Can specific vessel‐based papulopustular lesions of Behçet's disease be differentiated from nonspecific follicular‐based lesions clinically?

Background Although papulopustular lesions are one of the diagnostic criteria for Behçet's disease, controversy exists as to the nature of these lesions. Specific vessel‐based papulopustular lesions as well as nonspecific follicular lesions may be seen in patients with Behçet's disease. Some authors suggest that papulopustular lesions should be considered a positive criterion only if they exhibit a vessel‐based neutrophilic reaction. Objective To determine whether specific vessel‐based papulopustular lesions can be differentiated clinically from nonspecific follicular lesions in patients with Behçet's disease. Methods Twenty‐three papulopustular lesions in 20 patients with Behçet's disease were initially examined clinically by two dermatologists blind to each other's diagnosis. Biopsies taken from these lesions were examined by a pathologist unaware of the patient data. Results Leukocytoclastic vasculitis or perivascular infiltration was observed in 10 lesions, perifollicular and perivascular infiltration was noted in nine lesions, and perifollicular inflammation was seen in four biopsy specimens. Most of the lesions interpreted clinically as specific papulopustular lesions of Behçet's disease had predominantly perivascular infiltration or leukocytoclastic vasculitis; however, three papulopustular lesions evaluated by both observers as specific papulopustular lesions had only perifollicular inflammation, and one lesion diagnosed clinically as a nonspecific follicular eruption revealed perivascular neutrophilic reaction. Interobserver variance was noted in three papulopustular lesions. Conclusions Clinical examination may not be sufficient to predict the dermatopathologic pattern in all lesions. Papulopustular lesions with no specific clinical and histopathologic features may create problems in the diagnosis of Behçet's disease.     

Digital image analysis for diagnosis of cutaneous melanoma. Development of a highly effective computer algorithm based on analysis of 837 melanocytic lesions

BACKGROUND: Digital image analysis has been introduced into the diagnosis of skin lesions based on dermoscopic pictures. OBJECTIVES: To develop a computer algorithm for the diagnosis of melanocytic lesions and to compare its diagnostic accuracy with the results of established dermoscopic classification rules. METHODS: In the Department of Dermatology, University of Tuebingen, Germany, 837 melanocytic skin lesions were prospectively imaged by a dermoscopy video system in consecutive patients. Of these lesions, 269 were excised and examined by histopathology: 84 were classified as cutaneous melanomas and 185 as benign melanocytic naevi. The remaining 568 lesions were diagnosed by dermoscopy as benign. Digital image analysis was performed in all 837 benign and malignant melanocytic lesions using 64 different analytical parameters. RESULTS: For lesions imaged completely (diameter < or = 12 mm), three analytical parameters were found to distinguish clearly between benign and malignant lesions, while in incompletely imaged lesions six parameters enabled differentiation. Based on the respective parameters and logistic regression analysis, a diagnostic computer algorithm for melanocytic lesions was developed. Its diagnostic accuracy was 82% for completely imaged and 84% for partially imaged lesions. All 837 melanocytic lesions were classified by established dermoscopic algorithms and the diagnostic accuracy was found to be in the same range (ABCD rule 78%, Menzies' score 83%, seven-point checklist 88%, and seven features for melanoma 81%). CONCLUSIONS: A diagnostic algorithm for digital image analysis of melanocytic lesions can achieve the same range of diagnostic accuracy as the application of dermoscopic classification rules by experts. The present diagnostic algorithm, however, still requires a medical expert who is qualified to recognize cutaneous lesions as being of melanocytic origin.     

White lesions of the oral cavity

White lesions are frequently found during the examination of the oral cavity. Although some benign physiologic entities may present as white lesions, systemic conditions, infections, and malignancies may also present as white oral lesions. An appreciation of the many clinical entities that white lesions may represent is necessary if a differential diagnosis of white lesions is to be elucidated. The appreciation of subtle clinical findings associated with white lesions of the oral cavity permits clinicians to better care for their patients.     

