RESUMO
The clinical diagnosis of pigmented genital lesions is challenging. Reflectance confocal microscopy (RCM) is effective for diagnosis but is limited in its application due to elevated costs. A more affordable dermatoscope with a 400x magnification (D400) has recently been brought to market. The aim of our study was to compare these two imaging techniques for the analysis of pigmented genital tumours. An observational, prospective and mono-centric study was carried out from October 2017 to May 2019, in which clinical, dermatoscopic (20x and 400x) and RCM data from 207 pigmented genital lesions were collected. The images generated via D400 and RCM were analysed by three expert investigators. Similarities between the criteria observed using D400 and RCM were evaluated by each investigator. In total, 207 lesions were included: 183 melanosis, 19 nevi, one basal cell carcinoma (BCC), two condylomas and two melanomas in situ. Our series correlates well with data found in the literature especially for the distribution of different lesions, their topography, and their aspect using x20 dermatoscopy and RCM. Pattern and cell criteria defined using RCM largely paralleled those observed with D400 for all three investigators. Correlation between D400 and RCM was moderate to strong with regards to the identification of the ring pattern and clustered round cells, strong for dendritic and plump cells, and perfect for isolated round cells and spindle cells. D400 is an easy-to-use, cost-effective alternative for the analysis of pigmented genital lesions, particularly for melanosis.
Assuntos
Dermoscopia , Melanose , Microscopia Confocal , Neoplasias Cutâneas , Humanos , Microscopia Confocal/métodos , Melanose/diagnóstico por imagem , Melanose/patologia , Estudos Prospectivos , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/diagnóstico por imagem , Feminino , Masculino , Melanoma/diagnóstico por imagem , Melanoma/patologia , Carcinoma Basocelular/diagnóstico por imagem , Carcinoma Basocelular/patologia , Pessoa de Meia-Idade , Adulto , Condiloma Acuminado/diagnóstico por imagem , Condiloma Acuminado/diagnóstico , Condiloma Acuminado/patologia , Nevo Pigmentado/diagnóstico por imagem , Nevo Pigmentado/patologia , Idoso , Doenças dos Genitais Femininos/diagnóstico por imagem , Doenças dos Genitais Femininos/patologia , Nevo/diagnóstico por imagem , Nevo/patologiaRESUMO
Melasma is a frequent condition worldwide, and it represents one of the most challenging disorders to treat in cosmetic dermatology. One of the critical factors for treatment prognosis is the assessment of the depth and distribution of pigment within the hyperpigmented area. Nowadays, non-invasive skin imaging techniques, such as reflectance confocal microscopy (RCM), have been used to estimate pigment distribution and depth within different skin layers. This article aims to provide a systematic review of RCM applications in melasma, providing terminology and investigating characteristics of melasma at baseline and after medical and laser treatment. Our results support the recognition of two main types of melasma, epidermal and mixed type, thanks to the role of RCM in highlighting the precise pigment depth location in the skin non-invasively. RCM treatment monitoring enables the objectification of pigment variations after treatment and the identification of prognostic factors for different treatment modalities. After the era of the application of RCM as a technique applied strictly to skin cancers, additional cosmetic applications are emerging, such as the application of melasma treatment monitoring.
Assuntos
Melanose , Microscopia Confocal , Humanos , Epiderme/patologia , Epiderme/diagnóstico por imagem , Terapia a Laser/métodos , Melanose/diagnóstico por imagem , Melanose/terapia , Melanose/patologia , Microscopia Confocal/métodosRESUMO
BACKGROUND: Reflectance confocal microscopy (RCM) has quickly transitioned from a research tool to an adjunct diagnostic bedside tool, providing the opportunity for noninvasive evaluation of skin lesions with histologic resolution. RCM is an optical imaging technique that uses near-infrared excitation wavelengths and safe low-power lasers. En-face images of different skin layers (up to the superficial dermis) are acquired in grayscale based on the reflective indices of tissue components. Melanin has the highest reflective index (contrast) and appears bright on RCM. AIMS: We present a review of the current literature on the use of RCM in the diagnosis and management of pigmentary disorders. METHODS: We reviewed PubMed and Ovid Medline databases from January 2000 to June 2021, using MeSH key terms: "reflectance confocal microscopy, confocal laser scanning microscopy, pigmentary disorders, treatment, melasma, vitiligo, freckles, solar lentigo, lentigo, tattoo, complications, melanoma, skin cancers, pigmented lesions, post inflammatory, melanin, photoaging" to identify studies and review articles discussing the use of RCM in the diagnosis and management of pigmentary disorders. RESULTS: RCM findings of pigmentary disorders were divided into the following categories: (1) disorders of increased pigmentation (post-inflammatory hyperpigmentation, melasma, Riehl's melanosis, solar lentigines, ephelides, hori nevus, naevus of Ota, café-au-lait macules, melanocytic nevus, melanoma, nevus spilus, labial mucosal melanosis, and mucosal melanoma), (2) disorders of decreased pigmentation or depigmentation (post-inflammatory hypopigmentation, vitiligo, nevus depigmentosus, halo nevus), and (3) exogenous pigmentation (tattoo, ochronosis). CONCLUSION: RCM has been explored and proven valuable for the evaluation and management of pigmentary disorders including melasma, vitiligo, solar lentigines, tattoo, and tattoo-related complications.
