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At least 361 records · Page 20Linked to original sources

PubMed2001

Superficial black network: an additional dermoscopic clue for the diagnosis of pigmented spindle and/or epithelioid cell nevus.

Dermoscopy is a valuable method for improving the diagnostic accuracy of pigmented skin lesions. Specific dermoscopic criteria have been described for differentiating pigmented spindle and/or epithelioid cell nevi (SECN; Spitz nevi and Reed nevi) from cutaneous melanomas. In the present study, we report an additional dermoscopic feature of SECN, namely a distinctive type of pigment network, described as superficial black network, which was observed in 10.5% of SECN. Histopathologically, this network corresponds to focal areas of pigmented parakeratosis, producing a black reticulated appearance on the horizontal plane.

Adolescent↗

PubMed2003

Dermoscopic features of plaque psoriasis and lichen planus: new observations.

BACKGROUND: Dermoscopic features of common inflammatory dermatoses are not well studied and previous reports on this topic are limited to the search of vascular features (capillaroscopy). OBJECTIVE: Dermoscopic features of psoriasis and lichen planus (LP) are investigated to determine both vascular and nonvascular features of these two dermatoses. PATIENTS AND METHODS: Dermoscopic images of 25 patients with LP and 20 patients with plaque psoriasis (PP) were evaluated. Findings were statistically analyzed including the reproducibility of scoring (Cohen's kappa statistics). RESULTS: Our observations clearly showed that the evaluation of both vascular and nonvascular findings improved the surface microscopy of these diseases. A vascular feature (homogeneous red globules) was the most significant dermoscopic finding in the PP dermoscopic pattern (20/20, 100%; p < 0.001). A nonvascular feature (whitish striae) was the most significant dermoscopic feature in the LP pattern (23/25, 92%; p < 0.001). Dermoscopic features of LP also included gray-blue dots, comedo, milium-like cysts, and vascular structures (red lines). The intraobserver and interobserver reproducibility of scoring was very high (k value, 0.9). CONCLUSION: Our study shows for the first time that the efficacy of surface microscopy of common inflammatory dermatoses may be improved by investigating both vascular and nonvascular findings and its practicability in daily practice by using the dermoscope. Although dermoscopy does not provide clear additional help in the clinical differentiation between typical PP and LP, it could be helpful in patients with darker skin and for teaching settings.

Adult↗

PubMed2004

Primary vulvar melanoma with satellite metastasis: dermoscopic findings.

A 79-year-old woman presented with a 1-year history of a pigmented nodular lesion on the left labium minor. Histopathology of the nodule led to a diagnosis of metastatic melanoma. A pigmented flat lesion on the inner side of the left labium major was also biopsied and was found to be a superficial spreading melanoma. The dermoscopic findings of primary and metastatic vulvar melanoma which simultaneously occurred in the same patient are described. Dermoscopy revealed a homogeneous pattern associated with linear irregular vessels in the metastatic nodule, while irregular globules and streaks were seen in the primary melanoma.

Aged↗

PubMed2004

Revisiting the gender-linked melanoma burden.

BACKGROUND: Much is known about the worldwide rising incidence of skin cancers in the white populations. However, contradictory reports have been presented about a gender-linked risk for malignant melanoma (MM). OBJECTIVE: To review the recent epidemiological information about primary and metastatic MM in south-east Belgium. METHODS: Laboratory records of primary MM according to age and gender were compared per 3-year periods from 1988 to 2002. The numbers of MM per decade of patient age were corrected with regard to the number of citizens in the defined periods of age. This led to the calculation of the rate of estimated prevalence (REP). The same assessments were performed on 187 sentinel lymph node biopsies collected during the last 3-year period. RESULTS: A total of 1,051 primary MM in women and 594 primary MM in men were diagnosed over the 15-year period. The female-to-male ratio rose by 24% over time, with a mean value of 1.77. The most recent years showed a marked increase both in the numbers and REP of primary MM. This situation was present in both genders, although it was most prominent in women of the reproductive age. MM metastases were found in 38/187 sentinel lymph nodes with a female-to-male ratio of 2.17. The age distribution for all sentinel lymph node biopsies copied that of primary MM, but the vast majority of the nodal metastatic MM was found in patients older than 50 years. The ratio between MM metastases and primary MM reached 6.1% (12/198) in men and 6.9% (26/378) in women. CONCLUSION: A recent increase in primary MM incidence was observed in our laboratory. The most likely cause is ascribed to more sensitive MM detection using the combination of clinical dermoscopy and laboratory immunohistochemistry. During the past 15 years, women were more affected than men by both primary and metastatic MM. The gender difference in incidence of primary MM has progressively widened due to an increased incidence in young and middle-aged women. By contrast, nodal metastatic MM mostly affected postmenopausal women.

