[Dermoscopy in special locations : Nails, acral skin, face, and mucosa]. / Dermatoskopie in Sonderlokalisationen : Nägel, akrale Haut, Gesicht und Mukosa.

The use of dermoscopy by dermatologists across Europe has become a standard examination for benign and malignant skin lesions and increasingly also for inflammatory skin diseases. However, based on the experience of the authors from numerous dermoscopy courses, knowledge about important dermoscopic features in special locations such as mucosa or nails is often limited. This may be explained by (1) a different anatomy of the skin and its adnexa in special locations in comparison to the remaining integument, (2) difficult technical access to special locations with a dermatoscope, and (3) a rather low incidence of malignant skin neoplasms in areas of special locations (with the exception of facial skin/scalp). This article aims at explaining dermoscopic characteristics and features of important benign and malignant lesions of nails, acral skin, face, and mucosa.

Fabrication of self-assembled spherical Gold Particles by pulsed UV Laser Treatment.

We report on the fabrication of spherical Au spheres by pulsed laser treatment using a KrF excimer laser (248 nm, 25 ns) under ambient conditions as a fast and high throughput fabrication technique. The presented experiments were realized using initial Au layers of 100 nm thickness deposited on optically transparent and low cost Borofloat glass or single-crystalline SrTiO3 substrates, respectively. High (111)-orientation and smoothness (RMS ≈ 1 nm) are the properties of the deposited Au layers before laser treatment. After laser treatment, spheres with size distribution ranging from hundreds of nanometers up to several micrometers were produced. Single-particle scattering spectra with distinct plasmonic resonance peaks are presented to reveal the critical role of optimal irradiation parameters in the process of laser induced particle self-assembly. The variation of irradiation parameters like fluence and number of laser pulses influences the melting, dewetting and solidification process of the Au layers and thus the formation of extremely well shaped spherical particles. The gold layers on Borofloat glass and SrTiO3 are found to show a slightly different behavior under laser treatment. We also discuss the effect of substrates.

[Dermoscopy for malignant and benign skin tumors : Indication and standardized terminology]. / Dermatoskopie bei malignen und benignen Hauttumoren : Indikation und standardisierte Terminologie.

Dermoscopy has a high diagnostic accuracy in pigmented and nonpigmented malignant and benign skin tumors. These microscopic in vivo examinations with polarized and nonpolarized light are effective in the early detection of malignant skin tumors and reduce the number of unnecessary excisions of benign skin tumors. The selection of the skin lesions is crucial for the diagnostic accuracy of the dermoscopic examination. Not only large pigmented skin lesions, but also small hypo-, de-, or nonpigmented skin lesions, should be examined dermatoscopically as well as skin lesions that have changed in shape and/or color. In clinical routine, research and teaching, the dermoscopic diagnosis should be performed by describing the visible structures, their distribution and colors by means of descriptive and/or metaphoric terminology. Optionally, a diagnostic algorithm can also be used. Especially in benign lesions, the dermatoscopic diagnosis should be uniform for the complete area. Comparison with other nearby skin tumors of the same patient (comparative approach) is helpful in the evaluation of numerous melanocytic skin tumors. If it is unclear whether the lesion is malignant, a biopsy or complete excision should be performed with subsequent histopathological examination.

[Skin cancer screening in Germany : The situation in 2014 with suggestions for the future]. / Hautkrebsscreening in Deutschland : Eine Bestandsaufnahme im Jahr 2014 mit Vorschlägen für die Zukunft.

Based on the skin cancer screening model of Germany a critical statement is presented about skin cancer epidemiology, the total body examination and time intervals. The number of skin cancer cases will increase and the number of dermatologists will probably decrease; thus a fundamental and pragmatic strategy is required for further education and planning to comply with the increased dermato-oncological demand of an aging population. Hereby dermoscopy should be a basic diagnostic tool for the early recognition of skin cancer and precursors as well as to avoid unnecessary excisions of benign skin lesions. The excision ratio between malignant and benign skin tumours should be optimized.

[Dermoscopy of nails]. / Dermatoskopie der Nägel.

