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Background:Optical fluorescence imaging (OFI) has been shown to enhance the detection of oral potentially malignant disorders (OPMD), by providing additional information about the nature of these lesions, with loss of autofluorescence (LAF) signifying potential underlying oral epithelial dysplasia (OED) or malignancy. This study aims to assess the usefulness of OFI in identification and triaging of OPMDs by primary oral health practitioners, in a community setting. Methodology Participants were recruited from the LESIONS programme in South-East Queensland, Australia. Participants underwent both conventional oral examination (COE) of mucosal tissues as well as screening with OFI by trained dentists and oral health therapists (OHTs). Lesions were classified as homogeneous, non-homogeneous, lichenoid or other. The study protocol included blanching of lesions detected with VELscope (R) (diascopy) and a two-week review and reassessment of all lesions to reduce false-positive findings. Analysis of decisions made by dentists and OHTs about lesion identification and triaging was undertaken. Results:A total of 360 participants underwent both COE and OFI screening and presented with at least one lesion detected with either method. Lesion size increased and border distinctness and visibility improved with OFI. Of the 170 lesions that underwent two-week reassessment, 70% resolved or were confirmed as benign. OHTs were more likely to request review and referral for OPMDs compared to dentists. Conclusion:Optical fluorescence imaging is a useful tool to help dentists and OHTs identify and triage patients with possible OPMD in the primary care setting.

Introduction: Trichoscopy greatly facilitates clinical diagnosis in patients with hair loss and may decrease the necessity for histopathological examination. Structures which may be revealed by trichoscopy include hair shafts, hair follicle openings, the perifollicular epidermis, and cutaneous microvessels. Cutaneous microvessels revealed in trichoscopy may vary in type and number depending on the scalp area, type of the disease, and its activity. Firm direct pressure (diascopy) might result in their blanching, but as of yet, there are no studies on the types of vessels that do or do not blanch on applying pressure. Methods: We studied interfollicular twisted loops in 16 cases of biopsy-confirmed scalp psoriasis and 37 cases of arborizing vessels in normal subjects and seborrheic dermatitis patients. Results: We observed that all arborizing red line vessels blanched on applying pressure. Instead, the vast majority of twisted and simple loops, despite their vascular nature, did not blanch on performing diascopy. Conclusion: In the light of these findings, diascopy of vascular changes in hair loss patients might provide additional clues for a proper diagnosis, especially in differentiating scalp psoriasis, seborrheic dermatitis, and discoid lupus erythematosus.

Unilateral nevoid telangiectasia (UNT) is a benign cutaneous vascular disorder, first described by Blaschko in 1899, characterized by clustered telangiectasias with a reticular appearance, blanching with diascopy, and often following a dermatomal pattern especially in C3 and C4 dermatomes, although there are reported cases without this distribution. The pathogenesis is linked mostly to estrogenic action to release nitric oxide causing capillary relaxation; this theory is supported by the predominance in female teenagers and patients with chronic liver disease presenting with this condition; however, the estrogenic role remains unclear because of the lack of receptors in skin and normal estrogen and progesterone levels in some patients with UNT [1].

Nevus depigmentosus (nevus achromicus) is a rare congenital non-progressive hypopigmented nevus related to morphological abnormalities of melanosomes. A 6-year-old girl was brought with solitary hypopigmented patch with irregular, but well-defined, border on cheek of the left cheek since birth. On diascopy, the margin of the lesion did not fade. Diascopy showed off white lesion with faint pigment network over the lesion, and serrated borders extending onto the normal skin as “pseudopods.” Nevus depigmentosus usually doesn’t require any active treatment, but various treatment modalities include Camouflage, surgical grafting and excimer laser may be tried for cosmetic reasons.

