Minor cutaneous features of atopic dermatitis in South Korea

BACKGROUND: Minor cutaneous features are important in atopic dermatitis (AD) because they are related to the ethnic or genetic background and to the etiopathogenesis of the disease other than atopic allergy. In addition, they can be used as auxiliary diagnostic criteria in patients with uncertain major features. It is our experience that our AD patients have characteristic features that have not been described previously in the literature. METHODS: AD patients (n = 130) and control subjects (n = 198) were examined for the 32 conventional and seven additional minor features (sandpaper-like skin lesions on elbow/knee/lateral malleolus, hangnail, ventral wrist dermatitis, itchy hyperkeratotic papules on the dorsum of the hands, oily skin, fissured heel, and palmar erythema). The frequency of each feature was compared between AD patients and controls. The diagnostic significance of these minor features was analyzed separately in the childhood and adolescent-adult AD groups, and the age-related changes were documented. RESULTS: The seven additional features were significant for the diagnosis of AD in South Korean patients. Many of the other conventional minor features were also significant. Nine features were of diagnostic importance only in the adolescent-adult AD group, and three features were characteristic only in the childhood AD group. CONCLUSIONS: Our data suggest that ethnic backgrounds influence the phenotype of AD and that an additional seven features need to be examined to confirm the ethnic effect. As the general clinical presentation of AD is dependent upon age, the frequency of minor features varied in the different age groups.     

A systematic heuristic approach for feature selection for melanoma discrimination using clinical images

BACKGROUND: Numerous features are derived from the asymmetry, border irregularity, color variegation, and diameter of the skin lesion in dermatology for diagnosing malignant melanoma. Feature selection for the development of automated skin lesion discrimination systems is an important consideration. METHODS: In this research, a systematic heuristic approach is investigated for feature selection and lesion classification. The approach integrates statistical-, correlation-, histogram-, and expert system-based components. Using statistical and correlation measures, interrelationships among features are determined. Expert system analysis is performed to identify redundant features. The feature selection process is applied to 19 shape and color features for a clinical image data set containing 355 malignant melanomas, 125 basal cell carcinomas, 177 dysplastic nevi, 199 nevocellular nevi, 139 seborrheic keratoses, and 45 vascular lesions. RESULTS: Experimental results show reduced lesion classification error rates based on condensing the shape and color feature set from 19 features to 13 features using the feature selection process. Specifically, average test lesion classification error rates for discriminating malignant melanoma from non-melanoma lesions were reduced from 26.6% for 19 features to 23.2% for 13 features over five randomly generated training and test sets. CONCLUSIONS: The experimental results show that the systematic heuristic approach for feature reduction can be successfully applied to achieve improved lesion discrimination. The feature reduction technique facilitates the elimination of redundant information that may inhibit lesion classification performance. The clinical application of this result is that automated skin lesion classification algorithm development can be fostered with systematic feature selection techniques.     

The histology of "congenital features" in early acquired melanocytic nevi

To test the specificity of certain histologic features claimed to be frequent in congenital melanocytic nevi, 66 of 313 consecutive newborn infants without congenital nevi (verified by perinatal examination) were addressed in a questionnaire 2 1/2 years after birth. Fifty children with acquired melanocytic nevi were reexamined clinically and biopsies were performed in 15. Congenital features were found in seven biopsy specimens from the indubitably acquired melanocytic nevi. These nevi were larger and more speckled in color than melanocytic nevi without "congenital features." It is concluded that the histologic features said to be specific for congenital nevi are, in fact, not specific. The possible relationship between these features and an increased melanoma risk cannot be refuted by the present study, but the risk of misinterpretation based on congenital features as the sole criterion in the prediction of the potential malignancy of melanocytic nevi is real.     

Disseminate palmoplantar keratodermia with truncal lesions

A 20-year-old woman with clinical features of punctate palmoplantar keratodermia is presented. Specimens from the trunk, hands and feet showed similar histologic features. The nosology of disseminate palmoplantar keratodermia is discussed and its features delineated as an extension of punctate palmoplantar keratodermia. To our knowledge, truncal lesions have not been previously reported in disseminate palmoplantar keratodermia.     

