ABSTRACT
BACKGROUND: Grey perifollicular circles are a dermatoscopic clue to melanoma, especially in facial skin. So far, no other adnexal clues than follicular have been investigated in this diagnosis. OBJECTIVES: The study aimed to analyse the prevalence of hyperpigmented periadnexal microcircles (HMs) in melanoma and its common simulators at non-facial non-acral sites, analyse the relation between the presence of HM, regression and hypopigmentation, and evaluate the diagnostic accuracy of this structure in melanoma. METHODS: International Skin Imaging Collaboration (69,445 images) was searched in April 2020 for the pathology-confirmed dermatoscopic images with metadata including sex, age bin, and declared non-acral non-facial anatomic site. The final study sample (5,408 images, 1,326 of which were melanomas) was evaluated by expert dermatoscopist blinded to the diagnosis and labelled for the presence of ≥3 HM distributed centrally (cHM) or peripherally (pHM), hypopigmentation, and classic dermatoscopic regression structures. A subset of 40 images was labelled by 7 raters (2 residents, 5 experts) to assess interobserver agreement. We compared the presence of pHM with the presence of regression as well as performed a set of independent χ2 tests to evaluate the discriminatory power and its fragility. Performance of the models was assessed using measures of discrimination and calibration. RESULTS: HM were significantly more prevalent in melanomas than in non-melanomas and nevi. Fair/good interobserver agreement for HM was reached for all the raters, and moderate/good for experts only (single rater/average, respectively). Regardless of regression/hypopigmentation status, pHM were significantly more common in melanoma than in non-melanomas or nevi and were observed significantly more often in melanomas on sun-damaged skin (upper extremity, posterior torso). No significant differences between the groups were found for cHM. pHM proved a high odds ratio in the tests as to the classical indicators such as classic dermatoscopic regression structures. CONCLUSION: pHM could be considered a novel dermatoscopic clue to melanoma.
Subject(s)
Hypopigmentation , Melanoma , Nevus , Skin Neoplasms , Humans , Skin Neoplasms/diagnosis , Retrospective Studies , Dermoscopy/methods , Melanoma/diagnostic imagingABSTRACT
BACKGROUND: Hypocalcemia is the most frequent complication after thyroid surgery. Intraoperative measurement of parathormone levels (ioPTH) in patients undergoing thyroid surgery has been recently described as an accurate method of predicting postoperative parathyroid dysfunction. The aim of the study was to evaluate utility of ioPTH and parathormone level measured 24 hours after surgery (24PTH) as prognostic factors of hypoparathyroidism and consequent hypocalcemia. SUBJECTS AND METHODS: Fifty-four patients (50 females and 4 males) underwent 55 operations: subtotal thyroidectomy (44), total thyroidectomy (8), completion thyroidectomy due to goiter reoccurrence and cancer (2 and 1 patients, respectively). PTH and serum calcium levels were assessed one day prior to surgery, intraoperatively during wound closure, on the first postoperative day and 2 months after surgery. Hypoparathyroidism was defined as parathormone level less than 15 pg/ml. RESULTS: Seventeen patients presented ioPTH levels below 15 pg/ml. Twelve of them had low 24PTH levels. Only one patient with ioPTH (but not 24PTH) below 15 pg/ml developed persistent hypoparathyroidism, resulting in low parathormone level 2 months after surgery. Three investigated subjects with ioPTH greater than 15 pg/ml had low 24PTH levels but none of them developed persistent hypoparathyroidism. One patient with ioPTH and 24PTH within reference range presented hypoparathyroidism at the 2-month follow-up, presumably due to postoperative iodotherapy. CONCLUSIONS: This study suggests that ioPTH and 24PTH levels are not useful prognostic factors of persistent hypoparathyroidism but may indicate transient parathyroid gland dysfunction.
