Journal of Dermatology and Dermatologic Diseases

It has been hypothesized that establishing a histopathology data pool is useful in epidemiology research. Such a pool was established among the Igbos, who constitutes one of the three largest Ethnic Groups in Nigeria, West Africa. In an earlier personal series based on the 1970 to 1974 cohort, the regional distribution of 21 cases of melanoma was 17 (81%) in the foot, one each in the eye and conjunctiva, the remaining two being in the groin. Since that report, it is now possible for the cohort to be analysed up to the year 2000. Curiously, only 2 cases have appeared in the female finger. They constitute the substance of the present paper.

Background: Despite implementation of dermoscopy, the accuracy of diagnosing melanoma remains a challenge. The aim of this study was to retrospectively analyze cases of histologically confirmed melanoma, which were incorrectly diagnosed during initial evaluation.
Methods: A retrospective analysis of histologically diagnosed melanomas referred to the F.D. Roosevelt Hospital between 2008 and 2014, in which the initial diagnosis was incorrect. We evaluated their histological characteristics, localization of the lesion as well as the specialty of the physician who made the incorrect diagnosis.
Results: From a total of 936 histologicaly confirmed melanomas, 150 (16%) were diagnosed incorrectly. Of those, 26 (17.3%) were melanoma in situ. The average value of the Clark ́s level of true melanomas was 3.49, with an average Breslow thickness of 3.09 mm. Sixty of the melanomas developed on the trunk and 55 on the extremities. Incorrectly diagnosed lesions included nevi in 80 cases, basal-cell carcinoma in 32, non-specific tumor in 16, pyogenic granuloma in 5, squamous-cell carcinoma in 5, haemangioma in 5, seborrheic keratosis in 4 cases, and histiocytoma, keratoacanthoma and cornu cutaneum each in 1 case. The diagnosis of melanoma was missed by a dermatologistin 85 cases, by a surgeon in 38 cases, and by a general practitioner in 2 cases. In the remaining 25 cases we were unable to identify the specialty of the physician who made the wrong diagnosis.
Conclusion: This analysis revealed a high proportion of melanomas that were missed during initial evaluation. The outcome of this study points to the need for better education in the field of diagnostics of melanocytic lesions for dermatologists, surgeons and primary care physicians. In addition, there is a need for periodic evaluation of diagnostic accuracy of dermatology centers using various tools (e.g. Melanoma Diagnostic Index). Continually increasing awareness of malignant melanoma in the general public is also very important.

Lichen planus is a chronic, inflammatory, autoimmune disease that affects the skin, oral mucosa, genital mucosa, scalp, and nails. Lichen planus lesions are described using the six P's (planar (flat-topped), purple, polygonal, pruritic, papules, plaques). This review highlights the Pathophysiology and management of oral and cutaneous lichen planus.

Tuberous sclerosis complex is an autosomal dominant neurocutaneous disease principally characterized by the triad of mental retardation, adenoma sebaceum and epilepsy. It may affect all organs, but most commonly the skin, brain, heart, eyes and kidneys. The earliest finding, and the most common in the skin, consists of hypopigmented macules (ash leaf). In addition, numerous small hypopigmented macules (confetti-like macules) occur in the pretibial region. Shagreen patches, a form of collagenoma, may be seen in the lumbosacral region in half of patients. Skin findings also include angiofibromas, known as adenoma sebaceum, in the face and Koenen’s tumor. Other skin lesions include cafe-au-lait spots and molloscum fibrosum pendulum resembling acrochordon. We describe the skin findings in particular of tuberous sclerosis complex in the light of the current literature.