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Inherited epidermolysis bullosa (EB) encompasses a group of rare genetic disorders of the epidermal and dermal-epidermal junction complex, characterized by fra- gility of the skin and the mucous membranes, causing blistering and erosions after minor injury. The different types of EB present extreme phenotype variability; while some are mild, chronic and compatible with life, others are severe and associated with complications, morbidity, and increased mortality. Skin and mucous membranes are primarily affected by EB, but extracutaneous organs may be involved. The main types of EB include EB simplex (EBS), junctional EB (JEB), dystrophic EB (DEB), and Kindler syndrome (KS).

A 97-year-old man with a previous personal history of multiple nonmelanoma skin cancers presented with a fast-growing, ulcerated reddish nodule on his chest. The nodule was surgically removed, and hematoxylin and eosin stains of the specimen showed an asymmetrical, nonpigmented lesion with architectural and structural impairment, round cells with clear, whitish, foamy cytoplasm, multiple dermal mitoses and nuclear pleomorphism. Our first hypothesis was sebaceous carcinoma, a rare malignant neoplasm derived from epithelial cells showing sebaceous differentiation. A further histopathologic examination showed the presence of pigment in a few areas of the neoplasm. On immunohistochemical study, neoplastic cells were negative for wide-spectrum cytokeratin and diffusely positive for S-100, MART-1, and HMB-45 proteins. Our final diagnosis was nodular malignant melanoma (MM) with balloon epithelioid cells, a "bizarre" presentation of MM in vertical growth phase, mimicking metastatic and primary neoplasms of different lineage derivations. (C) 2018 The Author(s) Published by S. Karger AG, Basel

Skin biopsy is an important procedure for a correct diagnosis of varying skin conditions, from inflammatory to neoplastic diseases. Nevertheless, some authors still consider this procedure a high risk in patients affected by leg ulcers (LUs) and prefer reserving it for selected cases [1].

In the last 5 years, several cases of the drug-induced variant have been reported during treatment of metastatic disease with immunotherapy and targeted therapy.The pathogenesis of targeted therapy-associated Sweet syndrome and its significance as a putative marker of therapeutic response remain to be ascertained. Our patient’s skin eruption was temporally related to the beginning of targeted therapy treatment and meets allthe criteria for the drug-induced form.The molecular mechanisms leading to Sweet syndrome during melanoma could differ depending on the types of treatment.

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Spitz nevi are benign melanocytic neoplasms characterized by epithelioid or spindle melanocytes or both. In some rare cases their presentation overlaps with the clinical and histopathologic features of malignant melanoma, so a differential diagnosis can be difficult to make. Intermediate forms between Spitz nevi and malignant melanoma, with unpredictable behavior, have been called atypical Spitz tumors. A literature search was performed to review the clinical, dermoscopic, genetic, and histopathologic aspects of spitzoid tumors. Spitz nevi mainly occur in children, with no predilection for sex, and in young women. Common sites are the head and lower arms, where Spitz nevi present as pink nodules or hyperpigmented plaques. Spitzoid lesions may have diverse dermoscopic patterns: vascular, starburst, globular, atypical, reticular, negative homogeneous, or targetoid. The management of spitzoid lesions can be invasive or conservative; surgical excision is usually reserved for those with doubtful features, whereas clinical and dermoscopic follow-up is preferred for typical pediatric Spitz nevi. The role of sentinel lymph node biopsy in atypical Spitz tumors is debated. Immunohistochemistry and new molecular techniques such as comparative genomic hybridization, polymerase chain reaction, and fluorescence in situ hybridization offer new diagnostic perspectives, investigating genetic alterations that are specific for malignant melanoma or for Spitz nevi.

Nevus comedonicus is a rare, benign hamartoma of the pilosebaceous unit that may be isolated or part of the nevus comedonicus syndrome. Although rare in children, complication by hidradenitis suppurativa-like lesions has been described. We present a report of a 9-year-old girl in whom surgical excision was curative, with a review of the relevant literature.

Atopic dermatitis (AD) is a common chronic inflammatory skin disease that can affect all age groups. It is characterized by a relapsing course and a dramatic impact on quality of life for patients. Environmental interventions together with topical devices represent the mainstay of treatment for AD, in particular emollients, corticosteroids, and calcineurin inhibitors. Systemic treatments are reserved for severe cases. Phototherapy represents a valid second-line intervention in those cases where non-pharmacological and topical measures have failed. Different forms of light therapy are available, and have showed varying degrees of beneficial effect against AD: natural sunlight, narrowband (NB)-UVB, broadband (BB)-UVB, UVA, UVA1, cold-light UVA1, UVA and UVB (UVAB), full-spectrum light (including UVA, infrared and visible light), saltwater bath plus UVB (balneophototherapy), Goeckerman therapy (coal tar plus UVB radiation), psoralen plus UVA (PUVA), and other forms of phototherapy. In particular, UVA1 and NB-UVB have gained importance in recent years. This review illustrates the main trials comparing the efficacy and safety of the different forms of phototherapy. No sufficiently large randomized controlled studies have been performed as yet, and no light modality has been defined as superior to all. Parameters and dosing protocols may vary, although clinicians mainly refer to the indications included in the American Academy of Dermatology psoriasis guidelines devised by Menter et al in 2010. The efficacy of phototherapy (considering all forms) in AD has been established in adults and children, as well as for acute (UVA1) and chronic (NB-UVB) cases. Its use is suggested with strength of recommendation B and level of evidence II. Home phototherapy can also be performed; this technique is recommended with strength C and level of evidence III. Phototherapy is generally considered to be safe and well tolerated, with a low but established percentage of short-term and long-term adverse effects, with the most common being photodamage, xerosis, erythema, actinic keratosis, sunburn, and tenderness. A carcinogenic risk related to UV radiation has not been excluded. Phototherapy also has some limitations related to costs, availability, and patient compliance. In conclusion, phototherapy is an optimal second-line treatment for AD. It can be used as monotherapy or in combination with systemic drugs, in particular corticosteroids. It must be performed conscientiously, especially in children, and must take into account the patient’s features and overall condition.

