Importancia del seguimiento de lesiones melanocíticas con dermatoscopia digital para el diagnóstico temprano de melanoma / Importance of monitoring melanocytic lesions with digital dermatoscopy for diagnosis early melanoma

La dermatoscopia digital es una herramienta que permite el diagnóstico de melanomas en estadios tempranos, por medio del seguimiento de las lesiones pigmentarias a largo plazo. Se comunican tres casos de pacientes con alto riesgo de melanoma, en los cuales ‒a través del seguimiento con dermatoscopia digital‒ se realizó el diagnóstico de la enfermedad mediante la detección de cambios morfológicos, arquitecturales y de pigmentación de las lesiones estudiadas. (AU)

Digital dermoscopy is a tool that allows the early diagnosis of melanomas, through the long-term follow up of pigmentary skin lesions. We report three cases of patients with high-risk of melanoma, in which the diagnosis had been made by morphological, arquitectural and pigmentary changes observed by the digital dermoscopy follow-up. (AU)

A Multicenter Survey: How Do Transplant Dermatologists Monitor Organ Transplant Recipients With Nevi?

OBJECTIVES: The incidence and mortality of melanoma are increased in organ transplant recipients. Multiple acquired common and dysplastic nevi are risk factors for melanoma. A new or changing nevus may suggest melanoma. Strategies used by transplant dermatologists to monitor nevi are unknown. Herein, we aimed to assess the methods used by transplant dermatologists for monitoring multiple acquired common nevi, dysplastic nevi, and new or changing nevi. MATERIALS AND METHODS: A questionnaire was e-mailed to 63 members of the Skin Care in Organ Transplant Patients, Europe. RESULTS: Thirty-eight (92.7%) of 41 responders reported that they instruct their patients to perform regular self-skin examinations. Of 41 responders, 41.5% prescribed screening every 6 months, 36.6% prescribed it every 12 months, 12.2% prescribed it every 3 months, and 9.7% performed screening without regular intervals. Regarding type of examination, 80.5% performed full-body skin examinations with the naked eye, 70.7% performed dermoscopy of clinically suspicious nevi, 53.6% offered dermoscopic photography of dermoscopically suspicious nevi, 36.6% provided close-up photography of clinically suspicious nevi, 34.1% performed baseline total body photography, and 24.4% conducted dermoscopy of all nevi. We also found that 7.3%, 4.9%, and 4.9% performed only full-body skin examination with the naked eye, only dermoscopy of clinically suspicious nevi, and only dermoscopy of all nevi, respectively. CONCLUSIONS: Dedicated transplant dermatologists perform a wide variety of nevi screening procedures in organ transplant recipients. Transplant dermatologists should include sequential digital dermoscopic imaging in their armamentarium to follow organ transplant recipients with melanocytic lesions. A combination of techniques is advisable for detecting early posttransplant melanomas.

A survey on the pattern of dermoscopy use among dermatologists in India.

INTRODUCTION AND BACKGROUND: Dermoscopy is being increasingly used for improving dermatological diagnosis. Use of dermoscopy in the early recognition of skin malignancies, especially melanoma, is well established. Of late, its use in general clinical dermatology is growing with the recognition of new and specific patterns in conditions such as hair disorders, inflammatory disorders, and infections/infestations. This cross-sectional survey aims to assess the common patterns of dermoscopy use by Indian dermatologists. METHODS: This was across-sectional survey. An online questionnaire was used to collect data. The questionnaire focused on the frequency of dermoscopy use by Indian dermatologists, reasons for using it or not, and the training they had received on dermoscopy. RESULTS: Of the total 150 valid responses, eighty two (54.7%) participants reported that they were using dermoscopy routinely in their clinical practice. Lack of familiarity and lack of proper training were the important reasons cited for not using dermoscopy regularly. Among the dermatologists using dermoscopy, consensus on effectiveness was highest for hair disorders. CONCLUSIONS: Dermoscopy use by dermatologists in India is mainly in the context of inflammatory dermatosis and hair disorders rather than skin tumors. Lack of familiarity with the technique appears to be main factor limiting the use of dermoscopy in India. LIMITATIONS: Small sample size is the major limitation of this study. It is possible that a large number of dermatologists who do not use dermoscopy might not have responded to the survey, there by affecting the results and their interpretation.

[What is new in basal cell carcinoma?] / Was gibt es Neues zum Basalzellkarzinom?

