Dermoscopic-pathologic correlation: apropos of six equivocal cases.

The increasing use of dermoscopy in preoperative diagnosis of melanocytic skin neoplasms is impacting on routine histopathology to a relevant extent. We herein present the dermoscopic-pathologic features of 6 cases of histopathologically controversial melanocytic skin neoplasms. By illustrating these cases, we emphasize at least 3 different fields of interest for a combined (clinico-)dermoscopic-pathologic diagnostic approach, namely, information about the evolution of lesions; detection of gross sampling errors; definition of peculiar clinicopathologic entities.

Desmoplastic nevus: clinicopathologic keynotes.

We describe 3 cases of desmoplastic nevus with special emphasis on some repetitive dermoscopic and histopathologic features, which-if confirmed on larger series-could allow to identify desmoplastic nevus as a specific clinicopathologic entity within the spectrum of acquired melanocytic nevi.

Sclerosing nevus with pseudomelanomatous features (nevus with regression-like fibrosis): clinical and dermoscopic features of a recently characterized histopathologic entity.

Background: Sclerosing nevi with pseudomelanomatous features or, else, nevi with regression-like fibrosis (NRLF) are histopathologic simulators of regressing melanoma.

Objective: We aimed at evaluating the clinical features in a series of NRLF.

Methods: Dermoscopic images of NRLF were re-evaluated according to the amount of regression, the presence of white/blue areas and the 7-point checklist.

The influence of clinical information in the histopathologic diagnosis of melanocytic skin neoplasms.

Background: We tested the relevance of clinical information in the histopathologic evaluation of melanocytic skin neoplasm (MSN).

Methods: Histopathologic specimens from 99 clinically atypical MSN were circulated among ten histopathologists; each case had clinical information available in a database with a five-step procedure (no information; age/sex/location; clinical diagnosis; clinical image; dermoscopic image); each step had a histopathologic diagnosis (D1 through D5); each diagnostic step had a level of diagnostic confidence (LDC) ranging from 1 (no diagnostic certainty) to 5 (absolute diagnostic certainty). The comparison of the LDC was employed with an analysis of variance (ANOVA) for repeated measures.

Dermoscopic monitoring of melanocytic skin lesions: clinical outcome and patient compliance vary according to follow-up protocols.

Background: Dermoscopic monitoring of melanocytic lesions increases the likelihood that featureless melanomas are not overlooked and minimizes the excision of benign lesions. Objective To examine clinical outcome and patient compliance using different follow-up protocols.

Methods: A retrospective analysis of 600 lesions from 405 patients (aged 6-79 years) was performed to examine patient compliance and clinical outcome in patients with multiple atypical melanocytic lesions undergoing sequential dermoscopy imaging during short-, medium- or long-term follow-up.

Lentigo maligna in a young adult.

Background: Lentigo maligna is mainly diagnosed in the elderly with severely sun-damaged skin.

Observation: We describe a case of lentigo maligna in a 51-year-old woman with Fitzpatrick skin type III. Based on private photographs of the patient, we were able to ascertain that the lesion was already present at the age of 22 years.

Regarding the algorithm for the diagnosis of early mycosis fungoides proposed by the International Society for Cutaneous Lymphomas: suggestions from routine histopathology practice.

Background: Routine clinicopathologic practice is expected to refine/validate the scoring system proposed in 2005 by the International Society for Cutaneous Lymphomas (ISCL) for the diagnosing early mycosis fungoides (eMF), classical type.

Methods: An evaluation of 72 cases of erythematous and scaling dermatoses was employed with a partial implementation of the ISCL algorithm.

Results: The selected cases fulfilled the clinical criteria proposed by the ISCL; routine histopathology allowed to reach the ISCL minimum score for a diagnosis of eMF in 45 cases.

The many faces of blue nevus: a clinicopathologic study.

Background: In recent years, several histopathologic variants of blue nevus have been identified, whose clinical and dermoscopic correlates need further clarification.

Methods: A comparative evaluation of histopathologic and dermoscopic features was carried out on 52 melanocytic proliferations belonging to the morphologic spectrum of blue nevus.

Results: On dermoscopy, all lesions showed a homogeneous, structureless pigment pattern, with a curious variety of colors (blue, white-blue, black, brown, and polychromatic).

The spectrum of Spitz nevi: a clinicopathologic study of 83 cases.

Objective: To achieve a clinicopathologic classification of Spitz nevi by comparing their clinical, dermoscopic, and histopathologic features.

Design: Eighty-three cases were independently reviewed by 3 histopathologists and preliminarily classified into classic or desmoplastic Spitz nevus (CDSN, n = 11), pigmented Spitz nevus (PSN, n = 14), Reed nevus (RN, n = 16), or atypical Spitz nevus (ASN, n = 14); the remaining 28 cases were then placed into an intermediate category (pigmented Spitz-Reed nevus, PSRN) because a unanimous diagnosis of either PSN or RN was not reached.

Setting: University dermatology and pathology departments and general hospital pathology departments.

"Compound blue nevus": a reappraisal of "superficial blue nevus with prominent intraepidermal dendritic melanocytes" with emphasis on dermoscopic and histopathologic features.

We describe 5 cases of "compound blue nevus" (CBN) ("superficial blue nevus with prominent intraepidermal dendritic melanocytes," "Kamino nevus"). Dermoscopically in 2 of 4 cases the bluish pigmentation characteristic of blue nevi was centrally replaced by a black lamella, with black dots and brown globules also observed in one case, thus revealing a structural asymmetry suggestive of melanoma. Histopathologically, pigmented parakeratosis was the underlying histopathologic finding of black lamella and dots/globules.

Post-apopletic trigeminal trophic syndrome.

Trigeminal trophic syndrome is an uncommon clinical entity in which cutaneous trophic ulceration develops with continuous manipulation of trigeminal dermatomes. Patients spontaneously refer picking, rubbing and/or scratching at the affected areas because of hypo-anaesthesia, paraesthesia and/or pain following damage of the sensory trigeminal fibres or nuclei. We herein describe a patient who developed the syndrome as a sequela of brain stem infarction.

Facial granulomatous diseases: a study of four cases tested for the presence of Mycobacterium tuberculosis DNA using nested polymerase chain reaction.

The histopathologic diagnosis of cutaneous tuberculosis (CTB) is often troublesome, because there are several other entities (tuberculids, demodicidosis, granulomatous rosacea, and acne agminata) that may display granulomatous inflammation with caseation necrosis. The current study describes four cases of granulomatous disease of the face. The final diagnosis (assessed on the basis of the clinical response to therapy) was CTB in three cases and granulomatous rosacea in one case.