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Direct-to-patient mobile teledermoscopy is a feasible and useful adjunct to smartphone imaging for monitoring patient-identified lesions of concern, achieving comparable diagnostic and management accuracy as in-office dermatology.

Early detection and treatment of skin cancer are important for patient recovery and survival. Dermoscopy images can help clinicians for timely identification of cancer, but manual diagnosis is time-consuming, costly, and prone to human error. To conduct this, an innovative deep learning-based approach has been proposed for automatic melanoma detection. The proposed method involves preprocessing dermoscopy images to remove artifacts, enhance contrast, and cancel noise, followed by feeding them into an optimized Convolutional Neural Network (CNN). The CNN is trained using an innovative metaheuristic called the Improved Chameleon Swarm Algorithm (CSA) to optimize its performance. The approach has been validated using the SIIM-ISIC Melanoma dataset and the results have been confirmed through rigorous evaluation metrics. Simulation results demonstrate the efficacy of the proposed method in accurately diagnosing melanoma from dermoscopy images by highlighting its potential as a valuable tool for clinicians in early cancer detection. [ABSTRACT FROM AUTHOR]

ABSTRACT Down syndrome (DS) is a common chromosomal disorder with distinct phenotypes and skin markers. This study reports 39 DS patients, aged 1–44  months, who presented from birth with rough, brownish skin in the dimples of their knees and/or elbows. Dermoscopy revealed hyperkeratosis with brownish scales, and biopsies in six cases showed papillomatosis and mild hyperkeratosis. In the cases followed, the condition resolved spontaneously. Hyperkeratosis in the skin dimples on the knees and elbows seems to be a congenital and perhaps characteristic finding in patients with DS. [ABSTRACT FROM AUTHOR]

Background: Proper diagnosis in primary care is crucial due to the large number of skin cancer diagnoses each year and its associated growing economic burden. Understanding how primary care providers can be best trained in dermoscopy is instrumental in helping primary care providers differentiate benign and malignant cutaneous lesions so that appropriate action can be taken (eg, biopsy/referral to dermatology or reassurance). Objective: To assess the success of concise dermoscopy training among primary care providers. Design: A cohort study was conducted in primary care at Mayo Clinic, Rochester, including primary care physicians, nurse practitioners, and physician assistants in internal medicine and family medicine. Diagnostic accuracy was measured on standardized testing through image-based recognition and in clinical practice through observation of referral and biopsy patterns both before and after dermoscopy education, focused on the TADA plus method. Results: Forty-three primary care providers completed the image-based recognition tests, with significant improvement in mean score measured after dermoscopy training workshop (20%). Among the thirteen primary care providers who continued to use dermoscopy in clinical practice, a significant improvement (31%) in mean clinical diagnostic accuracy was observed comparing 1 year of practice data before versus after dermoscopy training. Conclusion: Improvement in diagnostic accuracy with utilization of the TADA plus method translates into clinical practice. Therefore, training primary care providers in dermoscopy may improve the dermatologic care patients receive in primary care, especially in rural or medically underserved areas where access to dermatology is limited. [ABSTRACT FROM AUTHOR]

Simple Summary: This study focused on the potential role of non-invasive imaging diagnostic techniques, including LC-OCT, in the diagnosis of primary cutaneous lymphomas. Data from 40 lesions in 25 patients with a histological diagnosis of primary cutaneous lymphomas were retrospectively evaluated. Considering cutaneous T-cell lymphomas, RCM proved to be more effective than LC-OCT in detecting lymphocytes in the epidermis and dermis. As for B cell lymphomas, (25% of cases) mostly presented as nodules, with medium-reflective cell infiltration detected in 80% of cases by LC-OCT. This study suggests that non-invasive imaging could be valuable in supporting the diagnosis of primary cutaneous lymphomas, though further research is needed. Background/Objectives: Primary cutaneous lymphomas (PCL) are a heterogeneous group of non-Hodgkin lymphomas arising from malignant T (CTCL) or B (CBCL) cells, often mimicking other skin conditions. Recently, non-invasive diagnostic imaging modalities, including dermoscopy, Reflectance Confocal Microscopy (RCM), and Line-field Optical Coherence Tomography (LC-OCT), have become increasingly important, supporting clinicians in clinical practice. Hence, our study aimed to describe dermoscopic, RCM, and LC-OCT features of PCL and to explore their role in PCL management. Methods: Between December 2022 and January 2024, 40 lesions of 25 patients with PCL were retrospectively analyzed at the Dermatologic Unit of the University of Siena, Italy. Predefined dermoscopic, LC-OCT, and RCM criteria were assessed and their frequencies were calculated. Results: At dermoscopy, CTCL lesions were characterized by pinkish structureless areas (58,6%) and homogeneous distributed dotted vessels (35,7%), whereas 57.1% of CBCL presented with orange-yellow structureless areas. Considering CTCL, lymphocytes in the epidermis, dermal-epidermal junction, and dermis were detected by LC-OCT in 73.1%, 66.7%, and 51.9% and by RCM in 72.2%, 55.6%, and 61.1% of cases, respectively. The detection of lymphocytes was more precise using RCM than LC-OCT in CTCL (p < 0.001). Dermal infiltration of medium-reflective cells was visible in 80% and 40% of CBCL cases by LC-OCT and RCM, respectively. Conclusions: Non-invasive imaging techniques may support clinicians in managing PCL; however, further studies are mandatory in this field. [ABSTRACT FROM AUTHOR]

