Dermatology and Skin Cancer Unit

Santa Maria Nuova, Italy

Dermatology and Skin Cancer Unit

Santa Maria Nuova, Italy
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Giacomel J.,Spectrum | Zalaudek I.,Medical University of Graz | Zalaudek I.,Dermatology and Skin Cancer Unit
Dermatologic Clinics | Year: 2013

Dermoscopy (dermatoscopy or surface microscopy) is an ancillary dermatologic tool that in experienced hands can improve the accuracy of diagnosis of a variety of benign and malignant pigmented skin tumors. The early and more accurate diagnosis of nonpigmented, or pink, tumors can also be assisted by dermoscopy. This review focuses on the dermoscopic diagnosis of pink lesions, with emphasis on blood vessel morphology and pattern. A 3-step algorithm is presented, which facilitates the timely and more accurate diagnosis of pink tumors and subsequently guides the management for such lesions. © 2013 Elsevier Inc.

Salerni G.,National University of Rosario | Teran T.,National University of Rosario | Puig S.,Hospital Clinic of Barcelona | Malvehy J.,Hospital Clinic of Barcelona | And 4 more authors.
Journal of the European Academy of Dermatology and Venereology | Year: 2013

It has been demonstrated that dermoscopic monitoring of melanocytic lesions allows for the recognition of melanoma in early stages while minimizing the excision of benign lesions. However, it is still pending to determine the real impact of digital follow-up in the clinical management of pigmented lesions. To assess the evidence of follow-up of melanocytic skin lesions with digital dermoscopy in the management of individuals at risk for melanoma by performing a meta-analysis. Medline database was screened, no limits in terms of date or language were applied. Original studies were selected when the following criteria were met: performed in clinical setting with clinical and dermoscopic evaluation made by physicians, data regarding population characteristics included, follow-up strategy used described. Fourteen of 145 retrieved references were retained. Included studies account for a total of 5787 patients (mean 445 per study) and 52 739 lesions monitored (mean per study 4057; range 272-11 396) with a mean of 12 lesions monitored per patient; a total of 4388 lesions (8.3%) were excised. The mean length of follow-up was 30 months. A mean of <1 lesion was excised per patient along the surveillance period. The number needed to monitor (NNM) ranged from 31 to 1008 (mean: 348) among eligible studies. For every additional month of monitoring, 1additional melanoma was detected. Using digital dermoscopy follow-up, the proportion of in situ melanoma and thin melanomas are higher than expected in general population. Chances to detect a melanoma during surveillance increase as the length of follow-up extends. © 2012 European Academy of Dermatology and Venereology.

Ferrara G.,Gaetano Rummo General Hospital | Gianotti R.,University of Milan | Cavicchini S.,Dermatology Unit | Salviato T.,Santa Maria degli Angeli General Hospital | And 3 more authors.
Dermatologic Clinics | Year: 2013

Spitz nevus can clinically present either in the classical (reddish pink) or the pigmented (brownish black) variant. Dermoscopy demonstrates that the pigmented variant is much more common than the classical variant; however, none of these show dermoscopic patterns clearly distinguishable from melanoma. Even histopathologically, a clear-cut differentiation between benign and malignant spitzoid neoplasms is often difficult, so that intermediate diagnostic categories (atypical Spitz nevus and Spitz tumor) are admitted. Because of these difficulties in clinical and histopathologic evaluation, surgical excision is recommended for clinically atypical spitzoid lesions of childhood and for all spitzoid lesions of adulthood. © 2013 Elsevier Inc.

Gill M.,Skin Medical Research and Diagnostics | Longo C.,Dermatology and Skin Cancer Unit | Farnetani F.,University of Modena and Reggio Emilia | Cesinaro A.M.,University of Modena and Reggio Emilia | And 2 more authors.
Journal of the European Academy of Dermatology and Venereology | Year: 2014

Background Reflectance confocal microscopy (RCM) allows for non-invasive, in vivo evaluation of skin lesions and it has been extensively applied in skin oncology although systematic studies on nevi characterization are still lacking. Objective The aim of this study was to determine whether reliable RCM correlates to histological features used to diagnose melanocytic neoplasms exist. Methods We blindly evaluated the RCM and histological features of 64 melanocytic neoplasms (19 non-dysplastic nevi, 27 dysplastic nevi, 14 melanomas) and analysed the data using Spearman's rho calculation. Results Many histological features can be identified using RCM. Elongated rete ridges corresponded on RCM to edge papillae, whereas flattened rete ridges to several features which involve dermal-epidermal junction disruption. Bridging of junctional nesting (JN) corresponded on RCM to both JN with irregular size/shape and JN with short interconnections. While we could reliably identify dermal melanocytes, the RCM features did not reliably distinguish between benign and concerning dermal melanocytic arrangements, suggesting further refinement of dermal melanocytic RCM features is needed. Conclusion Reliable correlates for epidermal and junctional histological features used to diagnose melanocytic neoplasms are identifiable on RCM, suggesting harnessing histological criteria may be a reasonable method to move beyond the algorithmic approach. © 2013 European Academy of Dermatology and Venereology.

