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Articles by P Guitera
Total Records ( 2 ) for P Guitera
  G Pellacani , M Vinceti , S Bassoli , R Braun , S Gonzalez , P Guitera , C Longo , A. A Marghoob , S. W Menzies , S Puig , A Scope , S Seidenari and J. Malvehy

Objective  To test the interobserver and intraobserver reproducibility of the standard terminology for description and diagnosis of melanocytic lesions in in vivo confocal microscopy.

Design  A dedicated Web platform was developed to train the participants and to allow independent distant evaluations of confocal images via the Internet.

Setting  Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.

Participants  The study population was composed of 15 melanomas, 30 nevi, and 5 Spitz/Reed nevi. Six expert centers were invited to participate at the study.

Intervention  Evaluation of 36 features in 345 confocal microscopic images from melanocytic lesions.

Main Outcome Measure  Interobserved and intraobserved agreement, by calculating the Cohen statistics measure for each descriptor.

Results  High overall levels of reproducibility were shown for most of the evaluated features. In both the training and test sets there was a parallel trend of decreasing values as deeper anatomic skin levels were evaluated. All of the features, except 1, used for melanoma diagnosis, including roundish pagetoid cells, nonedged papillae, atypical cells in basal layer, cerebriform clusters, and nucleated cells infiltrating dermal papillae, showed high overall levels of reproducibility. However, less-than-ideal reproducibility was obtained for some descriptors, such as grainy appearance of the epidermis, junctional thickening, mild atypia in basal layer, plump bright cells, small bright cells, and reticulated fibers in the dermis.

Conclusion  The standard consensus confocal terminology useful for the evaluation of melanocytic lesions was reproducibly recognized by independent observers.

  P Guitera , L. X. L Li , R. A Scolyer and S. W. Menzies

Objectives  To determine morphologic features of melanophages under in vivo reflectance confocal microscopy (RCM) and to highlight morphologic features that are important in distinguishing melanophages from melanocytes.

Design  Consecutive retrospective study.

Setting  Referral center for pigmented lesions.

Patients  The study group retrospectively constituted 20 consecutive patients having biopsy-proven lichen planus–like keratoses that dermoscopically and histopathologically showed many melanophages and that had been imaged under RCM before biopsy.

Main Outcome Measures  The RCM characteristics of isolated dermal bright cells were scored blinded to dermoscopic features and histopathologic diagnosis.

Results  Under RCM, melanophages were significantly smaller than melanocytes (mean [SD] cell diameter, 13.6 [1.6] vs 18.2 [2.9] µm, P = .006). Nuclei (intracellular low-reflectance round-oval structures) were visible in only 16% (29 of 184) of the cells in melanophages vs 57% (28 of 49) of the cells in melanocytes (P < .001). When identified, nuclei were smaller in melanophages than in melanocytes (mean [SD] diameter, 3.2 [1.2] vs 6.4 [0.7] µm, P < .001). Compared with melanocytes, melanophages were significantly more ill defined (76% [140 of 184] vs 18% [9 of 49], P < .001), less round (23% [42 of 184] vs 69% [34 of 49], P < .001), and less dendritic (1% [2 of 184] vs 12% [6 of 49]) (P = .001).

Conclusion  Observed differences in morphologic features should enable distinction between melanophages and melanocytes under RCM, thereby improving the accuracy of skin lesion diagnosis using this technique.

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