Lichen planus-like keratosis: clinical applicability of in vivo reflectance confocal microscopy for an indeterminate cutaneous lesion

A Systematic Review of Diagnoses with Rosettes Under Dermoscopy

INTRODUCTION

Rosettes are a cluster of shiny white dots in the shape of a four-leaf clover seen under polarized dermoscopic light. Historically, rosettes were primarily reported in actinic keratoses and squamous cell carcinoma. However, rosettes have also been reported in other conditions.

OBJECTIVES

The objective of this systematic review to elucidate the breadth of diagnoses exhibiting this unique dermoscopic phenomenon.

METHODS

A review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Literature searches were performed in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Web of Science, as well as a manual search of the reference lists of screened articles.

RESULTS

A total of 73 articles met the inclusion criteria. Out of these, 47 distinct diagnoses with rosette were identified. Among neoplastic conditions, keratinizing neoplasms had the highest number of articles reported (N = 19). Discoid lupus was the most commonly reported diagnosis within the inflammatory category (N = 6). Molluscum contagiosum was the predominant diagnosis among infectious entities (N = 3), while acroangiodermatitis was the sole diagnosis reported in the vascular category (N = 1).

CONCLUSIONS

These findings confirm rosettes are not specific to keratinocytic growths and are observed in a wide range of conditions. Knowledge of the breadth of conditions with rosettes may aid clinicians when developing a differential diagnosis of a growth or an eruption with rosettes under dermoscopy.

The differential diagnosis of lichenoid keratosis and seborrheic keratosis with reflectance confocal microscopy: a preliminary study

BACKGROUNDS AND OBJECTIVES

Lichenoid keratosis (LK, or lichen planus-like keratosis, LPLK) and seborrheic keratosis (SK) present as similar benign keratotic lesions on cosmetically sensitive area, but require different therapies. Both lesions can be easily differentiated based on histological evaluation of biopsy materials. However, the biopsies may cause scarring and result in hyper-pigmentation, which reduces the compliance of the patients to be treated. In this study, we investigated the role of reflectance confocal microscopy (RCM) in the non-invasive differential diagnosis of LK and SK.

PATIENTS AND METHODS

Cases with facial brown patches or plaques suspicious of SK were enrolled in the study. After written informed consent was obtained, the lesions were photographed, imaged by RCM, and then biopsied. The RCM findings were analyzed and correlated with histology results. Evaluation of the RCM pictures and confirmation with histological results were conducted by two independent dermatologists.

RESULTS

In total, 10 cases were enrolled in the study. The main characteristics of LK lesions observed by RCM were the disarray of the dermal-epidermal junction (DEJ), and marked inflammatory infiltrates in the superficial dermis; while prominent cerebriform pattern, or elongated cords with bulbous projections without significant inflammation reaction, were the features of SK. Among the 10 cases, clinically suspicious of facial SK, 4 were determined as LK, 6 as SK by RCM imaging, and all the RCM findings were confirmed by histological results.

CONCLUSIONS

The RCM features of LK and SK have significant difference, highlighting the important role of RCM in the differential diagnosis of LK and SK, avoiding biopsies and allowing safe treatments.

A Secure Framework toward IoMT-Assisted Data Collection, Modeling, and Classification for Intelligent Dermatology Healthcare Services

The abnormal growth of the skin cells is known as skin cancer. It is one of the main problems in the dermatology area. Skin lesions or malignancies have been a source of worry for many individuals in recent years. Irrespective of the skin tone, there exist three major classes of skin lesions, i.e., basal cell carcinoma, squamous cell carcinoma, and melanoma. The early diagnosis of these lesions is equally important for human life. In the proposed work, a secure IoMT-Assisted framework is introduced that can help the patients to do the initial screening of skin lesions remotely. The initially proposed approach uses an IoMT-based data collection device which is accessible by patients to capture skin lesions images. Next, the captured skin sample is encrypted and sent to the collected image toward cloud storage. Later, the received sample image is classified into appropriate class labels using an ensemble classifier. In the proposed framework, four CNN models were ensemble i.e., VGG-16, DenseNet-201, Inception-V3, and Efficient-B7. The framework has experimented with the “HAM10000” dataset having 7 different kinds of skin lesions data. Although DenseNet-201 performed well, the ensemble model provides the highest accuracy with 87.22 percent as well as its test loss/error is lower than others with 0.4131. Moreover, the ensemble model's classification ability is much higher with an AUC score of 0.9745. Moreover, A recommendation team has been assigned to assess the sample of the patient as well as suggest the patient according to classified results by the CAD.

Lichenoid Keratosis: A Clinical Trap without Secrets for Reflectance Confocal Microscopy

Lichenoid keratosis, also defined as benign lichenoid keratosis, was reclassified as lichen planus-like keratosis by Shapiro and Ackerman. Clinical and dermoscopic features of lichen planus-like keratosis can vary, often not providing useful and necessary information to perform an accurate diagnosis without performing a biopsy or histological examination. We describe 2 difficult to detect lichen planus-like keratosis cases in which we performed reflectance confocal microscopy. We underline the usefulness of this noninvasive diagnostic tool in the unclear cases of lichen planus-like keratosis.