Simple Summary: Patients with skin lesions suspicious for skin cancer or atypical melanocytic nevi of uncertain malignant potential often present to dermatologists, who may have variable dermoscopy triage clinical experience. We evaluated the clinical utility of a digital dermoscopy image-based artificial intelligence algorithm (DDI-AI device) on the diagnosis and management of skin cancers. Thirty-six United States board-certified dermatologists evaluated 50 cases with clinical images and DDI of the same skin lesions (25 malignant and 25 benign), first without and then with knowledge of the DDI-AI device output. We identified that when using the DDI-AI device, management sensitivity, management specificity, diagnostic sensitivity, and diagnostic specificity all increased over baseline use of clinical images and dermoscopy images. Hence, the use of the DDI-AI device may quickly, safely, and effectively improve dermoscopy performance, skin cancer diagnosis, and management when used by dermatologists, independent of training and experience. Background: Patients with skin lesions suspicious for skin cancer or atypical melanocytic nevi of uncertain malignant potential often present to dermatologists, who may have variable dermoscopy triage clinical experience. Objective: To evaluate the clinical utility of a digital dermoscopy image-based artificial intelligence algorithm (DDI-AI device) on the diagnosis and management of skin cancers by dermatologists. Methods: Thirty-six United States board-certified dermatologists evaluated 50 clinical images and 50 digital dermoscopy images of the same skin lesions (25 malignant and 25 benign), first without and then with knowledge of the DDI-AI device output. Participants indicated whether they thought the lesion was likely benign (unremarkable) or malignant (suspicious). Results: The management sensitivity of dermatologists using the DDI-AI device was 91.1%, compared to 84.3% with DDI, and 70.0% with clinical images. The management specificity was 71.0%, compared to 68.4% and 64.9%, respectively. The diagnostic sensitivity of dermatologists using the DDI-AI device was 86.1%, compared to 78.8% with DDI, and 63.4% with clinical images. Diagnostic specificity using the DDI-AI device increased to 80.7%, compared to 75.9% and 73.6%, respectively. Conclusion: The use of the DDI-AI device may quickly, safely, and effectively improve dermoscopy performance, skin cancer diagnosis, and management when used by dermatologists, independent of training and experience. [ABSTRACT FROM AUTHOR]

Simple Summary: Merkel cell carcinoma (MCC) is a rare and aggressive skin cancer that grows quickly and has a life-threatening potential. Because of its severity, it is important to provide a fast diagnostic. For a tumor like this, diagnosis usually requires a tissue sample examined under a microscope with special staining techniques. However, newer non-invasive imaging methods could help identify MCC without a biopsy. These include advanced techniques which provide detailed images of the skin. This review highlights recent research on these imaging methods, emphasizing their potential to improve MCC diagnosis and treatment planning. This can also help patients get diagnosed more quickly and comfortably, without the need for more invasive procedures. Background/Objectives: Merkel cell carcinoma (MCC) is a rare and aggressive cutaneous neuroendocrine malignancy characterized by its propensity for rapid growth and early regional and distant metastasis. Given its potentially lethal nature, accurate and timely diagnosis of MCC is of utmost importance. This review aims to describe non-invasive imaging methods that can serve as additional tools in the examination of MCC. Methods: In this narrative review, we describe the up-to-date spectrum of non-invasive skin-imaging methods that can serve as additional tools in the examination of MCC based on the available literature. Dermoscopy might enhance the clinical diagnosis of MCC, facilitate differentiation from other benign and malignant tumors, and help optimize the treatment plan. New imaging technologies might also provide useful information at a sub-macroscopic level and support clinical diagnosis. These techniques include high-frequency ultrasound (HFUS), reflectance confocal microscopy (RCM) and optical coherence tomography (OCT). Results: Clinically, MCC typically presents as a rapidly growing, red, purple or skin-colored painless and firm nodule. Diagnosis is usually established with histopathological assessment and immunohistochemistry. However, dermoscopy and new imaging technologies might enhance the clinical diagnosis of MCC, facilitate differentiation from other benign and malignant tumors, and help optimize the treatment plan. [ABSTRACT FROM AUTHOR]

Background: The hands are one of the areas where skin aging is most noticeable, alongside the face, but limited studies used dermoscopic evaluation on hand aging. The Dermoscopy Photoaging Scale (DPAS) is frequently used to assess face aging but is never used for hand aging. Treating skin aging using chemical peeling is a commonly used method to rejuvenate the skin on the hands, as it is relatively affordable. Using multiple chemical peels may yield more significant results. Aims: To determine the effectiveness of a chemical peeling combination in retarding hand aging and to assess the utility of DPAS in this process. Methods: This study involved 69 Fitzpatrick skin types III–IV volunteers aged 20–69. One hand of each participant was treated with 20% glycolic acid (GA), while the other received a combination of peels consisting of 20% GA and 15% trichloroacetic acid (TCA). The hands were clinically examined before and after the treatments, and dermoscopic examinations were performed using a modified DPAS. Results: Four treatments improved clinical and dermoscopic characteristics in both hands. The combined peeling considerably improved pigmentation intensity on the dorsal hand compared to the GA peel (p < 0.001). Post‐chemical peeling patient satisfaction increased significantly. Conclusions: The modified DPAS is a valuable instrument to assess the signs of hand aging. The combination of GA and TCA effectively improves skin aging of the hands and offers an accessible and economical option for addressing skin aging. [ABSTRACT FROM AUTHOR]

ABSTRACT Rosacea diagnosis and treatment in children are challenging, due to its rarity and to the lack of approved pharmacological agents for its treatment in this age group. In this case series, response to treatment with once daily applications of ivermectin (IVM) 1% cream for 12 weeks in 10 children affected by mild to severe inflammatory rosacea was evaluated clinically by Investigator Erythema Severity Assessment (IESA), Investigator Global Assessment of Severity (IGA‐S), Investigator Global Assessment score of Global Efficacy (IGA‐GE), and instrumentally by dermoscopy and Erythema‐Directed Digital Photography (EDDP). Clinical improvement was achieved at the end of treatment compared to baseline (IESA: 2.3 vs. 0.5; IGA‐S: 2.1 vs. 0.3) and confirmed by IGA‐GE (0 = 55%, 1 = 33%, 3 = 11%) and instrumental monitoring (EDDP: 2.7 vs. 0.6). Once daily IVM application may be an effective therapeutic option for children with rosacea. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Objective Methods Results Conclusion The occurrence of scalp seborrheic dermatitis (SD) is closely related to the production of sebum and scalp barrier function. Supramolecular salicylic acid has the keratolytic and anti‐inflammatory properties, and zinc pyrithione is an antifungal drug delivered as a microparticle to skin epithelia.This study aimed to assess the efficacy and safety of 2% supramolecular salicylic acid (SSA) combined with 0.8% zinc pyrithione conditioner (SSA‐ZP) in treating scalp SD focusing on key outcome measures including sebum levels and scalp barrier function.Five patients with mild to moderate scalp SD were included in the 2‐week self‐controlled prospective study, receiving daily SSA‐ZP treatment. Evaluation on days 0, 7, and 14 included dermoscopy, the adherent scalp flaking scale (ASFS), sebum level, transepidermal water loss (TEWL), pH, and stratum corneum hydration. We also performed the fungal count across specific scalp regions, such as the left and right sides of the forehead, the top of the head, and the occiput.Five patients with mild to moderate scalp SD participated in this study. After 2 weeks of SSA‐ZP treatment, significant reductions in ASFS scores, sebum levels, and fungal count were observed, alongside improvements in TEWL and pH values across multiple scalp regions. Moreover, there was no difference in the hydration of stratum corneum.SSA‐ZP demonstrated efficacy in treating scalp SD without adverse effects, suggesting its potential as a first‐line treatment option. Further research with larger sample sizes and longer follow‐up periods is warranted to validate these findings. [ABSTRACT FROM AUTHOR]

