Benign Pigmented Lesions Research Articles

A New 675 nm Laser Device in the Treatment of Melasma: Results of a Prospective Observational Study

Objective: This study evaluates the efficacy and safety of a new 675 nm laser source system on melasma. Background: Melasma is an acquired circumscribed hyperpigmented disorder that has a negative impact on patients' life quality. Different treatments are currently available. This study evaluates this new 675 nm laser source system, on melasma with the use of established parameters that guarantee minimum pain, the absence of side effects, and simplifying posttreatment management. Materials and methods: A total of 25 subjects (all women, 21-50 years old), with facial melasma and Fitzpatrick skin types I-III, were treated with three sessions of a new 675 nm laser system. Efficacy of treatment was evaluated using Melasma Severity Index (MSI) score before and 3 months after the last session. The appearance of side effects has also been monitored to evaluate safety. A preclinical study was executed to evaluate laser effectiveness on sheep skin. Results: All 25 subjects treated with the 675 nm laser had significant improvement in melasma according to MSI score (mean baseline MSI 26.4 ± 19.2; mean 3-month follow-up MSI 17.3 ± 15, p: 0.003). Histology in preclinical study showed selective damage of melanin-rich areas. No side effects have been observed except some minor erythematous reactions in two patients. Conclusions: Due to its high affinity with melanin, and its minimal interaction with the vascular component, novel 675 nm laser may be considered promising when treating benign pigmented lesions with a low risk of side effects and simple posttreatment management.

687 Immunoprevention of chemical melanomagenesis through early recognition of oncogene mutations

Melanoma, an aggressive malignancy of melanocytes, is responsible for more deaths than any other skin cancer. We have developed an in vivo murine model of melanomagenesis in which benign pigmented lesions progress to become invasive melanomas. The polyaromatic hydrocarbon DMBA (7,12-dimethylbenz(a)anthracene) was applied to the skin of C3H/HeN mice followed by repeated exposure to phorbol 12-myristate 13-acetate (TPA). This treatment produces a specific activating mutation in the H-ras oncogene, resulting in a single amino acid substitution (leucine for glutamine) at the 61st residue.

Impression cytology for detection of clinically suspected ocular surface disorders: A cross-sectional study.

Investigating impression cytology (IC) results of various types of clinically suspected ocular surface lesions over a 14-year period in a referral center in Iran. IC findings obtained from patients with different types of ocular surface disorders between 2005 and 2018 were reviewed. Agreement between clinical suspicions and IC results was evaluated by calculating Cohen's Kappa coefficient (CKC). Clinical suspicions in 688 surveyed eyes were ocular surface squamous neoplasia (OSSN, 42.0%), limbal stem cell deficiency (LSCD, 36.3%), dry eye-related disorders (DERD, 11.5%), Acanthamoeba keratitis (AK, 7.2%), benign pigmented lesions (BPL, 1.9%), immune-related conjunctivitis (IRC, 0.7%), and malignant pigmented lesions (MPL, 0.4%). General agreement between clinical suspicions and IC results was 0.68 for all groups. This agreement was almost perfect in AK (CKC = 0.966) and BPLs (CKC = 0.843), and was substantial in MPLs (CKC = 0.749), OSSNs (CKC = 0.684), and LSCD (CKC = 0.612). CKC in IRC (0.567) and DERDs (0.443) was moderate. Histopathologic results were available in 22 eyes and were well-correlated with corresponding IC results (CKC = 0.86). Multiple post-treatment follow-up sessions of IC were performed in 51 eyes (11.4%) that had diagnosis of LSCD (31), OSSN (17), and MPL (3) at the first IC session. Our survey not only demonstrated an overall substantial agreement between IC results and primary clinical suspicions, but also showed an almost perfect correlation between IC results and existent histopathologic data. Therefore, IC as a non-invasive diagnostic modality can be of great importance in proper diagnosis of various ocular surface diseases especially when distinguishing malignant from benign lesions is required.