Pigmented and nonpigmented nail abnormalities often represent a challenge for clinicians because many, and sometimes potentially life-threatening differential diagnoses must be taken into consideration. Although many details of nail diseases can already be assessed with the naked eye, dermoscopy opens up a second microscopic level of inspection, which can be very useful for the diagnostic process. In the last 20 years dermoscopy has made rapid progress in the further development of criteria for the early recognition of melanoma. In addition, the use of dermoscopy has been extended to the examination of cutaneous adnexa, such as hairs (trichoscopy) and nails (onychoscopy). Many, sometimes highly specific criteria for the dermoscopic assessment of nail diseases have been described in a series of recently published articles. This review article provides important diagnostic aids for a well-founded dermoscopic assessment of nail diseases.

Dermoscopy of acral melanoma: a multicenter study on behalf of the international dermoscopy society.

BACKGROUND: Most studies on dermoscopy of acral lesions were conducted in Asian populations. In this study, we analyzed these features in a predominantly Caucasian population. OBJECTIVE: Estimate the prevalence of dermoscopic features in acral lesions, and assess their level of agreement between observers. METHODS: In this retrospective multicenter study, 167 acral lesions (66 melanomas) were evaluated for 13 dermoscopic patterns by 26 physicians, via a secured Internet platform. RESULTS: Parallel furrow pattern, bizarre pattern, and diffuse pigmentation with variable shades of brown had the highest prevalence. The agreement for lesion patterns between physicians was variable. Agreement was dependent on the level of diagnostic difficulty. CONCLUSION: Lesions with a diameter >1 cm were more likely to be melanoma. We found as well that a benign pattern can be seen in parts of melanomas. For this reason one should evaluate an acral lesion for the presence of malignant patterns first.

Dermoscopic semiology: further insights into vascular features by screening a large spectrum of nontumoral skin lesions.

BACKGROUND: Dermoscopic vascular criteria remain poorly evaluated and analysed. The increasing number of descriptions of amelanotic melanoma showing isolated vascular dermoscopic findings adds interest to this topic. OBJECTIVE: To evaluate and classify the dermoscopic vascular structures seen in nontumoral dermatoses (NTD). PATIENTS AND METHODS: The affected skin of 414 consecutive patients suffering from a variety of 31 different biopsy-proven NTD was evaluated with the dermoscope and photographed with the Dermaphot camera. RESULTS: The dermoscopic vascular structures seen in NTD consisted of round dotted and globular vessels, linear vessels and glomerular vessels. In addition, structureless coloured patches were also found. In some NTD the distribution of the vascular structures took on special arrangements. The most common vascular findings were the linear and the rounded vessels, which were distributed either homogeneously throughout the lesion or were present together with other vascular or pigmented features in a mixed pattern. CONCLUSION: The present study proposes a new classification of dermoscopic vascular features based on the screening of a large spectrum of nontumoral dermatoses. This list may be useful to define further dermoscopic semiology and to understand the vascular features most relevant to the diagnosis not only of different NTD but also of pigmented and amelanotic melanoma.

Efficacy and tolerability of a topical erythromycin/tretinoin combination preparation in acne treatment: post-marketing surveillance study involving over 6500 patients.

The good efficacy and tolerability of an alcoholic erythromycin/tretinoin solution was confirmed in a multicentre data investigation of over 6500 patients. The mean score for comedones declined clearly from 1.9 to 0.9 during treatment (average duration 70 days). The score for papules and pustules was reduced from 1.6 to 0.5. Overall medical assessment indicated 'very good' to 'good' efficacy in 86.1% of documented cases. Adverse drug reactions during treatment were mostly only very mild and were nearly always the known symptoms of redness, scaling, dryness and itching. Overall assessment of tolerability was 'very good' or 'good' in 88.1% of cases.

Feature selection for optimized skin tumor recognition using genetic algorithms.

