Structureless Areas Research Articles

Comparison of structureless areas recognition models in pigmented skin neoplasms images

Comparison of structureless areas recognition models in pigmented skin neoplasms images

Dermoscopic Aspects of Traumatized Nevi After Dermabrasion.

Melanocytic nevi submitted to trauma can undergo clinical, dermoscopic, and even histological changes, making it difficult to differentiate them from a melanoma. The aim of this study is to evaluate the dermoscopic changes of traumatized nevi after dermabrasion. Dermoscopic images of acquired melanocytic nevi were compared before and 4 weeks after half of their area had undergone dermabrasion. The sample consisted of 50 lesions from 15 patients. The homogeneous pattern was the most frequent, followed by the reticular, cobblestone, and globular patterns. After dermabrasion, nearly half of the lesions (46%) became dermatoscopically asymmetric. Among all lesions, structureless areas, dotted vessels and erythema were the most frequent new dermoscopic structures. Trauma after dermabrasion may induce significant dermoscopic changes in melanocytic nevi. Although the global pattern did not change, most of the lesions became asymmetric, with the appearance or fading of dermoscopic structures and colors. A history of recent trauma should be investigated when evaluating pigmented lesions.

Dermatoscopy of nodular/plaque-type primary cutaneous T- and B-cell lymphomas: A retrospective comparative study with pseudolymphomas and tumoral/inflammatory mimickers by the International Dermoscopy Society

Limited data on dermatoscopy of nodular/plaque-type T-/B-cell primary cutaneous lymphomas (PCLs) is available. To describe dermatoscopic features of nodular/plaque-type PCLs, comparing them with those of clinical mimickers (pseudolymphomas, tumors, and inflammatory lesions) and investigating possible differences according to histologic subtypes. Participants were invited to join this retrospective, multicenter case-control study by submitting histologically/immunohistochemically confirmed instances of nodular/plaque-type PCLs and controls. Standardized assessments of the dermatoscopic images and comparative analyses were performed. A total of 261 lesions were included (121 PCLs and 140 controls). Orange structureless areas were the strongest PCL dermatoscopic predictor on multivariate analysis compared with tumors and noninfiltrative inflammatory dermatoses. On the other hand, a positive association was found between PCLs and either unfocused linear vessels with branches or focal white structureless areas compared with infiltrative inflammatory dermatoses, whereas white lines were predictive of PCLs over pseudolymphomas. Differences in the vascular pattern were also seen between B- and T-cell PCLs and among B-cell PCL subtypes. Retrospective design and the lack of a dermatoscopic-pathologic correlation analysis. Nodular/plaque-type PCLs display dermatoscopic clues, which may partially vary according to histologic subtype and whose diagnostic relevance depends on the considered clinical differential diagnoses.

Trichoscopy may enhance the differential diagnosis of erythroderma.

There is a paucity of data concerning the usefulness of trichoscopy in patients with erythroderma. The aim of the study was to compare the trichoscopic features in erythroderma of various aetiologies. In total, 49 patients with a determined cause of erythroderma [including atopic dermatitis (AD), mycosis fungoides (MF), allergic contact eczema (ACE), psoriasis (Pso), Sézary syndrome (SS), drug reaction, pityriasis rubra pilaris (PRP), dermatomyositis (DM), actinic reticuloid (AR), crusted scabies (CS) and pemphigus foliaceus (PF)] were included in the study. Dotted vessels were present in patients with AD, PRP, MF, SS and Pso, and absent in DM, CS and PF (χ², P < 0.02). Spermatozoon-like vessels were observed only in MF and SS (P = 0.001). Whitish-pinkish structureless areas were described in all patients with DM, AR and CS (P < 0.03). The type of vessel and the presence of whitish-pinkish structureless areas under trichoscopy may indicate the cause of erythroderma.