Early detection of skin cancer significantly improves the five-year survival rate for patients. However, due to the subtle nature of early malignant tumors in the skin, their symptoms are not apparent, and specialized doctors need to perform multiple biopsies and extract lesion tissues to diagnose the type of lesion. Traditional artificial intelligence methods have low accuracy in identifying skin lesion images primarily because they are difficult to simultaneously focus on spatial details and shallow semantic features. To effectively represent spatial positions and shallow feature information, and avoid the model being overly concerned with detailed information, which can lead to misclassification of easily distinguishable images, a progressive aggregation attention network based on ConvNeXt is proposed. This method utilizes a hierarchical ConvNeXt encoder to extract deep and shallow features of lesion regions layer by layer. By employing parallel spatial attention, it effectively integrates spatial position information with deep or shallow semantic features, aggregating multi-scale contextual information. Meanwhile, a progressive feature aggregation module is designed to effectively integrate deep and shallow features and aggregate them by dynamically adjusting weights, closely aligning with the process of rough observation and meticulous examination in skin image classification by specialized doctors. Experimental tests on the ISIC2018 and ISIC2019 datasets show that the accuracy, precision, recall, and F1-Score of this method are 95.27%, 93.76%, 92.83%, and 93.18%, respectively, for ISIC2018, and 92.63%, 91.06%, 87.05%, and 88.81%, respectively, for ISIC2019. Compared to ConvNeXt, the accuracy is improved by 2.13 and 3.29 percentage points respectively, demonstrating its ability to effectively extract detailed and rough features, providing new evidence for the diagnosis of skin image through dermatoscopy. [ABSTRACT FROM AUTHOR]

ABSTRACT Eruptive melanocytic nevi (EMN) have been reported in the setting of immunosuppression, chemotherapy, and bullous skin disease, including less commonly, Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). This case report presents a 4‐year‐old girl who developed agminated EMN and nail changes after TEN. A systematic review of the literature supports clinically appropriate follow‐up of EMN, as there is no reports of malignancy in EMN following SJS/TEN, nor reports of pediatric melanoma arising within EMN of any etiology. Further study of the possible correlation of nail changes with the development of EMN and better characterization of the dermoscopic features of EMN could improve monitoring and care of these patients. [ABSTRACT FROM AUTHOR]

Background: Basal Cell Carcinoma (BCC) is the most common form of skin cancer, characterized by its low metastatic potential yet considerable diversity in clinical and dermatoscopic presentation. Advances in dermatoscopy have significantly improved the early detection of BCC, revealing specific patterns that guide diagnosis and management. Parallelly, immunohistochemical markers have been explored for their potential to elucidate the underlying tumor biology and prognosis, with particular focus on angiogenesis, melanocytic activity, and lymphangiogenesis. Objective: This study aims to investigate the correlations between dermatoscopic features and the immunohistochemical expressions of CD34, CD31, Melan-A, and D2-40 in BCC, through a comprehensive analysis of 100 cases We sought to determine whether visual dermatoscopic patterns correlate with the molecular characteristics defined by immunohistochemical staining, potentially enhancing diagnostic accuracy. Methods: A total of 100 cases of clinically and histopathologically confirmed BCC were prospectively analyzed, employing standard dermatoscopic techniques for lesion evaluation and immunohistochemical staining for CD34, CD31, Melan-A, and D2-40 to assess tumor angiogenic potential, melanocytic activity, and lymphangiogenesis. The study was conducted with adherence to ethical standards and informed consent from all participants. Results: Dermatoscopic examination revealed a variety of vascular patterns and pigmented features across different BCC anatomical locations. However, the comprehensive correlation analysis predominantly found a lack of significant associations between dermatoscopic appearances and expressions of the targeted immunohistochemical markers, with the notable exception of a correlation between observed hemorrhage and the Melan-A marker. Conclusions: The lack of significant correlations between dermatoscopic features and immunohistochemical marker expressions in BCC suggests that the biological behavior and angiogenic, melanocytic, and lymphangiogenic activities within BCC lesions may be influenced by factors beyond those assessed in this study. Despite the exploratory nature of these findings, they underscore the complexity of BCC biology and highlight the need for further research incorporating additional markers and advanced imaging techniques. [ABSTRACT FROM AUTHOR]

Melanoma is an acute and chronic skin disease, and if left untreated, it increases morbidity in the patient. The high degree of similarity between the images of different classes and the complex structure of lesion images makes automated skin lesion diagnosis very challenging. Dermoscopic images are widely used for the diagnosis of skin lesions. This study proposes a novel method by analyzing deep features and wavelet features. In this regard, a standard pre-trained ResNet50 model is used for extracting deep features. Lesion images are transformed to wavelet domain using lifting wavelet transform (LWT). The level-2 approximation component of LWT is taken as wavelet feature. Deep features and wavelet features are fused, and the neighborhood component analysis (NCA) algorithm is subsequently used to select a subset of fused features with reduced dimensions. The NCA-reduced feature set is classified by a multilayer perceptron (MLP). The suggested method is validated on the publicly available ISIC 2016 challenge dataset and PH2 dataset. An accuracy of 98%, auc of 99.62% on PH2 dataset while 71% accuracy, 80.61% auc on ISIC 2016 dataset is obtained. The experimental results are comparable to the existing state-of-the-art methods. This study demonstrates that the integration of LWT features improves discriminative information. Feature reduction by using NCA is able to provide robust details with reduced noise and redundancy. [ABSTRACT FROM AUTHOR]

