Niccolò Nami

Negative pigment network: an additional dermoscopic feature for the diagnosis of melanoma.

BACKGROUND The negative pigment network (NPN) is seen as a negative of the pigmented network and it is purported to be a melanoma-specific structure. OBJECTIVES We sought to assess the frequency, sensitivity, specificity, and odds ratios (ORs) of NPN between melanoma cases and a group of control lesions. METHODS Digitalized images of skin lesions from 679 patients with histopathological diagnosis of dermatofibroma (115), melanocytic nevus (220), Spitz nevus (139), and melanoma (205) were retrospectively collected and blindly evaluated to assess the presence/absence of NPN. RESULTS The frequency of occurrence of NPN was higher in the melanoma group (34.6%) than in Spitz nevus (28.8%), melanocytic nevus (18.2%), and dermatofibroma (11.3%) groups. An OR of 1.8 emerged for the diagnosis of melanoma in the presence of NPN as compared with nonmelanoma diagnosis. Conversely, for melanocytic nevi and dermatofibromas the OR was very low (0.5 and 0.3, respectively). For Spitz nevi the OR of 1.1 was not statistically significant. When comparing melanoma with dermatofibroma, melanocytic nevus, and Spitz nevus, we observed a significantly higher frequency of multicomponent pattern (68.1%), asymmetric pigmentation (92.9%), irregularly distributed NPN (87.3%), and peripheral location of NPN (66.2%) in melanomas. LIMITATIONS Further studies can provide the precise dermoscopic-histopathologic correlation of NPN in melanoma and other lesions. CONCLUSIONS The overall morphologic pattern of NPN, such as the irregular distribution and the peripheral location of NPN, along with the multicomponent pattern and the asymmetric pigmentation could be used as additional features in distinguishing melanoma from Spitz nevus and other benign lesions.

Crosstalk between platelets and PBMC: New evidence in wound healing

Abstract Platelet-derived products have proven useful in accelerating healing processes and tissue regeneration. However, despite their widespread use in clinical practice, the cellular and molecular mechanisms involved have not yet been completely clarified. Recent studies show that interaction between platelet gel (PG) and peripheral blood mononuclear cells (PBMC) can result in activation of PBMC and production of several cytokines involved in wound healing and tissue repair. The aim of our study was to analyze whether crosstalk between platelets and PBMC can influence wound healing by modulating release of VEGF, bFGF and IL-10 by PBMC. Cultures of PBMC alone and co-cultures with autologous PG of 24 healthy volunteers were incubated under normoxia for 24 h. VEGF, bFGF and IL-10 concentration and expression were then analyzed in supernatants by ELISA and by real-time RT-PCR. We observed a down-regulation of VEGF and bFGF release and an up-regulation of IL-10 release in co-cultures of PBMC and PG. Platelets are not only important in the early stages of the healing process (clot formation, direct release of growth factors), but also can influence the whole process of tissue regeneration by modulating synthesis and release of VEGF, bFGF and IL-10 by PBMC. These effects could give platelets a new key role in the control of healing processes and provide insights into the clinical success of platelet-derived products in many medical fields.

Geriatric teledermatology: store-and-forward vs. face-to-face examination

Background  Telemedicine could be useful in countries like Italy to meet the needs of elderly patients and in particular in those in precarious general conditions, for whom travelling even short distances can pose considerable practical and economical difficulties.

Impact of digital dermoscopy analysis on the decision to follow up or to excise a pigmented skin lesion: a multicentre study.

Background: The quality of early malignant melanoma (MM) diagnosis is dependent on the experience of dermatologists, tools like dermoscopy and histopathology, and awareness and education of the studied population. Does a higher rate of excision of pigmented skin lesions (PSL) increase the rate of detected melanomas?

Rosettes: optical effects and not dermoscopic patterns related to skin neoplasms.

The rosette is a dermoscopic sign observed only with polarised light examination. This dermoscopic structure consists of four brilliant white globules arranged symmetrically in a square, like a four-leafed clover radiating from a central stem. First observed by Cuellar and colleagues, it was described as a new dermoscopic pattern in actinic keratosis (AK), thought to be due to alternating areas of orthokeratosis and parakeratosis (the flag sign). Recently, Liebman and colleagues have pointed out that rosette signs may be observed in a wide range of skin neoplasms, not only in AK. They noted that rosettes are probably due to an optical effect of polarised light interacting with keratinfilled adnexal openings. We recently observed this dermoscopic sign in a non-neoplastic inflammatory disease of the face.

