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1.
Sci Rep ; 11(1): 3679, 2021 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-33574486

RESUMO

Reflectance confocal microscopy (RCM) is a non-invasive imaging tool that reduces the need for invasive histopathology for skin cancer diagnoses by providing high-resolution mosaics showing the architectural patterns of skin, which are used to identify malignancies in-vivo. RCM mosaics are similar to dermatopathology sections, both requiring extensive training to interpret. However, these modalities differ in orientation, as RCM mosaics are horizontal (parallel to the skin surface) while histopathology sections are vertical, and contrast mechanism, RCM with a single (reflectance) mechanism resulting in grayscale images and histopathology with multi-factor color-stained contrast. Image analysis and machine learning methods can potentially provide a diagnostic aid to clinicians to interpret RCM mosaics, eventually helping to ease the adoption and more efficiently utilizing RCM in routine clinical practice. However standard supervised machine learning may require a prohibitive volume of hand-labeled training data. In this paper, we present a weakly supervised machine learning model to perform semantic segmentation of architectural patterns encountered in RCM mosaics. Unlike more widely used fully supervised segmentation models that require pixel-level annotations, which are very labor-demanding and error-prone to obtain, here we focus on training models using only patch-level labels (e.g. a single field of view within an entire mosaic). We segment RCM mosaics into "benign" and "aspecific (nonspecific)" regions, where aspecific regions represent the loss of regular architecture due to injury and/or inflammation, pre-malignancy, or malignancy. We adopt Efficientnet, a deep neural network (DNN) proven to accurately accomplish classification tasks, to generate class activation maps, and use a Gaussian weighting kernel to stitch smaller images back into larger fields of view. The trained DNN achieved an average area under the curve of 0.969, and Dice coefficient of 0.778 showing the feasibility of spatial localization of aspecific regions in RCM images, and making the diagnostics decision model more interpretable to the clinicians.

2.
Am J Dermatopathol ; 2021 Feb 16.
Artigo em Inglês | MEDLINE | ID: mdl-33606373

RESUMO

ABSTRACT: Few reported cases discuss distinguishing between melanoma and melanoacanthoma, a seborrheic keratosis (SK) variant, using noninvasive imaging devices. We present a case of a 38-year-old man with Fitzpatrick skin type IV with an asymmetric black papule showing clinical and dermoscopic features of both melanoma and SK. Reflectance confocal microscopy (RCM) and dynamic optical coherence tomography (d-OCT) were used for further evaluation. RCM revealed acanthotic epidermis with a mixed honeycomb and cobblestone pattern, polycyclic bulbous rete ridges, and bright plump cells within entrapped, edged, dermal papillae, compatible with pigmented SK. Also noted were a population of fairly uniform bright dendritic cells scattered quite evenly at all levels of the epidermis and the notable absence of concomitant features of a melanocytic neoplasm (roundish Pagetoid cells, sheets of roundish or dendritic cells at the dermal-epidermal junction, junctional thickenings, and melanocytic nests), suggesting melanoacanthoma. d-OCT showed well-circumscribed, regular, epidermal acanthosis, superficial rounded hypodense structures, normal vascular flow, and notable absence of wiry or contoured vessels, features typically seen in SKs and benign lesions, respectively. Similarly, histologic examination revealed characteristics of pigmented SK containing a population of evenly dispersed dendritic melanocytes (decorated using Melan-A stain) confirming a diagnosis of melanoacanthoma. This case highlights the advantages of incorporating both RCM and d-OCT into clinical practice to noninvasively differentiate melanoma from its clinical mimickers.

