Dermatoscopy in the diagnosis of pigmented skin lesions: a new semiology for the dermatologist.

Dermatoscopy or epiluminescence microscopy (ELM), is a noninvasive method that enables clinicians to evaluate fully--by means of a magnified oil immersion diascopy--numerous morphological features, not visible with the naked eye, which enhance the diagnosis of nearly all pigmented skin lesions. In recent years, a burst of research activity in this topic has been carried out, dealing with different aspects, and new frontiers, of this technique. First, a continuous refinement of dermatoscopic terminology is undertaken, paying particular attention to the diagnostic performance of dermatoscopy at peculiar anatomical sites and to the building of different dermatoscopic algorithms aimed at a simplified diagnosis of melanoma, even for less experienced observers. Another point of interest concerns the possible role of dermatoscopy in the pre-operative assessment of melanoma thickness. Finally, promising data about the role of digital equipment in the follow up of melanocytic skin lesions as well as in the automated diagnosis of pigmented skin lesions have been recently reported. This paper should enable readers to become familiar with the procedure and terminology of ELM in the diagnosis of pigmented skin lesions encouraging a greater understanding of different methods (pattern analysis, algorithms) in the diagnosis of melanoma using ELM.     

The gold standard for photographing pigmented skin lesions for diagnostic purposes: contact versus distant imaging

Background: It is mandatory that a new diagnostic method be validated by comparison with a well-established reference procedure before being introduced for use in clinical practice. In the field of pigmented skin lesions (PSL), clinical examination should be considered the reference procedure for new diagnostic methods, such as dermoscopy. However, it has not yet been established which is the best photographic procedure for obtaining the most informative clinical images to be used in a formal diagnostic setting.
Methods: In this study we investigated the diagnostic information provided by the two most popular methods currently used for clinical photographing of PSL: 'contact' images obtained with a Dermaphot (Heine Ltd) at original × 10 magnification without oil application and 'distant' images obtained with a macro objective from a distance of 10 cm.
Results: Two experienced dermatologists observed clinical images of a series of 57 PSL (11 melanomas, 31 melanocytic nevi, 10 pigmented basal cell carcinomas, and four other diagnoses). The degree of concordance between the diagnoses based on 'contact' and 'distant' images (melanoma/non-melanoma) was very good (k = 0.819). Regarding histology, the degree of concordance was better when the diagnosis was based on 'contact' images (k = 0.54) than 'distant' images (k = 0.47). In particular, 'contact' images were superior to 'distant' images for diagnosis of non-melanoma lesions (specificity of melanoma diagnosis 87.7% vs. 83.6%), but we found no difference in melanoma detection (73% of sensitivity for both methods).
Conclusions: Although the two photographic procedures appear to provide similar levels of diagnostic information, the 'contact' method seems to provide a higher specificity for melanoma diagnosis.     

Surface microscopy of pigmented skin tumours

In vivo cutaneous surface microscopy, epiluminescence microscopy, dermatoscopy and dermoscopy are terms that all describe the same process of examination of cutaneous lesions with an incident light magnification system with oil at the skin-microscope interface. Increased investigation in surface microscopy has occurred in the last decade, primarily because of the introduction of inexpensive hand-held instruments. Research has focused particularly on morphological definitions, diagnostic models and image analysis systems. In this paper, these issues are discussed, and the relevant controversies highlighted.     