External ear lentigo maligna/lentigo melanoma (LM/LMM) represents approximately 1%–4% of all primary cutaneous melanomas. Over the past 20 years, dermoscopy has proven highly effective in early detection of LM/LMM, with recent studies identifying perifollicular linear projections (PLP) as a specific diagnostic criterion for early LM. However, in clinical practice, LM and LMM turn out to be very difficult to distinguish based on dermoscopic findings. Therefore, our retrospective monocentric study aimed to investigate dermoscopic characteristics, as well as the epidemiological and clinical data of 19 patients diagnosed with the external ear (EE) LM/LMM at the Oncologic Dermatology Unit in Bologna. Dermoscopic images were obtained using the FotoFinder Medicam 800HD, and specific criteria validated by the International Dermoscopy Society (IDS) for atypical pigmented facial lesions were assessed. Fisher's exact test was primarily used for statistical comparisons. As results, most of the patients were male (74%) with an average age (± SD) at diagnosis of 69.8 (± 15.1) years old. LMM appeared more commonly observed in elderly patients as compared to LM (mean 71.6 vs. 66.7, p = 0.514), presenting as pigmented macule (89.5%) of the ear lobule (23.9%). A statistically significant difference (p = 0.01) of tumour' diameter between LMM and LM was reported with the first resulting more than twice the size of the latter. Concerning dermoscopic findings, asymmetric pigmented follicles, obliteration of the follicular openings and grey circles were more frequently observed in LMM compared to LM (63.2% vs. 31.6%; 63.2% vs. 26.3%; 47.4% vs. 15.8%, respectively). [ABSTRACT FROM AUTHOR]

Autofluorescence is a remarkable property of human skin. It can be excited by UV and observed in the dark using special detection systems. The method of fluorescence photography (FP) is an effective non-invasive tool for skin assessment. It involves image capturing by a camera the emission of light quanta from fluorophore molecules in the skin. It serves as a useful tool for cosmetic and skincare research, especially for the detection of pathological skin states, like acne, psoriasis, etc. To the best of our knowledge, there is currently no comprehensive review that fully describes the application and physical principles of FP over the past five years. The current review covers various aspects of the skin FP method from its biophysical basis and the main fluorescent molecules of the skin to its potential applications and the principles of FP recording and analysis. We pay particular attention to recently reported works on the automatic analysis of FP based on artificial intelligence (AI). Thus, we argue that FP is a rapidly evolving technology with a wide range of potential applications. We propose potential directions of the development of this method, including new AI algorithms for the analysis and expanding the range of applications. [ABSTRACT FROM AUTHOR]

Background: Vulvar lichen sclerosus (VLS) is an underdiagnosed inflammatory disease of the vulva. It may mimic various inflammatory or tumor conditions of the vulva. Dermoscopy is a useful tool to support the non-invasive diagnosis. However, few studies are concerned with determining the specific signs of VLS. Objective: The aim of our study was to determine the vascular and non-vascular features of VLS and to correlate them with the duration of the disease. Methods: We conducted a retrospective study including eighty patients over a period from November 2020 to November 2022. Results: On dermoscopy, VLS lesions showed reduced overall vascularity and polymorphic vessels with an irregular arrangement. Yellowish-white, structureless areas over a diffuse, whitish background were prominent and constant dermoscopic features. In our study, dotted vessels were detected largely in the early stages of the disease. Conclusion: Our results showed that VLS has characteristic dermoscopic patterns that may be effective in the diagnosis of VLS, especially in the early stages. [ABSTRACT FROM AUTHOR]

Background: The use of dermatoscopes is constantly increasing globally, but to date, there are no studies on the use of dermatoscopes by Chinese dermatologists. Objective: To determine factors influencing the use of dermatoscopes in China. Methods: A web‐based questionnaire was designed by the Department of Dermatology at Huashan Hospital affiliated with Fudan University and was published online via the Shanghai Wheat Color Intelligent Technology Company, China. In 2019 and 2022, 1581 and 1507 dermatologists, respectively, were recruited and completed the questionnaire online. Results: In China, the application rate of dermatoscopy is higher in eastern provinces than in western and remote areas. The proportion of doctors from public tertiary hospitals is the highest, with females being the majority. The age range of 30–40 years has the highest proportion, the proportion of doctors with professional titles of attending physician or above is the highest, and the proportion of doctors with a bachelor's degree or above is the highest. Conclusions: By improving the education and professional standards of doctors, providing more training opportunities, simplifying access, and promoting dermatoscopy in grassroots hospitals, we can increase the confidence of dermatologists in the use of dermatoscopy. [ABSTRACT FROM AUTHOR]

Acral melanoma (AM) is a subtype of cutaneous melanoma located on the palms, soles, and nails. The pathogenesis of AM involves mechanical stimulation and characteristic tumor-promoting mutations, such as those in the KIT proto-oncogene. Dermoscopy is useful for diagnosing AM, which is characterized by parallel ridge patterns and irregular diffuse pigmentation. Although histopathological confirmation is the gold standard for diagnosing AM, lesions showing minimal histopathological changes should be considered early-stage AM if they clinically resemble it. Recently, immunohistochemical staining of preferentially expressed antigen in melanoma has been recognized as a useful method to distinguish benign from malignant melanocytic tumors. Research reveals that AM is associated with an immunosuppressive microenvironment characterized by increased numbers of M2 macrophages and regulatory T cells, alongside a decreased number of tumor-infiltrating lymphocytes. Mohs micrographic surgery or digit-sparing wide local excision has been explored to improve quality of life and replace wide local excision or proximal amputation. AM has a worse prognosis than other subtypes, even in the early stages, indicating its inherent aggressiveness. [ABSTRACT FROM AUTHOR]

Mohs micrographic surgery (MMS) is the gold standard for removing basal cell carcinomas (BCCs) due to its ability to guarantee 100% margin evaluation through frozen section histopathology, offering the highest cure rate among current treatments. However, noninvasive imaging technologies have emerged as promising alternatives to clinical assessment for defining presurgical margins. This systematic scoping review examines the efficacy of these imaging modalities, focusing on those approved for clinical use by the United States Food and Drug Administration (FDA) or the European Medicines Agency (EMA). A systematic search of EMBASE, Scopus, PubMed, and the Cochrane Public Library databases identified 11 relevant studies out of 2123 records, encompassing 644 lesions across five imaging techniques. The findings suggest that dermoscopy, high‐frequency ultrasound (HFUS), optical coherence tomography (OCT), line‐field optical coherence tomography (LC‐OCT), and reflectance confocal microscopy (RCM) show potential in detecting BCC margins, which could enhance MMS by providing better preoperative planning, informing patients of expected defect size, aiding in reconstruction decisions, and reducing overall procedure costs. This review discusses the benefits and limitations of each technique, offering insights into how these innovations could influence the future of BCC management. Emerging imaging techniques could enhance MMS by improving BCC margin assessment and reducing costs. Their adoption will depend on price and ease of use. [ABSTRACT FROM AUTHOR]

