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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]

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]

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: The dermoscopic features of classic patch stage mycosis fungoides (MF) have been described, but data on plaque and tumoral stage as well as rarer MF subtypes is limited. Objective: To evaluate dermoscopic morphology and dermoscopic‐pathological correlations of classic MF stages and investigate dermoscopic features of MF variants. Methods: Patients with histopathologically confirmed lesions of classic MF (patch, plaque and tumoral stage) or folliculotropic, erythrodermic and poikilodermatous MF were included. Standardized evaluation of dermoscopic pictures of the included MF variants and comparative analysis and dermoscopic‐pathological correlation assessment of different stages of classic MF were performed. Results: A total of 118 instances were included (75 classic MF, 26 folliculotropic MF, 9 erythrodermic MF and 8 poikilodermatous MF). Linear/linear‐curved vessels and white scales in the skin furrows were significantly associated with patch‐stage MF, while clustered dotted vessels were related to plaque‐stage MF and peripheral linear vessels with branches, ulceration and red globules separated by white lines to tumour‐stage MF. Moreover, patchy white scales were significantly more common in patches and plaques compared to tumours, whereas focal bright white structureless areas were related to plaque and tumoral stage. Vessels histopathologically corresponded to dilated vascular structures in the dermis, orange structureless areas to either dermal hemosiderin (patch/plaque stage) or dense cellular infiltration (tumours), bright white lines/structureless areas to dermal fibrosis and ulceration to loss of epidermis. The main dermoscopic findings of folliculotropic MF were lack of hairs, dilated follicles and follicular plugs, while erythrodermic MF was mainly characterized by linear/dotted vessels, patchy white scales and focal orange structureless areas and poikilodermatous MF by focal white and brown structureless areas, white patchy scales and brown reticular lines. Conclusion: Dermoscopy may allow a more precise characterization of classic MF and reveal clues suggestive of the main MF variants. [ABSTRACT FROM AUTHOR]

The incidence of non‐melanoma skin cancer is on the rise and melanoma is among the most common cancers in the United States. Establishing an early diagnosis is essential for improving the prognosis of patients with skin cancer. High‐resolution non‐invasive imaging techniques may represent key tools for helping to identify and monitor early signs of skin cancer in seemingly healthy skin. Cumulative lifetime sun exposure leads to photoaging and photocarcinogenenis and the reaction of the skin to this solar‐induced damage is balanced between the DNA repair and photoprotection defence mechanisms of melanocytes and keratinocytes. In the first part of this article we provide an overview of these defence mechanisms and of the photoaging process, and discuss how non‐invasive imaging can be used to evaluate these changes. We then propose a model in which skin aging manifestations can be classified according to subject‐specific sun‐damage reaction profiles observed by reflectance confocal microscopy (RCM) and optical coherence tomography (OCT). These photoaging profiles include an atrophic phenotype characterized by actinic keratosis, and a hypertrophic phenotype characterized by hyperplastic pigmented skin. According to our model, these phenotypes may be predictive of predispositions to different types of skin cancer: squamous cell carcinoma for the atrophic phenotype and lentigo maligna and freckles for the hypertrophic phenotype. In addition to RCM and OCT, dermoscopy is another non‐invasive technique that has improved the diagnosis of skin cancer. In the second part of this article, we describe how the YouDermoscopy™ application can improve skills and thus enhance the dermoscopic recognition of sun‐induced skin tumours, and then show how this training tool enables its users to collaborate with dermatologists worldwide to obtain second opinions for the diagnosis of ambiguous lesions. Altogether, RCM, OCT and dermoscopy are valuable tools that can contribute significantly to improving the early diagnosis of precancerous and cancerous lesions. [ABSTRACT FROM AUTHOR]

As purpura is often associated to serious conditions, reassurance of patients presenting with face mask-induced purpura is advisable after necessary investigations. In our patient, the intense photodamaged skin may be a predisposing factor for the development of purpura, similarly to what is observed in Bateman's purpura. As the patient noticed that the lesions had appeared after prolonged use of FFP2 face mask, she had autonomously started to wear surgical masks in order to reduce facial skin pressure and, after that, she was experiencing an improvement of her skin signs. [Extracted from the article]

Background: Squamous cell carcinoma of the lip accounts for 20% of all oral carcinomas. Its diagnosis may be challenging because it clinically resembles actinic cheilitis and inflammatory lesions of the lips. Objectives: To determine clinical and dermatoscopic predictors of squamous cell carcinoma of the lip vs. other lip lesions. Methods: Multicentre retrospective morphological study, including histologically confirmed cases of squamous cell carcinoma of the lip and controls consisting of actinic cheilitis and inflammatory lesions of the lips. Clinical and dermatoscopic images were evaluated for the presence of predefined criteria. Crude and adjusted odds ratios and corresponding 95% confidence intervals were calculated by univariate and multivariate logistic regression respectively. Results: A total of 177 lip lesions were evaluated, 107 (60.5%) were squamous cell carcinomas and 70 (39.5%) were controls. The most frequent dermatoscopic criteria of lip squamous cell carcinoma were scales (100%), white halos (87.3%) and ulceration (79.4%). The majority of squamous cell carcinomas displayed polymorphic vessels (60.8%), with linear (68.6%) and hairpin (67.6%) being the most frequent types. Multivariate logistic regression analysis showed that clinical predictors of lip squamous cell carcinoma were exophytic appearance and clinical hyperkeratosis, with 43‐fold and 6‐fold higher probability respectively. White clods and ulceration in dermoscopy presented a 6‐fold and 4‐fold increased risk for squamous cell carcinoma respectively. Conclusions: A scaly lesion with exophytic growth, dermatoscopically displaying white clods, ulceration and linear and hairpin vessels is very likely a squamous cell carcinoma of the lip. [ABSTRACT FROM AUTHOR]

