Edith Arzberger

Mobile teledermatology helping patients control high‐need acne: a randomized controlled trial

Acne is an important health issue with a major psychological impact in addition to the physical problems it causes.

Differentiation Between Balanitis and Carcinoma In Situ Using Reflectance Confocal Microscopy

IMPORTANCE Zoon plasma cell balanitis is a benign inflammatory disease of genital skin. It may be difficult to clinically distinguish between balanitis and carcinoma in situ (CIS); thus, a biopsy may be needed to exclude malignant disease. Reflectance confocal microscopy (RCM) is an in vivo imaging method to get morphologic information about architecture and single cells in the skin. OBJECTIVE To evaluate the ability of RCM to differentiate between balanitis and CIS compared with the gold standard histopathologic methods. DESIGN Observer blinded study. SETTING A referral center. PARTICIPANTS Fifteen patients with balanitis or CIS. INTERVENTION Patients were assessed by clinical, histologic, and RCM findings. All lesions were imaged with the Vivascope 1500. In 5 cases of balanitis, the surrounding, noninvolved skin also was evaluated. MAIN OUTCOME MEASURES Local recurrence, nodal metastasis, disease-specific death, overall death. RESULTS The clinical diagnoses showed 9 cases of balanitis and 6 cases of CIS. With histopathologic analysis, 12 cases of balanitis and cases of CIS were diagnosed, and RCM evaluation confirmed these diagnoses. The most relevant RCM criteria for CIS were atypical honeycomb pattern, disarranged epidermal pattern, and round nucleated cells. Balanitis showed a nucleated honeycomb pattern and vermicular vessels. Scattered small bright cells and round vessels were present in all lesions. The adjacent normal skin showed a typical honeycomb pattern and round papillary vessels. CONCLUSIONS AND RELEVANCE We were able to differentiate between balanitis and CIS. Reflectance confocal microscopy may help to avoid biopsies at this sensitive site.

Noninvasive differentiation between mamillary eczema and Paget disease by in vivo reflectance confocal microscopy on the basis of two case reports

MADAM, Differential diagnosis of erosive lesions of the mamilla comprises eczema, allergic and irritant contact dermatitis, erosive adenomatosis and Paget disease, a malignant skin condition. Itching is the most common symptom of these entities, followed by tingling, pain and burning. Whereas eczema and contact dermatitis can be treated with topical corticosteroids, Paget disease requires immediate surgical intervention. Before surgery, punch biopsies of the mamillary centre need to be performed to confirm the diagnosis and to exclude clinically similar, benign skin conditions. In this sensitive skin area, punch biopsies are, however, often refused by the patients. In vivo reflectance confocal microscopy (RCM) has been shown to be a useful, noninvasive tool in the diagnosis of both benign and malignant skin conditions. This technology enables the evaluation of skin structures at a cellular level resolution in real time, creating horizontal grey-scale images of up to 8 · 8 mm at various levels of the epidermis and upper dermis. In the two cases presented, RCM helped in confirming the diagnosis of eczema and Paget disease. Patient 1 was an 81-year-old woman who was hospitalized with a contact dermatitis on the face after use of chamomile cream. Medical history revealed hypertension, osteoporosis, tuberculosis in 1938, and occasional eczema. Besides the facial eczema, total skin examination showed two reddish, erosive papules on the left mamilla and two red papules in the left areolar region that were occasionally pruritic (Fig. 1a). The right mamilla appeared normal; palpation of the breasts was normal. Dermoscopy of the left mamilla revealed a nonspecific picture with globular structures, dotted and comma-like vessels (Fig. 1b). The RCM mosaic (Vivascope 1500 plus; Lucid Inc., Henrietta, NY, U.S.A.) at the level of the upper epidermis showed a central dark skin depression with focal aggregates of structureless material and tubular structures. The honeycomb pattern was regular but focally blurred, and displayed multiple, sharply demarcated, dark areas filled with bright reflecting particles, correlating to microvesicles harbouring necrotic keratinocytes (Fig. 1c, d).

The use of dermatoscopy in diagnosis and therapy of nonmelanocytic skin cancer.

Today, dermatoscopy is an integral part of every clinical skin examination, as it markedly enhances the early detection of melanocytic and nonmelanocytic skin cancer (NMSC) compared to naked‐eye inspection. Besides its diagnostic use, this noninvasive method is increasingly important in the selection of as well as the response assessment to various therapies used for NMSC, including basal cell carcinoma, actinic keratoses, squamous cell carcinoma, and also rare tumors such as Merkel cell carcinoma, angiosarcoma, or dermatofibrosarcoma protuberans. Thus, dermatoscopy is a valid tool for the preoperative assessment of tumor margins in basal cell carcinoma, but also for follow‐up of actinic keratoses after topical treatment. The present article presents an overview on the use of dermatoscopy in the diagnosis and therapy of various types of NMSC.

Assessment of changes in lentigo maligna during radiotherapy by in-vivo reflectance confocal microscopy: a pilot study

Radiotherapy is an effective treatment for therapy of lentigo maligna (LM).

New diagnostics for melanoma detection: from artificial intelligence to RNA microarrays

Early detection of melanoma remains crucial to ensuring a favorable prognosis. Dermoscopy and total body photography are well-established noninvasive aids that increase the diagnostic accuracy of dermatologists in their daily routine, beyond that of a naked-eye examination. New noninvasive diagnostic techniques, such as reflectance confocal microscopy, multispectral digital imaging and RNA microarrays, are currently being investigated to determine their utility for melanoma detection. This review presents emerging technologies for noninvasive melanoma diagnosis, and discusses their advantages and limitations.

