Comparison of classical dermatoscopy and acrylic globe magnifier dermatoscopy.

Dermatoscopic asymmetry of melanocytic skin lesion is pivotal in most algorithms assessing the probability of melanoma. Larger lesions cannot be assessed by dermatoscopy and the Dermaphot in a single field of vision, but this can be performed using the acrylic globe magnifier. We examined the diagnostic accuracy of the acrylic globe magnifier and compared it with classical dermatoscopy. A total of 119 patients successively referred to our naevus clinics had Dermaphot and acrylic globe magnifier pictures taken. Lesions were excised and assessed by histopathology. Observers blinded to histopathology diagnoses, assessed dermatoscopic and acrylic globe magnifier photo-slides according to the dermoscopic risk stratification. The observed agreement over all categories between acrylic globe magnifier dermatoscopy and classical dermatoscopy was 94% and Cohen's kappa coefficient was 90% (95% confidence interval 83-97%). Sensitivity for melanoma, benign melanocytic naevi and basal cell carcinoma was 100%, 98% and 85%, respectively. Specificity was 95%, 94% and 100% for melanoma, naevi and basal cell carcinoma. Acrylic globe dermatoscopy enables a diagnostic accuracy similar to epiluminescence microscopy.

Phytophotodermatitis in 19 children admitted to hospital and their differential diagnoses: Child abuse and herpes simplex virus infection.

BACKGROUND: Phytophotodermatitis is a non-immunologic cutaneous reaction that can be provoked after contact with plants containing psoralens followed by sun exposure. OBJECTIVES: The purpose of this study is to describe the clinical features of phytophotodermatitis and its differential diagnoses, especially child abuse and herpes virus infection. METHODS: Nineteen children seen in two county hospitals are described. RESULTS: The 19 children had various cutaneous manifestations, which were mistaken in one patient for child abuse and in one child for herpes simplex virus infection. LIMITATIONS: The doctors' perception is based on the doctors' education. CONCLUSION: Children are susceptible to contact with psoralen-containing plants followed by sun exposure. Phytophotodermatitis is a difficult diagnosis, which can sometimes lead to the inappropriate investigation of child abuse or herpes simplex virus infection.

[Acute necrosis of the skin--a possible result from the bite of a Hobo-spider]. / Akut hudnekrose--en mulig følge af hobo-edderkoppebid?

A 63-year-old male presented with painful erythema and bullae on his left knee. When working on his boat he suddenly felt a burning sensation followed by numbness of the area. The sensation wore off, but was followed by painful erythema and necrosis. A biopsy showed necrosis with sparse inflammatory cells, consistent with a toxic or thermal injury. The lesion did not heal until after 3 months despite intensive local treatment. This course is typical for a bite of a venomous spider, probably a Hobo-spider. Such a spider was recently observed on the coast of the Øresund area where the patient had his boat.

Poppyfield bleeding: a new dermatoscopic sign and its histopathological background.

Dermatoscopy increases the accuracy of diagnosis of melanoma. An atypical vascular pattern may be an indicator of cutaneous malignant melanoma (CMM). During dermatoscopy of certain CMMs numerous ruby droplets of blood appear when the dermatoscope is pressed firmly against the lesion. The aim of this paper was to examine the histopathological background for this observation. CMMs from 8 patients showing the poppyfield sign, i.e. squirts of ruby blood droplets, were paired with 8 CMMs of equal Breslow thickness not showing this sign. The 16 CMMs were placed in an unsystematic sequence and presented to two dermato-pathologists who assessed the lesions independently for confirmation of Breslow thickness, Clark level, ulceration and presence of dilated tumour vessels. There was no disagreement between the pathologists' assessments. Age of the patients and Breslow thickness of the cutaneous malignant melanoma were similar in the two groups. All 8 poppyfield CMMs had dilated tumour vessels compared with 25% (2/8) of the non-poppyfield CMMs (p< 0.007). Histological ulceration was observed in all poppyfield CMMs and none of the non-poppyfield CMMs (p< 0.001). The poppyfield bleeding sign is a dermatoscopic clue to dilated tumour vessels. It may be a dermatoscopic reflection of increased vascular density described in primary CMMs compared with adjacent skin and may also reflect the presence of primitive vessels in CMMs displaying increased fragility.

