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Biomedical subjects

Iris Zalaudek

Publications and source records attributed to Iris Zalaudek.

At least 19 recordsLinked to original sources
PubMed2006

Dermoscopy features of melanoma incognito: indications for biopsy.

BACKGROUND: To avoid missing melanoma, the current practice is to biopsy all suggestive skin lesions. Although most cases of melanoma exhibit clinical clues leading to the correct diagnosis, melanoma can mimic benign lesions. Dermoscopy has been shown to increase the diagnostic accuracy of clinically equivocal lesions, but little is known about its ability to detect melanoma in the context of lesions that appear clinically benign. METHODS: We present 7 difficult-to-diagnose melanomas, in which additional clues provided by dermoscopy increased the index of suggestion and led us to perform a biopsy. RESULTS: Our cases highlight the following 7 management rules: 1) Dermoscopy should not be used only for suggestive skin lesions. 2) Biopsy lesions missing clinicodermoscopic correlation. 3) Biopsy lesions with unspecific pigment pattern. 4) Biopsy lesions with spitzoid features. 5) Biopsy lesions with extensive regression features. 6) In patients with multiple nevi, biopsy lesions changing after short-term follow-up. 7) Biopsy pink lesions with an atypical vascular pattern. LIMITATIONS: The reported series of cases is small. Dermoscopy has not been rigorously compared with handheld magnification (as with a x7 loupe). CONCLUSIONS: Dermoscopy can increase the index of suggestion to perform biopsy in difficult-to-diagnose melanomas.

Adolescent↗
PubMed2006

Dermoscopy improves accuracy of primary care physicians to triage lesions suggestive of skin cancer.

PURPOSE: Primary care physicians (PCPs) constitute an appropriate target for new interventions and educational campaigns designed to increase skin cancer screening and prevention. The aim of this randomized study was to determine whether the adjunct of dermoscopy to the standard clinical examination improves the accuracy of PCPs to triage lesions suggestive of skin cancer. PATIENTS AND METHODS: PCPs in Barcelona, Spain, and Naples, Italy, were given a 1-day training course in skin cancer detection and dermoscopic evaluation, and were randomly assigned to the dermoscopy evaluation arm or naked-eye evaluation arm. During a 16-month period, 73 physicians evaluated 2,522 patients with skin lesions who attended their clinics and scored individual lesions as benign or suggestive of skin cancer. All patients were re-evaluated by expert dermatologists at clinics for pigmented lesions. Referral accuracy of both PCP groups was calculated by their scores, which were compared to those tabulated for dermatologists. RESULTS: Referral sensitivity, specificity, and positive and negative predictive values were 54.1%, 71.3%, 11.3%, and 95.8%, respectively, in the naked-eye arm, and 79.2%, 71.8%, 16.1%, and 98.1%, respectively, in the dermoscopy arm. Significant differences were found in terms of sensitivity and negative predictive value (P = .002 and P = .004, respectively). Histopathologic examination of equivocal lesions revealed 23 malignant skin tumors missed by PCPs performing naked-eye observation and only six by PCPs using dermoscopy (P = .002). CONCLUSION: The use of dermoscopy improves the ability of PCPs to triage lesions suggestive of skin cancer without increasing the number of unnecessary expert consultations.

Adolescent↗
PubMed2006

Dermoscopy patterns of fibroepithelioma of pinkus.

BACKGROUND: Fibroepithelioma of Pinkus (FeP) is a rare variant of basal cell carcinoma that may clinically mimic a number of benign skin tumors. While the dermoscopic features of basal cell carcinoma have been studied extensively, little is known about the dermoscopic features of FeP. OBSERVATIONS: Retrospective evaluation of clinical records and digital clinical dermoscopic images of 10 histopathologically proved FePs (6 nonpigmented and 4 pigmented) was performed. Clinically, no FeP was correctly identified and, in half of all patients, a clinical differential diagnosis of purely benign skin lesions was made. Dermoscopy enabled the correct diagnosis in 9 of 10 FePs, based on the presence of fine arborizing vessels, either alone or associated with dotted vessels, and white streaks (in 100%, 70%, and 90% of lesions, respectively). In the 4 pigmented FePs, a structureless gray-brown area of pigmentation and variable numbers of gray-blue dots were observed, in addition. CONCLUSIONS: Dermoscopy is helpful in diagnosing FeP and in differentiating this variant of basal cell carcinoma from other benign skin tumors commonly included in the clinical differential diagnosis. This presumes, however, that dermoscopy is used as a first-line examination for all skin lesions, not only for those that are clinically suspect.

Adult↗
PubMed2006

Dermoscopy patterns of halo nevi.

