Nathalie De Carvalho - Academia.edu (original) (raw)

Papers by Nathalie De Carvalho

Cancers

Along with the rising melanoma incidence in recent decades and bad prognoses resulting from late ... more Along with the rising melanoma incidence in recent decades and bad prognoses resulting from late diagnoses, distinguishing between benign and malignant melanocytic lesions has become essential. Unclear cases may require the aid of non-invasive imaging to reduce unnecessary biopsies. This multicentric, case-control study evaluated the potential of dynamic optical coherence tomography (D-OCT) to identify distinguishing microvascular features in nevi. A total of 167 nevi, including dysplastic ones, on 130 participants of all ages and sexes were examined by D-OCT and dermoscopy with a histological reference. Three blinded analyzers evaluated the lesions. Then, we compared the features to those in 159 melanomas of a prior D-OCT study and determined if a differential diagnosis was possible. We identified specific microvascular features in nevi and a differential diagnosis of melanomas and nevi was achieved with excellent predictive values. We conclude that D-OCT overcomes OCT´s inability ...

Journal of the European Academy of Dermatology and Venereology, 2021

Background Dynamic optical coherence tomography (D-OCT) allows in vivo visualization of blood ves... more Background Dynamic optical coherence tomography (D-OCT) allows in vivo visualization of blood vessels in the skin and in malignant tumours. Vessel patterns in malignant melanoma may be associated with tumour stage. Objective The aim of this study was to describe blood vessel patterns in melanomas and to correlate them with stage. Methods One hundred fifty-nine malignant melanomas were assessed in a multicentre study. Every tumour was imaged using D-OCT prior to surgery and histologic evaluation. The tumour data such as thickness and ulceration as well as the staging at primary diagnosis and a follow-up of at least 40 months resulted in a stage classification. The vessel patterns were assessed according to predefined categories, compared with healthy adjacent skin, and correlated to stage. Results Melanomas contained more blood vessels in different patterns compared with healthy adjacent skin. In particular, irregular vascular shapes such as blobs, coils, curves and serpiginous vessels were more common in melanomas. In addition, these patterns were significantly more often found in high-risk and metastatic melanomas than in low-risk lesions. Conclusion In melanomas, the density of the blood vessels is increased, and irregular vascular patterns are more frequent. At higher stages, especially in metastatic melanomas, these atypical vessels are significantly more common.

Journal of the European Academy of Dermatology and Venereology, 2018

Background: Lentigo maligna may be challenging to clear surgically. Objective: To evaluate feasib... more Background: Lentigo maligna may be challenging to clear surgically. Objective: To evaluate feasibility of using superficial skin cuts as RCM imaging anchors for attaining negative surgical margins in lentigo maligna. Methods: Included patients presented with lentigo maligna near cosmetically-sensitive facial structures. We evaluated, with handheld-RCM, microscopic clearance of melanoma beyond its dermoscopically-detected edges. Evaluated margins were annotated using shallow skin-cuts. If a margin was positive at 'first-step' RCM evaluation, we sequentially advanced the margin radially Accepted Article This article is protected by copyright. All rights reserved. outward at that segment by 2mm intervals until an RCM-negative margin was identified. Prior to final surgical excision, we placed sutures at the outmost skin-cuts to allow comparison of RCM and histopathological margin assessments. Primary outcome measure was histopathological verification that RCM-negative margins were clear of melanoma. Results: The study included 126 first-step margin evaluations in 23 patients, median age 70 years (range: 43-91). Seventeen patients (74%) had primary in situ melanoma and 6 (26%) invasive melanoma, mean thickness 0.3mm (range 0.2-0.4mm). Six cases (26%) showed complete negative RCM margins on 'first-step', 11 (48%) were negative at 'second-step', and 4 (17%) at 'third-step'. In two additional cases (9%), margins clearance could not be determined via RCM due to widespread dendritic cells proliferation. The RCM-negative margins in all 21 cases proved clear of melanoma on histopathology. Of the 15 cases that returned at one-year-follow-up, none showed any residual melanoma on dermoscopic and RCM examinations. Inter-observer reproducibility showed fair agreement between bedside RCM reader and blinded remote-site reader, with Spearman's rho of 0.48 and Cohen's kappa of 0.43; using bedside reader as reference, the remote reader's sensitivity was 92% and specificity 57% in positive margin detection. Conclusions: Margin mapping of lentigo maligna with handheld-RCM, using superficial skin cuts, appears feasible. This approach needs validation by larger studies.

