Progressive late-onset of cutaneous angiomatosis as possible sign of cerebral cavernous malformations.

BACKGROUND: Cerebral cavernous malformations (CCM) comprise enlarged capillary cavities in the central nervous system, with possible retinal or cutaneous vascular malformations. This condition is associated with CCM1, CCM2, and CCM3 gene mutations. OBJECTIVE: Cutaneous clinical, histological and cerebral MRI findings, including CCM1, CCM2, and CCM3 gene sequencing, of two unrelated, neurological symptom-free patients who consulted for late-onset of deep multiple cutaneous angiomatoid lesions, are described. RESULTS: The diagnosis of multiple cutaneous angiomatosis was confirmed and related to CCM as detected by MRI in both cases. Analysis of our patients showed normal nucleotide sequences of the genes proposed. CONCLUSIONS: A progressive late-onset of multiple, deep cutaneous venous malformations may indicate the need to investigate a potential coexistence of CCM by MRI. Early diagnosis and prompt treatment is required in these patients. The absence of CCM1, CCM2, and CCM3 mutations might indicate that different genes could be involved in the pathogenesis of these late-onset patients. Careful questioning about family history of CCM is important; our first patient's daughter had a history of cerebral cavernoma.

Dermoscopic Analysis of 72 "Atypical" Seborrheic Keratoses. / Análisis dermatoscópico de 72 queratosis seborreicas «atípicas¼.

BACKGROUND: Seborrheic keratoses (SK) are easily recognizable by clinical and dermoscopic approach, nevertheless, some lesions act as a simulator of different skin conditions lacking typical clinical and dermoscopic criteria. OBJECTIVE: The aim of our study was to find specific dermoscopic features or a global pattern to improve diagnostic skills for challenging SK. MATERIALS AND METHODS: We examined 72 atypical SK excised from September 2014 up to September 2017 by using the 2-step algorithm modified by Malvehy (2002) and Argenziano (2003). RESULTS: In our study population, an average of 4.04 out of 15 dermoscopic specific criteria for SK was found (for example, multiple milia-like cysts). Additional criteria not included in 2-step algorithm were blue-whitish veil (found in 3 SK; 4.2%), polymorphous vessels (18 SK; 25%), blotch/globules (6 SK; 8.3%), shiny white streaks (3 lesions; 4.2%). The most represented global patterns were reticular (27 SK; 37.5%) and not specific (15 SK; 20.8%). All lesions exhibited peculiar findings of SK, furthermore elements suggestive for melanocytic lesion were found in 79.2% of all lesions. Comparing the literature and our results, we found 3 significant differences: a) the less prevalence of SK specific criteria in our study population; b) the description of findings usually not related to SK, among which blue-whitish veil, polymorphous vessels, blotch/globules and shiny white streaks, and c) 2 patterns not previously defined represented by "not specific pattern" (20.9% of all lesions examined) and "vascular pattern" (12.5% of all lesions examined) were also described. No specific feature or global pattern, statistically significant for dermoscopic diagnosis of difficult-to-diagnose SK have been found. CONCLUSION: Nevertheless the useful findings, no specific feature or global pattern statistically significant for dermoscopic diagnosis of challenging SK have been found. According to the 2-step algorithm and the dermatoscopic scoring system for melanocytic and not melanocytic lesion, SK with one or more dermatoscopic findings typical of melanocytic lesion should be removed surgically to exclude classic melanoma or melanoma mimicking SK.

Análisis dermatoscópico de 72 queratosis seborreicas "atípicas" / Dermoscopic Analysis of 72 "Atypical" Seborrheic Keratoses