Genital psoriasis (GenPs) leads to numerous symptoms such as itch, pain, burning and dyspareunia; however, it is often neglected by patients and physicians.1,2 Recently, two double-blind, placebo-controlled phase IIIb studies demonstrated superiority of ixekizumab over placebo for the treatment of moderate-to-severe GenPs,3 but there are few data on anti-IL-23. Sixty percentage of patients had severe psoriasis with PASI between 18 and 25; the remaining 40% of patients had moderate psoriasis with PASI between 10 and 12, the mean sPGA-G was 3.5. Genital psoriasis awareness program: physical and psychological care for patients with genital psoriasis. [Extracted from the article]

The most characteristic dermoscopic aspect of the JXG is that of the "setting sun".3,4 However, JXG can show atypical dermoscopic features that have not been extensively described in the literature. Oppositely, it was found a high percentage of "atypical" features for JXGs such as the negative network (42.9%), white streaks (57.1%) and erosions (28.6%), all frequently detectable in tumours other than JXG. Juvenile xanthogranuloma (JXG) is a rare benign subtype of non-Langerhans cell histiocytosis.1,2 Dermoscopy is helpful in the diagnosis of JXG when presenting the typical dermoscopic features. [Extracted from the article]

Dermatoscopic features of thin (<=2 mm Breslow thickness) vs. thick (>2 mm Breslow thickness) nodular melanoma and predictors of nodular melanoma versus nodular non-melanoma tumours: a multicentric collaborative study by the International Dermoscopy Society. GLO:3NZ/01nov21:jdv17428-fig-0001.jpg PHOTO (COLOR): 1 Nodular melanomas presenting with a typical clinical morphology as arises from an agreement of 4 out of 6 evaluators: (a) pigmented nodular melanoma-like, (b) hypo/amelanotic melanoma-like and nodular melanomas imitating benign and malignant non-melanoma lesions, (c) seborrheic keratosis-like, (d) pyogenic granuloma-angioma-angiokeratoma-like and (e)-(f) non-melanoma skin cancer-like. gl The distinct patterns of NM identified are of great importance to address the early detection of this melanoma subtype in clinical practice. Dermoscopy improves the diagnostic accuracy of melanomas clinically resembling seborrheic keratosis: cross-sectional study of the ability to detect seborrheic keratosis-like melanomas by a group of dermatologists with varying degrees of experience. [Extracted from the article]

Pruritus is considered one of the most life-limiting symptoms and unmet needs of atopic dermatitis (AD) by both patients and physicians. All patients were evaluated by the most used scores for AD: Eczema Area Severity Index (EASI), Dermatology Life Quality Index (DLQI), basal pruritus Numerical Rating Scale (NRS) and sleep pruritus NRS scores. From May 2018 to December 2021, 556 patients of both sexes (360 male then 196 female patients) aged between 18 and 83 years old (patients average age is 36 years old) with severe AD are being treated with dupilumab in our unit. [Extracted from the article]

Background: Treatment of moderate‐to‐severe atopic dermatitis (AD) in the elderly may be challenging, due to side‐effects of traditional anti‐inflammatory drugs and to comorbidities often found in this age group. Furthermore, efficacy and safety of innovative drugs such as dupilumab are not yet well known. Objectives: A multicentre retrospective, observational, real‐life study on the efficacy and safety of dupilumab was conducted in a group of patients aged ≥65 years and affected by severe AD. Their main clinical features were also examined. Methods: Data of elderly patients with severe (EASI ≥24) AD treated with dupilumab at label dosage for 16 weeks were retrospectively collected. Treatment outcome was assessed by comparing objective (EASI) and subjective (P‐NRS, S‐NRS and DLQI) scores at baseline and after 16 weeks of treatment. Results: Two hundred and seventy‐six patients were enrolled in the study. They represented 11.37% of all patients with severe AD. Flexural eczema was the most frequent clinical phenotype, followed by prurigo nodularis. The coexistence of more than one phenotype was found in 63/276 (22.82%) subjects. Data on the 16‐week treatment with dupilumab were available for 253 (91.67%) patients. Efficacy of dupilumab was demonstrated by a significant reduction of all the scores. No statistically significant difference regarding efficacy was found in elderly patients when compared to the group of our AD patients aged 18–64 years, treated with dupilumab over the same period. Furthermore, only 18 (6.52%) patients discontinued the drug due to inefficacy. Sixty‐one (22.51%) patients reported adverse events, conjunctivitis and flushing being the most frequent. One (0.36%) patient only discontinued dupilumab due to an adverse event. Conclusions: Therapy with dupilumab led to a significant improvement of AD over a 16‐week treatment period, with a good safety profile. Therefore, dupilumab could be considered as an efficacious and safe treatment for AD also in the elderly. [ABSTRACT FROM AUTHOR]