Dermatologic therapy, Jan 4, 2017

Atopic dermatitis (AD) is a result of complex genetic, epigenetic, environmental, and immunologic... more Atopic dermatitis (AD) is a result of complex genetic, epigenetic, environmental, and immunological interactions with an overlapping epidermal barrier defect. The study evaluates the efficacy and tolerability of topical Vitamin B12-barrier cream (MB12) compared with standard glycerol-petrolatum-based emollient cream (GPC) used three times a day for mild AD. The study was conducted as a on one hemi-body randomized, controlled, single-blind, intra-patient left-to-right comparative trial by patients with clinical diagnosis of mild AD measured with total SCORAD index over 4 months. MB12 was compared on one hemi-body treated (GPC). The comparisons of score values were performed primarily by using non-parametric procedures: Mann-Whitney-U test (for independent samples) and Wilcoxon test (for dependent samples). All 22 patients were randomized (left or right side treated with MB12 or GPC). At week 12 a reduction from baseline in SCORAD index was assessed in both body sites with 77.6% SCORA...

Journal of the European Academy of Dermatology and Venereology, 2015

The sub-optimal diagnostic accuracy for melanoma leads to excise a high number of benign lesions,... more The sub-optimal diagnostic accuracy for melanoma leads to excise a high number of benign lesions, with consequent costs. Reflectance confocal microscopy (RCM) improves diagnostic specificity, thus possibly inducing a reduction in unnecessary excisions and related costs. To estimate the influence of RCM on number of benign lesions needed to excise (NNE) a melanoma, in term of clinical outcomes and costs per patient. Skin neoplasms excised by the dermatology public service in the Province of Modena were retrieved form centralized pathology database. Differences in NNE between the territorial service (using dermoscopy only) and the University Hospital (adding also RCM to the patients' workflow) were calculated and cost analysis was performed through a micro-costing approach. A large reduction in benign lesions excised at University Hospital was evident, leading to NNE of 6.25 for University Hospital, compared to 19.41 for Territorial Dermatology. Since 4320 unnecessary excisions can be saved every million inhabitants, an overall yearly saving of over 280,000 Eur can be expected from the use of RCM. The systematic use of RCM was dramatically affecting the number of benign lesions excised, and this can be translated in a significant cost-benefit advantage.

Journal of the European Academy of Dermatology and Venereology, 2015

In vivo micro-angiography by means of speckle-variance optical coherence tomography (SV-OCT) is a... more In vivo micro-angiography by means of speckle-variance optical coherence tomography (SV-OCT) is able to detect microscopic vascular changes in naevus to melanoma transition Editor The transition from benign junctional melanocytic proliferation to in situ melanoma is based on clinical-histopathological evidence and partially understood in vivo. 1 Due to the high prevalence of naevi, the knowledge of early phenomena characteristic of the development of a melanoma would help to identify lesions that need excision. Dermoscopy 2 and reflectance confocal microscopy (RCM) 3 are among the most commonly used methods for the diagnosis of skin cancer. 4 Neither of these diagnostic technologies identifies in vivo features, which may characterize early phenomena related to tumour-matrix interaction. Speckle-variance optical coherence tomography (SV-OCT) is a novel approach that allows the study of the vascular patterns Modena, Italy,

Journal of the European Academy of Dermatology and Venereology : JEADV, Jan 10, 2014

Early detection of melanoma is the main objective to ensure a high survival rate. In some cases m... more Early detection of melanoma is the main objective to ensure a high survival rate. In some cases melanoma diagnosis still remain difficult and this leads to unnecessary excisions. The aim of this study was to detect the most relevant Reflectance confocal microscopy (RCM) features for the detection of dermoscopic difficult melanomas. A total of 322 lesions were selected from database and were evaluated on dermoscopy according to the 7-point checklist score, in blind from histological diagnosis. We classified the lesions into three categories: (i) 'featureless' lesions with score ranging between 0 and 2; (ii) 'positive-borderline' moles with score between 3 and 4 and (iii) 'positive-clear cut' lesions with score from 5 to 10. We evaluated confocal features of the 'featureless' lesions and of the…

Journal of the European Academy of Dermatology and Venereology : JEADV, Jan 17, 2015

