Eccrine poroma: dermoscopical and confocal features of five cases

Background: Eccrine poroma (EP) is a rare benign adnexal tumor arising from the intraepidermal ductal portion of the sweat gland. It commonly occurs as a single, slowly growing, erythematous, skin-colored, cyanotic or pigmented papule, plaques or nodule. EP occurs usually at the acral sites, but it can develop in other cutaneous sites. It may occasionally mimic malignant tumors including basal cell carcinoma, squamous cell carcinoma and melanoma. Objective: The aim of this study was to describe dermoscopical and confocal features of EP. Methods: A retrospective analysis of the dermoscopical and confocal characteristics of EP was performed. All diagnosis were confirmed by histological examination. Results: A total of 5 cases of non-pigmented EP was analysed. Dermoscopic evaluation found in all lesions a polymorphous vascular pattern, including at least two type of vessels: hairpin (80%), linear (60%), leaf-like (60%), flower-like (40%) and glomerular (40%) vessels. A white-to-pink halo surrounding the vessels was found in 40% of the lesions. Multiple pink-white structureless areas were found in 4 out of 5 (80%) cases. Only in 2 cases irregular haemorrhagic and blue-white areas were also observed. Reflectance Confocal Microscopy (RCM) revealed the presence of well-demarcated hyporefractile tumor nests, dark holes corresponding to areas of ductal differentiation within the tumor and highly vascularized stroma in all 5 lesions. Conclusions: The great clinical variability of EP gives reason of the appellative of “big simulator”. Dermoscopy does not revealed univocal features except from “leaf-flower-like” vessels that have not been described in other types of skin tumors. This characteristic, when presents, may be considered an useful clue for the diagnosis. RCM examination of EP revealed features (hyporefractile tumor nests and dark holes) that relate with their histopathological findings. Dermoscopy and RCM improve the diagnostic accuracy and help for diagnosis, although they cannot replace histology that is still required

Role of in vivo reflectance confocal microscopy in the analysis of melanocytic lesions

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“Lambs” in wolves’ clothing: when basal cell carcinoma mimics melanoma, but it is detected by the use of reflectance confocal microscopy

Background Basal cell carcinoma (BCC) is the most frequent non-melanoma skin cancer. There are some cases in which clinical and dermoscopic examinations do not allow to formulate a unique diagnosis and in particular can be difficult the differential diagnosis with melanoma. Reflectance confocal microscopy (RCM) is a non-invasive technology, which allows an in vivo imaging of the skin with high resolution. Objectives We addressed our research to evaluate the reliability of the well-known RCM criteria for classic BCCs in a group of lesions with atypical dermoscopy presentation, possibly mimicking melanoma. Methods We retrospectively analyzed at RCM excised lesions presenting in dermoscopy ≥1 score at revisited 7-point checklist. The study population consisted of 177 cases showing no melanocytic RCM findings. Lesions were investigated for distinct non-melanocytic RCM features, while blinded from histopathology. Histopathology matching was performed before statistical analysis. Results Among the lesions classified at RCM with no-melanocytic characteristics, we recognized 34 cases, histopathological confirmed as BCCs (21 nodular BCCs and 13 superficial BCCs) and 143 cases classified as other lesions (DFs, SebKs, SCCs and others). The main features of nBCCs (with histopathological confirm) at RCM are peritumoral clefts (20/21 95,2%; p=0,037), peripheral palisading (19/21 90,5%; p=0,001), increased vascularization (20/21 95,2%; p=0,004). In sBCCs we found mild keratinocytic atypia (13/13 100%; p=&lt;0,001), solar elastosis (12/13 92,3%; p=0,002), cords connected to epidermidis (9/13 69,2%; p=&lt;0,001). Dendritic structures, nests of basaloid cells, inflammatory infiltrate can be seen in all tumors. Conclusions RCM classification proved high agreement with histopathology for BCCs with atypical dermoscopy presentations, allowing an early differential diagnosis and even identification of BCCs subtypes. RCM features in this group of lesions were similar to those described for typical cases of BCCs, and may drive clinicians decisions, helped them in the recognition of melanocytic and non melanocytic lesions, increasing the rate of accurate diagnoses and allowing better therapeutic management

