RSS 1.0Dermatology
Recent Submissions
-
Congenital cutaneous lymphadenomaCutaneous lymphadenoma is an uncommon benign neoplasm often considered to be an adamantinoid variant of trichoblastoma. Lesions present in both sexes, between 14 and 87 years of age, and are mainly located on the head and neck. Cases in children are rare and there is only 1 previous case of a congenital lymphadenoma. An 8-year-old Asian girl presented with a congenital lesion on her forehead comprising 4 pink papules, the largest 5 mm in diameter. Microscopy revealed a well-circumscribed tumor within the dermis and subcutis comprising well-demarcated epithelial lobules of basaloid and clear cells with subtle peripheral palisading, growing in a collagenous stroma but lacking retraction artefact. A relatively dense accompanying predominantly lymphocytic inflammatory cell infiltrate including both T-cells (CD3+) and B-cells (CD20+) permeated the nodules and spilled into the stroma. CD68+ histiocytes and CD1a+ Langerhans cells were moderately numerous. This is the second case of congenital lymphadenoma which-in spite of its rarity in childhood-widens the diagnostic possibilities of cutaneous lymphoepithelial tumors in children.
-
Follicular porokeratosis: Four new casesPorokeratosis, a disorder of keratinisation, is clinically characterized by the presence of annular plaques with a surrounding keratotic ridge. Clinical variants include linear, disseminated superficial actinic, verrucous/hypertrophic, disseminated eruptive, palmoplantar and porokeratosis of Mibelli (one or two typical plaques with atrophic centre and guttered keratotic rim). All of these subtypes share the histological feature of a cornoid lamella, characterized by a column of 'stacked' parakeratosis with focal absence of the granular layer, and dysmaturation (prematurely keratinised cells in the upper spinous layer). In recent years, a proposed new subtype, follicular porokeratosis (FP_, has been described, in which the cornoid lamella are exclusively located in the follicular ostia. We present four new cases that showed typical histological features of FP.
-
A recently changed, long-standing nodule on the chest wallA clinicopathological case of a 75‐year‐old white woman presented with a 35‐year history of a chest wall lesion that, in the 6 months prior to presentation, had increased in size and become tender.
-
A painful leg ulcerA clinicopathological case of a 59‐year‐old man presented with a 4‐week history of a painful ulcer on his right lower leg.
-
Establishing and prioritizing research questions for the treatment of alopecia areata: The Alopecia Areata Priority Setting PartnershipBackground: Alopecia areata (AA) is a common hair loss disorder that results in patchy to complete hair loss. Many uncertainties exist around the most effective treatments for this condition. Objectives: To identify uncertainties in AA management and treatment that are important to both service users (people with hair loss, carers and relatives) and healthcare professionals. Methods: An AA priority setting partnership was established between patients, their carers and relatives, and healthcare professionals to identify the most important uncertainties in AA. The methodology of the James Lind Alliance was followed to ensure a balanced, inclusive and transparent process. Results: In total, 2747 treatment uncertainties were submitted by 912 participants, of which 1012 uncertainties relating to AA (and variants) were analysed. Questions were combined into 'indicative uncertainties' following a structured format. A series of ranking exercises further reduced this list to a top 25 that were taken to a final prioritization workshop where the top 10 priorities were agreed. Conclusions: We present the top 10 research priorities for AA to guide researchers and funding bodies to support studies important to both patients and clinicians.
-
Severe blistering eruptions induced by immune checkpoint inhibitors: a multicentre international study of 32 casesAmong dermatologic adverse events induced by immune checkpoint inhibitors (ICI), bullous life-threatening reactions are rare. To better define the clinical and histological features, treatment, and prognosis of ICI-related severe blistering cutaneous eruptions. This retrospective case series was conducted between 2014/05/15 and 2021/04/15 by the dermatology departments of four international registries involved in drug reactions. Inclusion criteria were age ≥18 years old, skin eruption with blisters with detachment covering ≥1% body surface area and at least one mucous membrane involved, available pictures, and ICI as suspect drug. Autoimmune bullous disorders were excluded. Each participant medical team gave his own diagnosis conclusion: epidermal necrolysis (EN), severe lichenoid dermatosis (LD), or unclassified dermatosis (UD). After a standardized review of pictures, cases were reclassified by four experts in EN or LD/UD. Skin biopsies were blindly reviewed. Thirty-two patients were included. Median time to onset was 52 days (3-420 days). Cases were originally diagnosed as EN in 21 cases and LD/UD in 11 cases. After review by experts, 10/21 EN were reclassified as LD/UD. The following manifestations were more frequent or severe in EN: fever, purpuric macules, blisters, ocular involvement, and maximal detachment. Most patients were treated with topical with or without systemic corticosteroids. Eight patients (25%) died in the acute phase. The culprit ICI was not resumed in 92% of cases. In three patients, another ICI was given with a good tolerance. Histology did not reveal significant differences between groups. Severe blistering cutaneous drug reactions induced by ICI are often overdiagnosed as EN. Consensus for management is pending.
