Clinical Pearl: the use of the handheld digital camera to capture dermoscopic and microscopic images.
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Dermatology↗
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Results for “Dermoscopy”
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"Fat fingers:" a clue in the dermoscopic diagnosis of seborrheic keratoses.
"Fat fingers" are thick digitate linear, curvilinear, branched, or oval/circular dermoscopic structures typically seen in seborrheic keratoses where they represent the gyri of their cerebriform surfaces. Their recognition is very useful in the diagnosis of these lesions, especially when the classic features (eg, milia, comedo-like openings) are absent. Histologically and by confocal microscopy the "fat finger" gyri are accentuated by pigmented keratin filling the sulci. "Fat fingers" must be differentiated from other linear structures such as "network-like structures"; branched streaks; network; globules; pigmented ovoid-nests; and streaks/pseudopods seen in different melanocytic and non-melanocytic lesions.
Adult↗
Dispelling the myth of the "benign hair sign" for melanoma.
The vast majority of melanocytic lesions with hair, such as congenital melanocytic nevi, are benign. However, there is a notion that the presence of one or more hairs in a melanocytic lesion is confirmatory for the benign nature of the lesion. To dispel this notion, we present 3 examples of melanocytic lesions that showed terminal hairs on clinical and dermoscopic evaluation, but in which the final diagnosis was invasive melanoma. Thus, integrating all clinical and dermoscopic findings, rather than relying on a single criterion for the lesion at hand should guide clinicians to the correct diagnosis.
Adult↗
[Monitoring the evolution of a localized type of porokeratosis using dermatoscopy].
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Aged↗
[Clinical value of a dermatoscopic classification of Clark nevi].
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.
Dermoscopy↗
[Morphological classification is not keeping up with the times ].
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Dermatology↗
[Acute tissue toxicity of PMMA bone cements].
AIM: Local toxic reactions are one possible reason for fibrous tissue formation at the interface between bone and PMMA bone cement. Most of the numerous in vitro studies have shown severe cytotoxicity of bone cements and their components. However, in vivo investigations of the local tissue toxicity of bone cements have so far seldom been performed. METHODS: The in-vivo hens-egg chorion-allantoic-membrane test (HET-CAM), a well established replacement procedure for experiments with higher vertebrates, is used for the testing of potentially toxic solid and fluid substances. It was performed with PMMA bone cements, their components and their monomer extracts to measure in vivo biocompatibility. RESULTS: We showed that local toxic tissue reactions occurred, especially at the beginning of the processing phase of PMMA bone cements. We also proved that certain components of PMMA bone cements have poor tissue compatibility and sometimes cause severe local tissue changes. CONCLUSIONS: In the development of PMMA bone cements and when drafting the recommendations for their use, attention should be paid to their biocompatibility as well as their mechanical properties.
Animal Testing Alternatives↗
[Microvessel visualisation: applications and limitations].
Vessel systems and the microvascular unit may be studied by a variety of morphological techniques which enable improved structure-function analyses. Two-dimensional light and electron microscopic sectioning techniques with and without specific markers are complemented by 3D vascularisation and perfusion study techniques. Static ex vivo modalities still prevail, however, the future will be dominated by intravital high-resolution techniques.
Animals↗
Management of cutaneous melanoma.
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Biopsy↗
Implementation and analysis of relief patterns of the surface of benign and malignant lesions of the skin by microtopography.
The objective of this study was to be able to distinguish between healthy skin tissue and malignant ones, furthermore determining a unique pattern of roughness for each skin lesion by microtopographic analysis of the skin surface of Mexican patients during the period from April to October 2002. The standard technique used in this study for the diagnosis of skin cancer and the comparison of the results was the haematoxylin-eosin histopathological technique. Latex impressions were taken from skin lesions as well as from the healthy skin of each patient to serve as control samples. These impressions were analysed by the MICROTOP.03.MFC microtopographic system inspection. It was observed that when the tumour becomes rougher, more malign will be the lesion. On average, the melanoma present an increase of roughness of 67% compared to healthy skin, obtaining a roughness relation of 1:2.54. The percentage decreases to 49% (49%, 1:60) in the case of basal cell carcinoma and to 40% in pre-malignant lesions such as melanocytic nevus (40%, 1:150). In benign lesions such as the seborrhoea keratosis only a small increase in roughness was noted (4%, 1:0.72). Microtopographic inspection of the skin surface can be considered as a complementary diagnostic technique for skin cancer.
Adolescent↗
Digital surface microscopy analysis of conjunctival pigmented lesions: a preliminary study.
The objective of this study was to investigate whether digital surface microscopy (DSM) could be used for the follow-up and comparison of malignant and benign conjunctival pigmented lesions (CPLs). Thirty-nine CPLs [16 de novo malignant melanomas (MMs), one MM arising from primary acquired melanosis (PAM), six PAMs and 16 naevi] were digitally analysed and biopsied. All of the PAMs and 10 naevi, which had not been surgically excised, were followed up using DSM. Thirty parameters were evaluated grouped into four categories: geometry, colour, texture and islands of colour. None of the CPLs that were followed up, which comprised 10 naevocytic naevi and seven PAMs, showed any morphological change at DSM analysis, except for one PAM which developed an MM 1 year later. Of the geometric variables examined, the area, maximum diameter and minimum diameter showed significantly higher values in MMs compared with benign CPLs. With regard to the colour of CPLs, MMs were significantly darker and bluer than naevi. In the texture group, contrast was significantly higher in MMs. In the islands-of-colour group, the imbalance of blue-grey regions and the presence of dark areas were significantly higher in MMs. DSM greatly simplified the follow-up of CPLs, such as PAMs with atypia, by providing satisfactory quality images with high reproducibility; this technique is also easy to use and well accepted by patients. Moreover, this preliminary study allowed us to determine which objective variables could be important for distinguishing between benign CPLs and conjunctival MMs.
