Pseudomelanomas at a referral ocular oncology center in Brazil / Pseudomelanomas em um centro de referência em oncologia ocular no Brasil

ABSTRACT Objective: To evaluate the epidemiological, clinical, and imaging profile of lesions that mimic choroidal melanoma. Methods: Retrospective study of medical records of suspected choroidal melanoma lesions referred to the Ocular Oncology Service from the Universidade Federal de São Paulo, from 2014 to 2020. Demographic data, clinical history, and exams were evaluated. Results: A total of 104 patients (mean age: 65.57 ± 13.18; 49.04% female) were referred to our service with suspected choroidal melanoma. Of these, 32 (30.77%) were classified as pseudomelanoma, while 72 (69.23%) had a confirmed diagnosis of choroidal melanoma. Pseudomelanoma cases manifested in older individuals (p < 0.001), with smaller lesions in height (p < 0.001), anteroposterior diameter (p = 0.008), and lateral diameter (p = 0.003) on ultrasound. Pseudomelanoma cases were associated with higher frequencies of vitreous hemorrhage (p = 0.014) and lower rates of the presence of a mass (p = 0.001) and retinal detachment (p < 0.001). The main diagnoses of pseudomelanoma cases were choroidal nevus (40.63%), subretinal hemorrhage (18.75%) and choroidal neovascular membrane (18.75%). Conclusion: Almost one third of the cases referred with suspected choroidal melanoma were pseudomelanomas, which demonstrates that there is still a considerable path to improve the ability of general ophthalmologists to clinically discriminate melanoma from other conditions that can mimic it.

RESUMO Objetivo: Avaliar a frequência e o perfil epidemiológico, clínico e de imagem das lesões que simulam o melanoma de coroide. Métodos: Trata-se de estudo de revisão retrospectiva de prontuários de suspeita de lesões de melanoma de coroide de 2014 a 2020 no Setor de Oncologia Ocular da Universidade Federal de São Paulo. Foram avaliados dados demográficos, dados clínicos e exames complementares. Resultados: Um total de 104 pacientes (média de idade: 65,57 ± 13,18; 49,04% do sexo feminino) foram encaminhados ao nosso serviço com suspeita de melanoma de coroide. Destes, 32 (30,77%) foram classificados como pseudomelanoma, enquanto 72 (69,23%) tiveram diagnóstico confirmado de melanoma de coroide. Os casos de pseudomelanoma manifestaram-se em indivíduos mais velhos (p < 0,001) e apresentaram lesões menores em altura (p < 0,001), diâmetro anteroposterior (p = 0,008) e diâmetro lateral (p = 0,003) na ultrassonografia. Os casos de pseudomelanoma estão associados a maiores frequências de hemorragia vítrea (p = 0,014) e menores taxas de presença de massa (p = 0,001) e descolamento de retina (p < 0,001). Os principais diagnósticos dos casos de pseudomelanoma foram nevo (40,63%), hemorragia sub-retiniana (18,75%) e membrana neovascular coroidal (18,75%). Conclusão: Quase um terço dos casos encaminhados com suspeita de melanoma de coroide foram pseudomelanomas, o que demonstra que ainda há um caminho considerável para melhorar a habilidade do oftalmologista geral em discriminar clinicamente o melanoma de outras condições que o simulam.

Nevus apocrino puro: una entidad raramente sospechada / Pure apocrine nevus: a rarely suspected entity

Los nevus apocrinos puros son hamartomas de las unidades pilosebáceas caracterizadas por proliferaciones benignas de glándulas apocrinas maduras, la cual es una descripción microscópica realizada en los reportes de patología sin que se nombre el diagnóstico exacto. Considerando además, los diagnósticos diferenciales clínicos y la baja frecuencia de este diagnóstico, presentamos un caso clínico y una revisión del tema

Pure apocrine nevi are hamartomas of the pilosebaceous units characterized by benign proliferations of mature apocrine glands, which is a microscopic description made in pathology reports without the exact diagnosis being named. Considering the clinical differential diagnoses and its low frequency, we present a case report and a review of the literature on this topic

Mutations of PTCH1 gene in two pedigrees with bifid rib-basal cell nevus-jaw cyst syndrome / 浙江大学学报·医学版

