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Dermatology: Practical and Conceptual DERMATOLOGY PRACTICAL & CONCEPTUAL www.derm101.com Abstracts from the 4th World Congress of the International Dermoscopy Society, April 16-18, 2015, Vienna, Austria Citation: Abstracts from the 4th World Congress of the International Dermoscopy Society, April 16-18, 2015, Vienna, Austria. Dermatol Pract Concept 2015;5(2):28. http://dx.doi.org/10.5826/dpc.0502a28 ORAL PRESENTATIONS carcinoma and basal cell carcinoma), as well as infectious and genetic disease (storage diseases), could be evocated. The detection of parasites (Demodex folliculorum) on eye- FREE COMMUNICATIONS: lids was possible. Confocal images correlated well with con- CONFOCAL AND OCT ventional histopathology. The fluorescence examination of corneal squamous cell carcinoma by VivaScope 1500 was FC1-1 characterized by extravasation of fluorescein after intrave- nous injection. IN VIVO CONFOCAL MICROSCOPES DEDICATED TO THE SKIN FOR THE EXPLORATION OF THE Conclusions: Confocal microscopes dedicated to the skin of- fer new perspectives for the diagnosis, optimization of treat- OCULAR SURFACE: A NEW PERSPECTIVE FOR ments, and follow-up of the ocular diseases. They will allow DERMATOLOGISTS dermatologists to examine conjunctival and eyelid tumors, as it is for skin or genital mucosa. In addition, thanks to *1 1 1 Elisa Cinotti , Jean-Luc Perrot , Bruno Labeille , some adaptations of the dermatological device VivaScope® Gilles Thuret2, Damien Grivet2, Philippe Gain2, 1500, it is possible for the first time to perform a fluorsecnte Frédéric Cambazard1 examination of the ocular and peri-ocular tissue, opening a new era in the clinical imaging of the ocular surface. A new 1 2 Dermatology, Opthalmology, University Hospital of Saint-Etienne, semiology remains to be learned. Saint-Etienne, France Background: In vivo confocal microscopy is an imaging FC1-2 technique that has been applied to the study of the ocular surface. However, confocal microscopes dedicated to eye PINK PLAQUES ON THE LEGS. THE ROLE OF examination are routinely adopted only in ophthalmology REFLECTANCE CONFOCAL MICROSCOPY reference centres and do not allow an examination of peri- ocular tissue, nor a fluorescence examination. Ignacio Gómez Martín*1, Sara Moreno Fernández1, Methods: We applied for the first time the two in vivo confo- Ramon M Pujol Vallverdú1, Sonia Segura Tigell1 cal microscopes commonly used in dermatology (VivaScope ® 1500 and 3000, CALIBER, distributed in Europe by Mavig 1Dermatology, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain GmbH, Munich, Germany) to observe the cornea, the bulbar Introduction and Objectives: Pink plaques on the legs in el- and tarsal conjunctiva, the eyelid margin, the lacrimal punc- derly often represent a challenge for clinicians because of the tum and the palpebral skin of healthy volunteers. Tumoral, broad differential diagnosis. There is a great diagnostic vari- inflammatory and infectious diseases of the ocular mucosa ety of either tumoral and inflammatory diseases. The diagno- and periocular skin from more than 200 patients were ob- sis is complicated by the paucity of clinical and dermoscopic served under the same microscopes. Both microscopes have morphological clues and the existence of varying degrees of a reflectance mode. VivaScope® 1500 allows an additional xerosis, sun damage and venous stasis dermatitis. In addi- fluorescent examination and its placement on the ocular sur- tion, dermoscopic algorithms routinely used for pigmented face was made possible by the creation of a special interface lesions are not very helpful in the diagnosis of pink plaques. between the microscope and the ocular apparatus. Reflectance confocal microscopy (RCM) is a useful non-in- Results: Thanks to its compact and flexible configuration, vasive complementary tool in the diagnosis of malignancy. the handheld camera VivaScope® 3000 allowed to access The aim of our study was to describe the utility of RCM in more easily to the ocular and periocular tissues. Diagnosis pink plaques on the legs in photodamaged skin and to cor- of benign and malignant tumors (melanoma, squamous cell relate the findings with histopathology. Supplement | Dermatol Pract Concept 2015;5(2):28 137 Materials and Methods: Prospective study of 47 pink plaques evaluated at 4 different moments up to the end of photo- on the legs from 36 patients (10 males, 26 females, mean therapy. age: 72 years (44-91)). A 4mm punch biopsy was performed Results: Dermoscopy showed regression phenomena (with in all cases. Clinical, dermoscopic and RCM images were loss of structures such as network and dots/globules) and stored and blindly evaluated for clinical, dermoscopic and inflammatory features (such as dotted and fine telangiecta- RCM diagnosis. Analysis of dermoscopic and RCM