Clinicodermoscopic and immunopathological profile of non-infectious non-eczematous inflammatory tattoo reactions: A retrospective study from a tertiary care centre of East India

Introduction: Tattoo-associated complications are on the rise due to the popularity of decorative tattoos in recent years. The exact pathogeneses of various tattoo reaction patterns are still unclear, and their dermoscopic details are sparsely reported. Aim: We aimed to retrospectively study the clinical, dermoscopic and immunopathological details of patients with non-infectious, non-eczematous inflammatory tattoo reaction patterns in a tertiary care centre of East India. Method: The clinical, dermoscopic and pathological details of all the patients who had non-infectious, non-eczematous inflammatory tattoo reactions were collected. In all the cases, immunohistochemistry was done for CD1a, CD3, CD4, CD8, FoxP3, CD20 and CD56. Results: A total of five patients of skin phototypes IV and V and six tattoo reactions were analysed. Five lesions had reactions at the site of a black tattoo, and one at the site of red tattoo. Clinically, the patients presented with erythematous or blue-grey flat-topped to verrucous papules and plaques. Dermoscopic features were dominated by a central white to pink-white structureless area, a peripheral grey-white to bluish-white structureless area, white scales, comedo-like opening with keratotic plugging, milia-like cysts and shiny white structures. Pathologically, except for one lesion that only showed a lichenoid reaction pattern in the red tattoo, all had a combination of reaction patterns. Immunohistochemistry showed increased epidermal and dermal Langerhans cells, predominantly CD8 positive T cells in the epidermis and dermis, sparse dermal B cells and CD4 positive T cells, reduced T regulatory cells and a complete absence of CD56 positive NK cells. Limitations: Small sample size was the limitation of the study. Conclusion: The clinical morphology and dermoscopy may not differentiate between various types of non-infectious non-eczematous inflammatory tattoo reactions. The immunological profile supports a delayed hypersensitivity reaction due to contact sensitisation to tattoo pigment, and CD8 positive T cells play a central role in executing various pathological reaction patterns, both in the epidermis and dermis

The role of mobile teledermoscopy in skin cancer triage and management during the COVID-19 pandemic

The unprecedented onset of the COVID-19 crisis poses a significant challenge to all fields of medicine, including dermatology. Since the start of the coronavirus outbreak, a stark decline in new skin cancer diagnoses has been reported by countries worldwide. One of the greatest challenges during the pandemic has been the reduced access to face-to-face dermatologic evaluation and non-urgent procedures, such as biopsies or surgical excisions. Teledermatology is a well-integrated alternative when face-to-face dermatological assistance is not available.Teledermoscopy, an extension of teledermatology, comprises consulting dermoscopic images to improve the remote assessment of pigmented and non-pigmented lesions when direct visualisation of lesions is difficult. One of teledermoscopy’s greatest strengths may be its utility as a triage and monitoring tool, which is critical in the early detection of skin cancer, as it can reduce the number of unnecessary referrals, wait times, and the cost of providing and receiving dermatological care. Mobile teledermoscopy may act as a communication tool between medical practitioners and patients. By using their smartphone (mobile phone) patients can monitor a suspicious skin lesion identified by their medical practitioner, or alternatively self-detect concerning lesions and forward valuable dermoscopic images for remote medical evaluation. Several mobile applications that allow users to photograph suspicious lesions with their smartphones and have them evaluated using artificial intelligence technology have recently emerged. With the growing popularity of mobile apps and consumer-involved healthcare, this will likely be a key component of skin cancer screening in the years to come. However, most of these applications apply artificial intelligence technology to assess clinical images rather than dermoscopic images, which may lead to lower diagnostic accuracy. Incorporating the direct-to-consumer mobile dermoscopy model in combin

Máculas melanóticas del pene. Presentación de un caso

Las máculas melanóticas del pene son lesiones idiopáticas, benignas, poco frecuentes, en ocasiones multifocales, heterocrómicas e irregulares, que deben diferenciarse del melanoma de mucosas. Se presenta el caso de un paciente con lesiones pigmentadas en el pene, asintomáticas, pero que se habían incrementado en número. Con la ayuda de la dermatoscopia y la histopatología, se llegó al diagnóstico de máculas melanóticas del pene. Aunque son reducidas las opciones terapéuticas en el medio descrito, la trascendencia del diagnóstico de esta dermatosis radica en descartar la posibilidad de su malignidad.