Прочность и механизм разрушения при кручении технически чистого титана с ультрамелкозернистой структурой

The mechanical behavior and the mechanism of torsional fracture of medical grade titanium Grade4 with an ultrafine-grained (UFG) structure in comparison with a coarse-grained (CG) structure were investigated. CG titanium (dav = 25 μm) was investigated in the hot-rolled state. To obtain the UFG structure, two processing regimes were used. In the first regime, homogenization annealing was carried out at a temperature of 680°C for 1 hour, then equal-channel angular pressing (6 passes) according to the “Conform” scheme (ECAP-С) at a workpiece and tool temperature of 250°C (route Bc, φ =120°). The average grain size is equal to 0.4 μm. In the second regime, after homogenization annealing and six ECAP-C passes, the workpieces were drawn at a temperature of 200°C (ECAP-C+D). The average grain size is equal to 0.2 μm. The torsion test of samples with a diameter of 3 mm (close to the diameter of screws for fixing plates in traumatology) was carried out on a KTS 403‑20‑0.5 installation in accordance with GOST 3565-80. The torque, number of revolutions and angle of twisting of the samples made from CG and UFG titanium, as well as the mechanical properties of titanium during torsion were evaluated. Torsion tests have shown that the torsional strength and the torsional yield strength of UFG titanium increase, and the relative shear decreases in comparison with similar properties of CG titanium. In addition, the mode of nanostructuring (ECAP-C+D) provides higher values of the torsional strength properties of titanium compared to ECAP-C, which is favorable from the standpoint of resistance to fracture of titanium screws by torsion. On the surface of the fractures, there are three regions differing in microrelief: the central part of the fracture, the middle (transitional) and the peripheral parts. In the central part of the fractures, the microrelief consists of equiaxed dimples and structureless areas. In the middle part, shear dimples dominate, and in the peripheral part of fractures, areas of shear dimples alternate with areas of the rubbed surface.

Vulvar vitiligo and lichen sclerosus in children: A clinical challenge.

Vulvar vitiligo (VV) and vulvar lichen sclerosus (VLS), both feature skin and mucosal hypo-/depigmentation. The aim of this study was to describe the clinical and dermoscopic features of VV and VLS in the pediatric population, providing diagnostic clues, and to define their association. We performed a systematic literature review of the clinical and dermoscopic features of pediatric VV and VLS. An observational study was conducted on children affected by VLS associated with VV, referred to the Dermatology Unit of the Sant'Orsola Polyclinic in Bologna, Italy. Medical history, age at diagnosis, ethnicity, clinical and dermoscopic features, and symptoms were recorded for all patients. 124 cases of VLS and 10 cases of VV were reviewed. Clinical manifestations included hypo-/depigmented patches in both conditions, while ecchymosis/purpura and fissures/erosion were observed in VLS. Symptoms including pruritus, pain, or burning were reported only by VLS patients. In our study five patients with VLS associated with VV were retrieved. Clinical features included well-demarcated depigmented patches in VV and translucent areas, erythema, ecchymoses/purpura, and labial fusion in VLS. Dermoscopy showed white structureless areas with a whipped cream-like appearance, linear or dotted vessels, white chrysalis-like structures, erosion and red-purpuric blotches in VLS and reduced pigment network or pigment absence, intralesional spots of residual pigmentation and telangiectasias in VV. Symptoms were present in all patients. Both VV and VLS show hypo-/depigmented patches. In the presence of associated symptoms, possible VLS should be investigated with clinical and dermoscopic examination to achieve a prompt diagnosis.

Dermoscopic Patterns in Relation to the Clinicopathologic Manifestations of Leprosy

Objectives. Leprosy is a chronic granulomatous infection caused by the obligate intracellular organism Mycobacterium leprae. Current diagnostic tests for confirmation and treatment monitoring such as slit skin smear and biopsy are invasive and require time for processing, reading, and interpretation. Dermoscopy is a technique that allows the visualization of structures not readily seen by the naked eye. It can be performed at the point of care, providing a non-invasive link between clinical and histopathologic examination. This study aimed to determine the dermoscopic findings and associated clinicopathologic findings of the different forms of leprosy.&#x0D; Methods. A cross-sectional study was conducted. All new and follow-up patients aged 19 years old and above clinically diagnosed with leprosy were invited to participate in the study during the three-month investigation period. Clinical and dermoscopic photographs of representative skin lesions were taken, and a review of slit skin smear and histopathology results was done. Data analysis was performed using Stata SE version 13. The association between dermoscopic findings and the following parameters: anatomic location, Ridley-Jopling classification, WHO classification, treatment duration, and average bacteriologic index were analyzed using Fisher’s exact test. The level of significance was set at 5%.&#x0D; Results. A total of 57 lesions were included. Linear vessels (p=0.031), structureless areas (p=0.008), and globules (p=0.002) were found to be significantly associated with the anatomic location. Decreased hair was found to be significantly associated with treatment duration (p=0.038). No significant associations were found between dermoscopic findings and Ridley-Jopling classification, WHO classification, and ABI. Eight biopsies taken at the time of dermoscopy were reviewed, with all sites showing structureless or globular areas corresponding to the presence of granulomas on histopathology (100%). No other notable associations were observed.&#x0D; Conclusion. Dermoscopy is a potentially useful tool to aid in the diagnosis and treatment monitoring of leprosy. Limitations of this study include the small sample size, the preponderance of subjects in the lepromatous pole, and assessments by a single trained dermoscopist. A longer study duration including a larger number of newly diagnosed leprosy patients is recommended.

