Suspected Skin Lesions Research Articles

Outbreak of Feline Sporotrichosis with Zoonotic Potential in the Seventh Health District of Maceió-AL.

Sporotrichosis is a mycosis with zoonotic potential caused by species of Sporothrix. Once thought rare in northeastern Brazil, the disease has recently been spreading, leading to an emergency health issue. In this paper, we describe an outbreak of feline sporotrichosis in the Seventh Health District of Maceió-AL. We collected samples from 23 domiciled and non-domiciled felines without regard for age, breed, sex, and neutering state. Skin samples were analyzed cytologically under a light microscope and seeded onto Sabouraud dextrose agar at 25 °C for from 15 to 30 days. Fifteen of the twenty-three cats with suspected skin lesions were positive for Sporothrix spp. on either cytological or microbiological evaluation. Most of the infected cats were male, young adults, non-neutered, with free access to external areas, and living in environments with poor sanitation, a high population density, and an accumulation of garbage and organic matter. Three owners were bitten or scratched by infected cats and subsequently developed suspicious cutaneous lesions suggestive of sporotrichosis. The epidemiological features of feline sporotrichosis in the outbreaks of Maceió seemed to share similarities with the data obtained from outbreaks in current hyperendemic areas. Identifying geographical sites of infection and providing compulsory notification of the disease is essential for avoiding an epidemic in Alagoas.

Increasing melanoma incidence with unchanged mortality: more sunshine, better treatment, increased diagnostic activity, overdiagnosis or lowered diagnostic threshold?

Increasing melanoma incidence with less increasing mortality is observed in several countries. This discrepancy is not well understood. In this study, our aim was to discuss factors [ultraviolet radiation (UVR) exposure, melanoma treatment, diagnostic activity, overdiagnosis, pathologists' diagnostic threshold and clinicians' propensity to remove suspect skin lesions] that might influence melanoma incidence and mortality in Denmark. This was a register study with the number of melanocyte-related lesions and melanoma mortality based on comprehensive national pathology and mortality databases for the period 1999-2019. We investigated melanocyte-related diagnoses and mortality in a population of 5.5 million with a national healthcare system. Age-adjusted melanoma mortality and age-adjusted incidence of benign naevi, atypical lesion, or melanoma in situ and of invasive melanoma were computed for data analysis. In total, 1 434 798 biopsies were taken from 704 682 individuals (65% female). The mean age at biopsy was 39.8 years in males and 37.6 in females. In males and females, the incidence of invasive melanoma increased by 87% during the period 1999-2011. During the subsequent period it increased by 9% in males but remained unchanged in females. The incidence of melanoma in situ increased by 476% in males and 357% in females during the study period, while the increases for atypical melanocytic lesions were 1928% and 1686%, respectively. Biopsy rates increased by 153% in males and 118% in females from 1999 through 2011 but fell by 20% in males and 22% in females during the subsequent period. Mortality varied slightly from year to year without any significant time trend for males or females. We identified no evidence of increased UVR exposure over the latest 30 years in Denmark. Immunotherapy of advanced melanoma was introduced in Denmark in 2010 and came into general use in 2014. Comprehensive national data demonstrate increasing melanoma incidence correlated with increasing biopsy rates, but with no change in mortality. Previously suggested explanations for such a trend are a lowered threshold of melanoma diagnosis among pathologists, increased diagnostic activity in the presence of overdiagnosis and improved melanoma treatment. Because the study is observational and we have more explanatory factors than outcomes, the findings do not warrant conclusions about causal relationships.

