ABSTRACT
A 56-year-old man with recalcitrant psoriasis was treated with efalizumab, resulting in complete clearing of his skin lesions. However, multiple brown patches and papules, in the exact distribution of the previous psoriasis plaques, appeared on his lower legs. The pathological diagnosis was seborrhoeic keratoses (SKs) with overlapping features of solar lentigo. A variety of cutaneous adverse events has been observed in patients with psoriasis treated with efalizumab. To our knowledge, appearance of SKs after such treatment has not previously been reported. This may be due to the clinical insignificance of these benign skin tumours. However, it may be speculated whether efalizumab has an unknown effect in triggering the development of SKs in patients with psoriasis, and if this could shed any light on the pathogenesis of SKs.
Subject(s)
Anti-Inflammatory Agents/adverse effects , Antibodies, Monoclonal/adverse effects , Keratosis, Seborrheic/chemically induced , Psoriasis/drug therapy , Antibodies, Monoclonal, Humanized , Humans , Keratosis, Seborrheic/pathology , Leg Dermatoses/chemically induced , Leg Dermatoses/pathology , Male , Middle Aged , Psoriasis/pathology , Treatment OutcomeABSTRACT
BACKGROUND: A number of new tools have been developed in the last ten years to improve the diagnosis of cutaneous melanoma. AIMS: To review the value of diagnostic tools for cutaneous melanoma in a clinical setting. METHODS: Review of multiple databases from 1987 to 2007 and classification of publications in terms of level of evidence according to "The Australian Cancer Network". RESULTS: Dermoscopy has superior specificity and sensitivity to naked-eye examination according to a meta-analysis of nine level-2 studies. Sequential digital dermoscopic imaging allowed detection of melanoma in the absence of dermoscopic evidence of melanoma in four level-2 studies. Total body photography, generally performed for high-risk patients, seems to be equally valuable but has the additional advantage of allowing self-examination by patients themselves. Dermographic photographs with computer-assisted diagnosis of primary melanoma appear to have equivalent diagnostic capacity to experts but very few studies have been performed in a clinical setting. Optical methods still under development yield in vivo information that is closely correlated with histopathology data and may avoid unnecessary excision while providing improved control of excision margins. They will doubtless be used as a second-line method after clinical detection of suspect lesions and history-taking, which will continue to be primordial regardless of the other tools available.
Subject(s)
Melanoma/diagnosis , Skin Neoplasms/diagnosis , Consensus , Dermoscopy , Diagnosis, Computer-Assisted , Humans , Medical History Taking , Melanoma/pathology , Meta-Analysis as Topic , Microscopy, Confocal , Optical Phenomena , Photography , Sensitivity and Specificity , Skin/pathology , Skin Neoplasms/pathologyABSTRACT
BACKGROUND: Dermoscopy is a noninvasive technique that enables the clinician to perform direct microscopic examination of diagnostic features, not seen by the naked eye, in pigmented skin lesions. Diagnostic accuracy of dermoscopy has previously been assessed in meta-analyses including studies performed in experimental and clinical settings. OBJECTIVES: To assess the diagnostic accuracy of dermoscopy for the diagnosis of melanoma compared with naked eye examination by performing a meta-analysis exclusively on studies performed in a clinical setting. METHODS: We searched for publications from 1987 to January 2008 and found nine eligible studies. The selected studies compare diagnostic accuracy of dermoscopy with naked eye examination using a valid reference test on consecutive patients with a defined clinical presentation, performed in a clinical setting. Hierarchical summary receiver operator curve analysis was used to estimate the relative diagnostic accuracy for clinical examination with, and without, the use of dermoscopy. RESULTS: We found the relative diagnostic odds ratio for melanoma, for dermoscopy compared with naked eye examination, to be 15.6 [95% confidence interval (CI) 2.9-83.7, P = 0.016]; removal of two outlier studies changed this to 9.0 (95% CI 1.5-54.6, P = 0.03). CONCLUSIONS: Dermoscopy is more accurate than naked eye examination for the diagnosis of cutaneous melanoma in suspicious skin lesions when performed in the clinical setting.
