Dermoscopy of dermatofibromas: a prospective morphological study of 412 cases.
ABSTRACT To describe the dermoscopic features, including vascular structures and patterns associated with dermatofibromas in a large series of cases.
Digital dermoscopic images of the prospectively collected dermatofibromas were evaluated for the presence of multiple structures and patterns.
Dermatofibromas were collected in the Departments of Dermatology of the Hospital de Sant Pau i Santa Tecla, Tarragona, Spain, and Hospital de Sant Llatzer, Palma de Mallorca, Spain.
A total of 412 dermatofibromas (from 292 patients) with complete documentation were collected.
Frequency and intraobserver and interobserver agreement of the dermoscopic structures and patterns in dermatofibromas.
A total of 19 morphological dermoscopic structures were evaluated. Pigment network was observed in 71.8% (3% atypical pigment network), white scarlike patch in 57.0%, and a white network in 17.7%. Different vascular structures were observed in 49.5% (dotted vessels in 30.6%). Ten dermoscopic patterns were observed. The most common pattern seen in our series (34.7% of cases) was central white patch and peripheral pigment network, but in 65.3% of the cases, dermatofibromas presented different patterns including simulators of melanoma.
The most common pattern associated with dermatofibroma is the classic dermoscopic pattern (pigment network and central white patch), but this tumor has a wide range of presentations.
- SourceAvailable from: Mircea Suciu[Show abstract] [Hide abstract]
ABSTRACT: Aneurysmal dermatofibroma (AD) or aneurysmal fibrous histiocytoma (AFH) is a relatively rare form of histiocytoma representing less than 2% of total cases. It shares many clinical and dermoscopic similarities with skin tumors, especially malignant melanoma and Kaposi's sarcoma, which can make differentiation problematic. We report the case of a 53-year-old man, who presents with a black nodular tumor with increased consistency, edges infiltrated from the surface to depth, spontaneous and sensitive to touch that shows rapid growth in the last three months. Dermoscopically, the central region consists of intricate areas colored in red, violet, blue-white and black. On the periphery stand two rings, centrally white and peripherally pigmented, with an abundance of polymorphic capillaries. To clarify the diagnosis, the lesion was widely excised and histopathological examination was performed, which revealed immunophenotypical tumor cells negative for HMB-45 and S100, and numerous CD68 macrophages between tumor cells. This aneurysmal fibrous histiocytoma shows both clinical and dermoscopically discrete differential criteria, which are not specific and that make it difficult to distinguish from malignant melanoma and Kaposi's sarcoma, and required performing histopathology and immunohistochemistry.
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ABSTRACT: Skin cancer and melanoma in particular cause substantial mortality and morbidity in Australia1. This carries both a personal and economic cost. Melanoma is the most common cancer in the 15-45 year old age group1. Projected incidence and mortality from melanoma in Australia in 2010 were 11,500 and 1500 respectively1. Non-melanoma skin cancer (NMSC) is the costliest malignancy treated in Australia2. Apart from primary prevention the only way to prevent death from melanoma is to diagnose and treat it before it metastasises and early diagnosis can reasonably also be expected to reduce morbidity and mortality of, and costs associated with, NMSC. The high incidence of melanoma and non-melanoma skin cancer in Australia makes Australia an ideal place for research into these conditions and it is the opportunities provided by this situation that are being harnessed by the related projects in this endeavour. There is a relative deficiency of dermatologists in Australia3 and this, compounded with the high rate of skin cancer has created an ‘evolutionary niche’ that has of necessity been filled by primary care doctors who are sub-specialising in skin cancer management4. The role of these doctors is not defined and previously there are have been no studies to assess the effectiveness of these doctors, relative to either main-stream general practitioners or dermatologists3. SCARD was conceived to allow those doctors who treat skin cancer to measure their performance and compare it to that of their peers. It harvests data, which