Interobserver variability on the histopathologic diagnosis of cutaneous melanoma and other pigmented skin lesions

PURPOSE: To assess the interobserver agreement on the diagnosis and classification of cutaneous melanoma. MATERIALS AND METHODS: A set of 140 slides of cutaneous melanoma, including a small subset of benign pigmented skin lesions, were circulated to four experienced histopathologists. The kappa statistic for multiple ratings per subject was calculated using the method described by Fleiss. RESULTS: The kappa value on the diagnosis of cutaneous melanoma versus benign lesions was 0.61. There was some discordance on the diagnosis in 37 of 140 cases (26%). For the histopathologic classification of cutaneous melanoma, the highest kappa values were attained for Breslow thickness (kappa = 0.76) and presence of ulceration (kappa = 0.87). The agreement was generally poor for other histologic features, such as level of dermal invasion (kappa = 0.38), presence of regression (kappa = 0.27), and lymphocytic infiltration (kappa = 0.27). CONCLUSION: Our study suggests considerable disagreement among pathologists on the diagnosis of melanoma versus other pigmented lesions. Tumor thickness and presence of ulceration are the most reproducible histologic features of cutaneous melanoma.     

Laser treatment of pigmented lesions

Several pigment-specific lasers can effectively treat epidermal and dermal pigmented lesions without complications using the basic principles of selective photothermolysis. Although such pigmented lesions as solar lentigines and nevi of Ota are relatively easy to treat using pigment-specific laser technology, café-au-lait macules and melasma show variable responses to treatment. New, long-pulsed pigment-specific lasers may prove to further enhance the clinical results obtained in resistant pigmented lesions and other conditions.     

Biopsy of lesions of the female genital tract

Surgical biopsies are often the bedrock of contemporary medical care--the foundation upon which many subsequent and important medical decisions are based. The methods described herein have been found to be very reliable and to produce diagnostic material of high quality. Although some clinics have been reluctant to rely on FNA cytopathologic diagnoses, always insisting on traditional biopsies for histopathologic study, we have relied on both biopsy methods for more than 15 years. The diagnostic accuracy of both methods is greatly improved by attention to technical detail and adherence to an established protocol. Neither method is exclusively applicable in all clinical settings.     

Biopsy in non-neoplastic skin diseases

The Department of Dermatology at Ullev?l Hospital wanted to reveal any diagnostical problems with skin biopsies taken from patients in the Out-patient Clinic. 200 non-tumour skin biopsies from 200 patients were studied retrospectively (100 biopsies from 1986 and 100 from 1995/96). The tentative diagnosis coincided with the pathological anatomical diagnosis in 57.5%(n = 115) of the cases. Of the 200 patients, 22%(n = 44) had still not been given a specific diagnosis after biopsy. This study indicates that skin biopsy is of diagnostical help, but that closer cooperation between the pathologist and the clinician is probably necessary in order to increase the proportion of specific dermatological diagnoses.     

MR imaging techniques for soft-tissue lesions

MR imaging is the technique of choice for detection, characterization, and staging of soft-tissue neoplasms. MR examinations need to be tailored to each patient based upon the patient's size and anatomic region of interest so that optimal information is obtained. Technique is critical. Proper positioning to allow patient comfort and reduce motion artifacts is essential. Selection of the appropriate coils, image planes, and optimal pulse sequences to identify and determine the extent of lesions is critical for therapy planning.     

Biopsy of the skin. Thoughtful selection of technique improves yield

Skin biopsy can serve both diagnostic and therapeutic purposes. Site selection is not of major importance in the many types of lesions suggestive of malignancy but is crucial with diffuse eruptions. The shave technique is appropriate for many neoplastic lesions, while punch or incisional/excisional biopsy is necessary for more deeply invasive lesions. A variety of anesthetics are available to aid in patient comfort, as are a number of techniques for accomplishing the procedure to achieve the best cosmetic result.     

Preliminary experience with a flashlamp-pulsed tunable dye laser for treatment of benign pigmented lesions

Azo dyes, the largest portion of manufactured dyestuffs, are primarily used as colouring substances in food, textiles, and the plastic industry. It has been estimated that 128 tonnes per annum of dyes are released into the environment worldwide [Anliker, 1977]. Certain azo compounds are known to be mutagenic in bacterial tests [Yahagi et al., 1975; Venitt and Bushell, 1976; Brown et al., 1978]. Watersoluble dyes are biotransformed by intestinal micro-organisms in the gastro intestinal tract, and the toxicity, mutagenicity, and carcinogenicity of these dyes in the gut or liver may be attributed to their metabolites. Since it is desirable to have a genotoxic evaluation of a chemical being released into the environment in order to check their indiscriminate use, a project has been initiated to determine the mutagenicity of the azo dyes being used commercially. The present report deals with the results of 13 dyes tested in Salmonella typhimurium with and without metabolic activation.     

