Dermoscopy key points: recommendations from the international dermoscopy society.
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Dermatology↗
Biomedical subjects
R P Braun
Publications and source records attributed to R P Braun.
Three-point checklist of dermoscopy: an open internet study.
BACKGROUND: In a pilot study, the three-point checklist of dermoscopy has been shown to represent a valid and reproducible tool with high sensitivity for the diagnosis of skin cancer in the hands of a small group of nonexperts. OBJECTIVES: To re-evaluate these preliminary results in a large number of observers independently from their profession and expertise in dermoscopy. METHODS: The study was conducted via the internet to provide worldwide access for participants. After a short web-based tutorial, the participants evaluated dermoscopic images of 165 (116 benign and 49 malignant) skin lesions (15 training and 150 test lesions). For each lesion participants scored the presence of the three-point checklist criteria (asymmetry, atypical network and blue-white structures). Kappa values, odds ratios, sensitivity, specificity and likelihood ratios were estimated. RESULTS: Overall, 150 participants joined the study. The three-point checklist showed good interobserver reproducibility (kappa value: 0.53). Sensitivity for skin cancer (melanoma and basal cell carcinoma) was 91.0% and this value remained basically uninfluenced by the observers' professional profile. Only 20 participants lacking any experience in dermoscopy performed significantly more poorly, but the sensitivity was still remarkably high (86.7%) when considering that they were untrained novices in dermoscopy. The specificity was 71.9% and was significantly influenced by the profession, with dermatologists performing best. CONCLUSIONS: Our study confirms that the three-point checklist is a feasible, simple, accurate and reproducible skin cancer screening tool.
Basal Cell Carcinoma↗
A follow-up: previously reported apparent lymphomatoid contact dermatitis, now followed by T-cell prolymphocytic leukaemia.
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Aged, 80 and over↗
Multiple cutaneous osteomas of the face associated with chronic inflammatory acne.
Multiple miliary osteoma cutis of the face represents a rare and frequently unrecognized complication of chronic inflammatory acne. Their differentiation from microcomedones and macrocomedones may be challenging. The case of a 46-year-old Asian woman who suffered from chronic inflammatory acne is described. She had multiple papular lesions of the cheeks that did not respond to various topical and systemic therapies including oral isotretinoin. Light microscopy studies as well as ultrasound and computed tomography (CT) scan investigations demonstrated the presence of multiple osteoma cutis. Needle microincisions followed by mechanical extirpation of the bony formation resulted in a considerable cosmetic improvement of her skin disease. Knowledge of this rare complication of acne is mandatory, as its treatment is different from that of retentional and inflammatory acne and frequently relies on surgical modalities. Our novel technique consisting of needle microincisions with curettage of the lesions is simple and safe, leading to good cosmetic results.
Acne Vulgaris↗
Acquired melanocytic naevus in childhood vulval pemphigoid.
BACKGROUND: Eruptive epidermolysis bullosa (EB) naevi comprise a subset of melanocytic naevi with atypical features that characteristically occur in areas of former blistering in patients suffering from hereditary EB. OBSERVATION: The case is reported of a girl who presented with pruritus, blistering and erosions of the vulval region. Clinical and immunopathological features were consistent with the diagnosis of childhood vulval pemphigoid. In the course of the disease, she developed an atypical melanocytic naevus on the left labium at a site of former blistering. Although its clinical and dermoscopic features resembled malignant melanoma, the lesion completely regressed clinically during the 24-month follow-up. CONCLUSION: This is the first report describing the development of a melanocytic naevus at sites of blistering in an auto-immune subepidermal blistering disease in childhood. Our observation extends the spectrum of disorders, in addition to the group of congenital EB, in which 'eruptive' atypical melanocytic naevi may occur. Knowledge of this complication is important for appropriate management and follow-up and to avoid radical surgery.
Child↗
Dermoscopy of pigmented lesions: a valuable tool in the diagnosis of melanoma.
Although malignant melanoma is not the most frequent cancer, its incidence is increasing faster than any other. Early diagnosis of melanoma is particularly important because if the diagnosis is made at an early stage when the tumour thickness is less than 1 mm the prognosis is excellent. Dermoscopy is an in vivo method for the early diagnosis of melanoma and the differential diagnosis of pigmented lesions of the skin. It has been shown to increase diagnostic accuracy over clinical visual inspection in the hands of experienced physicians. This paper reviews the principles of dermoscopy, diagnostic strategies and recent technological developments.
Diagnosis, Differential↗
Dermoscopy for the in vivo detection of sarcoptes scabiei.
We report the case of an 80-year-old patient who had intense pruritus which did not respond to a 3-month treatment with topical corticosteroids. On dermoscopy examination of the excoriations, we found the typical dermoscopic aspect of the scabies mite at a distance. Dermoscopy allows identifying a triangular structure which corresponds to the anterior section of the mite including the mouth part and the 2 pairs of front legs. This aspect has been described as resembling a jetliner with its trail, a delta glider or a spermatozoid. Traditional diagnostic methods for scabies failed in this case because the mites were at a distance from the burrows. This was due to the fact that the reaction to the mite was less pronounced and the diagnosis is frequently missed. Dermoscopy is a useful tool for the diagnosis of scabies either as a diagnostic test or to guide the traditional diagnostic tests.
