Exploring Small-Diameter Melanomas: A Retrospective Study on Clinical and Dermoscopic Features.

BACKGROUND: Early melanoma detection allows for timely intervention and treatment, significantly improving the chances of favorable outcomes for patients. Small-diameter melanoma (SDM) typically represents an initial growth phase of cutaneous melanoma. One of the challenges in detecting melanoma in their early stage lies in the fact that dermoscopy criteria have been primarily designed for fully developed lesions. Early-stage melanomas may be difficult to detect and possibly even be overlooked or misinterpreted during examinations. METHODS: The primary aim of this study was to identify valuable clinical and dermoscopic clues to enhance the detection of SDMs. To achieve this objective, we conducted a comprehensive retrospective analysis, including forty SDMs with a diameter of 5 mm or less. These cases were diagnosed over an 8-year period and were collected from five referral centers across Brazil. Seven experienced dermatologists independently assessed the dermoscopic features of each lesion. Additionally, this study includes demographic and histological information. RESULTS: The study encompassed a total of 28 patients, of which 16 were females, accounting for 58% of the participants, with an average age of 43.6 years. Among the small-diameter melanomas (SDMs) under investigation, the majority, constituting 27 cases (69.2%), were identified as "de novo" lesions, i.e., not associated with a nevus. Additionally, eight SDMs (20%) exhibited invasive characteristics, with Breslow index measurements ranging between 0.2 to 0.4 mm, suggesting an early stage of malignancy. During dermoscopic examinations, the most prevalent features observed were irregular dots and globules, present in 95% and 87.5% of cases, respectively. Moreover, brown structureless areas were identified in 70% of lesions, followed by atypical network (67.5%), pseudopods (55%), dotted vessels (47.5%), flat structureless blue-gray areas (42.5%), and irregular blotches (40%). Notably, all SDM were diagnosed in patients under surveillance through total body skin photography (TBSP) and Digital Dermoscopy (DD). CONCLUSIONS: Dermoscopy significantly enhances the diagnostic accuracy of melanoma, even in its early stages. Particularly for high-risk patients with numerous nevi, the identification of a new lesion or subtle changes on dermoscopy during follow-up may serve as the sole clue for an early diagnosis. This emphasizes the critical role of dermoscopy in SDM detection and reinforces the importance of surveillance in high-risk patients for timely and effective management.

Psoriasis comorbidities: complications and benefits of immunobiological treatment

Abstract During the last decade, different studies have converged to evidence the high prevalence of comorbidities in subjects with psoriasis. Although a causal relation has not been fully elucidated, genetic relation, inflammatory pathways and/or common environmental factors appear to be underlying the development of psoriasis and the metabolic comorbidities. The concept of psoriasis as a systemic disease directed the attention of the scientific community in order to investigate the extent to which therapeutic interventions influence the onset and evolution of the most prevalent comorbidities in patients with psoriasis. This study presents scientific evidence of the influence of immunobiological treatments for psoriasis available in Brazil (infliximab, adalimumab, etanercept and ustekinumab) on the main comorbidities related to psoriasis. It highlights the importance of the inflammatory burden on the clinical outcome of patients, not only on disease activity, but also on the comorbidities. In this sense, systemic treatments, whether immunobiologicals or classic, can play a critical role to effectively control the inflammatory burden in psoriatic patients.

Psoriasis comorbidities: complications and benefits of immunobiological treatment.

During the last decade, different studies have converged to evidence the high prevalence of comorbidities in subjects with psoriasis. Although a causal relation has not been fully elucidated, genetic relation, inflammatory pathways and/or common environmental factors appear to be underlying the development of psoriasis and the metabolic comorbidities. The concept of psoriasis as a systemic disease directed the attention of the scientific community in order to investigate the extent to which therapeutic interventions influence the onset and evolution of the most prevalent comorbidities in patients with psoriasis. This study presents scientific evidence of the influence of immunobiological treatments for psoriasis available in Brazil (infliximab, adalimumab, etanercept and ustekinumab) on the main comorbidities related to psoriasis. It highlights the importance of the inflammatory burden on the clinical outcome of patients, not only on disease activity, but also on the comorbidities. In this sense, systemic treatments, whether immunobiologicals or classic, can play a critical role to effectively control the inflammatory burden in psoriatic patients.

