cells was performed through digital image analysis: entropy, area, perimeter, Ra, fractal dimension, circularity, color intensity, and largest diameter.ResultsThere were 13 patients included and 38 actinic keratosis biopsied. In morphometry, 1039 nuclei were analyzed, of which 228 represented axillary skin, 396 demonstrated actinic keratosis, and 415 represented the perilesional area to the actinic keratosis. There was a significant difference (p < 0.05) in all variables tested for the topographies evaluated. A significant correlation was identified between nucellar morphometric elements, KIN, proliferation markers, and apoptosis. Joint patterns of p53, Ki67, and KIN discriminated the topographies sampled.Study limitationsThis was a cross-sectional study with a small number of patients.ConclusionsThere are patterns of proliferation, resistance to apoptosis, and different cellular morphometrics between photoprotected skin and photoexposed skin. The joint expression of p53, Ki67, and KIN can characterize skin field cancerization activity.     

Estudio retrospectivo de los datos demográficos,los motivos de derivación y los datos diagnósticos de las primeras visitas llevadas a cabo en las consultas de Dermatología del Complejo Hospitalario de Navarra durante el año 2018

IntroductionThere are not many long term studies on most frequent conditions attended at dermatology consults. This article’s objective is to analyze referrals and diagnostics made at Dermatology Service in Navarra’s Hospital Complex during 2018.MethodologyA retrospective analysis of first visits attended at our dermatology department during 2018 has been made, evaluating the following items: sex, age, patient’s origin, referral code for primary care and diagnosis code of the dermatology department (International Classification of Diseases – ICD).ResultsReferral rate to our department during 2018 was 45.5 face-to-face consultation/1,000 population, with a face-to-face/teleconsultation rate 12:1. Most common diagnosis (ICD) was melanocytic nevus (15%), followed by seborrheic keratosis (12%) and actinic keratosis (9%). Forty seven per cent of diagnosis made in face-to –face consultation was benign and malignant neoplasms.ConclusionsDespite its limitations, coding is an essential activity in order to better understand the attended population, its real needs and optimization of resource allocation. We believe it is very important to invest in clinical and dermoscopic diagnosis of pigmented lesions in primary care in order to improve referral to specialist consults. Nowadays, with the available information we have, we cannot propose to screen or to prioritize referrals based on the analysis of the referral code for primary care.     

Differences in the Known Cellular Composition of Benign Pigmented Skin Lesions Reflected in Computer-Aided Image Analysis

Background

Computer-aided image analysis (CAIA) has been suggested as an effective diagnostic tool for pigmented skin lesions (PSLs), especially melanoma. However, few studies on benign PSLs have been reported.

Objective

The purpose of this study was to evaluate benign PSLs with our CAIA software and analyze the differences between the parameters of those lesions.

Methods

By using homegrown CAIA software, we analyzed 3 kinds of PSLs-nevus, lentigo, and seborrheic keratosis. The group of seborrheic keratosis was divided into pigmented seborrheic keratosis, sebolentigine, and hyperkeratotic seborrheic keratosis. The CAIA was used to extract the color, as well as the morphological, textural, and topological features from each image.

Results

In line with clinical observations, the objective parameters indicated that nevus was dark and round, lentigo was small and bright, and seborrheic keratosis was large and spiky. The surface of nevus showed the highest contrast and correlation. In topological analysis, the concentricity clearly separated melanocytic lesions from seborrheic keratosis. The parameters of pigmented seborrheic keratosis were between those of typical nevus and seborrheic keratosis.

Conclusion

We confirmed that definite correlations exist between the subjective differentiation by experts'' examination and the objective evaluation by using CAIA. We also found that the morphological differences observed in CAIA were greatly influenced by the composition ratios of keratinocytes and melanocytes, which are already known histopathological characteristics of each PSL.     

Case-based experience in the use of 5-fluorouracil cream 0.5% as monotherapy and in conjunction with glycolic acid peels for the treatment of actinic keratosis

Abstract

Actinic keratosis, commonly indicative of photodamage, requires treatment secondary to the risk of progression to squamous cell carcinoma. A number of effective treatments for actinic keratosis are available, including topical and lesion-directed therapies. While lesion-directed therapies such as cryotherapy are appropriate for isolated lesions, topical 5-fluorouracil is an effective modality for the treatment of multiple facial actinic keratoses. 5-Fluorouracil, available in a number of formulations, offers patients the benefit of treating subclinical lesions and may help to improve the overall appearance of the skin. In many cases, combination therapy is a better treatment option than monotherapy. The cases presented here demonstrate the use of topical 5-fluorouracil cream 0.5% as monotherapy and in conjunction with glycolic acid peels to treat facial actinic keratoses in two patients with extensive histories of prior actinic keratosis and skin cancer.     

