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Calik J, Zawada T, Bove T, Dzięgiel P, Pogorzelska-Antkowiak A, Mackiewicz J, Woźniak B, Sauer N. Healing Process after High-Intensity Focused Ultrasound Treatment of Benign Skin Lesions: Dermoscopic Analysis and Treatment Guidelines. J Clin Med 2024; 13:931. [PMID: 38398246 PMCID: PMC10888560 DOI: 10.3390/jcm13040931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 01/27/2024] [Accepted: 02/03/2024] [Indexed: 02/25/2024] Open
Abstract
Background: High-Intensity Focused Ultrasound (HIFU) has emerged as a precise and non-invasive modality for tissue ablation and healing. This study presents a detailed dermoscopic analysis of skin healing post-High-Intensity Focused Ultrasound (HIFU) treatment, focusing on common benign skin lesions, such as seborrheic keratosis, sebaceous hyperplasia, vascular lesions, and sebaceous nevi. Methods: Prior to HIFU treatment, a comprehensive assessment was conducted, integrating ultrasound scanning and clinical evaluations. The TOOsonix System ONE-M was employed for HIFU treatments, with parameters tailored to each lesion type. Results: A common pattern observed across all lesions includes initial whitening post treatment, followed by scab formation and the development of a pink area with reparative vessels. This study, however, highlights distinct differences in fibrosis patterns and healing timelines across different lesion types. Each lesion type exhibited unique fibrosis patterns post treatment. Flatter variants of seborrheic keratosis healed within a month, displaying hypopigmentation and reparative vessels, alongside a distinct lattice fibrosis pattern in more verrucous forms, which took about two months to heal. Sebaceous hyperplasia, characterized by rapid healing within three weeks, demonstrated fibrosis with pink areas and perpendicular white lines, concluding with a slight depression. Vascular lesions varied in healing time based on depth, with superficial ones showing whitening and crust formation, while deeper lesions had vessel occlusion and size reduction accompanied by concentric fibrotic bands. Sebaceous nevi presented the longest healing duration of three months, characterized by amorphous white-gray structures, scab formation, and the emergence of pink areas with branching vessels, leading to clear skin with reduced white lines. Conclusions: in conclusion, this meticulous clinical evaluation highlights the unique healing characteristics and timelines for each skin lesion type treated with HIFU. These insights are invaluable for optimizing follow-up assessments, identifying potential complications, and refining treatment protocols. By providing detailed insights into the healing timelines and patterns for different types of lesions, patients can be better informed about their post-treatment journey.
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Affiliation(s)
- Jacek Calik
- Department of Clinical Oncology, Wroclaw Medical University, 50-556 Wrocław, Poland
- Old Town Clinic, 50-136 Wroclaw, Poland;
| | - Tomasz Zawada
- TOOsonix A/S, 2970 Hoersholm, Denmark; (T.Z.); (T.B.)
| | - Torsten Bove
- TOOsonix A/S, 2970 Hoersholm, Denmark; (T.Z.); (T.B.)