Evaluation of a 3‐year teledermoscopy project in primary healthcare centres in Belgium

AbstractBackgroundWith the increasing incidence of skin cancer and limited access to specialised care, teledermoscopy (TDS) may represent a useful triage tool for skin cancer detection.ObjectivesAn evaluation of a 3‐year TDS project in primary healthcare centres (PHCs) in Belgium (TELESPOT project).MethodsA total of nine PHCs were trained to use an in‐house developed smartphone‐based application for macroscopic and dermoscopic acquisition of skin lesions, subsequently analysed independently by two investigators in a tertiary university skin cancer centre. The primary outcome was the proportion of high‐priority management (HPM) recommendations. Secondary outcomes included the TDS diagnoses, the quality of image acquisition, the mean time between HPM recommendations and subsequent surgery, the correlation between HPM reports and histopathology after surgery as well as patient and general practitioner satisfaction scores. All the endpoints were compared between the initial year of the TDS project and the subsequent 2‐year extension period of the study.ResultsOver 3 years, a total of 478 lesions were analysed in 335 patients: initial phase (105 lesions from 76 patients in six PHCs) and extension phase (373 lesions from 259 patients in nine PHCs). An HPM was recommended in 9.2% (initial and extension phases: 7.6% and 15.7%, respectively). The dermoscopic‐histological correlation achieved 84.1%. The median delay between HPM and surgery was 9 days.ConclusionsThis TDS project avoided unnecessary tertiary care visits in about 9 out of 10 cases, increased the HPM by a ninefold in comparison with the conventional care pathway and provided excellent satisfaction levels for PHCs and patients. Long‐term participation improved the triage quality for suspect skin lesions by 2.24‐fold.

Frequency of Cutaneous Leishmaniasis and Complete Ulcer Healing in Patients Referred to Skin Diseases and Leishmaniasis Research Center, Isfahan, Iran from 2018 to 2019

Introduction: Iran is one of the most important hot spots for cutaneous leishmaniasis (CL) in the world. To date, no studies have been done on both epidemiological aspects along with the length of the treatment course of CL. This study aimed to determine the relative frequency of CL in patients with suspected skin lesions and the duration of healing after treatment with different regimens.
 Methods: This cross-sectional study was conducted on patients with CL referred to the skin diseases and leishmaniasis research center (SDLRC) in Isfahan during the years 2018 to 2019. Among 389 patients with suspected skin lesions, 150 cases were included with proven CL. Information such as age, sex, education, location, size of the lesion, duration of treatment, and the rate of recovery were recorded. SPSS software version 20 was used for data analysis, the chi-square, Fisher´s Exact, and one Way ANOVA tests were used with a significant level of p < 0.05.
 Results: Among 350 admitted cases, 150 cases were CL. positive (42.85%). The rate of complete recovery was higher in cases with an average age of 33.55 ±18.9 years (P =0.077). There was 34 cases more than the other groups in this range of age. ( The rate of complete recovery in patients with a history of migration to endemic areas was higher than in patients without a history of migration (P = 0.81)). The rate of complete recovery in patients whose means treatment duration was 59.03 ± 41.43 days was higher than other recovery periods (P = 0.23).
 Conclusion: The rate of complete recovery was higher in adult cases than the other groups. In this study, it was proved that the rate of recovery of patients had the significant relationship with the average duration of treatment.

Monkeypox disease in a breastfeeding infant.

A previously healthy breastfed 7-month-old infant presented with several papulovesicular lesions, a hyperemic pharynx and a petechial enanthema. His mother had confirmed monkeypox infection with similar skin lesions on the chest wall. Skin-to-skin contact is the most likely mode of transmission of monkeypox. Precautions to limit skin contact during activities such as breastfeeding are recommended if suspected skin lesions are present.

Blistering erysipelas in a black patient

Blistering erysipelas bullosa constitutes a rare and severe variant of erysipelas, which is rarely reported in the medical literature. It is an acute inflammation of the epidermis and superficial lymphatics. The diagnosis is usually clinical. We report the case of blistering erysipelas of the lower limb complicated by sepsis in a young immunocompetent obese female. To the best of our knowledge, this is the first case being reported from sub-Saharan Africa. We recommend a high index of suspicion of this rare disease in a patient with suspected skin lesions and predisposing factors.

Leprosy survey among rural communities and wild armadillos from Amazonas state, Northern Brazil.

