Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 24
Filtrar
1.
Cancers (Basel) ; 13(21)2021 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-34771721

RESUMO

Background-Actinic keratoses (AKs) are the most common sun-induced precancerous lesions that can progress to squamocellular carcinoma (SCC). Recently, the grade-independent association between AKs and SCC has been suggested; however, the molecular bases of this potential association have not been investigated. This study has assessed the metabolomic fingerprint of AK I, AK II, AK III and SCC using high resolution magic angle spinning (HR-MAS) nuclear magnetic resonance (NMR) spectroscopy in order to evaluate the hypothesis of grade-independent association between AK and SCC. Association between AKs and SCCs has also been evaluated by histopathology. Methods-Metabolomic data were obtained through HR-MAS NMR spectroscopy. The whole spectral profiles were analyzed through multivariate statistical analysis using MetaboAnalyst 5.0. Histologic examination was performed on sections stained with hematoxylin and eosin; statistical analysis was performed using STATA software version 14. Results-A group of 35 patients affected by AKs and/or SCCs and 10 healthy controls were enrolled for metabolomics analysis. Histopathological analysis was conducted on 170 specimens of SCCs and AKs (including the ones that underwent metabolomic analysis). SCCs and AK I were found to be significantly associated in terms of the content of some metabolites. Moreover, in the logistic regression model, the presence of parakeratosis in AKs appeared to be less frequently associated with SCCs, while AKs with hypertrophy had a two-fold higher risk of being associated with SCC. Conclusions-Our findings, derived from metabolomics and histopathological data, support the notion that AK I are different from healthy skin and share some different features with SCCs. This may further support the expanding notion that all AKs should be treated independently from their clinical appearance or histological grade because they may be associated with SCC.

2.
J Am Acad Dermatol ; 2021 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-34695527

RESUMO

BACKGROUND: Limited data on dermatoscopy of nodular/plaque-type T-/B-cell primary cutaneous lymphomas (PCLs) is available. OBJECTIVE: To describe dermatoscopic features of nodular/plaque-type PCLs, comparing them with those of clinical mimickers (pseudolymphomas, tumors, and inflammatory lesions) and investigating possible differences according to histologic subtypes. METHODS: Participants were invited to join this retrospective, multicenter case-control study by submitting histologically/immunohistochemically confirmed instances of nodular/plaque-type PCLs and controls. Standardized assessments of the dermatoscopic images and comparative analyses were performed. RESULTS: A total of 261 lesions were included (121 PCLs and 140 controls). Orange structureless areas were the strongest PCL dermatoscopic predictor on multivariate analysis compared with tumors and noninfiltrative inflammatory dermatoses. On the other hand, a positive association was found between PCLs and either unfocused linear vessels with branches or focal white structureless areas compared with infiltrative inflammatory dermatoses, whereas white lines were predictive of PCLs over pseudolymphomas. Differences in the vascular pattern were also seen between B- and T-cell PCLs and among B-cell PCL subtypes. LIMITATIONS: Retrospective design and the lack of a dermatoscopic-pathologic correlation analysis. CONCLUSION: Nodular/plaque-type PCLs display dermatoscopic clues, which may partially vary according to histologic subtype and whose diagnostic relevance depends on the considered clinical differential diagnoses.