Assessment of Diagnostic Accuracy of Dermoscopic Structures and Patterns Used in Melanoma Detection

Dermoscopy increases the diagnostic accuracy for melanoma. However, the accuracy of individual structures and patterns used in melanoma detection has not been systematically evaluated. To assess the diagnostic accuracy of individual dermoscopic structures and patterns used in melanoma detection. A search of Ovid Medline, Embase, Cochrane CENTRAL, Scopus, and Web of Science was conducted from inception to July 2020. Studies evaluating the dermoscopic structures and patterns among melanomas in comparison with nonmelanoma lesions were included. Excluded were studies with fewer than 3 patients, studies in languages other than English or Spanish, studies not reporting dermoscopic structures per lesion type, and studies assessing only nail, mucosal, acral, facial, or metastatic melanomas or melanomas on chronically sun-damaged skin. Multiple reviewers applied these criteria, and 0.7% of studies met selection criteria. The Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline and Meta-analysis of Observational Studies in Epidemiology reporting guideline were followed. Guidelines were applied via independent extraction by multiple observers. Data were pooled using a random-effects model. The prespecified outcome measures were diagnostic accuracy (sensitivity and specificity) and risk (odds ratio [OR]) of melanoma for the following dermoscopic structures/patterns: atypical dots/globules, atypical network, blue-white veil, negative network, off-centered blotch, peripheral-tan structureless areas, atypical vessels (eg, linear irregular, polymorphous), pseudopods, streaks, regression (ie, peppering, scarlike areas), shiny white structures, angulated lines, irregular pigmentation, and a multicomponent pattern. A total of 40 studies including 22 796 skin lesions and 5736 melanomas were evaluated. The structures and patterns with the highest ORs were shiny white structures (OR, 6.7; 95% CI, 2.5-17.9), pseudopods (OR, 6.7; 95% CI, 2.7-16.1), irregular pigmentation (OR, 6.4; 95% CI, 2.0-20.5), blue-white veil (OR, 6.3; 95% CI, 3.7-10.7), and peppering (OR, 6.3; 95% CI, 2.4-16.1). The structures with the highest specificity were pseudopods (97.3%; 95% CI, 94.3%-98.7%), shiny white structures (93.6%; 95% CI, 85.6%-97.3%), peppering (93.4%; 95% CI, 81.9%-97.8%), and streaks (92.1%; 95% CI, 88.4%-94.7%), whereas features with the highest sensitivity were irregular pigmentation (62.3%; 95% CI, 31.2%-85.8%), blue-white veil (60.6%; 95% CI, 46.7%-72.9%), atypical network (56.8%; 95% CI, 43.6%-69.2%), and a multicomponent pattern (53.7%; 95% CI, 40.4%-66.4%). The findings of this systematic review and meta-analysis support the diagnostic importance of dermoscopic structures associated with melanoma detection (eg, shiny white structures, blue-white veil), further corroborate the importance of the overall pattern, and may suggest a hierarchy in the significance of these structures and patterns.

Dermoscopy-An Aid in the Diagnosis of Mycetoma.

