Vrijednost trihoskopije u dijagnostici primarnih ožiljnih alopecija

Primary cicatricial alopecias (PCAs) are a rare and poorly understood group of disorders that result in replacement of pilosebaceous unit with fibrous tissue which leads to permanent hair loss and therefore significantly affects the quality of life. The aim of treatment, currently, remains to reduce symptoms and to slow or stop PCA progression, namely the scarring process. Early treatment is the key to minimizing the extent of permanent alopecia. The diagnosis and therefore treatment are based on the Classification of scarring alopecia created by a group of experts from the North American Hair Research Society (NAHRS) at a meeting organized in February 2001. The classification is based on a clinical picture and a pathohistological analysis of the biopsies from the active phase of the disease. Scalp biopsy is the key diagnostic test for diagnosis of PCA because it determines the dominant inflammatory infiltration in active phase of the disease. However, pathohistological interpretation of scalp biopsy can be a major challenge for the pathologist, especially in the absence of detailed anamnesis, inadequate samples, inadequate tissue cuts and an inadequately chosen biopsy site. Although it is known that the biopsy should be taken from the edge of the active lesion, not all the follicles on the edges of the lesion are affected by the disease, especially at the early stage, when the changes are barely visible to the naked eye. Tools to increase the diagnostic accuracy of scalp biopsy are needed. The hypothesis of this study is that the trichoscopy is useful in determining the optimal site for scalp biopsies in primary scarring alopecia, thereby increasing the probability of exact pathohistological diagnosis. This study investigated the pathohistological interpretation of 60 primary scarring alopecia, of which 30 were taken from the edge of the lesion and the site was chosen by the naked eye, and in 30 cases the biopsy was guided with dermatoscope. Based on the results of the study it can be concluded that the examination and dermoscopy guided biopsy increases the probability of an exact histopathological diagnosis by 48% compared with examination and biopsy without dermoscopy. The results of additional analyzes showed that there is a good potential of trichoscopy to completely rule out the need for biopsy in terms of confirmatory diagnosis LPP and DLE. To conclude, the results of our study confirmed the important role of trihoscopy in determining the biopsy site in order to confirm the diagnosis of primary scarring alopecia. In addition, the results indicate a clear potential of trihoscopy as a possible diagnostic and not just auxiliary method

Kemijski pilinzi – kada i zašto?

Chemical peels are growing in popularity with new agents, formulas and methods giving them greater reliability and safety. Although the operative procedure may seem relatively simple, proper knowledge and skills of the physician and education of the patient is crucial. It is very important for the physician to know chemical structure of the peels, level of necrosis they make in the skin, indications, absolute and relative contraindications, side effects and complications. It is also very important to evaluate the patients, their needs and their expectations, and to present them objective possibilities of the procedure. In chemical peels and their efficacy, preoperative and postoperative care plays an important role, which is out of the reach of the physician and therefore should be emphasized in consultation with the patient.Kemijski pilinzi zauzimaju sve značajnije mjesto u estetskoj kozmetologiji. Velikom zanimanju za ove zahvate doprinosi visoka učinkovitost, relativna jednostavnost postupka, dostupnost, relativno malo nuspojava i komplikacija. Kako bi se postigao što bolji učinak kemijskog pilinga potrebna je obostrana angažiranost klijenta i liječnika. Liječnik treba znati sve o kemijskoj podlozi pilinga, stupnju nekroze koji pojedini piling izaziva u koži, indikacijama i kontraindikacijama te nuspojavama i komplikacijama. Prilikom prijeoperacijskih konzultacija važno je dobro procijenti klijenta, ne samo vrstu njegove kože već i njegova očekivanja od samoga postuka te ga upoznati s objektivnim mogućnostima istoga. Također je važno naglasiti i značenje prijeoperacijske i poslijeoperacijske njege, što je isključivo u rukama klijenta

Lentigo Maligna Melanoma – the Review

Lentigo maligna melanoma (LMM) is a slowly growing tumor of elderly white population. It typically develops on chronically sun-exposed skin of the head and neck area which indicates that the cumulative exposure to the UV radiation has crucial role in the development of LMM. Precursor lesion is lentigo maligna (LM) which commonly presents as an irregular brownish pigmented macular lesion persisting for years. Women are affected more often as men by LMM, with the average age of over 60 years. The age of onset has dropped over the past years and this tumour is nowadays also diagnosed in 40-year-old individuals. However, the incidence rate increases with age and peaks in the seventh and eighth decades of life. The prognosis for invasive lentigo maligna melanoma does not differ from that for other histogenetic types of melanoma after controlling for tumour thickness. The diagnosis and treatment of LMM remain challenging. In this presentation, we review the epidemiology, clinical presentation, histopathology, and treatment of LMM

