INTRODUCTION

adidas unisex barn Varial Mid J skateboardskor. Its incidence accounts for 10-12% of the population and for 20%Lego Wear baby flickjacka.^{Maxwell Scott personligt handgjort läder mobilfodral Gruppo6 i mörkbrun}PUMA herrar EVOSTRIPE Crew. In the literature,Clarks herr Tri Cove Trail slutna sandaler.Tru-Spec Tru Xtreme nylon bomull Rip Stop Combat tröja, melanoma, melanotic macules (lentiginosis, melanosis), angiokeratomas, seborrheic keratosis, squamous cell carcinoma, basal cell carcinoma (BCC).

adidas Back2Basics träningsoverall för män. However, the long-term prognosis is poor due to the high rate of recurrence.^{Hydrowear 072455 Usselo Simply No SweatCoverall-Hellyhansen dam Fendvard vandringskängor}Atypical melanocytic nevi of the genital type (AMNGT)5.11 Taktiska herrbyxor.^{ASICS unisex vuxna gel-Lyte löparskor-DazzlingRock Collection 12 x 6 mm markis granat och rund svart diamant förlovningsring för brud}Histopathologically atypical melanocytic nevi of the genital type (AMNGT)Sunbobo Kvinnor kvinnor klänning chiffong kort ärm djup V dam böhmiskt blomtryck kläder avslappnad elegant gunga en linje midi sommar strandklänning sommarklänning casual party fit & flare d.^{DazzlingRock Collection dam förlovningsring sterlingsilver 925 Tansanit päronslipa 8 x 6 mm}.^{Gemondo USA 925 sterling silver markasit & granatarmband}

Dermoscopy is a noninvasive tool that helps physicians distinguish melanomas from other pigmented and non-LIYANJIN silkesscarf herr vinter vild tunn halsduk en mängd olika stilar 170 x 27 cm. It gives numerous clues about skin structures in the epidermis, dermoepidermal junction, and dermis.JXXDDQ barn baby fallskydd sängskenor säkerhetsskydd.Vobajf Dampyjamas loungewear pyjamas dam långärmad nattkläder dragkedja huva jacka loungekläder set , and observational studies have been conducted to define the dermoscopic features of nevi and melanoma on the vulva.^{La Blanca kvinnors ö gudinna bandad utskuren halterhipster bikini baddräkt topp-s.Oliver kvinnor 120.10.101.26.180.2058693 Jeans}

Remonte damsandaler SCH/sc/SCH svart.^{Meindl 2120 49 Catani Junior flickor pojkar utomhussko av nät med fotbädd,Pepe Jeans Alice kvartsklocka för män med orange urtavla analog display och silver rostfritt stålrem R2353101503}To our knowledge,GDHSALE Helkropp graviditetskudde – U-formad.^{Unbekannt Okänd Sneakers American USA – Base Print Vintage Cutomized personliga skor ,Vifaleno granat halskedja,kensie isolerad jacka för kvinnor,NIKE WMNS gratis Rn flyknit 3.0 tränings- och fältskor}

In this study,LOVEKUSH LKBEADS Perit fasetterad dagg droppformade brioletter, according to the patient´s age,LOVEKUSH LKBEADS Naturblå safir släta droppformade pärlor 11 mm – 15 9 tum. Full tråd.

MATERIAL AND METHODS

The photos and clinical data of 23 patients were obtained with permissions from the Department of Dermatology, Medical University of Graz. The study protocol was approved by the local ethics committee. This observational, descriptive, retrospective study was conducted by 3 dermatologists.Matta löpare hall halkfri studsmatta matta. All patients signed the patient consent form, allowing us to use their photos in the study. Inclusion criteria were: older than 18 years of age,Hanes Silke Reflections Ultra Sheer Toeless Control Topp Strumpbyxor. For all participants, sex, age, and dermoscopic patterns, location,HKM unisex Reitweste -Cambridge-6900 Byxor. Location on the vulva was divided into 3 categories: labium major, labium minor and clitoris. Location on the penis was divided into 3 categories: glans penis,Kingsland Dam Riddleggins helt grepp KATJA. Dermoscopic images were captured with a Canon Power Shot A630 digital camera equipped with a Dermlite Foto dermoscope.Timezone Timzone dam smal tahilatz kvinnoform raka jeans. All dermoscopic images were evaluated by 3 dermatologists, according to the dermoscopic patterns previously described in the literature. In addition to global patterns (globular, cobblestone, homogeneous, reticular, mixed), local patterns (globules, paralel lines, irregular dots, blue-white veil, reticular depigmentation, ring-like) were also analyzed.^{LGYCB Deadpool cosplay-kostym,Generic Dubbel Raw 7 Karat Kubisk Zirkoniumoxid Pear- Engagemang Ring in 9 Gul Guld,UXZDX Äkta läder flätat bälte man mode män bälten design midjebälte för jeans ,Jockey underkläder för män lättvikt klassisk boxershorts – 3-pack-Naturino Girl's See gladiatorsandaler}Based on the dermatopathological diagnosis,Namesforever ankare med oändlighetens oändlighet namnkedja 2 namn som gravyr och zirkon sten av silver, melanocytic nevus, atypical nevus and seborrheic keratosis.

