Nevus Research Articles

Congenital melanocytic giant nevus on the back of a baby: Early excision by power-stretching and result after 14 years.

Congenital melanocytic giant nevus on the back of a baby: Early excision by power-stretching and result after 14 years.

A Method of Skin Disease Detection Using Image Processing and Machine Learning

Skin conditions are prevalent health issues globally. The dangers posed by these infections are unseen, leading to physical discomfort and mental anguish. In severe cases, skin diseases can even progress to skin cancer. Consequently, the identification of skin diseases from clinical images remains a significant challenge in medical image analysis. Furthermore, manual diagnosis by medical professionals is time-consuming and subjective. Therefore, there is a need for automated skin disease prediction to expedite treatment planning for both patients and dermatologists. These studies presents a digital hair removal method and de-blurs or denoise the images. To extract essential patterns from the skin imagesand statistical features techniques are utilized. Two efficient machine learning algorithms, namely Support Vector Machine (SVM), and Convolutional Neural Network (CNN) classifiers, are employed with the extracted features to accurately classify skin images as melanoma (MEL), melanocytic nevus (NV), basal cell carcinoma (BCC), actinic keratosis (AK), benign keratosis (BKL), dermatofibroma (DF), vascular lesion (VASC), and Squamous cell carcinoma (SCC). The models are validated using the ISIC 2019 challenge and HAM10000 datasets, with SVM demonstrating slightly superior performance compared to the other classifiers. Furthermore, a comparison with state-of-the-art methods is conducted to evaluate the effectiveness of the proposed approach.

Skin Cancer DetectionSkin Cancer Detection

Abstract: The skin is the largest organ and serves as a barrier to protect the internal organs, as well as the bones and muscles underneath it. When the skin deteriorates, the whole body is affected. Skin cancer is surprisingly common since the skin is so easily damaged by UV rays and other kinds of environmental pollutants. It seems that the two most common forms of skin cancer are benign melanoma and malignant melanoma. Malignant moles are significantly more harmful than benign moles and create bleeding blisters on the skin. They get their name because they resemble the more deadly melanocyte cells. Over 700,000 skin lesions are found annually in the United States, reports the American Cancer Society

An Improved Skin Lesion Classification Using a Hybrid Approach with Active Contour Snake Model and Lightweight Attention-Guided Capsule Networks.

Skin cancer is a prevalent type of malignancy on a global scale, and the early and accurate diagnosis of this condition is of utmost importance for the survival of patients. The clinical assessment of cutaneous lesions is a crucial aspect of medical practice, although it encounters several obstacles, such as prolonged waiting time and misinterpretation. The intricate nature of skin lesions, coupled with variations in appearance and texture, presents substantial barriers to accurate classification. As such, skilled clinicians often struggle to differentiate benign moles from early malignant tumors in skin images. Although deep learning-based approaches such as convolution neural networks have made significant improvements, their stability and generalization continue to experience difficulties, and their performance in accurately delineating lesion borders, capturing refined spatial connections among features, and using contextual information for classification is suboptimal. To address these limitations, we propose a novel approach for skin lesion classification that combines snake models of active contour (AC) segmentation, ResNet50 for feature extraction, and a capsule network with a fusion of lightweight attention mechanisms to attain the different feature channels and spatial regions within feature maps, enhance the feature discrimination, and improve accuracy. We employed the stochastic gradient descent (SGD) optimization algorithm to optimize the model's parameters. The proposed model is implemented on publicly available datasets, namely, HAM10000 and ISIC 2020. The experimental results showed that the proposed model achieved an accuracy of 98% and AUC-ROC of 97.3%, showcasing substantial potential in terms of effective model generalization compared to existing state-of-the-art (SOTA) approaches. These results highlight the potential for our approach to reshape automated dermatological diagnosis and provide a helpful tool for medical practitioners.

Assessment of RAS-RAF-MAPK Pathway Mutation Status in Healthy Skin, Benign Nevi, and Cutaneous Melanomas: Pilot Study Using Droplet Digital PCR.

