Nicola Arpaia

Accuracy in melanoma detection: A 10-year multicenter survey

BACKGROUND Early excision is the only strategy to reduce melanoma mortality, but unnecessary excision of benign lesions increases morbidity and healthcare costs. OBJECTIVE To assess accuracy in melanoma detection based on number-needed-to-excise (NNE) values over a 10-year period. METHODS Information was retrieved on all histopathologically confirmed cutaneous melanomas or melanocytic nevi that were excised between 1998 and 2007 at participating clinics. NNE values were calculated by dividing the total number of excised lesions by the number of melanomas. Analyses included changes in NNE over time, differences in NNE between specialized clinical settings (SCS) versus non-specialized clinical settings (NSCS), and patient factors influencing NNE. RESULTS The participating clinics contributed a total of 300,215 cases, including 17,172 melanomas and 283,043 melanocytic nevi. The overall NNE values achieved in SCS and NSCS in the 10-year period were 8.7 and 29.4, respectively. The NNE improved over time in SCS (from 12.8 to 6.8), but appeared unchanged in NSCS. Most of the effect on NNE in SCS was due to a greater number of excised melanomas. Higher NNE values were observed in patients younger than 40 years and for lesions located on the trunk. LIMITATIONS No data concerning the use of dermatoscopy and digital monitoring procedures were collected from the participating centers. CONCLUSION Over the 10-year study period, accuracy in melanoma detection improved only in specialized clinics maybe because of a larger use of new diagnostic techniques such as dermatoscopy.

VEGF concentration from plasma-activated platelets rich correlates with microvascular density and grading in canine mast cell tumour spontaneous model.

Canine cutaneous mast cell tumour (CMCT) is a common cutaneous tumour in dog, with a higher incidence than in human. CMCT is classified in three subgroups, well and intermediately differentiated (G1 and G2), corresponding to a benign disease, and poorly differentiated (G3), corresponding to a malignant disease, which metastasize to lymph nodes, liver, spleen and bone marrow. In this study, we have evaluated serum (S), platelet‐poor plasma (P‐PP), plasma‐activated platelet rich (P‐APR) and cytosol vascular endothelial growth factor (VEGF) concentrations, microvascular density (MVD) and mast cell density (MCD) in a series of 86 CMCTs and we have correlated these parameters with each other, by means of ELISA detection of VEGF and immunohistochemistry. Results show that VEGF level from cytosol P‐APR and MVD were significantly higher in G3 CMCTs as compared to G1 or G2 subgroups. Moreover, a significantly strong correlation among VEGF levels from P‐PAR and cytosol, MVD and MCD was found in G3 subgroup. Because VEGF levels from P‐APR well correlated with MVD and malignancy grade in CMCT, we suggest that VEGF might be secreted from MCs and it may be a suitable surrogate inter‐species angiogenetic markers of tumour progression in CMCT. Finally, CMCT seems to be a useful model to study the role of MCs in tumour angiogenesis and inhibition of MCs degranulation or activation might be a new anti‐angiogenic strategy worthy to further investigations.

Regressing cutaneous malignant melanoma and vitiligo-like depigmentation.

Association of malignant melanoma (MM) with various clinical forms of skin depigmentation is well‐known. We report a case highlighting the importance of careful examination of patients with skin hypomelanoses, including vitiligo and halo nevi, in order to exclude the presence of MM.

Melanocytic Nevus with Atypical Dermoscopic Features at the Site of Radiodermatitis

BACKGROUND Radiation therapy can cause acute and chronic damage of the skin. OBJECTIVE A 71-year-old woman presented with an atrophic and sclerotic plaque at a site previously treated with radiotherapy because of lung cancer. Inside the area affected by chronic radiodermatitis, she reported that a preexisting pigmentary lesion had gradually undergone morphologic changes after radiation therapy. MATERIALS AND METHODS On dermoscopy, the lesion showed features highly suspicious for malignant melanoma. The lesion was excised and examined histopathologically. RESULTS The histopathologic diagnosis was compound congenital melanocytic nevus associated with prominent dermal sclerosis and epidermal atrophy. CONCLUSIONS The existence of melanocytes within an atrophic and fibrotic area is a finding typically associated with recurrent or persistent melanocytic lesions. It is likely that the “pseudomelanoma” features of the lesion observed in our patient might have been secondary to the skin changes induced by radiation therapy.

In situ melanoma of the nail unit presenting as a rapid growing longitudinal melanonychia in a 9-year-old white boy.

Longitudinal melanonychia (LM) is a pigmented longitudinal band of the nail unit, which results from pigment deposition, generally melanin, in the nail plate. Such lesion is frequently observed in specific ethnic groups, such as Asians and African Americans, typically affecting multiple nails. When LM involves a single nail plate, it may be the sign of a benign lesion within the matrix, such as a melanocytic nevus, simple lentigo, or nail matrix melanocyte activation. However, the possibility of melanoma must be considered. Nail melanoma in children is exceptionally rare and only 2 cases have been reported in fairskinned Caucasian individuals.

Case Report: “Incognito” proteus syndrome

Proteus syndrome (PS) is a postnatal mosaic overgrowth disorder, progressive and disfiguring. It is clinically diagnosed according to the criteria reported by Biesecker et al. We describe the case of a 49-year-old woman who presented with a 10-year history of pauci-symptomatic infiltrating plaque lesions on the sole and lateral margin of the left foot, which had been diagnosed as a keloid. The patient had a positive history for advanced melanoma and a series of subtle clinical signs, such as asymmetric face, scoliosis, multiple lipomas on the trunk, linear verrucous epidermal nevi, and hyperpigmented macules with a mosaic distribution. Even if the clinical presentation was elusive, she had enough criteria to be diagnosed with PS. This case describes the first evidence, to the best of our knowledge, of pauci-symptomatic PS in adulthood, reports its rare association with advanced melanoma, and illustrates the importance of even minor cutaneous clinical signs, especially when atypical, in formulating the diagnosis of a complex cutaneous condition such as this.

Vascular Patterns in Cutaneous Ulcerated Basal Cell Carcinoma: A Retrospective Blinded Study Including Dermoscopy

The aim of this retrospective study was to determine the type and prevalence of vascular patterns in the ulcerated and non-ulcerated portions of histologically proven basal cell carcinomas (BCCs) and correlate them with other dermoscopic and clinical features, including the clinically supposed diagnosis. Three authors retrospectively collected 156 clinical and 156 dermoscopic digital images of ulcerated BCCs (histologically confirmed); each image was blindly evaluated by 2 other authors, who did not know the histological diagnosis. Seventeen lesions were completely ulcerated, while 139 lesions presented ulcerated and non-ulcerated portions. Correct clinical diagnosis was associated with the type of lesion, in particular 90.6% of partially ulcerated lesions were correctly diagnosed with clinical-dermoscopic examination, compared with 11.8% of totally ulcerated lesions (χ2 = 64.00, p = 0.000). Presence of arborizing pattern in the ulcerated portion was associated with a correct diagnosis (Fishers exact test, p = 0.015). Correct diagnosis was also associated with absence of dotted pattern in the non-ulcerated area (χ2 = 16.18, p = 0.000); the absence of hairpin (χ2 = 6.08, p = 0.000) and glomerular patterns were associated with correct diagnosis in the ulcerated areas (χ2 = 18.64, p = 0.000). In case of completely ulcerated BCC the clinician lacks the means to correctly identify the correct nature of the lesion, and is driven towards an incorrect diagnostic conclusion.