| | - Piotr Dzięgiel
- Division of Histology and Embryology, Department of Human Morphology and Embryology, Wroclaw Medical University, T. Chalubinskiego 6a, 50-368 Wroclaw, Poland;
- Department of Human Biology, Faculty of Physiotherapy, Wroclaw University of Health and Sport Sciences, 51-612 Wroclaw, Poland
| | | | - Jacek Mackiewicz
- Department of Medical and Experimental Oncology, Institute of Oncology, Poznan University of Medical Sciences, 61-701 Poznan, Poland;
| | | | - Natalia Sauer
- Old Town Clinic, 50-136 Wroclaw, Poland;
- Faculty of Pharmacy, Wroclaw Medical University, 50-556 Wroclaw, Poland
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Lin EY, Rao L, Wang WJ, Chen YF. Detection of sebaceous gland hyperplasia with dermoscopy and reflectance confocal microscopy. Front Med (Lausanne) 2023; 10:1194748. [PMID: 37457586 PMCID: PMC10349389 DOI: 10.3389/fmed.2023.1194748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/08/2023] [Indexed: 07/18/2023] Open
Abstract
Background Sebaceous gland hyperplasia (SGH) is a benign cutaneous proliferation of the sebaceous glands that are mostly present on the face or the neck of older adults. They typically appear as single or multiple soft umbilicated papules; however, in challenging cases, it can be difficult to distinguish them from trichoepitheliomas, base cell carcinomas, or other tumors. Although pathological results have diagnostic value, the significance of non-invasive examinations in diagnosis and differential diagnosis is also worth exploring. Objectives This study aimed to describe the dermoscopic and reflectance confocal microscopy (RCM) features of SGH. Methods A total of 31 patients diagnosed with SGH, according to clinical and histopathological standards, were examined using dermoscopy and RCM between March 2018 and January 2022. Results Dermoscopically, lesions revealed a yellowish-red background and a faint-yellow background in 25 (80.65%) and six cases (19.35%), respectively. White-yellowish lobulated structures in the center of the lesion were present in 31 patients (100%) and umbilications in 19 patients (61.29%). Crown vessels at the periphery of the lesions were observed in 11 patients (35.48%), whereas irregular linear vessels were observed on the surface of the lesions in 18 patients (58.06%). Under RCM, all lesions presented a honeycomb pattern in the epidermis and the typical morulae-shaped sebaceous lobules in the dermis. A dilated follicular infundibulum was observed in 15 patients (48.39%) and dilated vessels in 26 patients (83.87%). Conclusion Dermoscopy and RCM enabled us to describe the imaging features of SGH. Combining these two useful tools provides a non-invasive basis for accurate clinical diagnosis.
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Affiliation(s)
- Er-Yi Lin
- Dermatology Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Lang Rao
- Department of Dermatology, Chengdu Second People's Hospital, Chengdu, Sichuan, China
| | - Wen-Ju Wang
- Department of Dermatology, Chengdu Second People's Hospital, Chengdu, Sichuan, China
| | - Yong-Feng Chen
- Dermatology Hospital, Southern Medical University, Guangzhou, Guangdong, China
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3
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Lai M, Muscianese M, Piana S, Chester J, Borsari S, Paolino G, Pellacani G, Longo C, Pampena R. Dermoscopy of cutaneous adnexal tumors: a systematic review of the literature. J Eur Acad Dermatol Venereol 2022; 36:1524-1540. [PMID: 35536546 PMCID: PMC9545415 DOI: 10.1111/jdv.18210] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/20/2022] [Indexed: 12/01/2022]
Abstract
Cutaneous adnexal tumors (ATs) encompass a variegated group of hamartomas and benign or malignant tumors, originating from the hair follicle, sebaceous, eccrine or apocrine glands that may simulate other cutaneous neoplasms. This study aims to provide a comprehensive overview of the spectrum of clinical and dermoscopic features of ATs, to better define these lesions and assist in differential diagnosis. We performed a two-step systematic search of literature in PubMed, Embase, and Cochrane Library databases from inception until September 4, 2020. In the first step we aimed to define histological variants of ATs with descriptions of dermoscopic criteria. The second step included a search for the name of each previously identified AT variants in the same databases adding "AND (epilum* or dermosc* or dermatosc*)". All study types in English-language reporting dermoscopic images of ATs were included. Collisions between ATs and other inflammatory or neoplastic skin lesions were excluded, with the exception of collisions with a sebaceous nevus. The protocol of this study was prospectively registered in PROSPERO (CRD42021244677). In total, 206 articles met our inclusion criteria, encompassing 372 ATs in 365 patients. Most ATs were apocrine-eccrine (n=217, 58.3%, n=173 benign) with a prevalence of poromas (n=82), followed by follicular ATs (n=88, 23.7%, n=83 benign) and sebaceous ATs (n=67, 18.0%, n=49 benign). Most patients had a single AT lesion (320, 86.0%), while 42 (11.3%) had multiple ATs. A syndrome causing multiple ATs was identified in 15 patients. Histopathological analysis revealed 82% benign (n= 305) and 18.0% malignant (n=67). ATs were classified according to their ability to mimic 4 groups of more common skin tumors: basal cell carcinoma, squamous cell carcinoma, melanocytic lesions and benign cutaneous lesions. Moreover, we have highlighted the ability of malignant variants of ATs to simulate benign skin lesions. This systematic review offers a comprehensive overview of the common clinical and dermoscopic features of follicular, sebaceous and apocrine-eccrine ATs and details possible differential dermoscopic features.
