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Background Based on the dermoscopic classification of acquired melanocytic naevi, six different dermoscopic types can be distinguished by morphology (globular, globular-reticular, globular-homogeneous, reticular, reticular-homogeneous, homogeneous) and by pigment distribution (uniform, central hyperpigmentation, central hypopigmentation, peripheral hyperpigmentation, peripheral hypopigmentation, multifocal hyper/hypopigmentation). It has been suggested that most individuals harbour one predominant dermoscopic type among their naevi. Objectives To evaluate whether the age of the patient influences the predominant naevus pattern observed in individuals with multiple acquired melanocytic naevi. Methods Individuals were recruited from the pigmented skin lesion clinic in Graz between July 2000 and February 2001. Individuals with at least 10 melanocytic naevi were selected consecutively until a total of 10 individuals in each of five age groups was obtained. Age groups were: 0-15 years, 16-30 years, 31-45 years, 46-60 years and > 60 years. Digitized images of acquired melanocytic naevi, defined as benign melanocytic proliferations having a diameter of at least 5 mm with a macular component and which were not apparent within the first year of life, were evaluated by dermoscopic criteria. The associations of dermoscopic features as a function of patient age were analysed. We calculated absolute numbers and frequencies, given as percentages, as well as predominance of the dermoscopic types of naevi in the different age groups. Results Analysis of 1268 naevi revealed that the globular pattern predominated in the youngest age group. By contrast, the reticular and/or homogeneous patterns were increasingly exhibited in naevi from older individuals (older than 15 years). Uniform pigmentation was most common in melanocytic naevi in the youngest age group, while central hyperpigmentation was predominantly seen in the group of individuals aged 16-30 years. Conclusions The predominance of dermoscopic types of melanocytic naevi varies according to the individual's age. Awareness of the age-related dermoscopic predominance of melanocytic naevi might allow more accurate recognition of dermoscopic patterns of melanocytic skin lesions that are unusual with respect to the individual's age. This observation may help in the early recognition of some 'banal'-appearing melanomas. Furthermore, the observations made in this study raise interesting questions regarding naevus evolution.

Amelanotic/hypomelanotic melanoma often leads to delayed clinical diagnosis because its clinical appearance can mimic other hypopigmented skin conditions. Dermatoscopy (dermoscopy, epiluminescence microscopy) is thought to be a helpful diagnostic tool in pigmented skin lesions, but it can be used also in non-pigmented skin tumors due to the recognition of vascular structures not visible to the naked eye.7 amelanotic/hypomelanotic melanomas in 6 patients were analyzed in order to define their dermatoscopic findings using standard pattern analysis.Clinical and dermoscopic images of each lesion were obtained using Dermaphot (Heine Optotechnik, Herrsching, Germany), with 10-fold magnification of the lesion and the color slides were converted to digital format using a Kodak Photo CD system.All 7 amelanotic/hypomelanotic melanomas revealed peculiar dermatoscopic findings, namely, atypical vessels, dotted vessels, and a central pink to white veil. In addition, in 2 patients a slight brownish homogenous pigmentation at the periphery of the lesion was observed. In one case the correct diagnosis was done by an experienced dermatologist using dermatoscopy, whereas in the remaining 6 cases the clinical diagnoses included squamous cell carcinoma, Bowen disease, pyogenic granuloma and basal cell carcinoma. In 2 of 6 patients amelanotic/hypomelanotic melanoma was associated with a previous history of melanoma.Amelanotic/hypomelanotic melanoma exhibits as a common dermatoscopic denominator atypical vessels, varying in size and shape, usually associated with a central pink to white veil.

Primary cutaneous lymphomas represent a heterogeneous group of T- and B-cell lymphomas that show considerable variation in histology, phenotype, and prognosis. Recently, the European Organization for Research and Treatment of Cancer (EORTC) Cutaneous Lymphoma Project Group has reached consensus on a new classification for this group of diseases. The EORTC classification for primary cutaneous lymphomas is based on a combination of clinical, histologic, and immunophenotypic criteria, and thus contains well-defined disease entities rather than histologic subgroups. In addition, this new classification contains a number of provisional entities, which may display characteristic histologic features, but are not yet well defined clinically. These provisional entities account for less than 5% of all primary cutaneous lymphomas. In this report the basic principles of this new classification, as well as the characteristic features of the different disease entities, are described. In addition, survival data of 626 patients with primary cutaneous lymphomas derived from the registry of the Dutch Cutaneous Lymphoma Working Group, illustrating the clinical validity of this new classification, are presented.