Pellicano R.,Casa Sollievo della Sofferenza | Caldarola G.,Catholic University of the Sacred Heart | Filabozzi P.,Casa Sollievo della Sofferenza Hospital | Zalaudek I.,Dermatology and Skin Cancer Unit | Zalaudek I.,Medical University of Graz
Dermatology | Year: 2013

Background: Dermoscopy is traditionally used for the diagnosis of skin tumors, but it has also gained increasing interest as an adjunct in the clinical diagnosis of inflammatory skin diseases. Objective: To evaluate the dermoscopic patterns of necrobiosis lipoidica (NL) and granuloma annulare (GA) and to compare these findings with other granulomatous skin disorders. Methods: This is a retrospective analysis of patient data and clinical and dermoscopic images of histopathologically diagnosed cases of NL and GA. Results: A total of 24 cases, including 12 cases of NL and 12 cases of GA, were evaluated. In all cases of NL, dermoscopy revealed evident, sharply focused, elongated and serpentine telangiectasias, which were typically located over a whitish, structureless background. In contrast, all cases of GA were dermoscopically typified by peripheral, structureless orange-reddish borders, which were associated in 5 cases with isolated, unfocussed small vessels. Conclusion: Our study suggests that NL and GA reveal different dermoscopic patterns, which may aid the correct diagnosis. In addition, the dermoscopic patterns of NL and GA appear to differ from other forms of granulomatous diseases. © 2013 S. Karger AG, Basel.

Rosendahl C.,University of Queensland | Cameron A.,University of Queensland | Argenziano G.,Dermatology and Skin Cancer Unit | Zalaudek I.,Dermatology and Skin Cancer Unit | And 3 more authors.
Archives of Dermatology | Year: 2012

Objectives: To characterize dermoscopic criteria of squamous cell carcinoma (SCC) and keratoacanthoma and to compare them with other lesions. Design : Observer-masked study of consecutive lesions performed from March 1 through December 31, 2011. Setting: Primary care skin cancer practice in Brisbane, Australia. Participants: A total of 186 patients with 206 lesions. Main Outcome Measures: Sensitivity, specificity, predictive values, and odds ratios. Results: In a retrospective analysis of 60 invasive SCC and 43 keratoacanthoma cases, keratin, surface scale, blood spots, white structureless zones, white circles, and coiled vessels were commonly found in both types of lesions. We reevaluated the significance of these criteria in 206 raised, nonpigmented lesions (32 SCCs, 29 keratoacanthomas, and 145 other lesions). Central keratin was more common in keratoacanthoma than in SCC (51.2% vs 30.0%, P =.03). Keratin had the highest sensitivity for keratoacanthoma and SCC (79%), and white circles had the highest specificity (87%). When keratoacanthoma and SCC were contrasted with basal cell carcinoma, the positive predictive values of keratin and white circles were 92% and 89%, respectively. When SCC and keratoacanthoma were contrasted with actinic keratosis and Bowen disease, the positive predictive value of keratin was 50% and that of white circles was 92%. In a multivariate model, white circles, keratin, and blood spots were independent predictors of SCC and keratoacanthoma. White circles had the highest odds ratio in favor of SCC and keratoacanthoma. The interobserver agreement for white circles was good (0.55; 95% CI, 0.44-0.65). Conclusions: White circles, keratin, and blood spots are useful clues to differentiate SCC and keratoacanthoma from other raised nonpigmented skin lesions by dermoscopy. The significance of these criteria depends on the clinical context. ©2012 American Medical Association. All rights reserved.

Longo C.,Dermatology and Skin Cancer Unit | Pellacani G.,University of Modena and Reggio Emilia | Tourlaki A.,Iclid Institute Of Surgery And Laser Surgery In Dermatology | Galimberti M.,Iclid Institute Of Surgery And Laser Surgery In Dermatology | Bencini P.L.,Iclid Institute Of Surgery And Laser Surgery In Dermatology
Lasers in Medical Science | Year: 2014

Melasma is an acquired disorder of pigmentation for which several therapeutical options are currently available. Among them, low-energy Q-switched Nd:YAG laser (1,064 nm) has been successfully applied in case series although its long-term efficacy has yet to be proven. In vivo confocal microscopy is a novel imaging technique that permits to explore the skin tissue at a nearly histologic resolution. The aim of our study was to evaluate the laser treatment efficacy by means of confocal microscopy at different time points to elucidate the mechanism of action of the laser and its possible drawbacks. Eight women who presented with melasma on the face were subjected to low-energy Q-switched Nd:YAG laser treatment and then analyzed by means of confocal microscopy. An overall improvement of melasma was noticed clinically and microscopically by means of confocal microscopy. Four cases revealed the presence of dendritic-shaped cells upon confocal microscopy and those patients were the ones presenting with a relapse of the disease. The interpretation of these cells is that they could represent reasonably activated melanocytes. This opens the question whether laser treatment should be modulated to avoid side-effects associated with its use. Confocal microscopy has emerged as an excellent tool for a better understanding of the changes occurring during laser treatment. © 2013 Springer-Verlag.