There is evidence that in southern US, leprosy is a zoonosis infecting wild Dasypus novemcinctus armadillos but the extent of this finding is unknown. This ecological study investigated leprosy in rural communities and in wild armadillos from the Brazilian Amazon. The study area was the Mamiá Lake of Coari municipality, Amazonas State, Northern region, a hyper endemic leprosy area where residents live on subsistence farming, fishing and armadillo hunting and its meat intake are frequent. The leprosy survey was conducted in sixteen communities by a visiting team of specialists. Local partakers provided wild armadillos to investigate M. leprae infection. Volunteers had complete dermato-neurological examination by a dermatologist with expertise in leprosy diagnosis, suspect skin lesions were biopsied for histopathology (Hematoxylin-eosin/HE, Fite-Faraco/FF staining); slit skin smears were collected. Armadillos’ tissue fragments (skins, spleens, livers, lymph nodes, adrenal glands, others) were prepared for histopathology (HE/FF) and for M. leprae repetitive element-RLEP-qPCR. Among 176 volunteers, six new indeterminate leprosy cases were identified (incidence = 3.4%). Suspect skin sections and slit skin smears were negative for bacilli. Twelve wild D. novemcinctus were investigated (48 specimens/96 slides) and histopathological features of M. leprae infection were not found, except for one skin presenting unspecific inflammatory infiltrate suggestive of indeterminate leprosy. Possible traumatic neuroma, granuloma with epithelioid and Langhans cells, foreign-body granuloma were also identified. Granulomatous/non-granulomatous dermatitides were periodic-acid-Schiff/PAS negative for fungus. M. leprae-RLEP-qPCR was negative in all armadillos’ tissues; no bacillus was found in histopathology. Our survey in rural communities confirmed the high endemicity for leprosy while one armadillo was compatible with paucibacillary M. leprae infection. At least in the highly endemic rural area of Coari, in the Brazilian Amazon region where infectious sources from untreated multibacillary leprosy are abundant, M. leprae infected armadillos may not represent a major source of infection nor a significant public health concern.

Wishing to be perceived as a capable and resourceful person-A qualitative study of melanoma patients' experiences of the contact and interaction with healthcare professionals.

To explore patients' experiences of contact and interaction with healthcare professionals (HCPs) during the diagnostic process of melanoma. In Sweden, most patients with suspected skin lesions seek care at the primary level of services in the first instance. Previous research describes the diagnostic process as a complex journey with uncertainty. Nonetheless, the importance of contact and interaction between patient and HCPs during the diagnostic process is rarely explored. This study adopted a qualitative design in which semi-structured interviews were conducted and the COREQ-checklist for qualitative studies employed (EQUATOR guidelines). A sample of 30 patients (15 women, 15 men) diagnosed with melanoma was included. Secondary analysis of interviews was carried out using qualitative content analysis. One theme emerged: Wishing to be perceived as a capable and resourceful person that consisted of three categories: (a) The need of being valued, (b) The need of being informed and (c) The need of taking actions. Our results suggest that patients wish to be valued as capable and resourceful persons as well as to be provided with honest and sufficient information about the diagnosis and subsequent procedures. By fulfilling these wishes, HCPs can involve patients in the diagnostic process and reduce patients' uncertainty. A need of supportive and accessible health care to manage the diagnostic process and to reduce patients' struggle for care was also identified. Patients are satisfied when health care is organised in a patient-/person-centred manner, that is, in accordance with patients' needs, avoiding gatekeeping, and when HCPs interact respectfully in encounters. Accessible HCPs during the diagnostic process of melanoma are required to inform, support and navigate patients within the healthcare system and through their diagnostic journey.

Accuracy of tele-consultation on management decisions of lesions suspect for melanoma using reflectance confocal microscopy as a stand-alone diagnostic tool.

