of the International Dermoscopy Society, April 16-18, 2015, Vienna, Austria

134 Pages·2015·2.04 MB·English

by  Harald Kittler

DERMATOLOGY PRACTICAL & CONCEPTUAL
www.derm101.com
Abstracts from the 4th World Congress
of the International Dermoscopy Society,
April 16-18, 2015, Vienna, Austria
Citation: Abstracts from the 4th World Congress of the International Dermoscopy Society, April 16-18, 2015, Vienna, Austria. Dermatol
Pract Concept 2015;5(2):28. http://dx.doi.org/10.5826/dpc.0502a28
ORAL PRESENTATIONS carcinoma and basal cell carcinoma), as well as infectious
and genetic disease (storage diseases), could be evocated.
F : The detection of parasites (Demodex folliculorum) on eye-
ree communications
lids was possible. Confocal images correlated well with con-
c oct
onFocal and
ventional histopathology. The fluorescence examination of
corneal squamous cell carcinoma by VivaScope 1500 was
FC1-1 characterized by extravasation of fluorescein after intrave-
nous injection.
IN VIVO CONFOCAL MICROSCOPES DEDICATED
Conclusions: Confocal microscopes dedicated to the skin of-
TO THE SKIN FOR THE EXPLORATION OF THE
fer new perspectives for the diagnosis, optimization of treat-
OCULAR SURFACE: A NEW PERSPECTIVE FOR
ments, and follow-up of the ocular diseases. They will allow
DERMATOLOGISTS
dermatologists to examine conjunctival and eyelid tumors,
as it is for skin or genital mucosa. In addition, thanks to
Elisa Cinotti*1, Jean-Luc Perrot1, Bruno Labeille1, some adaptations of the dermatological device VivaScope®
Gilles Thuret2, Damien Grivet2, Philippe Gain2, 1500, it is possible for the first time to perform a fluorsecnte
Frédéric Cambazard1 examination of the ocular and peri-ocular tissue, opening a
new era in the clinical imaging of the ocular surface. A new
1Dermatology, 2Opthalmology, University Hospital of Saint-Etienne,
semiology remains to be learned.
Saint-Etienne, France
Background: In vivo confocal microscopy is an imaging
FC1-2
technique that has been applied to the study of the ocular
surface. However, confocal microscopes dedicated to eye PINK PLAQUES ON THE LEGS. THE ROLE OF
examination are routinely adopted only in ophthalmology
REFLECTANCE CONFOCAL MICROSCOPY
reference centres and do not allow an examination of peri-
ocular tissue, nor a fluorescence examination.
Ignacio Gómez Martín*1, Sara Moreno Fernández1,
Methods: We applied for the first time the two in vivo confo- Ramon M Pujol Vallverdú1, Sonia Segura Tigell1
cal microscopes commonly used in dermatology (VivaScope
® 1500 and 3000, CALIBER, distributed in Europe by Mavig 1Dermatology, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
GmbH, Munich, Germany) to observe the cornea, the bulbar
Introduction and Objectives: Pink plaques on the legs in el-
and tarsal conjunctiva, the eyelid margin, the lacrimal punc-
derly often represent a challenge for clinicians because of the
tum and the palpebral skin of healthy volunteers. Tumoral,
broad differential diagnosis. There is a great diagnostic vari-
inflammatory and infectious diseases of the ocular mucosa
ety of either tumoral and inflammatory diseases. The diagno-
and periocular skin from more than 200 patients were ob-
sis is complicated by the paucity of clinical and dermoscopic
served under the same microscopes. Both microscopes have
morphological clues and the existence of varying degrees of
a reflectance mode. VivaScope® 1500 allows an additional
xerosis, sun damage and venous stasis dermatitis. In addi-
fluorescent examination and its placement on the ocular sur-
tion, dermoscopic algorithms routinely used for pigmented
face was made possible by the creation of a special interface
lesions are not very helpful in the diagnosis of pink plaques.
between the microscope and the ocular apparatus.
Reflectance confocal microscopy (RCM) is a useful non-in-
Results: Thanks to its compact and flexible configuration, vasive complementary tool in the diagnosis of malignancy.
the handheld camera VivaScope® 3000 allowed to access The aim of our study was to describe the utility of RCM in
more easily to the ocular and periocular tissues. Diagnosis pink plaques on the legs in photodamaged skin and to cor-
of benign and malignant tumors (melanoma, squamous cell relate the findings with histopathology.
Supplement | Dermatol Pract Concept 2015;5(2):28 137
Materials and Methods: Prospective study of 47 pink plaques evaluated at 4 different moments up to the end of photo-
on the legs from 36 patients (10 males, 26 females, mean therapy.
age: 72 years (44-91)). A 4mm punch biopsy was performed
Results: Dermoscopy showed regression phenomena (with
in all cases. Clinical, dermoscopic and RCM images were
loss of structures such as network and dots/globules) and
stored and blindly evaluated for clinical, dermoscopic and
inflammatory features (such as dotted and fine telangiecta-
RCM diagnosis. Analysis of dermoscopic and RCM criteria
sic vessels and diffuse erythema). On RCM, predominantly
described in the literature and subsequent correlation with at the middle and end of protocol, the appearance of large
histopathology were also performed. dendritic cells within epidermis was observed, like real mela-
Results: 13 benign lesions (8 stasis dermatitis, 1 lichen pla- noma simulators. Immunohistopathology confirmed the
presence of activated melanocytes that could correspond to
nus, 1 viral wart, 1 scar, 1 neurofibroma, 1 lichen planus-like
the images seen on RCM. The presence of regression, mela-
keratosis) and 34 malignant neoplasms (20 basal cell car-
nophages and perivascular lymphocytic inflammatory infil-
cinoma (BCC), 14 Bowen’s disease) were analysed. A cor-
trate also corroborates the dermoscopy findings. Regarding
rect clinical diagnosis was established in only 38% of cases
the sunscreen protection role, we could verify nbUVB effects
(18/47). Dermoscopy following clinical assessment achieved
on both unprotected and protected halves, but more obvi-
49% (23/47) of correct diagnosis, whereas RCM evaluation
ously demonstrated on the unprotected halves.
after clinical and dermoscopic evaluation rendered a correct
diagnosis in 72% of cases (35/47). Conclusions: Benign melanocytic nevi can show features re-
sembling melanoma on RCM images when they are evalu-
Conclusions: Dermoscopic criteria of pink plaques on the legs
ated after repeated nbUVB sub-erythematogenic doses. This
are frequently not enough to set a proper diagnosis, due to
means that we have to be aware of RCM pitfalls, especially
lack of specific features. RCM may improve our diagnostic
in the context of recent UVR exposure, since these lesions
accuracy as a secondary evaluation after dermoscopy.
can simulate melanomas.