Adolescent↗

PubMed2005

Targetoid hemosiderotic nevus. A trauma-induced simulator of malignant melanoma.

BACKGROUND: Simulators of malignant melanoma comprise a heterogenous group of melanocytic and nonmelanocytic lesions of the skin. Among frequent clinical mimickers of melanoma are injured melanocytic nevi. Any change in the clinical appearance of a pre-existing nevus should alert the clinician to exclude the possibility of malignant transformation in order to early identify a lesion at a stage when complete cure can still be achieved. OBJECTIVE: The purpose of this study was to present the clinical, dermoscopic and histopathologic findings of a series of acquired melanocytic nevi which abruptly developed a pigmented peripheral halo, presumably following minor trauma. METHODS: A series of 6 cases of acquired melanocytic nevi which suddenly developed a targetoid halo were included in the study. All lesions were evaluated by dermoscopy. Three cases were surgically removed at different stages of evolution and submitted to histopathologic examination. In all cases, follow-up was obtained. RESULTS: All the lesions arose on trauma-prone skin sites of young women. The sudden development of an asymptomatic, targetoid halo on a long-lasting, acquired exophytic nevus was the main presentation. Whereas the central nevus persisted, the ecchymotic halo ultimately disappeared. Histopathologic examination disclosed changes of the traumatized nevus in the central part, whereas the ring showed hemorrhage and hemosiderin deposits. Increased numbers of small vessels with hobnail characteristics were associated features. CONCLUSIONS: Targetoid hemosiderotic nevus is a distinctive clinicopathologic variant of traumatized acquired melanocytic nevus which should be included in the list of clinical simulators of melanoma.

Adolescent↗

PubMedDate not supplied

Histopathologic interobserver agreement on the diagnosis of melanocytic skin lesions with equivocal dermoscopic features: a pilot study.

AIMS AND BACKGROUND: Dermoscopy (dermatoscopy, skin surface microscopy, epiluminescence microscopy) has been increasingly employed in recent years for the preoperative detection of cutaneous melanoma, and dermatoscopic features of pigmented skin lesions have been previously defined using histopathology (HP) as the "key to the code". The aim of the present study was to evaluate the interobserver agreement on the HP diagnosis in a series of epiluminescence microscopy equivocal melanocytic skin lesions. STUDY DESIGN: Ten melanocytic skin lesions were selected on the basis of diagnostic disagreement of at least 2 out of 9 epiluminescence microscopy observers. The histologic specimens from the 10 lesions were examined by 9 HP observers. The agreement of the HP diagnoses was calculated by means of Fleiss' k statistics. RESULTS: The overall HP agreement was less than excellent (k = 0.5). When considering the prevailing epiluminescence microscopic and HP diagnoses, 2 cases were shown to be epiluminescence microscopy false-negative melanomas. Virtually no agreement was found among epiluminescence microscopy observers in 4 cases (40%) or among HP observers in 3 cases (30%). However, only one pigmented skin lesion remained unclassifiable on epiluminescence microscopy as well as HP. CONCLUSIONS: When at least 2 epiluminescence microscopy experts disagree in the evaluation of a given melanocytic skin lesion, even HP consultations may give equivocal results. The need to establish more reliable epiluminescence microscopic and HP criteria by performing an improved and meticulous clinicopathologic correlation, e.g. by using telecommunication via Internet, is emphasized.

Adult↗

PubMed2005

Role of the CDKN2A locus in patients with multiple primary melanomas.