Purpura is defined as extravasation of red blood cells resulting in discoloration of the skin or mucous membranes secondary to any disturbance of the normal physiological mechanisms that normally prevent blood from escaping from the vessels, or from damage or lack of support to the vasculature. It is an important and easily recognizable sign and can occur isolated or as part of a systemic disorder. The causes of purpura range from trivial (actinic/senile purpura) to extremely alarming and life-threatening conditions (vasculitis) that need to be diagnosed and treated early. The most common causes of purpura are due to platelet and coagulation disorders. An easy clinical differentiation from intravascular causes of erythema can be made by diascopy where purpura do not show any blanching on being pressed by a slide, which is present in cases of erythema. Management of purpura is generally multidisciplinary involving the dermatologist, hematologist, rheumatologist, nephrologist, and other relevant specialists for life-threatening causes. Purpura is an important cutaneous clinical sign with myriad of causes ranging from trivial to life-threatening disorders. Prompt identification of this sign and approaching the patient based on thorough history and clinical examination can be significant as early diagnosis and treatment initiation can save the life of the patient in cases with purpura secondary to causes with significant mortality.

Aim The aim of the case report is to discuss the clinical, histological features, differential diagnosis, treatment and follow up the case. Case presentation Vascular malformations are defined as congenital lesions that become apparent later in life, formed by dysplastic vascular channels, with no endothelial proliferation or involution, that grow possibly due to hemodynamic mechanisms. It can be further subdivided into venous, capillary, arteriovenous and lymphatic malformations. A 54 yrs old housewife female patient reported to the dental clinics with a swelling in buccal mucosa near the left commissure of 5 years duration. Differential diagnosis: • Mucocele • Hemangioma • Vascular malformation • Mucoepidermoid carcinom Investigation The lesion was blanched on compression with diascopy. Histological sections confirmed the diagnosis of arteriovenous malformation. Follow up was done till 6 months. Conclusion This case demonstrates AVM of the left buccal mucosa. Although rare, clinicians should be aware of their potentially life threatening complications. This can be avoided by early detection and intervention, with adequate follow up to monitor recurrence.

Clinically, a vascular malformation is characterized by a soft, red to purple papule or nodule with a moriform or smooth surface. The clinical aspects depend on the level of vascular congestion and the depth of the lesion. It is usually asymptomatic, and when the oral mucosa involved, it commonly affects the lips, tongue, and buccal mucosa. A 72-year-old black male patient came to our oral diagnosis clinic presenting a lesion with 10 years of evolution. Oral examination revealed a purple nodular lesion on the lower lip measuring 9.0 × 9.0 cm, which had a positive result on diascopy. The clinical hypothesis was a vascular malformation. The treatment was sclerotherapy, and it was initiated with 5% of ethanolamine oleate, which was progressively concentrated up to 25%. A total remission of the lesion was seen after 8 weekly sessions of injection, and there are no signs of recurrence.

The diagnosis of pigmented lesions of the oral cavity and perioral tissues is challenging for the clinicians. The term orofacial pigmentation refers to a wide range of lesions and conditions, which change the color of the orofacial tissues. Even though some lesions may definitively be diagnosed on clinical grounds alone, the final diagnosis usually requires clinical, biochemical, and histopathologic evaluation. Clinical tests, such as diascopy and radiography, and laboratory investigations, such as blood tests, can be used to confirm a clinical impression and reach a definitive diagnosis. The oral cavity is the mirror of the body and is often the area where systemic diseases first present. Hereby, we are presenting a rare case of macular hyperpigmentation with lace-like pattern of oral cavity and macular hyperpigmentation of the face, skin, and palms, with a diagnosis of pigmentation due to iron-deficiency anemia.

