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Background: Studies demonstrating the potential utility of reflectance confocal microscopy (RCM) have been performed under experimental conditions., Objective: To provide an overview of RCM practice in real-life., Methods: A multicenter, prospective study carried out in 10 university dermatology departments in France., Results: Overall, 410 patients were enrolled. One-half of the patients (48%) were referred by private practice dermatologists. They were referred for diagnosis (84.9%) or presurgical mapping (13%). For diagnosis, the lesions were located on the face (62%), arms and legs (14.9%), and trunk (13.6%), and presurgical mapping was almost exclusively on the face (90.9%). Among those referred for diagnosis, the main indication was suspicion of a skin tumor (92.8%). Of these, 50.6% were spared biopsies after RCM. When RCM indicated surgery, histology revealed malignant lesions in 72.7% of cases. The correlation between RCM and histopathology was high, with a correlation rate of 82.76% and a kappa coefficient of 0.73 (0.63; 0.82)., Limitations: This study was performed in the settings of French tertiary referral hospitals., Conclusion: This study shows that in real-life RCM can be integrated into the workflow of a public private network, which enables a less invasive diagnostic procedure for patients., Competing Interests: Conflicts of interest None disclosed., (Copyright © 2024 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Despite the huge improvement in smartphone cameras, there has not been any real interest in the UK in pursuing patient-facing teledermatology within the sphere of skin lesion triage. High-specification dermoscopic images can be generated with smartphone attachments, but, to date, no formal clinical trial has been performed to establish the efficacy and feasibility of these consumer-level dermoscopes in skin lesion triage. The objectives of this study were to assess the ability of patients to capture dermoscopic images using a smartphone attachment, and to identify the safety and diagnostic accuracy of consumer-level dermoscopy in triaging out benign skin lesions from the 2-week-wait (2WW) cancer pathway. We recruited 78 patients already attending a face-to-face clinic at two locations. They were provided with instruction leaflets and asked to obtain dermoscopic and macroscopic images of their lesion(s) using their own smartphones. The images (and a brief history) were distributed to five experienced blinded assessors (consultants), who were asked to state their working diagnosis and outcome (reassurance, routine review or 2WW pathway), as they would in teledermatology. We compared their outcomes to the gold-standard in-person diagnosis and/or histological diagnosis, where available. The device achieved 100% sensitivity in diagnosing melanoma and squamous cell carcinoma (SCC). The specificity for the diagnoses of melanoma (89%) and SCC (83%) was high. The overall diagnostic accuracy was 77% for both benign and malignant lesions, The diagnostic accuracy was high for seborrhoeic keratosis (91%) and simple naevi (81%). Patient-captured dermoscopic images using bespoke smartphone attachments could be the future in safely triaging out benign lesions., Competing Interests: Conflicts of interest T.N. is director of Dyplens Ltd; however, he was not involved in the data analysis or review of images., (© The Author(s) 2024. Published by Oxford University Press on behalf of British Association of Dermatologists. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Paraneoplastic syndromes include a variety of cutaneous presentations that have an associated internal malignancy. Some syndromes have a strong correlation to specific internal malignancies, whereas others are associated with a multitude of tumors. There are many cutaneous manifestations that suggest hematologic disorders, which will be reviewed in detail. Cutaneous metastases are commonly from breast and lung cancers and can present as nodules, vascular lesions, eczematous dermatitis, or inflammatory lesions. The most common histologic presentation of cutaneous metastasis is that of a dermal-based or subcutaneous-based nodule with sparing of the epidermis. Determination of origin of tumor requires immunohistochemistry and clinical correlation., Competing Interests: Disclosure Dr A. Murina is a speaker for Abbvie, Amgen, Bristol-Meyers Squibb, and Janssen. She is a consultant for Abbvie, Bristol-Meyers Squibb, Novartis and UCB. Dr A. Allen has no conflicts of interest to disclose., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Competing Interests: The authors declare no conflicts of interest.

