Reflectance confocal microscopic evaluation of nonmelanocytic lip lesions.

Lips display various benign and malignant lesions. Considering their functional and cosmetic importance, noninvasive diagnostic methods are required. In vivo reflectance confocal microscopy (RCM) has already been reported to be useful in the evaluation of various skin lesions. The aim of this study was to define the RCM features of nonmelanocytic lip lesions, compare them with healthy lip, and demonstrate the applicability of RCM as a noninvasive diagnostic method for nonmelanocytic lip lesions. Sixty-seven patients with premalignant/malignant, inflammatory, and infectious lip lesions and twenty-one healthy volunteers were included in the study. Following clinical and RCM examination, histopathological confirmation was obtained in all lesions except herpes labialis, verrucae, and aphthae. RCM features of individual lesions and corresponding groups were evaluated and compared. Pleomorphism was the common feature of premalignant/malignant lesions. Dermal invasion of dyskeratotic keratinocytes was visualized in all squamous cell carcinoma lesions. Spongiosis and inflammatory cells were the common features of inflammatory lesions. Hypergranulosis and necrotic keratinocytes were highly specific for lichen planus. The most specific features for discoid lupus erythematosus were irregular pattern, follicular plugs, and perifollicular inflammatory cells. Virus-infected keratinocytes were visualized in herpes and verrucae. RCM features showed high sensitivity and specificity to detect nonmelanocytic lip lesions. Although the penetration is limited to the papillary dermis in nonmucosal skin, imaging down to the mid-dermis with satisfactory resolution was possible on the lips.

Reflectance confocal microscopy as a useful diagnostic tool for monitoring of skin containing vascularized composite allograft rejection: A preliminary study on rats.

Vascularized composite allografts can undergo immune-mediated rejection, and skin biopsies are needed for monitoring of the transplant. However it is an invasive method, and requires processing time and pathological assessment. The purpose of this study is to use a new noninvasive monitoring method of the reflectance confocal microscopy (RCM) to determine severity of the allograft rejection on rats. Five groin flap allotransplantation were performed between 10 male Sprague-Dawley rats. Immunosuppressive therapy with cyclosporine A was given to the recipients during 10 days after surgery and was ended at the 10th postoperative days to allow acute transplant rejection. Following cessation of CsA, concomitant RCM evaluation and skin biopsy was performed every other day from each animal until total rejection of the allograft. Complete rejection of the allograft took nearly about 10 days and 4 or 5 RCM evaluation and skin biopsy was performed from each rat during this period. A total of 17 specimens were evaluated. A scoring system was developed based on the RCM findings. Skin biopsies were evaluated according to the Banff 2007 working classification criteria. RCM evaluation revealed epidermal irregularity and collagen destruction, however mild perivascular inflammation and degeneration of the basal epidermal layer were observed in early and late rejection period respectively with histopathologic evaluation. High correlation was found between the RCM scores and histopathologic grading. The RCM may be the useful tool to reduce the need for skin biopsy for monitoring of the skin containing vascularized composite allograft.

Nicolau syndrome following intramuscular injection of oxytocin in pregnant women: report of two cases.

Nicolau syndrome, also known as embolia cutis medicamentosa, is a well known but very rare complication occuring after intramuscular drug injections and presenting with local intense pain. Immediately after injection the skin blanches and within minutes to hours an erythematous macule develops, which evolves into a livedoid violaceous patch with dendrites. This condition is initially hemorrhagic, then it ulcerates, and eventually heals with an atrophic scar. Many different drugs have been reported to cause Nicolau syndrome . To date there have been no reports of Nicolau syndrome caused by intramuscular oxytocin injection. We would like to report two cases that occured after intramuscular injection of oxytocin.

A new diagnostic technique for tinea incognito: in vivo reflectance confocal microscopy. Report of five cases.

BACKGROUND/PURPOSE: In vivo confocal laser scanning microscopy (CLSM) is a modern non-invasive method for investigation of the skin that allows real-time visualization of individual cells and subcellular structures with the highest resolution imaging comparable to the routine histopathology. Our aim was to demonstrate the potential of CLSM for non-invasive diagnosis of difficult tinea incognito cases. METHODS: Clinically atypical lesions in five cases of tinea incognito due to dermatophyte spp. were demonstrated using reflectance confocal laser scanning microscopy (RCM), parallel to KOH preparation and fungal culture of skin scrapings performed in the same patients. RESULTS: The morphological features characteristic for tinea incognito, namely linear branched hyphae in the intercellular area of the stratum corneum, were readily detectable by means of CLSM. In vivo tissue imaging were performed at three different wavelengths (785, 658, 445 nm) and the best images of fungal elements were obtained at 445 nm. All of our five cases had similar reflectance confocal microscopical findings. CONCLUSIONS: Our findings suggest the potential of CLSM as a non-invasive tool for the diagnosis of tinea incognito having atypical clinical appearance. Although at present the reflectance confocal microscopy cannot replace the current diagnostic standards for tinea incognito, it may be successfully used as in vivo non-invasive screening tool to facilitate the diagnosis and point to the need for further investigation of the patient.

