Pigmented nodular melanoma: the predictive value of dermoscopic features using multivariate analysis.

BACKGROUND: Nodular melanoma (NM), representing 10-30% of all melanomas, plays a major role in global mortality related to melanoma. Nonetheless, the literature on dermoscopy of NM is scanty. OBJECTIVES: To assess odds ratios (ORs) to quantify dermoscopic features of pigmented NM vs. pigmented superficial spreading melanoma (SSM), and pigmented nodular nonmelanocytic and benign melanocytic lesions. METHODS: To assess the presence or absence of global patterns and dermoscopic criteria, digitized images of 457 pigmented skin lesions from patients with a histopathological diagnosis of NM (n = 75), SSM (n = 93), and nodular nonmelanocytic and benign melanocytic lesions (n = 289; namely, 39 basal cell carcinomas, 85 seborrhoeic keratoses, 81 blue naevi, and 84 compound/dermal naevi) were retrospectively collected and blindly evaluated by three observers. RESULTS: Multivariate analysis showed that ulceration (OR 4.07), homogeneous disorganized pattern (OR 10.76), and homogeneous blue pigmented structureless areas (OR 2.37) were significantly independent prognostic factors for NM vs. SSM. Multivariate analysis of dermoscopic features of NM vs. nonmelanocytic and benign melanocytic lesions showed that the positive correlating features leading to a significantly increased risk of NM were asymmetric pigmentation (OR 6.70), blue-black pigmented areas (OR 7.15), homogeneous disorganized pattern (OR 9.62), a combination of polymorphous vessels and milky-red globules/areas (OR 23.65), and polymorphous vessels combined with homogeneous red areas (OR 33.88). CONCLUSIONS: Dermoscopy may be helpful in improving the recognition of pigmented NM by revealing asymmetric pigmentation, blue-black pigmented areas, homogeneous disorganized pattern and abnormal vascular structures, including polymorphous vessels, milky-red globules/areas and homogeneous red areas.

Morphological features of naevoid melanoma: results of a multicentre study of the International Dermoscopy Society.

BACKGROUND: Naevoid melanoma (NeM), a rare variant of melanoma, can be difficult to detect as its clinical and histopathological morphology can simulate a naevus. OBJECTIVES: To describe the clinical and dermoscopic features associated with NeM. METHODS: Lesions with a histopathological diagnosis of NeM were collected via an e-mail request sent to all members of the International Dermoscopy Society. All lesions were histopathologically reviewed and only lesions fulfilling a set of predefined histopathological criteria were included in the study and analysed for their clinical and dermoscopic features. RESULTS: Twenty-seven of 58 cases (47%) fulfilled the predefined histopathological criteria for NeM and were included in the study. Clinically, 16 of the 27 NeMs presented as a nodular lesion (59%), eight (30%) as plaque type and three (11%) as papular. Analysis of the global dermoscopic pattern identified three types of NeM. The first were naevus-like tumours (n = 13, 48%), typified by a papillomatous surface resembling a dermal naevus. In these lesions local dermoscopic features included irregular dots/globules (46%), multiple milia-like cysts (38%) and atypical vascular structures (46%). The second type were amelanotic tumours (n = 8, 30%), typified by an atypical vascular pattern (75%). The third type consisted of tumours displaying a multicomponent pattern (n = 4, 15%), characterized by classical local melanoma-specific criteria. Two lesions (7%) were classified as mixed-pattern tumours as they did not manifest any of the aforementioned patterns. CONCLUSIONS: While NeMs may be clinically difficult to differentiate from naevi, any papillomatous lesion displaying dermoscopically atypical vessels and/or irregular dots/globules should prompt consideration for the possible diagnosis of NeM.

Differences in clinicopathological features and distribution of risk factors in Italian melanoma patients.