Objectives: In kidney transplant, the use of immunosuppressive drugs, indispensable to avoid organ rejection, implies an increased risk of several infectious and neoplastic diseases. Cutaneous infections have a high incidence in kidney transplant recipients and are diagnosed in 55% to 97% of these patients. The objectives of this study were to identify the most frequent skin diseases and their clinical risk factors within a population of kidney transplant recipients., Materials and Methods: We reviewed the medical records of 200 kidney transplant recipients at Sahloul Teaching Hospital, Tunisia, between November 2007 and January 2018. We analyzed the clinical data of patients who sought skin consultations with either dermatologists or plastic surgeons within the hospital. We collected patient sociodemographic data, type of donor, and type of immunosuppressive therapy used by recipients. We also obtained history of skin lesions and examination findings., Results: Among 200 patients included in our study cohort, 131 were male and 69 were female. Age ranged from 6 to 75 years with a mean age of 30.51 ± 12 years. Patients had received kidneys from either living or deceased donors, with available data indicating 96.5% living donors and 3.5% deceased donors. The mean time interval from transplant to first skin consultation was 31 month (range, 3 months to 10 years). Prevalence of various skin conditions was 48.5%. We found that 62.9% of cases were skin infections, 59.8% were drug-induced skin conditions, and 2.9% were skin cancers. The estimated risk factors for skin lesions include use of cyclosporin and duration of immunosuppression., Conclusions: Our study demonstrated the spectrum of skin conditions that can be expected after kidney transplant. Careful dermatological screening and long-term follow-up are needed for these patients to reduce posttransplant skin complications.

Determining the shape of a skin lesion may provide a diagnostic clue in dermatology practice, more commonly for inflammatory diseases but also for skin tumors. The annular formation may develop by diverse mechanisms in skin tumors. Annular lesions may occur from the onset of the tumor as sparing the central area or depression and/or ulceration in the center of the tumor or outward expansion of the primary lesion. Clustering of multiple papulonodular lesions sparing the central area or relatively independent processes acting on the central and peripheral components of the tumor may also result in an annular appearance. We have explored a wide variety of benign and malignant skin tumors and lymphoproliferative diseases forming an annular shape., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2023. Published by Elsevier Inc.)

Introduction: Past studies have shown mixed results about the accuracy of store-and-forward (SAF) teledermatology in the evaluation of skin lesions. The objective of this study is to determine the accuracy of SAF teledermatology in the diagnosis of skin lesions and biopsy decision compared to in-person clinical evaluation., Methods: Histories and photographs of skin lesions gathered at clinic visits were sent as SAF consults to teledermatologists, whose diagnoses and biopsy decisions were recorded and compared statistically to the clinic data. Results and Discussion: We enrolled 206 patients with 308 lesions in the study. The study population was composed of 50% males ( n  = 104), and most patients were white ( n  = 179, 87%) and not Hispanic/Latino ( n  = 167, 81%). There was good concordance for biopsy decision between the clinic dermatologist (CD) and teledermatologist (TD) (Cohen's kappa (κ) = 0.51), which did not significantly differ when melanocytic lesions were excluded (κ = 0.54). The sensitivity and specificity of teledermatology based on biopsy decision was 0.71 and 0.85, respectively. Overall concordance in first diagnosis between the CD and TD was good (κ = 0.60). While there was no difference between CD and TD in proportion of correct diagnoses compared to histopathology, two skin cancers presentations were missed by TD. Study limitations included sample size, enrolment bias and differing amounts of teledermatologist case experience. Teledermatology has good concordance in diagnosis and biopsy decision when compared to clinic dermatology. Teledermatology may be utilized in the evaluation of skin lesions to expand access to dermatologic care.

Background and Objective: The burden of nonvenereal infections in Spanish dermatology practice has not yet been evaluated. The aim of this study was to analyze the overall weight of these infections in outpatient dermatology caseloads., Material and Methods: Observational cross-sectional study of diagnoses made by a random selection of dermatologists from the Spanish Association of Dermatology and Venereology (AEDV) working in outpatient dermatology clinics. The data were obtained through the anonymous DIADERM survey. Diagnoses of infectious diseases were selected using codes from the International Classification of Diseases, Tenth Revision. After excluding sexually transmitted infections, the diagnoses were classified into 22 groups., Results: Spanish dermatologists diagnosed an estimated 16190 (95% CI, 9338-23042) nonvenereal infections on average per week, a figure that accounted for 9.33% of the dermatology caseload. The most common diagnostic groups were nonanogenital viral warts (7475 diagnoses, 46.17% of nonvenereal infections), dermatophytosis (3336, 20.61%), and other viral infections (1592, 9.84%), which included Molluscum contagiosum infections. Nonvenereal infections were more common than noninfectious dermatologic conditions in private clinics (P<.0020) and adults (P<.00001). Patients with these infections were also more likely to be discharged than those with other conditions in both public (P<.0004) and private (P<.0002) practices., Conclusions: Nonvenereal infections are frequent in dermatology. They are the third most common reason for outpatient visits, behind actinic keratosis and nonmelanoma skin cancer. By enhancing the participation of dermatologists in the management of skin infections and encouraging interactions with other specialists, we will be able to carve out a niche in an area we have scarcely ventured into to date., (Copyright © 2023 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Infantile perianal pyramidal protrusion (IPPP) is a rare benign skin condition that is typically seen in infant girls. This condition is often mistaken for other skin lesions such as acrochordons, condyloma acuminatum, and sequelae of sexual abuse. Many clinicians are unfamiliar with IPPP which can lead to aggressive workup and treatment. The purpose of this study was to elucidate demographic data, clinical features, diagnostic workup, and management of IPPP in a large cohort of patients seen at an academic medical center., Methods: A retrospective review of patients diagnosed with IPPP at Mayo Clinic, Rochester, MN was conducted. Demographic data, examination findings, diagnostic workup, and treatments were noted., Results: Twenty-seven patients with IPPP, 24 of which were girls and 3 were boys from the ages of 1 day to 4 years (mean 10.8 months, median 8.6 months) were identified. Symptoms were reported in 63% (17/27) of patients. Four patients received treatment with topical corticosteroid or local anesthetic. No patient underwent skin biopsy., Conclusion: IPPP is commonly observed in healthy prepubertal girls. Constipation is a common symptom. Awareness of this entity may prevent overtreatment and unnecessary evaluation., (© 2023 Wiley Periodicals LLC.)