Two male patients with bifid rib-basal cell nevus-jaw cyst syndrome (BCNS) were admitted to Department of Stomatology, the First Affiliated Hospital of Bengbu Medical College due to radiological findings of multiple low density shadows in the jaw. Clinical and imaging findings showed thoracic malformation, calcification of the tentorium cerebellum and falx cerebrum as well as widening of the orbital distance. Whole exon high-throughput sequencing was performed in two patients and their family members. The heterozygous mutations of c.C2541C>A(p.Y847X) and c.C1501C>T(p.Q501X) in PTCH1 gene were detected in both patients. Diagnosis of BCNS was confirmed. The heterozygous mutations of PTCH1 gene locus were also found in the mothers of the two probands. Proband 1 showed clinical manifestations of low intelligence, and heterozygous mutations of c.C2141T(p.P714L) and c.G3343A(p.V1115I) were detected in FANCD2 gene. Proband 2 had normal intelligence and no FANCD2 mutation. The fenestration decompression and curettage of jaw cyst were performed in both patients. Regular follow-up showed good bone growth at the original lesion, and no recurrence has been observed so far.

Immunohistochemical Markers in the Differential Diagnosis of Melanoma and Nevus in Humans

SUMMARY: Immunohistochemistry allows in situ detection of cell and extracellular components through specific antibodies. The objective was to compare the immunohistochemical expression patterns of the S-100, HMB-45 and MART-1 proteins for differential diagnosis of malignant melanoma and melanocytic nevus in human skin biopsies. Thirty-nine biopsies of human tissue were used. They were divided into two groups: 19 in malignant melanoma and 20 in melanocytic nevi. Next, the samples were fixed with paraformaldehyde and processed following the protocol for inclusion. Then, immunohistochemical staining was performed. Finally, the histological and qualitative analysis of the samples was carried out. S-100, HMB-45, and MART-1 markers showed positive immunoreaction in melanoma biopsies. HMB-45 marker was generally present with weaker expression than S-100 and MART-1 in melanocytic nevus biopsies. No expression pattern was observed which specifically associates one or more markers with some types of histopathological diagnosis. Immunohistochemistry is fundamental in differential diagnosis of melanomas and melanocytic nevi. However, there is no antibody or set of antibodies which allows unequivocal diagnosis between melanoma and nevus. It is therefore necessary to analyze with care the expression pattern and location of the lesion using standard morphological characteristics.

RESUMEN: La inmunohistoquímica permite la detección in situ de componentes celulares y extracelulares a través de anticuerpos específicos. El objetivo de nuestro estudio fue comparar los patrones de expresión inmunohistoquímica de las proteínas S-100, HMB-45 y MART-1 para el diagnóstico diferencial de melanoma maligno y nevo melanocítico en biopsias de piel humana. Se utilizaron treinta y nueve biopsias de tejido humano, las que fueron divididas en dos grupos: 19 en melanoma maligno y 20 en nevos melanocíticos. A continuación, las muestras se fijaron con paraformaldehído y se procesaron siguiendo el protocolo convencional para su inclusión. Luego, se realizó la tinción inmunohistoquímica. Finalmente, se realizó el análisis histológico y cualitativo de las muestras. Los marcadores S-100, HMB- 45 y MART-1 mostraron inmunorreacción positiva en biopsias de melanoma. El marcador HMB-45 estuvo generalmente presente con una expresión más débil que S-100 y MART-1 en biopsias de nevo melanocítico. No se observó ningún patrón de expresión que asocie específicamente uno o más marcadores con algunos tipos de diagnóstico histopatológico. La inmunohistoquímica es fundamental en el diagnóstico diferencial de melanomas y nevos melanocíticos. Sin embargo, no existe ningún anticuerpo o panel de anticuerpos que permita un diagnóstico inequívoco entre el melanoma y el nevo. Por tanto, es necesario analizar con cuidado el patrón de expresión y la localización de la lesión utilizando características morfológicas estándar.

Nevo lipomatoso cutáneo superficial / Superficial cutaneous lipomatous nevus

RESUMEN El nevo lipomatoso cutáneo superficial es un nevo o hamartoma del tejido conectivo, idiopático, caracterizado por tumoraciones lobuladas del color de la piel, únicas o múltiples, con cierta predilección por la cintura pélvica; su aparición es poco frecuente. Histológicamente se destaca la presencia de células grasas maduras localizadas ectópicamente en la dermis. Se presentó un paciente de 40 años de edad con lesión en la piel de la región glútea derecha desde niño. Al examen dermatológico presentaba lesiones papulonodulares múltiples, de color de la piel, de tamaño variable, de consistencia blanda, localizadas en la nalga derecha. Se le realizó exéresis y biopsia de piel de lesión papulonodular de mayor tamaño, con diagnóstico histopatológico de nevo lipomatoso cutáneo superficial.

