Irregular Linear Vessels Research Articles

Atypical Presentation of Rapidly Progressive Cutaneous Metastases of Clear Cell Renal Carcinoma: A Case Report

Cutaneous metastases from clear cell renal carcinoma (ccRC) are uncommon and often indicate a poor prognosis. These metastases typically occur on the scalp, face, and trunk, and they can be difficult to diagnose due to their resemblance to benign dermatological tumors. We report the case of a 56-year-old patient with a history of ccRC (TNM stage 4) who was referred to our dermatology department with two rapidly enlarging, painful lesions on the left jawline and scalp, which had developed one month and one week earlier, respectively. On examination, the lesions appeared as well-defined, round to oval plaques with a central ulceration and a peripheral red rim, suggestive of an inflammatory appearance. Dermoscopic examination revealed a structureless pink to orange pattern, atypical central vessels, and irregular linear vessels in a corona-like arrangement. Despite the patient’s stable oncological treatment for six months, pain management had recently included paracetamol, tramadol, and NSAIDs. The primary presumptive diagnosis was of cutaneous metastasis, considering the patient’s history of metastatic ccRC. However, given the recent initiation of new pharmacological agents, the rapid progression of the cutaneous lesions, and their clinical presentation, alternative differential diagnoses were considered, including drug-induced reactions such as erythema multiforme or fixed drug eruption. A biopsy of the facial lesion revealed immunohistochemical positivity for CD10, CAIX, and PAX8, confirming the diagnosis of metastatic ccRC with sarcomatoid differentiation. Unfortunately, despite continued targeted therapies and palliative care, the patient’s condition deteriorated rapidly, leading to death two months later. This case highlights the potential for extremely rapidly evolving cutaneous metastases from ccRC and their capacity to occasionally mimic atypical drug eruptions. Additionally, it reaffirms the poor prognosis of such metastases, as evidenced by the patient’s death within two months.

Detection of sebaceous gland hyperplasia with dermoscopy and reflectance confocal microscopy.

Sebaceous gland hyperplasia (SGH) is a benign cutaneous proliferation of the sebaceous glands that are mostly present on the face or the neck of older adults. They typically appear as single or multiple soft umbilicated papules; however, in challenging cases, it can be difficult to distinguish them from trichoepitheliomas, base cell carcinomas, or other tumors. Although pathological results have diagnostic value, the significance of non-invasive examinations in diagnosis and differential diagnosis is also worth exploring. This study aimed to describe the dermoscopic and reflectance confocal microscopy (RCM) features of SGH. A total of 31 patients diagnosed with SGH, according to clinical and histopathological standards, were examined using dermoscopy and RCM between March 2018 and January 2022. Dermoscopically, lesions revealed a yellowish-red background and a faint-yellow background in 25 (80.65%) and six cases (19.35%), respectively. White-yellowish lobulated structures in the center of the lesion were present in 31 patients (100%) and umbilications in 19 patients (61.29%). Crown vessels at the periphery of the lesions were observed in 11 patients (35.48%), whereas irregular linear vessels were observed on the surface of the lesions in 18 patients (58.06%). Under RCM, all lesions presented a honeycomb pattern in the epidermis and the typical morulae-shaped sebaceous lobules in the dermis. A dilated follicular infundibulum was observed in 15 patients (48.39%) and dilated vessels in 26 patients (83.87%). Dermoscopy and RCM enabled us to describe the imaging features of SGH. Combining these two useful tools provides a non-invasive basis for accurate clinical diagnosis.

Dermoscopy of pilomatricoma: A case report with a review of the literature

Pilomatricoma is a benign tumor originating from hair follicle matrix cells and characterized by the presence of cutaneous and subcutaneous nodules up to 3.0 cm in diameter, usually on the head, neck, and upper extremities, rarely on the trunk and lower extremities. An eleven-year-old female with a painless, erythematous-purplish tumor of the back. A dermoscopic examination revealed irregular linear vessels, white structures, and structureless grayish-blue areas. Histological examination after excision confirmed the diagnosis of pilomatricoma. Dermoscopy may be a useful tool for improving the clinical recognition of pilomatricoma.