FC1-3
FC1-4
DOES PHOTOTHERAPY INDUCE MELANOMA
IN VIVO REFLECTANCE CONFOCAL MICROSCOPY
SIMULATORS? ROLE OF CONFOCAL MICROSCOPY
(RCM) OF MELANOTIC MACULES—KEY FEATURES
IN THE EVALUATION OF NEVI UNDERGOING NBUVB
AND IMPACT OF RCM ON NON-INVASIVE
IRRADIATION
DIAGNOSIS AND TREATMENT
Caroline M. Takigami*1, Mauricio Gamboa1, Marion Christine Prodinger*1, Martin Laimer1, Edith Arzberger2,
Chavez-Bourgeois1, Paula Aguilera1, 2, Llucia Alos 3, Clara Kirchner1, Rainer Hofmann-Wellenhof2,
Josep Malvehy2, 4, Susana Puig 2, 4, Cristina Carrera1, 4 Verena Ahlgrimm-Siess1
1Dermatology Department, Hospital Clínic de Barcelona, 2CIBER 1Dermatology, Paracelsus Medical University of Salzburg, Salzburg,
Enfermedades Raras, Instituto de Salud Carlos III, 3Pathology 2Dermatology, Medical University of Graz, Graz, Austria
Department, Hospital Clínic de Barcelona, 4Melanoma Unit,
Background: The distinction of melanotic macules and mel-
University of Barcelona, Barcelona, Spain
anoma is momentous but poses a major challenge in the
Background: Previous studies (1) have shown that UVR can daily routine due to overlapping clinical and dermoscopic
be responsible for inducing dynamic changes in nevi. Howev- features. Repeated biopsies and lifelong follow-up may be
er, further characterization of these likely dynamic and tran- necessary to rule out malignancy. RCM can assist ascertain
sient events are required. Reflectance Confocal Microscopy the diagnosis, by allowing visualization of the skin at nearly
(RCM) is a non-invasive in vivo imaging technique which histological resolution.
allows the evaluation over time of the same lesion obtaining
Objectives: The validity and reproducibility of RCM criteria
high sensitivity and specificity in cutaneous lesion diagnosis
for melanotic macules of mucocutaneous junctions (MCJ) is
(2). With this valuable tool, we could better recognize the
tested in order to evaluate the diagnostic value of RCM for
role of sunscreens in the prevention of these changes on nevi.
these lesions. Further the impact of RCM on lowering the
Objectives and Method: To make a comparative description excision rate of melanotic macules compared to clinical and
of the same nevi with and without sunscreen application dermoscopic evaluation alone is investigated.
over time, during narrow band UVB therapy, by means of Methods: A retrospective RCM image analysis of 39 pig-
dermoscopy and RCM. Patients who were programmed to mented macules (31 melanotic macules, 2 banal nevi, 4
receive nbUVB phototherapy for their underlying dermato- atypical nevi, 2 in situ melanomas) on genital (23) and labial
sis were included and submitted to the same irradiated nevi (16) MCJ was done by two groups of investigators blinded
protocol designed by Carrera et al (1). The selected nevi were to diagnoses, novices vs. expert. Both groups had to opt for
divided into two halves, one with and the other without sun- a differential diagnosis (melanotic macule or benign/atypi-
screen before nbUVB sub-erythematogenic repeated dose cal melanocytic skin lesion) and for a therapy (no treatment/
exposure. By means of dermoscopy and RCM, lesions were follow-up or biopsy) based on RCM image evaluation. The
138 Supplement | Dermatol Pract Concept 2015;5(2):28
procedures actually taken after dermoscopic evaluation and of clinically and dermoscopically equivocal lesions. We re-
decisions based on blinded RCM evaluation were compared. ported our experience in the use of RCM in differentiating
suspicious melanocytic lesions characterized by clinical and
Results: Melanotic macules displaying features of solar len-
dermoscopic features of regression, in parallel with histol-
tigines on non-glabrous skin (19%) were easily diagnosed
ogy. Our findings confirmed that RCM, although the specific
with RCM, whereas melanotic macules presenting dendritic
limitations of the technique, could be considered an adjunc-
cells at basal layer (81%) were sometimes impossible to dis-
tive diagnostic tool for second level examination of clinically
tinguish from melanoma. In sum, 77% (RCM group 1) and
and dermoscopically equivocal lesions with features of re-
87% (RCM group 2) of melanotic macules were correctly
gression, in particular for the differentiation of SNPF from
identified, with biopsy rates of 23% (group 1) and 13%
melanoma.
(group 2), respectively. Clinical-dermoscopic evaluation
yielded a correct diagnosis of melanotic macules in 39% of
cases and a biopsy rate of 61%. FC1-7
Conclusion: RCM criteria applied for melanotic macules are HANDHELD REFLECTANCE CONFOCAL MICROSCOPY
reliable and reproducible in a blinded evaluation, reflected AS A NON-INVASIVE DIAGNOSTIC TOOL IN
by the high conformity of investigators in this study. Non-
VESICOBULLOUS DERMATOSES
invasive RCM, as subsidiary diagnostic technique to dermos-
copy, is conducive to diagnose melanotic macules on MCJ,
Francesco Lacarrubba*1, Anna Elisa Verzì1,
since a significantly higher number of melanotic macules
Giuseppe Micali1
were correctly classified with RCM compared to clinical-der-
moscopic evaluation alone resulting in a lower biopsy rate.
1Dermatology Clinic, University of Catania, Catania, Italy
Vesicobullous dermatoses are characterized by intraepi-
FC1-6 dermal or subepidermal blistering resulting from different
mechanisms. The diagnosis is generally based on clinical
SCLEROSING NEVUS WITH PSEUDOMELANOMATOUS
examination and semi-invasive/invasive procedures such as
FEATURES VERSUS MELANOMA WITH REGRESSION:
cytology and histopathology. Reflectance confocal micros-
THE ADDED VALUE OF REFLECTANCE CONFOCAL copy (RCM) is a non-invasive technique for high-resolution,
MICROSCOPY in vivo imaging of the epidermis and upper dermis that is
mainly employed in the diagnosis of skin tumors. More re-
Alessandro Di Stefani*1 cently, it has been reported as a useful tool for in vivo assess-
ment of some inflammatory diseases. Our purpose was to
1Division of Dermatology, Association Columbus— establish the usefulness of RCM in the differential diagnosis
Catholic University of Sacred Heart, Rome, Italy of vesicobullous disorders. For this reason, a series of pa-
tients affected by blistering diseases, such as herpes simplex,
Benign melanocytic skin lesions may be difficult to differ-
herpes zoster, seborrheic pemphigus, Hailey-Hailey disease,
entiate from melanoma both clinically and dermoscopically.
bullous pemphigoid and porphyria cutanea tarda were eval-
One of the most confounding dermoscopic features, com-
uated using the handheld RCM device Vivascope® 3000 and
monly seen in melanoma but also in melanocytic naevi, is
the results were compared with conventional histopathology.
