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      Adult Xanthogranuloma Mimicking Basal Cell Carcinoma: Dermoscopy, Reflectance Confocal Microscopy and Pathological Correlation

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          Abstract

          Juvenile xanthogranuloma in adulthood is an infrequent non-Langerhans cell histiocytosis, which may simulate malignant tumors such as basal cell carcinoma (BCC) or amelanotic melanoma. Dermoscopy has been described as a useful tool in the preoperative diagnosis of xanthogranuloma. We report a xanthogranuloma on the suprapubic area of a 48-year-old female, which clinically and dermoscopically mimicked a BCC with a yellowish hue and arborizing vessels. Reflectance confocal microscopy exhibited large highly refractive atypical cells in the dermis, some of them with pleomorphic nuclei, corresponding to Touton cells in the histopathological study. To our knowledge this is the first description of the clinical, dermoscopic and confocal microscopy correlations of a xanthogranuloma.

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          Most cited references15

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          Dermoscopy of pigmented skin lesions: results of a consensus meeting via the Internet.

          There is a need for better standardization of the dermoscopic terminology in assessing pigmented skin lesions. The virtual Consensus Net Meeting on Dermoscopy was organized to investigate reproducibility and validity of the various features and diagnostic algorithms. Dermoscopic images of 108 lesions were evaluated via the Internet by 40 experienced dermoscopists using a 2-step diagnostic procedure. The first-step algorithm distinguished melanocytic versus nonmelanocytic lesions. The second step in the diagnostic procedure used 4 algorithms (pattern analysis, ABCD rule, Menzies method, and 7-point checklist) to distinguish melanoma versus benign melanocytic lesions. kappa Values, log odds ratios, sensitivity, specificity, and positive likelihood ratios were estimated for all diagnostic algorithms and dermoscopic features. Interobserver agreement was fair to good for all diagnostic methods, but it was poor for the majority of dermoscopic criteria. Intraobserver agreement was good to excellent for all algorithms and features considered. Pattern analysis allowed the best diagnostic performance (positive likelihood ratio: 5.1), whereas alternative algorithms revealed comparable sensitivity but less specificity. Interobserver agreement on management decisions made by dermoscopy was fairly good (mean kappa value: 0.53). The virtual Consensus Net Meeting on Dermoscopy represents a valid tool for better standardization of the dermoscopic terminology and, moreover, opens up a new territory for diagnosing and managing pigmented skin lesions.
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            Vascular structures in skin tumors: a dermoscopy study.

            To describe the different vascular structures seen by dermoscopy and to evaluate their association with various melanocytic and nonmelanocytic skin tumors in a large series of cases. Digital dermoscopic images of the lesions were evaluated for the presence of various morphologic types of vessels. Specialized university clinic. From a larger database, 531 excised lesions (from 517 patients) dermoscopically showing any type of vascular structures were included. The frequency and positive predictive value of the different vascular structures seen in various tumors were calculated, and the differences were evaluated by the chi2 or Fisher exact test. Arborizing vessels were seen in 82.1% of basal cell carcinomas, with a 94.1% positive predictive value (P<.001). Dotted vessels were generally predictive for a melanocytic lesion (90.0%, P<.001), and were especially seen in Spitz nevi (77.8% of lesions). In melanoma, linear-irregular, dotted, and polymorphous/atypical vessels were the most frequent vascular structures, whereas milky-red globules/areas were the most predictive ones (77.8%, P = .003). The presence of erythema was most predictive for Clark nevus, whereas comma, glomerular, crown, and hairpin vessels were significantly associated with dermal/congenital nevi, Bowen disease, sebaceous hyperplasia, and seborrheic keratosis, respectively (P<.001 for all). Different morphologic types of vessels are associated with different melanocytic or nonmelanocytic skin tumors. Therefore, the recognition of distinctive vascular structures may be helpful for diagnostic purposes, especially when the classic pigmented dermoscopic structures are lacking.
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              Development of a two-step method for the diagnosis of melanoma by reflectance confocal microscopy.

              Reflectance confocal microscopy (RCM) has been shown to improve accuracy in the differentiation of nevus from melanoma, but only a few studies have evaluated both melanocytic lesions (ML) and non-ML. We sought to develop an algorithm for the in vivo diagnosis of skin tumors by RCM. In 143 patients we evaluated 154 skin tumors (100 melanocytic, 54 nonmelanocytic) by RCM before their excision. We analyzed RCM features on stored images and performed univariate and multivariate analyses to determine the association of RCM features with tumor types. Four confocal features differentiated ML from non-ML: cobblestone pattern of epidermal layers, pagetoid spread, mesh appearance of the dermoepidermal junction, and the presence of dermal nests. Within ML, the presence of roundish suprabasal cells and atypical nucleated cells in the dermis was associated with melanoma, and the presence of edged papillae and typical basal cells was associated with nevi. Based on the correlation of RCM features with dermatoscopy and histology, we developed a two-step algorithm for the diagnosis of skin tumors by RCM. This is a preliminary study, and the results must be validated in further studies with a larger number of cases. RCM appears to be helpful in improving the presurgical diagnosis of difficult skin tumors.
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                Author and article information

                Journal
                DRM
                Dermatology
                10.1159/issn.1018-8665
                Dermatology
                S. Karger AG
                1018-8665
                1421-9832
                2010
                January 2010
                04 December 2009
                : 220
                : 1
                : 66-70
                Affiliations
                Melanoma Unit, Dermatology Department, Hospital Clinic, IDIBAPS, CIBER de enfermedades raras, Barcelona, Spain
                Article
                264670 Dermatology 2010;220:66–70
                10.1159/000264670
                19996569
                1b80865e-8dbf-4122-8860-07141ba20829
                © 2009 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                : 28 May 2009
                : 16 July 2009
                Page count
                Figures: 4, References: 18, Pages: 5
                Categories
                Case Report

                Oncology & Radiotherapy,Pathology,Surgery,Dermatology,Pharmacology & Pharmaceutical medicine
                Dermoscopy,Confocal microscope,Xanthogranuloma

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