3.
Med Image Anal ; 67: 101841, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33142135

RESUMO

In-vivo optical microscopy is advancing into routine clinical practice for non-invasively guiding diagnosis and treatment of cancer and other diseases, and thus beginning to reduce the need for traditional biopsy. However, reading and analysis of the optical microscopic images are generally still qualitative, relying mainly on visual examination. Here we present an automated semantic segmentation method called "Multiscale Encoder-Decoder Network (MED-Net)" that provides pixel-wise labeling into classes of patterns in a quantitative manner. The novelty in our approach is the modeling of textural patterns at multiple scales (magnifications, resolutions). This mimics the traditional procedure for examining pathology images, which routinely starts with low magnification (low resolution, large field of view) followed by closer inspection of suspicious areas with higher magnification (higher resolution, smaller fields of view). We trained and tested our model on non-overlapping partitions of 117 reflectance confocal microscopy (RCM) mosaics of melanocytic lesions, an extensive dataset for this application, collected at four clinics in the US, and two in Italy. With patient-wise cross-validation, we achieved pixel-wise mean sensitivity and specificity of 74% and 92%, respectively, with 0.74 Dice coefficient over six classes. In the scenario, we partitioned the data clinic-wise and tested the generalizability of the model over multiple clinics. In this setting, we achieved pixel-wise mean sensitivity and specificity of 77% and 94%, respectively, with 0.77 Dice coefficient. We compared MED-Net against the state-of-the-art semantic segmentation models and achieved better quantitative segmentation performance. Our results also suggest that, due to its nested multiscale architecture, the MED-Net model annotated RCM mosaics more coherently, avoiding unrealistic-fragmented annotations.

4.
J Cutan Pathol ; 2020 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-32989842

RESUMO

BACKGROUND: Accurate basal cell carcinoma (BCC) subtyping is requisite for appropriate management, but non-representative sampling occurs in 18% to 25% of biopsies. By enabling non-invasive diagnosis and more comprehensive sampling, integrated reflectance confocal microscopy-optical coherence tomography (RCM-OCT) may improve the accuracy of BCC subtyping and subsequent management. We evaluated RCM-OCT images and histopathology slides for the presence of two key features, angulation and small nests and cords, and calculated (a) sensitivity and specificity of these features, combined and individually, for identifying an infiltrative BCC subtype and (b) agreement across modalities. METHODS: Thirty-three RCM-OCT-imaged, histopathologically-proven BCCs (17 superficial and/or nodular; 16 containing an infiltrative component) were evaluated. RESULTS: The presence of angulation or small nests and cords was sufficient to identify infiltrative BCC on RCM-OCT with 100% sensitivity and 82% specificity, similar to histopathology (100% sensitivity, 88% specificity, kappa = 0.82). When both features were present, the sensitivity for identifying infiltrative BCC was 100% using either modality and specificity was 88% on RCM-OCT vs 94% on histopathology, indicating near-perfect agreement between non-invasive and invasive diagnostic modalities (kappa = 0.94). CONCLUSIONS: RCM-OCT can non-invasively identify key histopathologic features of infiltrative BCC offering a possible alternative to traditional invasive biopsy.

5.
J Cancer ; 11(20): 6019-6024, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32922542

RESUMO

The increasing rate of incidence and prevalence of basal cell carcinomas (BCCs) worldwide, combined with the morbidity associated with conventional surgical treatment has led to the development and use of alternative minimally invasive non-surgical treatments. Biopsy and pathology are used to guide BCC diagnosis and assess margins and subtypes, which then guide the decision and choice of surgical or non-surgical treatment. However, alternatively, a noninvasive optical approach based on combined reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) imaging may be used. Optical imaging may be used to guide diagnosis and margin assessment at the bedside, and potentially facilitate non-surgical management, along with long-term monitoring of treatment response. Noninvasive imaging may also complement minimally invasive treatments and help further reduce morbidity. In this paper, we highlight the current state of an integrated RCM/OCT imaging approach for diagnosis and triage of BCCs, as well as for assessing margins, which therefore may be ultimately used for guiding therapy.