BACKGROUND: Halo nevi (HN) are benign melanocytic nevi surrounded by a depigmented area (halo). This study aims to evaluate the dermoscopic features of HN and their changes during digital dermoscopic follow-up and to investigate the frequency of the halo phenomenon in a series of melanomas. OBSERVATIONS: In a retrospective study, digital dermoscopic images of HN from patients who attended the Pigmented Skin Lesions Clinic of the Department of Dermatology, Medical University of Graz, between October 1, 1997, and March 31, 2004, were reviewed and classified by dermoscopic morphologic criteria. For HN that were followed up with digital dermoscopy, the percentages of changes in the size of the nevus and halo components were calculated. In addition, digital dermoscopic images of histopathologically confirmed melanomas obtained from the same database were reviewed for the presence of an encircling halolike depigmentation. We classified 138 HN in 87 patients (mean age, 22.4 years). The most common dermoscopic structures were the globular and/or homogeneous patterns in more than 80% of HN. Follow-up of 33 HN revealed considerable size reduction of the nevus component, but this was not associated with significant structural changes. Of a total of 475 melanomas, only 2 revealed an encircling halo, but both displayed clear-cut melanoma-specific patterns according to dermoscopy. CONCLUSIONS: Halo nevi exhibit the characteristic dermoscopic features of benign melanocytic nevi, represented by globular and/or homogeneous patterns that are typically observed in children and young adults. Halo nevi reveal considerable changes of area over time during digital dermoscopic follow-up, albeit their structural patterns remain unchanged. For this reason and because melanoma with halolike depigmentation, despite being rare, additionally exhibits melanoma-specific dermoscopic criteria, the role of digital dermoscopic follow-up in the diagnosis of HN is insignificant.

Adolescent↗
PubMed2006

Melanoacanthoma simulating pigmented spitz nevus: an unusual dermoscopy pitfall.

BACKGROUND: The starburst pattern is the dermoscopic hallmark of pigmented Spitz nevus, although it has been rarely observed in melanoma as well. OBJECTIVE: To describe a case of melanoacanthoma simulating pigmented Spitz nevus. MATERIAL AND METHODS: Clinical, dermoscopic, and histopathologic examinations were performed for the occurrence of a 4-mm pigmented skin lesion on the hip of a 38-year-old Caucasian woman. RESULTS: Dermoscopy examination of the lesion disclosed a stereotypical starburst pattern characterized by pigmented streaks symmetrically distributed at the periphery. A preoperative diagnosis of pigmented Spitz nevus was made, and the lesion was excised. However, subsequent histopathologic examination revealed a melanoacanthoma. CONCLUSION: The starburst pattern, although diagnostic for pigmented Spitz nevus, can be rarely observed in other benign or malignant pigmented skin lesions. Accordingly, all lesions in adults exhibiting a starburst pattern or other spitzoid features should be excised for histopathologic evaluation.

Acanthoma↗
PubMed2006

[Atypical clinical presentation of pigmented purpuric dermatosis].

The term pigmented purpuric dermatosis (PPD) is used for a group of mainly asymptomatic, sometimes pruritic dermatoses that are clinically characterized by an eruption of pinpoint purpuric lesions along with yellow, orange, red and/or brown, often patchy pigmented areas. Traditionally five subtypes have been distinguished, but atypical clinical patterns may also occur. Because of the variable clinical spectrum and the similar histopathologic findings, a strict nosological classification is sometimes difficult or even impossible to achieve. We report a case of PPD with atypical clinical features in a young woman, underlining the difficulties in the clinical classification of this spectrum of diseases.

Adult↗
PubMed2006

Dermoscopy in general dermatology.

Dermoscopy improves the diagnostic accuracy in the clinical evaluation of pigmented skin lesions, but it is also useful for the assessment of vascular structures that are not visible to the naked eye. As a consequence, dermoscopy has been employed more and more for the differential diagnosis of nonpigmented skin disorders, including tumors but also inflammatory and infectious diseases. This article provides a review of the dermoscopic features seen in various nonpigmented tumoral and nontumoral skin lesions as well as the dermoscopic criteria used for monitoring skin reactions to various treatments.

Algorithms↗
PubMed2006

High- and low-penetrance cutaneous melanoma susceptibility genes.

The aim of this review is to report the current understanding of the molecular genetics of melanoma predisposition. To date, two high-penetrance melanoma susceptibility genes, cyclin-dependent kinas inhibitor (CDKN)2A on chromosome 9p21 and cyclin-dependent kinase (CDK4) on 12q13, have been identified. Germline inactivating mutations of the CDKN2A gene are the most common cause of inherited susceptibility to melanoma. Worldwide, a few families have been found to harbor CDK4 mutations. However, predisposing alterations to familial melanoma are still unknown in a large proportion of kindreds. Other melanoma susceptibility loci have been mapped through genome-wide linkage analysis, although the putative causal genes at these loci have yet to be identified. Much ongoing research is being focused on the identification of low-penetrance melanoma susceptibility genes that confer a lower melanoma risk with more frequent variations. Specific variants of the MC1R gene have been demonstrated to confer an increase in melanoma risk. In addition, conflicting data are available on other potential low-penetrance genes encoding proteins involved in pigmentation, cell growth and differentiation, DNA repair or detoxifying of metabolites.

Cyclin-Dependent Kinase 4↗