A Systematic Review of Picosecond Laser in Dermatology: Evidence and Recommendations

The use of picosecond laser in dermatology was originally focused on optimizing the removal of unwanted tattoos. Subsequent advances in this technology have broadened its clinical indications to include treatment of benign pigmented lesions, photodamage, melasma, and scar revision. In this systematic review, evidence-based recommendations are developed for the use of picosecond laser in dermatology. A comprehensive search of the English language literature was performed up to and including November 2019. Relevant citations were individually evaluated, synthesized, and categorized based on the Level of Evidence. With the addition of the authors' combined clinical experience, clinical recommendations were developed. After application of inclusion and exclusion criteria, a total of 77 unique studies were evaluated. Treatment of benign pigmented lesions was associated with level I-IV evidence; rejuvenation was associated with level II evidence; melasma was associated with level II evidence; scar revision was associated with level II-III evidence; tattoo removal was associated with level I evidence. Picosecond laser is a safe and effective treatment modality for an increasing range of dermatologic indications. Further development of this technology is warranted. Lasers Surg. Med. © 2020 Wiley Periodicals, Inc.

Benign pigmente bir lezyon: Siyah kıllı dil olgusu

Benign pigmente bir lezyon: Siyah kıllı dil olgusu

Shave biopsy for differential diagnosis of lentigo maligna on the face and scalp: diagnostic approach

Lentigo maligna is a subtype of melanoma in situ, which affects sun-exposed areas. On the face, it can have a clinical and dermoscopic appearance similar to several benign pigmented lesions. Differential diagnosis between them is fundamental for the appropriate therapeutic and should be made by histopathological analysis. Excisional biopsy is the gold standard, but in large, unresectable lesions or in difficult anatomical sites, it can have aesthetic or functional implications. In these cases, shave biopsy appears to be a safe and reliable alternative. Objective: To describe an appropriate shave biopsy technique, discuss its results and indications in the outpatient routine of the dermatologist. Methods: Sixteen patients with suspected : Lentigo maligna on the face and scalp were selected. Inclusion criteria were older than 18 years, lack of diagnosis and previous treatment, flat lesions larger than 8 mm and suggestive clinical and dermatoscopic signs. The approach performed was shave biopsy. Results: The diagnosis of : Lentigo maligna was confirmed in 25% of the cases, and a widening of margins presented compatible results in 100% of them. Conclusions: Shave biopsy seems to be a suitable alternative for flat lesions without clinical and dermoscopic criteria of vertical growth

Detection of Malignant Melanoma Using Artificial Intelligence: An Observational Study of Diagnostic Accuracy.

Malignant melanoma can most successfully be cured when diagnosed at an early stage in the natural history. However, there is controversy over screening programs and many advocate screening only for high-risk individuals. This study aimed to evaluate the accuracy of an artificial intelligence neural network (Deep Ensemble for Recognition of Melanoma [DERM]) to identify malignant melanoma from dermoscopic images of pigmented skin lesions and to show how this compared to doctors' performance assessed by meta-analysis. DERM was trained and tested using 7,102 dermoscopic images of both histologically confirmed melanoma (24%) and benign pigmented lesions (76%). A meta-analysis was conducted of studies examining the accuracy of naked-eye examination, with or without dermoscopy, by specialist and general physicians whose clinical diagnosis was compared to histopathology. The meta-analysis was based on evaluation of 32,226 pigmented lesions including 3,277 histopathology-confirmed malignant melanoma cases. The receiver operating characteristic (ROC) curve was used to examine and compare the diagnostic accuracy. DERM achieved a ROC area under the curve (AUC) of 0.93 (95% confidence interval: 0.92-0.94), and sensitivity and specificity of 85.0% and 85.3%, respectively. Avoidance of false-negative results is essential, so different decision thresholds were examined. At 95% sensitivity DERM achieved a specificity of 64.1% and at 95% specificity the sensitivity was 67%. The meta-analysis showed primary care physicians (10 studies) achieve an AUC of 0.83 (95% confidence interval: 0.79-0.86), with sensitivity and specificity of 79.9% and 70.9%; and dermatologists (92 studies) 0.91 (0.88-0.93), 87.5%, and 81.4%, respectively. DERM has the potential to be used as a decision support tool in primary care, by providing dermatologist-grade recommendation on the likelihood of malignant melanoma.