Pseudoxanthoma elasticum and reflectance confocal microscopy: report of two affected young sisters

Pseudoxanthoma elasticum (PXE) is a rare inherited multisystem disorder that mainly affects skin, eyes and cardiovascular system. The associated clinical signs are due to progressive calcification of elastic fibres and blood vessels, despite normal levels of calcium and phosphorus in blood and urine. The first clinical description of the disease was done in 1881 by Rigal, and in 1896 it was named PXE by Darier. Transmission of the disease is autosomal recessive. PXE is caused by homozygous or compound heterozygous mutations in the ATP-binding cassette subfamily C member 6 (ABCC6) gene, which encodes a transmembrane transport ADP-dependent protein (MRP6). The gene is expressed predominantly in the liver and kidney, and found in low level in the tissue involved by PXE. The clinical expression of PXE is heterogeneous with considerable variation in age of onset, progression and severity of the disease, even in individuals of the same family with identical mutations. We present the case of two young sisters affected by PXE and the correlation between the histopathology and the reflectance confocal microscopy (RCM). Parents and brother carry one copy of the mutated gene, without showing signs and symptoms of the disorder. We report the main clinical aspects of PXE and we highlight the importance of early diagnosis of the disease for adequate therapeutical management of associated complications

Osservazioni dermoscopiche ed in microscopia laser confocale sul poroma eccrino: la nostra casistica

Il poroma eccrino è una neoplasia benigna che clinicamente può simulare molteplici lesioni cutanee sai benigne che maligne. Le immagini dermoscopiche ed in microscopia laser confocale di cinque poroma eccrini non pigmentati, istologicamente provati, sono stati esaminate da due valutatori indipendenti. Le caratteristiche dermoscopiche più frequentemente osservate sono state il pattern vascolare polimorfo (100% dei casi) e le aree prive di struttura rosa-biancastre (80% dei casi). L’esame alla microscopia laser confocale ha evidenziato nei cinque casi di poroma nidi iporiflettenti ben demarcati circondati da abbondante stroma, assenza di cellule con disposizione a palizzata e “dark holes” corrispondenti ad aree di differenziazione duttale. L’integrazione delle caratteristiche clinico-dermoscopiche con l’osservazione alla microscopia laser confocale risulta utile nella diagnosi differenziale del poroma eccrino con altri tumori cutanei e nella sua corretta gestione terapeutica, sebbene la diagnosi definitiva resta affidata all’esame istologico che rimane imprescindibile nei casi dubbi

Permanent implants for lip augmentation: Results from a retrospective study and presentation of tips and tricks

Introduction: Lip augmentation request is increasing. Nowadays, several techniques to obtain temporary effects are available. On the other hand, permanent results can be reached through lip prosthesis implantation. This procedure represents an innovation in the field of aesthetic medicine and surgery. Material &amp; Methods: A total of 110 women with atrophic or hypoplastic lips were treated with lip implants. The treatment was performed in a single session and controls were scheduled at fixed time intervals. A standard digital photo was used for measurement and analysis. Data concerning patient satisfaction and complications of the technique were collected and analysed. Variations to the original technique were also considered. Results: Patient evaluation revealed that a permanent and natural result without discomfort for the patient and/or the partner was reached with the implantation of silicone prosthesis in the upper and/or lower lip. Swelling, bruising, and malpositions were the most frequent adverse events. A case of severe edema was reported. Practical tricks acquired through experience were analysed to prevent complications. Conclusions: The request of permanent results for lip augmentation allowed the development of silicone prosthesis. Advantages of this prosthesis are: safety, definitive result, and reversibility considering the possibility to remove the implanted prosthesis in case of request

