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OBJECTIVE The objective was to describe the clinical and dermoscopic characteristics of difficult-to-diagnose melanomas (DDM). DESIGN This study was a retrospective analysis of clinical data and dermoscopic images in a series of excised melanomas. SETTING Cases were obtained from the database registers of three public hospitals in Barcelona (Spain), Naples (Italy), and Graz (Austria). PATIENTS A total of 97 tumors with a main preoperative diagnosis different from melanoma and without sufficient criteria to be diagnosed clinically and dermoscopically as melanoma were studied. We studied clinical data from the patients and lesions, mean reason for excision, and consensus dermoscopic description of the lesions according to pattern analysis performed by a panel of four dermoscopists to obtain clues that allow these melanomas to be recognized. RESULTS Ninety-three DDMs were evaluated. Three main dermoscopic categories of DDM have been identified: (1) DDMs lacking specific features (16/97), (2) DDMs simulating nonmelanocytic lesions (14/93), and (3) DDMs simulating benign melanocytic proliferations (67/93). The reasons for excision were (1) the subjective history of change referred by the patient (38% of cases), (2) the presence of clinical and/or dermoscopic “hints” for biopsy (33% of cases), and (3) the objective evidence of changes detected by digital dermoscopic follow-up (29% of cases). CONCLUSIONS A diagnostic algorithm is proposed not to miss melanoma. [ABSTRACT FROM AUTHOR]

Examines the dermoscopy features of congenital melanocytic nevus (CMN). Importance of regular skin examination of patients with CMN; Use of dermoscopy to diagnose CMN; Risk of malignant transformation into melanoma.

Subcorneal hematoma is a pigmented skin lesion usually occurring on palms or soles after a trauma or sport activity. Clinically, it may exhibit overlapping features with acral melanoma or acral melanocytic nevi, leading to unnecessary excision of this otherwise harmless skin lesion. The objective was to describe the dermoscopic features in a series of subcorneal hematomas. Dermoscopic images of 15 subcorneal hematomas were evaluated for the presence of different colors and dermoscopic structures. In our series, a red-black hue was the most frequent color seen by dermoscopy (40% of the lesions) and a homogeneous pattern of pigmentation was the most frequent dermoscopic structure (53.3%). Remarkably, 40% of the lesions exhibited a parallel-ridge pattern that is usually found in early melanoma of palms and soles. In 46.7% of the lesions, red-black globules were additionally seen at the periphery as satellites disconnected from the lesion's body. Only two lesions showed either parallel-furrow or fibrillar pattern. A scratch test performed in four lesions, allowed complete or partial removal of the pigmentation. Dermoscopic features of subcorneal hematomas may be similar to those observed in acral melanocytic lesions. Nevertheless, in most cases the correct diagnosis can be facilitated by the presence of a red-black homogeneous pigmentation, often combined with satellite globules. A positive scratch test may be considered as an additional diagnostic clue. IRIS ZALAUDEK, MD, GIUSEPPE ARGENZIANO, MD, H. PETER SOYER, MD, JEAN-HILAIRE SAURAT, MD, AND RALPH P. BRAUN, MD HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [ABSTRACT FROM AUTHOR]

In this article, the authors review different approaches to the diagnosis of skin tumors using noninvasive diagnostic tools, which are becoming increasingly reliable and, as a consequence, increasingly popular among physicians and patients. Especially in the realm of pigmented skin lesions, dermoscopy and sonography may add useful information to the clinical constellation, improving the diagnostic performance for early diagnosis of melanoma and for differentiating various melanocytic and nonmelanocytic pigmented lesions. More recently, confocal scanning laser microscopy was introduced as a novel technique that enables the in vivo study of the skin at a nearly histologic resolution, being of diagnostic value in various skin disorders, including basal cell carcinoma and pigmented skin lesions. These modalities have various other potential applications besides diagnosis, including lesion's selection for biopsy, determination of appropriate therapeutic modalities, verification of treatment efficacy, and decision of surgical margins. Finally, a hint to the use of cytodiagnosis for basal cell carcinoma is provided. E. RUOCCO, MD, G. ARGENZIANO, MD, G. PELLACANI, MD, AND S. SEIDENARI, MD HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [ABSTRACT FROM AUTHOR]

The authors discuss the diagnosis of nonpigmented skin tumors (NPT) which is one biggest challenge in dermatology despite the support of advanced method such as dermoscopy. The authors state the two obstacles in the identification of poor pigmented melanoma such as presence of few well-known features and lack of clinical suspicion of melanoma of hypopigmented tumors. The authors also cite the study by Jaimes and colleagues which supports the use of dermoscopy in the assessment of NPT.

