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A nationwide cross-sectional online survey was administered to dermatologists managing patients with moderate-to-severe plaque psoriasis across Italy to obtain real-world dermatologists' perspectives on the impact of psoriasis and its treatment on patients' daily lives and quality of life (QoL). A total of 91 dermatologists (aged 39.1 ± 11.2 years) completed a 31-question survey and workshop sessions were undertaken in order to identify the best management approach to achieve patient wellbeing. Social (4.2 ± 0.1), physical (4.26 ± 0.2) and mental components (4.1 ± 0.3) were rated by dermatologists as contributing to patient wellbeing to similar extents. While a high proportion (85.4%; rating of 4.3 out of 5) of dermatologists felt that they considered the QoL of patients, a lower proportion (69.6%; rating of 3.7 out of 5) felt that patients were satisfied in this regard. The psoriasis area and severity index and body surface area were the instruments most frequently used to assess the physical domain, while interviews/questions and the dermatology life quality index were used to assess social and mental domains, with only 60% of dermatologists following up on these aspects. The importance of investigating the presence of comorbidities was recognized but not always carried out by many dermatologists, (>70%), particularly for obesity and anxiety/depression. This survey identified key components contributing to barriers impacting on the QoL of patients with moderate-to-severe psoriasis from the perspective of the dermatologist. [ABSTRACT FROM AUTHOR]

Purpose: 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. [ABSTRACT FROM AUTHOR]

Melanomas and nevi displaying regression features can be difficult to differentiate. To describe reflectance confocal microscopy features in benign and malignant pigmented skin lesions characterized by regression features in dermoscopy. Observational retrospective study. Inclusion criteria were presence of dermoscopic features of regression; availability of clinical, dermoscopic and RCM imaging; definite histopathologic diagnosis. The study sample comprised 217 lesions; 108 (49.8%) melanomas and 109 were benign lesions, of which 102 (47.0%) nevi and 7 (3.2%) lichen planus‐like keratosis (lplk). Patients with melanoma were significantly older than those with benign lesions (61.9 ± 15.4 vs 46.1 ± 14.8; P < 0.001) and a higher proportion of melanomas displayed dermoscopic regression structures in more than 50% of lesion surface (n = 83/108; 76.9%; P < 0.001). On RCM examination, pagetoid cells were significantly more reported in melanoma group, than in benign lesions (86.1% vs 59.6%; P < 0.001) and were more frequently widespread distributed (65.6% vs 20.0%; P < 0.001) and both dendritic and roundish (36.6% vs 15.4%; P < 0.001) in shape. Aspecific architecture at the dermo‐epidermal junction (DEJ) was more commonly seen among melanomas than benign lesions (23.1% vs 11.9%; P = 0.002) with higher presence of dendritic and both dendritic and roundish atypical cells at the DEJ (28.7% vs 18.3% and 19.4% vs 3.7%; P < 0.001, respectively). Focal pagetoid infiltration and ringed or clod patterns were more commonly seen in benign lesion. In conclusion, the correct interpretation of regressing lesions remains a challenge, assessing carefully the extent and characteristics of architectural and cytologic atypia on RCM is an additional piece of the complex puzzle of melanoma diagnosis. [ABSTRACT FROM AUTHOR]

Teledermatology and smartphone mobile applications have been at the forefront of advances in the screening and management of patients with skin lesions over the past decade. The Spanish teledermatology network, established in 2004 in the area surrounding the dermatology clinic in Seville, has now managed over 50,000 teleconsultations and has led to validated improvements in waiting times for referral and surgery, allowed patients to be treated in local settings, and improved the early diagnosis and initial prognosis of patients diagnosed with melanoma. Both teledermatology and smartphone mobile applications can be used as training tools to improve the diagnostic skills of physicians and dermatologists. They can also serve as rapid and reliable methods to prioritize patient care and ensure that specialized services and treatments are accessible regardless of patient circumstances. [ABSTRACT FROM AUTHOR]

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Gorlin-Goltz (GS) syndrome is an autosomal dominant disease linked to a mutation in the PTCH gene. Major criteria include the onset of multiple basal cell carcinoma (BCC), keratocystic odontogenic tumours in the jaws and bifid ribs. Dermoscopy and reflectance confocal microscopy represent imaging tools that are able to increase the diagnostic accuracy of skin cancer in a totally noninvasive manner, without performing punch biopsies. Here we present a case of a young woman in whom the combined approach of dermoscopy and RCM led to the identification of multiple small inconspicuous lesions as BCC and thus to the diagnosis of GS syndrome. [ABSTRACT FROM AUTHOR]

Abstract: The differential diagnosis of pigmented macules on the mottled chronic sun-damaged skin of the face is challenging and includes lentigo maligna (LM), pigmented actinic (solar) keratosis, solar lentigo, and lichen-planus-like keratosis. Although dermatoscopy improves the diagnostic accuracy of the unaided eye, the accurate diagnosis and management of pigmented facial macules remains one of the most challenging scenarios in daily practice. This is related to the fact that pigmented actinic (solar) keratosis, lichen-planus-like keratosis, and LM may reveal overlapping criteria, making their differential diagnosis clinically difficult. For this reason, practical rules have been introduced, which should help to minimize the risk for inappropriate diagnosis and management of LM. [Copyright &y& Elsevier]

There are three possible explanations for the improved melanoma recognition when a clinician uses dermoscopy: first, the presence of early dermoscopy signs that become visible in melanoma much before the appearance of the classical clinical features; second, an increased attitude of clinicians to check more closely clinically banal-looking lesions; and third, an improved attitude of clinicians to monitor their patients. In this review, the light and the dark sides of melanoma screening are briefly discussed, including the need to find better strategies to decrease the number of unnecessary excision of benign lesions on one hand, and to finally decrease melanoma mortality rates on the other. [ABSTRACT FROM AUTHOR]