5-氨基酮戊酸光动力在尖锐湿疣诊断中的应用

目的 探讨5-氨基酮戊酸光动力诊断（ALA-PDD）在人乳头瘤病毒（HPV）相关性疾病中应用及其临床意义。方法 将20% ALA乳膏应用于36例临床诊断为尖锐湿疣患者的皮损及其周围2 cm区域,2 h后进行荧光光动力诊断。同时对患者皮损、亚临床皮损、 皮损周围0.5 cm和2 cm处分别进行醋酸白试验、取材进行组织病理检查及基因芯片技术检测HPV DNA。结果 36例患者经组织病理确诊为尖锐湿疣者30例、鲍恩样丘疹病5例、脂溢性角化病1例（剔除病例）。30例尖锐湿疣和5例鲍恩样丘疹病患者皮损出现PpIX砖红色荧光;28例患者亚临床皮损也呈现砖红色荧光。17例皮损周围0.5 cm和5例2 cm处HPV潜伏感染部位也出现PpIX荧光。黏膜部位、炎症浸润和组织糜烂部位易产生非特异性荧光。结论 ALA-PDD对尖锐湿疣、鲍恩样丘疹病皮损和亚临床皮损诊断及HPV潜伏感染的定位诊断中有一定的应用价值,而黏膜部位、炎症浸润和组织糜烂部位不适宜进行荧光诊断。     

DISSEMINATED ROSACEA

SUMMARY.— Fourteen patients are described who, in the course of typical facial rosacea, developed papular lesions on the limbs similar in appearance to those on the face. In some cases the lesions were small and numerous; in others the individual lesions Mere large (up to 1 cm. in diameter) dark red or mauve and deeply set. The histology of these extra-facial lesions resembles that of the facial lesions as far as the inflammatory cellular infiltrate is concerned but there is a more prominent vascular component.
The relationship of these lesions to rosacea is discussed.     

Sensitivity and specificity of epiluminescence microscopy: evaluation on a sample of 2731 excised cutaneous pigmented lesions. The Melanoma Cooperative Study

To evaluate the role of epiluminescence microscopy (ELM) in the differential diagnosis of cutaneous pigmented lesions, and to improve the early diagnosis of cutaneous malignant melanoma (CMM), 15,719 pigmented lesions from 8782 consecutive patients were evaluated using ELM with a hand-held video microscope imaging system (MS 500B Micro-Scopeman, Moritex). Comparison between risk levels as inferred from ELM screening and histology was performed on 2731 surgically excised lesions. ELM sensitivity, specificity, positive and negative predictive values, as well as agreement with histological results for the different subgroups of lesions, were determined. Overall agreement was 87.3% (ranging from 85.1% to 92.2% for melanocytic and non-melanocytic lesions, respectively); sensitivity and specificity were high (values ranging from 87.3% to 96.3% among different subsets of ELM-analysed lesions) and statistically significant (P < 0.0001). ELM screening identified 165 new cases of CMM with a high proportion of lesions (115; 70%) in an early phase of tumour growth (Breslow thickness 相似文献   

早期梅毒皮损形成机制的研究

目的 探讨形成早期梅毒皮损的可能机制。方法 分别用常规病理、银染及免疫组化法检测30例早期梅毒皮损组织中的病理变化、梅毒螺旋体和Th1/Th2细胞因子的表达。结果 一期梅毒硬下疳和二期梅毒的结节、斑块、丘疹、脓疱等皮损中有典型的梅毒组织学结构和梅毒螺旋体,而斑疹损害中无典型的梅毒组织学结构和梅毒螺旋体。硬下疳中Th1型细胞因子表达占优势,二期梅毒患者的结节、斑块、丘疹、脓疱等皮损中Th1/Th2型细胞因子的表达视梅毒螺旋体感染时间长短而不同,Th2型细胞因子的表达主要见于感染时间较长的皮损,而斑疹中Th2型细胞因子表达与梅毒螺旋体的感染时间无关。结论 二期梅毒斑疹损害可能因机体的变态反应引起。     

The misdiagnosis of malignant melanoma

Despite the increasing awareness of malignant melanoma over the last 40 years, clinical diagnostic accuracy remains disappointing. Malignant melanoma can masquerade clinically as benign lesions (false negatives), and benign pigmented lesions can clinically simulate malignant melanoma (false positives). Histologic examination of pigmented lesions is therefore important to ensure proper diagnosis and treatment. We review many of the published reports of benign lesions mimicking melanoma and melanoma masquerading as other entities as well as present additional cases of clinical misdiagnoses of melanoma.     