Dermoscopy of skin lesions in two patients with xeroderma pigmentosum

BACKGROUND: Xeroderma pigmentosum (XP) is a rare disorder produced by a genetic defect in the repair of DNA damage caused by ultraviolet radiation. The early diagnosis of malignant skin tumours is crucial in the survival of patients with XP, but this is not easy even for experienced dermatologists due to the presence of a high number of actinic lesions. Dermoscopy is a new diagnostic method that increases the diagnostic accuracy for skin tumours. OBJECTIVES: To describe the clinical and dermoscopic features of different benign and malignant lesions [focusing on malignant melanoma, basal cell carcinoma (BCC) and benign melanocytic naevi] in two patients with XP. METHODS: Three dermatologists with experience in pigmented skin lesions and dermoscopy examined two siblings with XP over a period of 54 months. Diagnosis of skin tumours was obtained using clinical examination and dermoscopy with 10-fold magnification and digital images. All the tumours with criteria of malignancy were excised for further histopathological analyses. RESULTS: Multiple skin tumours showing some degree of pigmentation were detected in the patients. Clinical and dermoscopic examination allowed the discrimination of four melanomas (three of them in situ), 26 BCCs and five dysplastic naevi from other pigmented skin lesions. The features and parameters previously described for dermoscopy were shown to be appropriate for the recognition of tumours in our patients with XP. Generalized actinic lentigos were distinguished from BCCs by the presence of a delicate brown pigmented network. Fine vessels from poikiloderma were differentiated from the arborizing telangiectasia of BCC. CONCLUSIONS: The dermoscopic findings in the tumours were similar to those previously described in patients not affected by XP. Diagnosis by dermoscopic pattern analyses allowed a correct classification of malignant tumours in these cases.     

The ''common mole'' from the point of view of digital dermoscopy analysis: subjective vs. objective evaluation of easy pigmented skin lesions

BACKGROUND: The term 'common mole', often used to describe a subset of benign pigmented skin lesions, is traditionally defined on the basis of morpho-chromatic features. In recent years, certain research groups have developed equipment and methods, such as digital dermoscopy analysis, that enable objective evaluation of pigmented skin lesions. OBJECTIVE: In this study we use a digital dermoscopy analyser trained for the recognition of pigmented skin lesions to compare the subjective definition of 'common' and the mathematical concept of 'close to the mean of measurements'. METHODS: A subset (100) of digital images of flat pigmented lesions, obtained in daily practice, were classified by trained and non-expert clinicians as common moles (60) or clear-cut melanoma (40), and processed with a DB-Mips analyser. The resulting parameters, validated by a classifier, were used to evaluate Hotelling's T2 multivariate distances from the mean. RESULTS: 'Common' moles could not be clearly defined in terms of closeness to the means of objectively evaluated parameters. Their diagnosis indudes many other evaluations and clusters of variables. CONCLUSION: The clinical semantics of the term 'common' does not conform to any unambiguous mathematical definition.     

Inter‐ and intra‐variability of pigmented skin lesions: could the ABCD rule be influenced by host characteristics?

BACKGROUND/PURPOSE: Many differences in color, shape and dimension exist between different moles even in the same individual. Major differences might be accounted for anatomical location, genetic factors and by environmental factors, mainly sunlight exposure. Therefore, it would be of great value, when evaluating skin lesions, to take into account the degree of intra- and inter-variability of several diagnostic parameters. In order to assess the morphologic and chromatic differences between lesions belonging to different patients and between lesions belonging to the same individual, we examined objective digital parameters obtained with dermatoscopic analysis, using the DBDermo MIPS system (BIO MIPS Engineering, S.R.L, siena, Italy). METHODS: The automatic classifier inside the software is based on a 'match by similarity' algorithm, based on the measurement of the Euclidean distances of all variables considered from the reference image. Two-hundred and four clinically benign pigmented lesion, belonging to 18 patients were examined, stored and automatically processed. For each lesion objective parameters related to geometry, color and texture were automatically evaluated. RESULTS: We found skin color (healthy skin) is objectively different from subject to subject and the lesion color is more similar among different lesions of the same patient than among lesions belonging to different individuals both in their darkest and slightly dark component. We also observed that lesion dimensions are individual correlates, i.e. the probability for a lesion to be large is higher when the other, in the same patient, is large. CONCLUSION: Many parameters of pigmented skin lesions evaluated by digital dermoscopy analysis are similar in the same patient and different from those belonging to different individuals. This indicates that, when considering a lesion, we should take into account the peculiar patient's characteristics.     