We have recently observed three examples of solitary trichoblastomas (TB) with unusual histopathologic features characterized mainly by numerous aggregations of basaloid cells limited to the subcutis. The three trichoblastomas with unusual features were identified from a large series of 38 solitary TB cases collected over a period of 20 years. Clinically, all three neoplasms presented in men (49, 52, and 62 years old) as solitary, 1- to 1.5-cm skin-colored nodules situated on the scalp, face, and lower arm, respectively. Histopathologically, they showed numerous, smooth-bordered aggregations of basaloid cells limited to the subcutis and surrounded by a sclerotic and partly hyalinized stroma. Multiple sections revealed no connections of basaloid aggregations to the overlying epidermis or pre-existing follicular structures. All three cases displayed rather unusual morphologic growth patterns, including areas of variously sized, nodular aggregations of basaloid cells and extensive foci of elongated, thin columns and branching cords of basaloid cells. A striking feature in the stromal component in two cases was the presence of large, prominent areas of hyalinization and sclerosis. Characteristically, all three neoplasms showed numerous foci with rudimentary follicular germs and papillae. Cytomorphologically, the basaloid cells exhibited dark staining nuclei with large prominent nucleoli and scanty, pale or eosinophilic cytoplasm. Variable number of mitotic figures (2-4 mitoses per high-power field) and single necrotic cells were noted. In one case, small, foci of necrosis en masse were observed. Follow-up data after total excision in all three cases (80, 69, and 6 months) revealed no local recurrences. In light of our observations, we suggest that subcutaneous TB represents a rare variant of solitary TB. Besides the exclusive subcutaneous location, this neoplasm also displays a constellation of particular histopathologic features, namely, rather complex epithelial growth patterns and stroma with prominent foci of sclerosis and hyalinization.

Polymerase chain reaction is a recently developed procedure to detect point mutations in human genomic DNA. The sensitivity and specificity of this technique which requires a very little amount of DNA, have allowed the large scale screening of tumors. The Authors report the detection of point mutations of Ha-ras gene at codon 12 in 12 basal cell carcinomas and 10 cutaneous squamous cell carcinomas by the use of polymerase chain reaction in paraffin-embedded tissue sections. The gene alteration was identified in 2 basaliomas whereas no squamous cell carcinoma showed point mutations. These results suggest that point mutations of Ha-ras gene do not represent a general activating mechanism in cutaneous epitheliomas.

Introduction:Multiple dysplastic melanocytic nevi (DMN) represent generally accepted risk factors for melanoma. Although most melanomas are considered to grow de novo, an uncertain proportion of DMN may transform into melanoma, often characterized by a history of change. However, DMN may also show physiological changes as reported to occur during pregnancy, such as enlargement or change in color. Although neither hormones nor the pregnancy per se appear to influence the development and/or the prognosis of melanoma, close surveillance of pregnant females, particularly when displaying multiple DMN, is recommended.The introduction of dermatoscopy into clinical practice has been demonstrated to improve the early diagnosis of melanoma compared with the naked eye. In addition, digital dermatoscopy is a useful tool for the follow-up examination of individuals bearing multiple DMN, since it allows the surveillance and recognition of morphologic changes suspicious for melanoma over time. However, to date little is known about the dermatoscopic changes seen in DMN during pregnancy.We report for the first time on the changing dermoscopic pattern observed during digital dermatoscopic follow-up of a melanocytic skin lesion located on the leg of a 41-year-old pregnant female (skin type I) with multiple DMN. Clinically, the lesion revealed an 8.0 mm×9.0 mm in diameter, ill-defined light-brown macule. On dermatoscopic examination, a homogenous brown pigmentation with an eccentric hypo-pigmentation, and a few irregularly distributed brown globules at the periphery were seen (Fig. 1). Due to the asymmetry of the structures, differential diagnosis to dysplastic melanocytic nevus and melanoma was considered and surgical excision of the lesion was recommended. However, the patient, herself a medical doctor, was informed about the suspected diagnosis but refused excision as she was pregnant at that time. Thus, digital dermatoscopy was performed and a follow-up evaluation was performed 4 weeks later, showing no evidence of morphologic changes. The patient was advised to have further close follow-up.