Background: Combined blue nevi (CBN) may mimic melanoma and are relatively often biopsied for diagnostic reasons. Objective: To better characterize CBN and to compare it with melanoma. Methods: We collected clinical and dermatoscopic images of 111 histologically confirmed CBN and contrasted their dermatoscopic characteristics with 132 partly blue coloured melanomas. Furthermore, we compared the accuracy of human experts using pattern analysis with a computer algorithm based on deep learning. Results: Combined blue nevi are usually flat or slightly elevated and, in comparison with melanoma, more frequent on the head and neck. Dermatoscopically, they are typified by a blue structureless part in combination with either brown clods (n = 52, 46.8%), lines (n = 28, 25.2%) or skin‐coloured or brown structureless areas (n = 31, 27.9%). In contrast with melanoma, the blue part of CBN is more often well defined (18.9% vs. 4.5%, P < 0.001) and more often located in the centre (22.5% vs. 5.3%, P < 0.001). Melanomas are more often chaotic (OR: 28.7, 95% CI: 14.8–55.7, P < 0.001), have at least one melanoma clue (OR: 10.8, 95% CI: 5.2–22.2 P < 0.001) in particular white lines (OR: 37.1, 95% CI: 13.4–102.9, P < 0.001). Using simplified pattern analysis (chaos and clues), two raters reached sensitivities of 93.9% (95% CI: 88.4–97.3%) and 92.4% (95% CI: 86.5–96.3%) at corresponding specificities of 59.5% (95% CI: 49.7–68.7%) and 65.8% (95% CI: 56.2–74.5%). The human accuracy with pattern analysis was on par with a state‐of‐the‐art computer algorithm based on deep learning that achieved an area under the curve of (0.92, 95% CI: 0.87–0.96) and a specificity of 85.3% (95% CI: 76.5–91.7%) at a given sensitivity of 83.6% (95% CI: 72.5–91.5%). Conclusion: CBN usually lack melanoma clues, in particular white lines. The accuracy of pattern analysis for combined nevi is acceptable, and histopathologic confirmation may not be necessary in exemplary cases. [ABSTRACT FROM AUTHOR]

Background: Brodalumab was efficacious and safe in moderate‐to‐severe plaque‐type psoriasis in the AMAGINE trials; published reports under real‐life conditions are limited. Objectives: To evaluate the effectiveness and safety of brodalumab in patients with moderate‐to‐severe plaque‐type psoriasis in a real‐world setting. Methods: This observational, retrospective study enrolled adult patients (≥18 years) with moderate‐to‐severe plaque‐type psoriasis who underwent 24 weeks of treatment with brodalumab at 17 Italian dermatological centres. Baseline data included demographics, comorbidities, age of onset and duration of psoriasis and previous treatments. Psoriasis Area and Severity Index (PASI), Physician Global Assessment (PGA), static PGA of Genitalia, Dermatology Life Quality Index and patient satisfaction were assessed at weeks 0, 4, 12 and 24; adverse events were recorded. Results: Seventy‐eight patients (mean age 47.9 years, 71.8% male, average disease duration 16.8 years) were enrolled. A rapid and significant reduction in mean PASI score was observed after 4 weeks of treatment, decreasing further at weeks 12 and 24 (all P < 0.0001 vs. baseline). A higher number of cardiometabolic comorbidities and previous therapies were negatively associated with the achievement of PASI 90 at all assessments. Brodalumab was effective in bio‐experienced patients, including those who had failed on anti‐interleukin (IL)‐17 therapies. Quality of life and patient satisfaction increased significantly during treatment (P < 0.0001 and P < 0.01 vs. baseline, respectively). Treatment was interrupted in 9 (11.5%) patients due to adverse events (n = 4), lack of efficacy (n = 3), lost to follow‐up (n = 1) and surgical procedure (n = 1). Conclusions: Brodalumab is effective and safe in the treatment of moderate‐to‐severe psoriasis in a real‐world setting, including in patients with failure to anti‐IL17 therapies. [ABSTRACT FROM AUTHOR]

Background: The anatomical location of atypical melanocytic skin lesion (aMSL) was never combined into an algorithm for discriminating early melanomas (EM) from atypical nevi (AN). Aims: To investigate the impact of body location on the intuitive diagnosis performed in teledermoscopy by dermatologists of different skill levels. A further aim was to evaluate how the integration of the body location could improve an algorithm‐aided diagnosis. Methods: We retrospectively collected 980 standardized dermoscopic images of aMSL cases (663 AN, 317 EM): data on the anatomical location were collected according to 15 body sites classified into 4 macro‐areas of chronically/frequently/seldom/rarely exposure. Through a teledermatology web platform, 111 variously skilled dermoscopists performed either the intuitive diagnosis and 3 algorithm‐assisted diagnostic tests (i.e. iDScore, 7‐point checklist, ABCD rule) on each case, for a total of 3330 examinations. Results: In the rarely photoexposed area (side, bottom, abdomen), AN were the most tricky (i.e. highest quote of false positives), due to a frequent recognition of dermoscopic features usually considered as suggestive for melanoma in these lesions; the EM at these sites received the highest quote of false negatives, being generally interpreted as 'featureless' according to these traditional parameters, that were more frequently displayed on the chronically photoexposed area. In rarely and seldom photoexposed area, intuitive diagnosis fails to achieve adequate accuracy for all aMSLs, as the ABCD rule and the 7‐point checklist; by applying the iDScore algorithm the diagnostic performance was increased by 15% in young and 17% in experts. Conclusions: The body location of an aMSL can affect the quality of intuitive dermoscopic diagnosis, especially in sun‐protected areas. Accuracy can be improved by using the iDScore algorithm that assigns a different partial score of each body site. Linked Commentary: T. Deinlein. J Eur Acad Dermatol Venereol 2021; 35: 566. https://doi.org/10.1111/jdv.17141. [ABSTRACT FROM AUTHOR]

