Mauro Yoshiaki Enokihara

Dermoscopic examination of the nail bed and matrix

Background  Dermoscopy has furthered advances in the differential diagnosis of longitudinal melanonychia; however, fewer details observed in the nail, as compared to skin lesions, make interpretation difficult.

Dermatologists' Accuracy in Early Diagnosis of Melanoma of the Nail Matrix

OBJECTIVE To measure and compare the accuracy of 4 different clinical methods in the diagnosis of melanoma in situ of the nail matrix among dermatologists with different levels of clinical experience. DESIGN Twelve cases of melanonychias (5 melanomas and 7 nonmelanomas) were presented following 4 successive steps: (1) clinical evaluation, (2) evaluation according to the ABCDEF rule, (3) dermoscopy of the nail plate, and (4) intraoperative dermoscopy. At each step, the dermatologists were asked to decide if the lesion was a melanoma. SETTING The test was administered at 2 dermatological meetings in 2008. PARTICIPANTS A total of 152 dermatologists, including 11 nail experts, 53 senior dermatologists, and 88 junior dermatologists. MAIN OUTCOME MEASURES The answers were evaluated as percentage of right answers for each diagnostic step according to the different grade of expertise. Differences among the percentage of right answers in the different steps were evaluated with the z test at a 5% level of significance. The agreement was investigated using Cohen kappa statistic. RESULTS The only method that statistically influenced the correct diagnosis for each category (experts, seniors, and juniors) was intraoperative dermoscopy (z test; P < .05). Cohen kappa statistic showed a moderate interobserver agreement. CONCLUSIONS Overall accuracy of dermatologists in the diagnosis of nail matrix melanoma in situ is low because the percentages of physicians who indicated the correct diagnosis during each of the first 3 clinical steps of the test ranged from 46% to 55%. The level of expertise did not statistically influence the correct diagnosis.

Diagnóstico do tumor glômico pela dermatoscopia do leito e da matriz ungueal

Surgery is the best treatment for glomus tumors. Sometimes this can be a challenging procedure because, despite being a well-defined tumor, its visualization can be difficult. The use of nail bed and matrix dermoscopy facilitates the diagnosis and aids in the localization and demarcation of the tumor. It is a simple and low-cost procedure that does not involve additional risks to the patient who will undergo surgery.

First report of a fibro‐adenoma in axillary mammary tissue of a renal transplant patient taking cyclosporin

Longer survival and a better quality-of-life after solid organ transplantation have been observed since the development of immunosuppressive therapy, although comorbility has increased. Cyclosporin A (CsA) is one of the drugs that inhibits T-cell activation via calcineurin inhibition (CaN). Its chronic use could develop malignant cutaneous tumors and benign mucocutaneous proliferative diseases (fibro-adenomas, hypertrichosis, gingival hypertrophy, papillomas, sebaceous hyperplasia and epidermic cysts). 1,2 We report the first description of fibro-adenoma (FA) in accessory mammary tissue in a kidney transplant recipient using CsA.

Absence of tumor-infiltrating lymphocyte is a reproducible predictive factor for sentinel lymph node metastasis: A multicenter database study by the Brazilian melanoma group

Aims The aim of this study is to confirm the function of tumor-infiltrating lymphocytes (TILs) in sentinel lymph node (SLN) metastasis. Materials and Methods This retrospective study included 633 patients with invasive melanoma who underwent sentinel lymph node biopsy in 7 referral centers certified by the Brazilian Melanoma Group. Independent risk factors of sentinel node metastasis (SNL) were identified by multiple logistic regression. Results SLN metastasis was detected in 101 of 633 cases (16.1%) and in 93 of 428 patients (21.7%) when melanomas ≤ 1mm were excluded. By multiple logistic regression, the absence of TILs was as an independent risk factor of SLN metastasis (OR = 1.8; 95%CI: 1.1–3.0), in addition to Breslow index (greater than 2.00 mm), lymph vascular invasion, and presence of mitosis. Conclusion SLNB can identify patients who might benefit from immunotherapy, and the determination of predictors of SLNB positivity can help select the proper population for this type of therapy. The absence of TILs is a reproducible parameter that can predict SLNB positivity in melanoma patients, since this study was made with several centers with different dermatopathologists.

Reassessing Melanonychia Striata in Phototypes IV, V, and VI Patients.