In the present study, we employed the ddPCR and IHC techniques to assess the prevalence and roles of RAS and RAF mutations in a small batch of melanoma (n = 22), benign moles (n = 15), and normal skin samples (n = 15). Mutational screening revealed the coexistence of BRAF and NRAS mutations in melanomas and nevi and the occurrence of NRAS G12/G13 variants in healthy skin. All investigated nevi had driver mutations in the BRAF or NRAS genes and elevated p16 protein expression, indicating cell cycle arrest despite an increased mutational burden. BRAF V600 mutations were identified in 54% of melanomas, and NRAS G12/G13 mutations in 50%. The BRAF mutations were associated with the Breslow index (BI) (p = 0.029) and TIL infiltration (p = 0.027), whereas the NRAS mutations correlated with the BI (p = 0.01) and the mitotic index (p = 0.04). Here, we demonstrate that the "young" ddPCR technology is as effective as a CE-IVD marked real-time PCR method for detecting BRAF V600 hotspot mutations in tumor biopsies and recommend it for extended use in clinical settings. Moreover, ddPCR was able to detect low-frequency hotspot mutations, such as NRAS G12/G13, in our tissue specimens, which makes it a promising tool for investigating the mutational landscape of sun-damaged skin, benign nevi, and melanomas in more extensive clinical studies.

Repair of cervicothoracic skin defects with extra-long transverse cervical flaps by stepwise pressure packing in children: a technical innovation

ObjectiveTo investigate the clinical effect of prolonging predilated transverse cervical flap with stepwise pressure packing for neck and chest lesions in children.MethodsA retrospective review of children with large cervicothoracic lesions admitted to our department from January 2011 to June 2021 was conducted to compare stepwise pressure packing with normal dressing in the surgical method of transverse cervical pedicled flaps after expansion. Among 58 included children, 22 (14 males and 8 females) were allocated to the extended and expanded transverse cervical flap with stepwise compression dressing group, and 36 (19 males and 17 females) to the transverse cervical flap group. The causes of skin defects were: scars (37 cases) and giant nevus (21 cases). The course of the disease ranged from 0.5 to 8 years. The two groups were compared in terms of child satisfaction, the occurrence of infection, recurrence of the contracture, secondary operation, and repaired area.ResultsIn 22 cases of extended transverse cervical flaps, 8 cases were embedded with two expanders, resulting in a total of 30 expanded flaps, which were successfully transferred to the neck and chest without necrosis at the distal end of compression, with good effect. Comparison of pedicled transverse cervical flaps with stepwise pressure packing and pedicled transverse cervical flaps alone revealed no significant difference in child satisfaction, the occurrence of infection, recurrence of the contracture, and secondary surgery (all P > 0.05). Yet, there was a significant difference in the repair area between two groups (P < 0.05).ConclusionProlongation of pedicled cervical flaps after expansion with stepwise pressure packing resulted in an effective method for repairing the large skin defect of children's face and neck caused by various diseases. In terms of increasing neck repair area, the operation with stepwise pressure dressing was significantly superior to the simple packing.

Resurfacing of Sleeve-Like Circumferential Giant Congenital Melanocytic Nevi on the Upper Extremity With Pre-Expanded Pedicled Flap.

As the relative shortage of healthy tissue obviates the option of local soft tissue coverage, reconstruction of circumferential giant congenital melanocytic nevi (GCMN) on the upper extremity remains particularly challenging. Here the authors report a 3-stage procedure involving pre-expanded pedicled flap from the torso for the reconstruction of upper extremity after circumferential GCMN excision in pediatric patients. The giant nevus was completely removed and the size of the excised nevus was 31 × 14.5cm. The donor site was primarily closed. No major complication was encountered. Reconstruction with expanded pedicled flap achieved satisfactory results, both functionally and cosmetically.

NIMG-77. EARLY DIAGNOSIS OF NEUROCUTANEOUS MELANOSIS MASQUERADING AS SUBARACHNOID HEMORRHAGE

Abstract A 50-year-old male presented to the emergency room with a sudden onset right upper limb facial numbness and dysphasia, soon followed by full-recovery. Brain computed tomography revealed hyperdense lesions within the left frontal sulcus, highly suspicious of subarachnoid hemorrhage. T1-weighted magnetic resonance imaging showed multiple leptomeningeal enhancement in the left frontal area.The digital subtraction angiography indicated an absence of vascular lesions. One-month after, the lesions progressed in the occipital area, when left sixth nerve palsy developed. Multiple giant nevus over the legs, trunk, and scalp had attracted attention. Owing to the suspicious symptomatic leptomeningeal lesions, open biopsy was performed. Surprisingly, diffuse, thick, black-colored tissue infiltration of the subarachnoid space, involving prominent cortical vessels, was noted. Pathology confirmed meningeal melanocytosis. Neurocutaneous melanosis is characterized by giant congenital or multiple satellite nevi and melanocytic tumors of the leptomeninges. Early disease diagnosis is crucial. Once the patient develops neurological symptoms, prognosis could quickly worsen.