Diagnostic accuracy of reflectance confocal microscopy (RCM) as a stand-alone diagnostic tool for suspect skin lesions has not been extensively studied. Primary aim was to measure experts' accuracy in RCM-based management decisions. Secondary aim was to identify melanoma-specific RCM features. The study enrolled patients ≥18years that underwent biopsy of skin lesions clinically suspected to be melanoma. One hundred lesions imaged by RCM were randomly selected from 439 lesions prospectively collected at four pigmented lesion clinics. The study data set included 23 melanomas, three basal cell and two squamous cell carcinomas, 11 indeterminate melanocytic lesions and 61 benign lesions including 50 nevi. Three expert RCM evaluators were blinded to clinical or dermoscopic images, and to the final histopathological diagnosis. Evaluators independently issued a binary RCM-based management decision, 'biopsy' vs. 'observation'; these decisions were scored against histopathological diagnosis, with 'biopsy' as the correct management decision for malignant and indeterminate lesions. A subset analysis of 23 melanomas and 50 nevi with unequivocal histopathological diagnosis was performed to identify melanoma-specific RCM features. Sensitivity, specificity and diagnostic accuracy were 74%, 67% and 70% for reader 1, 46%, 84% and 69% for reader 2, and 72%, 46% and 56% for reader 3, respectively. The overall kappa for management decisions was 0.34. Readers had unanimous agreement on management for 50 of the 100 lesions. Non-specific architecture, non-visible papillae, streaming of nuclei, coarse collagen fibres and abnormal vasculature showed a significant association with melanoma in the evaluation of at least two readers. Reflectance confocal microscopy tele-consultation of especially challenging lesions, based on image review without benefit of clinical or dermoscopy images, may be associated with limited diagnostic accuracy and interobserver agreement. Architectural and stromal criteria may emerge as potentially useful and reproducible criteria for melanoma diagnosis.

Evaluation of incubation time for Microsporum canis dermatophyte cultures.

Objectives The goal of this study was to determine how frequently Microsporum canis was isolated after 1, 2 and 3 weeks of incubation on dermatophyte culture medium either from untreated cats or cats during treatment. Methods This was an observational retrospective study. Toothbrush fungal culture results were examined from two data pools: untreated cats with suspect skin lesions and weekly fungal cultures from cats being treated for dermatophytosis. Results Results from 13,772 fungal cultures were reviewed and 2876 (20.9%) were positive for M canis. Of these, 2800 were confirmed as positive within 14 days of incubation and only 76 (2.6%) required >14 days for confirmation of M canis. In pretreatment specimens, 98.2% (1057/1076) of M canis isolates were recovered within 14 days of incubation in specimens from cats not known to have received prior antifungal treatment. For cats receiving treatment, 96.8% (1743/1800) of M canis isolates were recovered within 14 days of incubation. Of the 57 cultures that required >14 days for finalization, 21 required extra incubation time because cultures were grossly abnormal, 12 had concurrent contaminant growth delaying microscopic confirmation and 24 had no growth in the first 14 days. Of these 24, 19 had 1-2 colony-forming units (cfu)/plate and the remaining five plates had 5 to >10 cfu/plate, all with abnormal morphology. Conclusions and relevance The findings of this study show that it is not necessary to hold pretreatment or post-treatment fungal cultures for 21 days before finalizing cultures for no growth. Growth requiring >14 days had grossly abnormal morphology.

The role of DNA polymerase chain reaction, culture and histopathology in the diagnosis of cutaneous tuberculosis

Cutaneous tuberculosis (TB) is re-emerging as a significant problem in India due to increased incidence of human immunodeficiency virus (HIV), acquired immune deficiency syndrome (AIDS), other immunosuppressive states/factors like drugs, and emergence of multidrug resistance (MDR-TB). Proper diagnosis is warranted as there is varied clinical presentation and similarity with many other diseases. To assess the sensitivities of DNA polymerase chain reaction (PCR), culture, and histopathology for the diagnosis of cutaneous TB in clinically suspected skin lesions. Clinically suspected cases of cutaneous TB were enrolled in the study. Two skin punch biopsies were taken from each patient and sent for histopathology examination and DNA PCR with culture, respectively. Of the total 70 cases enrolled, 49 were detected as cutaneous TB by the above tests. The sensitivities of DNA PCR, culture, and histopathology were 24.5, 16.3, and 91.8%, respectively. DNA PCR and culture should be advised in cases of cutaneous TB with inconclusive histopathology. DNA PCR should be considered in preference over culture if facilities are available as it gives rapid results and has a higher sensitivity.