Background Dermoscopy improves the diagnostic accuracy in pigmented skin lesions, but it is also useful in the evaluation of nonpigmented skin tumours as it allows the recognition of vascular structures that are not visible to the naked eye. Bowen's disease (BD) or squamous cell carcinoma in situ is usually nonpigmented, but may also rarely be pigmented. Objective To describe the dermoscopic features in a series of pigmented and nonpigmented BD. Methods Dermoscopic images of 21 histopathologically proven BD were evaluated for the presence of various dermoscopic features. Each lesion was photographed using the Dermaphot (Heine Optotechnik, Herrsching, Germany), at 10-fold magnification, and the colour slides were scanned to digital format using a Kodak Photo CD system. Results The majority of cases of BD revealed a peculiar dermoscopic pattern characterized by glomerular vessels (90%) and a scaly surface (90%). In addition, in pigmented BD small brown globules regularly packed in a patchy distribution (90%), and structureless grey to brown pigmentation (80%) were observed. Conclusions Dermoscopy can be helpful for diagnosing BD because of the presence of repetitive morphological findings such as glomerular vessels and a scaly surface. In pigmented BD, small brown globules and/or homogeneous pigmentation can be seen as well.

We investigated the feasibility and diagnostic agreement of a virtual slide system (VSS) in teledermatopathology. Forty-six biopsy specimens from inflammatory skin diseases were selected and scanned with a VSS at the Research Unit of Teledermatology, Medical University of Graz, Graz, Austria. Images were stored oil a virtual slide server on which a specific Web application suited for telepathology (http://telederm.org/research/dermatopath/) runs. Twelve teleconsultants from 6 different Countries reviewed the 46 cases, working directly oil the Web application. Telediagnoses agreed with gold standard and conventional diagnosis with an average of 73% and 74%, respectively. Complete concordance among all teleconsultants with gold standard and conventional diagnosis was found in 20% of the cases. In 10 cases in which complete clinical data were missing, the average agreement of telediagnosis with gold standard diagnosis and conventional diagnosis decreased to 65% and 66%, respectively. Only 3 of 4 cases of inflammatory skin diseases were correctly diagnosed remotely with VSS. The system that we have used, despite its usability, is not completely feasible for teledermatopathology of inflammatory skin disease. Moreover, the performance seems to have been influenced by the availability of complete clinical data and by the intrinsic difficulty of the pathology of inflammatory skin diseases. (c) 2007 Elsevier Inc. All rights reserved. RI Soyer, H. Peter/E-6000-2010

Primary cutaneous lymphomas are currently classified by the European Organization for Research and Treatment of Cancer (EORTC) classification or the World Health Organization (WHO) classification, but both systems have shortcomings. In particular, differences in the classification of cutaneous T-cell lymphomas other than mycosis fungoides, Sezary syndrome, and the group of primary cutaneous CD30+ lymphoproliferative disorders and the classification and terminology of different types of cutaneous B-cell lymphomas have resulted in considerable debate and confusion. During recent consensus meetings representatives of both systems reached agreement on a new classification, which is now called the WHO-EORTC classification. In this paper we describe the characteristic features of the different primary cutaneous lymphomas and other hematologic neoplasms frequently presenting in the skin, and discuss differences with the previous classification schemes. In addition, the relative frequency and survival data of 1905 patients with primary cutaneous lymphomas derived from Dutch and Austrian registries for primary cutaneous lymphomas are presented to illustrate the clinical significance of this new classification.

Clark’s nevi (atypical melanocytic nevi) are acquired melanocytic lesions that are well known clinically by physicians and especially by dermatologists. Clark’s nevi are named for Wallace H. Clark, Jr., who first drew attention to this particular type of nevus in studies of numerous melanocytic nevi in patients with concomitant melanomas. This melanocytic nevus, originally designated B-K mole, has also been called dysplastic nevus or atypical mole. We prefer to use the nomenclature set forth by Ackerman and Magana-Garcia and designate these acquired melanocytic lesions as Clark’s nevi. © 2002 by Elsevier Science Inc. All rights reserved.