3.
Cancers (Basel) ; 13(16)2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34439130

RESUMO

Non-melanoma skin cancer (NMSC) is the most common malignant tumor affecting fair-skinned people. Increasing incidence rates of NMSC have been reported worldwide, which is an important challenge in terms of public health management. Surgical excision with pre-operatively identified margins is one of the most common and effective treatment strategies. Incomplete tumor removal is associated with a very high risk of recurrence and re-excision. Biological tissues can absorb and re-emit specific light wave-lengths, detectable through spectrophotometric devices. Such a phenomenon is known as autofluorescence (AF). AF spectroscopy has been widely explored for non-invasive, early detection of NMSC as well as for evaluation of surgical margins before excision. Fluorescence-aided diagnosis is based on differences in spectral characteristics between healthy and neoplastic skin. Understanding the biological basis of such differences and correlating AF intensity to histological features could improve the diagnostic accuracy of skin fluorescence spectroscopy. The primary objective of the present pre-clinical ex vivo study is to investigate the correlation between the intensity of cutaneous AF and the histopathological features of NMSC. Ninety-eight lesions suggestive for NMSCs were radically excised from 75 patients (46 M; 29 F; mean age: 79 years). After removal, 115 specific reference points on lesions ("cases"; 59 on BBC, 53 on SCC and 3 on other lesions) and on peri-lesional healthy skin (controls; 115 healthy skin) were identified and marked through suture stitches. Such reference points were irradiated at 400-430 nm wavelength, and resulting emission AF spectra were acquired through spectrophotometry. For each case, AFIR (autofluorescence intensity ratio) was measured as the ratio between the number of photons emitted at a wavelength ranging between 450 and 700 nm (peak: 500 nm) in the healthy skin and that was captured in the pathological tissue. At the histological level, hyperkeratosis, neoangiogenesis, cellular atypia, epithelial thickening, fibrosis and elastosis were quantified by light microscopy and were assessed through a previously validated grading system. Statistical correlation between histologic variables and AFIR was calculated through linear regression. Spectrometric evaluation was performed on 230 (115 cases + 115 controls) reference points. The mean AFIR for BCC group was 4.5, while the mean AFIR for SCC group was 4.4 and the fluorescence peaks at 500 nm were approximately 4 times lower (hypo-fluorescent) in BCCs and in SCCs than in healthy skin. Histological variables significantly associated with alteration of AFIR were fibrosis and elastosis (p < 0.05), neoangiogenesis, hyperkeratosis and epithelial thickening. Cellular atypia was not significantly associated with alteration of AFIR. The intensity of fluorescence emission in neoplastic tissues was approximately 4 times lower than that in healthy tissues. Histopathological features such as hyperkeratosis, neoangiogenesis, fibrosis and elastosis are statistically associated with the decrease in AFIR. We hypothesize that such tissue alterations are among the possible biophysical and biochemical bases of difference in emission AF between neoplastic and healthy tissue. The results of the present evaluation highlighted the possible usefulness of autofluorescence as diagnostic, non-invasive and real-time tool for NMSCs.

4.
Adv Skin Wound Care ; 33(7): 367-374, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32544116

RESUMO

OBJECTIVE: To evaluate the efficacy and safety of a biologically engineered dermal matrix used in reconstructive surgery after skin tumor resection, focusing on the frequency of successful grafting and identifying potential factors influencing treatment outcomes. DESIGN AND PARTICIPANTS: This retrospective analysis involved consecutive patients diagnosed with skin cancer in any area of the body and for which treatment with a dermal skin template was recommended as alternative to traditional surgery. MAIN OUTCOME MEASURES: Percentage of successful grafting and the patient and tumor characteristics influencing treatment outcome via univariate analysis. MAIN RESULTS: A total of 302 patients were included. Surgical reconstruction with the matrix was effective in 88.9% of the patients within 21 days of surgery. Notably, the matrix was successful regardless of tumor location, type, or size. Infection was the only variable significantly associated with graft failure (P < .001). CONCLUSIONS: The studied dermal matrix provides an efficient alternative to traditional reconstructive surgery in patients who present specific comorbidities or risk factors. The only variable significantly associated with graft failure was infection, which should be properly controlled through appropriate treatment.