7.
J Invest Dermatol ; 140(6): 1214-1222, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31838127

RESUMO

In vivo reflectance confocal microscopy (RCM) enables clinicians to examine lesions' morphological and cytological information in epidermal and dermal layers while reducing the need for biopsies. As RCM is being adopted more widely, the workflow is expanding from real-time diagnosis at the bedside to include a capture, store, and forward model with image interpretation and diagnosis occurring offsite, similar to radiology. As the patient may no longer be present at the time of image interpretation, quality assurance is key during image acquisition. Herein, we introduce a quality assurance process by means of automatically quantifying diagnostically uninformative areas within the lesional area by using RCM and coregistered dermoscopy images together. We trained and validated a pixel-level segmentation model on 117 RCM mosaics collected by international collaborators. The model delineates diagnostically uninformative areas with 82% sensitivity and 93% specificity. We further tested the model on a separate set of 372 coregistered RCM-dermoscopic image pairs and illustrate how the results of the RCM-only model can be improved via a multimodal (RCM + dermoscopy) approach, which can help quantify the uninformative regions within the lesional area. Our data suggest that machine learning-based automatic quantification offers a feasible objective quality control measure for RCM imaging.

8.
Dermatol Online J ; 25(8)2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31553856

RESUMO

Reflectance confocal microscopy (RCM) is a non-invasive imaging tool for cellular-level examination of skin lesions, typically from the epidermis to the superficial dermis. Clinical studies show RCM imaging is highly sensitive and specific in the diagnosis of skin diseases. RCM is disseminating from academic tertiary care centers with early adopter "experts" into diverse clinical settings, with image acquisition performed by technicians and image interpretation by physicians. In the hands of trained users, RCM serves an aid to accurately diagnose and monitor skin tumors and inflammatory processes. However, exogenous and endogenous artifacts introduced during imaging can obscure RCM images, limiting or prohibiting interpretation. Herein we review the types of artifacts that may occur and techniques for mitigating them during image acquisition, to assist technicians with qualitative image assessment and provide physicians guidance on identifying artifacts that may confound interpretation. Finally, we discuss normal skin "landmarks" and how they can (i) obscure images, (ii) be exploited for additional diagnostic information, and (iii) simulate pathological structures. A deeper understanding of the principles and methods behind RCM imaging and the varying appearance of normal skin structures in the acquired images aids technicians in capturing higher quality image sets and enables physicians to increase interpretation accuracy.


Assuntos
Pontos de Referência Anatômicos , Artefatos , Microscopia Confocal , Dermatopatias/patologia , Pele/patologia , Humanos
10.
JAMA Dermatol ; 154(10): 1175-1183, 2018 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-30140851

RESUMO

Importance: The limited tissue sampling of a biopsy can lead to an incomplete assessment of basal cell carcinoma (BCC) subtypes and depth. Reflectance confocal microscopy (RCM) combined with optical coherence tomography (OCT) imaging may enable real-time, noninvasive, comprehensive three-dimensional sampling in vivo, which may improve the diagnostic accuracy and margin assessment of BCCs. Objective: To determine the accuracy of a combined RCM-OCT device for BCC detection and deep margin assessment. Design, Setting, and Participants: This pilot study was carried out on 85 lesions from 55 patients referred for physician consultation or Mohs surgery at Memorial Sloan Kettering Skin Cancer Center in Hauppauge, New York. These patients were prospectively and consecutively enrolled in the study between January 1, 2017, and December 31, 2017. Patients underwent imaging, with the combined RCM-OCT probe, for previously biopsied, histopathologically confirmed BCCs and lesions clinically or dermoscopically suggestive of BCC. Only patients with available histopathologic examination after imaging were included. Main Outcomes and Measures: Improvements in sensitivity, specificity, and diagnostic accuracy for BCC using the combined RCM-OCT probe as well as the correlation between OCT-estimated depth and histopathologically measured depth were investigated. Results: In total, 85 lesions from 55 patients (27 [49%] were female and 28 [51%] were male with a median [range] age of 59 [21-90] years) were imaged. Imaging was performed on 25 previously biopsied and histopathologically confirmed BCCs and 60 previously nonbiopsied but clinically or dermoscopically suspicious lesions. Normal skin and BCC features were correlated and validated with histopathologic examination. In previously biopsied lesions, residual tumors were detected in 12 of 25 (48%) lesions with 100% sensitivity (95% CI, 73.5%-100%) and 23.1% specificity (95% CI, 5.0%-53.8%) for combined RCM-OCT probe. In previously nonbiopsied and suspicious lesions, BCCs were diagnosed in 48 of 60 (80%) lesions with 100% sensitivity (95% CI, 92.6%-100%) and 75% specificity (95% CI, 42.8%-94.5%). Correlation was observed between depth estimated with OCT and depth measured with histopathologic examination: the coefficient of determination (R2) was 0.75 (R = 0.86; P < .001) for all lesions, 0.73 (R = 0.85; P < .001) for lesions less than 500 µm deep, and 0.65 (R = 0.43; P < .001) for lesions greater than 500 µm deep. Conclusions and Relevance: Combined RCM-OCT imaging may be prospectively used to comprehensively diagnose lesions suggestive of BCC and triage for treatment. Further validation of this device must be performed on a larger cohort.