Research on sexually transmitted infections in asymptomatic heterosexual males whose partners have cervical intraepithelial neoplasia

IntroductionHuman papillomaviruses (HPV) are the etiological agents of genital warts and of cervical intraepithelial neoplasia (CIN), and they are sexually transmitted. The aim of this study is to determine the prevalence of sexually transmitted infections (STI) in asymptomatic heterosexual males who consult their physicians seeking advice after their partners have been diagnosed with CIN.Methods181 asymptomatic males whose partners were women diagnosed with CIN were studied at the STI unit in Gijón over a five-year period (1999-2003). The same diagnostic protocol was used in all cases: clinical exam, genitoscopy and the taking of samples for bacterial, fungus and Trichomonas cultures, as well as samples for the genomic detection of Chlamydia, and syphilis, HIV and viral hepatitis serology.Results101 infections were diagnosed in 85 patients (47 %). By order of greatest prevalence, these were: urethritis from Ureaplasma urealyticum (35/181; 19.3 %), genital warts (31/181; 17.1%), Haemophilus spp. (12 de 181; 6.6%) and mycotic balanoposthitis (10/181; 5.5 %).ConclusionsThe prevalence of STI in the partners of women with CIN is high, and in these cases it is necessary to establish STI detection and control programs in both members of the couple.     

Clinical and Histopathological Investigation of Seborrheic Keratosis

BackgroundSeborrheic keratosis (SK) is one of the most common epidermal tumors of the skin. However, only a few large-scale clinicohistopathological investigations have been conducted on SK or on the possible correlation between histopathological SK subtype and location.ObjectiveThe aim of this study was to analyze the clinical and histopathological features of a relatively large number of cases of diagnosed SK.MethodsTwo hundred and seventy-one pathology slides of skin tissue from patients with clinically diagnosed SK and 206 cases of biopsy-proven SK were analyzed. The biopsy-proven cases of SK were assessed for histopathological subclassification. The demographic, clinical, and histopathological data of the patients were collected for analysis of associated factors.ResultsThe most frequent histopathological subtype was the acanthotic type, followed by mixed, hyperkeratotic, melanoacanthoma, clonal, irritated, and adenoid types; an unexpectedly high percentage (9.2%) of the melanoacanthoma variant was observed. The adenoid type was more common in sun-exposed sites than in sun-protected sites (p=0.028). Premalignant and malignant entities together represented almost one-quarter (24.2%) of the clinicopathological mismatch cases (i.e., mismatch between the clinical and histopathological diagnoses). Regarding the location of SK development, the frequency of mismatch for the sun-exposed areas was significantly higher than that for sun-protected areas (p=0.043).ConclusionThe adenoid type was more common in sun-exposed sites. Biopsy sampling should be performed for lesions situated in sun-exposed areas to exclude other premalignant or malignant diseases.     

Dermoscopy of pigmented seborrheic keratosis: a morphological study

OBJECTIVES: To describe morphological features of seborrheic keratosis as seen by dermoscopy and to investigate their prevalence. DESIGN: Prospective cohort study using macrophotography and dermoscopy for the documentation of seborrheic keratosis. SETTINGS: Seborrheic keratoses were prospectively collected in 2 sites: a private practice in Plantation, Fla (site 1), and the Department of Dermatology at the University Hospital Geneva in Switzerland (site 2). PATIENTS: A total of 203 pigmented seborrheic keratoses (from 192 patients) with complete documentation were collected (111 from site 1 and 93 from site 2). INTERVENTIONS: Screening for new morphological features of seborrheic keratosis and evaluation of all lesions for the prevalence of these criteria. MAIN OUTCOME MEASURES: Identification of new morphological criteria and evaluation of frequency. RESULTS: A total of 15 morphological dermoscopic criteria were identified. Standard criteria such as milialike cysts and comedolike openings were found in a high number of cases (135 and 144, respectively). We found network and networklike structures to be present in 94 lesions (46%). Using standard diagnostic criteria for seborrheic keratosis, 30 lesions would not have been diagnosed as such. CONCLUSIONS: The classic dermoscopic criteria for seborrheic keratosis (milialike cysts and comedolike openings) have a high prevalence but the use of additional dermoscopic criteria such as fissures, hairpin blood vessels, sharp demarcation, and moth-eaten borders improves the diagnostic accuracy. The proper identification of pigment network and networklike structures is important for the correct diagnosis.     