OBJECTIVE The objective was to describe the clinical and dermoscopic characteristics of difficult-to-diagnose melanomas (DDM). DESIGN This study was a retrospective analysis of clinical data and dermoscopic images in a series of excised melanomas. SETTING Cases were obtained from the database registers of three public hospitals in Barcelona (Spain), Naples (Italy), and Graz (Austria). PATIENTS A total of 97 tumors with a main preoperative diagnosis different from melanoma and without sufficient criteria to be diagnosed clinically and dermoscopically as melanoma were studied. We studied clinical data from the patients and lesions, mean reason for excision, and consensus dermoscopic description of the lesions according to pattern analysis performed by a panel of four dermoscopists to obtain clues that allow these melanomas to be recognized. RESULTS Ninety-three DDMs were evaluated. Three main dermoscopic categories of DDM have been identified: (1) DDMs lacking specific features (16/97), (2) DDMs simulating nonmelanocytic lesions (14/93), and (3) DDMs simulating benign melanocytic proliferations (67/93). The reasons for excision were (1) the subjective history of change referred by the patient (38% of cases), (2) the presence of clinical and/or dermoscopic “hints” for biopsy (33% of cases), and (3) the objective evidence of changes detected by digital dermoscopic follow-up (29% of cases). CONCLUSIONS A diagnostic algorithm is proposed not to miss melanoma. [ABSTRACT FROM AUTHOR]

The lack of consensus among clinicians and pathologists due to the mixture of clinical and histopathological features used to define the various melanocytic naevi underscores the need of a better classification system for these benign lesions. We describe a dermoscopic classification system for melanocytic naevi that is directed to clinicians dealing with the early diagnosis of melanoma, as well to pathologists, in order to promote better communication between these different specialists. [ABSTRACT FROM AUTHOR]

Examines the dermoscopy features of congenital melanocytic nevus (CMN). Importance of regular skin examination of patients with CMN; Use of dermoscopy to diagnose CMN; Risk of malignant transformation into melanoma.

Subcorneal hematoma is a pigmented skin lesion usually occurring on palms or soles after a trauma or sport activity. Clinically, it may exhibit overlapping features with acral melanoma or acral melanocytic nevi, leading to unnecessary excision of this otherwise harmless skin lesion. The objective was to describe the dermoscopic features in a series of subcorneal hematomas. Dermoscopic images of 15 subcorneal hematomas were evaluated for the presence of different colors and dermoscopic structures. In our series, a red-black hue was the most frequent color seen by dermoscopy (40% of the lesions) and a homogeneous pattern of pigmentation was the most frequent dermoscopic structure (53.3%). Remarkably, 40% of the lesions exhibited a parallel-ridge pattern that is usually found in early melanoma of palms and soles. In 46.7% of the lesions, red-black globules were additionally seen at the periphery as satellites disconnected from the lesion's body. Only two lesions showed either parallel-furrow or fibrillar pattern. A scratch test performed in four lesions, allowed complete or partial removal of the pigmentation. Dermoscopic features of subcorneal hematomas may be similar to those observed in acral melanocytic lesions. Nevertheless, in most cases the correct diagnosis can be facilitated by the presence of a red-black homogeneous pigmentation, often combined with satellite globules. A positive scratch test may be considered as an additional diagnostic clue. IRIS ZALAUDEK, MD, GIUSEPPE ARGENZIANO, MD, H. PETER SOYER, MD, JEAN-HILAIRE SAURAT, MD, AND RALPH P. BRAUN, MD HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article about the importance of dermoscopy for the diagnosis of pigmented skin lesions, a current issue in telemedicine.

We examined a combined (dermoscopic–pathological) approach to the telediagnosis of melanocytic skin lesions. A store-and-forward teleconsultation was simulated. Dermoscopic and histopathology images from 12 melanocytic lesions were stored in a telepathology workstation. A dermoscopy consultant, a histopathology consultant and an expert in dermoscopic–pathological correlation gave their diagnoses and comments on the images. The consensus diagnosis between two teleconsultants on the original histological slides was regarded as the gold standard. The diagnostic accuracy was 83% (including one false negative diagnosis of malignancy) for teledermoscopy and 100% for teledermatopathology. The combined approach detected one case that showed a much greater atypia on dermoscopy than on histopathology. In this case step-sections of the sample were deemed to be required for definite diagnosis. The combined approach was helpful in detecting macroscopic and microscope sampling errors of melanocytic lesions during teleconsultation. [ABSTRACT FROM AUTHOR]

In this article, the authors review different approaches to the diagnosis of skin tumors using noninvasive diagnostic tools, which are becoming increasingly reliable and, as a consequence, increasingly popular among physicians and patients. Especially in the realm of pigmented skin lesions, dermoscopy and sonography may add useful information to the clinical constellation, improving the diagnostic performance for early diagnosis of melanoma and for differentiating various melanocytic and nonmelanocytic pigmented lesions. More recently, confocal scanning laser microscopy was introduced as a novel technique that enables the in vivo study of the skin at a nearly histologic resolution, being of diagnostic value in various skin disorders, including basal cell carcinoma and pigmented skin lesions. These modalities have various other potential applications besides diagnosis, including lesion's selection for biopsy, determination of appropriate therapeutic modalities, verification of treatment efficacy, and decision of surgical margins. Finally, a hint to the use of cytodiagnosis for basal cell carcinoma is provided. E. RUOCCO, MD, G. ARGENZIANO, MD, G. PELLACANI, MD, AND S. SEIDENARI, MD HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [ABSTRACT FROM AUTHOR]