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Affiliation(s)
- M Lai
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy.,Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - M Muscianese
- Private practice, Via Ottaviano, 32, Rome, Italy
| | - S Piana
- Pathology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - J Chester
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - S Borsari
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - G Paolino
- Unit of Dermatology, IRCCS San Raffaele Hospital, Milan, Italy
| | - G Pellacani
- Dermatology Clinic, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, La Sapienza University of Rome, Italy
| | - C Longo
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy.,Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - R Pampena
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy.,Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
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4
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Behera B, Chandrashekar L, Thappa DM, Gochhait D, Srinivas BH, Ayyanar P. Dermoscopic features of benign cutaneous adnexal tumours in dark skin: A retrospective study from South India. Australas J Dermatol 2021; 62:e249-e255. [PMID: 33797080 DOI: 10.1111/ajd.13549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 12/09/2020] [Accepted: 12/15/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Biswanath Behera
- Department of Dermatology, and Venereology, AIIMS, Bhubaneswar, India
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5
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Shahriari N, Grant-Kels JM, Rabinovitz H, Oliviero M, Scope A. Reflectance confocal microscopy: Diagnostic criteria of common benign and malignant neoplasms, dermoscopic and histopathologic correlates of key confocal criteria, and diagnostic algorithms. J Am Acad Dermatol 2020; 84:17-31. [PMID: 32565210 DOI: 10.1016/j.jaad.2020.05.154] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/02/2020] [Accepted: 05/14/2020] [Indexed: 01/11/2023]
Abstract
Reflectance confocal microscopy (RCM) is a high-resolution, noninvasive tool that is currently approved by the US Food and Drug Administration for obtaining and interpreting images of the skin and cutaneous neoplasms with the goal of decreasing unnecessary biopsy procedures in patients with benign lesions. The second article in this continuing medical education series focuses on identifying key criteria for the diagnosis of common skin cancers-melanoma, basal cell carcinoma, and squamous cell carcinoma. We contrast these findings with RCM features of common benign lesions-melanocytic nevi, solar lentigo, seborrheic keratosis, lichen planus-like keratosis, and sebaceous hyperplasia. We also correlate the dermoscopic and histopathologic findings with the RCM features.
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Affiliation(s)
- Neda Shahriari
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut.
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut; Department of Dermatology, University of Florida, Gainesville, Florida
| | - Harold Rabinovitz
- Skin and Cancer Associates, Plantation, Florida; Dermatology Department, Medical College of Georgia at Augusta University, Augusta, Georgia
| | | | - Alon Scope
- The Kittner Skin Cancer Screening and Research Institute, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Dermatology Service, Memorial Sloan-Kettering Center, New York, New York
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6
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Abstract
Cutaneous adnexal tumors include lesions with apocrine, eccrine, follicular, sebaceous, and mixed differentiation. Most are benign and sporadic, although malignant forms are occasionally observed and some cases develop in the setting of inherited syndromes. These tumors often cause immense diagnostic difficulty. Dermoscopy is a noninvasive technique that has greatly improved the diagnostic accuracy of different skin lesions, including these tumors. We provide a review of the literature on the dermoscopic structures and patterns associated with adnexal tumors. Most patterns associated with this kind of tumor are nonspecific and are observed in other nonadnexal tumors, especially in basal cell carcinomas.
