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Diagnosis of non-facial melanomas on sun-damaged skin or extrafacial lentigo maligna is challenging.To identify the evolutionary dermoscopic signs, characteristic of this type of non-facial melanoma on sun-damaged skin.This retrospective descriptive observational study included 90 dermoscopic follow-up images of 22 non-facial melanomas on sun-damaged skin from 17 high-risk melanoma patients, followed with digital dermoscopy and diagnosed between January 2016 and October 2020. We recorded dermoscopic changes by comparing each dermoscopic image with the previous one (mean dermoscopic follow-up of the excised lesions was 3.6 years). Confocal microscopy images were taken at diagnosis.In total, 51.5% (95% CI: 39-64) showed an appearance or increase in featureless areas with surrounding small round or triangular dark brown-blue structures, 23% (95% CI: 23-46) showed an increase in other geometric structures (angulated lines, zig-zag lines and polycyclic structures), 5.9% (95% CI: 2-14) showed an appearance or increase in bright white lines and atypical vascularization, 26.5% (95% CI: 17-39) showed an appearance or increase in follicular pigmentation structures or follicular radial lines, and 39.7% (95% CI: 28-52) showed focal islands of pigmentation in these areas. Of the changes, 54% occurred at the last and diagnostic visit. There was an increase in size in only 20.6% (95% CI: 12-32). Also, 81.8% showed pagetoid cells in the epidermis, 95.5% atypical cells at the dermoepidermal junction by reflectance confocal microscopy, and 95.5% showed non-edged or edged and non-edged papillae.This study identifies the dermoscopic evolutionary changes associated with extrafacial lentigo maligna.

BACKGROUND The management of melanocytic lesions with peripheral globules (MLPGs) is usually age-dependent and can be challenging in high-risk melanoma patients. OBJECTIVES To evaluate clinical, dermoscopic and reflectance confocal microscopy (RCM) features of MLPG in patients under digital dermoscopic surveillance. To know whether dermoscopic or RCM findings correlate with histologic diagnosis and the accuracy of the dermoscopy-RCM compared with histopathology. METHODS During 24 months, we prospectively enrolled MLPG in patients under digital dermoscopy follow-up. All were evaluated by dermoscopy and RCM and excised for histologic examination. RESULTS We enrolled 154 patients, mean age 42.45 years (18.78-73.19). Three melanomas and 19 dysplastic naevi (DNs) were diagnosed. There were no significant differences in the age of the patients (P = 0.662). MLPGs with diameter of 6 mm or more and asymmetry in two axes were associated with melanoma (P = 0.01, P = 0.003). Patients with more than one MLPG were less likely to have melanoma. Blue-grey and red colours were more frequent in melanoma (P = 0.013 and P = 0.000). Different sizes and shapes of PG were associated with DN and melanoma (P = 0.000 and P = 0.001). In a new lesion, PG in

Pigmented Bowen’s disease is a rare variant of in situ squamous skin cell carcinoma. It mainly affects patients between 60 and 70 years of age. Its clinical features include well-demarcated, pigmented plaque arising in photo-exposed areas of the body. The best-characterized feature of the disease by histological examination is the presence of atypical keratinocytes, hyperpigmentation of the epidermis with trans-epidermal elimination of melanin and dermal melanophages. Precise diagnosis is often difficult, both clinically and dermoscopically, as Bowen’s disease is often mistaken with keratinocyte tumors such as solar lentigines, seborrheic keratosis, Bowenoid papulosis, pigmented basal cell carcinoma, pigmented actinic keratosis; or even melanocytic lesions such as melanocytic nevus, pigmented epithelioid melanocytoma, and melanoma. Precise diagnosis often requires biopsy and histopathological examination of the tissue. Reflectance confocal microscopy is a noninvasive technique to diagnose pigmented skin lesions. To date, not much data are available regarding its use in the diagnosis of pigmented Bowen’s disease. Herein, we report a well-represented case series of pigmented Bowen’s disease imaged using dermoscopy and reflectance confocal microscopy.

