Onychopapilloma: its clinical, dermoscopic and pathologic features.

BACKGROUND: Onychopapilloma is a benign tumour of the nail bed and distal matrix and commonly presents as longitudinal erythronychia, longitudinal leukonychia or longitudinal melanonychia. Because onychopapilloma is rare, its clinical characteristics and dermoscopic findings have not been well investigated in Asia. OBJECTIVES: This study aimed to investigate the clinical characteristics and dermoscopic and pathologic findings of onychopapilloma in Korea. METHODS: We retrospectively reviewed the medical records and clinical/dermoscopic photographs of 39 patients diagnosed with onychopapilloma in the Pusan National University Hospitals (Busan and Yangsan) for 11 years (2010-2021). RESULTS: Among 39 patients, 23 (59.0%) were men, and 16 (41.0%) were women. The mean age was 46.1 (16-77) years. All lesions were single, and most of them were located on the fingers (92.3%), especially the thumb (66.7%). The most common clinical feature was longitudinal erythronychia (56.4%), and the most common dermoscopic finding was distal subungual hyperkeratosis (100%). We found two new dermoscopic features: macrolunula and trailing lunula along the longitudinal band. Among 18 patients who underwent surgical excision, only 6 (33.3%) showed typical acanthosis and papillomatosis on the nail bed. CONCLUSIONS: We found that Asian onychopapilloma has similar clinicodermoscopic findings to the Caucasian one, that is to say, longitudinal erythronychia and distal subungual hyperkeratosis were the most common nail change and dermoscopic finding, respectively. We propose two new dermoscopic features of onychopapilloma: macrolunula and trailing lunula along the longitudinal band.

Outcome following computed tomographic imaging and subsequent surgical removal of keratomas in equids: 32 cases (2005-2016).

OBJECTIVE To describe the use of CT in the diagnosis of and presurgical planning for equids with keratomas treated by hoof wall resection and determine postoperative complications and outcome. DESIGN Retrospective case series. ANIMALS 29 horses and 3 mules with keratomas treated by partial or complete hoof wall resection following CT imaging of the distal portion of the affected extremity from 2005 through 2016. PROCEDURES For each equid, physical examination and lameness evaluation were performed, followed by imaging of the distal portion of the affected extremity. A tentative diagnosis of keratoma was made given results of clinical, radiographic, and CT examination, with the definitive diagnosis made on histologic examination. After CT imaging, each equid was treated with hoof wall resection. RESULTS CT allowed accurate identification of the size and location of 35 keratomas in 33 feet. Thirty equids underwent partial and 2 underwent complete hoof wall resection for keratoma removal. Complications developed in 4 of 31 (13%) equids and included excessive granulation tissue formation at the surgical site (n = 1), excessive granulation tissue formation and worsening lameness (1), incomplete keratoma removal with suspected regrowth (1), and incomplete healing of the surgical site with distal interphalangeal joint sepsis secondary to repeated debridement of abnormal tissue (1). Twenty-eight of 31 (90%) equids returned to their previous activity level. CONCLUSIONS AND CLINICAL RELEVANCE Preoperative CT examination of the feet was useful in the diagnosis of and surgical planning for keratomas in equids. A low complication rate was achieved with the described techniques.

Mechanic hands: clinical and capillaroscopy manifestations of patients with connective tissue diseases presented with and without mechanic hands.

