Hans Peter Soyer

CLINICAL AND HISTOPATHOLOGIC SPECTRUM OF PILOMATRICOMAS IN ADULTS

Background. Pilomatricomas are benign cutaneous neoplasms with differentiation toward hair matrix. Although previously reported to occur mostly in children and young adults, Taaffe et al. recently observed a second onset peak in adults and the elderly.

Telemedicine and teledermatology: Past, present and future

Telemedicine is an emerging field within medicine with potential to revolutionize the delivery of health care.It is defined as the use of telecommunication technologies to transfer medical information.Teledermatology is a category of telemedicine. Early experiments were already made at the beginning of the 20th century, the breakthrough happened in the nineties because of the rapid progress of telecommunication technology. The latest advance is mobile telemedicine which is characterized by the use of mobile devices such as mobile phone and PDA (personal digital assistant).Advantages of telemedicine are the possibility of remote patient‐care as well as the easy and fast access to expert opinions and education.This can either happen through exchange of previously stored data/images (store‐and‐forward method) or in real time.Since our society is increasingly becoming interconnected via technical advances, it is essential that medicine also has an objective understanding of the topic.

Reflectance confocal microscopy for skin diseases

This book focuses on the use and significance of in vivo reflectance confocal microscopy (RCM) for non-invasive high-resolution imaging of the skin. All of the chapters in this hands-on guide are generously illustrated with numerous confocal images and structured in a reader-friendly way. The contents include detailed information on the most relevant and up-to-date aspects of RCM, schematic drawings summarizing and explaining the most important RCM criteria, and a chapter specifically devoted to bridging the gap between dermoscopy, RCM, and histopathology. At the end of each chapter, core messages recapitulate the most pertinent aspects. Reflectance Confocal Microscopy for Skin Diseases will be a valuable resource for all physicians involved in the diagnosis and treatment of neoplastic and inflammatory skin diseases.

In vivo assessment of chronological ageing and photoageing in forearm skin using reflectance confocal microscopy.

Background  Skin ageing is a complex process due to intrinsic chronological factors (chronoageing) and extrinsic environmental factors. The primary extrinsic factor is cumulative ultraviolet (UV) exposure, and is therefore termed photoageing. The current standards for measuring cumulative sun damage are biopsy histology and skin microtopography. However, skin biopsies are too invasive for population studies and skin replicas render only superficial skin architecture data. Reflectance confocal microscopy (RCM) is a noninvasive imaging tool that allows for in vivo imaging of the skin at quasihistological resolution.

Teledermatopathology: a controlled study about diagnostic validity and technical requirements for digital transmission.

Telepathology is the practice of diagnostic histopathology performed on digital pictures. In this study, we focused on the technical requirements for achievement of a correct diagnosis on digital histopathologic images. A collection of 560 melanocytic lesions was selected from the files of the Department of Dermatology, Medical University of Graz, Austria. From each lesion one histologic slide was completely digitally scanned with a robotic microscope. Digital pictures were reviewed by 4 dermatopathologists using a presentation program, which recorded the number of image calls, applied magnifications, overall time needed, and amount of transmitted bits during the digital sign-out. One month later, the 4 microscopists had to review the corresponding slides and render a direct diagnosis on each case.Telepathologic diagnoses corresponded with the original diagnoses in a range from 90.4% to 96.4% of cases (κ 0.80 to 0.93; P < 0.001). The median time needed for achievement of a diagnosis was 22 seconds and was significantly higher for melanomas compared with nevi. The median transmission effort for each diagnosis was 510 kilobytes after JPEG compression. Using an ISDN line with a transmission capacity of 64 kilobits/ second, this correlates to a transmission time of about 1 minute.Our results demonstrate that correct reporting on digital histopathologic images is possible with only a little time exposure. For an adequately fast transmission ISDN lines are suffcient after JPEG compression.

Color atlas of melanocytic lesions of the skin

This atlas-like presentation covers the various faces of melanocytic skin lesions of cutaneous melanomas and other pigmented skin tumors. It encompasses the classical methods of morphology such as the clinical and dermoscopic examination and dermatopathology as well as the most up-to-date diagnostic approaches such as laser scanning in-vivo microscopy and automated diagnosis. The core of this book represents an atlas with excellent clinical, dermoscopic and histopathologic images on melanocytic nevi, various types of melanomas and relevant other pigmented skin tumors including basal-cell carcinomas. Each of these well illustrated entities is presented following the same structure characterized by definition, clinical and dermoscopic features, relevant clinical differential diagnosis as well as practical aspects of management. Core messages will recapitulate the most pertinent facets of each entity. This comprehensive up-to-date text informs the reader on all practical issues of the modern-day management of individuals with melanocytic skin lesions.