represented by regression. ‘Sclerosing nevi with pseudomela-
At the end of the study, a good correlation between RCM
nomatous features’ (SNPF) are a recently described clinico-
and histopathology was observed. RCM allowed in all cases
pathologic entity, which can closely simulate regressing
an easy identification of the blister spaces and of the split
melanoma. Those lesions are clinically characterized by a
levels and in some cases specific features were detected, such
whitish area and localized preferentially in the convex re-
as multinucleated giant keratinocytes in herpes infections
gion of the back, in young-adults individuals and are prob-
and acantholytic cells in seborrheic pemphigus and Hailey-
ably due to unnoticed trauma(s) on preexisting nevi. Dermo-
Hailey disease. In conclusion, although additional studies are
scopically SNPF display features of regression such as white
needed, our preliminary results show that RCM may play an
scar-like areas and blue peppering-like areas. From a histo-
important role in the differential diagnosis of vesicobullous
pathological point of view, SNPF are characterized by a tri-
diseases. The handheld device, which allows a rapid exami-
zonal pattern: (i) an atypical junctional proliferation associ-
nation of several skin lesions in real time, appears to be par-
ated with some pagetoid spreading, (ii) significant area(s) of
ticularly suitable for such evaluations.
dermal fibrosis/sclerosis containing architecturally atypical
melanocytic nests and (iii) residual nevus tissue (often with
congenital-like features) around and deep into the sclerotic FC1-8
tissue. The differential diagnosis between SNPF and regress-
EX VIVO FLUORESCENCE MICROSCOPY
ing melanoma is based mainly on histopathological ground,
while clinico-dermoscopically criteria often are not sufficient IN MOHS SURGERY
for accurate discrimination. In the recent years, several stud-
ies demonstrated that in vivo reflectance confocal micros- Caterina Longo*1, Moira Ragazzi1, Stefano Gardini1,
copy (RCM) can improve diagnostic accuracy for melanoma Giuseppe Argenziano1, Elvira Moscarella1,
and it seems particularly useful for second level examination Giovanni Pellacani2
Supplement | Dermatol Pract Concept 2015;5(2):28 139
1ASMN-IRCCS, Reggio Emilia, 2ASMN-IRCCS, Modena, Italy breast. Pigmented MPD is a rare variant which is very dif-
ficult to distinguish from melanoma. Although inflammatory
Background: Fluorescence confocal microscopy (FCM) is
or infectious diseases correspond to the majority of chronic
an emerging technology for rapid imaging of excised tis-
skin lesions of the nipple/areola, biopsies are usually per-
sue, without the need for frozen or fixed section processing.
formed in order to exclude a neoplastic process. Reflectance
Basal cell carcinomas (BCCs) and Squamous cell carcinomas
confocal microscopy (RCM) has gained increased relevance
(SCC) can be detected in Mohs excisions although few stud-
as a non-invasive, in vivo aid in such diagnostic challenges of
ies have described the major BCC and SCC-findings as seen
both inflammatory and tumoral skin diseases.
upon FCM and its diagnostic accuracy.
Objective: The aim of our study was to describe the RCM
Objectives: To describe the major BCC and SCC-findings of
features of MPP.
excised tissue during Mohs surgery and to correlate them
with histopathology and to assess diagnostic accuracy of Methods: A total of 5 lesions from 5 women (age range: 49-
FCM compared to frozen sections. 83 years) with histopathologically proven MPD were evalu-
ated by means of dermoscopy and RCM.
Methods: Eighty BCCs and 12 SCCs were prospectively col-
lected at our Skin Cancer Unit during Mohs surgery. Central Results: Four of the lesions presented as long-standing, itch-
section and 4 margins were scanned by ex vivo FCM (I° stag- ing, erosive, scaly, well-defined erythematous patches and
ing). In case of persistence of the tumor, a further staging (II° plaques on the mammilla. Dermoscopy showed pink struc-
staging) was performed. Each mosaic (corresponding to 1 tureless areas with diffuse glomerular, linear-looped and
margin) is assessed for the presence or absence of BCC/SCC. comma-like vessels within. The fifth patient, a 58-year old
After FCM imaging, all tissues were processed following the woman, presented with a fast-growing, partially pigmented
standard procedure for frozen sections. Sensitivity and speci- pink nodule on the left mammilla. Dermoscopy revealed
ficity of detecting residual BCC by means of FCM was ana- polymorphous vessels, milky-red areas and multiple irregu-
lyzed. A side-by-side comparison between FCM images and larly distributed brown-grey dots and globules. In all cases,
histologic stained sections was performed. RCM examination at the epidermal level enabled the visual-
ization of multiple, large atypical cells spreading in a paget-
Results: The majority of BCC belong to infiltrative subtype
oid fashion, separated from the surrounding structures by a
(87%). Distinct BCC types appeared unique in term of shape
black hollow, with loss of normal architecture. Histopathol-
and size of tumor islands (bigger in nodular, smaller and
ogy revealed nested or single atypical cells scattered through-
rounded in micronodular and tiny cords for infiltrative ones)
out the epidermis. Immunohistochemical analysis showed
and for the presence of clefting, palisading and increased
that these cells were positive for CK7, CEA and CAM 5. 2
nucleus/cytoplasm ratio. An excellent correlation was found
favoring the diagnosis of MPD. Further studies showed an
between FCM and histologic findings (Cohen’s Kappa sta-
association with intra-ductal carcinoma, except in the pig-
tistics = 0. 9). The sensitivity and specificity of detecting re-
mented MPD case where an invasive carcinoma was found.
sidual BCC was 89% and 96%, respectively. False negative
(10 cases) on FCM examination were found in sclerosing Conclusion: RCM enables a fast and non-invasive examina-
BCCs. False positive (5 cases) were due to the presence of tion of skin lesions in sensitive anatomical areas like the
sebaceous glands and adnexal structures that were misdiag- nipple and areola. Although the definitive diagnosis was
nosed as BCC islands. Twelve SCCs were collected belonging obtained by histopathology in all cases, RCM allowed an
to the poorly differentiated subtypes. in vivo differentiation from inflammatory skin diseases and
in the management decision. The exception was pigmented
Conclusions: FCM is a fast and new imaging technique that
MPD. RCM features of this rare variant were described, sup-
allows an excellent visualization of skin structures and BCC
porting its known diagnostic difficulties also due to close re-
and SCC-findings during Mohs surgery with a diagnostic
semblance with melanoma presentation.
accuracy that is similar to the “golden standard” of frozen
sections. Larger studies are needed to explore the diagnostic
accuracy for SCCs.