subject to meeting ethics requirements, is available for research5. As the second stream of this endeavour, innovative diagnostic techniques have been developed and tested. They were designed for application in routine practice without the obstacles of mathematical calculations or confusing metaphorical terminology. Not only have we studied the Chaos and Clues algorithm and shown it to be efficacious for the detection of all pigmented malignancies whether melanocytic or not6, but we have included case studies showing that it can diagnose the smallest published melanoma (1.6mm diameter) 7, the rarest non-melanocytic pigmented skin malignancy, pigmented invasive squamous cell carcinoma8 and one of the rarest melanomas, nail matrix melanoma9. This project focuses mainly on the diagnostic component of “improving the management of skin cancer in Australia” but also includes some work on treatment aspects with respect to the design of SCARD although there is no analysis of that in this study. A stated mandate of this PhD project is “Improving the management of skin cancer in Australia…”, therefore efforts at dissemination in Australia, of discoveries made, are an integral part of the thesis. A solicited educational paper on ‘Chaos and Clues’ is presented, published as a peer-reviewed article in the Australian Family Physician10. This has been a challenging project but it has been made possible by collaboration with people of outstanding commitment and creative ability. It has also been made possible by the enthusiastic participation of the people being studied – the primary care skin cancer practitioners of Australia. It is to them and their patients that this work is dedicated. References 1. Australian Institute of Health and Welfare 2010. Cancer in Australia 2010: An overview. Cancer Series No. 60. Cat. no. CAN 56. Canberra: AIHW. Retrieved from http://www.aihw.gov.au/publication-detail/?id=6442472459 on October 1, 2011 2. Australian Institute of Health and Welfare. Health system expenditures on cancer and other neoplasms in Australia 2000-2001. Health and Welfare Expenditure Series Number 22. Canberra: AIHW 2005 3. Commens CA. Skin cancer: changing paradigms of practice and medical education. Med. J. Aust 2007;187:207–8. 4. Wilkinson D, Bourne P, Dixon A, Kitchener S. Skin cancer medicine in primary care: towards an agenda for quality health outcomes. Med. J. Aust 2006;184:11-12 5. Rosendahl C, Hansen C, Cameron A, Bourne P, Wilson T, Cook B, et al. Measuring performance in skin cancer practice: the SCARD initiative. Int. J. Dermatol. 2011 Jan;50(1):44–51. 6. Rosendahl C, Tschandl P, Cameron A, Kittler H. Diagnostic accuracy of dermatoscopy for melanocytic and nonmelanocytic pigmented lesions. J. Am. Acad. Dermatol. 2011 Jun;64(6):1068–73. 7. Rosendahl C, Cameron A, Bulinska A, Williamson R, Kittler H. Dermatoscopy of a minute melanoma. Australas. J. Dermatol. 2011 Feb;52(1):76–8. 8. Rosendahl C, Cameron A, Bulinska A, Weedon D. Cutaneous pigmented invasive squamous cell carcinoma: a case report with dermatoscopy and histology. Dermatol Pract Concept 2011;1(1):14. doi: 10.5826/dpc.0101a14 9. Rosendahl C, Cameron A, Wilkinson D, et al. Nail matrix melanoma: consecutive cases in a general practice. Dermatopathol Pract Concept (in press). 10. Rosendahl C, Cameron A, McColl I, Wilkinson D. Dermatoscopy in routine practice: Chaos and Clues. Australian family Physician – in press12/2012, Supervisor: Professor David Wilkinson, Professor H Peter Soyer
Article: Vascularización en dermatoscopia[Show abstract] [Hide abstract]
ABSTRACT: Under the right conditions, dermoscopy allows us to observe the vascular features of many different types of skin lesions. The visualization and identification of vessels with a characteristic morphology can be the key to diagnosis, especially in hypopigmented lesions in which the typical pigmented structures are not visible.Some of the more characteristic associations are the presence of crown vessels in sebaceous hyperplasia, arborizing telangiectasias in basal cell carcinoma, comma-shaped vessels in intradermal and compound nevi, dotted vessels in Spitz nevi and melanoma, and hairpin vessels in seborrheic keratoses.The recognition of distinctive vascular features can be of great help in the diagnosis of many types of skin lesions, and very often such patterns are the only key to the diagnosis of melanoma.Actas Dermo-Sifiliográficas 06/2012; 103(5):357–375. DOI:10.1016/j.ad.2011.11.005