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BACKGROUND: Actinic keratosis (AK) incidence is increasing. Due to the risk of progression to squamous cell carcinoma, early detection and treatment are essential. The method stated in the European Consensus is cryotherapy, but there is no standard protocol defined for better results. OBJECTIVES: To compare two different cryotherapy protocols for AK using reflectance confocal microscopy (RCM) as a noninvasive imaging method for evaluation. METHODS: A self-controlled clinical trial was proposed to compare the efficacy of cryotherapy in two different application protocols. Grade II AKs in the forearms were submitted to freezing and thawing time of 10 seconds for 1 cycle (group A) or 2 cycles (group B). At baseline and 4 weeks after treatment, the same dermatologists assessed RCM evaluation (thickness of horny layer, parakeratosis, dyskeratosis, atypia in spinous layer, fibrosis, and presence of inflammatory cells in epidermis and dermis). RESULTS: We examined 24 AK lesions in each group. Statistical evaluation of the results evidenced superior response after 2 cycles of cryotherapy in parakeratosis and number of inflammatory cells in epidermis. CONCLUSION: Both protocols are effective in clearing clinical AK. Two cycles are not generating more side effects (fibrosis) and could reduce the risk of recurrence (better "clearance" of parakeratosis).
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Crioterapia/métodos , Ceratose Actínica , Carcinoma de Células Escamosas/prevenção & controle , Humanos , Ceratose Actínica/diagnóstico por imagem , Ceratose Actínica/terapia , Microscopia Confocal , Recidiva Local de Neoplasia , Neoplasias Cutâneas/prevenção & controleRESUMO
Diagnosticar carcinomas basocelulares por meio da clínica e dermatoscopia faz parte da rotina diária da maioria dos dermatologistas. No entanto, tumores dessa linhagem, quando densamente pigmentados, podem representar um desafio para o médico e cirurgião. Características dermatoscópicas típicas de lesões melanocíticas podem estar presentes nestes carcinomas e a similaridade com o melanoma resultar num verdadeiro dilema. Conhecimentos mais aprofundados sobre este tema podem fazer diferença no manejo destes casos.
Diagnosing basal cell carcinomas, both clinically and dermoscopically, is part of most dermatologists' daily routine. However, tumors of this lineage, when densely pigmented, can be a challenge for the physician and surgeon. Dermoscopic features typical of melanocytic lesions may be present in these carcinomas, and the similarity with melanoma results in a real dilemma. More in-depth knowledge on this topic can make a difference in the management of these cases
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BACKGROUND: Reflectance confocal microscopy (RCM) has been used for the evaluation of several inflammatory skin conditions, including skin discoid lupus erythematosus (DLE), and has been correlated with conventional histopathology (HP). However, RCM is not being widely used in trichology. Few reports and just preliminary data suggest the use of RCM as a complementary tool in alopecias. OBJECTIVES: To correlate the major RCM features of scalp DLE with trichoscopy and HP findings of biopsy specimens obtained from the same lesions. METHODS: This is an observational, analytical, and cross-sectional study involving 12 patients with a clinically established diagnosis of scalp DLE. Patients underwent global clinical photograph, trichoscopy, and RCM examination in the same site followed by two 4-mm punch biopsy specimens for HP analysis. Inter-methods agreement among RCM imaging, trichoscopy, and horizontal histopathology sections (HHS) were calculated using Cohen Kappa (k) statistics. RESULTS: Statistical analysis of the agreement between RCM and HP features disclosed an overall agreement similar to skin DLE. Seven of the eleven features evaluated had agreement superior to 75%. We also evaluated RCM features associated with three of their corresponding trichoscopic findings for further investigation of their agreement with HP. Statistical analysis showed an enhancement with agreement of 86% when the non-invasive techniques are used together. CONCLUSION: Consistent correlation between RCM and HP observed in our study supports the reliability of RCM in the diagnosis of scalp DLE. RCM may be considered a promising tool for scalp DLE microscopic evaluation and presents similar RCM features to DLE in other body sites. By associating clinical, trichoscopic and RCM evaluation, dermatologists will have a non-invasive arsenal for the assessment of hair and scalp disorders, benefiting patients.