It is known that the peripheral neuropathy is associated with the lower extremities in schistorrh... more It is known that the peripheral neuropathy is associated with the lower extremities in schistorrhachis patients. Pressure sores and skin breakdown are also known as skin symptoms of schistorrhachis; 10 however, VH has not been reported. We speculate that the lower limbs of our patient became insensitive to chronic stimuli because of decreased sensation from schistorrhachis, as patients with diabetic neuropathy are usually in similar conditions. Our patient had been given many kinds of treatment, such as topical steroid, cryotherapy and vitamin D3 ointment. Whether these factors contribute to the forming verrucous lesion were unclear. We suspected the neuropathy from the schistorrhachis was most involved in forming VH. Besides, the notable increases of collagen fibres in the dermis are likely due to lymphoedema caused by dysfunction of the autonomic nervous system or schistorrhachis. In conclusion, this is the first reported case of VH in a patient without diabetes but with neuropathy from schistorrhachis. We must remember to include VH among the skin dysfunctions in schistorrhachis patients.

Congresso Annuale AIDNID 2018, 2018

Supplementary material of the article Combined Reflectance Confocal Microscopy and Optical Cohere... more Supplementary material of the article Combined Reflectance Confocal Microscopy and Optical Coherence Tomography to improve the diagnosis of equivocal lesions for basal cell carcinoma, Monnier et al. Table1: Patient demographics, lesion characteristics, and histopathology diagnosis

Journal of the American Academy of Dermatology, 2020

Skin research and technology : official journal of International Society for Bioengineering and the Skin (ISBS) [and] International Society for Digital Imaging of Skin (ISDIS) [and] International Society for Skin Imaging (ISSI), Jan 24, 2018

Seborrheic keratoses (SebK) with atypical dermoscopy presentation are increasingly reported. Thes... more Seborrheic keratoses (SebK) with atypical dermoscopy presentation are increasingly reported. These lesions do not exhibit typical dermoscopy features of SebK and sometimes mimic melanoma, thus complicating the differential diagnosis. Reflectance confocal microscopy (RCM) is a non-invasive tool, which allows an in vivo imaging of the skin. The study objectives were to evaluate the agreement between RCM classification and histological diagnoses, and the reliability of well-known RCM criteria for SebK in the identification of SebK with atypical dermoscopy presentation. We retrospectively analysed at RCM excised lesions presenting in dermoscopy ≥1 score at revisited 7-point checklist. The study population consisted of cases showing no melanocytic RCM findings. Lesions were investigated for distinct non-melanocytic RCM features, blinded from histopathology diagnoses. Histopathology matching was then performed before statistical analysis. The study consisted of 117 cases, classified at RC...

Journal of the European Academy of Dermatology and Venereology : JEADV, Jan 30, 2017

Acne vulgaris is a disease of the pilosebaceous unit, characterized by hyper-keratinization proce... more Acne vulgaris is a disease of the pilosebaceous unit, characterized by hyper-keratinization process, comedos formation and inflammatory reactions. The definition of the morphology and the vascularization of acne lesions by means of dynamic optical coherence tomography (D-OCT), in order to non-invasively define the alterations occurring during the acne development and patient therapeutic management. A set of standardized clinical pictures and D-OCT images were acquired from 114 acne lesions of 31 volunteers, presenting mild to moderate acne and evaluated by experts. Fifteen patients treated with oral antibiotics were followed during time at 0, 20, 40, and 60 days. Optical coherence tomography enabled to identify vascular and morphological aspects characterizing different types of acne lesions. Oral antibiotic treatment improved the morphologic features and decreased the digitally reconstructed vascular signal during time. The characterization of acne lesions and the identification of...

The British journal of dermatology, Jan 21, 2014

The clinical recognition of lentigo maligna (LM) and LM melanoma can be very challenging due to t... more The clinical recognition of lentigo maligna (LM) and LM melanoma can be very challenging due to the overlapping features it shares with other pigmented macules of the skin. Noninvasive diagnostic techniques can assist in the differential diagnosis. To identify reflectance confocal microscopy (RCM) indicators for LM through the identification of in vivo microscopic substrates of the main dermoscopic features seen in flat pigmented lesions of the face. Retrospective analysis of 60 pigmented lesions (LM, invasive melanoma, solar lentigo/flat seborrhoeic keratosis, lichen planus-like keratosis, pigmented actinic keratosis) was carried out. The main dermoscopic patterns and RCM features were described. A new method for correlating RCM with dermoscopic patterns was developed. Pseudonetwork (37 of 60 lesions) and annular granular structures (37 of 60 lesions) were the most frequent dermoscopic patterns, followed by pigmented blotches (27 of 60 lesions). Upon RCM examination, pseudonetwork ...

