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[Multi-diagnosis of pigmented skin neoplasms].

A complex examination by radio-isotope (32P) and thermographic methods was carried out in 252 patients, 122 patients underwent surgery. The complex diagnostic study established the following three groups: test-positive, test-negative and test-suspected patients. Application of the complex (radioisotope and thermographic) examination technique provides a more adequate visualization of tumor process and, therefore, a better opportunity for selection of correct treatment. The application of the thermographic method is recommended for screening for subjects at high risk of malignant disease of the skin.

Adolescent↗

Nucleolar organizer regions in pigmented skin lesions. Value in the differential diagnosis of Spitz nevi.

Forty-one cases of typical melanocytic skin lesions (15 intradermal nevi, 14 Spitz nevi and 12 malignant melanomas) were used to investigate the value of staining of nucleolar organizer regions (NORs) in the differential diagnosis of such pigmented lesions. Histologic sections were stained by the silver colloid (Ag) method, with and without the prior use of a melanin blocking agent. There were statistically significant differences in the mean numbers of AgNORs per nucleus between the groups of lesions studied (1.658 for intradermal nevi, 3.0042 for Spitz nevi and 6.669 for malignant melanomas). Sections treated with potassium permanganate (melanin blocking agent) prior to staining showed an obvious increase in the AgNOR scores in all groups; this increase was highest for Spitz nevi. Although AgNOR staining allows a distinction to be made between intradermal nevi and malignant melanomas, the striking overlap between the counts for Spitz nevi and malignant melanomas precludes the use of this technique as the sole method for establishing the diagnosis of malignancy. Other clinical and morphologic data are especially required to make the diagnosis of Spitz nevi.

Analysis of Variance↗

Symmetry axis computation for almost-symmetrical and asymmetrical objects: application to pigmented skin lesions.

The detection of symmetry axes through the optimization of a given symmetry measure, computed as a function of the mean-square error between the original and reflected images, is investigated in this paper. A genetic algorithm and an optimization scheme derived from the self-organizing maps theory are presented. The notion of symmetry map is then introduced. This transform allows us to map an object into a symmetry space where its symmetry properties can be analyzed. The locations of the different axes that globally and locally maximize the symmetry value can be obtained. The input data are assumed to be vector-valued, which allow to focus on either shape. color or texture information. Finally, the application to skin cancer diagnosis is illustrated and discussed.

Algorithms↗

Punch biopsy for diagnosis of pigmented skin lesions.

Melanoma is a potentially fatal cancer with a relatively high incidence, but it can be cured if the lesions are removed at an early stage. Punch biopsy is a cosmetically acceptable, rapid method for removing small pigmented lesions to allow definitive pathologic diagnosis. The technique, which usually requires only a small amount of local anesthetic and no sutures, can be performed by a busy physician at the time the suspicious lesion is discovered.

Biopsy↗

Pigmented skin lesions in the elderly: considerations in the differential diagnosis.

Malignant melanoma affects all age groups, but its highest age-specific incidence is in the elderly. Early diagnosis depends on the ability to identify potential precursor lesions and subtle changes in melanocytic nevi indicative of malignant degeneration. Familiarity with the clinical appearance of the common benign pigmented lesions is essential to minimize unnecessary biopsy procedures. Certain clues aid the differential diagnosis and enhance early recognition, which is presently the most effective means of reducing both the morbidity and mortality from this most ominous of skin cancers.

Adult↗

Tumors of Schwann's cells and pigmented skin cells.

Both melanocytes and peripheral nerve sheath cells have an established origin from the neural crest. Benign and malignant neoplasms of these cells have distinctive ultrastructural features, but there is a group of tumors that has some characteristics of both cell types. The distinguishing feature of melanocytic neoplasms is the presence of cytoplasmic premelanosomes, which indicates cellular synthesis of melanin. Nerve-sheath neoplasms may show ultrastructural variation, but are generally found to have long cell processes associated with basal lamina-like material. Immunocytochemistry can be used to help distinguish tumors of melanocytic and Schwann's cells from unrelated neoplasms.

Humans↗

Melanocyte stimulation in focal dermal hypoplasia with unusual pigmented skin lesions: a histologic and immunohistochemical study.

Focal dermal hypoplasia (FDH) or Goltz syndrome is a rare genodermatosis transmitted in a dominant, X-linked mode. It is characterized clinically by atrophic skin lesions, multiple mucocutaneous papillomas, hyperpigmented linear skin lesions, and several skeletal and visceral anomalies. We followed over several years a female patient with FDH, who had the characteristic atrophic cutaneous lesions and periorificial papillomas, who developed at the periphery of atrophic lesions peculiar lentigo-like pigmented macules. Immunohistologically, increased melanin deposits within the epidermis and the dermis were seen, produced by stimulated epidermal melanocytes expressing the HMB-45 antigen. These findings further support the contention that cutaneous lesions of FDH may be progressive, and provide a physiopathologic basis for understanding the hyperpigmented lesions of FDH.

Adolescent↗

Nonablative laser surgery for pigmented skin.