Background: In Italy, comprehensive national studies, about mortality rates for cutaneous melanoma, are missing. The aim of this study was to analyze the trend of cutaneous melanoma mortality in Italy from 1982 to 2016. Methods: Data on death certificates were obtained from Italian National Institute of Statistics (ISTAT: Istituto nazionale di STATistica, Indagine sulle cause di morte). Mortality rates were age‐standardized on the European population 2013 and presented per 100,000 individuals. Age‐adjusted mortality rates (AMRs) were calculated by sex, age group, and geographic areas. To identify changes in mortality rate trends, a joinpoint regression model was used, and the annual percent change (APC) was estimated. Results: In Italy, a total number of 49,312 patients (44.0% women) died for cutaneous melanoma from 1982 to 2016. Melanoma mortality rates significantly increased in the study period in both sexes, with higher AMR values and a steeper increase in men (from 2.71 to 4.02; APC: 1.43; 95% CI 1.26–1.61) than women (from 1.94–2.10; APC: 0.23; 95% CI 0.00–0.46). The largest difference between men and women was observed in patients aged ≥65 years with APC of 2.17 in men (95% CI 1.97–2.37) and 0.37 in women (95% CI 0.08–0.66). Conclusion: In conclusion, the melanoma mortality rate in Italy progressively increased especially in elderly men. Several hypotheses might explain the observed age and geographic differences such as sun exposure habits or different strategies of prevention campaigns. [ABSTRACT FROM AUTHOR]

Background: The detection of cutaneous metastases (CMs) from various primary tumours represents a diagnostic challenge. Objectives: Our aim was to evaluate the general characteristics and dermatoscopic features of CMs from different primary tumours. Methods: Retrospective, multicentre, descriptive, cross‐sectional study of biopsy‐proven CMs. Results: We included 583 patients (247 females, median age: 64 years, 25%–75% percentiles: 54–74 years) with 632 CMs, of which 52.2% (n = 330) were local, and 26.7% (n = 169) were distant. The most common primary tumours were melanomas (n = 474) and breast cancer (n = 59). Most non‐melanoma CMs were non‐pigmented (n = 151, 95.6%). Of 169 distant metastases, 54 (32.0%) appeared on the head and neck region. On dermatoscopy, pigmented melanoma metastases were frequently structureless blue (63.6%, n = 201), while amelanotic metastases were typified by linear serpentine vessels and a white structureless pattern. No significant difference was found between amelanotic melanoma metastases and CMs of other primary tumours. Conclusions: The head and neck area is a common site for distant CMs. Our study confirms that most pigmented melanoma metastasis are structureless blue on dermatoscopy and may mimic blue nevi. Amelanotic metastases are typified by linear serpentine vessels and a white structureless pattern, regardless of the primary tumour. [ABSTRACT FROM AUTHOR]

Nonmelanoma skin cancers (NMSC), comprising basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), are typically encountered on photo‐exposed skin. Nevertheless, several cases of NMSC have been described in covered areas such as the genital region; furthermore, some of these lesions may express a variable degree of pigmentation. Due to the existence of mucosal melanoma, an accurate diagnosis is paramount. In this narrative review, we focused our attention on management and – in particular‐ diagnosis of pigmented NMSC (pNMSC) located in the genital region, emphasizing the features assessed by dermoscopy and reflectance confocal microscopy. As an implementation, we included data on pNMSC from the Dermatology Unit of the University of Campania Vanvitelli. BCC in the genital region represents only 1% of all BCC cases. It has been supposed that the mutation of patched 1 may lead to the development of BCC even without concomitant UV exposure. Pigmented variants on genitals have seldom been described. More prominent dermoscopic features seem to be blue‐gray ovoid nests and arborizing vessels associated with whitish structureless areas. SCC and Bowen's disease (BD) – a variant of in situ SCC – may be encountered in the genital area and are sometimes associated with human papillomavirus (HPV) infection. Pigmented SCC is very rare, and most of the literature is focused on pigmented BD (pBD), which is mainly characterized by gray‐brown dots in a linear fashion and glomerular vessels without evident scales. In conclusion, pNMSC is rarely encountered on genitals; evaluation with dermoscopy or other ancillary devices like RCM is important both to exclude benign lesions like seborrheic keratosis and lentigo and to rule out melanoma. [ABSTRACT FROM AUTHOR]

The article discusses a study on the significance of dermoscopy in the treatment of rosacea, a skin condition. Researchers state that the non-invasive microscopic examination of skin lesions leads to additional data for the therapy as it provides visualization of the vessels utilizing the Dermlite Foto Equipment. Several images of erythematotelangiectatic rosacea including its vascular pattern are also presented.

The development of new primary melanomas in patients treated with vemurafenib has been reported recently in a study by Perier-Muzet et al. The primary outcome of the study was to describe the dermoscopic changes that prompted excision of those melanomas. However, the crucial point raised by the study is the large number of melanomas that were detected. [ABSTRACT FROM AUTHOR]

Dermoscopic findings in umbilical granuloma are vascular polymorphism comprised of linear irregular and arborizing vessels with structureless areas distributed over a milky‐red background. The increase of angiogenesis and neovascularization is represented by the linear irregular and arborizing vessels. Structureless areas over an irregularly milky‐red background are originated by the proliferation of vascular endothelial cells and fibroblasts, with capillary and granulation tissue formation. [ABSTRACT FROM AUTHOR]

The article presents three cases studies on patients with cutaneous melanoma metastasis (CMM). It states that CMM is difficult to diagnose in patients with an unknown primary melanoma as it is similar to benign lesions such as blue nevus and hemangioma. It describes the appearance of nodules that could be malignant and features of CMM on the chest and on the nose. It concludes that peripheral stellate telangiectasis could be a clue for diagnosing CMM.