Unilateral naevoid trichoepitheliomas on the face of a child

Trichoepitheliomas are benign epidermal appendage tumours that present most commonly as solitary lesions, and less often as multiple, symmetrically distributed lesions on the face, scalp, neck and trunk. Only a few patients have been reported in whom trichoepitheliomas were found as unusually configured linear or plaque-like confluent lesions, all of which occurred in patients with skin types V or VI. We describe a white girl with a hemifacial plaque of confluent naevoid trichoepitheliomas, the first report of such lesions in a white patient.     

768例黑素细胞痣及类似可疑损害切除活检的回顾性分析

目的：了解黑素细胞痣诊断准确性，病理特征，去除方法及复发等问题。方法：回顾分析我院1990年－2000年诊断或疑诊黑素细胞痣的768例活检病理资料，结果：诊断为黑素细胞痣447例，疑诊为黑素细胞痣296例，黑素细胞痣恶变待排25例，共有30例（3．91％）病理诊断为恶性肿瘤，其中恶性黑素瘤6例（0．78％），基底细胞癌22例（2．86％），Bowen病2例（0．26％），结论：黑素细胞痣的诊断应予重视，在有疑问时，手术切除并做病理检查十分必要。     

Sarcoidosis presenting with erythema multiforme-like cutaneous lesions

Sarcoidosis is a systemic disease that involves the skin in approximately 35 percent of cases. Typical cutaneous lesions are violaceous or hyperpigmented papules, plaques, or nodules. Less commonly, cutaneous lesions of sarcoidosis simulate the lesions of other cutaneous diseases such as psoriasis, ichthyosis, and erythroderma. We report on a patient who presented with cutaneous sarcoidal lesions resembling the target lesions of erythema multiforme (EM).     

Novel method of minimally invasive removal of large lipoma after laser lipolysis with 980 nm diode laser

Lipomas are the most common benign tumor of the soft tissue, often presenting as soft, mobile subcutaneous masses. These lesions are often removed for cosmetic reasons, although they may be removed secondary to considerable discomfort or paresthesias. The large majority of lipomas appear as small, solitary lesions that are best removed by surgical excision. However, surgical removal of large (>10 cm) or multiple lesions may result in significant scarring. Tumescent local anesthesia and liposuction of larger lesions has been successful in a number of cases although this technique can be hindered by overly fibrous lesions. Laser lipolysis, performed alone or before liposuction, can further facilitate removal of these lesions. This technique is a minimally invasive and effective method of lipoma removal, resulting in an excellent cosmetic outcome. This report describes step-by-step removal of a large lipoma located on the back, as well as a review of currently employed techniques for minimally invasive treatment of lipomas.     

Papular leukemids

Skin lesions occurring in patients with leukemia may represent specific leukemic infiltrates or may manifest as nonspecific lesions not related to leukemic cell infiltration. Included in the latter are a number of nonspecific papular and nodular lesions generally called "leukemids." We present two patients with lesions we have categorized as papular leukemids.     

Urticarial Vasculitis with Papular Lesions in a Patient with Type C Hepatitis and Cryoglobulinemia

We describe a case of urticarial vasculitis accompanied by erythematous wheals, palpable pupura, and subsequent necrotic ulcerated papular lesions in a patient with type C chronic hepatitis and type II cryoglobulinemia (IgM-kappa and polyclonal IgG). A 56-year-old man developed recurrent urticarial lesions on his lower extremities and trunk. The histology revealed leukocytoclastic vasculitis with perivascular immunoglobulin deposits. Subsequently, multiple reddish papular lesions with necrotic ulcerations appeared on the extensor aspect of his extremities and buttocks. Histology of these lesions showed cryoglobulinemic vasculitis with prominent fibrinoid necrosis of the vascular walls and cryoprecipitate within the vasculature as well as increased hyalinized collagen bundles. These papular lesions have not previously been described as cutaneous necrotizing venulitis to the best of our knowledge. It is suggested that the immune response to hepatitis C virus infection and cryoglobulins may be responsible for severe necrotizing venulitis, resulting in unusual cutaneous lesions.     

