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PubMed2000

Hypoluminescence microscopy of pigmented skin lesions.

Since the 'renaissance' of epiluminescence microscopy (ELM), histological correlation of ELM structures has been the subject of many investigations. Direct correlation is difficult because of the methodological differences between ELM and histopathology. In order to further understand the features of pigmented skin lesions (PSLs), we studied whether hypoluminescence microscopy (HLM) had any advantages over ELM. Twenty pigmented skin lesions scheduled for surgical excision were chosen randomly for this study. After excision, the lesions were studied using standard ELM and an HLM technique. For the latter, illumination was performed from the dermal side. The HLM pattern was clearly different from that of ELM. In all lesions the 'deeper' (dermal) structures became more visible. Some structures already visible in ELM appeared more visible, particularly structures apparently localized in deeper layers of the PSL. For highly pigmented lesions the difference in the two approaches was striking. With the HLM technique details became visible, and structures which were hardly or not visible with the classic ELM approach could be easily distinguished and evaluated. In conclusion, HLM is a simple, easy to use, reproducible ex vivo technique that is able to provide additional information to the conventional ELM technique.

Diagnosis, Differential↗
PubMed2004

Community perceptions of suspicious pigmented skin lesions: are they accurate when compared to general practitioners?

Community responses (n=925, response rate=71%) of a series of eight photographs of pigmented skin lesions were compared against those of general practitioners (n=114, response rate=77%), considered to be the most relevant gold standard. The eight photographs included three melanomas, two potentially malignant lesions and three benign pigmented lesions. Over the pool of lesions examined, the average probability that community members thought a lesion was likely to be skin cancer (0.68 [99% CI=0.66-0.69]) was higher (p<0.0001) than that of the comparison general practitioners 0.58 [99% CI=0.55-0.62]. This reflects a general (but not consistent) inflated propensity to over-diagnose among community members. The average probability that respondents indicated they would seek medical advice for a lesion was 0.71 [99% CI=0.70-0.73]. As expected, this was strongly associated with their perceptions of the skin lesion. These results suggest that the community can play a valuable role in assessing the need for medical evaluation of pigmented skin lesions.

Adolescent↗
PubMedDate not supplied

Improvement of the diagnostic accuracy in pigmented skin lesions by epiluminescent light microscopy.

Epiluminescent light microscopy (ELM) represents a technique which permits to examine details of the surface of the skin and also--in by using the oil immersion technique--of the dermal-epidermal junction zone. Criteria are described which allow the distinction of benign from malignant growth patterns of pigmented skin lesions; thus ELM adds considerably to the diagnostic armamentarium of pigmented skin lesions at the clinical level.

Humans↗
PubMed1989

[Treatment of pigmented skin lesions with argon laser irradiation].

The article gives an account of material concerning treatment of 60 patients with pigmented lesions of the skin (capillary hemangiomas, pigmented nevus, tattoos) by exposure to argon laser radiation. The optimal regimens and doses of laser radiation for discoloration of pigmented skin lesions are stated. Methodological recommendations for applying three methods fo laser treatment of extensive capillary hemangiomas are suggested. The method used by the authors for treating pigmented skin lesions produced good and satisfactory cosmetic results in 95% of cases.

Hemangioma↗
PubMed1985

Neuroleptic-induced skin pigmentation in chronic hospitalized schizophrenic patients.

In the framework of a multi-national collaborative study carried out in eight countries, 768 chronic hospitalized schizophrenic patients were surveyed. Skin pigmentation was found to be present in 13 patients (1.7%), that is, within the same range (1-2.9%) of the initial reports. While the mean age and mean duration of hospitalization in the skin-pigmented population was slightly higher and larger than in the total population of our survey, no definitive relationships between sex, diagnosis, drugs and dosage of medication were revealed.

Adult↗
PubMed2002

Characterizing reactive hyperemia via tissue reflectance spectroscopy in response to an ischemic load across gender, age, skin pigmentation and diabetes.

PURPOSE: Pressure ulcers represent a major secondary complication for amputees with diabetes and further complications may arise since ulcers are particularly hard to heal in this population. This study characterized the hyperemic response to a localized ischemic load in people with diabetes and amputation and compared it to that of subjects without diabetes or amputation. SUBJECTS: Case-control study matching subjects by gender, age, skin pigmentation, and smoking status. METHODS: Applying 150 mmHg to the patellar tendon for 10 minutes induced reactive hyperemia (RH). Tissue reflectance spectroscopy measured hemoglobin (HbO(2)) concentration in tissue before, during and after application of pressure. Refill time, Maximum HbO(2), Time@Max HbO(2), RH area and RH half-life characterized the RH response and were analyzed using ANOVA. All values up to a level of p <0.1 are presented. RESULTS: Analysis included responses from 88 subjects. RH magnitude and temporal parameters varied across skin pigmentation; smokers showed a decreased RH magnitude; vasodilator users had greater RH temporal parameters; no evidence of differences were found across disease state or age. CONCLUSION: Decreased RH response in smokers and subjects with dark skin might indicate a reduced ability to recover from ischemia. The lack of difference in RH response between subjects with and without diabetes was consistent with studies using other disability groups and corroborates the theory that RH is locally mediated.