Assuntos
Carcinoma Basocelular/diagnóstico por imagem , Neoplasias Cutâneas/diagnóstico por imagem , Tomografia de Coerência Óptica , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Carcinoma Basocelular/patologia , Feminino , Humanos , Masculino , Microscopia Confocal , Pessoa de Meia-Idade , Imagem Multimodal , Projetos Piloto , Estudos Prospectivos , Sensibilidade e Especificidade , Pele/patologia , Neoplasias Cutâneas/patologia , Adulto Jovem
11.
Med J Aust ; 206(8): 345-350, 2017 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-28446116

RESUMO

OBJECTIVES: Hospital data used to assess regional variability in disease management and outcomes, including mortality, lack information on disease severity. We describe variance between hospitals in 30-day risk-adjusted mortality rates (RAMRs) for stroke, comparing models that include or exclude stroke severity as a covariate. DESIGN: Cohort design linking Australian Stroke Clinical Registry data with national death registrations. Multivariable models using recommended statistical methods for calculating 30-day RAMRs for hospitals, adjusted for demographic factors, ability to walk on admission, stroke type, and stroke recurrence. SETTING: Australian hospitals providing at least 200 episodes of acute stroke care, 2009-2014. MAIN OUTCOME MEASURES: Hospital RAMRs estimated by different models. Changes in hospital rank order and funnel plots were used to explore variation in hospital-specific 30-day RAMRs; that is, RAMRs more than three standard deviations from the mean. RESULTS: In the 28 hospitals reporting at least 200 episodes of care, there were 16 218 episodes (15 951 patients; median age, 77 years; women, 46%; ischaemic strokes, 79%). RAMRs from models not including stroke severity as a variable ranged between 8% and 20%; RAMRs from models with the best fit, which included ability to walk and stroke recurrence as variables, ranged between 9% and 21%. The rank order of hospitals changed according to the covariates included in the models, particularly for those hospitals with the highest RAMRs. Funnel plots identified significant deviation from the mean overall RAMR for two hospitals, including one with borderline excess mortality. CONCLUSIONS: Hospital stroke mortality rates and hospital performance ranking may vary widely according to the covariates included in the statistical analysis.