Assuntos
Derme Acelular , Neoplasias Cutâneas/terapia , Retalhos Cirúrgicos/transplante , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Transplante de Pele , Resultado do Tratamento , Cicatrização/fisiologia
5.
Int Wound J ; 17(4): 937-943, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32232964

RESUMO

Perioperative antibiotic treatment duration in skin reconstruction with dermal substitutes is not well established. This study compares the incidence of infective complications after two different durations of perioperative antibiotic treatment in patients undergoing surgical reconstruction with skin dermal substitutes (SDS) after excision of skin cancer. Infective complications at the site of SDS were compared in subjects undergoing surgical reconstruction who received either a > 24-hour (extended protocol) or a ≤ 24-hour (short protocol) perioperative antibiotic treatment. Of 116 patients undergoing SDS surgical reconstruction, 62 (53.4%) received an extended schedule, and 54 (46.6%) received a short schedule. The two groups were similar for gender, age, comorbidities, American Society of Anesthesiologists score, and type of skin cancer. Overall incidence rate of infection was 20.7% (24/116). No differences in terms of risk of infection were observed between the two groups (OR: 1.04, 95% CI: 0.42-2.55; P = .937). Patients undergoing SDS reconstruction in the limb/foot had a higher risk of infection in comparison with those undergoing SDS reconstruction in the chest/head (OR: 2.69, 95% CI: 1.06-6.86; P = .038). The short protocol was demonstrated to be beneficial to patients undergoing surgical reconstruction with SDS. A ≤ 24-hour perioperative antibiotic schedule did not increase the infection rate, potentially allowing a reduction of antibiotic exposure.


Assuntos
Antibacterianos/uso terapêutico , Antibioticoprofilaxia/métodos , Assistência Perioperatória/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Neoplasias Cutâneas/cirurgia , Transplante de Pele/métodos , Infecção da Ferida Cirúrgica/prevenção & controle , Derme Acelular/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibioticoprofilaxia/estatística & dados numéricos , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória/estatística & dados numéricos , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Neoplasias Cutâneas/epidemiologia , Transplante de Pele/estatística & dados numéricos
7.
Sci Rep ; 9(1): 11515, 2019 08 08.
Artigo em Inglês | MEDLINE | ID: mdl-31395965

RESUMO

Actinic keratosis (AK) is a skin premalignant lesion, which progresses into squamous cell carcinoma (SCC) if left untreated. Ingenol mebutate gel is approved for local treatment of non-hyperkeratotic, non-hypertrophic AK; it also has the potential to act as a field cancerization therapy to prevent the progression of AK to SCC. To gain better insights into the mechanisms of ingenol mebutate beyond the mere clinical assessment, we investigated, for the first time, the metabolome of skin tissues from patients with AK, before and after ingenol mebutate treatment, with high-resolution magic angle spinning nuclear magnetic resonance spectroscopy. The metabolomic profiles were compared with those of tissues from healthy volunteers. Overall, we identified a number of metabolites, the homeostasis of which became altered during the process of tumorigenesis from healthy skin to AK, and was restored, at least partially, by ingenol mebutate therapy. These metabolites may help to attain a better understanding of keratinocyte metabolism and to unmask the metabolic pathways related to cell proliferation. These results provide helpful information to identify biomarkers with prognostic and therapeutic significance in AK, and suggest that field cancerization therapy with ingenol mebutate may contribute to restore skin metabolism to a normal state in patients with AK.


Assuntos
Biomarcadores Tumorais/metabolismo , Diterpenos/farmacologia , Ceratose Actínica/tratamento farmacológico , Metabolômica , Pele/metabolismo , Estudos de Casos e Controles , Humanos , Ceratose Actínica/metabolismo , Espectroscopia de Prótons por Ressonância Magnética
9.
PLoS One ; 13(9): e0204330, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30261075

