Akane Minagawa

Accuracy in melanoma detection: A 10-year multicenter survey

BACKGROUND Early excision is the only strategy to reduce melanoma mortality, but unnecessary excision of benign lesions increases morbidity and healthcare costs. OBJECTIVE To assess accuracy in melanoma detection based on number-needed-to-excise (NNE) values over a 10-year period. METHODS Information was retrieved on all histopathologically confirmed cutaneous melanomas or melanocytic nevi that were excised between 1998 and 2007 at participating clinics. NNE values were calculated by dividing the total number of excised lesions by the number of melanomas. Analyses included changes in NNE over time, differences in NNE between specialized clinical settings (SCS) versus non-specialized clinical settings (NSCS), and patient factors influencing NNE. RESULTS The participating clinics contributed a total of 300,215 cases, including 17,172 melanomas and 283,043 melanocytic nevi. The overall NNE values achieved in SCS and NSCS in the 10-year period were 8.7 and 29.4, respectively. The NNE improved over time in SCS (from 12.8 to 6.8), but appeared unchanged in NSCS. Most of the effect on NNE in SCS was due to a greater number of excised melanomas. Higher NNE values were observed in patients younger than 40 years and for lesions located on the trunk. LIMITATIONS No data concerning the use of dermatoscopy and digital monitoring procedures were collected from the participating centers. CONCLUSION Over the 10-year study period, accuracy in melanoma detection improved only in specialized clinics maybe because of a larger use of new diagnostic techniques such as dermatoscopy.

Dermoscopic Characteristics of Congenital Melanocytic Nevi Affecting Acral Volar Skin

OBJECTIVE To characterize the dermoscopic features of acral congenital melanocytic nevi (CMN). DESIGN Retrospective independent evaluation of dermoscopic images by 2 dermoscopists. SETTING A dermatology clinic at a university hospital. PATIENTS Using the files of the clinic from January 1, 2004, through February 28, 2009, we selected cases with CMN lesions affecting acral volar skin that were present at birth or developed within the first few months of life. MAIN OUTCOME MEASURES Characteristic dermoscopic features and their frequencies. RESULTS We collected a total of 24 acral CMN lesions. Dermoscopically, 9 lesions (38%) showed a combination of the crista dotted pattern and the parallel furrow pattern. Of these 9 lesions, 1 also had a fibrillar pattern. The remaining 15 lesions showed the following single-component patterns: the parallel furrow pattern in 6 (25%), the crista dotted pattern in 3 (12%), the fibrillar pattern in 2 (8%), and the globular, globulostreaklike, nontypical, and parallel ridge patterns in 1 each (4%). We also followed up 6 lesions for several years. Changes in the dermoscopic features were observed in 4 CMN lesions from patients younger than 14 years. Three lesions had a combination of the crista dotted and parallel furrow patterns on the first visit that changed to the nontypical pattern; in addition, the degrees of pigmentation decreased during follow-up. In the remaining lesion, the globulostreaklike pattern changed to the parallel furrow pattern. CONCLUSIONS Most CMN lesions affecting acral volar skin show characteristic dermoscopic features distinguishable from acral melanoma. The combination of the crista dotted and parallel furrow patterns (ie, peas-in-a-pod pattern) is the most common feature in acral CMN. Some lesions of acral CMN fade during childhood.

Dermoscopy of pigmented poromas.

Background: To date, little is known about the dermoscopic features of pigmented poromas. Methods: Twelve cases of pigmented poromas examined by dermoscpy at the Department of Dermatology, Shinshu University Hospital (Matsumoto, Japan), between January 2000 and February 2009 were collected. Retrospectively, digital dermoscopic images were evaluated for the presence of dermoscopic structures. Results: Vascular structures were observed in 8 of 12 cases. Hairpin vessels were found in 3 cases. Most were elongated and irregularly shaped. Polymorphous vessels were observed in 3 cases, of which 2 showed combinations of dotted vessels and linear-irregular vessels and 1 combinations of hairpin vessels and glomerular vessels. Arborizing vessels were observed in 2 cases. Globule-like structures occurred in 7 cases. Globule-like structures and arborizing vessels coexisted in 2 cases. Comedo-like openings were observed in 3 cases, all of which were accompanied by hairpin vessels. Conclusions: Pigmented poromas mimic a number of skin tumors, including pigmented basal cell carcinomas, seborrheic keratosis and malignant melanoma, because they present various clinical, dermoscopic and histopathological features.

Dermoscopic features of nonpigmented eccrine poromas in association with their histopathological features

Background  Nonpigmented eccrine poromas (EPs) occasionally mimic various skin tumours, but their dermoscopic features have not been clarified.

Dermoscopic and histopathological findings of polymorphous vessels in amelanotic cutaneous metastasis of pigmented cutaneous melanoma

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Vascular structure absence under dermoscopy in two cases of angiosarcoma on the scalp

four cases. Black henna tattoos represent a source of sensitization to PPD that has potentially severe mediumand long-term consequences. Reactions can cause scars, cheloids, and hypopigmentation at the site of the tattoo. These temporary tattoos can cause significant and lifelong sensitization, which is likely to lead to future reactivity to permanent hair dyes, chemicals in rubber products, inks, clothing dyes, and some medications (sulfonamides and hydroclorothiazides). This sensitization might affect a subject’s future choice of occupation, particularly with reference to hairdressing and photography. In conclusion, we describe a case of erythema multiforme-like eruption that occurred after the administration of a paint-on tattoo. Temporary tattoos are considered to be safer than permanent tattoos because they disappear within a few weeks. Permanent tattooing is associated with inflammatory reactions to tattoo pigments, photoallergic reactions, and inoculation by certain infectious agents. However, the practice of skin painting is not devoid of risk, and thus public education programs that divulge the dangers of exposure to higher concentrations of PPD are required.

