International expert recommendations on image acquisition for in vivo reflectance confocal microscopy of cutaneous tumors.

BACKGROUND: No international recommendations exist for a minimum imaging requirement per lesion using reflectance confocal microscopy (RCM). This may be beneficial given the increasing use of remote RCM interpretation internationally. OBJECTIVE: To develop international expert recommendations for image acquisition using tissue-coupled RCM for diagnosis of cutaneous tumors. METHODS: Using a modified Delphi approach, a core group developed the scope and drafted initial recommendations before circulation to a larger group, the Cutaneous Imaging Expert Resource Group of the American Academy of Dermatology. Each review round consisted of a period of open comment, followed by revisions. RESULTS: The recommendations were developed after 5 alternating rounds of review among the core group and the Cutaneous Imaging Expert Resource Group. These were divided into subsections of imaging personnel, recommended lesion criteria, clinical and lesion information to be provided, lesion preparation, image acquisition, mosaic cube settings, and additional captures based on lesion characteristics and suspected diagnosis. LIMITATIONS: The current recommendations are limited to tissue-coupled RCM for diagnosis of cutaneous tumors. It is one component of the larger picture of quality assurance and will require ongoing review. CONCLUSIONS: These recommendations serve as a resource to facilitate quality assurance, economical use of time, accurate diagnosis, and international collaboration.

Dermoscopy of Linear Basal Cell Carcinomas, a Potential Mimicker of Linear Lesions: a Descriptive Case-series.

Introduction: Among the various widely recognized basal cell carcinoma (BCC) clinical patterns, linear basal cell carcinoma (LBCC) is an uncommon morphologic variant of BCC. Objectives: Describe the clinical and dermoscopic characteristics of LBCC. Methods: Retrospective study including LBCC cases from 5 dermatology centers in North and South America. Biopsy-proven primary BCCs, that presented with at least 3:1 length:width ratio on physical examination, irrespective of tumor subtype or location, were included. Clinical and dermoscopic analysis were performed by 2 experts in dermoscopy. Results: Eighteen cases of LBCC met our inclusion criteria and were included in the study. Median age at diagnosis was 86.0 years, 10 patients (58.8%) were males. Regarding anatomic location, 11/18 (61.1%) were located on the head and neck, 5/18 (27.7%) cases were found on the trunk, and 2 on lower extremities (11.1%). Under dermoscopy, 15/18 (83.3%) of LBCC were pigmented. All tumors displayed at least one of the BCC-specific dermoscopic criteria the most common being blue-grey globules (72.2%). Conclusions: Dermoscopy might be useful in the differentiation of LBCC from other diagnoses presenting as linear lesions such as scars, scratches/erosions, and tattoos, among others. Some of these lesions might be confused by naked eye examination alone.

Utility of optical coherence tomography in basal cell naevus syndrome: A case report.

Optical Coherence Tomography (OCT) is a useful non-invasive diagnostic tool for diagnosing and monitoring treatment of basal cell carcinomas. We describe the use of OCT in a patient with Basal Cell Naevus Syndrome. Through measuring tumour depth on OCT, management of individual tumours was triaged accordingly using 0.4 mm tumour depth as a cut-off for surgical and non-surgical management. OCT has potential to reduce unnecessary excisions and associated morbidity in this population of patients.

Comprehensive capture of cutaneous melanoma by the Ontario Cancer Registry: validation study using community pathology reports.

Melanoma is often managed outside hospital settings, creating the potential for underreporting to cancer registries. To our knowledge, completeness of melanoma capture in cancer registries has not been assessed using external data sources since the 1980s. We evaluated the melanoma capture rate from 1993 to 2009 in a provincial cancer registry. We identified all melanoma diagnoses in pathology reports from a major community laboratory in Ontario, Canada. Pathologically confirmed diagnoses were linked to Ontario Cancer Registry (OCR) records using health insurance numbers. We calculated capture rates as the proportion of patients with melanoma confirmed by a pathology report, with a corresponding melanoma diagnosis in OCR. OCR captured 3,798 of 4,275 (88.8, 95 % confidence interval: 87.9, 89.8 %) invasive melanoma diagnoses over the 17-year period. Annual capture rates of 94 % or higher were found for over half the study period. Among all 29,133 melanoma diagnoses in OCR, 27.6 % were registered based on a pathology report alone, compared with 3.4 % for non-cutaneous malignancies. This suggests that comprehensive capture of melanoma cases by a provincial cancer registry is achievable using source data from community laboratories. There is a need for ongoing validation to ensure data remain accurate and complete to reliably inform clinical care, research, and policy.

In vivo reflectance confocal microscopy of halo nevus.

BACKGROUND: RCM (reflectance confocal microscopy) is a noninvasive, high-resolution technology that has been proven to improve the diagnostic accuracy over clinical examination in several skin diseases. OBJECTIVE: The aim of this article is to describe the morphologic features of halo nevi (HN) observed with RCM and correlate them with their dermoscopic characteristics. METHOD: Nine patients with the clinical diagnosis of HN were assessed with RCM. A second assessment was performed up to 12 months later. Dermoscopic global patterns were obtained and correlated with the RCM findings. RESULTS: In five (55.6%) cases, pagetoid cells were observed. Nonedged dermal papilla and junctional thickening were found in three (33%) cases. Nucleated cells in the dermal papillae and plump bright cells were observed in seven (77.8%) and six (66.7%) cases, respectively. CONCLUSION: Our study shows that HN observed by RCM can show atypical features that overlap with those observed on atypical melanocytic lesions and malignant melanoma.