Assuntos
Hiperpigmentação , Hipopigmentação , Lentigo , Melanoma , Melanose , Nevo , Neoplasias Cutâneas , Vitiligo , Humanos , Vitiligo/patologia , Melaninas , Melanose/diagnóstico por imagem , Melanose/terapia , Neoplasias Cutâneas/patologia , Nevo/patologia , Lentigo/diagnóstico por imagem , Lentigo/terapia , Microscopia Confocal/métodosRESUMO
BACKGROUND: The pathophysiology of melasma is multifactorial, resulting in treatment resistance and a high recurrence rate. Recent research suggests that focused ultrasound might treat melasma effectively. OBJECTIVES: To investigate the efficacy and safety of superficial micro-focused ultrasound with visualization (MFU-V) for melasma in Asians. METHODS: Patients (n = 20) with mixed melasma on both cheeks received 2 MFU-V treatments spaced 1 month apart. At monthly visits over 5 months, treatment efficacy and safety were evaluated. Standardized photographs were clinically assessed using the modified Melasma Area and Severity Index (mMASI), and 6-point grading scales for melasma lightening and area of involvement. Patients provided pain, global aesthetic improvement scale (GAIS), and satisfaction assessments. RESULTS: In 40 cheeks, the mean mMASI score was significantly reduced from 13.2 at baseline to 2.4 at month 4, and 2.8 at month 5. Twenty-nine cheeks (72.5%) showed lightening of melasma at month 4 that persisted until month 5, with improvements up to 75% compared to baseline. Melasma area decreased overall, with sites containing >30% melasma involvement decreasing from 55% to 20% by month 5, and none with 70%-89% involvement. Melasma lightening and area improved visibly in 40% and 20% of cheeks, respectively, as early as 1 month after index MFU-V treatment. Improvements continued after the second treatment and persisted until study closure, correlating with patient GAIS and satisfaction scores. Procedure was well tolerated with only mild-to-moderate pain reported in 92.5% of treatments. CONCLUSION: Superficial MFU-V is a safe and effective treatment for melasma.
Assuntos
Melanose , Terapia por Ultrassom , Humanos , Povo Asiático , Melanose/diagnóstico por imagem , Melanose/terapia , Projetos Piloto , Resultado do TratamentoRESUMO
INTRODUCTION: Periorbital melanosis (POM) has a significant impact on quality of life. There is a dearth of literature regarding POM, especially in Asian population. Accurate classification of POM is contributory to the choice of therapy. The aim of this study was to assess the role of dermoscopy in etiologic classification of POM. METHODS: Two hundred and fifty adult patients (age > 18 years) of POM were enrolled over a period of 2 years. POM was classified clinically and re-evaluated based on their dermoscopic findings (pattern of pigmentary and vascular involvement, surface changes). RESULTS: Pigmented, vascular, structural, and mixed types of POM represented 6.4%, 4.8%, 0.4%, and 88.4%, respectively. Dermoscopy was found to be statistically more accurate in classifying pigmentary and vascular types of POM as compared to clinical examination with the naked eyes (p- value <0.05). Patchy or post-inflammatory pigmentation was the most common pigmentary pattern on dermoscopy (53.8%) followed by pseudoreticular (37.1%) and mixed pattern (9.1%). 80.4% patients had vascular involvement of which the most common vascular pattern was telangiectasia (58.8%). Wrinkling or increased skin laxity as a cause of shadow effect was found in 52% patients. Diffuse erythema and scaling suggestive of subtle inflammation was detected in 47.6% patients on dermoscopy. CONCLUSION: Dermoscopy as a diagnostic modality is more accurate in detecting pigmentary and vascular causes of POM and subtle signs of active inflammation in the form of erythema and scaling which is difficult to detect clinically. The major limitations of this study were lack of correlation of dermoscopic findings with the histological findings and the absence of any control group for comparison.