Dermatoscopy in the diagnosis of pigmented skin lesions: a new semiology for the dermatologist.

Dermatoscopy or epiluminescence microscopy (ELM), is a noninvasive method that enables clinicians to evaluate fully – by means of a magnified oil immersion diascopy – numerous morphological features, not visible with the naked eye, which enhance the diagnosis of nearly all pigmented skin lesions. In recent years, a burst of research activity in this topic has been carried out, dealing with different aspects, and new frontiers, of this technique. First, a continuous refinement of dermatoscopic terminology is undertaken, paying particular attention to the diagnostic performance of dermatoscopy at peculiar anatomical sites and to the building of different dermatoscopic algorithms aimed at a simplified diagnosis of melanoma, even for less experienced observers. Another point of interest concerns the possible role of dermatoscopy in the pre‐operative assessment of melanoma thickness. Finally, promising data about the role of digital equipment in the follow up of melanocytic skin lesions as well as in the automated diagnosis of pigmented skin lesions have been recently reported. This paper should enable readers to become familiar with the procedure and terminology of ELM in the diagnosis of pigmented skin lesions encouraging a greater understanding of different methods (pattern analysis, algorithms) in the diagnosis of melanoma using ELM.

Immunohistochemical Classification of Cutaneous Pseudolymphomas - Delineation of Distinct Patterns

Because of the broad spectrum of clinical and histological features, cutaneous pseudolymphomas are difficult to classify. To delineate objective criteria for classification, we investigated the immunoarchitecture of 53 cases of pseudolymphomas; 29 were classified as T cell pseudolymphomas. The immunohistologic characteristics were the absence of B cell compartments, the predominance of T helper‐inducer cells and the presence of Langerhans cells/indeterminate cells. Lymphomatoid contact dermatitis showed the bandlike (superficial) T cell pattern. Lymphocytic infiltration of the skin, lymphomatoid papulosis, lymphomatoid drug reactions, and persistent nodules following assaults by arthropods revealed a nodular T cell pattern. Twenty‐four cases represented B cell pseudolymphomas containing a nodular arrangement of B lymphocytes. In 6 lesions, there were B cell aggregates without the association of dendritic reticulum cells (non follicular B cell pattern); in 18, the B cell clusters were associated with dendritic reticulum cells and a typical expression of IgM and IgD, thus forming fully developed germinal centers (follicular B cell pattern). The B cell clusters were always surrounded by distinct T zones. B cell patterns were present in lymphadenosis benigna cutis, large cell lymphocytoma and occasionally, in persistent nodules, following assaults by arthropods.

Systematized inflammatory epidermal nevus with symmetrical involvement: An unusual case of CHILD syndrome?

The CHILD syndrome (congenital hemidysplasia with ichthyosiform nevus and limb defects) is usually characterized by lateralization of all associated anomalies. It has been assumed that the event of X-inactivation coincides and interferes with a clone of organizer cells controlling a large developmental field. A 16-year-old girl with bilateral manifestations of CHILD syndrome is described. The inflammatory skin lesions affected the body folds (ptychotropism) in a symmetrical distribution, although only the right side of the neck was involved. In addition, absence of several facial muscles, vertebral defects, and shortening of the leg on the right side were noted, and a ventricular septum defect was present. This unusual case may be explained by the assumption that X-inactivation did not coincide with the origin of inducer cell clones controlling large morphogenetic fields on either side of the body.

Morphometric diagnosis of melanocytic skin tumors.

Checking consecutively sampled routine sections of 206 melanocytic lesions with a maximum vertical diameter of at least 1 mm (133 benign dermal nevi, 20 Spitzs nevi, 53 primary malignant melanomas), we measured the morphometric features of at least 60 nuclei each from the superficial and the deep dermal tumor portion using a computer-assisted interactive image analysis system. Furthermore we calculated the so-called maturation parameter (MP) in each case as the ratio of the mean nuclear area in the deep portion and the superficial portion. When we compared the results with those obtained in a training set, we found that the lowest evidence for the discrimination of benign and malignant melanocytic lesions resulted from the application of the mean values of the nuclear area in the superficial layer (efficiency = 62.1%). The efficiency was higher when we used the mean values of the nuclear area in the deep layer (96.1%) and the maturation parameter (85.4%). By applying the mean nuclear area in the deep portion and the maturation parameter simultaneously, we gained the highest efficiency, specificity, and sensitivity for the distinction between benign dermal nevi and malignant melanomas (0.968, 0.955, 1) as well as for the distinction between Spitzs nevi and malignant melanomas (0.986, 0.950, 1). Our study shows that morphometry provides reliable diagnostic results in routinely sampled melanocytic skin tumors.