Clinically equivocal melanocytic skin lesions with features of regression: a dermoscopic-pathological study

BACKGROUND: Benign melanocytic skin lesions may be difficult to differentiate from melanoma both clinically and dermoscopically. One of the most confounding dermoscopic features, commonly seen in melanoma but in our experience also in melanocytic naevi, is represented by the so-called blue-white structures (BWS). OBJECTIVES: To evaluate diagnostic significance and histopathological correlates of BWS seen by dermoscopy in a series of clinically equivocal melanocytic skin lesions that were excised. METHODS: Patients were recruited from six specialized pigmented lesion clinics in Austria, Italy and Spain over a period of 9 months. All consecutive patients showing one or more melanocytic lesions with BWS, but not classified as melanoma dermoscopically, were included. Each lesion was photographed clinically and dermoscopically. All images were reviewed by one of us and the degree, type and location of BWS evaluated for each lesion. A panel of four experienced dermatopathologists independently reviewed all specimens for diagnosis and one of them evaluated presence and degree of melanosis and/or fibrosis. The main outcome measures were the percentage and histopathological correlates of lesions with different degree, type and location of BWS. RESULTS: All included lesions with BWS (n = 158) showed partial or focal regression histopathologically. One hundred and thirty-five (85.4%) lesions were diagnosed as melanocytic naevi (complete histopathological interobserver agreement), whereas 23 (14.6%) were defined as equivocal because at least one of four pathologists diagnosed the given lesion as melanoma. Only one lesion was diagnosed as melanoma by all four pathologists. The majority of naevi exhibited blue areas (84.4%) with a central distribution (57%) and involving < 50% of the lesion surface (89.6%). By contrast, 78.3% of equivocal lesions revealed a combination of white and blue areas with an irregular distribution (60.9%) and involving > 50% of the lesion surface (47.8%). CONCLUSIONS: Using degree and type of BWS, an algorithm was constructed that can be applied for the management of lesions exhibiting dermoscopic features of regression.     

Dermatoscopic pitfalls in differentiating pigmented Spitz naevi from cutaneous melanomas

Epiluminescence microscopy (ELM, skin surface microscopy, dermoscopy, dermatoscopy) is a valuable method for improving the diagnostic accuracy in pigmented skin lesions. Specific ELM criteria are already recognized for differentiating pigmented Spitz naevi (PSN) from cutaneous melanomas (CM). Our purpose was to describe the ELM appearance of a series of PSN with emphasis on PSN and CM with overlapping features. Thirty-six consecutive patients with PSN, and three cases of CM (selected from a larger database) exhibiting ELM 'spitzoid' features, were evaluated clinically, dermatoscopically and histopathologically. Most PSN (27 of 36; 75%) displayed two typical ELM patterns, namely, the starburst (19 of 36; 53%) or the globular pattern (eight of 36; 22%), which were correlated to different histopathological findings. In nine of 36 (25%) PSN, atypical ELM features which are more commonly seen in CM were observed. These PSN with an atypical pattern were characterized by an uneven distribution of colours and structures, and an irregular diffuse pigmentation resembling blue-white veil or irregular extensions (black blotches). These atypical lesions mostly occurred in children and showed no history of growth. In contrast, in three examples of CM, the typical ELM criteria of malignancy were less recognizable and either the characteristic starburst or globular pattern usually seen in PSN was present. These three lesions occurred in adults and had a recent history of change in colour, shape or size. The overlap in ELM features of some PSN and CM represents a major diagnostic pitfall when ELM examination is considered alone. In these atypical cases, clinical history including the age of the patient may be the only clue to enable a correct diagnosis.     

Analysis of the network pattern in dermatoscopic images

Procedures have been developed for automated analysis of the pigment network in dermatoscopic images. These procedures perform complete network segmentation as well as measurement of the width of network lines and the size and shape of network holes.

Methods:

The procedures were applied to images of 16 common nevi, 22 dysplastic nevi, and 31 melanomas.