Assuntos
Hiperpigmentação , Melanose , Adulto , Humanos , Pessoa de Meia-Idade , Estudos Transversais , Dermoscopia , Qualidade de Vida , Hiperpigmentação/diagnóstico por imagem , Hiperpigmentação/etiologia , Melanose/diagnóstico por imagem , Melanose/patologia , InflamaçãoRESUMO
Melanosis is a rare benign entity defined by the deposition of brownish-black pigment in a wide variety of organs especially the gastrointestinal tract, peritoneum, fallopian tubes and ovaries. Melanosis of the fallopian tube is widely known as pigmentosis tubae. Literature has mentioned ovarian teratomas and serous cystadenomas to be associated with the ovarian and peritoneal melanosis. We report five such cases of tubo-ovarian melanosis. The cases include mature teratoma and serous cystadenoma as well as melanosis of the fallopian tubes with otherwise normal ovarian histology. The importance of recognising this entity lies in its differential diagnosis.
Assuntos
Tubas Uterinas/patologia , Melanose/diagnóstico por imagem , Neoplasias Ovarianas/diagnóstico por imagem , Ovário/patologia , Teratoma/diagnóstico por imagem , Adolescente , Adulto , Idoso , Cistadenoma Seroso/diagnóstico por imagem , Tubas Uterinas/diagnóstico por imagem , Feminino , Humanos , Melanose/patologia , Neoplasias Ovarianas/patologia , Ovário/diagnóstico por imagem , Teratoma/patologia , UltrassonografiaRESUMO
A pediatric dermatology expert working group performed a narrative review to describe care related to congenital melanocytic nevi (CMN) in neonates and infants. There are no published guidelines for most aspects of care, including routine skin care and visit intervals. Few guidelines exist for surgical management; newer recommendations favor conservative practice. Emerging evidence contributes to recommendations for screening MRI to evaluate for neural melanosis and related central nervous system complications, however, more research is needed. Risk for melanoma is generally low, but those with large, giant, or multiple CMN have a higher risk. Multidisciplinary care, with a focus on family and patient preferences, is of paramount importance. Without standardized screening and management guidelines, questions abound regarding appropriate physical examination intervals, potential treatment including full or partial excision, timing and frequency of imaging, melanoma risk, and assessment for neural melanosis. This review highlights the current state of knowledge concerning care of patients with CMN, reveals gaps in the literature surrounding skin care, and provides management recommendations. We additionally discuss cutaneous complications of CMN, such as pruritus, hypertrichosis, and wound healing. Resources and references for families and providers can help patients navigate this sometimes challenging diagnosis. Finally, we contribute expert care recommendations to the current body of literature as a foundation for the development of future, more comprehensive care guidelines.
Assuntos
Nevo Pigmentado/congênito , Nevo Pigmentado/terapia , Neoplasias Cutâneas/congênito , Neoplasias Cutâneas/terapia , Remoção de Cabelo , Humanos , Hipertricose/etiologia , Hipertricose/terapia , Recém-Nascido , Imageamento por Ressonância Magnética , Melanose/diagnóstico por imagem , Síndromes Neurocutâneas/diagnóstico por imagem , Nevo Pigmentado/complicações , Nevo Pigmentado/patologia , Exame Físico , Prurido/etiologia , Higiene da Pele/métodos , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/patologia , CicatrizaçãoRESUMO
INTRODUCTION: Periorbital melanosis (POM) is an esthetic facial concern on increasing trend and has a severe emotional impact on patients. We aimed to study the clinical and dermoscopic patterns of periorbital melanosis to aid in the classification and strategize therapy. METHODS: A cross-sectional, observational study was conducted on one hundred patients with POM in a tertiary care center in India from January 2020-March 2020. Dermoscopic assessment of POM was done using video dermatoscope- FotoFinder Medicam 1000s (magnification up to 140x). RESULTS: The mean age of participants was 32.8 ± 9 years. It was more prevalent among females (78%). The constitutional type (43%) of POM was the most common followed by shadow-effect type (32%). The various dermoscopic pigmentary patterns seen were scattered pigmented dots (56%), exaggerated pigment network (31%), globules (30%), and blotches (27%). Dilated veins and telangiectasia were seen in 50% and 32% of subjects, respectively. Exaggerated skin markings were seen in 43% of participants. Scattered pigmented dots were most commonly seen in constitutional, vascular, and shadow types but were significantly associated with vascular type. Exaggerated pigment network was the most frequent pigmentary pattern in post-inflammatory type of POM. Globules were significantly associated with constitutional as well as shadow type of POM and blotches with shadow type of POM. CONCLUSIONS: Periorbital melanosis presents as multifactorial entity with constitutional type being the most common. The dermoscopic patterns of POM may provide a clue to the underlying etiology, thereby helping to plan appropriate treatment.
