RESUMO
Trichoepitheliomas are uncommon benign adnexal neoplasms that originate from the hair follicles. Multiple familial trichoepithelioma constitute an autosomal dominant disease characterized by the appearance of multiple flesh-colored, symmetrical papules, tumors and/or nodules in the central face and occasionally on the scalp. Although clinical diagnosis is usually straightforward in light of the family history and naked-eye examination, dermoscopy may aid in its confirmation. Dermoscopy of each papule revealed in-focus arborizing vessels, multiple milia-like cysts and rosettes amidst a whitish background. In a patient with multiple facial papules revealing a dermoscopic appearance described above, the diagnosis of sporadic or familial multiple trichoepithelioma should be considered.
RESUMO
IMPORTANCE: Basal cell carcinoma (BCC) is the most common type of skin cancer and is usually nonpigmented. Shiny white structures (SWSs) are frequently present in BCC. OBJECTIVE: To determine the diagnostic accuracy of various morphologies of SWSs for diagnosis of nonpigmented BCC. DESIGN, SETTING, AND PARTICIPANTS: Nonpigmented skin tumors, determined clinically and dermoscopically, were identified from a database of lesions consecutively biopsied over a 3-year period (January 2, 2009, to December 31, 2012) from a single dermatology practice. Data analysis was conducted from October 9, 2014, to November 15, 2015. Investigators blinded to histopathologic diagnosis evaluated the polarized dermoscopic images for the presence of SWSs, which were categorized as blotches, strands, short white lines, and rosettes. Measures of diagnostic accuracy for BCC were estimated. Participants included 2375 patients from a dermatologic clinic in Plantation, Florida. Review of the medical records identified 2891 biopsied skin lesions; 457 of these were nonpigmented neoplasms. MAIN OUTCOMES AND MEASURES: Diagnosis of BCC with dermoscopy compared with all other diagnoses combined was the primary outcome; the secondary outcome was diagnosis of BCC compared with amelanotic melanoma. We calculated diagnostic accuracy measured as odds ratios (ORs), sensitivity, and specificity of shiny white blotches and/or strands for the diagnosis of BCC. RESULTS: Of the 457 nonpigmented neoplasms evaluated, 287 (62.8%) were BCCs, 106 (23.2%) were squamous cell carcinoma, 39 (8.5%) were lichen planus-like keratosis, 21 (4.6%) were melanomas, and 4 (0.9%) were nevi. The prevalence of SWSs was 49.0% (n = 224). In multivariate analysis (reported as OR [95% CI]) controlling for age, sex, and anatomical location, the presence of any SWS was associated with a diagnosis of BCC (2.3 [1.5-3.6]; P < .001). Blotches (6.3 [3.6-10.9]; P < .001), strands (4.9 [2.9-8.4]; P < .001), and blotches and strands together (6.1 [3.3-11.3]; P < .001) were positively associated with BCC. Shiny white blotches and strands together had a diagnostic sensitivity of 30% and specificity of 91%. CONCLUSIONS AND RELEVANCE: The combined presence of shiny white blotches and strands is associated with high diagnostic specificity for nonpigmented BCC.
Assuntos
Carcinoma Basocelular/diagnóstico , Dermoscopia/métodos , Dermatopatias/diagnóstico , Neoplasias Cutâneas/diagnóstico , Idoso , Biópsia , Carcinoma Basocelular/patologia , Feminino , Florida , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Sensibilidade e Especificidade , Dermatopatias/patologia , Neoplasias Cutâneas/patologiaAssuntos
Dermoscopia , Granuloma Anular/patologia , Dermatopatias/patologia , Idoso , Diagnóstico Diferencial , Feminino , HumanosRESUMO
Dermatophytoses are common skin infections. Traditional diagnostic tests such as skin scrapings for light microscopy examination, fungal cultures and biopsies remain imperfect due to false-negative test results, cost, time required to perform the procedure, time delays in test results and/or a requirement for an invasive procedure. Herein, we present a case of an 80-year-old female whose tinea incognito was non-invasively diagnosed within seconds using handheld reflectance confocal microscopy (RCM). As non-invasive skin imaging continues to improve, we expect light-based office microscopy to be replaced with technologies such as RCM, which has multiple and continually expanding diagnostic applications.