Motivos dermatológicos de consulta en atención primaria. Análisis de la demanda derivada

IntroductionSkin conditions are among the main reasons for seeking primary health care. Primary care physicians (PCPs) must diagnose skin conditions and determine their impact, and must therefore incorporate the relevant knowledge and skills into their education. The present study analyzes the reasons for primary care referral to dermatology (referral demand) as well as diagnostic agreement between PCPs and dermatologists informed by pathology where appropriate.Material and methodsData were collected for 755 patients and 882 initial dermatology appointments from February 1, 2012 through April 30, 2012 following primary care referral. Data obtained included age, sex, occupation, reason for referral, primary care diagnosis, and dermatologic diagnosis. Statistical analysis of the data for each diagnosed condition identified frequency, reasons for referral, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the κ statistic for diagnostic agreement.ResultsThe most common diagnoses were seborrheic keratosis, melanocytic nevus, actinic keratosis, and acne. The main reason for referral was diagnostic assessment (52.5%). For skin tumors, sensitivity of primary care diagnosis was 22.4%, specificity 94.7%, PPV 40.7%, and NPV 88.3%, with a κ of 0.211. For the more common diagnoses, primary care sensitivity was generally low and specificity high.ConclusionsAccording to our results, primary care physicians are better qualified to rule out a given skin condition in a patient (high specificity) than to establish an accurate clinical diagnosis (poor sensitivity). This suggests that knowledge and skills training should be organized for primary care physicians to improve management of skin conditions—especially skin cancer, because of its impact. A more responsive system would ensue, with shorter waiting lists and better health care.     

Clinical Features of Cutaneous Premalignant Lesions in Busan City and the Eastern Gyeongnam Province,Korea: A Retrospective Review of 1,292 Cases over 19 Years (1995~2013)

BackgroundThe global prevalence of premalignant lesions has been continuously increasing in recent years, but there has been little research regarding the distribution and incidence of cutaneous premalignant lesions in Korean populations.ObjectiveWe conducted this retrospective study to analyze recent trends in the incidence and clinical patterns of cutaneous premalignant lesions in the Korean population.MethodsWe reviewed 1,292 cases (3,651 lesions) of patients with cutaneous premalignant lesions, including actinic keratosis (AK) and Bowen''s disease (BD), from the Department of Dermatology at Dong-A University Hospital (January 1995 to December 2013).ResultsThe average cutaneous premalignant lesion annual incidence was 1.82%, and the incidence continuously increased from 0.70% to 4.25% over the study period. The most common cutaneous premalignant lesion was AK (75.85%), followed by BD (24.15%). The mean age of onset was 68.76 years (men, 70.89 years; women, 65.56 years), and the male:female ratio of patients was 1:1.52. Major skin cancers, including squamous cell carcinoma (SCC, 8.90%), basal cell carcinoma (BCC, 6.42%), and malignant melanoma (MM, 0.70%), were detected in 15.79% of patients with cutaneous premalignant lesions. Three patients (0.23%) were previously diagnosed with both SCC and BCC. In addition, 59.13% of patients had a single lesion, while 40.87% had multiple lesions. Patient age, history of previous skin cancers, and occupation-related exposure to ultraviolet radiation were more common in patients with multiple lesions.ConclusionCutaneous premalignant lesion incidence has gradually increased in the Korean population.     

Validation of an algorithm based on clinical,histopathological and immunohistochemical data for the diagnosis of early-stage mycosis fungoides

BackgroundDiagnosis of mycosis fungoides is challenging due to the non-specificity of clinical and histopathological findings. The literature indicates an average delay of 4–6 years for a conclusive diagnosis. Refinement of the histopathological criteria for the diagnosis of patients in early stages of the disease is considered of interest.ObjectivesTo study the histopathological aspects of early-stage mycosis fungoides and the applicability, in a retrospective form, of the diagnostic algorithm proposed by Pimpinelli et al.MethodsObservational, retrospective, transversal study based on revision of histopathological exams of patients with suspected mycosis fungoides. Medical records were reviewed, and complementary immunohistochemistry performed.ResultsSixty-seven patients were included. The most frequent histopathological features were superficial perivascular lymphoid infiltrate (71.6%), epidermotropism (68.7%), lymphocytic atypia (63.8%), hyperkeratosis (62.7%) and acanthosis (62.7%). Forty-three patients scored 4 points at the algorithm, by clinical and histological evaluation. Immunohistochemistry was performed on 23 of the 24 patients with less than 4 points. Of those 23, 22 scored 1 point, allowing a total of 61 patients (91%) with the diagnosis of early-stage mycosis fungoides.Study limitationsIts retrospective character, reduced sample size and incomplete application of the algorithm.ConclusionsApplication of the Pimpinelli et al. algorithm, even in an incomplete form, increased the percentage of cases diagnosed as mycosis fungoides. Routine application of the algorithm may contribute to earlier and specific management and improvement of the patients’ outcome.     