RESUMO

The rising incidence of Non Melanoma Skin Cancers (NMSC) leads to a high number of surgical procedures worldwide. The strict compliance with international guidelines with regard to excisional margins may help decrease the number of re-excision procedures and reduce the risk of NMSC recurrence. The aim of this study was to investigate the prevalence of excisional margins as recommended by the European Academy of Dermatology and Venereology (EADV) and the European Dermatology Forum (EDF) guidelines, and the factors (demographic or clinical) that influence surgeons' compliance with these guidelines.This was a prevalence study looking at surgical excisions of NMSCs performed over a period of 2 years (2011-2012). A sample size of 1669 patients was considered. Definition of excisional margins recommended by the international guidelines (EADV and EDF) were used as point of reference for the analysis. Tumor and histologic specimen size were calculated ex vivo by 5 different pathologists. The size of skin specimens was measured with a major axis and a minor axis. The same was done for the tumor present on the skin specimens. The differences between the major and minor axes of surgical specimen and tumor were calculated. These differences were subsequently divided by two, hypothesizing that the lesion had the same distance from the margins of the surgical specimen. The differences obtained were named "Delta", the formulas applied being the following:Delta major = (major axis specimen-major axis tumor)/2; Delta minor = (minor axis specimen-minor axis tumor)/2.Results show a significant statistical difference, associated with factors such as: age of the patient, anatomical localization of the tumor, histological diagnosis, and surgeons' experience.The identification of these factors sheds light on clinicians' practice and decision-making regarding excisional margins. Hopefully a higher level of adherence to the guidelines can be achieved in the future.


Assuntos
Procedimentos Cirúrgicos Dermatológicos/normas , Guias de Prática Clínica como Assunto , Reoperação/estatística & dados numéricos , Neoplasias Cutâneas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisão Clínica , Feminino , Humanos , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Prevalência , Cirurgiões , Adulto Jovem
10.
Exp Dermatol ; 27(10): 1152-1159, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30033578

RESUMO

Ex vivo fluorescence confocal microscopy (FCM) is an innovative imaging tool that can be used intraoperatively to obtain real-time images of untreated excised tissue with almost histologic resolution. As inflammatory diseases often share overlapping clinical features, histopathology evaluation is required for dubious cases, delaying definitive diagnoses, and therefore therapy. This study identifies key-features at ex vivo FCM for differential diagnoses of cutaneous inflammatory diseases, in particular, psoriasis, eczema, lichen planus and discoid lupus erythematosus. Retrospective ex vivo FCM and histological evaluations with relevant diagnoses were correlated with prospectively reported histopathologic diagnoses, to evaluate agreement and the level of expertise required for correct diagnoses. We demonstrated that ex vivo FCM enabled the distinction of the main inflammatory features in most cases, providing a substantial concordance to histopathologic diagnoses. Moreover, ex vivo FCM and histological evaluations reached a substantial agreement with histopathologic diagnoses both for all raters and for each operator. After a yet to be defined learning curve, these preliminary results suggest that dermatologists may be able to satisfactorily interpret ex vivo FCM images for correct real-time diagnoses. Despite some limitations mainly related to the equipment of FCM with a single objective lens, our study suggests that ex vivo FCM seems a promising tool in assisting diagnoses of cutaneous inflammatory lesions, with a level of accuracy quite close to that offered by histopathology. This is the first study to investigate ex vivo FCM application in cutaneous inflammatory lesions, and to evaluate the diagnostic capability of this technology.


Assuntos
Eczema/diagnóstico por imagem , Líquen Plano/diagnóstico por imagem , Lúpus Eritematoso Discoide/diagnóstico por imagem , Psoríase/diagnóstico por imagem , Diagnóstico Diferencial , Eczema/patologia , Fluorescência , Humanos , Líquen Plano/patologia , Lúpus Eritematoso Discoide/patologia , Microscopia Confocal , Psoríase/patologia , Estudos Retrospectivos
13.
G Ital Dermatol Venereol ; 152(2): 169-177, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26889726