A gyermekkori nagyméretű és óriás festéksejtes anyajegyek eltávolításának szempontjai

The removal of common nevi is necessary only in case of irritation, changes causing complaints, or dermatological recommendations, in addition to regular inspections. In case of the need for surgical removal of special birthmarks (e.g. Spitz nevus, Halo nevus, etc.), a dermatological examination and recommendation are also essential. Congenital melanocytic nevus is a special entity. In 1-3% of newborn cases we encounter the small (<1.5 cm) congenital melanocytic nevus, and less often a giant (≥40 cm) nevus. The number, localization and morphology of congenital melanocytic nevi are more important than size in terms of the probability of melanoma occurrence. The treatment of these nevi varies individually and requires teamwork (e.g. dermatologist, oncologist, surgeon, anesthesiologist, pediatrician). All skin incisions leave a scar, and the characteristics of lifelong scars are influenced by many factors. These include age and surgical technique. For plastic surgery performed in childhood, it is advisable to choose the simplest technique – but the one that leads to the most favorable later results – when possible, to avoid complicated flap plasties and skin replacement procedures. When developing the surgical strategy, it is essential to involve the parent and the child in addition to the allied professions, as well as keeping in mind the characteristics of childhood. In the optimal case, the completion of the reconstruction should carry out before get into community, but at the latest by the teenage years.

Congenital Melanocytic Nevus: An Unusual Presentation

The overgrowth of melanocytes produces congenital melanocytic nevus. They are commonly present since birth, and the common terms used to describe them are called 'bathing trunk,' 'coat-sleeve,' or 'stocking naevi,' and they are usually found over thighs and back. The giant congenital nevus of size larger than twenty centimeters is highly pigmented and usually hairy. It is more commonly found in females compared to males. It is well recognized that the lesion's displeasing nature might have psychological and social ramifications, negatively affecting the patient's self-esteem, particularly females. Although congenital melanocytic nevus is mostly clinically diagnosed, the histological investigation is required to confirm the diagnosis and rule out malignant changes. The likelihood of transforming the giant nevus to malignant melanoma accounts for approximately five percent; fifty percent of melanomas develop before age two, and eighty percent develop before age seven. The risk of transformation to malignant melanoma is early in giant melanocytic nevus cases and adolescence in small and medium-sized nevi cases. Other complications like transformation to neurocutaneous melanosis consisting of the spread of melanoma to the central nervous system and leptomeninges are also dreadful. Hence, early removal is recommended. Here, we have reported a rare case of a six-year-old patient with a medium-sized nevus on their face with hairy tufts in between. On biopsy, the diagnosis was made as a junctional nevus. After which, the patient was managed with subsequent lesion excision and split skin grafting with an uneventful postoperative period. Our case report aims to report a rare case of congenital melanocytic nevus and to determine the importance of timely diagnosis and intervention. Keywords: , , , ,