Skin Research and Technology, 2020

Many factors relate to enlargement and visibility of facial pores. However, how enlargement relat... more Many factors relate to enlargement and visibility of facial pores. However, how enlargement relates to modification of the skin structure is still poorly analysed. Therefore, our aim was to characterise the visible features and the micro‐environment of facial pores.

Australasian Journal of Dermatology, 2021

Lentigo maligna (LM) is a subtype of melanoma, when intraepidermal (in situ). When dermal invasio... more Lentigo maligna (LM) is a subtype of melanoma, when intraepidermal (in situ). When dermal invasion occurs, it is termed lentigo maligna melanoma (LMM). It is usually located on sun-damaged skin, often on the face of elderly people with variegated pigmentation. Adequate identification of this subtype of melanoma may be difficult mainly in its early phase. Therefore, when misdiagnosed as a benign pigmented lesion, unwittingly definitive therapies can be inadequately performed. Dermoscopy increases the diagnostic accuracy in comparison with naked eye examination. The face is considered a special site due to histopathology with prominent adnexal openings, epidermal flattening and solar elastosis. Sometimes dermoscopy is challenging by the lack of specific features, such as asymmetrical follicle pigmentation, annular granular arrangement, pigmented rhomboidal structures and obliteration of hair follicles. In addition, an overlap of dermoscopic criteria with other benign non-melanocytic pigmented lesions, such as lichen planus-like keratosis, solar lentigo, flat seborrhoeic keratosis and pigmented actinic keratosis (PAK), may be present. The co-existence of LM with other pigmented lesions on the face is frequent and dermoscopic features may favour benign lesions, resulting in a false negative clinical diagnosis. Furthermore, LM can be hypopigmented or even amelanotic. Reflectance confocal microscopy (RCM) is a noninvasive imaging technique that allows real-time in vivo examination of the upper layers of the skin providing cellular resolution. RCM findings have been correlated to conventional histology, thereby improving the accuracy of skin tumour diagnosis. Based on the criteria described by Guiterra et al, an algorithm (LM score) using RCM was developed in order to distinguish LM from benign macules located on the face. The LM score is a summation of major and minor features with an 85% sensitivity and 76% specificity for the diagnosis of LM (score ≥ 2). The capacity of RCM to identify LM-specific features has been shown even in early and small lesions. A correlation between RCM findings and the dermoscopic features in facial pigmented flat lesions proved that RCM can add important information to distinguish different lesions with similar dermoscopic pattern. Likewise, it may help the identification of hidden dermoscopic clues of LM in difficult-to-diagnose lesions. Although it has been established that the presence of dendritic and/or roundish pagetoid cells as highly specific for LM/LMM, dendritic cells in the epidermal layer around the hair follicle are also frequently seen in PAK. However, a greater number of bright dendrites and the infiltration of the inner portion of the hair follicle infundibulum are mostly seen in LM/ LMM. LM represents a therapeutic challenge because of its large size, ill-defined borders, anatomical location frequently on the face and high rate of recurrence. In this scenario, RCM showed to be an excellent tool to determine pre-surgical margins of LM, therefore, avoiding tumour positive margins or unnecessary iatrogenic disfigurement. We present three cases of flat pigmented difficult-to-diagnose facial lesions in which RCM was of great importance for clinical management and adequate therapeutic choice. All lesions were evaluated with dermoscopy (Medicam 1000 – 20x magnification, FotoFinder Systems GmbH, Bad Birnbach, Germany) and RCM (Vivascope 1500 – 8x8mm mosaics and/or Vivascope 3000 – 0.5x0.5mm stacks. Caliber ID, Rochester, NY) prior to therapeutic decision.

Conventional optical coherence tomography (OCT) enables the visualization of morphological change... more Conventional optical coherence tomography (OCT) enables the visualization of morphological changes of skin cancer. The use of OCT in the diagnostic investigation and in the therapy decision of non-melanoma skin cancer and other skin changes is already established, and has found its way into routine practice. With the development of speckle-variance OCT, also named dynamic OCT (D-OCT), the vascular architecture and the blood flow of the skin can be displayed in vivo and in 3D. This novel angiographic variant of OCT offers the ability to visualize and measure vessel morphology providing a new insight into healthy, inflammatory and neoplastic skin lesions such as malignant melanoma. This review focuses on the possibilities of using D-OCT on healthy and diseased skin. We suggest and illustrate key diagnostic characteristics by analyzing the initial publications and preliminary unpublished data on vessel morphology and distribution. The potential of D-OCT as a diagnostic tool in dermatol...

