Francesco Cusano

A pilot study of a combined dermoscopic-pathological approach to the telediagnosis of melanocytic skin neoplasms

We examined a combined (dermoscopic–pathological) approach to the telediagnosis of melanocytic skin lesions. A store-and-forward teleconsultation was simulated. Dermoscopic and histopathology images from 12 melanocytic lesions were stored in a telepathology workstation. A dermoscopy consultant, a histopathology consultant and an expert in dermoscopic–pathological correlation gave their diagnoses and comments on the images. The consensus diagnosis between two teleconsultants on the original histological slides was regarded as the gold standard. The diagnostic accuracy was 83% (including one false negative diagnosis of malignancy) for teledermoscopy and 100% for teledermatopathology. The combined approach detected one case that showed a much greater atypia on dermoscopy than on histopathology. In this case step-sections of the sample were deemed to be required for definite diagnosis. The combined approach was helpful in detecting macroscopic and microscope sampling errors of melanocytic lesions during teleconsultation.

Congenital melanocytic nevus: an epidemiologic study in Italy.

Background: The prevalence of congenital melanocytic nevi (CMN) among newborns ranges between 0.2 and 6% in the worldwide literature. In the only available study from Italy the rate was 1% at birth and 1.4% at 2 years of age. Some surveys performed among samples of children and adolescents in other countries showed a prevalence which ranged from 1.4 to 4.4%. Additional data on the frequency in adults are not available. Objective: The aim of this study was to estimate the prevalence of CMN in a large sample of a young male Italian population, which is deemed to be representative of the general population of the same age and sex. Methods: The potential conscripts resident in the coastal regions of southern Italy, enlisted for the compulsory service in the Italian Navy, were called at the age of 18 to the Draft’s Council Medical Unit of the Italian Navy in Taranto to evaluate their psychophysical fitness to recruitment. All the subjects examined from September 2002 to March 2004 showing skin lesions evocative of CMN were referred by general practitioners of the Draft’s Council Medical Unit to the Department of Dermatology of the Italian Navy Hospital for confirming the diagnosis, which was based on the clinical features and the personal history. The confirmed cases were recorded in a predefined patient card, containing the main anamnestic and clinical data. Since the screening of small CMN in such a large sample of subjects was believed to be difficult, only CMN with a diameter ≧1.5 cm were recorded. Results: In 23,354 examined persons 157 CMN were diagnosed, with a prevalence of 0.67% (Bayesian 95% confidence interval 0.57–0.79); 126 (80.3%) CMN were medium-sized (≧1.5 and ≤19.9 cm in diameter), and 31 (19.7%) were large (≧20 cm in diameter). Three CMN (1.9%) were located on the face, 23 (14.6%) on the chest, 24 (15.2%) on the abdomen, 36 (22.9%) on the back, 48 (30.5%) on the lumbar area, 15 (9.5%) on the upper limb, 19 (12.1%) on the lower limb and 15 (9.5%) on the shoulder. No CMN was located on the head. In 19 cases (12.1%) ≧2 adjacent anatomical sites (shoulder/chest, shoulder/arm, etc.) were involved. In 73 moles (46.4%) terminal hairs were present. Eight CMN (5.1%) showed a zosteriform (i.e. segmental) feature. None of the examined subjects reported a personal history of malignant melanoma (MM), and no person with a history of MM was observed among all the enlisted men referred to the Department of Dermatology during the time of the study. Conclusion: The prevalence of CMN in the Italian young male general population is roughly in agreement with the rates detected in general populations from other European studies. The observations of this study also suggest that the risk of appearance of MM, at least in childhood and adolescence, is limited for medium-sized CMN.

Vitiligo and autoimmunity: an epidemiological study in a representative sample of young Italian males

Background  It is stated that patients with vitiligo have an increased risk of developing autoimmune diseases.

The ‘EpiEnlist’ project: a dermo‐epidemiologic study on a representative sample of young Italian males. Prevalence of selected pigmentary lesions

Background  Few studies on the prevalence and incidence of many skin conditions in the general population are available because it is difficult to submit to dermatologic examination large samples of seemingly healthy population.

Dermoscopic features of congenital melanocytic nevus and becker nevus in an adult male population : An analysis with a 10-fold magnification

