Melanocytic lesions with peripheral globules: results of an observational prospective study in 154 high-risk melanoma patients under digital dermoscopy follow-up evaluated with reflectance confocal microscopy.

BACKGROUND: The management of melanocytic lesions with peripheral globules (MLPGs) is usually age-dependent and can be challenging in high-risk melanoma patients. OBJECTIVES: To evaluate clinical, dermoscopic and reflectance confocal microscopy (RCM) features of MLPG in patients under digital dermoscopic surveillance. To know whether dermoscopic or RCM findings correlate with histologic diagnosis and the accuracy of the dermoscopy-RCM compared with histopathology. METHODS: During 24 months, we prospectively enrolled MLPG in patients under digital dermoscopy follow-up. All were evaluated by dermoscopy and RCM and excised for histologic examination. RESULTS: We enrolled 154 patients, mean age 42.45 years (18.78-73.19). Three melanomas and 19 dysplastic naevi (DNs) were diagnosed. There were no significant differences in the age of the patients (P = 0.662). MLPGs with diameter of 6 mm or more and asymmetry in two axes were associated with melanoma (P = 0.01, P = 0.003). Patients with more than one MLPG were less likely to have melanoma. Blue-grey and red colours were more frequent in melanoma (P = 0.013 and P = 0.000). Different sizes and shapes of PG were associated with DN and melanoma (P = 0.000 and P = 0.001). In a new lesion, PG in <25% of the circumference was related to malignancy (P = 0.010). RCM signs of malignancy were related to melanoma: pagetoid cells (P = 0.000), non-edged papillae (P = 0.001), atypical junctional thickenings (P = 0.000) and atypical cells at the dermal-epidermal junction (P = 0.000). Dense irregular nests were associated to melanoma (P = 0.019). Dermoscopy and confocal evaluation were able to diagnose 100% of melanomas and 84.21% of DNs. The kappa coefficient between dermoscopy-RCM vs. histology was 0.76. CONCLUSIONS: We recommend to excise a MLPG when it presents asymmetry in two axes, 6 or more mm, new lesion with PG in less than the 25% of the circumference, irregular size and shape PGs and irregular dense nests on RCM, regardless of the patient's age.

Microscopia confocal de reflectancia: una herramienta útil para diagnosticar malignidad en lesiones melanocíticas que presenten el signo de la isla / Reflectance Confocal Microscopy: A Promising Tool to Identify Malignancy in Melanocytic Lesions Exhibiting a Dermoscopic Island

El signo de la isla se define como un área bien delimitada en una lesión melanocítica, con un patrón dermatoscópico diferente al resto de la lesión. Es predictor de melanoma sobre todo cuando el patrón dermatoscópico de la isla es atípico. Presentamos las características con microscopia confocal de reflectancia (MCR) en un melanoma sobre nevus, un nevus melanocítico y un melanoma in situ con signo de la isla. El melanoma sobre nevus y el melanoma in situ, presentaban atipia celular (células atípicas aisladas y formando nidos) y distorsión arquitectural por MCR. El nevus presentaba un signo de la isla con un patrón globular típico con nidos densos sin atipia por MCR. El signo de la isla se relaciona sobre todo con melanomas in situ y melanomas sobre nevus. El MCR ofrece una buena resolución celular hasta dermis reticular, siendo útil en el diagnóstico de los melanomas con signo de la isla

The dermoscopic island is described as a well-defined area in a melanocytic lesion, with a different dermoscopic pattern from the rest of the lesion. It is predictive of melanoma, particularly when the pattern of the island is atypical. We present the reflectance confocal microscopy (RCM) findings in 3 lesions with dermoscopic islands: nevus-associated melanoma, melanocytic nevus, and in situ melanoma. The nevus-associated melanoma and in situ melanoma presented cellular atypia (atypical cells in isolation or forming nests) and architectural distortion on RCM. The nevus presented a dermoscopic island with a typical globular pattern with dense nests and no atypia on RCM. Dermoscopic island is mainly associated with in situ and nevus-associated melanomas. RCM offers good cellular resolution to the depth of the reticular dermis and is useful for diagnosing of melanomas presenting a dermoscopic island

Reflectance Confocal Microscopy: A Promising Tool to Identify Malignancy in Melanocytic Lesions Exhibiting a Dermoscopic Island. / Microscopia confocal de reflectancia: una herramienta útil para diagnosticar malignidad en lesiones melanocíticas que presenten el signo de la isla.

