Dermoscopic Features of Pigmented Bowen Disease: A Multicenter Study on Behalf of the Ibero-Latin American College of Dermatology (CILAD).

INTRODUCTION: Studies focused on dermoscopic aspects of pigmented Bowen disease (pBD) in Latin American population are scarce and limited to only case reports or small series. OBJECTIVES: To report dermoscopic findings in a large series of 147 pBD diagnosed in Ibero-Latin American population. METHODS: We conducted a multicentric, retrospective study on 147 histologically proven pBD under the auspices of the Dermoscopy Chapter of the Ibero-Latin American College of Dermatology. RESULTS: The study population consisted of 77 females (52%) and 70 males (48%) with a mean age of 68.6 years. 70.1% of patients had skin phototype 3, 15.6% to skin phototype 2, and 14.3% to skin phototype 4. On clinical examination, near 60% of pBD were flat, 70% presented with scales, and 90% were asymmetric. Under dermoscopy, structureless hypopigmented areas, dots brown and pink color were the most frequently observed. Regarding specific dermoscopic clues to pBD, the most prevalent were structureless hypopigmented areas, vessels arranged in linear fashion at the periphery, and pigmented lines or pigmented dots distributed in a linear fashion. Clustered, coiled, and dotted vessels were observed in 55.8%, 45.6%, and 45.6% of the cases, respectively. CONCLUSIONS: We report a large series of cases of pBD in Latin American patients, with most patients being skin phototype 3 and 4. Distinctively in our study, the pigmented structures and the clues derived from the presence of melanin were much more frequent than in previous reports in fair skin.

Dermatoscopic patterns of cutaneous metastases: A multicentre cross-sectional study of the International Dermoscopy Society.

BACKGROUND: The detection of cutaneous metastases (CMs) from various primary tumours represents a diagnostic challenge. OBJECTIVES: Our aim was to evaluate the general characteristics and dermatoscopic features of CMs from different primary tumours. METHODS: Retrospective, multicentre, descriptive, cross-sectional study of biopsy-proven CMs. RESULTS: We included 583 patients (247 females, median age: 64 years, 25%-75% percentiles: 54-74 years) with 632 CMs, of which 52.2% (n = 330) were local, and 26.7% (n = 169) were distant. The most common primary tumours were melanomas (n = 474) and breast cancer (n = 59). Most non-melanoma CMs were non-pigmented (n = 151, 95.6%). Of 169 distant metastases, 54 (32.0%) appeared on the head and neck region. On dermatoscopy, pigmented melanoma metastases were frequently structureless blue (63.6%, n = 201), while amelanotic metastases were typified by linear serpentine vessels and a white structureless pattern. No significant difference was found between amelanotic melanoma metastases and CMs of other primary tumours. CONCLUSIONS: The head and neck area is a common site for distant CMs. Our study confirms that most pigmented melanoma metastasis are structureless blue on dermatoscopy and may mimic blue nevi. Amelanotic metastases are typified by linear serpentine vessels and a white structureless pattern, regardless of the primary tumour.

Performance of an automated total body mapping algorithm to detect melanocytic lesions of clinical relevance.

IMPORTANCE: Total body photography for skin cancer screening is a well-established tool allowing documentation and follow-up of the entire skin surface. Artificial intelligence-based systems are increasingly applied for automated lesion detection and diagnosis. DESIGN AND PATIENTS: In this prospective observational international multicentre study experienced dermatologists performed skin cancer screenings and identified clinically relevant melanocytic lesions (CRML, requiring biopsy or observation). Additionally, patients received 2D automated total body mapping (ATBM) with automated lesion detection (ATBM master, Fotofinder Systems GmbH). Primary endpoint was the percentage of CRML detected by the bodyscan software. Secondary endpoints included the percentage of correctly identified "new" and "changed" lesions during follow-up examinations. RESULTS: At baseline, dermatologists identified 1075 CRML in 236 patients and 999 CRML (92.9%) were also detected by the automated software. During follow-up examinations dermatologists identified 334 CRMLs in 55 patients, with 323 (96.7%) also being detected by ATBM with automated lesions detection. Moreover, all new (n = 13) or changed CRML (n = 24) during follow-up were detected by the software. Average time requirements per baseline examination was 14.1 min (95% CI [12.8-15.5]). Subgroup analysis of undetected lesions revealed either technical (e.g. covering by clothing, hair) or lesion-specific reasons (e.g. hypopigmentation, palmoplantar sites). CONCLUSIONS: ATBM with lesion detection software correctly detected the vast majority of CRML and new or changed CRML during follow-up examinations in a favourable amount of time. Our prospective international study underlines that automated lesion detection in TBP images is feasible, which is of relevance for developing AI-based skin cancer screenings.