Also called as physiologic anemic macules, Bier spots are small, hypopigmented irregularly shaped macules against a background of diffuse erythema, which creates an appearance of speckled vascular mottling of the skin. Bier spots most commonly appear on distal portions of the limbs though there are case reports describing diffuse involvement, which also affect trunk and mucous membranes of the patient. Although the exact pathophysiological mechanisms underlying Bier spots still need to be elucidated, Bier spots have been suggested to be a vascular anomaly caused by vasoconstriction of small vessels. In addition, several diseases have been proposed to be associated with Bier spots, including scleroderma renal crisis, cryoglobulinemia, Peutz-Jeghers syndrome, alopecia areata and hypoplasia of the aorta, although it has not been shown whether these associations are casual or coincidental. The clinical presentation of Bier spots is quite typical. These tiny whitish macules easily become prominent when the affected limb is placed in a dependent position and fade away when the limb is raised. Here we report a case of Bier spots in a 32-year-old male patient with characteristical clinical manifestations.

Lupus miliaris disseminatus faciei (LMDF) is an inflammatory dermatosis characterized by 1- to 3-mm red-to-yellow-brown papules on the central and lateral face, particularly on and around the eyelids. Lesions can occur singly or in crops. The discrete papules appear yellow-brown (“apple-jelly”) on diascopy and as epithelioid cell granulomas histologically, thus, resembling tuberculosis, sarcoidosis, or other granulomatous diseases.1 LMDF classically presents on the face; however, an increasing number of cases are reported with extrafacial involvement.1, 2, 3, 4, 5, 6 We describe a unique presentation of LMDF characterized predominantly by bilateral axillae involvement.

A 53-year-old male patient presented with an approximately 8-year history of an asymptomatic "blood blister" on the lower lip. Extraoral examination revealed a soft, purplish, lobulated swelling on the left side of the lower lip skin. Intraoral examination showed a well-defined, purplish stain and papules on the left lower lip and alveolar mucosa, measuring approximately 1.5 × 1.0 cm. The diagnostic hypothesis was vascular lesion, which was later confirmed by a positive diascopy result. Under local anesthesia, the patient was submitted to 2 clinical sessions of photocoagulation with high-intensity diode laser (Thera Lase Surgery; 808∼830 nm ± 20 nm, 2.5 W, defocused 2 mm beam in continuous mode). The postoperative course was uneventful. After 6 months of follow-up, the patient reported only mild sensitivity in the region. Clinical examination revealed fibrosis compatible with the tissue repair process without aesthetic or functional impairment.

A 66-year-old man with mitral valve prolapse and use of an anticoagulant reported a lesion in the tongue. The lesion appeared 10 years earlier, without change in size, but impaired chewing. Intraoral exam showed a purple, well-circumscribed, smooth-surface nodule measuring 15 × 10 × 6 mm localized in the posterior dorsum of the tongue. The diascopy caused ischemia of the area. Doppler ultrasonography revealed presence of low flow in the venous vessels. Blood exams showed a change in coagulation, mainly the International Normalized Ratio (3.25). The diagnosis was oral varicose vein. The treatment performed was photocoagulation with diode laser. Topical anesthetic was applied on the anomaly for 5 minutes. The average power was 2500 mW, continuous mode, without contact until the anomaly turned white. Signs and symptoms reported by the patient were minimal. After 2 sessions at 28-day intervals, the lesion had complete clinical remission. No signs of recurrence were noted during the 8-month follow-up. Support: FAPEMIG.

We report three cases of verruciform xanthoma (VX) in male patients aged 82, 88 and 39 years, respectively. The clinical appearance was of a mulberry-like area consisting of small papillae, which is typical of and specific to VX, and the diagnosis were histologically confirmed in all cases. Dermoscopy revealed that each surface papilla contained linear or hairpin vessels, which were surrounded by a marginal whitish rim. These structures are thought to correspond to dilated vessels in dermal papillae and papillated acanthotic epidermis, respectively. Furthermore, observation under compression (similar to diascopy) revealed yellow dots and debris, reflecting lipid-laden foam cells. In order to compare these findings with those of other disorders with similar findings, two patients with xanthogranuloma, six with sebaceous naevus, and three with senile sebaceous hyperplasia were examined. The dermoscopic findings in these patients were not similar to those of VX. Therefore, we believe that the above dermoscopic findings are specific to VX and could be helpful in diagnosis.

