Summary
Background
Frozen histological sections are used for intraoperative margin assessment during Mohs surgery. Fluorescence confocal microscopy (FCM) is a new tool that offers a promising and ...faster alternative to frozen histology.
Objectives
To evaluate prospectively in a clinical setting the accuracy of FCM vs. frozen sections in margin assessment of basal cell carcinoma (BCC).
Methods
Patients with BCC scheduled for Mohs surgery were prospectively enrolled. Freshly excised surgical specimens were examined by FCM and then frozen sections were evaluated. Permanent sections were obtained, in order to validate the sample technique. A blind re‐evaluation was also performed for discordant cases. Sensitivity and specificity levels, as well as positive and negative predictive values (PPV and NPV, respectively), were calculated and receiver–operating characteristic curves generated.
Results
We enrolled 127 BCCs in as many patients (40·2% females). Seven hundred and fifty‐three sections were examined. All BCCs were located in the head and neck area. In evaluating the performance of FCM vs. frozen sections, sensitivity was 79·8%, specificity was 95·8%, PPV was 80·5% and NPV was 95·7% area under the curve 0·88, 95% confidence interval 0·84–0·92 (P < 0·001). Forty‐nine discordant cases were re‐evaluated; 24 were false positive and 25 false negative. The performance of FCM and frozen sections was also evaluated according to the final histopathological assessment.
Conclusions
We found high levels of accuracy for FCM vs. frozen section evaluation in intraoperative BCC margin assessment during Mohs surgery. Some technical issues prevent the wide use of this technique, but new devices promise to overcome these limitations.
What's already known about this topic?
Ex vivo fluorescent confocal microscopy (FCM) is a new imaging tool that offers an attractive alternative to conventional frozen histology for the detection of margins in freshly excised tissue.
What does this study add?
Our study of 753 specimens found that FCM is a valid imaging tool to assess basal cell carcinoma margins in Mohs surgery, with high diagnostic accuracy when compared with frozen sections.
Furthermore, FCM is a safe procedure that result in few false‐negative cases when compared with permanent formalin‐embedded sections.
Linked Comment: Notingher. Br J Dermatol 2019; 180:1295–1296.
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Background
Imiquimod 3.75% cream (Zyclara® Meda, Stockholm, Sweden) is a new field‐directed therapy for actinic keratosis (AK).
Objectives
The aim is to evaluate efficacy and the morphologic dynamic ...changes induced by this treatment by means of dermatoscopy and reflectance confocal microscopy (RCM) of imiquimod 3.75% cream for the treatment of AKs of the face or scalp and to evaluate.
Methods
Thirty‐two patients were treated with Imiquimod 3.75% cream. Demographic parameters, AK‐FAS and AKASI scores and side‐effects were collected. RCM and dermatoscopy on one target AKs were performed at each visit. We collected images at baseline (T0), after 1 week from the end of the first 2‐week cycle (T1), after 1 week from the end of the entire treatment (T2) and 2 months after the end of treatment (T3).
Results
One target representative AK in the selected area of treatment of each patient was analysed. All dermoscopic and confocal parameters were reduced 2 months after the end of the therapy (T3) with a substantial reduction of AKASI and AK‐FAS scores, and 17 cases (54.8%) were completely solved. Confocal microscopic analysis showed a reduction of keratinocytes disarray in 77.4% of cases; none showed crusts and parakeratosis. Inflammation was considerably decreased and was observed only in 12.9% of patients at the last visit. This improvement was not assessed on dermatoscopy because of inflammation and background erythema, which adversely influenced the assessments. LSRs were observed in almost all the patients during treatment being more severe after the first cycle of treatment (T1).
Conclusions
Imiquimod 3.75% cream is effective in treating clinical and subclinical AKs with an easy management of side‐effects. Dermatoscopy and mostly RCM allow non‐invasive monitoring of treatment response in vivo.