以脂膜炎为皮肤表现的皮肌炎九例研究

目的 探讨以脂膜炎为皮肤表现的皮肌炎的临床、病理特点.方法 收集2012年10月至2016年7月复旦大学附属中山医院皮肤科诊治的9例以脂膜炎为皮肤表现的皮肌炎患者的资料,分析其临床与病理特征.结果 9例中女6例,男3例,年龄28～73岁.9例患者脂膜炎皮损均表现为触痛性斑块或结节,分别发生在臀、股、腰、背、腹、上肢和腮部,先于、晚于或与皮肌炎特征性皮损和肌肉损害同时发生,其中1例脂膜炎先于皮肌炎特征性皮损30年发生.皮损组织病理示基底细胞液化变性,真皮血管周围及脂肪小叶和间隔内以淋巴细胞、浆细胞为主的炎性浸润,可有脂肪细胞坏死、钙化和膜囊性改变,血管壁纤维素样坏死和管腔闭塞.脂膜炎先于皮肌炎特征性皮损发生的2例患者曾被数次误诊为狼疮性脂膜炎和深部硬斑病.多数患者对联用糖皮质激素和免疫抑制剂的治疗反应良好,但伴脂肪膜性坏死者,对治疗反应差.结论 皮肌炎的脂膜炎表现具有一定组织学特征,与皮肌炎典型皮损的发生可不同步,在皮肌炎典型损害前出现易被误诊,持续跟踪随访对确诊具有重要意义.     

Psoriasis guttate acuta triggered by varicella zoster virus infection

A 23-year-old man had small desquamative erythematous lesions, round or oval in shape, spread over his entire body, and diagnosed as psoriasis guttate acuta because of clinical and pathological findings. Three weeks before the lesions had started, he was diagnosed as having varicella by his family physician. The psoriatic lesions appeared at the same sites where previously lesions of varicella had appeared. Therefore, VZV infection was regarded as a trigger in this case. We speculate that genetic factors and the change of skin condition are basically involved in the pathogenesis of psoriasis guttate. In addition, one more factor as a trigger is needed to cause the lesions of psoriasis. VZV infection might change the skin condition and induce subsequent immunological disregulation.     

以非水疱为初发皮疹的大疱性类天疱疮34例

目的 探讨以非水疱为初发皮疹的大疱性类天疱疮患者的临床表现、实验室检查和治疗特点。方法 回顾性分析34例以非水疱为初发皮疹的大疱性类天疱疮患者的临床资料。 结果 34例患者中男女之比1.83 ∶ 1，始发年龄平均为（59.79 ± 15.63）岁。在出现典型的水疱之前，表现为红斑、丘疹、丘疱疹、斑块、风团、结节、多形红斑样皮疹等多形性表现，以同时出现红斑、丘疹/斑块（占35.29%）为多见。结论 在所分析的病例中，近1/3大疱性类天疱疮患者初发表现为多形性，以同时出现红斑、丘疹/斑块多见。     

Cutaneous vasculitis in the LE patient

Specific cutaneous findings in systemic lupus erythematosus (SLE)—chronic cutaneous or discoid lesions, subacute lupus lesions (psoriasiform or annular polycyclic), and acute lesions such as the malar “butterfly” rash¹—have been dealt with elsewhere. Nonspecific findings of LE, such as alopecia and mucous membrane ulcers, will not be discussed. Instead, this chapter will focus mainly on the cutaneous manifestations of the nonspecific finding of vasculitis, emphasizing new data regarding urticaria-like vasculitic lesions in lupus erythematosus.The cutaneous manifestations of vasculitis are varied, ranging from small purpuric lesions in the nail bed and tips of fingers, to large areas of infarction with subsequent ulceration. In addition, palpable purpuric lesions, bullous formation, erythema multiforme-like, and urticaria-like lesions are cutaneous manifestations of vasculitis that have been reported in patients with systemic lupus erythematosus. In general, vasculitic lesions occur in lupus patients with severe disease.²     

Psoriasis with oral manifestations

A forty-seven year old woman had skin and oral lesions of three year's duration. The skin lesions were clinically and microscopically diagnosed as psoriasis. Oral examination revealed extensive involvement of the entire mucosa with white, elevated, circinate lesions. Biopsies of oral mucosa were interpreted as histologically similar to the characteristic dermal findings in psoriasis. Anesthetic mouth rinses afforded symptomatic relief; however, although there was definite improvement, the oral lesions have persisted.