FC1-10
DISTINCTION BETWEEN NON-MELANOMA
FC1-9
SKIN CANCER TYPES BY IN VIVO REFLECTANCE
REFLECTANCE CONFOCAL MICROSCOPY IN THE CONFOCAL MICROSCOPY
DIAGNOSIS OF MAMMARY PAGET’S DISEASE
Malou Peppelman*1, Esther Wolberink1, Kim Nguyen1,
André Oliveira*1, Edith Arzberger2, Cesare Massone2, Lisa Hoogedoorn1, Willeke Blokx2, Peter van de Kerkhof1,
Iris Zalaudek2, Rainer Hofmann-Wellenhof2 Piet van Erp1, Marie-Jeanne Gerritsen1
1Department of Dermatology, Hospital Curry Cabral Centro 1Dermatology, 2Pathology, Radboudumc, Nijmegen, Netherlands
Hospitalar de Lisboa Central, Lisboa, Portugal, 2Department of
In vivo reflectance confocal microscopy (RCM) is a non-
Dermatology , Medical University of Graz, Graz, Austria
invasive imaging technique, which enables imaging of the
Background: Mammary Paget’s disease (MPD) is an intra- skin at a cellular resolution. Currently, RCM is mainly used
epidermal adenocarcinoma of the nipple and/or areola of the for diagnosis of melanoma and non-melanoma skin cancer
140 Supplement | Dermatol Pract Concept 2015;5(2):28
(NMSC). However, studies that focus on the distinction be- with HD-OCT. Observers classified each image as AK, SCC
tween (sub) types of NMSC are not performed. Therefore or normal skin based on the diagnostic algorithm.
the purpose of this study was to establish RCM features for
Results: A total of 106 (38 AKs, 16 SCCs and 52 normal skin
the subtypes of basal cell carcinoma (BCC), actinic keratosis
sites) 3D HD-OCT images from 71 patients were included.
(AK) and squamous cell carcinoma (SCC) in order to allow
Sensitivity and specificity were 81.6 % and 92.6% for AK
prospective diagnosis of NMSC types.
diagnosis, and 93.8% and 98.9% for SCC diagnosis. A mod-
Methods: 43 BCCs, 6 SCCs and 24 AKs were selected for
erate inter-observer agreement was demonstrated.
RCM imaging. For histological evaluation, a 3-mm punch
biopsy was obtained and stained with hematoxylin-eosin. Conclusion: HD-OCT represents a promising technology for
the non-invasive diagnosis of AKs. Thanks to its high poten-
Results: For the subtypes of BCC, it was demonstrated that
tial in discriminating SCC from AK, HD-OCT could be used
size and shape of the tumor nests, peripheral palisading,
as a relevant tool for second level examination, thus increas-
branch-like structures, fibrotic septa and increase of vascu-
ing diagnostic confidence and sparing patients unnecessary
lar diameter were characteristic RCM features for nodular
excisions. Combining the higher resolution of RCM with the
BCC and micro-nodular BCC. Size and shape of the tumor
higher penetration depth and 3D imaging of HD-OCT could
nests allows further distinction between nodular BCC and
further increase the diagnostic accuracy in the setting of field
micro-nodular BCC. Solar elastosis and the location of the cancerization.
tumor nest just below or in connection with the basal cell
layer characterizes superficial BCC. Architectural disarray
in the stratum granulosum, architectural disarray in the spi- FC1-12
nous layer and nest-like structures in the dermis were RCM
OPTICAL COHERENCE TOMOGRAPHY AND
features that were helpful distinction between SCC and AK.
DERMOSCOPY IMAGES OF NAIL TREATED WITH
Conclusion: This study presents distinctive RCM features
FRACTIONAL CO2 LASER
for AK, SCC, nodular, micro-nodular and superficial BCC,
which might allow in vivo diagnosis between NMSC types.
Chih-Hsun Yang*1, Meng-Tsan Tsai2
1Dermatology, Chng Gung Memorial Hospital, 2Electrical
FC1-11
Engineering, College of Engineering, Chang Gung University, Taipei,
DISCRIMINATION OF ACTINIC KERATOSIS FROM Taiwan, Province of China
SQUAMOUS CELL CARCINOMA AND NORMAL
Background: Fractional laser is widely applied in skin resur-
SKIN BY HIGH-DEFINITION OPTICAL COHERENCE facing by creating hundreds of microscopic wounds that ex-
TOMOGRAPHY tend into dermis without injuring surrounding tissue, there-
by allowing rapid healing. Recently, many studies have been
Alice Marneffe*1, Mariano Suppa1, Makiko Miyamoto1, focusing on the improvement of drug delivery and the utili-
Véronique del Marmol1, Marc Boone1 zation of fractional laser is seemingly promising. However,
the treatment outcome relies on several parameters such as
1Dermatology, Hôpital Erasme, Bruxelles, Belgium the penetration depth, the spot size of the optical beams and
the incident density of laser spots, which were hard to obtain
Introduction: Actinic keratoses (AKs) are common epi-
instantaneously and noninvasively in clinical practice. Opti-
dermal pre-neoplastic lesions that develop on chronically
cal coherence tomography (OCT) system provides real-time,
sun-damaged skin. Visible lesions are often associated with
high-resolution images that acts as a solution for the investi-
subclinical lesions on surrounding skin, which gives rise to
gation of photothermolysis induced by fractional CO laser.
field cancerization. While visual examination may fail to de- 2
tect subclinical or early invasive lesions, the realization of Objectives: The purpose of this study is to investigate the
depth of penetration, density and water diffusion process of
multiple biopsies would not be feasible. Thus, there is an
microscopic ablation spots by using OCT system and der-
increasing interest in non-invasive diagnostic tools, such as
moscopy.
reflectance confocal microscopy (RCM) and high-definition
optical coherence tomography (HD-OCT). In a previous Material and Methods: In this study, we used fractional CO
2
study, we developed a HD-OCT based diagnostic algorithm laser to induce microscopic ablation spots on the nail. OCT
for the discrimination of AK from SCC and normal skin. (1) was implemented for quantitative evaluation of induced mi-
The aim of this study was to test the applicability of HD- croscopic ablation spots. To further study the feasibility of
OCT for non-invasive discrimination of AK from squamous drug delivery, normal saline was dripped on the exposure
cell carcinoma (SCC) and normal skin using this algorithm. area of fingernail and the speckle variance OCT signal was
used to evaluate water diffusion process.
Material and Methods: Three-dimensional (3D) HD-OCT
images of histopathologically proven AKs and SCCs, along Results: The fingernails were exposed to fractional CO laser
2
with 3D HD-OCT images of clinically normal skin were col- with various exposure energies of 20, 30, 40, and 50 mJ and
lected. All 3D HD-OCT images were shown in a random the nails were examined under dermoscope, which shows
sequence to 3 independent observers, blinded to the clini- clearly demarcated cylindrical holes extending into the nail
cal and histopathological data and with different experience plate. The nails were sequentially scanned with OCT system
Supplement | Dermatol Pract Concept 2015;5(2):28 141
and the estimated depth in response to the aforementioned used as a relevant tool for second level examination, thus
exposure energy was 248μm, 290μm, 320μm, and 368μm, increasing diagnostic confidence and sparing patients unnec-
respectively. The penetration depth is proportionate to the essary surgery.
exposure energy. Subsequently, all treated nails were clipped
and underwent histologic examination. Results have found FC1-14
no difference between the depths of penetration obtained by
OCT versus histology section (p<0. 05), validating OCT as DIAGNOSTIC ACCURACY OF OPTICAL COHERENCE
an acceptable methodology for fractional CO laser depth TOMOGRAPHY IN DIAGNOSIS OF SUPERFICIAL
2
evaluation.
