The accuracy of melanoma-specific dermoscopic criteria has been tested mainly in studies including invasive tumors. Scarce evidence exists on the usefulness of these criteria for the diagnosis of melanoma in situ (MIS). OBJECTIVE To investigate the diagnostic accuracy of dermoscopic criteria for the diagnosis of MIS. DESIGN, SETTING, AND PARTICIPANTS A diagnostic accuracy study with retrospective patient enrollment was conducted in 3 centers specializing in skin cancer diagnosis and management. A total of 1285 individuals with histopathologically diagnosed MIS or other flat, pigmented skin tumors that were histopathologically diagnosed or monitored for at least 1 year were included. Dermoscopic images of MIS and other flat, pigmented skin tumors were evaluated by 3 independent investigators for the presence of predefined criteria. Evaluators were blinded to the clinic dermoscopic and histopathologic diagnosis. MAIN OUTCOMES AND MEASURES Frequencies of dermoscopic criteria per diagnosis were calculated. Crude odds ratios, adjusted odds ratios, and corresponding 95% CIs were calculated by univariate and multivariate logistic regression, respectively. RESULTS A total of 1285 patients were included in the study (642 [50%] male); mean age was 45.9 years (range, 9-91 years). Of a total of 1285 lesions obtained from these patients, 325 (25.3%) were MIS; 574 (44.7%) were nevi (312 [24.3%] excised and 262 [20.4%] not excised); 67 (5.2%) were seborrheic keratoses, solar lentigines, or lichen planus-like keratoses; 91 (7.1%) were pigmented superficial basal cell carcinomas; 26 (2.0%) were pigmented intraepithelial carcinomas; 100 (7.8%) were Reed nevi; and 102 (7.9%) were invasive melanomas with a Breslow thickness less than 0.75 mm. The most frequent dermoscopic criteria for MIS were regression (302 [92.9%]), atypical network (278 [85.5%]), and irregular dots and/or globules (163 [50.2%]). The multivariate analysis revealed 5 main positive dermoscopic indicators of MIS: atypical network (3.7-fold; 95% CI, 2.5-5.4), regression (4.7-fold; 95% CI, 2.8-8.1), irregular hyperpigmented areas (5.4-fold; 95% CI, 3.7-8.0), prominent skin markings (3.4-fold; 95% CI, 1.9-6.1), and angulated lines (2.2-fold; 95% CI, 1.2-4.1). When compared only with excised nevi, 2 of these criteria remained potent MIS indicators, namely, irregular hyperpigmented areas (4.3-fold; 95% CI, 2.7-6.8) and prominent skin markings (2.7-fold; 95% CI, 1.3-5.7). CONCLUSIONS AND RELEVANCE Clinicians should take into consideration the aforementioned dermoscopic indicators for the diagnosis of MIS.

Aims: The primary aim was to determine the prevalence of aquagenic wrinkling of the palms (AWP) in patients with cystic fibrosis (CF) compared to controls, and secondarily to evaluate genotype-phenotype correlations among CF subjects found to have AWP. Methods: Fifty-eight patients with CF underwent a hand immersion test in tap water. Twenty-three of their CF carrier relatives and 7 subjects with a negative genetic test for CF were recruited as controls. Secondary analyses explored associations with genotype, pulmonary function, and sweat electrolyte levels in all subjects with and without AWP. Additional information about atopic diathesis, hyperhidrosis of the palms and drug intake were also collected. Results: Thirty-one of the patients with CF (53.4%) exhibited AWP, in contrast to only 2 carriers (8.7%) and none in the control group. No correlation was found between CF genotype and AWP score severity. Twenty-three (39.7%) CF patients reported a history of hyperhidrosis, and in 17 of them (74%) AWP had been provoked. No correlation with history of atopy and lung function was noted. The difference between CF patients with hyperhidrosis and those without was highly significant (p = 0.016). Salt concentrations were significantly higher in patients with AWP. Conclusions: AWP is linked to CF and its diagnosis should lead the patients to a genetic or sweat test for CF. We found a significant association with hyperhidrosis and sweat electrolytes which supports the ‘hyperconcentrated sweat' pathogenetic theory of AWP.

Erosive pustular dermatosis of the scalp induced by ingenol mebutate Editor Erosive pustular dermatosis of the scalp (EPDS) is a rare entity that develops in sun-damaged scalp skin of elderly people with alopecia and/or multiple actinic keratoses (AKs).1 It is often triggered by local trauma such as surgical procedures, skin graft, hair transplantation or physical and chemical procedures for AK including, cryotherapy, radiation therapy, laser therapy, topical retinoid, imiquimod and photodynamic therapy.

Drug-induced bullous pemphigoid (DIBP) has been reported to be an autoimmune bullous disease induced or precipitated by several drugs, immunopathologically similar to classic bullous pemphigoid. Several medications may not only cause DIBP, including diuretics, antiarrythmics-antihypertensives, and recently antitumor necrosis factor agents, other drugs as chloroquine, but also rarely by antibiotics as amoxicillin and penicillin. The authors present the third case of DIBP induced by quinolones and the second case of localized DIBP triggered by oral ciprofloxacin. A DIBP can be suspected in old patients when they add or change some drugs in their normal medication regimen.

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