Epiluminescence microscopy versus clinical evaluation of pigmented skin lesions: effects of Operator''s training on reproducibility and accuracy. Dermatology and Venereology Society of the Canton of Ticino

We report a case of B-cell chronic lymphocytic leukemia (B-CLL) in which trisomy 12 and t(14;18)(q32;q21) were simultaneously detected in the same leukemic clone. Southern blot analysis showed that the BCL2/IgJH rearrangement occurred at the major breakpoint region in the hot spot of the BCL2 gene. Double color fluorescence in situ hybridization analysis using multiple probes indicated that clonal B-cell with t(14;18) represented a subpopulation of the total leukemic cells and that trisomy 12 followed t(14;18) as the cytogenetic aberration in the development of B-CLL. Our findings suggests that both the t(14;18) and the trisomy are secondary chromosomal changes in the leukemogenesis of B-CLL.     

Arteriosclerotic skin lesions resembling cutaneous vasculitis

The author reviews literature relating to the use of activities in the treatment of chronic schizophrenia, citing several programs that combined activities and psychotherapy to produce effective modes of treatment. He also describes a program in which he used collage-making to help a group of schizophrenic women improve interpersonal relationships, reality-testing, and self-image as well as to help them express problems and develop feelings of autonomy. The author believes that such combined programs help meet the basic needs of schizophrenic patients and alleviate their tendencies to withdraw from their surroundings.     

Painless, red-violet skin lesions during immunosuppression

A patient with painless, bluish-red skin lesions under immunosuppressive treatment for kidney transplantation is presented. The clinical and histological diagnosis was Kaposi's sarcoma. This is a rare but serious complication in the immunocompromised patient. Human Herpes virus 8 (HHV 8) was recently found in the lesions from patients with Kaposi's sarcoma. This supports the important role of immunosuppression in the development of this tumor. Therapy consists of reduction or stopping of the immunosuppressive drugs which is usually followed by reduction in tumor mass. Local skin tumors can be treated with irradiation or laser therapy. In the case of lesions of visceral organs chemotherapeutic regimens consisting of vinicristine/bleomycin are indicated. New strategies aim to reduce the virus load with antiviral drugs or to inhibit the angiogenesis of this highly vascularized tumor.     

Considering Mycobacterium haemophilum in the differential diagnosis for lytic bone lesions in AIDS patients who present with ulcerating skin lesions

Incidence of neural tube defects in Poland in the 90's was 2.68 in 1000 births. The value of incidence has not been changed within last twenty years. Mortality caused by neural tube defects in Poland is much higher than in many other European countries and the United States. High rates of incidence of neural tube defects in Poland is probably caused by low utilisation of methods of secondary prevention in a group of low-risk pregnant women. Since methods of primary prevention of neural-tube defects are available; primary prevention with folic acid, should be immediately implemented in Poland.     

Treatment of peri-ocular skin lesions with the erbium:YAG laser

INTRODUCTION: A great number of consmetically disturbing, cutaneous lesions are localized in the periocular region. While various approaches for treatment such as excision, electrocauterization or cryosurgery often show unsatisfactory results, the use of laser technology is of increasing interest. MATERIAL AND METHODS: A total of 104 patients with different cutaneous periorbital lesions (wrinkles, xanthelasma, syringoma) were treated with a new erbium: YAG laser system (wavelength 2940 nm, pulse duration 0.350 ms and pulse energy 0.1-1.7 Joules), which works on the principle of vaporization. RESULTS: The erbium: YAG laser allows athermic ablation of very thin skin layers without scarring and with minimal lateral thermal injury due an extremely short pulse duration. Periorbital lesions can be treated effectively by erbium: YAG laser, and good to excellent cosmetic results can be obtained. CONCLUSIONS: The use of pulsed erbium: YAG laser is an effective and promising new method for treatment of different superficial periorbital cutaneous lesions.     

Biopsy for diagnosis of tuberculosis

Recent advances of molecular techniques make diagnosis of pulmonary tuberculosis rapid and easier comparing to conventional techniques. However, diagnosis for tuberculosis, especially tuberculous pleuritis, tuberculous lymphadenitis and non-pulmonary tuberculosis, is not easy. Transbroncheal lung biopsy (TBLB) is a helpful examination for not only pulmonary tuberculosis but also malignant diseases. The pleural biopsy using Cope needle was commonly used as a method for diagnosis of tuberculous pleuritis, and the sensitivity of pleural biopsy is about 50% or more. Furthermore, the pleural biopsy using thoracoscopy was reported to show a higher sensitivity for the diagnosis of tuberculous pleuritis. A lymph node biopsy is also a useful method for diagnosis of tuberculous lymphadenitis. Thus, a biopsy method is the reliable tool for diagnosis of not only pulmonary tuberculosis, but also other organ tuberculosis.     

Recognizing neoplastic skin lesions: a photo guide

Malignant lesions of the skin are common. Patients who develop squamous cell carcinoma and malignant melanoma often have recognizable precursor conditions. A few skin lesions resemble malignancies. Lesions that are growing, spreading or pigmented, or those that occur on exposed areas of skin are of particular concern. Knowing the similarities and differences between these lesions allows the primary physician to make a diagnosis in most cases by simple inspection and palpation. When in doubt, it is appropriate to perform an excisional biopsy of small lesions or punch biopsy of larger lesions. Removal of premalignant lesions will reduce the occurrence of malignant disease. Almost all skin cancers can be cured by early excision or destruction. For these reasons, physicians should be aware of the risk factors for skin cancer, educate patients about risk reduction and include skin inspection for premalignant and malignant lesions as a part of routine health maintenance examinations.