Sergio Yamada

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.

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.

Nevus-Associated Melanomas Clinicopathologic Features

OBJECTIVES The clinical significance of nevus-associated melanoma compared with de novo melanomas remains controversial. It has been suggested that nevus-associated melanomas have a higher Breslow thickness and therefore worse prognosis. Over a 10-year period, this study evaluated the incidence of nevus-associated melanoma and its prognostic significance related to clinicopathologic features. METHODS Cross-sectional study from 1995 through 2004 in a dermatopathology referral center. With available data, we evaluated sex, primary location, histologic subtype, Breslow thickness, Clark level, presence of ulceration, associated lesion, and histologic subtype of the associated lesion. RESULTS Of 135,653 pathologic records from skin biopsy specimens over a 10-year period, 1,190 melanoma records were selected. Nevus-associated melanomas corresponded to 390 (32.8%) melanomas, with thin melanomas having a nevus 1.52 times the association observed with thick melanomas (>1.01 mm; 95% confidence interval, 1.16-1.99; P < .001). Superficial spreading melanoma was the most frequent, while no lentigo maligna melanoma was associated with nevi. The median Breslow thickness of nevus-associated melanomas was lower than that of de novo melanomas. CONCLUSIONS Nevus-associated melanomas, which represent one-third of the melanomas in southeast Brazil, are associated with intermittent sun exposure, superficial spreading melanomas, and lower Breslow thickness. This is one of the largest series describing nevus-associated melanomas in Latin America.

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.

Prevalence of precancerous skin lesions and non-melanoma skin cancer in Japanese-Brazilians in Bauru, São Paulo State, Brazil

Precancerous lesions and skin cancer are infrequent in Asians, and have received little documentation in the literature. Brazil has the worlds largest contingent of Japanese immigrants and their descendants, and 70% live in the State of São Paulo. The prevalence of such skin lesions in Japanese-Brazilians is unknown. This study aimed to assess the prevalence of actinic keratoses and non-melanoma skin cancer in first and second-generation Japanese-Brazilians over 30 years of age, without miscegenation, living in the city of Bauru, São Paulo State, in 2006. Of the 567 Japanese-Brazilians that underwent dermatological examination, actinic keratosis was diagnosed in 76, with a mean age of 68.9 years, and a single case of basal cell carcinoma was detected in a 39-year-old female patient. In Japan, prevalence of actinic keratosis varies from 0.76% to 5%, and the incidence of non-melanoma skin cancer is 1.2 to 5.4/100 thousand. Japanese-Brazilians from Bauru showed a 13.4% prevalence of actinic keratoses and earlier age at onset. Proximity to the Equator and a history of farming contribute to these higher rates. Presence of solar melanosis was associated with a 1.9-fold risk of developing actinic keratosis.

Síndrome do desconforto respiratório agudo comocomplicação de psoríase pustulosa generalizada

Since 1991, eight cases of pulmonary leak capilary syndrome have been described associated with pustular or erythrodermic psoriasis induced or not by the use of acitretin or sirolimus - being one of the cases, fatal. We report the case of a female patient with diagnosed GPP or von Zumbusch and multiple hospitalizations due to such condition. At that time, the condition was evolving with pulmonary onset and resolution with corticosteroids. The patient was not using any previously described medication that could precipitate pulmonary condition (methotrexate and acitretin). This is a rare complication associated with psoriasis which has not been described in Brazilian patients so far.

Evaluation of skin tolerability in patients on a 7-day regimen of a new matrix transdermal estradiol delivery system: an open-label study

Abstract The incidence and severity of local skin reactions, as well as the impact on the local bacteriologic profile, in a 7-day regimen of a matrix transdermal estradiol delivery system compared with placebo (a piece of adhesive tape for sensitive skin of approximately the same shape and area) were assessed in healthy postmenopausal Brazilian women in an open-label study. The matrix estradiol and placebo patches were applied to different sites of the abdominal area, worn for 7 consecutive days, and then replaced according to an established rotation schedule, until 5 weeks of treatment were completed. The rotation schedule was adopted to provide an assessment of skin reaction as related to (1) interval between two consecutive placements at the same application site; (2) number of repetitions; and (3) abdominal region (upper, middle, and lower). A skin reaction score was obtained at each site before the application of each patch, 30 minutes after patch removal, and 7 days after patch removal. Skin swabs were obtained for bacteriologic cultures immediately before patch application and immediately after patch removal. Twenty-seven women were enrolled and completed the study; 270 skin observations were made with the estradiol patch and 162 with placebo. Skin reactions 30 minutes after patch removal included erythema (23.7%), erythema with induration (4.1%), and erythema with induration and vesicles (1.1%). Seven days after patch removal, skin reactions had decreased to erythema (2.2%) and erythema with induration (0.4%); no erythema with induration and vesicles was seen. This reduction in incidence and severity was statistically significant. Thirty minutes after placebo removal, 2.5% of skin observations detected erythema; no erythema was observed 7 days later. No other severe reactions were observed, and no clinically significant alteration in skin flora was detected. The results of this study indicate an acceptable level of local skin responses to this 7-day estradiol patch application. In addition, 96.3% of patients rated the estradiol patch as good or very good in its acceptability.

Dermoscopic patterns of melanocytic nevi in children and adolescents: a cross-sectional study

Background Childhood is a dynamic period regarding nevogenesis. Dermoscopy is a noninvasive technique, recommended for the evaluation of pigmented cutaneous lesions. Objectives The purpose of this study was to describe the structures and dermoscopic patterns of melanocytic nevi observed in children and adolescents. Methods Dermoscopy with photographic documentation was used for nevi located on the face, trunk, and extremities of 38 patients aged from one to 16 years examined at the Pediatric Dermatology Outpatient Clinic of the Federal University of São Paulo. Results The study included 201 skin lesions that were diagnosed as nevi during clinic examination. Upon evaluation of the global dermoscopic pattern of the lesions, the most frequently observed nevi were reticular (39.0%), followed by homogeneous (23.9%) and globular nevi (16.4%). During evaluation of the dermoscopic structures, according to the body site, the pigment network was the most observed in the extremities. Study limitations A limitation to be considered is that the inclusion of small or new lesions may hinder the differentiation between dots and globules. Conclusions In our study, the most observed pattern was reticular. There was a difference in the predominance of structures dependent on the anatomical location.

Case report: dermoscopic and histological aspects of skin graft and perigraft hyperpigmentation in acral location

Little is known about the use of dermoscopy in skin grafting. We describe the case of a patient with skin grafting and surrounding pigmentation on acral region. The dermoscopic findings were similar to those of benign acral lesions (lattice-like pattern) and reactive pigmentations (fine striae). Histopathology revealed pigment leakage and increased number of melanocytes. It is believed that this phenomenon occured as the result of an inflammatory stimulus.