Practical Dermoscopy
Spot the Differences Between 2 Pigmented Papules
Encuentra las diferencias entre 2 pápulas pigmentadas
P. Zaballos Diego
Servicio de Dermatología, Hospital de Sant Pau i Santa Tecla de Tarragona, Tarragona, Spain
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Varón de 60 años que presenta un nódulo pigmentado negruzco de 8<span class="elsevierStyleHsp" style=""></span>mm localizado en la pierna izquierda. Aparición y evolución desconocidas. B. Varón de 65 años que presenta un nódulo pigmentado negruzco de 8<span class="elsevierStyleHsp" style=""></span>mm localizado en la espalda. Aparición y evolución no aportadas.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "P. Zaballos Diego" "autores" => array:1 [ 0 => array:2 [ "nombre" => "P." 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"apellidos" => "Salamanca" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731013001300" "doi" => "10.1016/j.ad.2013.03.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731013001300?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013001819?idApp=UINPBA000044" "url" => "/15782190/0000010400000008/v1_201309240048/S1578219013001819/v1_201309240048/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Practical Dermoscopy</span>" "titulo" => "Spot the Differences Between 2 Pigmented Papules" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "719" "paginaFinal" => "720" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "P. Zaballos Diego" "autores" => array:1 [ 0 => array:3 [ "nombre" => "P." "apellidos" => "Zaballos Diego" "email" => array:1 [ 0 => "pzaballos@aedv.es" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital de Sant Pau i Santa Tecla de Tarragona, Tarragona, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Encuentra las diferencias entre 2 pápulas pigmentadas" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 739 "Ancho" => 2000 "Tamanyo" => 206474 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Comment</span><p id="par0005" class="elsevierStylePara elsevierViewall">The 2 patients presented pigmented lesions with a similar clinical (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) and dermoscopic (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) appearance. However, detailed evaluation of the dermoscopic images provides clues to the diagnosis in each case. Both tumors are formed of multiple, dark, round or oval structures in apposition. In my opinion, one of the diagnostic keys is to determine whether or not these structures are dark lacunae. Dark lacunae are multiple, well-defined, round or oval structures that are dark blue, violaceous, or black. Histologically, these structures are seen to be partially or completely thrombosed dilated blood vessels in the dermis, and their presence is highly suggestive of solitary angiokeratoma (sensitivity, 93.8%; specificity, 99.1%).<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> An important negative finding of lacunae is that there are no vascular structures in their interior.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">In the dermoscopic image of the first patient there are multiple, well-defined, round, oval, or occasionally polygonal structures (slightly out of focus on the right side of the image) that are violaceous or dark blue and do not contain blood vessels. These structures are dark lacunae and the diagnosis suggested by the dermoscopic image is solitary angiokeratoma.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In the dermoscopic image of the second patient the structures are slightly different. They are multiple, round or oval structures but they are poorly defined and are grayish-blue in color. Furthermore, a vascular structure, in perfect focus, formed of a thick central blood vessel that branches into smaller vessels, is visible in one of the structures at the left inferior pole of the nodule. Based on the comments above, these structures cannot be called lacunae. However, their description does match that of a recognized dermoscopic feature: large blue-gray ovoid nests. This is 98% specific for basal cell carcinoma.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Thus, if no criteria for a melanocytic lesion are observed and we recognize that the vascular structure described is a tree-like or arborizing telangiectasia, which has a positive predictive value of 94% for basal cell carcinoma,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> we should make a dermoscopic diagnosis of pigmented basal cell carcinoma.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of Interest</span><p id="par0020" class="elsevierStylePara elsevierViewall">The author declares that he has no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Comment" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of Interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Zaballos Diego P. Encuentra las diferencias entre 2 pápulas pigmentadas. Actas Dermosifiliogr. 2013;104:719–20.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 849 "Ancho" => 2000 "Tamanyo" => 336871 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, A dark pigmented nodule of 8-mm diameter on the left leg of a 60-year-old man. Time since onset and clinical course not reported. B, A dark pigmented nodule of 8-mm diameter on the left leg of a 65-year-old man. Time since onset and clinical course not reported.</p>" ] ] 1 => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 739 "Ancho" => 2000 "Tamanyo" => 206474 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermoscopy of solitary angiokeratomas: A morphological study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Zaballos" 1 => "C. Daufí" 2 => "S. Puig" 3 => "G. Argenziano" 4 => "D. Moreno-Ramírez" 5 => "H. Cabo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archderm.143.3.318" "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2007" "volumen" => "143" "paginaInicial" => "318" "paginaFinal" => "325" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17372096" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surface microscopy of pigmented basal cell carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S.W. Menzies" 1 => "K. Westerhoff" 2 => "H. Rabinovitz" 3 => "A.W. Kopf" 4 => "W.H. McCarthy" 5 => "B. Katz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2000" "volumen" => "136" "paginaInicial" => "1012" "paginaFinal" => "1016" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10926737" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vascular structures in skin tumors: A dermoscopy study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Argenziano" 1 => "I. Zalaudek" 2 => "R. Corona" 3 => "F. Sera" 4 => "L. Cicale" 5 => "G. Petrillo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archderm.140.12.1485" "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2004" "volumen" => "140" "paginaInicial" => "1485" "paginaFinal" => "1489" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15611426" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010400000008/v1_201309240048/S1578219013001820/v1_201309240048/en/main.assets" "Apartado" => array:4 [ "identificador" => "19289" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Practical Dermoscopy" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010400000008/v1_201309240048/S1578219013001820/v1_201309240048/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013001820?idApp=UINPBA000044" ]
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| 2016 Marzo | 4 | 0 | 4 |
| 2016 Febrero | 3 | 5 | 8 |
| 2016 Enero | 14 | 1 | 15 |
| 2015 Diciembre | 13 | 3 | 16 |
| 2015 Noviembre | 16 | 0 | 16 |
| 2015 Octubre | 17 | 6 | 23 |
| 2015 Septiembre | 2 | 0 | 2 |
| 2015 Agosto | 7 | 1 | 8 |
| 2015 Julio | 113 | 7 | 120 |
| 2015 Junio | 58 | 2 | 60 |
| 2015 Mayo | 55 | 1 | 56 |
| 2015 Abril | 42 | 5 | 47 |
| 2015 Marzo | 36 | 2 | 38 |
| 2015 Febrero | 47 | 4 | 51 |
| 2015 Enero | 48 | 1 | 49 |
| 2014 Diciembre | 46 | 5 | 51 |
| 2014 Noviembre | 35 | 5 | 40 |
| 2014 Octubre | 54 | 2 | 56 |
| 2014 Septiembre | 39 | 4 | 43 |
| 2014 Agosto | 34 | 4 | 38 |
| 2014 Julio | 24 | 9 | 33 |
| 2014 Junio | 38 | 6 | 44 |
| 2014 Mayo | 37 | 7 | 44 |
| 2014 Abril | 36 | 6 | 42 |
| 2014 Marzo | 44 | 4 | 48 |
| 2014 Febrero | 25 | 3 | 28 |
| 2014 Enero | 39 | 2 | 41 |
| 2013 Diciembre | 15 | 5 | 20 |
| 2013 Noviembre | 2 | 2 | 4 |
| 2013 Octubre | 2 | 2 | 4 |
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