True Amelanotic melanoma: the great Masquerader

Figure 1 (a) Pink lesion on the neck. (b) Epiluminescence dermoscopy with polarized light showed an atypical vascular pattern (circles) and transverse lighter bands (arrows). The rarity of true amelanotic melanoma and its elusive features make this a challenging disease for all dermatologists. Dermoscopy is a noninvasive technique that can assist the clinician in diagnosing skin lesions. The use of dermoscopy for true amelanotic melanoma has not been fully validated yet because of the lack of studies that are based on large series of these rare tumours. A 24-year-old woman presented with an erythematous lesion on the neck that appeared about 12 months earlier. The lesion had been mistaken for ringworm and then for discoid lupus erythematosus and treated with antimycotics (isoconazole nitrate 1%) and topical steroids (diflucortolone valerate 0.1%), respectively, without clinical improvement. Dermatological examination showed a roundish, slightly raised, non desquamative, erythematous lesion with clear borders (Figure 1a). Epiluminescence dermoscopy with polarized light showed an atypical vascular pattern with milky red globules, pinpoint vessels (dotted vessels) and transverse lighter bands (Figure 1b). An excisional biopsy was therefore performed. Histological examination indicated amelanotic epithelioid-cell melanoma, Clark level III, Breslow thickness 0.7 mm, with evidence of regression and abundant periand intralesional lymphocytic infiltrate. The dermal component showed no evidence of maturation. Mitotic figures were present in dermal melanocytes (1/mm2), including mitoses identified in deep dermal melanocytes. Amelanotic melanoma may appear as erythematous, sometimes scaly, macules, nodules or plaques with irregular borders, simulating benign inflammatory plaques or other benign and/or malignant skin neoplasms. The differential diagnosis for ‘true’ amelanotic melanoma is extremely wide. It frequently simulates basal cell carcinoma, squamous cell carcinoma, actinic keratosis, Paget’s or Bowen’s disease and discoid lupus erythematosus. In its most insidious forms, it mimicks even vascular lesions, such as haemangioma and pyogenic granuloma. Our case report demonstrates the relevance of dermoscopy in the early diagnosis of true amelanotic melanoma. Compared to non polarized, polarized dermatoscopes (noncontact

Evaluation of cutaneous melanoma thickness by digital dermoscopy analysis: a retrospective study.

Digital dermoscopy analysis (DDA) exploits computerized analysis of digital images and offers the possibility of parametric analysis of morphological aspects of pigmented skin lesions by means of integration with dedicated software. We conducted a study by DDA in 141 melanomas, with the aim assessing whether the numerical variables extrapolated by univariate logistic analysis could be used in a system of multivariate analysis to predict melanoma thickness before surgery. Melanoma images were evaluated for 49 DDA parameters. Logistic analysis was conducted to identify statistically significant variables. The leave-one-out method was used to evaluate the predictive representations of rules for stepwise logistic classification. The percentage of correctly classified cases was calculated by a classification matrix. Melanomas less than 1 mm had a smaller area, faded borders and were more symmetrical than melanomas greater than 1 mm. The latter had a bluer colour and more random disposition of elements. The accuracy was 86.5%. Specifically, 97 of 108 thin melanomas (specificity 89.8%) and 25 of 33 thick melanomas (sensitivity 75.7%) were correctly classified. In conclusion, the predictive value of DDA for melanoma thickness was quite good. Moreover, DDA allowed us to know objectively those dermoscopic features important in the differentiation between thick and thin melanoma. However, further studies should be performed in a prospective setting before the clinical application.

Melanoma with halo

A 35-year-old man presented with a 3-month history of an achromic halo around a pigmented skin lesion (PSL) on the abdomen (Fig. 1a). The patient, who had many naevi on various parts of his body, reported that the lesion had been present for at least 2 years, but that about 6 months before presentation it had begun to change. In the past 3 months, a vitiligo-like halo had appeared and the diameter of the pigmented skin lesion (PSL) had decreased suddenly. There was no family history of melanoma. Physical examination showed a notably black PSL about 6 mm in diameter, with irregular borders, surround by a uniform, vitiligo-like halo. Dermatoscopy showed asymmetry and a pronounced but poorly defined pigmented reticulum and coarse peripheral pseudopods (Fig. 1b). A grey-blue veil covered about 30% of the lesion. On the basis of the clinical and dermatoscopical pattern, a halo melanoma was suspected and the lesion was excised, maintaining a distance of 10 mm outside the halo. Histological examination showed a slightly asymmetrical, compound, melanocytic lesion with active and old regression. Melanocytes were atypical, and mitoses, positive to the proliferating antigen Ki67, were easily seen all throughout the lesion (Fig. 2a,b). Atypical mitoses were also seen in the deep part of the lesion. There was a scanty intraepidermal pagetoid spread and occasional Kamino bodies. A diagnosis of regressing melanoma was made (Breslow thickness 0.30; Clark s level III). Results of tests such as ophthalmic examination and whole-body computed tomography for possible primary melanoma at a different site were negative. Halo naevi (HN), also termed Sutton naevi, are defined as benign melanocytic naevi surrounded by a rim of depigmentation resembling a halo. A vitiligo-like halo may be associated with acquired and congenital naevi, blue naevi, Spitz naevi, and very rarely nonmelanocytic proliferations such as neurofibroma and dermofibroma. Cutaneous hypopigmentation has often been reported during the course of malignant melanoma (MM) and may include several clinical forms, such as regression of the primary MM and ⁄ or its PD

A single centre melanoma thickness trend (1985–2009) in relation to skin areas accessible and non-accessible to self-inspection

Background/Objectives:  Melanoma has become a major public health problem worldwide and its incidence in individuals of Caucasian origin continues to rise. The objective was to determine historical changes in thickness, melanoma proportions and anatomical site of presentation over a 25‐year period in our Department.

A simple scoring system for the diagnosis of palmo-plantar pigmented skin lesions by digital dermoscopy analysis

Background  Many research groups have recently developed equipments and statistical methods enabling pattern classification of pigmented skin lesions. To differentiate between benign and malignant ones, the mathematical extraction of digital patterns together with the use of appropriate statistical approaches is a challenging task.