BackgroundWe tested the relevance of clinical information in the histopathologic evaluation of melanocytic skin neoplasm (MSN).MethodsHistopathologic specimens from 99 clinically atypical MSN were circulated among ten histopathologists; each case had clinical information available in a database with a five-step procedure (no information; age/sex/location; clinical diagnosis; clinical image; dermoscopic image); each step had a histopathologic diagnosis (D1 through D5); each diagnostic step had a level of diagnostic confidence (LDC) ranging from 1 (no diagnostic certainty) to 5 (absolute diagnostic certainty). The comparison of the LDC was employed with an analysis of variance (ANOVA) for repeated measures.FindingsIn D1 (no information), 36/99 cases (36.3%) had unanimous diagnosis; in D5 (full information available), 51/99 cases (51.5%) had unanimous diagnosis (p for difference between proportions <0.001). The observer agreement expressed as kappa increased significantly from D1 to D5. The mean LDC linearly increased for each observer from D1 through D5 (p for linear trend <0.001). On average, each histopathologist changed his initial diagnosis in 7 cases (range: 2–23). Most diagnostic changes were in D2 (age/sex/location).InterpretationThe histopathologic criteria for the diagnosis of MSN can work as such, but the final histopathologic diagnosis is a clinically-aided interpretation. Clinical data sometimes reverse the initial histopathologic evaluation.

Eccrine poroma (EP) may clinically mimic a number of benign and malignant skin tumors. Dermoscopy improves the clinical diagnosis of many pigmented and nonpigmented skin tumors, but to date little is known about the impact of dermoscopy in the diagnosis of EP. We report 2 patients with EP and discuss the diagnostic significance of the observed dermoscopic findings.

To determine the time required to perform a complete skin examination (CSE) as a means of opportunistic screening for skin cancer both without and with dermoscopy.

Background: Sclerosing nevi with pseudomelanomatous features or, else, nevi with regression-like fibrosis (NRLF) are histopathologic simulators of regressing melanoma. Objective: We aimed at evaluating the clinical features in a series of NRLF. Methods: Dermoscopic images of NRLF were re-evaluated according to the amount of regression, the presence of white/blue areas and the 7-point checklist. Results: Forty-six lesions from 44 patients (M:F = 3.4:1; mean age: 42 years) were evaluated. Thirty-seven lesions were excised from the back, mostly from the scapular area. All the lesions were dermoscopically atypical, with large amounts of regression (>10% in 43 cases) and with coexistence of white and blue areas (41 cases). According to the 7-point checklist, 25 lesions were labeled as benign, probably because regression obscured other dermoscopic features of atypia. Conclusion: NRLF are mostly found in the convex area of the back. A better recognition of their clinicopathologic features can allow a more conservative management.