Neurofibroma like nodules on shoulder: First sign of gastric adenocarcinoma.

Cutaneous metastasis is a relatively uncommon manifestation of visceral malignancies. It most often occurs late in the course of a disease but may also be the first presenting sign of advanced visceral cancer. The average incidence of cutaneous metastasis from a visceral neoplasm is 5.3 percent. The incidence of cutaneous metastases from carcinomas of the upper digestive tract has been reported as less than 1 percent. Cutaneous metastases of gastrointestinal tumors are usually nodular and their typical location is in the abdominal wall. A 68-year-old woman presented with a three-month history of painless nodules on the right side of her neck. Skin examination revealed two joined nodules on the right side of her neck. The nodules were skin colored, well-circumscribed, non-motile, soft, and non-tender. Histopathological examination of the skin growth revealed diffuse infiltration of the dermis and subcutaneous tissue by tumoral cells. A diagnosis of metastatic gastric carcinoma was made. However,various cutaneous metastases have been reported as erysipelas-like, zosteriform, and epidermoid cyst-like. Cutaneous metastases must always be distinguished from primary skin tumors. This report emphasizes the need for appropriate investigation of newly appearing, unusual, or persistent skin lesions such as non-healing ulcers, persistent indurated erythemas, and all skin nodules of undetermined causes.

Generalized granuloma annulare resolving to anetoderma.

Granuloma annulare is a benign, degenerative skin disease; the generalized form is rare. The question of an association between generalized granuloma annulare and other internal diseases has been a matter of debate for many years. In this report, we present a 54-year-old latent diabetic patient with generalized granuloma annulare who developed anetoderma during its treatment.

The reflectance confocal microscopy in diagnosis of recurrent basal cell carcinoma.

BACKGROUND: Reflectance confocal microscopy (RCM) is very valuable, non-invasive diagnostic tool in the diagnosis of basal cell carcinoma (BCC). Objective: We aimed to demonstrate the positive predictive value (PPV), negative predictive value, sensitivity and specificity of RCM and dermoscopic features in recurrent BCC. METHODS: The 152 entire lesion sites in 128 patients with BCC were evaluated by clinical examination, dermoscopy and RCM imaging techniques. Biopsy was performed from 46 lesions if there was at least one of the clinical findings or at least one of the diagnostic criteria of BCC with dermoscopy or RCM examination. Histopathological examination was considered as a gold standard for the diagnosis of recurrence BCC. RESULTS: Recurrence was observed in 29 cases (63%). In the dermoscopic examination, arborizing telangiectasia and blue-grey globules were found to be statistically significantly correlated with BCC recurrence (p<0.05). The specificity and PPV of nucleated corneocytes in the stratum corneum and polarisation of elongated nuclei in the epidermis was 100%. PPV of streaming of aggregated tumour cells and variable refractile stroma was 92% with RCM examination. CONCLUSION: RCM is a diagnostic tool with a high PPV, sensitivity and specificity for the diagnosis of recurrence of BCC lesions.

Effectiveness and safety of topical emollients in the treatment of PUVA-induced pruritus.

BACKGROUND: In this study we tried to assess the efficacy of topical emollients in the treatment of patients with PUVA-induced pruritus. MATERIAL AND METHODS: 41 patients over 18 years of age, who received PUVA treatment in the phototherapy unit, were included in the study. Patients were randomly divided into two groups; Group I was administered with a 4% urea lotion and Group II was administered with liquid petrolatum. The follow-up period was minimum 4 weeks. During the first 2 weeks, patients were administered topical emollients and received PUVA treatment together. The next 2 weeks, they continued PUVA treatment without any medication. RESULTS: When time-dependent changes in the visual analogue scale scores for pruritus of both groups were considered, both treatment methods were found to be remarkably successful (p < 0.0001). In addition, an insignificant group-time interaction was identified (p = 0.753). CONCLUSIONS: Topical emollients were found to be effective in the treatment of PUVA-induced pruritus. Both forms of medication can be successfully administered and increase the patient's compliance with medication.