RESUMO

BACKGROUND: Non-melanoma skin cancer (NMSC) represents the most common cutaneous neoplasms of the head and neck. In recent years, novel non-invasive diagnostic tool have been developed, and among these we have the reflectance confocal microscopy (RCM), that offers the evaluation of the skin at real time with cellular resolution. Numerous studies have identified the main confocal features of skin tumours, demonstrating the good correlation of these features with certain dermatoscopic patterns and histologic findings. EVIDENCE ACQUISITION: The aim of this analysis was to provide new insight into the role of RCM in the diagnosis and management of NMSC of the head and neck. Data comes from the most recent literature, taking into account previous essential reported information in this field. The study eligibility criteria were: studies providing update information, focusing on RCM findings in NMSC, without restrictions for age, sex, ethnicity. A search concerning the role of dermoscopy and RCM in the diagnosis of NMSC was performed on Medline. Duplicated studies, single case report and papers with language other than English were excluded from this study. EVIDENCE SYNTHESIS: RCM clues were analysed for NMSC in association with clinical, dermoscopic and histopathologic findings. Moreover, some new findings have been described and possible applications for NMSC of the head and neck have been discussed. CONCLUSIONS: RCM allows tissue imaging in vivo contributing to a more accurate diagnosis of NMSC of the head and neck, sparing time for the patient and costs for the public health system. RCM can also be used for selection of the biopsy site and it is helpful in defining the surgical safety margins to keep during the excision of skin cancers.


Assuntos
Neoplasias de Cabeça e Pescoço/diagnóstico , Microscopia Confocal/métodos , Neoplasias Cutâneas/diagnóstico , Biópsia/métodos , Dermoscopia/métodos , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/terapia , Humanos , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/terapia
14.
Am J Surg Pathol ; 40(10): 1360-7, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27259013

RESUMO

Interstitial mycosis fungoides (IMF) is a rare histopathologic variant of mycosis fungoides (MF) that may mimic other inflammatory dermatoses, mainly interstitial granuloma annulare, inflammatory morphea, and interstitial granulomatous dermatitis. Only small series and sporadic case reports of IMF have been described in the literature. We reviewed 27 specimens from 21 patients with IMF (M:F=11:10, median age 60) to better characterize clinical, histopathologic, and immunohistochemical features of this disease. Most patients presented clinically with patches and/or plaques. Conventional MF was documented before, concomitant with, or after IMF in 12 patients, whereas only in 2 patients different biopsies showed exclusive features of IMF over a period of 4 and 191 months, respectively. Histology revealed in all cases variably long, linear aggregates of dermal lymphocytes splaying the collagen fibers, involving predominantly the superficial and mid-dermis (6 cases) or the entire dermis (21 cases). Immunohistochemical stainings revealed a cytotoxic phenotype in 9/18 tested cases. Variable amounts of histiocytes/macrophages were found interstitially in all tested biopsies but never represented a population larger than that of T lymphocytes. Our study shows that IMF is a peculiar variant of MF with frequent cytotoxic phenotype. This histopathologic variant in most cases represents a transient pattern in otherwise conventional MF. Accurate clinicopathologic correlation and phenotypic studies of atypical dermal interstitial lymphohistiocytic infiltrates allow to make a correct diagnosis.


Assuntos
Micose Fungoide/diagnóstico , Micose Fungoide/patologia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologia , Pele/patologia , Adulto , Idoso , Biópsia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Micose Fungoide/imunologia , Prognóstico , Pele/imunologia , Neoplasias Cutâneas/imunologia
15.
Dermatology ; 232(2): 177-84, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26771575

RESUMO

INTRODUCTION AND OBJECTIVES: Nail apparatus melanoma (NAM) is an uncommon tumor, especially in Caucasians. The prognosis of patients affected by NAM was analyzed and correlated with the histopathological criteria and the surgical management of the tumors. MATERIALS AND METHODS: We collected data regarding NAM referred to the Skin Cancer Unit of the Dermatology Department of the University of Bologna, from 1992 to January 2012. RESULTS: Out of 1,327 melanoma cases diagnosed between 1992 and 2012, 42 patients were affected by NAM (2.93%). All the patients were Caucasian. Two deceased patients with insufficient medical records and 1 woman with a personal history of breast cancer were excluded. Thirty-nine cases entered this study: 24 were women (67%) and 15 men (33%). The mean age at diagnosis of NAM was 57.3 years (range 29-88 years). Statistical analyses showed that prognosis was significantly correlated with the Breslow thickness (≥/<2 mm; p = 0.02), regression (p < 0.0001) and ulceration (p = 0.04). Regarding surgical management, Kaplan-Meier's test pointed out that performing functional surgery compared to disarticulation did not correlate with a better prognosis of patients (p = 0.08). CONCLUSIONS: In our experience, the surgical management (disarticulation with respect to functional surgical excision) did not influence the prognosis of NAM patients. The latter was affected by the histopathological characteristics (Breslow thickness, regression and mitoses) and location (fingers vs. foot).