This work displays the bridging of two fields - namely dermatopathology and art. What is astonishing is that structures one sees through the microscope reveal aesthetic and artistic aspects and sometimes resemble in a startling way the designs of certain artists. Specific examples are illustrated to enhance the joy and appreciation of morphologic images.

We describe two exceptional collision tumors, namely: a 63-year-old woman revealing a melanocytic tumor within a trichoblastoma and a 71-year-old woman with a squamous cell carcinoma colonized by dendritic cells of a melanoma. Both neoplasms showed two different tumor components with intimate relationship. The lesions are labeled in a "playful" way with the acronyms METRO (MElanocytic tumor +TRichOblastoma) and CAMEL (CArcinoma +MELanoma) to facilitate memorization.

Background: Dermoscopic classification of acquired melanocytic nevi (AMN) is based on the evaluation of 3 main criteria-global pattern, pigment distribution, and color. Objective: To determine whether these features are different in AMN in white people with different skin types (STs) according to the Fitzpatrick classification. Design: Digital dermoscopic images of AMN were evaluated, and the correlation of the 3 main dermoscopic criteria with patient ST was analyzed. Setting: Consecutive patients were recruited from 7 pigmented lesion clinics between june 1, 2004, and june 30, 2005. Patients: For each patient, the ST (I [always burns, never tans] to IV [rarely burns, tans with ease]) was scored, and 1 representative AMN (defined as the AMIN showing a dermoscopic typology that is repeatedly seen in the same patient) was selected and photographed. Main Outcome Measures: The distribution of the dermoscopic criteria of AMN in patients with different STs was calculated by univariate analysis. Differences in prevalence were tested using the chi(2) test. The correlation between dermoscopic criteria and ST, adjusted for age, sex, and enrolling center, was evaluated by calculating odds ratios and 95% confidence intervals by logistic regression analysis. Results: Of 680 included patients, dermoscopic analysis revealed significant differences in the prevalent nevus pattern in the 4 ST groups. Light brown AMN with central hypopigmentation were associated with ST I, and ST IV was associated with the so-called black nevus (P

The dermoscopic features of melanocytic nevi in children are clearly different from those in adults. While nevi in children show almost exclusively globular patterns, those in adults usually exhibit reticular patterns. These remarkable differences could be explained by a dual concept of nevogenesis, based on current clinico-epidemiologic, dermoscopic, histopathologic and genetic data.

A non-commercial teledermatology network based on store-and-forward operation was established in April 2002. The aim was to create an easy-to-use platform for teleconsultation services, where physicians could seek diagnostic advice in dermatology from a pool of expert consultants and where they could present and discuss challenging dermatology cases with special emphasis on diagnosis and therapy. An online moderated discussion forum was added in October 2003. During the first two years, 348 health-care professionals from 45 countries registered to use the Website. A total of 783 requests for consultations were answered; 285 requests concerned pigmented skin lesions, 440 requests were from the whole range of clinical dermatology and 58 requests were about non-melanoma skin cancer. Of a total of 133 requests analysed, 80 (60%) were answered within one day, 47 (35%) within one week, five (4%) within two weeks and one (1%) consultation was answered in more than two weeks. Our experience with a discretionary, non-commercial, multilingual Website for open-access teleconsulting in dermatology appears to be successful. The Website represents an example of user-generated content, together with active interaction between users, who can present and discuss cases with remote colleagues.

Dermoscopy improves the diagnostic accuracy in the clinical evaluation of pigmented skin lesions, but it is also useful for the assessment of vascular structures that are not visible to the naked eye. As a consequence, dermoscopy has been employed more and more for the differential diagnosis of nonpigmented skin disorders, including tumors but also inflammatory and infectious diseases. This article provides a review of the dermoscopic features seen in various nonpigmented tumoral and nontumoral skin lesions as well as the dermoscopic criteria used for monitoring skin reactions to various treatments. Copyright (c) 2006 S. Karger AG, Basel.

