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Amelanotic/hypomelanotic melanoma (AHM) may be difficult to diagnose because of a lack of pigmentation. To evaluate whether dermoscopy can be useful for the diagnosis of early AHM, 133 digital dermoscopic images of lesions histopathologically diagnosed as amelanotic/hypomelanotic superficial spreading melanoma with ≤1 mm thickness (AHSSMs) (n = 27), amelanotic/hypomelanotic non‐melanocytic lesions (AHNMLs) (e.g., seborrhoeic keratosis and basal cell carcinoma) (n = 79), and amelanotic/hypomelanotic benign melanocytic lesions (AHBMLs) (e.g., compound and dermal nevi) (n = 27), were dermoscopically assessed by three blinded dermatologists. Using multivariate analysis, we found a significantly increased risk of diagnosing AHSSM versus AHNML and AHBML when the lesion was characterized by the presence of more than one shade of pink (odds ratio [OR] 37.11), irregular dots/globules (OR 23.73), asymmetric pigmentation (OR 8.85), and structureless pattern (OR 7.33). In conclusion, dermoscopy may improve early AHM detection, discriminating AHSSM from amelanotic/hypomelanotic non melanoma lesions. [ABSTRACT FROM AUTHOR]

Giuseppe Argenziano,1,* Paolo Amerio,2 Maria Grazia Aragone,3 Ginevra Baggini,4 Manuela Baldari,5 Gianpiero Castelli,6 Simmaco Coppola,7 Antonio Costanzo,8,9 Rocco De Pasquale,10 Maria Concetta Fargnoli,11 Caterina Foti,12 Claudia Giofrè,13 Serena Lembo,14 Claudia Leporati,15,16 Francesco Loconsole,17 Giovanna Malara,18 Ketty Peris,19,20 Antonio Giovanni Richetta,21 Paola Savoia,22 Rossana Tiberio,23 Massimo Travaglini,24 Maria Teresa Uzzauto,25 Luca Bianchi26,* 1Dermatology Unit, University of Campania, Naples, Italy; 2Department of Medicine and Aging Science and Dermatologic Clinic, University “G. d’Annunzio”, Chieti-Pescara, Chieti, Italy; 3ASL AL, Alessandria, Italy; 4Osp. Civile di Varzi, Pavia, Italy; 5ASL4 Liguria, Genova, Italy; 6UOSD of Dermatology, Ospedale Umberto I°, Siracusa, Italy; 7IQVIA, Rome, Italy; 8Department of Biomedical Sciences, Humanitas University, Milano, Italy; 9Skin Pathology Laboratory, Humanitas Research Hospital IRCCS, Milano, Italy; 10UOC Dermatologia, AOU Policlinico “G. Rodolico – San Marco”, Catania, Italy; 11Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy; 12Department of Biomedical Science and Human Oncology, Dermatological Clinic, University of Bari, Bari, Italy; 13U.O.C. Dermatologia, A.O. Papardo, Messina, Italy; 14Dipartimento di Medicina, Chirurgia e Odontoiatria Scuola Medica Salernitana, University of Salerno, Fisciano, Italy; 15Dermatology Unit, ASL AL Casale Monferrato, Alessandria, Italy; 16Dermatology Unit, ASL TO4 Ivrea, Torino, Italy; 17Department of Dermatology, University of Bari, Bari, Italy; 18UOC of Dermatology, Grande Ospedale Metropolitano “BMM”, Reggio Calabria, Italy; 19Institute of Dermatology, Catholic University, Rome, Italy; 20Dermatology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; 21Dipartimento di Scienze Cliniche Internistiche e Cardiovascolari Policlinico Umberto I University of Rome “La Sapienza”, Rome, Italy; 22Department of Health Science, Università del Piemonte Orientale, Novara, Italy; 23SCDU Dermatologia, AOU Maggiore della Carità, Novara, Italy; 24U.O.S.D. dermatologica - centro per la cura della psoriasi, Ospedale Perrino, Brindisi, Italy; 25U.O.C. Dermatologia, ASL Salerno, Ospedale “A:Tortora”-Pagani, Salerno, Italy; 26Dermatology Unit, Tor Vergata University Hospital, Rome, Italy*These authors contributed equally to this workCorrespondence: Giuseppe ArgenzianoDermatology Unit, University of Campania “Luigi Vanvitelli”, Via Pansini, 5, Naples, 80131, ItalyTel +39335415093Fax +39 069 762 5822Email g.argenziano@gmail.comLuca BianchiUniversity of Rome “Tor Vergata”, Policlinico Tor Vergata, Viale Oxford 81, Rome, 00133, ItalyTel +39 0620902739Fax +39 0620902742Email luca.bianchi@uniroma2.itPurpose: For patients with psoriasis, treatment adherence and persistence are fundamental if therapeutic goals are to be met. Patient Support Programs (PSPs) may be used as a support tool to assist patients and health care professionals optimize treatment and improve disease management.Patients and Methods: In Italy, the PSP PSOLife CARE, which began on the 9th of February 2017 and is ongoing, aimed to support patients with psoriasis under therapy with secukinumab (Cosentyx®). A team of medical professionals including Dermatologists, Psychologists, Nutritionists, and field Nurses provided outpatient treatment as well as remote support via phone calls. Patients had a standard duration in the Program of 6 months. This report analyzes the data of patients who benefited from the Program from February 2017 to August 2020, for a total observation of 42 months.Results: We provide here a descriptive report on the benefits of participation in the PSOLife CARE Program for patients with psoriasis and medical professionals involved in their care. Throughout their time in the PSOLife CARE Program, patient satisfaction remained consistently high with sustained improvements observed in all aspects of quality of life (ie emotional, social, physical, and economic). Despite exiting from the Program, most patients continued to adhere to secukinumab. Medical professionals also reported positive outcomes on their interactions with patients, with more than half of those surveyed rating the overall quality of the Program as “Outstanding”.Conclusion: By supporting treatment adherence, the PSOLife CARE Program may have empowered patients to better manage their psoriasis, increasing their satisfaction with treatment and quality of life.Keywords: dermatology, PSOLife CARE Program, quality of life, treatment adherence

