Basal cell carcinoma: dermoscopy vascular features of different subtypes

Background: Non pigmented eccrine poroma is a benign tumor that can have dermoscopic features mimicking malign neoplasias. The characteristic vascular pattern of this tumor hasn’t been established. We found a scarcely reported vascular pattern, which can be useful to distinguish this tumor from malignant ones and propose a new nomenclature to these vessels due their similarity with the common calla flower and cherry blossoms tree. Observations: We study 10 proven Mexican cases of eccrine poroma and nearly half of them presented irregular linear and branched vessels with semi-elliptical, circular or semicircular endings, we called them “chalice-form” and “cherry-blossoms” vessels. The structureless pink-white areas were the most common finding and some vascular patterns reported in other studies were barely found. Conclusions: Due to the variability in the dermoscopic patterns found in non pigmented eccrine poroma, further studies are required to establish the specificity of these vessels, however they hasn’t been reported in other benign or malign neoplasias so, if seen, they can be an useful key leading to the diagnostic of eccrine poroma. Basal cell carcinoma: dermoscopy vascular features of different subtypes John Pyne1, Devendra Sapkota1, Jian Cheng Wong2

::Tyr-Nras Q61K mice. We followed the development of lesions over time using digital photography and dermoscopy to correlate the clinical appearance with histopathologic features of melanocytic lesions developing in this model. We have identified essentially two types of lesions and studied their respective growth patterns. We developed a staging system, based on the level of extension in to the dermis, which offers a practical linkage between murine MM models and standard clinical diagnosis. We will discuss how we have used these methods to help us understand the development of melanomas in mice carrying other mutations (e.g., in the p53 and Arf genes) that result in a very different mode of tumour progression than we see in the original model. melanomas arising in patients attending a tertiary skin cancer clinic in the United Kingdom from 2005-2010 were reviewed.
We found that patients with synchronous melanomas may not show a predilection for any particular dermoscopic pattern. Therefore, unlike benign naevi, multiple primary melanomas do not 'breed true'; these 'ugly ducklings' need to be assessed, clinically and dermoscopically, on an individual basis. Results: In facial PSLs unclear dermoscopic lesions were registered by both evaluators significantly more often after DHA use than before (42 vs.12 %, p=0,021 and 69 vs.19 %, p=0.001). Furthermore, follicular pigmentation that partly mimics that of lentigo maligna was also seen significantly more often after DHA use than before (80 vs.12%, p<0.001 and 69 vs. 15%, p<0.001) and in these instances the evaluators recommended a biopsy. Unclear lesions in nevi on the body were not significantly increased after DHA use. Methods: An online survey was sent to 139 chief residents of US Dermatology Training Programs.

Usefulness of dermoscopy during laser or IPL treatments
Results: A 59% response rate was achieved. All residents accept the dysplastic nevus as a clinical entity, and all report access to a dermatoscope in clinic. 98% agree that dysplastic nevi mark persons at increased risk for melanoma, compared to 59% of AAD fellows in 2002. 94% of chief residents use dermoscopy to manage pigmented lesions, compared to 23% of AAD fellows in 2002. Although 92% of chief residents report receiving dermoscopy training, only 48% train with a pigmented lesion specialist. Among those training without a specialist, less than half receive classroom or bedside teaching compared to 77% of those who train with a specialist.
Of those who train with a specialist, 77% agree that dermos-copy can help differentiate melanoma from benign lesions, compared to 46.5% of those who train without a specialist (p=0.0067).

Conclusion:
Residents are receiving a more unified message regarding the biological significance of dysplastic nevi and nearly all use dermoscopy as a diagnostic tool. Additionally, specialists can provide dedicated instruction to trainees fostering greater confidence in the utility of dermoscopy for the management of pigmented lesions. Background: The aetiology of seborrheic keratoses (SK), the most common benign epithelial tumours, and any relationship with malignancy are not yet known. As a protective anti-cancer mechanism, apoptosis reflects cellular loss as a reaction to proliferative activity.
Objectives: The objective of this study was to quantify apoptosis in different SK types (acanthotic, hyperkeratotic, reticulated, irritated, and clonal) and correlate the dermoscopic picture with apoptosis rate.

