Aslı Vefa Erdemir

Vascular patterns of nonpigmented tumoral skin lesions: confocal perspectives.

The characteristic vascular patterns of nonpigmented skin tumors have been established by dermoscopy. Recently, in vivo reflectance confocal microscopy (RCM) has become an established method for the noninvasive examination of skin tumors.

Divided nevus of the penis

A 3-year-old male patient presented with dark brown pigmented macules on his penis. His history was notable for circumcision operation 2 months before his referral to our clinic. Circumcision was performed for religious reasons. One month after this operation, his parents noticed the lesion. The dermatological examination of the patient revealed two opposing pigmented lesions on each side of the coronal sulcus. There was also a dark brown, well-circumscribed macule, 7 mm in diameter, on the left ventral aspect of the glans penis, and a 4-mm dark brown macule on the inner foreskin on the opposite side (Fig. 1). A dermoscopic evaluation revealed that both lesions had similar properties, with irregularly scattered pigmented globules of varying size on a pigmented area with a pale center and a dark periphery (Fig. 2). Since the lesion contained irregularly scattered globules, the macule on the prepuce was totally excised. The histopathological examination of the lesions showed nests of nevus cells in the dermo epidermal junction and upper dermis (Fig. 3). No cytological atypia was detected in the nevus cells. The diagnosis of “divided nevus” was made, and the patient was placed under a regular follow-up regime.

A Case Report of Real-Time in vivo Demonstration of Sarcoptes scabiei

Scabies is a pruritic dermatosis caused by the ectoparasite Sarcoptes scabiei var. hominis. The diagnosis of scabies is usually made on clinical grounds, but histopathological and/or dermoscopic examinations may sometimes be of assistance. However, these diagnostic modalities do not offer a detailed in vivo demonstration of the motile microorganism. Reflectance confocal microscopy (RCM) is a relatively novel imaging modality that permits in vivo examination of the skin at a resolution similar to that used during similar to histopathologic resolution. Here, a patient with crusted scabies is presented in whom a brief section of the lifecycle of S. scabiei was captured by RCM. Using this advanced imaging modality, the ectoparasites motion within the human host can be examined for clinical or research purposes and the mites viability may be assessed to monitor the response to treatment.

Superficial acral fibromyxoma in the heel with new vascular features on dermoscopy

Superficial acral fibromyxoma (SAFM) is an uncommon mesenchymal soft tissue tumor with a predilection for the acral extremites and nail bed involvement. SAFM is diagnosed with clinicopathological and immunohistochemical examination. Awareness of this rare tumor is important because of amounts of benign and malignant neoplasms. We report a case of SAFM in a rare localization in the heel with a new finding on dermoscopy.

The investigation of the relationships of demodex density with inflammatory response and oxidative stress in rosacea

The relationships of demodex density with systemic oxidative stress, inflammatory response, and clinical severity in rosacea are not clear. This study aimed to (a) analyze the levels of systemic oxidative stress, antioxidant capacity, inflammatory parameters, and matrix metalloproteinases (MMPs) in systemic circulation in patients with rosacea, (b) identify the relationship between mite density and both oxidative stress and inflammation, and (c) investigate the role of photoaging and sebum secretion in etiopathogenesis. Forty patients with rosacea and 40 age-, sex-, and skin phenotype-matched healthy volunteers were included in the study. Clinical disease severity of the patients was determined. Sebum levels were measured in both the groups, and photoaging was evaluated. Reflectance confocal microscopy was used to calculate demodex density. Serum total antioxidant capacity (TAC), total oxidant capacity (TOC), myeloperoxidase (MPO), MMP-1, MMP-9, arylesterase (ARES), interleukin-1β (IL-1β), paraoxonase-1 (PON-1), and tumor necrosis factor-α (TNF-α) levels were also analyzed. The patients with rosacea had significantly higher serum TOC and lower TAC levels (p < 0.001). The serum ARES and PON-1 levels were significantly lower (p = 0.045 and p < 0.001, respectively); however, the serum levels of MMP-1, MMP-9, IL-1β and MPO were higher in the patient group. Demodex parameters were higher in the patient group compared to the control group. There was no significant correlation between the number of mites and disease severity. In addition, the number of mites was not correlated with the serum levels of TAC, TOC, OSI, MPO, MMP-1, MMP-9, ARES, PON-1, TNF-α, and IL-1β. However, sebum levels were directly proportional to the number of mites. Photoaging severity was similar between the patients and control subjects. The changing sebaceous microenvironment in rosacea leads to an increase in the number of demodex mites. However, increased demodex density does not alter disease severity, level of oxidative stress, or inflammation. Although none of the patients with rosacea had any underlying systemic disease, patients’ systemic oxidative stress and inflammation parameters were found high in systemic circulation. It is assumed that the patients with rosacea are more prone to systemic diseases.