Determining the shape of the skin lesion may provide a diagnostic clue in dermatology practice, more commonly for inflammatory diseases but also for skin tumors. The annular formation may develop by diverse mechanisms in skin tumors. Annular lesions may occur from the onset of the tumor as sparing the central area or depression and/or ulceration in the center of the tumor or outward expansion of the primary lesion. Clustering of multiple papulonodular lesions sparing the central area or relatively independent processes acting on the central and peripheral components of the tumor may also result in an annular appearance. We have explored a wide variety of benign and malignant skin tumors and lymphoproliferative diseases forming an annular shape., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Inc.)

Purpose: To investigate factors related to omitted total body skin examination (TBSE) in skin cancer diagnostics while managing patients using teledermoscopy (TDS) in Swedish primary care., Methods: 4,987 TDS referrals from primary care centers were analyzed to identify factors associated with failing to perform TBSE. Data collected included age, gender of patient and physician, and reason for a visit. Logistic regression was used to test the association between the variables and risk of failing to complete a TBSE., Results: The risk for omitted TBSE is higher in older patients, females, patients whose primary reason for seeking care was not specifically for a complete skin check, and with female physician. Patients > 80 years had more than four times increased risk of not undergoing TBSE compared to the youngest (< 30 y). The strongest correlation to omitting TBSE was with other reasons for primary care visits than "skin check". Male gender of the patient and being examined by male physicians decreased the risk of omitted TBSE by 20% and 30%, respectively. There was no evidence of interaction between the gender of the patient and the physician., Conclusion: Since TDS reduces the opportunities to have a TBSE by dermatologists, the standard management of patients with suspicious skin lesions in primary care must be revised and evidence-based. TBSE is strongly recommended for patients with increased risk of skin cancer, for example old persons with fair skin and a history of skin cancer, when managing them with TDS., (© 2023. The Author(s).)

Dermatological conditions are a relevant health problem. Machine learning (ML) models are increasingly being applied to dermatology as a diagnostic decision support tool using image analysis, especially for skin cancer detection and disease classification. The objective of this study was to perform a prospective validation of an image analysis ML model, which is capable of screening 44 skin diseases, comparing its diagnostic accuracy with that of General Practitioners (GPs) and teledermatology (TD) dermatologists in a real-life setting. Prospective, diagnostic accuracy study including 100 consecutive patients with a skin problem who visited a participating GP in central Catalonia, Spain, between June 2021 and October 2021. The skin issue was first assessed by the GPs. Then an anonymised skin disease picture was taken and uploaded to the ML application, which returned a list with the Top-5 possible diagnosis in order of probability. The same image was then sent to a dermatologist via TD for diagnosis, as per clinical practice. The GPs Top-3, ML model's Top-5 and dermatologist's Top-3 assessments were compared to calculate the accuracy, sensitivity, specificity and diagnostic accuracy of the ML models. The overall Top-1 accuracy of the ML model (39%) was lower than that of GPs (64%) and dermatologists (72%). When the analysis was limited to the diagnoses on which the algorithm had been explicitly trained (n = 82), the balanced Top-1 accuracy of the ML model increased (48%) and in the Top-3 (75%) was comparable to the GPs Top-3 accuracy (76%). The Top-5 accuracy of the ML model (89%) was comparable to the dermatologist Top-3 accuracy (90%). For the different diseases, the sensitivity of the model (Top-3 87% and Top-5 96%) is higher than that of the clinicians (Top-3 GPs 76% and Top-3 dermatologists 84%) only in the benign tumour pathology group, being on the other hand the most prevalent category (n = 53). About the satisfaction of professionals, 92% of the GPs considered it as a useful diagnostic support tool (DST) for the differential diagnosis and in 60% of the cases as an aid in the final diagnosis of the skin lesion. The overall diagnostic accuracy of the model in this study, under real-life conditions, is lower than that of both GPs and dermatologists. This result aligns with the findings of few existing prospective studies conducted under real-life conditions. The outcomes emphasize the significance of involving clinicians in the training of the model and the capability of ML models to assist GPs, particularly in differential diagnosis. Nevertheless, external testing in real-life conditions is crucial for data validation and regulation of these AI diagnostic models before they can be used in primary care., (© 2023. The Author(s).)