Trends, Habits and Attitudes towards Suntanning

Epidemiological studies suggest a relationship between suntanning habits and high risk of malignant melanoma (MM). The incidence of MM is increased during the last 40 years. Sun exposure is highly prevalent in all age groups, especially among young and it is influenced by certain believes and attitudes towards suntanning and stimulated by peer pressure and aesthetic references. What is the cause of higher incidence of MM? Is it only trend and attitudes towards suntanning? A prototype of a young female of 21st century is attractive, slim, with bronze complexion, dresses in the bathing suit, whereas the lady of the 19th is pale, dressed in white dress and with hat or sunshade that protects face and hair from the sun. When did social mores and medical knowledge about sun exposure change? A critical interplay occurred between the end of 19th century and the start of the 20th century with significant success of phototherapy and the growing popularity of sunbathing which reflected number of social changes. During the same time of invigoration of sun exposure, appeared the first reports about correlation between sunlight and skin cancer, but without significant repercussion on medical profession and therefore without knowledge of the public. The 1920s and 1930s were highlighted with the great discovery that ultraviolet wavelengths less than 313 nm played the role in vitamin D synthesis which prevents rickets. Numerous other medical benefits were soon attributed to the sunlight. Finally, the cancerogenity of UV light came to attention when scientist succeeded in induction of skin cancer in rodents after UV light exposure. The etiology of sunlight in development of skin cancer was mentioned in scientific articles and public magazines in 1940s and 1950s. Over the decades the message that sunlight exposure leads to increased risk of skin cancer, reach the public. But despite the knowledge, even at present people believe that tan person looks healthier. Additional and continuous educational campaigns are needed for changing people’s behavior

Nevus Spitz – Everlasting Diagnostic Difficulties – The Review

In 1910, Darier and Civatte described in details an unusual melanocytic tumor characterized by rapid growth on the nose of a young child. They could not state whether the tumor was benign or malignant. In 1947, Sophie Spitz described the same lesion as juvenile melanoma in which prognosis was frequently excellent. Later, the study was revised and it was concluded that juvenile melanoma was a benign tumor and can affect adults. Although, the prognosis was mostly excellent, Spitz reported in one of 13 cases fatal metastases from nevus Spitz. In 1999, Barnhill et al described one fatal case of the patient for whom it was thought to have typical Spitz nevus. Nowadays, there is still a lack of consensus about histopathology and also a terminology of the tumors that are neither typical nevus Spitz, neither malignant melanoma. All histopathological, clinical and ancillary criteria must be weighed in the final interpretation of epitheloid/spindle cell lesion. At the present, the final diagnosis remains pathohistological, with important emphasis given to clinical impression. Persistently changing lesion indicates malignancy potential of the lesion. Barnhill recommends that all Spitz tumors are completely excised. Atypical tumors should be excised with wider margins up to 1 cm. Patient should be carefully monitored by regular examinations for recurrence and metastasis

Melasma – Updated Treatments

Melasma is a common, acquired facial skin disorder, mostly involving sun-exposed areas like cheeks, forehead and upper lip. Melasma occurs in both sexes, although almost 90 percent of the affected are women. It is more common in darker skin types (Fitzpatrick skin types IV to VI) especially Hispanics/Latinos, Asians and African-Americans. The onset of the melasma is at puberty or later, with exception of darker skin types, who tend to develop this problem in the first decade of life. The etiology is still unknown, although there are a number of triggering factors related to the onset of melasma. The most important are sun-exposure and genetic factors in both sexes, while hormonal activity has more important role in females. In addition, stress and some cosmetic products and drugs containing phototoxic agents can cause outbreaks of this condition. Melasma should be treated using monotherapies or combination of therapy, mainly fixed triple or dual combinations containing hydroquinone, tretinoin, corticosteroids or azelaic acid. Modified Kligman’s formula is also very effective. Above mentioned therapy regimens in combination with UVA and UVB blocking sunscreens are mostly effective in epidermal melasma. Discontinuation of the use of birth control pills, scented cosmetic products, and phototoxic drugs coupled with UV protection are also benefitial in clearing of melasma. Alternative treatment including chemical peels and glicolic acid, seem to have the best result as a second line treatment after bleaching creams. Laser treatments show limited efficacy and should rarely be used in the treatment of melasma. Combining topical agents like hydroquinone, tretinoin and a corticosteroid in addition to sun avoidance, regular use of sunscreen throughout the year and patient education is the best treatment in this difficult to treat condition

