Juliana Casagrande Tavoloni Braga

The significance of reflectance confocal microscopy in the assessment of solitary pink skin lesions

BACKGROUND Solitary pink lesions often manifest nondescript clinical and dermatoscopic primary morphologic features. The differential diagnosis for pink lesions tends, therefore, to be broad, ranging from inflammatory processes to malignancy. In vivo reflectance confocal microscopy (RCM) may help in the evaluation of pink lesions. OBJECTIVE We sought to demonstrate the use of RCM as an adjunct to the bedside diagnosis of pink lesions. METHODS We describe a series of patients with clinically and dermatoscopically equivocal pink lesions for which RCM examination allowed for a rapid and accurate diagnosis. All lesions were excised for histopathologic evaluation. Integrating the findings in the case series with a literature review, we present RCM diagnostic criteria for pink lesions. RESULTS Lesions included basal cell carcinoma, squamous cell carcinoma, amelanotic melanoma, and inflamed seborrheic keratosis. RCM shows distinctive findings for each diagnostic entity when stratified by anatomic level into suprabasal epidermis, dermoepidermal junction, and papillary dermis. In the cases presented RCM allowed for a rapid and accurate noninvasive diagnosis. LIMITATIONS The study is descriptive and does not test accuracy of RCM criteria in a prospective series of pink lesions. CONCLUSION RCM may add useful diagnostic features to the clinical evaluation of solitary pink lesions.

Hypomelanotic melanoma mimicking pigmented Bowen disease

Dermaimage Medical Associates; Cutaneous Oncology epartment, AC Camargo Cancer Center; Dermatology epartment, ABC Medical School; Maria Bussade Medical ssociates; and Pathology Department, Universidade Federal S~ao Paulo. ing sources: None. licts of interest: None declared. Reprint requests: Gisele Gargantini Rezze, MD, PhD, Av. General Furtado do Nascimento, 740 cj24, Sao Paulo, SP, Brazil, CEP 05465-070. E-mail: ggrezze@hotmail.com. J Am Acad Dermatol 2016;74:e11-3. 0190-9622/

Reflectance confocal microscopy features of BRAF V600E mutated thin melanomas detected by immunohistochemistry

36.00 a 2015 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2015.09.052

Dermoscopic and reflectance confocal microscopy findings in extra-genital HPV16-associated pigmented squamous cell carcinoma in situ

The classification of melanoma into four histological subtypes has been questioned regarding its clinical validity in providing relevant information for treatment for metastatic tumors. Specific genetic alterations are associated with particular clinical and histopathological features, suggesting that these could be helpful in refining existing melanoma classification schemes. We analyzed BRAF V600E mutated melanomas to explore the Reflectance confocal microscopy (RCM) utility as a screening aid in the evaluation of the most appropriate patients for genetic testing. Thus, 32 melanomas were assessed regarding their BRAF V600E mutational status. Experts blinded to dermoscopic images and V600E immunohistochemistry results evaluated RCM images regarding previously described melanoma features. BRAF positive melanomas were related to younger age (p = 0.035), invasive melanomas (p = 0.03) and to the presence of hiporreflective cells (p = 0.02), epidermal nests (p = 0.02), dermal-epidermal junction nests (p = 0.05), edged papillae (p = 0.05), and bright dots (p = 0.05), and to absence of junctional thickening due to isolated cells (p = 0.01) and meshwork (p = 0.02). This study can not characterize other mutations in the BRAF, because the immunohistochemistry is specific to the type V600E. The findings should encourage the genetic evaluation of BRAF mutation. This study highlights the potential of RCM as a supplementary tool in the screening of BRAF-mutated melanomas.

Melanoma mimicking seborrheic keratosis : An error of perception precluding correct dermoscopic diagnosis

Fig. S2. Histopathology and immunohistochemistry sections from Case 1. (A) Haematoxylin and eosin (H&E). Papillomatous proliferation with atypical keratinocytes occupying the entire thickness of the epidermis. Inset: confocal image at the dermo-epidermal junction (DEJ) revealing bright atypical keratinocytes surrounding the papillae. (B) p16 showing strong and diffuse immunoexpression