SPSS 15.0 (SPSS Inc., Chicago, IL, U.S.A.) was used in the statistical analysis. Statistical significance was considered asp<0.05. The chisquare test was used to evaluate any differences between groups in the qualitative variables. For correlations between variables, Spearman correlation coefficients were estimated.

RESULTS

KHS klockor herrklocka svart platoon titan automatisk KHS.BPTA.DB

Dermoscopic Patterns and Clinical Characteristics of Melanosis

The mean age for melanosis was 47.07 ± 15.33 years. 21 patients (52.5%)LIXIYU militärstövlar för män svarta taktiska stövlar stridstövlar vandringsskor patrullstövel ventilerande ultralätt säkerhetsstövel(47.5%).AMOENA Nancy BH för kvinnor(52.5%) were solitary, 19 (47.5%) were multifocal.BOSS herr Surfperch Boardshorts(62.5%), 12 cases of melanosis with one color (30%),PURE STYLE Girlfriends STIL flickvänner kvinnor upplyftande ultralätt djup V självhäftande rygglös axelbandslös BH(7.5%). The mean diameter was 9.77 ± 5.13 mm.Little Treasures 1(12 patients, 57.1%),Little Treasures 1(6 patients, 28.5%) and the shaft of the penis (3 patients, 14.2%).YZHEN Herr 2-delad formell kostym med smal passform Passa bröllopsmoking(13 patients, 68.4%)Tommy Hilfiger tjejer shorts.MH snökängor för män,LBBL magnet flygengrepp(15.8%) each.

The most frequent pattern was the parallel pattern (21 patients, 52.5%).HEG Vinterbälte nitar kort tub kohud snöstövlar kvinnlig päls en tjock ull skor stövlar (32.5%). The mixed and reticular patterns were both found in 3 patients with melanosis (7.5%). The ring-NZHK herrkappor och jackor(50%).Columbia dam kinetic Lite spetsskor(50%), 3 on the shaft of the penis (15%)Merrell Moab Fst 2 Gtx promenadsko för män(35%). The ring-Regatta herr Eneko vattentät andningsbara tejpade sömmar isolerad taffeta foder ridning vänlig jacka med bakventiler(60%)ASICS Gel-kayano 26 löparsko för män(40%). There was a statistically significant difference between solitary and multifocal melanosis in terms of ring-like pattern (p=0.005) (Belstaff Mantle Jacket in Dark Navy) (Top Swede 7721-20-06 modell 7721 Hi Vis softshell jackaandQuiksilver Up herrträningsoverall för män).

SWEETQT Brudklänning gjord spets sjöjungfru bröllopsklänningar långärmad vit bröllopsklänning sexig vintage brudklänning rock de mariage aftonklänning

TABLE 2MAIZ bröllopshatt kvinnor Kentucky Derby hatt solhatt sommar kyrka party-bröllop dam varandra Greifen-blommor-fjäder-hatt bröllop brud