Dermoscopy in Selected Latin American Countries: A Preliminary Look into Current Trends and Future Opportunities Among Dermatology Residency Programs.

INTRODUCTION: Skin cancer remains a global public health burden. Dermoscopy is a useful technique that aids in early detection and increases diagnostic accuracy with adequate training. However, dermoscopy is not uniformly taught to residents worldwide. Dermoscopy training in Latin American dermatology residency programs has not been explored. OBJECTIVES: To assess current dermoscopy training among dermatology residency programs in Latin America (eg training modalities, preferred/most effective modalities per residents, diseases/pathologies taught). METHODS: Cross-sectional survey distributed via e-mail between March and May 2021. Chief residents from Argentina, Brazil, Colombia, Costa Rica, Chile, Ecuador, Guatemala, Mexico, Panama, and Uruguay were invited to participate. RESULTS: 81 chief residents completed the questionnaire (81/126, 64.2%). Seventy-two percent of programs had an established dermoscopy curriculum, with dedicated hours of training varying greatly by program. Institutions commonly utilized sessions with "unknown" dermoscopy images and direct teaching by experts in the clinical setting as supplements to lectures, also described by residents as most effective. The most commonly taught methods included pattern analysis (74.1%), the two-step algorithm (61.7%), and the ABCD rule (59.3%). Almost all respondents reported desiring additional training during residency and believe that dermoscopy training should be a requirement to graduate from residency. CONCLUSIONS: This study highlights a preliminary look into current landscape in dermoscopy training among selected Latin American dermatology residency programs, demonstrating room for improvement and standardization in dermoscopic education and training. Our results serve as a baseline reference and provide valuable information to guide future educational initiatives incorporating successful teaching strategies (eg. spaced education/repetition, flipped classroom model) used in dermatology and other fields.

Dermoscopic Findings in Intraepidermal Carcinoma: an Interobserver Agreement Study.

INTRODUCTION: A wide range of descriptive terms have been used for dermoscopic findings in intraepidermal carcinoma (IEC) and the clinical diagnostic accuracy of IEC can be challenging. Furthermore, dermoscopic findings in IEC have only rarely been evaluated in fair-skinned populations. OBJECTIVES: To measure the interobserver agreement between dermatologists for dermoscopic findings in IEC. Furthermore, to describe the frequency of these findings in a predominantly fair-skinned population. METHODS: One hundred dermoscopic images of histopathologically verified IECs were collected. The 11 most common dermoscopic findings described in previous studies were re-defined in a new terminology in a pre-study consensus meeting. Images were assessed by eight experienced international dermoscopists. The frequency of findings and the interobserver agreement was analyzed. RESULTS: Scales (83%), dotted/glomerular vessels (77%), pinkish-white areas (73%) and hemorrhage (46%) were the most commonly present dermoscopic findings. Pigmented structures were found in 32% and shiny white structures (follicular or stromal) in 54% of the IEC. Vascular structures (vessels and/or hemorrhage) could be seen in 89% of the lesions. Overall, the interobserver agreement for the respective dermoscopic findings was poor to moderate, with the highest kappa values noted for scales (0.55) and hemorrhage (0.54) and the lowest for pinkish-white areas (0.015). CONCLUSION: Our results confirm those of previous studies on dermoscopy in IEC, including the frequency of pigmented structures despite the fair-skinned population. The interobserver agreement was relatively low. The proposed new terminology and our findings can hopefully serve as a guideline for researchers, teachers and students on how to identify IEC.

Extrafacial Lentigo Maligna: A Clinical And Dermoscopic Analysis According to Localization.

INTRODUCTION: Whether extrafacial lentigo maligna (EFLM) differs clinically and/or dermoscopically according to location has not been analyzed in depth. OBJECTIVES: To evaluate clinical and dermoscopic characteristics regarding different localization in a series of EFLM. METHODS: We conducted a retrospective analysis of clinical and dermoscopic characteristics of 69 histologically proven EFLM retrieved from the database of two private institutions. RESULTS: Of the 69 EFLM included in the study, 25 (36.2%) were located in posterior trunk (PT), 16 (23.2%) in anterior trunk (AT), 15 (21%) in upper extremities (UE), and 13 (18.8%) in lower extremities (LE). Mean diameter among localization were as follows: 14.3 mm in PT, 11.8 mm in AT, 14 mm in UE, and 10 mm in LE (p 0.44). The most frequent dermoscopic criteria were angulated lines and tan structureless areas (70%), followed by atypical pigment network (60%), both with similar distribution among groups. Angulated lines pattern was the most frequent global pattern, observed in 55% of cases. Tan structureless/granularity pattern and patchy peripheral pigmented islands pattern were seen in 15.6% and 11.6% cases, respectively. No statistically significant differences were observed in the distribution of global dermoscopic pattern in the different localizations. CONCLUSIONS: From the clinical point of view, EFLM did not differ in terms of patient's age and diameter regarding localization. Upon dermoscopy, we found no significant differences in the overall dermoscopic pattern in the different localizations.