Aged↗
An evaluation of dermoscopy fluids and application techniques.
BACKGROUND: Dermoscopy, a noninvasive technique used to help physicians better visualize pigmented skin lesions, is becoming widely used by dermatologists. Yet despite its popularity, to our knowledge basic aspects such as the best immersion fluid (IF) to use and proper procedures for applying the IF and dermatoscope have never been the subject of a systematic investigation. OBJECTIVES: To determine the best techniques for application of IF and the dermatoscope; to discover which IF results in the least amount of air inclusions; to determine which IF provides the best image quality. MATERIALS AND METHODS: This study was divided into three phases. Phase I examined several techniques of taking digital dermoscopic photographs in an attempt to eliminate air bubbles. Phase II tested seven IFs to analyse quantitatively the number of air inclusions for each IF. Phase III investigated these same IFs to judge the image quality for each. RESULTS: Phase I: in our hands, the best technique to apply an IF is to use an eyedropper and place the IF directly onto the skin in combination with a 'roll-on technique': the dermatoscope's edge is placed on the skin first and is then rotated until the glass plate lies flat against the skin. Phase II: the alcoholic IF resulted in the least amount of air bubble inclusions (70% ethanol, 90% isopropanol and alcoholic disinfectant), while liquid paraffin (a mineral oil) resulted in the most air bubbles. Phase III: dermoscopic structures were equally clear with alcohols and liquid paraffin, but slightly blurry with ultrasound gel and water. CONCLUSIONS: Although 90% isopropanol performed slightly better in terms of air inclusions, we prefer to use 70% ethanol in most circumstances because it has the advantage of being odourless, unlike its counterpart. Additionally, ethanol will not stain clothing, does not crystallize on the dermatoscope, disinfects and evaporates immediately (does not need to be wiped off). For certain local considerations, such as dermoscopy on mucosa or the nail, we prefer to use ultrasound gel because it will not flow.
Air↗
Computerized digital dermoscopy.
Within the past 15 years, dermoscopy has become a widely used non-invasive technique for physicians to better visualize pigmented lesions. Dermoscopy has helped trained physicians to better diagnose pigmented lesions. Now, the digital revolution is beginning to enhance standard dermoscopic procedures. Using digital dermoscopy, physicians are better able to document pigmented lesions for patient follow-up and to get second opinions, either through teledermoscopy with an expert colleague or by using computer-assisted diagnosis. As the market for digital dermoscopy products begins to grow, so do the number of decisions physicians need to make when choosing a system to fit their needs. The current market for digital dermoscopy includes two varieties of relatively simple and cheap attachments which can convert a consumer digital camera into a digital dermoscope. A coupling adapter acts as a fastener between the camera and an ordinary dermoscope, whereas a dermoscopy attachment includes the dermoscope optics and light source and can be attached directly to the camera. Other options for digital dermoscopy include complete dermoscopy systems that use a hand-held video camera linked directly to a computer. These systems differ from each other in whether or not they are calibrated as well as the quality of the camera and software interface. Another option in digital skin imaging involves spectral analysis rather than dermoscopy. This article serves as a guide to the current systems available and their capabilities.
Journal Article↗
Periorbital oedema and erythema as a manifestation of discoid lupus erythematosus.
Periorbital oedema and erythema are a rare cutaneous manifestation of discoid erythematosus (DLE) which is well known to ophthalmologists but less to dermatologists. We report the case of a 74-year-old female patient with periorbital oedema and erythema. Since swelling of the eyelid is common in the dermatological practice, dermatologists should be aware of the differential diagnosis and its occurrence in patients with DLE.
Aged↗
Multiple hyperkeratotic spicules and myeloma.
We report the case of a 58-year-old patient with multiple myeloma with a monoclonal gammopathy of the IgG type, who developed a striking eruption characterized by multiple hyperkeratotic spicules of the face, nose and scalp. Light-microscopic studies revealed a follicular orthohyperkeratosis, while direct immunofluorescence microscopy remained negative. Hence, our patient presented features characteristic of a rare distinctive disorder associated with an underlying paraprotein or multiple myeloma, paraneoplastic hyperkeratotic spicules.
Humans↗
[Dermatoscopy of pigmented lesions].
Dermoscopy is a simple to use in vivo method for the early diagnosis of malignant melanoma and the differential diagnosis of pigmented skin lesions. It has been shown to increase diagnostic accuracy over clinical visual inspection in the hands of an experienced physician. This paper is a review of the principles of Dermoscopy as well as recent technological developments.
Algorithms↗
Fusion of C3d molecule with bovine rotavirus VP7 or bovine herpesvirus type 1 glycoprotein D inhibits immune responses following DNA immunization.
