Plantation, FL, United States
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Balagula Y.,Sloan Kettering Cancer Center | Braun R.P.,University of Zürich | Rabinovitz H.S.,Skin and Cancer Associates | Dusza S.W.,Sloan Kettering Cancer Center | And 6 more authors.
Journal of the American Academy of Dermatology | Year: 2012

Background: Crystalline/chrysalis structures (CS) are white shiny streaks that can only be seen with polarized dermatoscopy. Objectives: We sought to estimate the prevalence and assess the clinical significance of CS in melanocytic and nonmelanocytic lesions. Methods: This was a prospective observational study in which dermatoscopic assessment of lesions was recorded in consecutive patients examined during a 6-month period. In addition, a data set of biopsy-proven melanomas was retrospectively analyzed. Results: In all, 11,225 lesions in 881 patients were prospectively examined. Retrospectively, 229 melanomas imaged with polarized dermatoscopy were analyzed. In the prospective data set, a median of 12.7 lesions (range, 1-54) were evaluated per patient. None of clinically diagnosed Clark nevi (n = 9750, 86.8%) demonstrated CS. Overall, CS were observed in 206 (1.8%) lesions, most commonly dermatofibromas and scars among nonbiopsied lesions. A total of 265 (2.4%) lesions were biopsied, including 20 melanomas and 36 nevi. Among biopsied malignant lesions, CS were most commonly observed in basal cell carcinoma (47.6%) and invasive melanomas (84.6%). Melanomas were more likely to have CS than biopsied nevi (odds ratio = 9.7, 95% confidence interval 2.7-34.1). In the retrospective data set, CS were more commonly observed among invasive melanomas (41%) compared with in situ melanomas (17%) (odds ratio = 3.4, 95% confidence interval 1.9-6.3, P <.001). The prevalence of CS correlated with increased melanoma thickness (P =.001). Limitations: Biopsied lesions represent a small percentage of the total number of lesions evaluated. Conclusion: Among biopsied malignant lesions, CS are most commonly observed in basal cell carcinoma and invasive melanomas and rarely seen in nevi. In melanoma, CS may reflect increased tumor thickness and progression. © 2011 by the American Academy of Dermatology, Inc.


Stricklin S.M.,University of Missouri | Stoecker W.V.,University of Missouri | Stoecker W.V.,Stoecker And Associates | Stoecker W.V.,Dermatology Center | And 5 more authors.
Journal of the American Academy of Dermatology | Year: 2012

Background: Studies have shown that the incidence of melanoma in situ (MIS) is increasing significantly. Objective: This study analyzes selected clinical and demographic characteristics of MIS cases observed in private dermatology practices in the United States. Methods: This study collected 257 MIS cases from 4 private dermatology practices in the United States from January 2005 through December 2009, recording age, gender, anatomic location, lesion size, patient-reported change in lesion, and concern about lesion. Case totals for invasive melanoma during the same period were recorded. Results: The data collected showed a higher incidence of MIS in sun-exposed areas of older patients, especially men. The median age of patients at the time of MIS detection was 69 years. The most common site for MIS was the head-neck region. The number of MIS cases collected exceeded the number of invasive malignant melanoma cases during the study period, with an observed ratio of 1.35:1. Limitations: For 136 patients, data were collected retrospectively for lesion size, location, gender, and age. For these patients, patient-reported change in lesion and concern about lesion were not collected. Patients often did not consent to a full body examination, therefore, it is possible that MIS lesions may have been missed in double-clothed areas. Conclusion: Careful attention to pigmented lesions, even lesions less than 4 mm, on sun-exposed areas, including scalp, trunk, and feet, will facilitate earlier diagnosis of MIS. As only 30.4% of male patients and 50% of female patients had concern about these lesions, it still falls to the dermatologist to discover MIS. © 2011 by the American Academy of Dermatology, Inc.


