Tamara Micantonio

Dermoscopic features of actinic keratosis

Actinic keratosis (AK) is a keratinocytic neoplasm that typically develops on sun‐damaged skin of elderly individuals. Only a few reports so far have described the dermoscopic diagnostic features of AK, mainly focusing on facial non‐pigmented AKs. A typical feature of facial non‐pigmented AK is a composite pattern named “strawberry pattern”, characterized by a background erythema/red pseudonetwork consisting of unfocused, large vessels located between the hair follicles, associated with prominent follicular openings surrounded by a white halo. Dermoscopic characteristics of pigmented AK on the face include multiple slate‐gray to dark‐brown dots and globules around the follicular ostia, annular‐granular pattern and brown to gray pseudonetwork. Recognizing specific dermoscopic features of AK can be useful in guiding the clinician in the differential diagnosis of AK with melanocytic skin lesions such as LM and non‐melanocytic lesions. Histopathologic examination should be performed whenever clinical and/or dermoscopic differential diagnosis is inconclusive.

The additive value of second opinion teleconsulting in the management of patients with challenging inflammatory, neoplastic skin diseases : a best practice model in dermatology?

Background  Telemedicine is the practice of healthcare using interactive processes of communication to facilitate healthcare delivery, including diagnosis, consultation and treatment, as well as education and transfer of medical data. The aim of teledermatology, just as telemedicine, is to promote best practice procedures and to improve the consistency and competence of health care.

Vascular patterns in basal cell carcinoma

Background  Dermoscopy has been proved to increase the diagnostic accuracy of basal cell carcinoma (BCC).

Dermoscopy in the diagnosis and management of non-melanoma skin cancers

Over the past two decades, dermoscopy has remarkably enhanced the diagnostic accuracy of pigmented skin lesions and, more recently, of non-pigmented skin disorders, including skin cancers, inflammatory and infectious diseases. With respect to non-melanoma skin cancers (NMSC), dermoscopy is an effective diagnostic tool for the clinical assessment of basal cell carcinoma, Bowens disease, actinic keratosis and squamous cell carcinoma. Besides its relevance for diagnostic purposes, further applications of dermoscopy in the management of NMSC have been suggested in the preoperative evaluation, in monitoring the outcome of topical, light-based or laser treatments and in the post-treatment follow-up. This article summarizes the dermoscopic diagnostic criteria of NMSC and provides a review of the published literature as well as of our own experience on the usefulness of dermoscopy in monitoring surgical and medical treatment of NMSC.

The spectrum of dermatoscopic patterns in blue nevi.

BACKGROUND Blue nevi are congenital or acquired, dermal dendritic melanocytic proliferations that can simulate melanocytic and nonmelanocytic lesions including melanoma, cutaneous metastasis of melanoma, Spitz/Reed nevi, and basal cell carcinoma. OBJECTIVE We sought to investigate global and local dermatoscopic patterns of blue nevi compared with melanomas and basal cell carcinomas. METHODS We retrospectively analyzed global and local features in 95 dermatoscopic images of blue nevi and in 190 melanomas and basal cell carcinomas that were selected as control lesions on the basis of similar pigmentation. Lesion pigmentation was classified as monochromatic, dichromatic, or multichromatic. RESULTS A global pattern characterized by homogeneous pigmentation was observed in all of 95 (100%) blue nevi. Eighty of 95 (84.2%) blue nevi presented a homogeneous pattern consisting of one color (blue, black, or brown) or two colors (blue-brown, blue-gray, or blue-black). Fifteen of 95 (15.8%) blue nevi had a multichromatic (blue, gray, black, brown, and/or red) pigmentation. In all, 47 of 95 (49.5%) blue nevi were characterized by pigmentation in the absence of pigment network or any other local dermatoscopic features. And 48 of 95 (50.5%) blue nevi showed local dermatoscopic patterns including whitish scarlike depigmentation, dots/globules, vascular pattern, streaks, and networklike pattern. LIMITATIONS The study was retrospective and involved only Caucasian people of Italian origin. CONCLUSION The characteristic feature of blue nevi is a homogeneous pigmentation that is blue, blue-gray, blue-brown, or blue-black. We showed that a wide spectrum of local dermatoscopic features (whitish scarlike depigmentation, dots/globules, peripheral streaks or vessels) may also be present. In such cases, clinical and dermatoscopic distinction from melanoma or nonmelanocytic lesions may be difficult or impossible, and surgical excision is necessary.