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Lúpus Eritematoso Discoide , Microscopia Confocal , Couro Cabeludo , Estudos Transversais , Humanos , Lúpus Eritematoso Discoide/diagnóstico por imagem , Reprodutibilidade dos Testes , Couro Cabeludo/diagnóstico por imagemRESUMO
Myiasis is a common travel-associated dermatosis. We describe a 52-year-old Italian man who acquired Dermatobia hominis when bitten by a mosquito during a visit to Argentina. He had a painful nodular lesion on the left cheek that had been present for about 3 weeks. The complete removal of the larva is the goal of medical treatment. Prescription of antibiotics to avoid secondary infections is not recommended. For psychological reasons and due to the failure of previous therapies, the lesion was excised. Travelers to endemic areas should be informed of preventive measures to reduce mosquito bites and transmission of the infestation.
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Miíase/diagnóstico , Dermatopatias Parasitárias/diagnóstico , Pele/patologia , Viagem , Animais , Argentina/etnologia , Biópsia , Dípteros , Humanos , Itália/epidemiologia , Larva , Masculino , Pessoa de Meia-Idade , Miíase/etnologia , Miíase/parasitologia , Pele/parasitologia , Dermatopatias Parasitárias/etnologia , Dermatopatias Parasitárias/parasitologiaRESUMO
Although uncommonly diagnosed, clear cell acanthoma represents an original source of speculative interest for dermatologists. Due to its clinical variability, it is often only recognized accidentally after histology. Dermoscopy has improved the reliability of clinical diagnosis of typical clear cell acanthoma thanks to the vascular pinpoint pattern and desquamative, peripheral collarette. Generally, therapy of clear cell acanthoma is oriented towards ablative solutions, such as surgery or cryotherapy. We propose a conservative therapy, based on the application of topical calcipotriol, which has produced complete regression after 2 months and no relapse one year after the end of treatment. A dermatoscope monitored all changes of clear cell acanthoma, showing its utility not only in diagnosis but also in therapeutic follow-up. This new therapeutic approach should support an inflammatory etiology of clear cell acanthoma, although further observations are needed to confirm this.
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Acantoma/tratamento farmacológico , Calcitriol/análogos & derivados , Fármacos Dermatológicos/uso terapêutico , Neoplasias Cutâneas/tratamento farmacológico , Administração Cutânea , Idoso , Antineoplásicos/uso terapêutico , Calcitriol/uso terapêutico , Dermoscopia , Humanos , Masculino , Fatores de Tempo , Resultado do TratamentoRESUMO
Although uncommonly diagnosed, clear cell acanthoma represents an original source of speculative interest for dermatologists. Due to its clinical variability, it is often only recognized accidentally after histology. Dermoscopy has improved the reliability of clinical diagnosis of typical clear cell acanthoma thanks to the vascular pinpoint pattern and desquamative, peripheral collarette. Generally, therapy of clear cell acanthoma is oriented towards ablative solutions, such as surgery or cryotherapy. We propose a conservative therapy, based on the application of topical calcipotriol, which has produced complete regression after 2 months and no relapse one year after the end of treatment. A dermatoscope monitored all changes of clear cell acanthoma, showing its utility not only in diagnosis but also in therapeutic follow-up. This new therapeutic approach should support an inflammatory etiology of clear cell acanthoma, although further observations are needed to confirm this.
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Idoso , Humanos , Masculino , Acantoma/tratamento farmacológico , Calcitriol/análogos & derivados , Fármacos Dermatológicos/uso terapêutico , Neoplasias Cutâneas/tratamento farmacológico , Administração Cutânea , Antineoplásicos/uso terapêutico , Calcitriol/uso terapêutico , Dermoscopia , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Pigmented actinic keratosis (PAK) is a frequent simulator of lentigo maligna (LM) on the face upon clinical and dermoscopic examination, leading to misdiagnosis and unnecessary excisions. LM and PAK share dermoscopic features, making it difficult to have a confident diagnosis of PAK only with current dermoscopic knowledge. OBJECTIVE: We sought to evaluate sensitivity, specificity, and interobserver reproducibility of a novel dermoscopic feature, inner gray halo (IGH), and establish its histopathological and confocal correlations. METHODS: Dermoscopists blinded to histopathological diagnosis evaluated 58 PAK and 21 LM for the presence of IGH and dermoscopy parameters. Areas exhibiting IGH were marked and imaged with reflectance confocal microscopy before sampling for histopathologic correlation. Reflectance confocal microscopy and transverse histologic sectioning were performed in 14 of 79 cases. RESULTS: IGH was present in 53 of 58 (94.1%) PAK and in 5 of 21 (23.8%) LM in our series (sensitivity 91.4%; specificity 71.4%; positive predictive value 89.8%). Interobserver agreement was excellent (Kappa 0.846). Through transverse and perpendicular histologic sections, a dermoscopic-histologic-confocal correlation of IGH was established. LIMITATIONS: A larger test set is needed to further validate the use of IGH in the differential diagnosis of PAK and facial pigmented lesions. CONCLUSION: IGH is a novel dermoscopic parameter useful for the differentiation of PAK from LM on the face.