Effect of estrogen in malignant melanoma.

BACKGROUND: Melanoma is associated with poor prognosis in its advanced stages. Potential influence of estrogen and its metabolites on melanoma growth has been suggested. AIMS: The objective of this review was to provide an overview on the evidence related to estrogen in malignant melanoma. MATERIALS AND METHODS: Literature search using PubMed, Google Scholar and relevant cross-references of the retrieved articles was performed to review relevant published articles related to estrogen and its effects in malignant melanoma. RESULTS: Effect of estrogen signaling on a tissue largely depends on the relative expression of estrogen receptors (ER) α and ß. Gender differences in melanoma may be explained by the difference in expression of these receptors. ERß is the principal ER in melanoma. DISCUSSION: Although there is uncertainty about role of estrogen in pathogenensis and progression of melanoma, evidence suggests that its growth and metastasis are influenced by estrogen stimulation. Role ER on the proliferation of melanoma cells is well described. CONCLUSION: There is a need of safe and effective therapy for melanoma, especially for advanced cases. After the establishment of specific role of estrogen and its receptor, analysis of specific genetic mutation can be performed for proper utilization of targeted therapies.

Non-invasive diagnostic techniques in pigmentary skin disorders and skin cancer.

BACKGROUND: Diagnosis of pigmentary skin disorders, pre-cancerous and cancerous skin diseases is traditionally relied on visual assessment. The most widely applied invasive diagnostic technique is the skin biopsy. There have been significant technological advances in non-invasive diagnostic methods for skin disorders. OBJECTIVE: The objective of this article is to discuss different non-invasive diagnostic modalities, used in the diagnosis of pigmentary skin disorders and cutaneous cancers. METHODS: Comprehensive literature search was performed to screen articles related to non-invasive diagnostic techniques in pigmentary skin disorders and cutaneous cancers. Articles published in journals indexed in PubMed were searched along with those in Google Scholar. Clinical trials, review articles, case series, case reports and other relevant articles were considered for review. References of relevant articles were also considered for review. RESULTS: Dermoscopy and ultrasonography were the only non-invasive diagnostic and imaging techniques available to dermatologists for many years. The advent of computed tomography (CT) and magnetic resonance imaging (MRI) augmented the visualization of deeper structures. Confocal laser microscopy (CLM) and reflectance spectrophotometers have showed promising results in the non-invasive detection of pigmented lesions. Optical coherence tomography (OCT), electrical impedance spectroscopy (EIS), multispectral imaging, high frequency ultrasonography (HFUS) and adhesive patch biopsy aid in the accurate diagnosis of benign, as well as neoplastic skin diseases. CONCLUSION: There have been significant advancements in non-invasive methods for diagnosis of dermatological diseases. These techniques can be repeatedly used in a comfort manner for the patient, and may offer an objective way to follow the course of a disease.

International Dermoscopy Society criteria for non-neoplastic dermatoses (general dermatology): validation for skin of color through a Delphi expert consensus.

BACKGROUND: The International Dermoscopy Society (IDS) recently released a set of five basic dermoscopic parameters (vessels, scales, follicular findings, "other structures," and specific clues) encompassing a total of 31 subitems to standardize the use of dermoscopy in non-neoplastic dermatoses, yet they have been developed taking into account Caucasian/Asian skin, with consequent possible limitations if used in dark skin. OBJECTIVES: To validate the abovementioned criteria for the use in dark-skinned patients (phototypes IV-VI) through an expert consensus. METHODS: The two-round Delphi method was adopted, with an iterative process consisting of two rounds of email questionnaires. Potential panelists were recruited via e-mail from all over the world based on their expertise on dermoscopy of non-neoplastic dermatoses in skin of color. RESULTS: Twenty-two panelists took part in the validation process. All of the five originally proposed parameters and subitems reached agreement during the first round, aside from "follicular red dots." Additionally, during round 1, five new subitems were proposed (perifollicular scales distribution, follicular openings obliteration, broken hairs, eccrine pigmentation, and eccrine ostia obliteration), along with the possibility to change the denomination of parameter 3 (from "follicular findings" to "follicular/eccrine findings") and split it into two subparameters ("follicular findings" and "eccrine findings"). All such proposals reached agreement during the second round and therefore were included in the final list, for a total of 37 items. CONCLUSIONS: Although nearly all the dermoscopic criteria originally proposed by the IDS are applicable even to darker phototypes, several additional variables need to be assessed.