The authors discuss the diagnosis of nonpigmented skin tumors (NPT) which is one biggest challenge in dermatology despite the support of advanced method such as dermoscopy. The authors state the two obstacles in the identification of poor pigmented melanoma such as presence of few well-known features and lack of clinical suspicion of melanoma of hypopigmented tumors. The authors also cite the study by Jaimes and colleagues which supports the use of dermoscopy in the assessment of NPT.

Background: Melanoma disease patterns vary with patient age. Aim: To evaluate sentinel lymph node biopsy (SLNB) in managing melanoma at differing patient ages. Methods: Online prediction tools were applied to compare SLNB positivity (SLNB+) and survival risk at patient ages 20–80. Tübingen melanoma data were used to determine variations in the hazard ratio of SLNB+ for mortality at different patient ages. Results: Regardless of tumour thickness, predicted SLNB+ rates were markedly higher than mortality rates for 20‐year‐old patients. For 80‐year‐old patients, it is the opposite. Discussion: If 1000 20‐year‐olds with a 0.4 mm thickness non‐ulcerated melanoma underwent SLNB, 100 would likely be positive. If all 100 were to be offered adjuvant drug therapy (ADT), fewer than three more melanoma deaths in those 1000 patients would be avoided. In total, 97 patients would have received medication they may never have needed. If 1000 80‐year‐olds with a 3 mm thickness non‐ulcerated melanoma underwent SLNB, only 40 would likely be positive. In total, 274 patients would be predicted to die of melanoma, 245 being SLNB negative and 29 SLNB+. ADT linked to SLNB+ could deny treatment to 89% of these high‐risk patients. Limitations: The authors relied on published risk data. Conclusion: SLNB has poor specificity at predicting mortality in young melanoma patients and poor sensitivity in older patients. SLNB is not indicated in managing cutaneous melanoma for patients under 40 or over 60 years of age. Many such patients could be managed with wide local excision alone in their clinician's office‐based practice. For all cutaneous melanoma patients at all ages, linking ADT to BAUSSS biomarker, (an algorithm of Breslow thickness, age, ulceration, subtype, sex and Site) rather than SLNB+ is likely more appropriate. BAUSSS provides a more accurate melanoma‐specific mortality risk assessment for patients without burdening them with added surgery, hospitalization, costs or morbidity risk. [ABSTRACT FROM AUTHOR]

Introduction: Patients with psoriasis who have failed multiple biologic drugs have been defined as "multi‐failure," although there are no clear data on the characteristics, comorbidities, and best treatment strategies for this population. Nowadays, given the next generation and the number of biologics available, patients are considered multi‐failure when ≥4 biologics fail to achieve a good response. Methods: Demographic characteristics and efficacy of anti‐interleukin drugs in multi‐failure patients were compared to a cohort of general psoriatic patients treated with IL‐23 or IL‐17 inhibitors. Results: In total 97 multi‐failure patients (≥4 lines of biologics) were compared with 1,057 patients in the general cohort. The current drugs in the multi‐failure group were risankizumab (34), ixekizumab (23), guselkumab (21), brodalumab (7), tildrakizumab (5), ustekinumab (4), secukinumab (2), and certolizumab pegol (1). A significant difference was found in the multi‐failure cohort for age of psoriasis onset (mean 29.7 vs. 35.1, P < 0.001), concurrent psoriatic arthritis (45.4 vs. 26.9%, P < 0.001), diabetes mellitus (30.9 vs. 10.9%, P < 0.001), and cardiovascular comorbidity (54.6 vs. 39.8%, P = 0.005). In multi‐failure patients, current biological therapy showed a good initial response (PASI 90 and 100 of 41.24 and 27.84%, respectively, at 16 weeks); the response tended to decline after 40 weeks. Anti‐IL‐17 agents showed clinical superiority over IL‐23 agents in terms of achieving PASI90 at 28 weeks (P < 0.001) and 40 weeks (P = 0.007), after which they reached a plateau. In contrast, IL‐23 agents showed a slower but progressive improvement that was maintained for up to 52 weeks. A similar trend was also seen for PASI100 (28 weeks P = 0.032; 40 weeks P = 0.121). Conclusions: The multi‐failure patient is characterized by many comorbidities and longstanding inflammatory disease that frequently precedes the introduction of systemic biologic therapy. Further studies are needed to identify more specific criteria that could be applied as a guideline by clinicians. [ABSTRACT FROM AUTHOR]