DP11 Dermal plexiform spindle cell lipoma: a perplexing entity

Abstract We present a 66-year-old man who presented to dermatology with an unusual lesion. An outdoor worker with prior history of melanoma, the patient was referred with a new pigmented lesion adjacent to his melanoma scar. This was identified as a seborrhoeic keratosis and the patient was reassured. Following a full body examination, an incidental lesion was identified on the left anterior shoulder. The lesion measured 9 × 7 mm, was dermal-based, dome-shaped, soft to palpation and skin coloured with light peripheral pigmentation. The lesion was featureless upon dermoscopic examination. The clinical differential diagnosis included neurofibroma and an intradermal naevus. The lesion was narrowly excised. Histological examination revealed an ill-defined, wedge-shaped dermal lesion with tumour fascicles with a vaguely plexiform arrangement. The widely separated fascicles comprised loosely arranged spindle cells, mature adipocytes and scant collagen fibres with a myxoid stroma. The spindle cells were stained diffusely with CD34 immunohistochemistry. The adipocytes and a proportion of spindle cells (around 20–30%) were stained with S100. The features were in keeping with a dermal plexiform spindle cell lipoma. Spindle cell lipoma is an uncommon benign, histologically distinct tumour, accounting for 1.5% of all adipocytic neoplasms. More common within the subcutis, it is rare for these lesions to present with a purely intradermal location. Dermal spindle cell lipomas tend to be less cellular than their subcutaneous counterpart. This coupled with the variable representation of the three constituent lesion components (spindle cells, mature adipocytes and fibromucinous stroma) results in a wide range of possible differential diagnoses. The plexiform variant of spindle cell lipoma (PSCL) is a poorly recognized form with even greater potential for misdiagnosis, particularly with plexiform neurofibroma—­leading to an erroneous diagnosis of neurofibromatosis. Dermal PSCL is an exceptionally rare diagnosis with only eight cases reported in the literature thus far. Here, we report a further case of dermal plexiform spindle cell lipoma, with, for the first-time, corresponding clinical images. In our summary, we discuss in detail the potential diagnostic pitfalls of this rare tumour and how to best employ immunohistochemical staining to avoid them.

BT21 Usability evaluation and reporting for mobile health apps targeting patients with skin diseases: a systematic review

Abstract Usability is an important method for evaluating emerging technologies, including mobile health apps, from a user perspective. However, many apps have been made available to the public with insufficient effort devoted to their design, development and evaluation. We conducted a systematic review to assess usability evaluation and reporting for mobile health apps targeting patients with skin diseases. The primary outcome was to assess the usability of patient/public-facing skin disease-specific smartphone apps. The secondary outcome was to assess the usability testing methods employed. The protocol was registered with PROSPERO (CRD42022347184). A search strategy combined terms for usability evaluation, user experience, skin disease and mobile health apps (search date 2012–27 May 2022). Six databases (Embase, MEDLINE, CINAHL, Cochrane CENTRAL, Cochrane Database of Systematic Reviews and Scopus) were searched providing 15 234 results. Nine studies were eligible for inclusion in the final analysis. A narrative synthesis of usability evaluation methods used was reported. All studies included an equal uptake between men and women. Two studies of interest included sun protection (n = 3) and skin cancer (n = 3), and one study identified cutaneous leishmaniasis, spina bifida, chronic pruritus, acne, psoriasis, rosacea laser treatments, actinic damage, monitoring benign moles, alopecia and inflammatory rash. All studies assessed app usability and/or feasibility, with eight of nine studies concluding that their app was useful and easy to use. Most studies were qualitative, employing usability questionnaires or semi-structured interviews. Common emerging themes included easy to use/easy to navigate, easy to understand, security/privacy, method of self-monitoring, data sharing with a healthcare provider, customizability, costs and ability to track progress. The most common modules of the apps included taking/storing skin photographs, reminders to monitor skin, education modules and e-diaries/rating of symptoms. Usability encompassed various concepts, including feasibility, usefulness and satisfaction. In conclusion, smartphone apps used in the context of health-related skin disorders have a high degree of usability and are being developed across a wide variety of disease processes and indications. The paucity of reported literature compared with the current explosion of app development and deployment highlights the importance of careful user-centred design and rigorous evaluation of these tools before they are released for widespread uptake. Future studies should aim to evaluate all usability factors rather than focusing on single components of usability as this would optimize greater long-term uptake of these apps.

Giant conjunctival nevus

A 61-year-old male presented with 20/20 vision and a lesion on his left eye, unchanging since childhood (Fig. 1). A giant pigmented mass with cystic spaces in bulbar conjunctiva with pseudopterygium-type extension was noted on the cornea. Pathology result was compatible with giant benign conjunctival nevus. Conjunctival nevi are the most common melanocytic conjunctival tumours. Giant nevi, defined as >10 mm, represent 5% of cases. Nevi usually exhibit intralesional cystic spaces (also visible on ultrasound), a characteristic finding that is helpful in differentiating them from other worrisome lesions. The overall risk of malignant transformation is 1%–3%, so continued vigilance is warranted.