Pilot Evaluation of the Lutronic PicoPlus System for the Treatment of Benign Pigmented Lesions of the Hands

Pilot Evaluation of the Lutronic PicoPlus System for the Treatment of Benign Pigmented Lesions of the Hands

Clinical and dermoscopic features of benign pigmented ear lesions- A cross-sectional study

Clinical and dermoscopic features of benign pigmented ear lesions- A cross-sectional study

Benign pigmented skin lesions

Benign pigmented skin lesions are extremely common. Such lesions are seen every day in general practice. The objectives of this paper are to develop a framework that may be used to evaluate pigmented skin lesions and a strategy for dealing with pigmented lesions, outline the conditions that improve the diagnosis of pigmented lesions (eg good lighting, careful inspection and dermoscopy), and increase clinician confidence in identifying pigmented lesions with concerning features. Regular assessment of pigmented skin lesions during patient consultations, including in an opportunistic fashion, will increase diagnostic acumen and help to identify potentially problematic lesions, and may improve patient awareness of lesions on their skin.

Pigmented lesions: when should I worry?

Abstract Pigmented lesions in children are very common. The majority are benign melanocytic naevi that develop during childhood but, rarely, sinister lesions such as melanoma and atypical Spitz naevi can also occur. The group of benign pigmented lesions includes benign acquired and congenital melanocytic naevi, blue naevi, halo naevi and Spitz naevi. This article will enable clinicians to be aware of the concerning features, use the ABCDE criteria appropriately, understand how to use the available diagnostic tools and when to refer to a Paediatric Dermatology department for further opinion and management.

Oral malignant melanoma: History of malignant degeneration of a pigmented lesion

Introduction: Oral malignant melanoma (OMM) is a rare malignant lesion of the oral mucosa. It accounts for 0.5% of oral cavity cancers and less than 1% of all melanomas. Most cases arise on the palate or gingiva. OMM is caused by unknown factors. Benign pigmentation may precede the neoplasm by several years. The malignant transformation of benign melanosis is poorly understood. Observation: The aim of this work is to present a new clinical case of oral malignant melanoma which appeared on benign melanosis with a brief review of the literature. A 37-year-old woman presented with a blackish pigmented plaque that covered the hard palate and vestibular maxillary gingiva and a soft, friable 2 cm nodule with ulcerated surface next to the 11, 12 and 13. Fifteen years ago, the patient underwent a biopsy that was in favor of benign melanosis. Unfortunately, the patient was followed for one year and then was lost. Recently, in front of the rapidity of the extension of the lesion, she came again. After biopsy, a final diagnosis of OMM is retained. Commentaries: OMM is often asymptomatic. It presents usually as a 1.5–4 cm, blackish grey, irregular, flat or nodular lesion. The neoplasm can appear on apparently normal oral mucosa and may be preceded by benign pigmented lesions. Few articles discussed malignant transformation of benign melanosis. OMM is characterized by its poor prognosis. The treatment of choice for OMM remains surgery with wide clear margins. Conclusion: Close monitoring is needed to detect signs of transformation and to early diagnose melanoma.

Treatment of benign pigmented lesions using a novel Dermal Cooling System.

Benign pigmented lesions are among the most common dermatologic diagnoses that patients seek treatments for. Treatment modalities range from cryotherapy to light and laser-based technologies. These treatments have been shown to be effective, yet may lead to dyschromia or significant downtime. Therefore, we report the first clinical experience with a novel Dermal Cooling System that provides localized and controlled freezing to benign pigmented lesions. Twenty patients seeking treatment for benign pigmented lesions were treated with the Dermal Cooling System at the laser and cosmetic dermatology clinic at the University of California, San Diego. Photographs were captured at baseline and follow-up visits. Two blinded investigators reviewed and graded the photographs. Most patients experienced improvement after 1 month following the first treatment. Macular or slightly raised lesions responded best. Treatment side effects were transient, lasted a maximum of 3 days, and included erythema, swelling, itching, and darkening. There was no observed long-term dyschromia. The novel Dermal Cooling System shows promise in the treatment of flat to slightly raised benign pigmented lesions with little-to-no downtime. Further clinical experience is necessary to continue to optimize treatment parameters. Lasers Surg. Med. 51:59-61, 2019. © 2018 Wiley Periodicals, Inc.