Apart the first observation of a reaction against MC induced by COVID vaccine, our report is also the first positive reaction after vaccine. Dermoscopy supported the diagnosis of MC, thus showing the typical central amorphous whitish structures, surrounded by tiny linear vessels.1 The patient was encouraged to avoid treatments, as it could be logically deduced the current reaction could have a benign course and progressively induce a positive response with complete disappearance of MC. At clinical examination, the patient showed erythematous-crusting lesions mostly surrounding papules, consistent with molluscum contagiosum (MC), better seen where the reaction was still absent. [Extracted from the article]

COVID vaccine-induced pustular psoriasis in patients with previous plaque type psoriasis Patients in this manuscript have given written informed consent to the publication of their case details. BNT162b2 mRNA COVID-19 vaccine-induced chilblain-like lesions reinforces the hypothesis of their relationship with SARS-CoV-2. [Extracted from the article]

The patient mentioned in this manuscript has given written informed consent for the publication of her case details. GLO:3NZ/01jan22:jdv17687-fig-0001.jpg PHOTO (COLOR): 1 Lichen planus exclusively localized on pre-existing vitiligo patches of the hands. gl GLO:3NZ/01jan22:jdv17687-fig-0002.jpg PHOTO (COLOR): 2 Dermoscopy showing the typical Wickham striae of lichen planus. gl Even if uncommon, the co-occurrence of LP on vitiligo is certainly not new, as several reports are present in the literature.1-3 In most cases, LP appeared after vitiligo, although concurrent diseases or LP preceding vitiligo have been reported. COVID vaccine-induced lichen planus on areas previously affected by vitiligo. [Extracted from the article]

Nevi of the back were not affected. gl GLO:3NZ/01jan22:jdv17688-fig-0002.jpg PHOTO (COLOR): 2 Clinical images showing the purpuric ring around the nevi. Albeit the pathogenesis of EM "targeting" nevi is obscure, in our case, we can hypothesize a similar mechanism as that involved in post-HSV nevocentric EM. The patient in this manuscript has given written informed consent to the publication of her case details. [Extracted from the article]

Late-onset pustular skin eruption in a healthy neonate born from COVID-positive mother: a coincidence or a new skin sign of the infection? Given none of the diseases listed in the differential diagnoses thoroughly fits the characteristics of our patient, the hypothesis of a late-onset pustular skin eruption secondary to mother's SARS-CoV-2 infection could be reasonably advanced. Parents of the patient in this manuscript have given written informed consent to the publication of their case details. [Extracted from the article]

I Dear Editor i , Recently, dupilumab, an anti-IL-4R antibody, has become available for the treatment of moderate-to-severe atopic dermatitis (AD).1-4 Baseline patient characteristics that can be used as predictors of response to dupilumab treatment in AD patients have not yet been identified. In conclusion, this study highlights that specific baseline patient characteristics may help to predict treatment outcomes and the time of a complete response to dupilumab in AD. [Extracted from the article]

Background: Thin nodular melanoma (NM) often lacks conspicuous melanoma‐specific dermatoscopic criteria and escapes clinical detection until it progresses to a thicker and more advanced tumour. Objective: To investigate the dermatoscopic morphology of thin (≤2 mm Breslow thickness) vs. thick (>2 mm) NM and to identify dermatoscopic predictors of its differential diagnosis from other nodular tumours. Methods: Retrospective, morphological case–control study, conducted on behalf of the International Dermoscopy Society. Dermatoscopic images of NM and other nodular tumours from 19 skin cancer centres worldwide were collected and analysed. Results: Overall, 254 tumours were collected (69 NM of Breslow thickness ≤2 mm, 96 NM >2 mm and 89 non‐melanoma nodular lesions). Light brown coloration (50.7%) and irregular brown dots/globules (42.0%) were most frequently observed in ≤2 mm NMs. Multivariate analysis revealed that dotted vessels (3.4‐fold), white shiny streaks (2.9‐fold) and irregular blue structureless area (2.4‐fold) were predictors for thinner NM compared to non‐melanoma nodular tumours. Overall, irregular blue structureless area (3.4‐fold), dotted vessels (4.6‐fold) and serpentine vessels (1.9‐fold) were predictors of all NM compared to non‐melanoma nodular lesions. Limitations: Absence of a centralized, consensus pathology review and cases selected form tertiary centres maybe not reflecting the broader community. Conclusions: Our study sheds light into the dermatoscopic morphology of thin NM in comparison to thicker NM and could provide useful clues for its differential diagnosis from other non‐melanoma nodular tumours. [ABSTRACT FROM AUTHOR]