Risk factors for epilepsy in Bas-Uélé Province, Democratic Republic of the Congo: a case-control study.

The reason for the high prevalence of epilepsy in onchocerciasis endemic areas remains unknown. The aim of this study was to detect risk factors associated with epilepsy in a region endemic for onchocerciasis. In June 2014, a case-control study was performed in Titule, Bas-Uélé Province in the Democratic Republic of the Congo. Individuals with unprovoked convulsive epilepsy of unknown aetiology were enrolled as cases (n=59). Healthy members of families without cases of epilepsy in the same village were recruited as controls (n=61). A multivariate binomial logistic regression analysis was performed to identify potential risk factors associated with epilepsy. To evaluate the potential protective effect of ivermectin treatment on the development of epilepsy, a nested age-matched case-control study was performed including only those who were eligible for ivermectin treatment in the year before they developed epilepsy. Suspected onchocerciasis skin lesions were more often present in cases than in controls: 12/41 (29%) vs. 1/56 (2%), respectively (odds ratio (OR) 20.26, 95% confidence interval (CI) 2.42-170; p<0.01). Ivermectin had been taken 7 months earlier in 29/59 (49%) cases and 29/61 (48%) controls. Onchocerca volvulus (OV) DNA was detected by PCR in skin snips in 26/34 cases (76%) and 10/14 controls (71%) (p=0.7), and there was presence of OV IgG4 antibodies in 35/48 (73%) cases and 15/18 (83%) controls (p=0.5). OV DNA was not detected in the cerebrospinal fluid of cases (controls not tested). Both cases and controls reported frequent bites by blackflies (Diptera, Simuliidae). Bathing daily as opposed to less often (OR 16.7, 95% CI 2.2-125.8; p<0.01), bathing between 11 a.m. and 4 p.m. (OR 12.7, 95% CI 1.6-103.7; p=0.02), and washing clothes between 11 a.m. and 4 p.m. (OR 10.9, 95% CI 1.5-77.3; p=0.02) were all independently associated with epilepsy. Blood screening by specific PCR tests for Toxoplasma and Wuchereria bancrofti was negative in all cases and controls. A Loa loa infestation was found in only one case and one control by PCR and Giemsa smear. Antibodies to Taenia solium, Toxocara, and Trypanosoma sp were not detected in any of the participants. In an age-matched case-control analysis, 16/18 (89%) cases had not taken ivermectin the year before they developed epilepsy, compared to 7/18 (39%) controls that same year (p=0.002). These data suggest that frequent activities at rivers known to be blackfly breeding sites and a historical lack of ivermectin treatment were risk factors for epilepsy in this onchocerciasis endemic area.

Clinical and demographic criteria for cutaneous leishmaniasis in Sirte, Libya

Background Cutaneous leishmaniasis (CL) comprises a major parasitic health problem worldwide, particularly in Libya where the prevalence of CL continues to re-emerge. Objective The aim of the present study was to determine the clinical patterns and demographic criteria of CL among cases with suspected skin lesions, prophylactically treated as a routine by intra-lesion injection of pentostam in the outpatient polyclinic in Sirte, Libya. Participants and methods This cross-sectional study was conducted on a total of 84 patients attending the dermatology clinic in the outpatient polyclinic at Sirte, Libya, during the period from March 2010 to January 2011; 40 (47.6%) females and 44 (52.4%) males. Age of the participants ranged from 12 to 40 years, with a mean age of 27±7.24 years. Cutaneous lesions were diagnosed microscopically by using the slit smear technique after staining with Giemsa stain for the amastigote forms of Leishmania spp. Results The infection rate was 63/84 (75%) among the studied group. Sex was significantly associated with acquisition of CL, with more males being at risk (60.3 vs. 39.7%; P=0.01). Occupation as a farmer posed a greater risk for infection (P=0.0004). Among the positive cases, the number of lesions ranged from three to five on lower limbs and were ulcerative in type (P=0.02, 0.01, and 0.0004, respectively). Conclusion Our results were in agreement with those of the previous studies about the prevalence of CL in Sirte, Libya. CL was found to be more common among male farmers, and most lesions were on the lower limb and were of the ulcerative type.

