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

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

Comedo-like openings in melanoma

We describe a case of melanoma with the presence of comedo-like openings atdermoscopy. These structures, typical of seborrheic keratosis, represent an uncommonfinding in melanoma. We emphasize the importance of searching for specificdermoscopic criteria for melanocytic lesions during the examination of a pigmentedlesion, despite possible observations of characteristic structures of non-melanocyticlesions, in order to increase the accuracy in the diagnosis of melanoma.     

Approximate lesion localization in dermoscopy images

Background: Dermoscopy is one of the major imaging modalities used in the diagnosis of melanoma and other pigmented skin lesions. Because of the difficulty and subjectivity of human interpretation, automated analysis of dermoscopy images has become an important research area. Border detection is often the first step in this analysis.
Methods: In this article, we present an approximate lesion localization method that serves as a preprocessing step for detecting borders in dermoscopy images. In this method, first the black frame around the image is removed using an iterative algorithm. The approximate location of the lesion is then determined using an ensemble of thresholding algorithms.
Results: The method is tested on a set of 428 dermoscopy images. The localization error is quantified by a metric that uses dermatologist-determined borders as the ground truth.
Conclusion: The results demonstrate that the method presented here achieves both fast and accurate localization of lesions in dermoscopy images.     

皮肤镜对面部光线性角化病的鉴别诊断价值评估

目的 探讨皮肤镜在面部光线性角化病鉴别诊断中的应用价值.方法 从北京大学第三医院皮肤镜数据库选取经病理确诊的面部光线性角化病皮损作为病例组,同时选取临床曾疑诊光线性角化病,但病理证实为其他疾病的面部皮损作为对照组,比较两组间各皮肤镜特征的差异,以病理为金标准,用诊断试验方法评价皮肤镜诊断面部光线性角化病的价值.结果 病例组43个皮损,对照组22个皮损.病例组中基底假网状红斑(38/43,88.37％)、毛囊口周围白晕(39/43,90.70％)、毛囊口黄色角栓(41/43,95.35％)、表面黄白色鳞屑或角化物团块(42/43,97.67％)、玫瑰花瓣征(26/43,60.47％)、毛囊口周围粗大的不规则线状血管(19/43,44.19％)、毛囊口周围细小、线状-波浪状血管(29/43,67.44％)及周边色素加深(14/43,32.56％)的出现频率显著高于对照组(均P＜0.05).在这8个皮肤镜特征中,毛囊口周围白晕、基底假网状红斑、毛囊口黄色角栓及玫瑰花瓣征单独诊断面部光线性角化病的约登指数最高,分别为0.54、0.52、0.50和0.38,表面黄白色鳞屑或角化物团块灵敏度最高(97.67％),周边色素加深特异度最高(95.45％).基底假网状红斑、毛囊口黄色角栓及毛囊口周围白晕3个特征联合诊断价值最高,其灵敏度、特异度、阳性预测值、阴性预测值分别为90.70％、81.82％、90.70％、81.82％,约登指数为0.73,与病理诊断的符合率为80.00％.结论 面部光线性角化病具有较特异的皮肤镜表现,基底假网状红斑、毛囊口周围白晕、毛囊口黄色角栓3个皮肤镜特征联合诊断价值最高.     

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

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

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

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

Progressive symmetrical erythrokeratodermia - Case report

Progressive symmetrical erythrokeratodermia is a rare autosomal dominant genodermatosis with variable penetrance described by Darier in 1911. It is characterized by erythematous and keratotic plaques, sharply defined and symmetrically distributed along the extremities, buttocks and, more rarely, on the face. We report a case of a 55-year-old patient with lesions on the dorsum of the hands, interphalangeal pads, wrists, groin and back feet. This case demonstrates a rare and late diagnosis, clinical profusion and presence of familiar involvement.     

