Nilceo Schwery Michalany

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.

Nail Melanoma in Children : Differential Diagnosis and Management

The clinical presentations of melanonychia depend on the number of the bands, color, edges, and width. Whatever is the trigger factor that has activated, or increased in number, the nail matrix melanocytes, the possibility of melanoma (malignant melanocytic hyperplasia) should always be ruled out. Hutchinson’s sign (extension of the pigmentation to the proximal or lateral nail folds) is an important indicator of nail melanoma and can help the clinician in performing the diagnosis even if it is not always present. In children nail melanoma is very rare, and melanonychia is generally due to nail matrix nevi (benign melanocytic hyperplasia). To our knowledge, until now only eight cases have been reported in the literature. We report two additional cases and discuss the histopathology, differential diagnosis, and management.

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.

Actinic cheilitis: histopathology and p53

Background:  Chronic actinic cheilitis (AC) is a precursor of squamous cell carcinoma (SCC) of the lip.

Urticaria unresponsive to antihistaminic treatment: An open study of therapeutic options based on histopathologic features

Background: The non‐ or low‐sedating H1 receptor antagonists represent the basic therapy for urticaria. Objective: To test an alternative approach to patients unresponsive to conventional treatment. Materials and methods: A total of 22 patients with chronic urticaria unresponsive to conventional antihistamine treatment were enrolled for this study. They had uncontrolled urticaria even using multiple combinations of antihistamines on maximum doses and corticosteroids in short cycles (prednisone 20–40 mg, per os once a day, 3–7 days per month). Cutaneous biopsies of the urticaria lesions were taken. These findings were classified as: (I) a mixture of perivascular dermal inflammatory infiltrate composed of lymphocytes, monocytes and neutrophils and/or eosinophils; (II) inflammatory infiltrate composed chiefly of neutrophils; and (III) inflammatory infiltrate composed mainly of eosinophils. According to histology, the patients were submitted to one of the following therapeutic schemes: class A – antihistamine treatment plus dapsone; class B – colchicine or dapsone; class C – montelukast. Results: Four patients in class A, 08 in class B and seven in class C displayed complete control of urticaria after 12 weeks of treatment; one patient in class B and two in class C did not respond to treatment. Two years after discontinuation, 16 patients are still free of urticaria. Conclusions: This study suggests an alternative approach for treating unresponsive chronic urticaria.

The oral mucosa in leprosy: a clinical and histopathological study

INTRODUCTION Multibacillary leprosy may involve the oral mucosa, with or without apparent lesions. There are few studies that deal with this issue in the era of multidrug therapy. AIM To assess the frequency of oral mucosa involvement in multibacillary leprosy patients. PATIENTS AND METHODS A transversal study with twenty non-treated multibacillary leprosy patients. The patients were treated in Dracena, São Paulo, between 2000 and 2002. Clinical examination of the oral mucosa was carried out. All patients were submitted to jugal mucosa, soft palate and tongue biopsies, in altered or in pre-established sites. The cross-sections were stained by techniques of hematoxilin-eosin and Ziehl-Neelsen. Granuloma and alcohol-acid-resistant bacilli findings determined the specific histopathological involvement. RESULTS The study involved 19 patients with an average of 2.5 years of disease progression. Specific histopathological involvement occurred in the tongue and soft palate of one lepromatous patient with an apparently normal oral mucosa. CONCLUSIONS (1) Clinical alterations in the oral mucosa does not imply disease involvement, it is necessary to have histopathological confirmation. (2) Apparent specific clinical alterations are rare. (3) The clinically normal oral mucosa can show specific histopathological involvement.

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.

Granular parakeratosis in children: case report and review of the literature.

Abstract: Granular parakeratosis is a cutaneous eruption with erythematous and/or brownish hyperkeratotic papules and plaques which are exclusively localized to intertriginous areas and show histopathologic features of an unusual form of parakeratosis. The etiology is unknown, but the excessive use of various topical preparations (e.g., ointments and deodorants) has been associated with this disease. It has heretofore been reported only in adults. We report two children, ages 3 and 5 months, with characteristic lesions in the groin associated with topical pomades used to prevent diaper rash. This is the first report associating the clinical presentation and the histopathologic diagnosis of granular parakeratosis in children. The literature on this entity is also reviewed and all case reports are summarized.

A mucosa oral na hanseníase: um estudo clínico e histopatológico

INTRODUCAO: a anseniase multibacilar pode causar comprometimento da mucosa oral, com ou sem lesoes aparentes. Ha poucos estudos que tratam deste assunto na era da multidrogaterapia. OBJETIVO: Verificar a frequencia do comprometimento da mucosa oral em pacientes de hanseniase multibacilar. CASUISTICA E METODOS: Foi realizado um estudo transversal em vinte pacientes de hanseniase multibacilar, nao-tratados, atendidos consecutivamente em Dracena, Sao Paulo, entre o periodo de 2000 e 2002. Foi realizado exame clinico completo da mucosa oral. Os pacientes foram submetidos a biopsias na mucosa jugal, na lingua e no palato mole, em alteracao ou em pontos pre-estabelecidos. Os cortes foram corados pelas tecnicas da hematoxilina-eosina e Ziehl-Neelsen. O encontro de granuloma e bacilos alcool-acido-resistentes ao exame histopatologico determinou o comprometimento especifico. RESULTADOS: O estudo envolveu 19 pacientes multibacilares com tempo medio de evolucao de 2,5 anos. Ocorreu comprometimento histopatologico especifico em apenas um paciente virchowiano, com mucosa oral clinicamente normal, na lingua e no palato mole. CONCLUSOES: 1. Alteracao clinica na mucosa oral nao implica em comprometimento pela doenca, e necessario confirmacao histopatologica. 2. Alteracoes clinicas especificas aparentes sao raras. 3. A mucosa oral clinicamente normal pode exibir comprometimento histopatologico especifico.

Zosteriform connective tissue nevus: a case report.

Because of its distinctive clinical features and histopathological characteristics, zosteriform connective tissue nevus is considered a separate entity from other connective tissue nevi. Only two cases have previously been reported in the worldwide dermatological literature. Here we report a zosteriform connective tissue nevus in a 3‐year‐old boy with similar clinical presentation.