3-10c in Visual Studio .NET

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3-10c
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Recognize QR Code ISO/IEC18004 In .NET Framework
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3
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RISK
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DIAGNOSIS
Painting EAN-13 In .NET Framework
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Nevus Seborrheic keratosis Basal cell carcinoma Vascular Dermatofibroma Squamous cell carcinoma Melanoma Other
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3-11a
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No intervention Follow-up Histopathologic diagnosis
Read EAN 13 In None
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CASE 11
HISTORY
This lesion was found on the arm of a 52-year-old man 1 This is a benign halo nevus characterized by a cobblestone pattern and surrounding white halo 2 This is a benign halo hemangioma characterized by well-dermarcated lacunae and hypopigmentation 3 The brown color of the lacunae-like structures is a clue that this might be a melanocytic lesion 4 Clinically and dermoscopically, this could be a melanoma with halo nevus-like regression 5 Brown, blue, gray, and white colors plus irregular vessels are clues that this is a melanoma
3-11b
DERMOSCOPY: AN ILLUSTRATED SELF-ASSESSMENT GUIDE
RISK
Low Intermediate High
DIAGNOSIS
Nevus Seborrheic keratosis Basal cell carcinoma Vascular Dermatofibroma Squamous cell carcinoma Melanoma Other
1 3-11c
DISPOSITION
No intervention Follow-up Histopathologic diagnosis
ANSWERS
Answers: 3,4,5
Discussion:
DERMOSCOPIC CRITERIA
Asymmetry of color and structure Multicomponent global pattern (1,2,3) Irregular brown globules (white boxes) Regression (stars) Gray color (black arrows) Irregular blue blotch (yellow box) Irregular vessels (red arrows)
A halo nevus is in the clinical and dermoscopic differential diagnosis With an eccentrically located lesion and several high risk dermoscopic criteria, an invasive melanoma with halo nevus-like regression is a more likely diagnosis The differential diagnosis of the tumor includes an irregular cobblestone pattern of a melanocytic nevus or lacunae-like vascular structures of a hemangioma The brown color rules out a vascular lesion Halo phenomenon can occur around melanocytic and nonmelanocytic lesions: Congenital, acquired, dysplastic, blue, Spitz nevi, and melanoma Seborrheic keratosis, neurofibroma, basal cell carcinoma But not around hemangiomas ascular lesions typically have white color but within the lesion V (fibrous septae) Cutaneous metastatic melanoma could have this dermoscopic picture with lacunae-like structures Bony hite, blue, and gray color make up the area of regression w The fine gray granules ( peppering ) that can be seen in regression are not identified
PEARLS
A halo nevus-like lesion in an adult is melanoma until proven otherwise Halo nevi can be found in children and in most cases are not high risk lesions Halo phenomenon in a patient with a history of melanoma can be a clue that the patient has metastatic melanoma One should search for irregular criteria before diagnosing a benign halo nevus
3
Trunk and Extremities
RISK
Low Intermediate High
DIAGNOSIS
Nevus Seborrheic keratosis Basal cell carcinoma Vascular Dermatofibroma Squamous cell carcinoma Melanoma Other
3-12a
DISPOSITION
No intervention Follow-up Histopathologic diagnosis
CASE 12
HISTORY
This isolated lesion was thought to be high risk by the referring general practitioner, and was located on the back of a 34-year-old woman 1 Milky-red areas and a blue-white veil characterize this nodular-melanoma 2 Well-dermarcated vascular spaces, fibrous septa, and the absence of criteria seen in a melanocytic lesion characterize this classic hemangioma 3 By definition, hemangiomas must have tightly spaced lacunae 4 Bright red, violaceous, blue, and black colors can be found in hemangiomas 5 Pyogenic granulomas can have similar lacunae-like structures and a white peripheral border
3-12b
DERMOSCOPY: AN ILLUSTRATED SELF-ASSESSMENT GUIDE
RISK
Low Intermediate High
DIAGNOSIS
Nevus Seborrheic keratosis Basal cell carcinoma Vascular Dermatofibroma Squamous cell carcinoma Melanoma Other
DISPOSITION
No intervention Follow-up Histopathologic diagnosis
ANSWERS
Answers: 2,4
Discussion:
DERMOSCOPIC CRITERIA
Lacunae (boxes) Fibrous septa (white arrows) Fibrous border (black arrows)
Clinically and dermoscopically this is a classic hemangioma There are no criteria for a melanocytic there should be no criteria for a melanocytic lesion The main criteria are lacunae (aka saccules, lagoons) Lacunae sharply demarcated, vary in size and distribution round to oval structures Lacunae can be tightly packed or loosely distributed throughout the lesion The color is determined by the location of vascular spaces in the dermis Bright red (cherry/senile hemangiomas) the vascular spaces are high up in the papillary dermis The deeper the vascular spaces, the darker the color (ie, darker shades of red, violaceous, blue) Black color indicates thrombosis Individual hemangiomas can have single or multiple colors Bluish-white or white fibrous septa are commonly seen and should not be confused with the bluish-white or bony- white color found in melanomas Milky-red areas in melanomas can have lacunae-like structures but the borders are not sharply demarcated Pyogenic granulomas can have septa-like white lines in the lesion and at the periphery but lack lacunae Angiokeratomas are hemangioma-like with varying amounts of scale or crust Lymphangiomas have clear vascular-like spaces Lymph-hemangiomas have a combination of clear and red vascular spaces
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