Cutaneous tuberculosis is a major cause of morbidity in children in India. Lupus vulgaris is one of the commonest manifestations. The clinical recognition of lupus vulgaris may be difficult with atypical presentation. It is important to have a high index of suspicion to recognize and treat these children to prevent morbidities. The buttocks are common but often neglected sites for lupus vulgaris in children. We present a case report of lupus vulgaris occurring on the buttocks, and discuss our approach in diagnosis and treatment.

Rosacea is a chronic hyperaemic disease of the skin involving the flush area of the face. It is characterized by persistent erythema and often by telangiectasia with acute episodes of oedema, papules, and pustules. It tends to occur more commonly in females between the ages of 30 and 50 years, but it follows a more severe course in males leading to formation of rhinophyma, gnathophyma, etc. Ocular involvement is the most serious complication and can cause conjunctivitis, blepharitis, episcleritis, iritis, and keratitis. Granulomatous rosacea is an atypical variant, characterized by papular and occasionally granulomatous lesions, which on diascopy appear as yellowish brown nodules and on histopathology exhibit epithelioid cell granulomas [1]. We present here one such case.

Lupus miliaris disseminatus faciei, a chronic inflammatory disorder, is a controversial and enigmatic diagnostic/therapeutic entity. Multiple, discrete, smooth 1-3 mm brown/red or brown-to-yellowish dome-shaped papules (sometimes with mild scaling) are its clinical characteristics. The lesions are usually located on the central and lateral side of the face. The condition is most often seen in young adults of both sexes, and diascopy may reveal apple-jelly nodules. Lupus miliaris disseminatus faciei has clearly been defined into four histopathologic groups: epithelioid cell granuloma with central necrosis; epithelioid cell granuloma without central necrosis (sarcoid/foreign body reaction); epithelioid cell granuloma with abscesses; and nongranulomatous, nonspecific inflammatory infiltrate. While in early lesions granuloma is absent and lymphocytes and a few neutrophils surround the follicles, fully developed lesions show well formed granuloma surrounding ruptured hair follicles, often with large numbers of neutrophils. Lupus miliaris disseminatus faciei must be differentiated from other conditions; to facilitate this, in Part I of this paper the histopathologic undertones were delineated into early, intermediate (first stage, second stage, and third stage), and late stages. This part of the article presents an overview of lupus miliaris disseminatus faciei.

Objective To assess dermoscopic findings of “non-blanchable erythema” in stage I pressure ulcers and to determine their characteristics. Methods Dermoscopic examinations using DermLite® II pro of redness over a bony prominence that did not resolve within 30 min of pressure relief or if a positional change was impossible for three days. Results Characteristic dermoscopic findings of redness in stage I pressure ulcers included petechial dots and telangiectatic streaks while other discolorations disappeared by diascopy. These dermoscopic features were seen in 9 of 10 cases. In one case, purpura that persisted under dermoscope compression was observed. Likewise, petechial dots and telangiectatic streaks were detected in three cases with redness surrounding stage II pressure ulcers. Conclusion The “non-blanchable erythema” in pressure ulcers consists of petechial dots, telangiectatic streaks and purpura that persist after compression by the dermoscope and these characteristics are helpful for dermoscopically diagnosing pressure ulcers.