The use of ustekinumab in a patient with severe psoriasis and positive HBV serology.

Psoriasis is a chronic inflammatory, immune-mediated disease that affects 1% to 2% of the world's population. Immunobiological medications are prescribed for certain patients with severe forms of psoriasis, however, these drugs increase the risk of reactivation of viral diseases such as hepatitis B. We report the case of a patient with severe psoriasis with positive serology for the Hepatitis B virus, who received ustekinumab (a human monoclonal antibody against interleukin 12 and 23). In this patient, the use of ustekinumab did not reactivate the Hepatitis B virus. Given the high prevalence of chronic viral infections in patients who are candidates for biologic therapy, as well as the potential for reactivate chronic viral illness, randomized controlled studies are needed to assess the risks and benefits of such therapy in these populations.

The use of ustekinumab in a patient with severe psoriasis and positive HBV serology

Psoriasis is a chronic inflammatory, immune-mediated disease that affects 1% to 2% of the world's population. Immunobiological medications are prescribed for certain patients with severe forms of psoriasis, however, these drugs increase the risk of reactivation of viral diseases such as hepatitis B. We report the case of a patient with severe psoriasis with positive serology for the Hepatitis B virus, who received ustekinumab (a human monoclonal antibody against interleukin 12 and 23). In this patient, the use of ustekinumab did not reactivate the Hepatitis B virus. Given the high prevalence of chronic viral infections in patients who are candidates for biologic therapy, as well as the potential for reactivate chronic viral illness, randomized controlled studies are needed to assess the risks and benefits of such therapy in these populations.

Do you know this syndrome?

Congenital hypotrichosis and Stargardt macular dystrophy are rare autosomal recessive disorder of unknown etiology respectively characterized by hair loss, macular degeneration and severe progressive vision reduction. There are few reports in the literature with this association. Studies show that the defective gene is on the chromosome I6q22.1 and involve cadherin molecule in the pathogenesis. Early recognition of these disorders often starts with hair changes and should alert the dermatologist for an eye examination thereby avoiding more severe ocular defect.

Late reaction to ustekinumab infusion.

Psoriasis is a chronic inflammatory disease that directly affects the quality of life. Biologics are prescribed for patients unresponsive to conventional treatments and with severe forms of the disease. Ustekinumab is a fully human monoclonal antibody against the p40 subunit of interleukins 12/23 that is being used with satisfactory responses, achieving an improvement in the baseline Psoriasis Area and Severity Index of approximately 75% after 12 weeks of treatment. It has few side effects, including grater susceptibility to infections and development of reactions to the drug. Our report discusses a case of a cutaneous reaction to the use of ustekinumab in a 27 year-old male patient after the third dose of the medication. No similar case has been reported in the literature.

Vasculite urticariforme com comprometimento renal glomerular: relato de caso / Urtical vasculitis with renal glomerular disease: case report

JUSTIFICATIVA E OBJETIVOS: A vasculite urticariforme (VU) corresponde entre 5% a 10% das urticárias crônicas, devendo-se distinguir suas lesões daquelas da urticária crônica idiopática, que é a forma mais comum. Apesar de comumente ser de origem idiopática, pode ocorrer em associação com doenças autoimunes, reação a drogas, infecções ou malignidade, podendo ocorrer de forma sistêmica ou limitada à pele. O diagnóstico de VU deve ser considerado na presença de urticária persistente com achados clínicos e sorológicos sugestivos, ou evidência de doença sistêmica. O objetivo deste estudo foi mostrar um caso raro de acometimento renal da forma normocomplementêmica da vasculite urticariforme. RELATO DO CASO: Paciente do sexo masculino, 38 anos, previamente hígido, que apresentava lesões papulares eritêmato-violáceas extensas. Exames laboratoriais iniciais não apresentavam alterações significativas; exame qualitativo de urina demonstrava alteração progressiva da função renal e níveis nefróticos de proteinúria. A imunofluorescência renal foi negativa. Sorologias foram todas negativas e exames imunológicos não reagentes. Dosagemde complemento sérico (C3 e C4) foi normal. Realizou-se pulsoterapia com corticoide endovenoso e seguimento com corticoide oral, obtendo-se boa resposta clínica. A lesão cutânea apresentou regressão espontânea sem o uso de medicação tópica. CONCLUSÃO: O diagnóstico da doença sistêmica a partir de uma alteração cutânea salienta a importância da investigação adicional das lesões vasculares de pele.

