Computer-aided clinical image analysis as a predictor of sentinel lymph node positivity in cutaneous melanoma.

BACKGROUND: Delays in sentinel lymph node (SLN) biopsy may affect the positivity of non-SLNs. For these reasons, effort is being directed at obtaining reliable information regarding SLN positivity prior to surgical excision. However, the existing tools, e.g., dermoscopy, do not recognize statistically significant predictive criteria for SLN positivity in melanomas. AIM: To investigate the possible association of computer-assisted objectively obtained color, color texture, sharpness and geometry variables with SLN positivity. METHODS: We retrospectively reviewed and analyzed the computerized medical records of all patients diagnosed with cutaneous melanoma in a tertiary hospital in Germany during a 3-year period. The study included patients with histologically confirmed melanomas with Breslow > 0.75 mm who underwent lesion excision and SLN biopsy during the study period and who had clinical images shot with a digital camera and a handheld ruler aligned beside the lesion. RESULTS: Ninety-nine patients with an equal number of lesions met the inclusion criteria and were included in the analysis. Overall mean (± standard deviation) age was 66 (15) years. The study group consisted of 20 patients with tumor-positive SLN (SLN+) biopsy, who were compared to 79 patients with tumor-negative SLN biopsy specimen (control group). The two groups differed significantly in terms of age (61 years vs 68 years) and histological subtype, with the SLN+ patients being younger and presenting more often with nodular or secondary nodular tumors (P < 0.05). The study group patients showed significantly higher eccentricity (i.e. distance between color and geometrical midpoint) as well as higher sharpness (i.e. these lesions were more discrete from the surrounding normal skin, P < 0.05). Regarding color variables, SLN+ patients demonstrated higher range in all four color intensities (gray, red, green, blue) and significantly higher skewness in three color intensities (gray, red, blue), P < 0.05. Color texture variables, i.e. lacunarity, were comparable in both groups. CONCLUSION: SLN+ patients demonstrated significantly higher eccentricity, higher sharpness, higher range in all four color intensities (gray, red, green, blue) and significantly higher skewness in three color intensities (gray, red, blue). Further prospective studies are needed to better understand the effectiveness of clinical image processing in SLN+ melanoma patients.

[Successful treatment of Old World cutaneous leishmaniasis with red or green light photodynamic therapy]. / Erfolgreiche Therapie der kutanen Leishmaniose der Alten Welt mit photodynamischer Therapie unter Einsatz von Rot- oder Grünlicht.

Cutaneous leishmaniasis is one of the most common travel dermatoses in Germany, which can be acquired not only in Africa, Asia or the American continent, but also in southern European countries. In addition to the currently available topical and systemic therapy options, there have been increasing reports of successful treatment of cutaneous leishmaniasis with photodynamic therapy (PDT) using numerous therapy regimens and different photosensitizers in recent years. We report on successful photodynamic therapy of Old World cutaneous leishmaniasis with red and green light PDT with 10% 5­aminolevulinic acid.

Sexually acquired pubogenital dermatophytosis induced by Trichophyton quinckeanum.

Tinea corporis is a common superficial dermatophytosis mostly located at the trunk and extremities. In contrast, tinea of the anogenital region is rare and predominantly occurs in tropical countries. In recent years, a distinctive variant of pubogenital tinea (PT) characterized by deep tissue infiltration and systemic symptoms has been reported, and transmission via sexual contacts has been hypothezised. In the majority of cases, a new genotype of Trichophyton mentagrophytes classified as T. mentagrophytes VII was detected as the causative pathogen. We report a case of PT caused by T. quinckeanum that experienced a strong inflammatory reaction following initiation of successful antifungal treatment with itraconazole.

Baricitinib for recalcitrant subacute cutaneous lupus erythematosus with concomitant frontal fibrosing alopecia.

We read with great interest the recently published article by Joos et al. on the successful use of baricitinib for cutaneous lupus erythematosus. The authors presented a heavily pretreated case of subacute cutaneous lupus erythematosus (SCLE) with almost complete clearance following 6 months of baricitinib therapy. We would like to add our experiences of baricitinib for SCLE in a patient with concomitant frontal fibrosing alopecia.

Computer-aided clinical image analysis for non-invasive assessment of tumor thickness in cutaneous melanoma.

OBJECTIVE: Computerized clinical image analysis is shown to improve diagnostic accuracy for cutaneous melanoma but its effectiveness in preoperative assessment of melanoma thickness has not been studied. The aim of this study, is to explore how melanoma thickness correlates with computer-assisted objectively obtained color and geometric variables. All patients diagnosed with cutaneous melanoma with available clinical images prior to tumor excision were included in the study. All images underwent digital processing with an automated non-commercial software. The software provided measurements for geometrical variables, i.e., overall lesion surface, maximum diameter, perimeter, circularity, eccentricity, mean radius, as well as for color variables, i.e., range, standard deviation, coefficient of variation and skewness in the red, green, and blue color space. RESULTS: One hundred fifty-six lesions were included in the final analysis. The mean tumor thickness was 1.84 mm (range 0.2-25). Melanoma thickness was strongly correlated with overall surface area, maximum diameter, perimeter and mean lesion radius. Thickness was moderately correlated with eccentricity, green color and blue color. We conclude that geometrical and color parameters, as objectively extracted by computer-aided clinical image processing, may correlate with tumor thickness in patients with cutaneous melanoma. However, these correlations are not strong enough to reliably predict tumor thickness.

Acquired lymphangioma circumscriptum in high-grade penile intraepithelial neoplasia.

Lymphangioma circumscriptum (LC) is a rare, benign vascular malformation induced by abnormal lymphatic vessels of the skin. LC might be either congenital or acquired, and is predominantly located on the trunk, buttock, axillary region, or thighs. Penile LC is rare. This case report describes a patient with acquired LC associated with high-grade penile intraepithelial neoplasia induced by human papillomavirus type 66. As the patient had multifocal lesions on the glans penis and prepuce we decided to perform circumcision, followed by electrocoagulation of the lesions on the glans. Electrocautery should be considered as a first choice for treatment of LC located at surgically challenging regions such as the glans penis.