Zoe Apalla

Accuracy of dermoscopic criteria for discriminating superficial from other subtypes of basal cell carcinoma

BACKGROUND The management of basal cell carcinoma (BCC) depends, among other factors, on its histopathologic subtype. Although dermoscopic criteria of BCC have been investigated, the possible role of dermoscopy in predicting the tumor subtype remains unclear. OBJECTIVES We sought to assess the diagnostic accuracy of dermoscopic criteria for differentiating superficial BCC (sBCC) from other BCC subtypes. METHODS Dermoscopic images of histopathologically confirmed BCCs were retrospectively evaluated for the presence of predefined criteria. Univariate and adjusted odds ratios were calculated. Discriminant functions were used to plot receiver operating characteristic curves. RESULTS In all, 77 sBCCs and 258 non-sBCCs were included. Maple leaf-like areas, short fine superficial telangiectasia, multiple small erosions, and shiny white-red structureless areas were potent predictors of sBCC, each making its diagnosis over 5-fold more likely. Conversely, the presence of arborizing vessels, blue-gray ovoid nests, and ulceration gave 11-fold, 15-fold, and 3-fold increased possibility for the diagnosis of non-sBCCs, respectively. Based on the results of the multivariate analysis, we propose a diagnostic algorithm that can predict the diagnosis of sBCC with a sensitivity of 81.9% and a specificity of 81.8%. LIMITATIONS The retrospective design and the inclusion of only Caucasian patients are limitations. CONCLUSION Dermoscopy is reliable in differentiating sBCC from other BCC subtypes.

Botulinum toxin A in postherpetic neuralgia: a parallel, randomized, double-blind, single-dose, placebo-controlled trial.

Objectives:Cumulative evidence support a beneficial effect of botulinum toxin A (BTX-A) in postherpetic neuralgia (PHN). We aimed to assess efficacy, safety, and tolerability of BTX-A in the management of PHN, performing a randomized, double-blind, single-dose, placebo-controlled trial. Methods:Thirty adults with PHN were randomized either to BTX-A or placebo. Severity of pain was evaluated by patients using a visual analogue scale (VAS) and quality of sleep was assessed using a 5-item questionnaire. Primary outcome was reduction in VAS score, with a greater than 50% reduction being considered clinically significant. Secondary outcomes were reduction in sleep score and maintenance of VAS score after treatment, with over 50% maintenance considered clinically meaningful. Results:Thirteen patients from the experimental arm achieved an at least 50% reduction in VAS score, compared with none of the placebo patients (NNT=1.2, 95% CI, 2-1; ARR=0.87, 95% CI, 055-096; P<0.001). BTX-A patients showed significant reduction in VAS pain scores between baseline and week 2, which persisted for a median period of 16 weeks. BTX-A patients showed significant reduction in sleep scores between baseline and week 2, which remained unchanged until 16th week (P<0.001). Treatment was well tolerated. Discussion:Data confirm that BTX-A is effective and well tolerated in the treatment of PHN.

The dermatoscopic universe of basal cell carcinoma

Following the first descriptions of the dermatoscopic pattern of basal cell carcinoma (BCC) that go back to the very early years of dermatoscopy, the list of dermatoscopic criteria associated with BCC has been several times updated and renewed. Up to date, dermatoscopy has been shown to enhance BCC detection, by facilitating its discrimination from other skin tumors and inflammatory skin diseases. Furthermore, upcoming evidence suggests that the method is also useful for the management of the tumor, since it provides valuable information about the histopathologic subtype, the presence of clinically undetectable pigmentation, the expansion of the tumor beyond clinically visible margins and the response to non-ablative treatments. In the current article, we provide a summary of the traditional and latest knowledge on the value of dermatoscopy for the diagnosis and management of BCC.

Dermoscopy in General Dermatology

In addition to its traditional use for the evaluation of skin tumors, dermoscopy continuously gains appreciation in other fields of dermatology. The patterns of several inflammatory and infectious skin diseases have already been described, and dermoscopy has been shown to improve the clinical diagnostic performance in the daily practice. The increasing use of dermoscopy was significantly enhanced by the development of the new generation hand-held dermatoscopes that can be easily placed in every dermatologists pocket and do not require the use of immersion fluid. In this article, we provide an up-to-date summary of data on dermoscopy in general dermatology.

Skin Cancer: Epidemiology, Disease Burden, Pathophysiology, Diagnosis, and Therapeutic Approaches.

