Legal Aspects of Atopic Dermatitis
Donald Rudikoff, Steven R. Cohen, Noah Scheinfeld in Atopic Dermatitis and Eczematous Disorders, 2014
Given its prevalence, however, atopic dermatitis can also provide the excuse for a patient to ask the dermatologist about another skin issue, which must be pursued if evaluated and can lead to legal liability on its own. In one case, a patient sought treatment for a flare of atopic dermatitis but also asked his dermatologist about a growing mole that the dermatologist then biopsied. The mole was reported as a nonmalignant nevus. During a subsequent visit 30 months later, again for an eczema flare, the patient pointed out a lump under his left arm for which the dermatologist referred the patient to his internist. Subsequent biopsy of the lump revealed it to be a metastatic melanoma, and the patient died soon after. A malpractice case followed, which the court ultimately dismissed for failure to have been filed within the statute of limitations. The patient’s family was not allowed to claim that there had been continuous treatment for the condition from the time of the first biopsy to the second (Trimper v Jones 2007). The case nevertheless serves as a reminder that a physician must carefully identify the scope of a patient’s treatment in a given situation and adhere to it.
Benign Melanocytic Lesions
Ashfaq A Marghoob, Ralph Braun, Natalia Jaimes in Atlas of Dermoscopy, 2023
Melanocytic nevi are common skin lesions and the primary differential diagnosis of early presentations of cutaneous melanoma. Their accurate recognition is critical for efficient skin cancer detection. Fortunately, the majority of melanocytic nevi can be correctly identified after careful clinical and dermatoscopic inspection as well as integration of patient- and lesion-related factors such as age, anatomic location, skin color, and clinical history. In this chapter, we review the common dermatoscopic patterns of melanocytic nevi, including reticular, globular, homogeneous, starburst, peripheral globules, multicomponent patterns, and their variants. We also discuss banal/common nevi, atypical/dysplastic nevi, growing nevi, and congenital nevi. Finally, we point out dermatoscopic features relevant to less common nevus subtypes, including halo nevi, balloon cell nevi, traumatized nevi, combined nevi, and nevi subjected to ultraviolet irradiation.
Melanomas
E. George Elias in CRC Handbook of Surgical Oncology, 2020
The differential diagnosis of cutaneous melanoma involves other pigmented lesions that may contain melanocytes or hemosiderin. Benign nevi are uniformly colored (tan to brown), have sharp, clear-cut margins, without nodularity, and are usually 0.5 cm or less in diameter. Benign nevi appear during childhood and adolescence and are multiple. By age 20, they may reach 25 to 30 in number, then gradually decrease in number. Pathologically, there are three types of benign nevi: Intradermal nevus can occur anywhere in the body except the palms, soles, and genitalia. Microscopically, benign nests or cords of cells are located in the dermis below the basal cell layer of the epidermis.Junctional nevus can occur anyplace in the body but more often in the palms, soles, and genitalia. Clinically, it cannot be differentiated from the intradermal nevus except by the clinical location. Histologically, nests of cells with occasional clear cells are in the epidermis, and it may involve the basal cells.Compound nevus can be found at any site but mainly on the trunk. Microscopically, it is a combination of intradermal nevus with junctional activity.
Blue nevi of the palpebral conjunctiva: report of 2 cases and review of literature
Published in Orbit, 2022
Armida L. Suller, Jiawei Zhao, Nickisa M. Hodgson, Gulsun Erdag, Raja R. Seethala, Aparna Ramasubramanian, Roxana Fu
Clinically, blue nevi can simulate other pigmented lesions of the conjunctiva, such as common nevus, racial melanosis, PAM, melanoma, and pigmented squamous cell carcinoma. Common nevus is a benign melanocytic tumor, which typically presents as a variably pigmented, circumscribed, slightly elevated lesion with intralesional cysts in the bulbar conjunctiva.25 Although common nevus is the most frequently encountered pigmented tumor on the ocular surface, it rarely presents in the tarsal conjunctiva.25 Racial melanosis is a bilateral condition typically found in darkly pigmented individuals and appears as flat conjunctival pigmentation.31 PAM presents as a diffuse, flat, patchy brown pigmentation of the bulbar conjunctiva, but it can involve the palpebral conjunctiva as well.31 Malignant melanoma appears as a brown to tan, elevated mass in the bulbar conjunctiva with surrounding PAM and prominent feeder vessels.30,31 Involvement of the palpebral conjunctiva or eyelid margin is unusual in melanoma, but it is associated with higher risk of recurrence, orbital exenteration, metastasis, and death.30 Given the rarity of benign lesions, such as blue nevi in the palpebral conjunctiva, any pigmented lesion in this location should raise suspicion of melanoma.30 Squamous cell carcinoma can be pigmented in rare cases and has been documented in the bulbar and palpebral conjunctiva in both Whites and non-Whites.32,33
The Markers Auxiliary in Differential Diagnosis of Early Melanomas and Benign Nevi Sharing Some Similar Features Potentially Leading to Misdiagnosis – A Review of Immunohistochemical Studies
Published in Cancer Investigation, 2022
Łukasz Kuźbicki, Anna A. Brożyna
Study results of marker can be binary when a given molecule is or is not detectable. However, most often the results of the percentage fraction of stained cells or the intensity of immunohistochemical staining constitute numbers on a continuous scale. In diagnostic tests continuous results are often dichotomized. Ultimately, what matters is whether the skin lesion is a nevus or a melanoma. However, this entails the need to introduce optimal thresholds of the marker level. A good practice allowing for objective analysis and comparison of research results would be their presentation using the receiver operating characteristic (ROC) curve illustrating the variability of the sensitivity and specificity of the diagnostic test for consecutive threshold values of the marker level. The measure of test quality constitutes the area under the ROC curve (AUC) which allows quantifying the overall ability to discriminate between two outcomes: benign or malignant lesion (55–60). The test is considered perfect if AUC = 1.0, excellent if 1.0 > AUC ≥0.9, good if 0.9 > AUC ≥0.8, fair if 0.8 > AUC ≥0.7, poor if 0.7 > AUC >0.5 and non-useful if AUC ≤0.5 (57).
Systematic review of machine learning for diagnosis and prognosis in dermatology
Published in Journal of Dermatological Treatment, 2020
Kenneth Thomsen, Lars Iversen, Therese Louise Titlestad, Ole Winther
Three systems had multiway output functions (12,22,28). The rest had binary outcomes. Five publications used more than 1000 images (12,20,29–31); seven publications used between 500 and 992 images (21,23,27,28,32–34); the rest used between 100 and 370 images (Table 1). The ratio of training to test set varied considerably. Data saved for the test set varied from 0% (35) to 68% (36) of the entire data set. Seven publications did not describe the ratio. Twenty of the 23 publications used the binary outcome MM or benign lesions (binary classification). The benign lesions were most often nevi. Some studies also included seborrheic keratosis, actinic keratosis, lentigines, basal cell carcinoma (BCC) and dermatofibromas. Eight publications did not describe the benign lesions; data not shown.
Related Knowledge Centers
- Mucous Membrane
- Skin Cancer
- Neoplasm
- Skin
- Hyperplasia
- Melanin
- Melanocyte
- Melanocytic Nevus
- Lesion
- Chronic Condition