ABSTRACT A superficial cutaneous lipomatous nevus is an idiopathic connective tissue nevus or hamartoma characterized by single or multiple lobulated skin-colored tumors with a certain predilection for the pelvic girdle; its appearance is rare. Histologically, the presence of mature fat cells located ectopically in the dermis stands out. We present a 40-year-old male patient with a skin lesion of the right gluteal region since he was a child. On dermatological examination, he had multiple, skin-colored, papulonodular lesions of variable size and soft consistency located on the right buttock. Exeresis and skin biopsy of a larger papulonodular lesion were performed, with histopathological diagnosis of superficial cutaneous lipomatous nevus.

Nevu agminado en síndrome de nevus displásico / Agminated nevus in dysplastic nevus syndrome

Los nevus melanocíticos agminados (NMA) son poco reportados en la bibliografía mundial. El nevus agminado (NA), puede presentar varios orígenes, dependiendo de ello pueden desarrollar características displásicas, con riesgo potencial de desarrollar melanoma y entrar a formar parte del Síndrome de Nevus Displásico (SND) de acuerdo a su diagnóstico clínico, dermatoscópico, histológico e historia familiar. El objetivo del presente trabajo es presentar y discutir el caso clínico de un paciente masculino de 26 años de edad sin antecedentes patológicos, evaluado en la Clínica Dermatológica Skinlaser en Quito Ecuador en mayo 2020, que presentó múltiples nevus en la superficie corporal, especialmente en la espalda a nivel posterior e interescapular. El estudio enfatiza la importancia de los controles dermatoscópicos y el seguimiento para hacer el reconocimiento de signos de atipia y cambios que hacen sospechar de malignización(AU)

Agminate melanocytic nevus (AMN) are little reported in the world literature. The agminated nevus (NA) can have various origins, depending on it, they can develop dysplastic characteristics, with a potential risk of developing melanoma and become part of Dysplastic Nevus Syndrome (SND) according to its clinical, dermoscopic, histological and history diagnosis. family. The objective of this work is to present and discuss the clinical case of a 26-year-old male patient with no pathological history, evaluated at the Clinica Dermatologica Skinlaser in Quito Ecuador in May 2020, who presented multiple nevi on the body surface, especially in the back at posterior and interscapular level. The study emphasizes the importance of dermoscopic controls and follow-up are essential to recognize signs of atypia and changes that lead to suspicion of malignancy(AU)

Nódulo proliferativo en nevus melanocítico congénito gigante / Proliferative nodule in giant congenital melanocytic nevus

El nevus melanocítico gigante es una entidad poco frecuente. En los primeros meses o años de vida, pueden aparecer nódulos dérmicos pequeños o grandes, muy pigmentados, que pueden crecer rápidamente o incluso ulcerarse. Esto obliga a realizar diagnóstico diferencial con el melanoma. Se presenta el caso de una paciente de 3 años de edad, con gran lesión pigmentada en pierna izquierda, con nódulos de rápido crecimiento, compatibles con nódulo proliferativo.

Giant melanocytic nevi are rare. In the fi rst few months or even years of life, they may develop small or large dermic nodules, very pigmented, with rapid growth o even ulcer formation. This forces the diff erential diagnosis with melanoma. We present a case of a 3 year old female patient, with a large pigmented lesion on the left leg, with nodules compatible with proliferative nodules.

A Case of Cutaneous Spindle Cell Squamous Cell Carcinoma Arising in a Nevus Sebaceous

No abstract available.

Síndrome de CLOVES: tratamiento con rapamicina oral: reporte de dos casos / CLOVES syndrome: treatment with oral rapamycin: report of two cases