A 43-year-old woman presented with erythematous papules and plaques on the forehead evolving in the previous 3 months (Fig. 1). Diascopy, by showing a yellowish nodule-like aspect (Fig. 2), raised the hypothesis of cutaneous sarcoidosis, which was confirmed by histopathological examination. Sarcoidosis is a multisystemic granulomatous disease, a histologically evident characteristic shared by its cutaneous lesions. This granulomatous nature can be elicited by diascopy. The pressure from the glass slide application eliminates the characteristic erythema (Fig. 1), revealing a yellow-brown granulomatous appearance resembling apple-jelly (Fig. 2). Although not specific for cutaneous sarcoidosis, as it can also be seen on other granulomatous conditions such as granuloma annulare, this ‘apple jelly’ sign, classically described in association with sarcoidosis, can be a useful diagnostic tool. It is absent in the majority of sarcoidosis differential diagnosis, such as in lupus tumidus. Apart from its usefulness it also constitutes a curious clinical picture.1,2

Background Widespread idiopathic telangiectasia (generalized essential telangiectasia) is a rare skin disorder characterized by the development and gradual spreading of telangiectases. The condition tends to affect women in their midthirties. For no apparent reason telangiectases start to appear to the lower extremities and progress steadily to involve the skin of the trunk, the arms, and the face. General health is not affected by the condition and standard laboratory tests consistently yield normal results. Case report In February 1997 a 78-year-old lady was admitted for treatment of cataracta corticonuclearis of her left eye. Complete ophthalmological and dermatological examinations were performed. She presented marked conjunctival telangiectases of both eyes and widespread cutaneous telangiectases involving her face, trunk, arms, and legs. Complete blanching of lesional skin was observed on diascopy. The Rumpel-Leede-test was normal. Cutaneous and conjunctival changes appeared not to be associated with internal disease or bleeding abnormalities. Discussion The patient presented here shows widespread idiopathic telangiectasia with marked conjunctival involvement. Ocular changes rarely have been reported in patients with generalized essential telangiectasia to date. Concomittant conjunctival and cutaneous telangiectases may be seen in other conditions such as hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber disease) and ataxia telangiectasia (Louis-Bar syndrome). The former shows an associated bleeding abnormality and is transmitted autosomal dominantly. The latter presents associated neurological signs such as cerebellar ataxia, strabism, nystagmus, apraxia, and mental retardation.

Hemangiomas are benign vascular anomalies characterized by benign proliferation of blood vessels. There are no well-defined criteria for the diagnosis and treatment of oral capillary hemangioma (OCH). The objective of this study is to report a safe, effective, and low-cost protocol for diagnosis and treatment of OCH. Eight patients were diagnosed with OCH, through two physical examination maneuvers—the diascopy and head lowering maneuver with abdominal compression (HLMAC). The treatment performed was sclerotherapy with ethanolamine oleate, weekly, until the disappearance of the lesion. No local anesthetics were administered prior to the sclerosing agent injection. All cases showed a complete remission of the lesions after sclerotherapy. There were no visible scars or compromise esthetics or normal function, and there was no evidence of recurrence. Only one patient had superficial ulceration, which remained asymptomatic and healed without specific treatment. This protocol was effective in the diagnosis of OCH through two physical examination maneuvers with low-cost and easy implementation, the diascopy and the HLMAC. The low concentration associated with a reduced amount of the sclerosing agent was responsible for the excellent results in the cases treated.

A28-year-old woman presented with a 3-month history of asymptomatic bumps on both eyebrows (Figure 1A). She had had cosmetic tattooing of these areas approximately 1.5 year before the manifestation of the lesions and depilated her eyebrow hairs using tweezers. Her medical history was positive for diabetes mellitus type 2, for which she used metformin. She denied other symptoms such as shortness of breath. On physical examination, multiple hard yellowish–red papules were observed arranged in a linear fashion within the tattoo ink. When examined using diascopy an apple-jelly color was observed. The remaining skin showed no other abnormalities. The clinical differential diagnosis included a granulomatous foreign body reaction, sarcoidosis, or xanthomas. A 3-mm punch biopsy of the left eyebrow revealed a granulomatous dermatitis without necrosis (Figure 2). Serum analyses (angiotensin-converting enzymes [ACEs] and lysozyme) and a chest X-ray were normal, excluding sarcoidosis. A diagnosis of a delayed granulomatous reaction to tattoo ink was made. The lesions were injected using Dermojet with triamcinolone acetonide A10 1:1 diluted with lidocaine. When the patient visited the hospital 6 weeks after the triamcinolone acetonide injection for follow-up review, all lesions had resolved (Figure 1B). The lesions did not recur during 4 months of follow-up.