BACKGROUND Recent studies demonstrating accuracy of teledermatology and teledermoscopy in the evaluation of pigmented skin lesions (PSL) have been performed only on PSL previously selected by face-to-face examination. OBJECTIVES The objective was to investigate the feasibility of teledermatology for the management of individuals exhibiting multiple PSL with a two-step procedure. MATERIALS AND METHODS In the first step, remote consultants selected clinically equivocal lesions evaluating a teletransmitted clinical image of patients' backs. In the second step, dermoscopic images of selected lesions were evaluated. Management recommendations of both steps were compared with face-to-face. RESULTS For a total of 465 PSL in 18 patients, the agreement between the face-to-face and the two remote experts resulted moderate (κ value, 0.530–0.565) in the first step and substantial (κ value, 0.681–0.703) in the second step. CONCLUSIONS Although there are limitations of this pilot experience (population and technical restrictions), our results provide preliminary evidence that a two-step teledermatologic approach may be feasible in managing individuals with multiple PSL. [ABSTRACT FROM AUTHOR]

The article presents a study which evaluates the dermoscopy features of small and large size basal cell carcinoma (BCC). Methods used in the study were dermoscopic images of 100 BBCs proven histopathologically and the examination of dermoscopy was performed through a polarized device. Results show that there were 43 lightly pigmented lesions, 46 as pigmented and 11 as heavily pigmented

The authors have indicated no significant interest with commercial supporters. [ABSTRACT FROM AUTHOR]

The article reports on the case of a 30-year-old woman who developed two primary melanomas on her left lower extremity where atypical melanocytic skin lesions were seen in a quadrant or segmented distribution. She was diagnosed with a quadrant or segmental atypical nevus syndrome. Surgical excision of the nevi is impractical because it may not save the patient from the development of de novo melanoma within the affected site. Patients benefit from digital dermoscopic follow-up.

The article presents the use of dermoscopic-pathologic correlation in the diagnosis of an unusual case of pigmented basal cell carcinoma. Dermoscopy is an in vivo technique that improves clinical diagnostic accuracy of benign, malignant, melanocytic, and nonmelanocytic pigmented skin lesions by observing specific dermoscopic patterns. The case of a 29-year-old white woman with erythematous and partially pigmented lesion on the back is also presented.

BACKGROUND The starburst pattern is the dermoscopic hallmark of pigmented Spitz nevus, although it has been rarely observed in melanoma as well. OBJECTIVE To describe a case of melanoacanthoma simulating pigmented Spitz nevus. MATERIAL AND METHODS Clinical, dermoscopic, and histopathologic examinations were performed for the occurrence of a 4-mm pigmented skin lesion on the hip of a 38-year-old Caucasian woman. RESULTS Dermoscopy examination of the lesion disclosed a stereotypical starburst pattern characterized by pigmented streaks symmetrically distributed at the periphery. A preoperative diagnosis of pigmented Spitz nevus was made, and the lesion was excised. However, subsequent histopathologic examination revealed a melanoacanthoma. CONCLUSION The starburst pattern, although diagnostic for pigmented Spitz nevus, can be rarely observed in other benign or malignant pigmented skin lesions. Accordingly, all lesions in adults exhibiting a starburst pattern or other spitzoid features should be excised for histopathologic evaluation. [ABSTRACT FROM AUTHOR]

I. ZALAUDEK, MD, L. CITARELLA, MD, H. P. SOYER, MD, R. HOFMANN-WELLENHOF, MD, AND G. ARGENZIANO, MD HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [ABSTRACT FROM AUTHOR]