Dermoscopy vs. reflectance confocal microscopy for the diagnosis of lentigo maligna

Several dermoscopic and in vivo reflectance confocal microscopy (RCM) diagnostic criteria of lentigo maligna (LM)/lentigo maligna melanoma (LMM) have been identified. However, no study compared the diagnostic accuracy of these techniques.

Melanoma and Satellite Blue Papule

The colors that are seen in dermoscopy depend on the anatomic level of the skin at which the chromophores are seen. Blue color can be found in a variety of melanocytic and nonmelanocytic lesions. An 89-year-old man presented with a 3-year history of a slow-growing, hyperpigmented patch located on the distal third of the right arm. Dermoscopy showed an atypical network, irregularly distributed globules, pigmented internal streaks and a milky-red area. Based on these findings a diagnosis of slow-growing malignant melanoma was made. Simultaneously, a well-defined blue papule was seen on the proximal third of the same arm. Dermoscopy disclosed a homogeneous blue pattern. After clinical and dermoscopic correlation our differential diagnosis for this blue lesion included cutaneous melanoma metastasis, blue nevus and foreign body reaction. The patient recalled its onset 75 years ago after a grenade explosion. We also discuss the blue lesion appearance under reflectance confocal microscopy and high-definition optical coherence tomography. Histopathological examination after excision of the hyperpigmented patch and blue papule revealed a melanoma in situ and a foreign body reaction, respectively. The diagnostic evaluation of a blue lesion should always rely on the integration of all data, especially clinical and dermoscopic features. Other non-invasive techniques, like reflectance confocal microscopy and high-definition optical coherence tomography can also be important aids for its differential diagnosis.

Verrucous melanoma simulating melanoacanthoma: Dermoscopic, reflectance confocal microscopic and high-definition optical coherence tomography presentation of a rare melanoma variant.

Melanoma is characterised by a variety of clinical and histopathological presentations. Dermoscopy is a fast, non-invasive technique that increases diagnostic accuracy for both melanocytic and non-melanocytic skin tumours. One example of a potential pitfall in melanoma diagnosis using dermoscopy is represented by seborrheic keratosis (SK) that looks like melanomas, which may show overlapping features of both tumours. Reflectance confocal microscopy (RCM) and high-definition optical coherence tomography (HD-OCT) are non-invasive imaging techniques that are considered second or tertiary level diagnostic tools for the diagnosis of clinically and dermoscopically selected equivocal skin lesions. Herein we report the case of a 56-year-old Caucasian woman who presented with a 12-month history of a new, growing, asymptomatic, pigmented plaque on her left ankle. A physical examination disclosed a sharply demarcated, heavily pigmented black plaque with a verrucous surface and a maximum diameter of 2 cm (Fig. 1a). Based on the clinical history and dermoscopic features (details in Fig. 1b) a diagnosis of verrucous melanoma versus SK, melanoacanthoma type, was made. The lesion was further examined by RCM and HD-OCT (details in Figs 2,3) that favoured the diagnosis of melanoma. Therefore, surgical excision of the lesion with narrow margins was performed. A histopathological examination (details in Fig. 4) showed features of an invasive melanoma, verrucous variant. From a histopathological perspective, a melanoma clinically resembling SK could correspond to three rare variants: verrucous-hyperkeratotic melanoma, follicular melanoma and discohesive (acantholytic-like) melanoma. Kuehnl-Petzoldt and colleagues described a series of the verrucous-hyperkeratotic variant of melanoma, showing marked verrucous hyperplasia and hyperkeratosis. To date, only rare additional cases of its clinical and histopathological presentation have been reported. Melanoacanthoma is a rare, heavily pigmented variant of SK showing a marked increase in the concentration of melanocytes. Our case could be clinically mistaken for melanoacanthoma due to the presence of a sharply demarcated, hyperpigmented plaque with a verrucous surface. However, the clinical history and unusual location for a SK raised doubts about the diagnosis. Moreover, dermoscopy disclosed equivocal structures of peripheral streaks arising from a heavily pigmented centre, which are commonly Figure 1 (a) Sharply demarcated, heavily pigmented black plaque with a verrucous surface on the left ankle. (b) Dermoscopy enabled the observation of peripheral streaks displaying variable nuances of blue and grey colouration arising from adjacent, confluent black, structureless areas surrounding a central aggregation of multiple, large, confluent comedo-like openings and keratotic plugs; a few milia-like cysts were also noted.

Desmoplastic Trichoepithelioma and Melanocytic Nevus: Dermoscopic and Reflectance Confocal Microscopy Presentation of a Rare Collision Tumor

Fig 1. Desmoplastic trichoepithelioma and melanocytic nevus (collision tumor). Dermoscopy of the skin-colored papule on the right cheek (clinical detail) disclosed sharply focused, fine arborizing vessels (arrows), mostly at the periphery on a white-ivory background (black asterisk) in the upper half of the lesion and structureless light-brown (white asterisk) in the lower half. Few white clods (arrowheads) probably corresponding to horn cysts were also seen. There were no leaflike structures, ovoid nests, or shiny-white streaks.