Combination of features from skin pattern and ABCD analysis for lesion classification

BACKGROUND/PURPOSE: It is known that the standard features for lesion classification are ABCD features, that is, asymmetry, border irregularity, colour variegation and diameter of lesion. However, the observation that skin patterning tends to be disrupted by malignant but not by benign skin lesions suggests that measurements of skin pattern disruption on simply captured white light optical skin images could be a useful contribution to a diagnostic feature set. Previous work using both skin line direction and intensity for lesion classification was encouraging. But these features have not been combined with the ABCD features. This paper explores the possibility of combing features from skin pattern and ABCD analysis to enhance classification performance. METHODS: The skin line direction and intensity were extracted from a local tensor matrix of skin pattern. Meanwhile, ABCD analysis was conducted to generate six features. They were asymmetry, border irregularity, colour (red, green and blue) variegations and diameter of lesion. The eight features of each case were combined using a principal component analysis (PCA) to produce two dominant features for lesion classification. RESULTS: A larger set of images containing malignant melanoma (MM) and benign naevi were processed as above and the scatter plot in a two-dimensional dominant feature space showed excellent separation of benign and malignant lesions. An ROC (receiver operating characteristic) plot enclosed an area of 0.94. CONCLUSIONS: The classification results showed that the individual features have a limited discrimination capability and the combined features were promising to distinguish MM from benign lesion.     

Large plaque-like glomuvenous malformation (glomangioma) simulating venous malformation

Glomuvenous malformations and venous malformations are vascular lesions that can be distinguished on the basis of clinical and pathological features. A vascular lesion of the skin and superficial and deep soft tissues of a lower limb in a 5-year-old child is described. The clinical and radiological features, including skeletal muscle involvement, were typical of venous malformation, whereas the histopathological features were those of a glomuvenous malformation. The clinical and histopathological features are briefly discussed.     

Quantification of histologic features of dysplastic nevi

We quantified the histologic features of 100 consecutive dysplastic nevi. Although there is heterogeneity in the microscopic attributes of dysplastic nevi, certain features that are seen repeatedly should enable the histologic identification of these melanocytic neoplasms. These features include a central dermal nevocytic component with a peripheral extension of a junctional component, elongated epidermal rete ridges, bridging of nests of melanocytes at the dermo-epidermal junction, nests of melanocytes at the sides of rete ridges as well as at their bases, and concentric eosinophilic fibrosis. Cytologic features of melanocytes were not as valuable as architectural features of individual nevi in classifying these lesions. We also provide an atlas of selected histologic features that depicts some aspects of this heterogeneity.     

Kindler syndrome: a study of five Egyptian cases with evaluation of severity

Background Kindler syndrome (KS) is a rare genodermatosis characterized by four major features (acral blisters, photosensitivity, poikiloderma, and cutaneous atrophy) and many associated findings. The diagnosis of KS includes clinical features, ultrastructural findings, and, recently, immunostaining and genetic studies. Varying degrees of severity of the syndrome have been described. Methods Five patients with clinical features consistent with KS were included in this study. All patients were subjected to histopathologic and ultrastructural studies. Results Cases 1 and 2 presented with severe major features, severe mucosal involvement, and many other associated findings. Case 3 presented with severe major features, but mild and limited mucosal involvement and other associated findings. Cases 4 and 5 showed mild major features and few other findings. Histopathology revealed nonspecific poikiloderma. Marked thickening of the lamina densa and splitting of the lamina lucida were the main ultrastructural findings. Conclusion KS may be classified into mild, moderate, and severe according to the severity of the major features and mucosal involvement. Because histopathologic and ultrastructural findings are not pathognomonic, clinical features remain the mainstay for the diagnosis of KS, and the need for immunostaining with kindlin antibody and genetic studies may be restricted to early cases with incomplete features.     

Two cases of palmoplantar lichen planus with various clinical features

Two cases of palmoplantar lichen planus with various clinical features. Palmoplantar lichen planus is a rare, localized variant of lichen planus. Although several clinical features of palmoplantar lichen planus may be seen, the erythematous scaly form is most common. We present two cases of palmoplantar lichen planus that show vesicle-like and petechia-like features, which are uncommon variants of palmoplantar lichen planus.     

Melanoma and seborrheic keratosis differentiation using texture features

Purpose: To explore texture features in two-dimensional images to differentiate seborrheic keratosis from melanoma.
Methods: A systematic approach to consistent classification of skin tumors is described. Texture features, based on the second-order histogram, were used to identify the features or a combination of features that could consistently differentiate a malignant skin tumor (melanoma) from a benign one (seborrheic keratosis). Two hundred and seventy-one skin tumor images were separated into training and test sets for accuracy and consistency. Automatic induction was applied to generate classification rules. Data analysis and modeling tools were used to gain further insight into the feature space.
Result and Conclusions: In all, 85–90% of seborrheic keratosis images were correctly differentiated from the malignant skin tumors. The features correlation_average, correlation_range, texture_energy_average and texture_energy_range were found to be the most important features in differentiating seborrheic keratosis from melanoma. Over-all, the seborrheic keratosis images were better identified by the texture features than the melanoma images.     

