Melanosis of the nipple and areola is probably significantly underreported in the medical literature and, based on our experience, is likely to be the most common cause of pigmentation at this site. Considering this, benign condition on clinical and dermoscopic features should lead to biopsy rather than excision to confirm the diagnosis. Further reports of the dermoscopic features will help to define this condition further.

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Summary Background and objectives Convolutional neural networks (CNN) enable accurate diagnosis of medical images and perform on or above the level of individual physicians. Recently, collective human intelligence (CoHI) was shown to exceed the diagnostic accuracy of individuals. Thus, diagnostic performance of CoHI (120 dermatologists) versus individual dermatologists versus two state‐of‐the‐art CNN was investigated. Patients and Methods Cross‐sectional reader study with presentation of 30 clinical cases to 120 dermatologists. Six diagnoses were offered and votes collected via remote voting devices (quizzbox®, Quizzbox Solutions GmbH, Stuttgart, Germany). Dermatoscopic images were classified by a binary and multiclass CNN (FotoFinder Systems GmbH, Bad Birnbach, Germany). Three sets of diagnostic classifications were scored against ground truth: (1) CoHI, (2) individual dermatologists, and (3) CNN. Results CoHI attained a significantly higher accuracy [95 % confidence interval] (80.0 % [62.7 %–90.5 %]) than individual dermatologists (75.7 % [73.8 %–77.5 %]) and CNN (70.0 % [52.1 %–83.3 %]; all P < 0.001) in binary classifications. Moreover, CoHI achieved a higher sensitivity (82.4 % [59.0 %–93.8 %]) and specificity (76.9 % [49.7 %–91.8 %]) than individual dermatologists (sensitivity 77.8 % [75.3 %–80.2 %], specificity 73.0 % [70.6 %–75.4 %]) and CNN (sensitivity 70.6 % [46.9 %–86.7 %], specificity 69.2 % [42.4 %–87.3 %]). The diagnostic accuracy of CoHI was superior to that of individual dermatologists (P < 0.001) in multiclass evaluation, with the accuracy of the latter comparable to multiclass CNN. Conclusions Our analysis revealed that the majority vote of an interconnected group of dermatologists (CoHI) outperformed individuals and CNN in a demanding skin lesion classification task.

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A 56-year-old man presented with tingling ulcers on the feet. On further skin examination, papules on the knees were observed. Biopsies revealed extravascular eosinophilic deposits of IgM, and Waldenström macroglobulinaemia was diagnosed. The skin manifestations have resolved with chemotherapy. Peripheral neuropathy and storage papules are rare manifestations of Waldenström’s macroglobulinaemia.