Jonathan Bowling

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

Dermoscopic appearance of juvenile xanthogranuloma

Juvenile xanthogranuloma (JXG) is the commonest form of non-Langerhans cell histiocytosis and manifests as asymptomatic yellow-red papulonodules that usually occur in childhood and spontaneously regress within a year of formation. The diagnosis may be made by clinical examination alone and confirmed by histology in cases of diagnostic doubt. Here we report the use of dermoscopy in evaluating skin lesions suggestive of JXG. Three patients diagnosed as having JXG in our dermatology department over the last year showed a characteristic orange-yellow ‘setting sun’ appearance on dermoscopy. We therefore feel that the use of dermoscopy can be extended to include the examination of non-pigmented skin lesions, particularly in paediatric patients.

Clinical guidelines for the recognition of melanoma of the foot and nail unit

Malignant melanoma is a life threatening skin tumour which may arise on the foot. The prognosis for the condition is good when lesions are diagnosed and treated early. However, lesions arising on the soles and within the nail unit can be difficult to recognise leading to delays in diagnosis. These guidelines have been drafted to alert health care practitioners to the early signs of the disease so an early diagnosis can be sought.

Melanotan-associated melanoma in situ

Injectable synthetic melanotropic peptides (often called melanotan) to enhance tanning are available over the Internet despite being unlicensed compounds with an unproven safety record. There have been reports of dysplastic naevi and melanoma associated with the use of melanotropic peptides. We report a case of melanotan‐associated melanoma in situ.

Trends in dermoscopy use in the UK: results from surveys in 2003 and 2012.

Background: Dermoscopy is a useful tool to aid diagnosis of pigmented and non-pigmented skin lesions, as well as many other dermatological conditions. Use of dermoscopy is increasing worldwide, but to date, there are no reported data on attitudes of dermatologists in the United Kingdom (UK) towards dermoscopy. Objective: To determine current attitudes of UK dermatologists towards dermoscopy and assess how these attitudes have changed over the last decade. Methods: In October 2012, an online survey was sent to members of British Association of Dermatologists over a 12-week period. Data were subsequently compared with data from a similar UK nationwide paper questionnaire distributed to members in 2003. Results: The 2003 survey collected 292 responses (uptake 42%), and in 2012 there were 209 responses (22%), predominantly from consultants and registrars. In 2012, 86% respondents reported increased use of dermoscopy over the previous decade with 98.5% of respondents reporting regular clinical use of dermoscopy, compared with 54% in 2003. Overall, 81% respondents in 2012 had received dermoscopy training, mainly from UK-based courses (62% of respondents) but increasingly via Internet-based resources (30% vs. 7% in 2003). However, 39% respondents lacked confidence when making a diagnosis based on their interpretation of dermoscopy findings. Conclusions: Over the last decade, use of dermoscopy has increased amongst UK dermatologists and the majority of respondents now employ dermoscopy in daily clinical practice. However, the use of dermoscopy in the dermatology community overall is not known and for those individuals there is a continued need for education.

Dermoscopy as a technique for the early identification of foot melanoma

Malignant melanoma is the most common primary malignant tumour arising on the foot. Where improvements in the prognosis have been observed for patients with melanoma elsewhere on the skin, pedal lesions are still frequently delayed in presentation through neglect or misdiagnosis. Detection of foot melanoma relies on the health care practitioners skills and observations in recognising early changes. Recent publications have documented the use a dermoscopy as a tool to improve recognition of such suspicious lesions. This paper reviews current literature with a special emphasis of its potential applications on plantar and nail unit melanoma. Data from these studies suggest that the technique is a useful and significant adjunct to clinical examination, which ultimately may lead to earlier recognition of this aggressive tumour.

Diagnosing melanoma: how do we assess how good we are?

Evaluating and improving diagnostic accuracy in identification of melanomas is important for both conservation of healthcare resources and reduction in patient morbidity. Useful indicators in assessing this accuracy include the number needed to treat (NNT) and the benign:malignant (B:M) ratio. Both of these methods lack sensitivity, as they do not account for the ability to detect early or in situ melanomas.

Cutaneous mastocytosis localized to a radiotherapy field

A 62-year-old woman presented with a 12-month history of an asymptomatic rash on the right breast, right submammary area and medial left breast (Fig. 1a). She had no systemic symptoms. Two years previously, she had undergone conservative surgery and localized radiotherapy for breast cancer. She denied any cutaneous symptoms before the breast cancer treatment. Examination revealed multiple monomorphic erythematous macules 3–5 mm in diameter, which blanched on pressure (Fig. 1b). Darier s sign was negative and there was no evidence of dermographism either in the radiotherapy field or elsewhere. On dermatoscopy, telangiectatic vessels were seen (Fig. 1b). There were no other abnormalities on full clinical examination. A diagnostic skin biopsy (Fig. 2a) showed a superficial dermal perivascular infiltrate composed predominantly of mast cells, which stained positively for toluidine blue (Fig. 2b), mast-cell tryptase (MCT) and c-Kit (CD117), with scattered admixed CD3-positive T-lymphocytes. None of the MCT or CD117-positive cells expressed CD2. There were no definite features of radiotherapy change. Based on the clinical and histological findings, a diagnosis of localized cutaneous mastocytosis (CM) was made. CM, a rare condition in which an excess of functionally normal mast cells accumulates in the skin, can be divided into four major subtypes: urticaria pigmentosa (UP), solitary mastocytoma, diffuse cutaneous mastocytosis and telangiectasia macularis eruptiva perstans (TMEP). In our patient, red telangiectatic macules predominated, and it would probably be designated as TMEP, which is a rare CM subtype. In the context of a radiotherapy field, the major clinical differential diagnosis of telangiectatic macules would be radiotherapyinduced telangiectasia. CM falls within a spectrum of mast-cell proliferations, ranging from those with cutaneous involvement only, which are often self-limiting and are the predominant type of mastocytosis in children, to aggressive systemic conditions predominantly affecting adults. The latter may be associated with myelodysplasia, myeloproliferative disorders or leukaemias, and often exhibit clonal PD

Dermoscopy: Ex vivo visualization of fleas head and bag of eggs confirms the diagnosis of Tungiasis.

Tungiasis, caused by the impregnated female sand flea Tunga penetrans, is increasingly common in returned travellers from endemic areas. Clinical suspicion is raised by the clinicodermoscopic correlation, leading to rapid treatment which involves extraction of the intact flea. Ex vivo dermoscopy demonstrates the parasites head and distended abdomen full of eggs, confirming the diagnosis.

Dermoscopic features of extraocular sebaceous carcinoma

Sebaceous carcinoma is a rare adenocarcinoma with variable degrees of sebaceous differentiation, most commonly found on periocular skin, but also occasionally occur extraocular. It can occur in isolation or as part of the MuirTorre syndrome. Sebaceous carcinomas are yellow or red nodules or plaques often with a friable surface, ulceration, or crusting. On histological examination, sebaceous carcinomas are typically poorly circumscribed, asymmetric, and infiltrative. Individual cells are pleomorphic with atypical nuclei, mitoses, and a coarsely vacuolated cytoplasm.