SummaryBackground Electrical impedance spectroscopy (EIS) is a noninvasive diagnostic technique that measures tissue impedance. Objectives To evaluate the effect of adding an EIS measurement at baseline to suspicious melanocytic lesions undergoing routine short-term sequential digital dermoscopy imaging (SDDI). Methods Patients presented with suspicious melanocytic lesions that were eligible for short-term SDDI (with no clear feature of melanoma on dermoscopy). EIS measurement was performed at the first visit following dermoscopic photography. Normally, an EIS score of ≥ 4 is considered positive; however, this protocol investigated a higher cut-off in combination with SDDI. When the EIS score was ≥ 7 the lesion was excised immediately owing to the high risk of melanoma. Lesions with a score < 7 were monitored with standard SDDI over a 3-month period.Results From a total of 160 lesions analysed, 128 of 154 benign lesions received an EIS score of 0-6, giving a specificity of the EIS method for the diagnosis of melanoma of 83Á1% [95% confidence interval (CI) 76Á3-88Á7]. Five of the six melanomas found in this study had an EIS score ≥ 7, with a sensitivity for melanoma diagnosis of 83Á3% (95% CI 35Á9-99Á6).When EIS 0-6 lesions were subsequently followed up with SDDI, one additional melanoma was detected (EIS = 6) giving a sensitivity for the diagnosis of melanoma overall of 100% (95% CI 54Á1-100; six of six malignant melanomas excised) and a specificity of 69Á5% (95% CI 61Á5-76Á6; 107 of 154 benign lesions not excised). Conclusions If utilizing a protocol where an EIS score ≤ 3 requires no SDDI and ≥ 7 requires immediate excision, it reduced the need for SDDI by 46Á9% (n = 75/160; 95% CI 39Á0-54Á9).

Background Atypical intraepidermal melanocytic proliferations (AIMP) is a descriptive term sometimes applied to biopsies that do not fulfill diagnostic criteria of melanoma. They are common on sun-damaged skin, but their definition and management are controversial.Objective To describe dermoscopic (DS), reflectance confocal microscopic (RCM) and histopathological features of AIMP and identify features associated with subsequent melanoma in situ (MIS). Methods A retrospective analysis of AIMP lesions correlated with patient outcome at two melanoma tertiary centers between 2005 and 2015. Results Thirty-four patients were included. Nine (26%) patients had MIS in subsequent biopsies. Predictors of later MIS were target-like pattern (OR:12.0 [CI: 1.23, 117.41]; P = 0.032) and high-density vascular network (OR:12 [CI: 1.23-117.41], P: 0.032) on DS, and presence of dendritic cells touching each other (OR:9.1 [CI: 1.54, 54.59], P = 0.014) on RCM. Clinical predictors of worse outcome included a previous history of MIS at the same site. Radiotherapy for AIMP had a high failure rate (all patients presented with recurrent disease, three as AIMP and two as MIS).Conclusions Considering that most cases in this series received non-surgical treatment at baseline, we recommend close monitoring for lesions with target-like pattern and density vascular network on DS and treatment for lesions with progression of atypia and/or with "confluent" dendritic cells on RCM. Although the number of patients in this series is very low, early surgery is recommended for MIS cases that recur as AIMP.

No abstract

No abstract

Introduction: Atypical intraepidermal melanocytic proliferation (AIMP) is an early form of lentigo maligna (LM) which itself is a precursor to melanoma. It presents commonly on the head and neck where tissue conserving therapies are attractive. When treating LM with imiquimod, dermatologists treat until a certain level of skin inflammation is achieved. Radiation oncologists treat to a set dose of radiation irrespective of the skin reaction at completion. The dose of radiotherapy for AIMP is unknown and these lesions are currently treated in the same manner as LM. Case series: Five immunocompetent patients (average age 80 years) with AIMP or early LM (ELM) on the head and neck region were treated with RADICAL radiotherapy (RT) protocols. All treatment sites were mapped with in vivo reflectance confocal microscopy (RCM) and measured on average 4.0 cm in diameter (range 2.0–6.0 cm). The median RT dose administered was 50 Gray (Gy) [45-54 Gy] in 1.8-2Gy per fraction to the planning target volume (PTV), usually by megavoltage electrons. All patients completed RT. The peak radiation acute skin toxicity observed at any time in all patients was only dry desquamation, equivalent to a grade 2 acute radiation dermatitis reaction by Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0. At a median of follow up of 10 months, all patients had biopsy proven recurrence of AIMP (n=3) or LM (n=2). All recurrences were within the RT field. Patients were followed for an average total of five years post salvage treatment (range: 26 - 124 months). Discussion: This series raises questions. First, what radiation dose is required to cure AIMP and ELM? This series suggests that the same dose, if not higher, used in established in-situ disease, is required. Second, should radiation oncologists treat to a grade 3 skin reaction? It may be then advisable to use standard fractionation (2Gy or less) so that the peak RT reaction coincides with the end of treatment and allows for titration and extra dose to be added.

No abstract

Circumscribed palmoplantar hypokeratosis is a recently recognized dermatosis and rarely reported. It was first described in 2002 and is characterized by localized loss of the horny layer in the palmoplantar area. This dermatosis is clinically presented with a sharply circumscribed, reddish and asymptomatic plaque with slightly depressed surface localized on the palms or the soles. The clinical differential diagnosis includes mainly porokeratosis and Bowen's disease. Its pathogenesis remains unknown, but studies have proposed a human papillomavirus induced disease or a localized keratinization disorder in the palmoplantar area. We report herein two cases of patients with lesions clinically and microscopically compatible with the diagnosis of circumscribed palmoplantar hypokeratosis. We also present a brief literature review of the etiopathogenic hyphoteses of this dermatosis.

No abstract