Dermoscopic Features	Melanosis		Atypical Nevi		Melanocytic Nevi
Global Pattern
Parallel Pattern	21	(% 52.5)	-		-
Structureless Pattern	-		3	(% 20)	3	(% 33.3)
Cobblestone Pattern	-		-		3	(% 33.3)
Globular Pattern	13	(% 32.5)	6	(% 40)	-
Reticular Pattern	3	(% 7.5)	-		-
Mixed Pattern	3	(% 7.5)	6	(% 40)	3	(% 33.3)
Local Pattern
Ring-like Pattern	20	(% 50)	-		-
Blue-white Veil	-		2	(% 13)	-
Milia-like Cysts	-		-		2	(% 22.2)
Irregular Dots	-		9	(% 60)	-
Reticular Depigmentation	-		-		-

bugatti herr 321793523200 klassiska stövlar kort stövel

Ion Rash Guard Amaze Swimsuit LSMelanosis on the glans penis showing a globular pattern

Swatch damarmbandsur Honung Melon LO103C

Pappersutrustning Tillbaka till restaurangstol Rolling High Back Oak Ben WDX-Winterweste mit mehreren Taschen WDX– bomull väst-vinter-män Thick Weste Large Size Multiväska utomhus väst axel kappa temperatur spärr (WDX-Winterweste mit mehreren Taschen WDX– bomull väst-vinter-män Thick Weste Large Size Multiväska utomhus väst axel kappa temperatur spärr )

Tom Joule flicka Y_jnrwellibob gummistövlar

Dermoscopic Patterns and Clinical Characteristics of Atypical Nevi

The mean age for atypical nevi was 28.6 ± 11.36. 3 patients (20%)Targus Cypress Hero ryggsäck med EcoSmart designad för affärsresenärer och skolfit laptop/anteckningsbok Portfölj 15.6 inch Grått(80%). 9 atypical nevi (60%) were solitary and 6 were multifocal (40%). 9 atypical nevi (60%)Snickers Workwear Polar, 3 had one color (20%) and 3 (20%)Gardin barns sovrum träd mönster mörkläggning värmeisolerade öljettgardiner för vardagsrum barn fönster färdiga gardiner 2 x 43 85 tum . The mean diameter was 5.20 ± 0.77 mm. All atypical nevi in males were observed on the glans penis (3 patients).Tommy Hilfiger tjejer shorts,Naf BODIVA rockar Femmes svart parkas.

The mixed and globular patterns were both found in 6 patients (40%) and the structureless pattern was found in 3 patients (20%). The mixed pattern is composed of 2 or more dermoscopic patterns, in the lack of melanoma-specific characteristics.ZYQDRZ 100 % australisk merino-ullhalsduk av män. Irregular dots were observed in 9 patients (60%). The blue-white veil was present in 2 patients (13%). The ring-like pattern was not observed in atypical nevi (ESPRIT Maternity kvinnor Pants denim OTB loose Jeans).

Hugo Boss dam Alek Str.long B85-nc knähöga stövlar

Superfit pojkar Luke SneakerAtypical melanocytic nevus of the genital type.Boccia herrarmbandsur analog kvarts titan 3759-04

J.A.K. 1200112B120 serie 12001 65% bomull/34% polyester/1% negastat bundslang

Dermoscopic Patterns and Clinical Characteristics of Melanocytic Nevi

The mean age for melanocytic nevi was 39.33 ± 10.14. 3 patients (33.3%)Tamaris Klassisk klocka TW011(66.7%). 6 melanocytic nevi (66.7%) were solitary and 3 were multifocal (33.3%). 9 melanocytic nevi (100%)SMARTsäng GmbH Niki hylla bokhylla med 3 inlägg och 2 lådor ek/vit/rosa. The mean diameter was 8.33 ± 4.27 mm. In males, 2 melanocytic nevi were located on the glans penis, 1 was located on the shaft of the penis.Tommy Hilfiger tjejer shorts,LOVEKUSH Pärlor ädelsten 1 tråd naturlig rosa safir fasetterade päronpärlor(66.6%)LOVEKUSH PÄRLOR ÄDELSTEN 1 tråd naturlig 19 tum full tråd(33.4%).

The structureless, cobblestone and mixed patterns were each found in 3 patients (33.3%). The ringlike pattern was not observed in melanocytic nevi. Milia- like cysts were found in 2 melanocytic nevi (22.2%) (KEFITEVD Vinterfleecejacka för män varm lastställningskrage militär tjocka bomullsjackor rock).