A novel two‐staged network for skin disease detection using atrous residual convolutional networks

SummaryThe preferred modality for the identification of skin disease has predominantly been dermoscopy. Skin lesion identification is the primary diagnostic basis for the dermatologist to evaluate the severity and impact of the disease. Current diagnostic procedures for the identification of skin lesions may be subjected to misdiagnosis among observers. Also, these procedures are conventionally labour‐intensive and prone to delays in treatment. Deep learning has proven to be beneficial for automated computer‐aided diagnosis in the medical field. This research presents a two‐stage approach involving segmentation and classification architectures for the effective detection of skin disease. The proposed approach aims to combine the architectural benefits of residual learning with the contextual retention of atrous convolutions. The classification is performed on seven different classes of skin lesions namely, melanoma (MEL), melanocytic nevus (NV), basal cell carcinoma (BCC), actinic keratosis/Bowen's disease (AKIEC), benign keratosis (BKL), dermatofibroma (DF), and vascular lesion (VASC). To the best of our knowledge, this is the first research that reports the impact of a two‐staged detection network using atrous residual convolutions for these seven classes. Experimental observations indicate that the proposed model is characteristically balanced in terms of inter‐class performance, with precise segmentation. The proposed network was trained with the HAM10000 dataset and reported a classification accuracy and precision of 89.27% and 89.06%, respectively.

Reconstruction of Hemifacial Congenital Giant Nevus with Pre-expanded Scalp Flaps and Deltopectoral Skin Flaps.

The hemifacial congenital giant nevus impacts both physical and mental health of the patients. Excision is typically the most suitable option in these situations, but reconstructing the subsequent surgical defects is always a serious challenge. Between February 2012 and January 2021, a retrospective review of 4 patients who suffered from hemifacial congenital giant nevus was conducted, and they were treated by pre-expanded scalp flap and deltopectoral flap simultaneously. All patients receive tissue expansion, nevus resection, expanded skin flap transfer, and pedicle division. Four patients with hemifacial congenital giant nevi were successfully treated with no major complications. One patient with a transferred deltopectoral flap experienced distal necrosis of the flap, and healed after dressing changes. No recurrence of the nevus was found during the follow-up period, and the transferred skin flaps match well with facial skin in contour and color. This modified pre-expanded scalp flap combined with a deltopectoral flap provides an easy and reliable way for hemifacial reconstruction in patients with a congenital giant nevus.

Photo gallery. Rare dermatoses. Part I

Orphan dermatoses are caused by both genetic causes and a number of autoimmune, inflammatory and infectious processes in the body. Congenital giant nevus is associated with serious complications: malignant melanoma, CNS lesions (neurocutaneous melanosis). Multiple epidermoid cysts are often a component of Gardner's syndrome. Angiolymphoid hyperplasia with eosinophilia, a vascular tumor formation with proliferation of histiocytoid endothelial cells, with severe lymphocytic and eosinophilic infiltration, recurs in 1/3 of cases. Morbigan's disease is persistent erythema and swelling of the middle third and upper part of the face. Skin mastocytosis in children is prone to spontaneous resolution during puberty. Squamous cell skin cancer accounts for 20% of all skin cancers and has a high risk of recurrence, metastasis, and death. Buschke's scleroderma is a scleroderma-like disease that causes progressive fibrous-mucinous thickening of the skin affecting the neck, shoulders, proximal upper extremities, and face. Fulminant (lightning) acne is a sharply exacerbated form of acne vulgaris, characterized by an acute onset and the appearance of confluent abscesses. Cases of acne fulminans have been observed during treatment with isotretinoin. Norwegian (crustose) scabies is associated with a compromised immune response, which allows the mites to multiply and can number in the millions. Pretibial myxedema (thyroid dermopathy) is a rare extrathyroid manifestation of Graves' disease along with thyrotoxicosis, thyroid hypertrophy, ophthalmopathy, and acropachy. Porokeratosis Mibelli predisposing factors of development are immunosuppressive conditions, malignancy is possible. Osteomas are formations from bone tissue in the dermis or subcutaneous fat as a result of metaplasia of fibroblasts into osteoblasts, or differentiation of primitive mesenchymal cells into osteoblasts and their migration to an ectopic site. Sarcoidosis of the skin is characterized by a variety of clinical forms, rarely observed before 40 years. Xanthomas with histiocytosis X ― a violation of lipid metabolism. The rural type of leishmaniasis (acute necrotizing) has a short incubation period, a significant spread of rashes and healing with the formation of scar tissue. The giant condyloma of BuschkeLevenshtein is characterized by progressive growth, large size and recurrent course, it can transform into squamous cell carcinoma. Degos disease ― malignant atrophic papulosis ― a rare disease caused by blockage of the arteries and veins.

