Klinische Wertigkeit einer dermatoskopischen Klassifikation von Clark‐Nävi

Background and objectives: The aim of this study was to evaluate the practical value of the dermatoscopic classification of Clark nevi Patients and methods: Dermatoscopic images of 268 lesions clinically and dermatoscopically diagnosed as Clark nevi were presented to 2 dermatologists without knowledge of the histological diagnosis. The dermatologists evaluated the lesions according to a simplified version of the classification scheme for Clark nevi proposed by Hofmann‐Wellenhof and differentiated between 12 different types of Clark nevi. Results: The most common type of Clark nevus was the reticular‐homogenous type (n = 64, 23,9 %), followed by the globular‐homogeneous type (n = 32, 12 %) and by the homogenous type (n = 30, 11,2 %). The overall inter‐rater agreement between the examiners was moderate to good (kappa = 0,58). The highest level of agreement was found for the peripheral hyperpigmented type (kappa = 0,83). Histologically, 17 lesions (6,3 %) were diagnosed as melanomas. The frequency of melanoma was highest among the peripheral‐hyperpigmented type for one observer and among the homogenous type for the other observer. No melanoma was found among the globular, reticular‐globular, and the central‐hyperpigmented types. Conclusions: A dermatoscopic classification of Clark nevi is practically feasible and allows – to some extent – a risk stratification of Clark nevi, which could be useful for clinical management.     

Digital computer analysis of dermatoscopical images of 260 melanocytic skin lesions; perimeter/area ratio for the differentiation between malignant melanomas and melanocytic nevi

BACKGROUND: Digital computer analysis of dermatoscopical images has been reported to facilitate the differential diagnosis of pigmented skin lesions in recent years. OBJECTIVE: The aim of our study was to perform digital computer analysis of a set of different melanocytic lesions and compare the objective results. METHODS: The set of 260 melanocytic lesions (150 excised difficult cases (46 melanomas, 47 atypical nevi, 57 common nevi and 110 unexcised common nevi) was automatically analysed by the digital dermatoscopical system microDERM. We searched for differences in asymmetry, size, compactness and colour distribution. Perimeter/area ratio was calculated. RESULTS: The perimeter/area ratio was detected as the most important criterion for differentiation between malignant and benign melanocytic lesions (sensitivity 91.3% and specificity 90.7% for malignant melanomas vs. all benign nevi; sensitivity 91.3% and specificity 80.8% for melanomas vs. clinically atypical nevi). Differences in size of the lesion, shape and asymmetry of colour were found and statistically verified. Using step-wise logistic regression the formula for calculation of probability of malignant nature of every analysed lesion was constructed. CONCLUSION: The perimeter/area ratio is a simple parameter for the differential diagnosis of melanocytic skin lesions.     

Alopecia areata. How not to miss Satoyoshi syndrome?

Satoyoshi syndrome is a multisystem disorder of suspected autoimmune etiology, characterized predominantly by alopecia, muscle spasms and diarrhea. Antinuclear antibodies are present in 60% of patients. The syndrome primarily affects girls and young women. Trichoscopy shows regularly distributed yellow dots, indistinguishable from typical alopecia areata. The condition may be easily misdiagnosed and treated as alopecia areata. On the basis of an in‐depth analysis of all published cases we developed diagnostic criteria for Satoyoshi syndrome. We also suggest that two subtypes of the disorder should be distinguished, the ANA‐positive Satoyoshi syndrome with generally good response to systemic glucocorticosteroid therapy and the ANA‐negative Satoyoshi with less favorable prognosis. In our opinion all patients will alopecia areata (in particular alopecia totalis) should be inquired about muscle spasms and diarrhea and tested for antinuclear antibodies to decrease the risk of missing Satoyoshi syndrome.     

Novel dermoscopic features of pityriasis versicolor–like macules in epidermodysplasia verruciformis

Epidermodysplasia verruciformis (EV) manifests early in childhood as pityriasis versicolor (PV)–like macules on sun-exposed sites such as the face. These hypopigmented lesions closely resemble commoner pediatric dermatoses such as PV or pityriasis alba. In this report of two cases, we describe the distinguishing dermoscopic features of PV-like macules in EV. Unfocused dotted vessels in a hypopigmented or erythematous background with whitish scales and pigment diluted vellus hairs on dermoscopy should raise the suspicion of EV in children presenting with PV-like lesions.     

脉冲染料激光治疗皮肤微静脉畸形疗效分析

目的：观察595nm脉冲染料激光治疗皮肤微静脉畸形的疗效和不良反应,分析疗效相关因素,初步探讨皮肤镜技术在皮肤微静脉畸形治疗和随访中的作用。方法：应用595rim脉冲染料激光治疗皮肤微静脉畸形患者226例,观察治疗效果、不良反应,比较疗效与患者性别、年龄及病变类型等因素间的相关性,运用皮肤镜技术对疗效及不良反应进行评价分析及随访。结果：脉冲染料激光治疗皮肤微静脉畸形的总体有效率为51．8％,发生副反应7例（3．09％）,其疗效与患者年龄、病灶类型等因素相关（P〈0．05）,与性别无明显相关性;皮肤镜技术可明确区分病灶残留与色素沉着,指导后续治疗。结论：595nm脉冲染料激光治疗皮肤微静脉畸形安全性高,疗效良好,副反应低,皮肤镜技术可用于皮肤微静脉畸形激光治疗疗效的客观评价及随访。     

Dysplastic nevus syndrome with development of multiple melanomas. A surgical concept for prophylaxis

A 58‐year‐old man presented in 2001 with dysplastic nevus syndrome with at least 300 nevi and about 100 clinically highly atypical nevi. Three melanomas had been excised by a private dermatologist within the past year. We then removed two additional melanomas. Between 2002 and 2003, 117 nevi which were atypical on dermatoscopy were removed; most by horizontal (shave) excision. Adequate clinical and dermatoscopic control was not feasible due to the large number of atypical nevi. In order to reduce the number of nevus cells, we treated test sites with both dermabrasion and split‐thickness excision. The latter proved to be more efficient and was used to completely excise the skin of the back, as well as parts of the arms and chest in two sessions under general anesthesia. Wound healing was uneventful. Following these procedures, adequate clinical and dermatoscopic monitoring of the remaining nevi was possible and only a few had to be removed. No more melanomas appeared in the treated areas.