Melanotic macules of the penis are idiopathic, benign, rare lesions, sometimes multifocal, heterochromic and irregular, which must be differentiated from mucosal melanoma. A patient with asymptomatic pigmented lesions on the penis, but which had increased in number is presented. With dermoscopy and histopathology test, the diagnosis of melanotic macules of the penis was reached. Although the therapeutic options in the described environment are limited, the significance of this dermatosis diagnosis lies in ruling out the possibility of its malignancy.

Dermoscopic features of basal cell carcinoma in skin of color: A retrospective cross-sectional study from Puducherry, South India

Background: Dermoscopy is useful in the diagnosis of basal cell carcinoma (BCC). However, most descriptions of the dermoscopic features of BCCs are in Caucasians (skin types I-III) and there is a paucity of data in dark-skinned Indian patients. Aims: The aim of this study was to describe the various dermoscopic features of BCC in dark-skinned patients from South India and correlate these with the histopathologic subtypes. Methods: A retrospective observational study of biopsy-proven cases of BCC was conducted at a tertiary care center in South India using nonpolarized contact dermoscopy. Results: Sixty BCCs in 35 patients predominantly of skin phototypes IV or V were studied. These included 32 nodular, 27 superficial and 1 infiltrative type of BCC. The most common dermoscopic features noted were maple leaf-like areas (61.7%), blue-white veils (53.4%), ulceration (48.4%) and short fine telangiectases (46.7%). Ulceration, blue-white veils and arborizing vessels were significantly associated with nodular BCCs, while maple leaf-like areas, red-white structureless areas, multiple small erosions and spoke wheel areas were noted with superficial BCCs. Limitations: The limitations of this study include its retrospective nature, the use of only nonpolarized light for examination, the lack of other histopathological variants of BCC as well as the lack of a comparison group. Conclusion: We report a dermoscopic study of BCC in dark-skinned patients from Puducherry, South India. The blue-white veil was observed in half of the patients and was significantly associated with nodular BCCs. The addition of the blue-white veil to the diagnostic criteria for pigmented BCC could improve the diagnostic accuracy of dermoscopy in Indian patients.

Dermoscopy of cutaneous sarcoidosis: a cross-sectional study

Abstract Background Although traditionally used for the diagnosis of skin tumors, in the past few years dermoscopy as a clinical diagnostic aid for inflammatory and infectious skin manifestations has also received more and more attention. The clinical variability of cutaneous sarcoidosis (CS) often makes its correct diagnosis challenging. Dermoscopy can be used as an auxiliary examination method. Objective Our aim was to evaluate the role of dermoscopy in the diagnosis and differential diagnosis of CS. Methods This was a retrospective analysis of 39 CS clinical and dermoscopic images collected in the Department of Dermatology, Huashan Hospital Affiliated with Fudan University from August 2013 to February 2021. Results Retrospective dermoscopic evaluation revealed small grouped, translucent orange globular structures in all 39 cases. Variable diameter linear vessels were found in 38 cases. A central scar-like area was seen in 26 cases. Bright white streaks were seen in 30 cases. The follicular plugs were seen in 15 cases. Study limitations First, the number of cutaneous sarcoidosis cases the authors collected is small. Second, due to the lack of a control group, the sensitivity and specificity of the proposed criteria were not calculated. Finally, since our study mainly includes suspicious lesions that were biopsied for diagnostic purposes, there may be a selection bias. Conclusion Lesions showing on dermoscopy grouped translucent orange ovoid structures associated with linear vessels should raise the suspicion of CS. Central scar-like areas and bright white streaks are also helpful in the diagnosis of CS.