A 45-year-old farmer consulted for a gradually increasing swelling over right leg. Examination revealed hard swelling with multiple discharging sinuses over right foot. Many pin-point hypopigmented macules arranged in a schematic pattern were seen, corresponding to the site of administration of indigenous medication [Figure 1]. Dermoscopic examination using DermLite™ DL3-3Gen under contact polarized mode from one of the active sinus revealed small black grains, surrounded by bluish white veil suggestive of deeper fungal colonies [Figure 2a]. White structureless area around the openings corresponding to dermal fibrosis was seen[Figure 2b]. Skin punch biopsy from the lesion demonstrated periodic-acid-schiff positive, pigmented fungal colonies over a background of granulation tissue [Figure 3].Figure 1: Diffuse woody hard swelling over dorsum of right foot with multiple discharging sinusesFigure 2: a. Dermoscopy of the sinus opening shows multiple small black grains. b. The sinuses are surrounded by bluish white veil (Red arrow). Crust surrounding the sinus opening can be seen (Yellow arrow) Structureless pink-white areas related to the underlying fibrosis was seen surrounding to the lesion (Star). (DL3 dermoscope, polarized mode 10x)Figure 3: Histopathology shows pigmented fungal colony comprising of radiating hyphae of eumycetoma, showing splendor hoeppli phenomenon and surrounded by dense neutrophilic infiltrate. (PAS stain, 10x)Mycetoma is a granulomatous infection that can be caused by bacteria (actinomycotic mycetoma) or fungi (eumycotic mycetoma). Grains represent the hallmark of mycetoma and color of grains is often suggestive of the probable causative agent. However, diagnostic facilities are often limited and inaccessible to many patients affected by this neglected tropical disease.[1] Dermoscopy is an easy, quick, and noninvasive tool, which can be helpful in visualizing minute grains and ascertain the type of mycetoma.[1] Black colored granules are highly suggestive of eumycotic mycetoma and its visualization by dermoscopy can help in early institution of definitive treatment. The dermoscopic images can also be stored and transferred electronically and an expert opinion sought through teledermoscopy.[2] Dermoscopy has been explored in the diagnosis of many pigmentary disorders, granulomatous infective diseases like leprosy and sporotrichosis.[34] The current report reinstitutes the importance of dermoscopy in diagnosis of dermatological disorders with clinico-dermoscopic-pathological correlation.[2] Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Dermoscopy of topical steroid-dependent or damaged face: A cross-sectional study.

Topical corticosteroid (TCS) abuse is rampant and results in steroid addiction labeled as topical steroid-dependent or damaged face (TSDF). Indian market is replete with triple combination creams containing TCS sold as over-the-counter products at low cost, luring people to use them without prescription. The resultant damage if detected late is irreversible and difficult to treat. Dermoscopy can help in the early identification of features of TSDF at a preclinical stage resulting in better prognosis. However, the literature on the same is limited. This study is undertaken to characterize dermoscopic features of TSDF and to correlate them with potency and duration of application of the TCS. One hundred and thirty-two patients aged 18 years or above, with clinical symptoms and signs suggestive of TSDF and with history of application of TCS on the face for a period of more than one month, were enrolled in the study. Their demographic details, clinical features, and dermoscopy findings were recorded using a predesigned structured format. Comparison of dermoscopic findings with clinical examination, gender, potency of TCS, and duration of TCS use was done using Chi-square test, Fisher's exact test, and one-tailed Z-test. Mean age of the patients was 31.7 ± 8.1 years. Male to female ratio was 2:9. Sixty-nine (52.3%) patients abused TCS for more than one year. Clinical findings noted in the patients were erythema (81.1%), hyperpigmentation (80.3%), and hypertrichosis (68.2%). The most common dermoscopy findings seen were brown globules (96.2%), red diffuse areas (92.4%), vessels (87.1%), white structureless areas (86.4%), and hypertrichosis (80.3%). Red diffuse areas, vessels, brown globules, white structureless areas, and white hair were observed in a statistically higher proportion of cases dermoscopically. Y-shaped vessels and brown globules were seen in significantly higher number of patients, using TCS for more than three months and in those continuing it beyond six months, polygonal vessels were predominant. Lack of histopathological correlation is the limitation of our study. Furthermore, brown globules seen in 96.2% patients of TSDF on dermoscopy may have been over-estimated and not always signify TSDF; instead, it could represent melasma for which patient applied TCS. Dermoscopy in TSDF can help dermatologists in a multitude of ways from confirming the diagnosis to differentiating from other causes of red face and predicting the approximate duration of TCS abuse.