Results/Conclusions:

There were highly significant differences among the three groups on the measured parameters, and a linear discriminant function composed of mean line width and mean hole area distinguished nevi and melanomas with 80% accuracy.     

The impact of dermoscopy on the management of pigmented lesions in everyday clinical practice of general dermatologists: a prospective study

Background Dermoscopy greatly improves the clinical diagnosis of pigmented lesions. Few studies have investigated, however, how dermoscopy is guiding management decisions in everyday clinical practice. In addition, most studies have been performed in the setting of dermoscopy experts working in pigmented lesion clinics. Objectives To assess the impact of dermoscopy on clinical diagnosis and management decisions for pigmented lesions in everyday practice of general dermatologists. Methods We performed a prospective study in general dermatology clinics in community hospitals run by dermatologists with intermediate dermoscopy experience and expertise. Each clinician independently included suspicious lesions from consecutive patients. Pre‐ and postdermoscopy diagnoses and management decisions were recorded. Pathology was used as reference diagnosis. Results In total, 209 suspicious lesions were included in the study by 17 dermatologists. Fourteen lesions were histologically proven in situ or invasive malignant melanomas. Based on clinical diagnoses, dermoscopy improved sensitivity from 0·79 to 0·86 (P = 1·0). All 14 melanomas were intended to be excised based on naked eye examination alone, independent of dermoscopic evaluation. Specificity increased from 0·96 to 0·98 (P = 0·22). Dermoscopy resulted in a 9% reduction of the number of excisions. Conclusions Dermoscopy reduced the number of excisions, but did not improve the detection of melanomas. Our results suggest that in everyday clinical practice of general dermatologists the main contribution of dermoscopy is a reduction of unnecessary excisions.     

Digital dermoscopy analysis of atypical pigmented skin lesions: a stepwise logistic discriminant analysis approach

Background: Digital microscopy is a non-invasive diagnostic technique enabling determination of characteristics that cannot be appreciated by direct observation. If correctly applied, this technique can be useful for the diagnosis of pigmented skin lesions.
Purpose: To evaluate the utility of digital microscopy for analysing atypical benign and malignant pigmented skin lesions exploiting digital numerical filtering and automatic measurements.
Methods: Forty-eight parameters were identified as possible discriminating variables, and were grouped in four categories: geometries, colours, textures, and islands of colour. Statistical analysis was used to identify the variables with the highest discriminating power.
Results: The high quality of the digital image made it possible to observe diagnostic signs in pigmented skin lesion images, acquired by the present technique, in great detail. Specially designed filtering enhanced certain diagnostic patterns. Stepwise discriminant analysis selected only 10 variables (the means of these variables were higher in melanomas than in nevi).
Conclusions: The combined use of digital dermoscopy and stepwise logistic discriminant analysis made it possible to single out the best objective variables for distinguishing atypical nevi and early melanoma.     

Amelanotic/hypomelanotic melanoma: clinical and dermoscopic features

BACKGROUND: Amelanotic malignant melanoma is a subtype of cutaneous melanoma with little or no pigment on visual inspection. It may mimic benign and malignant variants of both melanocytic and nonmelanocytic lesions. OBJECTIVES: To evaluate whether dermoscopy is also a useful technique for the diagnosis of amelanotic/hypomelanotic melanoma (AHM). METHODS: We conducted a retrospective clinical study of 151 amelanotic/hypomelanotic skin lesions from 151 patients with a mean age of 47 years (+/- 17.5 SD). Digitized images of amelanotic/hypomelanotic skin lesions were converted to JPEG format and sent by e-mail from the five participating centres. Lesions included 55 amelanotic/hypomelanotic nonmelanocytic lesions (AHNML), 52 amelanotic/hypomelanotic benign melanocytic lesions (AHBML), and 44 AHM, 10 (23%) of which were nonpigmented, truly amelanotic melanomas (AM). The 44 AHM lesions were divided into thin melanomas (TnM) 1 mm (15 cases), according to the Breslow index. Five clinical features (elevation, ulceration, shape, borders and colour) as well as 10 dermoscopic criteria (pigment network, pigmentation, streaks, dots/globules, blue-whitish veil, regression structures, hypopigmentation, leaf-like areas, multiple grey-bluish globules, central white patch) and eight vascular patterns (comma, arborizing, hairpin, dotted, linear irregular, dotted and linear irregular vessels, and milky-red areas) were evaluated in order to achieve clinical and dermoscopic diagnoses. Statistical analyses were performed with the chi2-test and Fisher's exact test, when appropriate. RESULTS: The most frequent and significant clinical features for TnM and TkM were asymmetry and ulceration (the latter only for TkM) compared with AHBML. Irregular dots/globules (62% vs. 35%; P 相似文献   

