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Background: Line‐field confocal optical coherence tomography (LC‐OCT) is an emerging diagnostic tool with imaging depth reaching ~400 μm and a novel three‐dimensional (3D) cube providing cellular resolution. As far as we are aware, there are only a limited number of papers that have reported diagnostic criteria for melanocytic lesions using this technique, and none of them have been multicentric. Objectives: Our aim was to establish the diagnostic criteria for melanocytic lesions using LC‐OCT and identify the most significant architectural and cytologic features associated with malignancy. Methods: A retrospective evaluation of 80 consecutive melanocytic lesions from a prospective multicentric data set spanning three European centres was conducted. We excluded facial, acral and mucosal lesions from the study. Dermoscopic and LC‐OCT images were evaluated by a consensus of four observers. Multivariate logistic regression with backward elimination was employed. Results: The main melanoma diagnostic criteria include detecting >10 pagetoid cells in 3D acquisition, irregular 3D epidermal architecture, disrupted dermoepidermal junction (DEJ) and clefting. Significant risk factors were irregular 3D epidermal architecture, >10 pagetoid cells, dendritic cells at DEJ without underlying inflammation. Novel malignancy criteria in vertical view were DEJ disruption and clefting around atypical melanocyte nests. Exclusive melanoma features were epidermal nests, epidermal consumption, dense dermal nests with atypia. Protective features in the absence of any malignancy indicators were DEJ ring pattern, cobblestone, elongated rete ridges (vertical), well‐defined DEJ and wave pattern (vertical). Conclusions: A series of diagnostic criteria for the identification of melanocytic lesions with LC‐OCT have been established. Validation of these criteria in clinical practice through future studies is essential to further establish their utility. [ABSTRACT FROM AUTHOR]

Background Molecular skin profiling techniques, typically performed on skin samples taken by punch biopsy, have enhanced the understanding of the pathophysiology of atopic dermatitis (AD), thereby enabling the development of novel targeted therapeutics. However, punch biopsies are not always feasible or desirable, and novel minimally invasive methods such as skin tape stripping have been developed. Aim To develop, optimize and validate a novel tape stripping method guided by noninvasive in vivo skin imaging to sample atopic skin in children. Methods Skin tape stripping-based procedures were compared and optimized using data from 30 healthy controls (HCs: 5 adults, 25 children) and 39 atopic children. Evaluations were guided by high-resolution photography, reflectance confocal microscopy, optical coherence tomography and transepidermal water loss measurements. We assessed and compared adverse events (AEs), the time needed to perform the sampling and the cDNA levels obtained from the tapes. Results Tape stripping methods based on previously described protocols resulted in erosions in all participants and required a median time of 65 min to perform (range 60–70 min), but provided good cDNA yield. Shorter durations appeared less invasive but provided lower cDNA yield. The final optimized tape stripping protocol, using 11 tapes of 22 mm in diameter, each applied twice for 5 s with 90° rotation, did not produce significant AEs, was completed within a median time of 7 min (range 5–15 min) and provided good cDNA yield both in HCs and atopic children. Conclusion Our minimally invasive method is safe and reliable, and provides reproducible acquisition of cDNA in atopic children. In addition, it enables rapid sample collection, a crucial factor in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Treatment response for psoriasis is typically evaluated using clinical scores. However, patients can relapse after clinical clearance, suggesting persistent inflammation. Dermoscopy, reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) can non‐invasively improve treatment response assessment. Objectives: To compare the clinical and non‐invasive microscopic features in a psoriatic target lesion treated with clobetasol cream or calcipotriol/betamethasone dipropionate foam (Cal/BD foam). Methods: Prospective, unicentric, open, randomized clinical trial comparing clinical data [total clinical score (TCS)] and microscopic data (dermoscopy, RCM and OCT) in psoriasis patients treated with clobetasol or Cal/BD foam. Results: We included 36 adult patients (22 men). At week 4, more patients treated with Cal/BD foam achieved TCS ≤1 than with clobetasol (63.2% vs. 18.8%, P = 0.016). Treatment satisfaction was higher with Cal/BD foam (P < 0.03). Microscopically, Cal/BD foam induced more reduction in epidermal thickness at week 4 (P < 0.049). Dilated horizontal blood vessels were more common with clobetasol than with Cal/BD foam at week 8 (69.2% vs. 31.2%, P = 0.159). If epidermal hyperplasia was noted at baseline, the response was poorer with clobetasol (P = 0.029). Limitations: Small sample size, open study, imaging sampling bias. Conclusion: Cal/BD foam is more effective than clobetasol, has better patient satisfaction and induces greater reduction in the hyperkeratosis/acanthosis, regardless of baseline epidermal hyperplasia. [ABSTRACT FROM AUTHOR]