Melanoma of unknown primary origin coexisting with early-onset multifocal basal cell carcinoma.

Melanoma of unknown primary origin coexisting with early-onset multifocal basal cell carcinoma.

Molecular identification of Leishmania species in Taybad district, Iran

ObjectiveTo identify Leishmania species in patients with cutaneous leishmaniasis in the city of Taybad in Razavi Khorasan Province from April 2012 to March 2013. MethodsAmong 52 persons who referred to Health Center of Taybad with suspected skin lesions, stained slide smears of 35 patients showed positive result for Leishmania. Also polymerase chain reaction assay performed using specific kDNA primers. Data of patients were analyzed with SPSS. ResultsOf 35 positive smears for Leishmania, 21 (60%) belonged to males and 14 (40%) belonged to females. Polymerase chain reaction bands were observed in all 35 samples of which 31 (88.6%) samples showed Leishmania tropica and 4 (11.4%) showed Leishmania major. The highest infected age group was 11–20 years old. ConclusionsBoth anthroponotic cutaneous leishmaniasis and zoonotic cutaneous leishmaniasis are present in Taybad. Leishmania tropica is the dominant causative species for anthroponotic cutaneous leishmaniasis. Further study is recommended to discover probable reservoir and vector for Leishmania major in Taybad.

Skin lesions suspected of malignancy: an increasing burden on general practice

BackgroundSkin cancer is believed to impose a heavy burden on healthcare services, but the burden of skin lesions suspected of malignancy on primary healthcare has never been evaluated. Therefore the aim of this study was to determine the demand for care in general practice due to these suspected skin lesions (i.e. lesions that are suspected of malignancy by either the patient or the GP).MethodsRegistry study based on data (2001–2010) from the Registration Network Groningen. This is a general practice registration network in the northern part of the Netherlands with an average annual population of approximately 30,000 patients. All patient contacts are coded according to the International Classification of Primary Care (ICPC). Consultations for skin lesions suspected of malignancy were selected according to the assigned ICPC codes. Subsequently, the number of consultations per year and the annual percent change in number of contacts (using the JoinPoint regression program) were calculated and analysed. Additionally, the percentage of patients referred to secondary care or receiving minor surgery within one year after the first contact were calculated.ResultsFrom 2001 onwards we found an annual increase in demand for care due to skin lesions suspected of malignancy of 7.3% (p < 0.01) and in 2010 the benign:malignant ratio was 10:1. In total 13.0% of the patients were referred and after 2006, minor surgery was performed on 31.2% of the patients. Most surgeries and referrals took place within 30 days.ConclusionsSuspected skin lesions impose an increasing burden on primary healthcare and most likely on healthcare costs as well. General practitioners should therefore be trained in diagnosing skin lesions suspected of malignancy, as a high diagnostic accuracy can save lives in the case of melanoma, and may also prevent unnecessary, costly, excisions and referrals to secondary healthcare.

The changing profile of cutaneous leishmaniasis agent in a central province of Iran.

Cutaneous leishmaniasis in Iran is usually caused by Leishmania major or L. tropica. However, the direct examination or the cultures of biopsies for diagnosis are not very sensitive. The objective of this study was to identify the responsible species obtained from patients suspected of cutaneous leishmaniasis referred to the reference laboratory atYazd in Iran during 2010-2011 using parasitological and molecular assays. After completing a clinical/epidemiologic data questionnaire for 145 patients with suspected skin lesions, scraping samples were collected. Each specimen was examined using both direct microscopy and molecular assay using polymerase chain reaction-restriction length polymorphism (PCR-RFLP). Location of the lesions included 47.7% on hands, 30.7% on face, 15.4% on feet, and the remainder on other regions. Out of 145 samples, Leishman body was observed in 52 by direct smear and 73 by PCR assay. Molecular assay indicated 36 cases as L. major, 36 cases as L. tropica and one case as unknown. In conclusion, molecular-characterization showed changing profile of Leishmania species in the study area which may have implications on treatment and/or control strategies.