Improving clinical diagnosis of early-stage cutaneous melanoma based on Raman spectroscopy

BackgroundClinical diagnosis of early melanoma (Breslow thickness less than 0.8 mm) is crucial to disease-free survival. However, it is subjective and can be exceedingly difficult, leading to missed melanomas, or unnecessary excision of benign pigmented skin lesions. An objective technique is needed to improve the diagnosis of early melanoma.MethodsWe have developed a method to improve diagnosis of (thin) melanoma, based on Raman spectroscopy. In an ex vivo study in a tertiary referral (pigmented lesions) centre, high-wavenumber Raman spectra were collected from 174 freshly excised melanocytic lesions suspicious for melanoma. Measurements were performed on multiple locations within the lesions. A diagnostic model was developed and validated on an independent data set of 96 lesions.ResultsApproximately 60% of the melanomas included in this study were melanomas in situ. The invasive melanomas had an average Breslow thickness of 0.89 mm. The diagnostic model correctly classified all melanomas (including in situ) with a specificity of 43.8%, and showed a potential improvement of the number needed to treat from 6.0 to 2.7, at a sensitivity of 100%.ConclusionThis work signifies an important step towards accurate and objective clinical diagnosis of melanoma and in particular melanoma with Breslow thickness <0.8 mm.

Onychoscopy: an observational study in 237 patients from the Kashmir Valley of North India.

BackgroundNail disorders comprise approximately 10% of all dermatological conditions. Because diagnosis is not always possible by clinical means alone, additional diagnostic procedures may be required at times. Dermoscopy of nails (onychoscopy) has shown promising results in diagnosing various nail disorders and also avoids time-consuming investigations such as culture and biopsy.ObjectiveTo study the dermoscopic features of various nail disorders to determine the correlation between KOH examination and onychoscopic patterns in patients with the clinical suspicion of onychomycosis, and to differentiate benign pigmented lesions from malignant ones.MethodsAn open, observational and cross-sectional study of 237 patients was conducted. All patients underwent clinical examination and the affected nails were examined with a dermatoscope. The onychoscopic patterns were identified and recorded.ResultsThe study included 237 patients with the following diagnoses: 81 onychomycosis, 63 psoriasis, 27 lichen planus, 30 longitudinal melanonychia, 24 connective tissue disorders, 5 onychophagia and nail tics, 3 subungual verrucae, 2 glomus tumor, 1 Darier disease, and 1 enchondroma. The most common onychoscopic findings were spiked pattern in cases of onychomycosis, dilated and tortuous capillaries in cases of psoriasis, longitudinal streaks and nail fragmentation in cases of lichen planus, and enlarged capillaries in cases of connective tissue diseases.LimitationsThe study was only observational and did not compare the results to biopsy and culture.ConclusionsOnychoscopy may be used as an important diagnostic tool when evaluating nail disorders. It should be used to aid in the diagnosis of various nail disorders and to avoid unnecessary and time-consuming investigations.

Onychoscopy: an observational study in 237 patients from the Kashmir Valley of North India

Background: Nail disorders comprise approximately 10% of all dermatological conditions. Because diagnosis is not always possible by clinical means alone, additional diagnostic procedures may be required at times. Dermoscopy of nails (onychoscopy) has shown promising results in diagnosing various nail disorders and also avoids time-consuming investigations such as culture and biopsy. Objective: To study the dermoscopic features of various nail disorders to determine the correlation between KOH examination and onychoscopic patterns in patients with the clinical suspicion of onychomycosis, and to differentiate benign pigmented lesions from malignant ones. Methods: An open, observational and cross-sectional study of 237 patients was conducted. All patients underwent clinical examination and the affected nails were examined with a dermatoscope. The onychoscopic patterns were identified and recorded. Results: The study included 237 patients with the following diagnoses: 81 onychomycosis, 63 psoriasis, 27 lichen planus, 30 longitudinal melanonychia, 24 connective tissue disorders, 5 onychophagia and nail tics, 3 subungual verrucae, 2 glomus tumor, 1 Darier disease, and 1 enchondroma. The most common onychoscopic findings were spiked pattern in cases of onychomycosis, dilated and tortuous capillaries in cases of psoriasis, longitudinal streaks and nail fragmentation in cases of lichen planus, and enlarged capillaries in cases of connective tissue diseases. Limitations: The study was only observational and did not compare the results to biopsy and culture. Conclusions: Onychoscopy may be used as an important diagnostic tool when evaluating nail disorders.

