Pigmented onychomatricoma: A clinical simulator that could not mislead ultrasound.

INTRODUCTION: Onychomatricoma is a rare subungual tumor composed of stroma and nail matrix-like epithelium. Only seven cases of the pigmented variant have been reported in the literature. CASE REPORT: We present a 62-year-old male patient with a 2-years history of a single fingernail thickening, deformation, and hyperpigmentation. He had been treated for onychomycosis, without improvement. Due to the increasing hyperpigmentation, and to rule out tumoral entities, including melanoma, a color Doppler ultrasound examination of the nail was requested, which showed a hypoechoic tumor of the nail matrix and bed, with hyperechogenic linear images inside, suggesting the diagnosis of onychomatricoma. Onychectomy and partial matricectomy were performed. Histological evaluation confirmed the diagnosis of onychomatricoma. Discusion and conclusion: Histological evaluation is the gold standard for the diagnosis of onychomatricoma. However, ultrasonography represents an easily accessible, non-invasive diagnostic tool for the initial evaluation of these tumors, especially in unsuspected atypical clinical presentations.

Impact of the time interval between primary melanoma excision and sentinel node biopsy: A systematic review and meta-analysis.

BACKGROUND: Obtaining a sentinel lymph node biopsy (SLNB) specimen is a standard staging procedure in the management of cutaneous melanoma. However, there is no consensus on the safe time interval between the primary melanoma biopsy procedure and the SLNB procedure. OBJECTIVE: We evaluated the association between time from biopsy to SLNB and patients' outcomes for melanoma. METHODS: We performed this systematic review and meta-analysis based on the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: Six retrospective studies were included. Nine thousand seven hundred five patients were identified, of which 4383 underwent a SNLB procedure at a time interval defined as early and 4574 at an interval defined as late. A combined hazard ratio of 1.25 (95% confidence interval [CI] 0.92-1.68) was determined, and there was high heterogeneity (I2 = 83%; P = .002) of the SLNB time interval on melanoma-specific survival. The combined HR for disease-free survival was 1.05 (95% CI 0.95-1.15), with low heterogeneity (I2 = 9%; P = .36). Regarding overall survival, a combined HR of 1.25 (95% CI 0.92-1.70) was found, with low heterogeneity (I2 = 37%; P = .2). LIMITATIONS: There is heterogeneity between some studies. CONCLUSION: There are no significant differences in patient outcome between a short interval versus a long interval between the primary biopsy procedure and obtaining a SNLB specimen.

Dermoscopy of Juvenile Xanthogranuloma.

BACKGROUND: Dermoscopy is useful for the evaluation of juvenile xanthogranuloma (JXG). The classical "setting sun" pattern is characteristic of JXG, but its sensibility appears to be limited. An extensive description of other dermoscopic findings is not available in the literature. OBJECTIVES: The aim of this study was to valuate and describe the clinical and dermoscopic characteristics of a series of JXG cases. METHODS: This is a retrospective descriptive study, including cases with histopathologic diagnosis of JXG, and the availability of clinical and dermoscopic images, assessed for the presence of dermoscopic features based on the available literature. RESULTS: A total of 17 lesions were analyzed. 70.6% showed global symmetry, 35.3% presented the typical "setting sun" pattern. All lesions showed yellow-orange and/or pink-red structureless color. Other dermoscopic features were yellow globules (35.3%), shiny white streaks (23.5%), brown globules (17.6%), pale-brown network (11.8%), negative network (11.8%), erosion/ulceration (11.8%), rosettes (5.9%), and hemorrhage (5.9%). Scales were seen in 64.7% of patients. Vascular structures were observed in all the lesions, mostly in an irregular distribution (76.5%). The observed vessel types were dotted (52.9%), linear (52.9%), branching-arboriform (29.4%), comma-like (23.5%), hairpin-like (17.6%), globular (17.6%), coiled (11.8%), and milky-red globules (5.9%). CONCLUSIONS: Symmetry, yellow/orange-pink/red color, yellow globules, shiny white streaks, and irregularly distributed different types of vascular structures are the main dermoscopic features of JXG. This is the largest dermoscopic registry of JXG published to date.