The dermoscopic island is described as a well-defined area in a melanocytic lesion, with a different dermoscopic pattern from the rest of the lesion. It is predictive of melanoma, particularly when the pattern of the island is atypical. We present the reflectance confocal microscopy (RCM) findings in 3 lesions with dermoscopic islands: nevus-associated melanoma, melanocytic nevus, and in situ melanoma. The nevus-associated melanoma and in situ melanoma presented cellular atypia (atypical cells in isolation or forming nests) and architectural distortion on RCM. The nevus presented a dermoscopic island with a typical globular pattern with dense nests and no atypia on RCM. Dermoscopic island is mainly associated with in situ and nevus-associated melanomas. RCM offers good cellular resolution to the depth of the reticular dermis and is useful for diagnosing of melanomas presenting a dermoscopic island.

Nevus esclerosante con rasgos seudomelanomatosos / Sclerosing nevus with pseudomelanomatous features: a case report

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Embolismos sépticos cutáneos tras angioplastia / Septic Emboli to the Skin Following Angioplasty

Los procedimientos vasculares invasivos son en el momento actual ampliamente utilizados para el diagnóstico y tratamiento de muchas patologías del sistema cardiovascular, con un buen perfil de seguridad y eficacia, aunque entrañan potenciales complicaciones que ocasionalmente pueden comprometer la vida del paciente. Presentamos un nuevo caso de pseudoaneurisma infeccioso postangioplastia complicado con embolismos sépticos cutáneos. Se trata de una entidad infrecuente caracterizada por bacteriemia persistente, sepsis sin foco aparente y embolismos sépticos regionales. El análisis histopatológico de las lesiones cutáneas habitualmente permite evidenciar la presencia de cocobacilos Gram positivos y de vasculitis séptica. Es una entidad con una importante morbimortalidad, por lo que el diagnóstico precoz resulta esencial. Por ello, ante lesiones cutáneas tras procedimientos vasculares invasivos deben considerarse en el diagnóstico diferencial no solo los embolismos de colesterol, sino también los embolismos sépticos (AU)

Invasive vascular procedures have good efficacy and safety profiles and are now widely used for the diagnosis and treatment of many cardiovascular disorders. However, they do have potential complications that can occasionally be life-threatening. We present a new case of infectious pseudoaneurysm following percutaneous transluminal coronary angioplasty and complicated by septic emboli to the skin. It is a rare condition characterized by persistent bacteremia, sepsis of unknown origin, and regional septic emboli. Histopathology of the skin lesions typically reveals gram-positive coccobacilli and septic vasculitis. The condition carries a significant morbidity and mortality, making early diagnosis essential. Both cholesterol and septic emboli should be considered in the differential diagnosis of skin lesions after invasive vascular procedures (AU)

[Septic emboli to the skin following angioplasty]. / Embolismos sépticos cutáneos tras angioplastia.

Invasive vascular procedures have good efficacy and safety profiles and are now widely used for the diagnosis and treatment of many cardiovascular disorders. However, they do have potential complications that can occasionally be life-threatening. We present a new case of infectious pseudoaneurysm following percutaneous transluminal coronary angioplasty and complicated by septic emboli to the skin. It is a rare condition characterized by persistent bacteremia, sepsis of unknown origin, and regional septic emboli. Histopathology of the skin lesions typically reveals gram-positive coccobacilli and septic vasculitis. The condition carries a significant morbidity and mortality, making early diagnosis essential. Both cholesterol and septic emboli should be considered in the differential diagnosis of skin lesions after invasive vascular procedures.

Vainas peripilares / Hair casts

Describimos el caso de una paciente con vainas peripilares por utilizar peinados a tensión tipo cola de caballo. El problema se resolvió fácilmente con el uso de lociones queratolíticas. Las vainas peripilares son una modificación estructural del cabello. Son unas masas de queratina que envuelven el tallo piloso. Instrumentos sencillos, como una lupa, pueden ayudarnos a distinguirlas de su principal diagnóstico diferencial, la Pediculosis capitis(AU)

We describe the case of a female patient with hair casts due to her hairstyle (a pulled-back ponytail). The problem was solved very easily with keratolytic lotions. Hair casts are a structural variation of the hair. They are keratin accretions encircling a segment of the hair shaft. They must be differentiated from pediculosis capitis with simple tools such as a magnifying glass(AU)

Placas hiperqueratósicas localizadas exclusivamente en palmas y plantas / No disponible

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