A Di Stefani

Dermoscopy of facial nonpigmented actinic keratosis

Background  The accuracy of clinical diagnosis of nonpigmented, facial actinic keratosis (AK) is often suboptimal, even for experienced clinicians.

The additive value of second opinion teleconsulting in the management of patients with challenging inflammatory, neoplastic skin diseases : a best practice model in dermatology?

Background  Telemedicine is the practice of healthcare using interactive processes of communication to facilitate healthcare delivery, including diagnosis, consultation and treatment, as well as education and transfer of medical data. The aim of teledermatology, just as telemedicine, is to promote best practice procedures and to improve the consistency and competence of health care.

Two years' experience with Web-based teleconsulting in dermatology

A non-commercial teledermatology network based on store-and-forward operation was established in April 2002. The aim was to create an easy-to-use platform for teleconsultation services, where physicians could seek diagnostic advice in dermatology from a pool of expert consultants and where they could present and discuss challenging dermatology cases with special emphasis on diagnosis and therapy. An online moderated discussion forum was added in October 2003. During the first two years, 348 health-care professionals from 45 countries registered to use the Website. A total of 783 requests for consultations were answered; 285 requests concerned pigmented skin lesions, 440 requests were from the whole range of clinical dermatology and 58 requests were about non-melanoma skin cancer. Of a total of 133 requests analysed, 80 (60%) were answered within one day, 47 (35%) within one week, five (4%) within two weeks and one (1%) consultation was answered in more than two weeks. Our experience with a discretionary, non-commercial, multilingual Website for open-access teleconsulting in dermatology appears to be successful. The Website represents an example of user-generated content, together with active interaction between users, who can present and discuss cases with remote colleagues.

Dermoscopy for challenging melanoma; how to raise the ‘red flag’ when melanoma clinically looks benign

Melanoma may mimic clinically a number of benign skin tumours by exhibiting overlapping features that do not allow accurate differentiation. Dermoscopy is a noninvasive diagnostic tool allowing the evaluation of specific subsurface morphological structures that are useful in most cases to distinguish melanoma from other melanocytic and nonmelanocytic skin tumours. In order to minimize the risk of missing melanoma, the diagnosis should be based on a good correspondence between the clinical and the dermoscopic findings. The case presented here refers to a melanoma clinically simulating dermatofibroma that was biopsied because dermoscopic examination revealed unusual features that did not confirm the clinical diagnosis.

Personal Digital Assistants in Teledermatology

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The BRAAFF checklist: a new dermoscopic algorithm for diagnosing acral melanoma

The parallel ridge pattern (PRP) is considered the dermoscopic hallmark of acral melanoma (AM). However, it was recently shown that approximately one‐third of AMs do not display a PRP dermoscopically, rendering their detection more troublesome.

Dermoscopic variability of basal cell carcinoma according to clinical type and anatomic location

Correctly diagnosing basal cell carcinoma (BCC) clinical type is crucial for the therapeutic management. A systematic description of the variability of all reported BCC dermoscopic features according to clinical type and anatomic location is lacking.

Benign dermoscopic features in melanoma

Various dermoscopic features are usually associated with benign melanocytic lesions. Our objective was to determine frequency and extension of benign dermoscopic features (BDF) in melanoma.

Occurrence of hidradenitis suppurativa and phrynoderma after bariatric surgery

Editor We read with great interest the review of Wollina et al. describing the potential impact of bariatric surgery (BS) on inflammatory skin diseases, such as psoriasis and hidradenitis suppurativa, both strongly linked to morbid obesity and metabolic syndrome. We report a case of hidradenitis suppurativa (HS) associated with phrynoderma, developing after BS. A 47-year-old, former morbidly obese (BMI 49.1) man presented with a 2-year history of multiple cutaneous follicular, hyperkeratotic inflammatory lesions disseminated on the extensor areas of the legs. Deep, painful subcutaneous abscesses with draining sinuses and extensive fistulization, involved the inguinal and perianal area (Fig. 1).The patient initially developed follicular lesions 1 month after a procedure of BS, a bilio-pancreatic diversion with duodenal switch. Four years earlier, he underwent a first restrictive procedure, consisting of a laparoscopic adjustable gastric band, which resulted in less than 20% improvement of excess weight loss (EWL). The second BS procedure, a primarily malabsorptive one, was associated with a massive weight loss of 67 kg over a 2-year period (BMI 23.4), as well as subclinical malabsorption, the latter treated promptly with micronutritional supplements. In the same period, the follicular lesions gradually extended over the inguinal folds, with the occurrence of abscesses and fistulization. The axillary regions were otherwise unaffected. The patient, a smoker (30 pack-years), had neither a history of acne conglobata or HS, nor any ocular complaints. Cutaneous lesions responded only partially to multiple courses of topical and systemic antibiotics, while affected areas partially healed with extensive scarring. At the time of our observation, laboratory investigations showed multiple nutritional deficiencies, including low levels of Vitamin D