Cancers

Along with the rising melanoma incidence in recent decades and bad prognoses resulting from late ... more Along with the rising melanoma incidence in recent decades and bad prognoses resulting from late diagnoses, distinguishing between benign and malignant melanocytic lesions has become essential. Unclear cases may require the aid of non-invasive imaging to reduce unnecessary biopsies. This multicentric, case-control study evaluated the potential of dynamic optical coherence tomography (D-OCT) to identify distinguishing microvascular features in nevi. A total of 167 nevi, including dysplastic ones, on 130 participants of all ages and sexes were examined by D-OCT and dermoscopy with a histological reference. Three blinded analyzers evaluated the lesions. Then, we compared the features to those in 159 melanomas of a prior D-OCT study and determined if a differential diagnosis was possible. We identified specific microvascular features in nevi and a differential diagnosis of melanomas and nevi was achieved with excellent predictive values. We conclude that D-OCT overcomes OCT´s inability ...

Journal of the European Academy of Dermatology and Venereology, 2021

Background Dynamic optical coherence tomography (D-OCT) allows in vivo visualization of blood ves... more Background Dynamic optical coherence tomography (D-OCT) allows in vivo visualization of blood vessels in the skin and in malignant tumours. Vessel patterns in malignant melanoma may be associated with tumour stage. Objective The aim of this study was to describe blood vessel patterns in melanomas and to correlate them with stage. Methods One hundred fifty-nine malignant melanomas were assessed in a multicentre study. Every tumour was imaged using D-OCT prior to surgery and histologic evaluation. The tumour data such as thickness and ulceration as well as the staging at primary diagnosis and a follow-up of at least 40 months resulted in a stage classification. The vessel patterns were assessed according to predefined categories, compared with healthy adjacent skin, and correlated to stage. Results Melanomas contained more blood vessels in different patterns compared with healthy adjacent skin. In particular, irregular vascular shapes such as blobs, coils, curves and serpiginous vessels were more common in melanomas. In addition, these patterns were significantly more often found in high-risk and metastatic melanomas than in low-risk lesions. Conclusion In melanomas, the density of the blood vessels is increased, and irregular vascular patterns are more frequent. At higher stages, especially in metastatic melanomas, these atypical vessels are significantly more common.

Journal of the European Academy of Dermatology and Venereology, 2018

Background: Lentigo maligna may be challenging to clear surgically. Objective: To evaluate feasib... more Background: Lentigo maligna may be challenging to clear surgically. Objective: To evaluate feasibility of using superficial skin cuts as RCM imaging anchors for attaining negative surgical margins in lentigo maligna. Methods: Included patients presented with lentigo maligna near cosmetically-sensitive facial structures. We evaluated, with handheld-RCM, microscopic clearance of melanoma beyond its dermoscopically-detected edges. Evaluated margins were annotated using shallow skin-cuts. If a margin was positive at 'first-step' RCM evaluation, we sequentially advanced the margin radially Accepted Article This article is protected by copyright. All rights reserved. outward at that segment by 2mm intervals until an RCM-negative margin was identified. Prior to final surgical excision, we placed sutures at the outmost skin-cuts to allow comparison of RCM and histopathological margin assessments. Primary outcome measure was histopathological verification that RCM-negative margins were clear of melanoma. Results: The study included 126 first-step margin evaluations in 23 patients, median age 70 years (range: 43-91). Seventeen patients (74%) had primary in situ melanoma and 6 (26%) invasive melanoma, mean thickness 0.3mm (range 0.2-0.4mm). Six cases (26%) showed complete negative RCM margins on 'first-step', 11 (48%) were negative at 'second-step', and 4 (17%) at 'third-step'. In two additional cases (9%), margins clearance could not be determined via RCM due to widespread dendritic cells proliferation. The RCM-negative margins in all 21 cases proved clear of melanoma on histopathology. Of the 15 cases that returned at one-year-follow-up, none showed any residual melanoma on dermoscopic and RCM examinations. Inter-observer reproducibility showed fair agreement between bedside RCM reader and blinded remote-site reader, with Spearman's rho of 0.48 and Cohen's kappa of 0.43; using bedside reader as reference, the remote reader's sensitivity was 92% and specificity 57% in positive margin detection. Conclusions: Margin mapping of lentigo maligna with handheld-RCM, using superficial skin cuts, appears feasible. This approach needs validation by larger studies.