Melasma – Updated Treatments

Melasma is a common, acquired facial skin disorder, mostly involving sun-exposed areas like cheeks, forehead and upper lip. Melasma occurs in both sexes, although almost 90 percent of the affected are women. It is more common in darker skin types (Fitzpatrick skin types IV to VI) especially Hispanics/Latinos, Asians and African-Americans. The onset of the melasma is at puberty or later, with exception of darker skin types, who tend to develop this problem in the first decade of life. The etiology is still unknown, although there are a number of triggering factors related to the onset of melasma. The most important are sun-exposure and genetic factors in both sexes, while hormonal activity has more important role in females. In addition, stress and some cosmetic products and drugs containing phototoxic agents can cause outbreaks of this condition. Melasma should be treated using monotherapies or combination of therapy, mainly fixed triple or dual combinations containing hydroquinone, tretinoin, corticosteroids or azelaic acid. Modified Kligman’s formula is also very effective. Above mentioned therapy regimens in combination with UVA and UVB blocking sunscreens are mostly effective in epidermal melasma. Discontinuation of the use of birth control pills, scented cosmetic products, and phototoxic drugs coupled with UV protection are also benefitial in clearing of melasma. Alternative treatment including chemical peels and glicolic acid, seem to have the best result as a second line treatment after bleaching creams. Laser treatments show limited efficacy and should rarely be used in the treatment of melasma. Combining topical agents like hydroquinone, tretinoin and a corticosteroid in addition to sun avoidance, regular use of sunscreen throughout the year and patient education is the best treatment in this difficult to treat condition

Multiple Primary Melanoma: Epidemiological and Prognostic Implications; Analysis of 36 Cases

Patients who are already diagnosed with cutaneous melanoma are at increased risk of developing another primary melanoma. The occurrence of multiple primary melanoma is a rare phenomenon, varying in frequency, with an estimated incidence ranging from 0.2% to 8.6%. The authors are presenting data on the patients with multiple primary melanoma from the Croatian Referral Melanoma Centre. The clinical, histological and epidemiological characteristics of 36 (3.6%) patients, identified from 991 patients with histologically confirmed melanoma, are analyzed in this study. Twenty-eight of the patients (78%) had two primary melanomas, six had three melanomas (16,7%) and two (5,6%) had four melanomas. Diagnosis was established synchronously in 11 patients (30%) and, in the rest of the patients, time interval between the diagnosis of the first and second melanoma varied from 1 month to the longest interval of 16 years. However, the majority of subsequent melanomas were removed within 2 years of the initial operation. The mean Breslow’s thickness of the first melanoma was significantly higher than the mean Breslow’s thickness of the second primary melanoma. The proportion of in situ to invasive melanomas was greater for the second melanomas compared with the first melanomas. Therefore, we emphasize the importance of regular follow-up as well as the education in regular self-skin examinations in melanoma patients in order to detect subsequent primary melanomas in the early phase

Senile Lentigo – Cosmetic or Medical Issue of the Elderly Population

Senile lentigo or age spots are hyperpigmented macules of skin that occur in irregular shapes, appearing most commonly in the sun- exposed areas of the skin such as on the face and back of the hands. Senile lentigo is a common component of photoaged skin and is seen most commonly after the age of 50. There are many disscusions on whether senile lentigo represents a melanoma precursor, namely lentigo maligna melanoma and, if there is a need for a regular follow up in cases of multiple lesions. Clinical opservations sometimes report that in the location of the newly diagnosed melanoma, such lesion preexsisted. On contrary, some authors believe that senile lentigo represents a precursor of seborrheic keratosis, which does not require a serious medical treatment. However, the opservation of the possible association of senile lentigo with the melanoma development makes us cautious in the assessment of this lesion. Histologically, there are elongated rete ridges with increased melanin at the tips, and the number of melanocytes is not increased. The dermatoscopic features are also distinctive. If the lesion becomes inflammed it may evolve into benign lichenoid keratosis. Cryotherapy and laser treatment are common therapeutic approaches. Sun protection creams may be useful in early lesions

Ten-Year Study on the Correlation of Clinical and Patohistological Diagnosis of Dysplastic Nevi

The aim of the study was to analyze the clinical prevalence and pathohistological correlation of dysplastic nevi. In the period between 2000 and 2009, in the Outpatient Clinic of Referral Centre for Melanoma of the Ministry of Health and SocialWelfare of the Republic of Croatia, 12,344 patients were examined, and 35.07% of them were surgically removed in the same institution. Among the patients, 69.16% had clinically diagnosed melanocytic tumor. Out of them, 28.39% were dysplastic. Dysplastic nevus was pathohistologically diagnosed in 20.02% of pathohistologically diagnosed melanocytic tumors. There was women predominace among patients with clinically diagnosed dysplastic nevi (65.22%). The most frequent localization was the trunk in both sexes, women 78.18%, men 76.75%. The coincidence of clinical and pathohistological diagnosis of dysplastic nevus was 30.70%. The results of this study, based on a large number of patients could be a significant contribution in understanding characteristics of dysplastic nevus, its clinical and pathohistological complexity. We hope that the data will contribute to the creation of general accepted protocols in the diagnostics of dysplastic nevus