Gaetano Licata,1 Camila Scharf,1 Andrea Ronchi,2 Sebastiano Pellerone,1 Giuseppe Argenziano,1 Pasquale Verolino,3 Elvira Moscarella1 1Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli Naples, Naples, Italy; 2Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli Naples, Naples, Italy; 3Plastic Surgery Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli Naples, Naples, ItalyCorrespondence: Giuseppe Argenziano Email g.argenziano@gmail.comAbstract: Cutaneous melanoma is a public health issue and the head and neck region is of particular interest, despite accounting for only 9.0% of the total body surface, it harbours 20% of melanoma cases. Data from the literature show that scalp melanomas (SM) carry high mortality rates, with a 10-year survival rate of 60% which lead them to be named as the “invisible killer”. Moreover, SMs are more common in the elderly than in young population, and they occur six times more frequently in men than in women. This is probably related to the higher incidence of androgenetic alopecia and a higher cumulative and intermittent ultraviolet damage on the scalp. Histologically, SM is a heterogenous group, including lentiginous melanoma (LM), desmoplastic melanoma, superficial spreading and nodular melanoma. Thin melanomas tend to display an atypical network or pseudo-network and regression in dermoscopy. Blue-white veil, irregular pigmented blotches and an unspecific pattern are most commonly detected in thick lesions. On reflectance confocal microscopy (RCM), the most frequent pattern is irregular meshwork, but also ringed and disarranged pattern have been described. Differential diagnosis includes benign solar lentigo, actinic keratoses, lichen planus like keratosis, melanocytic nevi and blue nevi. All suspicious lesions should be biopsied; therefore, an excisional biopsy with 2 mm margins is usually the best option. The management of SM is the same as for melanoma on other body sites. However, sentinel node biopsy tends to be more challenging, as well as achieving adequate excision margins of the primary tumor. In this review, we summarize clinical, pathologic, dermoscopic and RCM features of SM, and focus on its epidemiology, risk factors and best management options.Keywords: scalp, melanoma, dermoscopy, reflectance confocal microscopy