Background: Hidradenitis suppurativa (HS) is a chronic, debilitating disease with a considerable effect on patient quality of life. Its clinical severity can be measured using different scoring systems; however, few of them include patient‐centred parameters. Objective: To create a new scoring system for HS that includes a quality‐of‐life instrument, the HIDRAdisk. Methods: This post hoc analysis was carried out within the framework of a multicentre, longitudinal, epidemiologic study conducted over 9 months on quality‐of‐life aspects of HS. The new severity score was created using as reference a question from the Subject Satisfaction Questionnaire (SSQ) concerning the severity of HS as evaluated by the patient. Associated variables were selected using univariable and multivariable logistic regression models. The discriminant capabilities of the final model and of the final score were evaluated by the area under the receiver operating characteristic curve and the Hosmer–Lemeshow test. Results: The study population included 308 patients with HS of any severity grade. According to the results of the regression models, the variables associated with the reference SSQ measure were number of inflammatory nodules, abscesses and draining fistulas; the HIDRAdisk score; and the number of subumbilical lesions. The HIDRAscore is obtained by the sum of the scores associated with the number of these parameters. Possible scores range from 0 to 10. Conclusion: The HIDRAscore is a new scoring system for HS severity which, in addition to the clinical evaluation by the physician, includes a validated patient‐reported outcome measure, the HIDRAdisk. [ABSTRACT FROM AUTHOR]

Background: Erosive pustular dermatosis of the scalp (EPDS) is characterized by crusted erosions or superficial ulcerations that lead to scarring alopecia. Objectives and Methods: We performed a multicentre retrospective clinical study including 56 patients (29 females and 27 males, mean age 62.7) with a confirmed EPDS in order to describe epidemiology, clinical findings and therapeutic choices of this disease. Results: Mechanical/chemical trauma was reported in 28.6%, a previous infection in 10.7%, a previous cryotherapy in 5.4% androgenetic alopecia in 48.2% and severe actinic damage in 25%. Trichoscopy showed absence of follicular ostia, tufted and broken hair, crusts, serous exudate, dilated vessels, pustules and hyperkeratosis. Histopathology revealed three different features, depending on the disease duration. The most prescribed therapy was topical steroids (62.5%), followed by the combination of topical steroids and topical tacrolimus (8.9%), systemic steroids (7.1%) and topical tacrolimus (5.4%). A reduction of inflammatory signs was observed in 28 patients (50%) treated with topical steroids and in all three patients treated with topical tacrolimus. Conclusion: The relatively high number of patients collected allowed us to identify a better diagnostic approach, using trichoscopy and a more effective therapeutic strategy, with high‐potency steroids or tacrolimus, which should be considered as first‐line treatment. [ABSTRACT FROM AUTHOR]

Background: Although live and teledermoscopic examination has been successfully used to achieve non‐invasive diagnosis of melanocytic skin lesions (MSLs), early melanoma (EM) and atypical nevi (AN) continue to be a challenge, and none of the various algorithms proposed have been sufficiently accurate. We designed a scoring classifier diagnostic method, the iDScore that combines clinical data of the patient with dermoscopic features of the MSL. Objective: To test the accuracy of the iDScore in differentiating EM from AN in a teledermoscopy setting and to compare it with intuitive diagnosis, the ABCD rule and the seven‐point checklist. Materials and methods: A dedicated teledermoscopy web platform was designed. This involved the following: (i) collecting a large integrated clinical–historical–dermoscopic data set of difficult MSLs from eight European dermatology centres; (ii) online testing, education and training in using the iDScore. A total of 904 images were combined with age, sex, lesion diameter and body site data and evaluated on the platform by 111 participants with four levels of skill in dermoscopy. Each testing session consisted of 30 blind cases to examine consecutively by the above four methods. 'Management decisions' and personal participant data were also recorded. Results: iDScore‐aided diagnosis achieved satisfactory diagnostic accuracy for all lesions, irrespective of centre of affiliation, showing an average AUC of 0.776 in all participant testing sessions. All skill groups improved their accuracy by 10–16% with respect to intuitive diagnosis and the other methods, showing high concordance and avoiding wrong management decisions. Conclusion: We demonstrated the validity of the iDScore method for managing suspicious MSLs in a large multicentric data set and a teledermoscopic setting. The platform designed for the iDScore project provides ready support for physicians of any dermoscopy skill level and is useful for education and training. [ABSTRACT FROM AUTHOR]

Background: Complete surgical excision is the preferred biopsy type for suspicious melanocytic lesions. However, partial biopsy is sometimes used in special situations. Previous studies have explored the effect of partial biopsy of a primary melanoma on patient outcome with controversial results. Objective: We performed a meta‐analysis on the influence of the type of biopsy of a primary melanoma on recurrence‐free survival (RFS) and melanoma‐related survival (MRS). Methods: Clinical trials, observational cohort studies and case–control studies reporting absolute number of recurrences and/or melanoma‐related deaths in patients undergoing a partial or excisional biopsy of melanoma were included in the meta‐analysis. Results: In all, the five included studies reported 3249 patients, 1121 (34.5%) of them in the partial biopsy group and 2128 (65.5%) in the excisional biopsy group. Despite a trend in favour of excisional biopsy in reducing the risk for recurrences, the forest plot related to RFS failed to demonstrate significant differences among groups (RR: 1.27; 95% CI 0.97–1.67; P: 0.09; random effects; I2: 55%). The forest plot showed no difference in the risk of dying for melanoma‐related causes for patients undergoing partial biopsy vs. excisions biopsy (RR: 1.50; 95% CI 0.98–2.30; P: 0.06; random effects; I2: 60%). Limitations: The majority of the studies were retrospective, and follow‐up time was not uniform among studies and not always reported. Conclusion: In conclusion, a partial biopsy can be performed in special situations, such as large primary tumours located in surgically sensitive areas, without altering MRS and RFS. [ABSTRACT FROM AUTHOR]