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Affiliation(s)
- Pedro Zaballos
- Dermatology Department, Hospital Sant Pau i Santa Tecla, C/ Joan Fuster s/n, 43007 Tarragona, Spain.
| | - Ignacio Gómez-Martín
- Dermatology Department, Hospital Sant Pau i Santa Tecla, C/ Joan Fuster s/n, 43007 Tarragona, Spain
| | - José María Martin
- Dermatology Department, Hospital Clínico Universitario, Avenida Blasco Ibáñez 17, 46010 Valencia, Spain
| | - José Bañuls
- Dermatology Department, Hospital General Universitario de Alicante, ISABIAL, C/Maestro Alonso 109, 03010 Alicante, Spain
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7
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Toyoshima A, Osada SI, Umebayashi Y, Manabe M. Dermoscopic features of dermatofibroma with overlying sebaceous hyperplasia. J Dermatol 2017; 44:548-549. [PMID: 28256746 DOI: 10.1111/1346-8138.13804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Aya Toyoshima
- Department of Dermatology and Plastic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Shin-Ichi Osada
- Department of Dermatology and Plastic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoshihiro Umebayashi
- Department of Dermatology and Plastic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Motomu Manabe
- Department of Dermatology and Plastic Surgery, Akita University Graduate School of Medicine, Akita, Japan
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9
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Abstract
Dermoscopy is an aiding method in the visualization of the epidermis and dermis. It
is usually used to diagnose melanocytic lesions. In recent years, dermoscopy has
increasingly been used to diagnose non-melanocytic lesions. Certain vascular
structures, their patterns of arrangement and additional criteria may demonstrate
lesion-specific characteristics. In this review, vascular structures and their
arrangements are discussed separately in the light of conflicting views and an
overview of recent literature.
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Affiliation(s)
| | - Derya Ucmak
- Faculty of Medicine, Dicle University, Diyarbakır, TR
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10
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Abstract
Dermoscopy (dermatoscopy or surface microscopy) is an ancillary dermatologic tool that in experienced hands can improve the accuracy of diagnosis of a variety of benign and malignant pigmented skin tumors. The early and more accurate diagnosis of nonpigmented, or pink, tumors can also be assisted by dermoscopy. This review focuses on the dermoscopic diagnosis of pink lesions, with emphasis on blood vessel morphology and pattern. A 3-step algorithm is presented, which facilitates the timely and more accurate diagnosis of pink tumors and subsequently guides the management for such lesions.
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Affiliation(s)
- Jason Giacomel
- Skin Spectrum Medical Services, 400 Canning Highway, Como, Perth, Western Australia 6152, Australia.
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11
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Jegou Penouil MH, Gourhant JY, Segretin C, Weedon D, Rosendahl C. Non-choroidal yellow melanoma showing positive staining with Sudan Black consistent with the presence of lipofuscin: a case report. Dermatol Pract Concept 2014; 4:45-9. [PMID: 24855574 PMCID: PMC4029254 DOI: 10.5826/dpc.0402a09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 10/08/2013] [Indexed: 11/04/2022] Open
Abstract
A case of a predominantly yellow primary superficial spreading melanoma arising on the back of a 44-year-old woman is presented. Possible causes of the clinical and dermatoscopic yellow color are discussed. Staining with the histochemical stain, Sudan Black, revealed a differential uptake compared to a closely matched control melanoma. We speculate that the clinical and dermatoscopic yellow color could be due to the presence of increased amounts of the pigment lipofuscin, which is known to produce subtle orange color in some choroidal melanomas.
