Filomena Mandato

Malignant nodular hidradenoma of the skin : report of seven cases

Background  Malignant nodular hidradenoma (MNH) is an infrequent, highly malignant, primary skin tumour derived from eccrine sweat glands. Most tumours occur in elderly individuals. MNH has very poor prognosis, high recurrence and a high rate of metastases. The best method of treatment is still unclear: radical surgical excision is widely used, and selective lymph node dissection is also suggested. The value of the adjuvant radiotherapy and chemotherapy has not been confirmed.

Frontal Fibrosing Alopecia: Role of Dermoscopy in Differential Diagnosis

Frontal fibrosing alopecia (FFA) is more common in postmenopausal women, but it can occur in younger women. Some authors consider FFA to be a distinct frontal variant of lichen planopilaris. From a clinical point of view, this relatively uncommon condition is characterized by progressive frontotemporal recession due to inflammatory destruction of hair follicles. Dermoscopy can be very useful, as the differential diagnosis between traction alopecia, alopecia areata, FFA and cicatricial marginal alopecia may be difficult. It is not clear whether or not treatment alters the natural history of the disease – the disease stabilized with time in most of the patients with or without continuing treatment. Here we report a case of a 50-year-old woman with FFA and discuss the relevance of dermoscopy in the differential diagnosis of this disease.

Juvenile Xanthogranuloma: Dermoscopic Pattern

Palmer and Bowling [1] have recently described the dermoscopic features in 3 cases of juvenile xanthogranuloma (JXG). A dermoscopic pattern characterized by orange-yellow background with ‘clouds’ of paler yellow deposits was observed in all patients. We have had recent occasion to observe many cases of single and multiple JXG and noted a further constant dermoscopic feature, namely branched and linear vessels running from the periphery to the centre of the lesions. This feature disappeared when slight pressure was exerted on the dermoscope ( fig. 1 ). We therefore wonder if the absence of a vascular pattern in the image of JXG proposed by Palmer and Bowling was simply due to pressure on the lesion with the dermoscope that could have caused ischaemia. This idea is supported by the fact that the authors described the growths clinically as yellowred papulonodules, but on dermoscopic analysis the lesions only showed orange-yellow setting-sun colouration. Although our observation may seem scientifically trivial, in our opinion it is important for a complete definition of the dermoscopic picture of JXG and to avoid that such methodological errors prejudice the correct dermoscopic analysis of lesions, such as amelanotic melanoma, a correct diagnosis of which depends on evaluation/detection of the dermoscopic vascular pattern [2, 3] . Published online: November 10, 2008

Dermoscopic patterns of cutaneous melanoma metastases.

In 2–8% of patients with melanoma, the first clinical manifestation of the disease may be skin metastasis. In these cases, differential diagnosis with the primary melanoma, benign melanocytic lesions, and other malignant and benign skin growths is particularly challenging. For this reason, the dermatologists approach to cutaneous metastases of malignant melanoma calls for knowledge of the great morphological variety of these lesions. Dermoscopic characteristics associated with CMMMs have not yet been codified. The aim of the present review is to provide additional information about dermoscopic aspects of these skin lesions.

Non-invasive diagnosis of nodular scabies: The string of pearls sign

In recent years, dermoscopic patterns have been described for many cutaneous infectious diseases such as scabies. A 68-year-old man presented with a 9-month history of widespread itching and rash. Physical examination showed multiple 6–10-mm smooth reddish nodules on the abdomen, groins, legs and axillae (Fig. 1). Dermoscopic examination was performed using DermLite® II pro (3Gen, San Juan Capistrano, CA, USA), connected to a Cyber-shot 7.2megapixel camera (Sony Inc, Tokyo, Japan), set to photograph the top of a nodule. By magnifying the photo in the camera by 150%, we identified a triangular structure

False Leser―Trélat sign

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Neonatal Skin Disorders

By the end of pregnancy, fetal skin anatomy and composition are similar to those of adults. By 22–24 weeks all anatomical elements are present, while functional and biochemical maturity takes several years to achieve (Table 148.1). There are structural differences between the skin of the preterm neonate, term neonate and adult that have significant physiological and clinical consequences [1].

A case of multiple blue macules on the scalp.

A 52-year-old Caucasian man with a history of hypertension and diabetes mellitus type I was referred by his family doctor for evaluation of recently noticed, asymptomatic, pigmented lesions on the scalp. His family and personal medical history was negative for melanoma and other skin disorders. The patient had undergone an autologous hair transplant for aesthetic reasons 6 years earlier. Objective examination showed bluish, oval, non-palpable macular lesions with clear borders, 3–4 mm in diameter, at the base of the hair follicles. The rest of the scalp had normal pigmentation (Fig. 1a). Dermoscopic examination showed steel blue pigmentation in a diffuse pattern and absence of a pigment network, brown globules, radial striae or pseudopods. On the basis of the data, the diagnosis was multiple tattoos of the scalp (Fig. 1b).

Xanthomatous papule in a child

A 13-year-old boy presented with a 5-month history of a firm, asymptomatic, yellowish-brown papule located on the trunk. The lesion had a xanthomatous appearance, with a thin ring measuring approximately 5 mm in diameter surrounding the base, and was not ulcerated (Fig. 1a). Dermatoscopy revealed linear branched vessels predominantly at the periphery of the lesion on an orange-yellow background with clouds of paler yellow deposits. Pigmented reticulum, corpuscles and blue veil were absent (Fig. 1b). The lesion was removed by simple local excision under locoregional anaesthesia.