INTRODUCCIÓN: El síndrome de CLOVES se caracteriza por sobrecrecimiento lipomatoso asociado a malformaciones vasculares, representando un desafío diagnóstico y terapéutico. La rapamicina, un inhibidor de la vía mTOR, ha demostrado ser una buena alternativa terapéutica en un grupo de anomalías vasculares. Reportamos dos casos de síndrome de CLOVES con buena respuesta al tratamiento con rapamicina oral. OBJETIVO: Reportar la experiencia del uso de rapamicina oral en el tratamiento de dos pacientes con síndrome de CLOVES. CASOS CLÍNICOS: Caso 1: preescolar femenino de tres años de edad con sín drome de CLOVES e historia de hospitalizaciones reiteradas por infección severa de malformaciones linfáticas macroquísticas y episodios trombóticos. Evoluciona con mala calidad de vida, múltiples hospitalizaciones, riesgo quirúrgico y progresión de las lesiones, por lo que se indicó rapamicina oral. A los 6 meses de tratamiento se evidenció reducción clínica y radiológica del tamaño de las masas lipomatosas y linfáticas, ausencia de linforrea cutánea y mejoría significativa de la calidad de vida, sin requerir nuevas hospitalizaciones. Caso 2: escolar femenino de diez años de edad, portadora de síndrome de CLOVES, que desarrolló escoliosis y deterioro de su capacidad motora, haciéndose dependiente del uso de silla de ruedas. Se indicó rapamicina oral, evidenciándose a los cuatro meses de tratamiento mejoría en su capacidad física, independencia y autovalencia, con desaparición de la linforrea. CONCLUSIÓN: Proponemos la rapamicina oral para el tratamiento de pacientes con sín drome de CLOVES que presenten complicaciones y deterioro de la calidad de vida producto de su enfermedad.

INTRODUCTION: CLOVES syndrome is characterized by lipomatous overgrowth associated with vascular malforma tions, representing a diagnostic and a therapeutic challenge. Rapamycin, an mTOR inhibitor, has proved to be a good therapeutic option in some vascular anomalies. In this article, we report two ca ses of CLOVES syndrome with good response to oral rapamycin treatment. OBJECTIVE: To report the outcome of two patients with CLOVES syndrome treated with oral rapamycin. CLINICAL CASES: Case 1: A three-year-old female preschooler with CLOVES syndrome and history of repeated hospita lizations due to severe infections resulting from macrocystic lymphatic malformations and due to thrombotic episodes. The patient evolved with poor quality of life, multiple hospitalizations, surgical risk and progression of the lesions, therefore, oral rapamycin was indicated. After six months of treatment, clinical and radiological reduction in the size of the lipomatous and lymphatic masses, cutaneous lymphorrhea absence and a significant improvement of her quality of life were observed, without requiring new hospitalizations. Case 2: a ten-year-old female schooler with CLOVES syndro me, who developed scoliosis and deterioration of her motor skills, becoming wheelchair-dependent. Oral rapamycin was indicated, showing improvement in her physical capacity, independence and au tonomy, and absence of lymphorrhea after four months of treatment. CONCLUSION: We propose oral rapamycin for the treatment of patients with CLOVES syndrome who present with complications and deterioration in the quality of life as a result of the disease.

Efeitos estéticos e de autoestima do peeling para manchas faciais em idosas / Aesthetic and self-esteem effects of peeling for facial spots in elderly women

Introdução: O processo de envelhecimento da pele é inevitável e contínuo, decorrente de mudanças bioquímicas, morfológicas e fisiológicas, que acomete a estética cutânea, impactada por fatores intrínsecos e extrínsecos. Este processo de envelhecimento gera: linhas de expressão, flacidez, rugas e manchas, provocando baixa da autoestima, levando ao isolamento social comprometendo a qualidade de vida. Objetivo: Identificar a influência do peeling químico Lumix Peel® - Peeling Sequencial Intensivo, no tratamento de manchas faciais e na melhora da autoestima de pacientes idosas. Métodos: O estudo foi composto por 20 idosas; coletou-se o perfil sociodemográfico, as condições da pele e caracterização da mancha. Respondeu-se um questionário de Autoimagem e Autoestima juntamente com registro fotográfico antes e após o tratamento. Na terceira etapa, foram realizadas sessões do Protoloco Lumix Peel® no tratamento de clareamento de manchas. Resultados: Os resultados mostraram que 100% das idosas tratadas apresentaram clareamento geral das manchas faciais e perceptível suavização das linhas de expressão. No que se refere à autoestima e autoimagem, todas as idosas afirmaram melhora após o tratamento. Conclusão: O protocolo de tratamento estético facial resultou em melhorias das condições gerais da pele das idosas, influenciando positivamente na autoestima e autoimagem das idosas. (AU)