Herein, we describe three patients, with no history of SARS-CoV-2 infection, who developed skin reactions after receiving Pfizer-BioNTech (New York, NY, USA) COVID-19 vaccine. The patients in this manuscript have given written informed consent to the publication of their case details Conflict of interest The authors have no financial obligations or conflict of interest to declare. Purpuric lesions on the eyelids developed after BNT162b2 mRNA COVID-19 vaccine: another piece of SARS-CoV-2 skin puzzle?. [Extracted from the article]

We would also like to underline that three family clusters were psychologically stressed by the long lasting 5% permethrin cream treatment, especially for the skin irritation caused by the cream and also for the high economic expenses incurred to buy the medications. This type of therapy was very successful in our daily clinical practice, and the cases of relapses or non-responsiveness were rare and usually attributed to an incorrect application of the cream by the patients or to lack of treatment of asymptomatic family members. Guideline for the diagnosis and treatment of scabies in Japan (third edition): executive committee of guideline for the diagnosis and treatment of scabies. [Extracted from the article]

Considering only the 14 patients affected by conjunctivitis that performed preventive therapy, history of previous conjunctivitis was found in 6 patients (42.8% of the total). Considering the total of patients with facial eczema and peripalpebral eczema, (146 patients), the percentage of subjects who developed conjunctivitis is 9.5%. In our Dermatology Unit, from May 2018 to January 2020, we enrolled 277 patients affected by moderate-severe forms of atopic dermatitis for the treatment with dupilumab. [Extracted from the article]

Background: Mammary Paget's disease (MPD) is a rare intraepidermal adenocarcinoma of the nipple‐areola complex, associated with an underlying breast cancer in approximately 90% of cases. Delayed diagnosis of MPD is common. Its dermoscopic features have been ill defined in the literature. Objectives: To determine the clinical and dermoscopic features of MPD versus other dermatologic entities that involve nipple and areola. Methods: Members of the IDS were invited to submit any case of histologically confirmed MPD, as well as other benign and malignant dermatoses that involve the nipple and areola complex. A standardized evaluation of the dermoscopic images was performed and the results were statistically analyzed. Results: Sixty‐five lesions were included in the study, 22 (33.8%) of them MPD and 43 (66.2%) controls. The most frequent dermoscopic criteria of MPD were white scales (86.4%) and pink structureless areas (81.8%), followed by dotted vessels (72.7%), erosion/ulceration (68.2%) and white shiny lines (63.6%). The multivariate analysis showed that white scales and pink structureless areas were significant predictors of MPD, posing a 68‐fold and a 31‐fold probability of MPD, respectively. Split of the population into pigmented and non‐pigmented lesions showed that in pigmented MPD, pink structureless areas, white lines and grey granules and dots are positive predictors of the disease. Among non‐pigmented lesions, pink structureless areas, white lines, erosion/ulceration and white scales served as predictors of MPD. Conclusions: The most frequent profile of an individual with MPD is an elderly female with unilateral, asymptomatic, erythematous plaque of the nipple, dermoscopically displaying pink structureless areas, fine white scales, dotted and a few short linear vessels. In case of pigmentation we may also observe brown structureless areas and pigmented granules. Limitations: Small sample size, retrospective design. [ABSTRACT FROM AUTHOR]

Background: Pink skin tumours are difficult to differentiate, clinically and dermoscopically. In previous studies, mainly focused on pigmented lesions, pattern analysis provided the best sensitivity and specificity values, as compared to other algorithms. These findings suggest that the global dermoscopic appearance, based on the evaluation of prevalent features, could represent a valuable and practical approach even when dealing with pink lesions. Objective: In this study, we aimed to evaluate the diagnostic accuracy of a new dermoscopic approach for pink tumours based on the prevalent criterion, as compared to a standard diagnostic method (Menzies algorithm). Methods: The databases of two referral centres were retrospectively evaluated to retrieve dermoscopic images of amelanotic/hypomelanotic skin lesions. Two experts in dermoscopy, blinded for the final diagnosis and for clinical and demographic information, evaluated separately dermoscopic pictures of 1000 lesions according to the Menzies score and to the prevalent criterion method. Results: According to the high sensitivity model of the Menzies score, 129 (12.9%) lesions were considered as non‐suspicious (of which 16 were false negative) and 871 (87.1%) as suspicious (of which 212 were false positive), with 97.6% sensitivity and 34.8% specificity. According to the high specificity model, 370 (37%) lesions were evaluated as non‐suspicious (of which 105 were false negative) and 630 (63%) as suspicious (of which 60 were false positive), with 84.4% sensitivity and 81.5% specificity. Concerning the prevalent criterion method, 316 (31.6%) lesions were evaluated as non‐suspicious (of which 46 were false negative) and 684 (68.4) as suspicious (of which 55 were false positive), with 93.2% sensitivity and 83.1% specificity. Conclusions: This study demonstrated that focusing on the prevalent dermoscopic features could allow to detect malignant pink tumours with similar sensitivity but higher specificity than using the conventional Menzies scoring system. [ABSTRACT FROM AUTHOR]