Importance of Dermoscopy in Differentiating Common Urticaria and Urticarial Vasculitis

Background: Urticarial vasculitis is a clinicopathological entity that overlaps with common urticaria, and histopathological diagnosis is required for differentiation between them. Objectives: To determine, for the first time, if skin surface microscopy can aid in the clinical differentiation between common urticaria and urticarial vasculitis in daily practice. Materials and Methods: Lesions in 20 patients with a clinical diagnosis of urticaria were studied. All urticarial lesions were subjected to dermoscopy, skin biopsy, and histopathological examination to confirm the diagnosis. Dermoscopy was performed using Derm Lite 3 dermoscope and images captured were anyalysed. Clinical images were taken. A punch biopsy was performed in all patients. Statistical analysis was done. Results: In 11 patients diagnosed clinically as chronic urticaria, on dermoscopy showed red lines in 9(45%), red dots in 2 (10%) and structureless areas in 8(40%) patients. In 9 patients diagnosed as urticarial vasculitis clinically, on dermoscopy revealed purpuric dots in 8(40%) and purpuric globules in 5(25%) patients. Conclusion: We conclude that in our setting dermoscopy significantly facilitates the detection, diagnosis and differentiation of common urticaria and urticarial vasculitis.

Melanocytic lesions ≤ 6mm: Prospective series of 481 melanocytic trunk and limb lesions in Brazil.

Early diagnosis when melanoma is still small and thin is essential for improving mortality and morbidity. However, the diagnosis of small size melanoma might be particularly difficult, not only clinically but also dermoscopically. This study aimed to define clinical and dermatoscopic parameters in the diagnosis of suspicious pigmented cutaneous lesions with a diameter of ≤ 6mm and determine the sensitivity, specificity, positive and negative predictive values as well as the accuracy of each clinical and dermatoscopic criterion. This is a transversal, descriptive and analytical study of dermatoscopic analysis with the gold standard being the pathologic examination obtained from the excisional biopsy of suspicious melanocytic lesions with a diameter of ≤ 6mm. Trunk and limb lesion data from a public health service and a private clinic were prospectively collected from 2011 to 2017 by a unique observer. In total, 481 melanocytic lesions were included, with 73.8% being ≤ 4mm in diameter. Overall, 123 were diagnosed as melanoma, 56.0% in situ and 22.0% as thin melanomas (Breslow index 0.1 to 1.0mm). Melanoma presented symmetry in 53.7% of cases, regular borders in 54.5% and a single color in 60.2%. Regarding evolution, 13.8% of melanomas versus 10.9% of benign lesions (p = 0.116) were new by comparing photos from baseline with photos from the follow-up. The majority of melanomas (65%) were found on the limbs compared to 37.2% of the benign lesions at this location (p<0.001). A multiple logistic regression model adjusted for age, gender and location was created. The independent variables associated with the diagnosis of melanoma ≤ 6mm, adjusted for age, gender and location, were: streaks (adjusted Odds Ratio [aOR] 2.5; 95% CI 1.3–4.7; p = 0.006), and the presence of a structureless area (aOR 2.2, 95% CI 1.2–4.0, p = 0.011). Conversely, a symmetric typical pigment network was a protection variable (aOR 0.4, 95% 0.7–0.9, p = 0.040). In conclusion, dermatoscopic criteria have been identified which help to diagnose cases of small size melanoma. These include streaks and structureless areas that can be taken, particularly in consideration for the diagnosis of this subset of small difficult melanomas.

A Case of Blue Nevus Mimicking Malignant Melanoma Within a Keloid Scar

Blue nevus is a type of melanocytic nevus which clinically presents itself as blue/gray plaque or nodule. It most commonly develops upon distal extremities especially dorsal hands and feet, trunk and scalp. Histopathologically, heavy melanocyte aggregations in the deep dermis result in blue nevus formation. Different types of blue nevus include common blue nevus, cellular blue nevus, plaque-type blue nevus, combined blue nevus, desmoplastic blue nevus and subungal blue nevus. Although clinical findings may be sufficient to diagnose blue nevus, dermoscopy could be used as a helpful tool to aid in reaching the correct diagnosis. Dermoscopy usually shows diffuse blue-gray structureless area but since atypical clinical and dermoscopical features may be observed, histopathological diagnosis is the definitive step to differentiate blue nevus from its mimickers such as malignant melanoma. We want to present an interesting case of blue nevus mimicking malignant melanoma developing in a scar.

Diagnostic Algorithm for Conjunctival Melanocytic Lesions.