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

Dermoscopy of the nail unit (onychoscopy) is a method which allows for non‐invasive observation of the nail structures, increasing the accuracy of clinical diagnosis. Currently, it is used in evaluation of both inflammatory and neoplastic conditions of the nail unit. However, in contrast to the skin, the anatomy of the nail unit prevents direct observation of nail bed or nail matrix structure during classic onychoscopy. Intra‐operative onychoscopy is a variant of the technique which uses direct visualization of the nail unit structures after nail plate avulsion. The aim of this systematic review was to summarize the current state of knowledge on intra‐operative onychoscopy. The MEDLINE, EMBASE and Cochrane databases were systematically searched in January 2024. All types of study designs assessing intra‐operative dermoscopy of the nail unit were included in this study. The risk of bias in included studies was assessed using the Joanna Briggs Institute critical appraisal tools. The qualitative synthesis of 19 studies totalling a number of 218 cases in 217 patients included the following entities: melanoma, nevus, hypermelanosis (melanocytic activation), melanocytic hyperplasia, melanophages accumulation, squamous cell carcinoma, glomus tumour, lichen planus, onychomatricoma, onychomycosis and subungual exostosis. The main limitation of the study was a relatively low number of identified studies, most with low levels of evidence. Intra‐operative onychoscopy does not replace histologic examination, though it may be useful in determining the modality of surgical diagnostic procedures. [ABSTRACT FROM AUTHOR]

Background: Nailfold capillaroscopy is recommended to diagnose primary or secondary Raynaud's phenomenon (RP). Capillaroscopy is normal in primary RP, which is the most frequent. Screening for RP capillary anomalies with nailfold dermoscopy has been promising. Objective: To determine whether normal nailfold dermoscopy—based on the absence of five criteria that define a sclerodermic pattern—is able to predict normal capillaroscopy with good positive‐predictive value (PPV). Methods: Prospective, 2‐phase (monocentre and multicentre) study on patients at first consultation for RP undergoing nailfold video capillaroscopy (NVC) and nailfold dermoscopy by two different 'blinded' trained observers, respectively, a vascular specialist and a dermatologist, not familiar with capillaroscopy. The five criteria noted were as follows: disorganization, megacapillaries, low capillary density, avascular areas and haemorrhages. Results: Based on 105 patients, the dermoscopy PPV for a normal NVC was 100% (p = 0.015), with 37.9% sensitivity, when no criterion was observed. Excluding haemorrhages, the PPV remained 100% (p < 0.0001), with sensitivity rising to 73.7% and 100% specificity. Conclusions: Normal nailfold dermoscopy with the absence of four easy‐to‐observe criteria predicts normal NVC with an excellent PPV. [ABSTRACT FROM AUTHOR]

Background: Diagnosis of cutaneous hypopigmentation can sometimes be challenging. Dermoscopy may play a role in identifying hypo or-depigmented dermatoses. The aim was to investigate which dermoscopic criteria represent potent indicators for the diagnosis of vitiligo, nevus depigmentosus, pityriasis alba, hypopigmented pityriasis versicolor, idiopathic guttate hypomelanosis, hypopigmented mycosis fungoides (MF), lichen sclerosus et atrophicus and ash leaf hypopigmented macules of tuberous sclerosis, and evaluate their diagnostic accuracy. 168 individuals diagnosed with one of these hypopigmented disorders were evaluated for the presence or absence of predetermined dermoscopic criteria. Evaluation of dermatoscopic characteristics in each condition and analysis for sensitivity and specificity of dermatoscopic diagnosis in these hypopigmented lesions was performed. The starburst pattern, micro-koebnerization, and trichrome pattern were unique to vitiligo diagnosis. Vitiligo had higher comet-tail appearance, perifollicular pigmentation, and perilesional hyperpigmentation than other hypopigmented illnesses. Other hypopigmented lesions had greater incidence of amoeboid pattern, faint or diminished pigment network, islands of pigmentation, ill-defined boundaries, pseudopods, and widespread scaling than vitiligo. Finally, perifollicular scaling, comedo-like openings, blue-gray specks, and fibrotic regions excluded vitiligo. Dermoscopy can help identify common hypopigmented skin lesions and reduce the need for skin biopsy. Nevus depigmentosus, pityriasis alba and idiopathic guttate hypomelanosis were the top three hypopigmented dermatoses that could be diagnosed by dermoscopy with 100% sensitivity. Vitiligo was in the second rank (94.7%), followed by lichen sclerosis et atrophicus (93.3%) then hypopigmented MF at 81.2% sensitivity. Dermoscopy sensitivity was lowest in pityriasis versicolor and ash leaf macules of tuberous sclerosis (52.6% and 46.7%, respectively). [ABSTRACT FROM AUTHOR]

Dermoscopy has been used for the non-invasive diagnosis of demodicosis. Several studies have evaluated the usefulness of this tool in the diagnosis, however, there are differences in the gold standard (SSSB or KOH test) and criteria of positivity used between studies. Added to this, is the lack of controls and objective quantification of the usefulness of dermoscopic signs in clinically observable and relevant ranges. To validate the usefulness of dermoscopy for the diagnosis of demodicosis by calculating the performance indicators for the different dermoscopic signs. Retrospective intrapatient case-control study, which included adults with suspicion of demodicosis. Dermoscopic photographs and scraping of healthy and lesional skin were obtained. Samples were analyzed microscopically by trained personnel. Photographs were evaluated by determining the presence of Demodex tails (DT), dilated follicular openings (DFO) and dilated blood vessels (DBV) in pre-defined ranges. 64 patients were included (total = 256 samples); the presence of demodex on skin scraping was seen in 69%. Under dermoscopy, the presence of DT in range 11–20/field had a positive likelihood ratio (LR) of 12.10 (95%CI 6.52–22.45) and negative LR 0.32 (95%CI 0.23–0.45). Combined and dichotomized performance for at least one positive sign under dermoscopy (DT > 10/field, DFO > 10/field or DBV > 50% of the field): positive LR 7.14 (95%CI 4.80-10.62) and negative LR 0.11 (95%CI 0.06–0.22). The presence of DT, DFO or DBV has a high correlation with a positive mite test, so the diagnosis of demodicosis could be made only through dermoscopy. [ABSTRACT FROM AUTHOR]