PubMed | Skin Cancer Unit, Dermatology Practice, Medical University of Graz, University of Queensland and 5 more.
Type: Journal Article | Journal: The British journal of dermatology | Year: 2016

Dermoscopy is limited in differentiating accurately between pigmented lentigo maligna (LM) and pigmented actinic keratosis (PAK). This might be related to the fact that most studies have focused on pigmented criteria only, without considering additional recognizable features.To investigate the diagnostic accuracy of established dermoscopic criteria for pigmented LM and PAK, but including in the evaluation features previously associated with nonpigmented facial actinic keratosis.Retrospectively enrolled cases of histopathologically diagnosed LM, PAK and solar lentigo/early seborrhoeic keratosis (SL/SK) were dermoscopically evaluated for the presence of predefined criteria. Univariate and multivariate regression analyses were performed and receiver operating characteristic curves were used.The study sample consisted of 70 LMs, 56 PAKs and 18 SL/SKs. In a multivariate analysis, the most potent predictors of LM were grey rhomboids (sixfold increased probability of LM), nonevident follicles (fourfold) and intense pigmentation (twofold). In contrast, white circles, scales and red colour were significantly correlated with PAK, posing a 14-fold, eightfold and fourfold probability for PAK, respectively. The absence of evident follicles also represented a frequent LM criterion, characterizing 71% of LMs.White and evident follicles, scales and red colour represent significant diagnostic clues for PAK. Conversely, intense pigmentation and grey rhomboidal lines appear highly suggestive of LM.


Guitera P.,Royal Prince Alfred Hospital | Guitera P.,University of Sydney | Pellacani G.,University of Modena and Reggio Emilia | Crotty K.A.,Royal Prince Alfred Hospital | And 8 more authors.
Journal of Investigative Dermatology | Year: 2010

Limited studies have reported the in vivo reflectance confocal microscopy (RCM) features of lentigo maligna (LM). A total of 64 RCM features were scored retrospectively and blinded to diagnosis in a consecutive series of RCM sampled, clinically equivocal, macules of the face (n81 LM, n203 benign macules (BMs)). In addition to describing RCM diagnostic features for LM (univariate), an algorithm was developed (LM score) to distinguish LM from BM. This comprised two major features each scoring 2 points (nonedged papillae and round large pagetoid cells 20 m), and four minor features; three scored 1 point each (three or more atypical cells at the dermoepidermal junction in five 0.5 × 0.5 mm 2 fields, follicular localization of atypical cells, and nucleated cells within the dermal papillae), and one (negative) feature scored 1 point (a broadened honeycomb pattern). A LM score of 2 resulted in a sensitivity of 85% and specificity of 76% for the diagnosis of LM (odds ratio (OR) for LM 18.6; 95% confidence interval: 9.3-37.1). The algorithm was equally effective in the diagnosis of amelanotic lesions and showed good interobserver reproducibility (87%). In a test set of 29 LMs and 44 BMs, the OR for LM was 60.7 (confidence interval: 11.9-309) (93% sensitivity, 82% specificity). © 2010 The Society for Investigative Dermatology.


Tiodorovic-Zivkovic D.,University of Niš | Argenziano G.,Irccs Instituto Of Ricovero E Cura A Carattere Scientifico | Lallas A.,Irccs Instituto Of Ricovero E Cura A Carattere Scientifico | Thomas L.,University of Lyon | And 6 more authors.
Journal of the American Academy of Dermatology | Year: 2015

Background Little is known about the frequency of clinical and dermoscopic patterns of lentigo maligna (LM) in relation to specific anatomic subsites and patients characteristics. Objective We sought to assess the frequency of clinical and dermoscopic features of LM and to correlate them to specific anatomic subsites, and patients' age and gender. Methods This was a retrospective analysis of clinical and dermoscopic images of a series of consecutive, histopathologically diagnosed, facial and extrafacial LM. Results A total of 201 cases from 200 patients (mean age 69.51 ± 12.26 years) including 120 women were collected. Most cases were located on the face (n = 192, 95.5%). In 102 cases, LM presented as clinically solitary facial macule (s/LM), whereas it was associated with multiple surrounding freckles in the remaining cases. s/LM were significantly smaller (<10 vs >10 mm; P =.020) and associated with younger age compared with LM associated with multiple surrounding freckles (mean age 67.73 ± 12.68 years vs 71.34 ± 11.59 years, respectively; P =.036). Dermoscopically, gray color irrespective of a specific pattern was the most prevalent finding seen in 178 (88.6%) cases. Limitations This was a retrospective study. Conclusions The knowledge about patient age, patient gender, and site-related clinical features of LM associated with gray color upon dermoscopy may enhance the clinical recognition of LM. © 2015 by the American Academy of Dermatology, Inc.