Spitzoid melanoma in childhood

Spitzoid melanoma is a rare variant of melanoma. It has morphological features similar to those of Spitz's nevus. In this study, the histologic and immunohistochemical features of both Spitzoid melanoma and Spitz's nevus are emphasized. We report two cases of melanoma with spitzoid features occurring in the extremities of 9 and 8-year-old girls. Histologically both lesions had typical features of Spitzoid melanoma. We conclude that the differential diagnosis of Spitzoid melanoma and Spitz's nevus is at times problematic in childhood, in that distant metastasis may be the only diagnostic criteria for some cases to be distinguished from Spitz's nevus if strict criteria are followed. Spitzoid melanoma must be treated as other types of melanoma.     

Subepidermal Bullous Disease

The histologic features of 51 cases of subepidermal bullous disease were evaluated and correlated with the clinical features including the course of the disease and the response to therapy. There was a good clinico-pathologic correlation, 46 out of 51 cases showing concordant clinical and histologic diagnoses. We conclude that although immuno-fluorescence is a confirmatory procedure histologic diagnosis is still of great value, particularly in the early stages of the disease when the clinical features may not yet have evolved sufficiently to allow for a confident diagnosis.     

WHO/EORTC classification of cutaneous lymphomas 2005: histological and molecular aspects

ABSTRACT: The new WHO/EORTC classification for cutaneous lymphomas comprises mature T-cell and natural killer (NK)-cell neoplasms, mature B-cell neoplasms, and immature hematopoietic malignancies. It reflects the unique features of lymphoproliferative diseases of the skin, and at the same time it is as compatible as possible with the concepts underlying the WHO classification for nodal lymphomas and the EORTC classification of cutaneous lymphomas. This article reviews the histological, phenotypical, and molecular genetic features of the various nosological entities included in this new classification. These findings always have to be interpreted in the context of the clinical features and biologic behavior. AIM: To review the histological, phenotypical and molecular genetic features of the various nosological entities of the new WHO/EORTC classification for cutaneous lymphomas. METHODS: Extensive review of the literature cited in Medline and own data of the authors. RESULTS: The WHO/EORTC classification of cutaneous lymphomas comprises mature T-cell and NK-cell neoplasms, mature B-cell neoplasms and immature hematopoietic malignancies. It reflects the unique features of primary cutaneous lymphoproliferative diseases. CONCLUSION: This classification is as much as possible compatible with the concept of the WHO classification for nodal lymphomas and the EORTC classification of cutaneous lymphomas. The histological, phenotypical and molecular genetic features always have to be interpreted in the context of the clinical features and biologic behavior.     

HYPER IgE SYNDROME WITH UMBILICAL HERNIA

Hyper IgE Syndrome (HIES) is a rare multi system genetic immunodeficiency disorder, with immunological and non-immunological features. Immunolgical features are 1) Recurrent cutaneous abscesses, 2) Atopic dermatitis like lesions, 3) Sino pulmonary infections, 4) Elevated serum IgE levels and 5) Abnormal neutrophil chemotaxis. Non immunological features include cranio facial and skeletal abnormalities. We are reporting a girl with classical features of HIES with umbilical hernia with her younger brother suffering from right sided inguinal hernia, as both herniae are hitherto unreported in patients with HIES.     

Evaluation of dermoscopic and histopathologic features and their correlations in pigmented basal cell carcinomas