Objective This study aims to analyze the clinical, pathological and dermoscopic of lichen planus (LP) patients from Jiangsu Provincial Hospital of Traditional Chinese Medicine. Methods A comprehensive analysis of clinical pathology data of 82 LP patients and dermoscopic images of 103 LP patients from January 2011 to February 2024 was conducted. Results Among the 185 LP patients, 70 were male and 115 were female, the ratio of male to female was 1-1.64. Ages ranged from 7 to 82 years, with a mean age was 45.34 ± 16.46 years. The clinical manifestations were diverse, presenting as generalized or localized eruptions, the primary affected areas on the limbs in 93 cases (50. 21%). The lesions primarily manifested as papules or plaques in 142 cases (76.76%). Histopathological examination mainly showed liquefaction degeneration of the basal layer and band-like infiltration of lymphocytes in the superficial dermis, present in 82 cases (100.00%) and 76 cases (92.68%), respectively. The concordance rate between clinical and pathological diagnoses was 62. 20%. Reflectance confocal microscopy images showed liquefaction degeneration of the basal layer in 65 cases (100. 00%) and pigment-laden macrophages and inflammatory cell infiltration in the dermal papillae in 60 cases (92. 31%). Dermoscopy examination observed Wickham striae in 32 cases (84.21%). Conclusion Site involvement, coloration of lesions, Wickham's striae, and lesion arrangement are pivotal diagnostic indicators for LP. Dermoscopy aids in detecting Wickham's striae, while reflectance confocal microscopy emerges as a crucial screening modality. Histopathological examination remains integral for definitive diagnosis. [ABSTRACT FROM AUTHOR]

Patient 1 was a 48-year-old female presented with progressive headache for 1 year. Head CT showed multiple intracranial nodules. Dermatological examination showed multiple brown spots and subcutaneous nodules on the right abdomen in patient and her son. Whole exome and Sanger sequencing showed that the patient and her son carried the c. 1260 +3dupA mutation on exon 11 of the NF1 gene, caused to elongate by 14 bases GTAAAGTCCAAAAG. Patient 2 was a 17-year-old female presented with back prickling for three years. Physical examination showed wide facial distance between the eyes, a flat nasal bridge, masses of various sizes in the corners of the right mouth, lower lip and mandible, multiple brown rashes and subcutaneous nodules on the trunk and limbs, axillary and inguinal freckles. Her partents were normal. Dermatoscopy showed regular and well-defined brown grid-like pigmentation on the upper left side of the back. Histopathology of the tumor on the lateral side of the lower lip showed that there were a large number of spindle cells and scattered mast cells in the dermis. Whole exome sequencing showed the deletion of 1.37 Mb in the 17q11.2 region of the chromosome. All the above patients were diagnosed as neurofibromatosis type I. The skin lesion of Patient 1 was not specially treated, while the skin lesion of Patient 2 was surgically removed. Both cases were under follow-up. [ABSTRACT FROM AUTHOR]

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Background. Alopecia areata (AA) is a nonscarring alopecia that can affect any hairy area of the body. Excimer light at 308 nm with immunosuppressive effects is recommended as a promising management method for AA. Objectives. To assess the efficacy and safety of excimer light at 308 nm alone versus a combination of tacrolimus 0.1% and excimer light in the treatment of alopecia areata. Methods. Forty patients with AA of the scalp were divided into two groups, group A was treated with an excimer lamp twice per week for three months, and group B was treated with a combination of tacrolimus 0.1% and an excimer light. The efficacy of the treatment was evaluated by the SALT score and serum T‐regulatory cells at the baseline, after 3 months from the baseline, and after 6 months from the beginning of treatment. Results. In group (A), the median SALT decreased from the baseline (13.15) to (6.15) 3 months after the baseline and further decreased after 6 months of follow‐up to (3.3). While in group (B), the median SALT score was decreased from the baseline (11.15) to (0.5) after 6 months from the beginning of treatment. After 3 months, there was improvement in Treg function in both groups A and B (4.98 ± 1.02, 5.50 ± 0.84), respectively. There was a significantly higher improvement in group B (85.19 ± 8.55) than group A (70.05 ± 9.95). Dermoscopic findings reveal decreased signs of activity in group B more than group A. Conclusion. The combination of excimer light and tacrolimus is more effective than excimer light alone in treatment of AA. [ABSTRACT FROM AUTHOR]

Onychomycosis, a nail infection caused by dermatophytes, yeast, and molds makes up roughly half of all onychopathies and is the most prevalent nail condition in the world. Clinically, nail psoriasis and onychomycosis can frequently be difficult to distinguish from one another. To assess the prevalence of onychomycosis in patients with psoriasis. Fifty patients with psoriasis associated with nail disease were included in this study. After taking clinical history, nail samples were gathered for dermoscopic inspection, culture, direct microscopy with 20% KOH solution, and nail clipping with PAS stain. Of the 50 patients recruited, 43 were males and 7 were females, with mean age 6–71 years (mean ± SD 44.06 ± 16.2). Eleven patients (22%) tested positive for onychomycosis. Dermatophytes were isolated from 2% of patients, yeast from 14% of patients, and non-dermatophytic mold from 38% of patients. Histopathological results revealed fungal hyphae and spores in 18% of patients. The most prevalent dermoscopic sign in psoriatic patients with onychomycosis was spikes (81.8%) with statistical significance (P-value < 0.001), while nail pitting was the most prevalent dermoscopic feature in nail psoriasis. This study lays the way for an accurate diagnosis of nail lesions by highlighting the significance of cooperation between mycology, histology, and dermoscopy in the diagnosis of onychomycosis in patients with nail psoriasis. [ABSTRACT FROM AUTHOR]

