Publications by authors named "Gisele Gargantini Rezze"

14 Publications

  • Page 1 of 1

Pigmented lesion on the face: which is the chance of being melanoma using reflectance confocal microscopy features?

Arch Dermatol Res 2021 Jun 21. Epub 2021 Jun 21.

Derma Image, São Paulo, SP, Brazil.

Facial melanoma presents itself as a brownish macula, being difficult to differentiate it from benign pigmented lesions of the face on clinical examination. Reflectance confocal microscopy (RCM) assists in diagnosing facial lesions in which dermoscopy has limitations, allowing to increase the diagnostic accuracy. The study aimed to analyze the RCM features of pigmented isolated lesions of the face for diagnosing melanoma. Also, we sought to establish the chance of a pigmented lesion on the face being a melanoma using RCM criteria. In this retrospective and prospective study, 105 clinical pigmented lesions on the face underwent RCM, and cytoarchitectural features in the epidermis, the dermo-epidermal junction (DEJ), and dermis were described. For statistical analysis, the exact chi-square test was applied to the RCM criteria. The odds ratio was estimated using univariate logistic regression. Finally, we used the multiple logistic regression method for creating a nomogram to predict the chance of a lesion being a melanoma. After univariate and multivariate logistic regression, atypical round nucleated cells within the epidermis, pagetoid spread, and follicular dendritic cells presented as statistically significant features. Then, a complex nomogram was created to give the chance of a pigmented lesion on the face being a melanoma. The presence of these three features resulted in a 98% probability for melanoma. This study allowed to estimate the diagnosis of melanoma on the face, using RCM, practicable and feasible in the daily routine, through the presence of some RCM nomogram criteria.
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http://dx.doi.org/10.1007/s00403-021-02263-6DOI Listing
June 2021

Reflectance confocal microscopy as a tool for screening surgical margins of basal cell carcinoma.

An Bras Dermatol 2018 Jul-Aug;93(4):601-604

Course in Dermatology, Faculdade de Medicina do ABC, Santo André (SP), Brazil.

Surgical excision of basal cell carcinoma with minimum margins requires serial assessment of layers by frozen histopathology in the case of Mohs micrographic surgery. Evaluation of presurgical tumor margins by in vivo reflectance confocal microscopy is a potential alternative. We selected 12 basal cell carcinoma lesions that were analyzed by confocal microscopy to define margins. The lesions were excised by Mohs surgery. Six tumors showed negative margins in the first phase of Mohs micrographic surgery. We concluded that reflectance confocal microscopy can be useful in the preoperative definition of basal cell carcinoma margins.
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http://dx.doi.org/10.1590/abd1806-4841.20187089DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6063104PMC
September 2018

Reflectance confocal microscopy features of BRAF V600E mutated thin melanomas detected by immunohistochemistry.

PLoS One 2017 29;12(6):e0179745. Epub 2017 Jun 29.

Cutaneous Oncology Department, AC Camargo Cancer Center, São Paulo, Brazil.

The classification of melanoma into four histological subtypes has been questioned regarding its clinical validity in providing relevant information for treatment for metastatic tumors. Specific genetic alterations are associated with particular clinical and histopathological features, suggesting that these could be helpful in refining existing melanoma classification schemes. We analyzed BRAF V600E mutated melanomas to explore the Reflectance confocal microscopy (RCM) utility as a screening aid in the evaluation of the most appropriate patients for genetic testing. Thus, 32 melanomas were assessed regarding their BRAF V600E mutational status. Experts blinded to dermoscopic images and V600E immunohistochemistry results evaluated RCM images regarding previously described melanoma features. BRAF positive melanomas were related to younger age (p = 0.035), invasive melanomas (p = 0.03) and to the presence of hiporreflective cells (p = 0.02), epidermal nests (p = 0.02), dermal-epidermal junction nests (p = 0.05), edged papillae (p = 0.05), and bright dots (p = 0.05), and to absence of junctional thickening due to isolated cells (p = 0.01) and meshwork (p = 0.02). This study can not characterize other mutations in the BRAF, because the immunohistochemistry is specific to the type V600E. The findings should encourage the genetic evaluation of BRAF mutation. This study highlights the potential of RCM as a supplementary tool in the screening of BRAF-mutated melanomas.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0179745PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5491027PMC
September 2017

Opening a Window into Living Tissue: Histopathologic Features of Confocal Microscopic Findings in Skin Tumors.

Dermatol Clin 2016 Oct;34(4):377-394

DermaImage associates, Avenida General Furtado do Nascimento, 740, cj. 24. São Paulo, SP 05465-070, Brazil. Electronic address:

The knowledge of histopathology and in vivo reflectance confocal microscopy correlation has several potential applications. Reflectance confocal microscopy can be performed in all skin tumors, and in this article, the most common histopathologic features of confocal microscopic findings in melanocytic skin tumors and nonmelanocytic skin tumors are described.
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http://dx.doi.org/10.1016/j.det.2016.05.002DOI Listing
October 2016

Hypomelanotic melanoma mimicking pigmented Bowen disease.