Objectives:
Our classic histopathologic study of aneurysmal bone cyst (ABC) revealed that “blue reticulated chondroid-like material” (BRC) is characteristic of ABC.
Methods:
The light microscopic ...findings were retrospectively analyzed in 215 cases of ABC, including 101 primary and 114 secondary cases. In addition, 22 cases of telangiectatic osteosarcoma (TOS) were drawn from the same source and used as a control.
Results:
We found the presence of typical BRC in 24 (23.8%) of 101 cases of primary ABC and in six (5.3%) of 114 cases of secondary ABC, with an overall incidence of 30 (14%). None of the cases of TOS showed BRC. BRC was significantly more common in primary ABC than in secondary ABC (P < .05) and in patients 19 years or younger than in those 20 years or older (P < .05).
Conclusions:
BRC appears to be a unique histopathologic feature of ABC, making it valuable to differentiate benign ABC from TOS. Simple H&E stain can be economically performed anywhere.
The use of confocal microscopy is possible using two different modalities: first, at patient's bedside for a rapid in vivo diagnosis of basal cell carcinoma and second, in the operating room directly ...on freshly excised specimen for a fast ex vivo margin‐controlled surgery. In the current review, we report the main application of confocal microscopy for basal cell carcinoma diagnosis and management in both modalities.
Background
In vivo reflectance confocal microscopy significantly improves melanoma diagnosis as compared to clinical/dermoscopic examination alone. Several confocal criteria have been described ...allowing to differentiate melanoma from nevi; by combining different criteria, three pure confocal scores (Pellacani 2005, Segura 2009 and Pellacani 2012) and one mixed dermoscopic/confocal score (Borsari 2018) were constructed.
Objective
Our aim was to externally validate and compare the performance of these confocal scores.
Methods
We retrospectively enrolled excised melanocytic lesions which underwent confocal examination in a 2‐year period. Lesions located on the face and acral sites were excluded. Both dermoscopic and confocal criteria considered in the four scores were evaluated by experts. Subsequently, specificity and sensitivity levels for each score were calculated, together with the positive and negative predictive values and likelihood ratios; also, receiver operating characteristic curves were constructed.
Results
A total of 389 patients with 422 lesions were retrospectively enrolled, of which 162 (38.4%) were melanomas and 260 (61.6%) were nevi (189 common and 71 Spitz/Reed nevi). The highest sensitivity levels were recorded for Segura 2009 with cut‐off ≥−1 (92.0%), while Pellacani 2005 with cut‐off ≥5 achieved the highest specificity (69.6%). The score by Borsari et al. showed the highest levels of positive and negative predictive values (59.8% and 91.5%) and likelihood ratios (2.4 and 0.1) as well as the highest area under the curve values (0.76; 95% CI 0.72–0.81; P < 0.001).
Conclusions
High levels of accuracy were found for each of the four considered scores. No differences were found among scores in confirming melanoma diagnosis when positive; however, the score by Borsari 2018 was the best in excluding melanoma diagnosis when negative.
Crilin (Crystal Calorimeter with Longitudinal Information) is a semi-homogeneous, longitudinally segmented electromagnetic calorimeter based on high-
Z
, ultra-fast crystals with UV-extended SiPM ...readout. The Crilin design has been proposed as a candidate solution for both a future Muon Collider barrel ECAL and for the Small Angle Calorimeter of the HIKE experiment. As a part of the Crilin development program, we have carried out beam tests of small (10 × 10 × 40 mm
3
) lead fluoride (PbF
2
) and ultra-fast lead tungstate (PbWO
4
, PWO-UF) crystals with 120 GeV electrons at the CERN SPS to study the light yield, timing response, and systematics of light collection with a proposed readout scheme. For a single crystal of PbF
2
, corresponding to a single Crilin cell, a time resolution of better than 25 ps is obtained for
>
3 GeV of deposited energy. For a single cell of PWO-UF, a time resolution of better than 45 ps is obtained for the same range of deposited energy. This timing performance fully satisfies the design requirements for the Muon Collider and HIKE experiments. Further optimizations of the readout scheme and crystal surface preparation are expected to bring further improvements.