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Affiliation(s)
| | | | | | - David Weedon
- Sullivan Nicolaides Pathology, Brisbane, Australia
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Lallas A, Moscarella E, Argenziano G, Longo C, Apalla Z, Ferrara G, Piana S, Rosato S, Zalaudek I. Dermoscopy of uncommon skin tumours. Australas J Dermatol 2013; 55:53-62. [PMID: 23866027 DOI: 10.1111/ajd.12074] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 04/01/2013] [Indexed: 02/01/2023]
Affiliation(s)
- Aimilios Lallas
- Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia
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13
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Offenbächer M, Sauer S, Rieß J, Müller M, Grill E, Daubner A, Randzio O, Kohls N, Herold-Majumdar A. Contractures with special reference in elderly: definition and risk factors – a systematic review with practical implications. Disabil Rehabil 2013; 36:529-38. [DOI: 10.3109/09638288.2013.800596] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bellucci C, Arginelli F, Bassoli S, Magnoni C, Seidenari S. Dermoscopic yellow structures in basal cell carcinoma. J Eur Acad Dermatol Venereol 2013; 28:651-4. [DOI: 10.1111/jdv.12092] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 12/07/2012] [Indexed: 11/29/2022]
Affiliation(s)
- C. Bellucci
- Department of Dermatology and Venereology; University of Modena and Reggio Emilia; Modena Italy
| | - F. Arginelli
- Department of Dermatology and Venereology; University of Modena and Reggio Emilia; Modena Italy
| | - S. Bassoli
- Department of Dermatology and Venereology; University of Modena and Reggio Emilia; Modena Italy
| | - C. Magnoni
- Department of Dermatology and Venereology; University of Modena and Reggio Emilia; Modena Italy
| | - S. Seidenari
- Department of Dermatology and Venereology; University of Modena and Reggio Emilia; Modena Italy
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Vascularización en dermatoscopia. ACTAS DERMO-SIFILIOGRAFICAS 2012; 103:357-75. [DOI: 10.1016/j.ad.2011.11.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 11/02/2011] [Accepted: 11/06/2011] [Indexed: 11/19/2022] Open
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Micali G, Lacarrubba F, Massimino D, Schwartz RA. Dermatoscopy: Alternative uses in daily clinical practice. J Am Acad Dermatol 2011; 64:1135-46. [PMID: 21292346 DOI: 10.1016/j.jaad.2010.03.010] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 02/22/2010] [Accepted: 03/03/2010] [Indexed: 01/06/2023]
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18
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Zalaudek I, Kreusch J, Giacomel J, Ferrara G, Catricalà C, Argenziano G. How to diagnose nonpigmented skin tumors: a review of vascular structures seen with dermoscopy: part II. Nonmelanocytic skin tumors. J Am Acad Dermatol 2010; 63:377-86; quiz 387-8. [PMID: 20708470 DOI: 10.1016/j.jaad.2009.11.697] [Citation(s) in RCA: 204] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2009] [Revised: 11/28/2009] [Accepted: 11/30/2009] [Indexed: 11/17/2022]
Abstract
Nonmelanoma skin cancer refers to a broad class of tumors, including actinic keratosis, basal cell carcinoma, and squamous cell carcinoma, and as a group these are the most frequent cancers occurring in light skinned humans. In contrast to the rarity of amelanotic melanoma, nonmelanoma skin cancer commonly lacks pigmentation. Although these tumors rarely cause death related to metastases, they commonly destroy underlying tissues and should be removed at the earliest possible stage. Dermoscopy improves the clinical diagnosis of nonpigmented skin tumors by allowing the visualization of specific vascular structures that are usually not visible to the naked eye. Dermoscopic vascular patterns of several nonmelanocytic nonpigmented skin tumors, such as sebaceous hyperplasia, seborrheic keratosis, clear cell acanthoma, Bowen disease, or nodular cystic basal cell carcinoma are highly specific, allowing a ready diagnosis in most cases. Others, such as actinic keratosis, pyogenic granuloma, or uncommon adnexal tumors, may be difficult to differentiate even with the aid of dermoscopy. For this reason, general guidelines have been established to assist in making the most appropriate management decision. In the second part of this review of dermoscopic vascular structures of nonpigmented skin tumors, the dermoscopic patterns associated with benign and malignant nonmelanocytic skin tumors and recommendations for the management of these tumors will be discussed.
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Affiliation(s)
- Iris Zalaudek
- Division of Dermatology, Medical University of Graz, Graz, Austria.
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20
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Oztas P, Polat M, Oztas M, Alli N, Ustun H. Bonbon toffee sign: a new dermatoscopic feature for sebaceous hyperplasia. J Eur Acad Dermatol Venereol 2008; 22:1200-2. [DOI: 10.1111/j.1468-3083.2008.02827.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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