Search

Objective: To investigate changes in dermoscopic patterns of acquired acral melanocytic nevi (AAMN) over time., Design: Retrospective analysis of digital dermoscopic follow-up of 230 AAMN located on acral volar skin., Setting: Outpatient clinics at university dermatology departments. Patients A total of 230 AAMN located on the soles (n = 149), fingers (n = 62), and palms (n = 19), of 230 white subjects 14 years or younger (n = 81), 15 to 30 years (n = 72), and older than 30 years (n = 77)., Main Outcome Measure: Comparison of baseline and follow-up dermoscopic patterns., Results: Individual AAMN had a digital follow-up of 6 months (n = 59), 12 months (n = 74), 18 months (n = 44), and 24 months (n = 53). Baseline dermoscopic images showed the following patterns: parallel furrow (48.8%), latticelike (16.1%), fibrillar (10.9%), nontypical (10.9%), homogeneous (4.8%), globular (3.5%), transition (3.5%), and reticular (2.6%). Dermoscopic changes over time were observed in 42 of the 230 AAMN (18.3%), with the greatest frequency of changes occurring in patients 14 years or younger (23 of 81 lesions; 28.4%) (P = .005). The parallel furrow pattern (25.9%) showed more variations over time than other dermoscopic patterns (11.0%) (P = .004). The frequency of change increased linearly over time (P = .001). Four of 7 clinically regressing nevi showed a homogeneous pattern at the last examination., Conclusions: Dermoscopic changes of AAMN are most common in subjects younger than 14 years. The parallel furrow pattern appears to be the dermoscopic pattern most subject to change, while the homogeneous pattern may be seen also in AAMN showing clinical and dermoscopic involution.

Background: Dermoscopic classification of acquired melanocytic nevi (AMN) is based on the evaluation of 3 main criteria-global pattern, pigment distribution, and color., Objective: To determine whether these features are different in AMN in white people with different skin types (STs) according to the Fitzpatrick classification., Design: Digital dermoscopic images of AMN were evaluated, and the correlation of the 3 main dermoscopic criteria with patient ST was analyzed., Setting: Consecutive patients were recruited from 7 pigmented lesion clinics between June 1, 2004, and June 30, 2005. Patients For each patient, the ST (I [always burns, never tans] to IV [rarely burns, tans with ease]) was scored, and 1 representative AMN (defined as the AMN showing a dermoscopic typology that is repeatedly seen in the same patient) was selected and photographed., Main Outcome Measures: The distribution of the dermoscopic criteria of AMN in patients with different STs was calculated by univariate analysis. Differences in prevalence were tested using the chi(2) test. The correlation between dermoscopic criteria and ST, adjusted for age, sex, and enrolling center, was evaluated by calculating odds ratios and 95% confidence intervals by logistic regression analysis., Results: Of 680 included patients, dermoscopic analysis revealed significant differences in the prevalent nevus pattern in the 4 ST groups. Light brown AMN with central hypopigmentation were associated with ST I, and ST IV was associated with the so-called black nevus (P<.001), typified by reticular pattern, central hyperpigmentation, and dark brown coloration. A significant association was also found between multifocal pattern and ST II and ST III., Conclusions: The dermoscopic nevus type varies according to different ST in white people. This knowledge may have an effect on obtaining for biopsy lesions that exhibit unusual dermoscopic patterns when patient ST is considered.

Objectives: To describe the different vascular structures seen by dermoscopy and to evaluate their association with various melanocytic and nonmelanocytic skin tumors in a large series of cases., Design: Digital dermoscopic images of the lesions were evaluated for the presence of various morphologic types of vessels., Setting: Specialized university clinic., Patients: From a larger database, 531 excised lesions (from 517 patients) dermoscopically showing any type of vascular structures were included., Main Outcome Measures: The frequency and positive predictive value of the different vascular structures seen in various tumors were calculated, and the differences were evaluated by the chi2 or Fisher exact test., Results: Arborizing vessels were seen in 82.1% of basal cell carcinomas, with a 94.1% positive predictive value (P<.001). Dotted vessels were generally predictive for a melanocytic lesion (90.0%, P<.001), and were especially seen in Spitz nevi (77.8% of lesions). In melanoma, linear-irregular, dotted, and polymorphous/atypical vessels were the most frequent vascular structures, whereas milky-red globules/areas were the most predictive ones (77.8%, P = .003). The presence of erythema was most predictive for Clark nevus, whereas comma, glomerular, crown, and hairpin vessels were significantly associated with dermal/congenital nevi, Bowen disease, sebaceous hyperplasia, and seborrheic keratosis, respectively (P<.001 for all)., Conclusions: Different morphologic types of vessels are associated with different melanocytic or nonmelanocytic skin tumors. Therefore, the recognition of distinctive vascular structures may be helpful for diagnostic purposes, especially when the classic pigmented dermoscopic structures are lacking.

