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The differential diagnosis of nipple and areola complex (NAC) lesions encompasses a large spectrum of conditions from benign tumours to inflammatory diseases that could be challenging to recognize on clinical ground. While melanoma (MM) of the NAC is exceedingly rare, benign lesions are more frequent but could be difficult to distinguish from MM. Besides MM, other malignant tumours can affect this area and in particular Paget's disease (PD). For clinically doubtful lesions, biopsy is required, with possible functional and aesthetic consequences in this sensitive area. Dermoscopy and reflectance confocal microscopy (RCM) are widely used techniques for the diagnosis of many skin lesions, but their use for NAC lesions is not well established. The objective of this study was to evaluate current literature on these imaging techniques for NAC lesions. We searched in Medline, PubMed and Cochrane database all studies up to November 2018 dealing with dermoscopy, RCM and this special site. We found that the most described malignant tumour was PD and that only two primary MMs of the NAC have been reported with these imaging techniques. Although there are few data on diagnostic accuracy of non‐invasive imaging techniques for NAC lesions, it seems that dermoscopy and RCM can add relevant information to be integrated with clinical examination for the diagnosis of NAC lesions and in particular for the differential diagnosis of PD and eczema. [ABSTRACT FROM AUTHOR]

Abstract: Background: Cutaneous endometriosis (CE) is rare and its dermoscopic features were reported only in 3 patients. The aim of this study was to examine a case of pigmented CE with multiple non‐invasive imaging techniques, to compare the obtained images with histopathology and to define their utility in an early diagnosis of the disease. Case report: We performed dermoscopy, high‐frequency ultrasound (HFUS), in vivo and ex vivo reflectance confocal microscopy (RCM) of a pigmented CE arising on the caesarean scar of a phototype IV patient, along with histologic studies. Dermoscopy showed a greyish background and a brownish pigmentation. HFUS shows well‐demarcated anechoic areas corresponding to ectopic endometrial tissue at histopathologic examination. RCM and OCT only showed the alterations of the epidermis. Conclusion: High‐frequency ultrasound could represent a very useful tool for an early diagnosis of CE and its usefulness could be tested in patients with unusual cyclical pain, even before skin lesion appearance. RCM allowed the visualization of skin surface modification due to underlying endometriosic tissue. Dermoscopy showed a new aspect that was probably related to the mix of blood extravasation (ie, greyish background) and epidermal pigmentation (ie, brown pigmentation). [ABSTRACT FROM AUTHOR]

Background Acral lentiginous melanoma ( ALM) can be difficult to differentiate from acral nevus. Reflectance confocal microscopy ( RCM) is widely used for the diagnosis of melanocytic tumours, but the RCM features of ALM and acral nevus have not been described yet. Objective To determine the RCM features of ALM and acral nevus, and their correlation with clinical and histological characteristics. Methods Retrospective study of 17 cases of ALM and 26 acral nevi. Results Pagetoid cells were present in all ALMs with a visible epidermis and in three nevi. A proliferation of atypical melanocytes at the dermal-epidermal junction ( DEJ) and/or in the dermis was visible in nine ALMs but not in nevi. The histopathological examination of initial skin biopsies was unable to diagnose ALM in four cases, differing from RCM that could identify malignant tumour cells by exploring the whole lesions. Conclusion Reflectance confocal microscopy can help in the differentiation of ALM and acral nevus, and to guide the biopsy. [ABSTRACT FROM AUTHOR]

Background and objectives: The differential diagnosis between vulvar naevi and melanoma is challenging. In vivo reflectance-mode confocal microscopy (RCM) is an emerging technique that allows non-invasive high-resolution imaging of the skin and mucosa. It has recently been used for the study of vulvar melanosis and melanoma, but it has not been so far employed for the diagnosis of genital naevi. The objective of this study is to evaluate RCM features of vulvar naevi and to compare them with dermoscopical and histopathological aspects. Methods: Clinical, dermoscopical, in vivo RCM and histological features of six vulvar naevi were evaluated. Results: The clinical and/or dermoscopical aspects were suspicious in all six cases. RCM showed a blue naevus, an atypical genital naevus, a junctional naevus and three compound naevi that were later confirmed by histological examination. In one compound naevus, RCM showed focal cytological atypia and architectural irregularity without clear features of malignancy, confirmed by histological examination. Conclusions: Reflectance-mode confocal microscopy can play a role in non-invasive diagnosis of vulvar naevi, but further broader studies are required to validate our observations. [ABSTRACT FROM AUTHOR]

Background Melanosis is the most common cause of mucosal pigmentation and can be clinically difficult to differentiate from early melanoma (MM). Dermoscopy can help in the distinction between melanosis and MM, but in some instances, melanoses may exhibit overlapping features with MM such as the presence of grey colour. Objective We sought to evaluate whether reflectance confocal microscopy (RCM) can help to better understand the dermoscopic features of melanoses in order to assist clinicians in their diagnosis. Methods All melanoses diagnosed between June 2011 and December 2014 in the Departments of Dermatology of the University of Saint-Etienne (France) and of Modena and Reggio Emilia (Italy), for which dermoscopic and RCM images were available, were included. Twenty-two lesions were biopsied to confirm the clinical diagnosis, whereas the others did not present any change at a follow-up of at least 6 months. The correlation between dermoscopic and RCM features were evaluated by the Spearman's rho correlation coefficient. Results 55 melanoses were studied: 31 of the oral mucosa and 24 of the genital mucosa. 49% (n = 27) of melanoses exhibited a grey colour under dermoscopy. The grey colour correlated with the presence of melanophages under RCM (q = 0.424, P = 0.002). Conclusion Our findings highlight that the presence of the grey colour on dermoscopy, considered as an alerting feature, is common in melanoses and it is related to the presence of melanin-laden inflammatory cells in the papillary dermis on RCM. When it is present as a 'pure' feature not associated to other colours than brown or to atypical dermoscopical structures, it could be related to the diagnosis of melanosis. [ABSTRACT FROM AUTHOR]

The article presents a study which highlights several advantages of the spaghetti technique coupled with reflectance confocal microscopy (RCM) combined with the spaghetti technique and the identification of surgical margins of lentigo maligna. It mentions spaghetti, included in paraffin, stained with haematoxylin and eosin and Lentigo maligna (LM) and lentigo maligna melanoma (LMM) account of all melanomas. It also mentions pigmentation of the scar with the presence of tumour cell.

The article presents a case study of a 59-year-old patient with recurrent falls who was taken to the hospital because of cerebellar syndrome. It mentions that the patient was not immunodeficient and did not have any fungal lung infection. It informs about the examination of the patient's brain biopsy through smear technique and confocal microscopy.