OBJECTIVES: The condition known as 'Mechanic's Hands' is a thickened, hyperkeratotic eruption, which is bilaterally symmetric along the fingers, and often occurs in patients with some connective tissue diseases. Nail fold capillaroscopy is a non-invasive technique for evaluation of connective tissue diseases. We evaluated the prevalence of mechanic hands in patients with connective tissue diseases and compared the clinical manifestations and capillaroscopic changes in the patients with and without mechanic hands. METHODS: The clinical manifestations and capillaroscopy of 576 patients with scleroderma, dermatomyositis, systemic lupus erythematosus, Sjogren's syndrome, undifferentiated and mixed connective tissue diseases were evaluated and compared in patients with and without mechanic hands. RESULTS: A total of 576 patients were enrolled. Mechanic hands were observed in 17.2% of patients: 50% of mixed connective tissue disease, 35% of dermatomyositis, 15.4% of scleroderma, 14.9% of undifferentiated connective tissue disease, 14.3% of Sjogren's syndrome, and no patient with SLE. Among them, 80.8% had abnormal capillaroscopic findings. In dermatomyositis patients, Raynaud's phenomenon, anti-Jo-1 positivity, and some capillaroscopy findings were detected more frequently in patients with mechanic hand. In scleroderma, positive Scl70 and capillary loss were observed more frequently in patients without mechanic hands. CONCLUSIONS: Mechanic hands can be a presenting sign of some systemic connective tissue diseases. Probably, finding this sign on examination, especially together with Raynaud's phenomenon or abnormal capillaroscopy, can be helpful in the early diagnosis of the connective tissue diseases and can be used as a predictive and prognostic tool in future studies.

Acquired digital fibrokeratoma: review of its clinical and dermoscopic features and differential diagnosis.

Acquired digital fibrokeratoma (ADFK) is a rare, benign, fibrous tumor that most often occurs on fingers. It may resemble a rudimentary supernumerary digit and is often misdiagnosed as another common benign condition, such as common wart. It is typically asymptomatic and occurs as a solitary nodule less than 1 cm in diameter. Oftentimes ADFK shares clinical and/or histologic resemblance with other benign and malignant cutaneous conditions so it is crucial that careful examination is undertaken. In this article, we will discuss the clinical presentation, epidemiology, etiology, dermoscopic and histologic findings, management, and differential diagnoses for ADFK, with the hope that this review will facilitate timely diagnosis and management for this distinct condition.

A novel cumulative level difference mean based GLDM and modified ABCD features ranked using eigenvector centrality approach for four skin lesion types classification.

BACKGROUND AND OBJECTIVE: Melanoma is one of the major death causes while basal cell carcinoma (BCC) is the utmost incident skin lesion type. At their early stages, medical experts may be confused between both types with benign nevus and pigmented benign keratoses (BKL). This inspired the current study to develop an accurate automated, user-friendly skin lesion identification system. METHODS: The current work targets a novel discrimination technique of four pre-mentioned skin lesion classes. A novel proposed texture feature, named cumulative level-difference mean (CLDM) based on the gray-level difference method (GLDM) is extracted. The asymmetry, border irregularity, color variation and diameter are summed up as the ABCD rule feature vector is originally used to classify the melanoma from benign lesions. The proposed method improved the ABCD rule to also classify BCC and BKL by using the proposed modified-ABCD feature vector. In the modified set of ABCD features, each border feature, such as compact index, fractal dimension, and edge abruptness is considered a separate feature. Then, the composite feature vector having the pre-mentioned features is ranked using the Eigenvector Centrality (ECFS) feature ranking method. The ranked features are then classified by a cubic support vector machine for different numbers of selected features. RESULTS: The proposed CLDM texture features combined with the ranked ABCD features achieved outstanding performance to classify the four targeted classes (melanoma, BCC, nevi and BKL). The results report 100% outstanding performance of the sensitivity, accuracy and specificity per each class compared to other features when using the highest seven ranked features. CONCLUSIONS: The proposed system established that Melanoma, BCC, nevus and BKL are efficiently classified using cubic SVM with the new feature set. In addition, the comparative studies proved the superiority of the cubic SVM to classify the four classes.

Dermoscopy of Common Inflammatory Disorders.

In addition to its "traditional" application for the early diagnosis of melanoma and nonmelanoma skin cancers, dermoscopy gains appreciation in fields beyond dermato-oncology. Nowadays, dermoscopy has been established as a reliable adjunctive tool to the everyday clinical practice of general dermatology. Morphology and distribution of vascular structures, background colors, follicular abnormalities, and the presence of scales are important features that should be evaluated. Clinical examination remains the undoubted mainstay of diagnosis in inflammatory and infectious diseases.