Trichoadénome : description anatomoclinique et dermatoscopique

Trichoadenoma is a very rare follicular tumour with a remarkable histopathological appearance. In this article we present a series of 12 cases of trichoadenoma, as well as the anatomoclinical and dermatoscopic findings in a typical case. We discuss these findings in the light of an extensive literature research. We collated 12 cases of trichoadenoma of indisputable diagnosis made at the dermatopathology laboratory of the Dermatological Clinic of the University Hospitals of Strasbourg over a 30-year period (1989-2018). The 12 cases comprised 7 women and 5 men, of average age 58.9 years, the majority having lesions on the cephalic extremity followed by the buttocks and thighs. Histopathological examination, which was similar in all 12 cases, showed multiple epidermal cysts containing an eosinophil lamellar keratin with a stratified wall without any visible hair, located in the superficial and mid dermis and appearing to be stacked on top of one another. In immunohistochemistry, broad spectrum keratin markers were still positive, the follicular marker Ber-EP4 weakly expressed and PHLDA1 was negative. For the case examined using polarized-light dermatoscopy, small rounded white-yellow areas were observed corresponding to cystic structures surrounded by irregular linear vessels. Trichoadenoma is a rare tumour seen in middle-aged adults of mean age 45 years, and has no sexual predominance. It is asymptomatic, slow-growing, variable in colour, measures less than one centimeter and is most often located on the face or buttocks. In terms of histology, the juxtaposition of multiple small cystic structures suggests a follicular origin. Differential diagnosis is made with trichoblastomas, which always intensely express PHLDA1 and/or Ber-EP4, desmoplastic trichoepithelioma, which consists of multiple much thinner spans in a highly fibrous stroma with clearly visible arborescent vessels over a white-yellow ivory background at dermatoscopy, microcystic carcinoma, which has a deeper extension, and plaque milium, in which the cysts are larger.

Application of different noninvasive diagnostic techniques used in HMME-PDT in the treatment of port wine stains.

Hematoporphyrin monomethyl ether photodynamic therapy (HMME-PDT) is an effective method for treating port wine stains (PWS). However, methods to evaluate the treatment of HMME-PDT for PWS effectively and objectively are lacking. This study aimed to describe the different noninvasive diagnostic techniques used in the evaluation of treatment response to HMME-PDT for PWS. Thirty-one lesions of 22 patients with PWS were treated with HMME-PDT. Four noninvasive diagnostic techniques including VISIA-CR™ system, dermoscopy, high-frequency ultrasound (HFUS), and laser speckle contrast imaging (LSCI) were used to obtain standard radiographic data on skin color, skin thickness, blood vessel morphology, blood vessel distribution, and blood perfusion from lesions and surrounding normal skin before and after HMME-PDT. The standard image pattern of VISIA-CR™ system showed color change in the lesions of PWS after HMME-PDT. RBX red image of VISIA-CR™ system showed that erythema was highly aggregated even in invisible lesions at baseline but decreased after HMME-PDT. The erythema index reduced value d was related to the efficacy rating (γ = 0.631, P < 0.05). Dermoscopy showed that the number of spot-like and irregular linear vessels increased, which was correlated with the increase in clinical classification. After HMME-PDT, vascular rupture was observed by dermoscopy. The response rate of lesions with vascular rupture was 100.00% (20/20). Moreover, the response rate of lesions without vascular rupture was 63.64% (7/11). Vascular rupture sign was correlated with better efficacy (P < 0.05). HFUS showed that the dermis of PWS thickened and was arranged loosely with scattered linear hypoechoic signal. After HMME-PDT, the dermal layer of the lesions became thinner with a decreased linear hypoechoic signal. The response rate of the lesions with linear hypoechoic signal was 76.92% (10/13), and that without linear hypoechoic signal was 94.44% (17/18). The lesions without linear hypoechoic signal in the dermis showed better efficacy (P < 0.05). In some lesions, LSCI showed high blood perfusion signal in PWS lesions and blood perfusion reduction after HMME-PDT. VISIA-CR™ system can be used to observe not only visible but also invisible lesions of PWS. Moreover, lesions fading after HMME-PDT can be described objectively by VISIA-CR™ system. Dermoscopy played an important role in the clinical classification of PWS, including assessing vascular injury after HMME-PDT, guiding the adjustment of therapeutic dose, and selecting the end point of treatment. Both HFUS and LSCI can be used to assist treatment response evaluation of HMME-PDT.