Introduction: The aging process of the skin is inevitable and continuous, due to biochemical, morphological and physiological changes, that affect the cutaneous esthetics, being impacted by intrinsic and extrinsic factors. This aging process generates lines of expression, sagging, wrinkles and blemishes, causing low self-esteem, leading to social isolation compromising the quality of life. Objective: To identify the influence of the chemical peeling Lumix Peel® - Intensive Sequential Peeling, in the treatment of facial spots and in the improvement of the self-esteem of elderly patients. Methods: The sample was composed of 20 elderly women; the sociodemographic profile, the skin conditions and the characterization of the spots were collected. A self-concept and selfesteem questionnaire was used along with photographic records before and after treatment. In the third stage, sessions of the Protocol Lumix Peel® were carried out in the treatment of bleaching of spots. Results: The results showed that 100% of the treated elderly presented general bleaching of the facial spots and significant smoothing of the expression lines. About selfesteem and self-image, all the elderly women reported improvement after treatment. Conclusion: The protocol of esthetic facial treatment resulted in improvements of the general conditions of the skin of the elderly, positively influencing the self-esteem and self-concept of the elderly. (AU)

Granuloma anular, pronóstico de diabetes mellitus. A propósito de un caso / Annular granuloma, prognosis of diabetes mellitus. On the purpose of a case

RESUMEN El granuloma anular es una dermatosis de relativa frecuencia en niños, jóvenes y adultos. Está caracterizado por lesiones cutáneas eritemato-pápulo-nodulares, que adoptan una disposición anular. Su etiopatogenia es desconocida, pero con numerosos factores predisponentes, desencadenantes o asociados a ella; como es la diabetes mellitus y/o procesos neoplásicos o paraneoplásicos. Resulta importante el estudio de pacientes con este diagnóstico por su asociación con entidades como las antes mencionadas. Se realizó el reporte de un caso en adulto mayor de 65 años, con diagnóstico de granuloma anular, diabetes mellitus y neoplasia de páncreas.

ABSTRACT Annular granuloma is a dermatosis relatively frequent in children, young and adult people. It is characterized by erythematous-papular-nodular skin lesions adopting annular disposition. Its etio-pathogenesis is unknown, but there are many predisposal, unleashing factors, or associated to this disease, like diabetes mellitus and/or neoplastic or paraneoplastic processes. It is important to study the patients diagnosed with the disease due to its association with entities like those before mentioned. The reported case is the case of a patient elder than 65 years, diagnosed with annular granuloma, diabetes mellitus and pancreas neoplasia.

Inflammatory and linear verrucous epidermal nevus in vulvar region: a differential diagnosis with vulvar condyloma / Nevo epidérmico verrucoso inflamatório e linear na região vulvar: um diagnóstico diferencial com condiloma vulvar

Introduction: Inflammatory linear verrucous epidermal nevus (ILVEN) is a variant of verrucous epidermal nevus. It has a psoriasiform or eczematous and itchy aspect, and has differential diagnosis compared to other more common dermatoses; thus, histological studies are often necessary. It mainly affects women of early age and must be differentiated from condyloma acuminatum. Interestingly, the lower left limb is often involved, but the genital region is rarely affected. Treatment is refractory and the best method is not yet established. Objective: We present a case of unusual vulvar involvement known as inflammatory linear verrucous epidermal nevus. Methods: This was a clinical case report of a child diagnosed with ILVEN in the vulvar region. Case report: An 11-year-old female presented to the gynecology department of the Universidade Federal de Alagoas complaining of pruritic lesions on the large left vulvar lip, perianal and anal regions, and vaginal introitus. The lesions were hypochromic, eroded, and covered by scabs along the Blaschko line with verrucous lesions in the abdomen and upper and lower limbs. These characteristics fit the clinical criteria of Altman and Mehregan, and the histological criteria of Dupre and Christol for diagnosis of ILVEN. The treatment was performed with Vitanol A® and Epidrat Ultra® with partial improvement of the lesions. We chose to excise the lesions to control the condition. Conclusion: These lesions are characterized by recurrent inflammatory phenomena including psoriasiform or eczematous aspects in the extremities with genital involvement being rare. Other common dermatoses are often confused with ILVEN and make anatomically pathological analysis extremely important for diagnosis. Despite details on several types of treatment for ILVEN, there are no studies on relative advantages because this lesion is very refractory to the treatment.