Skin cancer, including both melanoma and non-melanoma, is the most common type of malignancy in the Caucasian population. Firstly, we review the evidence for the observed increase in the incidence of skin cancer over recent decades, and investigate whether this is a true increase or an artefact of greater screening and over-diagnosis. Prevention strategies are also discussed. Secondly, we discuss the complexities and challenges encountered when diagnosing and developing treatment strategies for skin cancer. Key case studies are presented that highlight the practic challenges of choosing the most appropriate treatment for patients with skin cancer. Thirdly, we consider the potential risks and benefits of increased sun exposure. However, this is discussed in terms of the possibility that the avoidance of sun exposure in order to reduce the risk of skin cancer may be less important than the reduction in all-cause mortality as a result of the potential benefits of increased exposure to the sun. Finally, we consider common questions on human papillomavirus infection.

Severe Post-herpetic Neuralgia Successfully Treated with Botulinum Toxin A: Three Case Reports

Herpes zoster is a disease that can significantly impair quality of life for affected individuals. Anyone infected with varicella (chickenpox) virus in childhood is at risk for reactivation of dormant virus and the onset of zoster disease, although it occurs with increasing frequency in the elderly as a result of waning of cell-mediated immu-nity. The most common complication of herpes zoster is post-herpetic neuralgia (PHN), which can cause chronic and debilitating pain (1). In some patients, pain persists for weeks or even years after regression of the rash. We report here three cases of PHN, which were relieved by botulinum toxin type A (BTX-A). PATIeNTs ANd meTHods

Epidemiological trends in skin cancer.

Skin cancer, including melanoma and non-melanoma skin cancer (NMSC), represents the most common type of malignancy in the white population. The incidence rate of melanoma is increasing worldwide, while the associated mortality remains stable, or is slightly decreasing. On the other hand, the incidence for NMSC varies widely, with the highest rates reported in Australia. In the current review, we highlight recent global trends in epidemiology of skin cancer. We discuss controversial issues raised in current epidemiological data, we analyze the most important risk factors associated with the development of melanoma and NMSC and the impact of skin cancer on health care services. Furthermore, we underline the pressing need for improved registration policies, especially for NMSC, and lastly, we refer to the ongoing primary and secondary prevention strategies and their outcomes so far.

Efficacy of adalimumab in recalcitrant hidradenitis suppurativa

Auteur(s) : Elena Sotiriou, Zoe Apalla, Eustratios Vakirlis, Demetrios Ioannides First Dermatologic Department, Medical School, Aristotle University Thessaloniki, 8, Papakyriazi str, 54645 Thessaloniki, Greece Hidradenitis suppurativa (HS) is a recurrent, chronic inflammatory disease, localized in apocrine gland-bearing areas of the body [1]. Treating HS is challenging as common therapeutic approaches do not achieve complete remissions, or lead to relapses after their discontinuation [1]. Based [...]

Management rules to detect melanoma.

Most melanomas are easy to be diagnosed clinically and dermoscopically. The question remains open concerning the correct strategies to detect those melanomas that look morphologically inconspicuous from a clinical and/or dermoscopic point of view. In our estimation, when morphology is not enough to recognize melanoma, one has to use specific management strategies. Herein we summarize the following 7 simple and practical rules that outline the need for a more general approach integrating clinical information with dermoscopic examination: (1) Look basically at all lesions. (2) Undress high-risk patients. (3) Use the 10 seconds rule in single lesions. (4) Compare and monitor multiple moles. (5) Excise doubtful nodular lesions. (6) Combine clinical and dermoscopic criteria. (7) Combine clinical and histopathologic criteria.

Dermoscopic pattern of psoriatic lesions on specific body sites

Background: Scarce evidence exists on the dermoscopic pattern of psoriasis on specific body sites. Objective: To describe the dermoscopic characteristics of psoriatic plaques located on the scalp, face, folds, palms, soles and genitalia. Methods: Dermoscopic images of psoriatic lesions located on the aforementioned body sites were retrospectively evaluated for the presence of predefined criteria. Results: A total of 139 lesions from 85 patients were included in the study. Dotted vessels were the commonest dermoscopic criterion (97.1%) followed by white scales (64.7%), while vessel distribution was regular in 87.7% of cases. Regularly distributed dotted vessels represented a constant finding in all locations, while the frequency of white scales varied significantly among different body sites. Conclusion: The well-known dermoscopic criteria of psoriasis can also be seen in lesions located on the scalp, face, palms, soles, folds and genitalia, with the frequency of white scales varying among different body sites.