Assuntos
Melanoma/patologia , Melanoma/cirurgia , Doenças da Unha/patologia , Doenças da Unha/cirurgia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Desarticulação , Feminino , Hallux , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Índice Mitótico , Prognóstico , Úlcera Cutânea/etiologia , Polegar , Carga Tumoral
16.
Am J Dermatopathol ; 37(7): e83-6, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24786579

RESUMO

A panel of immunohistochemical markers may be used to differentiate between pagetoid Bowen disease (PBD) and primary extramammary Paget disease (EMPD) in selected cases. Although diffuse staining with cytokeratin 7 (CK7), CAM5.2, carcinoembryonic antigen, epithelial membrane antigen (EMA), and gross cystic disease fluid protein 15 generally supports diagnosis of EMPD, cases have been reported where PBD also expressed CK7, EMA, and CAM5.2. Based on these findings, some authors suggested that the 2 entities may arise from the same multipotent stem cell, capable of further differentiation toward squamous and secretory lines. To the best of our knowledge, this issue has never been investigated by comparing PBD and EMPD at the ultrastructural level. We performed the first ultrastructural study of a case of PBD exhibiting common immunohistochemical features with EMPD. The lesion displayed some ultrastructural features often observed in Bowen disease and some that are typically found in EMPD. These findings indicate the presence of a bidirectional differentiation--secretory and squamous--within the same lesion, thus supporting the hypothesis that PBD and primary EMPD may arise from a common progenitor cell.


Assuntos
Doença de Bowen/química , Doença de Bowen/ultraestrutura , Queratinas/análise , Doença de Paget Extramamária/química , Neoplasias Cutâneas/química , Neoplasias Cutâneas/diagnóstico por imagem , Idoso , Doença de Bowen/patologia , Antígeno Carcinoembrionário/análise , Proteínas de Transporte/análise , Glicoproteínas/análise , Humanos , Masculino , Antígenos Específicos de Melanoma/análise , Proteínas de Membrana Transportadoras , Mucina-1/análise , Receptor ErbB-2/análise , Proteínas S100/análise , Neoplasias Cutâneas/patologia , Fatores de Transcrição/análise , Proteínas Supressoras de Tumor/análise , Ultrassonografia , Antígeno gp100 de Melanoma
17.
Exp Dermatol ; 23(6): 414-8, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24750486

RESUMO

Distinct melanoma types exist in relation to patient characteristics, tumor morphology, histopathologic aspects and genetic background. A new diagnostic imaging tool, reflectance confocal microscopy (RCM), allows in vivo analysis of a given lesion with nearly histologic resolution while offering a dynamic view of the tissue in its 'natural' environment. The aim of this study was to analyse cell morphology of consecutive melanomas as they appear on RCM and to correlate morphology with tumor and patient characteristics. One hundred melanomas were visualized by RCM before excision. Clinical data, confocal features and histologic criteria were analysed. Four types of melanomas were identified as follows: (i) Melanomas with a predominantly dendritic cell population ('dendritic-cell melanomas') typically were thin by Breslow index; (ii) Melanomas typified by roundish melanocytes were smaller in size than dendritic cell MMs, but thicker by Breslow index, and predominantly occurred in patients with a high nevus count; (iii) Melanomas characterized by dermal nesting proliferation usually were thick by Breslow index at the time of diagnosis, although frequently smaller in size compared with the other types; and (iv) combined type melanomas may represent an evolution of dendritic cell and/or round cell types. Integration of confocal microscopy with clinical and histologic aspects may help in identifying and managing distinct tumors.


