Cutaneous vascular lesions and their management in Indian setting

Clinical and Dermoscopic Patterns of Basal Cell Carcinoma and Its Mimickers in Skin of Color: A Practical Summary

The diagnosis of basal cell carcinoma (BCC) in dark phototypes can be a challenging task due to the lack of relevant clues and its variable presentation. In this regard, there is growing evidence that dermoscopy may benefit the recognition of BCC even for skin of color (SoC). The objective of this review is to provide an up-to-date overview on clinical and dermoscopic patterns of BCC in SoC, also comparing such findings with those of the main clinical mimickers reported in the literature. A comprehensive search of the literature through the PubMed electronic database was carried out in order to identify papers describing the clinical and dermoscopic features of BCC in dark phototypes (IV-VI). By finding macroscopic clinical presentations of BCCs in SoC patients and any possible clinical mimickers considered in the retrieved papers, we built a differential diagnosis list and analyzed the dermoscopic findings of such conditions to facilitate the diagnosis of BCC. BCC in darker skin may present as pigmented nodular lesions, pigmented patches or plaques, ulcers, erythematous nodular lesions, erythematous plaques or patches, or scar-like lesions, depending on its subtype and body site. The differential diagnosis for BCC in patients with SoC includes squamous cell carcinoma, melanoma, nevi, adnexal tumors and sebaceous keratosis. Additionally, it differs from that of Caucasians, as it also includes lesions less common in fair skin, such as dermatosis papulosa nigra, melanotrichoblastoma, and pigmented dermatofibrosarcoma protuberans, and excludes conditions like actinic keratosis and keratoacanthoma, which rarely appear in darker skin. The resulting differences also include infectious diseases such as deep cutaneous mycosis and inflammatory dermatoses. The most prevalent differentiating dermoscopic feature for BCC includes blue, black and gray dots, though arborizing vessels still remain the predominant BCC feature, even in dark phototypes. Diagnostic approach to BCC in dark-skinned patients varies due to the prevalence of dermoscopy findings associated with hyperpigmented structures. Clinicians should be aware of such points of differentiation for a proper management of this tumor in SoC.

Five years’ experience of combined intralesional therapy in infantile hemangioma

Background

Infantile hemangiomas (IHs) are common vascular tumors. Although it involutes spontaneously, outcomes are unpredictable. Intralesional therapy is one of its treatment modality. We present our experience with combined intralesional therapy for IHs over a 5-year duration. A total of 427 patients were treated and followed at Al-Azhar University Hospitals during the study period of 5 years. All patients were treated by intralesional therapy in the form of combined injection of triamcinolone and bleomycin. All patients were followed for the response. Response to the treatment was graded as marked, partial, and poor improvement.

Results

IHs were noticed within the first month of life in 90.2% of patients. The commonest site of involvement was head and neck in 90% of patients. The commonest clinical presentation was swelling with discoloration. Mean age was 7.43 ± 6.04 months and mean IHs size was 15.54 ± 11.13 cm2. The response to the treatment was highest for patients below 1 year of age. The reported complications were ulceration, scarring, and subcutaneous atrophy in some cases.

Conclusion

Combined intralesional therapy in IHs showed good efficacy in most patients. It is a reliable and safe treatment modality with clear curative effects and minimal complications. If IHs treatment is indicated, combined intralesional therapy should be considered as an alternative effective treatment modality.

A further experience of propranolol for severe infantile hemangiomas of the face: an observational study

Infantile hemangiomas (IHs) are the most common proliferating embrional tumors of infancy, which are constituted by endothelial cell hyperproliferation. The authors want to report their observations of further 14 patients suffering from complicated IHs involving the facial district who were treated with propranolol. 14 patients, with ages between 3 and 12 months, completed a cycle of treatment with propanolol. The observational study aimed at focusing IHs involving the facial district. The treatment with propranolol showed good to very good results in the major part of the treated young patients. The authors want to report their experience and add more data in the confirmation of the use of β-blockers for IH (either in efficacy or in safety profile), focusing on the efficacy of propanolol when IHs involve the face.