Objective: The aim of our study was to evaluate human papillomavirus (HPV) infection as a risk factor for cutaneous squamous cell carcinoma (SCC) in immunocompetent individuals., Design: Hospital-based case-control study., Setting: Referral center for dermatologic diseases for central and southern Italy., Participants: Consecutive patients with histologically confirmed cutaneous SCC (n = 46) and control subjects (n = 84) chosen by frequency matching (age and sex) among patients admitted with unrelated diseases., Main Outcome Measure: Infection with epidermodysplasia verruciformis-related HPV types, blindly assessed by serologic testing (viruslike particle enzyme-linked immunosorbent assay). Information was obtained on known potentially confounding risk factors (family history, history and signs of sun exposure, and pigmentary traits) and on history of HPV-related lesions and diseases, assessed by interview and examination by a dermatologist., Results: Positive serologic findings for HPV type 8 were associated with SCC (odds ratio, 3.2; 95% confidence interval, 1.3-7.9) independently of other risk factors, whereas positive serologic findings for HPV type 15 were negatively associated with SCC (odds ratio, 0.4; 95% confidence interval, 0.2-0.9). Other variables significantly associated with the tumor were family history of skin cancer, professional or recreational sun exposure, light eye color, high number of solar keratoses and seborrheic keratoses on the body surface, and residency in radon-emitting buildings., Conclusions: Positive serologic findings for HPV type 8 are associated with SCC occurrence in immunocompetent individuals. Viral infection could act as a cofactor in the tumor development, along with genetic predisposition, solar radiation, and other environmental exposures. If confirmed, these findings could open new perspectives for treatment and prevention of SCC.

Background: There is a need to evaluate severity of psoriasis with a simple, patient-assessed instrument., Objective: To investigate whether the self-administered Psoriasis Area and Severity Index (SAPASI) could be used as a measure of severity in different clinical types of psoriasis., Design: Hospital-based cross-sectional study, with measures of clinical severity collected separately by dermatologists (PASI) and patients with psoriasis (SAPASI)., Setting: Part of a large project on clinical, epidemiological, emotional, and quality-of-life aspects of psoriasis (the IDI Multipurpose Psoriasis Research on Vital Experiences study), performed between February 21 and August 31, 2000, at the inpatient wards of the Istituto Dermopatico dell'Immacolata-Istituto di Ricovero e Cura a Carattere Scientifico (IDI-IRCCS), Rome, Italy., Patients: The study population comprised 351 eligible patients with complete sets of information on PASI and SAPASI hospitalized at IDI-IRCCS with a diagnosis of psoriasis., Main Outcome Measures: Correlation between PASI and SAPASI scores and analysis of variance on the difference between PASI and SAPASI scores in subsets of patients based on clinical and sociodemographic characteristics., Results: A high correlation between the 2 measures was observed (overall Pearson correlation coefficient, r = 0.69). The SAPASI values were higher and had a wider scattering than PASI values, and SAPASI was able to discriminate properly between clinical types and global severity as assessed by dermatologists., Conclusions: The SAPASI scoring system is well understood and accepted by patients in different populations than previously tested, adding confidence in the validity of the instrument. It could be used as a severity measure for psoriasis even for "at-distance" follow-up. Some caution, though, is needed when using SAPASI strictly to estimate PASI measurements, especially for guttate psoriasis.

Objective: To investigate the role of pigmentary traits, different patterns of sun exposure, artificial sources of UV radiation, and lifestyle-related factors on the risk of basal cell carcinoma (BCC) in a Mediterranean population from central-southern Italy., Design: Hospital-based case-control study., Setting: A referral dermatological hospital in Rome, Italy., Patients: A convenience sample of 166 case patients with histologically confirmed BCC and 158 cancer-free control subjects with minor dermatological conditions observed between March 1995 and June 1997., Results: In the multivariate analysis, the mean number of weeks per year spent at the beach before the age of 20 years was significantly associated with BCC. A dose-response trend was found for subjects who had spent 3 to 4 (odds ratio, 1.8; 95% confidence interval, 0.8-4.4), 5 to 8 (odds ratio, 3.7; 95% confidence interval, 1.5-9.0), or more than 8 (odds ratio, 4.5; 95% confidence interval, 1.9-10.5) weeks per year at the beach (P =.01 for trend). There was a significant association with the presence of actinic keratoses or solar lentigines, whereas no effect was found for skin type, history of sunburns, exposure to nonsolar UV radiation, and lifestyle-related habits such as cigarette smoking, alcohol consumption, and coffee drinking. Subjects reporting a family history of skin cancer had an extremely increased risk of BCC., Conclusion: The definite association with recreational sun exposure during childhood and adolescence and the strong relation with family history of skin cancer suggest that genetic predisposition and peculiar exposure patterns to UV radiation are key independent risk factors for the development of BCC in a southern European population.