Digital dermoscopy (DD) follow up is a useful strategy for monitoring patients at high risk of melanoma. Reflectance confocal microscopy (RCM) is a valuable second-level examination after dermoscopy for the evaluation of difficult to diagnose lesions. The aim of this study was to assess the value of RCM in routine DD monitoring of patients at high risk of melanoma. In this prospective study, performed over 22 months, changing melanocytic lesions were detected by DD and excised. RCM imaging was performed before surgical excision of all the lesions, and histopathology used as the gold standard diagnostic test. Eighty-seven lesions, including 11 thin melanomas, were studied. Dermoscopic evaluation at follow up revealed a significant association between melanoma and asymmetry in two axes (P = 0.035). Enlargement and other changes in structure or color did not significantly differ between nevi and melanomas. Widespread pagetoid cells, non-edged papillae, irregular and dishomogeneous junctional clusters, and sheet-like structures were significantly associated with malignancy (P < 0.001). RCM allowed accurate diagnosis of melanoma in 10 of 11 cases (90.9%). The remaining case was classified as a dysplastic nevus. Forty-six lesions (52.8%) in which RCM revealed no atypia were deemed unnecessarily removed. This study was limited by sample size. In conclusion, combined DD and RCM facilitates the recognition of thin malignant melanomas and reduces unnecessary excisions.

Background The frequency of nevus-associated melanoma (NAM) has been estimated to be 29% of diagnosed melanomas. Materials and methods This is an observational retrospective study of 22 cases of NAM diagnosed in the Universitary Hospital Alcorcon between September 2011 and 2018. The main objective was to analyze dermoscopic and RCM features of NAM. We also studied if there was an association between any dermoscopic or RCM parameter and Breslow depth. Results The most frequent dermoscopic characteristics were multicomponent pattern (50%), multifocal pigmentation (45.5%), atypical network (59.1%), and blue-gray regression structures (77.3%). RCM evidenced pagetoid cells in 95.5% melanomas (abundant in 59.1%), non-edged dermal papillae in 86.4%, atypical cells at the dermal-epidermal junction in 90.9%, and atypical junctional nesting in 81.8%. Deeper Breslow index was associated with red color (mean Breslow 0.65 vs 0.37 in melanomas without red, P = 0.035), shiny white streaks (0.85 vs 0.38, P = 0.041), abundant pagetoid cells (0.68 vs 0.26, P = 0.017), and non-edged papillae (0.59 vs 0.00, P = 0.014). Conclusion RCM is a valuable tool for diagnosing NAM. Even it is very difficult to differentiate NAM from DNM both with dermoscopy and RCM, RCM can help us to detect remnants of a preexisting nevus and estimate Breslow depth.

Background/objectives Lentigo maligna is usually located on the face. Extrafacial lentigo maligna is less common, and diagnosis of early forms is very difficult. Confocal microscopy of facial and extrafacial lentigo maligna shares the same features (abundant dendritic cells and generalised atypical junctional thickenings) and helps us to identify the dermoscopic features of extrafacial lentigo maligna. Methods We analysed dermoscopic and clinical features of 41 lesions diagnosed by confocal microscopy of extrafacial lentigo maligna confirmed on histology to identify dermoscopic signs of early lesions. Results Erased areas on dermoscopy were the clue to diagnose early lesions. At the borders of these areas, very small, round or triangular structures were found. At the lesion periphery, dermoscopy revealed a fine reticular pattern that helped to identify them as a melanocytic lesion. A progressive increase of the number and size of erased areas was accompanied by the appearance of various angulated structures around them (angulated lines, zig-zag structures or polygonal structures). Analysis of invasive lesions revealed very large erased areas containing white lines and atypical vascularisation. Conclusions We have identified the dermoscopic early features and signs of progression by examining the dermoscopic and reflectance confocal microscopy findings of early and invasive extrafacial lentigo maligna.

A 67-year-old-woman with a history of basal cell carcinoma (BCC) and actinic keratosis presented with an asymptomatic lesion on her central forehead for the preceding 3 months. There was no significant family history of cancer.

The dermoscopic island is described as a well-defined area in a melanocytic lesion, with a different dermoscopic pattern from the rest of the lesion. It is predictive of melanoma, particularly when the pattern of the island is atypical. We present the reflectance confocal microscopy (RCM) findings in 3 lesions with dermoscopic islands: nevus-associated melanoma, melanocytic nevus, and in situ melanoma. The nevus-associated melanoma and in situ melanoma presented cellular atypia (atypical cells in isolation or forming nests) and architectural distortion on RCM. The nevus presented a dermoscopic island with a typical globular pattern with dense nests and no atypia on RCM. Dermoscopic island is mainly associated with in situ and nevus-associated melanomas. RCM offers good cellular resolution to the depth of the reticular dermis and is useful for diagnosing of melanomas presenting a dermoscopic island.