Automatic skin lesion subtyping is a crucial step for diagnosing and treating skin cancer and acts as a first level diagnostic aid for medical experts. Although, in general, deep learning is very effective in image processing tasks, there are notable areas of the processing pipeline in the dermoscopic image regime that can benefit from refinement. Our work identifies two such areas for improvement. First, most benchmark dermoscopic datasets for skin cancers and lesions are highly imbalanced due to the relative rarity and commonality in the occurrence of specific lesion types. Deep learning methods tend to exhibit biased performance in favor of the majority classes with such datasets, leading to poor generalization. Second, dermoscopic images can be associated with irrelevant information in the form of skin color, hair, veins, etc.; hence, limiting the information available to a neural network by retaining only relevant portions of an input image has been successful in prompting the network towards learning task-relevant features and thereby improving its performance. Hence, this research work augments the skin lesion characterization pipeline in the following ways. First, it balances the dataset to overcome sample size biases. Two balancing methods, synthetic minority oversampling TEchnique (SMOTE) and Reweighting, are applied, compared, and analyzed. Second, a lesion segmentation stage is introduced before classification, in addition to a preprocessing stage, to retain only the region of interest. A baseline segmentation approach based on Bi-Directional ConvLSTM U-Net is improved using conditional adversarial training for enhanced segmentation performance. Finally, the classification stage is implemented using EfficientNets, where the B2 variant is used to benchmark and choose between the balancing and segmentation techniques, and the architecture is then scaled through to B7 to analyze the performance boost in lesion classification. From these experiments, we find that the pipeline that balances using SMOTE and uses the adversarially trained segmentation network achieves the best baseline performance of 91% classification accuracy with EfficientNet B2. Based on the scaling experiments, we find that optimal performance is reached with the B6 architecture that classifies with a 97% accuracy. Furthermore, the proposed pipeline for lesion characterization outperforms the state of the art performance on the ISIC dataset. [ABSTRACT FROM AUTHOR]

Objective: The goal is to determine if the implementation of dermoscopy improves the accuracy, specificity, and sensitivity rates of skin cancer detection among dermatology clinicians and identify the optimal training method for dermatology clinicians to become proficient in dermoscopy. Methods: A comprehensive search through the A.T. Still Memorial Library, including the electronic health databases PubMed, Scopus, UpToDate, and CINAHL, was performed. Google Scholar search results were sorted by relevance, and the first 30 pages were included within the search due to the large quantity of results. The search keywords included "skin cancer diagnosis," "accuracy," "detection," "dermoscopy," and "dermatologists." The search was performed in July 2023. The date limitations used within the search parameters ranged from 2017 to 2023 to review the past seven years of publications. The search evaluated reference lists and encompassed those that met the inclusion and exclusion criteria. Dermatologists, dermatology physician assistants, dermatology nurse practitioners, and primary care practitioners were eligible for inclusion. The search included literature from any country. The English language was the only language permitted within the search. Gray literature was included in the search using news, press release, and MedRxiv. Results: A total of 28 articles met the inclusion criteria. All of the articles included were from peer-reviewed sources and in the English language. The articles came from 10 different countries of origin and were published from 2017 to 2023. The main results of the scoping review discovered that the use of dermoscopy improves the accuracy of skin cancer diagnosis. The results also demonstrated that dermoscopy training is highly variable; multiple different types of diagnostic algorithms are used in the professional medical education systems of the 10 countries included within the scoping review. The dermoscopy training algorithms recommended include pattern analysis, 7-point checklist, Menzies method, Triage Amalgamated Dermoscopy Algorithm, Australasian College of Dermatology Dermoscopy Course, 3-point checklist, ABCD rule, Skin Imaging College of China, and no particular algorithm. Of these, the three most commonly recommended included the 7-point checklist, Menzies method, and pattern analysis. Conclusion: The results demonstrated that dermoscopy improves the accuracy of skin cancer diagnosis for dermatology clinicians and primary care providers. Key implications of these findings for practice include earlier skin cancer detection, which can lead to reduced rates of morbidity and mortality, reduced overall healthcare costs, reduced number of benign lesions biopsied, and improved patient outcomes. [ABSTRACT FROM AUTHOR]

Objectives Methods Results Conclusions To explore the dermoscopic features of lichen sclerosus in different parts of the external genitalia in children.A retrospective analysis of the dermoscopic features of 42 female children with vulvar lichen sclerosus treated in the Department of Dermatology of Shanxi Children's Hospital from January 2020 to May 2023.Among the 42 female children, aged 3–14 years (mean: 7.24 ± 2.43 years), the duration of vulvar lichen sclerosus ranged from 3 months to 2 years (mean: 9.83 ± 4.93 months). Clinical lesions occurred in the labia minora in 18 cases (42.9%), labia majora in 38 cases (90.5%), posterior fourchette in 36 cases (85.7%), perianal area in 13 cases (31.0%), anterior fourchette in 17 cases (40.5%), clitoris in seven cases (16.7%), and interlabial sulcus in 11 cases (26.2%). Dermoscopic findings common in the labia majora included follicular keratotic plugs, cloverleaf‐like structures, comedo‐like openings, and linear vessels (p < .05); however, purple–red globules and patches and white linear streaks were more common in the posterior fourchette (p < .05), whereas dotted vessels were more common in the labia minora (p < .05).Common dermoscopic findings in pediatric vulvar lichen sclerosus were yellow‐white structureless areas, white linear streaks, follicular keratotic plugs, and cloverleaf‐like structures; yellow‐white structureless areas and white linear streaks showed the highest specificity. The dermoscopic findings varied among different affected areas, which provides a basis for further understanding of the characteristics of different sites of vulvar lichen sclerosus in the pediatric population. [ABSTRACT FROM AUTHOR]