BACKGROUND Mohs surgery (MS) is regarded as one of the most efficient surgical procedures for the treatment of skin tumors. OBJECTIVES Delineating tumor margins accurately is important in limiting broad excisions during conventional surgery and in reducing the number of stages during Mohs procedure. METHODS This study aimed to evaluate the role of 2 simple procedures, curettage and videodermoscopy (VDS), in determining margins during MS for the treatment of basal cell carcinoma (BCC) of the head and neck. RESULTS The use of both procedures offered a good intraoperative margin definition and consequently small surgical defects in 197 patients affected by BCC. Recurrences in basal cell cancers, which included both primary and recurrent lesions, occurred less frequently than in the institution's previous experience, appearing in only 8 of 197 cases (approx. 4%). CONCLUSION In the authors' experience, both VDS and curettage were found advantageous in delineating tumor margins while treating BCC with MS.

neonatal and infantile skin diseases are frequently encountered in the clinical practice and represent worldwide a socioeconomic issue. They encompass a wide range of acquired or congenital conditions, including infections, vascular lesions and inflammatory diseases and can present with different degrees of severity, leading in some cases to dramatic complications. Areas covered: In this paper we report the most recent evidences on the management of some common skin diseases in neonates and infants. Hemangiomas, viral, fungal and bacterial infections, omphalitis, atopic and seborrhoeic dermatitis, napkin disease will be treated and discussed. Expert opinion: The majority of the dermatologic alterations in neonates are physiological, transient and do not require any treatment, thus the parents can be reassured about the good prognosis. However, in some cases, serious conditions must be excluded. In particular neonatal and infantile infections should be promptly recognized and properly managed, to avoid severe complications. The therapeutic options include traditional and, although few, innovative medical treatments, which will be carefully taken into consideration by the expert Dermatologists and Paediatricians.

Atopic Dermatitis (AD), a common skin disease, can occur in patients of all age, gender and ethnicity. It is an inflammatory affection, characterized by chronic and highly debilitating behavior. First-line interventions against AD include environmental measures and topical emollients, corticosteroids or calcineurin inhibitors. When these measures are not sufficient, phototherapy represents an efficient second-line option of treatment; it can be administered on its own, or in the most severe cases combined with systemic medicaments such as corticosteroids.Different types of light therapy, including photochemotherapy, have been tested in the past and in recent years for AD: in particular, ultraviolet A1 (UVA1) and narrow band ultraviolet B (NB-UVB) have been reported in the literature as the most effective resources, respectively for acute and chronic AD. However, to date, no guidelines have been realized concerning the use of phototherapy for AD, as no light form has been defined superior to the others. The most reliable protocols and dosimetry are standardized within the American Academy of Dermatology (AAD) psoriasis guidelines.In adults and children over 12 years (8 years for NB-UVB) phototherapy is recommended with strength B and level of evidence II (excluding home phototherapy, which is recommended with strength C and level of evidence III). It is usually safe and well tolerated; however its short- and long-term adverse effects are the same as those observed when light therapy is performed for other pathologic conditions. Erythema and photodamage are in particular quite frequent; moreover it has not been clarified whether UV radiation may induce neoplastic cellular transformation. For all these reasons, the use of phototherapy must be chosen only after a comprehensive and careful evaluation of the patient's features and compliance, as well as of the limitations of the procedure due to costs and availability.

Ipilimumab is an immunomodulatory antibody directed against cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4), which is administered to patients with advanced melanoma, with a proven positive effect on overall survival. The cutaneous adverse effects (AEs) of ipilimumab are relatively frequent, although described as usually mild and rarely life threatening. To describe a three-year experience of a single institute in detecting and managing cutaneous AEs. A cohort of patients (n = 41) treated with ipilimumab (3 mg/kg/three weeks) for metastatic melanoma, from 2013 to 2016, was investigated for adverse cutaneous events. On dermatological evaluation, 34.1% of the patients in our series developed cutaneous AEs: rash (7.3%; n = 3), folliculitis (7.3%; n = 3), mucositis (2.4%; n = 1), rosacea (2.4%; n = 1), eczema (2.4%; n = 1), acneiform eruption (2.4%; n = 1), syringometaplasia mucinosa (2.4%; n = 1), Stevens-Johnson syndrome (2.4%; n = 1), and vitiligo (4.9%; n = 2). These were all Grade 1 and 2 AEs, except for the case of Stevens-Johnson syndrome (Grade 4). On a patient-reported scale, 4.9% (n = 2) and 9.8% (n = 4) of the patients complained of severe xerosis and pruritus, respectively. Ipilimumab was relatively well tolerated in our series, mainly causing mild cutaneous AEs, which, in our experience, responded satisfactorily to conventional therapies. Only in one case was the treatment discontinued, due to Grade 4 side effects.

Skin disinfection with chlorhexidine gluconate has not been standardized in preterm infants. We present 5 cases of chemical burns that occurred within the first 2 days of life in very low birth weight neonates after skin disinfection with aqueous and alcohol-based chlorhexidine solutions.

A one-month-old infant was admitted to the paediatric unit with high fever (38.5°C) and irritability. He was otherwise healthy and born at term. His parents reported contact with a cousin with high fever. The physical examination was unremarkable except for tense fontanelle. Suspecting infection, an antibiotic (amoxicillin) and antiviral (ganciclovir) therapies were started. However, the blood count, the C-reactive protein and the cerebrospinal fluid analysis were normal, …