A 20 years-old girl presented with multiple asymptomatic reddish vesicles on face for four years. It used to get worse in summer and was associated with localized hyperhidrosis. The lesions were notable for disappearance on diascopy. Histopathology from the vesicle showed mononuclear cell infiltration in the upper dermis, especially around eccrine sweat apparatus, along with dilatation of superficial capillaries and lymphatics. Based on clinical presentation and histopathology, diagnosis of Granulosis rubra nasi (GRN) was made. GRN usually resolves at puberty; however, rarely it may persist in adulthood. We here report a case of GRN having lesions in adulthood. Moreover, she showed excellent response to topical tacrolimus, a finding not observed in literature.

T HE LESIONS SHOWN WERE LOCATED ON the forearm of a 47-year-old man (Figure 1A), the forearm of a 51-yearold man (Figure 1B), and the trunk of a 55-year-old woman (Figure 1C), all of them presenting with a lichenoid rash. Dermoscopy revealed 2 differential patterns in these lesions: (1) reticular, white Wickham striae (WS) (Figure 2A) in the papules shown in Figure 1A and (2) round to oval, yellowbrown, homogeneous patches (YPs) (Figure 2B and C) and absence of WS in the lesions shown in Figure 1B and C. A histopathologic diagnosis of lichen planus (LP) was made in 1 patient (Figure 1A, inset), and lichenoid sarcoidosis was diagnosed in the other 2 patients (Figure 1B and C, insets). Lichenoid sarcoidosis represents 1% to 2% of cutaneous sarcoidosis cases and mimics LP. The examples illustrated herein show that dermoscopy may be useful for discriminating between the lesions of LP and those of lichenoid sarcoidosis. The absence of WS and the presence of YPs should prompt clinicians to perform a biopsy to rule out a granulomatous skin disease in clinically lichenoid lesions. Dermoscopy and diascopy of sarcoidosis lesions reveal individual yellow nodules (“grains of sand”) or a yellow-brown discoloration (“applejelly” sign). Yellow-brown homogeneous patches are not specific for sarcoidosis, but they are indicative of a granulomatous skin disease (sarcoidosis, lupus vulgaris, leishmaniasis). Conversely, dermoscopy of active LP lesions reveals the characteristic WS but not the YPs.

A 59-year-old Chinese woman was referred to our department in November 2005 for erythematous lesions of the chest, the back, and the limbs that had appeared six months before, with no obvious cause. The rash faded upon diascopy. The affected area had gradually extended, merged into a large patch, and spread to both arms. Three months earlier, rice-grain or broad bean-sized erythema had appeared on both thighs, and the affected area had gradually increased and partly merged. The patient did not report [...]

Lupus vulgaris is the most common form of cutaneous tuberculosis which usually occurs in patients previously sensitized to Mycobacterium tuberculosis. We present a case of a 10-year-old boy who was diagnosed as lupus vulgaris clinically and histopathologically. He had well demarcated, irregularly bordered, pink, infiltrated plaques on his left cheek showing apple-jelly appearance on diascopy. The histopathological examination showed tuberculoid granulomas with Langhans type giant cells. The Mantoux reactivity was in normal limits, and no acid-fast bacilli was found in the lesion, either by direct stained smears or by culture. The lesions showed marked improvement on anti-tuberculosis treatment. We want to emphasize that histopathological examination has diagnostic value in lupus vulgaris in correlation with clinical appearance, when direct analysis or culture is negative.