Background: Methyl aminolevulinate (MAL) photodynamic therapy (PDT) is commonly used for field treatment of actinic keratoses (AKs). In standard natural daylight PDT (n‐DL‐PDT) the first step, after the application of chemical solar filter, is removal of crusts and scales by curettage, followed by the application of MAL cream. Some patients experience intense pain during curettage and stinging after application of the photosensitizer to just curettaged skin. Objectives: To evaluate whether n‐DL‐PDT without curettage, but preceded by application of keratolytics, would maintain a similar efficacy, based on clinical, dermoscopic, reflectance confocal microscopy (RCM) assessments, safety and patient satisfaction as standard n‐DL‐PDT with curettage. Methods: Forty patients with multiple AKs on the face and/or scalp were enrolled in this study. Patients were randomized into two groups of treatment as follows: (i) MAL n‐DL‐PDT without previous curettage, preceded by skin preparation at home with keratolytics (30% urea cream, twice a day for 7 days; −Cur group) and (ii) MAL n‐DL‐PDT preceded by skin preparation at the hospital with curettage (+Cur group). Results: Thirty‐nine participants completed the study. Four hundred and twenty‐one AKs in −Cur group and 337 AKs in +Cur group were treated. The mean reduction in the number of AK lesions 3 months after the treatment was 10.7 (−54.7%) in the −Cur and 10.4 (−58.7%) in the +Cur group. We found that the differences in terms of efficacy and patient satisfaction comparing the two treatment regimens were not statistically significant. The pain score reported during and after daylight exposure was similar and low in both groups. Moreover, no unexpected adverse events occurred during the trial period. Conclusions: According to our results, curettage is not necessary to obtain the full treatment effect of n‐DL‐PDT. We experienced in a real‐life setting that n‐DL‐PDT protocol could be changed by replacing curettage with keratolytics. [ABSTRACT FROM AUTHOR]

Background Lentigo maligna/lentigo maligna melanoma (LM/LMM) is usually diagnosed in older patients, when lesions are larger. However, it is important to detect it at an earlier stage to minimize the area for surgical procedure. Objectives To determine and define clinical, dermoscopic and reflectance confocal microscopy (RCM) features of LM/LMM in patients<50 years old. Methods This was a multicentre study involving tertiary referral centres for skin cancer management. The study included cases of consecutively excised LM/LMM arising in patients<50 years of age with a histopathological diagnosis of LM/LMM and a complete set of clinical and dermoscopic images; RCM images were considered when present. Results In total, 85 LM/LMM of the face from 85 patients<50 years were included in the study. A regression model showed a direct association with the size of the lesion (R2=0.08; P=0.01) and with the number of dermoscopic features at diagnosis (R2=0.12; P<0.01). In a multivariable analysis, an increasing number of dermoscopic features correlated with increased patient age (P<0.01), while the presence of grey colour was a predictor of younger age at diagnosis (P=0.03). RCM revealed the presence of melanoma diagnostic features in all cases (pagetoid cells and atypical nesting). Conclusions LM is not a disease limited to older people as previously thought. LM presenting in young adults tends to be smaller and with fewer dermoscopic features, making its diagnosis challenging. Careful evaluation of facial pigmented lesions prior to cosmetic procedures is imperative to avoid incorrectly treating early LM as a benign lesion. [ABSTRACT FROM AUTHOR]

This article discusses a case of myofibroma of infancy, a rare benign tumor that commonly occurs in childhood. The patient, a female newborn, presented with a purple-red ulcerated and indurated plaque on her foot. Dermoscopy revealed specific characteristics of the lesion, and further diagnostic procedures, including a skin biopsy and imaging tests, were performed to confirm the diagnosis. The article also highlights the differential diagnoses that should be considered and discusses the management options for myofibroma of infancy. [Extracted from the article]

The syndrome of Birt-Hogg-Dube´ BHD is an autosomal dominant syndrome. characterized by a triad oicuianeous lessons including multiple fibrofolliculomas, trichodiscomas, and acrochordons. There are many clinical expressions, solitary and multiple forms, with or without other skin tumors. In the literature BHD syndrome has been associated with internal malignancy. We describe a patient with multiple firm, skin-colored papules in which the three types of lesion are documented. No signs of systemic disease were present. [ABSTRACT FROM AUTHOR]

Several reports in the current issue of the journal are presented including on digital dermoscopy and digital imaging systems.

During SARS‐CoV‐2 pandemic, an outbreak of chilblain‐like lesions has been developed, even if the relationship with the virus infection is still debated. We report the good results obtained in 12 patients with chilblain lesions and the use of oral cinnarizine, a piperazine derivative with many pharmacological properties among whom antihistaminic and calcium channel blocking activities. [ABSTRACT FROM AUTHOR]

Background: Risankizumab is a humanized monoclonal antibody that selectively inhibits interleukin-23. It has been approved for moderate-to-severe plaque psoriasis and has shown efficacy and safety in clinical trials and real-world experiences. This study aimed to evaluate the long-term effectiveness, safety, and drug survival of risankizumab in a real-life setting. Materials and Methods: We included patients treated with risankizumab from January 2019 to February 2023. A Psoriasis Area and Severity Index score (PASI) was collected at weeks 0, 16, 28, 52, 104, and 156, when available. The occurrence of any adverse events was recorded at each visit. Results: We enrolled 1047 patients. At week 52, a ≥90% improvement in PASI was observed in 81.44% of patients, with a continuous improvement throughout the study (88.99% and 99.07% at weeks 104 and 156, respectively). After three years of treatment, all patients involving the scalp, palms/soles, and genitalia and 95% of patients with nail psoriasis achieved a complete or almost complete skin clearance. No significant safety findings were observed, and 90.73% of the patients were still on treatment after 36 months. Conclusions: This study supports the long-term effectiveness and safety of risankizumab in a real-world setting, even in patients involving difficult-to-treat areas. [ABSTRACT FROM AUTHOR]

