Multiple Pigmented Skin Lesions Research Articles

MULTIPLE ORAL MUCOSA PIGMENTATION: IMPORTANCE OF CLINICAL ASPECTS AND MEDICAL INVESTIGATION

Solitary and multiple macules of the oral mucosa are associated with various causes. These lesions may represent different pathologic entities, thus requiring different treatments and follow-up. We present 2 clinical cases of patients with multiple pigmentations on oral mucosa. Case 1: A 31-year-old woman exhibited brown hyperpigmentation macules less than 5 mm in diameter affecting buccal mucosa and tongue borders. Homogeneous hyperpigmentation stripes on nails were also identified. Based on these characteristics and the absence of gastrointestinal signs and symptoms, the diagnosis of Laugier-Hunziker syndrome was established. Case 2: A 68-year-old woman showed multiple pigmented lesions on the tongue. Clinical hypotheses were Peutz-Jeghers syndrome and Laugier-Hunziker syndrome. Medical investigation revealed chronic abdominal pain history, gastrointestinal bleeding, and previous surgery for excision of polyps. In addition, multiple pigmented skin lesions were detected except on the nails, leading to the final diagnosis of Peutz-Jeghers Syndrome. Both patients remain under follow-up. Solitary and multiple macules of the oral mucosa are associated with various causes. These lesions may represent different pathologic entities, thus requiring different treatments and follow-up. We present 2 clinical cases of patients with multiple pigmentations on oral mucosa. Case 1: A 31-year-old woman exhibited brown hyperpigmentation macules less than 5 mm in diameter affecting buccal mucosa and tongue borders. Homogeneous hyperpigmentation stripes on nails were also identified. Based on these characteristics and the absence of gastrointestinal signs and symptoms, the diagnosis of Laugier-Hunziker syndrome was established. Case 2: A 68-year-old woman showed multiple pigmented lesions on the tongue. Clinical hypotheses were Peutz-Jeghers syndrome and Laugier-Hunziker syndrome. Medical investigation revealed chronic abdominal pain history, gastrointestinal bleeding, and previous surgery for excision of polyps. In addition, multiple pigmented skin lesions were detected except on the nails, leading to the final diagnosis of Peutz-Jeghers Syndrome. Both patients remain under follow-up.

A new total body scanning system for automatic change detection in multiple pigmented skin lesions.

The detection of newly appearing and changing pigmented skin lesions (PSLs) is essential for timely diagnosis of cutaneous melanoma. Total body skin examination (TBSE) procedures, currently practiced for this purpose, can be extremely time-consuming for patients with numerous lesions. In addition, these procedures are prone to subjectivity when selecting PSLs for baseline image comparison, increasing the risk of missing a developing cancer. To address this issue, we propose a new photogrammetry-based total body scanning system allowing for skin surface image acquisition using cross-polarized light. Equipped with 21 high-resolution cameras and a turntable, this scanner automatically acquires a set of overlapping images, covering 85%-90% of the patient's skin surface. These images are used for the automated mapping of PSLs and their change estimation between explorations. The maps produced relate images of individual lesions with their locations on the patient's body, solving the body-to-image and image-to-image correspondence problem in TBSEs. Currently, the scanner is limited to patients with sparse body hair and, for a complete skin examination, the scalp, palms, soles and inner arms should be photographed manually. The initial tests of the scanner showed that it can be successfully applied for automated mapping and temporal monitoring of multiple lesions: PSLs relevant for follow-up were repeatedly mapped in several explorations. Moreover, during the baseline image comparison, all lesions with artificially induced changes were correctly identified as "evolved."

Computerized analysis of pigmented skin lesions: A review

Computerized analysis of pigmented skin lesions (PSLs) is an active area of research that dates back over 25years. One of its main goals is to develop reliable automatic instruments for recognizing skin cancer from images acquired in vivo. This paper presents a review of this research applied to microscopic (dermoscopic) and macroscopic (clinical) images of PSLs. The review aims to: (1) provide an extensive introduction to and clarify ambiguities in the terminology used in the literature and (2) categorize and group together relevant references so as to simplify literature searches on a specific sub-topic. The existing literature was classified according to the nature of publication (clinical or computer vision articles) and differentiating between individual and multiple PSL image analysis. We also emphasize the importance of the difference in content between dermoscopic and clinical images. Various approaches for implementing PSL computer-aided diagnosis systems and their standard workflow components are reviewed and summary tables provided. An extended categorization of PSL feature descriptors is also proposed, associating them with the specific methods for diagnosing melanoma, separating images of the two modalities and discriminating references according to our classification of the literature. There is a large discrepancy in the number of articles published on individual and multiple PSL image analysis and a scarcity of reported material on the automation of lesion change detection. At present, computer-aided diagnosis systems based on individual PSL image analysis cannot yet be used to provide the best diagnostic results. Furthermore, the absence of benchmark datasets for standardized algorithm evaluation is a barrier to a more dynamic development of this research area.