Description of the dermatoscopic features observed in sporotrichosis and American cutaneous leishmaniasis in a reference center in Rio de Janeiro, Brazil

Abstract Background The evaluation of American cutaneous leishmaniasis (CL) and sporotrichosis (SP) with dermoscopy may improve the diagnosis accuracy and clinical monitoring. Objectives To describe the dermoscopic findings and patterns of skin lesions of patients with CL and SP followed up at the Laboratory of Clinical Research and Surveillance in Leishmaniasis (LaPClinVigiLeish), Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation, Rio de Janeiro, Brazil. Methods The authors included patients with a diagnosis of CL or SP, who attended at INI/ Fiocruz, between 2019‒2021. All patients had 3 dermoscopic examinations (DermLite DL4): before treatment (T0), during treatment (T1), and after healing (T2). Up to three lesions per patient were evaluated. Results The authors studied 47 patients with CL (74 lesions), and 19 patients with SP (24 lesions). The authors described dermoscopic structures such as rosettes, white lines, white dots, brown focal structureless areas, brown lines and dots, white perilesional circles, perilesional hyperchromic circles, microulcerations and the rainbow patterns. The authors created specific patterns; in CL: CL-T0 "central yellow scales with a white perilesional circle pattern", CL-T1 "diffuse structureless white area pattern" and CL-T2 "white and brown focal structureless areas pattern". In SP: SP-T0 the "pustule with erythema pattern"; SP-T1 the "focal structureless white areas with erythema pattern" and SP-T2 the "white linear pattern". Study limitations This study does not correlate dermoscopic findings with time of disease evolution at the first medical examination. Conclusions The recognition of CL and SP dermoscopy patterns may be helpful tool for the differential diagnosis and monitoring of disease evolution.

Dermoscopy of very small basal cell carcinoma (≤3 mm)

Abstract Background Basal cell carcinoma (BCC) dermoscopy is key to lower the biopsy threshold of suspicious lesions. There is a scarcity of published data on the dermoscopy of very small BCC (≤3 mm) and its differences from larger BCCs. Objective To describe and compare dermoscopic features of BCCs measuring ≤3 mm, with those from 3 to 10 mm. Methods An analytical cross-sectional study, included biopsy-proven BCCs that had dermoscopic photographic images, between January 2017 and December 2022 in a Skin Cancer Center in Medellín, Colombia. Demographic, clinic-pathological and dermoscopic features were compared between very small BCCs (vsBCCs) and a reference group. Results A total of 326 BCCs in 196 patients were included, of whom 60% were male. The most common Fitzpatrick phototype was III. vsBCCs accounted for 25% of the lesions (81/326). Face and neck were the most frequent locations (53%), especially in very small tumors. The nodular type was more common in very small tumors than in larger lesions, the superficial type was less frequent, and aggressive types were equally prevalent in both groups. On dermoscopy, very small tumors were statistically more likely to present pigmented structures than reference lesions, especially blue-gray dots (67% vs. 54%), vessels were less frequent, particularly short-fine telangiectasias (SFT) (52% vs. 66%), as were other structures such as shiny white structures (SWS), ulceration, micro-erosions, and scales. Study limitations Latin-American sample, lacks information on dark phototypes Conclusions Pigmented structures, especially blue-gray dots, were most common in vsBCCs when compared to larger lesions; SFT, SWS and other findings were less prevalent.

Dermoscopy of annular elastolytic giant cell granuloma

Abstract Annular elastolytic giant cell granuloma is an uncommon granulomatous cutaneous disease that usually affects sun-exposed skin. Non-scarring alopecia is a possible presentation. Although histopathology is mandatory for the diagnosis, dermoscopy may help to narrow down the clinical differential diagnosis. The authors report a case of annular elastolytic giant cell granuloma in the scalp of a female adult patient, showing multiple yellowish/orange follicular dots in a diffuse erythemato-whitish background in the dermoscopy.

The use of dermoscopy in distinguishing the histopathological subtypes of basal cell carcinoma: A retrospective, morphological study

Background: The role of dermoscopy in distinguishing the histopathological subtypes of basal cell carcinoma (BCC) is not fully elucidated. Aims: To determine the accuracy of dermoscopy in diagnosing different BCC subtypes. Methods: The dermoscopic features of 102 histopathologically verified BCCs were studied retrospectively. The tumours were classified as superficial (n=33,32.3%), nodular (n=46,45.1%) and aggressive (n=23,22.6%) BCCs by histopathology. Statistical analysis included Cohen’s kappa test, proportion of correlation, measures of diagnostic accuracy, diagnostic odds ratio and the credibility ratio of positive (LR+) and negative (LR?) tests. Results: The highest value in all performed tests was seen in superficial BCCs (kappa 0.85; proportion of correlation 93%; diagnostic accuracy 93.1%), good correlation was noted in nodular BCCs (kappa 0.62, proportion of correlation 80%; diagnostic accuracy 80.4%) but dermoscopic correlation with histopathology was low for aggressive BCCs (kappa 0.13; proportion of correlation 79%; diagnostic accuracy 78.4%). Short, fine telangiectasias (83.3%) showed the greatest importance for the diagnosis of superficial BCCs, blue-grey ovoid nests (61.8%) had the highest diagnostic accuracy in nodular BCCs, while arborising vessels (79.4%) was the most significant dermoscopic feature for the diagnosis of aggressive BCCs. Limitations: This was a retrospective analysis and included only Caucasian patients from a single centre. Conclusion: The highest agreement of dermoscopic features with the histologic type was found in superficial BCCs. We did not find any specific dermoscopic structure that could indicate a diagnosis of aggressive BCC. The presence of relevant dermoscopic features in the evaluated cases was determined by the depth of tumour invasion and not by its histology