Age-related prevalence of dermoscopy patterns in acquired melanocytic naevi

BACKGROUND: Based on the dermoscopic classification of acquired melanocytic naevi, six different dermoscopic types can be distinguished by morphology (globular, globular-reticular, globular-homogeneous, reticular, reticular-homogeneous, homogeneous) and by pigment distribution (uniform, central hyperpigmentation, central hypopigmentation, peripheral hyperpigmentation, peripheral hypopigmentation, multifocal hyper/hypopigmentation). It has been suggested that most individuals harbour one predominant dermoscopic type among their naevi. OBJECTIVES: To evaluate whether the age of the patient influences the predominant naevus pattern observed in individuals with multiple acquired melanocytic naevi. METHODS: Individuals were recruited from the pigmented skin lesion clinic in Graz between July 2000 and February 2001. Individuals with at least 10 melanocytic naevi were selected consecutively until a total of 10 individuals in each of five age groups was obtained. Age groups were: 0-15 years, 16-30 years, 31-45 years, 46-60 years and > 60 years. Digitized images of acquired melanocytic naevi, defined as benign melanocytic proliferations having a diameter of at least 5 mm with a macular component and which were not apparent within the first year of life, were evaluated by dermoscopic criteria. The associations of dermoscopic features as a function of patient age were analysed. We calculated absolute numbers and frequencies, given as percentages, as well as predominance of the dermoscopic types of naevi in the different age groups. RESULTS: Analysis of 1268 naevi revealed that the globular pattern predominated in the youngest age group. By contrast, the reticular and/or homogeneous patterns were increasingly exhibited in naevi from older individuals (older than 15 years). Uniform pigmentation was most common in melanocytic naevi in the youngest age group, while central hyperpigmentation was predominantly seen in the group of individuals aged 16-30 years. CONCLUSIONS: The predominance of dermoscopic types of melanocytic naevi varies according to the individual's age. Awareness of the age-related dermoscopic predominance of melanocytic naevi might allow more accurate recognition of dermoscopic patterns of melanocytic skin lesions that are unusual with respect to the individual's age. This observation may help in the early recognition of some 'banal'-appearing melanomas. Furthermore, the observations made in this study raise interesting questions regarding naevus evolution.     

The role of pattern analysis and the ABCD rule of dermoscopy in the detection of histological atypia in melanocytic naevi

BACKGROUND: Clinical features of melanocytic naevi correlate poorly with the presence, histopathologically, of architectural disorder and cytological atypia, making the detection of histological atypia by means of macroscopic appearance unreliable. OBJECTIVES: The aim of this study was to investigate the diagnostic effectiveness of dermoscopy in the non-invasive detection of histological atypia in naevi. METHODS: Observers blinded for histological diagnosis classified a series of 168 melanocytic naevi as common or atypical on the basis of their clinical features and on their dermoscopic profile. The diagnostic performance of both methods compared with the true (histopathological) diagnosis was assessed. RESULTS: Dermoscopy using pattern analysis showed better results than clinical examination in the non-invasive detection of naevi with architectural disorder with or without cytological atypia (diagnostic accuracy 45% vs. 28%). A statistically significant difference in the frequency of dermoscopic parameters between atypical and common naevi was found for atypical pigment network (39% vs. 17%, P = 0.001) and dermoscopic regression structures (13% vs. 2%, P = 0.008). Dermoscopic features, which best predicted histological atypia in naevi, were regression structures (white scar-like areas or peppering), irregular vascular pattern and grey-blue areas (positive predictive values 83%, 83% and 73%, respectively). In contrast, no statistically significant difference in the mean values of the ABCD score between common and atypical naevi was found. The best diagnostic performance of dermoscopy by means of the ABCD rule (cut-off point of 4.0 of total dermoscopy score) was not dissimilar to that of clinical diagnosis (diagnostic accuracy 30%). CONCLUSIONS: Dermoscopy by means of pattern analysis enhances the diagnostic accuracy of dermatologists in the prediction of histological atypia in melanocytic naevi as compared with clinical examination alone.     