Dermoscopic diagnosis of epidermal cyst

Aim: The clinical features of epidermal cyst (EC) are well known, however, dermoscopic aspect of the entity has rarely been a subject of investigation. Here we aimed to identify the dermoscopic findings of EC which may increase the accuracy of diagnosis before surgical interventions. Material and Methods: The study included the patients diagnosed with EC those who applied to outpatient dermatology clinic of a tertiary center. Age and gender of the patients, disease durations, symptoms, site and size of the lesions, dermoscopic and histopathological findings were retrospectively reviewed. Results: A total of 24 lesions from 24 patients were enrolled in the study. The most common dermoscopic finding was white structureless background (96%) followed by punctum/pore sign (75%), widely distributed/branched irregular linear vessels (71%), blue-white structureless color (46%), mobility sign (41%), peripheral thick branched vessel (33%) and polychromatic structures (4%).Conclusion: We describe two novel dermoscopic features which were not described previously for EC: Mobility sign and polychromatic structures. Along with the previous studies, our study revealed that EC has a peculiar dermoscopic pattern. Dermoscopic examination may increase diagnostic accuracy before surgery making possible a management with minimal invasive procedures.Keywords: Dermatoscopy; dermoscop; epidermal cyst.

Dermoscopic profile of pityriasis rosea

Background: Pityriasis rosea (PR) is a common, self-limited cutaneous disease characterized by wide distributed erythematous scaly lesions. The diagnosis is usually based on the clinical features. Objectives: Here, we aimed to investigate the dermoscopic features of PR which may provide helpful clues to the diagnosis. Methods: Demographic, clinical, and dermoscopic features of the patients with PR were retrospectively reviewed, and the findings identified were recorded. Results: A total of 100 lesions from 25 different patients were included in the study. The most common dermoscopic finding was peripheral collarette scale (84%), followed by central yellow with peripheral reddish background (40%), peripheral dotted vessels with patchy distribution (35%), diffuse reddish background (31%), scattered dotted vessels (30%), and irregular distributed scales and red globules (20%). Conclusion: To the best of our knowledge, this is the most comprehensive study focusing on the dermoscopic features of PR. Here, we identified new dermoscopic findings which were not described previously for PR. These findings were irregular linear vessels, blood spots, brown globules, and brown structureless areas. It can be concluded that dermoscopy may provide remarkable clues to diagnosis, especially in atypical presentations of the entity.

Dermoscopic Diagnosis of Ashy Dermatosis: A Retrospective Study.

Aim:Ashy dermatosis (AD) is a cutaneous pigmentation disorder with unknown etiology characterized by ash-colored hyperpigmented macules. The diagnosis of Ashy dermatosis is primarily based on the clinical and histopathological findings. In this study, we aimed to identify the dermoscopic features of AD, which may facilitate the diagnosis by reducing the need for invasive procedures.Material and Methods:The study included the patients diagnosed with Ashy dermatosis. Demographic, clinical, dermoscopic and histopathological features of the lesions were reviewed and the findings observed were recorded.Results:A total of 60 lesions from 15 patients were included. The most common dermoscopic finding were irregular linear dots and globules, pinkish brown color was the predominant color of the background, and found to be associated with early lesions. Among the vascular structures observed, irregular linear vessels were the most prevalent. There were no significant differences in terms of dermoscopic structures according to age and localization of the lesions.Conclusion:Dermoscopy can serve as a noninvasive helpful tool for the diagnosis of Ashy dermatosis.