Darier disease: the use of dermoscopy in monitoring acitretin treatment

Abstract Darier disease is an uncommon autosomal dominant inherited disease, caused by a mutation in the ATP2A2 gene. The clinical findings are hyperkeratotic papules on the trunk, scalp, face, and neck, maceration of intertriginous areas, palmar pits, whitish papules on the oral mucosa and nail abnormalities. The main histopathologic findings are acantholysis and dyskeratotic keratinocytes. Dermatoscopic features are comedo-like openings with a central polygonal yellowish/brownish structure, surrounded by a whitish halo. First-line treatment includes acitretin. Five reports have been published describing Darier disease dermatoscopic findings. Herein, we report for the first time a patient under acitretin treatment and dermatoscopic follow-up.

Predictive factors of melanoma thickness

Abstract Background: Melanoma thickness is a relevant prognostic marker that is crucial for staging and its calculation relies on the histopathological examination. There is a risk of thickness underestimation with an incisional biopsy if the latter is not performed on a tumor area where the thickness is maximal. This occurrence may have an impact on a therapeutic decision, particularly regarding the excision margins and the need for sentinel lymph node biopsy. Objective: To assess the association between melanoma thickness and dermoscopic, demographic, epidemiological and clinical variables, aiming to identify predictive factors of thickness >1 mm. Methods: This was an observational and cross-sectional study, carried out on patients diagnosed with melanoma, from a single center over a time span of four years. Anatomopathological (thickness), dermoscopic, demographic, epidemiological, and clinical variables were collected. The associations between the variables with melanoma thickness were assessed. Results: A total of 119 patients were included. The presence of atypical vessels on the dermoscopic examination was an independent predictive factor of thickness >1 mm. Conversely, an atypical reticular pattern predicted melanoma thickness <1 mm. The presence of ephelides and a previous history of sunburn were also associated with melanomas thinner than 1 mm in the univariate analysis. Study limitations: The lack of data related to some variables and the absence of an optimal correlation between the dermoscopic and the anatomopathological examination constituted study limitations. Conclusion: An atypical vascular pattern on dermoscopy is associated with thickness >1 mm, helping with the choice of the optimal site to perform an incisional biopsy when an excisional biopsy is not feasible.

Melanoma nodular amelanótico: a propósito de un caso / Amelanotic nodular melanoma: a case report

RESUMEN Introducción: El melanoma es un tumor maligno de estirpe melanocítica que constituye el sexto cáncer más frecuente en la población general y tiene una alta capacidad para producir metástasis. Aproximadamente el 95% de los melanomas primarios pertenecen a cuatro tipos clínico-patológicos: extensivo superficial, nodular, lentigo maligno y lentiginoso acral. El 5% restante corresponde a variantes menos frecuentes entre las que se encuentra el melanoma amelanótico, que representa entre el 0.4-27.5% de los casos de este subgrupo. Objetivo: Presentar un caso de un melanoma amelanótico, como una variante que puede acompañar a cualquier otro tipo clínico de melanoma, en este caso a uno de tipo nodular,lesión que, debido a su disminución o ausencia de pigmento, puede conducir a errores diagnósticos que inciden en la demora en el tratamiento y reducen la sobrevida de los pacientes que lo padecen. Caso Clínico: Se presenta el caso de un paciente de sexo masculino de 75 años que acude por presentar una lesión tumoral exofítica en la frente, de aproximadamente un año de evolución. Al examen físico se observa la lesión tumoral cupuliforme, eritematosa y brillante, que bajo dermatoscopio de luz polarizada muestra un patrón vascular polimorfo a predominio de vasos lineales gruesos. Se plantean varios diagnósticos diferenciales entre los que se destacan: carcinoma basocelular, granuloma piógeno, linfoma y metástasis cutáneas; se realiza una toma de muestra para biopsia y técnicas de tinción con inmunohistoquímica, que confirman el diagnóstico de melanoma, se decide exéresis de la tumoración con márgenes y seguimiento multidisciplinario del caso. Conclusiones: Las variantes hipo/amelanóticas del melanoma son poco frecuentes y su diagnóstico presenta dificultades que suelen generar demoras que influyen en el tratamiento y pronóstico de la enfermedad. La dermatoscopía se presenta como una herramienta sumamente útil que puede aumentar la sospecha diagnóstica de estos tumores, aunque el estudio histopatológico continúa siendo el patrón de referencia para el diagnóstico, así como para el abordaje terapéutico y seguimiento ulteriores.