Clinical selection of melanocytic lesions for dermoscopy decreases the identification of suspicious lesions in comparison with dermoscopy without clinical preselection

BACKGROUND: In most cases dermoscopy is performed only on lesions selected by clinical inspection which present worrying clinical features or appear to deviate from the patient's average type of naevus. Thus, possible early malignant melanomas (MMs) or MM precursors, lacking typical clinical characteristics, may elude the dermoscopic examination. OBJECTIVES: To perform a comparison between two different approaches to the patient's examination, one based on a clinical preselection of lesions to be examined by dermoscopy, and the other consisting of the dermoscopic scrutiny of all melanocytic lesions with a diameter>or=2 mm (total dermoscopy). METHODS: Sixty-three consecutive patients with MM, undergoing periodic dermoscopic examinations of their naevi, were enrolled in the study. The patients first underwent an assessment of the entire skin with the unaided eye for the identification of lesions for dermoscopy. Subsequently, the patients underwent dermoscopic examination of all melanocytic lesions. Images of naevi identified by clinical examination or by total dermoscopy as having dermoscopic aspects characteristic of a suspicious lesion, i.e. necessitating either surgical excision or follow-up examinations, were separately recorded, classified and described employing the ABCD rule of dermoscopy and the seven-point checklist. RESULTS: Five hundred and fifty-one lesions were chosen by clinical inspection for subsequent dermoscopic examination; among these, 117 were considered for excision or follow-up. Ninety-two further lesions were identified for excision or follow-up by employing only total dermoscopy. Dermoscopy scores of lesions selected by clinical inspection plus dermoscopy were similar to those identified by dermoscopy alone. In the former group, 13 lesions showed either an ABCD or a seven-point score corresponding to a suspicious lesion, whereas eight such lesions were identified only by total dermoscopy. Thus, by clinical selection plus dermoscopy we were able to identify only 62% of dermoscopically suspicious lesions. CONCLUSIONS: Clinical selection of melanocytic lesions for dermoscopic examination is associated with the 'loss' of a conspicuous number of lesions which deserve surgical excision or follow-up examinations. Total dermoscopy, enabling the detection of suspicious lesions, together with storage, retrieval and sequential comparison of their images, could enhance MM diagnosis by follow-up, in comparison with clinical preselection for dermoscopy.     

Diagnosis of pigmented skin lesions by dermoscopy: web-based training improves diagnostic performance of non-experts

