1,721,693 research outputs found
Topical calcipotriol as a new therapeutic option for the treatment of clear cell acanthoma
Full text linkAlthough uncommonly diagnosed, clear cell acanthoma represents an original source of speculative interest for dermatologists. Due to its clinical variability, it is often only recognized accidentally after histology. Dermoscopy has improved the reliability of clinical diagnosis of typical clear cell acanthoma thanks to the vascular pinpoint pattern and desquamative, peripheral collarette. Generally, therapy of clear cell acanthoma is oriented towards ablative solutions, such as surgery or cryotherapy. We propose a conservative therapy, based on the application of topical calcipotriol, which has produced complete regression after 2 months and no relapse one year after the end of treatment. A dermatoscope monitored all changes of clear cell acanthoma, showing its utility not only in diagnosis but also in therapeutic follow-up. This new therapeutic approach should support an inflammatory etiology of clear cell acanthoma, although further observations are needed to confirm this
Melanomas
No full textMelanomas are a wide range of tumors that differ in their epidemiology, morphology, genetic profile, and biological behavior. They can be grouped as superficial spreading melanoma, lentigo maligna, and nodular melanoma. Reflectance confocal microscopy is useful for the evaluation of skin lesions that are dermoscopically doubtful by increasing diagnostic accuracy and specificity. This article provides a comprehensive overview of the different confocal main morphologies of distinct melanoma types as a function of the anatomic location of the tumor
Comparison between morphological parameters in pigmented skin lesion images acquired by means of epiluminescence surface microscopy and polarized-light videomicroscopy
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Surface microscopy features of congenital nevi
No full textCongenital melanocytic nevi (CMN) are pigmented skin lesions (PSL) that are present at birth. The frequency of PSLs at birth is estimated to be 2.5%, and 1% of newborns have biopsy-confirmed melanocytic nevi.[1, 2 and 3] The most widely used classification of congenital nevi is based on their size, subdividing the lesions into three groups: small (<1.5 cm), medium (1.5–19.9 cm), and large (20 cm or greater). [4] It is well established that giant congenital nevi have a potential risk of malignant transformation, and the probable lifetime risk is quoted between 5% and 15%. [4, 5, 6, 7, 8 and 9] Small and medium-size CMNs (SCMNs) are considerably more common than large ones and are thus of greater epidemiologic significance if they represent precursors of melanoma. The risk for the occurrence of melanomas in SCMNs, however, is still under debate. [3, 4, 10, 11, 12, 13, 14 and 15] The problem is that until the SCMN cannot be precisely diagnosed because of the lack of specific clinical and histologic criteria and the frequent unreliability of patient history, their melanoma risk cannot be evaluated. In fact, ascertainment of congenital nevi beyond the newborn period may be difficult because the prevalence of acquired nevi rises rapidly during early childhood. Although histologic examination is useful in distinguishing whether or not a nevus is congenital or acquired, there are no features that are completely specific and sensitive. [16] A careful history, therefore, is at times more sensitive than histologic examination in diagnosing a nevus as congenital, although the reliability of anamnesis regarding the congenital nature of the lesion cannot always be proven.Yet, this issue is of practical importance: routine prophylactic removal of all SCMNs has been suggested by some authors,[6, 8 and 12] and it is necessary to balance the cost and risk of surgery with any possible risk of malignant change. The introduction of instrumental devices allowing the observation of subsurface structures has enabled the identification of morphologic features characterizing different pigmented skin lesions. [17, 18, 19, 20, 21 and 22] Therefore, the identification of specific surface microscopic aspects of SCMNs appears to be relevant to correlate different morphologic subgroups to different risk classes in prospective studies assessing the incidence of melanomas arising from CMNs.We recently proposed a classification of SCMNs according to their macroscopic and surface microscopic appearance.[23] The following data refer to a series of SCMNs (mean diameter of 18 mm) that were examined and recorded by means of a polarized-light surface microscope using 20-fold images for the description of the global aspect of the lesion and 50-fold ones for identification of the characteristic patterns. An equal number of acquired melanocytic nevi randomly selected from our database was examined for comparison of the two series of PSLs. Images were acquired by a VMS-110A videomicroscope (Scalar, Mitsubishi, Japan), based on the polarizing-light method [24] and the Videocap 8.09 (DS-Medica, Italy) software
Preoperative melanoma thickness determination by 20-MHz sonography and digital videomicroscopy in combination
