Clinician's Ability to Identify Non-Melanoma Skin Cancer on 3D-Total Body Photography Sectors that Were Initially Identified during In-Person Skin Examination with Dermoscopy.

INTRODUCTION: Non-melanoma skin cancer (NMSC) is a cause of significant morbidity and mortality in high-risk individuals. Total body photography (TBP) is currently used to monitor melanocytic lesions in patients with high risk for melanoma. The authors examined if three-dimensional (3D)-TBP could be useful for diagnosis of NMSC. METHODS: Patients (n = 129; 52 female, 77 male) with lesions suspicious for NMSC who had not yet had a biopsy underwent clinical examination followed by examination of each lesion with 3D-TBP Vectra®WB360 (Canfield Scientific, Parsippany, NJ, USA) and dermoscopy. RESULTS: The 129 patients had a total of 182 lesions. Histological examination was performed for 158 lesions; the diagnoses included basal cell carcinoma (BCC; n = 107), squamous cell carcinoma (SCC; n = 27), in-situ SCC (n = 15). Lesions were located in the head/neck region (n = 138), trunk (n = 21), and limbs (n = 23). Of the 182 lesions examined, 12 were not visible on 3D-TBP; reasons for not being visible included location under hair and on septal of nose. Two lesions appeared only as erythema in 3D-TBP but were clearly identifiable on conventional photographs. Sensitivity of 3D-TBP was lower than that of dermoscopy for BCC (73% vs. 79%, p = 0.327), higher for SCC (81% vs. 74%, p = 0.727), and lower for in-situ SCC (0% vs. 33%, p = 125). Specificity of 3D-TBP was lower than that of dermoscopy for BCC (77% vs. 82%, 0.581), lower for SCC (75% vs. 84%, p = 0.063), and higher for in-situ SCC (97% vs. 94%, p = 0.344). Diagnostic accuracy of 3D-TBP was lower than that of dermoscopy for BCC (75% vs. 80%), lower for SCC (76% vs. 82%), and lower for in-situ SCC (88% vs. 89%). Lesion location was not associated with diagnostic confidence in dermoscopy (p = 0.152) or 3D-TBP (p = 0.353). If only lesions with high confidence were included in the calculation, diagnostic accuracy increased for BCC (n = 27; sensitivity 85%, specificity 85%, diagnostic accuracy 85%), SCC (n = 10; sensitivity 90%, specificity 80%, diagnostic accuracy 83%), and for in-situ SCC (n = 2; sensitivity 0%, specificity 100%, diagnostic accuracy 95%). CONCLUSION: Diagnostic accuracy appears to be slightly lower for 3D-TBP in comparison to dermoscopy. However, there is no statistically significant difference in the sensitivity and specificity of 3D-TBP and dermoscopy for NMSC. Diagnostic accuracy increases, if only lesions with high confidence are included in the calculation. Further studies are necessary to determine if 3D-TBP can improve management of NMSC.

[Optical coherence tomography for the diagnosis and differentiation of cutaneous cysts: a case series]. / Diagnose und Differenzierung von kutanen Zysten mit optischer Kohärenztomographie: eine Fallserie.

Cutaneous cystic lesions (n = 35) were examined with optical coherence tomography. Cysts were visible as a hyporeflective roundish area with a clear margin; in some cases, the epidermis was thinned. Epidermal cysts, trichilemmal cysts, and hidrocystomas had a linear margin representing the epithelium of the cyst, whereas mucoid pseudocysts showed no linear margin. Trichilemmal and epidermal cysts presented with hyperreflective content that corresponds to keratin. By visualizing the margin and the content of the cyst, it was possible to differentiate between different types of cysts.

Examination of Subungual Hematomas and Subungual Melanocytic Lesions by Using Optical Coherence Tomography and Dermoscopy.

INTRODUCTION: Examination of subungual pigmented lesions is sometimes a diagnostic challenge for clinicians. OBJECTIVES: The study was aimed to investigate characteristic patterns in optical coherence tomography (OCT) of subungual hematomas and determine distinctive features that can differentiate them from subungual melanocytic lesions. METHODS: VivoSight® (Michelson Diagnostics, Maidstone, UK) was used to examine 71 subungual hematomas and 11 subungual melanocytic lesions in 69 patients (18 female and 51 male patients). RESULTS: On OCT, bleeding was related to sharply defined black sickle-shaped (p < 0.001) or globular regions (not significant [ns]) with a hyperreflective margin (0.002), a grey center (0.013), hyperreflective lines in the area (ns) or periphery (p = 0.031), peripheral fading (p = 0.029), and red dots in the area (p = 0.001). In the 1 case of melanoma in situ examined, we found curved vessels with irregular sizes and distribution on the dermis of the nailbed, while subungual hematomas and subungual benign nevi presented as clustered red dots and/or regularly distributed curved vessels. CONCLUSION: Our findings indicate that the use of OCT in addition to dermoscopy provides high-resolution optical imaging information for the diagnosis of subungual hematoma and facilitates the differential diagnosis of subungual hematomas and subungual melanocytic lesions.

Successful therapy of pemphigus vulgaris with immunoadsorption using the TheraSorb adsorber.

Pemphigus vulgaris (PV) is caused by autoantibodies to desmogleins. Standard immunosuppressive therapy may be limited by concomitant diseases or ineffective.In these cases, removal of circulating antibodies by immunoadsorption can induce remission. An 87-year-old woman with PV and considerable co-morbidities suffered from extensive mucous membrane erosions and bouts of skin blistering refractory to treatment with methotrexate,as well as mycopheno-late mofetil and corticosteroids even when combined with plasmapheresis and intravenous immunoglobulin. Adjuvant immunoadsorption therapy with the TheraSorbtrade mark columns-first weekly, than monthly-induced a complete remission, as well as a parallel decrease in PV antibody titers. Continued therapy for 18 months kept the patient in remission but for one infection-related relapse, and remission has been stable over two further years on low-dose methotrex-ate monotherapy. This case confirms the clinical efficacy of immunoad-sorption in PV and adds another type of adsorber column to the armamentarium, which is useful to the dermatologist who has to cooperate with local lipid apheresis or dialysis units.

Macular exanthema due to fumaric acid esters.

OBJECTIVE: To report a case of an unusual skin reaction to fumaric acid esters (FAE). CASE SUMMARY: A 68-year-old white woman who was treated with FAE for 4 days for lichen planus developed generalized pruritic exanthema. This was suspected to be an allergic drug reaction to FAE, and the treatment was discontinued. After 48-72 hours, the exanthema resolved completely. An objective causality assessment revealed that the adverse drug event was probable. As skin testing for diagnostic purposes is not feasible with FAE, the drug-related origin of the exanthema was confirmed by oral rechallenge with FAE. DISCUSSION: The effectiveness of FAE in the systemic treatment of psoriasis vulgaris has been proven by controlled clinical trials. The compound has been shown to be tolerable and safe even during prolonged treatment. The most frequent adverse effects are gastrointestinal symptoms and flushing, which typically occur 4-6 hours after administration of the drug. Allergic reactions to FAE have not yet been reported. Since the patient was rechallenged with the suspected drug, we could confirm the allergic origin of the exanthema. CONCLUSIONS: The occurrence of allergic skin reaction should be considered in patients receiving treatment with FAE.