BACKGROUND: Basal cell carcinoma (BCC) is the most common skin cancer in fair-skinned individuals. Although lymph node or visceral metastases are observed in less than 0.5 % of all cases, BCC can have a fatal course due to its highly invasive growth pattern. OBJECTIVES: To provide a comprehensive update on diagnosis, treatment, and prevention of BCC. MATERIALS AND METHODS: We review the current literature and recommendations of the German guidelines on treatment and prevention of skin cancer. The most pertinent developments are summarized in this review article. RESULTS: The use of optical coherence tomography and reflectance confocal microscopy can significantly improve the diagnosis of BCC compared with clinical assessment and dermoscopy alone. Mohs micrographic surgery remains the therapeutic gold standard for tumors in the head and facial area and tumors with high-risk features. The application of imiquimod, 5­fluorouracil, or photodynamic therapy should be restricted to low-risk superficial tumors. Topical inhibitors of the sonic hedgehog (SHH) pathway are currently being evaluated in early clinical trials. In contrast, vismodegib and sonidegib have been approved for the systemic treatment of locally advanced and metastatic BCC with good response rates. The most common adverse events of both agents are muscle cramps, dysgeusia, diffuse alopecia, weight loss, and fatigue. In an Australian phase III trial, oral nicotinamide (vitamin B3) reduced the occurrence of new BCC by 20 % in skin cancer patients. CONCLUSIONS: Targeted therapy with SHH inhibitors has improved the prognosis of locally advanced and metastatic BCC, albeit at the cost of a significant number of adverse events.

Dermatoscopia del liquen plano pigmentado inverso / Dermoscopic Features of Lichen Planus Pigmentosus-Inversus

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Pediatric dermatohistopathology--histopathology of skin diseases in newborns and infants.

While neonatal skin physiology has been thoroughly examined using non-invasive techniques in recent years, only few systematic studies and review articles addressing the histopathology of neonatal skin have been published thus far. In most cases, histopathological findings of dermatoses in neonatal skin do not significantly differ from those seen in adult skin. Nevertheless, a comprehensive knowledge of embryonic and fetal skin development as well as the microanatomical structure of neonatal skin can contribute to a better understanding of various dermatoses of infancy. In the first part of this review article, we present the histopathological features of such skin diseases, which, though generally rare, almost exclusively appear during the first weeks of life due to distinctive structural and functional features of neonatal skin. The second part is dedicated to classic dermatoses of infancy and their histopathological features.

The future of keratinocyte skin cancer surveillance: automated image analysis to identify and monitor keratinocyte dysplasia.

Clinical assessment of actinic keratosis is known to be a variable process; however, there are currently no non-invasive alternatives for objectively assessing the condition besides excision and histopathology. While a number of technologies for examining potential actinic keratoses are under development, each of these still requires subjective human assessment. The existing approaches focus on assessing colour and texture features in clinical-scale images, such as those from dermoscopy and digital photography, and on structural or cellular characteristics in cellular-scale images, such as those from multiphoton microscopy and reflectance confocal microscopy. The future of actinic keratosis management is likely to be a combination of analysing regional photography to determine potential lesion locations and analysis of the structural and cellular features by reflectance confocal microscopy for an in vivo pathology diagnosis.

Current diagnosis and treatment of basal cell carcinoma.

Basal cell carcinoma represents is most common tumor in fair-skinned individuals. In Germany, age-standardized incidence rates are 63 (women) and 80 (men) per 100,000 population per year. Early lesions may be difficult to diagnose merely on clinical grounds. Here, noninvasive diagnostic tools such as optical coherence tomography and confocal laser scanning microscopy may be helpful. The clinical diagnosis is usually confirmed by histology. Standard therapy consists of complete excision with thorough histological examination, either by means of micrographic surgery or, depending on tumor size and location as well as infiltration, using surgical margins of 3-5 mm or more. In particular, multiple basal cell carcinomas (such as in Gorlin-Goltz syndrome) and locally advanced as well as rarely also metastatic basal cell carcinoma may pose a therapeutic challenge. In superficial basal cell carcinoma, nonsurgical therapies such as photodynamic therapy or topical agents may be considered. In case of locally advanced or metastatic basal cell carcinoma, an interdisciplinary tumor board should issue therapeutic recommendations. These include radiation therapy as well as systemic therapy with a hedgehog inhibitor.

Screening, early detection, education, and trends for melanoma: current status (2007-2013) and future directions: Part I. Epidemiology, high-risk groups, clinical strategies, and diagnostic technology.

While most cancers have shown both decreased incidence and mortality over the past several decades, the incidence of melanoma has continued to grow, and mortality has only recently stabilized in the United States and in many other countries. Certain populations, such as men >60 years of age and lower socioeconomic status groups, face a greater burden from disease. For any given stage and across all ages, men have shown worse melanoma survival than women, and low socioeconomic status groups have increased levels of mortality. Novel risk factors can help identify populations at greatest risk for melanoma and can aid in targeted early detection. Risk assessment tools have been created to identify high-risk patients based on various factors, and these tools can reduce the number of patients needed to screen for melanoma detection. Diagnostic techniques, such as dermatoscopy and total body photography, and new technologies, such as multispectral imaging, may increase the accuracy and reliability of early melanoma detection.