Full text linkObjective: To identify accurately thick melanomas preoperatively by means of a combined approach based on sonography and clinical-videomicroscopic evaluation. Design: Ultrasonographic thickness measurement, obtained by means of a 20-MHz B-scanner, and identification of clinical and videomicroscopic variables useful in distinguishing between thick and thin melanomas were performed on a training set of 40 melanomas. An algorithm based on echographic, clinical, and videomicroscopic criteria was constructed to develop a method for preoperative evaluation of melanoma thickness and was validated on a test set of 48 melanomas. Setting: University medical department. Patients: Eighty-eight patients affected by primary cutaneous melanoma, Main Outcome Measures: Sensitivity and specificity of the algorithm, with the use of sonographic, clinical, and video microscopic data, in thick melanoma identification. Results: Echographic thickness was calculated for each lesion. On the training set, 2 clinical and 7 videomicroscopic features were identified for distinction between thick and thin melanomas: nonpalpability, central pigment network, central brown globules, and blotches were characteristic of thin melanomas; clinical regression, localized peripheral pigment network, veil, grayish polygonal areas, and blood vessels were characteristic of thick ones. A coefficient was attributed to each variable and a score was obtained for each lesion. The algorithm, developed for preoperative thickness prediction, was validated on the test set, enabling the distinction of thick melanomas with an 86.7% sensitivity and a 100% specificity. Conclusion: The correct classification of all thin melanomas as such renders this approach suitable in clinical practice
Water sorption-desorption test and moisture accumulation test for functional assessment of atopic skin in children
No full textSorption-desorption and moisture accumulation tests are simple and quick methods for the irt vivo functional analysis of stratum corneum hydration kinetics. The aim of this study was to evaluate the hydration dynamics of the uninvolved and affected skin of children with atopic dermatitis and to compare them nifh the skin of healthy children. The study investigated 45 children. The dynamic tests were performed using the corneometer CM820. Numerical parameters were calculated. With the sorption-desorption test, eczematous skin showed lower water accumulation during the sorption phase, whereas water was released more slowly during the desorption phase. With the moisture accumulation test, increases in water accumulation velocity and in water accumulation were observed in atopic children. Dynamic, tests showed that the stratum corneum of unaffected atopic skin was less hydrated but more easily hydratable than normal skin. (Conversely, despite a lower absorption capability, eczematous skin showed a greater avidity to retain wafer. New functional parameters (water-sorption capacity and accumulated water decay) are proposed to describe more precisely the hydration kinetics of eczematous skin
Variations in facial skin thickness and echogenicity with site and age
No full textThe characteristic pattern of reflectivity of facial skin, as evaluated by ultrasound, has not previously been described quantitatively. The aim of this study was to evaluate site- and age-dependent variations in skin thickness and echogenicity of facial skin, A total of 40 women, in different age groups, were studied at 12 different facial skin sites. Echographic images were recorded with a 20 MHz B-Scanner and processed by dedicated software. Skin thickness measurements showed significantly higher values on the lower part of the face, whereas skin echogenicity was higher on the upper part of the face. In elderly subjects, an increase in facial skin thickness and overall echogenicity was observed compared with the younger subjects at all assessed skin areas, except the infraorbital regions. Moreover, modifications of skin echogenicity according to age, consisting in the appearance of a subepidermal band and an enhancement of the lower dermis' reflectivity, were observable at most facial skin sites
Merkel cell Carcinoma arising on a pre-existing Bowen's disease: Is it just by chance?
No full textMerkel cell Carcinoma (MCC) is a cutaneous Carcinoma with neuroendocrine differentiation. It arises typically on sun-exposed areas of elderly men as an asymptomatic, rapidly growing, red nodule. Although it is usually found as a solitary nodule, in almost one third of cases MCC may be associated with other malignancies such as basal cell or squamous cell carcinomas. Merkel cell Carcinoma should be considered as differential diagnosis every time we have a rapidly growing, red nodule, arising in an elderly patient with signs of sun-damage. We report a case of MCC developing in association with a pre-existing Bowen's disease. The association between MCC and Bowen's disease is quite common and their area of occurrence is usually a sun-exposed area. Ultraviolet radiation contributes to the etiology of both the malignancies
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