This study aimed to develop an algorithm allowing the differentiation between conjunctival melanoma and other melanocytic infiltrations of the conjunctiva, on the basis of a dermatoscopic examination. A total of 160 conjunctival pigmented lesions were studied (40 melanomas and 120 non-melanoma conjunctival infiltrations). The clinical characteristics of the tumours were assessed with the use of dermatoscopic characteristics as described by Kittler, and with taking into consideration the typical characteristics of conjunctival lesions. On the basis of modified dermatoscopic criteria, an algorithm was generated consisting of an assessment of the presence of 9 suspicious characteristics, e.g. more than two colours, colour asymmetry, pattern asymmetry, vascular polymorphism, presence of short vessels, linear vascular pattern, the presence of a peripheral structureless area, the presence of a grey structureless area and black dots in any part of the lesion. The presence of any of these characteristics scores 1 point. If a melanocytic lesion scores ≥3 points, the probability of diagnosing melanoma is on the level of p>0.001. The use of the proposed algorithm, based on modified dermatoscopic characteristics, may be a valuable tool for the diagnosis of conjunctival melanoma.

Evaluation of relationship between antihypertensive drug usage and dermatoscopic features in patients with keratinizing skin cancer.

Keratinizing skin cancers including actinic keratoses (AK), in situ squamous cell carcinoma/Bowen's disease/intraepidermal carcinoma (IEC), invasive cutaneous squamous cell carcinoma (cSCC) and keratoacanthoma share similar dermatoscopic features and also reveal different patterns that assist in their diagnosis. Recently epidemiological studies reveal the association between antihypertensive drugs and skin cancer risk, especially cSCC. This study aims to determine the dermatoscopic features of keratinizing skin cancer in patients using antihypertensive drug and compare with non-users. A total of 46 patients with 64 keratinizing skin cancer lesions were included in the study. The demographic, clinical characteristic of patients, the number, duration, localization and dermatoscopic features from each lesion were collected. First, we evaluated the dermatoscopic features according to the histopathologic diagnosis. Then, all patients were divided into two groups as users of antihypertensive drugs and non-users. The dermatoscopic features were compared in terms of antihypertensive drug usage and histopathologic diagnosis in antihypertensive drug users and non-users, separately. The users of anti-hypertensive drugs were 22 (47,8%) and non-users 24 (52,2%). Of the total 64 lesions including 47 AK, 5 IEC, 10 cSCC, and 2 keratoacanthoma were evaluated. White structureless area was found statistically significant in cSCC lesions of patients using antihypertensive drugs (P=.004). This finding in cSCC may be a clue for antihypertensive drug usage and these drugs may be a predisposan factor for dermal fibrosis. Regardless of histopathology, dermatoscopic features show no statistically difference between antihypertensive drug users and non-users (P > .05). Clearer results can be obtained by conducting more detailed and long-term studies.

Evaluation of dermatoscopic criteria for early detection of squamous cell carcinoma arising on an actinic keratosis

Advanced squamous cell carcinoma (SCC) can be discriminated easily from actinic keratosis (AK) based on clinical and dermatoscopic features. However, at the initial stage of dermal invasion, SCC might still be clinically flat and discrimination from AK remains challenging, even with the addition of dermatoscopy. The aim of this study was to investigate the clinical and dermatoscopic criteria that could suggest early invasion and serve as potent predictors to discriminate early SCC from AK. Clinical and dermatoscopic images of histopathologically diagnosed AKs and early SCCs were evaluated for the presence of predefined criteria by 3 independent investigators. A total of 50 early SCCs and 45 AKs were included. The main positive dermatoscopic predictors of early SCC were dotted/glomerular vessels (odds ratio [OR] 3.83), hairpin vessels (OR 12.12), and white structureless areas (OR 3.58), whereas background erythema represented a negative SCC predictor (OR 0.22). The retrospective evaluation of images. Moreover, the differential diagnosis included in the study is restricted between AK and early SCC. We identified potent predictors for the discrimination of AK and early SCC that may better guide management decisions in everyday clinical practice.

