In vivo Confocal Laser Microscopy for monitoring of actinic keratosis treatment: a comparison with histopathologic assessment after treatment with topical 5% 5-fluorouracil.

BACKGROUND: Histological examination is the gold standard for actinic keratosis diagnosis; however, it is not always a feasible approach. Reflectance confocal microscopy (RCM) is a non-invasive technique that may be an alternative for monitoring actinic keratoses treatment response. Topical 5-fluorouracil is indicated for actinic keratosis multiple lesions and for field cancerization treatment. OBJECTIVES: To assess the RCM accuracy, sensibility and specificity for actinic keratosis, considering as a gold standard the histopathological examination; as well as to evaluate the efficacy of 5% 5-fluorouracil treatment. METHODS: This is a prospective study in actinic keratosis patients between August 2014 and November 2015. RCM analyses were performed in one randomly selected actinic keratosis lesion of the upper limbs by two independent observers before and after 5% 5-fluorouracil treatment. At the end of treatment and with clinical bleaching of treated lesions, histological examination was performed by two pathologists. RESULTS: A total of 50 lesions were enroled, and 40 lesions presented complete clinical bleaching after treatment and were included in the final analysis. Accuracy, sensibility and specificity means among observers were 83.8%, 84.6% and 83.3%, respectively. After 5-fluorouracil treatment, actinic keratosis was diagnosed in 45.0% (observer 1) and 32.5% (observer 2) of subjects according to RCM and in 32.5% of subjects according to histological examination. Considering RCM observers diagnosis, the concordance was substantial (k 0.637, P < 0.001). 5-fluorouracil led to a reduction in 55.0%-67.5% of actinic keratoses according to RCM analysis. CONCLUSION: This study allows to validate RCM as a non-invasive method capable of monitoring actinic keratosis therapeutic response to 5-fluorouracil, presenting efficacy comparable to histological examination. Additionally, the results suggest that 5-fluorouracil may be a satisfactory option for therapeutic control of this condition.

Prevalence of acquired melanocytic naevi in Brazilian schoolchildren.

BACKGROUND: The prevalence of acquired melanocytic naevi (AMN) is one of the most important known risk factors for malignant melanoma (MM) in homogeneous white populations. However, there are few studies on AMN in heterogeneous populations. Insight into the causes of AMN in heterogeneous populations in a country with intense ultraviolet radiation should lead to successful strategies in the prevention of MM. AIM: To evaluate the frequency and anatomical distribution of AMN and to observe the influence of environmental and constitutional variables. METHODS: A cross-sectional study on the prevalence of AMN was performed on 1279 Brazilian schoolchildren, aged 2-8 years, according to an international protocol. RESULTS: Both girls and boys had the same number of AMN. The number of AMN was higher on sun-exposed body sites, such as shoulders, thorax/upper abdomen, face/ears and back. A high number of AMN was associated with lighter skin type, greater sun exposure, age, number of sunburns and presence of freckles. CONCLUSIONS: In genetically predisposed people, the body-site distribution of AMN in a heterogeneous population (mixed ethnic backgrounds) is similar to that in a homogeneous population and has the same tendency toward potential proliferation of melanocytes in the presence of ultraviolet radiation. Strategies to reduce the incidence of MM should start at an early age. We believe that these findings will have a direct effect on concepts for preventive strategies. Studies in different populations may serve as a starting point for research into the mechanism underlying increasing rates of AMN.

Dermoscopic examination of the nail bed and matrix.

Abstract Background Dermoscopy has furthered advances in the differential diagnosis of longitudinal melanonychia; however, fewer details observed in the nail, as compared to skin lesions, make interpretation difficult. Methods Ten cases of longitudinal melancholia, from several etiologies, were submitted to direct dermoscopic examination of the nail bed and matrix. Results We observed the presence of globules, streaks, and pigment network in the nail bed and matrix, which are dermoscopic features not seen in the nail plate. Conclusions This procedure enables visualization of dermascopic features not seen in the nail plate, making the diagnosis of melanocytic lesions easier.

Floating-Harbor syndrome: case report and craniofacial phenotype characterization.

Floating-Harbor syndrome is a rare genetic disorder of unknown aetiology. It was described for the first time in 1973. The syndrome is characterized mainly by short stature, delay in speech development and characteristic facial features. This article describes a report of a case of the syndrome and emphasizes the oral aspects, including descriptions of soft tissues, teeth, occlusion, stage of dental development and findings on examination of the temporomandibular joint. The treatment provided and its outcome is also described. Hopefully this information will be compared with findings from other patients in the future to assist in clarifying the phenotype of the Floating-Harbor syndrome.