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Sarda Melanótica de Hutchinson/diagnóstico , Hiperpigmentação/diagnóstico , Ceratose Actínica/diagnóstico , Lesões Pré-Cancerosas/patologia , Neoplasias Cutâneas/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha , Brasil , Estudos de Coortes , Intervalos de Confiança , Dermoscopia/métodos , Diagnóstico Diferencial , Face , Feminino , Humanos , Sarda Melanótica de Hutchinson/patologia , Sarda Melanótica de Hutchinson/ultraestrutura , Hiperpigmentação/patologia , Imuno-Histoquímica , Ceratose Actínica/patologia , Masculino , Microscopia Confocal , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/ultraestruturaRESUMO
Histopathologic interpretation of dermoscopic and reflectance confocal microscopy (RCM) features of cutaneous melanoma was timidly carried out using perpendicular histologic sections, which does not mimic the same plane of the image achieved at both techniques (horizontal plane). The aim of this study was to describe the transverse histologic sections research technique and correlate main dermoscopic features characteristic of cutaneous melanoma (atypical network, irregular globules and pseudopods) with RCM and histopathology in perpendicular and transverse sections in order to offer a more precise interpretation of in vivo detectable features. Four melanomas and 2 nevi with different dermoscopic clues have been studied. Lesion areas that showed characteristic dermoscopic features were imaged by dermoscopy and confocal microscopy and directly correlated with histopathology in perpendicular and transverse sections. We presented the possibility to perform transverse sections as a new approach to understand RCM features. Atypical network showed different aspects in the 2 melanomas: in one case it was characterized by pleomorphic malignant melanocytes with tendency to form aggregates, whereas in the other elongated dendritic cells crowded around dermal papillae, some of them forming bridges that resembled the mitochondrial aspect at confocal and histopathology transversal sections. Pigment globules in melanomas and nevi differed for the presence of large atypical cells in the former, and pseudopods showed up as elongated nests protruded toward the periphery of the lesion. Transverse histologic research sections have a consistent dermoscopic and confocal correlate, and it may represent an help in confocal feature interpretation and an advance in improving melanoma diagnosis and knowledge of the biology of melanocytic lesions.
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Interpretação de Imagem Assistida por Computador/métodos , Melanócitos/patologia , Microscopia Confocal/métodos , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologia , HumanosRESUMO
O carcinoma basocelular é o tumor cutâneo maligno mais comum. A microscopia confocal reflectante a laser é uma técnica não-invasiva que proporciona imagens horizontais in vivo do tecido com resolução próxima à histológica e em tempo real, através do emprego de um feixe de laser de 830nm. O presente estudo apresenta uma análise dos principais critérios morfológicos utilizados na diagnose do carcinoma basocelular através da microscopia confocal reflectante a laser
Basal cell carcinoma is the most common malignant skin tumor. Reflectance confocal microscopy is a non-invasive technique that provides real-time, in vivo, horizontal tissue images, at a quasi-histological resolution, by employing a low-power laser beam of 830 nm. In this paper, we review the major morphological criteria for diagnosing this tumor using reflectance skin confocal microscopy.
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Paciente femenino de 55 años, quien presentaba lesión papulo-nodular localizada en tórax posterior, de aproximadamente 0,8 centímetros de diámetro, de meses de evolución; la lesión era muy oscura y de consistencia dura, recordando clínicamente a un melanoma maligno (Foto 1). Al examen con dermatoscopio, la lesión se caracterizaba por áreas ovoides azuladas. Además, en la periferia se observaron estructuras marrón-azuladas con digitaciones periféricas compatibles con estructuras en hojas de arce. Se observó ulceración central, no se observaron estructuras vasculares.(Foto 2)