Simple Summary: Nevus-associated cutaneous melanoma (CM) is a malignant melanocytic proliferation occurring in the context of a pre-existing benign melanocytic nevus. This type of melanoma is not infrequent, accounting for up to 35% of all superficial spreading CMs. Discriminating between malignant and benign cellular populations may be challenging, but it is mandatory for diagnostic and staging purposes and is consequently critical for accurate patient management. The aim of this study was to assess the diagnostic performance of PRAME immunohistochemistry in this clinical setting. In this study, PRAME immunohistochemistry showed a perfect specificity and a good sensitivity, showing negative values for all nevus components and positive values for 59.4% of the malignant cellular components. The diagnostic agreement between morphology and PRAME immunohistochemistry was perfect for the diagnosis of nevus components and fair for the diagnosis of malignant components. PRAME was significantly more expressed in thick invasive CMs than in thin cases (p = 0.02). Our results support the use of PRAME immunohistochemistry as a useful tool in the diagnosis of nevus-associated CM. (1) Background: Nevus-associated cutaneous melanoma (CM) is relatively common in the clinical practice of dermatopathologists. The correct diagnosis and staging of nevus-associated cutaneous melanoma (CM) mainly relies on the correct discrimination between benign and malignant cells. Recently, PRAME has emerged as a promising immunohistochemical marker of malignant melanocytes. (2) Methods: PRAME immunohistochemistry (IHC) was performed in 69 cases of nevus-associated CMs. Its expression was evaluated using a score ranging from 0 to 4+ based on the percentage of melanocytic cells with a nuclear expression. PRAME IHC sensitivity, specificity, positive predictive values, and negative predictive values were assessed. Furthermore, the agreement between morphological data and PRAME expression was evaluated for the diagnosis of melanoma components and nevus components. (3) Results: PRAME IHC showed a sensitivity of 59%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 71%. The diagnostic agreement between morphology and PRAME IHC was fair (Cohen's Kappa: 0.3); the diagnostic agreement regarding the benign nevus components associated with CM was perfect (Cohen's Kappa: 1.0). PRAME was significantly more expressed in thick invasive CMs than in thin cases (p = 0.02). (4) Conclusions: PRAME IHC should be considered for the diagnostic evaluation of nevus-associated CM and is most useful in cases of thick melanomas. Pathologists should carefully consider that a PRAME-positive cellular population within the context of a nevus could indicate a CM associated with the nevus. A negative result does not rule out this possibility. [ABSTRACT FROM AUTHOR]

Dermoscopy is widely used for the diagnosis of skin cancer and it increases the accuracy of basal cell carcinoma (BCC) detection. BCC dermoscopic criteria have been updated and divided into vascular, pigment-related, and non-vascular/non-pigmentrelated. Our multicenter retrospective study tested a new dermoscopic pigment-related characteristic to detect pigmented BCC (pBCC) [brown homogeneous blotches (BHB)]. Cases of pBCC were collected from the databases of IDI-IRCCS of Rome and from three Italian private dermatology centers. BHB are confined patches of brown uniform pigmentation without dermoscopic features (net, fat fingers, etc.) or other internal dermoscopic structures, except for occasional vascular ones like arborizing vessels or globules/dots. Melanocytic and non-melanocytic controls were used. We reviewed photos of 270 pigmented lesions (female 145; 51.8%), including 90 histopathologically verified pBCC and 180 control cases (90 melanocytic and 90 non-melanocytic). BHB were found in 61 cases of 90 pBCC patients. The results showed a 67.8 sensitivity, 93.3 specificity, 83.6 positive and 85.3 negative predictive values, posLR 10.2, negLR 0.3, odds ratio 29.4, p<0.001. Our multicentre retrospective analysis suggested the BHB may be a novel dermoscopic pBCC diagnosis criterion. [ABSTRACT FROM AUTHOR]

Chronic hand eczema (CHE) is a common inflammatory skin condition that significantly impacts the quality of life. From work-related disabilities to social embarrassment, pain, and financial costs, the burden on society is substantial. Managing this condition presents challenges such as long-term treatment, poor patient compliance, therapy side effects, and economic feasibility. As a result, significant efforts have been made in this field in recent years. Specifically, the broader understanding of CHE pathogenesis has led to the development of new drugs, both topical and systemic. The aim of this narrative review is to summarize the current available data on hand eczema pathophysiology and explore the resulting developments in drugs for its treatment. A comprehensive search on PubMed and the other main scientific databases was conducted using keywords related to CHE and its pathogenesis. The most relevant pathways targeted by therapies include the JAK-STAT cascade, IL-4, and IL-13 axis, phosphodiesterase 4 enzyme, and chemo-attractant cytokines. In the near future, physicians will have a plethora of therapeutic alternatives. Consequently, they should be well-trained not only in how to use these alternatives but also how to combine these treatments to address the ongoing challenges related to efficacy, tolerability, and safety. [ABSTRACT FROM AUTHOR]

Background: Extra facial lentigo maligna (EF‐LM) arises outside the head and neck area. EF‐LM presents the classic histological features of lentigo maligna. The dermoscopic aspects of EF‐LM have been poorly studied. Objective: The primary aims of our study were to analyse and describe the clinical, dermoscopic and confocal microscopy features of a series of histologically confirmed EF‐LM. Method: We conducted a retrospective and multicentric study. From our database, we selected 48 cases of thin melanomas on photodamaged skin with histological features of EF‐LM of which clinical, dermoscopic and confocal microscopy images were available, and a control group of 45 lesions, that can be subjected to differential diagnosis such as solar lentigo, lichenoid keratosis, seborrheic keratosis and melanocytic nevi, of which dermoscopic and confocal microscope images were available. Results: Extra facial lentigo maligna had a higher prevalence of lentigo‐like pigment patterns, angulated lines and zigzag structures. At confocal microscopy, LM‐EF cases showed a higher prevalence of pagetoid spreading, round cells, dendritic cells in the epidermis, atypical cells at the dermo‐epidermal junction, dendritic cells at the junction, meshwork pattern and elastosis. Our study shows that reflectance confocal microscopy (RCM) has a sensitivity of 90% and a specificity of 97% for the differential diagnosis of this type of melanoma. Conclusions: Extra facial lentigo maligna does not have the classic dermoscopic features of superficial spreading melanoma, the most observed dermoscopic criteria are angulated lines and lentigo‐like pigment patterns without lentigo‐like border. RCM can be a valuable imaging tool for the evaluation of all those suspicion skin lesions at dermoscopy highlighting cellular atypia suggestive for melanoma. [ABSTRACT FROM AUTHOR]