J Am Acad Dermatol 2016 Jan;74(1):e11-3

Dermaimage Medical Associates, São Paulo, Brazil; Cutaneous Oncology Department, AC Camargo Cancer Center, São Paulo, Brazil. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2015.09.052DOI Listing
January 2016

Characterization of individuals at high risk of developing melanoma in Latin America: bases for genetic counseling in melanoma.

Genet Med 2016 07 17;18(7):727-36. Epub 2015 Dec 17.

Unidad de Lesiones Pigmentadas, Cátedra de Dermatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay.

Purpose: CDKN2A is the main high-risk melanoma-susceptibility gene, but it has been poorly assessed in Latin America. We sought to analyze CDKN2A and MC1R in patients from Latin America with familial and sporadic multiple primary melanoma (SMP) and compare the data with those for patients from Spain to establish bases for melanoma genetic counseling in Latin America.

Methods: CDKN2A and MC1R were sequenced in 186 Latin American patients from Argentina, Brazil, Chile, Mexico, and Uruguay, and in 904 Spanish patients. Clinical and phenotypic data were obtained.

Results: Overall, 24 and 14% of melanoma-prone families in Latin America and Spain, respectively, had mutations in CDKN2A. Latin American families had CDKN2A mutations more frequently (P = 0.014) than Spanish ones. Of patients with SMP, 10% of those from Latin America and 8.5% of those from Spain had mutations in CDKN2A (P = 0.623). The most recurrent CDKN2A mutations were c.-34G>T and p.G101W. Latin American patients had fairer hair (P = 0.016) and skin (P < 0.001) and a higher prevalence of MC1R variants (P = 0.003) compared with Spanish patients.

Conclusion: The inclusion criteria for genetic counseling of melanoma in Latin America may be the same criteria used in Spain, as suggested in areas with low to medium incidence, SMP with at least two melanomas, or families with at least two cases among first- or second-degree relatives.Genet Med 18 7, 727-736.
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http://dx.doi.org/10.1038/gim.2015.160DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4940430PMC
July 2016

Early detection of melanoma arising within nevus spilus.

J Am Acad Dermatol 2014 Feb;70(2):e31-2

Department of Cutaneous Oncology, A.C. Camargo Cancer Center, São Paulo, Brazil. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2013.09.011DOI Listing
February 2014

Learning reflectance confocal microscopy of melanocytic skin lesions through histopathologic transversal sections.

PLoS One 2013 5;8(12):e81205. Epub 2013 Dec 5.

Cutaneous Oncology Department, A C Camargo Hospital, Sao Paulo, Brazil.

Histopathologic interpretation of dermoscopic and reflectance confocal microscopy (RCM) features of cutaneous melanoma was timidly carried out using perpendicular histologic sections, which does not mimic the same plane of the image achieved at both techniques (horizontal plane). The aim of this study was to describe the transverse histologic sections research technique and correlate main dermoscopic features characteristic of cutaneous melanoma (atypical network, irregular globules and pseudopods) with RCM and histopathology in perpendicular and transverse sections in order to offer a more precise interpretation of in vivo detectable features. Four melanomas and 2 nevi with different dermoscopic clues have been studied. Lesion areas that showed characteristic dermoscopic features were imaged by dermoscopy and confocal microscopy and directly correlated with histopathology in perpendicular and transverse sections. We presented the possibility to perform transverse sections as a new approach to understand RCM features. Atypical network showed different aspects in the 2 melanomas: in one case it was characterized by pleomorphic malignant melanocytes with tendency to form aggregates, whereas in the other elongated dendritic cells crowded around dermal papillae, some of them forming bridges that resembled the mitochondrial aspect at confocal and histopathology transversal sections. Pigment globules in melanomas and nevi differed for the presence of large atypical cells in the former, and pseudopods showed up as elongated nests protruded toward the periphery of the lesion. Transverse histologic research sections have a consistent dermoscopic and confocal correlate, and it may represent an help in confocal feature interpretation and an advance in improving melanoma diagnosis and knowledge of the biology of melanocytic lesions.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0081205PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3855214PMC
March 2015

Dermoscopic findings in a patient with multiple piloleiomyomas.

Dermatol Pract Concept 2012 Oct 31;2(4):204a06. Epub 2012 Oct 31.

Dermatology Department, ABC Medical School, São Paulo, Brazil.

Piloleiomyoma can manifest itself as a pigmented lesion and part of the differential diagnosis with other pigmented skin lesions. However, we are not aware of previous descriptions in the literature of the dermoscopic features of piloleiomyoma. This article describes the dermoscopic findings observed in a patient with multiple piloleiomyomas. On dermoscopic evaluation, piloleiomyoma has characteristics similar to dermatofibroma with a thin peripheral pigmented network and central scar-like area. Some of the piloleiomyomas analyzed in this patient also presented with hyperpigmented circular and/or elongated structures within the central hypopigmented area.
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http://dx.doi.org/10.5826/dpc.0204a06DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3663367PMC
October 2012

Dysplastic nevus (atypical nevus).