Screening, early detection, education, and trends for melanoma: current status (2007-2013) and future directions: Part II. Screening, education, and future directions.

New evidence has accumulated over the past several years that supports improved melanoma outcomes associated with both clinician and patient screening. Population-based and workplace studies conducted in Australia and the Unites States, respectively, have shown decreases in the incidence of thick melanoma and overall melanoma mortality, and a year-long statewide screening program in Germany has shown a nearly 50% reduction in mortality 5 years after the screening ended. Current melanoma screening guidelines in the United States are inconsistent among various organizations, and therefore rates of both physician and patient skin examinations are low. As policymaking organizations update national screening recommendations in the United States, the latest research reviewed in part II of this continuing medical education article should be considered to establish the most effective recommendations. Patient and provider education will be necessary to ensure that appropriate patients receive recommended screening.

Hallazgos dermoscópicos para la detección precoz del melanoma. Análisis de 200 casos / Dermoscopic Findings for the Early Detection of Melanoma: An Analysis of 200 Cases

INTRODUCCIÓN: La dermatoscopia es una técnica complementaria que ha supuesto un gran avance en el diagnóstico de las lesiones pigmentadas. El objetivo del presente trabajo es describir las características dermatoscópicas de una serie de melanomas y analizar las diferencias entre los melanomas in situ y los melanomas invasivos. MATERIAL Y MÉTODOS: Se obtuvieron de forma retrospectiva los datos referentes a las características epidemiológicas, clínicas, histológicas y dermoscópicas de una serie de 200 melanomas primarios. Se realizó un estudio descriptivo y analítico de las variables dermoscópicas. RESULTADOS: La edad media de los pacientes fue de 63 años, con una distribución similar por sexos. Los tipos histológicos más frecuentes fueron el melanoma de extensión superficial (62,5%) y el lentigo maligno (25,5%). El 67% de los melanomas tuvieron un índice de Breslow menor de 1 mm y un 24,5% fueron melanomas in situ. Los patrones dermatoscópicos globales más frecuentes fueron el multicomponente (33,5%), el reticular (18%) y el inespecífico (15,5%). Las estructuras dermatoscópicas más frecuentes fueron las áreas homogéneas desestructuradas (67,5%), las estructuras blanco-azuladas (58%), el retículo pigmentado atípico (55,5%) y los puntos y glóbulos de distribución irregular (44%). Los colores azul-gris, rojo y blanco, los patrones multicomponente y homogéneo, los puntos y glóbulos, las estructuras blanco-azuladas, las áreas homogéneas, el velo azul-blanquecino, las estructuras blancas brillantes, el retículo invertido y las áreas rojo lechosas fueron más frecuentes en los melanomas invasivos que en los melanomas in situ. El patrón reticular fue más frecuente en los melanomas in situ. DISCUSIÓN: El uso de la dermatoscopia ha contribuido al diagnóstico precoz del melanoma. Los datos dermatoscópicos más frecuentes en el melanoma son la presencia de múltiples estructuras y colores (patrón multicomponente), un patrón reticular atípico con una red ensanchada e irregular y la ausencia de criterios dermatoscópicos (patrón inespecífico) asociada a la presencia de estructuras vasculares. CONCLUSIONES: La dermatoscopia facilita el diagnóstico de melanoma. Podría tener utilidad para diferenciar los melanomas in situ de las formas invasivas

INTRODUCTION: Dermoscopy is a complementary technique that has led to major advances in the diagnosis of pigmented skin lesions. The aim of this study was to describe the dermoscopic features of a series of melanomas and analyze the differences between melanomas in situ and invasive melanomas. MATERIAL AND METHODS: We retrospectively recorded epidemiological, clinical, histologic, and dermoscopic features of a series of 200 primary melanomas. We performed a descriptive and analytical study of the dermoscopic features identified. RESULTS: The mean age of the patients was 63 years and there was a similar distribution of male and female patients. The most common histologic subtypes were superficial spreading melanoma (62.5%) and lentigo maligna (25.5%); 67% of the melanomas had a Breslow thickness of less than 1 mm and 24.5% were melanomas in situ. Overall,the most common global dermoscopic features were the multicomponent pattern (33.5%), the reticular pattern (18%), and the nonspecific pattern (15.5%). The most common local features were structureless homogeneous areas (67.5%), white-blue structures (58%), an atypical pigmented network (55.5%), and irregularly distributed dots and globules (44%). The following features were more common in invasive melanomas than in melanomas in situ: blue, gray, red and white colors, multicomponent and homogeneous patterns, dots and globules, blue-white structures, homogeneous areas, a blue-white veil, white shiny structures, a reverse pigment network, and milky-red areas. The reticular pattern was more common in melanomas in situ. DISCUSSION: The use of dermoscopy has contributed to the early diagnosis of melanoma. The most common dermoscopic features of melanoma are multiple structures and colors (multicomponent pattern), an atypical reticular pattern (with wide, irregular meshes), and an absence of distinguishing features (nonspecific pattern) associated with the presence of vascular structures. CONCLUSIONS: Dermoscopy facilitates the diagnosis of melanoma and could be useful for differentiating between melanoma in situ and invasive melanoma

Systemic sclerosis - focus on dermatological aspects. Part 2: diagnostics, therapy.