ABSTRACT Introduction: Melanoma is a malignant melanocytic tumor that constitutes the sixth most frequent cancer in the general population and has a high capacity to produce metastasis. Approximately 95% of primary melanomas belong to four clinicopathological types: extensive superficial, nodular, lentigo maligna, and acral lentiginous. The remaining 5% correspond to less frequent variants, among which is amelanotic melanoma, that represents between 0.4-27.5% of the cases in this subgroup. Objective: To present a case of an amelanotic melanoma, as a variant that can accompany any other clinical type of melanoma, in this case a nodular type, a lesion that, due to its decrease or absence of pigment, can lead to diagnostic errors that affect the delay in treatment and reduce the survival of patients who suffer from it. Clinical Case: The case of a 75-year-old male patient who presents with an exophytic tumor lesion on the forehead of approximately one year of evolution. Physical examination reveals a bright, erythematous, dome-shaped tumor which shows a polymorphous vascular pattern with a predominance of thick linear vessels under a polarized light dermatoscope. Several differential diagnoses are proposed, among which the following stand out: basal cell carcinoma, pyogenic granuloma, lymphoma, and skin metastases; a sample is taken for biopsy and staining techniques with immunohistochemistry, which confirm the diagnosis of melanoma, it is decided to excise the tumor with margins and multidisciplinary follow-up of the case. Conclusions: The hypo / amelanotic variants of melanoma are rare and their diagnosis presents difficulties that usually generate delays that influence the treatment and prognosis of the disease. Dermoscopy is presented as an extremely useful tool that can increase the diagnostic suspicion of these tumors, although the histopathological study continues being the gold standard for diagnosis, as well as for the therapeutic approach and subsequent follow-up.

Dermoscopic criteria of discoid lupus erythematosus: An observational cross?sectional study of 28 patients

Background: Discoid lupus erythematosus (DLE) affects mainly the head and neck and lesions heal with scaring. Early diagnosis of DLE is crucial; dermoscopy may enable early diagnosis and help to assess the prognosis of well-established lesions. Aims: To describe the dermoscopic features of DLE and to correlate them with the histological findings, site and duration of DLE. Material and Method: This study included 28 patients diagnosed as DLE based on clinical and histopathological examination. We examined the lesions clinically, dermoscopically and histopathologically. Evaluated dermoscopic variables were based on data in the available literature and on our observations. Results: Whitish scales (89.3%), arborizing blood vessels (85.7%), follicular plugging (82.1%), and pigmentation (82.1%) were the commonest dermoscopic findings. Radial arrangement of arborizing blood vessel in between a radially arranged perifollicular whitish halo (starburst pattern) (39.3%) was noticed for the first time in this study. Rosettes (57.1%) were also seen. There was significant agreement between many dermoscopic and pathological findings with high sensitivity and specificity of many dermoscopic variants in the diagnosis of DLE. Follicular plugging, perifollicular whitish halo, starburst pattern, follicular red dots and rosettes were detected in early stages of the disease but structureless whitish areas and telangiectasia need more time to develop. Limitations: We examined our patients at the time of presentation only without prospective monitoring and we had a relatively small sample size. Conclusion: Dermoscopy helps in the diagnosis of DLE at different body sites

In vivo reflectance confocal microscopic findings in a case of trichofolliculoma

Abstract Trichofolliculoma is a rare follicular hamartoma whose dermoscopic features have been scarcely reported. On the other hand, reflectance confocal microscopy features have not been described yet. In the present study, the authors report reflectance confocal microscopy features in a case of trichofolliculoma as squamous hyperplasia forming irregular finger-like protrusions around the hair follicle and papillomatous hyperplasia of the hair follicle epithelium, which correlated with histopathology. This case suggests that reflectance confocal microscopy may help incorrect in vivo diagnosis of trichofolliculoma in cases difficult to diagnose by morphology and dermoscopy.