Background: A variety of cutaneous smooth muscle neoplasms may arise in the skin and are frequently unrecognized by clinicians. There is sparse data relating to the dermoscopy of piloleiomyomas (PL), and nothing has been published about the dermoscopy of angioleiomyomas (AL) and leiomyosarcomas (LS). Objectives: To evaluate the morphological findings of a large series of cutaneous PL, AL and LS under dermoscopic observation, comparing these findings among them. Methods: Digital dermoscopic images of 136 histopathologically confirmed cases of cutaneous smooth muscle neoplasms (114 PL, 13 AL and 9 LS) collected from 10 Hospitals in Spain, Austria and Italy were evaluated for the presence of dermoscopic structures and patterns. Results: The pattern composed of a symmetric, total delicate pigment network with the variable presence of multiple hypopigmented areas in a painful lesion is the most common dermoscopic pattern associated with PL. This pattern was found in 69.3% of PL and in no cases of AL and LS. The most common and characteristic pattern associated with AL was the one composed of symmetric pink‐reddish tumour with vessels, white structures and the absence of ulceration, which was found in 46.2% of AL, but also in 3.5% of PL, and in 22.2% of LS. Finally, the most common pattern associated with LS was the one composed of an asymmetric, multilobulated tumour with linear‐irregular or polymorphic‐atypical vessels and white structures, which was found in 44.4% of cases, but also in 0.9% of PL and in 15.4% of AL. Conclusion: Dermoscopy is helpful in improving the diagnostic accuracy of PL. The dermoscopic patterns associated with AL and LS were more variable and less specific. [ABSTRACT FROM AUTHOR]

Background: Dermoscopy revealed to be extremely useful in the diagnosis of early melanoma, the most important limitation being its subjectivity in giving a final diagnosis. To overcome this problem, several algorithms and checklists have been proposed. However, they generally demonstrated modest level of diagnostic accuracy, unsatisfactory concordance between dermoscopists and/or poor specificity. Objective: To test a new methodological approach for the differentiation between early melanoma and atypical nevi, based on an integrated clinical‐anamnestic dermoscopic risk scoring system (iDScore). Methods: We selected a total of 435 standardized dermoscopic images of clinically atypical melanocytic skin lesion (MSL) excised in the suspect of malignancy (i.e. 134 early melanomas – MM – and 301 atypical nevi). Data concerning patient age and sex and lesion dimension and site were collected. A scoring classifier was designed based on this data set integrated with the dermoscopic evaluations performed by three experts blinded to histological diagnosis. Results: A total of seven dermoscopic structures, three age groups (30–40 years, 41–60 years and >60 years), two maximum diameter categories (5–10 mm and >10 mm) and three body areas (i.e. frequently, chronically and seldom photoexposed sites) were selected by the scoring classifier as interdependently significant variables. The total risk score (S) of a lesion resulted from the simple sum of partial scores assigned to each selected variable. The iDScore‐aided diagnosis showed an high accuracy (receiver operating characteristic‐area under the curve = 0.903; IC: 95% = 0.887–0.918). A risk‐based criticality scale corresponding to different S ranges was proposed. Conclusion: The iDScore checklist is proposed as a feasible and efficient tool to support dermatologists in non‐invasive differentiation between atypical nevi and early MM on the basis of few selected clinical‐anamnestic data and standardized dermoscopic features. [ABSTRACT FROM AUTHOR]

During the first phase of European epidemic of COVID-19, a contemporary outbreak of chilblain-like lesions (CLL) has been reported.1 After that, hundreds of similar cases have been described in the world. In Italy, during the trimester March-April-May we experienced the majority of cases of COVID-19 and contemporarily of CLL.2-4 During summertime, a dramatic decrease of infected patients was observed, and in that context, CLL were not reported anymore. CLL typically appeared in young otherwise healthy patients with no proven SARS-CoV-2 infection, and most studies did not show positivity of PCR of serology. [Extracted from the article]

I Dear Editor i , Naevi typically involute after the fourth decade of life and are rare in the elderly.1,2 However, the rate at which naevi disappear with age varies greatly with some individuals still having large numbers of naevi in late middle age. Melanocytic lesions fulfilled the following 4 criteria: (i) a clinical-dermoscopic diagnosis of enlarging naevus with a peripheral rim of brown clods as in accordance with Kittler4; (ii) lesions that showed a growth and maintained a growth were routinely excised; (iii) no other dermoscopic signs of melanoma, and (iv) a histopathologic diagnosis of naevus or melanoma. [Extracted from the article]

Discontinuation rates ranged from 1.4% for patients using guselkumab to 5.5% for those treated with infliximab, when the decision was taken by the patients, while ranged between 0.5% for ixekizumab-treated patients and 2.8% for adalimumab-treated when the decision was taken after dermatological consultation. Patients and dermatologists are satisfied using biologics for psoriasis treatment. The impact of COVID-19 pandemic on patients with chronic plaque psoriasis being treated with biologic therapy: the Northern Italy experience. [Extracted from the article]