The binding of the complement C3d molecule with receptors on B cells and/or follicular dendritic cells (FDCs) influences the induction of humoral immune responses. For example, C3d fused to an antigen has been shown to have a strong adjuvant effect on antibody production. We investigated the possibility that co-expression of antigen and C3d as a fusion protein could enhance antigen-specific immune responses, following plasmid immunization. One or two copies of murine C3d-cDNA, C3d or (C3d)(2), respectively, were cloned together with bovine rotavirus (BRV) VP7 or bovine herpesvirus type 1 (BHV-1) glycoprotein D (gD) genes. All constructs contained a signal peptide that resulted in the secretion of the expressed proteins. In vitro, the characterization of the chimeric proteins indicated that both VP7 and gD retained their antigenicity and the C3d remained biologically active. However, immunization with plasmids encoding VP7-C3d chimeras did not enhance rotavirus-specific antibody responses and the frequency of BRV-specific IFN-gamma secreting cells in the spleens were significantly lower in mice immunized with pVP7-(C3d)(2) when compared with mice immunized with plasmid encoding VP7. The same pattern of immune responses was observed for plasmids encoding gD-C3d. Both gD-specific antibody responses and the frequency of gD-specific IFN-gamma secreting cells were significantly lower in mice immunized with plasmid expressing gD-C3d chimeras when compared with mice immunized with plasmid encoding gD alone. These results indicate that co-expression of C3d with an antigen actually inhibit both humoral and cell-mediated antigen-specific immune responses.
Animals↗
Changes even in benign melanocytic nevi.
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Adult↗
The "wobble sign" in epiluminescence microscopy as a novel clue to the differential diagnosis of pigmented skin lesions.
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Diagnosis, Differential↗
Cutaneous pseudolymphoma, lymphomatoid contact dermatitis type, as an unusual cause of symmetrical upper eyelid nodules.
We describe a 74-year-old woman who rapidly developed bilateral voluminous nodules on the upper eyelids, following 4 months' treatment for chalazion. Histological and immunohistochemical findings were suggestive of cutaneous pseudolymphoma (CPL), and extensive screening for malignant lymphoma (ML) remained negative. Cutaneous pseudolymphomas are inflammatory diseases that can simulate ML either clinically, histopathologically, or both. They are a rare cause of nodules of the upper eyelids, usually characterized by a benign evolution, that can be secondary to ultraviolet sensitivity, adverse reactions to systemic medications and contact sensitization, among others. In our case, epicutaneous patch tests were strongly positive for a series of allergens contained in the ophthalmological preparations used; therefore, they were suggestive that the patient had CPL, lymphomatoid contact dermatitis type. In addition, the patient had been treated previously with several drugs, known to cause CPL and immune dysregulation. Complete regression of the lesions required treatment with systemic steroids and chlorambucil. No relapse occurred within a 5-year follow-up period.
Aged↗
Teledermatoscopy in Switzerland: a preliminary evaluation.
BACKGROUND: Since devices for digital epiluminescence microscopy and for telemedicine have become affordable, a critical evaluation of this new method has been needed. OBJECTIVE: Our aim was a critical evaluation of teledermatoscopy under routine conditions in private practice. METHODS: Pigmented skin lesions (PSLs) scheduled for excision were documented with a digital epiluminescence microscopy (DELM) system. Images were sent to the PSL consultation at the Department of Dermatology of the University Hospital Geneva, where a diagnosis was established. The histopathologic report including the initial diagnosis was sent afterward. Both approaches were compared concerning diagnostic accuracy. RESULTS: Over a period of 6 months, 55 lesions on 51 patients have been included in this study. Picture quality was good or very good in more than 90%. Diagnostic accuracy of the teledermatoscopy approach was superior to that of the conventional approach for malignant melanocytic lesions. CONCLUSION: We have shown the feasibility of a teledermatoscopic consultation. The gain of diagnostic accuracy in this teledermatoscopic approach, especially for malignant melanocytic lesions, suggests that patients might benefit directly from such a consultation at distance.
Feasibility Studies↗
Hypoluminescence microscopy of pigmented skin lesions.
Since the 'renaissance' of epiluminescence microscopy (ELM), histological correlation of ELM structures has been the subject of many investigations. Direct correlation is difficult because of the methodological differences between ELM and histopathology. In order to further understand the features of pigmented skin lesions (PSLs), we studied whether hypoluminescence microscopy (HLM) had any advantages over ELM. Twenty pigmented skin lesions scheduled for surgical excision were chosen randomly for this study. After excision, the lesions were studied using standard ELM and an HLM technique. For the latter, illumination was performed from the dermal side. The HLM pattern was clearly different from that of ELM. In all lesions the 'deeper' (dermal) structures became more visible. Some structures already visible in ELM appeared more visible, particularly structures apparently localized in deeper layers of the PSL. For highly pigmented lesions the difference in the two approaches was striking. With the HLM technique details became visible, and structures which were hardly or not visible with the classic ELM approach could be easily distinguished and evaluated. In conclusion, HLM is a simple, easy to use, reproducible ex vivo technique that is able to provide additional information to the conventional ELM technique.
Diagnosis, Differential↗