Ahlgrimm-Siess V.,University of Salzburg | Cao T.,Skin and Cancer Associates | Oliviero M.,Skin and Cancer Associates | Laimer M.,University of Salzburg | And 5 more authors.
Journal of the American Academy of Dermatology | Year: 2013

Background: Differentiation between seborrheic keratosis (SK) and skin cancers may be difficult. Reflectance confocal microscopy (RCM) enables noninvasive assessment of skin neoplasms at cellular-level resolution. Objective: We sought to describe RCM features of SK and to correlate these RCM findings with dermoscopic structures. Methods: Clinical, dermoscopic, and RCM images of 45 consecutive SK were obtained at a private and university dermatology clinic. Fourteen SK were biopsied because of equivocal clinical or dermoscopic features. Results: With RCM, all SK displayed a regular honeycomb pattern of the epidermis and densely packed, round to polymorphous, well-circumscribed dermal papillae at the dermoepidermal junction, features suggestive of a benign neoplasm. RCM features indicating the diagnosis of SK were also observed, including epidermal projections (43/45 SK; 96%) and keratin-filled invaginations (36/45 SK; 80%) at the lesion surface; corneal pseudocysts at epidermal layers (19/45 SK; 42%); and melanophages (21/45 SK; 47%) and dilated round and linear blood vessels (21/45 SK; 47%) in the papillary dermis. Of biopsied SK, 93% (13/14) displayed at least 3 characteristic RCM findings in the absence of RCM features suggestive of malignancy. Limitations: This was a limited study sample and retrospective study design. Conclusions: SK display a distinct set of RCM criteria despite their variable clinical and dermoscopic appearances. © 2012 by the American Academy of Dermatology, Inc.


Stricklin S.M.,Stoecker And Associates | Stoecker W.V.,Stoecker And Associates | Oliviero M.C.,Skin and Cancer Associates | Rabinovitz H.S.,Skin and Cancer Associates | Mahajan S.K.,Missouri University of Science and Technology
Journal of the European Academy of Dermatology and Venereology | Year: 2011

Background Seborrheic keratoses are the most common skin lesions known to contain small white or yellow structures called milia-like cysts (MLCs). Varied appearances can sometimes make it difficult to differentiate benign lesions from malignant lesions such as melanoma, the deadliest form of skin cancer found in humans. Objective The purpose of this study was to determine the statistical occurrence of MLCs in benign vs. malignant lesions. Methods A medical student with 10 months experience in examining approximately 1000 dermoscopy images and a dermoscopy-naïve observer analysed contact non-polarized dermoscopy images of 221 malignant melanomas and 175 seborrheic keratoses for presence of MLCs. Results The observers found two different types of MLCs present: large ones described as cloudy and smaller ones described as starry. Starry MLCs were found to be prevalent in both seborrheic keratoses and melanomas. Cloudy MLCs, however, were found to have 99.1% specificity for seborrheic keratoses among this group of seborrheic keratoses and melanomas. Conclusion Cloudy MLCs can be a useful tool for differentiating between seborrheic keratoses and melanomas. © 2010 The Authors. Journal of the European Academy of Dermatology and Venereology © 2010 European Academy of Dermatology and Venereology.


Liebman T.N.,Sloan Kettering Cancer Center | Jaimes-Lopez N.,Sloan Kettering Cancer Center | Balagula Y.,Sloan Kettering Cancer Center | Rabinovitz H.S.,Skin and Cancer Associates | And 3 more authors.
Dermatologic Surgery | Year: 2012

Background Basal cell carcinomas (BCCs) can be diagnosed using different dermoscopic modalities. Objective To evaluate dermoscopic features of BCCs using nonpolarized and polarized dermoscopy to highlight similarities and differences between dermoscopic modalities. Materials and Methods Retrospective study of 149 BCCs under nonpolarized dermoscopy (NPD), polarized contact dermoscopy (PCD), and polarized noncontact dermoscopy (PNCD). Images were evaluated for a range of dermoscopic colors, structures, and vessels. Features were compared according to histopathologic subtype. Results The most common dermoscopic structures in BCCs across all modalities included globules (50.3-51.0%), dots (49.7-50.3%), white structureless areas (63.1-74.5%), structureless gray-brown areas (24.2-24.8%), and ulcerations (28.2%). The most frequently observed vasculature included arborizing vessels (18.8-38.3%), short fine telangiectasias (SFTs) (73.8-82.6%), and vascular blush (41.6-83.2%). Structures with higher levels of agreement across modalities included pigmented structures and ulcerations. Lower levels of agreement existed between contact and noncontact modalities for certain vascular features. White shiny structures, which include shiny white lines (chrysalis and crystalline structures) (0-69.1%), shiny white areas (0-25.5%), and rosettes (0-11.4%), exhibited no agreement between NPD and polarized modalities. Conclusions This study highlights differences in dermoscopic features of BCCs under three dermoscopic modalities. Shiny white lines (chrysalis and crystalline structures) and shiny white areas may be used as additional criteria to diagnose BCCs. © 2011 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.