BACKGROUND: No studies are available in the literature on the distribution of different melanoma features and risk factors in the Italian geographical areas. OBJECTIVE: To identify the differences in clinical-pathological features of melanoma, the distribution of risk factors and sun exposure in various Italian macro-areas. METHODS: Multicentric-observational study involving 1,472 melanoma cases (713 north, 345 centre, 414 south) from 26 referral centres belonging to the Italian Multidisciplinary Group for Melanoma. RESULTS: Melanoma patients in northern regions are younger, with thinner melanoma, multiple primaries, lower-intermediate phototype and higher counts of naevi with respect to southern patients; detection of a primary was mostly connected with a physician examination, while relatives were more involved in the south. Northern patients reported a more frequent use of sunbeds and occurrence of sunburns before melanoma despite sunscreen use and a lower sun exposure during the central hours of the day. CONCLUSIONS: The understanding of differences in risk factors distribution could represent the basis for tailored prevention programmes.

Relapsed actinic keratosis evaluation: an observational Italian multicenter prospective study. Does gender have a role?

AIM: Relapsed actinic keratoses evaluation study (RAKE) was performed in nine Italian centers of dermatology in order to observe the outcome of the treatments of these common skin neoplasms. METHODS: A total of 182 patients were enrolled in 2 cohorts: the first included 144/182 patients (79.1%) evaluated after 6 months from clinical remission, and the second 116/182 (63.7%) evaluated for at least 12 months after clinical remission. Patients were previously treated with topical diclofenac 3% in hyaluronic acid, cryotherapy, photodynamic, curettage or imiquimod cream. RESULTS: Subjects with history of malignant skin diseases showed an increased number of new lesions at 16 months from baseline (12 months from remission) compared to patients without history of cancers (mean 1.58 versus 1.17). Hyperkeratotic lesions healed more rapidly but relapsed at 6 months more frequently than non-hyperkeratotic ones (32.9% versus 20.7%). The results showed gender-related differences: male patients recovered better and independently from the treatment used; in contrast, men showed a higher recurrence (32% at 6 months and 6.6% between 6 and 12 months versus 16% at 6 months and 5.9% between 6 and 12 months for females) and a higher average number of new lesions after 12 months from remission (1.6 versus 0.88 for females). CONCLUSION: The results may suggest a lower adherence to photoprotection in male patients. Hyperkeratotic lesions recurred mostly at 6 months in comparison to non-hyperkeratotic lesions.

Blue-black rule: a simple dermoscopic clue to recognize pigmented nodular melanoma.

BACKGROUND: Dermoscopy improves melanoma recognition, but most criteria were described in the context of superficial spreading melanoma. OBJECTIVES: To test whether pigmented nodular melanoma could be recognized dermoscopically by the presence of a combination of blue and black colour within the lesion. METHODS: Dermoscopic images of histopathologically diagnosed pigmented nodular tumours with no (or only minimal) flat component were evaluated for the presence of standard melanoma criteria and for the presence of a new feature named blue-black (BB) colour. Sensitivity, specificity, positive predictive value and negative predictive value were calculated for standard criteria and BB feature in relation to the diagnosis of melanoma and to diagnosis of malignancy. RESULTS: Of 283 lesions, 160 were malignant, including 78 (27·6%) melanomas, and 123 were benign. The BB feature and the standard criteria had 78·2% and 43·6% sensitivity for melanoma, respectively, whereas a combined method based on the presence of either the BB feature or one (or more) of the standard criteria reached 84·6% sensitivity, with 80·5% specificity and 93·2% negative predictive value. Sensitivity values for malignant lesions were only 24·4%, 56·9% and 60% for standard criteria, BB feature and the combined method, respectively. However, the combined method gave 91·9% specificity and 90·6% positive predictive value for malignancy. CONCLUSIONS: Using a method based on the BB feature or one of the standard melanoma criteria, only 9·4% of positive pigmented nodular lesions were found to be benign and only 6·8% of negative lesions were found to be melanoma histopathologically.

Primary cutaneous gamma/delta T-cell lymphoma presenting as disseminated pagetoid reticulosis.