BACKGROUND: Because of their clinical similarities, pigmented basal cell carcinomas (BCCs) can be confused with melanocytic pigmented lesions especially with melanoma. Since special dermoscopic features have been described for pigmented BCCs, dermoscopy is accepted as a useful tool for the diagnosis of pigmented BCCs. OBJECTIVE: To investigate dermoscopic and corresponding histopathologic features of BCCs and to evaluate their correlations in pigmented BCCs. METHODS: In this study, 32 pigmented BCCs in 30 patients whose diagnoses were confirmed with clinical and histopathologic features were included. Before the histopathologic evaluation, the lesions were analysed for dermoscopic features. Histopathologic correlations of dermoscopic features of BCCs and the localization of pigment accumulation in tumour mass were investigated. RESULTS: In addition to ulceration, large grey-blue ovoid nests, multiple grey-blue globules, maple leaf areas and arborizing telangiectasia; dermoscopically yellow-brown, whitish-yellow, and black-dark brown colour showed statistically significant correlation with their histopathologic counterparts (P < 0.05). Whitish veil, which is among dermoscopic features of BCCs, did not show significant correlation with its histopathologic counterpart (P > 0.05). It was histopathologically determined that pigmentation is found within the tumour mass as well as in the tumour stroma and in the hyperplastic epidermal melanocytes. CONCLUSIONS: Ulceration, large grey-blue ovoid nests, multiple grey-blue globules, maple leaf-like areas and arborizing telangiectasia, which are specific dermoscopic features for the diagnosis of pigmented BCC, were found to correlate with their histopathologic counterparts. In conclusion, dermoscopy can be described as a valuable tool for the diagnosis of pigmented basal cell carcinomas.     

Dermoscopic features of actinic keratosis and follow up with dermoscopy: A pilot study

Actinic keratosis (AK) is a common precursor of sun‐related squamous cell carcinoma. AK is difficult to be differentiated from other malignancies with the naked eyes. Dermoscopic features of AK were previously described in some studies, but not extensively investigated. We investigated the dermoscopic features of AK in Asians and assessed dermoscopy as a post‐treatment monitoring tool of AK. We retrospectively examined 34 AK lesions which had been diagnosed by histology. The changes of dermoscopic features and histopathological findings were assessed in all these lesions before and after treatment. Before treatment, 18 lesions were pigmented and 16 lesions were non‐pigmented AK dermoscopically. The frequent dermoscopic features of AK were keratin/scales (79.4%), red pseudonetwork (73.5%), targetoid‐like appearance (55.9%), rosette sign (38.2%) and absent fissures/ridges, crypts and milia‐like cysts. All the lesions had been treated with either photodynamic therapy, cryotherapy or 5% imiquimod cream. After treatment, dermoscopic features of 33 AK lesions were decreased or disappeared, and skin biopsies confirmed that atypical keratinocytes disappeared. One lesion showed accentuated and new dermoscopic features after treatment, and skin biopsy also showed progressing squamous cell carcinoma. In conclusion, scales, red pseudonetwork, targetoid‐like appearance and rosette sign were common dermoscopic findings of AK in Asians. In most cases, the treatment response correlated with the changes in dermoscopic features. These findings suggest that dermoscopy is a useful tool to monitor AK.     

中国5家系类脂蛋白沉积症临床和遗传特点分析

目的：了解中国人群中类脂蛋白沉积症(LP)的临床表型和遗传学特点。方法：描述了我院确诊的一LP家系中患者的临床表型和遗传特点，并综合20多年来国内文献报道的LP家系进行比较分析。结果：(1)LP在家系中的传递符合常染色体隐性遗传方式；(2)表型特点为患者多在2岁内发病，声音嘶哑、眼睑串珠状半透明丘疹，在每个患者均出现；一些少见的表现，如颅内钙化灶仅在家系1中出现，复发性腮腺炎或扁桃体炎仅在家系1和家系5中出现；6例患者健康状况不受该病影响，家系1中的先证者在18岁时曾出现呼吸困难；(3)多不伴发其他遗传病和系统疾病；(4)患者临床表现有一定程度的相似性，但严重程度有很大差异，既使在同一家系中也如此。结论：LP是一种罕见的常染色体隐性遗传病，中国人群中其致病基因的突变频率很低；LP临床表型相似，但不同患者表现度存在较大差异。     

Extraction of skin lesion texture features based on independent component analysis

Background/purpose: During the recent years, many diagnostic methods have been proposed aiming at early detection of malignant melanoma. The texture of skin lesions is an important feature to differentiate melanoma from other types of lesions, and different techniques have been designed to quantify this feature. In this paper, we discuss a new approach based on independent component analysis (ICA) for extraction of texture features of skin lesions in clinical images.
Methods: After preprocessing and segmentation of the images, features that describe the texture of lesions and show high discriminative characteristics are extracted using ICA, and then these features, along with the color features of the lesions, are used to construct a classification module based on support vector machines for the recognition of malignant melanoma vs. benign nevus.
Results: Experimental results showed that combining melanoma and nevus color features with proposed ICA-based texture features led to a classification accuracy of 88.7%.
Conclusion: ICA can be used as an effective tool for quantifying the texture of lesions.