In this paper, a new approach to computer supported diagnosis of skin tumors in dermatology is presented. High resolution skin surface profiles are analyzed to recognize malignant melanomas and nevocytic nevi (moles), automatically. In the first step, several types of features are extracted by 2D image analysis methods characterizing the structure of skin surface profiles: texture features based on cooccurrence matrices, Fourier features and fractal features. Then, feature selection algorithms are applied to determine suitable feature subsets for the recognition process. Feature selection is described as an optimization problem and several approaches including heuristic strategies, greedy and genetic algorithms are compared. As quality measure for feature subsets, the classification rate of the nearest neighbor classifier computed with the leaving-one-out method is used. Genetic algorithms show the best results. Finally, neural networks with error back-propagation as learning paradigm are trained using the selected feature sets. Different network topologies, learning parameters and pruning algorithms are investigated to optimize the classification performance of the neural classifiers. With the optimized recognition system a classification performance of 97.7% is achieved.

Computer-supported diagnosis of melanoma in profilometry.

Laser profilometry offers new possibilities to improve non-invasive tumor diagnostics in dermatology. In this paper, a new approach to computer-supported analysis and interpretation of high-resolution skin-surface profiles of melanomas and nevocellular nevi is presented. Image analysis methods are used to describe the profile's structures by texture parameters based on co-occurrence matrices, features extracted from the Fourier power spectrum, and fractal features. Different feature selection strategies, including genetic algorithms, are applied to determine the best possible subsets of features for the classification task. Several architectures of multilayer perceptrons with error back-propagation as learning paradigm are trained for the automatic recognition of melanomas and nevi. Furthermore, network-pruning algorithms are applied to optimize the network topology. In the study, the best neural classifier showed an error rate of 4.5% and was obtained after network pruning. The smallest error rate in all, of 2.3%, was achieved with nearest neighbor classification.

Image analysis and pattern recognition for computer supported skin tumor diagnosis.

A new approach to computer supported recognition of melanoma and naevocytic naevi based on high resolution skin surface profiles is presented. Profiles are generated by sampling an area of 4 x 4 mm2 at a resolution of 125 sample points per mm with a laser profilometer at a vertical resolution of 0.1 micron. With image analysis algorithms Haralick's texture parameters, Fourier features and features based on fractal analysis are extracted. Genetic algorithms are employed successfully to select good feature subsets for the following classification process. As quality measure for feature subsets, the error rate of the nearest neighbor classifier estimated with the leaving-one-out method is used. Classification is performed with feed forward back-propagation network and the nearest neighbor classifier. Classification performance of the neural classifier is optimized using different topologies, learning parameters and pruning algorithms. The best neural classifier achieved an error rate of 4.5% and was found after network pruning. The best result with an error rate of 2.3% was obtained with the nearest neighbor classifier.

[Incident light microscopic characterization of vascular patterns in skin tumors]. / Auflichtmikroskopische Charakterisierung von Gefässmustern in Hauttumoren.

The search for vascular structures in skin tumors by incident light microscopy has revealed a surprisingly high proportion of vascularized tumours. Characteristic vascular patterns, in some cases highly tumour-specific, have been defined. The vascular structure is a valuable feature for characterization and differentiation of skin tumours, especially for amelanotic malignant melanoma. We propose a flowchart procedure for analysis and diagnosis of skin tumours using incident light microscopy, which appears to be valuable for advanced image analytic techniques.

Sources of unwanted variability in measurement and description of skin surface topography.

BACKGROUND/AIMS: Quantitative measurement of skin roughness has proved to be a valuable tool in the efficacy-control of external applications, but it suffers from not yielding easily comparable results. The most important sources of inter-observer variability are high-pass filters used to separate roughness and waviness, and low-pass filters which result from the finite resolution of the instrument or from the finite sampling interval of digital measurement. In the present study, the effects of high-pass filters and sampling intervals on the roughness measured were investigated. METHODS: Dynamically focusing optical profilometry was used to measure the surfaces of negative replicas of healthy human skin. High-pass cut-off wavelengths and sampling intervals were varied systematically. RESULTS/CONCLUSIONS: Virtually unbiased estimates for the roughness parameters K, Sk, Rq , and Ra can be obtained using sampling intervals of 40 or even 80 µm. Regarding these roughness parameters, it is far better to do more scans than to shorten the sampling interval. The roughness parameters Rz , Rp , Rt , Rpm , Rmax , Pt , on the other hand are very sensitive to the influence of the sampling interval; to achieve satisfying estimates, the sampling interval should be no longer than 2 to 5 urn; as an important parameter'of the measurement, it is worthy of remark and should always be indicated. The way the mean square roughness Rq depends on the cut-off wavelength is not well described by the Sayles-Thomas-relation Rq ∼λc (0.5) . If the power-spectrum |h*(v)|(2) approximates sufficiently to a power law, |h*(v)|(2) ∼v(δ) , a better estimate is given by Rq ∼λc (γ) with γ=-(δ+1)/2. In many cases, γ=1 or Rq ∼λc will suffice.