Background: Dermoscopic features of congenital melanocytic nevi (CMN) have been mostly assessed by high-resolution videodermoscopy. However, optical dermoscopy with the 10-fold magnification is largely available. In some instances, the differential diagnosis between large CMN and Becker nevus (BN) may be difficult. Objective: The aims of this work were: (1) to assess by dermoscopy with the 10-fold magnification the morphological features which have been previously suggested as useful for the identification of CMN in high-resolution videodermoscopy; (2) to search and point out the dermoscopic features of BN; (3) to explore dermoscopic differences between CMN and BN. Methods: The subjects were observed among about 23,000 consecutive young men assessed at the Draft Council’s Medical Unit of the Italian Navy in Taranto for compulsory recruitment and referred to the Department of Dermatology of the Italian Navy Hospital for dermatological examination. Lesions were examined by the same observer using a dermatoscope with a 10-fold magnification, and both the dermoscopic criteria stated by the international Consensus Net Meeting on Dermoscopy and dermoscopic features previously suggested as useful for the identification of CMN by videodermoscopy were recorded in a predisposed patient’s card. Results: There were 127 male subjects, median age 19 years, with 127 CMN, measuring ≧1.5 to ≤19.9 cm in 78% and ≧20 cm in 22% of cases, and 64 male subjects, median age 19 years, with 64 BN. In the sample of medium-sized and large CMN, dermoscopic features previously identified as characteristic of congenital lesions (i.e. target network, focal thickening of network lines, target globules, skin furrow hypopigmentation, focal hypopigmentation, hair follicles, perifollicular hypopigmentation, vessels and target vessels) were observed in sufficiently high rates. In the BN group, network, focal hypopigmentation, skin furrow hypopigmentation, hair follicles, perifollicular hypopigmentation and vessels were the main dermoscopic features. Focal thickening of network lines, globules, target globules, homogeneous diffuse pigmentation, hyperpigmented areas, blotches and target vessels were more frequently observed in CMN than in BN. Conclusions: (1) The same dermoscopic features observed in small and medium-sized CMN by videodermoscopy with high magnifications are also detectable in medium-sized and large CMN, employing the dermoscopy with the 10-fold magnification. (2) Network, focal, skin furrow and perifollicular hypopigmentation, hair follicles and vessels could be considered as peculiar dermoscopic features of BN. (3) Major differences in the frequency of dermoscopic characteristics were detected between CMN and BN, and dermoscopy seems to provide some diagnostic aid in differentiating CMN from BN in equivocal cases.

The constellation of dietary factors in adolescent acne: a semantic connectivity map approach

Different lifestyle and dietetic factors have been linked with the onset and severity of acne.

Ethylenediamine contact dermatitis

A retrospective study of 50 patients with ethylenediamine allergy revealed that 2 topical products containing ethylenediamine as a stabiliser are the main sources of sensitization in Italy. Some of these patients cross‐reacted to piperazine and diethylenetriamine, but none to ethylenediamine tetracetic acid.

Primary cutaneous marginal zone B-cell lymphoma with anetoderma: spontaneous involution plus de novo clonal expansion.

We describe a rare case of primary cutaneous marginal zone B‐cell lymphoma (PCMZL) in a 33‐year‐old male affected by hepatitis B virus (HBV)‐related chronic active hepatitis. The patient presented with multiple cutaneous papulonodular lesions characterized by polymorphic immunomorphology, with inverse pattern of immunoglobulin light chain restriction in two different lesions, coupled with mucin deposition and anetoderma in a third lesion. The involution of lesions of PCMZL with secondary anetoderma has been previously described, but this has not been reported in the context of multiple lesions showing differing immunoglobulin light chain restriction. We speculate that these findings may be secondary to a variable interaction between a chronic antigenic stimulus (i.e. HBV) and its specific immune response.

Clinicopathologic Features of Systemic Contact Dermatitis from Ethylenediamine in Cetirizine and Levocetirizine

Case Report A 49-year-old woman had a long-standing eczematous foot lesion which she had been self-treating for at least 6 months with topical remedies including a halcinonide-neomycin-amphotericin B ointment containing ethylenediamine as a stabilizer (Anfocort). As the clinical picture did not improve, her general practitioner intermittently administrated betamethasone and cetirizine for about 3 months, and finally systemic therapy with deflazacort and levocetirizine. In spite of this treatment, the skin eruption consistently worsened and spread; so, when the patient was first seen after about a week of this latter regimen, she showed a generalized eruption ( fig. 1 ). A skin biopsy was performed after a 1-week washout period from the systemic steroid. Histologic examination of 2 skin biop

Clinical relevance of contact sensitization in atopic dermatitis.

Patients and Methods 280 consecutive adult eczematous patients were patch tested with the GIRDCA standard series (FIRMA, Florence, Italy) on the healthy upper back with Finn Chambers (Epitest Ltd, Oy, Finland), and read at D2 and D3. A diagnosis of ‘‘definite allergic contact dermatitis (ACD)’’ was made when the current relevance of positive reactions was ‘‘possible’’ or ‘‘likely’’, according to criteria suggested by Lachapelle (9). All patients were also prick tested with aeroallergens and food allergens (Bayropharm, Milan, Italy) and their level of total serum IgE (MEIA – IMX System, Abbott, Rome, Italy) determined. A diagnosis of AD was made when the criteria of Hanifin & Rajka (10) were fulfilled, and clinical severity calculated using the SCORAD index (11). 78 eczematous patients, 74 male and 4 female, with mucosal or constitutional atopy, in whom AD criteria were nevertheless not fulfilled, were excluded from the study. Thus, the following groups were selected: 1. AD group, consisting of 115 patients, 113 male and 2 female, with a mean age of 21.3 years (range, 17– 41 years) and a mean SCORAD index of 32.8∫16.99 (range: 3.5–87.5); 2. nonatopic (NA) group, consisting of 87 eczematous patients, 78 male and 9 female, with a mean age of 24.8 years (range: 18–73 years). Statistical differences between the test results in the 2 groups were calculated using the c2 test, and 95% confidence intervals (CI) were provided.