Skin cancer has a high mortality rate, and early detection can greatly reduce patient mortality. Convolutional neural network (CNN) has been widely applied in the field of computer-aided diagnosis. To improve the ability of convolutional neural networks to accurately classify skin lesions, we propose a multiscale feature fusion model for skin lesion classification. We use a two-stream network, which are a densely connected network (DenseNet-121) and improved visual geometry group network (VGG-16). In the feature fusion module, we construct multireceptive fields to obtain multiscale pathological information and use generalized mean pooling (GeM pooling) to reduce the spatial dimensionality of lesion features. Finally, we built and tested a system with the developed skin lesion classification model. The experiments were performed on the dataset ISIC2018, which can achieve a good classification performance with a test accuracy of 91.24% and macroaverages of 95%., Competing Interests: Commons Attribution License, which permits use, distribution, and reproduction in any medium, provided in the original work is properly cited., (Copyright © 2023 Gang Wang et al.)

Cutaneous melanoma is one of the most aggressive forms of skin cancer, with the development of advanced stage disease resulting in a high rate of patient mortality. Accurate diagnosis of melanoma at an early stage is essential to improve patient outcomes, as this enables treatment before the cancer has metastasised. Histopathologic analysis is the current gold standard for melanoma diagnosis, but this can be subjective due to discordance in interpreting the morphological heterogeneity in melanoma and other skin lesions. Immunohistochemistry (IHC) is sometimes employed as an adjunct to conventional histology, but it remains occasionally difficult to distinguish some benign melanocytic lesions and melanoma. Importantly, the complex morphology and lack of specific biomarkers that identify key elements of melanoma pathogenesis can make an accurate confirmation of diagnosis challenging. We review the diagnostic constraints of melanoma heterogeneity and discuss issues with interpreting routine histology and problems with current melanoma markers. Innovative approaches are required to find effective biomarkers to enhance patient management., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Competing Interests: Competing interests: None declared.

Considering the limited availability of dermatologists to perform live consultations in nursing homes, teledermatology could be used as a triage tool for selection of cases for which live consultations are considered to be of added value compared with teledermatology. This prospective, multicentre observational study aimed to determine the reasons for dermatology consultations in nursing homes and the estimated value of teledermatology as a triage tool, including potential predictors. Skin tumours were the most common reason (n = 161/270; 59.6%) for dermatology consultations in nursing homes. Dermatologists estimated that live consultations added value compared with teledermatology in 67.8% of cases (n = 183). Multivariable logistic regression showed that predictors for this added value of live consultations were: consultations because of a skin tumour; consultations during which a diagnostic or treatment procedure was performed; consultations during which a secondary diagnosis was made; and the dermatologist involved. These results indicate that using teledermatology as a triage tool potentially reduces the need for additional live consultations in one-third of patients, whereas live consultations are estimated to have added value over teledermatology in two-thirds of cases. To make optimal use of the limited capacity for live consultations by dermatologists, it could therefore be helpful if elderly care physicians use teledermatology more frequently.