Dermatologic therapy, Jan 4, 2017

Atopic dermatitis (AD) is a result of complex genetic, epigenetic, environmental, and immunologic... more Atopic dermatitis (AD) is a result of complex genetic, epigenetic, environmental, and immunological interactions with an overlapping epidermal barrier defect. The study evaluates the efficacy and tolerability of topical Vitamin B12-barrier cream (MB12) compared with standard glycerol-petrolatum-based emollient cream (GPC) used three times a day for mild AD. The study was conducted as a on one hemi-body randomized, controlled, single-blind, intra-patient left-to-right comparative trial by patients with clinical diagnosis of mild AD measured with total SCORAD index over 4 months. MB12 was compared on one hemi-body treated (GPC). The comparisons of score values were performed primarily by using non-parametric procedures: Mann-Whitney-U test (for independent samples) and Wilcoxon test (for dependent samples). All 22 patients were randomized (left or right side treated with MB12 or GPC). At week 12 a reduction from baseline in SCORAD index was assessed in both body sites with 77.6% SCORA...

Journal of the European Academy of Dermatology and Venereology, 2015

The sub-optimal diagnostic accuracy for melanoma leads to excise a high number of benign lesions,... more The sub-optimal diagnostic accuracy for melanoma leads to excise a high number of benign lesions, with consequent costs. Reflectance confocal microscopy (RCM) improves diagnostic specificity, thus possibly inducing a reduction in unnecessary excisions and related costs. To estimate the influence of RCM on number of benign lesions needed to excise (NNE) a melanoma, in term of clinical outcomes and costs per patient. Skin neoplasms excised by the dermatology public service in the Province of Modena were retrieved form centralized pathology database. Differences in NNE between the territorial service (using dermoscopy only) and the University Hospital (adding also RCM to the patients' workflow) were calculated and cost analysis was performed through a micro-costing approach. A large reduction in benign lesions excised at University Hospital was evident, leading to NNE of 6.25 for University Hospital, compared to 19.41 for Territorial Dermatology. Since 4320 unnecessary excisions can be saved every million inhabitants, an overall yearly saving of over 280,000 Eur can be expected from the use of RCM. The systematic use of RCM was dramatically affecting the number of benign lesions excised, and this can be translated in a significant cost-benefit advantage.

Journal of the European Academy of Dermatology and Venereology, 2015

In vivo micro-angiography by means of speckle-variance optical coherence tomography (SV-OCT) is a... more In vivo micro-angiography by means of speckle-variance optical coherence tomography (SV-OCT) is able to detect microscopic vascular changes in naevus to melanoma transition Editor The transition from benign junctional melanocytic proliferation to in situ melanoma is based on clinical-histopathological evidence and partially understood in vivo. 1 Due to the high prevalence of naevi, the knowledge of early phenomena characteristic of the development of a melanoma would help to identify lesions that need excision. Dermoscopy 2 and reflectance confocal microscopy (RCM) 3 are among the most commonly used methods for the diagnosis of skin cancer. 4 Neither of these diagnostic technologies identifies in vivo features, which may characterize early phenomena related to tumour-matrix interaction. Speckle-variance optical coherence tomography (SV-OCT) is a novel approach that allows the study of the vascular patterns Modena, Italy,

Journal of the European Academy of Dermatology and Venereology : JEADV, Jan 10, 2014

Early detection of melanoma is the main objective to ensure a high survival rate. In some cases m... more Early detection of melanoma is the main objective to ensure a high survival rate. In some cases melanoma diagnosis still remain difficult and this leads to unnecessary excisions. The aim of this study was to detect the most relevant Reflectance confocal microscopy (RCM) features for the detection of dermoscopic difficult melanomas. A total of 322 lesions were selected from database and were evaluated on dermoscopy according to the 7-point checklist score, in blind from histological diagnosis. We classified the lesions into three categories: (i) 'featureless' lesions with score ranging between 0 and 2; (ii) 'positive-borderline' moles with score between 3 and 4 and (iii) 'positive-clear cut' lesions with score from 5 to 10. We evaluated confocal features of the 'featureless' lesions and of the…

Journal of the European Academy of Dermatology and Venereology : JEADV, Jan 17, 2015

