Linda Tognetti

Benign dermoscopic parallel ridge pattern in plantar hyperpigmentation due to capecitabine

We report the case of a 37-year-old woman (phototype II) who presented at our outpatient clinic with a two-month history of hyperpigmented plantar macules. Medical history revealed that the patient had taken capecitabine in the past three months as adjuvant chemotherapy for recurrent breast cancer. Dermoscopic examination of the plantar macules showed parallel ridge pattern with pigmentation in the furrows without obliteration of eccrine gland apertures. Besides in acral melanoma, parallel ridge pattern can also be observed in benign plantar lesions, such as congenital or acquired acral nevi, subcorneal hemorrhage, dye-related pigmentation and drug-induced hyperpigmentation, especially in patients with phototypes III–VI. The few reported cases of capecitabine-induced hyperpigmentation have been associated with hand and foot syndrome in patients with phototypes IV–V and palmar as well as plantar involvement.

Dermoscopy of Biett's sign and differential diagnosis with annular maculo-papular rashes with scaling

Correspondence: Dr. Linda Tognetti, Department of Medical, Surgical and Neuro‐Sciences, Dermatology Unit, University of Siena, Siena, Italy, and Department of Medical Biotechnologies, University of Siena, Siena, Italy. E‐mail: linda.tognetti@gmail.com Laurent‐Théodore Biett (1781–1840), a Swiss‐born dermatologist, first described the thin white ring of scaling on the surface of secondary syphilis papules since known as “Biett’s collarette.”1 Although the clinical features allow the diagnosis of secondary syphilis in most cases, it may be at times difficult to differentiate it from other annular maculo‐papular dermatoses with scaling. Dermoscopy has been most often used to improve the diagnostic accuracy in the clinical evaluation of pigmented skin lesions but it has also been found useful in the assessment of vascular structures that are not visible to the naked eye. As a consequence, dermoscopy has been more widely employed for the differential diagnosis of even non‐pigmented skin conditions including tumors and also inflammatory and infectious dermatoses.2‐7 Though some dermatoscopic features appear to be highly specific for a particular disease, others can be seen in more than one entity and are subsequently considered “non‐specific.” However, a “non‐specific” dermatoscopic feature may be rendered particularly valuable when coupled with certain other clinical and/or dermoscopic criteria, forming a set of features that are relatively specific for certain disorders.

Scoring systems in dermatology

Three scoring systems were considered and described for dermatological applications in which malignant and benign skin lesions have to be recognized: two models are derived from logistic regression and naïve Bayes rule by rounding model parameters to their nearest integer values; the third approach defines the scoring system by a direct stepwise adding of the most significant binary risk factors. An application example of a direct score model was then developed to illustrate important aspects of its design in dermoscopy. The results show that, having many variables available, score models combine simplicity, practicality, high accuracy and good control of overfitting. Also they can incorporate different diagnostic styles of experienced dermatologists, introducing into the model subjective binary variables, some of which also assessed with a significant degree of disagreement.

Ocular involvement in generalized fixed drug eruption from nimesulide

1. Lincoff H, Lopez R, Kreissig I, Yannuzzi L, Cox M, Burton T. Retinoschisis associated with optic nerve pits. Arch Ophthalmol 1988; 106: 61–7. 2. Imamura Y, Zweifel SA, Fujiwara T, Freund KB, Spaide RF. High-resolution optical coherence tomography findings in optic pit maculopathy. Retina 2010; 30: 1104– 12. 3. Spaide RF, Costa DL, Huang SJ. Macular schisis in a patient without an optic disk pit optical coherence tomographic findings. Retina 2003; 23: 238– 40. 4. Zaidi AA, Brucker AJ, Johnson MW. Diagnostic and therapeutic challenges. Retina 2011; 31: 2125– 8. 5. Doyle E, Trivedi D, Good P, Scott RA, Kirkby GR. Highresolution optical coherence tomography demonstration of membranes spanning optic disc pits and colobomas. Br J Ophthalmol 2009; 93: 360–5. Ocular involvement in generalized fixed drug eruption from nimesulide

Noninvasive diagnosis of liquefied gouty tophus: Reflectance confocal microscopy as an alternative to polarizing light microscopy analysis