A novel hybrid Extreme Learning Machine and Teaching–Learning-Based​ Optimization algorithm for skin cancer detection

Skin cancers, such as melanoma, can be difficult to spot in their early stages because they often resemble benign moles. Early detection of melanoma is crucial as it increases the chances of successful treatment and prevents cancer from spreading to other areas of the body. Machine learning algorithms and computer vision techniques are versatile techniques for detecting melanoma. However, current research has limitations, such as inaccurate detection and longer computation times. This paper proposes a novel hybrid Extreme Learning Machine (ELM) and Teaching–Learning-Based Optimization (TLBO) algorithm as a versatile technique for detecting melanoma. ELM is a single-hidden layer feed-forward neural network that can be trained quickly and accurately, while TLBO is an optimization algorithm used to fine-tune the network’s parameters for improved performance. Together, these techniques can classify skin lesions as benign or malignant images, potentially improving melanoma detection accuracy.

Spotlight in Plastic Surgery: January 2023.

Spotlight in Plastic Surgery: January 2023.

Morphological evaluation of melanocytic lesions with three-dimensional line-field confocal optical coherence tomography: correlation with histopathology and reflectance confocal microscopy. A pilot study.

Line-field confocal optical coherence tomography (LC-OCT) is a new invivo emerging technique that provides cellular resolution, allows deep imaging (400 μm) and produces real-time images in both the horizontal and vertical plane and in three dimensions. No previous description of different subtypes of melanocytic lesions and their correlation with histopathology and reflectance confocal microscopy has been reported. To describe the features of melanocytic lesions by LC-OCT and their correlation with histopathology and reflectance confocal microscopy (RCM) findings. Selected melanocytic benign lesions and melanomas were imaged invivo with RCM and LC-OCT at the Fundación Hospital Clinic (Barcelona, Spain). A minimum area of 4 × 4 mm (block image) at four depths (stratum granulosum, suprabasal, layer dermoepidermal junction and upper dermis) were acquired with RCM and a minimum of three cubes with LC-OCT. Horizontal, vertical sections and three-dimensional (3D) cubes of LC-OCT were matched with RCM (Vivablock two-dimensional composite mosaic) and histopathology, with ~5 μm lateral resolution accuracy (the same cell nuclei were measured in X, Y and Z) and evaluated by three observers experienced in using RCM and histopathology. In total, 12 melanocytic tumours (2 insitu melanomas, 2 invasive melanomas, 4 atypical naevi, 2 intradermal naevi, 1 compound naevus and 1 junctional naevus) were included. High correlation with 5 μm accuracy between RCM and LC-OCT was observed for each tumour. The 3D images of melanocytic lesions were obtained with cellular resolution and correlated with both RCM and histopathology, allowing an understanding of the architecture and precise correlation at the cellular level with RCM. Similarities between LC-OCT and RCM for the described diagnostic features and architecture (nests of melanocytic cells, ringed and meshwork pattern, and cellular details of tumour cells as dendritic and pagetoid cells) were confirmed. The main advantage of diagnosis by RCM fixed probe was the ability to produce larger scans of the lesion using mosaicing compared with an LC-OCT handheld probe. LC-OCT allows the architectural and cellular description of different types of melanocytic lesions. LC-OCT showed high correlation with histopathology (vertical sections) and RCM (horizontal sections) in melanocytic lesions. Diagnostic criteria for RCM were similar to those for LC-OCT.

575 Geniouskin: the first pigmented artificial skin for clinical use

Skin replacement is of major concern especially for burnt people and giant nevi. According to our knowledge in modelling pigmented skin, we decided to develop an artificial, pigmented autologous skin for therapeutic use. Our pigmented models were made on dead deepidermized dermis, which do not allow standardization of procedure. Thus, since dermal collagen-based matrices such as IntegraTM or Matriderm® were used as dermal substitute from many years in reconstructive surgery, we decided to develop our artificial skin on these matrices.