Feasibility of a Two-Step Teledermatologic Approach for the Management of Patients with Multiple Pigmented Skin Lesions

BACKGROUND Recent studies demonstrating accuracy of teledermatology and teledermoscopy in the evaluation of pigmented skin lesions (PSL) have been performed only on PSL previously selected by face-to-face examination. OBJECTIVES The objective was to investigate the feasibility of teledermatology for the management of individuals exhibiting multiple PSL with a two-step procedure. MATERIALS AND METHODS In the first step, remote consultants selected clinically equivocal lesions evaluating a teletransmitted clinical image of patients' backs. In the second step, dermoscopic images of selected lesions were evaluated. Management recommendations of both steps were compared with face-to-face. RESULTS For a total of 465 PSL in 18 patients, the agreement between the face-to-face and the two remote experts resulted moderate (κ value, 0.530–0.565) in the first step and substantial (κ value, 0.681–0.703) in the second step. CONCLUSIONS Although there are limitations of this pilot experience (population and technical restrictions), our results provide preliminary evidence that a two-step teledermatologic approach may be feasible in managing individuals with multiple PSL.

Feasibility of a Two-Step Teledermatologic Approach for the Management of Patients with Multiple Pigmented Skin Lesions

Recent studies demonstrating accuracy of teledermatology and teledermoscopy in the evaluation of pigmented skin lesions (PSL) have been performed only on PSL previously selected by face-to-face examination. The objective was to investigate the feasibility of teledermatology for the management of individuals exhibiting multiple PSL with a two-step procedure. In the first step, remote consultants selected clinically equivocal lesions evaluating a teletransmitted clinical image of patients' backs. In the second step, dermoscopic images of selected lesions were evaluated. Management recommendations of both steps were compared with face-to-face. For a total of 465 PSL in 18 patients, the agreement between the face-to-face and the two remote experts resulted moderate (kappa value, 0.530-0.565) in the first step and substantial (kappa value, 0.681-0.703) in the second step. Although there are limitations of this pilot experience (population and technical restrictions), our results provide preliminary evidence that a two-step teledermatologic approach may be feasible in managing individuals with multiple PSL.

MR imaging of symptomatic neurocutaneous melanosis in children.

Neurocutaneous melanosis is a syndrome consisting of cutaneous nevi and melanocytosis of the leptomeninges. Over a 5-year period (1989-1994) we evaluated with MR imaging the central nervous system of five children with a confirmed histologic diagnosis of neurocutaneous melanosis. The children ranged in age from 7 to 10 years and consisted of two girls and three boys. They all had multiple pigmented skin lesions (cutaneous nevi) and presented with seizures, signs of raised intracranial pressure, cranial nerve palsies and/or myelopathy. The MR studies were performed with T1-weighted, T2-weighted and T1-weighted post-gadolinium images of the brain in addition to T1-weighted post-gadolinium images of the entire spine. The MR findings in all the children consisted of marked, diffuse enhancement of thickened leptomeninges surrounding the brain and spinal cord which was only demonstrated on the post-gadolinium T1-weighted images and mild to moderate hydrocephalus. We present our MR findings and compare these findings with other imaging findings in the literature. Our findings represent part of a spectrum of imaging abnormalities seen in patients with neurocutaneous melanosis.

The McCune-Albright syndrome: a lethal gene surviving by mosaicism.

In the McCune-Albright syndrome, fibrous dysplasia of bones and various forms of endocrine dysfunction are associated with multiple pigmented skin lesions. Examination of a 4-year-old female patient and comparison with photographs published in the literature revealed that the cutaneous pigmentation is arranged in a systematized pattern following the lines of Blaschko. Apparently, this pattern visualizes the dorso-ventral outgrowth of two different populations of cells during early embryogenesis. As all cases of the syndrome are sporadic, it is postulated that the disease is caused by an autosomal "dominant" lethal gene, leading to loss of the zygote in utero. Cells bearing the mutation can only survive when they are intermingled with normal cells. The mosaic may arise either from a gametic half chromatid mutation, or from an early somatic mutation. This concept offers an explanation for the scattered asymmetric distribution of bone lesions, and for the observation that the endocrinopathy may be either of central or peripheral origin, according to the random distribution of the mutant population of cells.

The significance of multiple, recurrent, and “complex” cardiac myxomas

We reviewed the Mayo Clinic records of 56 patients who underwent operation for cardiac myxoma and 29 cases in which cardiac myxoma was found at autopsy. Five patients had a "complex" of unusual findings including multiple pigmented skin lesions (lentiginosis), myxoid fibroadenomas of the breast, skin myxomas, and primary pigmented nodular adrenocortical disease (a cause of Cushing's syndrome). Four of these five patients had multiple cardiac myxomas. Three of the four patients who underwent surgical excision of the cardiac myxomas had recurrent myxomas (the only recurrences in our series), and one of these patients had a second recurrence. The occurrence of multiple and recurrent myxomas in patients with the complex was significantly (p less than 0.001) higher than in our 80 patients with sporadic myxomas. The world literature was searched for cases of cardiac myxomas with the unusual associations of the complex, and also for familial, multiple, and recurrent myxomas. A group of patients were identified who had unusual biologic behavior including early development of myxomas, atypical myxoma locations, and a high risk for the development of recurrent myxomas. For these patients, we recommend a thorough search for multiple tumors at operation, close postoperative follow-up, and careful screening of family members.