Cristiane Benvenuto-Andrade

Congenital melanocytic nevi needing treatment

ABSTRACT:u2002 Patients presenting with congenital melanocytic nevi (CMN) need individualized treatment based upon nevus size, thickness, location, risk for developing melanoma, and psychological characteristics of the patient and family. The present authors review CMN types and prognoses, as well as absolute and relative indications for treatment. Risks and benefits of several treatment options are discussed, including surgical options, such as excision, chemical peels, dermabrasion and curettage, and laser therapy. The main focus of treatment is, in all cases, to address the concern for developing melanoma, at the same time optimizing the aesthetic and functional outcomes.

Predominant Dermoscopic Patterns Observed among Nevi

Background: It has been clinically observed that patients “normal” moles resemble each other. Whether this concept is applicable to dermoscopic practice has not been sufficiently studied. Objective: To investigate whether physicians evaluating dermoscopic images would identify common dermoscopic profiles of nevi within individual patients. Methods: Images of 205 nevi belonging to 18 patients were evaluated by 2 dermatologists for dermoscopic global pattern, color, and specific structures. We defined dermoscopic patterns as dominant if seen in ≥ 40% of the patients nevi; a minor pattern was defined as 20 to 39%. Results: A dominant pattern was seen in 15 patients (83%). In 13 (72%) of the patients, ≥ 80% of the nevi were classified into one, two, or three global patterns. The reticular global pattern was the most prevalent dominant pattern, seen in 9 patients (50%); the homogeneous pattern was the most prevalent minor pattern, seen in 16 patients (89%). Conclusion: Individuals tend to have one to three predominant dermoscopic nevus global patterns.

Terapia fotodinámica en dermatología

Photodynamic therapy (PDT) is a therapeutic modality based on the photooxidation of biological materials induced by a photosensitizer, which selectively locates itself in certain tumorous cells or tissues, so that when illuminated by a light of the right length and at a sufficient dose, these cells are destroyed. In dermatology, PDT with topical 5-aminolevulinic acid or 5-methyl aminolevulinate is very effective in the treatment of actinic keratoses, basal cell carcinomas and Bowens disease. In addition, very promising results have been obtained in inflammatory pathologies like morphea or sarcoidosis, infections like warts, and cosmetic processes such as photoaging, among others. This article reviews the most significant aspects of PDT in dermatology. First of all, we will review the basic fundamentals of photodynamic treatment. Next, we will outline its clinical applications in dermatology, both in oncological applications and all those dermatological processes in which PDT may play a role in their management. We will also discuss its promising cosmetic application in the treatment of photoaging. We will complete the review with photodiagnosis and the different non-invasive ways to monitor the effectiveness of PDT.Resumen La terapia fotodinamica (TF) es una modalidad terapeutica basada en la fotooxidacion de materiales biologicos inducida por un fotosensibilizante, el cual se localiza selectivamente en determinadas celulas o tejidos tumorales, de forma que al ser iluminadas con una luz de adecuada longitud y en dosis suficiente, dichas celulas resultan destruidas. En dermatologia, la TF con acido 5-aminolevulinico o 5-metilo aminolevulinato topicos es muy efectiva en el tratamiento de queratosis actinicas, carcinomas basocelulares y enfermedad de Bowen. Ademas, se han obtenido resultados muy prometedores en patologia inflamatoria como la morfea o la sarcoidosis, infecciones como las verrugas y procesos cosmeticos, como el fotoenvejecimiento, entre otras. El presente articulo revisa los aspectos mas relevantes de la TF en dermatologia. En primer lugar se hara una revision de los fundamentos basicos del tratamiento fotodinamico; posteriormente se expondran sus aplicaciones clinicas en dermatologia, tanto las oncologicas como todos aquellos procesos dermatologicos en los que la TF puede desempenar un papel en su manejo, sin olvidar su prometedora aplicacion cosmetica en el tratamiento del fotoenvejecimiento. Finalizaremos la revision con el fotodiagnostico y las diferentes formas de monitorizacion no invasiva de la efectividad de la TF.

Cutaneous melanoma: surveillance of patients for recurrence and new primary melanomas

ABSTRACT:u2002 The increasing incidence and overall survival of patients diagnosed with melanoma of the skin are leading to an ever‐increasing population of individuals with a personal history of melanoma. These patients are at risk for developing local, regional, or distant recurrence and are also at greater risk than the general population for developing a new primary melanoma. This article presents the rational for implementing surveillance strategies for patients with a history of melanoma.

Reflectance Confocal Microscopy of Molluscum Contagiosum

R EFLECTANCE CONFOCAL MICROSCOPY (RCM) allows noninvasive imaging of the skin at cellular-level resolution. However, unlike pathologic analysis, RCM obtains horizontal optical sections (en face). We present RCM images (Figure 1A and Figure 2A) with histopathologic correlation (Figure 1B and Figure 2B) of molluscum contagiosum, a viral infection that manifests clinically as solitary or multiple umbilicated, dome-shaped papules (Figure 1C). The 4 4-mm RCM mosaic image (Figure 1A) shows a round, wellcircumscribed lesion with central round cystic areas filled with brightly refractile material. The corresponding histopathologic image (Figure 1B [hematoxylin-eosin, original magnification 20]) shows several regular, rounded, squamoid lobules opening into central dilated infundibula filled with keratotic plugs. (The line in Figure 1B indicates the level of the corresponding Figure 1A RCM image.) The characteristic molluscum bodies seen on histopathologic analysis (Figure 2B, arrow [hematoxylin-eosin, original magnification 100]) correlated with refractile structures seen on 0.5 0.5-mm RCM optical sections (Figure 2A, arrow). This is a repeatable pattern seen on RCM of patients with molluscum. Additional Contributions: Daphne Demas, MA, provided technical assistance in the preparation of the figures.

Ten reasons why dermoscopy is beneficial for the evaluation of skin lesions

The dermoscope is an imaging instrument equipped with a light source and a magnifying lens. It is used for the noninvasive evaluation of subsurface skin structures and studies have shown that its use by trained physicians can improve the diagnostic accuracy for skin lesions. Although widely used in Europe and Australia, in the USA and the UK, many physicians still remain skeptical about the clinical utility of this instrument. In this article we present ten reasons why dermoscopy is beneficial for the evaluation of skin lesions and why it should be routinely used by trained physicians for the differential diagnosis of skin tumors.

Reflectance Confocal Microscopy for Imaging Pigmented Basal Cell Cancers in vivo

Reflectance confocal microscopy (RCM) may permit in-vivo diagnosis of pigmented basal cell carcinomas. RCM demonstrated distinctive aggregations of tumor cells forming cords and nodules of variable brightness, associated with bright granular and dendritic structures.

Dermoscopy-to-Confocal Scanning Laser Microscopy Correlation of Melanocytic Neoplasms

Both confocal microscopy and dermoscopy acquire en-face images. Confocal microscopy allowed for precise correlation of important dermoscopic structures of melanoma and nevi with the microscopic tissue counterparts.