Sergio Henrique Hirata

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.

Consensus on melanonychia nail plate dermoscopy

This statement, focused on melanonychia and nail plate dermoscopy, is intended to guide medical professionals working with melanonychia and to assist choosing appropriate management for melanonychia patients. The International Study Group on Melanonychia was founded in 2007 and currently has 30 members, including nail experts and dermatopathologists with special expertise in nails. The need for common definitions of nail plate dermoscopy was addressed during the Second Meeting of this Group held in February 2008. Prior to this meeting and to date (2010) there have been no evidence-based guidelines on the use of dermoscopy in the management of nail pigmentation.

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.

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.

Mycetoma caused by Fusarium solani with osteolytic lesions on the hand: case report

Eumycetoma is a mycotic disease caused by saprophytic soil fungi that are usually inoculated through minor injuries. A case of mycetoma in a Brazilian farmer aged71 years is reported. This patient presented erythema and edema on the dorsal surface of the left hand with multiple crusted and cicatricial lesions. No macroscopic grains were observed. The histopathological findings showed grains consisted of numerous hyphae which stained well with Gomori-Grocott method. This material obtained by cutaneous biopsy was submitted to culture on Sabouraud’s medium and the colonies were identified as Fusarium solani. The radiological studies revealed bone osteolytic lesions and the ultrasound showed pseudocysts and fistulae at the site of this infection. The patient was treated with oral ketoconazole with a good clinical response.

Aspectos dermatoscópicos na psoríase ungueal

The authors report on their experience with the use of dermoscopy in nail psoriasis and describe their findings with this diagnostic tool.

Dermatophytosis on the eyelid caused by Microsporum gypseum

We report a case of tinea on the eyelid in a woman with psoriasis. Due to the history of psoriasis and clinical aspect of the lesion the diagnosis of psoriasis was suggested in the first place; however, laboratory examination revealed Microsporum gypseum. The patient was treated with oral itraconazole resulting in clinical and mycological cure. We emphasize the uncommon location of tinea caused by M. gypseum and the importance of searching for fungal infection on scaly lesions.

A comparative study of teledermatoscopy and face-to-face examination of pigmented skin lesions

We examined the agreement between diagnoses of pigmented skin lesions based on an in-person (face-to-face) dermatological examination and diagnoses based on the study of medical records and images transferred through the web (teledermatoscopy). Two experienced dermatologists examined and diagnosed 64 pigmented skin lesions, which had been surgically excised and undergone histopathology examination. Two years later, the same cases were studied and diagnosed once again by the same dermatologists via the web. There was 72% agreement between the in-person diagnoses and the biopsy results (the gold standard), and 66% agreement between the telediagnoses and the biopsy results. Telemedicine had high sensitivity (87%) and specificity (73%), although there were 4 false-negative diagnoses. A web-based dermatoscopic diagnostic service appears to be feasible and would meet the needs for access to specialized services in rural areas. However, further work is required to decrease the number of false negative cases.

Dermoscopy of Bowen's disease: pigmented variant on the penis

Abstract: Pigmented Bowens disease (PBD) is a variant of squamous cell carcinoma in situ and repre-sents less than 2% of cases of Bowens disease. It is characterized by a sharply demarcated, pigmentedplaque with a scaly or crusted surface on intertriginous and genital areas. The authors describe a case ofPBD on the penis and analyze the dermoscopic aspects of this type of lesion.Keywords: Bowens disease; Carcinoma, squamous cell; Dermoscopy; Neoplasms, squamous cell Resumo: A doenca de Bowen Pigmentada (DBP) e uma variante do carcinoma espinocelular in situ ecompreende menos de 2% dos casos da Doenca de Bowen. Apresenta-se como placa pigmentada, hiper-queratosica, delimitada, localizada em areas intertriginosas e anogenital. Os autores descrevem um casode DBP no penis e abordam os aspectos dermatoscopicos dessa lesao. Palavras-chave: Carcinoma de celulas escamosas; Dermoscopia; Doenca de Bowen; Neoplasias de celulas escamosas Received on 20.07.2011.Approved by the Advisory Board and accepted for publication on 16.11.2011. * Work conducted at the Department of Dermatology at Escola Paulista de Medicina – Federal University of Sao Paulo (EPM-UNIFESP) – Sao Paulo (SP), Brazil.Conflict of interest: None Financial funding: NonePigmented Bowens disease (PBD) is a variant of squamous cell carcinoma in situ and represents less than 2% of cases of Bowens disease. It is characterized by a sharply demarcated, pigmented plaque with a scaly or crusted surface on intertriginous and genital areas. The authors describe a case of PBD on the penis and analyze the dermoscopic aspects of this type of lesion.