Summary: Background: Ex vivo confocal microscopy (CM) works under two modes, fluorescence and reflectance, allowing the visualization of different structures. Fluorescence CM (FCM) requires a contrast agent and has been used for the analysis of basal cell carcinomas (BCCs) during Mohs surgery. Conversely, reflectance CM (RCM) is mostly used for in vivo diagnosis of equivocal skin tumours. Recently, a new, faster ex vivo confocal microscope has been developed which simultaneously uses both lasers (fusion mode). Objectives: To describe the BCC features identified on reflectance, fluorescence and fusion modes using this novel device. To determine the best mode to identify characteristic BCC features. To develop a new staining protocol to improve the visualization of BCC under the different modes. Methods: From September 2016 to June 2017, we prospectively included consecutive BCCs which were excised using Mohs surgery in our department. The lesions were evaluated using ex vivo CM after routine Mohs surgery. The specimens were first stained with acridine orange and then stained using both acetic acid and acridine orange. Results: We included 78 BCCs (35 infiltrative, 25 nodular, 12 micronodular, 6 superficial). Most features were better visualized with the fusion mode using the double staining. We also identified new CM ex vivo features, dendritic and plump cells, which have not been reported previously. Conclusions: Our results suggest that nuclei characteristics are better visualized in FCM but cytoplasm and surrounding stroma are better visualized in RCM. Thus, the simultaneous evaluation of reflectance and fluorescence seems to be beneficial due to its complementary effect. What's already known about this topic? Ex vivo fluorescent confocal microscopy (FCM) is an imaging technique that allows histopathological analysis of fresh tissue.FCM is faster – at least one‐third of the time – than conventional methods.FCM has a sensitivity of 88% and a specificity of 99% in detecting basal cell carcinomas (BCCs). What does this study add? Reflectance and fluorescence modes can be used simultaneously in a new ex vivo CM device.Each mode complements the other, resulting in an increase in the detection of BCC features in fusion mode.A combined staining using acetic acid and acridine orange enhances the visualization of tumour and stroma without damaging the tissue for further histopathological analysis. Linked Editorial: Navarrete‐Dechent et al. Br J Dermatol 2020; 182:257–259. Plain language summary available online [ABSTRACT FROM AUTHOR]