Introdução: Nevo epidérmico verrucoso inflamatório linear (NEVIL) é uma variante do nevo epidérmico verrucoso. Tem aspecto psoriasiforme ou eczematoso e pruriginoso, sendo o diagnóstico diferencial com outras dermatoses mais comuns e o estudo histológico é necessário para diferenciálas. Afeta, principalmente, mulheres em idade precoce e deve ser diferenciado do condiloma acuminado. Curiosamente, o membro inferior esquerdo está envolvido, sendo a região genital raramente afetada. O tratamento é refratário e ainda não está estabelecido qual o melhor método. Objetivo: Apresentar um caso de incomum acometimento vulvar conhecido como nevo epidérmico verrucoso inflamatório linear (NEVIL). Métodos: Realizada documentação de caso clínico de criança com diagnóstico de NEVIL em região vulvar. Relato de caso: Uma paciente do sexo feminino, 11 anos de idade, procurou o serviço de ginecologia da Universidade Federal de Alagoas queixando-se de lesões pruriginosas vegetantes em grande lábio vulvar esquerdo, regiões perianal e anal e introito vaginal. As lesões eram hipocrômicas, erosadas, recobertas por crostas ao longo da linha de Blaschko com lesões verrucosas no abdome e nos membros superiores e inferiores. Essas características se enquadram nos critérios clínicos de Altman e Mehregan e aos critérios histológicos de Dupre e Christol para diagnóstico de NEVIL. O tratamento foi realizado com Vitanol A® e complexo hidratante (Epidrat Ultra®) com melhora parcial das lesões. Optou-se pela exérese das lesões com controle do quadro. Conclusão: Essas lesões se caracterizam por fenômenos inflamatórios recorrentes, incluindo aspecto psoriasiforme ou eczematoso, normalmente em extremidades, sendo raro o acometimento genital. Outras variedades de dermatoses mais comuns são frequentemente confundidas com NEVIL, tornando a análise anatomopatológica de extrema importância para o diagnóstico. Apesar dos detalhes sobre diversos tipos de tratamento para NEVIL, não há estudos sobre vantagens relativas entre eles, uma vez que essa lesão é muito refratária ao tratamento.

Aplicação da microscopia confocal in vivo como método diagnóstico complementar ao exame de dermatoscopia digital: um estudo longitudinal retrospectivo / Application of in vivo confocal microscopy as a complementary diagnostic method to digital dermatoscopy examination: a longitudinal retrospective study

Introdução: O melanoma cutâneo é uma neoplasia que apresenta comportamento agressivo quando em estágio de evolução avançado, de forma que o sucesso no tratamento depende do diagnóstico precoce. A utilização da microscopia confocal in vivo (MC) como técnica complementar à dermatoscopia digital tem se mostrado útil para aumentar a acurácia diagnóstica dessa neoplasia. Semelhante à dermatoscopia, a MC revela detalhes morfológicos da arquitetura tecidual no plano paralelo à pele e, além disso, fornece imagens instantâneas com alta magnificação e resolução celular. Objetivo: Determinar como a utilização da microscopia confocal in vivo como técnica complementar à dermatoscopia digital pode melhorar a acurácia no diagnóstico do melanoma e reduzir o número de excisões cirúrgicas desnecessárias em um hospital referência de oncologia cutânea. Demonstrar por meio do cálculo do Número necessário para tratar (NNT), o impacto da associação dos métodos de imagem na rotina de um hospital referência em oncologia cutânea. Material e método: Trata-se de um estudo, retrospectivo observacional a ser realizado no Departamento de Oncologia Cutânea do A.C.Camargo Cancer Center. Foram incluídas 209 lesões melanocíticas duvidosas, divididas em dois grupos de análise: as lesões que sofreram modificações no seguimento dermatoscópico, sugestivas de melanoma, encaminhadas para excisão cirúrgica, após realização da MC (Grupo de lesões excisadas) e outro grupo em que os achados de benignidade da MC indicaram o seguimento da lesão (Grupo de lesões em seguimento). Todos os casos foram analisados em 3 etapas distintas: dermatoscopia isolada da lesão a ser analisada antes do exame de MC, utilizando-se o método de Análise de Padrão; dermatoscopia digital comparativa: análise das mudanças que levaram a indicação da MC; análise da Microscopia confocal, utilizando protocolo do Departamento. Para o cáculo do NNT da dermatoscopia de seguimento, foram analisadas mais 300 lesões melanocíticas de pacientes que estavam em acompanhamento digital. Resultados: Por meio da regressão logística simples e múltipla, foram criados dois nomogramas de análise para predizer a chance de uma dada lesão ser um melanoma. Posteriormente, de forma inédita, foi calculado valores de NNT em 3 cenários distintos. Os valores obtidos foram de 7,89 para dermatoscopia digital de seguimento, 5,8 para MC e um NNT hipotético de 3,09 quando aplicado aos nomogramas criados, aplicados na amostra. Conclusão: O presente estudo comprova a importância da MC como método de avaliação complementar no seguimento dos nevos melanocíticos em pacientes com alto risco para câncer de pele, aumentando a detecção do melanoma no seu estágio inicial, por meio da criação de dois nomogramas e a criação de uma aplicativo para a sua aplicabilidade.Comprovou-se a redução significativa do NNT quando associado o exame de microscopia confocal à dermatoscopia digital na rotina ambulatorial de seguimento dos pacientes de alto risco num hospital oncológico de referência (AU)