Assuntos
Melanoma/classificação , Melanoma/patologia , Microscopia Confocal/métodos , Neoplasias Cutâneas/classificação , Neoplasias Cutâneas/patologia , Idoso , Proliferação de Células , Diagnóstico Diferencial , Diagnóstico por Imagem/métodos , Feminino , Humanos , Células de Langerhans/patologia , Masculino , Melanócitos/patologia , Melanoma/diagnóstico , Pessoa de Meia-Idade , Nevo/patologia , Estudos Retrospectivos , Neoplasias Cutâneas/diagnóstico
18.
JAMA Dermatol ; 149(8): 941-5, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23740161

RESUMO

IMPORTANCE: Nested melanoma of the elderly is a newly identified histopathologic variant of superficial spreading melanoma, characterized by intraepidermal large nests. However, the clinical, dermoscopic, and confocal aspects have been depicted only partially. OBSERVATIONS: In our cases series, nested melanoma was a flat, irregularly shaped lesion with variably pigmented and irregularly distributed globules on dermoscopic examination. Confocal microscopy revealed the presence of a "clod" pattern made of large compact nests with variable atypia. These findings correlated well with histopathologic features. CONCLUSIONS AND RELEVANCE: Nested melanoma of the elderly should be included in the differential diagnosis when a flat pigmented lesion, showing dermoscopically an irregular globular pattern, is seen in a patient older than 60 years.


Assuntos
Dermoscopia/métodos , Melanoma/diagnóstico , Microscopia Confocal/métodos , Neoplasias Cutâneas/diagnóstico , Fatores Etários , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Melanoma/patologia , Pessoa de Meia-Idade , Neoplasias Cutâneas/patologia
19.
Dermatology ; 226(3): 207-11, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23711617

RESUMO

Fibroepithelioma of Pinkus (FeP) is an unusual form of basal cell carcinoma, which may clinically mimic a range of benign skin tumors that are not routinely excised. Preliminary observations on a total of 20 published cases of FeP suggest that dermoscopy and reflectance confocal microscopy may aid the clinical diagnosis and management of FeP. Herein we report the clinical, dermoscopic and confocal microscopic features of 3 additional cases of FeP, which were clinically misclassified as benign skin tumors, and discuss the role of dermoscopy and confocal microscopy in the clinical diagnosis of this condition.


Assuntos
Carcinoma Basocelular/patologia , Dermoscopia , Erros de Diagnóstico , Neoplasias Fibroepiteliais/patologia , Neoplasias Cutâneas/patologia , Idoso de 80 Anos ou mais , Carcinoma Basocelular/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Microscopia Confocal , Pessoa de Meia-Idade , Neoplasias Fibroepiteliais/cirurgia , Neoplasias Cutâneas/cirurgia
20.
Dermatology ; 226(1): 52-60, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23485555

RESUMO

Most melanomas are easy to be diagnosed clinically and dermoscopically. The question remains open concerning the correct strategies to detect those melanomas that look morphologically inconspicuous from a clinical and/or dermoscopic point of view. In our estimation, when morphology is not enough to recognize melanoma, one has to use specific management strategies. Herein we summarize the following 7 simple and practical rules that outline the need for a more general approach integrating clinical information with dermoscopic examination: (1) Look basically at all lesions. (2) Undress high-risk patients. (3) Use the 10 seconds rule in single lesions. (4) Compare and monitor multiple moles. (5) Excise doubtful nodular lesions. (6) Combine clinical and dermoscopic criteria. (7) Combine clinical and histopathologic criteria.


Assuntos
Dermoscopia/métodos , Melanoma/patologia , Nevo Pigmentado/patologia , Neoplasias Cutâneas/patologia , Idoso , Algoritmos , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nevo/patologia , Guias de Prática Clínica como Assunto , Valor Preditivo dos Testes
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...