Adult↗
PubMedDate not supplied

Proliferative activity in the progression of pigmented skin lesions, diagnostic and prognostic significance.

Proliferative compartments of a tumour can be determined cytophotometrically, by in situ hybridisation or by immunohistochemical detection of Ki67 antigen. The main objective of this study was to analyse the proliferative activity during the progression of pigmented skin lesions with respect to differential diagnostic and prognostic applications. The material investigated consisted of 209 pigmented skin lesions (31 naevi, 30 dysplastic naevi, 106 primary melanomas, 20 lymphatic and 22 organ melanoma metastases). Comparison of the ratios of cells in the S-phase gained by two different methods (cytometry, in situ hybridisation) did not show any significant differences. The correlations between Ki67 and S-phase indices in every diagnostic group were highly significant. The results of forward and backward Cox regression were identical and only Ki67 showed an independent prognostic influence (p < 0.001, coefficient in regression 0.02) with change in risk 2% and confidence limit ranging between 1.1% and 2.9%.

Adolescent↗
PubMed1981

[Two cases of skin pigmentation in association with minocycline therapy (author's transl)].

Report of two cases of skin pigmentation during minocycline therapy. Examination showed confluent blue-gray oval patches on the anterior part of the legs, occurring after ingestion of respectively 12 g and 100 g of minocycline. Microscopic examination of each case was identical and showed two lesions: increase in the amount of melanine deposition in the basal layer of the epidermis; presence of brown-black pigment at all the level of the dermis but specially near the sweet glands. This pigment was strongly positive with Perls' stain. Electron microscopic examination showed a finely granular pigment exclusively intracellular in dermis fibroblast and macrophage. This pigment seemed to contain mainly hemodiderine.

Hemosiderin↗
PubMed2004

Pressure ulcer risk assessment in patients with darkly pigmented skin.

Traditionally, nurses have been taught to look for areas of skin redness as the first signs of pressure damage to a patient's skin. However, in patients with black skin many early signs of damage may not be so visible. This paper describes the holistic approach nurses should take to assessing a person with darkly pigmented skin for pressure damage.

Black People↗
PubMed2006

Topical application of gamma-tocopherol derivative prevents UV-induced skin pigmentation.

We previously reported that a novel hydrophilic gamma-tocopherol (gamma-Toc) derivative, gamma-tocopheryl-N,N-dimethylglycinate hydrochloride (gamma-TDMG) gets converted to the antioxidant gamma-Toc in skin. We also found that this derivative displayed greater bioavailability than gamma-Toc itself. In the present study, we determined whether gamma-TDMG could reduce UV-induced skin pigmentation in brownish guinea pigs. gamma-TDMG (0.1 or 0.5%) was topically applied to the skin before and after it was exposed to UVB plus UVA (3 times/week for 1 week), and then 10 times/week for 4 weeks thereafter. Treatment with 0.5% gamma-TDMG resulted in significant skin lightening (70% of the pigmentation of irradiated controls). We also found that melanin synthesis was dose-dependently inhibited by gamma-TDMG in murine B16 melanoma cells. When gamma-TDMG or kojic acid (250 microM) were added to homogenates of B16 melanoma cells, their tyrosinase activity was significantly inhibited by approximately 40% and 75%, respectively. Mushroom tyrosinase activity was significantly inhibited by 200 microM gamma-Toc and kojic acid, but not gamma-TDMG. When B16 cells were incubated with 250 microM gamma-TDMG for 24 or 48 h, their intracellular gamma-Toc concentrations rose over 100 fold to 10.5 and 11.2 nmol/10(6) cells, respectively, suggesting that gamma-TDMG was rapidly converted to gamma-Toc in these cells and that their reduced melanin synthesis may have been due to the activity of gamma-Toc. Our data further suggest that the topical application of gamma-TDMG may be efficacious in preventing photo-induced skin pigmentation in humans.

Administration, Topical↗
PubMed1998

Epiluminescence microscopy versus clinical evaluation of pigmented skin lesions: effects of Operator's training on reproducibility and accuracy. Dermatology and Venereology Society of the Canton of Ticino.

BACKGROUND: An acceptable level of reliability is a prerequisite for the introduction of epiluminescence microscopy (ELM) into the diagnosis of pigmented skin lesions. OBJECTIVE: To assess the effects of a training program on the reproducibility and accuracy of ELM as compared to clinical evaluation. METHODS: Before and after the program, 48 clinical images and their ELM counterparts were independently evaluated by seven participants. Reproducibility was measured by the kappa index, accuracy by the rate of exact diagnoses (RED) assuming histology as a reference. RESULTS: We observed (i) no effect of training on clinical reproducibility, (II) an improved reproducibility of ELM diagnoses of non-melanocytic lesions (NML) and melanomas but not of melanocytic nevi (MN), (iii) a greater increase in the clinical RED of NML and melanomas compared with MN and (iv) a similar though more pronounced increase in the RED on ELM. CONCLUSIONS: The effects of training were greater for ELM as compared to clinical diagnosis, and for NML and melanomas as compared to MN.

