Dermoscopy of Lentiginous Melanomas and Equivocal Benign Pigmented Macules of the Scalp: A Case-Control Multicentric Study

INTRODUCTION

Although the dermoscopic features of facial lentiginous melanomas (LM), including lentigo maligna and lentigo maligna melanoma, have been extensively studied, the literature about those located on the scalp is scarce. This study aims to describe the dermoscopic features of scalp LM and assess the diagnostic accuracy of dermoscopy to discriminate them from equivocal benign pigmented macules.

METHODS

Consecutive cases of scalp LM and histopathology-proven benign but clinically equivocal pigmented macules (actinic keratoses, solar lentigos, seborrhoeic keratoses, and lichen planus-like keratoses) from four referral centres were included. Dermoscopic features were analysed by two blinded experts. The diagnostic performance of a predictive model was assessed.

RESULTS

56 LM and 44 controls were included. Multiple features previously described for facial and extrafacial LM were frequently identified in both groups. Expert's sensitivity to diagnose scalp LM was 76.8% (63.6-87.0) and 78.6% (65.6-88.4), with specificity of 54.5% (38.9-69.6) and 56.8% (41.0-71.7), and fair agreement (kappa coefficient 0.248). The strongest independent predictors of malignancy were (OR, 95% CI) chaos of colour (15.43, 1.48-160.3), pigmented reticular lines (14.96, 1.68-132.9), increased density of vascular network (3.45, 1.09-10.92), and perifollicular grey circles (2.89, 0.96-8.67). The predictive model achieved 85.7% (73.8-93.6) sensitivity, 61.4% (45.5-75.6) specificity, and 81.5 (73.0-90.0) area under curve to discriminate benign and malignant lesions. A diagnostic flowchart was proposed, which should improve the diagnostic performance of dermoscopy.

CONCLUSION

Both facial and extrafacial dermoscopic patterns can be identified in scalp LM, with considerable overlap with benign pigmented macules, leading to low specificity and interobserver agreement on dermoscopy.

Involvement of Nail Apparatus in Pemphigus Vulgaris in Ethnic Poles Is Infrequent

Pemphigus vulgaris lesions have a tendency to localize around natural body orifices. The aim here was to analyze the involvement of nail apparatus in pemphigus vulgaris. Sixty seven ethnic Poles suffering from pemphigus vulgaris on photographic files archiving initial presentation were retrospectively evaluated. Pemphigus vulgaris was diagnosed using combination of clinical data, H+E histology, direct immunofluorescence of plucked scalp hair and/or perilesional tissue also for IgG1 and IgG4 deposits evaluation, indirect immunofluorescence on mosaic substrate and/or monkey esophagus, mono-analyte ELISA with desmoglein 1/3 or multi-analyte ELISA. The nail apparatus involvement was found in 9 of 67 patients (13.4%; 3 females and 6 males). Periungual fingernail lesions were found in 6 patients (2 females, 4 males), whereas periungual toenail lesions in just 3 patients (1 female, 2 males). Our patients nail apparatus changes included, by order of frequency, paronychia, nail discoloration, onychorrhexis, Beau lines, periungual hemorrhages, onychomadesis, cross-ridging, onycholysis, and trachyonychia. The average time between the onset, as recalled by patients, and the diagnosis of pemphigus vulgaris with direct immunofluorescence was not statistically different in PV patients with and without nail apparatus lesions. In this article the molecular and immunological rationale for of periungual involvement is discussed. Our single-center study suggests that nail apparatus involvement is infrequent in pemphigus vulgaris in ethnic Poles. Due to the fact that nail apparatus lesions in pemphigus vulgaris may clinically resemble onychomycosis, giving the proper diagnosis can be difficult particularly when other lesions are overlooked or misinterpreted.

Mucosal-dominant pemphigus vulgaris in a captopril-taking woman with angioedema

We describe a 39-year-old woman with an apparent captopril-induced, contact mucosal-dominant pemphigus vulgaris and angioedema, who took captopril during a bout of arterial hypertension. This exposure suggests that captopril and pathophysiology of angioedema stimulated the development of pemphigus vulgaris, which was diagnosed using the novel, indirect immunofluorescence BIOCHIP mosaic, with the modification to detect serum IgG4 autoantibodies. We discuss the patient, who experienced a chain of events leading to the active stage of pemphigus vulgaris, and review concepts of pemphigus vulgaris inducible by drugs and pathological immunity.

