RESUMO

Some melanocytic lesions do not present enough clinical and dermoscopic features to allow ruling out a possible melanoma diagnosis. These "doubtful melanocytic lesions" pose a very common and challenging scenario in clinical practice and were selected at this study for reflectance confocal microscopy evaluation and subsequent surgical excision for histopathological diagnosis. The study included 110 lesions and three confocal features were statistically able to distinguish benign melanocytic lesions from melanomas: "peripheral hotspot at dermo-epidermal junction", "nucleated roundish cells at the dermo-epidermal junction" and "sheet of cells". The finding of a peripheral hotspot (atypical cells in 1mm2) at the DEJ is highlighted because has not been previously reported in the literature as a confocal feature related to melanomas.

Assuntos

RESUMO

RESUMEN El objetivo de este reporte de caso fue identificar las características de un nevo abultado conjuntival en una paciente femenina de 72 años de edad. Se muestran las pruebas complementarias realizadas para llegar al diagnóstico de melanoma conjuntival, que consiste en un tumor poco frecuente, el cual constituye el 2 por ciento de todos los tumores del ojo. Las células involucradas son los melanocitos del epitelio conjuntival. Un factor de riesgo para esta entidad puede ser la exposición a la luz ultravioleta; sin embargo, esto no está bien determinado. La mayoría de los casos se originan de una melanosis adquirida primaria (50-70 por ciento). La presentación más común es una lesión pigmentada, unilateral, elevada, gruesa, con vasos sanguíneos y áreas de melanosis a su alrededor. Su diagnóstico se realiza con la sospecha clínica que se confirma con el estudio histopatológico. El tratamiento en la actualidad es la excisión local, seguida de crioterapia, radioterapia o quimioterapia. La enfermedad matastásica ocurre en el 11 - 42 por ciento y en el 20 - 52 por ciento de los pacientes en un seguimiento de 5 y 10 años, respectivamente(AU)

ABSTRACT The objective of this case report is to describe the characteristics of a conjunctival bulging nevus in a 72-year-old female patient and the complementary tests that were performed to reach the diagnosis of conjunctival melanoma. Conjunctival melanoma is a rare tumor, which account for 2 percent of all eye tumors. The cells involved are the melanocytes of the conjunctival epithelium. A risk factor for this entity may be exposure to ultraviolet light. However, it has not been precisely described. Most cases originate from a primary acquired melanosis (50-70 percent). The most common presentation is a pigmented, unilateral, elevated, thick, lesion with blood vessels and areas of melanosis around it. Its diagnosis is made with the clinical suspicion confirmed with the histopathological study. Current treatment is local excision, followed by cryotherapy, radiotherapy, or chemotherapy. Metastatic disease occurs in 11-42 percent and 20-52 percent of patients in a 5-year and 10-year follow-up, respectively(AU)

Assuntos

Assuntos

RESUMO

Abstract: Dermoscopic examination allows visualization of horizontal images on the skin, showing well-defined patterns. The authors propose ex vivo dermoscopic visualization using a vertical view of skin sections. The new image clearly distinguishes the stratum corneum, epidermis, and dermis as well as the anatomical location of the pigment. Will this new approach be useful in dermoscopic diagnosis? Further studies are needed.

Assuntos

RESUMO

Dermoscopic examination allows visualization of horizontal images on the skin, showing well-defined patterns. The authors propose ex vivo dermoscopic visualization using a vertical view of skin sections. The new image clearly distinguishes the stratum corneum, epidermis, and dermis as well as the anatomical location of the pigment. Will this new approach be useful in dermoscopic diagnosis? Further studies are needed.

Assuntos

RESUMO

PURPOSE:: To compare measurements of lesions clinically diagnosed as choroidal nevi using spectral domain optical coherence tomography (SD-OCT) and 10- and 20-MHz ultrasound (US). METHODS:: This prospective study, which was conducted between May 2011 and December 2011, evaluated eyes diagnosed with choroidal nevus via photographic documentation using 10- or 20-MHz A- and B-mode US (experienced examiner using both the transpalpebral technique and direct contact) or SD-OCT in the enhanced depth imaging mode (performed by a different examiner blinded to the US results). Anteroposterior (AP) and transverse (T) US sections corresponded to sections adjusted perpendicularly on SD-OCT. RESULTS:: We evaluated 14 eyes from 12 patients (six males, mean patient age= 64.5 years) diagnosed with choroidal nevus. The choroidal nevi of all samples had a melanocytic profile. Moreover, eight nevi were located at the equator, five nevi were located in the posterior pole (peripapillary in one sample), and one nevus shifted from the equator to the periphery. On SD-OCT, the maximum measurable dimension was 9 mm. The lesions in the posterior pole were easier to evaluate, and image acquisition of lesions located more peripherally was possible depending on patient cooperation. The accurate assessment of height was difficult. Baseline dimensions on 10- and 20-MHz US were larger than those determined via OCT. No significant differences in height were observed between US and SD-OCT. All parameters were statistically similar between 10- and 20-MHz US measurements. CONCLUSIONS:: No significant difference in the AP and T diameters was observed between 10- and 20-MHz US measurements; however, these measurements (AP and T) were significantly higher than those obtained using OCT. No significant differences in height were observed among the techniques adopted.