The new WHO/EORTC classification for cutaneous lymphomas comprises mature T-cell and natural killer (NK)-cell neoplasms, mature B-cell neoplasms, and immature hematopoietic malignancies. It reflects the unique features of lymphoproliferative diseases of the skin, and at the same time it is as compatible as possible with the concepts underlying the WHO classification for nodal lymphomas and the EORTC classification of cutaneous lymphomas. This article reviews the histological, phenotypical, and molecular genetic features of the various nosological entities included in this new classification. These findings always have to be interpreted in the context of the clinical features and biologic behavior. AIM: To review the histological, phenotypical and molecular genetic features of the various nosological entities of the new WHO/EORTC classification for cutaneous lymphomas. METHODS: Extensive review of the literature cited in Medline and own data of the authors. RESULTS: The WHO/EORTC classification of cutaneous lymphomas comprises mature T-cell and NK-cell neoplasms, mature B-cell neoplasms and immature hematopoietic malignancies. It reflects the unique features of primary cutaneous lymphoproliferative diseases. CONCLUSION: This classification is as much as possible compatible with the concept of the WHO classification for nodal lymphomas and the EORTC classification of cutaneous lymphomas. The histological, phenotypical and molecular genetic features always have to be interpreted in the context of the clinical features and biologic behavior.