BASAL CELL CARCINOMA
Conclusions: This study illustrates the correlation of nail
morphology after fractional laser therapy through the utili- Hui Mei Cheng*1, Pascale Guitera1, 2
zation of OCT. OCT proved to be an effective tool in deter-
1Melanoma Institute Australia, North Sydney, 2Sydney Melanoma
mining the optimal laser treatment energy setting and water/
Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, Australia
drug delivery process.
Non-melanoma skin cancers (NMSC) are the commonest
cancer worldwide and incidence continues to rise in Austra-
FC1-13
lia. Basal cell carcinomas form the majority of NMSCs, and
VALIDATION OF A NEW HIGH-DEFINTION OPTICAL in the last decade noninvasive therapies have significantly
reduced excision rates. Non-invasive techniques are increas-
COHERENCE TOMOGRAPHY ALGORITHM FOR
ingly important for the diagnosis of superficial BCC which
BASAL CELL CARCINOMA DIAGNOSIS AND SUBTYPE
can be safely treated topically. The use of optical coherence
CLASSIFICATION tomography has previously been used to diagnose BCC. The
aim of this study was to investigate the diagnostic accuracy
Mariano Suppa*1, Alice Marneffe1, Makiko Miyamoto1, of optical coherence tomography (OCT) in the diagnosis
Véronique Del Marmol1, Marc Boone1 of superficial subtype of BCC in a clinical setting. Lesions
which were suspicious for superficial BCC were consecu-
1Department of Dermatology, Free University of Brussels, Erasmus
tively recruited in this prospective study. Clinical confidence
Hospital, Brussels, Belgium based on clinical and dermoscopic assessment was recorded.
Clinical and dermoscopic images were taken. OCT images of
In a previous study we provided a thorough description of
lesions and adjacent normal skin were acquired at baseline
three-dimensional (3-D) High-Definition Optical Coherence
visit. A 2mm punch biopsy of the lesion was taken. Interpre-
Tomography (HD-OCT) features that can permit discrimi-
tations of the OCT images were performed by 2 investiga-
nation of basal cell carcinoma (BCC) from clinical imitators
tors blinded to the biopsy results. Statistical analysis for the
and differentiation of BCC subtypes (superficial, nodular, and
study is pending. So far, 130 lesions were recruited, 52.3%
infiltrative). Based on these features a diagnostic algorithm
of the lesions were superficial BCC. Remaining lesions con-
was proposed. The aim of the present study is to validate the
sisted mainly of other subtypes of BCC (25.2%) and actinic
afore-mentioned HD-OCT algorithm for BCC diagnosis and
keratosis (8%). Sensitivity, specificity, positive predictive
subtype classification. To this purpose, 3D HD-OCT images
value, and negative predictive value for diagnosis of super-
of histopathologically proven superficial BCCs (sBCCs),
ficial BCC as well as other BCC, improvement of clinical
nodular BCCs (nBCCs) and infiltrative BCCs (iBCCs) were
confidence with OCT and interobserver agreement of OCT
collected, along with 3D HD-OCT images of clinical BCC
will be calculated. (Recruitment is ongoing till end 2014.)
imitators including actinic keratoses, compound and intra-
dermal nevi, amelanotic melanomas, sebaceous hyperplasias
and small haemangiomas. All 3D HD-OCT images were FC1-15
shown in a random sequence to 3 independent observers,
HIGH-DEFINTION OPTICAL COHERENCE
blinded to the clinical and histopathological data and with
TOMOGRAPHY ALGORITHM FOR DISCRIMINATION
different experience with HD-OCT. Based on the diagnostic
algorithm proposed; observers firstly classified each image OF BASAL CELL CARCINOMA FROM CLINICAL
as “BCC” or “BCC imitator.” Secondly, observers provided IMITATORS AND DIFFERENTIATION BETWEEN
a more detailed diagnosis for each of the two categories (for COMMON SUBTYPES
BCCs: sBCC, nBCC, iBCC; for BCC imitators: actinic kera-
tosis, compound nevus, intradermal nevus, amelanotic mela- Marc Boone*1, Mariano Suppa1, Giovanni Pellacani2,
noma, sebaceous hyperplasia, haemangioma). Herein we Alice Marneffe1, Makiko Miyamoto1, Ivette Alarcon3,
present the results of this study, including sensitivity, speci- Cristel Ruini2, Rainer Hofmann-Wellenhof 4, Josep
ficity, positive predictive value, negative predictive value, and
Malvehy3, Gregor Jemec5, Véronique Del Marmol1
inter-observer agreement by means of Cohen’s kappa for our
HD-OCT diagnostic algorithm for BCC. HD-OCT repre- 1Department of Dermatology, Free University of Brussels, Erasmus
sents a promising technology for the non-invasive diagnosis Hospital, Brussels, Belgium, 2Department of Dermatology, University
of BCC. Thanks to its high potential in detecting BCC and of Modena, Modena, Italy, 3Department of Dermatology, University
in discriminating between BCC subtypes, HD-OCT could be of Barcelona, Barcelona, Spain, 4Department of Dermatology,
142 Supplement | Dermatol Pract Concept 2015;5(2):28
University of Graz, Graz, Austria, 5Department of Dermatology, skin surface. In contrast, conventional histopathologic evalu-
Roskilde Hospital; Health Sciences Faculty, University of ation of the skin is based on vertical tissue sections that show
Copenhagen, Copenhagen, Denmark microscopic features and their interrelationships according
to their depth within the skin. The ability to similarly de-
Background: Preliminary studies have described morphologi-
pict the skin in the vertical plane during in vivo microscopic
cal features of basal cell carcinoma (BCC) imaged by High-
imaging poses several significant challenges with respect to
Definition Optical Coherence Tomography (HD-OCT) and
scanning speed and resolution.
suggested that this technique may aid in its diagnosis and
Objective: To develop a laser scanning multimodal micros-
management. However, systematic studies evaluating the ac-
copy system which combines RCM and MPM, and has the
curacy of HD-OCT for the diagnosis of BCC are lacking.
ability to achieve high resolution vertical “optical section-
Objective: The aim of this study is to identify three-dimen-
ing” of in vivo human skin at real-time. RCM and MPM
sional (3-D) HD-OCT features able i) to distinguish BCC
images can be obtained simultaneously thereby providing
from clinical BCC imitators and ii) to discriminate between
complementary morphological information.
the most common BCC subtypes. Based on these particular
Methods: The light source was a femtosecond laser with
features a diagnostic algorithm will be suggested.
pulse width of 130 fs. A resonant mirror was used for rapid
Methods: A total of 50 histopathologically confirmed BCCs X-axis horizontal scanning and a piezoelectric actuator was
(18 superficial, 19 nodular, 13 infiltrative) were imaged by used for Z-axis vertical scanning. An acoustic optical modu-
HD-OCT at the centre of the lesion prior to standard surgi- lator was integrated into the system to match the desired
cal excision and subsequent histopathological analysis. Fifty laser power at different imaging depths in real-time.