BACKGROUND: Dermoscopy has been shown to enhance the diagnosis of melanoma. However, use of dermoscopy requires training and expertise to be effective. OBJECTIVES: To determine whether an Internet-based course is a suitable tool in teaching dermoscopy, and to evaluate the diagnostic value of pattern analysis and diagnostic algorithms in colleagues not yet familiar with this technique. METHODS: Sixteen colleagues who were not experts in dermoscopy were asked to evaluate the dermoscopic images of 20 pigmented skin lesions using different diagnostic methods (i.e. pattern analysis, ABCD rule, seven-point checklist and Menzies' method), before and after an Internet-based training course on dermoscopy. Mean +/- SEM sensitivity, specificity and diagnostic accuracy, and kappa (kappa) intraobserver agreement were evaluated for each diagnostic method before and after training for the 16 participants. Differences between mean values were assessed by means of two-tailed Wilcoxon rank-sum tests. RESULTS: There was a considerable improvement in the dermoscopic melanoma diagnosis after the Web-based training vs. before. Improvements in sensitivity and diagnostic accuracy were significant for the ABCD rule and Menzies' method. Improvements in sensitivity were also significant for pattern analysis, whereas the sensitivity values were high for the seven-point checklist in evaluations both before and after training. No significant difference was found for specificity before and after training for any method. There was a significant improvement in the kappa intraobserver agreement after training for pattern analysis and the ABCD rule. For the seven-point checklist and Menzies' method there was already good agreement before training, with no significant improvement after training. CONCLUSIONS: We demonstrated that Web-based training is an effective tool for teaching dermoscopy.     

Predictors of skin self-examination in subjects attending a pigmented lesion clinic in Italy

BACKGROUND: Skin self-examination (SSE) is associated with thinner melanomas in both North American and Italian patients. The knowledge of conditions associated with SSE may help in refining educational strategies for the prevention of melanoma. OBJECTIVE: The aim of the study was to investigate the frequency of SSE and the factors associated with SSE in subjects followed at a specialized pigmented lesion clinic (PLC) in Italy. PATIENTS/METHODS: A series of 299 consecutive subjects who visited the Florence PLC was investigated by means of a self-administered questionnaire regarding SSE habits. The statistical association between SSE and selected variables was examined by univariate and multivariate analyses. RESULTS: In the univariate analysis, variables significantly associated with SSE were: green/blue eyes, phototype I/II, the presence of large numbers of common acquired and atypical melanocytic naevi, sunscreen use, having had a previous PLC examination, and having received a leaflet explaining SSE. SSE was less frequent in women using sunbeds and more frequent in those performing breast self-examination. Using the multivariate model, which included all the variables associated with SSE in the previous analysis, we found that, among males, the only variable significantly associated with SSE was the report of having received a leaflet explaining SSE [odds ratio (OR) 3.02, 95% confidence interval (CI) 1.24-7.38]. Among females, having had a previous consultation at a PLC was significantly associated with SSE (OR 4.84, 95%CI 1.57-14.93); this might be because of the explanation and advice about skin cancer prevention customarily provided as a part of the PLC consultation at our department. CONCLUSION: Educational tools, including a leaflet explaining SSE and counselling given within previous PLC visits, seem to play a crucial role in promoting SSE habits in subjects followed at a specialized PLC consultation.     

Melanocytic skin lesions and pregnancy: digital dermoscopy analysis

BACKGROUND: Very few studies have tried to clarify how pregnancy influences the morphology of pigmented skin lesions (PSL). Our purpose was to objectively determine, by digital dermoscopy analysis (DDA), any dermoscopic changes of acquired melanocitic nevi during pregnancy and after 1 year from delivery. METHODS: Thirty-five healthy pregnant women and 35 age-matched female controls were enrolled in the study. Nevi of pregnant women were analysed by DDA between 5 and 8 weeks of pregnancy, between 39 and 41 weeks of pregnancy and 12 months after delivery. Nevi of control women were analysed by DDA in a month of the year matching the period of recruitment of pregnant women and 21 months later. RESULTS: Multivariate analysis of variance (manova) for repeated measures revealed that dermoscopic variables SKIN-GREEN-AVERAGE, SKIN-BLUE-AVERAGE and CONTRAST changed during pregnancy but returned to non-significant values after a year from delivery. The variable ENTROPY showed significant differences between initial evaluation and 1 year after delivery. Finally, the variable VARIANCE OF BORDER GRADIENT showed a significant difference between the first and the last evaluations, in both pregnant and control subjects. CONCLUSIONS: The study showed that pregnancy leads to significant modifications in PSL, especially with regard to pigment network, globules and architectural order or disorder.