Dermatology↗
PubMed2004

Ancestral proportions and their association with skin pigmentation and bone mineral density in Puerto Rican women from New York city.

Hispanic and African American populations exhibit an increased risk of obesity compared with populations of European origin, a feature that may be related to inherited risk alleles from Native American and West African parental populations. However, a relationship between West African ancestry and obesity-related traits, such as body mass index (BMI), fat mass (FM), and fat-free mass (FFM), and with bone mineral density (BMD) in African American women has only recently been reported. In order to evaluate further the influence of ancestry on body composition phenotypes, we studied a Hispanic population with substantial European, West African, and Native American admixture. We ascertained a sample of Puerto Rican women living in New York ( n=64), for whom we measured BMI and body composition variables, such as FM, FFM, percent body fat, and BMD. Additionally, skin pigmentation was measured as the melanin index by reflectance spectroscopy. We genotyped 35 autosomal ancestry informative markers and estimated population and individual ancestral proportions in terms of European, West African, and Native American contributions to this population. The ancestry proportions corresponding to the three parental populations are: 53.3+/-2.8% European, 29.1+/-2.3% West African, and 17.6+/-2.4% Native American. We detected significant genetic structure in this population with a number of different tests. A highly significant correlation was found between skin pigmentation and individual ancestry ( R(2)=0.597, P<0.001) that was not attributable to differences in socioeconomic status. A significant association was also found between BMD and European admixture ( R(2)=0.065, P=0.042), but no such correlation was evident with BMI or the remaining body composition measurements. We discuss the implications of our findings for the potential use of this Hispanic population for admixture mapping.

Aged↗
PubMed1993

[Amiodarone-induced skin pigmentation].

Amiodarone (Cordarone) is used in the treatment of cardiac arrhythmias. A blue-grey skin pigmentation appears after long term use or a high concentration of amiodarone. Two cases are described. Histopathological findings of skin punch biopsies from the face showed collections of yellow-brown granula pigment within histiocytes throughout the dermis. Sunlight initiates accumulation of the pigment. It is recommended to use sunprotection to avoid the pigmentation.

Aged↗
PubMed2002

Laypersons' perceptual discrimination of pigmented skin lesions.

BACKGROUND: Most cutaneous malignant melanomas of the skin are visible and should, at least in theory, be possible to detect with the naked eye. OBJECTIVE: This study was conducted to learn more about laypersons' ability to discriminate between benign pigmented lesions and malignant ones. METHODS: Four groups of laypersons (n = 120) were asked to evaluate pictures of different types of pigmented skin lesions, before and after they received information about the ABCD (asymmetry, border irregularity, color variegation, and diameter greater than 6 mm) criteria, with respect to the necessity of action. RESULTS: The respondents made adequate assessments of melanomas but overestimated the danger of benign pigmented skin lesions. Information about the ABCD criteria enhanced their ability to make adequate assessments. CONCLUSION: People seem to make adequate decisions concerning how to act if they have a melanoma. On the other hand, common moles and dysplastic nevi were harder to discriminate. Providing information to the public about the features of melanomas, in accordance with the ABCD criteria, might help laypersons in their perceptual discrimination of skin lesions.

Analysis of Variance↗
PubMed2003

[Comparison of two measurement methods with a gold standard as applied to 20-MHz-sonography and clinical palpation for ascertaining the thickness of pigmented skin tumours].

AIM: This paper focuses on different statistical methods for comparing two measurement methods with an additionally available gold standard. A given data example is used as the basis of the calculations. METHOD: We provide a complementary statistical analysis of a study presented by Hoffmann et al. on sonometric and palpatory measurements of the size of pigmented skin tumours in 681 patients. RESULTS: For comparing two measurement methods with respect to a gold standard, several statistical parameters assessing one measurement method can be used. In addition, there are further descriptive and some inference-statistical methods available. CONCLUSION: If there is a suitable categorization of the measurements, the comparison of the methods should be performed using the positive predictive values and kappa coefficients as descriptive measures. Moreover, the McNemar test can be used for comparing the differential accuracy of allocation. When investigating continuous measurements, a comparison using mere correlation analyses can lead to false conclusions. Therefore, we recommend the direct analysis of the individual measurement errors by means of numerical and graphical representations. The absolute values of the measurement errors can be compared using the sign test for paired samples.

Biometry↗
PubMed1995

Visual discrimination of pigmented skin lesions.

Three experiments explored human performance in discrimination of pigmented skin lesions from photographic slides. Experiment 1 showed that latent ability in identifying early melanoma was low, and some benign lesions tended to be falsely identified as serious. Performance overall did not decline when viewing time was reduced, suggesting that judgments could be made on the general appearance of lesions. Experiment 2 showed that enlargement of stimuli had no effect. Experiment 3 showed that performance was better with pictorial examples than with written descriptions for some classes of lesion, but for melanoma performance improved with longer viewing time when information was provided, suggesting that an opportunity to scrutinize could be beneficial. Guidelines to the public should distinguish melanoma from benign lesions and stress the importance of seeking prompt medical attention for suspicious lesions.

Adolescent↗