Queilitis granulomatosa de Miescher

La queilitis granulomatosa es un raro proceso de etiología desconocida que se considera una forma oligosintomática del síndrome de Melkersson-Rosenthal. En este artículo presentamos un caso y hacemos una revisión de los procesos granulomatosos en la región oral, los procesos que cursan con hinchazón labial y del tratamiento de la queilitis granulomatosa

DERMA: A melanoma diagnosis platform based on collaborative multilabel analog reasoning

The number of melanoma cancer-related death has increased over the last few years due to the new solar habits. Early diagnosis has become the best prevention method. This work presents a melanoma diagnosis architecture based on the collaboration of several multilabel case-based reasoning subsystems called DERMA. The system has to face up several challenges that include data characterization, pattern matching, reliable diagnosis, and self-explanation capabilities. Experiments using subsystems specialized in confocal and dermoscopy images have provided promising results for helping experts to assess melanoma diagnosis

Contrastive and attention-based multiple instance learning for the prediction of sentinel lymph node status from histopathologies of primary melanoma tumours

Sentinel lymph node status is a crucial prognosis factor for melanomas; nonetheless, the invasive surgery required to obtain it always puts the patient at risk. In this study, we develop a Deep Learning-based approach to predict lymph node metastasis from Whole Slide Images of primary tumours. Albeit very informative, these images come with complexities that hamper their use in machine learning applications, namely their large size and limited datasets. We propose a pre-training strategy based on self-supervised contrastive learning to extract better image feature representations and an attention-based Multiple Instance Learning approach to enhance the model’s performance. With this work, we quantitatively demonstrate that combining both methods improves various classification metrics and qualitatively show that contrastive learning encourages the network to output higher attention scores to tumour tissue and lower scores to image artifacts.Work supported by the Spanish Research Agency (AEI) under project PID2020-116907RB-I00 of the call MCIN/AEI/10.13039/501100011033 and the project 718/C/ 2019 funded by Fundació la Marato de TV3.Peer ReviewedPostprint (author's final draft

In Vivo and Ex Vivo Confocal Microscopy for Dermatologic and Mohs Surgeons

Confocal microscopy is a modern imaging device that has been extensively applied in skin oncology. More specifically, for tumor margin assessment, it has been used in two modalities: reflectance mode (in vivo on skin patient) and fluorescence mode (on freshly excised specimen). Although in vivo reflectance confocal microscopy is an add-on tool for lentigo maligna mapping, fluorescence confocal microscopy is far superior for basal cell carcinoma and squamous cell carcinoma margin assessment in the Mohs setting. This article provides a comprehensive overview of the use of confocal microscopy for skin cancer margin evaluation

Shiny White Streaks: A Sign of Malignancy at Dermoscopy of Pigmented Skin Lesions

The aim of this study was to evaluate the practical importance of the presence of shiny white streaks (SWS) (chrysalis or crystalline structures in polarized dermoscopy) for suspicion of malignancy, diagnosis of melanoma, and pre-operative estimation of Breslow thickness and its correlation with total dermoscopy score (TDS). SWS were present in 13.6% of 800 consecutive excised lesions. the presence of SWS was associated with malignancy (odds ratio (OR) 10.534, 95% confidence interval (95% Cl) 6.357-17.455, p<0.0005), in the context of melanocytic lesions with invasive melanoma (OR 10.333, 95% CI 3.812-28.014) and melanomas with high TDS (OR 6.286, 95% CI 1.673-23.619), but was also a factor in the diagnosis of featureless and some thin melanomas. These results corroborate the clinical applicability of SWS in aiding the diagnosis of malignancy and helping to raise the general dermatologist's awareness in cases of doubt and featureless lesions.Fondo de Investigaciones Sanitarias, SpainCIBER de Enfermedades Raras of the Instituto de Salud Carlos III, SpainCatalan Government, SpainEuropean CommissionHosp Clin Barcelona, Dept Dermatol, Melanoma Unit, IDIBAPS, ES-08036 Barcelona, SpainUniversidade Federal de São Paulo, Dept Dermatol, São Paulo, BrazilInst Dermatol Jalisco Dr Jose Barba Rubio, Guadalajara, Jalisco, MexicoInst Salud Carlos III, CIBER Enfermedades Raras, Barcelona, SpainUniversidade Federal de São Paulo, Dept Dermatol, São Paulo, BrazilFondo de Investigaciones Sanitarias, Spain: P.I. 09/01393Fondo de Investigaciones Sanitarias, Spain: P.I. 12/00840Catalan Government, Spain: AGAUR 2009 SGR 1337European Commission: LSHC-CT-2006-018702Web of Scienc

