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)

Do you know this syndrome? Type 2 benign symmetric lipomatosis (Launois-Bensaude)

Abstract A 57-year-old female showed bulky, loose tumors, which progressively spread to her arms, anterior chest, and back. She reported dysphagia and dyspnea after mild exertion. She denied alcohol consumption. CT scan of her chest showed no internal lesions. Benign symmetric lipomatosis is a rare syndrome, clinically described as multiple nonencapsulated lipomas of various sizes and symmetrical distribution. This syndrome has three known phenotypes; in type 2 (Launois-Bensaude syndrome), lesions occur primarily on the shoulders, upper arms, and chest, and is unrelated to alcoholism. It causes aesthetic deformities and might block the upper airways. Mediastinal invasion might occur as well.

Syndrome in question

Abstract: Dermatomyositis is a rare inflammatory disease, autoimmune, with proximal myopathy associated with characteristic dermatological manifestations. In adults, 20-50% of the cases are paraneoplastic manifestation, being mandatory the workup for malignancy Herein we report a case of a woman with classic dermatological presentation of dermatomyositis and newly diagnosed breast cancer. In general, the clinical presentation of paraneoplastic dermatomyositis is more exuberant and manifestations may precede, concur or succeed the diagnosis of neoplasia. The prognosis of cases associated with breast cancer is worse than the idiopathic form. Treatment is based mainly on the resolution of the underlying disease, beyond immunosuppressants.

Hyaline fibromatosis syndrome: cutaneous manifestations

Abstract Hyaline fibromatosis syndrome is the current name for clinical manifestations of diseases previously known as “infantile systemic hyalinosis” and “juvenile hyaline fibromatosis”. The authors report representative clinical cases of each one of the above subtypes with emphasis on cutaneous manifestations and difficulties for early diagnosis in this syndrome, essentially of multidisciplinary approach.