The Association between the Morphology of Vessels in Primary Cutaneous Melanoma on Dermoscopy, with the Breslow Index, the Presence of Ulceration, and the Dermoscopic Signs of Extensive Regression.

BACKGROUND: Dermoscopy is a noninvasive technique for the diagnosis of cutaneous melanoma that may play a role in the preoperative assessment of melanoma thickness. With this technique, several vascular morphologies have been identified. The objectives of this study are to study the presence and morphology of blood vessels in a series of primary melanomas and to investigate whether they are related to the Breslow index, the presence of ulceration, and extensive dermoscopic regression. METHODS: This cross-sectional study included nonacral, nonfacial primary melanomas, with dermoscopic images from four hospitals in Spain. The outcome variables were the Breslow index, the presence of dermoscopic ulceration, and an extensive dermoscopic regression. The explicative variables were the presence of vessels, the predominant vessel in the most raised area of the melanoma, and the presence of polymorphous vessels. To study the association between qualitative variables and the Breslow index, we used the Kruskal-Wallis test or Mann-Whitney U test and between qualitative variables, the χ2 test. To study the magnitude of the association, the ORs (95% CI) were calculated. RESULTS: A set of 516 images from melanomas was collected. The presence of vessels was associated with thicker melanomas (p < 0.001). Vessel type was associated with different Breslow indexes (p < 0.001) (arborizing, linear irregular, corkscrew, glomerular, hairpin, and dotted vessels (in decreasing order)). The polymorphous vessels were associated with thicker melanomas (p < 0.001). Linear irregular vessels were associated with ulceration (OR = 10.6, 95% CI 4.9-24.0, p < 0.001) and dotted vessels with the presence of extensive dermoscopic regression (OR = 2.7, 95% CI 1.4-5.2, p = 0.003). The main limitations of this study were the high selection of cases and the difficulty in identifying vessels in pigmented melanomas by dermoscopy. CONCLUSIONS: The morphology of blood vessels in cutaneous melanoma on dermoscopy is associated with the Breslow index, the presence of ulceration, and extensive dermoscopic regression.

Divided or kissing nevus of the penis: A new case with dermoscopic findings.

We report on a child with a divided or kissing nevus of the penis with benign symmetric globular pattern on dermoscopic examination that evolved into a globular-reticular pattern after 1 year of follow-up. Divided nevus of the penis is exceedingly rare, with only four cases with dermoscopic findings reported to date. Dermoscopy seems to be useful when deciding on the most appropriate management of these cases.

The association between dermoscopic features and BRAF mutational status in cutaneous melanoma: Significance of the blue-white veil.

BACKGROUND: The genetic basis of melanoma affects its clinicopathologic characteristics and increasingly influences its management. B-Raf proto-oncogene, serine/threonine kinase gene (BRAF)-mutated melanoma may present with specific dermoscopic features. OBJECTIVES: To identify the dermoscopic features associated with BRAF mutation in cutaneous melanoma and to evaluate a model capable of predicting BRAF mutations on the basis of dermoscopic and clinicopathologic features that are easily accessible in normal clinical practice. METHODS: A prospective, cross-sectional, observational, and descriptive study was performed. A total of 93 cutaneous melanomas with dermoscopic images from 93 patients were included. BRAF mutational status was determined by genetic analysis using 2 methods: cobas 4800 BRAF V600 Mutation Test (Roche Molecular Systems, Pleasanton, CA) and Sanger sequencing. Clinicopathologic data were collected; dermoscopic images were analyzed by 2 independent blind observers. RESULTS: Blue-white veil in dermoscopy was significantly associated with BRAF mutations (odds ratio, 4.3; 95% confidence interval, 1.6-11.5; P = .003). Patients with BRAF-mutated melanomas were significantly younger than those with wild-type melanomas (odds ratio, 0.96; 95% confidence interval, 0.93-0.99; P = .008). On the basis of these 2 variables, it was possible to predict BRAF mutational status in melanoma with 73% accuracy. LIMITATIONS: Histologic data were obtained from pathology reports. The accuracy of the predictive model has not been tested with a new data set. CONCLUSIONS: Blue-white veil in dermoscopy is associated with BRAF mutations in cutaneous melanoma.

Allergic contact dermatitis from cetearyl alcohol in Thrombocid® ointment.

Thrombocid® ointment (Lacer, Barcelona, Spain) is widely used in Spain and other countries for varicose veins and 22 hematomas. To our knowledge, there are no reported cases of allergic contact dermatitis following its use. Herein we present 23 two cases of allergic contact dermatitis to Thrombocid® ointment, owing to cetearyl alcohol.

Sclerosing perineurioma: case report and literature review.

Perineuriomas are rare tumors derived from perineural cells usually presenting as a single asymptomatic papule or nodule located on an extremity of an adult. A sclerosing subtype has been rarely described. We report a case of painful sclerosing perineurioma in a 42-year-old woman.

Dermoscopic rosettes as a clue for pigmented incipient melanoma.

The rosette structure is a dermoscopic sign visible under polarized light, characterized by 4 white points arranged as a 4-leaf clover. It has been mainly described in facial sun-damaged skin and actinic keratosis, although it has also been found in squamous and basal cell carcinomas, and in 2 cases of hypomelanotic melanomas. We describe 2 different cases of pigmented incipient melanomas with the presence of multiple rosettes and shiny white structures on dermoscopy. In the reflectance confocal microscope they exhibit a disarranged epidermal architecture with atypical and dendritic cells. Histological examination showed focal hyperkeratosis and a normal corneal layer presented alternatively. To our knowledge this is the first description of rosette structures in pigmented melanomas. Based on a proper dermoscopic- confocal-histopathological correlation, we hypothesize that rosettes could correspond to optic phenomena due to changes in the superficial epidermal reaction and in the acrosyringia.

Omalizumab in chronic urticaria: a retrospective series of 15 cases.

Omalizumab is a monoclonal anti-IgE antibody approved for the treatment of severe allergic asthma. There is increasing evidence in the literature of its usefulness in chronic urticaria. Herein, we report a retrospective case series of 15 patients with chronic idiopathic urticaria treated with omalizumab. We reviewed their medical records to assess the improvement achieved after 3 and 6 months of treatment. Complete response was defined as symptom disappearance that could be followed by discontinuation of antihistamines, and partial response as symptom improvement, but with symptom worsening when attempting to discontinue antihistamines. After 3 months of treatment, 12 patients responded, with partial response in 9 and complete response in 3. At 6 months, 8 of 10 patients continuing on omalizumab had a complete response and 2 a partial response. The results of the present retrospective series show the effectiveness of omalizumab in most treated patients, which is consistent with other recently published series and studies. These data support its role in the management of patients with chronic urticaria refractory to conventional treatments.