Dermoscopy features of atypical fibroxanthoma: A multicenter study of the International Dermoscopy Society

Little is known about the dermoscopic features of atypical fibroxanthoma. This was a case-control study. Atypical fibroxanthoma lesions were compared with a control group with non-melanoma skin cancer. Altogether 40 atypical fibroxanthoma were collected. Most developed in men (93%), appearing mainly as nodular (63%), amelanotic (93%) and ulcerated (78%) lesions. Most lesions were located on the scalp (55%) and the ears (13%). Dermoscopically, most atypical fibroxanthoma displayed red (83%) and white (70%) structureless areas and irregular linear vessels (43%). A series of features achieved statistical significance when comparing atypical fibroxanthoma with non-melanoma skin cancer. The presence of red and white structureless areas and white lines, and the absence of yellowish-white opaque scales, hairpin vessels and arborising vessels were predictive of atypical fibroxanthoma in univariate analysis. However, when squamous cell carcinoma was excluded from the analysis, none of the criteria achieved statistical significance. When basal cell carcinoma was excluded, three variables achieved statistical significance in predicting atypical fibroxanthoma: red, structureless areas, the absence of opaque yellowish-white scales and absence of white circles. Atypical fibroxanthomas seem to be barely distinguishable from basal cell carcinoma dermoscopically, but they are more easily distinguishable from a well to moderately differentiated squamous cell carcinoma. A histopathological examination is needed for the final diagnosis.

Patrones dermatoscópicos del melanoma hipo/amelanótico. Serie de 4 casos

Introducción Hypo/amelanotic melanoma accounts for 2% to 8% of all melanomas and it is extremely difficult to calculate its incidence. Malignant melanoma dermoscopic patterns described have a low representation in this melanoma subtype. Recently, new dermoscopic patterns were described in hypo/amelanotic melanoma and it appears that the type of vascularization is an important point for diagnosis. Methods We describe the dermoscopic patterns observed in a 4 patients with hypo/amelanotic melanoma. Results All 4 hypo/amelanotic melanomas revealed peculiar dermatoscopic findings, namely, irregular linear vessels and dotted vessels. In addition, in 2 patients a slight brownish homogenous pigmentation at the periphery of the lesion was observed. Whitish or pink-red central areas was described in thicker melanomas (Breslow>1 mm). Conclusion At present, there is no established pathognomonic dermatoscopic vascular pattern for hypo/amelanotic melanoma. A polymorhous vascular pattern (presence of more than one type of vessels) and whitish and pink-red areas seem to be the most useful dermoscopic features for the diagnosis of hypo/amelanotic melanomas.

Dermoscopic Vascular Patterns in Nodular “Pure” Amelanotic Melanoma

D ERMOSCOPIC VASCULAR PATTERN MAY BE essential for the correct diagnosis of completelyamelanoticmelanomas,which are still a diagnostic challenge because of thelackofpigmentation.Hereweillustrate thedermoscopyimagesof3biopsy-provenamelanoticmelanomas, all Clark level IV and Breslow depth greater than 4 mm, belonging to different patients (Figures 1, 2, and3).Milky redglobules and/orareas (blackarrows)and irregular linearvessels(whitearrows)werealwaysdetected; hairpin (white arrowheads) and dotted vessels (black arrowheads) were observed in 2 cases; and highly tortuous vessels, a rarelydescribed feature,were found inonly1case (stars inFigure1). Inconclusion,themilkyredglobulesand/ orareas,whichcorrespondtohighlyvascularizedtumorcell nests, together with the irregular linear vessels seem to be the most useful dermoscopic features for the diagnosis of trulyamelanoticmelanomas, althoughhairpin,dotted, and highly tortuous vessels should also be considered.