Benefit-risk assessment of sonidegib and vismodegib in the treatment of locally advanced basal cell carcinoma

Sonidegib and vismodegib are Hedgehog pathway inhibitors (HhIs) that play a relevant role in the management of locally advanced basal cell carcinoma (laBCC). This study compared the efficacy and safety of both HhIs based on their available data using effect size measures such as number needed to treat (NNT), number needed to harm (NNH), and likelihood to be helped or harmed (LHH)

Monitoring treatment of field cancerisation with 3% diclofenac sodium 2.5% hyaluronic acid by reflectance confocal microscopy: a histologic correlation

Visual inspection may fail to accurately evaluate field cancerisation (subclinical actinic keratoses [AKs]). We aimed to describe field cancerisation by confocal reflectance microscopy and changes induced by the application of 3% diclofenac sodium gel in 2.5% hyaluronic acid. Fourteen male patients, > 50 years old, with AKs on the bald scalp were included. Clinical examination, confocal microscopy and histological study of clinically visible lesions and 'normal appearing' adjacent skin before and after treatment was completed. Reflectance confocal microscopy showed a decrease in scaling (p = 0.001) and atypia of the honeycomb pattern (p = 0.001) at 2 weeks of treatment. Changes in parakeratosis, inflammation and dermal collagen remodelling were also observed. Histology correlated with confocal features in AK and subclinical AK. Reflectance confocal microscopy was useful in the evaluation of field cancerisation and monitoring of treatment response. A rapid improvement in epidermal atypia was observed

Standards in Dermatologic Imaging

The current era of ubiquitous digital cameras, digital cameras integrated into smartphones, and virtually limitless data storage affords exciting new opportunities for medicine in general and specifically dermatology. Digital photography has the potential to dramatically enable and facilitate improvements in dermatology teaching, clinical documentation, and diagnosis. One of the barriers to the diffusion of digital imaging into dermatology practice is the lack of standards for digital photography. As noted in the article by Quigley et al,1 there are currently no standards for dermatologic photography designated by Digital Imaging and Communications in Medicine. While some organizations, such as the American Teledermatology Association,2 have offered general guidelines, to our knowledge, no consistent actionable standards exist in medical publications. The absence of standards severely impedes the integration of dermatologic images across systems that support documentation, diagnosis, and clinical practice

Genetic counseling in melanoma

Genetic counseling may be offered to families with melanoma and to individuals with multiple melanomas to better understand the genetic susceptibility of the disease, the influence of environmental factors, the inheritance of the risk, and behavior that decreases the risk of dying from melanoma, including specific dermatological follow‐up such as total body photography and digital dermoscopy. Genetic testing may be offered to those individuals with more than a 10% chance of being a carrier of a mutation. This risk varies according to the incidence of melanoma in the country and sun behavior. In countries with a low‐medium incidence of melanoma, genetic testing should be offered to families with two cases of melanoma or an individual with two primary melanomas. In countries with a high incidence, families with three cases of melanoma, with two melanomas and one pancreatic adenocarcinoma, or patients with three primary melanomas, may benefit from genetic testing

In Vivo

In recent years, technology has allowed the development of new diagnostic techniques which allow real-time, in vivo, noninvasive evaluation of morphological changes in tissue. This study compares and correlates the images and findings obtained by high-definition optical coherence tomography (HD-OCT) and reflectance confocal microscopy (RCM) with histology in normal healthy oral mucosa. The healthy lip mucosa of ten adult volunteers was imaged with HD-OCT and RCM. Each volunteer was systematically evaluated by RCM starting in the uppermost part of the epithelium down to the lamina propia. Afterwards, volunteers were examined with a commercially available full-field HD-OCT system using both the “slice” and the “en-face” mode. A “punch” biopsy of the lower lip mucosa was obtained and prepared for conventional histology. The architectural overview offered by “slice” mode HD-OCT correlates with histologic findings at low magnification. In the superficial uppermost layers of the epithelium, RCM imaging provided greater cellular detail than histology. As we deepened into the suprabasal layers, the findings are in accordance with physiological cellular differentiation and correlate with the images obtained from conventional histology. The combined use of these two novel non-invasive imaging techniques provides morphological imaging with sufficient resolution and penetration depth, resulting in quasihistological images