Introduction: Cutaneous melanoma is a neoplasm that presents aggressive behavior when in advanced stage of evolution, so success in treatment depends on early diagnosis. The use of in vivo confocal microscopy (CM) as a complementary technique to digital dermatoscopy has been shown to be useful to increase the diagnostic accuracy of this neoplasm. Similar to dermoscopy, CM reveals morphological details of tissue architecture in the plane parallel to the skin and, in addition, provides instant images with high magnification and cellular resolution. Objective: To determine how the use of in vivo confocal microscopy as a complementary technique to digital dermatoscopy can improve the accuracy of melanoma diagnosis and reduce the number of unnecessary surgical excisions in a cutaneous oncology referral hospital. Demonstrate by calculating the Number Needed to Treat (NNT) the impact of combining imaging methods on the routine of a referral cutaneous oncology hospital. Material and method: This is a retrospective observational study to be performed at the Department of Cutaneous Oncology, Hospital A.C.Camargo Cancer Center. We included 209 dubious melanocytic lesions divided into two groups of analysis: lesions that underwent changes in the dermoscopic follow-up, suggestive of melanoma, which were referred for surgical excision after MC (Excised lesions group) and another group in which the findings of benignity of the MC indicated follow-up of the lesion (Group of injuries in follow-up). All cases were analyzed in 3 distinct stages: isolated dermatoscopy of the lesion to be analyzed before the MC examination, using the Pattern Analysis method; Comparative digital dermatoscopy: analysis of changes that led to the indication of MC, analysis of confocal microscopy, using MC protocol of the Department. For the NNT calculation of the follow up dermatoscopy, it was analysed more than 300 melanocytic lesions from patients that were under digital follow up. Results: Through simple and multiple logistic regression, two analysis nomograms were created to predict the chance of a given lesion being a melanoma. Subsequently, unpublished, NNT values were calculated in 3 different scenarios. The values obtained were 7.89 for follow-up digital dermatoscopy, 5.8 for MC and a hypothetical NNT of 3.09 when applying the nomograms applied to the sample. Conclusion: The current study proves the importance of the MC as complementar evaluation method in the follow up of the melanocytic nevi in patients with high risk for skin cancer, increasing the melanoma detection in its early stage. Through the creation of two new nomograms and its applicability by the creation of an app, it was proven a significative reduction of the NNT when the confocal microscopy examination is associate to the digital dermoscopic in the ambulatory routine of high risk patients follow up in an oncologic reference hospital (AU)

Enfermedades poco frecuentes. Halo nevus. Presentación de un caso clínico / Rare diseases. Halo nevus. Presentation of a clinical case

El Halo Nevus consiste en un área hipopigmentada que rodea un nevus melanocítico preexistente y lo hace desaparecer, dejando una cicatriz hipocrómica en el lugar del nevo. Un 20% puede malignizarse. Se presenta un adolescente con lesiones en sus diferentes estados evolutivos, sin sintomatología adicional, ni antecedentes familiares. Es importante el seguimiento clínico y dermatológico para detectar signos tempranos de malignización con el consiguiente tratamiento oportuno

Summary Halo Nevus consists is an hypopigmented area surrounding a pre-existing melanocytic nevus and make it desappared leaving a hypochromic scar in it place, and 20% may become malignant. We present an adolescent with lesions in their different stages of evolution, without additional symptoms or family history. Clinical and dermatological follow-up is important to detect early signs of malignancy with the following timely treatment

Clinical Analysis of Serial (Staged) Excision for Congenital Melanocytic Nevi: A Single-center Experience / 대한피부과학회지