Antecedentes: Las queratosis seborreicas (QS) son reconocidas con facilidad a través de una aproximación clínica y dermatoscópica, sin embargo, algunas lesiones presentan un comportamiento que simula distintas afecciones de la piel que carecen de criterios clínicos y dermatoscópicos típicos. Objetivo: El objetivo de este estudio fue encontrar características dermatoscópicas específicas o un patrón general que permita mejorar las habilidades diagnósticas en los casos de QS complejas. Materiales y métodos: Estudiamos 72 casos de QS atípicas extirpadas entre septiembre del 2014 y septiembre del 2017 utilizando para ello el algoritmo en 2 pasos modificado por Malvehy (2002) y Argenziano (2003). Resultados: En nuestra población de estudio, encontramos una media de 4,04 de los 15 criterios específicos dermatoscópicos de QS (por ejemplo, múltiples puntos similares a quistes tipo milium). Se identificaron los siguientes criterios adicionales no incluidos en el algoritmo en 2 pasos: velo azul-blanquecino (en 3 QS; 4,2%), patrón vascular polimorfo (18 QS; 25%), manchas/glóbulos (6 QS; 8,3%), manchas blancas brillantes (3 lesiones; 4,2%). Los patrones generales más representados fueron el patrón reticular (27 QS; 37,5%) y no específico (15 QS; 20,8%). Todas las lesiones exhibieron hallazgos peculiares de QS; además, en el 79,2% de todas las lesiones estudiadas se identificaron elementos indicativos de lesión melanocítica. Cuando comparamos la literatura con nuestros resultados, encontramos 3 diferencias significativas: a) una menor prevalencia de los criterios específicos de QS en nuestra población de estudio; b) la identificación de hallazgos generalmente no relacionados con la QS, como el velo azul-blanquecino, el patrón vascular polimorfo, las manchas/glóbulos y las manchas blancas brillantes, y c) también se describieron 2 patrones no definidos previamente representados por «patrón no específico» (20,9% de todas las lesiones examinadas) y "patrón vascular" (12,5% de todas las lesiones examinadas). No se encontró ninguna característica específica o patrón general estadísticamente significativo para el diagnóstico dermatoscópico de QS de diagnóstico difícil. Conclusión: A pesar de los hallazgos, no hemos encontrado ningún patrón específico o general estadísticamente significativo para el diagnóstico dermatoscópico de la QS de diagnóstico difícil. Conforme al algoritmo en 2 pasos y el sistema de puntuación dermatoscópica para lesiones melanocíticas y no melanocíticas, las QS con uno o varios hallazgos dermatoscópicos típicos de lesión melanocítica deberían ser extirpados quirúrgicamente para excluir el melanoma clásico o el melanoma que simula una QS

Background: Seborrheic keratoses (SK) are easily recognizable by clinical and dermoscopic approach, nevertheless, some lesions act as a simulator of different skin conditions lacking typical clinical and dermoscopic criteria. Objective: The aim of our study was to find specific dermoscopic features or a global pattern to improve diagnostic skills for challenging SK. Materials and methods: We examined 72 atypical SK excised from September 2014 up to September 2017 by using the 2-step algorithm modified by Malvehy (2002) and Argenziano (2003). Results: In our study population, an average of 4.04 out of 15 dermoscopic specific criteria for SK was found (for example, multiple milia-like cysts). Additional criteria not included in 2-step algorithm were blue-whitish veil (found in 3 SK; 4.2%), polymorphous vessels (18 SK; 25%), blotch/globules (6 SK; 8.3%), shiny white streaks (3 lesions; 4.2%). The most represented global patterns were reticular (27 SK; 37.5%) and not specific (15 SK; 20.8%). All lesions exhibited peculiar findings of SK, furthermore elements suggestive for melanocytic lesion were found in 79.2% of all lesions. Comparing the literature and our results, we found 3 significant differences: a) the less prevalence of SK specific criteria in our study population; b) the description of findings usually not related to SK, among which blue-whitish veil, polymorphous vessels, blotch/globules and shiny white streaks, and c) 2 patterns not previously defined represented by "not specific pattern" (20.9% of all lesions examined) and "vascular pattern" (12.5% of all lesions examined) were also described. No specific feature or global pattern, statistically significant for dermoscopic diagnosis of difficult-to-diagnose SK have been found. Conclusion. Nevertheless the useful findings, no specific feature or global pattern statistically significant for dermoscopic diagnosis of challenging SK have been found. According to the 2-step algorithm and the dermatoscopic scoring system for melanocytic and not melanocytic lesion, SK with one or more dermatoscopic findings typical of melanocytic lesion should be removed surgically to exclude classic melanoma or melanoma mimicking SK

Melanocitosis dérmica agminada en el territorio del nevus de Ota / Agminated Dermal Melanocytosis in the Territory of Ota's Nevus

No disponible