Diagnostic accuracy of dermoscopy for 934 basal cell carcinomas: A single-center retrospective study

Although the efficacy of dermoscopic diagnosis of basal cell carcinoma (BCC) has already been established, most studies have been conducted in Western countries. However, there are racial differences in the clinicopathological characteristics of BCC, highlighting the need for a survey among Asians. Herein, we aimed to investigate the diagnostic accuracy of dermoscopy in 934 Japanese patients with BCC and statistically analyze the clinicopathological factors affecting diagnostic accuracy. We analyzed 5093 skin lesions, including 934 BCCs that were diagnosed consecutively from 1998 to 2018. The sensitivity and specificity of dermoscopic diagnosis for BCC were calculated. The sensitivity and specificity of dermoscopic diagnosis were 92.2% and 96.0%, respectively. There were 73 false-negative cases of BCCs that were clinically diagnosed with other diseases. The most common incorrect clinical diagnosis was seborrheic keratosis (n = 18), followed by melanocytic nevus (n = 15). Multiple logistic regression analysis showed that sensitivity was significantly lower in BCCs located on the trunk and extremities, which showed low pigmentation (less than 10% of the lesion surface) and were diagnosed by a resident dermatologist. Experience of 3–6 months of 12 resident dermatologists revealed increased sensitivity. Dermoscopy is a reliable tool for the accurate diagnosis of BCC in Japanese individuals. Care should be taken when diagnosing BCCs of the trunk and extremities, and the less-pigmented subtype because of lower sensitivity. A certain amount of experience is required to improve the skills for dermoscopy.     

Sclerodermiform basal cell carcinoma: how much can we rely on dermatoscopy to differentiate from non-aggressive basal cell carcinomas? Analysis of 1256 cases

Background:The behaviour of each basal cell carcinoma is known to be different according to the histological growth pattern. Among these aggressive lesions, sclerodermiform basal cell carcinomas are the most common type. This is a challenging-to-treat lesion due to its deep tissue invasion, rapid growth, risk of metastasis and overall poor prognosis if not diagnosed in early stages.ObjectiveTo investigate if sclerodermiform basal cell carcinomas are diagnosed later compared to non-sclerodermiform basal cell carcinoma Method: All lesions excised from 2000 to 2010 were included. A pathologist classified the lesions in two cohorts: one with specimens of non-aggressive basal cell carcinoma (superficial, nodular and pigmented), and other with sclerodermiform basal cell carcinoma. For each lesion, we collected patient’s information from digital medical records regarding: gender, age when first attending the clinic and the tumor location.Results:1256 lesions were included, out of which 296 (23.6%) corresponded to sclerodermiform basal cell carcinoma, whereas 960 (76.4%) were non-aggressive subtypes of basal cell carcinoma. The age of diagnosis was: 72.78±12.31 years for sclerodermiform basal cell and 69.26±13.87 years for non-aggressive basal cell carcinoma (P<.0001). Sclerodermiform basal cell carcinomas are diagnosed on average 3.52 years later than non-aggressive basal cell carcinomas. Sclerodermiform basal cell carcinomas were diagnosed 3.40 years and 2.34 years later than non-aggressive basal cell carcinomas in younger and older patients respectively (P=.002 and P=.03, respectively).Study Limitations:retrospective design.Conclusion:The diagnostic accuracy and primary clinic conjecture of sclerodermiform basal cell carcinomas is quite low compared to other forms of basal cell carcinoma such as nodular, superficial and pigmented. The dermoscopic vascular patterns, which is the basis for the diagnosis of non-melanocytic nonpigmented skin tumors, may not be particularly useful in identifying sclerodermiform basal cell carcinomas in early stages. As a distinct entity, sclerodermiform basal cell carcinomas show a lack of early diagnosis compared to less-aggressive subtypes of BCC, and thus, more accurate diagnostic tools apart from dermatoscopy are required to reach the goal of early-stage diagnosis of sclerodermiform basal cell carcinomas.     