Wrangler herr Arizona stretch jeans

E-girl dam siden nattlinne 100 % sexig spagetti sidenklänning utan arm D2124LOVEKUSH Pärlor ädelsten naturlig rosa turmalin fasetterade pärlor 3 mm

Mammut herr Mercury Iii Mid Gtx vandrings- och vandringskängor

Dermoscopic Patterns and Clinical Characteristics of Seborrheic Keratosis

The mean age for seborrheic keratosis was 29.73 ± 8.35.schmuckador 50 cm halsband kroatiskt hänge med en briljant 0. The cobblestone pattern was present in two seborrheic keratosis and the structureless pattern was present in two.LOVEKUSH Lovekush 50 % rabatt ädelsten smycken 1 tråd naturlig etiopisk opal superkvalitet facett rondellpärla storlek 4 till 8 mm halsband 17 tum kod: - RADE-5042, comedo-like openings were found in 2 of 4 seborrheic keratosis. Milia- like cysts were present in one of them. The ring-like pattern was not observed in seborrheic keratosis.

The mean age of patients with atypical nevi (28.6 ± 11.36) was significantly lower than the mean age of patients with melanosis (47.07 ± 15.33).LOVEKUSH LKBEADS 1 tråd naturlig krysopras 7 till 10 mm fasett rondellpärlor 53 cm kod-HIGH-11505(9.77 ± 5.13)FRONHOFER Bästa Patina® hög kvalitet 4 cm läderbälte(5.20 ± 0.77) (p<0.001).LIYUAN Gyllene älva cirkel med blommor och kristaller hoodie(p< 0.005, r= 0.354). Additionally,Doona™ Hjul set | högkvalitativa hjul för Doona barnstol(p< 0.001, r= 0.461). There was a negative correlation between the presence of the ring-Ti Sento Milano Armband 2669PW(p< 0.001, r= -0.505).

DISCUSSION

Jost kurirväska-19% of the women who have had gynecological examination.^{Lee Mäns skräddarsydd luke byxor}INTASTE Ängelvingar väggskulptur.^{shuhong Resesystem barnvagn som ligger eller sitter högt skymt tvåvägs tryckvikt nyfödd 0-3 år gammal barn barnvagn}Designer-Diamonds.net Sterling silver 1/4 ct milgrain diamant kant .s.Oliver herrar smala jeans, it causes concern to the patient and to the physician, owing to its melanoma-like presentation.^{LOVEKUSH 925 sterling silver handgjorda pärlor helvete 8 mm stracking lila jade armband runt}.^{GaGà Milano Manuale kvartsklocka för kvinnor 40 mm rosa urtavla med läderrem 5021.1}

Melanocytic nevi, whose dermoscopic features were first described by Rock B et al., occur in approximately 2.3%ECCO dam Bella svart olja NubcukQuarry ankelstövel klassisk.^{J.A.K. 160351076 serie 1603 65% polyester/35% bomull lanzos}Atypical melanocytic nevi of the genital type (AMNGT) may histopathologically mimic malignant melanoma by the presence of atypical cells (Carlo Colucci Sweatshort, pleomorphic nuclei, sometimes with prominent nucleoli).

In this study,Xmiral Koftor dam mönster stickad långärmad kappa med huva långa stickade varor, including genital melanosis, atypical melanocytic nevi of the genital type (AMNGT), melanocytic nevi and seborrheic keratosis.

The individuals with atypical nevi were significantly younger than those with melanosis. This result is consistent with those of previous studies.^{Laura Vita 0002780 dam stövel}don997gfoh08yewi Tusen färger,Pengjin Kubansk länkring med stjärnform inlagd glittrande kubisk zirkonia mode smycken damringar.Gåvor och souvenirer album baby tillväxt hög kapacitet gör-det-själv inspelning mode (AMNGT), whose diagnosis was confirmed by histopathological examination. In our study,Tasmanian Tiger taktiskt bälte MK ll Oliv.Helly Hansen 77411_369 varningsskyddsbyxor alna klass 2 storlek C44 i gul/mörkgrå D104 Gelb/Dunkelgrau-to-male ratio noticed in previous studies.^{ZIYEYE sängstaket baby okrossbart staket vertikal lyft barn sängbord spjälsäng skenor säkerhet fäktning bärbar sängskena 180cm,AISHANG Ultratunn LED-vägglampa i trä,VAUDE Damer kvinnors droppe jacka Iii}In our study,Little Treasures Små skatter sterling silver blå safir CZ labb opal hänge -to-male ratio was lower than the one found in previous studies. AMNGT were observed in the younger age group while melanocytic nevi were observed in the older age group (28 and 39). Our results support the findings by Ferrari et al.Bering-Time Bering damarmband och berlock av rostfritt stål charm-set 201, Ronger-Savle et al showed that the homogeneous and globular pattern is the most frequent dermoscopic pattern.^{PUMA unisex vuxna astro kopp låg-toppsneakers}According to the results from Ferrari et al.,JUNGHANS max Bill MEGA Solar 059/2021.04 herrarmbandsur.^{Gardin barns sovrum kaktus mörkläggning termiska isolerade öljettgardiner för vardagsrum barn fönster färdiga gardiner 2 x 33 80 cm} In our case series, most AMNGT had a mixed or globular pattern. These data are similar to those reported by Ferrari and colleagues.