Melasma: Quality of life before and after treatment

The self-esteem and body image alongside with the functional status are closely connected with patients` quality of life (QoL). The aim of the study is to assess the impact of melasma and other facial benign pigmented skin lesions on QoL. A secondary point was to evaluate the effect of the treatment on Heath related quality of life (HRQoL). Materials and Methods: The presented monocentric, prospective study includes 28 out-patients, with melisma and facial benign pigmentations. For the evaluation of QoL Dermatological Life Quality Index (DLQI) questionnaire was applied at the beginning and end of the treatment. Results: The DLQI score for facial pigmented disorders before treatment was 10.83 ± 1.62 (median 11.00; IQR 8.00-15.00) and after treatment 8.62±3.25 (median 9.00; IQR 6.00-12.00). There were no correlation between severity of pigmented disorders and the degree of their improvement and QoL. For patients with high expectation QoL before and after treatment show minor impairment. Therefore facial pigmented disorders affect the QoL of the patients mostly psychologically. Conclusion: The self-esteem and body image have negative influence on patients` wellbeing.

Oral Melanoacanthoma: a Case Report of Diffuse Oral Pigmentation

Oral melanoacanthoma (OM) is an uncommon, acquired benign pigmented lesion. Normally, OM exhibits diffuse pigmentation in the oral cavity, affecting black women in the fourth decade of their life. A 53 years-old white woman, who has been a smoker for approximately 1 year, presented in an intraoral examination, brownish macules in the lower lip, gingiva, and buccal mucosa. The diagnostic hypotheses were melanin pigmentation and Addison's disease. Laboratory exams showed normal levels of ACTH and cortisol. Incisional biopsy in a region of the gingiva was performed and a microscopic exam revealed parakeratinized stratified squamous epithelium, exhibiting acanthosis and spongiosis. Numerous dendritic cells, compatible with melanocytes, distributed in the granular, prickle cell, and basal layers exhibited brownish pigments in the cytoplasm, compatible with melanin. The propria lamina consisted of dense fibrous connective tissue with mild chronic inflammatory infiltrate. Melanocytes were positive for S-100 protein. The final diagnosis was OM. All macules were removed and, after 18 months of follow-up, had no relapse of lesions.

Reflectance Confocal Microscopy Criteria of Pigmented Squamous Cell Carcinoma In Situ.

Pigmented squamous cell carcinoma in situ (pSCCis) is difficult to diagnose based on clinical and dermoscopic examination. Reflectance confocal microscopy (RCM) allows noninvasive differentiation between malignant and benign pigmented skin lesions. We determined the frequency of key RCM features of pSCCis and correlated the RCM criteria with the corresponding dermoscopic and histopathologic criteria. The study included 28 lesions with biopsy-proven diagnosis of pSCCis derived from 28 patients. Clinical, dermoscopic, and RCM images of these lesions were retrospectively analyzed by 3 independent observers. Assessment for the presence of RCM criteria revealed scale or parakeratosis (20/28; 71%); irregular honeycomb pattern in the spinous-granular layer (28/28; 100%); spindle-shaped cells with dendritic branches infiltrating the epidermis (12/28; 43%); edged papillae (24/28; 86%), and dilated looped blood vessels within the papillae (18/28; 64%). Fifty-three percent of the cases displayed at least 4 RCM criteria and 96% of cases displayed at least 3 RCM criteria. We propose that the diagnosis of pSCCis could be established based on 1 major criterion-irregular honeycomb pattern-and 2 of the following minor criteria-scale or parakeratosis, spindle-shaped cells with dendritic branches infiltrating the epidermis, edged papillae, and dilated looped blood vessels within the papillae.

Oral Melanotic Macule – An Unusual Occurrence In Gingiva

AbstractMelanotic macule is the most common benign pigmented lesion of the oral cavity characterised by a focal increase in the melanin deposition. A 34 year old female patient reported with a chief complaint of black pigmentation with respect to maxillary gingiva between the central incisors since one year. An excisional biopsy was done for histo pathological examination, which revealed the lesion as melanotic macule.