As one of the most common cancers globally, the incidence of skin cancer has been rising. Dermoscopy-based classification has become the most effective method for the diagnosis of skin lesion types due to its accuracy and non-invasive characteristics, which plays a significant role in reducing mortality. Although a great breakthrough of the task of skin lesion classification has been made with the application of convolutional neural network, the inter-class similarity and intra-class variation in skin lesions images, the high class imbalance of the dataset and the lack of ability to focus on the lesion area all affect the classification results of the model. In order to solve these problems, on the one hand, we use the grouping of multi-scale attention blocks (GMAB) to extract multi-scale fine-grained features so as to improve the model's ability to focus on the lesion area. On the other hand, we adopt the method of class-specific loss weighting for the problem of category imbalance. In this paper, we propose a deep convolution neural network dermatoscopic image classification method based on the grouping of multi-scale attention blocks and class-specific loss weighting. We evaluated our model on the HAM10000 dataset, and the results showed that the ACC and AUC of the proposed method were 91.6% and 97.1% respectively, which can achieve good results in dermatoscopic classification tasks., Competing Interests: Declaration of Competing Interest The authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Cutaneous pseudolymphomas (CPL) is a group of benign, reactive, and polyclonal lymphoproliferative dermatoses that simulate cutaneous lymphomas (CL) clinically and histologically. Based on the predominating component of lymphocytic infiltrate, CPL can be divided into cutaneous B-cell pseudolymphomas (CBPL), cutaneous T-cell pseudolymphomas (CTPL), mixed (T-/B-cell) pseudolymphomas, CD30-positive pseudolymphomas, and non-classifiable pseudolymphomas. Most patients with localized nodular CBPL present with a solitary nodule. However, few patients develop multiple skin lesions, rarely in generalized forms. Here we describe a rare case of multiple nodular CBPL on both sides of the patient's neck, which was treated successfully with intramuscular injection of compound betamethasone, oral methotrexate, and hydroxychloroquine for 4 months. No recurrence was observed in the patient at the one-year follow-up. This combined treatment may be a promising treatment choice for multiple nodular CBPL., (© 2022 Wiley Periodicals LLC.)

Today, the rapid development of industrial zones leads to an increased incidence of skin diseases because of polluted air. According to a report by the American Cancer Society, it is estimated that in 2022 there will be about 100,000 people suffering from skin cancer and more than 7600 of these people will not survive. In the context that doctors at provincial hospitals and health facilities are overloaded, doctors at lower levels lack experience, and having a tool to support doctors in the process of diagnosing skin diseases quickly and accurately is essential. Along with the strong development of artificial intelligence technologies, many solutions to support the diagnosis of skin diseases have been researched and developed. In this paper, a combination of one Deep Learning model (DenseNet, InceptionNet, ResNet, etc) with Soft-Attention, which unsupervisedly extract a heat map of main skin lesions. Furthermore, personal information including age and gender are also used. It is worth noting that a new loss function that takes into account the data imbalance is also proposed. Experimental results on data set HAM10000 show that using InceptionResNetV2 with Soft-Attention and the new loss function gives 90 percent accuracy, mean of precision, F1-score, recall, and AUC of 0.81, 0.81, 0.82, and 0.99, respectively. Besides, using MobileNetV3Large combined with Soft-Attention and the new loss function, even though the number of parameters is 11 times less and the number of hidden layers is 4 times less, it achieves an accuracy of 0.86 and 30 times faster diagnosis than InceptionResNetV2.

Objectives: The aim of this study was to examine, from the patient's perspective, the most common reasons for seeking medical attention for skin disease and how this varies among different races., Methods: We conducted a cross-sectional analysis on the National Ambulatory Medical Care Survey between 2007 and 2018, the most recent years available. The frequency of each reason for visits was determined using the survey procedures of SAS version 9.4., Results: Among White patients, skin cancer screening (8.2%) was the most common reason for visits followed by skin lesions (7.8%) and discoloration/abnormal pigmentation (7.4%). Among Blacks/African Americans, acne (9.2%), progress visit (8.2%), and skin rash (7.0%) were the top reasons for visits. Acne (12%), skin rash (7.5%), and discoloration/abnormal pigmentation (7.3%) were the most common reasons for patient visits in the "other" race category., Conclusions: Reasons for visits to the dermatologist vary with race. White patients appear to be aware of their increased risk of skin cancer, visiting frequently for skin cancer screenings and skin lesions, whereas Blacks/African Americans are more affected by conditions associated with chronic pruritus. To train dermatologists and nondermatologists to provide equitable care for cutaneous conditions to all races and skin types, especially for those groups experiencing barriers to receiving dermatologic care, it is important that we characterize the reasons why patients visit the dermatologist.

Skin disease is the major health problem around the world. The diagnosis of skin disease remains a challenge to dermatologist profession particularly in the detection, evaluation, and management. Health data are very large and complex due to this processing of data using traditional data processing techniques is very difficult. In this paper, to ease the complexity while processing the inputs, we use multilayered perceptron with backpropagation neural networks (MLP-BPNN). The image is collected from the devices that contain nanotechnology sensors, which is the state-of-art in the proposed model. The nanotechnology sensors sense the skin for its chemical, physical, and biological conditions with better detection specificity, sensitivity, and multiplexing ability to acquire the image for optimal classification. The MLP-BPNN technique is used to envisage the future result of disease type effectively. By using the above MLP-BPNN technique, it is easy to predict the skin diseases such as melanoma, nevus, psoriasis, and seborrheic keratosis., Competing Interests: The authors declare that there are no conflicts of interest., (Copyright © 2022 Dr Aruna R et al.)