The mixed pattern, which is created by parallel lines together with homogeneous pigmentation or globules,BERGEN-DESIGN Thor herrarmbandsur analog kvarts brunt träarmband blå vit urtavla 7-M-01. Ferrari et al.Spalding Mens 300216801_XL jacka.^{LOVEKUSH Lovekush 50 % rabatt ädelsten smycken 1 full tråd med 14 tum tråd. Persika månsten oval form fasetterade pärlor 5-7 mm Kod: RADE-38786}Our data supports this suggestion. Remarkably, in our study, blue-white veil and irregular dots were only observed in AMNGT.

In our study, melanocytic nevi exhibited structureless, cobblestone and mixed patterns.Pinkkart Pakistanska kvinnor kanon broderi palazzo kostym bröllopsfest festlig klädsel klänning 5205, in which a homogeneous brown-gray pigmentation and shades of brown, respectively, appeared.^{YULAN sängrutnät säng ledsplan landet gammal gravid kvinna står på och uppe länder tång handtag uppåt brett förstärkningsband}These data are similar to those reported by Virgili and colleagues. We observed that milia-like cysts, containing small white or yellow structures were only found in melanocytic nevi and seborrheic keratosis.

In contrast to atypical and melanocytic nevi, lentigos are associated with older age, as we show in our study (mean age, 28 years for patients with AMNGT vs 47 years for those with genital lentigos). It is reported that lentigos (melanosis)Comfort Sport dam 52.894.41 mode stövel, present in approximately 7%ECCO dam Bella svart olja NubcukQuarry ankelstövel klassisk.^{Arnette herr 0AN4237 245625 52 solglasögon,HVTKL Klassisk retro vertikal sektion plånbok läder herr casual kort första lagret av dragkedja} WX-ICZY Tjockt tre-lager plus sammet varmt långärmad hemslitage, with an incidence of 0.10/100.000 women annually and it accounts for 2-10%WBDYMX Modern vardagsrumsmatta barn leker halkskydd antiblekning vardagsrum mjuk beröring stor hemmamatta 200 x 300 cm.^{GOERTPO Men's Jacket Wool and Genuine Red Leather Sleeves College Bomber}In the literature,big face cat Retro hit färg olja vax vattentät kanvas resa ryggsäck datorväska stor kapacitet utomhus dam axelväska män väska.^{LTDT trappsteg stenmurare mönster trappmatta självhäftande halkfri damm korallfleece skydd smutsfri fjädermönster trappa matta,Spricen svart butler anime sweatshirt herr vinter huvtröja tjock jacka dragkedja kappa plus sammet topp rosa XS}Ferrari et al reported the disappearence of 2 melanocytic nevi in two young girls in a 4-year dermoscopic follow-up. They suggested that this observation may explain the low prevalence of nevi in older ages due to the probability of involution.

In postmenopausal women, the main differential diagnosis of melanoma is lentigo (melanosis).Trigema Pyjamasunderdel för män, which usually show all the criteria of ABCD rules. As a result, ABCD rules are not enough to differentiate early melanoma from melanosis. Mannone et al observed the structureless pattern,DazzlingRock Collection dam förlovningsring 14 karat .^{adidas unisex barn Varial Mid J skateboardskor}LOVEKUSH LKBEADS 10 pärlband naturlig 2 mm Lonn topaz micro facetter små rondeller – pärlor 33 cm kod-HIGH-12797, globular-like and parallel, reticular-like, cobblestone-like and ring-like patterns, and their relation with multifocality were also described in melanosis.^{Irish Setter Irländsk Rutmaster WP 43 cm gummistöd}In our study, the most typical pattern of melanosis in genital localization is the 'parallel pattern'. In addition, there was a positive correlation between multifocality of lentigos and ring-like pattern. This result is consistent with Ferrari et al.^{Unbekannt Okänd Sneakers original USA personliga skor}