High expression level of homocitrulline is correlated with seborrheic keratosis and skin aging

BackgroudHomocitrulline (Hcit), is involved in the pathological processes of some diseases. However, the role and function of Hcit (CBL) in human skin remains largely obscure.ObjectiveTo investigate the correlation of the level of Hcit in seborrheic keratosis, skin aging, and its clinical significance.MethodsImmunohistochemistry was used to analyze the level of Hcit in skin lesions of seborrheic keratosis (SK), unaffected skin (distant 0.5 centimeters from SK lesion), and normal skin of healthy subjects in the control group. ELISA test was used to detect the serum level of CBL in SK patients and healthy subjects of different ages.ResultsHcit was mainly localized in the nucleus of epidermal cells. In healthy control skin, the expression of Hcit increased with age and showed a positive correlation with age (the correlation coefficient was 0.806, p = 0.0002). The expressional level of Hcit in SK lesions was higher than that in healthy control skin (Z = −3.703, p = 0.0002). The serum level of CBL in healthy subjects and in SK patients increased with age (the correlation coefficient were 0.5763, p = 0.0032; 0.682, p = 0.004. respectively). The serum level of CBL in SK patients was higher than that in healthy subjects (Z = −2.19, p = 0.030).Study limitationsThe small serum sample size in the study.ConclusionThe high expressional level of Hcit is correlated with seborrheic keratosis and skin aging. HCit may be one of the potential biomarkers of skin aging.     

Predictive Model for Differential Diagnosis of Inflammatory Papular Dermatoses of the Face

BackgroundThe clinical features of inflammatory papular dermatoses of the face are very similar. Their clinical manifestations have been described on the basis of a small number of case reports and are not specific.ObjectiveThis study aimed to use computer-aided image analysis (CAIA) to compare the clinical features and parameters of inflammatory papular dermatoses of the face and to develop a formalized diagnostic algorithm based on the significant findings.MethodsThe study included clinicopathologically confirmed inflammatory papular dermatoses of the face: 8 cases of eosinophilic pustular folliculitis (EPF), 13 of granulomatous periorificial dermatitis-lupus miliaris disseminatus faciei (GPD-LMDF) complex, 41 of granulomatous rosacea-papulopustular rosacea complex (GR-PPR) complex, and 4 of folliculitis. Clinical features were evaluated, and area density of papular lesions was quantitatively measured with CAIA. Based on these variables, we developed a predictive model for differential diagnosis using classification and regression tree analysis.Results The EPF group showed lesion asymmetry and annular clusters of papules in all cases. The GPD-LMDF complex group had significantly higher periocular density. The GR-PPR complex group showed a higher area density of unilateral cheek papules and the highest total area density. According to the predictive model, 3 variables were used for differential diagnosis of the 4 disease groups, and each group was diagnosed with a predicted probability of 67%~100%.ConclusionWe statistically confirmed the distinct clinical features of inflammatory papular dermatoses of the face and proposed a diagnostic algorithm for clinical diagnosis.     

Seguimiento digitalizado combinado en población con alto riesgo de desarrollar un melanoma maligno: análisis retrospectivo de 152 pacientes

BackgroundDigital dermoscopy (DD) has been found to improve the accuracy of melanoma diagnosis in high-risk patients. A 2-step approach combining DD and total-body photography (TBP) can facilitate the detection of new lesions or early macroscopic changes in existing lesions.ObjectivesThe aim of this study was to determine the number of biopsies needed to diagnose melanoma and to describe the clinical and dermoscopic characteristics of melanoma diagnosed in patients with pigmented lesions under follow-up with DD and TBP.Patients and methodsRetrospective study of 152 patients with a high risk of melanoma who were followed using a 2-step digital approach at Hospital del Mar in Barcelona, Spain, between 2002 and 2016. We analyzed the characteristics of pigmented lesions excised after macroscopic changes were detected by periodic DD and TBD.ResultsBiopsy results of 99 lesions (84 dysplastic nevi, 13 melanomas, and 2 compound melanocytic nevi) showed a ratio of benign melanocytic lesions to melanomas of 1:6.6. The mean Breslow thickness was 0.19 mm. Macroscopic changes were significantly more common in melanomas than in melanocytic nevi (P = 0.018). Dermoscopic findings associated with melanoma were asymmetric growth and focal structural changes (P < 0.001). The specific features associated with a diagnosis of melanoma were asymmetry (P < 0.001), a reverse pigment network (P = 0.011), atypical globules (P = 0.011), and polymorphous vessels (P = 0.045).ConclusionsTBP follow-up is a useful tool for the early diagnosis of melanoma. In our series, 50% of melanomas diagnosed during digital follow-up were detected by observation of a new lesion via TBP mapping or macroscopic changes in an existing lesion. Dermoscopic follow-up is essential in patients at high risk for melanoma as both melanocytic nevi and melanoma show a range of specific dermoscopic features, and a diagnosis of melanoma can only be based on a record of changes in the appearance of lesions during follow-up.