Total body skin examination for skin cancer screening in patients with focused symptoms.

BACKGROUND: The value of total body skin examination (TBSE) for skin cancer screening is controversial. OBJECTIVE: We sought to determine whether TBSE could be helpful in patients with focused skin symptoms who would not otherwise have undergone TBSE. METHODS: In a prospective, multicenter, cross-sectional study consecutive adult patients were recruited during a period of 18 months. Physicians first inspected problem areas and uncovered areas and then performed TBSE. Equivocal lesions detected in both steps were excised or biopsied. Primary outcomes were the absolute and relative risks of missing skin cancer and the number of patients needed to examine to detect melanoma or another malignancy. A secondary outcome was the proportion of false-positive results obtained by TBSE. RESULTS: We examined 14,381 patients and detected 40 (0.3%) patients with melanoma and 299 (2.1%) with at least one nonmelanoma skin cancer by TBSE. In 195 (1.3%) patients equivocal lesions found by TBSE turned out to be benign. We calculated that 47 patients need to be examined by TBSE to find one skin malignancy and 400 patients to detect one melanoma. The risk of missing one malignancy if not performing TBSE was 2.17% (95% confidence interval 1.25-3.74). Factors significantly increasing the chance to find a skin cancer were age, male gender, previous nonmelanoma skin cancer, fair skin type, skin tumor as the reason for consultation, and presence of an equivocal lesion on problem/uncovered areas. LIMITATIONS: The impact of TBSE on skin cancer mortality was not evaluated. CONCLUSIONS: TBSE improves skin cancer detection in patients with focused skin symptoms and shows a low rate of false-positive results.

Basal cell carcinoma with fibroepithelioma-like histology in a healthy child: report and review of the literature.

We report the case of a 13-year-old girl with a 7 mm plaque on the trunk. The mother of the patient reported that the lesion developed at the age of 3 and it was characterized by a slow growth. In 2003 a dermoscopic examination was executed and a diagnosis of dermical nevus was made. On examination at our department, a red-pinkish plaque with two small areas of ulceration was found on the anterior part of the trunk. At dermoscopic examination we observed vascular pattern with linear-irregular vessels, multiple blue-gray dots, blue-gray ovoid nests, and ulceration. A diagnosis of basal cell carcinoma was made and confirmed by histopathologic examination. The histopathologic specimen showed nests or lobules of basalioid cells associated with a surrounding loose fibromucinous stroma; two patterns were observed: adenoid-cystic and fibroepithelial. Some fibroepithelioma of Pinkus-like areas were present, where the fibrovascular stroma was very abundant with an arborizing network of long, thin cords of basaliod cells that extended downward from the epidermis and created a fenestrating pattern. The lesion was surgically excised. Basal cell carcinoma occurs rarely in children and is most often associated with an underlying condition that predisposes patients to the development of malignancy that was not present in our case.

Dermoscopy of microvenular hemangioma: report of a case.

We describe a 31-year-old woman with an asymptomatic solitary red plaque on the back which measured 2 x 1 cm. The patient reported that it had been growing for a few months. Upon dermoscopic examination, multiple well-demarcated red globules were seen. At the periphery a fine pigment network was present. The lesion was excised and examined histopathologically. The specimen showed proliferation of irregular branching venules with inconspicuous lumina. The tumor cells lacked cellular atypia. Microvenular hemangioma is a rare, slowly growing, benign vascular tumor. It usually presents on the trunk or the extremities of young to middle-aged adults. Microvenular hemangioma is a benign vascular tumor with distinct dermoscopic and histopathological features which enable it to be distinguished from other vascular neoplasms.

Bullous Fixed Drug Eruption Induced by Paracetamol: Report of a Pediatric Case.

Drug eruptions are among the most common adverse drug reactions, affecting approximately 3% of hospitalized patients. A fixed drug eruption (FDE) is a distinct drug-induced reaction pattern that characteristically recurs at the same skin or mucosal site. We report a case of a 2-year-old girl with bullous FDE due to Tachipirina syrup, a preparation containing paracetamol, a commonly used nonsteroidal anti-inflammatory drug in Italy.

Tungiasis: Case Report of a Traveller to Kenya.

Tungiasis is a neglected parasitic skin disease caused by the permanent penetration of the female sand flea Tunga penetrans (also called jigger flea) into the skin of its host. Growing urbanisation, improved housing and the use of appropriate footwear have presumably led to an overall reduction of the occurrence of this ectoparasitosis within the last few decades. However, it is still highly prevalent in regions where people live in extreme poverty, such as in many Latin American and African countries [1, 2]. We report the case of a 44-year-old woman who returned from an excursion trip to Kenya's savannah with an infection of T. penetrans located on her right big toe around the nail. The natural history, pathology, epidemiology, diagnosis, therapy and control of this parasitic skin disease are discussed [1].

Dermoscopic patterns of superficial basal cell carcinoma.

BACKGROUND: Superficial basal cell carcinoma (BCC) presents as a scaly, pink to red-brown patch and is predominantly located on the trunk. Clinical diagnosis may not be always easy and implicates a variety of differential diagnoses; in this situation dermoscopy has been reported improving the diagnostic accuracy. This study investigated dermoscopic patterns of superficial BCC focalizing the most specific and frequent structures in order to improve the diagnostic accuracy. LIMITATIONS: Study population referred to skin lesion clinic. METHODS: Dermoscopic patterns of 42 superficial BCCs were analyzed and photographed. These cases represented the 8% of all BCCs excised in our Department between 2005 and 2006. RESULTS: Dermoscopic structures observed in the 42 superficial BCCs consisted of shiny white to red areas (100%), "erosions" (78.6%), short fine telangiectasias (SFTs) (66.6%), leaf-like areas (16.6%), arborizing telangiectasias (14.3%), blue-gray globules (14.3%) and large blue-gray ovoid nests (4.7%). CONCLUSIONS: Our study identifies the presence of shiny white to red areas, SFTs and "erosions" as main dermoscopic criteria of superficial BCC. Other dermoscopic features, such as leaf-like areas, arborizing telangiectasias, blue-gray globules and large blue-gray ovoid nests, are not strongly associated with the diagnosis of superficial BCC but they are useful in the differential diagnosis from other pigmented and nonpigmented skin lesions.