An Bras Dermatol 2010 Nov-Dec;85(6):863-71

Department of Cutaneous Oncology, AC Camargo Hospital, Sao Paulo, SP, Brazil.

Atypical nevum (dysplastic) is considered an important factor associated with increased risk of developing cutaneous melanoma. It is believed that atypical nevi are precursor lesions of cutaneous melanoma. They may be present in patients with multiple melanocytic nevi (atypical nevus syndrome) or isolated and in small numbers in a non-familial context. The disease usually begins at puberty and predominates in young people. It has a predilection for sun-exposed areas, especially the trunk. The major challenge in relation to atypical nevi lies in the controversy of defining its nomenclature, clinical diagnosis, dermoscopic criteria, histopathological diagnosis and molecular aspects. This review aims at bringing knowledge, facilitating comprehension and clarifying doubts about atypical nevus.
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http://dx.doi.org/10.1590/s0365-05962010000600013DOI Listing
October 2011

Cell adhesion and communication proteins are differentially expressed in melanoma progression model.

Hum Pathol 2011 Mar 28;42(3):409-18. Epub 2010 Dec 28.

Department of Skin Oncology, Hospital AC Camargo, São Paulo, SP, Brazil.

Cutaneous melanoma is an aggressive cancer derived from skin melanocytes. Tissue microarrays are being used to evaluate the roles of numerous proteins implicated in some of the pathways involved in melanoma pathogenesis. Based on a previous study using a complementary DNA microarray platform, the aim of this study was to evaluate the immunohistochemical expression of the adhesion and communication molecules connexin 43, desmocollin 3, cytokeratin 5, kallikrein 6, and kallikrein 7 in a melanoma progression model. We analyzed 59 common nevi, 22 atypical nevi, and 162 invasive and 29 metastatic melanomas on tissue microarrays using digital microscopy. The expression of desmocollin 3 and connexin 43 was higher in melanomas (P < .001). Kallikrein 6 expression was higher in melanomas than in common nevi (P < .006). The expression of cytokeratin 5 and kallikrein 7 was higher in atypical nevi than in melanomas (P < .001) and was higher in melanomas than in common nevi (P < .001). The expression of desmocollin 3 and connexin 43 in melanomas indicates loss of cell-cell interactions, which starts in the early steps of the melanoma progression model. Keratin expression in melanomas may play a particular role during melanocyte development. The expression of kallikrein 7 and kallikrein 6 in melanomas may be responsible for the loss of cell-cell adhesion.
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http://dx.doi.org/10.1016/j.humpath.2010.09.004DOI Listing
March 2011

Structural correlations between dermoscopic features of cutaneous melanomas and histopathology using transverse sections.

Am J Dermatopathol 2006 Feb;28(1):13-20

Department of Cutaneous Oncology of Hospital do Câncer A. C. Camargo São Paulo, Brazil.

Interpretation of dermoscopic features of cutaneous melanoma is based on histologic description of perpendicular sections of the lesions that does not reflect the overview achieved by epiluminescence. We describe the utilization of transverse sections as a tool to define the histopathology of features that are the dermoscopic hallmarks of cutaneous melanoma. From a collection of 23 pigmented lesions with the dermoscopic diagnosis of cutaneous melanoma submitted for surgical excision we selected, from each specimen, one dermoscopic feature (black dots and globules, brown dots, blues dots and globules, depigmentation, broadened network, radial streams or pseudopods) that was sampled with a 4-mm punch (specimen) to obtain perpendicular and transverse sections. Using this strategy, it was possible to correlate the histopathology of all features that are often used as criteria for diagnostic dermoscopy. The black dots were pigmented neoplastic cells at the dermal-epidermal junction (DEJ) and within the epidermis in heavily pigmented columns. Similar findings were seen in brown dots, however there was slightly less pigment. No statistical difference was observed between brown dots and black dots regarding size, area and number of atypical cellnests. Blue dots correlated to melanophages, surrounding the superficial vascular plexus. Depigmentation was characterized by intense fibrosis of the papillary dermis. The pigmented network showed atypical pigmented or non-pigmented melanocytes at the DEJ and epidermis as well as heavily pigmented keratinocytes in the basal cell layer. The radial streaming and pseudopods had neoplastic cells in nests, a stratified growth pattern arranged in centrifugal linear extensions, resembling a arborescent branching. The results represented herein, are an important tool for understanding histopathological alterations responsible for dermoscopic features and for improving the efficacy of this diagnostic method.
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http://dx.doi.org/10.1097/01.dad.0000181545.89077.8cDOI Listing
February 2006
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