-
The age-old problem of acneAcne vulgaris is one of the top three most commonly encountered dermatological problems worldwide in both primary and secondary care. Acne diagnosis and treatment date back to ancient Greek and Egyptian times. This article explores acne through the ages and discusses past theories on etiology and treatment with particular focus on the discovery of retinoids and their impact on women's health.
-
National epidemiology of digital papillary adenocarcinoma in England 2013-2020 : a population-based registry studyBackground: Digital papillary adenocarcinoma (DPA), formerly known as aggressive DPA, is a rare adnexal cancer of sweat gland differentiation with metastatic potential. DPA epidemiology and patient outcome data are a prerequisite to develop diagnostic and therapeutic guidance, which is lacking for this rare cancer. Objectives: To report the incidence, patient demographics and treatment of patients with DPA in England from 1 January 2013 to 31 December 2020 using national cancer registry data. Methods: DPA diagnoses in England during 2013-2020 were identified from the National Cancer Registration Dataset using morphology and behaviour codes. These were registered from routinely collected pathology reports and cancer outcomes and services datasets. The 2013 European age-standardised incidence rates (EASRs) were calculated. Results: In total, 36 DPA (7 in females and 29 in males) were diagnosed. The median age at diagnosis for the cohort was 54 years (interquartile range 46-64). The most frequently affected sites were upper limbs (81%). All patients in the cohort received surgical excisions. The European age-standardised incidence rate (EASRs) was 0.10 [95% confidence interval (CI) 0.07-0.14] per 1,000,000 person-years (PY)]. Conclusion: This study reports the incidence and variation of DPA in England between 2013 and 2020. DPA was more common in older men and predominantly affected the upper limbs. This supports the need to develop a national policy for the reporting and management of DPA as well as clinical guideline development.
-
Comment on ‘The detection rate of human papillomavirus in well‐differentiated squamous cell carcinoma and keratoacanthoma: is there new evidence for a viral pathogenesis of keratoacanthoma?’This comment piece responds to an article by Conforti et al (doi: 10.1111/bjd.18212).
-
Dyeing for treatment : the colourful history of the use of dyes in dermatologyThis abstract from the British Association of Dermatologists 99th Annual Meeting outlines the historical use of pharmacologically active dye compounds in dermatology.
-
Hot feet! Dancing the chilblains Cha ChaThis poster abstract reports a case of chilblains arising during a warm summer holiday.
-
Rare necrotic lesion in a pregnant womanA 34-year-old female community nurse in her first trimester of pregnancy presented with a 2-week history of a tender, swollen and hyperkeratotic lesion on her chest with no history of trauma. The lesion started as a red ‘spot’, became crusted, pustular and formed an eschar. A generous incisional biopsy was taken.
-
An unusual case of multiple nodules on the lower legsA 64-year-old man presented with a 6-week history of lesions on his lower legs (Fig. 1). He had no itching, pain or any other symptoms related to the lesions. His medical history included chronic obstructive pulmonary disease (COPD), hypertension and osteoporosis. His medications included alendronic acid, doxazocin, lisinopril, Evacal D3, amlodipine and the inhalers tiotropium bromide 180 lg, Sirdupla (salmeterol 25 lg, fluticasone 250 lg) and salbutamol 200 lg, all of which he had been taking for many years. Physical examination of the right lower leg revealed a single erythematous, warty nodule. There were three further large, warty, erythematous nodules on the left lower leg. Both legs had surrounding scale and haemosiderin staining. Further systemic examina tion did not reveal any other abnormalities.
-
An enlarging pedunculated nodule on the shoulder of a 21-year-old manA 21-year-old man presented with an 8-month history of an enlarging lesion on his left shoulder that had started as a small spot. A general practitioner, suspect ing a boil, had previously prescribed antibiotics and steroid cream, but the lesion continued to grow. It did not bleed. The patient was a student. He was other wise well with no relevant personal or family history. On physical examination, a solid red pedunculated and nonfriable nodule, 29 9 25 mm, was found. No vascular channels were seen dermoscopically (Fig. 1a). The patient had no palpable lymphadenopathy. The lesion was suspicious for amelanotic melanoma, and was excised with a 5-mm margin.
-
Another typical case of bullous pemphigoid?This British Society for Dermatopathology conference abstract reports a rare case of acquired haemophilia A in association with bullous pemphigoid.
-
Confidence of paediatric trainees in dermatological conditions and suggested improvements to trainingThis conference abstract assesses the confidence of paediatric trainees in dermatological conditions and suggests improvements to training.
-
PRAME immunohistochemistry as an adjunct in the diagnosis of paucicellular lentigo maligna in a young manA letter to the Editor reporting the use of PRAME immunohistochemistry as an adjunct in the diagnosis of paucicellular lentigo maligna in a young man.
