Critical effects of intense sun exposure on the expression of epiluminescence microscopy features of acquired melanocytic nevi.

BACKGROUND: Current knowledge of the histologic counterparts of epiluminescence microscopy (ELM) features in pigmented skin lesions is limited. As a particular aspect of this problem, the transient effects of intense sun exposure on the morphological characteristics of melanocytic nevi may influence the expression of ELM features as well as the demonstration of stable and consistent histologic correlates. OBSERVATIONS: Forty melanocytic nevi from 11 subjects living in Northern Italy were examined by digital ELM before and after 5 to 13 days of sun exposure at latitudes of 5 degrees north to 3 degrees south. A number of multifaceted changes were observed. In particular, 3 lesions showed the expression of some structures compatible with radial streaming, pseudopods, and gray-blue areas. These features are considered to have often severe histologic correlates. In a third image, obtained 5 to 6 weeks later, they showed partial or total regression. Another case showed a massive regression of the pigment network as a result of a progressive inflammatory reaction with marked asymmetry in the distribution of pigmentation. CONCLUSIONS: Digital ELM has the potential to detect subtle changes in the structure of nevi after intense sun exposure. The transient observation of certain ELM features often associated with severe histologic substrates casts doubts on the ability of ELM to characterize sun-exposed nevi by a single examination.

The safety of cluster immunotherapy with aluminium hydroxide-adsorbed honey bee venom extract.

Venom immunotherapy (VIT) with aqueous extracts is considered a life-saving treatment in insect allergy, but systemic side effects are quite common, especially in patients sensitized to Apis mellifera venom. Only a few studies are available regarding depot VIT administered according to the standard weekly schedule, while no data are available for cluster VIT with depot preparations. This study was designed to compare the tolerance of aqueous cluster or rush VIT versus cluster depot VIT in patients sensitized to Apis mellifera. Fifty-five patients with a history of systemic reaction (grade II to IV according to Müller) after an Apis mellifera sting were divided at random into 3 groups. Forty patients were treated with aqueous VIT (20 according to a cluster schedule and 20 according to a rush schedule) and 15 with Depot VIT according to a cluster schedule. All local and systemic side effects were recorded. Four patients belonging to the aqueous-cluster, 4 belonging to the aqueous-rush, and 1 belonging to the depot-cluster schedule had large local reactions after VIT (p < 0.009). Systemic side effects were recorded in 1, 7 and 0 patients (p < 0.003) respectively. No statistically significant difference was found between the two cluster regimens in the frequency of side effects. Depot VIT administered according to a cluster schedule was well tolerated, and its tolerance is better than aqueous-rush VIT for Apis mellifera.

Anaphylactic reaction to cinoxacin: report of one case associated with inferior acute myocardial infarction.

Cinoxacin is an oral synthetic antibacterial agent, of the second generation quinolones group, with excellent efficacy in respiratory, intra-abdominal, pelvic, and skin and soft tissue infections. Overall, quinolones are well tolerated drugs, although phototoxicity and photoallergenicity is well demonstrated experimentally. In this report we show you a case of a man who presented a anaphylactic reaction associated with myocardial infarction, after taking a capsule of cinoxacin. We suppose that there is a direct participation of the heart in anaphylactic reactions, because acttivated mast-cells mediators can determine cardiovascular effects. Then performed double-blind placebo controlled challenge test with an alternative drug. We did not observe any adverse immediate or late adverse reaction to this drug.

Seasonal prevalence of digital epiluminescence microscopy patterns in acquired melanocytic nevi.

BACKGROUND: Available information of the effect of sun exposure on the biologic activity and morphologic characteristics of nevi is based on a few cross-sectional studies. According to these, nevi excised in summer show a higher mitotic count, a greater extent of the junctional component, and more frequent regression and inflammation. OBJECTIVE: Our goals were to obtain data on the seasonal prevalence of digital epiluminescence microscopy (D-ELM) patterns in acquired melanocytic nevi (AMN) and to test the reliability of D-ELM as a substitute for histology in prospective studies of the morphologic response of AMN to sun exposure. METHODS: Two independent series of AMN located on intermittently sun-exposed body sites and undergoing D-ELM in winter (n=121) and in summer (n=116) were compared for the prevalence of major ELM patterns. RESULTS: Cases in the summer series showed a greater frequency of a broad and prominent pigment network; black dots with varied size, irregular distribution, and peripheral location; and peripheral depigmentation. CONCLUSION: On the basis of known histologic correlates of D-ELM features, our findings were consistent with studies of seasonal histologic changes in AMN. D-ELM may be a useful tool in the prospective evaluation of effects of sun exposure on AMN morphology.

Intraobserver agreement in interpretation of digital epiluminescence microscopy.

BACKGROUND: Although a major problem with the classification of epiluminescence microscopy (ELM) findings is the lack of standard definitions, reproducibility of the criteria proposed has never been investigated. OBJECTIVES: Our purposes were (1) to perform a review of four major published classifications to obtain a set of apparently well-defined ELM variables and descriptors and (2) to evaluate the ability of one of us to report consistently ELM findings in melanocytic lesions according to these criteria. METHODS: Intraobserver agreement (with a set of 44 selected descriptors) between two readings of 150 digital ELM images was evaluated with the kappa (kappa) statistic. Subgroups of descriptors were compared for kappa value distribution. RESULTS: The median kappa value for the whole series of descriptors was 0.66. Median kappa did not vary significantly among the four classification systems (kappa = 0.61 to 0.67). Agreement was significantly better as to the presence or absence of ELM findings (kappa range, 0.39 to 1.00; median kappa, 0.77) compared with agreement as to their distribution (kappa range, 0.10 to 0.79; median kappa, 0.47; p = 0.0007) and their width, thickness, and size (kappa range, 0.06 to 0.83; median kappa, 0.39; p = 0.0075). CONCLUSION: Although nothing can be inferred from a single study, descriptors associated with low intraobserver agreement are likely to be inadequately defined.

Correlation between the histopathology and the epiluminescence microscopy features of malignant blue nevus.

BACKGROUND: The validation of epiluminescence microscopy (ELM) for the diagnosis of pigmented skin lesions is conditional on the demonstration of consistent histologic correlates of the ELM patterns. The ELM characteristics of malignant blue nevus (MBN) have never been reported previously. OBJECTIVE: To evaluate the histologic counterparts of the ELM features of a case of MBN. METHODS: Comparison between the histologic characteristics observed in step-sections of the lesion and the structures observed in a digital ELM image. RESULTS: On ELM, the lesion showed a diffuse whitish-blue veil, round black blotches, a collection of dark colored punctate spots, and fragmented bluish reticular-like formations in the periphery. At histologic examination, the black blotches and the spots appeared to correlate with areas of intense focal necrosis in the papillary and reticular dermis, and the reticular-like structures were demonstrated to correspond to the presence of free melanin and melanophages in the papillary dermis. CONCLUSION: In this case of MBN, blotches and spots seen on ELM correlated with intense necrosis in the papillary and reticular dermis, and reticular-like formations were the counterparts of free melanin and melanophages in the papillary dermis.