[Abdominal variant of benign symmetrical Launois-Bensaude lipomatosis]. / Abdominelle Variante einer benignen symmetrischen Lipomatose Launois-Bensaude.

We report on a patient with an abdominal type of benign symmetrical Launois-Bensaude lipomatosis. New aspects of the pathogenesis of abnormal distribution of the fatty tissue are also discussed.

[Bacillary angiomatosis]. / Bazilläre Angiomatose.

Bacillary angiomatosis (BA) is a rare infectious disease usually associated with HIV infection. Recent molecular biologic investigations confirm that both Rochalimaea henselae and Rochalimaea quintana can cause BA. The bacteria can be identified by Warthin-Starry staining and electron microscopy. The typical clinical signs are solitary or multiple dermal or subcutaneous nodules. Bone, liver, spleen and other organs may also be involved. We describe the clinical and histological features of a 39-year-old HIV-infected patient with cutaneous and bony lesions of BA. All manifestations of BA disappeared during therapy with erythromycin.

Quantitative surface topography as a tool in the differential diagnosis between melanoma and naevus.

BACKGROUND/AIMS: The mainstays of the clinical diagnosis of melanoma are asymmetry, border irregularity, color variegation, and a diameter >6 mm, and any major progress in diagnostic accuracy will probably be related to the development of additional criteria. Such independent criteria might arise from the study of the geometry of the tumour surface, because this quality has been substantially disregarded until now. Our work is aimed at utilizing the surface topography for the differential diagnosis between malignant melanoma and naevocytic naevus. METHODS: Dynamically focusing optical profilometry was used to measure the surfaces of negative replicas of melanocytic skin tumours and of the surrounding normal skin. 21 silicone imprints of superficial spreading melanomas and 25 imprints of naevocytic naevi were examined. RESULTS: Melanomas and naevi differed with respect to a variety of statistical surface parameters, and a linear discriminant analysis correctly allocated 19 out of 21 melanomas (90%) and 21 out of 25 naevi (84%). To get an unbiased estimate of the errors to be expected with this classification rule, we calculated bootstrap-corrections to the apparent errors. Estimated probabilities of correct allocation were 84.1% for melanomas and 77.1% for naevi. CONCLUSION: Our findings suggest that simple statistical parameters of surface topography can differentiate effectively between malignant melanomas and naevocytic naevi.

Treatment of subgingival implant surfaces with Teflon-coated sonic and ultrasonic scaler tips and various implant curettes. An in vitro study.

Removal of plaque and calculus by means of sonic and ultrasonic scalers causes considerable damage to implants. With a view to avoiding the aggressive effects of these instruments, an experimental study was carried out for which conventional sonic and ultrasonic scalers were coated with Teflon. The effects of these instruments on implant surfaces was then compared with that of plastic and metal implant curettes. Stereo-microscopy, scanning electron microscopy and surface profilometry were used to detect and record damage to implant surfaces and changes in surface roughness. Generation and propagation of heat in subgingival simulation of use of sonic and ultrasonic scalers were also recorded by means of temperature measurements at the implant surface. The results revealed that no discernible damage was caused by Teflon-coated sonic and ultrasonic scalers or implant curettes made of plastic on smooth titanium surfaces. Instrument material residues were found on rough implant surfaces. It was not the intention of this study to provide an analysis of the prerequisites for the cleaning of rough implant surfaces, but rather to determine what type of damage is to be expected when contact is made with smooth and rough surfaces unintentionally. Temperature measurements during the subgingival use of sonic and ultrasonic scalers indicated satisfactory functioning of the cooling system. Coating of sonic and ultrasonic scaler tips with Teflon thus facilitates the use of high-frequency instruments to achieve professional cleaning of implants.