Uncoiled linear looped vessels in basal cell carcinoma: a novel morphology.

We describe two cases of nodular basal cell carcinoma presenting with novel morphology of linear looped hairpin vessels under dermoscopy.

Melanomas de diámetro pequeño: papel de la dermatoscopia y seguimiento con dermatoscopia digital / Small-diameter melanomas: role of dermoscopy and digital dermoscopy follow-up

Antecedentes: El reconocimiento de los melanomas de diámetro pequeño (MDP) a menudo plantea un desafío. Objetivos: Analizar el papel de la dermatoscopia y el seguimiento con dermatoscopia digital en el diagnóstico de los MDP. Diseño: Análisis retrospectivo, observacional, descriptivo, de una serie de 50 MDP diagnosticados entre 2015 y 2019. Resultados: De los MDP, 9 fueron motivo de consulta del paciente (MMC), 30 se detectaron durante el control rutinario de nevos (MMCR) y 11 se diagnosticaron por los cambios observados durante el seguimiento con dermatoscopia digital (MMDD). Cerca del 45% de los MMC fueron clasificados correctamente como lesiones malignas según la "regla ABCD de dermatoscopia"; esto se observó solo en el 20% de los MMCR y en ninguno de los MMDD. El algoritmo "caos y pistas" condujo a la extirpación en casi el 90% de los MMC, el 60% de los MMCR y el 50% de los MMDD. Los porcentajes de melanoma in situ fueron: 55% entre los MMC, 73,3% entre los MMCR y 72,9% entre los MMDD. En los melanomas invasores, el grosor de Breslow medio fue de 0,62 mm en el grupo MMC, de 0,5 mm en el MMCR y de 0,4 mm en el MMDD. Conclusiones: El uso rutinario de la dermatoscopia permite la detección de melanomas con bajo índice de sospecha que los pacientes podrían desconocer. Mediante el seguimiento digital es posible la detección de los melanomas incipientes que carecen no solo de criterios clínicos, sino también dermatoscópicos de malignidad.

Background: Recognition of small-diameter melanomas (SDM) is often challenging. Objective: To analyze the role of dermoscopy and follow-up with digital dermoscopy in the diagnosis of SDM. Design: Retrospective, observational, descriptive analysis of a series of 50 SDM diagnosed between 2015 and 2019. Results: Among the SMD, 9 cases were the patients' reason for consultation (MMC), 30 were detected during routine nevi control (MMCR) and 11 were diagnosed due to changes observed during followup with digital dermoscopy (MMDD). Near 45% of the MMC were correctly classified as malignant lesions according to the "ABCD rule of dermoscopy"; this was observed only in 20% of the MMCR and in none of the MMDD. The "chaos and clues" algorithm led to excision in almost 90% of MMC, 60% of MMCR, and 50% of MMDD. The percentages of in situ melanoma were: 55% in the MMC, 73.3% in the MMCR and 72.9% in the MMDD. Among invasive melanomas, mean Breslow thickness was 0.62 mm in the MMC group, 0.5 mm in the MMCR, and 0.4 mm in the MMDD. Conclusions: The routine use of dermoscopy allows for the detection of melanomas with a low index of suspicion that patients may not be aware of. The use of digital follow-up enables the detection of incipient melanomas that lack not only clinical but also dermoscopic criteria of malignancy.

Basal cell carcinoma, blue-white variant: Dermatoscopic findings in 32 cases.

BACKGROUND: The diagnosis of basal cell carcinoma is histopathological, but there are dermatoscopic criteria that confer high sensitivity and specificity to help the clinician improve its identification. However, the basal cell carcinoma blue-white variant does not totally meet these dermatoscopic criteria, and thus can be confused with other pigmented tumors. In the literature reviewed, we found only five cases of this variant. AIMS: The present objective is to describe the dermatoscopic characteristics of the blue-white variant of basal cell carcinoma observed in a tertiary dermatology institute. METHODS: The dermatoscopy files of patients with a histopathological diagnosis of basal cell carcinoma between January 1, 2006 and December 31, 2015 were reviewed. RESULTS: A total of 32 cases with blue-white variant of basal cell carcinoma were observed over a period of 10 years. Of these cases, 97% presented dermatoscopic findings not included in the aforementioned criteria, such as whitish septa, structureless white areas, homogenous blue pigmentation and shiny white structures. LIMITATIONS: The small sample size and the retrospective nature of the design. CONCLUSION: We consider it important for dermatologists to know this rare variant of basal cell carcinoma and to familiarize themselves with their dermatoscopic findings, in order to prevent erroneous diagnoses or inadequate treatments.