images of clinical BCC imitators were also retrieved as a
Results: Vertical section RCM and MPM microscopic im-
“pitfalls” group.
ages of normal human skin in vivo were obtained at half
Results: The simultaneous presence of grey/dark subepider- video rates (15 frames / second). Keratinocytes with dark-
mal (hemi-spherical) or intradermal lobulated structure(s) appearing nuclei, the dermal-epidermal junction, the dermal
presenting a typical cocarde feature in both HD-OCT modes collagen and elastic fibers, and dynamic intracapillary blood
was a significant feature for BCC diagnosis. Features dis- flow were readily seen. The imaging depth is about 200 µm,
criminating between BCC subtypes were location of the and the best axial resolution of the system is measured to be
roof of BCC lobules, vascular pattern of the papillary plexus 1. 1µm.
and stretching effect on the stroma. Clinical BCC imitators
Conclusions: This real-time laser scanning multimodal mi-
such as actinic keratosis, compound and intradermal nevi,
croscope could achieve high resolution vertical sectioning of
amelanotic melanoma, sebaceous hyperplasia and small hae-
human skin in vivo. It provides a new potential tool to non-
mangioma could be differentiated from BCC by means of
invasively assess the skin in health and disease.
HD-OCT.
Conclusion: This study provides a thorough description of
3-D HD-OCT features that can permit discrimination of FC1-17
BCC from clinical BCC imitators and differentiation of BCC
IN VIVO IMAGING OF SARCOPTES SCABIEI BY
subtypes. Based on these features a diagnostic algorithm is
REFLECTANCE CONFOCAL MICROSCOPY AND HIGH
proposed which requires additional validation, but enhances
current understanding of the morphological correlates of DEFINITION-OPTICAL COHERENCE TOMOGRAPHY
HD-OCT images in skin.
Makiko Miyamoto*1, Mariano Suppa1, Alice Marneffe1,
Véronique del Marmol1, Marc Boone1
FC1-16
1Department of Dermatology, Université Libre de Bruxelles, Hôpital
IN VIVO REAL-TIME CONFOCAL AND MULTIPHOTON
Erasme, Brusssels, Belgium
MICROSCOPY OF HUMAN SKIN IN THE VERTICAL
Scabies is a contagious skin infection caused by the mite Sar-
PLANE
coptes scabiei. The characteristic symptom is intensive pruri-
tus particularly at night induced by a delayed type hypersen-
Zhenguo Wu1, 2, Yunxian Tian1, 3, Jianhua Zhao1, 2,
sitivity response to the body, excretion, exuvia of the mite.
Harvey Lui1, 2, David McLean1, 2, Haishan Zeng*1, 2
In clinical routine, scabies is diagnosed based on patient’s
symptoms, clinical history and identification of mites or eggs
1Imaging Unit—Integrative Oncology, BC Cancer Reserach Centre,
by clinical examination and microscopy. Dermoscopy has
2Dermatology and Skin Science, 3Physics and Astronomy, University
been suggested as a useful tool in diagnosing scabies in vivo.
of British Columbia, Vancouver, Canada
More recently, Reflectance Confocal Microscopy (RCM)
Background: Reflectance confocal microscopy (RCM) and and High-Definition Optical Coherence Tomography (HD-
multiphoton microscopy (MPM) are non-invasive methods OCT) are used as non-invasive, real-time in vivo imaging
of acquiring morphological images of the skin in vivo. Most techniques. RCM provides images of horizontal skin sections
research in this area focuses on instruments that are config- with a 1-μm lateral resolution and a maximum depth of 250
ured for 2-D imaging in a horizontal plane parallel to the μm. HD-OCT allows the 3-dimensional imaging of the skin
Supplement | Dermatol Pract Concept 2015;5(2):28 143
by combining en face and cross sectional images with a 3-μm invasion (true negatives). In 1/18 cases HIS showed an area
resolution in both lateral and axial direction and a maxi- suspect for invasion which was not in concordance with
mum depth of 570 μm. Both RCM and HD-OCT can detect histological findings (false positive). Thus, HIS achieved the
Sarcoptes scabiei in vivo and can therefore be useful to diag- positive predictive value of 85.7% and negative predictive
nose and follow up scabies as well as to describe in real time value of 94.4%.
skin morphology within parasitized lesions where biopsy is
Conclusions: HIS offers a promising non-invasive tool for the
rarely performed. Herein we present the results of a study
detection of the dermal invasion in LMMs, and thus facili-
comparing images of Sarcoptes scabiei acquired through a
tates preoperative tumor staging.
dermoscopic digital device (Dermlite® DL III with Pigment
Boost), RCM (Vivascope®3000, MAVIG GmbH, Munich,
Germany) and HD-OCT (Skintell®, Agfa Healthcare).
F : d 1
ree communications ermatoscopy
FC1-18
FC2-1
HYPERSPECTRAL IMAGING IN DETECTING BASAL
EARLY DERMOSCOPIC CRITERIA OF MALIGNANCY
MEMBRANE INVASION IN LENTIGO MALIGNA
IN A BOY SUFFERING FROM XERODERMA
MELANOMA
PIGMENTOSUM
Noora Neittaanmäki-Perttu*1, Mari Grönroos2,
Leila Jeskanen1, Ilkka Pölönen3, Annamari Ranki1, Hans Schulz*1, Max Hundeiker2, Christian Hallermann3
Erna Snellman4, Olli Saksela1
1Private, Dermatology Research Center, Bergkamen, 2Dermatology,
1Department of Dermatology and Allergology, Skin and Allergy Skin Cancer Center Hornheide, 3Dermatology, Skin Cancer Center
hospital, Helsinki University Central Hospital, Helsinki, Hornheide, Medical University, Muenster, Germany
2Department of Dermatology and Allergology, Päijät-Häme Central
Objective: A Libyan boy suffering from xeroderma pigmen-
Hospital, Lahti, 3(3) Department of Mathematical Information
tosum since early childhood was 6 years old when he at-
Technology, University of Jyväskylä, Jyväskylä, 4Department of
tended our practice for the first time. Within the following
Dermatology, Tampere University and Tampere University Central
14 years, he developed multiple skin tumors: angiosarcoma,
Hospital, Tampere, Finland
keratoacanthoma, lentigo maligna, superficial spreading and
Background: Lentigo maligna melanoma (LMM) represents desmoplastic melanomas, squamous cell carcinomas, basal
the development of dermal invasion within a lentigo maligna cell carcinomas, and a probable leiomyosarcoma. Demos-
(LM), the most prevalent melanoma in situ. LM and LMM copy resp. epiluminescence microscopy led to early diagno-
form the most common melanocytic malignancies of the head sis and successful therapy every time. First clinical aspect:
and neck regions. Clinically, in situ LM and invasive LMM Mottled skin with dense hyper- and hypopigmented spots,
are difficult to distinguish. Preoperative tumor staging is cru- freckle-like lesions, telangiectases mainly in face, neck, arms
cial for determining the accurate treatment, i.e., resection and hands.