Assuntos
Mortalidade Hospitalar , Hospitais/estatística & dados numéricos , Qualidade da Assistência à Saúde/normas , Acidente Vascular Cerebral/mortalidade , Idoso , Idoso de 80 Anos ou mais , Austrália , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Avaliação de Resultados em Cuidados de Saúde , Estudos Prospectivos , Sistema de Registros , Risco Ajustado
12.
Dermatol Clin ; 34(4): 443-458, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27692450

RESUMO

Solitary pink lesions can pose a particular challenge to dermatologists because they may be almost or completely featureless clinically and dermoscopically, previously requiring biopsy to exclude malignancy. However, these lesions usually are not particularly challenging histopathologically. Thus, the incorporation of in vivo reflectance confocal microscopy into the clinical practice, which allows for noninvasive examination of the skin at the cellular level revealing features previously seen only on histopathology, is particularly useful for this subset of clinically difficult lesions.


Assuntos
Acantoma/diagnóstico por imagem , Adenoma/diagnóstico por imagem , Carcinoma/diagnóstico por imagem , Hemangioma/diagnóstico por imagem , Histiocitoma Fibroso Benigno/diagnóstico por imagem , Melanoma Amelanótico/diagnóstico por imagem , Neoplasias das Glândulas Sebáceas/diagnóstico por imagem , Neoplasias Cutâneas/diagnóstico por imagem , Doença de Bowen/diagnóstico por imagem , Neoplasias da Mama/diagnóstico por imagem , Carcinoma in Situ/diagnóstico por imagem , Carcinoma de Células Escamosas/diagnóstico por imagem , Dermoscopia , Granuloma Piogênico/diagnóstico por imagem , Humanos , Microscopia Intravital , Ceratose Actínica/diagnóstico por imagem , Ceratose Seborreica/diagnóstico por imagem , Microscopia Confocal , Doença de Paget Extramamária/diagnóstico por imagem , Doença de Paget Mamária/diagnóstico por imagem , Dermatopatias/diagnóstico por imagem
13.
Cutis ; 95(2): 93-7, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25750962

RESUMO

Current methods for diagnosing dermatophytic infections have various drawbacks. Analysis via skin scrapings and biopsies can be invasive and/or take too long to yield results. Reflectance confocal microscopy (RCM) is an emerging in vivo imaging technology that can potentially be used to diagnose cutaneous dermatophytic infections. This modality provides high-resolution images of the skin extending to the level of the superficial reticular dermis that could reveal the presence of fungal hyphae. In this retrospective chart review, we investigated the application of RCM as a diagnostic tool in the setting of a private practice. Images were used to diagnose dermatophyte infections and the results were compared to those of other established diagnostic methods. We found RCM to be a potentially effective and highly sensitive tool in the diagnosis of cutaneous dermatophytic infections.


Assuntos
Dermatite/patologia , Tinha/patologia , Adolescente , Adulto , Idoso , Antifúngicos/uso terapêutico , Estudos de Coortes , Dermatite/diagnóstico , Diagnóstico Diferencial , Humanos , Hidróxidos , Hifas , Indicadores e Reagentes , Microscopia Confocal , Pessoa de Meia-Idade , Compostos de Potássio , Estudos Retrospectivos , Tinha/diagnóstico , Tinha/tratamento farmacológico , Adulto Jovem
14.
Case Rep Psychiatry ; 2015: 846459, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25688318

RESUMO

Water intoxication is a rare condition characterised by overconsumption of water. It can occur in athletes engaging in endurance sports, users of MDMA (ecstasy), and patients receiving total parenteral nutrition. This case outlines water intoxication in a patient with psychogenic polydipsia. When the kidney's capacity to compensate for exaggerated water intake is exceeded, hypotonic hyperhydration results. Consequences can involve headaches, behavioural changes, muscular weakness, twitching, vomiting, confusion, irritability, drowsiness, and seizures. Cerebral oedema can lead to brain damage and eventual death. In this case, psychogenic polydipsia led to significant hyponatraemia, cerebral oedema, and tonic-clonic seizures. Differential diagnoses for hyponatraemia are outlined. The aetiology of psychogenic polydipsia is uncertain, but postulated hypotheses are explored. Psychogenic polydipsia occurs in up 20% of psychiatric patients and this case serves to remind us to be cognizant of water overconsumption.