Adolescent↗
Dermatoscopic and histopathological diagnosis of primary and metastatic melanoma: report of a workshop at the Third Research Meeting on Melanoma, Milan, Italy, May 2003.
The clinical and histopathological session of the Third Research Meeting on Melanoma, Milan, Italy, held in May 2003, highlighted several key topics, including clinical, dermatoscopic and computer-aided diagnosis and the use of immunohistochemical, immunological and biochemical approaches to diagnosis and monitoring. This report is a brief summary of the main themes covered.
Biomarkers, Tumor↗
Dermatoscopic differences between atypical melanocytic naevi and thin malignant melanomas.
Dermatoscopy is used to aid in the differential diagnosis of pigmented skin lesions. The aim of this study was to identify dermatoscopic differences between atypical melanocytic naevi and thin malignant melanomas. A set of 180 difficult cases (60 thin melanomas, 120 clinically atypical benign melanocytic naevi) was analysed. Differences in structure, distribution of pigmentation, presence or absence of important structures, total number of colours and asymmetry of the lesions were identified. The three-structure type, multifocal distribution of pigmentation, eccentric peripheral hyperpigmentation, multiple colours (three or more) and asymmetry of structures/colours in the dermatoscopic image were considerably more frequent in melanomas than in benign lesions (P<0.001, chi-squared test). No single dermatoscopic criterion exists to discriminate between all melanocytic lesions with sufficient confidence. Some criteria are helpful in the differential diagnosis and management of difficult cases.
Adolescent↗
Segmentation of psoriasis vulgaris images using multiresolution-based orthogonal subspace techniques.
In this paper, a method is proposed for the segmentation of color images using a multiresolution-based signature subspace classifier (MSSC) with application to psoriasis images. The essential techniques consist of feature extraction and image segmentation (classification) methods. In this approach, the fuzzy texture spectrum and the two-dimensional fuzzy color histogram in the hue-saturation space are first adopted as the feature vector to locate homogeneous regions in the image. Then these regions are used to compute the signature matrices for the orthogonal subspace classifier to obtain a more accurate segmentation. To reduce the computational requirement, the MSSC has been developed. In the experiments, the method is quantitatively evaluated by using a similarity function and compared with the well-known LS-SVM method. The results show that the proposed algorithm can effectively segment psoriasis images. The proposed approach can also be applied to general color texture segmentation applications.
Algorithms↗
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.
Adult↗
Pigment distribution in melanocytic lesion images: a digital parameter to be employed for computer-aided diagnosis.
BACKGROUND/PURPOSE: Since in early melanoma (MM) and especially in in situ MM differential structures, which are diagnostic for MM may be lacking, pigment distribution asymmetry represents an important diagnostic feature. Our aim was to automatically assess pigment distribution in images referring to MMs, atypical nevi (AN) and clearly benign nevi (BN), and to evaluate the diagnostic capability of numerical parameters describing a non homogeneous distribution of pigmentation. METHODS: An image analysis program enabling the numerical assessment of pigment distribution in melanocytic lesions (ML), based on evaluation and comparison of red, green, blue (RGB) colour components inside image colour blocks, was employed on 459 videomicroscopic digital images, referring to 95 MMs, 76 AN and 288 BN. RESULTS: Significant differences in pigment distribution parameters (mean RGB distance, variance and maximum distance) between the three ML populations were observed, permitting a good discrimination of MMs. On the test set comprising 230 lesion images, the area under the curve value of the receiver operating characteristic curve was 0.933. For a D score equal to 0, corresponding to the best diagnostic accuracy (86.6%), a sensitivity of 87.5% and a specificity of 85.7% were obtained. CONCLUSION: This original evaluation method for digital pigment distribution, based on mathematical description and comparison of colours in different image blocks, provides numerical parameters to be implemented in image analysis programs for computer-aided MM diagnosis.
Biomarkers, Tumor↗
Objective evaluation for severity of atopic dermatitis by morphologic study of skin surface contours.
BACKGROUND/AIMS: Wide variation in outcome methodology can make the interpretation of patient outcomes confusing and the comparison of the results of different studies almost impossible. It is important to objectively measure and record the severity of atopic dermatitis (AD) for routine clinical practice and research. The aim of this study was to evaluate whether morphologic study of skin surface contours might be helpful to objectively quantify the severity of AD. METHODS: Thirty atopic patients (12 females, 18 males) participated in this study. Moisturizer was applied twice daily for 2 weeks. Bioengineering methods such as D-Squame, corneometer, evaporimeter, and spectrophotometer were measured at the start of the study and after 1 week and 2 weeks. In addition, we assessed moisturizer effects after 3 h of moisturizer application.The stereoimage optical topometer (SOT) based on a new concept of stereoimage was applied for this study. We compared SOT, other bioengineering methods, and the severity scoring of atopic dermatitis (SCORAD) index. RESULTS: After 3 h of application with moisturizer, the results measured by SOT, conventional optical profilometer (COP), D-Squame, and corneometer showed significant differences (P<0.05). After 1 and 2 weeks, there were significant changes in the results measured by SOT, COP, D-Squame, corneometer, spectrophotometer, and SCORAD index. We observed a significant correlation between bioengineering methods and the SCORAD index (P<0.05). CONCLUSION: These data indicate that morphologic study of skin surface contours are useful in evaluating of AD severity. If we would combine methods to evaluate the physiologic changes and those such as SOT to measure the morphological changes of skin surface, we could evaluate more objectively and quantitatively the severity of AD.
Adolescent↗