Assuntos
Melanose , Neoplasias Cutâneas , Adulto , Estudos Transversais , Dermoscopia , Feminino , Humanos , Melanose/diagnóstico por imagem , Centros de Atenção Terciária , Adulto JovemAssuntos
Transformação Celular Neoplásica/genética , Cromograninas/genética , Deleção Cromossômica , Variações do Número de Cópias de DNA , Subunidades alfa Gs de Proteínas de Ligação ao GTP/genética , Melanose/genética , Síndromes Neurocutâneas/genética , Transformação Celular Neoplásica/patologia , Criança , Cromossomos Humanos Par 10 , Dexametasona/uso terapêutico , Humanos , Laminectomia , Imageamento por Ressonância Magnética , Masculino , Melanose/diagnóstico por imagem , Melanose/patologia , Melanose/terapia , Síndromes Neurocutâneas/diagnóstico por imagem , Síndromes Neurocutâneas/patologia , Síndromes Neurocutâneas/terapia , Piridonas/uso terapêutico , Pirimidinonas/uso terapêuticoAssuntos
Melanose/complicações , Melanose/diagnóstico por imagem , Síndromes Neurocutâneas/complicações , Síndromes Neurocutâneas/diagnóstico por imagem , Nevo/etiologia , Encéfalo/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Recém-Nascido , Imageamento por Ressonância Magnética/métodos , Coluna Vertebral/diagnóstico por imagemRESUMO
BACKGROUND AND OBJECTIVES: Melasma may be related to aberrant blood vessels, but there has been no report on the utility of dynamic optical coherence tomography (D-OCT) in studying vessel characteristics in melasma. We studied the characteristics of cutaneous blood vessels in melasma and the effects of oral tranexamic acid (TXA) with D-OCT. STUDY DESIGN/MATERIALS AND METHODS: Six patients with moderate to severe melasma had a D-OCT scanning of the areas on the face affected by melasma and not affected by it. Three of them had scans within 3 months after starting oral TXA and at a follow-up visit. Blood flow at different depths of the skin and vessel diameter were compared between the melasma and normal skin. For those taking oral TXA, we compared the percent change of blood flow and diameter between the melasma and normal skin. RESULTS: Dermal blood flow and vessel diameter were greater in the melasma skin than in the normal skin. Oral TXA reduced dermal blood flow in both the melasma and normal skin, but the reduction was more dramatic in the lesional melasma skin. CONCLUSIONS: D-OCT findings that (i) dermal blood vessels in melasma are increased in size and flow and (ii) oral TXA reduced the vessel size and flow, providing evidence supporting the relationship between melasma and cutaneous blood vessels. D-OCT may be utilized in measuring response to treatments targeting melasma. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.
Assuntos
Melanose , Ácido Tranexâmico , Humanos , Lasers , Melanose/diagnóstico por imagem , Melanose/tratamento farmacológico , Tomografia de Coerência ÓpticaRESUMO
INTRODUCTION: Neurocutaneous melanosis (NCM) is a rare congenital syndrome. Except for some retrospective studies, information on clinical follow-up and management of these patients are limited. This study aimed to review our experience on diagnostic protocol and clinical follow-up of patients with NCM in a referral children's hospital in Iran. METHODS: Between 2012 and 2019, eight patients with NCM were consecutively managed in our center. Brain magnetic resonance imaging and cutaneous biopsy were done in all patients at diagnosis. Follow-up surveillance and characteristics of the disease are described. RESULTS: The mean follow-up period was 25.75 ± 13.81 months, and 75% of patients were male. Most magnetic resonance imaging findings were hypersignal lesions in the temporal lobe (75%), cerebellum (62.5%), brainstem (50%), and thalamus (12.5%). Dandy-Walker syndrome was found in 4 patients (50%), and shunt-dependent hydrocephalus was found in 3 patients (37.5%). Cutaneous malignant melanoma and malignant involvement of the central nervous system were found in 2 (25%) and 3 cases (37.5%), respectively. The mortality rate was 37.5%. CONCLUSIONS: There are no specific guidelines for management of NCM due to the rarity of the disease. This study proposed modifications in diagnostic criteria, as well as recommendations for follow-up surveillance.