Atypical pigmented facial lesions (aPFLs)—including lentigo maligna (LM) and lentigo maligna melanoma (LMM), solar lentigo (SL), pigmented actinic keratosis (PAK), atypical nevi (AN), seborrheic keratosis (SK) and lichen planus‐like keratosis (LPLK)—can exhibit clinical and dermoscopic overlapping features. We aimed to investigate if and how 14 dermoscopic features suggestive for the aforementioned aPFLs vary according to six facial sites among 1197 aPFLs cases (excised to rule out malignancy) along with lesion and patients' metadata. According to distribution and association analysis, aPFLs on the forehead of a male patient aged > 69 years displaying the obliterated follicular openings pattern, appear to be more at risk of malignancy. Of converse, aPFLs of the orbital/cheek/nose area with evident and regular follicular openings with diameter < 10 mm in a female aged below 68 are probably benign. The obliterated follicular openings, keratin plugs, evident and regular follicular openings and target‐like pattern features differed significantly among six facial areas in all aPFLs cases. Lesion of the nose may show both features suggestive of malignancy and benignity (e.g. many SL and PAK may display target‐like pattern and some LM/LMM cases display keratin plugs and evident and follicular openings), making these features less specific. [ABSTRACT FROM AUTHOR]

Background: Due to progressive ageing of the population, the incidence of facial lentigo maligna (LM) of the face is increasing. Many benign simulators of LM and LMM, known as atypical pigmented facial lesions (aPFLs—pigmented actinic keratosis, solar lentigo, seborrheic keratosis, seborrheic‐lichenoid keratosis, atypical nevus) may be found on photodamaged skin. This generates many diagnostic issues and increases the number of biopsies, with a subsequent impact on aesthetic outcome and health insurance costs. Objectives: Our aim was to develop a risk‐scoring classifier‐based algorithm to estimate the probability of an aPFL being malignant. A second aim was to compare its diagnostic accuracy with that of dermoscopists so as to define the advantages of using the model in patient management. Materials and Methods: A total of 154 dermatologists analysed 1111 aPFLs and their management in a teledermatology setting: They performed pattern analysis, gave an intuitive clinical diagnosis and proposed lesion management options (follow‐up/reflectance confocal microscopy/biopsy). Each case was composed of a dermoscopic and/or clinical picture plus metadata (histology, age, sex, location, diameter). The risk‐scoring classifier was developed and tested on this dataset and then validated on 86 additional aPFLs. Results: The facial Integrated Dermoscopic Score (iDScore) model consisted of seven dermoscopic variables and three objective parameters (diameter ≥ 8 mm, age ≥ 70 years, male sex); the score ranged from 0 to 16. In the testing set, the facial iDScore‐aided diagnosis was more accurate (AUC = 0.79 [IC 95% 0.757–0.843]) than the intuitive diagnosis proposed by dermatologists (average of 43.5%). In the management study, the score model reduced the number of benign lesions sent for biopsies by 41.5% and increased the number of LM/LMM cases sent for reflectance confocal microscopy or biopsy instead of follow‐up by 66%. Conclusions: The facial iDScore can be proposed as a feasible tool for managing patients with aPFLs. [ABSTRACT FROM AUTHOR]

The author reflects on the use of dermatoscope, a clinical tool of dermatologist for dermoscopic diagnosis of inflammatory skin diseases. He discusses whether the method dermoscopy has improved showing dermoscopic patterns for several skin diseases. Furthermore, he mentions the evidence of the utility of dermoscopy for general practitioners as discussed in the study of S. S. Thatte and colleagues.

Several combinations of different skin tumors occuring one adjacent to the other or even in a single lesion have been described up to date. Collision tumors involving atypical fibroxanthoma and melanoma are extremely uncommon. Herein we present a case of melanoma associated with AFX and discuss on the usefulness of dermoscopy in the clinical diagnosis of collision tumors. [ABSTRACT FROM AUTHOR]

Background:Atypical pigmented facial lesions (aPFLs) often display clinical and dermoscopic equivocal and/or overlapping features, thus causing a challenging and delayed diagnosis and/or inappropriate excisions. No specific registry dedicated to aPFL paired with clinical data is available to date. Methods: The dataset is hosted on a specifically designed web platform. Each complete case was composed of the following data: (1) one dermoscopic picture; (2) one clinical picture; (3) two lesion data, that is, maximum diameter and facial location (e.g., orbital area/forehead/nose/cheek/chin/mouth); (4) patient's demographics: family history of melanoma, history of sunburns in childhood, phototype, pheomelanine, eyes/hair color, multiple nevi/dysplastic nevi on the body; and (5) acquisition device (videodermatoscope/camera-based/smartphone-based system). Results:A total of 11 dermatologic centers contributed to a final teledermoscopy database of 1,197 aPFL with a distribution of 353 lentigo maligna (LM), 146 lentigo maligna melanoma (LMM), 231 pigmented actinic keratoses, 266 solar lentigo, 125 atypical nevi, 48 seborrheic keratosis, and 28 seborrheic-lichenoid keratoses. The cheek site was involved in half of aPFL cases (50%). Compared with those with the other aPFL cases, patients with LM/LMM were predominantly men, older (69.32 ± 12.9 years on average vs. 62.69 ± 14.51), exhibited larger lesions (11.88 ± 7.74 mm average maximum diameter vs. 9.33 ± 6.46 mm), and reported a positive history of sunburn in childhood. Conclusions:The iDScore facial dataset currently represents a precious source of data suitable for the design of diagnostic support tools based on risk scoring classifiers to help dermatologists in recognizing LM/LMM among challenging aPFL in clinical practice. [ABSTRACT FROM AUTHOR]