Methods:
After a qualitative and quantitative analysis of dermoscopic images, we defined a new quantitative dermoscopic score (C3V2F, crypts, millia cysts, colours, hairpin vessels, irregular vessels, fissures) from 0 to 22, which enabled us to establish cut-offs correlating with apoptosis rates.
Results: All five SK forms were associated with lower apoptosis rates compared to normal skin. A C3V2F score >10 and greater number of crypts and colours reflected a higher apoptosis rate, which implies a benign character of evolution. In contrast, the presence of irregular vessels on more than 50% of the lesion surface implied a lower rate of apoptosis and probably associated with a risk of malignant transformation. Based on the dermoscopic information, we used multiple regression to establish a model for estimating the rate of apoptosis with a 0.7 prediction interval (approximately 1 standard deviation).

Conclusions:
The new C3V2F score could be valuable for the clinical evaluation of possible SK prognosis and decisions regarding excision.
Evaluating the first step of the dermatoscopic 2-step method in non-sun damaged and chronically sun damaged patients P. Tschandl 1 , C. Rosendahl  Usage of the diagnostic two-step method in teaching dermatoscopy is widely accepted and was approved in a con-sensus meeting in 2003. The differentiation of melanocytic and non-melanocytic lesions ("the first step") contains the risk of misclassification and can therefore lead to wrong diagnoses. This risk is inherent especially when applied by dermatoscopists at a beginning level, the most frequent users of published algorithms.
The present study aimed to evaluate the frequency of misclassifications according to the first step. We included 707 consecutive cases from 553 patients (mean age: 54.7 years, SD: ±18.1 years) with (n=331) and without (n=222) chronically sun-damaged skin. The cases were collected from a tertiary referral center at a University hospital in Europe and from a Primary Care Skin Cancer Clinic in Brisbane (Australia). Dermatoscopic images were evaluated in a blinded fashion for the presence of features described in the 2-step algorithm to determine their melanocytic or nonmelanocytic origin. Mucosal, genital and non-pigmented lesions were excluded. The sensitivity of the first step was 97.1% for patients with chronic sun-damage and 96.8% for patients without or moderate sun damaged skin. The specificity was 33.6% for patients with chronic sun-damage and 67.9% for patients without or moderate sun-damaged skin.
The most common reasons for misclassification were a pigmented network in 69 cases and an absence of any given features in 74 cases.

Mauricio Nascimento
Pigmented actinic keratoses play a difficult role in the differential diagnosis of lentigo maligna on the face. However some helpful hints as neighborhood sign, rough appearance, abrupt interruption of pigment pseudo network could help in such diagnosis. The authors present a visual set of lesions illustrating this concept. Results: Totally 668 young people were physically examined in this study (268 of which were women and 400 of which were men). The most common skin phototype in both sexes was type 3 (91.6% of women, 85.25% of men).
Conclusion: This is the first study about the characteristics of melanocytic nevi at this age group and lays the foundation for future studies that will elucidate the relationship between nevi, dermatoscopic pattern and the other factors in a population-based cohort. Discussion: In woman, breast cancer is the most common malignancy that metastasizes to the skin. Alopecia neoplastica is a rare asymptomatic manifestation of cutaneous metastases and it might present as single or multiple slightly erythematous round plaques of alopecia, usually with peripheral telangiectasias. The clinical picture may mimic several dermatoses and therefore the diagnosis might be delayed.

Dermoscopy of alopecia neoplastica
Dermoscopy might be an important diagnostic tool, mainly on the exclusion of other dermatoses with already described dermoscopy patterns such as alopecia areata, which presents for example short "exclamation mark" hairs and yellow dots, discoid lupus erythematous, that shows follicular plugs and red dots, and tinea capitis, which exhibits broken and comma hairs. In conclusion, alopecia neoplastica is an uncommon cutaneous disease. Although it lacks a characteristic dermoscopic pattern, dermoscopy might be helpful in  In conclusion, dermoscopy may be applied in differential diagnosis of inflammatory diseases of the face. The six dermoscopic patterns of CMMM were blue nevus-like, nevus-like globular and non-globular, angiomalike, vascular and unspecific. When CMMM were classified accordingly to these patterns, agreement between the investigators and the four dermatologists ranged from κ = 0.56 to 0.7. The interobserver agreement was good (> 80% for angioma-like, nevus-like and blue nevus-like patterns).   Teledermoscopy using handheld dermoscope coupled with smartphone compared to the histopathological report. Furthermore, the image quality was assessed. These same parameters were also provided by two experienced dermoscopists who independently reviewed the clinical and dermoscopic photographs together with relevant clinical information but without seeing the patient and without knowledge of the histopathological report. We will report on the diagnostic accuracy of the dermatologist meeting the patient face-to-face compared to histopathology, the diagnostic accuracy of the two teledermatologists, the interobserver agreement between the two teledermatologists and between the teledermatologists and the dermatologist meeting the patient face-to-face. We will also present the image quality of this innovative dermoscopic technology and discuss the potential of using this method for teledermoscopy between primary care physicians and dermatologists. Interobserver agreement between dermatologists and experts was a perfect agreement (first and second opinion) for melanoma K value > 0.89 (0,79-0,92), for melanocytic nevus K value > 0,92 (0,85-0,94), for seborrheic keratosis K value > 0,89 (0,75-0,92), for angioma K value > 0,93 (0,78-0,96), for dermatofibroma K value > 0,86 (0,49-0,94) and for basal cell carcinoma K value > 0,95 (0,84-0,98 ).