15.
Psychiatr Bull (2014) ; 38(5): 250-1, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25285227
16.
J Am Acad Dermatol ; 66(3): e109-21, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21742408

RESUMO

BACKGROUND: Dysplastic nevi are thought to be precursors of melanoma during a stepwise process. However, this concept is still controversial and precise correlation between clinical and histopathologic features is lacking. In vivo confocal microscopy represents a noninvasive imaging technique producing horizontal sections at nearly histopathologic resolution. OBJECTIVE: We sought to determine whether specific histologic features in dysplastic nevi have reliable correlates on confocal microscopy and to develop an in vivo microscopic grading system. METHODS: Sixty melanocytic lesions with equivocal dermatoscopic aspects, corresponding to 19 nondysplastic nevi, 27 dysplastic nevi, and 14 melanomas, were analyzed by confocal microscopy and histopathology, using the Duke grading criteria. RESULTS: All architectural and cytologic features of the Duke grading score had significant reflectance confocal microscopy correlates. Confocally, dysplastic nevi were characterized by a ringed pattern, in association with a meshwork pattern in a large proportion of cases, along with atypical junctional cells in the center of the lesion, and irregular junctional nests with short interconnections. A simplified algorithm was developed to distinguish dysplastic nevi from melanoma and nondysplastic nevi. The contemporary presence of cytologic atypia and of atypical junctional nests (irregular, with short interconnections, and/or with nonhomogeneous cellularity) was suggestive of histologic dysplasia, whereas a widespread pagetoid infiltration, widespread cytologic atypia at the junction, and nonedged papillae suggested melanoma diagnosis. LIMITATIONS: A small number of cases were evaluated because of the necessity to analyze numerous histopathologic and confocal features. CONCLUSION: The possibility to detect dysplastic nevi in vivo may lead to an appropriate management decision.


Assuntos
Síndrome do Nevo Displásico/patologia , Melanoma/patologia , Microscopia Confocal/métodos , Microscopia Confocal/normas , Gradação de Tumores/métodos , Neoplasias Cutâneas/patologia , Algoritmos , Dermatologia/instrumentação , Síndrome do Nevo Displásico/classificação , Humanos , Gradação de Tumores/instrumentação , Gradação de Tumores/normas , Patologia Clínica/instrumentação , Projetos Piloto , Reprodutibilidade dos Testes
17.
Dermatol Surg ; 36(10): 1514-20, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20698872

RESUMO

BACKGROUND: Diagnostic accuracy and preferred therapeutic strategies for actinic keratoses (AKs) and squamous cell carcinoma (SCC) have significant public health implications. OBJECTIVE: To evaluate clinical-pathologic agreement on the diagnosis of AKs and early SCCs and to characterize the effect of diagnosis on therapeutic decisions. METHODS & MATERIALS: Nine dermatologists and two dermatopathologists reviewed an image-based dataset of AKs and early SCCs. Clinical-pathologic agreement, inter- and intraobserver reliability for clinical diagnosis, and frequencies of therapies according to pathologic diagnosis were assessed. RESULTS: Clinical-pathologic (κ=0.10) agreement was poor, whereas interobserver (κ=0.24) and intraobserver (κ=0.28) agreements were fair. Participants were more likely to treat AKs with cryotherapy (64.2%) and to manage SCCs with surgery (72.8%). Therapeutic choice rarely changed after participants were shown histological photomicrographs. Participating clinicians treated most lesions histologically diagnosed as SCC in situ arising within AK using surgery, whereas pathologists selected cryotherapy or curettage and electrodesiccation for these lesions. CONCLUSION: We found poor clinical-pathologic agreement and reproducibility for clinically distinguishing between AK and early SCC even between skin cancer specialists from a single academic group practice. Nomenclature used in the pathologic diagnosis of AK and SCC affects clinicians' therapeutic decisions. The authors have indicated no significant interest with commercial supporters.


