The peculiar dermatoscopic pattern of scalp melanoma.

BACKGROUND: Melanomas developing on anatomic sites other than the trunk and extremities have a special pathogenetic and mutational profile, morphologic characteristics and biologic behaviour. OBJECTIVE: By retrospectively screening the databases of our centres, we aimed to investigate the dermatoscopic morphology of early scalp melanoma, including in situ and invasive tumours with a Breslow thickness up to 1 mm. METHODS: The databases of three specialized centres for skin cancer diagnosis and management in Greece were retrospectively evaluated to retrieve dermatoscopic images of scalp melanomas. Patients' age and sex were recorded, as well as the precise location of the tumour, using 6 possible sub-locations: frontal, parietal, occipital, temporal, nuchal scalp and vertex. The dermatoscopic images were evaluated by 3 independent investigators for the presence of pre-defined criteria. The dermatoscopic criteria included in the evaluation were selected based on available literature and were categorized in 2 groups: 'classic melanoma criteria' and 'lentigo maligna (LM) criteria'. RESULTS: Of 38 melanomas, 37 (97.4%) displayed brown colour and 23 (60.5%) displayed additional grey or blue colour. The most frequent dermatoscopic criteria were regression (18/38, 47.4%), grey dots/globules (17/38, 44.7%), atypical network (16/38, 42.1%), obliterated follicles (16/38, 42.1%) and angulated lines (15/38, 39.5%). Of 38 melanomas, 28 (73.7%) displayed at least 1 classic melanoma criterion plus at least 1 LM criterion. Of the remaining melanomas, 8 (21.1%) displayed only classic melanoma criteria, 1 (2.6%) only LM criteria and 1 (2.6%) did not exhibit any of the evaluated criteria. CONCLUSIONS: This study demonstrates that early scalp melanoma combines classic with LM criteria in terms of colours and structures.

Clinical and dermatoscopic predictors of squamous cell carcinoma of the lips: a case-control, multicentric study.

BACKGROUND: Squamous cell carcinoma of the lip accounts for 20% of all oral carcinomas. Its diagnosis may be challenging because it clinically resembles actinic cheilitis and inflammatory lesions of the lips. OBJECTIVES: To determine clinical and dermatoscopic predictors of squamous cell carcinoma of the lip vs. other lip lesions. METHODS: Multicentre retrospective morphological study, including histologically confirmed cases of squamous cell carcinoma of the lip and controls consisting of actinic cheilitis and inflammatory lesions of the lips. Clinical and dermatoscopic images were evaluated for the presence of predefined criteria. Crude and adjusted odds ratios and corresponding 95% confidence intervals were calculated by univariate and multivariate logistic regression respectively. RESULTS: A total of 177 lip lesions were evaluated, 107 (60.5%) were squamous cell carcinomas and 70 (39.5%) were controls. The most frequent dermatoscopic criteria of lip squamous cell carcinoma were scales (100%), white halos (87.3%) and ulceration (79.4%). The majority of squamous cell carcinomas displayed polymorphic vessels (60.8%), with linear (68.6%) and hairpin (67.6%) being the most frequent types. Multivariate logistic regression analysis showed that clinical predictors of lip squamous cell carcinoma were exophytic appearance and clinical hyperkeratosis, with 43-fold and 6-fold higher probability respectively. White clods and ulceration in dermoscopy presented a 6-fold and 4-fold increased risk for squamous cell carcinoma respectively. CONCLUSIONS: A scaly lesion with exophytic growth, dermatoscopically displaying white clods, ulceration and linear and hairpin vessels is very likely a squamous cell carcinoma of the lip.

A bicarotid trunk in association with an aberrant right subclavian artery. Report of two cases, clinical impact, and review of the literature.

A combination of an aberrant right subclavian artery (ARSA) and a bicarotid trunk (BCT) appears in up to 2.5% of the population. The aim of this study is to report the higher total and male incidence of this variation in the literature and to summarise its clinical impact, providing useful knowledge to anatomists, radiologists, cardiologists, and vascular and thoracic surgeons in order to avoid diagnostic pitfalls and therapeutic complications. A total of 72 (43 female and 29 male) Greek Caucasian formalin-embalmed cadavers were studied. The international literature was reviewed along with the dissection archives of the Department of Anatomy from 1986 to 2009. Two male cadavers were found to have an ARSA combined with a BCT (incidence: total 2.78%, males 6.9%, females 0%). Both aortic arches consisted of three branches: (1) the BCT, (2) the left subclavian artery, and (3) the ARSA. The common carotids followed a normal route to the neck; the ARSA passed between the trachea and the oesophagus in the first case and behind the oesophagus in the second case, and was accompanied by a non-recurrent laryngeal nerve. In the second cadaver the ARSA formed a sharp angle (kinking/buckling) on its route to the right arm. The ARSA is associated with several congenital cardiovascular anomalies and some chromosomal and other syndromes. It is occasionaly responsible for causing dysphagia, dyspnoea, or acute ischaemia to the right upper limb, and it may present as a superior mediastinal mass in cases of aneurysm formation.