Line-field confocal optical coherence tomography of psoriasis, eczema and lichen planus: a case series with histopathological correlation

BACKGROUND

Line-field confocal optical coherence tomography (LC-OCT) is a novel, non-invasive technique that provides in vivo, high-resolution images in both vertical and horizontal sections.

OBJECTIVES

The aim of the study was to evaluate LC-OCT imaging in some inflammatory disorders and to correlate the resulting features with histopathology.

METHODS

The retrospective study included patients with histopathological confirmed diagnosis of plaque psoriasis, atopic eczema and lichen planus, who were imaged with LC-OCT before the biopsy. LC-OCT was performed with the commercially available LC-OCT device.

RESULTS

A total of 15 adult patients with histopathologically proven plaque psoriasis (N: 5), atopic eczema (N: 5) and lichen planus (N: 5) were included. In all cases, LC-OCT allowed the in vivo recognition of the main microscopic features of the examined inflammatory skin disease, with a strong correlation with histopathology.

CONCLUSIONS

Although future studies on larger series of patients are necessary, LC-OCT, based on these preliminary findings, may represent a promising tool in inflammatory skin disorders with potential applications including enhanced diagnosis, biopsy guidance, follow-up and treatment monitoring.

Dermoscopy of genital diseases: a review

The male and female external genital regions are anatomical areas in which various types of skin disorders may occur. Although most of these conditions can be diagnosed by means of clinical examination and an accurate medical history, in most cases further investigations with time-consuming and/or invasive procedures are needed in order to reach the correct diagnosis. Dermoscopy, as a modern non-invasive tool, is able to better diagnose pigmented and non-pigmented skin tumours along with various inflammatory and infectious skin and appendage disorders. The aim of this paper was to provide a review of the use of dermoscopy in genital disorders based on published data and to include personal experience gained from real life, focusing on any possible gender difference and whether disease mucosal/semimucosal dermoscopy features may differ from those observed on the skin. In conclusion, genital dermoscopy should always be considered during clinical inspection in order to enhance the diagnosis or to rule out those conditions that may look similar but that show a different dermoscopy pattern, thus narrowing down the differential diagnoses and avoiding unnecessary invasive investigations.

Immunohistochemical and molecular analysis of spitzoid neoplasms with pulverocyte subclones

BACKGROUND

Clonal naevi are characterized by a focal proliferation of pigmented melanocytes in an otherwise banal naevus. These subclones are often composed of aggregates of larger, epithelioid melanocytes with nuclear atypia and dusty-grey cytoplasmic pigmentation, which are referred to as 'pulverocytes', and this finding may lead to a misdiagnosis of malignant melanoma (MM).

AIM

To characterize the significance of subclones of dusty-grey pigmented epithelioid melanocytes within spitzoid neoplasms.

METHODS

We studied the histological and molecular features of a series of 20 spitzoid neoplasms with pulverocyte subclones encountered in our practice, including both atypical Spitz tumours (ASTs) and invasive MMs.

RESULTS

Pulverocytes were predominantly dermal, and the percentage of subclones ranged from 2% to 40%, with a median of 10% in ASTs and 25% in lesions we classified as MM. In cases with > 10% subclones, there was an increased odds of fluorescence in situ hybridization positivity (OR = 12; 95% CI 1.2-293.4; P = 0.03) and an increased odds of homozygous 9p21 deletion (OR = 3.6; 95 CI 0.28-89.82; P = 0.33), although the latter did not reach statistical significance.

CONCLUSIONS

We consider spitzoid lesions with a small subclone population to be a variant of a clonal naevus with indolent behaviour, whereas lesions with larger pulverocyte populations are more likely to have chromosomal copy number aberrations and in some cases may represent malignant transformation.

Reflectance confocal microscopy in the diagnosis of vesicobullous disorders: case series with pathologic and cytologic correlation and literature review

BACKGROUND

Vesicobullous disorders are characterized by intraepidermal or subepidermal blistering resulting from different pathogenetic mechanisms. The diagnosis is generally based on clinical examination and semi-invasive/invasive procedures such as cytology and histopathology. In vivo reflectance confocal microscopy (RCM) is a non-invasive technique for real-time, en face imaging of the epidermis and upper dermis with high resolution close to conventional histopathology.

PURPOSE

To evaluate RCM features of different vesicobullous diseases and correlate with cytologic and histopathologic examination.

METHODS

Ten patients (6M/4F, age range: 9-81 years) affected by blistering diseases, such as herpes simplex, herpes zoster, Kaposi's varicelliform eruption, pemphigus vulgaris, Hailey-Hailey disease, bullous pemphigoid, and porphyria cutanea tarda were evaluated using a handheld RCM device.

RESULTS

In our study, a clear correlation between RCM and Tzanck's test and/or histopathology was observed. RCM allowed in all cases an easy identification of the blister spaces and of the split levels, and in some cases specific features were detected, such as giant keratinocytes in herpes infections and acantholytic cells in pemphigus vulgaris and Hailey-Hailey disease.

CONCLUSION

Reflectance confocal microscopy may support the clinical diagnosis of vesicobullous disorders and indicate to the physician the appropriate patient management and/or the need for further investigation.

Dermatoscopy in inflammatory and infectious skin disorders

Dermatoscopy is a non-invasive technique that allows a rapid and magnified in vivo observation of the skin surface. By definition, it is performed with handheld devices (dermatoscopes) allowing X10 magnification. More expensive, computer-assisted digital systems (videodermatoscopes) may be equipped with lenses that ensure magnifications up to X1000; in this case the term videodermatoscopy is generally used. Dermatoscopy is mainly utilized for the evaluation of pigmented skin lesions, and has increasing applications in dermatology. In this paper the use of dermatoscopy in a variety of inflammatory (psoriasis, lichen planus, pityriasis lichenoides, rosacea, lichen sclerosus, Darier's disease, pigmented purpuric dermatoses) and infectious (human papillomaviruses infections, molluscum contagiosum, tinea capitis, tinea nigra, scabies, head and pubic lice, tungiasis, cutaneous leishmaniasis and cutaneous larva migrans) cutaneous disorders will be analyzed. In these conditions, dermatoscopy may assist the clinical diagnosis, reducing the need of semi-invasive or invasive procedures such as skin scrapings and/or biopsy. Depending on the disease, the choice to use low or high magnifications may be crucial. Dermatoscopy may also be useful for prognostic evaluation and monitoring of response to treatment, representing an important and relatively simple aid in daily clinical practice.