Reflectance Confocal Microscopy Assessment of the Depigmenting Agents Complex for Melasma Treatment.

BACKGROUND: The management of melasma remains a challenge in dermatology, despite the availability of a variety of therapies, such as sunscreens, hypopigmented topical treatments, and chemical peels. The ideal treatment for melasma should be efficient, conclusive, and free from side effects. OBJECTIVE: The aim of this study is to assess the efficacy and tolerability of a depigmenting agent complex, based on the synergy of oligopeptide-68, phytic acid, glycolic acid, lactic acid, and octinoxate measured by clinical and reflectance confocal microscopy outcomes in melasma patients. METHODS: Twenty female patients exhibiting clinical evidence of melasma, aged between 29 and 61 years, were randomly enrolled in the study. Reflectance confocal microscopy was performed at baseline and after three months of treatment. RESULTS: Clinically, all patients showed significant improvement in melasma after treatment without adverse reactions. A relevant improvement in the treated skin areas was also assessed using reflectance confocal microscopy analysis. CONCLUSION: This study suggests that a combination of topical agents containing oligopeptide-68, phytic acid, glycolic acid, lactic acid, and octinoxate produces significant rapid improvement in melasma at clinical and cellular levels.

Performance of the "if in doubt, cut it out" rule for the management of nodular melanoma.

BACKGROUND: The recognition of nodular melanoma is clinically challenging, and the diagnostic accuracy of dermoscopy and confocal microscopy is lower than for superficial spreading melanoma. OBJECTIVES: To test a management strategy consisting in the excision of any nodular lesion that cannot be confidently and precisely classified as a benign tumor after clinical and dermoscopic examination. METHODS: Clinical and dermoscopic images of excised nodular lesions were retrospectively collected and evaluated. The evaluators were asked to record the level of diagnostic confidence for each lesion, by declaring if they were confident or doubtful about the given diagnosis. The NNE (number needed to excise) value was used to evaluate the efficacy of the proposed method. RESULTS: A total of 1,319 excised nodular lesions formed the study set. The NNE for any malignancy was 3.9 (634/164), while the NNE for melanoma was 13.2 (634/48). NNE for hypo and amelanotic melanoma was 27.3 (327/12). CONCLUSIONS: Excising doubtful nodular lesions seems to be an effective management strategy not to miss nodular melanoma, resulting in an acceptable rate of unnecessary excision of benign lesions.

Dermatofibroma looks dermoscopically different on trunk versus extremities.

BACKGROUND: Several dermoscopic patterns have been described in dermatofibroma (DF), but little is known about morphologic features of DF in different anatomic locations. The aim of this study was to evaluate the association between the dermoscopic pattern of DF and the anatomic location. METHODS: We conducted a retrospective observational study of 169 DF that were evaluated for the presence of dermoscopic structures and patterns. Patients' age and sex were recorded, while the anatomic location of each lesion was categorized in 2 main groups, namely extremities and trunk. The possible correlation between the dermoscopic pattern and the anatomic site was tested using the χ2 test or the Fisher's exact test, as appropriate. RESULTS: DFs resulted mainly located on extremities as compared to trunk (79.2% and 20.7%, respectively). Frequencies of dermoscopic patterns of DF were the following: atypical (26.6%), network and patch (23.7%), total structureless (17.1%), structureless and patch (9.5%), total network (6.5%), network and structureless (3.5%), double network (2.9%), white network and total structureless (2.9%), white network (2.9%), multifocal patches (2.4%), and total patch (1.8%). A significant association between network and patch pattern and extremities (27.6%) was found (P<0.05). Similarly structureless and patch pattern resulted completely absent on trunk and quite frequent on extremities (11.9%; P<0.05). In contrast, total structureless was the most common pattern on the trunk (31.4%) and less represented on extremities (P<0.05). Total network pattern followed the same trend (P<0.05). CONCLUSIONS: Our study reveals that the dermoscopic pattern of DF is significantly influenced by the anatomic location of the lesion. The "classic" pattern with a white patch surrounded by network dermoscopically characterizes DFs of the extremities, while DFs located on the trunk often exhibit different findings.