PURPOSE: We have studied a consecutive case series of patients with multiple primary melanoma (MPM) for the involvement of the melanoma susceptibility loci CDKN2A and CDK4. PATIENTS AND METHODS: One hundred four MPM patients (81 patients with two primary melanomas, 14 with three, five with four, one with five, two with six, and one with seven) were included. RESULTS: Seven different CDKN2A germline mutations were identified in 17 patients (16.3%). In total, we identified 15 CDKN2A exon 2, one exon 1alpha missense mutation, and one exon 1beta frameshift mutation. The age of onset was significantly lower and the number of primary melanomas higher in patients with mutations. CDKN2A mutations were more frequent in patients with familial history of melanoma (35.5%) compared with patients without (8.2%), with a relative risk (RR) of 4.32 (95% CI, 1.76 to 10.64; P = .001), and in patients with more than two melanomas (39.1%) compared with patients with only two melanomas (10%) with an RR of 3.29 (95% CI, 1.7 to 6.3; P = .002). The A148T polymorphism was more frequent in patients with MPMs than in the control population (P = .05). A variant of uncertain significance, A127S, was also detected in one patient. No CDK4 mutations were identified, suggesting that it has a low impact in susceptibility to MPM. CONCLUSION: MPM patients are good candidates for CDKN2A mutational screening. These patients and some of their siblings should be included in a program of specific follow-up with total body photography and digital dermoscopy, which will result in the early detection of melanoma in this subset of high-risk patients and improve phenotypic characterization.

Adolescent↗

PubMed2000

Teledermoscopy--results of a multicentre study on 43 pigmented skin lesions.

We performed a multicentre study to evaluate the agreement between the direct clinical diagnosis and the telediagnosis of 43 cutaneous pigmented lesions. Digital clinical and dermoscopic images of the 43 pigmented skin lesions (11 melanomas, 23 melanocytic naevi, three basal cell carcinomas, three lentigines, two seborrhoeic keratoses and one angiokeratoma) were sent by email to 11 colleagues (six dermatologists, two residents in dermatology, one oncologist, one specialist in internal medicine and one general practitioner) in 10 centres. These 11 colleagues had different degrees of experience in dermoscopy. With histopathology as the gold standard, an average of 85% of the telediagnoses were correct, with results varying from 77% to 95%, whereas face-to-face diagnosis by an expert dermatologist was correct in 91% of cases. The kappa value for all participants ranged from 0.35 to 0.87. The results confirm that teledermoscopy can be a reliable technique for the diagnosis of pigmented skin lesions but one that will depend on the expertise of the observer.

Adolescent↗

PubMed2001

Issues in the epidemiology of melanoma.

Cutaneous melanoma is a significant health problem throughout the developing world. Primary and secondary prevention are discussed. The wavelengths of the ultraviolet radiation spectrum and their association with melanoma are discussed. Although excessive sun exposure during childhood is a critical risk factor, excessive sun exposure during adult years is also important. The major risk factors for melanoma--numerous or atypical moles and a sun-sensitive phenotype--are genetic. Their interaction with sun exposure is currently being examined, as well as the interaction of other genetic factors, such as alterations in the melanocortin receptor and the familial melanoma gene, INK4A. Secondary prevention strategies include self-examination and physician examination. New technologies are being developed to supplement visual examination of suspected lesions. These technologies are discussed in detail and include digital photography, digital dermoscopy, confocal scanning laser microscopy and automated diagnosis systems.

Humans↗

PubMed2006

Role of dermatologists in treating melanoma.

Melanoma is a major focus of dermatology training and practice, with dermatologists playing a central role in managing melanoma through primary prevention, secondary prevention, diagnosis, and treatment of thinner tumors. Dermatologists have led public health efforts to raise melanoma awareness, promulgate the early warning signs of melanoma, and promote melanoma prevention through sun protection. Dermatologists have unique expertise in melanoma risk assessment and the clinical diagnosis of melanoma through visual inspection and the use of diagnostic aids, including dermoscopy and photographically assisted follow-up. Increasing incidence of melanoma, earlier melanoma detection, narrower excision margins, and improved surgical training in dermatology have recently combined to enhance the role of dermatologists in melanoma care. For patients with thin primary melanomas, dermatologists are increasingly assuming complete care, including wide local excision and long-term surveillance for both disease recurrence and detection of new primary melanoma. Conversely, the advent of sentinel lymph node biopsy and adjuvant therapy has made melanoma management more complex and has intensified the need for a multidisciplinary approach to the disease. In this context, dermatologists contribute significantly to the formation, administration, and implementation of multidisciplinary melanoma programs.

Dermatology↗

PubMed1999

The seven features for melanoma: a new dermoscopic algorithm for the diagnosis of malignant melanoma.