Teledermoscopy in
Between general practitioners and experts, moderate to perfect (0,60-0,92) agreement was obtained for most of the lesions. And at the end, between surgeons and experts, K value was substantial to perfect (0,67-0,83) for all lesions.
Conclusion: In our experience, this large teledermoscopy study provided data that teledermoscopy is more reliable concerning melanocytic lesions vs. non-melanocytic lesions.
Apart from its teaching potential, the use of teledermoscopy as a triage tool offers the potential to improve the healthcare access and delivery, both in general practice and on specialist level.

Method:
We evaluated the dermoscopies of 152 melanomas and 123 atypical nevi recommended for excision. The melanoma group was divided in four subgroups in accordance with the thickness of melanoma: in situ, under 1 mm, between 1-2 mm and more than 2 mm. We registered the following dermatoscopic structures: grey-blue areas with different patterns (globules, net with lines and holes, structureless, grey dots with peppering aspect), blue-whitish veil and white areas. We analyzed the frequency of every structure in each group of lesions.

Results:
We found that grey-blue areas are high suggestive for melanoma in all the four types of patterns: the reticular ones are most frequently encountered in thin melanomas and the structureless blue areas in thicker melanomas. The whitish-blue veil was most frequently found in the thicker melanomas. The blue areas were also found in dysplastic nevi but in a lower degree in comparison with melanomas.

Conclusions:
The grey-blue structures are relevant for melanoma in high degree, even for very thin melanomas. including LM, is increasing in diagnostic incidence but the dermatoscopic features of non-acral non-facial LGP melanomas are not yet described. Early recognition of LGP melanomas is important, as these tend to lack BRAF mutations that are a target of therapies for metastatic melanoma.

Method:
A 12-month case series of melanomas detected in a primary care skin cancer clinic was imaged clinically and dermatoscopically before biopsy. Dermatoscopic images were assessed for proposed clues to LGP melanoma, including: lentigo-like pigment patterns associated with a lack of lentigo-like border; atypical follicular pigmentation patterns; geometric/polygonal pigment patterns and grey structures.
The results of this were compared for statistical significance between groups of non-facial non-acral melanomas categorised by the following histologically reported growth patterns: LGP, mixed lentiginous and nested growth pattern, and superficial spreading melanoma (SSM).

Conclusion:
LGP melanomas may have a specific pattern of dermatoscopic features. Further multicentre study is required. We present the dermoscopic aspects of a patient with gastric adenocarcinoma and multiple skin nodules.

Dermoscopic features of clear-cell acanthoma
Case report: A 55-year-old man presented with a progressive generalized cutaneous eruption. Examination revealed asymptomatic small erythematous firm nodules.
Dermoscopy showed a polymorphous vascular pattern. One year prior to this event, this patient had been submitted to a partial gastrectomy due to a poorly differentiated, diffuse type, signet-ring cell gastric adenocarcinoma. Histologic and immunohistochemical studies of the lesions confirmed progression of the neoplasia to the skin. week 11 reserved for cases that get left behind for any reason) into The Teledermoscopy Network. Clinical diagnosis will be the one to be established first, with the dermoscopic image being made available for review and diagnosis after the clinical diagnosis has been made. Clinical diagnosis will not be made available for correction.

Results:
The study will show results of accordance amongst experts in relation to HP diagnosis, for every PSL type and not only the relation between dermoscopic vs. HP diagnosis, but also relation between clinical and HP diagnosis.

Discussion:
We believe that the right path for teledermoscopy is to be directed towards primary healthcare. In order for that path to be realised it is necessary for experts to provide background education and quick an efficient control, until the arrival of an automated process. The validity of this opinion will be pointed out by the expected results. Conclusions: SWS in the context of a melanocytic tumour is associated to malignancy, and to invasive melanoma, with a higher Breslow thickness and higher TDS. In some few cases the presence of SWS was seen in MM with TDS of benignity.