Elvira Moscarella,1 Gabriella Brancaccio,1 Giulia Briatico,1 Andrea Ronchi,2 Simonetta Piana,3 Giuseppe Argenziano1 1Dermatology Unit, University of Campania, Naples, Italy; 2Pathology Unit, University of Campania, Naples, Italy; 3Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, ItalyCorrespondence: Elvira MoscarellaDermatology Unit, University of Campania, Nuovo Policlinico (edificio 9C), Via Pansini 5, Naples, 80131, ItalyTel +39 335 1727229Email elvira.moscarella@gmail.comAbstract: Seborrheic keratoses are exceedingly common in the elderly and usually are easy to diagnose and do not require treatment. However, given their great variety of clinical presentation, they may give rise to false-positive cases, meaning that they may at times mimic melanoma, squamous cell carcinoma and basal cell carcinoma. On the other hand, melanoma may mimic seborrheic keratosis, leading to incorrect patient management. With this review, we would like to summarize the current knowledge about epidemiology, clinical, dermoscopic and reflectance confocal microscopy imaging of this common entity, and we also summarize the currently available treatment options.Keywords: seborrheic keratosis, melanoma, dermoscopy, reflectance confocal microscopy, elderly, basal cell carcinoma

Alessio Gambardella,1 Gaetano Licata,1 Giulia Calabrese,1 Alina De Rosa,1 Francesca Pagliuca,2 Roberto Alfano,3 Giuseppe Argenziano1 1Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy; 2Division of Pathology, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy; 3Department of Anesthesiology, Surgery and Emergency, University of Campania Luigi Vanvitelli, Naples, ItalyCorrespondence: Gaetano LicataDepartment of Dermatology, University of Campania “Luigi Vanvitelli”, Via Sergio Pansini, 5, Napoli 80131, ItalyTel +39 081 5666828Fax +39 081 546 87 59Email gaetano.licata89@gmail.comAbstract: The use of biological therapy is now common practice in the treatment of immune-mediated inflammatory diseases (IMID). Currently, there are no guidelines related to the management of cytomegalovirus (CMV) infections or reactivation during therapy with biological agents. Furthermore, there is a lack of guidance on the management of asymptomatic patients with persistent positive immunoglobulin (Ig)M anti-CMV after an extended period and who have to undergo therapy with biological agents. We report the case of a patient in this situation for whom treatment with biological drugs for psoriasis was indicated. A good clinical response was obtained with secukinumab and maintained during 6 months of follow-up. No infectious disease or reactivation of CMV infection occurred. We suggest some possible guidelines for the management of such cases.Keywords: immune-mediated inflammatory diseases, biological therapy, anti-TNF-α therapy, cytomegalovirus, psoriasis, case report

Background: Atopic dermatitis (AD) is a common inflammatory skin disease that affects both children and adults. However, limited research has been conducted on gender differences in AD. Objectives: This study aimed to assess gender differences in adult AD patients, focusing on demographic and clinical features, comorbidities and treatment approaches. Methods: In this multicentre, observational, cross‐sectional study, we enrolled 686 adult patients with AD (357 males and 329 females). For each patient, we collected demographic data (age and sex), anthropometric measurements (weight, height, hip circumference, waist circumference and waist‐to‐hip ratio), clinical information (onset age, disease duration, severity, itching intensity, impact on quality of life) and noted comorbidities (metabolic, atopic and other). We recorded past and current topical and systemic treatments. We analysed all collected data using statistical techniques appropriate for both quantitative and qualitative variables. Multiple correspondence analysis (MCA) was employed to evaluate the relationships among all clinical characteristics of the patients. Results: We found no differences in age at onset, disease duration, severity and quality of life impact between males and females. Males exhibited higher rates of hypertriglyceridaemia and hypertension. No significant gender differences were observed in atopic or other comorbidities. Treatment approaches were overlapping, except for greater methotrexate use in males. MCA revealed distinct patterns based on gender, disease severity, age of onset, treatment and quality of life. Adult males with AD had severe disease, extensive treatments and poorer quality of life, while adult females had milder disease, fewer treatments and moderate quality of life impact. Conclusions: Our study reveals that gender differences in adult AD patients are largely due to inherent population variations rather than disease‐related disparities. However, it highlights potential undertreatment of females with moderate AD and quality of life impact, emphasizing the need for equitable AD treatment. JAK inhibitors may offer a solution for gender‐based therapeutic parity. [ABSTRACT FROM AUTHOR]