Discordant expression of desmoglein 2 and 3 at the mRNA and protein levels in nodular and superficial basal cell carcinoma revealed by immunohistochemistry and fluorescent in situ hybridization

BACKGROUND

Basal cell carcinoma (BCC) is the most common human cancer. It is thought that skewed expression of desmogleins (Dsgs) in BCC may promote tumourigenesis.

AIM

To comparatively examine expression of Dsg2/Dsg3, using fluorescent in situ hybridization (FISH) and immunohistochemistry (IHC) in BCC subtypes.

METHODS

In total, 84 frozen sections from patients with various clinical or histological subtypes of BCC were analyzed. Expressions of Dsg2/Dsg3 protein and Dsg2/Dsg3 mRNA were evaluated using IHC and FISH, respectively, in BCC nests and BCC-free epidermis, and then quantitatively measured.

RESULTS

There was loss of correlation between Dsg2 and Dsg3 (IHC) in nodular and superficial BCC (nBCC, sBCC), and significant correlation between Dsg2 and Dsg3 (FISH) in BCC, but not nBCC and sBCC.

CONCLUSIONS

Because more prominent aberrations of Dsg2/Dsg3 expression were seen at the protein than at the mRNA level in BCC, these comparative observations indicate greater importance of events at the proteome level than those at the genome level in tumour functional compartments. Different Dsg2/Dsg3 expression in sBCC and nBCC might corroborate the possibility that sBCC and nBCC are separate conditions. These results may contribute to better understanding of the biological behaviour of BCC.

Comparative assessment of aluminum and lead concentrations in serum and tissue bioptates in patients with laryngeal papilloma or cancer

A comparative assessment of toxic element concentrations in serum and tissue bioptates in patients with laryngeal papilloma or cancer was performed. Examinations were conducted in 60 patients (40 men and 20 women) aged 20-88 years (average 59 +/- 05). Patients were divided into 3 groups; 20 patients with laryngeal papilloma were in group I, 20 with laryngeal cancer were in group II, and 20 with deviated nasal septums were included as a control group (III). Diagnosis of laryngeal papilloma (removed by direct microlaryngoscopy--Kleinsasser method) and laryngeal cancer (removed by the Rethi method) was histopatologically confirmed in patients from groups I and II, respectively. Patients in the control group received functional surgery to repair deviated nasal septums. Serum and tissue samples were obtained from all patients before surgery. Aluminum and lead concentrations were analysed by inductively coupled plasma atomic emission spectrometry (ICP-AES) using a Spectroflame M spectrometer. The considerable rise of aluminum and lead concentration in tissue bioptates and aluminum in serum in groups I and II in comparison to the control group suggests that these elements may play a significant part in the aetiology and development of precancerous lesions and laryngeal cancers. Measuring toxic chemical element concentrations in tissue bioptates can be useful in the diagnosis and estimation of development of precancerous lesions of the larynx as well as laryngeal cancer. Toxic elements concentration may play a significant role in carcinogenesis and may determine trends in cancer aetiology.

Lithium carbonate 24-hour extended-release capsule filled with 6 mm tablets

A 24-h extended-release multiparticulate capsule containing a dose of 500 mg of lithium carbonate divided into 6 tablets 6 mm in size was produced. In order to achieve an immediate and prolonged drug release profile one uncoated tablet and 5 tablets coated with methacrylic acid/ethyl acrylate copolymer Kollicoat MAE30DP were filled into a capsule. The core of tablets consisted of microcrystalline cellulose, lactose, povidone, macrogol and magnesium stearate.

[Histopathological verifications clinical indications in the inferior turbinoplasty]

Surgical treatment in cases of disturbances of nasal patency caused changes in the nasal inferior turbinates are controversial. The authors performed the microscopic (light microscope) and morphometric examinations of mucous membrane of the nasal inferior turbinates obtained after inferior turbinoplasty in patients with vasomotor and perennial allergic rhinitis and compensation hypertrophy of nasal inferior turbinate accompanied of nasal deviation septum. Analysing of morphologic changes in mucous membrane of the nasal inferior turbinates verified of clinic indications to inferior turbinoplasty.