Use of dermoscopy as aid for the diagnosis of extramammary Paget disease (EMPD), and clinical assessment after brachytherapy
Extramammary Paget's disease (EMPD) is a rare, usually non-invasive intraepithelial adenocarcinoma, preferentially localized on genitals in postmenopausal women in their sixth-seventh decade of life. EMPD may or may not be associated with an underlying malignancy. The diagnosis is obtained by histopathology and immunohistochemistry. In the last few years, dermoscopy, besides pigmented lesions, has been increasingly employed also for the evaluation of non-pigmented skin tumours and inflammatory diseases, such as for assessment after therapies. We report five cases of EMPD: 4 women and 1 man, aged from 65 to 79 years old, with lesions localized on the vulva, perianal region and glans penis, which we evaluated by dermoscopy. In 5/5 cases, dermoscopic examination revealed a repetitive pattern characterized by a diffuse pinkish background mottled with crimson and bright white irregular structures, grossly mixed together, occasionally forming a sort of thick reticulation; this picture was reminiscent for us of a raspberry slush. In all 5 cases histopathology subsequently confirmed the diagnosis of EMPD.
Whereas there is no standard treatment, as alternative to surgery, we treated our patients by superficial brachytherapy.
This new therapy, successfully utilized for non-melanocytic skin tumors, basically consists in a superficial high dose brachytherapy, characterized by the use of a radioactive betaemitting isotope, rhenium188, incorporated in a specially formulated inert synthetic resin. An histological examination confirmed the clinical-dermoscopic healing of our patient's lesions. Thanks to dermoscopy, we could better identify the extent of the tumor and follow up our patient after therapy. Dermatofibroma is a skin neoplasm that is usually easy to be diagnosed clinically and dermoscopically, but in some cases its differentiation from other tumors may be difficult. Different morphologic faces of dermatofibromas may be dependent to various evolutive stages, but also to special histopathologic variants or special locations of these tumors. We report the results of a dermoscopic study of 130 cases of dermatofibromas that were consecutively collected at the Melanoma Unit of San Gallicano Dermatological Institute in Rome. "Central white scar-like patch and peripheral thin pigment network" was the most frequently observed pattern. In particular we Results: Twenty lesions in 13 cases (10 male, age ranged 34-80 years) were observed. All were located on toes and all were gray-black in color. Clinically, 2 of them were difficult to differentiate from a melanocytic lesion. On dermoscopy, melanonychia was mostly observed as multicolored (brown, gray, black, and in some cases red indicating hemorrhage) pigmentation (19/20). The multicolored pigmentation was homogeneous in 9 of the cases and, gray-black pigment aggregates, which may be called as pigmented clusters, accompanied the multicolored homogeneous pigmentation in 10 lesions. In 1 of the cases, the pigmentation was homo-geneous and was observed only in gray-black color. Trichophyton rubrum and Candida albicans were causative agents.

Imaging of an atypical naevus spilus with in vivo confocal microscopy
Epidermal cysts are one of the most common types of benign skin tumors. Although they are frequently encountered in the daily dermatological practice, the differential diagnosis of epidermal cysts is very broad. Therefore, they often become a complex diagnostic challenge for the clini-

Dermoscopic features of melanocytic skin lesions in Greek children and adolescents. Association with environmental factors and skin types. Preliminary data
Introduction: Acquired nevi often present in childhood and increase in number and size during early and middle life.
As they represent important risk factors for melanoma, the knowledge of their epidemiology, especially in young age, is essential. In our study, that is currently ongoing, we intend to determine the dermoscopic features and prevalence of dermoscopic patterns of nevi and their association with environmental factors and skin types, using cross-sectional data from a population-based cohort of children and adolescents.

Method:
The study population is going to include all students, aged 6-18 years, from 6 different schools in Thessaloniki, Greece, whose parents are going to consent to a total body clinical and dermoscopic examination of their nevi. In conclusion, we believe that skin ultrasonography allows evaluation of melanoma thickness prior to surgery and is an important accessory tool to dermoscopy or video-dermoscopy, which serve as diagnostic aids to establish the diagnosis. In conclusion, dermoscopy and RCM may be helpful tools in diagnosing beard folliculitis of atypical clinical presentation.