It is known that the peripheral neuropathy is associated with the lower extremities in schistorrh... more It is known that the peripheral neuropathy is associated with the lower extremities in schistorrhachis patients. Pressure sores and skin breakdown are also known as skin symptoms of schistorrhachis; 10 however, VH has not been reported. We speculate that the lower limbs of our patient became insensitive to chronic stimuli because of decreased sensation from schistorrhachis, as patients with diabetic neuropathy are usually in similar conditions. Our patient had been given many kinds of treatment, such as topical steroid, cryotherapy and vitamin D3 ointment. Whether these factors contribute to the forming verrucous lesion were unclear. We suspected the neuropathy from the schistorrhachis was most involved in forming VH. Besides, the notable increases of collagen fibres in the dermis are likely due to lymphoedema caused by dysfunction of the autonomic nervous system or schistorrhachis. In conclusion, this is the first reported case of VH in a patient without diabetes but with neuropathy from schistorrhachis. We must remember to include VH among the skin dysfunctions in schistorrhachis patients.

Congresso Annuale AIDNID 2018, 2018

Supplementary material of the article Combined Reflectance Confocal Microscopy and Optical Cohere... more Supplementary material of the article Combined Reflectance Confocal Microscopy and Optical Coherence Tomography to improve the diagnosis of equivocal lesions for basal cell carcinoma, Monnier et al. Table1: Patient demographics, lesion characteristics, and histopathology diagnosis

Journal of the American Academy of Dermatology, 2020

Skin research and technology : official journal of International Society for Bioengineering and the Skin (ISBS) [and] International Society for Digital Imaging of Skin (ISDIS) [and] International Society for Skin Imaging (ISSI), Jan 24, 2018

Seborrheic keratoses (SebK) with atypical dermoscopy presentation are increasingly reported. Thes... more Seborrheic keratoses (SebK) with atypical dermoscopy presentation are increasingly reported. These lesions do not exhibit typical dermoscopy features of SebK and sometimes mimic melanoma, thus complicating the differential diagnosis. Reflectance confocal microscopy (RCM) is a non-invasive tool, which allows an in vivo imaging of the skin. The study objectives were to evaluate the agreement between RCM classification and histological diagnoses, and the reliability of well-known RCM criteria for SebK in the identification of SebK with atypical dermoscopy presentation. We retrospectively analysed at RCM excised lesions presenting in dermoscopy ≥1 score at revisited 7-point checklist. The study population consisted of cases showing no melanocytic RCM findings. Lesions were investigated for distinct non-melanocytic RCM features, blinded from histopathology diagnoses. Histopathology matching was then performed before statistical analysis. The study consisted of 117 cases, classified at RC...

Journal of the European Academy of Dermatology and Venereology : JEADV, Jan 30, 2017

Acne vulgaris is a disease of the pilosebaceous unit, characterized by hyper-keratinization proce... more Acne vulgaris is a disease of the pilosebaceous unit, characterized by hyper-keratinization process, comedos formation and inflammatory reactions. The definition of the morphology and the vascularization of acne lesions by means of dynamic optical coherence tomography (D-OCT), in order to non-invasively define the alterations occurring during the acne development and patient therapeutic management. A set of standardized clinical pictures and D-OCT images were acquired from 114 acne lesions of 31 volunteers, presenting mild to moderate acne and evaluated by experts. Fifteen patients treated with oral antibiotics were followed during time at 0, 20, 40, and 60 days. Optical coherence tomography enabled to identify vascular and morphological aspects characterizing different types of acne lesions. Oral antibiotic treatment improved the morphologic features and decreased the digitally reconstructed vascular signal during time. The characterization of acne lesions and the identification of...

The British journal of dermatology, Jan 21, 2014

The clinical recognition of lentigo maligna (LM) and LM melanoma can be very challenging due to t... more The clinical recognition of lentigo maligna (LM) and LM melanoma can be very challenging due to the overlapping features it shares with other pigmented macules of the skin. Noninvasive diagnostic techniques can assist in the differential diagnosis. To identify reflectance confocal microscopy (RCM) indicators for LM through the identification of in vivo microscopic substrates of the main dermoscopic features seen in flat pigmented lesions of the face. Retrospective analysis of 60 pigmented lesions (LM, invasive melanoma, solar lentigo/flat seborrhoeic keratosis, lichen planus-like keratosis, pigmented actinic keratosis) was carried out. The main dermoscopic patterns and RCM features were described. A new method for correlating RCM with dermoscopic patterns was developed. Pseudonetwork (37 of 60 lesions) and annular granular structures (37 of 60 lesions) were the most frequent dermoscopic patterns, followed by pigmented blotches (27 of 60 lesions). Upon RCM examination, pseudonetwork ...

