J. Malvehy

Tumour lymphangiogenesis is a possible predictor of sentinel lymph node status in cutaneous melanoma: a case–control study

Background: Cutaneous melanoma spreads preferentially through the lymphatic route and sentinel lymph node (SLN) status is regarded as the most important predictor of survival. Aims: To evaluate whether tumour lymphangiogenesis and the expression of vascular endothelial growth factor C (VEGF-C) is related to the risk of SLN metastasis and to clinical outcome in a case–control series of patients with melanoma. Methods: Forty five invasive melanoma specimens (15 cases and 30 matched controls) were investigated by immunostaining for the lymphatic endothelial marker D2-40 and for VEGF-C. Lymphangiogenesis was measured using computer assisted morphometric analysis. Results: Peritumorous lymphatic vessels were more numerous, had larger average size, and greater relative area than intratumorous lymphatics. The number and area of peritumorous and intratumorous lymphatics was significantly higher in melanomas associated with SLN metastasis than in non-metastatic melanomas. No significant difference in VEGF-C expression by neoplastic cells was shown between metastatic and non-metastatic melanomas. Using logistic regression analysis, intratumorous lymphatic vessel (LV) area was the most significant predictor of SLN metastasis (p = 0.04). Using multivariate analysis, peritumorous LV density was an independent variable affecting overall survival, whereas the intratumorous LV area approached significance (p = 0.07). Conclusions: This study provides evidence that the presence of high peritumorous and intratumorous lymphatic microvessel density is associated with SLN metastasis and shorter survival. The intratumorous lymphatic vessel area is the most significant factor predicting SLN metastasis. The tumour associated lymphatic network constitutes a potential criterion in the selection of high risk patients for complementary treatment and a new target for antimelanoma therapeutic strategies.

Entodermoscopy: A New Tool for Diagnosing Skin Infections and Infestations

Background: There is upcoming evidence that dermoscopy facilitates the in vivo diagnosis of skin infections and infestations. As such, dermoscopy connects the research fields of dermatologists and entomologists, opening a new research field of ‘entodermoscopy’. Objective: To provide an overview on the current applications of entodermoscopy. Methods: Systematic review of the English- and German-language literature by searches of Medline, Medscape and abstracts of the 1st World Congress of the International Dermoscopy Society. Results: Dermoscopic patterns have been described for viral warts, molluscum contagiosum, scabies, pediculosis, tinea nigra, tungiasis, cutaneous larva migrans, ticks and reactions to spider leg spines. Besides the diagnostic role of dermoscopy, there is increasing evidence that it can also assist in the monitoring of treatment efficacy for some of these conditions. Conclusion: Although most of the current available literature is based on single observations and small case studies rather than controlled trials, an increasing interest in this field can be observed.

Meta-analysis of digital dermoscopy follow-up of melanocytic skin lesions: a study on behalf of the International Dermoscopy Society

It has been demonstrated that dermoscopic monitoring of melanocytic lesions allows for the recognition of melanoma in early stages while minimizing the excision of benign lesions. However, it is still pending to determine the real impact of digital follow‐up in the clinical management of pigmented lesions. To assess the evidence of follow‐up of melanocytic skin lesions with digital dermoscopy in the management of individuals at risk for melanoma by performing a meta‐analysis. Medline database was screened, no limits in terms of date or language were applied. Original studies were selected when the following criteria were met: performed in clinical setting with clinical and dermoscopic evaluation made by physicians, data regarding population characteristics included, follow‐up strategy used described. Fourteen of 145 retrieved references were retained. Included studies account for a total of 5787 patients (mean 445 per study) and 52 739 lesions monitored (mean per study 4057; range 272–11 396) with a mean of 12 lesions monitored per patient; a total of 4388 lesions (8.3%) were excised. The mean length of follow‐up was 30 months. A mean of <1 lesion was excised per patient along the surveillance period. The number needed to monitor (NNM) ranged from 31 to 1008 (mean: 348) among eligible studies. For every additional month of monitoring, 1additional melanoma was detected. Using digital dermoscopy follow‐up, the proportion of in situ melanoma and thin melanomas are higher than expected in general population. Chances to detect a melanoma during surveillance increase as the length of follow‐up extends.

Impact of in vivo reflectance confocal microscopy on the number needed to treat melanoma in doubtful lesions

The number needed to treat (NNT) ratio is an effective method for measuring accuracy in melanoma detection. Dermoscopy reduces the number of false positives and subsequently unnecessary excisions. In vivo reflectance confocal microscopy (RCM) is a noninvasive technique that allows examination of the skin with cellular resolution.

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.

Dermoscopy of cutaneous leishmaniasis

Summary Background Dermoscopy has been proposed as a diagnostic tool in the case of skin infections and parasitosis but no specific dermoscopic criteria have been described for cutaneous leishmaniasis (CL).

Dermoscopy of pyogenic granuloma: a morphological study

Background  Pyogenic granuloma is a common, benign, vascular lesion of the skin and mucous membranes which is a simulator of amelanotic/hypomelanotic melanoma and other tumours.

Dermoscopy Key Points: Recommendations from the International Dermoscopy Society

J. Bowling G. Argenziano A. Azenha J. Bandic R. Bergman A. Blum H. Cabo A. Di Stephani J. Grichnik A. Halpern R. Hofman-Wellenhof R. Johr H. Kittler A. Kopf J. Kreusch D. Langford J. Malvehy A. Marghoob S. Menzies F. Ozdemir K. Peris D. Piccolo M.A. Pizzichetta D. Polsky S. Puig H. Rabinovitz P. Rubegni T. Saida M. Scalvenzi S. Seidenari H.P. Soyer M. Tanaka I. Zalaudek R.P. Braun

Ex vivo fluorescence confocal microscopy for fast evaluation of tumour margins during Mohs surgery

Ex vivo fluorescence confocal microscopy (FCM) enables real‐time imaging of skin morphology directly in freshly excised tissue. FCM displays wide field‐of‐view mosaics with cellular resolution, thus enabling a rapid bedside pathology. An application of interest is rapid detection of residual basal cell carcinoma (BCC) in skin excisions during Mohs surgery.

Dermoscopic features of melanomas associated with MC1R variants in Spanish CDKN2A mutation carriers

Background  The presence of at least one MC1R gene variant is associated with a reduction in age at melanoma diagnosis in families with CDKN2A mutations.