Giant Dermatofibroma Appearing During Pregnancy

Sir, Dermatofibroma (DF) is a common benign fibrohistiocytic neoplasm that usually occurs in mid-adult life and shows a slight female predominance. DF may represent a dermal response to a local injury such as an insect bite, rupture of a follicle or a follicular cyst and typically appears as a slow-growing, firm solitary papule, more rarely a plaque or nodule, preferentially located on the lower extremities. The colour varies from light brown to dark brown, red, purple or yellow, and the surface may be shiny or keratotic. DF is often asymptomatic, although pruritus and/or ulceration following trauma may be present. On palpation, the lesion is freely movable over deeper tissues, and lateral compression produces a dimple-like depression in the overlying skin. Several uncommon clinical variants of DF have been reported, including giant DF (1) and multiple DF (2). The prototypic dermoscopic pattern of DF is a central white scar-like patch surrounded by a delicate light brown pigment network in an annular distribution or by a diffuse light brown pigmentation (3). We report herein the case of a young woman with an unusual clinical and dermoscopic presentation of giant DF characterized by a rapid growth during pregnancy.

Dermoscopic variability of basal cell carcinoma according to clinical type and anatomic location

Correctly diagnosing basal cell carcinoma (BCC) clinical type is crucial for the therapeutic management. A systematic description of the variability of all reported BCC dermoscopic features according to clinical type and anatomic location is lacking.

Pigmented reticular structures in basal cell carcinoma and collision tumours

Background  The dermatoscopic diagnosis of basal cell carcinoma (BCC) is based on well‐known specific criteria. Despite the fact that a pigment network is considered a negative feature for the diagnosis of BCC, its detection in a BCC context has been reported in 2·8% of cases.

Dermoscopic features and follow-up changes of acral melanocytic naevi in childhood and adolescence

The dermoscopic features of acral acquired melanocytic naevi have been extensively reported in the adult population. Little knowledge is available on acral naevi in childhood and adolescence.

A new dermoscopic algorithm for the differential diagnosis of facial lentigo maligna and pigmented actinic keratosis

BackgroundThe clinical and dermoscopic diagnosis of facial lentigo maligna (LM) and pigmented actinic keratosis (PAK) remains challenging, particularly at the early disease stages.ObjectivesTo identify dermoscopic criteria that might be useful to differentiate LM from PAK, and to elaborate and validate an automated diagnostic algorithm for facial LM/PAK.Materials & MethodsWe performed a retrospective multicentre study to evaluate dermoscopic images of histologically-proven LM and PAK, and assess previously described dermoscopic criteria.ResultsIn the first part of the study, 61 cases of LM and 74 PAK were examined and a parsimonious algorithm was elaborated using stepwise discriminant analysis. The following eight dermoscopic criteria achieved the greatest discriminative power: (1) light brown colour; (2) a structureless zone, varying in colour from brown to brown/tan, to black; (3) in-focus, discontinuous brown lines; (4) incomplete brown or grey circles; (5) a structureless brown or black zone, obscuring the hair follicles; (6) a brown (tan), eccentric, structureless zone; (7) a blue structureless zone; and (8) scales. The newly developed algorithm was subsequently validated using an additional series of 110LMand 75 PAKcases. Diagnostic accuracy was 86.5% (k: 0.73, 95% CI: 0.63-0.83). For the diagnosis of LM vs PAK, sensitivity was 82.7% (95% CI: 75.7-89.8%), specificity was 92.0% (95% CI: 85.9-98.1%), positive predictive value was 93.8% (95% CI: 89.0-98.6%), and negative predictive value was 78.4% (95% CI: 68.4-86.5%).ConclusionsThis algorithm may represent an additional tool for clinicians to distinguish between facial LM and PAK.