Biomedical subjects
Domenico Piccolo
Publications and source records attributed to Domenico Piccolo.
Dermoscopic classification of Clark's nevi (atypical melanocytic nevi).
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Jumping into the future using teledermoscopy.
BACKGROUND: Teledermoscopy uses telecommunication technologies to transfer images of pigmented skin lesions via the Internet for teleconsultation. DESIGN: Clinical and dermoscopic images of 66 and 43 pigmented skin lesions achieved in two consecutive studies were sent by e-mail to dermatologists with different degrees of experience in dermoscopy for a telediagnosis. All lesions included in these studies were surgically excised and diagnosed histopathologically. RESULTS: The diagnostic concordance between the face-to-face diagnosis and the telediagnosis was 91% in the first study, whereas, in the second study, it varied from 76.7%-95.3%. The accuracy of the diagnoses in both studies was not related to the quality of the images, but did highly depend on the level of diagnostic difficulty of a given pigmented skin tumor and on the level of experience of each observer. CONCLUSIONS: Teleconsultation of dermoscopic images of pigmented skin lesions via e-mail provides a similar degree of diagnostic accuracy as face-to-face diagnosis when the diagnosis is made by a dermatologist confident with dermoscopy.
Interobserver agreement of the dermoscopic diagnosis of 129 small melanocytic skin lesions.
AIM AND BACKGROUND: Dermoscopic diagnosis of pigmented skin lesions is based on the evaluation of dermoscopic criteria (classical pattern analysis) and on alternative diagnostic methods, such as the ABCD (A, asymmetry; B, border; C, color; D, differential structures) rule based on the total dermatoscopic score. The aim of the study was to investigate the interobserver agreement of standard dermoscopic criteria between two observers and the diagnostic validity of dermoscopic diagnosis by pattern analysis and by the ABCD rule. STUDY DESIGN: The study included a total of 129 small (< or = 5 mm) melanocytic skin lesions selected from all lesions observed in consecutive patients between April 1996 and September 1998. Before surgery, each lesion was photographed with a Dermaphot. Dermoscopic images were examined independently by two observers to evaluate the presence or absence of standard dermoscopic criteria and to establish the dermoscopic diagnosis by pattern analysis and by the ABCD rule. RESULTS: Interobserver agreement for dermoscopic criteria varied from moderately good to good, with the highest agreement for radial streaks (k = 0.96) and the lowest for pseudopods (k = 0.49). Interobserver agreement was moderately good in dermoscopic diagnosis by pattern analysis (k = 0.48) and by the total dermatoscopic score (k = 0.44). The sensitivity and specificity of dermoscopic diagnosis by pattern analysis were 40% and 99%, respectively, for both observers. As regards the total dermatoscopic score (a cutoff score of < or = 5.45 vs > 5.45), sensitivity ranged from 80% to 100% and specificity from 48% to 59%. CONCLUSIONS: The study showed that the pattern analyses as well as the ABCD rule give a poor discrimination between benign and malignant lesions and do not add relevant information for management decision in small melanocytic lesions. However, close follow-up examinations of small equivocal melanocytic lesions using digital equipment allow evaluation of their dermoscopic features during progression and whether their rather commonly found atypical dermoscopic features are lost during their natural course of growth.
Skin cancer day in Italy: method of referral to open access clinics and tumor prevalence in the examined population.
Education campaigns to encourage self-examination coupled with rapid access to specialized dermatological clinics is considered the key strategy in the realization of early detection of cutaneous melanoma and non-melanoma skin cancer (NMSC). An alternative to an initial visit to the family doctor is open access to a skin cancer clinic at the decision of the individual. This approach has been followed mainly in countries with high melanoma incidence where the majority of the population is of northern European origin. However, the efficacy of this system has not been well established because there are few studies involving systematic follow up of individuals with positive screening through pathological confirmation of the diagnosis. We report the follow up data focussed on melanoma and NMSC detection rates in more than 1,000 subjects examined at numerous 1-day, open access clinics on the occasion of the Italian nation-wide "Skin Cancer Day" campaign promoted by the Federation of Italian Dermatological Societies. Total body skin examination was performed on all subjects, and surgical excision of a lesion was recommended in 41 of the 1042 subjects (3.9 %). Histologic diagnosis, available for 39/41 lesions, evidenced 3 superficial spreading melanomas (1 in situ, one "thin" lesion, ie. 0.30 mm in thickness, and one "thick" lesion, with a thickness of 4.53 mm) and 6 NMSC (5 BCC and 1 SCC). Thus, the prevalence of skin cancer (melanoma and NMSC) in this group was 0.8 % (9/1042), and the prevalence of melanoma was 3/1042, 0.2 %, rather similar to that found in populations of northern European origin. Open access to skin cancer clinics may represent an alternative approach to melanoma prevention also in southern European populations. Increased public awareness regarding skin cancer probably represents the main effect of this type of campaign.
Kaposi's sarcoma of the glans penis in an immunocompetent patient.
We report a 39-year-old HIV negative man with a solitary reddish-brown papule located on the glans penis, which had developed 6 months previously. Histopathologic examination showed spindle-shaped cells scattered between collagen bundles and intermingled with small, pointed vascular-like spaces. Spindle-shaped cells stained positively for antiFactor VIII and anti-CD34 antibodies. Human herpes virus-8 DNA was detected in tumor tissue and in peripheral blood mononuclear cells. Based on clinicopathologic and molecular findings, the diagnosis of classic Kaposi's sarcoma was made. Two months after the initial observation, three additional papules developed on the glans penis. Histopathologic examination of one lesion confirmed the diagnosis of classic Kaposi's sarcoma. The remaining lesions were treated with electrodessication and curettage. After a follow-up period of 6 months no evidence of recurrence was observed. We report this case for the unusual localization of Kaposi's Sarcoma in a young, HIV-negative patient.