Cutis verticis gyrata secondary to giant cerebriform intradermal nevus in a pediatric patient

Cutis verticis gyrata (CVG) is a long-lasting and progressive condition in which there is hypertrophy and folding of the scalp skin. Cerebriform intradermal nevus (CIDN) is a rare cause of CVG. Here, we report a case with CIDN of the scalp in a 12-year-old girl. Dermatological examination showed a cerebriform appearance with accentuating folds and deep furrows, thickening in the temporal regions. We want to emphasize that CIDN should not be forgotten in the differential diagnosis of the causes of CVG.

Cutaneous angiosarcoma mimicking panniculitis in the lower extremities

Sir, The 36-year-old, otherwise healthy male admitted to our clinic with a complaint of a red swelling on his right ankle for 3 months. A history of lymphedema with an unknown etiology in the lower extremities was present in the patient. On the physical examination; a painful, red-livid erythematous, soft plaque; which was surrounded by a yellowish ecchymotic color was observed on the medial malleolus of the right ankle [Figure 1]. A punch biopsy was performed with prediagnosis of traumatic panniculitis and erythema nodosum. In the histopathologic examination; eosinophilic stained, atypical epithelioid cells with prominent nucleoli trying to form several vessel structures were observed [Figure 2]. In the immunohistochemical study, tumoral cells stained strongly positive with CD31 and friend leukemia integration 1 (FLI-1) [Figure 3]. Ki-67 proliferation index was very high (60%). A diagnosis of cutaneous angiosarcoma was made with clinical and histopathological findings. At the follow-up, 3 weeks after the first admittance, a rapid growth in the diameter of the lesion and a pronounced vascular character was observed [Figure 4]. No distant metastases were detected in the positron emission tomography-computed tomography examination. A wide local surgical excision was performed which was followed by 33 sessions of local radiotherapy postoperatively. After 16 months, in his regular follow-ups, metastatic disease involvement in the lungs was detected, and chemotherapy was planned.

Clinical and Prognostic Factors in the Development of Basal Cell Carcinoma

We investigated the environmental and personal risk factors associated with the development of basal cell carcinoma (BCC). This retrospective cohort study included a total of 997 patients whose diagnosis was confirmed by histopathologic examination between 2007 and 2014. A control examination was performed in 363 of these patients, who were accessed via telephone. A total of 1151 tumors were detected in 997 patients. During their follow-up, 13% of them developed subsequent tumors. The risk of developing subsequent tumor was 2.7-fold higher in patients with multiple BCCs at the time of diagnosis than those with single BCC. Multiple BCCs tended to develop in older patients and men. The risk of developing multiple BCCs was increased in patients with a history of BCC, skin type 1 or 2, and chronic sun exposure (sun exposure of >500 weeks, a high photoaging score [≥30], and the presence of actinic keratosis). We concluded that chronic sun exposure may increase the risk of developing multiple BCCs. These data also indicate that cumulative sun exposure is as important for developing BCC as for squamous cell carcinoma.

A case of dyskeratosis congenita with dermoscopic and reflectance confocal microscopic features

CLINICAL PRESENTATION A 23-year-old man presented to our clinic with nail dystrophy, reticular pigmentation (Fig 1), oral leukoplakia, microcephaly, pectus carinatum, gray hair, and short stature. With these characteristic clinical features he was given a diagnosis of dyskeratosis congenita. Systemic evaluation revealed associated osteoporosis, scoliosis, mental retardation, pulmonary fibrosis, cerebellar hypoplasia, periodontitis, extensive caries of teeth, and short-blunted roots. Acitretin therapy was started to prevent dermatologic malignancy. The patient is still followed up by dermatology and hematology clinics regularly.