Isil Kilinc Karaarslan

Dermoscopic evaluation of nodular melanoma

IMPORTANCE Nodular melanoma (NM) is a rapidly progressing potentially lethal skin tumor for which early diagnosis is critical. OBJECTIVE To determine the dermoscopy features of NM. DESIGN Eighty-three cases of NM, 134 of invasive non-NM, 115 of nodular benign melanocytic tumors, and 135 of nodular nonmelanocytic tumors were scored for dermoscopy features using modified and previously described methods. Lesions were separated into amelanotic/hypomelanotic or pigmented to assess outcomes. SETTING Predominantly hospital-based clinics from 5 continents. MAIN OUTCOME MEASURES Sensitivity, specificity, and odds ratios for features/models for the diagnosis of melanoma. RESULTS Nodular melanoma occurred more frequently as amelanotic/hypomelanotic (37.3%) than did invasive non-NM (7.5%). Pigmented NM had a more frequent (compared with invasive non-NM; in descending order of odds ratio) symmetrical pigmentation pattern (5.8% vs 0.8%), large-diameter vessels, areas of homogeneous blue pigmentation, symmetrical shape, predominant peripheral vessels, blue-white veil, pink color, black color, and milky red/pink areas. Pigmented NM less frequently displayed an atypical broadened network, pigment network or pseudonetwork, multiple blue-gray dots, scarlike depigmentation, irregularly distributed and sized brown dots and globules, tan color, irregularly shaped depigmentation, and irregularly distributed and sized dots and globules of any color. The most important positive correlating features of pigmented NM vs nodular nonmelanoma were peripheral black dots/globules, multiple brown dots, irregular black dots/globules, blue-white veil, homogeneous blue pigmentation, 5 to 6 colors, and black color. A model to classify a lesion as melanocytic gave a high sensitivity (>98.0%) for both nodular pigmented and nonnodular pigmented melanoma but a lower sensitivity for amelanotic/hypomelanotic NM (84%). A method for diagnosing amelanotic/hypomelanotic malignant lesions (including basal cell carcinoma) gave a 93% sensitivity and 70% specificity for NM. CONCLUSIONS AND RELEVANCE When a progressively growing, symmetrically patterned melanocytic nodule is identified, NM needs to be excluded.

Dermoscopy of scalp tumours: a multi-centre study conducted by the international dermoscopy society

Background  Little is known about the dermoscopic features of scalp tumours.

Atypical melanosis of the foot showing a dermoscopic feature of the parallel ridge pattern.

A 62‐year‐old male Turkish patient had a pigmented lesion on the sole with a 10‐year history. It was an asymmetrical macular lesion with an irregular border and irregular brown pigmentation and had a diameter of 1.2 cm × 1.7 cm.

Clinical, Dermoscopic and Histopathological Features of Eccrine Poroid Neoplasms

Background: Eccrine poroma (EP) belongs to the group of benign adnexal tumors, but cases of eccrine porocarcinoma (EPC) arising on long-standing and untreated EP suggest a certain risk of malignant transformation. Objectives: To describe the clinical, dermoscopic and histopathologic features associated with different extremes in the spectrum of eccrine poroid neoplasms and to review the according literature. Methods: A retrospective analysis of patient characteristics and morphologic features associated with EP, EPC in situ and invasive porocarcinoma patients who attended two skin lesion clinics in Italy and Turkey between 2010 and 2011. Results: A total of 4 cases including 1 EP, 1 EPC in situ and 2 cases of invasive EPC in 4 patients were analyzed. Recent changes including bleeding, ulceration and sudden enlargement of a pre-existing lesion were associated with malignant transformation. Dermoscopically, polymorphous vessels consisting of coiled, hairpin and linear vessels were seen at all stages of progression. Histopathological findings of EPC in situ were limited to the epidermal component and were evident only at higher magnification. Conclusions: Clinicians and pathologists should carefully evaluate EPs with a recent history of change and erosion in order to avoid overlooking the potential development of EPC.

Generalized pustular eruptions due to terbinafine

Terbinafine, a widely used antifungal agent, may rarely cause cutaneous side effects with an incidence of 2.7%. Generalized pustular eruptions are quite uncommon but severe adverse cutaneous reactions of terbinafine have been reported. The main pustular eruptions due to terbinafine include acute generalized exanthematous pustulosis and drug induced pustular psoriasis. In this report, two cases of acute generalized exanthematous pustulosis and one case of generalized pustular psoriasis triggered with terbinafine are presented.

Trichilemmal cyst with homogeneous blue pigmentation on dermoscopy.