Liebman T.N.,Sloan Kettering Cancer Center | Rabinovitz H.S.,Skin and Cancer Associates | Dusza S.W.,Sloan Kettering Cancer Center | Marghoob A.A.,Sloan Kettering Cancer Center
Journal of the European Academy of Dermatology and Venereology | Year: 2012

Background White shiny structures, including white shiny lines, white shiny areas and rosettes, are features only observed under polarized dermoscopy (PD). Objective To evaluate the prevalence of the varied morphologies of white shiny structures in melanoma, basal cell carcinoma (BCC), squamous cell carcinoma (SCC), actinic keratosis (AK) and lichen planus-like keratosis (LPLK). Methods Retrospective study using dermoscopic images of biopsy-proven melanoma, BCC, SCC, AK and LPLK. Results A total of 538 lesions were assessed under PD. One or more types of white shiny structures were observed in 38.7% of study lesions (208/538). BCCs were significantly more likely to display a combination of white shiny areas and white shiny lines (short lines and/or ill-defined strands) (31.9%; 61/191) than any other lesions (P < 0.001). BCC were more likely than other lesions to have white shiny lines distributed without any organized pattern (P < 0.001). Lines in melanoma were significantly more likely than other lesion types to be oriented orthogonally (P < 0.001). When white shiny lines were present, melanomas were significantly more likely than other lesions to exhibit short discrete white lines (P < 0.001). Rosettes were significantly more likely to be observed in actinic tumours than other lesions (P < 0.001). Conclusion The presence of white shiny lines of any length accompanied by white shiny areas is most suggestive of a diagnosis of BCC (P < 0.001). Melanomas are more likely to display short white shiny lines in an orthogonal distribution (P < 0.001) and without white shiny areas. Actinic tumours are most likely to exhibit rosettes (P < 0.001). © 2011 The Authors. Journal of the European Academy of Dermatology and Venereology © 2011 European Academy of Dermatology and Venereology.


PubMed | Sloan Kettering Cancer Center and Skin and Cancer Associates
Type: Journal Article | Journal: JAMA dermatology | Year: 2016

Basal cell carcinoma (BCC) is the most common type of skin cancer and is usually nonpigmented. Shiny white structures (SWSs) are frequently present in BCC.To determine the diagnostic accuracy of various morphologies of SWSs for diagnosis of nonpigmented BCC.Nonpigmented skin tumors, determined clinically and dermoscopically, were identified from a database of lesions consecutively biopsied over a 3-year period (January 2, 2009, to December 31, 2012) from a single dermatology practice. Data analysis was conducted from October 9, 2014, to November 15, 2015. Investigators blinded to histopathologic diagnosis evaluated the polarized dermoscopic images for the presence of SWSs, which were categorized as blotches, strands, short white lines, and rosettes. Measures of diagnostic accuracy for BCC were estimated. Participants included 2375 patients from a dermatologic clinic in Plantation, Florida. Review of the medical records identified 2891 biopsied skin lesions; 457 of these were nonpigmented neoplasms.Diagnosis of BCC with dermoscopy compared with all other diagnoses combined was the primary outcome; the secondary outcome was diagnosis of BCC compared with amelanotic melanoma. We calculated diagnostic accuracy measured as odds ratios (ORs), sensitivity, and specificity of shiny white blotches and/or strands for the diagnosis of BCC.Of the 457 nonpigmented neoplasms evaluated, 287 (62.8%) were BCCs, 106 (23.2%) were squamous cell carcinoma, 39 (8.5%) were lichen planus-like keratosis, 21 (4.6%) were melanomas, and 4 (0.9%) were nevi. The prevalence of SWSs was 49.0% (n=224). In multivariate analysis (reported as OR [95% CI]) controlling for age, sex, and anatomical location, the presence of any SWS was associated with a diagnosis of BCC (2.3 [1.5-3.6]; P<.001). Blotches (6.3 [3.6-10.9]; P<.001), strands (4.9 [2.9-8.4]; P<.001), and blotches and strands together (6.1 [3.3-11.3]; P<.001) were positively associated with BCC. Shiny white blotches and strands together had a diagnostic sensitivity of 30% and specificity of 91%.The combined presence of shiny white blotches and strands is associated with high diagnostic specificity for nonpigmented BCC.

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