Dermoscopy of topical steroid-dependent or damaged face: A cross-sectional study

Background: Topical corticosteroid (TCS) abuse is rampant and results in steroid addiction labeled as topical steroid-dependent or damaged face (TSDF). Indian market is replete with triple combination creams containing TCS sold as over-the-counter products at low cost, luring people to use them without prescription. The resultant damage if detected late is irreversible and difficult to treat. Dermoscopy can help in the early identification of features of TSDF at a preclinical stage resulting in better prognosis. However, the literature on the same is limited. Aims: This study is undertaken to characterize dermoscopic features of TSDF and to correlate them with potency and duration of application of the TCS. Methods: One hundred and thirty-two patients aged 18 years or above, with clinical symptoms and signs suggestive of TSDF and with history of application of TCS on the face for a period of more than one month, were enrolled in the study. Their demographic details, clinical features, and dermoscopy findings were recorded using a predesigned structured format. Comparison of dermoscopic findings with clinical examination, gender, potency of TCS, and duration of TCS use was done using Chi-square test, Fisher’s exact test, and one-tailed Z-test. Results: Mean age of the patients was 31.7 ± 8.1 years. Male to female ratio was 2:9. Sixty-nine (52.3%) patients abused TCS for more than one year. Clinical findings noted in the patients were erythema (81.1%), hyperpigmentation (80.3%), and hypertrichosis (68.2%). The most common dermoscopy findings seen were brown globules (96.2%), red diffuse areas (92.4%), vessels (87.1%), white structureless areas (86.4%), and hypertrichosis (80.3%). Red diffuse areas, vessels, brown globules, white structureless areas, and white hair were observed in a statistically higher proportion of cases dermoscopically. Y-shaped vessels and brown globules were seen in significantly higher number of patients, using TCS for more than three months and in those continuing it beyond six months, polygonal vessels were predominant. Limitations: Lack of histopathological correlation is the limitation of our study. Furthermore, brown globules seen in 96.2% patients of TSDF on dermoscopy may have been over-estimated and not always signify TSDF; instead, it could represent melasma for which patient applied TCS. Conclusion: Dermoscopy in TSDF can help dermatologists in a multitude of ways from confirming the diagnosis to differentiating from other causes of red face and predicting the approximate duration of TCS abuse.

A very rare localization of a rare disease: palmar lichen nitidus

Abstract Lichen nitidus is an uncommon lichenoid dermatosis that could be defined as multiple, separated, shiny, pinpoint, pale to skin-colored papules. Palmoplantar lichen nitidus is a quite rare variant of lichen nitidus. It is hard to make a diagnosis of palmar lichen nitidus when there are no lesions elsewhere on the body. There are some dermoscopic features defined for both palmoplantar and non-palmoplantar lichen nitidus that might be useful to facilitate the diagnosis before histopathological examination. Herein, we report a case of a 24-year-old man diagnosed with isolated palmar lichen nitidus with dermoscopic features and histopathological confirmation.

Acurácia da teledermatoscopia móvel na avaliação de lesões cutâneas pigmentadas / The accuracy of mobile teledermatoscopy in the assessment of pigmented skin lesions

Neste estudo transversal, comparamos o diagnóstico feito por meio da teledermatoscopia ao diagnóstico histopatológico. Fotos convencionais e dermatoscópicas de 31 lesões pigmentadas foram enviadas a um dermatologista experiente por meio do aplicativo WhatsApp® Messenger. Todas as lesões foram excisadas e examinadas por um dermatopatologista. A acurácia global da teledermatoscopia móvel foi de 90,32%. Em relação à capacidade de a teledermatoscopia definir malignidade da lesão pigmentada, a especificidade foi de 81,8% e a sensibilidade de 100%. Nossos resultados fornecem evidências adicionais sobre a confiabilidade da teledermatoscopia móvel, com alta sensibilidade e precisão.