margins and possible need for sentinel lymph node biopsy. Method and Results: Within a course of 4 years, we observed
Objectives: To determine the accuracy of the hyperspectral tumor progression utilizing a retrospective follow-up of pho-
imaging system (HIS) in the detection of dermal invasion in tographs and within 1 year a prospective follow-up of der-
LMMs. moscopy resp. epiluminescence microscopy. The progression
of an initially unsuspicious grayish papule of 2.0mm on the
Methods: We used a novel HIS prototype developed by
left cheek was of special interest: Within 12 months, this le-
the VTT Technical Research Centre of Finland. The device
sion grew up to 3. 5 mm. Dermoscopic examination raised
detects the diffuse reflectance of visible and infrared light
the suspicion of a melanoma. Following excision, histology
within a large 12 cm2 field rapidly, in seconds. Automated
revealed a desmoplastic melanoma of 1. 65mm Breslow
computational analysis techniques provide abundance maps
thickness. Further small diameter tumors were detected on
representing the end-members of healthy skin and tumor
the basis of typical pattern modification with time by der-
area. Altogether 25 lesions on the head area clinically sus-
moscopy: a melanoma of 1.3 mm diameter with 0.34 mm
pected as LM or LMM were included, imaged in vivo and
Breslow thickness, an angiosarcoma of 2.6 mm diameter and
biopsied before surgical excision. Histopathology served as
2 basal cell carcinomas of 1.5 mm diameter.
the gold standard for the diagnosis.
Conclusion: Dermoscopic resp. epiluminescence microscopic
Results: Of the 25 lesions 18 were histologically confirmed
follow-up of small diameter skin lesions in patients with xe-
as LMs and seven invasive LMMs. The diffuse reflectance
roderma pigmentosum is suitable for the early detection of
spectra of LM and invasive LMM differed. The dermal inva-
developing malignant tumors and may contribute to a better
sion was seen as a separate clear white area in abundance
prognosis.
images in 6/7 of the LMMs (true positives). In 1/7 of the
LMMs, in which the dermal invasion was only 0.5mm in
Breslow thickness, the HIS did not reveal the invasion (false
negative). In 17 of 18 LMs HIS showed no suspicion for
144 Supplement | Dermatol Pract Concept 2015;5(2):28
FC2-2 Results: We found that 31 (8.7%) melanomas were associ-
ated with a nevus, 284 (79.5%) melanomas developed de
NEW DERMOSCOPY FEATURES OF MELANOCYTIC novo, and in 42 (11.8%) a preexisting nevus could not be
NEVI IN PATIENTS WITH VITILIGO excluded although the alternative explanation that the entire
lesion represents a melanoma was also possible. The pre-
Natalia Ilina*1, Natalia Pikelgaupt1, Irina Sergeeva1, 2 existing nevus had a congenital pattern in 27 cases (87%)
and the pattern of a Clark’s nevus in 4 cases (13%). In 149
1Medical, Novosibirsk State University, 2Laboratory of translational (41.7%) cases clinical and/or dermatoscopic images were
brain research, The Institute International Tomography Center of the also available. We found that in 16 (51.6%) melanomas that
Russian Academy of Sciences, Novosibirsk, Russian Federation developed in association with a nevus, the nevus was also
visible clinically or dermatoscopically. In general preexisting
Vitiligo is one of autoimmune disease that is often associated
nevi did not show signs of atypia clinically and/or derma-
with another autoimmune disorders like diabetes or auto-
toscopically. The median invasion thickness of . . . de novo
immune thyroiditis, and in pathogenesis of which there is
melanomas was 0.80mm in comparison to 0.85mm in mela-
an autoimmune reaction against melanocytes. The disease is
nomas in a preexisting nevus (p=0. 98). The frequency of in
characterized by depigmented patches, localized segmentally
situ melanomas was higher in . . . de novo group (n=114, 40.
or non-segmentally. However, there are not only depigment-
1% versus n=5, 16. 1%, p=0. 009). Patients with a melanoma
ed patches, but also depigmented hair. Halo nevi are strongly
in association with a nevus were younger (mean age=54. 9
associated with vitiligo, as well as multiple halo nevi are
years, SD:16.3) than patients with . . . de novo“ melanomas
common in patients with vitiligo. The aim of the study was
(mean age=68. 3 years, SD:14. 8 p<. 0001). There were no
to characterize dermoscopy features of melanocytic nevi in
significant differences between the two groups with regard
patients with vitiligo. In our research we have noticed anoth-
to the frequencies among males and females and anatomic
er features of melanocytic nevi in vitiligo-patients. Among
site. The median overall survival for patients with de novo
all patients with vitiligo the most common were acquired
melanomas was 7.6 years compared to 8. 9 years in the other
dermal and combined nevi that were located on the body
group (p= 0. 016). In multivariate survival analysis tumor
and extremities. Also halo nevi, multiple halo nevi, middle-
thickness and age were significant independent predictors of
sized congenital nevi have been observed. Dermoscopy char-
survival.
acteristics of which were structureless hypopigmented areas,
Conclusion: The majority of melanomas arise de novo. Mela-
globules and circles. The most interesting thing was that
nomas occur more often in association with a superficial and
circles were originally the globules, central part of which
deep“ congenital nevus than with a Clark’s nevus. Survival
were depigmented with time. In addition, depigmentation as
rate of patients with nevi associated melanomas is higher
dermoscopy feature was present in all melanocytic nevi in
because patients are younger but probably also because pa-
patients with vitiligo and moreover it was also seen in com-
thologists tend to overestimate the tumor thickness of mela-
bined nevi. In these combined nevi also it was noticed that
nomas in association with a nevus.
pigment network was fragmented and this network at the
periphery was seen like radial lines or pseudopods. In con-
clusion, important to notice that depigmentation in patients FC2-4
with vitiligo can be observed not only as skin patches, but
also as dermoscopy feature in melanocytic nevi, that is not DERMOSCOPIC FEATURES OF ACRAL MELANOMAS
any pathology nor any sign of dysplasia, but only the sign of IN A REFERRAL CENTER IN BARCELONA.
the autoimmune reaction against pigment.
PROGNOSTIC ROLE OF HISTOPATHOLOGIC SUBTYPE
FC2-3 Zamira Barragan*1, Alicia Barreiro1, Adria Gual1,
Alba Diaz2, Antoni Bennassar1, Susana Puig1, 3,
NEVUS ASSOCIATED VERSUS DE NOVO
Josep Malvehy1,3, Cristina Carrera1,4
MELANOMAS
1Dermatology, Melanoma Unit, 2Pathology, Hospital Clinic
Temeida Alendar*1, Harald Kittler1 Barcelona. Melanoma Unit. Dermatology Department, 3CIBER
Enfermedades Raras, Instituto Carlos III, 4Dermatology, Medicine,
1Department of Dermatology, Division of General Dermatology, University of Barcelona, Barcelona, Spain
Medical University of Vienna, Vienna, Austria
Introduction: Acral melanoma (AM) in our population is still
Aims: The aim of this study was to compare de novo melano- one of the most severe forms of melanoma, and is poorly
mas and melanomas in association with a nevus with regard characterized. Its prognosis is mainly affected by delay in
to morphology and prognosis. diagnosis, in part due to the fact that it can affect non-visible
areas on elderly people, but also because it is usually misdi-
Material and Methods: We included a consecutive series of
agnosed in early stages.