中国皮肤恶性黑素瘤皮肤镜特征专家共识

【摘要】 皮肤恶性黑素瘤（MM）是来源于黑素细胞的恶性肿瘤,恶性程度高,进展快,预后差,早期发现可极大提高生存率。皮肤镜作为一种无创检查手段,可提高早期诊断准确率,减少漏诊和误诊,避免盲目活检。本共识总结了不同类型MM的皮肤镜主要表现,并简要概述需要鉴别诊断的疾病,旨在为MM的早期无创诊断提供依据。     

The use of digital dermoscopy in the surveillance of melanocytic skin lesions: A real-life retrospective study comparing university hospital and private practices

BackgroundFew studies have evaluated the role of digital dermoscopy (DD) in the surveillance of pigmented lesions in real-life practice.Patients and methodsPatients followed with DD by 4 hospital dermatologists (group 1) and 4 private dermatologists (group 2) were retrospectively included if they had had at least 2 DD examinations for a minimum of 4 pigmented lesions. Their characteristics, risk factors, history of excision of benign nevi and melanomas prior to and during the DD follow-up, and characteristics of detected melanomas, were recorded.ResultsOne hundred and ninety-six patients were included in group 1 and 205 in groups 2. A family history of melanoma (25% vs. 12%, p < 0.01), a personal history of melanoma before DD follow-up (47% vs. 15%, p < 0.01), and a family (3% vs. 0%, p = 0.01) and personal (8% vs. 1%, p < 0.01) germline CDKN2a mutation were more frequent in group 1 than in group 2. In both groups, the number of excisions of benign lesions was higher before DD follow-up (380 and 347, respectively) than during DD follow-up (194 and 132). During follow-up, 29 melanomas were detected in group 1, with a median Breslow thickness of 0.4 mm, versus 1.3 mm for melanomas diagnosed before DD follow-up (p < 0.02). In group 2, 4 melanoma and 5 superficial atypical melanocytic proliferations of unknown significance were detected. The median Breslow thickness of newly diagnosed melanomas was 0.35 mm vs. 0.6 mm before DD follow-up (p = 0.1).ConclusionIn both populations in real-life practice, DD seemed to allow the detection of thin melanomas and to decrease the rate of “futile” resections.     

microRNA在人皮肤黑素瘤与色素痣中共同差异表达的研究

目的 筛选人皮肤黑素瘤组织中表达的已知hsa-microRNA。方法 采用SBC microRNA芯片技术,将6例人皮肤黑素瘤组织总RNA分别与9例健康人色素痣总RNA混合物对比,筛选已知的468条hsa-microRNA表达情况。用qPCR分别检测这6例人皮肤黑素瘤组织中各候选hsa-microRNA的表达。将芯片和qPCR两种方法检测结果一致的候选hsa-microRNA确定为有意义的共同差异表达hsa-microRNA。结果 2倍以上差异表达miRNA占所检测miRNA的12.18% ～ 86.33%,5倍以上差异表达miRNA占1.28% ～ 19.02%,10倍以上差异表达miRNA占0.43% ～ 5.34%。 此6例人皮肤黑素瘤中miRNA-21 明显上调表达,miRNA-320和miRNA-494明显下调表达。结论 人皮肤黑素瘤组织中miRNA-21明显上调表达,miRNA-320和miRNA-494明显下调表达。     

Tungiasis under dermoscopy: in vivo and ex vivo examination of the cutaneous infestation due to Tunga penetrans

The female flea Tunga penetrans is responsible for a cutaneous parasitosis known as Tungiasis. We report the clinical case of a 12 year-old Caucasian boy who sought treatment in a dermatological private office due to a painful lesion in the plantar area and whose dermoscopic examination, without skin contact, allowed the visualization of parasite''s movement inside the skin. The diagnosis of tungiasis is clinical, but it can be aided by in vivo and ex vivo dermoscopic examination of the lesion.     

In vivo and ex vivo dermoscopy of lesions from implantation of human papillomavirus in tattoos: report of two cases

The number of individuals with tattoos has been increasing worldwide, alongside with reports of complications varying from reactions to the injected pigments to infections caused by agents inoculated in the pigmentation process. The diagnosis of such unwanted events can be obtained through complementary non-invasive methods, preserving the maximum of the tattoo design. The authors present two cases of patients with warts on tattooing, and correlate their clinical aspects to in vivo and ex vivo dermoscopy, and to the findings in the histopathological examination, aiming to determine patterns that aid the diagnosis of these lesions without performing biopsy.     

Simultaneous occurrence of multiple melanoma in situ on sundamaged skin (lentigo maligna), solar lentigo and labial melanosis: the value of dermoscopy in diagnosis

We report on a patient developing simultaneous occurrence of lentigo maligna lesions, solar lentigines and an extensive melanosis of the oral mucosa. Diagnostically, epiluminescence microscopy had a relevant role in the preoperative assessment and selection of suspicious pigmented lesions, as the lesions histologically labelled as lentigo maligna and solar lentigo were clinically indistinguishable. We review the clinical, dermoscopic and histopathologic differential diagnosis of solar lentigo, malignant lentigo and mucosal melanosis with other melanocytic and keratinocytic lesions and discuss the possible relationship between these entities.     