[Otoacoustic emission examinations in soldiers before and after shooting]

Firearms are a common source of impulse noise that may potentially damage hearing organ. The purpose of this study was evaluation of the click evoked otoacoustic emission (TEOAE) and distortion-product otoacoustic emission (DPOAE) before and after shooting and comparison with conventional pure tone audiometry. Standard pure tone audiometry, tympanometry, TEOAE and DPOAE were made before and 10-15 minutes after shooting. Ten male soldiers (20 ears) were exposed to impulse noise from automatic gunfire (15 single rounds of live ammunition). They did not use any earplugs. The reduction amplitude of the TEOAE after shooting was found especially for the frequency 3,4 kHz for the right ear and 1 and 2 kHz for the left ear. The DPOAE greatest reduction concerned frequency 2,5 and 4 kHz for the left ear. All our shooters were right-handed and probably the asymmetrical effect resulted from the shooting posture. Any differences existing between the audiometric threshold before and after shooting were not noticed. Clinical experience with OAE indicates that it may play a role as a screening method for the soldiers exposed to noise and as a tool for monitoring early changes in cochlea. Emissions seem to be more sensitive for monitoring early cochlear changes after shooting than pure tone audiometry.

Tinnitus suppression by electrical promontory stimulation (EPS) in patients with sensorineural hearing loss

OBJECTIVE

Almost 10-15% of the population suffer from chronic tinnitus. There are clinical indications that a 'pathological sound' may be induced by any level of the auditory pathways. Theraupeutical difficulties and many hypotheses about tinnitus and places from which they originate might indicate various methods of treatment. Electrostimulation tinnitus suppression was achieved by many authors from 22 (Graham, Hazell) to 87% (Portman). The aim of our study was to define the usefulness of electrostimulation in treatment of persistent noise induced cochlear lesion tinnitus (group I - 43 men) and compare the results with the non noise induced tinnitus group II (68 patients).

METHODS

Otolaryngological and audiological examination of the patients was made before and after electrostimulation, and at 90 days. The stimulation system consisted of a prototype tinnitus suppressor, the active platino-iridium needle electrode and silver surface electrode located on the forehead. Transtympanal electrical stimulation was performed using positive polarity direct current. Parameters of electrical impulse were individually different and depended on tinnitus parameters and patients sensation. The current levels ranged from 20 to 600 microA and frequency ranged from 60 to 10000 Hz. Average time of EPS was 60 s.

RESULTS

The control examination 90 days after stimulation in group I showed subjective improvement in 18 (41.9%) patients, 22 (51.2%) did not notice any change and tinnitus deteriorated in 3 (6.9%) of the patients. In the comparative group II improvement was occurred in 34 (50%) persons including 2 (17.6%) in whom tinnitus was abolished, in 30 (44.1%) tinnitus was unchanged and 4 (0.6%) became worse. In both groups our method did not have a destructive influence on hearing. Electrical stimulation to relieve tinnitus has been used for nearly 200 years, but it is unclear how electrical stimulation works to suppress tinnitus.

CONCLUSION

In our opinion electrical stimulation by using positive DC changes the spontaneous activity of cochlear nerve fibres. According to our results it is suggested that the mechanism of beneficial effects is due to increased microcirculation in part of the auditory pathways. Poorer results in patients with noise induced tinnitus could be explained by greater damage of the cochlea outer hair cells. In our opinion EPS could be a method of treatment for persistent tinnitus in cases which fail to respond to other methods.

[Treatment results of acoustic trauma]

20 patients aged from 18 to 42 treated in the past few years because of acoustic trauma. Together the investigations concerned 24 years. Therapeutic schema comprised intravenous infusion--Sermion (Nicergoline--amp. a 4 mg) or Cavinton (Vinpocetine--amp. a 10 mg) 1 amp.--twice a day for 10 days. The treatment of 60% of the patients started in the first week after the trauma occurred, of 20% in the second week and the remaining 20% later on after 15 days when the trauma took place. The obtained results of treatment both of improvement of hearing (79.2%) and tinnitus (66.6%), support the necessity of treatment of acoustic trauma independently from the time that passed after trauma had occurred. Better results of audiometric improvement of hearing (54.2%) and tinnitus disappearance (50%) were obtained in the patients whose treatment started in the first week after trauma. The improvement of hearing and tinnitus disappearance was more observed in patients after treatment by using Sermion than Cavinton.