Age-Related Prevalence of Dermoscopic Patterns in Acquired Melanocytic Nevus on Acral Volar Skin

Conflict of Interest Disclosures: Dr Winthrop has received a research grant from Pfizer and scientific advisory board or consultant fees from Amgen, Abbott, Genentech, and Pfizer. Dr Blauvelt has received scientific advisory board and consulting fees from Janssen, Abbott, Amgen, Novartis, Pfizer, Anacor, Takeda, and Boehringer Ingelheim. Dr Deodhar has received research grants from Amgen, Genentech, Janssen, Abbott, Novartis, and UCB pharmaceuticals; and consulting fees and speaking honoraria from Abbott, Pfizer, and UCB.

Eccrine porocarcinoma shares dermoscopic characteristics with eccrine poroma: A report of three cases and review of the published work

Eccrine porocarcinoma (EPC) is a rare malignant skin tumor presumably arising from the intraepidermal ductal portion of the sweat gland. EPC occasionally mimics eccrine poroma (EP), seborrhea keratosis (SK), basal cell carcinoma (BCC), pyogenic granuloma (PG) and amelanotic melanoma with its clinical appearance as a pink nodule. Dermoscopy is an invaluable technique in diagnosing skin tumors. However, few cases of EPC have been reported using dermoscopic images, and their details were not well examined. Here, we present three histopathologically proven cases of EPC and summarize their dermoscopic findings together with five previously reported cases. None of the eight cases showed dermoscopic evidence indicative of SK (comedo‐like openings, milia‐like cysts, fissures and ridges, and hairpin vessels with white halo), BCC (blue‐gray ovoid nests, multiple blue‐gray globules, wheel‐like structures, shiny white areas, leaf‐like areas and arborizing vessels) or PG (reddish homogeneous area with collarette and white rail lines). A milky red area, which was suggestive of amelanotic melanoma, was not detectable in any cases. Seven cases exhibited a polymorphous vascular pattern mainly consisting of hairpin, linear‐irregular and dotted vessels. A combination of round‐to‐oval pink‐white structureless areas and white‐to‐pink halo was observed in five of eight cases, with one case showing the white‐to‐pink halo alone. Our investigation revealed that the dermoscopic characteristic of EP was also observed in discrete areas of EPC lesions. Thus, it is possible that the histopathological architecture of EPC contains portions of benign EP‐like components. Awareness of this dermoscopic aspect of EPC may be helpful when diagnosing pink nodules.

Dermoscopy of white fibrous papulosis of the neck.

W HITE FIBROUS PAPULOSIS OF THE NECK (WFPN), which was first described by Shimizu et al in 1985, clinically presents as asymptomatic white papules, measuring 2 to 3 mm in diameter, on the neck of elderly persons. The lesions are round to oval, clearly marginated, and unrelated to hair follicles. The lesions shown in Figures 1, 2, 3, and 4 were located on the neck of a 58-year-old Japanese man (Figures 1 and 2) and a 68-year old Japanese man (Figures 3 and 4). Dermoscopy of both lesions revealed clearly circumscribed, homogeneous, white areas, including dotted or short, thin vessels, without follicular involvement. Peripheral pigmentation can be seen but fails to form a pigment network (Figures 1 and 2). The diagnosis of WFPN was confirmed histopathologically in both cases (Figure 5 and Figure 6 [hematoxylin-eosin, original magnification 100]). The histopathologic characteristics of WFPN include relatively well-circumscribed areas consisting of thickened collagen bundles in the papillary to middle dermis, without vascular proliferation, and a decrease of melanin content in the epidermis. These histopathologic features are consistent with the white, nodular, dermoscopic appearance. The differential diagnosis includes dermatofibroma, which is less well circumscribed and has a peripheral delicate pigment network. Furthermore, dermatofibromas have been noted to be erythematous (31.5%) and include dotted vessels (30.6%). Ten patterns of dermatofibroma have been described, but none matches our cases of WFPN. The differential diagnosis of WFPN may also include sebaceous hyperplasia and molluscum contagiosum, which are both distinguishable because of the presence of crown vessels. The dermoscopic features of WFPN may be unique and include homogeneous, white, wellcircumscribed lesions punctuated with dotted or short, thin vessels.

Dermoscopy–pathology relationship in seborrheic keratosis

Making a definitive diagnosis of seborrheic keratosis (SK) can be challenging for the naked eye due to its wide variation in clinical features. Fortunately, however, most cases of SK exhibit the typical dermoscopic findings of fissures and ridges, hairpin vessels with white halo, comedo‐like openings, and milia‐like cysts, all of which are helpful to distinguish SK from melanoma, melanocytic nevus, squamous cell carcinoma, basal cell carcinoma (BCC) and other skin tumors. Histopathologically, these dermoscopic characteristics correspond to papillomatous surface of the epidermis, enlarged capillaries of the dermal papillae, pseudohorn cysts in the epidermis opened to the surface of the lesion and intraepidermal cysts, respectively. Clinicians should bear in mind that the clonal type of SK dermoscopically mimics melanoma and BCC by the presence of globule‐like structures, while regressing SK exhibits a granular pattern that is similar to the peppering found in melanoma. Furthermore, milia‐like cysts alone are insufficient for a conclusive diagnosis of SK because melanoma in rare cases displays cysts along with other SK‐like dermoscopic findings.