Resumen Introduccion Los melanomas hipo/amelanoticos suponen un 2–8% de todos los melanomas cutaneos y su incidencia real es dificil de precisar. Los patrones dermatoscopicos hasta ahora descritos para el melanoma maligno tienen una escasa representacion en este subtipo melanomas. Recientemente nuevos patrones dermatoscopicos se han descrito en los melanomas hipo/amelanoticos y parece ser que el tipo de vascularizacion es crucial para su diagnostico. Material y metodos Describimos los patrones dermatoscopicos observados en una serie de 4 pacientes con melanoma hipo/amelanotico. Resultados En nuestra serie observamos que la presencia de vasos lineales irregulares fue el hallazgo mas frecuente, seguido de los vasos puntiformes irregulares. El reticulo en periferia solo se detecto en los 2 casos de melanomas hipomelanoticos y las areas rojo lechosas se presentaron en los 3 melanomas de mayor grosor (Breslow>1 mm). Conclusion Aunque no existe un patron vascular dermatoscopico establecido ni patognomonico para los melanomas hipo/amelanoticos, el patron vascular polimorfo (constituido por la presencia de mas de un tipo de vasos, habitualmente, de vasos puntiformes y vasos lineales irregulares) y la presencia de areas rojo-lechosas nos debe hacer sospechar un posible melanoma hipo/amelanotico.

Granuloma annulare (GA) is a benign inflammatory dermatosis of unknown etiology and chronic course, with different clinical variants. The cases associated with a photodistributed pattern are rare and show a palisading histopathological pattern. We report a case of generalized GA affecting sun-exposed areas with an interstitial pattern. The patient has been followed-up for 6 years, presenting a recurrent course of the disease, with a good response to chloroquine and relapse when no treatment was prescribed.

Granuloma annulare (GA) is a benign inflammatory dermatosis of unknown etiology and chronic course, with different clinical variants. The cases associated with a photodistributed pattern are rare and show a palisading histopathological pattern. We report a case of generalized GA affecting sun-exposed areas with an interstitial pattern. The patient has been followed-up for 6 years, presenting a recurrent course of the disease, with a good response to chloroquine and relapse when no treatment was prescribed.

Resumen —Presentamos el caso de una mujer de 30 anos, diagnosticada hacia 2 anos de necrobiosis lipoidica por la presencia de lesiones tipicas en su pierna izquierda. Consulto en nuestro servicio por la aparicion durante el ultimo mes de lesiones nodulares eritematosas muy similares al eritema nodoso en ambos muslos y pierna izquierda. La biopsia cutanea revelo una paniculitis por necrobiosis lipoidica. No se encontro ninguna patologia asociada y la respuesta al tratamiento fue favorable.

Sir, Pityriasis rubra pilaris (PRP) is an uncommon, idiopathic, papulosquamous disorder that often progresses to erythroderma and causes disabling keratoderma. The disease is classified into 5 groups on the basis of clinical appearance, behaviour and prognosis, as proposed by Griffiths in 1980 (1). Recently, a sixth group has been proposed in order to acknowledge the HIV-associated type of PRP (2). No single therapy is universally effective, and some cases are resistant to multiple therapies. We describe here a case of recalcitrant type I, adult-onset PRP that was treated successfully with infliximab.

In 1988, Tumiati et al described the first case of calcinosis cutis related to a calcium-containing heparin. Since then, only 18 cases have been reported in the literature; they usually have an altered calcium-phosphate product, an elevated parathyroid hormone (PTH), or both. We report a 33-year-old patient who developed calcinosis cutis at sites of nadroparin injections without any disturbance of calcium-phosphate product, PTH, or vitamin D. The pathogenesis of calcinosis cutis secondary to nadroparin injections remains controversial; Proposed causes included metastatic, dystrophic, iatrogenic, or multifactorial etiologies. This is the first case of multiple nodules of calcinosis cutis without alterations of calcium-phosphate product, PTH, or vitamin D, which supports an iatrogenic mechanism. We also suggest that calcinosis cutis could be more frequent than we thought and is probably an underdiagnosed entity.