Measuring the horizontal and vertical growth rates of superficial spreading melanoma: a pilot study with sequential digital dermoscopy.

BACKGROUND: Some authors have hypothesized that the initial kinetics of the primary melanoma (MM) growth could reflect its biologic aggressiveness. The aim of this study was to pilot a measure of the horizontal vs. vertical growth of superficial spreading melanomas (SSM). METHODS: The dermoscopic images of twenty-three consecutive MMs (17 SSMs and 6 MMs in situ), excised after digital sequential dermoscopy, were reviewed. We built up two indexes: 1) dROG (digital Rate of Growth) defined as Breslow thickness/(t1-tR), where t1 was the reported time of the first dermoscopic image acquisition and tR was the reported time of the acquisition before the lesion excision; 2) lHGR (linear Horizontal Growth Rate) took into account the greater axis of the lesion at two time points, at the time (t1) of the first image acquisition (D1) and before (tR) lesion excision (DR). The index was computed as (DR-D1)/(t1-tR). We built up the Composite Rate of Growth index (cROG) calculated as dROG/lHRG. If the value of cROG is <1 the superficial growth is prevalent on the vertical growth, and if the value is >1 the vertical growth is prevalent on the superficial growth. RESULTS: In 82.6% of lesions the horizontal growth was prevalent on the vertical growth, and in 17.4% of cases the vertical growth was equal or prevalent on the superficial growth. CONCLUSIONS: A small proportion of SSMs with a slow horizontal growth could have a precocious vertical growth. Other larger studies are needed to confirm this observation.

Psoriasis, biological drugs and Coronavirus Disease 2019: Real life experience of two Italian provinces.

On January 30, 2020, World Health Organization (WHO) stated that a new coronavirus disease outbreak [COronaVIrus Disease - 19 (COVID-19)] was an international public health emergency. Many news, often fake ones, about the derived pandemic rapidly spread along the media, thus leading many dermatological patients to identify as "risk category" and sometimes discontinue treatments by themselves. The Dermatology Units in Grosseto and Pordenone simultaneously carried out a data collection by remote-conducted visits, evaluating the incidence of COVID-19 in psoriatic patients. Only 1 patient (close contact of a case) as part of the psoriasis analyzed group was tested and turned out to be positive for SARS-CoV-2, developing no symptoms during the observation period. The collected information may suggest that psoriasis, biotechnologically treated or not, cannot promote or aggravate the clinical trend of the SARS-CoV-2 infection, hence stopping systemic therapy in negative or clinically free SARS-CoV-2 patients is not recommended in general.

Crosstalk between platelets and PBMC: New evidence in wound healing.

Platelet-derived products have proven useful in accelerating healing processes and tissue regeneration. However, despite their widespread use in clinical practice, the cellular and molecular mechanisms involved have not yet been completely clarified. Recent studies show that interaction between platelet gel (PG) and peripheral blood mononuclear cells (PBMC) can result in activation of PBMC and production of several cytokines involved in wound healing and tissue repair. The aim of our study was to analyze whether crosstalk between platelets and PBMC can influence wound healing by modulating release of VEGF, bFGF and IL-10 by PBMC. Cultures of PBMC alone and co-cultures with autologous PG of 24 healthy volunteers were incubated under normoxia for 24 h. VEGF, bFGF and IL-10 concentration and expression were then analyzed in supernatants by ELISA and by real-time RT-PCR. We observed a down-regulation of VEGF and bFGF release and an up-regulation of IL-10 release in co-cultures of PBMC and PG. Platelets are not only important in the early stages of the healing process (clot formation, direct release of growth factors), but also can influence the whole process of tissue regeneration by modulating synthesis and release of VEGF, bFGF and IL-10 by PBMC. These effects could give platelets a new key role in the control of healing processes and provide insights into the clinical success of platelet-derived products in many medical fields.

Parallel-ridge pattern on dermatoscopy: observation in a case of purpura traumatica pedis.

Dermatologists are often referred urgent cases of acral hematoma by general practitioners and sports medicine specialists for the purpose of excluding warts, nevi or melanoma. Acral hematoma is often a cause of anxiety to patients and their families. Here, we report a case of purpura traumatica pedis, referred to us as suspected plantar melanoma because of the finding of parallel-ridge pattern on dermatoscopic examination. To avoid unnecessary and costly procedures, doctors should inquire about any episode of physical exertion before the onset of purpura, recording the lesion's anatomic site (e.g., unilateral vs. bilateral involvement) and clinical features.

Computer-assisted melanoma diagnosis: a new integrated system.