A 56-year-old woman presented with multiple, erythematous cutaneous vessels that blanched with diascopy and were symmetrically distributed over both lower and upper extremities. The lesions had been present for approximately 6 years and were asymptomatic. Generalized essential telangiectasia (GET) is an idiopathic syndrome of widespread, asymptomatic telangiectases of unknown cause. In our patient, an extensive laboratory evaluation showed low levels of circulating vitamin C as well as the presence of urinary matrix metalloproteinases. The relevance of these abnormal findings is unclear. No uniformly effective treatment exists for GET. Our patient was started on oral doxycycline and was referred for laser therapy.

Granuloma faciale (GF) is a benign, chronic inflammatory disorder, characterized by reddish brown plaques with prominent follicular orifices and telangeictasia, usually occurring over the face. The condition often presents a problem in differential diagnosis. Herein we describe a case of GF with an unusual diascopic finding of an apple jelly appearance on diascopy.

A 14-year-old boy presented with a pink firm plaque with well-defined borders in the right infra-orbital skin area. On diascopy, the infiltrate exhibited a typical apple-jelly appearance. No acid-fast bacilli could be demonstrated. A polymerase chain reaction (PCR) assay did not reveal the presence of mycobacteria in a lesional biopsy sample. Culture of biopsied tissue on Loewenstein-Jensen medium was negative. Although the tuberculosis culture and PCR did not confirm tuberculosis, a diagnosis of lupus vulgaris was made considering the clinical and histopathological findings. After a 9-month antituberculous therapy, the lesion disappeared. We believe that a diagnosis of lupus vulgaris still depends more on clinical and histopathological findings than on tuberculosis culture or PCR.

© 2013 The Authors. doi: 10.2340/00015555-1547 Journal Compilation © 2013 Acta Dermato-Venereologica. ISSN 0001-5555 Telangiectasias are small dilated vessels observed after inflammatory diseases, radiotherapy and in vascular malformations, such as Sturge-Weber neurovascular syndrome (1). Purpura is a discoloration of the skin due to extravasation of red blood cells. Extravasated blood is broken down to various metabolites derived from haem within 3 weeks. Purpura can originate from platelet or coagulation disorders, elevated intravascular pressure, vasculitis or toxic reactions to drugs. Purpura lesions do not blanch on applying pressure (diascopy) (2). Treatment of metastatic malignant disease often involves regional lymph node dissection. Axillary lymph node clearance involves removal of all lymph nodes in levels I–III. The intercostobrachial sensory nerves in the area are removed, but the motor nerves (long thoracic and thoracodorsal nn.) are preserved (3, 4). Significant morbidity can be related to axillary dissection including seroma, wound infection, haematoma, neuro praxia, lymphoedema and shoulder dysfunction (3, 5). We present here 2 cases of transient purpura discoloration of the skin after axillary dissection in 2 patients with different malignancies.

A painless, bluish, submucosal swelling on one side of the floor of the mouth usually indicates the presence of a ranula. Rarely, such a swelling may be caused by an inflammatory disease process in a salivary gland, a neoplasm in the sublingual salivary gland, hemangiomas, a lymphatic nodular swelling, amyloidosis, or embryologic cysts/dermoid cyst. We report a 35-year-old female patient with swelling in the floor of her mouth that was clinically diagnosed as a ranula due to negative diascopy, the site of swelling, and the age of patient. Because of a strong clinical suspicion of a ranula, diagnostic methods such as angiography and magnetic resonance imaging (MRI) were not used in our case. A preoperative diagnosis was not truly established. We report a case of hemangioma in the floor of the mouth masquerading as a ranula. Although a rarity, vascular malformations should always be ruled out by using digital subtraction angiography and MRI studies before going for surgical intervention.

Hemangiomas and vascular malformations (VMs) are the two types of vascular lesions. VMs are further subdivided according to the type of involved vessels present as arterial, arterio-venous, venous, and capillary or lymphatic malformations. The capillary malformation (CM) previously was considered to be a hemangioma and was known as port wine stain, and hereby presenting a case report on the orodental manifestations of CM.