This article examines the effectiveness of risankizumab, a medication used to treat moderate-to-severe plaque psoriasis. The study found that risankizumab was effective in improving psoriasis symptoms, with a high percentage of patients experiencing significant improvement and complete skin clearance. The study also found that patients who had not previously been treated with biologic drugs and those with a shorter disease history had better responses to the treatment. However, the study has some limitations, and further research is needed to fully understand the long-term effects of risankizumab on psoriasis. [Extracted from the article]

Background: Breslow thickness, patient age and ulceration are the three most valuable clinical and pathological predictors of melanoma survival. A readily available reliable online tool that accurately considers these and other predictors could be valuable for clinicians managing melanoma patients. Objective: To compare online melanoma survival prediction tools that request user input on clinical and pathological features. Methods: Search engines were used to identify available predictive nomograms. For each, clinical and pathological predictors were compared. Results: Three tools were identified. The American Joint Committee on Cancer tool inappropriately rated thin tumours as higher risk than intermediate tumours. The University of Louisville tool was found to have six shortcomings: a requirement for sentinel node biopsy, unavailable input of thin melanoma or patients over 70 years of age and less reliable hazard ratio calculations for age, ulceration and tumour thickness. The LifeMath.net tool was found to appropriately consider tumour thickness, ulceration, age, sex, site and tumour subtype in predicting survival. Limitations: The authors did not have access to the base data used to compile various prediction tools. Conclusion: The LifeMath.net prediction tool is the most reliable for clinicians in counselling patients with newly diagnosed primary cutaneous melanoma regarding their survival prospects. [ABSTRACT FROM AUTHOR]

Background: Although primary care physicians (PCPs) play a key role in skin cancer screening, their skills in detecting malignant tumours is suboptimal. Objectives: To determine whether a short dermoscopy e‐learning course (4 h) in skin tumour diagnosis for PCPs is non‐inferior to a long course (12 h) in selective triage of skin lesions. Secondly, to evaluate whether regular refresher training sessions are necessary to maintain the PCPs' skills in the medium term. Methods: A randomized 2 × 2 factorial non‐inferiority trial was conducted online over an 8‐month period among 233 PCPs including 126 certified general practitioners, 94 PCPs in training, and 13 occupational physicians, all without prior advanced dermoscopy training. Participants were randomized 1:1:1:1 to receive short training and mandatory refreshers (n = 58), short training and optional refreshers (n = 59), long training and mandatory refreshers (n = 58), or long training and optional refreshers (n = 58). PCPs' skills were evaluated before training (T0), immediately after training (T1) to test the non‐inferiority, and after 5 months (T2) to evaluate the impact of the refreshers. The primary endpoint was the difference in the change of score after short and long training. The non‐inferiority margin was set at −28%. Results: Among the 233 randomized participants, 216 (93%) completed T1 and 197 (84.5%) completed T2. For short versus long training, the primary endpoint was 1.392 (95% CI: 0.138; 2.645) in the per‐protocol population (p < 0.001) and 1.016 (95% CI: −0.224; 2.256) in the modified intention‐to‐treat population (p < 0.001). After training, the type of refresher showed no impact on the score (p = 0.840). However, PCPs who completed all refreshers showed the best mean overall score at T2 (p < 0.001). Conclusions: These findings confirm that short dermoscopy e‐learning is non‐inferior in training PCPs to triage skin lesions compared to long training. After training, regular refreshers are important to maintain the PCPs' acquired skills over time. [ABSTRACT FROM AUTHOR]