Improving the aging of the neck: combined treatments

INTRODUCTION, OBJECTIVES, PURPOSE OF THE STUDY The request for less aggressive procedures to treat skin laxity of face and neck is increasing. Only a few approaches are available for aesthetic treatments of the neck. Several factors are known to be involved in aging process: skin laxity and photodamage, fat tissue deposition, variation of muscle tone. MATERIALS AND METHODS Clinical evaluation of the patient. Classification and selection of the patient and targeted therapies: from microbotox, bio-stimulation, high intensity focused ultrasound to traction thread. Inclusion criteria: people aged &gt;18 years old; moderate skin laxity and horizontal wrinkles of the neck. Exclusion criteria: severe diseases; skin laxity showing a high grade of severity and severe fat tissue deposition. Different treatments in multiple sessions. Controls at T0 + T30 + T90. Measurement and analysis: standard digital photo. Evaluation of results and satisfaction of patients. RESULTS The targeted approach focused on the correction of specific expressions of the ageing of the neck, showing a variable grading, is effective. The association of target therapy results to satisfy patient expectations. CONCLUSIONS In the field of aesthetic medicine we have available various techniques such as microbotox, bio-stimulation, high intensity focused ultrasound and traction thread. One treatment does not exclude the others. The combination of the two treatment it is possible to optimize the results. The targeted treatment and an appropriate selection of patients are essential to reach satisfactory results in the treatment of imperfections related to the process of ageing of the neck

Skin above the knees: treatments for a difficult area

INTRODUCTION, OBJECTIVES, PURPOSE OF THE STUDY The interest for non-invasive techniques for skin rejuvenation is increasing. However, lax skin above the knee is often forgotten. As a matter of fact, there were not so many options for its treatment. The aim of our study is to present the application of selected rejuvenation techniques and to define their efficacy and safety. MATERIALS AND METHODS Clinical evaluation of the patient. Classification and selection of the patient and targeted therapies: from calcium hydroxyapatite to microfocused ultrasound. Inclusion criteria: people aged &gt;18 years old; skin laxity. Exclusion criteria: severe diseases and severe skin laxity. Treatment in single or multiple sessions. Controls at T0 + T30 + T90. Measurement and analysis: standard digital photo. Evaluation of results and satisfaction of patients. RESULTS The targeted approach focused on the correction of specific morphologic variations of the skin above the knee, showing a variable grading, is effective and able to satisfy patient expectations. The treatment was well tolerated; we reported only a few adverse events: local reactions (erythema, oedema, swelling). All these effects last few days. CONCLUSIONS The treatment of the skin above the knee is challenging. Our protocols have shown good results in this difficult area and a good tolerability profile. A good selection of patients is mandatory in order to achieve the best result

Management of patients with giant basal cell carcinoma during SARS COV2 outbreak in italy

Basal cell carcinoma (BCC) is the most frequently occurring type of all cancers, and represents 80% of all skin cancer. The estimated lifetime risk for BCC in the white population is between 33% and 39% for men and 23% and 28% for women. Its incidence doubles every 25 years and is increasing in the young population. Death is uncommon and seems to decrease in the last years, probably due to early and better diagnosis. BCC arises from abnormal and uncontrolled growth of basal cells. It is a slow-growing tumor, therefore usually curable at an early stage with surgery or alternative treatment, such as cryotherapy, laser, photodynamic therapy, retinoids and topical agent like 5-Fluorouracil cream, imiquimod cream, and so forth. Topical treatment of superficial basocellular carcinoma is a viable option, when surgery is not an advisable treatment, especially in the case of giant basocellular carcinoma. In this subtype, imiquimod 5% cream can be a safe and effective treatment, but there are few reports in available literature. We present our case series of eight patients with superficial giant basocellular carcinoma successfully treated with imiquimod 5% cream, which showed clinical improvement after 8 weeks of treatment