In this cross-sectional study, we compared the diagnosis made through teledermatoscopy with histopathological diagnosis. Conventional and dermoscopic photos of 31 pigmented lesions were taken and sent to an experienced dermatologist using the WhatsApp® Messenger application. A dermatopathologist excised and examined all lesions. The global accuracy of mobile teledermatoscopy was 90.32%. Regarding the ability of teledermatoscopy to define malignancy of the pigmented lesion, the specificity was 81.8% and the sensitivity was 100%. Our results provide additional evidence of the reliability of mobile teledermatoscopy with high sensitivity and accuracy.

Melanoma amelanótico acral / Acral amelanotic melanoma

O melanoma amelanótico acral é raro e pode mimetizar muitas entidades, como poroma écrino, carcinoma de células escamosas, verruga plantar e úlceras crônicas. Devido a esta variedade de possíveis diagnósticos diferenciais, é um diagnóstico difícil e, muitas vezes, tardio. As características da dermatoscopia podem ajudar no diagnóstico precoce. O clínico deve ter esse diagnóstico em mente ao se deparar com uma lesão rosada, de crescimento progressivo e formato irregular, principalmente se localizada nas mãos e nos pés.

Acral amelanotic melanoma is rare and can mimic many entities, such as eccrine poroma, squamous cell carcinoma, plantar wart, and chronic ulcers. Due to the variety of possible differential diagnoses, it is a challenging and frequently late diagnosis. Dermoscopy features can help in early diagnosis. The dermatologist should keep this diagnosis in mind when faced with a pink, progressively growing, irregularly shaped lesion, mainly if located on the hands and feet.

Nevo azul agminado sobre cicatrizes de acne: coincidência ou relação fisiopatológica? / Agminated blue nevus over acne scars: coincidence or pathophysiological relationship?

Nevo azul é uma lesão benigna originada de melanócitos dérmicos contendo grande quantidade de melanina. A variante agminada apresenta-se como um agrupamento de lesões de nevo azul com distribuição linear ou blaschkoide. Relatamos dois casos de pacientes com nevo azul agminado que surgiu sobre cicatrizes prévias de acne, sendo a dermatoscopia de grande auxílio para diagnóstico diferencial. Esta é a primeira ocorrência relatada de nevo azul agminado sobre cicatrizes prévias, o que pode ter ocorrido ao acaso ou em decorrência do processo de remodelamento do colágeno, próprio do processo cicatricial.

Blue nevus is a benign lesion arising from dermal melanocytes containing large amounts of melanin. The agminated variant presents a cluster of blue nevus lesions with linear or blaschkoid distribution. We report two cases of patients with agminated blue nevus that developed on previous acne scars, and dermoscopy helped a lot in the differential diagnosis. This is the first occurrence found in the literature of agminated blue nevus that appeared on a previous scar,

Rosetas em angiossarcoma cutâneo: uma nova pista dermatoscópica / Rosettes in cutaneous angiosarcoma: a new dermoscopic clue

O angiossarcoma cutâneo é um câncer raro, de mau prognóstico, que acomete principalmente idosos do sexo masculino. Está relacionado à exposição solar crônica, linfedema crônico e procedimentos com uso de radiação. Relatamos o caso de um homem de 62 anos com presença de tumoração violácea de crescimento progressivo na região temporal esquerda. A dermatoscopia demonstrou áreas eritematosas de diferentes tons, estruturas semelhantes à pseudo-aberturas foliculares e rosetas. A biópsia e a análise imunohistoquímica confirmaram o diagnóstico de angiossarcoma cutâneo. O paciente atualmente está em tratamento quimioterápico no serviço de oncologia com melhora significativa da lesão.

Cutaneous angiosarcoma is a rare cancer with a poor prognosis that affects mainly elderly men. It is related to chronic exposure to sunlight, chronic lymphedema, and procedures using radiation. We report a case of a 62-year-old man with a progressively growing violaceous tumor in the left temporal region. Dermoscopy showed erythematous areas of different shades, pseudo-follicular openings structures, and rosettes. The biopsy and the immunohistochemical study confirmed the diagnosis of cutaneous angiosarcoma. The patient is currently undergoing chemotherapy treatment in the oncology service with significant improvement of the lesion.