Combined tumor: Atypical Spitz naevus associated with deep penetrating naevus: Case report
The association of Spitz nevus with deep penetrating nevus is a tumor of rare cancers combined, especially in puberty.
The authors report a case of a 11-year-old girl with a pigmented lesion of about 1x08 cm, centered by a bluish papule on the skin of 0.7x06 detected with sharp margins.   and change of illumination simply amounts to movement along such lines. Therefore, it is straightforward to devise a 1D illumination-invariant image by projecting the 2D chro-lines. We find the projection angle such that minimizes the entropy. This intrinsic images plus a calibration image of the normal skin is used to find the artifact pattern to be subtracted from dermoscopy images to recover the image that portrays only the inherent reflectance properties of skin. There was a chronic inflammatory response at the periphery of the lesion consisting of foreign body type giant cells.

Results
PAS stain was negative. Where some immunohistochemical stainings including HMB-45, cytokeratin-7, and S-100 were negative, EMA and HMWCK were found to be positive.
According to these histopathologic and dermoscopic find-ings our case was diagnosed as inverted follicular keratosis.
We present this case to draw attention to the importance of Clinical examination revealed scattered cicatricial alopecia areas and tufted hairs limited to his parietal region. There were crusts and scales around hairs and scalp in trichoscopy.
Tufts of 8-15 hairs that appear to emerge from a single follicular orifice were seen. Perifollicular teleangiectasic erythema was detected in cicatricial areas. We present this rare case to demonstrate and discuss the trichoscopic, dermoscopic, and histopathologic findings of tufted hair folliculitis.

Subclinical extension of morphea-like basal cell carcinoma: hyperspectral evaluation
T. Nagaoka 1 , Y. Kiyohara 2 , A. Nakamura 1 , A. Yamaguchi 3 , and T. Sota 1,3 Patient and method: The patient was a 64-year-old Japanese female. The pigmented tumor was located on the nose.
Dermoscopic and ultrasonographic images were taken and hyperspectral data were measured using a hyperspectral imager (MSI-03: Mitaka Kohki, Japan). The hyperspectral data were analyzed and converted into several images using an original spectral analysis algorithm. The resultant images were compared with the dermoscopic and ultrasonographic images and, furthermore, with histopathological findings. 46,1% had dystrophic-broken hair; 27,9% had cadaverised hairs, black dots in the hair follicles. 8,8% had short pseudo regrowing hairs that are apparently regrowing but they are atrophic hairs and are a sign of activity of alopecia areata.

Results
They mostly disappear at 3 months trichoscopic follow up. 13,2 % had corkscrew hairs; 4,8% had circle hairs; 4,1% had vellus hairs-0,03 mm or less in thickness; 3,5% had white dots-feature of fibrosis; they have extensive persistent alopecia areata. I did not find any pseudo moniletrix hairs. A twenty-two-year-old-woman had red-brown hyperkeratotic linear and annular plaques with elevated borders extending from the right mammary to the right axilla along the Blaschko lines.
The dermoscopic features observed in the case were varying according to the age of the lesions. The "early" papular lesions exhibited peripheral, thin whitish-yellow "thread-like structure" together with brown-black dots at the inner side.
The early plaques revealed the same peripheral thread-like structure, however the dots were at the outer side and the ones in the inner part coalesced to form a gray-brown "network-like appearance." The early larger plaques showed linear arrangement of these dots both in the inner and the outer side of this thread-like peripheral structure, thus appeared as a "whitish-yellow track" together with a network-like appearance at the center again. The "mature" plaques showed the peripheral whitish-yellow track together with a central "reddish vascular network" instead of gray-brown network-like structure. Finally in the oldest lesions central Dermoscopic examination demonstrated slate-blue dots/ globules and irregular blue-white network in the center of the lesion. Atypical vascular pattern and multiple gray to brown dots in lines were observed at the periphery. Glomerular vessels were not observed. We suspected a pigmented skin lesion and performed the excisional biopsy.
The histopathology showed the psoriasiform pattern with regular acanthosis with thickening of the rete ridges and overlying hyperkeratosis. Epidermis showed full-thickness involvement with an atypical keratinocytes. Atypical mitoses were also observed. Basal hyperpigmentation was observed. Dermal papillae are elongated upward and filled with melanin pigment. There was no evidence of dermal invasion. Inflammation was not observed in the dermis. In the papillary and reticular dermis, numbers of dilated vessels were increased. Considering these findings, the diagnosis of pigmented Bowen's disease was made and the local wide resection was performed by the plastic surgeon.
Bowen's disease on the lip is exceedingly rare and this is the first reported case featuring the dermoscopic findings as far as we know. We discuss the dermoscopic/dermatopathologic correlation and conclude that Bowen's disease should be considered in the differential diagnoses of mucosal pig-