Maria Banzi,1 Simona De Blasio,2 Aimilios Lallas,3 Caterina Longo,2 Elvira Moscarella,2 Roberto Alfano,4 Giuseppe Argenziano5 1Department of Medical Oncology, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy; 2Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy; 3First Department of Dermatology, Aristotle University, Thessaloniki, Greece; 4Department of Anesthesiology, Surgery and Emergency, 5Dermatology Unit, Second University of Naples, Naples, Italy Abstract: Prior to 2011, the 1-year survival rates for patients suffering from advanced or metastatic melanoma was as low as 33%, with a median overall survival of about 9 months. Several chemotherapeutic regimens have been applied, either as monochemotherapy or as polychemotherapy, overall not resulting in an improvement of progression-free or overall survival. Novel insights into the epidemiology and biology of melanoma allowed the development of newer therapies. The discovery of mutations in BRAF, a part of the mitogen-activated protein kinase, allowed the development of two BRAF inhibitors, vemurafenib and dabrafenib, which significantly improved the outcome of metastatic melanoma treatment. This article reviews the mechanism of action, efficacy, and safety profile of dabrafenib. An in-depth knowledge of this medication will encourage clinicians to select the appropriate therapeutic strategy for each patient, as well as to prevent or adequately manage side effects, optimizing, thus, the drug’s applicability. Keywords: melanoma, BRAF, target therapy, dabrafenib, melanoma survival

Sentinel lymph node biopsy is now identified as a far less accurate method of predicting melanoma survival and selecting patients for adjuvant drug therapy. 3 Moody JA, Ali RF, Carbone AC, Singh S, Hardwicke JT. Complications of sentinel lymph node biopsy for melanoma - a systematic review of the literature. [Extracted from the article]

Background: Glomus tumours (GTs) are benign cutaneous neoplasms derived from the neuromyoarterial apparatus with a strong predilection for acral sites, especially the subungual space. Current data regarding dermoscopy of these lesions are very limited. Objectives: To analyse the dermoscopic structures and patterns seen in a large series of subungual (SUGTs) and extraungual glomus tumours (EUGTs) and to determine their diagnostic significance. Methods: Clinical and dermoscopic images of 86 histopathologically proven cases of GTs (47 SUGTs and 39 EUGTs) collected from 9 hospitals in Spain, France, Italy, and Brazil were evaluated for the presence of dermoscopic structures and patterns. Similarly, 189 and 185 dermoscopic images of other ungual tumours and other extraungual non‐pigmented tumours, respectively, were evaluated for the same structures and patterns. Finally, we evaluate diagnostic testing accuracy calculating sensitivity (S), specificity (Sp), and positive and negative predictive values of the different patterns for the diagnosis of GT. Results: Regarding SUGTs, four patterns were built from the combination of different structures. The pattern composed of a structureless purplish/red subungual spot with or without vessels reached the highest S (S1, 78.8%). The combination of a structureless purplish/red subungual spot and longitudinal erythronychia (LE) (S2) is highly specific (96.3%). Patterns S3 (proximal purplish/red subungual spot, LE, and distal notch) and S4 (bed subungual spot and onycholysis) are the most specific and exclusive of matrix and bed tumours, respectively. The most consistent pattern in EUGTs is composed of a structureless purplish‐white to reddish‐white homogeneous area and linear unfocused vessels (E) (S: 61.5%, Sp: 95.7%). EUGTs did not show lacunae, unlike other vascular tumours. Conclusions: Dermoscopy is helpful in improving the diagnostic accuracy of GTs, not only in SUGTs but also when these lesions arise out of the ungual apparatus. [ABSTRACT FROM AUTHOR]