The first case of primary gamma/delta cutaneous T-cell lymphoma (CTCL) with a fatal outcome is reported. The patient had the clinical and histopathologic features of disseminated pagetoid reticulosis, a rare form of CTCL characterized by a strong epidermotropic lymphoid infiltrate. Extensive immuno-cytochemical studies showed that the neoplastic cells were almost exclusively localized in the epidermis, expressed the gamma/delta variant of the T-cell receptor (CD3+, TCR-delta-1+) and were CD5+, CD7+, CD27+, CD29+, CD43+, CD44+, CD45+, CD45RA+, CD54+, CD69+, but beta F1-, Ti gamma a-, BB3-, A13-, CD2-, CD4-, CD8-, CD11a-, CD49d-, CD25-, CD30-, and HLA-DR-. A comparison of our results with those of the literature, which have not included gamma/delta T-cell receptor analysis, suggests that some reported cases of pagetoid reticulosis may have phenotypes similar to our case. Electron microscopy studies demonstrated that the gamma/delta T lymphocytes were villous, containing dense and multivesicular bodies, and formed close contacts with the surrounding keratinocytes, suggesting that these cells should have a role in the skin-associated lymphoid tissue. The proliferating cells in our case might represent the neoplastic counterpart of the recently reported CD2- subset of normal human peripheral blood gamma/delta T lymphocytes.

Dermochondrocorneal dystrophy (François' syndrome). Report of a case.

Dermochondrocorneal dystrophy (François' syndrome) is an extremely rare disorder characterized by firm, nodular lesions involving the hands and the face; osteochondrodystrophy of the peripheral extremital bones, resulting in limitation of movement; and corneal dystrophy marked by white or brownish opacities. A nonfamilial case of dermochondrocorneal dystrophy was studied in a 45-year-old woman who had severe involvement of the gingival and palatal mucous membranes.

The avidin-biotin peroxidase complex (ABCPx)/in skin immunoelectron microscopy.

The interaction between avidin and biotin can be exploited in immunoperoxidase techniques in three main way: the labeled avidin-biotin technique (LAB); the bridge avidin-biotin technique (BRAB); the performed avidin-biotin complex (ABCPx). In a comparative study of these three methods and the peroxidase antiperoxidase method using serial dilutions of antinuclear positive serum, the ABCPx method yielded the most intense staining. For this reason, the ABCPx method has been applied in immunoelectron microscopy (IEM) techniques on normal and pathological skin employing monoclonal OKT4, OKT6, OKT8 antibodies to detect target membrane antigens. The authors notes that the ABCPx method allows strong staining both in normal and pathological skin and improves tissue preservation.

The dermoscopic versus the clinical diagnosis of melanoma.

Dermoscopy is an useful technique for the diagnosis of melanoma. All the diagnostic dermoscopic methods developed until now have been tested on dermoscopic slides and the real improvement given by this technique to the clinical diagnosis based upon ABCDE criteria is still unknown. For this reason, we decided to undertake a prospective study to compare the clinical diagnosis made with ABCDE criteria, to the dermoscopic diagnosis, made with the method 7FFM, developed by us. A total of 401 lesions were evaluated clinically and dermoscopically. On the basis of the number of the clinical criteria considered sufficient to diagnose a melanoma, various clinical scores, ranging from 1 to 5, can be obtained; data about the sensitivity of the clinical diagnosis of melanoma suggest that the most often used score is score 3. Our method 7FFM presents a sensitivity and a specificity better than those obtained with score 3: 80% versus 66.6% and 89.1% versus 79.3%. Besides this, we have evaluated if the sensitivity of our method 7FFM in the diagnosis of melanoma can be improved with the adjunct of the clinical criteria or of the clinical scores. The best values of sensitivity 93.3% and predictive value negative 97.3% have been obtained with score 2 plus 7FFM. Our results confirm that our method can be used in the screening of pigmented skin lesions in daily office practice and that an improvement in sensitivity without an excessive sacrifice of specificity can be obtained with the adjunct of the clinical score 2.

Long-term treatment of acne with 20% azelaic acid cream.