Primär kutane Lymphome sind typische Krankheitsbilder in der Dermatologie. Obwohl diese Erkrankungen zu den seltenen Krankheiten zählen, sind sie jedoch von therapeutischem und wissenschaftlichen Interesse. Der erste Teil der Arbeit beschäftigt sich mit der Klassifikation und Therapie primär kutaner Lymphome. Die 1997 veröffentlichte EORTC-Klassifikation wird mit ihren wichtigsten Entitäten erläutert. Die EORTC-Klassifikation geht auf spezifische Besonderheiten der primär kutanen Lymphome ein und orientiert sich an der guten Prognose dieser Erkrankungen. Therapeutische Strategien wie der Einsatz von für kutane Lymphome typische Behandlungsmethoden (PUVA, Exzision, Radiatio) als auch gentechnisch hergestellte Medikamente wie therapeutische Antikörper und Vakzinen werden erklärt. Der zweiten Teil der Habilitationsschrift konzentriert sich auf experimentelle Arbeiten zur molekularbiologischen Untersuchung von primär kutanen Lymphomen. Im Mittelpunkt steht die Methode der Mikromanipulation und Einzelzell-PCR. Für die Mykosis fungoides konnte gezeigt werden, daß im initialen Ekzemstadium nur wenige klonale maligne T-Zellen in der Probe nachzuweisen sind. Mit Zunahme des Infiltrates (Plaque) sind die malignen Zellen in der Epidermis oder gruppiert in der Dermis lokalisiert. Im Tumorstadium dominieren die malignen Zellen das dermale Infiltrat (Gellrich S, J Invest Dermatol, 2000). Die Tumorzellen primär kutaner B-Zell-Lymphome weisen einen dem Keimzentrum ähnlichen Mutationsstatus, nämlich somatische Mutationen und intraklonale Diversifikation, auf (Gellrich S, J Invest Dermatol, 1997; Gellrich S, J Invest Dermatol, 2001). Die Daten sprechen für einen noch aktiven Mutationsmechanismus, sogenannte ongoing mutations (Golembowski S, Immunobiology, 2000). Eine Unterform der kutanen Lymphome stellen die primär kutanen CD30+ T-Zell Lymphome dar. In Untersuchungen mittels Mikromanipulation und Einzelzell-PCR wurden CD30+ Zellen aus primär kutanen CD30+ großzelligen Lymphomen hinsichtlich ihrer T-Zell-Klonalität untersucht. Dabei stellte sich heraus, daß nicht alle atypischen Zellen zur Tumorpopulation gehören. Es wird vermutet, daß ein unbekannter Stimulus zur Ausprägung der Zellmorphe und zur Expression des CD30-Moleküls führt (Gellrich S, J Invest Dermatol, 2003). Eine weitere Entität, bei welcher CD30+ Zellen eine Rolle spielen, ist die lymphomatoide Papulose. In den hier dargestellten Untersuchungen wurden CD30+ große atypische Zellen einzeln isoliert und anschließend mittels PCR für die Gene des T-Zell-Rezeptor-Gamma und des Immunglobulinrezeptors amplifiziert bei einem Patienten mit lymphomatoider Papulose und assoziierter Morbus Hodgkin-Erkankung. In zwei von drei Fällen waren diese CD30+ Zellen polyklonal. Die aus der Fragmentanalyse bekannte klonale T-Zell-Population konnte dagegen in CD3+CD30- kleinen Zellen gefunden werden. In einem dritten Fall enthielten die CD30+ Zellen klonale B-Zellen, welche die gleichen Immunglobulingene rearrangiert hatten wie Zellen aus einem zuvor bestehenden Hodgkin-Lymphom desselben Patienten. Diese Ergebnisse lassen vermuten, dass es für das Aufschießen und die Regredienz der Läsionen der lymphomatoiden Papulose einen Stimulus gibt und die klonalen T- und B-Zellen als Begleitinfiltrat ohne pathologische Bedeutung anzusehen sind. Insgesamt bilden die Daten dieser Arbeit eine Grundlage für eine Fortsetzung der Untersuchung zur Ätiopathogenese von primär kutanen Lymphomen und deren Therapie und bieten die Möglichkeiten vielfältiger wissenschaftlicher Kooperationen. Primary cutaneous lymphomas present with typical clinical features in dermatology. Although these diseases are rare, they particularly are of scientific and therapeutic interest. The first part of this work deals with the classification and treatment of primary cutaneous lymphomas (PCBCL). The 1997 published EORTC classification will be explained according to the good prognosis of PCBCL. Therapeutic strategies as well as typical procedures (PUVA, excision, irradiation) and gene-technically produced drugs (therapeutic antibodies, vaccination) are illustrated in detail. The second part of this publication focuses on the experimental molecular biological work-out, done in primary cutaneous lymphomas by means of micromanipulation and single cell PCR. For the mycosis fungoides could be shown that in the patch stage only a few malignant T cells can be detected. Increasing infiltrates (plaque-stage) are characterized by epidermotrop or dermally grouped atypical cells. In tumor stage dermal atypical T cells are predominating (Gellrich S, J Invest Dermatol, 2003). The tumor cells of primary cutaneous B cell lymphomas are comparable with the stage of mutation of follicle centre cells: somatic mutations and intraclonal diversity (Gellrich S, J Invest Dermatol, 1997; Gellrich S, J Invest Dermatol, 2001). The data indicate, that there may be an active mutation mechanism, the so-called ongoing mutations (Golembowski S, Immunobiology, 2000). One subgroup of PCBCL, are presented by the CD30positve entities. By means of micromanipulation and PCR, single cells were investigated due to T cell clonality. Not all atypical cells belong to the malignant population. It is supposed that an unknown stimulus leads to morphological features and CD30 expression (Gellrich S, J Invest Dermatol, 2003). Another CD30positive entity is reflected by the lymphomatoid papulosis. In these experiments large atypical CD30positve cells were isolated and have been investigated via PCR for T cell receptor g or immunoglobuline heavy and light chain gene rearrangement. The majority of the large CD30postive cells (two cases) belong to a polyclonal T cell population. In the opposite, the small CD3positive cells are the cells persisting within the T cell clone. In another case B cells with the same immunoglobulin gene rearrangement like in a preceding Hodgkin disease of the same patient could be detected. The data seem to underline the fact that reactive polyclonal CD30positive cells are triggered by an unkown stimulus with clonal bystander cells without any pathological significance. In summary, this work could be the basis for further investigations about the etiopathogenesis of PCBCL.