BACKGROUND: Nonablative laser surgery has been proven to improve early photodamaged skin and acne scars. These techniques include treatments with lasers, light sources, and/or radiofrequency devices. OBJECTIVES: To review the history of nonablative technology and its applicability to darker skin types and to provide an objective look at the various published studies documenting the efficacy of nonablative technology. CONCLUSION: Nonablative laser surgery can improve skin quality and acne scars in all skin types. Complications are rare but can occur. Future studies are required to compare the efficacy of the various nonablative technologies.

Humans↗

[Suspicious pigmented skin lesions. Screening campaign by occupational physicians in the Provence-Alpes-Côte d'Azur region].

OBJECTIVE: Cutaneous melanoma prevention has become a public health issue. The incidence of this cancer has been steadily growing for 50 years, and the related death ratio is not decreasing. Today, the surgical resection of a thin lesion is the only validated curative treatment. The early detection of melanoma represents a major line in the management of such tumours. METHODS: Occupational physicians of the PACA area were invited to participate in a campaign for the screening of pigmented suspect cutaneous lesions for 2 years. Voluntary physicians were trained to use the ABCDEF diagnostic criterion. Lesions were detected during regular yearly consultations (1998/1999) and the data concerning the development and care of these lesions was collected during consultations over the following year (1999/2000). RESULTS: Two hundred and fifty occupational physicians of the PACA area participated in the campaign. Two pre-cancerous lesions and 10 cancers (5 melanoma and 5 pigmented basocellular carcinoma) were found among the 487 suspect lesions detected. Each melanoma had a Breslow score of less than 0.9 mm and were of good or even excellent prognosis. CONCLUSION: The cutaneous examination, although rapid, during the occupational medicine consultations, is an effective means of detecting the early onset tumoral lesions which, at that stage may potentially be cured. The ABCDEF criterion is a useful diagnostic tool and should be taught to the all the medical and paramedical staff.

Adult↗

Optimized UVB treatment of psoriasis: a controlled, left-right comparison trial.

In a randomized, controlled, left-right comparison study, 20 patients with chronic plaque psoriasis were treated with UVB. One side of the body received UVB in a conventional regimen with fixed dose increments, the other side was given UVB doses according to measurements of skin pigmentation. Skin pigmentation was quantified by the skin reflectance technique. The relationship between skin pigmentation and sensitivity to UV radiation was used to optimize and individualize the initial UVB exposure dose. Clinical outcome, initial, final and cumulative UVB doses, time to 50% reduction in PASI score, and side-effects were compared. The consequence of the optimization of the UVB doses with a skin reflectance meter was that the initial UVB dose was significantly higher than in the conventional UVB regimen. PASI scoring demonstrated a more rapid improvement during the first 2 weeks of treatment on the half body receiving the optimized treatment compared to the other side (P < 0.05). This new technique offers the same therapeutical advantages and security as a dose regimen guided by minimal erythema dose testing. However, measurement of skin pigmentation by skin reflectance is a quick method which can be operated easily by nurses.

Adult↗

"Syndrome myxoma": a subset of patients with cardiac myxoma associated with pigmented skin lesions and peripheral and endocrine neoplasms.

From January 1954 to December 1985 cardiac myxoma was diagnosed in 75 patients at the Mayo Clinic. The clinical presentation was typical in 70 cases and was referred to as "sporadic myxoma". Forty four other cases of cardiac myxomas (five from the Mayo Clinic) presented with a combination of distinctive clinical features and these cases are described as "syndrome myxoma". The patients with syndrome myxoma were younger (mean age, 25 vs 56 years) and had unusual skin freckling (68%), associated benign non-cardiac myxomatous tumours (57%), endocrine neoplasms (30%), and a high frequency of familial cardiac myxoma (25%) and familial endocrine tumours (14%). The two types of cardiac tumour were different (syndrome vs sporadic): atrial location, 87% vs 100%; ventricular location, 13% vs 0%; single tumour, 50% vs 99%; multiple tumours, 50% vs 1%; and recurrent tumour, 18% vs 0%. It is concluded that patients with syndrome myxoma represent a distinctive subgroup in which there are important clinical, surgical, and genetic implications. More importantly, syndrome myxoma appears to be only one expression of a much larger disease entity.

Adolescent↗

A portable scanning reflectance spectrophotometer using visible wavelengths for the rapid measurement of skin pigments.

A portable rapid scan reflectance spectrometer (400-700 nm in 2.8 s) has been developed for the measurement of cutaneous pigments. The instrument incorporates a tungsten halogen lamp light source, light transmission by fibre optics and wavelength selection by a circular variable wavelength interference filter. A microcomputer controls the instrument and processes the data. The performance of the instrument was evaluated by undertaking in vitro measurements of the reflectance spectra of blood. An index of the haemoglobin content of the sample based on the gradients of the log inverse reflectance spectrum between isobestic points at 527.5, 544 and 573 nm was devised and shown to be independent of the oxygenation of the haemoglobin. The haemoglobin index was combined with measurements at 558.5 nm, a wavelength at which absorbance is sensitive to the oxygenation of haemoglobin, to give a measure of oxygen saturation. The parameter was validated by determining the oxygen dissociation curve of red cells in plasma in vitro at pH 7.33, 37 degrees C and under a partial pressure of 40 mmHg of CO2.

Erythrocytes↗