Preliminary clinical studies (2) proved the effectiveness of topical azelaic acid (AZA) in the treatment of acne vulgaris. During the period of 1982-86 we carried out two studies with 20% AZA cream in patients with acne to determine its clinical indications and therapeutic schedules. The first, open study was of 100 unselected patients of either sex, while a second group of 30 patients formed a part of a larger (309 patients) multicentre single-blind comparison of topical AZA vs. 5% benzoylperoxide (BPO) gel for the treatment of papulopustular acne. The rates of improvement obtained indicate that topical AZA can be considered an effective therapy chiefly for papulo-pustular acne, with a very good local tolerance.

[Use of high-dose lysozyme in the treatment of herpes zoster and flat warts]. / L'uso del lpsozima ad alte dosi nel trattamento dell'herpes zoster e delle verruche piane.

Lysozyme is a natural enzyme with antiviral, antibacterial and immunomodulating+ action. This drug has several dermatological applications particularly in the therapy of some viral skin diseases as herpes zoster, viral warts and aphthous stomatitis. In this work the Author has valued the efficacy of high dosage lysozyme in the treatment of 30 patients with herpes zoster infection and in 10 patients affected with viral plane warts. The good results obtained in this clinical trial confirm those reported in previous papers and denote the usefulness of this therapy.

[National and international experiences with azelaic acid cream in the treatment of papulo-pustular acne]. / Esperienze cliniche nazionali ed internazionali con una crema a base di acido azelaico nel trattamento dell'acne papulo-pustolosa.

In a series of investigation using 20% azelaic acid as a therapy for acne, it was found that the treatment, compared with most common therapies (benzoylperoxide, oral tetracycline) significantly reduced inflamed lesions in papulo-pustular acne. The rates of improvement obtained indicate that topical azelaic acid treatment can be considered an effective therapy for papulo-pustular acne and it compares well with other agents. Azelaic acid cream shows a progressive and significant beneficial effect and its action is more pronounced in long-term treatment.

[Clinical and monitoring experience of isotretinoin in Italy]. / Esperienze cliniche e di monitoraggio dell'isotretinoina in Italia.

We report the results of a multicentric evaluation on effectiveness and safety of isotretinoin in severe acne, recalcitrant to traditional treatments. 208 patients, suffering especially from cystic acne, have been enrolled in a post-marketing clinical trial in 11 Dermatological Italian Departments. The clinical effectiveness of isotretinoin has been very good in 77% of patients, good in 16% and sufficient in 4%. The tolerability of the drug was considered good in 90% of patients. Finally, isotretinoin might be considered as one of the most effective drugs in the therapy of severe forms of acne, resistant to usual treatment, and often affecting patients on the physical and psychological side.

[Skin metastasis of adenocarcinoma of the esophagus. Description of a clinical case]. / Metastasi cutanea di adenocarcinoma esofageo. Descrizione di un caso clinico.

Skin metastasis of digestive tumors is rarely encountered. In this paper the Authors describe a 60 years old patient who developed a submental skin metastasis from esophageal adenocarcinoma. A short literature review this unusual pathological event is also given.

[Atenolol-induced psoriasiform dermatitis]. / Dermatite psoriasiforme indotta da atenololo.

We report the case of a patient who presented a psoriasiform dermatitis after 8 months of atenolol therapy. Regression of the lesions was obtained after suspension of therapy. To our knowledge, few reports of psoriasiform dermatitis induced by atenolol are present in the literature. The Authors briefly discuss the pathogenesis of this drug induced disease.

A clinical contribution to guideline criteria in the excision of pigmentary lesions.

The clinical diagnosis of cutaneous melanoma is often difficult at the first stages of the malignant proliferation. The proposed anamnestic and clinical guidelines can offer useful criteria for the majority of the cases but sometimes a preventive excision is required for lesions that only partially fulfill the classic markers of "at risk" lesions. In this paper based on a comparative study between 2000 pigmented lesions and 40 melanomas of uncertain clinical diagnosis, the Authors recognize 5 statistically significant clinical pattern of benign pigmented lesions undistinguishable from clinically unusual melanomas. Epidemiological data about sex and age of the patients, histologically classification, site of the pigmented lesions and malignant transformation of congenital nevi are also reported.