BACKGROUND AND OBJECTIVES: Urticarial vasculitis (UV) corresponds between 5% to 10% of chronic urticaria, and their lesions must be distinguished from those of chronic idiopathic urticaria, which is more common. Although commonly idiopathic, it may occur associated with autoimmune diseases, drug reactions, infections or malignancy, which may occur in asystemic presentation or limited to the skin. The diagnosis of UV should be considered in the presence of persistent urticaria with suggestive clinical and serologic findings, or evidence of systemic disease. The case report illustrates a rare renal complication of the normocomplementemic form of urtical vasculitis. CASE REPORT: Male patient, 38 years, previously healthy, who presented extensive erythematous-violaceous papules. Initial laboratory tests showed no significant changes, qualitative urine test showed progressive impairment of renal function and levels of nephrotic proteinuria. Renal immunofluorescence was negative. Serology and immunological tests were all negative. Dosage of serum complement (C3 and C4) was normal. We performed intravenous steroid pulse therapy and follow up with oral steroids,obtaining good clinical response. The skin lesions regressed spontaneously without the use of topical medication. CONCLUSION: The diagnosis of systemic disease from a skin change emphasizes the importance of further investigation of cutaneous vascular lesions.

Neurofibromatose tipo 1 / Neurofibromatosis type 1

Uma mulher de 45 anos se apresentou no Serviço de Pneumologia relatando cansaço, dispneia, nodulações na pele e manchas em todo o corpo. Apresentou diagnóstico de neurofibromatose tipo 1, também conhecida como doença de von Recklinghausen, uma das doenças de herança autossômica dominante mais frequentes na espécie humana e que será objeto desta revisão. As manifestações dermatológicas clássicas da NF caracterizam-se pela presença de neurofibromas e manchas café com leite. Será discutida aqui a importância do diagnóstico dessa doença de caráter hereditário para possibilitar aconselhamento genético à família acometida e esclarecimento ao portador

A 45-year-old female visited the pulmonology department reporting fatigue, dyspnea, skin nodules and stains throughout the body. She had the diagnosis of neurofibromatosis type 1, also known as von Recklinghausen’s disease, one of the most frequent autosomal dominant diseases in humans, which will be the focus of this review. The typical skin manifestations of neurofibromatosis are characterized by the presence of neurofibromas and café au lait spots. Here we discuss the importance of diagnosing this hereditary disease in order to deliver genetic counseling and information to the carriers and their families

Xanthogranulomatous cystitis: case report and literature review

A cistite xantogranulomatosa (CX) é uma rara doença inflamatória crônica e benigna de etiologia desconhecida. É apresentado um caso de cistite xantogranulomatosa em um paciente masculino de 53 anos. A evolução do paciente incluiu estudos clínicos, radiológicos e histológicos. Não houve recorrência em 32 meses de seguimento após o tratamento. Este caso é provavelmente o 21o a ser relatado no mundo, e o primeiro caso na literaturabrasileira

Xanthogranulomatous cystitis (XC) is a rare benign chronic inflammatory disease of unknown etiology. A case of Xanthogranulomatous cystitis in a 53 year-old male is presented. Patient evolution included clinical, radiological, and histological studies. He had no recurrence of XC 32 months after treatment. The present case is probably the 21st to be reported in the world, and the first case in the Brazilian literature