Dermoscopy in Leprosy: A Clinical and Histopathological Correlation Study

Leprosy, an insidious infectious granulomatous disease, is diagnosed traditionally through clinical examination coupled with skin smears and histopathology. It has myriad clinical presentations that pose diagnostic challenges. Lately, dermoscopy has emerged as a rapid, noninvasive diagnostic modality for many dermatoses. We evaluated the dermoscopic findings of various manifestations of leprosy and correlated them with clinical and histopathological features. This prospective, cross-sectional study was conducted in our skin outpatient department for a period of 1 year. Patients newly diagnosed as having leprosy or those undergoing leprosy treatment for less than 6 months were included. The most representative lesion was dermoscopically evaluated and later biopsied. We included 73 patients in the study. Results indicated an obvious correlation between dermoscopic findings and histopathology. We noted orangish yellow and white structureless areas, steadily throughout the spectrum, depicting dermal granuloma. Additionally, we observed focal vascular structures such as branching, linear, and crown vessels that result from the pressure of granuloma pushing the dilated vessels upwards. The relative absence of skin appendages aided in differentiating leprosy from other granulomatous disorders. Novel findings of our study were the detection of a branch-like pattern of clofazimine-induced pigmentation on dermoscopy and orange globules on onychoscopy. Other unique findings included violaceous structureless areas, characteristic large telangiectatic vessels, follicular plugging, star-shaped silvery-white scaling, and white globules in type 1 reaction; white shiny steaks were observed in patients with borderline lepromatous leprosy, and central white dots and keratotic plugs were observed in patients with histoid leprosy. Dermoscopy, as a noninvasive modality, could aid in the quick diagnosis of leprosy and should be used as a handy tool to complement other investigative tools for this disease.

Dermoscopy Features of Acquired Perforating Dermatosis Among 39 Patients.

In this report, we concluded there are four dermoscopic features of APD including a yellow-brown homogeneous structureless area in the center of the lesion, dotted and linear vessels distribution radially and a dam shape uplift at the periphery, as well as a white irregular ring surrounding the lesion. There are three features, including the yellow-brown homogeneous structureless area in the center of the lesion, the dotted and linear vessels distribution radially and the white irregular ring surrounding the lesion were correspond to the report of Emma Ormerod et al.These features are also similar to those previously discribed in three separated reports of seven cases with APD. In our report, we found a new dermoscopic features: the dam shape uplift at the periphery. These finding may be contributed to improve the rate of clinical diagnosis of APD.

Lupus miliaris disseminatus faciei: A report with a new dermoscopy finding

Lupus miliaris disseminatus faciei (LMDF) is a rare inflammatory disorder characterized by asymptomatic papular lesions mainly over the central part of the face, common in young adults and with a spontaneously resolving course. Its exact etiology remains unknown, its treatment is problematic, and there is a lack of controlled studies on LMDF. Histopathology shows dermal epithelioid granulomas with central necrosis and surrounding lymphocytic infiltrate with multinucleate giant cells. Dermoscopic findings published show discrete focal orangish structureless areas located around follicular openings with whitish keratotic plugs. Herein, we report a case of LMDF with dermoscopy showing stellate scar signs and structureless white areas.

Idiopathic perniosis presenting as acral purpuric lesions: Clustering of cases before COVID-19 pandemic and their comparison with chilblain like lesions reported in the literature.

Perniosis/chilblains are the acral inflammatory skin lesions developing in susceptible individuals as an abnormal reaction to cold. In the absence of a discernible cause, it is labeled as idiopathic perniosis (IP). With the ongoing COVID‐19 pandemic, there was an upsurge of reports of chilblain like lesions (CLL) especially in young patients possibly implicated to the SARS‐CoV‐2 virus. Twelve clinically suspected and histopathologically confirmed cases of IP seen from November 2019 through February 2020 were retrospectively recruited. Clinical, dermoscopic, and histopathological characteristics of these were reviewed and compared with CLL reported in the literature. Mean age of patients was 26.58 ± 15.18 years with an equal male to female ratio. Characteristic histopathology findings were spongiosis (100%), dermal edema (100%), perivascular lymphocytic infiltrate (100%) with peri‐eccrine accentuation (66.7%), keratinocyte necrosis (50%), focal basal vacuolar damage (58.3%), and lymphocytic vasculitis (58.3%). Significant dermoscopy findings were variable background color ranging from dull red and violaceous to copper red and brown orange, coiled vessels (44.4%) and orange‐red structureless areas (63.9%). Lesions over palms and soles preferentially had white dots/clods and lines (38.9%). There appears no exclusive histopathological as well as dermoscopy features of CLL and IP, yet certain clues can be appreciated. Keratinocyte necrosis and severe dermal edema favors IP, whereas fibrin thrombi with involvement of both superficial and deep dermal vessels favor CLL. Dermoscopically presence of irregular, linear or branching vessels, red/purple dots and clods and gray brown reticule supports CLL while white dots/clods and lines supports IP.