criteria sic vessels and diffuse erythema). On RCM, predominantly described in the literature and subsequent correlation with at the middle and end of protocol, the appearance of large histopathology were also performed. dendritic cells within epidermis was observed, like real mela- Results: 13 benign lesions (8 stasis dermatitis, 1 lichen pla- noma simulators. Immunohistopathology confirmed the nus, 1 viral wart, 1 scar, 1 neurofibroma, 1 lichen planus-like presence of activated melanocytes that could correspond to keratosis) and 34 malignant neoplasms (20 basal cell car- the images seen on RCM. The presence of regression, mela- cinoma (BCC), 14 Bowen’s disease) were analysed. A cor- nophages and perivascular lymphocytic inflammatory infil- rect clinical diagnosis was established in only 38% of cases trate also corroborates the dermoscopy findings. Regarding (18/47). Dermoscopy following clinical assessment achieved the sunscreen protection role, we could verify nbUVB effects on both unprotected and protected halves, but more obvi- 49% (23/47) of correct diagnosis, whereas RCM evaluation ously demonstrated on the unprotected halves. after clinical and dermoscopic evaluation rendered a correct diagnosis in 72% of cases (35/47). Conclusions: Benign melanocytic nevi can show features re- sembling melanoma on RCM images when they are evalu- Conclusions: Dermoscopic criteria of pink plaques on the legs ated after repeated nbUVB sub-erythematogenic doses. This are frequently not enough to set a proper diagnosis, due to means that we have to be aware of RCM pitfalls, especially lack of specific features. RCM may improve our diagnostic in the context of recent UVR exposure, since these lesions accuracy as a secondary evaluation after dermoscopy. can simulate melanomas. FC1-3 FC1-4 DOES PHOTOTHERAPY INDUCE MELANOMA IN VIVO REFLECTANCE CONFOCAL MICROSCOPY SIMULATORS? ROLE OF CONFOCAL MICROSCOPY (RCM) OF MELANOTIC MACULES—KEY FEATURES IN THE EVALUATION OF NEVI UNDERGOING NBUVB AND IMPACT OF RCM ON NON-INVASIVE IRRADIATION DIAGNOSIS AND TREATMENT *1 1 Caroline M. Takigami , Mauricio Gamboa , Marion Christine Prodinger*1, Martin Laimer1, Edith Arzberger2, 1 1, 2 3 Chavez-Bourgeois , Paula Aguilera , Llucia Alos , Clara Kirchner1, Rainer Hofmann-Wellenhof2, 2, 4 2, 4 1, 4 Josep Malvehy , Susana Puig , Cristina Carrera Verena Ahlgrimm-Siess1 1 2 Dermatology Department, Hospital Clínic de Barcelona, CIBER 1Dermatology, Paracelsus Medical University of Salzburg, Salzburg, Enfermedades Raras, Instituto de Salud Carlos III, 3Pathology 2Dermatology, Medical University of Graz, Graz, Austria Department, Hospital Clínic de Barcelona, 4Melanoma Unit, University of Barcelona, Barcelona, Spain Background: The distinction of melanotic macules and mel- anoma is momentous but poses a major challenge in the Background: Previous studies (1) have shown that UVR can daily routine due to overlapping clinical and dermoscopic be responsible for inducing dynamic changes in nevi. Howev- features. Repeated biopsies and lifelong follow-up may be er, further characterization of these likely dynamic and tran- necessary to rule out malignancy. RCM can assist ascertain sient events are required. Reflectance Confocal Microscopy the diagnosis, by allowing visualization of the skin at nearly (RCM) is a non-invasive in vivo imaging technique which histological resolution. allows the evaluation over time of the same lesion obtaining Objectives: The validity and reproducibility of RCM criteria high sensitivity and specificity in cutaneous lesion diagnosis for melanotic macules of mucocutaneous junctions (MCJ) is (2). With this valuable tool, we could better recognize the tested in order to evaluate the diagnostic value of RCM for role of sunscreens in the prevention of these changes on nevi. these lesions. Further the impact of RCM on lowering the Objectives and Method: To make a comparative description excision rate of melanotic macules compared to clinical and of the same nevi with and without sunscreen application dermoscopic evaluation alone is investigated. over time, during narrow band UVB therapy, by means of Methods: A retrospective RCM image analysis of 39 pig- dermoscopy and RCM. Patients who were programmed to mented macules (31 melanotic macules, 2 banal nevi, 4 receive nbUVB phototherapy for their underlying dermato- atypical nevi, 2 in situ melanomas) on genital (23) and labial sis were included and submitted to the same irradiated nevi (16) MCJ was done by two groups of investigators blinded protocol designed by Carrera et al (1). The selected nevi were to diagnoses, novices vs. expert. Both groups had to opt for divided into two halves, one with and the other without sun- a differential diagnosis (melanotic macule or benign/atypi- screen before nbUVB sub-erythematogenic
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