BACKGROUND Racial melanonychia striata is a nail plate dyschromia described as a gray coloration of the background in dermatoscopy and hypermelanosis in histology. However, many cases with brown or black coloration of the background in the dermatoscopic examination have been followed. OBJECTIVE Evaluate racial melanonychia striata dermatoscopical patterns and histological diagnosis in Fitzpatrick skin Types IV, V, or VI population. MATERIALS AND METHODS 482 Fitzpatrick skin Types IV, V, or VI patients, between 19 and 72 years of age, were clinically evaluated and underwent nail plate dermatoscopic examination. Fifty-eight patients presenting melanonychia striata and dermatoscopic patterns with brown or black coloration of the background were submitted to a nail matrix biopsy. When occurring in more than 1 digit, biopsy was performed in the lesion with the darkest coloration presented in dermatoscopy. RESULTS All skin Types IV, V, or VI patients who had melanonychia striata, with brown or black coloration of the background in the dermatoscopic examination, revealed histopathological analysis compatible with hypermelanosis. CONCLUSION Racial melanonychia in skin Types IV, V, or VI patients, resulting from hypermelanosis, may present brown or black coloration of the background in the dermatoscopic examination.

Hiperplasia sebácea cutânea: estudo piloto para a correlação da doença com hormônios androgênios

FUNDAMENTOS: As glândulas sebaceas sao suscetiveis a acao dos hormonios androgenios e apresentam proliferacao benigna com a idade, ou seja, hiperplasia. OBJETIVOS: Estudo piloto para verificar se ha correlacao entre a taxa de hormonios masculinos circulantes e o aumento da incidencia da hiperplasia das glândulas sebaceas. METODOS: 16 pacientes do sexo feminino, com diagnostico de hiperplasia sebacea cutânea, foram comparados a um grupo-controle de mesmo genero e idades semelhantes, sem a doenca. Ambos os grupos foram submetidos a testes de dosagem sanguinea para avaliacao das taxas de hormonios androgenios circulantes (testosterona livre e total, androstenediona). Os resultados foram tabulados e analisados estatisticamente. RESULTADOS: Os dados demonstraram nao haver mudancas nos niveis de hormonios masculinos circulantes dos pacientes com hiperplasia sebacea cutânea, quando comparados ao grupo-controle. CONCLUSAO: Os dados sugerem que nao ha alteracoes estatisticamente significantes nas taxas dos hormonios circulantes (testosterona livre e total, androstenediona, deidroepiandrosterona, sulfato de deidroepiandrosterona) dos pacientes com hiperplasia sebacea cutânea.

Sebaceous hyperplasia: systemic treatment with isotretinoin

The study aimed to verify the therapeutic action of isotretinoin in the treatment of sebaceous hyperplasia. During two months, 20 patients with sebaceous hyperplasia took isotretinoin at a dosage of 1mg/kg per day. Their skin lesions were counted and photographed before and after treatment and re-evaluated two years later. The average number of sebaceous hyperplasia lesions before treatment was 24 per patient. At the end of two months of therapy, the number of lesions decreased to 2 per patient. The statistically analyzed data showed a reduction in the number of lesions following isotretinoin use (p < 0.05). Two years after the end of the treatment, the average number of sebaceous hyperplasia lesions was 4 per patient. There were no severe side effects. Thus, the data analysis suggests that isotretinoin is a safe and effective drug for treating the disease under study.

Melanoma developed during pregnancy--a case report.

We describe a case of plantar interdigital cutaneous melanoma in a 22-year-old woman who reported changes in a pigmented lesion during pregnancy. Diagnosis was late and evolution unfavourable. The purpose of this report is to draw the attention of dermatologists to the need for careful regular examination of melanocytic lesions in pregnant women, not ignoring possible changes as always physiological.

Xantogranuloma necrobiótico solitário sem paraproteinemia

Necrobiotic xanthogranuloma is a chronic granulomatous and xantomathous disease, characterized by indurated, nontender, yellowish and erythematous nodules and plaques especially located on the periorbital region. It is commonly associated with paraproteinemia and an increased risk for hematological and lymphoproliferative malignancies. Its pathogenesis remains unclear. Alkylating agents, such as chlorambucil and melphalan may be used to treat the disease with variable success. We report a case of this rare disease in a patient with a solitary tumor and without paraproteinemia.