357 histologically verified melanomas, diagnosed between
January 1, 2005 and December 31, 2007. All histopathologic Method: Retrospective clinical-prognostic, dermoscopic and
specimens were reexamined and searched for remnants of histopathologic review of AM in a referral unit from 1986
associated nevi. to 2010.
Supplement | Dermatol Pract Concept 2015;5(2):28 145
Results: 75 cases were dermoscopically characterized within ing Cancer Center. In a timed session, 20 images were shown
a total series of 275 melanomas on hands and feet whose (10 in gray-scale and 10 in color), for which participants
outcome was reviewed (61% women; mean age of 56y, range blinded to the study objective rendered a diagnosis and as-
12-96). The most frequent location was on feet (83%), 60% sociated confidence level per image. An additional subset of
were ulcerated 20% achromic. Within the whole series, histo- 20 lesions was shown twice, in both gray-scale and color to
pathologically they consisted of acral lentiginous melanoma gleam insight into if there were particular lesions in which
(ALM) 57%, superficial spreading (SSM) 30%, and nodular color may help or hinder the diagnosis.
(NM) 6%. 24% were in situ melanomas whereas the mean
Results: There were 158 participants. In a parallel study de-
Breslow thickness of invasive cases was 3. 02mm. At the time
sign, participants correctly identified a higher proportion of
of consultation in our Unit all tumors showed dermoscopic
lesions viewed in gray-scale as compared to color (72.5%
features of malignancy. Dermoscopically multicomponent
vs. 57.9% correct answers, respectively), with an equiva-
global pattern was the most frequent (35%), parallel ridge
lent mean confidence level in gray-scale and color images
pattern could be identified in up to 50% of cases. More
(p=.50). The paired images showed that there were particu-
than 40% presented blue-whitish veil and streaks. All the
lar instances in which color either dramatically added to or
achromic tumors presented milky-red areas, and 70% dot-
diverted from the correct diagnosis. For example, when SKs
ted vessels (50% multiple atypical vessels), 40% remnants of
with a blue-white veil, and DFs with multiple colors were
pigment, and 40% chrysalides (shiny white streaks). Milky
shown in color, they were incorrectly classified as melano-
red areas, chrysalides and/or non-specific pattern were as-
ma, whereas the percentage that rendered a correct diagnosis
sociated to non-SMM subtype and higher Breslow (p<0. 01),
nearly doubled in gray-scale. On the other hand, “pink le-
with a negative predictive value of 97%. In the whole series,
sions” such as SCCs were difficult to diagnose in gray-scale.
after a mean follow-up of 55, 16 months prognostic factors
by multivariate analysis were age at diagnosis, Breslow, and Conclusion: The results indicate that for certain common
histopathologic subtype. ALM and NM presented a poorer cutaneous neoplasms, gray-scale dermoscopic images may
outcome than SSM (OR 10. 95, p0. 02). make pattern more conspicuous leading to improved diag-
nostic accuracy. Notable exceptions do exist including “pink
Conclusions: In our complete series of 275 AM, subtypes of
lesions” and vascular lesions. The place for gray-scale images
ALM and NM presented a poorer prognosis after been ad-
in either teaching versus in formal dermoscopic evaluation
justed by age and Breslow. Dermoscopy could help not only
should be investigated further.
to identify incipient and achromic tumors, but it could pre-
dict the histological subtype and Breslow, and therefore the
prognosis.
FC2-6
THE THOUSAND FACES OF SPITZ/REED NEVI
FC2-5
Pedro Zaballos*1, Giuseppe Argenziano2, Angel Pizarro3,
THE ROLE OF MORPHOLOGY AND COLOR IN
Jose Bañuls4, Luc Thomas5, Alex Llambrich6, Carolina
DERMOSCOPIC DIAGNOSIS
Medina7, Angel Vera8, Aimilios Lallas2, Iris Zalaudek9,
Shirin Bajaj*1, Cristian Navarrete-Dechent2, Michael A. Horacio Cabo10, Susana Puig11, Josep Malvehy11
Marchetti1, Stephen W. Dusza1, Ashfaq Marghoob1
1Dermatology, Hospital Sant Pau i Santa Tecla, Tarragona, Spain,
2Dermatology, Skin Cancer Unit, Arcispedale Santa Maria Nuova.
1Dermatology Service, Department of Medicine, Memorial Sloan
, Reggio Emilia, Italy, 3Dermatology, Clínica Dermatológica
Kettering Cancer Center, New York, United States, 2Department of
Internacional y Clínica Ruber, Madrid, 4Dermatology, Hospital
Dermatology, Facultad de Medicina, Pontificia Universidad Católica
Universitario de Alicante, Alicante, Spain, 5Dermatology, . Lyons
de Chile, Santiago, Chile
Cancer Research Center, Lyon, France, 6Dermatology, Hospital
Background: Expert dermoscopists largely rely on pattern Son Llatzer, Palma Mallorca, 7Dermatology, Hospital Universitario
analysis to make diagnoses. Novices may place more em- de Gran Canaria “Doctor Negrín.” , Gran Canaria, 8Dermatology,
phasis on color than on pattern, which can lead to incorrect Complejo Hospitalario Carlos Haya, Malaga, Spain, 9Dermatology,
diagnosis. We wanted to explore whether the use of gray- Medical Univeristy of Graz, Graz, Austria, 10Dermatology, Instituto
scale dermoscopic images would help to make patterns more de Investigaciones Médicas “A. Lanari,” Buenos Aires, Argentina,
conspicuous leading to improved diagnostic accuracy. 11Dermatology, Hospital Clinic de Barcelona, Barcelona, Spain
Objective: To evaluate diagnostic accuracy and confidence
Dermoscopy is a noninvasive and valuable method for im-
level for common melanocytic and non-melanocytic lesions
proving the diagnosis of Spitz and Reed nevi, also called
in gray-scale dermoscopic images.
spindle and/or epithelioid cell nevi, which are a special group
Methods: Forty dermoscopic color images [8 nevi, 8 seb- of melanocytic lesions with specific clinical and pathologi-
orrheic keratoses (SKs), 7 basal cell carcinomas (BCCs), 7 cal treats. A recent study, including 349 excised Spitz/Reed
melanomas, 4 hemangiomas, 4 dermatofibromas (DFs), 2 nevi, only 18% were correctly clinically diagnosed. The ob-
squamous cell carcinomas (SCCs)] were selected from a con- jective of this study is to collect and evaluate a large series
venience sample of photographed lesions. The study took of histopathologically proven cases of Spitz and Reed nevi
place during a dermoscopy course at Memorial Sloan Ketter- (more than 1000!), to describe their dermoscopic structures
146 Supplement | Dermatol Pract Concept 2015;5(2):28