Assuntos
Encéfalo/diagnóstico por imagem , Neoplasias do Sistema Nervoso Central/patologia , Hidrocefalia/diagnóstico por imagem , Melanoma/patologia , Melanose/diagnóstico por imagem , Síndromes Neurocutâneas/diagnóstico por imagem , Neoplasias Cutâneas/patologia , Pele/patologia , Assistência ao Convalescente , Biópsia , Tronco Encefálico/diagnóstico por imagem , Cerebelo/diagnóstico por imagem , Derivações do Líquido Cefalorraquidiano , Pré-Escolar , Síndrome de Dandy-Walker/complicações , Síndrome de Dandy-Walker/diagnóstico por imagem , Progressão da Doença , Feminino , Hospitais Pediátricos , Humanos , Hidrocefalia/etiologia , Lactente , Recém-Nascido , Irã (Geográfico) , Imageamento por Ressonância Magnética , Masculino , Melanose/complicações , Melanose/patologia , Síndromes Neurocutâneas/complicações , Síndromes Neurocutâneas/patologia , Nevo Pigmentado/patologia , Lobo Temporal/diagnóstico por imagem , Centros de Atenção Terciária , Tálamo/diagnóstico por imagemRESUMO
Pseudomelanosis duodeni is a very rare appearance of the duodenal mucosa, characterized by the presence of a dark pigment (iron oxide) seen in the surface of the villi, evident by endoscopy. It can be associated with pathologies such as arterial hypertension, chronic heart failure, chronic kidney failure, gastrointestinal bleeding, and consumption of different drugs. We describe the case of a 68-year-old male patient, with chronic renal insufficiency, hemodialysis and intravenous iron treatment.
La Pseudomelanosis duodeni es una entidad muy poco frecuente de la mucosa duodenal que se caracteriza por la presencia de un pigmento oscuro de las vellosidades (oxido de hierro) que es evidente mediante endoscopía y puede estar asociado a patologías como hipertensión arterial, insuficiencia cardíaca crónica, insuficiencia renal crónica, hemorragia gastrointestinal y consumo de diferentes fármacos. Describimos el caso de un paciente masculino de 68 años, con antecedentes de insuficiencia renal crónica, en hemodiálisis y uso de hierro intravenoso.
Assuntos
Humanos , Masculino , Idoso , Duodenopatias/patologia , Duodeno/patologia , Melanose/patologia , Duodenopatias/diagnóstico por imagem , Duodeno/diagnóstico por imagem , Endoscopia/métodos , Melanose/diagnóstico por imagemRESUMO
Melasma and facial pigmentary demarcation lines (FPDL) are common causes of patterned facial pigmentation that may mimic each other. There is a paucity of studies investigating these two conditions. The objective of this study was to make a detailed comparative analysis of these disorders. A clinical, dermoscopic, histopathological and immunohistochemical analysis of lesional and perilesional skin was conducted in 20 patients each of melasma and FDPL. The most common morphological patterns were centrofacial in melasma and W-shaped pattern in FPDL. Dermoscopy in melasma revealed similar patterns in lesional and perilesional skin, whereas FPDL did not. Histopathology of melasma revealed increased melanin in the suprabasal and basal layers (100%), melanophages in the upper dermis and solar elastosis (65%) in contrast to FPDL, wherein increased basilar melanin (75%) and dermal melanophages were the key findings. Expression of vascular endothelial growth factor and stem cell factor was slightly increased in lesional melasma skin, but not in FPDL. The study was limited by its small sample size and immunohistochemistry carried out in a few patients. Melasma and FPDL, although similar in presentation, are distinct entities. Dermoscopy, histology and immunohistochemistry reveal subtle differences.