A demographic "revolution" has been taking place in the last decades: the world population, due to an increase in life expectancy, is ageing.1 Centenarians are no longer a rarity: they are 14 000 in Italy, and other countries, such as Japan, have more than 70 000 most of which are women.2 Data on skin surgery in the elderly have been reported only for patients up to 75 years old3; however, no data are available for centenarians. The lesions excised were as follows: 9 squamous cell carcinomas (SCC), 8 basal cell carcinomas (BCC) and 1 melanoma. Cutaneous surgery under local anesthesia in very elderly patients 90 years of age and older is as safe as in elderly patients ranging in age from 75 to 80 years old. [Extracted from the article]

We have recently noticed an outbreak of chilblain-like lesions in Italy contemporarily to COVID-19 epidemic. Pictures of patients were uploaded in 54 patients, with 31/54 presenting with erythematous-oedematous lesions (Fig. At time of diagnosis, most patients presented active lesions, so it was not possible to establish the overall duration of the lesions. [Extracted from the article]

We report the case of a 50-year-old man affected by a moderate form of atopic dermatitis and hidradenitis suppurativa (HS) (Fig. a and b). Previously, he received a diagnosis of hand psoriasis associated with a moderate form of hidradenitis suppurativa and he was treated with the anti-TNF-alfa antibody adalimumab, at the dosage for hidradenitis suppurativa. [Extracted from the article]

Abstract: Background: Ingenol mebutate (IngMeb) 0.015% gel is an approved field treatment option for non‐hyperkeratotic non‐hypertrophic actinic keratosis (AK) of face and scalp. Efficacy of IngMeb has been assessed only on a clinical ground, in the majority of studies. Dermoscopy is a pivotal tool for the diagnosis of AK, while its role in evaluating the response to non‐surgical therapies for AK has not been fully defined. Objectives: Our study aims to determine whether some dermoscopic features of AK of the face and scalp areas may independently predict the response to IngMeb therapy. Methods: Clinical and dermoscopic responses, 1 month after 0.015% IngMeb therapy, were retrospectively evaluated using a per‐patient and per‐lesion approach. Safety was evaluated through local skin reaction composite score calculation. Demographic, clinical and dermoscopic factors were then evaluated via univariate and multivariate logistic regression analysis to assess independent predictors of response. Results: Fifty‐five patients with 245 AKs were enrolled. Clinically, per‐patient response evaluation identified 25 (45.4%) poor/partial and 30 (54.5%) complete responders, corresponding on a per‐lesion approach to 66 (26.9%) and 179 (73.1%) AKs, respectively. Dermoscopy reclassified 14 patients in the per‐patient and 48 AKs in the per‐lesion analysis from complete to poor/partial responders. Multivariate logistic regression analysis showed that AKs dermoscopically characterized by red pseudonetwork and located on the face were independently associated with a complete dermoscopic response to 0.015% IngMeb therapy, while microerosions were negative predictors. Conclusion: Specific dermoscopic features of AK may predict the response to 0.015% IngMeb therapy, together with the location on the face. [ABSTRACT FROM AUTHOR]

Abstract: Background: Mycosis fungoides (MF) is the major subtype of cutaneous T‐cell lymphomas (CTCL). It usually has a prolonged indolent clinical course with a minority of cases acquiring a more aggressive biological profile and resistance to conventional therapies, partially attributed to the persistent activation of nuclear factor‐kappa B (NF‐κB) pathway. In the last decade, several papers suggested an important role for the FK506‐binding protein 51 (FKBP51), an immunophilin initially cloned in lymphocytes, in the control of NF‐κB pathway in different types of human malignancies. Objectives: We aimed to investigate the possible value of FKBP51 expression as a new reliable marker of outcome in patients with MF. Methods: We assessed by immunohistochemistry (IHC) FKBP51 expression in 44 patients with MF, representative of different stages of the disease. Immunohistochemical results were subsequently confirmed at mRNA level with quantitative PCR (qPCR) in a subset of enrolled patients. In addition, IHC and qPCR served to study the expression of some NF‐κB‐target genes, including the tumour necrosis factor receptor‐associated factor 2 (TRAF2). Results: Our results show that FKBP51 was expressed in all evaluated cases, with the highest level of expression characterizing MFs with the worst prognosis. Moreover, a significant correlation subsisted between FKBP51 and TRAF2 IHC expression scores. Conclusions: We hypothesize a role for FKBP51 as a prognostic marker for MF and suggest an involvement of this immunophilin in deregulated NF‐κB pathway of this CTCL. [ABSTRACT FROM AUTHOR]

We performed a retrospective descriptive cohort study based on chart reviews of patients who excised a pT1b and pT2a melanoma between January 2017 and July 2021 at our Institution to assess the rate of positive SLNB. I Editor i , Sentinel lymph node biopsy (SLNB) is an essential step of melanoma staging,being assessed as one of the most significant clinicopathological prognostic factors to determine survival. Overall, SLN metastases occur in more than 10% of patients with primary melanomas >1 mm in thickness (pT2-pT4), in approximately 5% to 12% of patients with melanomas ranging from 0.8 to 1.0 mm (pT1b) and are very infrequent (<5%) in melanomas <0.8 mm (pT1a-pT1b).1Consequently, consensus guidelines recommend offering SLNB for pT2 melanoma patients, and to discuss and consider it in pT1b melanoma patients.2 Noteworthy, AJCC guidelines also state that "pathological N category is not required for T1 melanomas". [Extracted from the article]