Assuntos
Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/terapia , Dermatologia/normas , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/terapia , Algoritmos , Aminoquinolinas/uso terapêutico , Biópsia/estatística & dados numéricos , Carcinoma in Situ/patologia , Criocirurgia/estatística & dados numéricos , Curetagem/estatística & dados numéricos , Diagnóstico Diferencial , Fluoruracila/uso terapêutico , Humanos , Imiquimode , Ceratose Actínica/patologia , Ceratose Actínica/terapia , Cirurgia de Mohs/estatística & dados numéricos , Fotoquimioterapia , Lesões Pré-Cancerosas/patologia , Reprodutibilidade dos Testes , Terminologia como Assunto , Estados Unidos
18.
Dermatol Surg ; 35(6): 952-9, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19397663

RESUMO

BACKGROUND: Clear cell acanthoma (CCA) is a rare, benign neoplasm of unknown etiology, whose dermoscopic and histological features have been previously described. Usually, CCA can be diagnosed by clinical and dermoscopic examination. In some cases, diagnosis remains uncertain, and histological examination is needed. The aim of this paper was to describe the features of reflectance confocal microscopy (RCM) in diagnosing CCA, compare them with findings on dermoscopy and histology, and evaluate their possible usefulness in CCA evaluation. PATIENTS AND METHODS: Five lesions diagnosed clinically as CCA were imaged using dermoscopy and RCM. All lesions were surgically excised to confirm the diagnosis and compare the morphological attributes under light microscopy with in vivo imaging. RESULTS: RCM showed well-circumscribed lesions, often edged by a hyperkeratotic collarette with parakeratosis; inflammatory cells in the spinous layer; large keratinocytes; acanthosis with papillomatosis; epidermal disarray; and dilated capillaries forming glomeruloid shapes in the upper dermis. CONCLUSIONS: In this small study, RCM was able to identify most of the established diagnostic histological features of CCA. RCM appears to be a useful tool for in vivo diagnosis of CCA and may help avoid unnecessary biopsies.


Assuntos
Acantoma/patologia , Dermoscopia/métodos , Técnicas Histológicas/métodos , Microscopia Confocal/métodos , Neoplasias Cutâneas/patologia , Acantoma/cirurgia , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Neoplasias Cutâneas/cirurgia
20.
Dermatology ; 215(4): 354-8, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17911996

RESUMO

BACKGROUND: Trichoepitheliomas (TE) are benign neoplasms of follicular differentiation. Solitary lesions are often confused with basal cell carcinoma (BCC). Reflectance confocal microscopy (RCM) and dermoscopy are imaging tools for in vivo, noninvasive evaluation of skin lesions. To date, there has been no description of their findings in the evaluation of TE. OBJECTIVE: Our aim is to describe the dermoscopic and RCM findings of histopathologically confirmed TE. METHODS: Four TE were evaluated, 2 each of the desmoplastic and nondesmoplastic variants. RCM was performed on 1 of the desmoplastic and both of the nondesmoplastic lesions. RESULTS: Dermoscopically, all of the lesions showed arborizing telangiectasias. The desmoplastic lesions also had an ivory-white background throughout. RCM showed oval, darker-appearing tumor islands that contained brightly refractile material, consistent with keratin horn cysts at the center, as well as parallel bundles of highly refractile dermal collagen surrounding the tumor islands. CONCLUSION: The ivory-white background throughout the lesion seen on dermoscopy may be helpful in distinguishing desmoplastic TE from BCC. The RCM findings in TE of keratin-filled cysts in tumor islands and attachment of the tumor to follicular structures have not been previously observed in BCC, and thus may also be diagnostically helpful. Further study is necessary for validation of these findings.


Assuntos
Carcinoma Basocelular/patologia , Dermoscopia/métodos , Neoplasias de Cabeça e Pescoço/patologia , Microscopia Confocal , Neoplasias Cutâneas/patologia , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
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