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

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

Clinical and histological challenge in the differential diagnosis of diffuse alopecia: female androgenetic alopecia,telogen effluvium and alopecia areata - Part II

Diffuse alopecia is mainly caused by telogen effluvium, diffuse androgenetic alopecia (female-pattern hair loss) and diffuse alopecia areata. Differential diagnosis between the three disorders may be difficult in several occasions. In this second part of our study, chronic telogen effluvium and diffuse alopecia areata are discussed in detail, including clinical, dermoscopic and histological aspects. A flowchart presents a practical and objective differential diagnostic approach to diffuse alopecia.     

趋化因子受体4、7在皮肤黑素瘤、色素痣组织中的表达及意义

目的 探讨皮肤黑素瘤和色素痣组织中趋化因子受体4(CXCR4)和趋化因子受体7(CXCR7)的表达及其与病理特征的相关性.方法 免疫组化法检测CXCR4、CXCR7在两个组(黑素瘤组及色素痣组)中的表达情况.结果 黑素瘤组与色素痣组免疫组化比较:CXCR4分别是20％(8/40)和50％(20/40)为(-);12.5％(5/40)和42.5％(17/40)为(+);32.5％(13/40)和7.5％(3/40)为(++);35％(14/40)和0％(0/40)为(+++);差异有统计学意义(均P＜ 0.05).CXCR7分别是15％(6/40)和35％ (14/40)为(-);10％(4/40)和62.5％ (25/40)为(+);22.5％(9/40)和2.5％(1/40)为(++);52.5％(21/40)和0为(+++);差异有统计学意义(均P＜0.05).CXCR4的表达水平在年龄、性别、Breslow厚度、溃疡情况、淋巴细胞浸润情况分组中差异无统计学意义(P＞0.05);在发病部位、Clark分级、淋巴结转移分组中差异有统计学意义(P＜ 0.05);CXCR7的表达水平在年龄、性别、溃疡情况、淋巴细胞浸润情况、淋巴结转移分组中差异无统计学意义(P＞0.05);在发病部位、Breslow厚度、Clark分级分组中差异有统计学意义(P＜0.05).结论 皮肤黑素瘤和色素痣组织标本中,CXCR4和CXCR7有不同程度的表达,CXCR4和CXCR7可能参与黑素瘤的发生发展.     

Case report: dermoscopic and histological aspects of skin graft and perigraft hyperpigmentation in acral location

Little is known about the use of dermoscopy in skin grafting. We describe the case ofa patient with skin grafting and surrounding pigmentation on acral region. Thedermoscopic findings were similar to those of benign acral lesions (lattice-likepattern) and reactive pigmentations (fine striae). Histopathology revealed pigmentleakage and increased number of melanocytes. It is believed that this phenomenonoccured as the result of an inflammatory stimulus.     

Possible histopathologic correlates of dermoscopic features in pigmented melanocytic lesions identified by means of optical coherence tomography

Optical coherence tomography (OCT) is a novel non-invasive imaging technique for in vivo histologic characterization of tissues. Besides pure morphology, additional functional parameters of the tissue investigated can be evaluated at the same time, such as the refractive index and the scattering coefficient. The purpose of our study is to correlate in vivo the dermoscopic structures that first appear in the melanocytic pigmented lesion (pigment network and brown globules) using this new method, with the histopathologic correlates, in order to improve their characterization and achieve easier recognition and inter-observer reproducibility. We concentrated in particular on the pigment network and the brown globules, as these are dermoscopic parameters of great diagnostic importance in melanocytic lesions. Moreover, as these parameters are the histopathologic equivalents of structures located at the level of the dermo-epidermal junction, they enable a correct evaluation to be made using OCT, that at present has only a few millimetres penetration power. The results of our trial, performed using the histopathological preparation as an evaluation gold standard, show that in selected cases OCT allows an in vivo correlation to be made between surface dermoscopic parameters and histopathologic correlates, in particular the pigment network and brown globules. The resolution is not high enough to reveal the morphology of the single cells, but it is possible to evaluate the architecture of a lesion.