Assuntos

RESUMO

ABSTRACT Purpose: To compare measurements of lesions clinically diagnosed as choroidal nevi using spectral domain optical coherence tomography (SD-OCT) and 10- and 20-MHz ultrasound (US). Methods: This prospective study, which was conducted between May 2011 and December 2011, evaluated eyes diagnosed with choroidal nevus via photographic documentation using 10- or 20-MHz A- and B-mode US (experienced examiner using both the transpalpebral technique and direct contact) or SD-OCT in the enhanced depth imaging mode (performed by a different examiner blinded to the US results). Anteroposterior (AP) and transverse (T) US sections corresponded to sections adjusted perpendicularly on SD-OCT. Results: We evaluated 14 eyes from 12 patients (six males, mean patient age= 64.5 years) diagnosed with choroidal nevus. The choroidal nevi of all samples had a melanocytic profile. Moreover, eight nevi were located at the equator, five nevi were located in the posterior pole (peripapillary in one sample), and one nevus shifted from the equator to the periphery. On SD-OCT, the maximum measurable dimension was 9 mm. The lesions in the posterior pole were easier to evaluate, and image acquisition of lesions located more peripherally was possible depending on patient cooperation. The accurate assessment of height was difficult. Baseline dimensions on 10- and 20-MHz US were larger than those determined via OCT. No significant differences in height were observed between US and SD-OCT. All parameters were statistically similar between 10- and 20-MHz US measurements. Conclusions: No significant difference in the AP and T diameters was observed between 10- and 20-MHz US measurements; however, these measurements (AP and T) were significantly higher than those obtained using OCT. No significant differences in height were observed among the techniques adopted.

RESUMO Objetivo: Comparar as medidas obtidas de lesões diagnosticadas clinicamente como nevus de coroide através da tomografia de coerência óptica de domínio espectral (Spectralis, Heidelberg Engineering, Inc.), ultrassonografia com 10 MHz e de 20 MHz. Métodos: Estudo prospectivo realizado entre maio e dezembro de 2011, avaliou olhos com diagnóstico de nevus de coroide, utilizando documentação fotográfica, ultrassonografia com transdutor 10-MHz e 20-MHz A- e B-mode e SD-OCT em modo de EDI, por um examinador diferente para cada técnica. Os cortes realizados perpendiculares entre si, correspondentes ao corte ântero-posterior e latero-lateral à ultrassonografia. Resultados: Foram avaliados 14 olhos de 12 pacientes (6 do sexo masculino), com média de idade média de 64,5 anos. Todos os nevus tinham um perfil melanocítico. Observou-se 8 nevus no equador, 5 no polo posterior (peripapilar em uma amostra), e 1 deslocado a partir do equador para a periferia. Em SD-OCT, a dimensão máxima mensurável foi de 9 mm. As lesões no polo posterior eram mais fáceis de avaliar e aquisição de imagens de lesões mais periféricas era possível, dependendo da colaboração do paciente. A avaliação precisa da altura era difícil. As dimensões usando transdutor 10-MHz e 20-MHz US foram maiores que as encontradas pelo SD-OCT. Não foram observadas diferenças significativas na altura entre métodos SD-OCT e US. Todas as medidas foram estatisticamente semelhantes entre 20-MHz e 10-MHz. Conclusão: Para o parâmetro AP e T não foi detectada diferença entre as medidas utilizando US de 10-MHz e de 20-MHz. Porém estas medidas se mostraram significativamente maiores em relação à medida obtida com OCT. Para a altura, não foram detectadas diferenças estatística em relação à técnica utilizada, US 10-MHz e 20-MHz e SD-OCT.

Assuntos

RESUMO

The knowledge of histopathology and in vivo reflectance confocal microscopy correlation has several potential applications. Reflectance confocal microscopy can be performed in all skin tumors, and in this article, the most common histopathologic features of confocal microscopic findings in melanocytic skin tumors and nonmelanocytic skin tumors are described.

Assuntos