[Clinical evaluation of Olbas oil effect on nasal mucosa in acute rhinitis patients during common cold]

The aim of the study was the clinical evaluation of the effect of Olbas oil on nasal mucosa in patients with acute rhinitis during common cold. 15 patients with 2-3 days history of acute rhinitis during common cold, both sexes, in the age between 23-47 were investigated. All the examinations were done before using, after the first inhalation, and after 7 days of Olbas oil administration. The investigation before using Olbas oil was comprised of: history data, general and otorhinolaryngological examination with particular evaluation of nasal mucosa, anterior rhinomanometry, saccharin translocation time, olfactometry, microbiological cultures, histamine nasal provocation test. At the end, after 7 days of Olbas oil inhalation 3 times a day for 4 minutes 4 drops of Olbas oil applied into a handkerchief, all the test were done again, as at the beginning. The study showed a good of the effect of Olbas oil on nasal mucosa in patients with acute rhinitis during common cold.

[Clinical studies of Olbas oil tolerance and its effect on nasal mucosa in healthy volunteers]

The aim of the study was the clinical examinations of the tolerance and effect of Olbas oil on nasal mucosa in healthy volunteers during permanent 4 weeks administration. 23 healthy volunteers both sexes in the age between 20-50 were investigated. This investigations consisted of: history data, general and otorhinolaryngological examination, with particular evaluation of nasal mucosa, anterior rhinomanometry, olfactometry, saccharin translocation time, microbiological cultures, histamine nasal provocation test. Besides, each patient has follow up self evaluating chart of symptoms and adverse effect from the eyes, nose, pharynx and others. All the examined persons showed a very good tolerance of Olbas oil after 28 days of inhalation.

[A prognostic value of of stapedius reflex and accommodation coefficient in patients with Bell's palsy]

At 25 patients with Bell's palsy every 7 days stapedius reflex (SR), accommodation coefficient as well as improvement of mimical facial movements were examined. At 5 patients SR was noticed before treatment, at 13 after 14 days, at 4 after 21 and at 3 after 28 days since disease beginning. There was significant correlation between return SR and improvement of mimical facial movements, but there wasn't correlation between SR and accommodation coefficient.

[The evaluation of granulocyte (PMNL) function of patients with chronic hypertrophy of larynx and paranasal sinuses]

The evaluation of granulocytes function (PMNL) at patients with chronic hypertrophy of larynx and paranasal sinuses. There were 40 people examined and divided into: 10 patients with hypertrophy of larynx, 13 patients with hypertrophy of paranasal sinuses and 17 healthy people. There were evaluated: emission of chemiluminescence (CL), absorption of isotope (phagocytic index) in our modification migration in vivo and in vitro and the bacteriotoxic index. The function of granulocytes in patients with hypertrophy of larynx and paranasal sinuses were changed more in comparison with the healthy people.

[The generation of oxygen free radicals in blood in patients with hypertrophy of paranasal sinuses and larynx]

The evaluated of oxygen specious generation in blood granulocytes of patients with hypertrophy of paranasal sinuses and larynx. There were 33 patients tested (13 with hypertrophy of paranasal sinuses, 10 with hypertrophy of larynx and 10 healthy). The superoxide anion generation of peripheral blood granulocytes described by the rate of the reduced cytochrome C at rest and after stimulation with opsonized zymosan according to Bellavite were measured. There were statistically significant differences between the superoxide anion generation in patients with hypertrophy of paranasal sinuses and larynx in comparison with the healthy ones.

[Aeroacoustic and pneumotachometric studies in the evaluation of vicarious voice in laryngectomy patients]

The aim the study was showed some spirometric and aerodynamic parameters of the respiratory system and of vicarious voice at laryngectomized patients, which were performed in plethysmographic cabin and by using of pneumotachometer. Clinical material stated 20 laryngectomized men, aged 45-77 years, who were divided into two groups (by Pruszewicz): A-well or very well speaking and B-bad speaking. The obtained results showed that laryngectomized well or very well speaking made bigger work of the respiratory system during vicarious voice than bad speaking ones. The well and very well speaking patients used twice (in case of consonants) and three times (in case of vowels) the volume of oesophageal-throat's air greater than bad speaking patients. Aerodynamic examinations in plethysmographic cabin allows for monitoring of vicarious voice at laryngectomized after operation and qualification some of ones for voice prosthetization in the aim of voice amplification.