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Summary: Ex vivo (meaning that it takes place outside the body) confocal microscopy is an imaging technique which allows scientists to look at samples of skin that have been removed by biopsy (where a small tissue sample is removed surgically), and it is often used to diagnose skin cancers including basal cell carcinomas (BCC). There are two main types, fluorescence confocal microscopy (FCM) and reflectance confocal microscopy (RCM), allowing the visualization of different structures in the tissue sample. FCM requires a stain, a type of dye, to be added to the sample and has been used for the analysis of BCC during a type of surgery called Mohs micrographic surgery (MMS). MMS involves removing a thin layer of the tumour at a time with a very small margin of healthy skin around it, and each layer is immediately checked under the microscope. In RCM, a beam of light is focused on a small area of skin. Varying amounts of this light are reflected back depending on the structure of the cells. This creates a grey‐scale image of a section of the skin which allows doctors to see abnormalities. Recently, a new, faster ex vivo confocal microscope has been developed which uses reflectance and fluorescence simultaneously, providing high‐resolution images in both modes separately and in combination (fusion mode). In this study, the researchers, from Spain, explain which features of a BCC are seen using each of the methods, and if one of the methods is better than the others. They also wanted to develop a new staining protocol to improve the visualization of BCC under the different modes. The researchers used BCCs which were excised (removed) using Mohs surgery in their department. The specimens were first stained with acridine orange and then stained using both acetic acid and acridine orange. Most features were better visualized with the fusion mode using double staining. They also identified new ex vivo confocal microscopy features, dendritic and plump cells, which have not been previously reported. Their results suggest that some features (nuclei characteristics) are better visualized in FCM but others (cytoplasm and surrounding stroma) are better visualized in RCM. For this reason, using both reflectance and fluorescence at the same time, using fusion mode, seems to be beneficial. This summary relates to the study: Basal cell carcinoma characterization using fusion ex vivo confocal microscopy: a promising change in conventional skin histopathology Linked Article: Pérez‐Anker et al. Br J Dermatol 2020; 182:468–476 [ABSTRACT FROM AUTHOR]

The article presents a case study of a 44-year-old man was presented for examination because of irregular masses in hair shafts and coloration of hair. Also discusses the performing microscopic and reflectance confocal microscopy (RCM) for diagnostic imaging, and presence of bacterial colonization in the hair.

There are two largely competing models for an athletics organization at both the collegiate and professional levels: the High Performance Model and the Medical Model. The High Performance Model arises from international Football perspective that places a "Performance Director" at the center of teams supporting the athletes. The Medical Model, supported by both the National Athletic Trainers Association and the NCAA, separates off medical staff (athletic trainers, physical therapists, and physicians, predominantly) and emphasizes the autonomy of medical decisions. The Medical Model has left clinicians in a "medical silo", limiting our ability to care for the individual athletes as holistic people and limits our wider impact in the field of athlete health and injury mitigation. We argue that Medical. Model is consistent with the High Performance Model only if we reject the notion that the "Performance Director" is an administrative person and instead conceptualize this as a "Health and Performance Information Hub" which facilitates transdisciplinary collaboration. This Commentary details how a data broker system can be used to accelerate transdisciplinary collaboration within an athletic organization, leading to better healthcare for athletes and improved team and individual performance. Furthermore, a transdisciplinary organization with data sharing is able to turn real-world data into real-world evidence, enhancing the care and performance of athletes locally as well as facilitating the creation of generalizable knowledge in the area of sports medicine and human performance.

Background: Line-field confocal optical coherence tomography (LC-OCT) is a new in vivo emerging technique that provides cellular resolution, allows deep imaging (400 μm) and produces real-time images in both the horizontal and vertical plane and in three dimensions. No previous description of different subtypes of melanocytic lesions and their correlation with histopathology and reflectance confocal microscopy has been reported., Aim: To describe the features of melanocytic lesions by LC-OCT and their correlation with histopathology and reflectance confocal microscopy (RCM) findings., Methods: Selected melanocytic benign lesions and melanomas were imaged in vivo with RCM and LC-OCT at the Fundación Hospital Clinic (Barcelona, Spain). A minimum area of 4 × 4 mm (block image) at four depths (stratum granulosum, suprabasal, layer dermoepidermal junction and upper dermis) were acquired with RCM and a minimum of three cubes with LC-OCT. Horizontal, vertical sections and three-dimensional (3D) cubes of LC-OCT were matched with RCM (Vivablock two-dimensional composite mosaic) and histopathology, with ~5 μm lateral resolution accuracy (the same cell nuclei were measured in X, Y and Z) and evaluated by three observers experienced in using RCM and histopathology., Results: In total, 12 melanocytic tumours (2 in situ melanomas, 2 invasive melanomas, 4 atypical naevi, 2 intradermal naevi, 1 compound naevus and 1 junctional naevus) were included. High correlation with 5 μm accuracy between RCM and LC-OCT was observed for each tumour. The 3D images of melanocytic lesions were obtained with cellular resolution and correlated with both RCM and histopathology, allowing an understanding of the architecture and precise correlation at the cellular level with RCM. Similarities between LC-OCT and RCM for the described diagnostic features and architecture (nests of melanocytic cells, ringed and meshwork pattern, and cellular details of tumour cells as dendritic and pagetoid cells) were confirmed. The main advantage of diagnosis by RCM fixed probe was the ability to produce larger scans of the lesion using mosaicing compared with an LC-OCT handheld probe., Conclusion: LC-OCT allows the architectural and cellular description of different types of melanocytic lesions. LC-OCT showed high correlation with histopathology (vertical sections) and RCM (horizontal sections) in melanocytic lesions. Diagnostic criteria for RCM were similar to those for LC-OCT., (© 2022 British Association of Dermatologists.)