[Dynamic dermoscopy]. / Dynamisk dermoskopi.

Dermoscopy of early-stage melanoma can be challenging, and repeated examination at three-month intervals may disclose subtle changes. In patients with atypical nevus syndrome or more than 50 nevi, repetitive excision of benign lesions does not guarantee that melanomas will be identified at an early stage and exposes patients to potentially disfiguring surgery. We present the case of a high-risk patient where repeated dermoscopy of an in situ melanoma showed that part of the pigment network had coarsened, even though the lesion had not changed macroscopically.

[Imiquimod treatment of lentigo maligna to dermoscopic and histologic clearance]. / Imiquimodbehandling af lentigo maligna til dermoskopisk og histologisk tumorsvind.

Imiquimod is an immune system-modifying drug that switches the immune system to a Th1 response, enabling it to defeat virus-infected and neoplastic cells. We report on a 94-year-old woman with a large lentigo maligna (LM) on her cheek whom we treated with imiquimod 5% cream. Dermoscopy was used to identify the most suspect areas of the lesion for biopsy and in follow-up. By week 19 the lesion was cleared, and no remnants of the lesion were seen by dermoscopy or histology. Published LM cases treated with imiquimod are reviewed.

Incidence, clinical presentation and treatment of neurosyphilis in Denmark 1980-1997.

Neurosyphilis is now a rare disease in the developed countries. In Denmark 92 cases of neurosyphilis were identified in the period 1980-1997. We obtained the hospital records for 77 of these patients and studied the clinical presentation, treatment and result of the treatment. Most patients were treated with penicillin by the intramuscular or intravenous route, but the amounts and duration of the antibiotic treatment varied a lot among the patients. All patients treated with intravenous penicillin were cured.

[The shadow rule and appropriate sun behavior]. / Hensigtsmaessig soladfaerd med skyggeregel.

INTRODUCTION: Sun lotions have not been effective in preventing the alarming increase in the incidence of melanoma, possibly, because of incorrect use, lack of protection from UVA and increased exposure times caused by reduced penetration of erythemogenic UVB. Seeking shade prevents deleterious effects from the sun's ultraviolet rays. MATERIAL AND METHODS: We examined the association between UV intensity and the ratio of shadow length to object height. A linear model fitted the data (R = 0.95). With an astronomical navigation equation for the calculation of altitude of the sun and substituting altitude with UV intensity we developed a model predicting the UV load from the point of observation, the time of the year (declination) and the time of day (hour angle). Accumulated UV doses can be calculated by integration. RESULTS: When the shadow to object ratio is 0.5, skin types I and II will experience erythema after a few minutes, when the ratio is 1 erythema appears after 20-30 minutes, and when the ratio is 2 erythema appears after about one hour. In the Mediterranean, accumulated UV exposure from sunrise to sunset in late summer will be 30-50 times the minimal erythema dose (skin types I + II) of which more than 60% is in the interval where the shadow is shorter than its object. DISCUSSION: The shadow rule (short shadows--seek shade) is simple and universal and children can be taught it. A rule of thumb is: when shadows are shorter than objects throwing them, avoid direct sunlight, when shadow and object are of equal length restrict sun exposure to half an hour, and when shadows are twice the length of objects an hour in the sun is permissible.

[Scabies]. / Scabies.

The aim of this review is to draw attention to the fact that scabies still causes clinical problems and gives rise to epidemics in hospitals and institutions. We describe the clinical aspects of ordinary and crusted scabies and newer diagnostic methods, such as epiluminescence microscopy and PCR. The current treatment of scabies in Denmark is mentioned, and the importance of simultaneous preventative treatment of household contacts and hygienic measures in the surroundings is emphasised. The role of ivermectin in the treatment and prevention is briefly described. A series of scabies epidemics in hospitals and institutions are discussed with emphasis on factors influencing the spread and subsequent interruption of the epidemic. It is concluded that each institution should have guidelines for the handling of such epidemics and that the local hygiene unit should be involved immediately in the case of an epidemic.

[Institutional scabies]. / Institutionsscabies.

We describe an outbreak of scabies affecting 13 patients and staff members in a geriatric ward. The difficulties of diagnosis and treatment are discussed, and it is suggested that the local hygiene unit should be involved immediately if institutional scabies is suspected.