Systemic sclerosis is a chronic inflammatory multiorgan disease which may involve the skin and internal organs to a varying extent. Pathogenetically the vasculature, connective tissue and the immune system are involved in a yet to be defined sequence and impact. Case history and results of physical as well as laboratory examinations will determine individually adapted further organ imaging or invasive procedures. Based on their results therapy is initiated which may include supportive measures such as physiotherapy as well as basic skin care and avoidance of any trauma. Many agents are available for the circulatory problems including Raynaud phenomenon and digital ulcers such as calcium channel blockers, ACE inhibitors and intravenous prostacyclin derivatives, as well as endothelin receptor blockers and phosphodiesterase inhibitors. Immunosuppressive and immunomodulatory agents are of varying efficacy depending on organ involvement. Though various therapeutic measures are available, beneficial effects are limited and associated with various unwanted effects. In any case, the therapy has to be individually adapted to the disease stage and course of the disease.

New trends in dermoscopy.

The dermatologists, in their educational training, learn to observe, recognize and classify lesions in order to obtain those stereotypes that allow them to make the diagnosis. For this reason, they have not felt the need to develop means to flank examination. For some years, however, this sort of prejudice is disappearing and also dermatology has begun to make use of semiotics instrumental. Among the most tried and tested equipment in clinical practice, worth remembering the dermoscopy and digital dermoscopic analysis. The recent availability of digital cameras and phones equipped with the latest generation of optical systems capable of capturing images of pigmented lesions in epiluminescence, has further expanded the range of tools at our disposal.

State of the art in non-invasive imaging of cutaneous melanoma.

BACKGROUND: This review focuses on looking at recent developments in the non-invasive imaging of skin, in particular at how such imaging may be used at present or in the future to detect cutaneous melanoma. METHODS: A MEDLINE search was performed for papers using imaging techniques to evaluate cutaneous melanoma, including melanoma metastasis. RESULTS: Nine different techniques were found: dermoscopy, confocal laser scanning microscopy (including multiphoton microscopy), optical coherence tomography, high frequency ultrasound, positron emission tomography, magnetic resonance imaging, and Fourier, Raman, and photoacoustic spectroscopies. This review contrasts the effectiveness of these techniques when seeking to image melanomas in skin. CONCLUSIONS: Despite the variety of techniques available for detecting melanoma, there remains a critical need for a high-resolution technique to answer the question of whether tumours have invaded through the basement membrane.

New developments in fluorescence diagnostics.

In the last decade, significant advances have been achieved in the direct viewing of the skin. Non-invasive analysis of various skin diseases in vivo has become possible by special skin display devices, allowing the physician to view the structure and properties of the skin in greater detail than can be achieved by simple visual examination. We review the last 100 years of fluorescence imaging development from clinical observation to advanced spectral imaging, addressing the role of fluorescence diagnostics (FD) in modern dermatology as well as the detection of autofluorescence.

Lesiones pigmentadas. Valoración dermatoscópica / Pigmented lesions. Dermatoscopic evaluation

Presentamos el caso de una mujer de 73 años de edad que consulta por la presencia de varias lesiones maculopapulares de color marrón oscuro en región frontal siguiendo el nacimiento del pelo, de crecimiento y aparición progresiva, de varios meses de evolución. El diagnóstico a simple vista es dudoso, haciéndonos pensar en queratosis seborreica, nevus atípico, melanoma o carcinoma basocelular. La dermatoscopia es una técnica de interés creciente para todos los médicos, posee una utilidad demostrada en el estudio de los tumores cutáneos, especialmente los pigmentados, y facilita el diagnóstico diferencial y la mejora de la precisión diagnóstica. Mediante este examen, las lesiones presentan estructuras características de carcinoma basocelular(AU)

We present the case of a 73 year old woman, who came to the consultancy due to several dark-brown maculopapular lesions on her forehead, all along the hairline. The lesions exhibited progressive growth and appeared to be of several months of evolution. At first glance diagnosis was unclear and led us to consider seborrhoeic keratosis, atypical nevus, melanoma or basal cell carcinoma. Dermatoscopy is a technique of increasing interest for the medical community since it has been demonstrated to be useful in the study of cutaneous tumours, specially pigmented ones. It facilitates differential diagnosis and improves diagnostic precision. Using this technique we determined that the lesions had the typical structures of basal cell carcinoma(AU)