[Possible role of psychological and environmental factors in the genesis of childhood vitiligo]. / Factores psicobiológicos en vitiligo infantil: posible rol en su génesis e impacto en la calidad de vida.

BACKGROUND: The exposure to stressing situations may play a role in the appearance of vitiligo. Patients with the disease have a greater sensitivity to environmental stress and a lower threshold to generate catecholamine mediated responses. AIM: To evaluate the temperament and character of patients with vitiligo and explore the relationship of the disease with negative life events and life quality impairment. MATERIAL AND METHODS: The study population were 21 patients with vitiligo aged 5 to 12 years, and two control groups (Gl and G2). Gl was composed by 14 healthy siblings of vitiligo patients. G2 was composed by 21 age and gender matched healthy students from two schools in Santiago, Chile. The Junior Temperament and Character Inventory (JTCI), the Qualitative Psychosocial Development Survey (QPDS), the Life Event Checklist (LEC) and the Children's Life Quality index (CDLQI) were applied (LEC only to vitiligo patients). RESULT: On the temperament dimensions, vitiligo patients scored high on the "harm avoidance" scale in comparison to G2 (13.7 v/s 10.6). Compared with Gl, QPDS showed in vitiligo patients a higher frequency of fear to strangers (71% and 36%, respectively) and a predominant feeling of fear and shyness in response to changes in a close relative (80% and 8%, respectively). There was a negative correlation (protective factor) between the character dimension "self-directedness" and CDLQI score (r =-0.703). CONCLUSIONS: In this group of patients, we found a possible relationship between a specific temperament dimension, vitiligo and its impact on life quality.

Factores psicobiológicos en vitiligo infantil: Posible rol en su génesis e impacto en la calidad de vida / Possible role of psychological and environmental factors in the genesis of chilhood vitiligo

Background: The exposure to stressing situations may play a role in the appearance of vitiligo. Patients with the disease have a greater sensitivity to environmental stress and a lower threshold to generate catecholamine mediated responses. Aim: To evaluate the temperament and character of patients with vitiligo and explore the relationship of the disease withnegative life events and life quality impairment. Material and methods: The study population were 21 patients with vitiligo aged 5 to 12 years, and two control groups (G1 and G2). G1 was composed by 14 healthy siblings of vitiligo patients. G2 was composed by 21 age and gender matched healthystudents from two schools in Santiago, Chile. The Junior Temperament and Character Inventory (JTCI), the Qualitative Psychosocial Development Survey (QPDS), the Life Event Checklist (LEC) and the Childrens’ Life Quality Index (CDLQI) were applied (LEC only to vitiligo patients). Results: On thetemperament dimensions, vitiligo patients scored high on the “harm avoidance“ scale in comparison toG2 (13.7 v/s 10.6). Compared with G1, QPDS showed in vitiligo patients a higher frequency of fear to strangers (71% and 36%, respectively) and a predominant feeling of fear and shyness in response to changes in a close relative (80% and 8%, respectively). There was a negative correlation (protective factor) between the character dimension “self-directedness“ and CDLQI score (r =–0.703). Conclusions: In this group of patients, we found a possible relationship between a specific temperament dimension, vitiligo and its impact on life quality.

Intense pruritus and failure to thrive in Alagille syndrome.

A 4-year-old girl with failure to thrive and intense pruritus associated with Alagille syndrome is described. The clinical features of this autosomal dominant disorder are reviewed. This case highlights the importance of recognizing the severe pruritus as a manifestation of the disease.

[Cost-benefit in the study of the dissemination of stage I and II in breast cancer]. / Costo beneficio del estudio de diseminación en estadios I y II del cáncer de mama.

BACKGROUND: Chest X ray, abdominal ultrasound and bone scintigraphy are usually requested to study a possible dissemination of breast carcinoma. AIM: To study the yield and costs of these exams in the study of dissemination of stage I and II breast carcinoma. MATERIAL AND METHODS: A retrospective analysis of patients operated for a breast carcinoma in a public surgical service. A chest X ray, abdominal ultrasound and bone scintigraphy was requested to all patients in the immediate postoperative period. Age, stage according to pathological TNM and costs per patient were registered. RESULTS: Of 210 women operated, 40 were in stage I (19%) and 85 in stage II (41%). Dissemination study was negative in all stage I patients and in all but two patients in stage II. The yield for detection of distant metastases in these patients was 0.9% for chest X ray, 0% for abdominal ultrasound and 0.9% for bone scintigraphy. The total cost of the study, in Chilean pesos, was $10,369,620 in a public hospital and $16,535,400 in a private clinic. DISCUSSION: Additional exams to detect distant metastases in early stages of breast carcinoma have a low yield and high costs.