Adhesive tape has been used in the scientific study of human skin for more than 90 years. Use of the tape stripping method in dermatology has aided the research and diagnosing of different skin diseases. Basic science, identification, and therapeutic interventions in skin diseases, such as psoriasis, atopic dermatitis, nonmelanoma skin cancer, and melanoma, have been studied using this technique. Among many promising applications that will be discussed throughout this contribution, the pigmented lesion assay will be discussed in depth in relation to melanoma. This product carries considerable and significant research toward early detection of melanoma. Tape stripping is unique and advantageous in its ability to provide a nonsurgical approach to evaluating the human epidermis. The cellular and molecular components of the skin are used to diagnose different skin conditions without invasive skin biopsy., (Copyright © 2022 Elsevier Inc. All rights reserved.)

B-cell chronic lymphocytic leukemia (CLL) is the most prevalent leukemia in the United States, and its diagnosis can have many dermatologic implications. For one, the cutaneous manifestations of CLL include several entities, most notably leukemia cutis, eosinophilic dermatosis of hematologic malignancy, and a heightened risk of skin infections. Additionally, CLL patients are at an increased risk of secondary malignancies, most commonly of the skin. Furthermore, a number of commonly utilized treatments for CLL have cutaneous implications which should be considered in the interdisciplinary management of CLL patients. In this review, we will provide an update on the diverse cutaneous manifestations of CLL and CLL-directed therapies in order to help guide dermatologic management of this increasingly prevalent patient population., (© 2021 the International Society of Dermatology.)

The aim of this work was to systematically collect all previously published population-based epidemiological data on skin diseases in Germany. The present part 2 of the publication series deals with non-infectious skin diseases. The results on cutaneous tumor diseases (part 1) and infectious skin diseases (part 3) form the other parts of this publication series. A systematic literature search was performed using PubMed/MEDLINE for the period of the last 15 years. With the aim of including all dermatologic diseases, a diagnostic list was developed based on the ICD-11 catalogue. This list included 1,347 skin diseases and formed the basis for the search. The literature search yielded 4,650 hits, of which 72 were included in the synthesis. Among them were 37 publications on non-infectious skin diseases. Among these, psoriasis and atopic eczema were the most common. The highest lifetime prevalence was found for acne. This work is the first systematic literature review that aimed to report all available epidemiological data on skin diseases in Germany. It was found that representative data on many non-infectious diseases are not yet available. Among the included studies, there was a high heterogeneity regarding the methodology. Nevertheless, the utility of these epidemiological data is wide-ranging and can serve as a reference of various epidemiological questions., (© 2022 The Authors. Journal der Deutschen Dermatologischen Gesellschaft published by John Wiley & Sons Ltd on behalf of Deutsche Dermatologische Gesellschaft.)

High-resolution millimeter-wave imaging (HR-MMWI), with its high discrimination contrast and sufficient penetration depth, can potentially provide affordable tissue diagnostic information noninvasively. In this study, we evaluate the application of a real-time system of HR-MMWI for in-vivo skin cancer diagnosis. 136 benign and malignant skin lesions from 71 patients, including melanoma, basal cell carcinoma, squamous cell carcinoma, actinic keratosis, melanocytic nevi, angiokeratoma, dermatofibroma, solar lentigo, and seborrheic keratosis were measured. Lesions were classified using a 3-D principal component analysis followed by five classifiers including linear discriminant analysis (LDA), K-nearest neighbor (KNN) with different K-values, linear and Gaussian support vector machine (LSVM and GSVM) with different margin factors, and multilayer perception (MLP). Our results suggested that the best classification was achieved by using five PCA components followed by MLP with 97% sensitivity and 98% specificity. Our findings establish that real-time millimeter-wave imaging can be used to distinguish malignant tissues from benign skin lesions with high diagnostic accuracy comparable with clinical examination and other methods., (© 2022. The Author(s).)

Abstract: Primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder and primary cutaneous marginal zone B-cell lymphoma are 2 distinct entities with several overlapping features which can result in diagnostic uncertainty. Clinically, they both follow an indolent course and present with solitary or multiple papules or nodules. Histologically, they are characterized by polymorphous dermal infiltrates rich in mixed populations of B cells and T cells, often in similar proportions. The histological hallmark of primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder is the presence of follicular T-helper cells within the infiltrate and has historically been used as a marker for differentiating between the 2 conditions. However, there is now mounting evidence that follicular T-helper cells are also seen in primary cutaneous marginal zone B-cell lymphoma and nodal marginal zone lymphoma. The 2 cases presented herein caused diagnostic uncertainty because they displayed appreciable features of both conditions. We discuss the potential mechanisms behind these overlapping histopathological features and hypothesize a model that explores the idea of a collective organoid response to an antigenic stimulus., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Competing Interests: The authors declare no conflict of interest.