Longo C.,Dermatology and Skin Cancer Unit | Moscarella E.,Dermatology and Skin Cancer Unit | Argenziano G.,Dermatology and Skin Cancer Unit | Lallas A.,Dermatology and Skin Cancer Unit | And 3 more authors.
British Journal of Dermatology | Year: 2015

Reflectance confocal microscopy (RCM) is a noninvasive tool that can be helpful in the diagnosis of nonpigmented skin tumours. As RCM enables visualization of architectural and cytological structures at near-histological resolution, it can improve the diagnostic accuracy of dermoscopically equivocal solitary pink neoplasms. For management decisions, it is important to identify specific morphological clues that allow bedside classification of nonpigmented skin neoplasms into benign vs. malignant and melanocytic vs. nonmelanocytic. More specifically, the presence of a nested melanocytic proliferation at the dermoepidermal junction or dermis level permits the clinician to ascribe a given lesion as melanocytic; the identification of basaloid bright tumour islands is a key RCM feature for the diagnosis of basal cell carcinoma; and the presence of disarrayed epidermis along with small demarcated papillae is suggestive for the diagnosis of squamous cell carcinoma. The present review offers a comprehensive description of the main RCM diagnostic clues for solitary pink neoplasms that direct clinicians to the correct diagnosis and that may serve as groundwork for future prospective studies. What's already known about this topic? Solitary pink tumours represent a diagnostic challenge for clinicians as they often reveal subtle clinical and dermoscopic features. Reflectance confocal microscopy (RCM) has been shown to improve the accuracy of diagnosis of amelanotic melanoma and basal cell carcinoma. What does this study add? This review describes the criteria for RCM diagnosis of neoplasms that present as solitary pink lesions. This descriptive information may facilitate the formulation of prospective studies testing RCM-based diagnosis of amelanotic neoplasms. © 2015 British Association of Dermatologists.

Longo C.,Dermatology and Skin Cancer Unit | Galimberti M.,Iclid Institute Of Surgery And Laser In Dermatology | Galimberti M.,HIGH-TECH | De Pace B.,Dermatology and Skin Cancer Unit | And 3 more authors.
Lasers in Medical Science | Year: 2013

Fractionated carbon dioxide (CO2) laser resurfacing is an effective treatment of skin aging. Several studies investigated the morphologic changes due to this laser treatment by using skin biopsies or animal model. Recently, reflectance confocal microscopy (RCM) has emerged as a new tool that can "optically" scan the skin in vivo with a nearly histologic resolution and in a totally noninvasive modality. Our study aims to analyze the skin changes following the ablative fractional CO2 laser sessions by using RCM. Ten patients were subjected to ablative fractional CO2 laser sessions for skin aging. Confocal microscopic images were acquired at baseline (w0), 3 weeks (w3), 6 weeks (w6), and 12 weeks (w12) after laser session. Previously identified confocal parameters were used to assess the skin aging at baseline and after treatment. At w3, the epidermis showed a complete disappearance of the mottled pigmentation upon RCM along with the presence of few Langherans' cells. The collagen type as seen upon RCM observed at baseline was replaced by a newly formed collagen type of long, bright and straight fibers (collagen remodeling). These fibers were parallel arranged and observed throughout the entire RCM mosaic. At w6 and w12 the confocal aspects of the skin was unchanged compared to w3. RCM confirmed the presence of an intense collagen remodeling following laser resurfacing. In line with previous studies, this collagen showed a peculiar arrangement and distribution. The collagen remodeling was still present after 3 months and confirms the long-term effect of the treatment. This is the first time that the skin can be analyzed in vivo at patient's bedside. In the near future, RCM can be an essential adjunct for Clinicians to measure the effects of laser treatment and possibly to gain new insights into the development of side effects. © 2012 Springer-Verlag London Ltd.

Moscarella E.,Dermatology and Skin Cancer Unit | Argenziano G.,Dermatology and Skin Cancer Unit | Lallas A.,Dermatology and Skin Cancer Unit | Pellacani G.,University of Modena and Reggio Emilia | Longo C.,Dermatology and Skin Cancer Unit
Experimental Dermatology | Year: 2014

One of the emerging and intriguing applications of reflectance confocal microscopy is the evaluation of 'dynamic' processes of the skin that cannot be otherwise analysed using histopathology that offers a picture of the tissue at one time point. This is nicely illustrated by recent article by Wolberink et al. in the current issue of Exp Dermatol, in which the Authors evaluated patterns and time interval of polymorphonuclear neutrophil (PMN) migration in psoriatic plaques by means of reflectance confocal microscopy (RCM). This example underscores that a new era of confocal microscopy is starting, which promises to reveal a dynamic in vivo understanding of the pathophysiology of human skin diseases. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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