A 62-year-old white woman presented with an 8-month history of a slowly and progressively growing, erythemato-infiltrative plaque on her right temporo-malar region. The lesion was originally described as reddish, confluent papules, expanding at the periphery and leaning towards the scarring resolution in the central area. Physical examination revealed an extensive atrophic area, of 4 cm in diameter, with confluent, small, yellow-brown, scaly papules surrounding it, localized on the right temporo-malar region ( Fig. 1). On diascopy, ‘‘apple-jelly-like nodules’' were seen at the periphery. A complete clinical evaluation showed the patient in good health. The results of the routine laboratory tests were normal. Figure 1. Extensive atrophic plaque with dusky hypertrophic border of the face Download figure to PowerPoint A punch-biopsy (3 mm in diameter) was performed at the border of the plaque for histologic study. The tissue sections, stained with hematoxylin and eosin, showed acanthosis and a granulomatous dermal infiltrate composed of lymphohistiocytic cells, a few plasma cells, and Langhans epithelial giant cells ( Fig. 2). No areas of necrosis were seen. The apposition of the skin biopsy, followed by the May-Grunwald stain, showed rare Leishman's bodies. Figure 2. Histopathology of the skin „lesion showing typical granulomatous dermal infiltrate Download figure to PowerPoint During detailed questioning, the patient stated that 1 year previously a micropapular lesion, mosquito-bite-like, appeared in the same area of the present plaque and healed after 2 weeks of therapy with an undefined topical antibiotic. These anamnestic data, together with the clinical and histopathologic findings, support the diagnosis of leishmaniasis recidiva cutis (LRC). The patient was treated with intralesional meglumine antimonate (Glucantim) (twice in a week for 3 weeks). At the end of therapy an atrophic plaque remained. After 5 years of follow-up no relapses were found.

Dermoscopy (also known as dermatoscopy, diascopy, epiluminescent microscopy, and surface microscopy) combines oil immersion with standard magnifying optics to permit in vivo visualization of features of pigmented melanocytic neoplasms that are not discernible by examination with the naked eye. Dermoscopy is being used to assist in clinically differentiating melanoma from its benign simulators. The use of dermoscopy can increase the diagnostic accuracy of pigmented lesions.1,2 More than 100 features have been described using dermoscopy.3-5Globules, one of the structural components, are typically found in melanocytic neoplasms. According to their color, size, shape, and distribution, globules are suggestive of common melanocytic nevus, congenital nevus, Spitz nevus, dysplastic nevus, and malignant melanoma.3-5Histologically, globules correspond to superficial nests of melanin-containing melanocytes in the papillary dermis6and maybe in the lower portion of the epidermis.3,5 We report that seborrheic keratoses also show globulelike structures on dermoscopy. We have

In vivo cutaneous surface microscopy, epiluminescence microscopy, dermoscopy, dermatoscopy and magnified oil immersion diascopy, are terms that describe the use of an incident light magnification system to examine cutaneous lesions, usually with immersion oil at the skin-microscope interface. The result is the visualization of a multitude of morphological features, not visible with the naked eye, that enhance the clinical diagnosis of nearly all pigmented lesions. Sixty-two invasive melanomas and 159 randomly selected non-melanoma pigmented lesions were used in the study. The non-melanomas, while randomly selected from a large data base, were all clinically atypical. Using the x 10 magnification of hand-held surface microscopes (Dermatoscope, Episcope), we present an analysis of 72 surface microscopic variables (constituting over 15,000 single observations) for the diagnosis of invasive melanoma. Forty of the 72 features studied were shown to differ significantly between invasive melanoma and non-melanoma pigmented lesions. Blue-white veil, multiple brown dots, radial streaming and pseudopods had a specificity greater than 95% for melanoma. Two features, symmetrically irregular pigment (non-uniform pigmentation with point and axial symmetry) and the presence of a single colour, had a sensitivity of 0%, i.e. were absent, in melanoma. The other significant features are presented, with their sensitivity and specificity for melanoma.