Background: Hospitalized patients with hematologic malignancies are medically complex and commonly affected by dermatologic conditions., Methods: Retrospective chart review from January 1, 2014, to December 31, 2018, at Rochester Methodist Hospital (Rochester, Minnesota, USA). Patients hospitalized on hematology and BMT services receiving dermatology consultation were included., Results: In all, 578 consultations (63% male, median age 61 years) were reviewed. Drug reactions (22%), infection (17%), and malignant neoplasm (10%) accounted for nearly half of diagnoses. Exanthematous drug reaction (10%), graft-versus-host disease (7%), and lymphoma or leukemia cutis (6%) were the commonest individual diagnoses. There were significantly more drug reactions in severe neutropenia (33.2% vs. 15.0%), neutrophilic dermatoses in myeloid neoplasm (5.2% vs. 0.3%), and viral infection in lymphoid neoplasm (8.3% vs. 1.2%). Consultation frequently altered treatment (68%), diagnostic workup (63%), and the primary service's initial diagnostic impression (53%). Biopsies were performed in 52% of consultations and helped secure a diagnosis 73% of the time. A total of 16.4% of consultations did not receive a definitive final diagnosis, and 18.5% were resolved in one visit., Conclusion: This is the largest study to date of hospital dermatology consultation in hematology patients. Biopsies are utilized frequently and are diagnostically useful. The complexity of this patient population is evidenced by the fact that a final diagnosis remains elusive in a number of cases despite the multiple visits required for the vast majority of consultations. Nevertheless, dermatology consultation alters diagnosis and treatment in the majority of patients, highlighting the critical role dermatologists have in the care of these patients., (© 2021 the International Society of Dermatology.)

Background: Solid organ transplant recipients (SOTRs) are at ∼100-fold increased risk for developing skin cancers compared with the general population, with increased morbidity and mortality. These patients are closely followed by dermatology; however, it is unclear how referral reasons from nondermatologic providers affect care in these patients., Objective: This study examines the reason SOTRs are referred to dermatologic care by nondermatologic providers as a potential predictor of nonmelanoma skin cancer (NMSC) outcomes., Materials and Methods: A retrospective case-control study was conducted with the records of 353 adult SOTRs referred to a specialized transplant dermatology clinic within an academic tertiary care center between 2007 and mid-2012., Results: Eighty-one patients were diagnosed with 491 total premalignant and malignant skin lesions. A considerable proportion of patients diagnosed with NMSC were referred for benign skin conditions such as rash or acne., Conclusion: These results indicate that some SOTRs referred to dermatology for benign skin disorders are incidentally diagnosed with cutaneous malignancies; this is concerning given that referrals for benign skin conditions may delay appropriate care for cutaneous malignancies and preventative care. Better risk stratification, improved interdisciplinary collaboration, and prompt referrals for dermatologic care are needed in the care of SOTRs., (Copyright © 2021 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Aquaporin 3 (AQP3) is the membrane channel of water and involved in fluid homeostasis. The aim of this study was to reveal the expression and significance of AQP3 in cutaneous lesions. We analyzed AQP3 mRNA levels using RT-PCR in 311 cutaneous lesions and confirmed AQP3 expression in these lesions by immunohistochemistry. AQP3 mRNA was detected in normal epidermis, seborrheic keratosis, solar keratosis, Bowen's disease, squamous cell carcinoma, eccrine poroma, apocrine carcinoma, and sebaceoma; however, AQP3 mRNA was absent in basal cell carcinoma, nevocellular nevus, or malignant melanoma. By immunohistochemistry, diffuse AQP3 expression was seen in all keratotic lesions including seborrheic keratosis, verruca vulgaris, molluscum contagiosum, solar keratosis, Bowen's disease, and squamous cell carcinoma. Diffuse AQP3 expression was also present in all extramammary Paget's disease. No AQP3 staining was obtained in basal cell carcinoma. Positive AQP3 staining was seen in sweat gland tumors including hidradenoma, eccrine poroma, and apocrine carcinoma. Among sebaceous tumors, AQP3 expressed diffusely in all sebaceous hyperplasia and sebaceous adenoma, but not in sebaceous carcinomas. Only focal AQP3 staining was seen in nevocellular nevus and no AQP3 staining in melanoma. Our findings indicate the function of AQP3 maintained in most skin tumors. AQP3 may be used for differential diagnosis in skin tumors., Competing Interests: The authors declare that they have no conflict of interest., (Copyright © 2021 Dongfeng Niu et al.)