To the Editor, Gout is a wellknown arthropathic disease caused by deposition of monosodium urate monohydrate (MSUM) crystals in the joint space and adjacent soft tissue, causing pain and chronic relapsing joint inflammation.1,2 The pathognomonic manifestation of the chronic form is the gouty tophus, a granulomalike structure of inflammatory cells surrounding MSUM crystals aggregates usually localized on the first metatarsophalangeal joint, the olecranon bursa, the Achilles tendon, and the ear.1-4 Although the typical clinical presentation of an inflamed gouty tophus is a hardswelling nodule with translucent erythematous overlying skin, there is a great variety of uncommon presentation of tophi including ulcerated, papular, plaque, bullous, panniculitislike, and pustular lesions.3,4 In some cases, tophi can be the first gout manifestation.1-5 Diagnosis of gout relies on clinicalanamnestic criteria (ie, history of painful joint swelling with abrupt onset and remission within 2 weeks; serum urate level >7 mg/dL; presence of tophi), but the gold standard criteria remains the identification of MSUM crystals in synovial fluid or tissue through polarizing light microscopy analysis.5-7 Reflectance confocal microscopy (RCM) is a noninvasive diagnostic tool that permits to obtain in vivo images at a nearly histological resolution. First used and validated for skin cancer early diagnosis,

Benign and malignant collision tumors of melanocytic skin lesions with hemangioma: Dermoscopic and reflectance confocal microscopy features

Though the combination/collision of nevi or lentigo simplex and hemangiomas is frequent, the malignant collision tumor melanoma‐hemangioma is exceptional and can sometime clinically simulate a benign collision. To date, a series of collision tumors of hemangiomas associated with either benign or malignant melanocytic skin lesions (MSL) has yet to be studied by non‐invasive imaging and clinico‐pathologic correlates.

How transparent film applied on dermatologic imaging devices in order to prevent infections affects image quality

In the clinical practice, transparent films are used as sterile interfaces in in vivo dermatologic imaging in order to prevent the transmissions of infections. However, in our experience, the use of a transparent film can alter skin images. Our study aimed to compare the optical quality of a series of different plastic films used as interfaces in order to understand if some might be more suitable for imaging.

New findings in non-invasive imaging of cutaneous endometriosis: Dermoscopy, high-frequency ultrasound and reflectance confocal microscopy

Cutaneous endometriosis (CE) is rare and its dermoscopic features were reported only in 3 patients. The aim of this study was to examine a case of pigmented CE with multiple non‐invasive imaging techniques, to compare the obtained images with histopathology and to define their utility in an early diagnosis of the disease.

SNHG5 promotes proliferation and induces apoptosis in melanoma by sponging miR-155

Background: Melanoma is the most common malignancy of skin cancer. Small nucleolar RNA host gene 5 (SNHG5), a long non-coding RNA (lncRNA), has been demonstrated to be abnormally expressed in multiple malignances. However, the roles and molecular mechanisms of SNHG5 in melanoma progression have not been well identified. Methods: RT-qPCR assays were used to detect the expression patterns of SNHG5 and microRNA-155 (miR-155). Cell proliferation was assessed using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and colony formation assays. Cell apoptosis rate was measured by flow cytometry via double-staining of fluorescein isothiocyanate (FITC)-labeled annexin V (Annexin V-FITC) and propidium iodide (PI). The interaction between SNHG5 and miR-155 was validated using bioinformatics analysis, subcellular fraction assay, luciferase assay and RNA immunoprecipitation (RIP) assay. A mouse model of melanoma was established to further verify the effect of SNHG5 on tumor growth in vivo. Results: SNHG5 expression was upregulated in melanoma tumor tissues and cell lines. Moreover, higher SNHG5 expression was associated with advanced pathogenic status and poor prognosis. Functional analysis showed that SNHG5 knockdown suppressed proliferation and facilitated apoptosis in melanoma cells. Mechanical exploration revealed that SNHG5 acted as a molecular sponge of miR-155 in melanoma cells. Restoration experiments delineated that miR-155 down-regulation partly abrogated SNHG5-knockdown-mediated anti-proliferation and pro-apoptosis effect in melanoma cells. In vivo assays further demonstrated that SNHG5 depletion hindered tumor growth through up-regulating miR-155 expression. Conclusion: SNHG5 promoted the development of melanoma by sponging miR-155 in vitro and in vivo, implying the important implication of lncRNAs in melanoma progression and providing a potential therapeutic target for melanoma.

In vivo reflectance confocal microscopy combined with the ‘spaghetti technique’ for the identification of surgical margins of lentigo maligna: experience in 70 patients

Lentigo maligna (LM) and lentigo maligna melanoma (LMM) account for 10% of all melanomas and are mainly located on head and neck areas.1-4 Complete surgical excision is the recommended treatment. However, this treatment is often challenging because of LM/LMM location in the face and the difficulty in the identification of its surgical margins1-5 . Local recurrence of LM/LMM still represents a major concern with recurrence rates after conventional surgical excision of 8 to 20% of cases, up to 47% in absence of Mohs micrographic surgery (MMS). This article is protected by copyright. All rights reserved.