Summary Background Melanoma in situ (MIS) occurs on various body sites, in various age groups, and is managed by a variety of treatment modalities. Despite early treatment, recurrences may be encountered. Objectives To evaluate the influence of sex, age, body site and treatment modalities on recurrence rate in MIS. Methods Histologically confirmed cases of MIS from our dermatopathological database (n = 1351) from 1990 to 2000 were statistically analysed with respect to epidemiological characteristics, treatment modalities and outcome. Treatment modalities of the included MIS were evaluated by searching for data in the medical records and histopathological data sheets. Results There was a predominance of female patients (60·8%), and of involvement of the head and neck (53·4%). Total excision was performed in 95·9% of all patients; the remainder received cryotherapy, laser therapy or radiotherapy. In 265 patients, no data on definitive treatment were available. Alternatives to total excision were particularly performed in patients with advanced age and with lesions localized on the face. The mean ± SD 5-year recurrence rate was 6·8 ± 1·3% for surgically removed lesions, but was 31·3 ± 8·5% for lesions treated by other modalities (log rank test: P

Background: There is a need for better standardization of the dermoscopic terminology in assessing pigmented skin lesions. Objective: The virtual Consensus Net Meeting on Dermoscopy was organized to investigate reproducibility and validity of the various features and diagnostic algorithms. Methods: 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. κ Values, log odds ratios, sensitivity, specificity, and positive likelihood ratios were estimated for all diagnostic algorithms and dermoscopic features. Results: 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 κ value: 0.53). Conclusion: 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. (J Am Acad Dermatol 2003;48:679-93.) J Am Acad Dermatol 2003;48:679-93.

Summary We describe three cases of a new variant of dysplastic melanocytic naevi (DMN), which is characterised by complete lack of pigmentation. Clinically, white DMN were non-pigmented white to pale-red macules with accentuated skin markings, and had a silvery, shiny appearance under tangential light. Histology showed characteristic features of DMN—ie, non-typical melanocytes arranged as solitary units and nests at the dermoepidermal junction and in the papillary dermis, and mild stromal changes. Association with malignant melanoma in all three patients emphasises the importance of this morphological type of DMN as a possible precursor to, or marker of, malignant melanoma.

Objective: To study the validity and feasibility of transferring images of cutaneous biopsy specimens via e-mail to remote physicians active in dermatopathology for teleconsultation. Design: Twenty skin specimens previously diagnosed at the Department of Dermatology, University of Graz, Austria, were subsequently sent for teleconsultation using the store-and-forward method. For each case, 3 or 4 images at different magnifications were sent by e-mail to 16 colleagues (11 dermatopathologists and 5 pathologists) in 15 centers in 6 different countries. Six weeks later each observer received the hematoxylin-eosin-stained specimens to render a conventional diagnosis. Setting: Dermatopathology and pathology units within institutional and private settings. Material: Twenty small skin biopsy specimens of cutaneous diseases were selected randomly from a study set of 80. Main Outcome Measure: Concordance between telepathologic diagnoses and conventional histopathologic diagnoses of 20 skin specimens. Results: On average, 78% of the telediagnoses were correct (range, 60%-95%), whereas 8510 of the conventional diagnoses were correct (range, 60%-95%). A perfect diagnostic concordance was obtained in 7 (35%) of 20 cases, and a significant difference was identified in only 1 case. Conclusions: Results suggest that telepathology performed by physicians active in dermatopathology may serve as a reliable technique for the diagnosis of cutaneous diseases when experts in dermatopathology are not available locally. Furthermore, teledermatopathology is attractive because it provides an opportunity to obtain timely consultation on difficult cases. RI Soyer, H. Peter/E-6000-2010

We performed a multicentre study to evaluate the agreement between the direct clinical diagnosis and the telediagnosis of 43 cutaneous pigmented lesions. Digital clinical and dermoscopic images of the 43 pigmented skin lesions (11 melanomas, 23 melanocytic naevi, three basal cell carcinomas, three lentigines, two seborrhoeic keratoses and one angiokeratoma) were sent by email to 11 colleagues (six dermatologists, two residents in dermatology, one oncologist, one specialist in internal medicine and one general practitioner) in 10 centres. These 11 colleagues had different degrees of experience in dermoscopy. With histopathology as the gold standard, an average of 85% of the telediagnoses were correct, with results varying from 77% to 95%, whereas face-to-face diagnosis by an expert dermatologist was correct in 91% of cases. The kappa value for all participants ranged from 0.35 to 0.87. The results confirm that teledermoscopy can be a reliable technique for the diagnosis of pigmented skin lesions but one that will depend on the expertise of the observer.