Background: Skin and subcutaneous disease is the fourth-leading cause of the nonfatal disease burden worldwide and constitutes one of the most common burdens in primary care. However, there is a severe lack of dermatologists, particularly in rural Chinese areas. Furthermore, although artificial intelligence (AI) tools can assist in diagnosing skin disorders from images, the database for the Chinese population is limited., Objective: This study aims to establish a database for AI based on the Chinese population and presents an initial study on six common skin diseases., Methods: Each image was captured with either a digital camera or a smartphone, verified by at least three experienced dermatologists and corresponding pathology information, and finally added to the Xiangya-Derm database. Based on this database, we conducted AI-assisted classification research on six common skin diseases and then proposed a network called Xy-SkinNet. Xy-SkinNet applies a two-step strategy to identify skin diseases. First, given an input image, we segmented the regions of the skin lesion. Second, we introduced an information fusion block to combine the output of all segmented regions. We compared the performance with 31 dermatologists of varied experiences., Results: Xiangya-Derm, as a new database that consists of over 150,000 clinical images of 571 different skin diseases in the Chinese population, is the largest and most diverse dermatological data set of the Chinese population. The AI-based six-category classification achieved a top 3 accuracy of 84.77%, which exceeded the average accuracy of dermatologists (78.15%)., Conclusions: Xiangya-Derm, the largest database for the Chinese population, was created. The classification of six common skin conditions was conducted based on Xiangya-Derm to lay a foundation for product research., (©Kai Huang, Zixi Jiang, Yixin Li, Zhe Wu, Xian Wu, Wu Zhu, Mingliang Chen, Yu Zhang, Ke Zuo, Yi Li, Nianzhou Yu, Siliang Liu, Xing Huang, Juan Su, Mingzhu Yin, Buyue Qian, Xianggui Wang, Xiang Chen, Shuang Zhao. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 21.09.2021.)

The cutaneous lymphomas are malignancies of T-cell and B-cell lymphocytes in which the skin is the primary organ of involvement. The cutaneous T-cell lymphomas include variants that can mimic the presentation of common skin diseases or arthropod bites. Mycosis fungoides, the most common cutaneous T-cell lymphoma, usually presents as fixed asymptomatic patches or plaques in sun-protected areas. The cutaneous B-cell lymphomas have fewer variants that often present as papules or nodules that can mimic nonmelanoma skin cancers. Some therapies for cutaneous lymphoma have unique side effects such as central hypothyroidism, hyperlipidemia, and peripheral neuropathy., (Published by Elsevier Inc.)

Aims: Pseudomelanocytic nests or "pseudonests" arising in lichenoid dermatoses can be a diagnostic pitfall for melanoma in situ (MIS), especially on sun-damaged skin. We sought to evaluate histopathological features that may be helpful in distinguishing this benign process from inflamed MIS., Methods: Ten biopsy specimens containing pseudomelanocytic nests within lichenoid dermatoses and twenty cases of inflamed MIS were retrospectively reviewed. Cases with pseudomelanocytic nests represented either a rash (n = 6) or a discrete non-melanocytic lesion, such as lichenoid keratosis (n = 4)., Results: All cases with pseudomelanocytic nests showed nests of microphthalmia-associated transcription factor-positive cells at the dermoepidermal junction (DEJ) with interface changes and lichenoid inflammation. Pagetoid scatter, confluence of solitary melanocytes at the DEJ and significant cytologic atypia was not seen in any of these cases. In contrast, all cases of inflamed MIS demonstrated confluence of single melanocytes at the DEJ with cytologic atypia (P < 0.001) and 18/20 cases showed pagetoid scatter of melanocytes (P = 0.001)., Conclusions: Our results show that, of the different histopathological features assessed, confluent growth and pagetoid scatter of atypical melanocytes were seen in most cases of inflamed MIS but were absent in all cases with pseudomelanocytic nests. Therefore, in addition to clinicopathological correlation, these features may be useful in differentiating pseudomelanocytic nests arising in lichenoid dermatoses from inflamed MIS., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Competing Interests: The authors declare no conflict of interest.

Dermatology is a visual speciality suited for implementation of computer-aided diagnostic (CAD) systems as summarised in this review. There has been great progress in CAD melanoma detection, whereas the detection of multiple lesion skin diseases has proved more difficult. We need data on clinical implementation of CAD systems in order to know, how data from studies can be extrapolated to real-world clinical settings. Good clinical test designs and common standards for reporting and monitoring efficacy are needed. Implementation of CAD in the best possible way will be a challenge for health systems and clinicians in the coming years.