The current evidence on paediatric melanoma is heterogeneous, especially regarding the prognosis of different histological subtypes. We sought to systematically review the evidence on paediatric melanoma, highlighting the major sources of heterogeneity and focusing on available data on single patients. A systematic search was performed from 1948 to 25 January 2021. Only studies reporting at least one case of cutaneous melanoma in patients aged ≤18 years were included. Unknown primary and uncertain malignant melanomas were excluded. Three couples of authors independently performed title/abstract screening and two different authors reviewed all the relevant full texts. The selected articles were manually cross‐checked for overlapping data for qualitative synthesis. Subsequently data on single patients were extracted to perform a patient‐level meta‐analysis. PROSPERO registration number: CRD42021233248. The main outcomes were melanoma‐specific survival (MSS) and progression‐free survival (PFS) outcomes. Separate analyses were done of cases with complete information on histologic subtype, focusing on superficial spreading (SSM), nodular (NM) and spitzoid melanomas, as well as of those classified as de‐novo (DNM) and acquired or congenital nevus‐associated melanomas (NAM). The qualitative synthesis covered 266 studies; however, data on single patients were available from 213 studies including 1002 patients. Among histologic subtypes, NM had a lower MSS than both SSM and spitzoid melanoma, and a lower PFS than SSM. Spitzoid melanoma had a significantly higher progression risk than SSM and trended toward lower mortality. Focusing on nevus‐associated status, DNM demonstrated better MSS after progression than congenital NAM, and no differences were highlighted in PFS. Our findings describe the existence of different biological patterns in paediatric melanoma. Specifically, spitzoid melanomas demonstrated intermediate behaviour between SSM and NM and showed a high risk of nodal progression but low mortality. This raises the question of whether spitzoid lesions are being over‐diagnosed as melanoma in childhood. [ABSTRACT FROM AUTHOR]

Effective cancer screening detects early‐stage tumours, leading to a lower incidence of late‐stage disease over time. Dermoscopy is the gold standard for skin cancer diagnosis as diagnostic accuracy is improved compared to naked eye examinations. As melanoma dermoscopic features are often body site specific, awareness of common features according to their location is imperative for improved melanoma diagnostic accuracy. Several criteria have been identified according to the anatomical location of the melanoma. This review provides a comprehensive and contemporary review of dermoscopic melanoma criteria according to specific body sites, including frequently observed melanoma of the head/neck, trunk and limbs and special site melanomas, located on the nail, mucosal and acral region. [ABSTRACT FROM AUTHOR]

Background: Incidence of cutaneous melanoma is steadily growing, and its early recognition is of paramount importance. Small, pigmented lesions often represent a challenge for the clinician, as predictors of melanoma have not yet been uniquely identified in this setting. Objectives: To identify dermoscopic features that aid in distinguishing small diameter melanomas (≤5 mm) from equivocal melanocytic nevi measuring ≤5 mm. Methods: A retrospective multicenter study was conducted to collect demographics, clinical and dermoscopic pictures of (i) histology‐proven flat melanomas, measuring ≤5 mm, (ii) histology‐proven but clinically/dermoscopically equivocal melanocytic nevi measuring ≤5 mm, and (iii) histology‐proven flat melanomas, measuring >5 mm. An independent dermoscopic evaluation was performed. Differences in predefined dermoscopic features were assessed across the three groups. Results: A total of 103 melanomas measuring ≤5 mm were collected; 166 control lesions, comprising 85 large (>5 mm) melanomas and 81 dubious, clinically equivocal melanocytic nevi measuring ≤5 mm were included. Of the 103 mini‐melanomas, only 44 were melanoma in situ. Five dermoscopic predictors of melanoma were identified for the assessment of flat, non‐facial melanocytic lesions measuring ≤5 mm, namely: atypical pigment network, blue‐white veil, pseudopods, peripheral radial streaks, and presence of more than one color. The latter were combined into a predictive model capable of identifying melanoma with 65% sensitivity and 86.4% specificity, at a cut‐off score of 3. Among melanomas measuring ≤5 mm, presence of a blue‐white veil (P = 0.0027) or negative pigment network (P = 0.0063) was associated with invasiveness. Conclusion: A set of five dermoscopic predictors of melanoma, atypical pigment network, blue‐white veil, pseudopods, peripheral radial streaks, and presence of more than one color is proposed for the assessment of flat, non‐facial melanocytic lesions measuring ≤5 mm. [ABSTRACT FROM AUTHOR]

One of the emerging and intriguing applications of reflectance confocal microscopy is the evaluation of 'dynamic' processes of the skin that cannot be otherwise analysed using histopathology that offers a picture of the tissue at one time point. This is nicely illustrated by recent article by Wolberink et al. in the current issue of Exp Dermatol, in which the Authors evaluated patterns and time interval of polymorphonuclear neutrophil ( PMN) migration in psoriatic plaques by means of reflectance confocal microscopy ( RCM). This example underscores that a new era of confocal microscopy is starting, which promises to reveal a dynamic in vivo understanding of the pathophysiology of human skin diseases. [ABSTRACT FROM AUTHOR]