-
Keratoacanthoma management: results of a survey of U.K. dermatologists and surgeonsDistinction of keratoacanthoma (KA) from squamous cell carcinoma (SCC) is challenging and management is controversial, with some advocating prompt surgical excision and others monitoring to allow for spontaneous resolution.1 There are rare reports of metastasis.2 And yet, the benign natural history of KA is supported by various studies, including a systematic review of 455 cases with no metastasis or death1 and observational studies confirming spontaneous resolution.1 Unlike in SCC, perineural or venous invasion in KA is not associated with an adverse outcome.3,4 Comparative genomic hybridization and DNA microarray studies indicate that KA and SCC are genetically distinct.5,6 Some have suggested that the rare reports of metastatic KA may have arisen from SCC development within KA.3 Our online 22‐item questionnaire ascertained clinicians’ views about KA and its management, previously observed outcomes and willingness to enrol patients into a proposed clinical trial (the questionnaire and further details of results are available from the authors on request). The questionnaire was circulated via the British Association of Dermatologists, the British Society for Dermatological Surgery, Reconstructive Surgery Trials Network, U.K. Dermatology Clinical Trials Network and the national trainee electronic mailing lists. Of 223 respondents 162 (73%) were consultants. Responses to a subset of questions were compared between specialties (dermatology n = 152; dermatological surgery n = 48; and plastic surgery n = 21) with χ2‐ or Fisher's exact test (SPSS Version 22, IBM, Armonk, NY, U.S.A.).
-
CD34 and BerEP4 Are Helpful to Distinguish Basaloid Tricholemmoma From Basal Cell CarcinomaTricholemmoma, a benign follicular neoplasm with outer root sheath differentiation, typically comprises clear or pale cells, and when multiple is pathognomic of Cowden's syndrome. The tumor is probably underrecognized and in basaloid examples can be difficult to distinguish from basal cell carcinoma (BCC). We studied 55 tricholemmomas (including 15 basaloid cases) and compared immunohistochemical profile with nodular BCC from our archives. Basaloid and non–basaloid tricholemmomas had similar staining characteristics. BerEP4 was focally positive (range 10%–20%) in only 3/39 (7.7%) tricholemmomas compared with widespread positivity in BCC (90.8%, 139 of 151 cases with ≥50% tumor area stained). CD34 was expressed, usually focally (median 20%, range 10%–90%), in 52/53 (98.1%) tricholemmomas and was negative in all 21 BCCs stained. EMA staining lacked sensitivity or specificity in differentiating tricholemmoma from BCC. Five or more Merkel cells were found in 7/17 (40.1%) tricholemmomas and 1/23 (4.3%) nodular BCCs studied. In summary, immunohistochemistry is helpful in distinction between tricholemmoma, including difficult basaloid examples (BerEP4 negative or focal, CD34 positive) compared with BCC (BerEP4 widespread in most cases, CD34 negative). The presence of 5 or more Merkel cells is a relatively specific but not a particularly sensitive discriminator.
-
Skin cancer classification via convolutional neural networks : systematic review of studies involving human experts.Background: Multiple studies have compared the performance of artificial intelligence (AI)-based models for automated skin cancer classification to human experts, thus setting the cornerstone for a successful translation of AI-based tools into clinicopathological practice. Objective: The objective of the study was to systematically analyse the current state of research on reader studies involving melanoma and to assess their potential clinical relevance by evaluating three main aspects: test set characteristics (holdout/out-of-distribution data set, composition), test setting (experimental/clinical, inclusion of metadata) and representativeness of participating clinicians. Methods: PubMed, Medline and ScienceDirect were screened for peer-reviewed studies published between 2017 and 2021 and dealing with AI-based skin cancer classification involving melanoma. The search terms skin cancer classification, deep learning, convolutional neural network (CNN), melanoma (detection), digital biomarkers, histopathology and whole slide imaging were combined. Based on the search results, only studies that considered direct comparison of AI results with clinicians and had a diagnostic classification as their main objective were included. Results: A total of 19 reader studies fulfilled the inclusion criteria. Of these, 11 CNN-based approaches addressed the classification of dermoscopic images; 6 concentrated on the classification of clinical images, whereas 2 dermatopathological studies utilised digitised histopathological whole slide images. Conclusions: All 19 included studies demonstrated superior or at least equivalent performance of CNN-based classifiers compared with clinicians. However, almost all studies were conducted in highly artificial settings based exclusively on single images of the suspicious lesions. Moreover, test sets mainly consisted of holdout images and did not represent the full range of patient populations and melanoma subtypes encountered in clinical practice. Keywords: Artificial intelligence; Convolutional neural network(s); Deep learning; Dermatology; Digital biomarkers; Machine learning; Malignant melanoma; Skin cancer classification.