The clinical diagnosis of melanoma has a mean sensitivity of 67%, dermoscopy or dermatoscopy is a non invasive technique which improves this sensitivity. Our purpose was to create a simple dermoscopic method for the diagnosis of melanoma useful in daily office practice. For this reason a training set of 218 cutaneous pigmented lesions was used and scored for 16 dermoscopic features: for each feature sensitivity, specificity and statistical significance were evaluated. The results were used to create a simple dermoscopic diagnostic method of only seven dermoscopic features (7FFM). The method was used to evaluate a test set of 713 pigmented skin lesions consecutively observed. The diagnostic dermoscopic method developed gave a sensitivity of 94.6%, a specificity of 85.5% and an efficiency of 87.6%. Our method improves the sensitivity in the diagnosis of melanoma and can be used for the screening of pigmented skin lesions.

Diagnosis, Differential↗

PubMed1999

The dermoscopic versus the clinical diagnosis of melanoma.

Dermoscopy is an useful technique for the diagnosis of melanoma. All the diagnostic dermoscopic methods developed until now have been tested on dermoscopic slides and the real improvement given by this technique to the clinical diagnosis based upon ABCDE criteria is still unknown. For this reason, we decided to undertake a prospective study to compare the clinical diagnosis made with ABCDE criteria, to the dermoscopic diagnosis, made with the method 7FFM, developed by us. A total of 401 lesions were evaluated clinically and dermoscopically. On the basis of the number of the clinical criteria considered sufficient to diagnose a melanoma, various clinical scores, ranging from 1 to 5, can be obtained; data about the sensitivity of the clinical diagnosis of melanoma suggest that the most often used score is score 3. Our method 7FFM presents a sensitivity and a specificity better than those obtained with score 3: 80% versus 66.6% and 89.1% versus 79.3%. Besides this, we have evaluated if the sensitivity of our method 7FFM in the diagnosis of melanoma can be improved with the adjunct of the clinical criteria or of the clinical scores. The best values of sensitivity 93.3% and predictive value negative 97.3% have been obtained with score 2 plus 7FFM. Our results confirm that our method can be used in the screening of pigmented skin lesions in daily office practice and that an improvement in sensitivity without an excessive sacrifice of specificity can be obtained with the adjunct of the clinical score 2.

Biopsy, Needle↗

PubMed2000

Reproducibility of a dermoscopic method (7FFM) for the diagnosis of malignant melanoma.

Dermoscopy improves sensitivity in the diagnosis of melanoma. We have developed a new diagnostic dermoscopic method which evaluates only seven dermoscopic features or criteria. We called the method Seven features for melanoma (7FFM). To present and to evaluate the reproducibility of our dermoscopic diagnostic method (7FFM) we held eight dermoscopic courses from 10/4/96 to 04/03/98 in various Italian cities. In fact the reliability of a diagnostic test or method mainly depends on the level of agreement in the interpretation of results among different observers. Only methods with good agreement can be used in clinical practice for the diagnosis of melanoma. Many dermatologists (207) attended one of the eight dermoscopic courses: each course was one-day in length and at the end of the course the participants evaluated a set of 25 dermoscopic slides using our dermoscopic method. Percentages of concordance and K values for a kappa statistical analysis to evaluate inter-rater reliability have been calculated. The method showed a mean percentage of concordance of 85.7%, median 88%, a mean K value of 0.699, median 0.684. These data point to a good agreement level. Our method shows good reproducibility after a short training program.

Basal Cell Carcinoma↗

PubMed2001

Dermoscopic criteria for melanoma in situ are similar to those for early invasive melanoma.