A 61‐year‐old woman was referred to our dermoscopy unit for a pigmented lesion that had been present on her left arm for 8 years. The patient did not notice any enlargement or change in colour. On dermoscopy, homogeneous blue pigmentation was seen. The lesion was excised with the pre‐operative diagnosis of melanoma, blue naevus and dermatofibroma. Histopathological examination showed a trichilemmal cyst in the mid‐dermis. Although homogeneous blue pigmentation on dermoscopy is the hallmark of blue naevus, it may be seen in metastatic melanoma and exceptionally in hemosiderotic and cellular types of dermatofibroma. Trichilemmal cyst should be borne in mind also in the dermoscopic differential diagnosis.

Phakomatosis pigmentovascularis type IIb associated with Klippel-Trénaunay syndrome and congenital triangular alopecia.

kyphosis, and restriction of movement. Two had bilateral Achilles tendon rupture. Radiography of the dorsolumbar spine revealed typical intervertebral disc calcification. Darkening of urine on standing overnight was seen in each case. Palmar plantar pigmentation as a diagnostic clue to alkaptonuric ochronosis was first reported by Cherian. Similar case reports have since emerged from the Indian subcontinent. This is the first series highlighting the unique pattern of pigment deposition that was present in a consistently similar manner resembling marginal keratoderma in all five patients. DCPH and AKE are distinct variants of marginal acrokeratoderma, which occur as a result of a combination of long-term trauma and pressure. They are characterized by symmetric, acral, hyperkeratotic lesions,most frequentlyon thehands, andareassociated with abnormalities of the dermal connective tissue. DCPH typically consists of linear, firm plaques formed by the fusion of disk-like areas along the lines of transgredience of the fingers. AKE is a genodermatosis that involves the epidermis and manifests as horny papules favoring the thenar and hypothenar eminences. Histopathologically, DCPH is characterized by collagen degeneration, whereas epidermal changes with normal collagen and distorted elastic fibers distinguishAKE.The skin lesions inourpatients had combined features of both conditions but showed a greater resemblance toDCPHhistopathologically. In previous published reports of acral pigmentation in alkaptonuria, the histopathology has been similar to our cases, with changes mainly in the dermal collagen while the epidermis was relatively uninvolved. Pigment deposition in alkaptonuria is observed to favor stress-bearing sites, such as the dorsolumbar vertebrae and large joints. The occurrence of lesions on the palms and soles in our patients exposed to manual labor also seemed to be influenced by stress and frictional factors. Ochronotic pigment has been found to have a particular affinity for collagen fibers, which could explain its deposition in the pattern of DCPH. A positive family history has not been documented in previous reports. In conclusion, acral lesions in alkaptonuric ochronosis may resemble DCPH. This presentation should be considered as a cutaneous marker for alkaptonuria, in addition to the typical sites of involvement.

Multiparameter analysis of naevi and primary melanomas identifies a subset of naevi with elevated markers of transformation.

Here we have carried out a multiparameter analysis using a panel of 28 immunohistochemical markers to identify markers of transformation from benign and dysplastic naevus to primary melanoma in three separate cohorts totalling 279 lesions. We have identified a set of eight markers that distinguish naevi from melanoma. None of markers or parameters assessed differentiated benign from dysplastic naevi. Indeed, the naevi clustered tightly in terms of their immunostaining patterns whereas primary melanomas showed more diverse staining patterns. A small subset of histopathologically benign lesions had elevated levels of multiple markers associated with melanoma, suggesting that these represent naevi with an increased potential for transformation to melanoma.

Dermoscopy of Nodular Hidradenoma, a Great Masquerader: A Morphological Study of 28 Cases

Background: Nodular hidradenoma is an uncommon, benign, adnexal neoplasm of apocrine origin which is a clinical simulator of other tumours. Objective: The aim of this study was to evaluate the morphological findings of a large series of nodular hidradenomas under dermoscopic observation. Methods: Dermoscopic examination of 28 cases of nodular hidradenomas was performed to evaluate specific dermoscopic criteria and patterns. Results: The most frequently occurring dermoscopic features were: (1) in 96.4% of cases, a homogeneous area that covered the lesion partially or totally, the colour of which was pinkish in 46.4% of cases, bluish in 28.6%, red-blue in 14.3%, and brownish in 10.7%; (2) white structures were found in 89.3% of cases; (3) in 82.1% of cases, vascular structures were also observed, especially arborising telangiectasias (39.3%) and polymorphous atypical vessels (28.6%). Conclusion: Nodular hidradenomas represent a dermoscopic pitfall, being difficult to differentiate clinically and dermoscopically from basal cell carcinomas and melanomas.

Dermoscopy of lymphangioma circumscriptum: A morphological study of 45 cases

The dermoscopy of lymphangioma circumscriptum, also known as superficial lymphatic malformation, remains to be clarified.