Background
Ingenol mebutate (IngMeb) 0.015% gel is an approved field treatment option for non‐hyperkeratotic non‐hypertrophic actinic keratosis (AK) of face and scalp. Efficacy of IngMeb has been ...assessed only on a clinical ground, in the majority of studies. Dermoscopy is a pivotal tool for the diagnosis of AK, while its role in evaluating the response to non‐surgical therapies for AK has not been fully defined.
Objectives
Our study aims to determine whether some dermoscopic features of AK of the face and scalp areas may independently predict the response to IngMeb therapy.
Methods
Clinical and dermoscopic responses, 1 month after 0.015% IngMeb therapy, were retrospectively evaluated using a per‐patient and per‐lesion approach. Safety was evaluated through local skin reaction composite score calculation. Demographic, clinical and dermoscopic factors were then evaluated via univariate and multivariate logistic regression analysis to assess independent predictors of response.
Results
Fifty‐five patients with 245 AKs were enrolled. Clinically, per‐patient response evaluation identified 25 (45.4%) poor/partial and 30 (54.5%) complete responders, corresponding on a per‐lesion approach to 66 (26.9%) and 179 (73.1%) AKs, respectively. Dermoscopy reclassified 14 patients in the per‐patient and 48 AKs in the per‐lesion analysis from complete to poor/partial responders. Multivariate logistic regression analysis showed that AKs dermoscopically characterized by red pseudonetwork and located on the face were independently associated with a complete dermoscopic response to 0.015% IngMeb therapy, while microerosions were negative predictors.
Conclusion
Specific dermoscopic features of AK may predict the response to 0.015% IngMeb therapy, together with the location on the face.
Background
Nevi of special sites encompass a class of benign lesions characterized by the presence of atypical clinical and histopathological features that can be difficult to distinguish from ...melanoma. Dermoscopy and reflectance confocal microscopy may improve the clinical assessment of melanocytic lesions to avoid unnecessary excisions.
Objectives
The aim of this study was to assess the value of specific dermoscopic and confocal criteria in distinguishing melanomas from nevi of the breast area.
Methods
Dermoscopic and confocal images from consecutive patients with at least one clinically and/or dermoscopically equivocal melanocytic skin lesion of the breast area were retrospectively evaluated. In this case–control study, only histopathologically proven melanomas (cases) and nevi (controls) were included. Spearman's coefficients were first calculated to flag significant correlation; then univariate and multivariate logistic regression analyses were performed to assess which factors were independently associated with the histopathological diagnosis. Finally, a mixed dermoscopic/confocal score was created to distinguish nevi from melanomas on the breast area.
Results
The study population included 55 skin lesions of the breast area, 34 (61.8%) nevi and 21 (38.2%) melanomas. Among dermoscopic criteria, atypical network and irregular pigmentation resulted independently associated with melanoma diagnosis (OR: 11.1; 95% CI 1.0–119.9; P:0.048 and OR: 6.5; 95% CI 1.1–37.5; P:0.037, respectively). Furthermore, on RCM examination, the presence of pagetoid cells was an independent positive predictor for melanoma (OR: 38.5; 95% CI 3.9–379.6; P:0.002). The mixed score showed high levels of sensitivity and specificity, 95.2% and 82.4%, respectively, which were higher than dermoscopic and confocal evaluations alone.
Conclusion
The combined use of dermoscopy and confocal microscopy in the triage of pigmented lesions of the breast area may help in increasing the diagnostic accuracy and avoiding unnecessary excisions.
A
bstract
The NA62 experiment reports an investigation of the
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, are currently the most precise results worldwide, and are able to constrain some New Physics models that predict large enhancements still allowed by previous measurements.
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