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Background: Melanocytic nevi with eccentric foci of hyperpigmentation ("Bolognia sign") can be considered as a melanoma-simulating type of acquired melanocytic nevus. We report on the morphologic changes of this type of melanocytic nevus over a 39-month period of dermoscopic follow-up. Observations: A 5-year-old girl had a 4-mm brown papule with a peripheral blue-black area on her right upper arm. The eccentric focus of the hyperpigmentation corresponded dermoscopically to a blue-gray area of pigmentation associated with irregular brown-black globules or dots and partially with a superficial black network. After 39 months, a globular type of acquired melanocytic nevus was detectable, which clinically and dermoscopically appeared to be completely benign. A nearly identical situation was observed in 5 other melanocytic nevi, underlining the involution of the pigmented foci in these nevi. The histopathologic diagnoses of 2 lesions were consistent with a compound type of acquired melanocytic nevus with eccentric foci of hyperpigmentation. Conclusions: Dermoscopy allows identification of a morphologic pathway of modifications, probably typical for this type of melanocytic nevus in children, and therefore enables avoidance of surgical excision with attendant hypertrophic scarring in children. Conversely, in adults, when dermoscopic follow-up of melanocytic nevi reveals eccentric foci of hyperpigmentation, surgical excision of the lesion is indicated. ©2006 American Medical Association. All rights reserved.

Objective To evaluate the diagnostic accuracy of confocal examination of basal cell carcinoma (BCC) in microscopy-guided surgery. Design Four independent observers with no previous experience in confocal laser scanning (CLS) microscopy received standardized instruction about diagnostic CLS microscopic features. Subsequently, 120 confocal images of fresh excisions from BCCs or normal skin were evaluated by each observer, imaged using a commercially available, near-infrared, reflectance CLS microscope. Logistic regression analysis was performed on a combination of all morphologic features using the forward-stepwise (Wald) method. Reliability (interobserver agreement) data were evaluated by κ statistic. Setting Department of Dermatology, Medical University of Graz. Patients Twenty patients with histologically verified BCC. Interventions Evaluation of fresh BCC excisions by CLS microscopy. Main Outcome Measures Diagnostic accuracy of the method was evaluated by χ 2 test. Diagnostic impact and reliability of each morphologic feature were evaluated by logistic regression analysis and κ statistic, respectively. Results Overall, high diagnostic accuracy was achieved by the 4 observers. Logistic regression analysis revealed that mainly tumor cell nuclei and tumor nests should be taken into account for diagnostic decisions, whereas disintegration of tumor cells, peripheral palisading, and retraction of stroma were rarely useful. However, most of the features were highly reliable. Conclusions This diagnostic validation study of CLS microscopy in microscopy-guided surgery yielded promising results and opens avenues for further studies. In the future, CLS microscopy may guide microsurgery of any skin cancer.

We read with interest the article by Braun et al,1 who merely demonstrated the feasibility of telemedical wound care consultation via a new generation of cellular phones. In this context, we would like to share our experience with cellular phones and patients with typical skin conditions in a routine clinical setting. A total of 95 patients (male-female ratio, 39:56; mean age, 49 years; median age, 46 years; and age range, 6-90 years) were selected consecutively in the outpatient service of the Department of Dermatology, Medical University of Graz, Graz, Austria, in July 2003. Patients who presented for the first time and who were referred for all skin conditions except melanocytic lesions were included. Only patients who agreed and signed the patient consent form were enrolled. A face-to-face diagnosis was always formulated by the same board-certified dermatologist (I.Z.). A medical student (E.W.) acquired the images (under routine conditions, with no additional . . . [from full text of this article]