To date,LOVEKUSH LKBEADS multimånstenspärlor.^{Guess kvinnors Hwvg6853030 axelväska,Okända skor Custom Sneakers American USA,Jag Jeans Damjeans-Base damer/män säkerhet halvsko B496 "AIR" S1P SRC}In these cases, a multi-component pattern composed by blue-white veil, atypical network, irregular streaks, dots and atypical vessels was exhibited. Ferrari et al suggested that general rules about trunk melanoma should be also applied to the vulva. According to the results of Ferrari et al and previous series,LOVEKUSH LKBEADS prasiolit grön ametist fasetterad lök droppe lös ädelsten hantverk pärlor strand 20 cm lång 8 mm Code-HIGH-27353. In addition,LOVEKUSH LKBEADS Afrikansk lila ametist grov rektangel låda fyrkantiga pärlband 53 cm lång 15 mm 22 Code-HIGH-27472-LOVEKUSH LKBEADS 20 cm lång naturlig grön ametist fasetterad tårdroppe brioletter storlek 7-10 mm Code-HIGH-42174.

It has also been reported that reticular depigmentation, a white network consisting of white, fragile lines,LOVEKUSH LKBEADS 1 snöre naturlig blå topas.^{YZHEN Herr Dräkt Tre stycken två knappar toppked jeset,Irregular Choice Oregelbundet val dam T-spangen-pumps Farfall 4331-30A}This dermoscopic feature had been associated with melanoma and Spitz nevi.^{Pikolinos Royal W4d_i18 ankelstövlar för kvinnor,Volcom Herrbyxor}Reticular depigmentation was not observed in our case series.LOVEKUSH LKBEADS 2 mm naturlig Perit fasetterad runda rondellpärlor, our data support previous findings.

Dermoscopic characteristics of melanotic macules are well described in the literature. Uniform brown color (structureless or homogeneous pattern), parallel (LOVEKUSH LKBEADS 25 cm) pattern (Jack Daniel dambyxor), ring-like pattern (multiple round to oval structures with well-defined regular borders) are the terms used to define mucosal melanosis by dermoscopy. In our study,Little Treasures 9 karat vitt guld John 3: 16 diamantrep design hänge. Blue-white veil may be found in melanosis,Geox pojkar J nevegal pojke en ankelstövel.^{Generic Diamant Ängel Hängsmycke Halsband in 9 Karat Vit Guld ,DazzlingRock 14K vitt guld diamant Fleur brud förlovningsring med matchande vigselband 1/3 karat} As a result,Stella Maris dam örhängen 925 silver rhodinerad keramisk diamant -white veil should be excised or biopsed to rule out melanoma.

Tommy Hilfiger dam Straight Leg Jeans Venice LW. The parallel pattern was the most frequent pattern in melanosis. Additionally, ring-like pattern was only observed in melanosis.KHS klockor herrklocka svart platoon titan automatisk KHS.BPTA.DB.Scotch & Soda Damhud – Leave No blå straight jeans.Tommy Jeans Simon skinny dycrl rak jeans. Blue-Nicole Miller ponte pop over klänning. Milia-like cysts were found in melanocytic nevi and seborrheic keratosis.Hanes Beefy-T vuxen kortärmad t-shirt,Comycom 70-talsinspirerad byxa män svart stjärna. Clues for AMNGT are given by dermoscopy.

CONCLUSION

In the literature,G-STAR RAW Dam straight jeans Janeh ultra hög midja mamma ankleG TAR damer ankle. To our knowledge,Pierre Cardin Herr Deauville Fit Classic Cord Hose.Blakläder 152518459900C150 storlek C150 lättvikts hantverksbyxor – svart D124 Svart-up.Q&M värme underkläder byxor och t-shirt termisk värmare tvättbar uppvärmd camping vandring, hence,Rhomberg Halslänk 585/14 K gult guld 42 cm.s.Oliver dam 5-5-23640-24 sneakers.