Skin Research and Technology, 2020

Many factors relate to enlargement and visibility of facial pores. However, how enlargement relat... more Many factors relate to enlargement and visibility of facial pores. However, how enlargement relates to modification of the skin structure is still poorly analysed. Therefore, our aim was to characterise the visible features and the micro‐environment of facial pores.

Australasian Journal of Dermatology, 2021

Lentigo maligna (LM) is a subtype of melanoma, when intraepidermal (in situ). When dermal invasio... more Lentigo maligna (LM) is a subtype of melanoma, when intraepidermal (in situ). When dermal invasion occurs, it is termed lentigo maligna melanoma (LMM). It is usually located on sun-damaged skin, often on the face of elderly people with variegated pigmentation. Adequate identification of this subtype of melanoma may be difficult mainly in its early phase. Therefore, when misdiagnosed as a benign pigmented lesion, unwittingly definitive therapies can be inadequately performed. Dermoscopy increases the diagnostic accuracy in comparison with naked eye examination. The face is considered a special site due to histopathology with prominent adnexal openings, epidermal flattening and solar elastosis. Sometimes dermoscopy is challenging by the lack of specific features, such as asymmetrical follicle pigmentation, annular granular arrangement, pigmented rhomboidal structures and obliteration of hair follicles. In addition, an overlap of dermoscopic criteria with other benign non-melanocytic pigmented lesions, such as lichen planus-like keratosis, solar lentigo, flat seborrhoeic keratosis and pigmented actinic keratosis (PAK), may be present. The co-existence of LM with other pigmented lesions on the face is frequent and dermoscopic features may favour benign lesions, resulting in a false negative clinical diagnosis. Furthermore, LM can be hypopigmented or even amelanotic. Reflectance confocal microscopy (RCM) is a noninvasive imaging technique that allows real-time in vivo examination of the upper layers of the skin providing cellular resolution. RCM findings have been correlated to conventional histology, thereby improving the accuracy of skin tumour diagnosis. Based on the criteria described by Guiterra et al, an algorithm (LM score) using RCM was developed in order to distinguish LM from benign macules located on the face. The LM score is a summation of major and minor features with an 85% sensitivity and 76% specificity for the diagnosis of LM (score ≥ 2). The capacity of RCM to identify LM-specific features has been shown even in early and small lesions. A correlation between RCM findings and the dermoscopic features in facial pigmented flat lesions proved that RCM can add important information to distinguish different lesions with similar dermoscopic pattern. Likewise, it may help the identification of hidden dermoscopic clues of LM in difficult-to-diagnose lesions. Although it has been established that the presence of dendritic and/or roundish pagetoid cells as highly specific for LM/LMM, dendritic cells in the epidermal layer around the hair follicle are also frequently seen in PAK. However, a greater number of bright dendrites and the infiltration of the inner portion of the hair follicle infundibulum are mostly seen in LM/ LMM. LM represents a therapeutic challenge because of its large size, ill-defined borders, anatomical location frequently on the face and high rate of recurrence. In this scenario, RCM showed to be an excellent tool to determine pre-surgical margins of LM, therefore, avoiding tumour positive margins or unnecessary iatrogenic disfigurement. We present three cases of flat pigmented difficult-to-diagnose facial lesions in which RCM was of great importance for clinical management and adequate therapeutic choice. All lesions were evaluated with dermoscopy (Medicam 1000 – 20x magnification, FotoFinder Systems GmbH, Bad Birnbach, Germany) and RCM (Vivascope 1500 – 8x8mm mosaics and/or Vivascope 3000 – 0.5x0.5mm stacks. Caliber ID, Rochester, NY) prior to therapeutic decision.

Conventional optical coherence tomography (OCT) enables the visualization of morphological change... more Conventional optical coherence tomography (OCT) enables the visualization of morphological changes of skin cancer. The use of OCT in the diagnostic investigation and in the therapy decision of non-melanoma skin cancer and other skin changes is already established, and has found its way into routine practice. With the development of speckle-variance OCT, also named dynamic OCT (D-OCT), the vascular architecture and the blood flow of the skin can be displayed in vivo and in 3D. This novel angiographic variant of OCT offers the ability to visualize and measure vessel morphology providing a new insight into healthy, inflammatory and neoplastic skin lesions such as malignant melanoma. This review focuses on the possibilities of using D-OCT on healthy and diseased skin. We suggest and illustrate key diagnostic characteristics by analyzing the initial publications and preliminary unpublished data on vessel morphology and distribution. The potential of D-OCT as a diagnostic tool in dermatol...