Pedro Zaballos

Dermoscopy of Dermatofibromas: A Prospective Morphological Study of 412 Cases

OBJECTIVE To describe the dermoscopic features, including vascular structures and patterns associated with dermatofibromas in a large series of cases. DESIGN Digital dermoscopic images of the prospectively collected dermatofibromas were evaluated for the presence of multiple structures and patterns. SETTINGS Dermatofibromas were collected in the Departments of Dermatology of the Hospital de Sant Pau i Santa Tecla, Tarragona, Spain, and Hospital de Sant Llatzer, Palma de Mallorca, Spain. PATIENTS A total of 412 dermatofibromas (from 292 patients) with complete documentation were collected. MAIN OUTCOME MEASURES Frequency and intraobserver and interobserver agreement of the dermoscopic structures and patterns in dermatofibromas. RESULTS A total of 19 morphological dermoscopic structures were evaluated. Pigment network was observed in 71.8% (3% atypical pigment network), white scarlike patch in 57.0%, and a white network in 17.7%. Different vascular structures were observed in 49.5% (dotted vessels in 30.6%). Ten dermoscopic patterns were observed. The most common pattern seen in our series (34.7% of cases) was central white patch and peripheral pigment network, but in 65.3% of the cases, dermatofibromas presented different patterns including simulators of melanoma. CONCLUSION The most common pattern associated with dermatofibroma is the classic dermoscopic pattern (pigment network and central white patch), but this tumor has a wide range of presentations.

Blue-black rule: A simple dermoscopic clue to recognize pigmented nodular melanoma

Background  Dermoscopy improves melanoma recognition, but most criteria were described in the context of superficial spreading melanoma.

Dermoscopic findings of haemosiderotic and aneurysmal dermatofibroma : report of six patients

Background  The clinical diagnosis of dermatofibroma is commonly easy. However, the differentiation of dermatofibroma from other cutaneous tumours is difficult in some instances, primarily in atypical cases and rare variants. Haemosiderotic dermatofibroma is a variant composed of numerous small vessels, extravasated erythrocytes and intra‐ and extracellular haemosiderin deposits. Aneurysmal dermatofibroma is a variant composed of large, blood‐filled spaces without endothelial lining. Some authors consider that haemosiderotic dermatofibroma is an early stage in the development of aneurysmal dermatofibroma. The clinical differential diagnosis of haemosiderotic or aneurysmal dermatofibroma must include melanoma and other melanocytic tumours, vascular neoplasms, adnexal tumours and nonspecific cysts. Dermoscopy improves the diagnostic accuracy in pigmented and nonpigmented skin lesions.

Dermoscopy of cutaneous leishmaniasis

Summary Background Dermoscopy has been proposed as a diagnostic tool in the case of skin infections and parasitosis but no specific dermoscopic criteria have been described for cutaneous leishmaniasis (CL).

Dermoscopy of pyogenic granuloma: a morphological study

Background  Pyogenic granuloma is a common, benign, vascular lesion of the skin and mucous membranes which is a simulator of amelanotic/hypomelanotic melanoma and other tumours.

Mycobacterium chelonae infection with multiple cutaneous lesions after treatment with acupuncture

A 58‐year‐old‐woman was first seen in November 1999 with a 4‐week history of several tender, deep red or purple, suppurating subcutaneous nodules on the skin of the abdomen, suggestive of a panniculitis ( Fig. 1 ). She had no history of systemic immunosuppression. Three months prior to examination, the patient had treated with acupuncture for obesity. Two biopsy specimens of the nodules were taken and sent for culture and histologic examination. Histology showed a pattern of panniculitis with chronic inflammatory cells mixed with areas of polymorphonuclear abscesses and necrosis ( Fig. 2 ). Culture of the biopsy specimen grew acid fast bacilli within 4 days, later identified with biochemical and molecular tests as Mycobacterium chelonae (subspecies chelonae). Polymerase chain reaction‐restriction enzyme pattern analysis (PRA) was used for molecular identification of mycobacteria. In vitro sensitivity tests showed sensitivity to clarithromycin, amikacin, tobramycin, doxycycline and erythromycin and resistance to ciprofloxacin, ofloxacin, trimethoprim‐sulfamethoxazole, imipenem and cefoxitin. Oral clarithromycin (500 mg b.d.) was started and after 3 months of therapy the lesions had cleared completely.

Dermoscopy is useful for the recognition of benign-malignant compound tumours.

The association of two different neoplasms in the same lesion is uncommon and has been reported as collision or compound tumours in the medical literature. In cases where a malignant neoplasm exists in association with a benign lesion it is important to make an accurate diagnosis in order to treat the lesions correctly. Dermoscopy is an in vivo, noninvasive technique that improves the clinical accuracy in diagnosing melanoma and other pigmented skin lesions. We describe the dermoscopic characteristics of various collision or compound tumours that were composed of benign and malignant neoplasms: two cases of seborrhoeic keratosis associated with basal cell carcinoma, two cases of melanocytic naevus and basal cell carcinoma and one case of dermatofibroma associated with basal cell carcinoma. We conclude that dermoscopy is a useful tool for improving the recognition of these kinds of tumours.

Dermoscopic findings in pyogenic granuloma

Background  To the best of our knowledge, no specific dermoscopic criteria have been described in the medical literature for the diagnosis of pyogenic granuloma.

Dermoscopic features of melanomas associated with MC1R variants in Spanish CDKN2A mutation carriers

Background  The presence of at least one MC1R gene variant is associated with a reduction in age at melanoma diagnosis in families with CDKN2A mutations.

Dermoscopic patterns of common facial inflammatory skin diseases

Several common inflammatory dermatoses, such as rosacea, seborrheic dermatitis (SD), discoid lupus erythematosus (DLE) and granulomatous skin diseases manifest as erythematous macules or plaques on the facial skin. Although clinical examination represents the cornerstone of diagnosis, the broad variety of clinical features and uncommon presentations of these diseases may cause at times diagnostic and therapeutic uncertainty. Dermoscopy, in addition to its well‐documented value in evaluation of skin tumours, is continuously gaining appreciation also in the field of general dermatology.