Molecular identification of Leishmania isolates obtained from patients suspected as having cutaneous leishmaniasis referred to reference laboratories from Yazd province in central Iran

Background:Cutaneous leishmaniasis (CL) continues to be an increasing public health problem in Iran. The dominant etiologic agents of CL in the Old World are Leishmania major and Leishmania tropica. One of the important endemic foci of CL in Iran is Yazd. Recently, previous studies showed the equal prevalence of L. major and L. tropica as the agents of cutaneous leishmaniasis in this area. This prompted us to identify the genotype of L. major isolates obtained from patients with cutaneous leishmaniasis.Materials and Methods:After completing a clinical/epidemiologic data questionnaire for 218 patients with suspected skin lesions, scraping samples were collected, and each specimen was examined using both direct microscopy and molecular assay of polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP).Results:Results showed that of the 218 samples, Leishman body was observed in 77 by direct smear and 104 by PCR assay. Molecular assay indicated 50 cases as L. major, 52 cases as L. tropica, and two cases as unknown. Molecular characterization of L. major isolates showed four patterns, named LmA1, LmA2, LmA3, and LmA4.Conclusion:Our study is the first report for molecular characterization of L. major from one of the important central province of Iran that could affect the control strategies in this field.

“Mistletoe sign”: probably a new dermoscopic descriptor for melanoma in situ and melanocytic junctional nevus in the inflammatory stage

Melanomas in situ (MIS) are difficult to diagnose as they lack well-established, dermoscopic descriptors. In numerous clinical cases, there are no definitive differentiating criteria between atypical nevus and melanoma in situ. So far, no digital dermoscopic criteria have been developed which can clearly distinguish atypical naevi from MIS. It is necessary to search for predictors of MIS and clinically suspected skin lesions in dermoscopy. We present 2 patients diagnosed with and treated for melanoma in situ and junctional nevus in its inflammatory stage. This includes a new morphological structure in dermoscopy known as the “mistletoe sign”. Below, we have described dermoscopic pictures, with appropriate histopathology, for patients with the “mistletoe sign”. Dermoscopy in two cases revealed multiple, well-circumscribed areas, consisting of non-uniform, sometimes pseudo-dichotomously branched structures, mimicking pseudopods, which were not reticular, arising from overall reticular or homogenous patterns resembling the mistletoe. Due to the fact that this is one of the several reports of its kind, further research and observation are still necessary. The “mistletoe sign” may be a descriptor of the melanocytic nevus in the inflammatory stage and the melanoma in situ; however, further studies are necessary.

Increased expression of CD24 in nonmelanoma skin cancer

Skin cancer detection is based on the macroscopic and microscopic appearance of the lesions and the experience of the surgeon. The final diagnosis is done by pathological analysis, based on established criteria. Currently, there is no serum marker that can be used for the diagnosis of skin cancer. CD24, a mucin-like glycoprotein, is overexpressed in a variety of cancers including skin malignancies. Evaluate the potential utility of CD24 expression in peripheral blood leukocytes (PBLs) for the detection of nonmelanoma skin cancers (NMSC). Twenty-nine consented individuals attending Tel Aviv Sourasky Medical Center for excision of suspected skin lesions, and 21 age- and gender-matched subjects were prospectively recruited. The resected lesions were examined by an expert dermatopathologist. PBLs were isolated from blood samples and protein extracts were subjected to sulfate polyacrylamide gel electrophoresis (SDS-PAGE) and immunoblotting. The study was double blinded. CD24 expression in PBLs distinguishes between NMSC and healthy subjects, with high sensitivity (81%) and specificity (67%) for basal cell carcinoma, and 100% and 71%, respectively, for squamous cell carcinoma. The CD24 test can successfully distinguish NMSC from healthy subjects. CD24 may serve as a new potential and promising diagnostic biomarker for the detection and surveillance of NMSC.