BACKGROUND: Serial (staged) excision of congenital melanocytic nevi (CMN) is an important treatment option for medium-sized CMN. However, few studies have investigated the outcomes of serial excision in detail.OBJECTIVE: We report our experience regarding serial excision of CMN, including methods to effectively reduce the procedural stages and scar length.METHODS: We retrospectively reviewed medical records of patients with CMN treated between 2008 and 2015; 33 patients (7 men and 26 women) underwent serial excision.RESULTS: The CMN were located on the face (n=11), arms (n=6), legs (n=11), and other areas of the body (n=11), including the back (n=2), chest (n=1), deltoid region (n=1), and buttocks (n=1). The mean CMN area was 19.7 cm². The mean number of surgical stages was 2.2. The mean interval between surgeries was 10.6 months. A marginal S-shaped incision along both edges of the nevus was preferred over elliptical excision, to reduce scarring. Pulsed dye, erbium:yttrium–aluminum–garnet (YAG), neodymium-doped:YAG, and carbon dioxide fractional lasers were used to improve the final outcomes and minimize scarring.CONCLUSION: Serial excision is an effective treatment option associated with greater patient satisfaction, particularly for medium-sized and hairy CMN. Conventional elliptical serial excision is associated with the formation of elongated scars and sacrifices normal skin adjacent to the lesion. The marginal S-shaped incision reduces scarring by dispersing mechanical tension on the scar without skin wastage. Compared with the elliptical excision method, the marginal S-shaped incision reduces the number of surgical stages and results in a cosmetically superior scar. Performing a marginal S-shaped incision is technically challenging in certain anatomical locations, such as the eyes, nose, and mouth. Therefore, it is necessary to combine this procedure with erbium:YAG and neodymium-doped:YAG ablation.

Dermoscopic Evolution of Pediatric Nevi

BACKGROUND: The incidence of pediatric melanoma is very rare. Dermoscopic features help to distinguish pediatric melanoma and common nevi. OBJECTIVE: To study the evolution of dermoscopic findings in benign nevi in childhood through serial observation and photography. METHODS: We examined 504 melanocytic lesions in 100 patients. From each participant, dermoscopic images of the nevi from 4-year dermoscopic follow-up were obtained, including randomly selected nevi. RESULTS: The most common dermoscopic patterns were homogeneous (193 nevi; 38.3%), globular (92 nevi; 18.3%), and reticular (86 nevi; 17.1%). Dermoscopic pattern changes were detected in 27% of patients aged 2~10 years and in 20% of patients aged 11~16 years. The main pattern changes consisted of the transition from homogeneous to globular-homogeneous (16%), from homogeneous to reticular-homogeneous (12%) and from globular to globular-homogeneous (10%). Although 257 of the 504 nevi (51.0%) have stable duration without size changes, 169 of the 504 nevi (33.5%) were enlarged, and 78 of the 504 nevi (15.5%) had become smaller. CONCLUSION: These results contrast with the prevailing view that dermoscopic patterns in pediatric nevi are usually characterized by globular patterns and that melanocytic nevi generally undergo a characteristic transition from a globular pattern to a reticular pattern. Fifty one percent of patients did not exhibit a size change. While 33% of patients had symmetrical enlargement, 15% of patients had involution. Therefore, enlargement is a common dermoscopic change in pediatric nevi, and is not a specific sign of pediatric melanoma.

Hair Follicle Nevus Located on the Neck: Comparison with Accessory Tragus, Cervical Chondrocutaneous Branchial Remnants and Trichofolliculoma

Hair follicle nevus (HFN) is a rare, benign, follicular hamartoma that most frequently presents as a congenital nodule on the face. We experienced a rare case of HFN on the neck of a 14-year-old boy and performed a pilot immunohistochemical study with cytokeratin 19 (CK19) to compare the staining pattern of hair follicles in HFN and its differential diagnoses, accessory tragus, cervical chondrocutaneous branchial remnants (CCBR) and trichofolliculoma. With hematoxylin and eosin stain, HFN showed numerous tiny hair follicles in the dermis with several sebaceous and eccrine glands, and perifollicular fibrous thickening. With CK19 stain, some hair follicles in HFN and CCBR showed positive expression, a few hair follicles in accessory tragus showed weak expression, and no hair follicles in trichofolliculoma showed expression. The present report supports the view that HFN, accessory tragus and CCBR are within the same spectrum of hamartomas.