Introduction: Non-invasive imaging techniques offer the possibility to optimize the first approach to melanoma. Reflectance Confocal Microscopy (RCM) has a promising role in predicting the main prognostic events in the dermo-epidermal and papillary dermis., Objectives: To identify pre-surgical criteria that can predict the main prognostic features of melanoma., Methods: A retrospective cohort-study evaluated dermoscopic, confocal and histopathological characteristics of consecutively diagnosed sporadic melanomas. RCM-melanoma patterns classified into 1) dendritic-cell, 2) round-cell, 3) dermal nest and 4) combined type. Acral, facial and mucosal locations were excluded., Results: Ninety-two primary melanomas were included: 44 males and 48 females (mean age 60.4 years, standard deviation [SD] 16.2) with a mean Breslow of 1.43 mm (SD 1.6). The most frequent dermoscopic presentation was the multicomponent pattern, the predominant confocal pattern was dendritic-cell type (44.6%). The presence of pigmented network on dermoscopy was related to lower Breslow and mitotic rates (both P = 0.002); in contrast to the presence of visible vessels, which was related to higher Breslow and mitotic indexes (both P = 0.001). Confocal observation of dermal nests or atypical cells in the papillary dermis was related to a higher mitotic rate (P = 0.006 and P = 0.03, respectively). Similarly, diffuse inflammatory infiltrates visible in the superficial dermis was associated with higher Breslow (P = 0.04) and mitotic index (P = 0.04)., Conclusions: Dermoscopic and RCM in vivo findings on primary melanoma correlate with histopathologic Breslow index, mitotic rate and tumor infiltrating lymphocytes. The architecture and cytology of primary melanoma can be estimated by combining dermoscopy and RCM prior to excision., Competing Interests: Competing interests: None., (©2022 Barragán-Estudillo et al.)

Nevus count is highly determined by inherited variants and has been associated with the origin of melanoma. De novo melanomas (DNMMs) are more prevalent in patients with a low nevus count and have distinctive dermoscopic features than nevus-associated melanomas. We evaluated the impact of nine single nucleotide polymorphisms (SNPs) of MTAP (rs10811629, rs2218220, rs7023329 and rs751173), PLA2G6 (rs132985 and rs2284063), IRF4 (rs12203592), and PAX3 (rs10180903 and rs7600206) genes associated with nevus count and melanoma susceptibility, and the MC1R variants on dermoscopic features of 371 melanomas from 310 patients. All MTAP variants associated with a low nevus count were associated with regression structures (peppering and mixed regression), blue-whitish veil, shiny white structures, and pigment network. SNPs of PLA2G6 (rs132985), PAX3 (rs7600206), and IRF4 (rs12203592) genes were also associated with either shiny white structures or mixed regression (all corrected p-values ≤ .06). Melanomas from red hair color MC1R variants carriers showed lower total dermoscopy score (p-value = .015) and less blotches than melanomas from non-carriers (p-value = .048). Our results provide evidence that germline variants protective for melanoma risk and/or associated with a low nevus count are associated with certain dermoscopic features, more characteristic of de novo and worse prognosis melanomas., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Competing Interests: None