In vivo reflectance confocal microscopy of equivocal melanocytic lesions detected by digital dermoscopy follow-up.

BACKGROUND: Digital follow-up is a useful method for the detection of melanoma in atypical mole syndrome patients. The combination of digital follow-up (DFU) and reflectance confocal microscopy (RCM) could be useful to increase the accuracy in the classification of equivocal lesions in atypical mole syndrome patients. OBJECTIVES: To assess the impact of RCM analysis on sensitivity and specificity of digital follow-up in a high-risk melanoma setting. METHODS: Retrospective study with dermoscopy and RCM of consecutive equivocal atypical melanocytic lesions exhibiting changes in digital dermoscopy in a referral centre. RESULTS: Sixty-four lesions from 51 patients were included. Thirteen changing lesions (20.3%) corresponded to eight melanomas in situ and five invasive melanomas with Breslow less than 1 mm. Fifty-one lesions corresponded to melanocytic naevus with variable atypia. Total dermoscopy scores were not different between naevus and melanoma neither in the baseline (mean 5.06 and 5.24; P = 0.37) nor in the follow-up dermoscopic control (mean 5.44 and 5.55; P = 0.37). The only significant dermoscopic feature associated with melanoma in multivariate analysis was the presence of streaks after follow-up (P = 0.027; OR = 3.6; CI 1.50-8.70). The confocal microscopy evaluation (by means both the Modena and Barcelona methods) showed a sensitivity and specificity for the diagnosis of melanoma of 100% and 69% respectively. Based on our experience, the combination of RCM and DFU could have avoided 35 of 51 nevi excised. CONCLUSIONS: Reflectance confocal microscopy evaluation of equivocal lesions detected by DFU improved the accuracy in the detection of melanoma. The combination of dermoscopy, DFU and confocal microscopy in equivocal lesions can be useful to dramatically reduce the number of excisions of benign lesions in atypical mole syndrome patients.

Dermoscopic patterns of melanoma metastases: interobserver consistency and accuracy for metastasis recognition.

BACKGROUND: Cutaneous metastases of malignant melanoma (CMMM) can be confused with other skin lesions. Dermoscopy could be helpful in the differential diagnosis. OBJECTIVES: To describe distinctive dermoscopic patterns that are reproducible and accurate in the identification of CMMM. METHODS: A retrospective study of 146 dermoscopic images of CMMM from 42 patients attending a melanoma unit between 2002 and 2009 was performed. Firstly, two investigators established six dermoscopic patterns for CMMM. The correlation of 73 dermoscopic images with their distinctive patterns was assessed by four independent dermatologists to evaluate the reproducibility in the identification of the patterns. Finally, 163 dermoscopic images, including CMMM and nonmetastatic lesions, were evaluated by the same four dermatologists to calculate the accuracy of the patterns in the recognition of CMMM. RESULTS: Five CMMM dermoscopic patterns had a good interobserver agreement (blue naevus-like, naevus-like, angioma-like, vascular and unspecific). When CMMM were classified according to these patterns, correlation between the investigators and the four dermatologists ranged from κ = 0.56 to κ = 0.7. In total, 71 CMMM, 16 angiomas, 22 blue naevi, 15 malignant melanomas, 11 seborrhoeic keratoses, 15 melanocytic naevi with a globular pattern and 13 pink lesions with a vascular pattern were evaluated according to the previously described CMMM dermoscopy patterns, showing an overall sensitivity of 67.9% (range 54.9-76%) and a specificity of 79.9% (range 68.5-93.5%) for the diagnosis of CMMM. CONCLUSIONS: Five dermoscopic patterns of CMMM with good interobserver agreement obtained a high sensitivity and specificity in the diagnosis of metastasis, with the accuracy varying according to the experience of the observer.

Meta-analysis of digital dermoscopy follow-up of melanocytic skin lesions: a study on behalf of the International Dermoscopy Society.

It has been demonstrated that dermoscopic monitoring of melanocytic lesions allows for the recognition of melanoma in early stages while minimizing the excision of benign lesions. However, it is still pending to determine the real impact of digital follow-up in the clinical management of pigmented lesions. To assess the evidence of follow-up of melanocytic skin lesions with digital dermoscopy in the management of individuals at risk for melanoma by performing a meta-analysis. Medline database was screened, no limits in terms of date or language were applied. Original studies were selected when the following criteria were met: performed in clinical setting with clinical and dermoscopic evaluation made by physicians, data regarding population characteristics included, follow-up strategy used described. Fourteen of 145 retrieved references were retained. Included studies account for a total of 5787 patients (mean 445 per study) and 52,739 lesions monitored (mean per study 4057; range 272-11,396) with a mean of 12 lesions monitored per patient; a total of 4388 lesions (8.3%) were excised. The mean length of follow-up was 30 months. A mean of <1 lesion was excised per patient along the surveillance period. The number needed to monitor (NNM) ranged from 31 to 1008 (mean: 348) among eligible studies. For every additional month of monitoring, 1additional melanoma was detected. Using digital dermoscopy follow-up, the proportion of in situ melanoma and thin melanomas are higher than expected in general population. Chances to detect a melanoma during surveillance increase as the length of follow-up extends.

Angiosarcoma de Kaposi en mujer HIV positiva / Kaposi`s Angiosarcoma in an HIV positive female

Se presenta el caso de una mujer de 23 años de edad,adicta parental y heterosexual (ejercía la prostitución), que desarrolló lesiones de Kaposi en mucosa oral e infección pulmonar a P. carinii. Se discute la infrecuencia de casos y los factores que pueden predisponer a que la mujer HIV positiva pueda desarrrollar un sarcoma de Kaposi

Ulceras de mikembro inferior: su importancia desde el punto de vista sanitario y social / Lower extremity ulcers: sanitary and social importance

Los autores estudian los cambios observados en las internacions de pacientes con UMI dutante el período 1995-1998 en el Hospital Carrasco, con especial referncia a egresos, tiempo de estadía, costos de internación y reinternaciones.Exponen protocolo de internacxión para estos pacientes, haciéndose referencia también a los problemas sociales que estas patologías determinan