Serena Sestini

Multidimensional non-linear laser imaging of Basal Cell Carcinoma

We have used a multidimensional non-linear laser imaging approach to visualize ex-vivo samples of basal cell carcinoma (BCC). A combination of several non-linear laser imaging techniques involving fluorescence lifetime, multispectral two-photon and second-harmonic generation imaging has been used to image different skin layers. This approach has elucidated some morphological (supported by histopathological images), biochemical, and physiochemical differences of the healthy samples with respect to BCC ones. In particular, in comparison with normal skin, BCC showed a blue-shifted fluorescence emission, a higher fluorescence response at 800 nm excitation wavelength and a slightly longer mean fluorescence lifetime. Finally, the use of aminolevulinic acid as a contrast agent has been demonstrated to increase the constrast in tumor border detection. The results obtained provide further support for in-vivo non-invasive imaging of Basal Cell Carcinoma.

Nonlinear laser imaging of skin lesions.

We investigated different kinds of human ex-vivo skin samples by combined two-photon intrinsic fluorescence (TPE), second-harmonic generation microscopy (SHG), fluorescence lifetime imaging microscopy (FLIM), and multispectral two-photon emission detection (MTPE). Morphological and spectroscopic differences were found between healthy and pathological skin samples, including tumors. In particular, we examined tissue samples from normal and pathological scar tissue (keloid), and skin tumors, including basal cell carcinoma (BCC), and malignant melanoma (MM). By using combined TPE-SHG microscopy we investigated morphological features of different skin regions. Further comparative analysis of healthy skin and neoplastic samples was performed using FLIM, and MTPE. Finally, we demonstrated the use of methyl-aminolevulinate as a contrast agent to increase the contrast in BCC border detection. The results obtained represent further support for in-vivo noninvasive imaging of diseased skin.

Estrogen Receptor Expression in Cutaneous Melanoma A Real-Time Reverse Transcriptase-Polymerase Chain Reaction and Immunohistochemical Study

OBJECTIVE To evaluate estrogen receptor (ER) expression in human melanoma tissues and in the adjacent healthy skin with the aim of explaining whether the ERalpha:ERbeta expression ratio has a role in neoplastic progression. DESIGN Prospective study. SETTING Department of Dermatology, University of Florence, Florence, Italy. Patients Fourteen patients, 12 with cutaneous melanoma (6 women and 6 men) and 2 with melanocytic nevi (1 woman and 1 man). MAIN OUTCOME MEASURES Using quantitative reverse transcriptase-polymerase chain reaction and immunohistochemical analysis, we analyzed ERalpha and ERbeta messenger RNA (mRNA) and ERbeta protein expression in cutaneous melanoma and in the healthy skin surrounding the lesions. RESULTS All melanocytic lesions expressed detectable levels of ERalpha and ERbeta mRNA as well as ERbeta protein. Dividing melanoma cases into 2 groups according to Breslow thickness, we found lower ERalpha and ERbeta mRNA levels and lower ERbeta protein levels in thicker, more invasive tumors. CONCLUSIONS These observations suggest a role for ERs in the metastatic process of melanoma cells, pointing at the possibility of using ERbeta expression as a prognostic indicator of melanoma. The possibility of distinguishing proliferative melanomas, which are associated with dismal prognosis, from the so-called dormant melanomas opens up novel avenues in tailoring individual treatments, as already happens for other tumors.

Pattern analysis, not simplified algorithms, is the most reliable method for teaching dermoscopy for melanoma diagnosis to residents in dermatology

Summary Background Simplified algorithms for dermoscopy in melanoma diagnosis were developed in order to facilitate the use of this technique by non‐experts. However, little is known about their reliability compared with classic pattern analysis when taught to untrained observers.

Combined non-linear laser imaging (two-photon excitation fluorescence microscopy, fluorescence lifetime imaging microscopy, multispectral multiphoton microscopy) in cutaneous tumours : first experiences

Background  Two‐photon excitation (TPE) fluorescence microscopy is a high‐resolution laser‐scanning imaging technique enabling deep imaging inside biological tissues. TPE microscopy has the triple advantage of offering high spatial resolution (250 nm radially, 800 nm axially), high penetration depth inside skin (200mm ), and low photodamage effects. Further, cells and extracellular matrix intrinsically contain a variety of fluorescent molecules (NADH, tryptophan, keratins, melanin, elastin, cholecalciferol and others), so that biological tissues can be imaged by TPE microscopy without any exogenous probe.

Cutaneous collision tumour (melanocytic naevus, basal cell carcinoma, seborrhoeic keratosis): a clinical, dermoscopic and pathological case report

The association of contiguous or ‘collision’ tumours in the same biopsy specimen is not uncommon and is often reported in the literature. The most common association, basal cell carcinoma (BCC) and naevus, is very difficult to diagnose clinically. We describe a 38‐year‐old woman with a previous history of melanoma, who presented with a modified pigmented lesion of the hip that had begun to change 6 months earlier. Histologically, the lesion was a melanocytic compound naevus and a BCC with a seborrhoeic keratosis. The case was investigated clinically and by focusing on the dermoscopic features and their pathological correlates. Cutaneous collision tumours are extremely difficult to diagnose preoperatively, even with the help of dermoscopy, in particular when one of the lesions is melanocytic.

The use of silicone gel in the treatment of fresh surgical scars: a randomized study

Aim.  To evaluate the effectiveness of a silicone gel in treating surgical wounds compared with a control group of the same phenotype and same scar site for which a placebo was advised.

Prevalence and distribution of melanocytic naevi on the scalp: a prospective study

Background  Few studies have examined the incidence and characteristics of naevi on the scalp. Most studies of scalp naevi have been performed in children, whose incidence of scalp naevi is relatively high, at about 0·5–11·7% of the total body count of common naevi.

Solitary cutaneous metastasis as the first sign of relapse of thyroid carcinoma: a clinical, dermoscopic-pathologic case study.

Cutaneous metastases are a rare event, representing 0.7% to 2.0% of all cutaneous malignant neoplasms. They may be the first sign of a previously undiagnosed visceral malignancy or the initial presentation of a recurrent neoplasm. The frequency of cutaneous metastases according to the type of underlying malignancies varies with sex. In men, the most common internal malignancies leading to cutaneous metastases are lung cancer, colon cancer, melanoma, squamous cell carcinoma of the oral cavity, and renal cell carcinoma. In women, breast cancer, colon cancer, melanoma, lung cancer, and ovarian cancer are the most common malignancies leading to cutaneous metastases.

Lipoma of the finger: a case report and differential diagnosis

1 Monzillo L, Hamdy O. Evaluation of insulin sensitivity in clinical practice an in research settings. Nutr Rev 2003; 61: 397–412. 2 Bloomgarden ZT. Definitions of the insulin resistance syndrome. Diabetes Care 2004; 27: 824–30. 3 Hisler BM, Savoy LB. Acanthosis nigricans of the forehead and fingers associated with hyperinsulinaemia. Arch Dermatol 1987; 123: 1441–2. 4 Akyol M, Polat M, Ozcelik S et al. Acanthosis nigricans with atypical localization. Acta Derm Venereol 2000; 80: 399. 5 Schwartz RA. Acanthosis nigricans. J Am Acad Dermatol 1994; 31: 1–19. 6 Torley D, Bellus GA, Munro CS. Genes, growth factors and acanthosis nigricans. Br J Dermatol 2002; 147: 1096–101.