In dermatology, attempts at synergy between man and machine have mainly been made to improve melanoma diagnosis. The aim of the present study was to test an 'integrated digital dermoscopy analysis' (i-DDA) system with a series of melanocytic lesions that were benign and malignant in nature, and to evaluate its discriminating power with respect to histological diagnosis. In a retrospective study we used an i-DDA system to evaluate a series of 856 excised, clinically atypical pigmented skin lesions (584 benign and 272 malignant). The system evaluated 48 parameters to be studied as possible discriminant variables, grouped into four categories (geometries, colours, textures and islands of colour) integrated with three personal metadata items (sex, age and site of lesion) and presence/absence of three dermoscopic patterns (regression structures, blue-white veil and polymorphic vascular structures). Stepwise multivariate logistic regression of i-DDA data selected nine variables with the highest possible discriminant power. At the end of the stepwise procedure the percentage of cases correctly classified by i-DDA was 89.2% (100% sensitivity and 40.8% specificity). The limitations of the study included those associated with a retrospective design and the 'a priori' exclusion of nonmelanocytic skin lesions. By incorporating numerical digital features with personal data and some dermoscopic patterns into the learning process, the proposed i-DDA improved the performance of assisted melanoma diagnosis, with the advantage that our results can be objectively repeated in any other clinical setting.

Influence of Ambient Stressors and Time Constraints on Diagnostic Accuracy of Borderline Pigmented Skin Lesions.

BACKGROUND: Health professionals are required to make complex decisions in dynamic contexts involving many variables and factors. Decisions are more difficult in the presence of uncertainty, urgency and high risk. OBJECTIVE: To evaluate the effect of ambient stressors and time constraints on decision making by expert dermatologists faced with borderline pigmented skin lesions (PSL) (early melanoma vs. atypical nevi). METHODS: We performed a retrospective chart review of PSL from the image databases of our department. A total of 321 PSL (219 nevi and 102 melanomas) were randomly assigned to three groups: control group, ambient stress group and time stress group. The diagnostic accuracy of each group was evaluated as sensitivity and specificity. RESULTS: Mean sensitivity and specificity of diagnosis were 69.2 and 90.5% in the control group, 62 and 81.2% in the ambient stress group and 59.6 and 82.5% in the time stress group, respectively. CONCLUSION: Time constraints and stressors negatively influenced the performance of dermatologists in the diagnosis of atypical PSL.

A case of primitive non-neural granular cell tumor presenting as a single painless bleeding nodule.

Primitive non-neural granular cell tumor is a rare tumor of uncertain lineage that clinically presents as a solitary painless nodule most typically on the extremity or trunk of an adult. We report the case of a 20-year-old man with a small reddish papule on the abdomen, measuring about 2 x 3 mm, surrounded by a faint erythematous halo. Dermoscopy examination shows diffuse red color and weak whitish striae. However, only histological and immunohistochemical evaluation allowed us to perform the correct diagnosis.

Thirty-six cases of epidemic infections due to Trichophyton violaceum in Siena, Italy.

Trichophyton violaceum is an anthropophilous dermatophyte endemic to parts of Africa and Asia, sporadic in Europe. It is an emerging pathogen in Italy due to immigration. We report 36 cases of infections due to T. violaceum, diagnosed in the last 5 years by mycological examination. The source of contagion was 13 children adopted from orphanages.

Granuloma annulare, autoimmune thyroiditis, and lichen sclerosus in a woman: randomness or significant association?

We report a 60-year-old Caucasian female with a 2-year history of diffused granuloma annulare (GA), who presented for the simultaneous occurrence of genital lichen sclerosus (LS) and autoimmune thyroiditis (AT). In our opinion this combination is not just coincidental but may share similar immunopathological mechanisms.

Photolocalized purpura during levofloxacin therapy.

Side-effects associated with levofloxacin treatment include phototoxicity, hypersensitivity and skin disorders. Purpuric eruptions have rarely been reported. We describe the case of a 75-year-old woman who was prescribed a 15-day course of levofloxacin (500 mg twice a day) for hemorrhagic cystitis. On exposure to sunlight, the patient developed a pruritic purpuric eruption on the lower extremities. The acute reaction differed from a classical sunburn, manifesting as confluent petechiae limited to sun-exposed areas and accompanied by pruritus. This was a rare case of solar capillaritis. Purpuric eruptions on photoexposed skin should be considered another unusual side effect of levofloxacin.

Tinea corporis purpurica and onychomycosis caused by Trichophyton violaceum.

We report two cases of tinea corporis purpurica of the legs, presumably caused by self-inoculation of the mycete from the toenails, in two elderly women (80 and 78 years). Trichophyton violaceum was isolated from the skin and nails. Histological examination of a biopsy specimen from the leg lesions confirmed the diagnosis. The source of infection was an Ethiopian carer who had tinea capitis in the first case, and was undiagnosed in the second patient. Cases of purpuric variants of tinea corporis are rare and this is the first report of probable self-inoculation of T. violaceum from onychomycosis.