BACKGROUND: Dermoscopy is a noninvasive technique that increases the diagnostic accuracy of pigmented skin lesions, particularly improving the diagnosis of patients with cutaneous melanoma in situ (CMIS) and early invasive melanoma. To establish reliable and reproducible dermoscopic criteria for the diagnosis of CMIS, the authors conducted a retrospective clinical study of 37 patients with CMIS and 53 patients with invasive cutaneous melanomas (ICM). METHODS: The 37 patients with CMIS were divided into three groups: those with CMIS lesions measuring < or = 5 mm in greatest dimension (8 patients), those with CMIS lesions measuring from > 5 mm to < or = 10 mm in greatest dimension (20 patients), and those with CMIS lesions measuring > 10 mm in greatest dimension (9 patients). The 53 patients with ICM were divided into two groups according to Breslow index: those with ICM lesions measuring < or = 0.75 mm in tumor thickness (19 patients) and those with ICM lesions measuring > 0.75 mm in tumor thickness (34 patients). Lesions were examined with a dermatoscope and were photographed at a magnification of x10. Dermoscopic criteria were evaluated from examination of the photomicrographs. RESULTS: Blue-whitish veil, gray-blue areas, black dots, and irregular extensions and branched streaks were the most relevant dermoscopic criteria for CMIS and were present in 78%, 76%, 73%, and 62% of lesions, respectively. Brown globules, irregular pigment network, pseudopods, and depigmentation were present in 57%, 54%, 54%, and 51% of CMIS lesions, respectively. White scar-like areas and linear and/or dotted vascular patterns, two criteria that are associated frequently with ICM, were not found in our patients with CMIS. No clinically significant differences were observed between the three groups of CMIS patients. CONCLUSIONS: Dermoscopic criteria for CMIS were similar to those for ICM, although white scar-like areas and linear and/or dotted vascular patterns were observed only in patients with ICM. Dermoscopic criteria appeared to be independent of CMIS lesions size.

Adolescent↗

PubMed2002

[Tanning benches to accusation benches].

Sunbeds used in sun parlours do not garantee a controlled innocuity. By contrast, health hazards are obvious in many instances. Forceful tanning is a transitory aspect behind which the spectrum of many skin changes includes accelerated photoageing, irreversible pigmentary and keratotic changes, and cutaneous malignancies including malignant melanoma. In the absence of protection, the eye is also affected. Even if tanning salon exposure increases the risk for skin cancer by a small amount, it represents a significant potential public health hazard given the number of people attending salons. Digital dermoscopy and ultraviolet light videoscopy are new methods allowing to predict the cutaneous ransom to be paid by the sunbed worshippers.

Humans↗

PubMed2004

Immunohistochemical aid at risk stratification of melanocytic neoplasms.

There is increasing awareness of the population about the risk of cutaneous melanoma. In recent years, some improvement was gained in the early recognition of clinical warning signs using dermoscopy. As a result, the number of puzzling cases exhibiting limited classical clues for malignancy are submitted to the dermatopathologist. Thus, the risk of microscopic uncertainty or misdiagnosis may be increasing. The aim of the study was to assess retrospectively the contribution of immunohistochemistry in establishing the histological diagnosis of 520 melanocytic neoplasms. According to the disease evolution and the histological presentation, 6 profiles of phenotypical expressions were distinguished.

Antibodies, Monoclonal↗

PubMedDate not supplied

Skin weathering and ashiness in black Africans.

Ashiness describes a common physiological skin condition that may develop in people with dark skin complexion. Environmental influences, particularly cold and dry weather, seem obvious. This condition has seldom been studied so far. In the present study, skin ashiness was assessed in 37 black African women by means of colorimetric assessments and xerosis ratings. Colour changes were measured by the parameters a* and the individual typology angle ITA degrees. Xerosis was assessed by visual inspection, the ultraviolet light-enhanced visualization (ULEV) method, and the cyanoacrylate skin surface stripping (CSSS) method. The assessments were performed on ashy skin of the legs and on the normal looking forehead during the winter season. Ashy skin was lighter but not erythematous. The ITA-revealed colour changes were correlated with xerosis severity as assessed by dry dermoscopy and by the ULEV and CSSS methods. In conclusion, ashiness due to skin weathering does not appear to be related to mild inflammation. It corresponds to a peculiar type of xerosis with reduction in Fresnel reflection by the stratum corneum.

Adult↗

PubMed2003

[How to investigate....A darkened skin lesion during pregnancy. A difficult task for the clinician].

Cancers rarely coexist with pregnancy. Cutaneous melanoma, however, is one of the most frequently encountered neoplasms during pregnancy. Gestation may also be a period during which the aspect of some melanocytic naevi can change eventhough the tumor remains benign. Distinction between a benign and a malignant lesion may then be a dilemma. Clinical morphometry, dermoscopy, skin surface biopsy, conventional histology and immunohistochemistry are valuable means that can be used to secure maximum diagnostic confidence.

Biopsy↗