Background and Design: The aim of this study is to enhance the diagnosis and treatment of basal cell carcinoma (BCC) by comparing clinical, dermoscopic, and pathological features. Materials and Methods: This retrospective study included patients from the dermatology clinic between 2012 and 2015 with 111 BCC lesions. Results: The average age for aggressive-type BCC patients was higher. Aggressive-type BCCs were more common on the face. Dermoscopic, gray-blue ovoid nests were more common on the trunk. Pigmented dots were less common on the face, while globules were more frequent on the scalp. Small erosions were more prevalent on the extremities, while shiny white-red structureless areas were more common on the trunk and extremities. Dot vessels were more prevalent on the scalp. Vascular features were more common on the face, whereas pigmented characteristics were less common. Other dermoscopic features were more common on the face and trunk. Arborizing vessels, ulcerations, white crystals, and hairpin vessels were more common in nodular lesions. Other dermoscopic features were more prevalent in nodular lesions. Mixed-type BCCs had more gray-blue ovoid nests and globules, while single-type BCCs had more small erosions. Vascular features were more common in mixed-type BCCs. Ulceration was more common in aggressive BCCs, while small erosions were more prevalent in nonaggressive BCCs. Histopathologically, pigmented BCCs were more common on the scalp and trunk than on the face. Superficial BCCs were more common in trunks and flat lesions. Adenoid BCC was more prevalent in nodular lesions. Scalp mixed-type BCCs were more common and aggressive. Mixed-type BCCs had a higher number of subtypes, including pigmented, infiltrative, adenoid, micronodular, and solid BCCs. Cystic degeneration was more common in mixed-type BCCs. Conclusion: Clinical-pathological correlations and dermoscopic findings improve our understanding of BCC, aiding in accurate diagnosis and management. [ABSTRACT FROM AUTHOR]

Melanoma is the deadliest skin cancer, presenting typically with changing pigmented areas and usually treated with surgical removal. As benign cutaneous pigmented lesions are very common in all populations, it can be challenging to identify which areas should be cut out or left untreated. Delayed treatment in melanoma increases the risk of death, but it is not possible to remove all lesions. Dermatoscopy uses polarized light and can be used to help distinguish melanomas from benign lesions. Dermatoscopy images with a confirmed diagnosis can be used to develop artificial intelligence (AI) as a medical device (AIaMD) tool. This contribution discusses the utilization of AI in melanoma management and describes an AIaMD tool used in current UK clinical practice on more than 80,000 patients. This is a springboard for discussing the scope, risks, and mitigations for future AI use by all clinicians involved in managing people with melanoma. [ABSTRACT FROM AUTHOR]

The prognosis, outcome, and overall survival of melanoma patients improve with early diagnosis which has been facilitated in the past few decades with the introduction of dermoscopy. Further advancements in dermoscopic research, coupled with skilled, educated dermatologists in dermoscopy, have contributed to timely diagnoses. However, detecting amelanotic and hypomelanotic melanoma remains a challenge even to the most skilled experts because these melanomas can mimic inflammatory diseases, numerous benign lesions, and non-melanoma skin cancers. The list of the possible differential diagnoses can be long. Melanoma prediction without the pigment relies only on vascular criteria, and all classic dermoscopic algorithms have failed to fulfill our expectations. In fact, the diagnosis of amelanotic and hypomelanotic melanomas is very challenging, which is why every tool in detecting these lesions is of significance. This review aims to explore the current knowledge and the literature on the possibility of detecting amelanotic/hypomelanotic melanomas using sequential monitoring with digital dermoscopy and total body skin photography. [ABSTRACT FROM AUTHOR]

Background: Several clinical signs in dermatoscopy are very characteristic of onychomycosis and can be a quick complement for the diagnosis of onychomycosis. Objectives: The aim of this study was to evaluate the diagnostic accuracy of dermatoscopy compared to microbiological culture and polymerase chain reaction (PCR), as well as the clinical signs associated with onychomycosis. Methods: The clinical signs of 125 patients were assessed cross‐sectionally using dermatoscopy, and a positive or negative result was assigned. A sample was then taken for PCR and microbiological culture. Results: Of the 125 patients, 69.6% (87/125) had positive results when both laboratory tests were combined. When they were not combined, the prevalence was lower at 48% (60/125) with PCR and at 43.2% (54/125) with culture. Furthermore, 76.8% (96/125) were classified as positive with dermatoscopy with a sensitivity of 1, a specificity of 0.76, positive predictive value of 0.91 and negative predictive value of 1 (with 95% confidence intervals). Of the 96 dermatoscopy‐positive samples, 36 were negative with PCR (p < 0.001), 42 were negative with culture (p < 0.001) and nine were negative when both tests were combined (p < 0.001). Clinical signs that were significantly associated with the presence of onychomycosis were subungual hyperkeratosis (dermatoscopy: p = 0.004, odds ratio (OR) = 2.438; PCR + microbiological culture: p = 0.004, OR = 3.221), subungual detritus (p = 0.033, OR = 3.01, only with dermatoscopy) and dermatophytoma (dermatoscopy: p = 0.049, OR = 3.02; PCR + microbiological culture: p = 0.022, OR = 2.40). Conclusions: The results suggest that dermatoscopy is a good tool for the diagnosis of onychomycosis but should be used as a complementary test or for screening patients to be sampled for laboratory testing. The combination of the three tests can lead to a reduction of false‐positive and false‐negative clinical and laboratory results. This allows for early diagnosis and specific treatment based on test results. [ABSTRACT FROM AUTHOR]

Background: Onychomycosis (OM) is a common nail infection treated with amorolfine hydrochloride nail lacquer in China. Monitoring drug concentrations and using dermoscopy to evaluate treatment efficacy may provide new insights. Objective: The study aims to analyse amorolfine concentrations in nails with mild to moderate OM, assess treatment outcomes using dermoscopy and explore factors influencing drug concentrations and efficacy. Methods: Patients with mild to moderate OM confirmed by fungal microscopy were enrolled. Amorolfine nail lacquer was applied twice weekly for 36 weeks. Monthly nail samples measured amorolfine concentrations using liquid chromatography. Dermoscopy was performed before and after treatment to evaluate responses. Mixed‐effects models and logistic regression analysed factors affecting drug concentrations and outcomes. Results: Ninety‐seven nails were included. Amorolfine concentrations increased over time, with higher levels in females, fingernails, 2nd–5th digits and superficial white OM (p < 0.05). Age was a risk factor, while drug concentration and OM type were protective for clinical efficacy (p < 0.05). Peak concentration correlated with clinical (r = 0.487, p = 0.000) and mycological (r = 0.433, p = 0.000) responses. Dermoscopic features improved significantly in successful cases (p < 0.05). Limitations: In the assessment of fungal efficacy, only fungal microscopy was used, and fungal cultures were not performed. The study was limited by a small sample size and the lack of a longer follow‐up to assess relapse. Conclusion: Amorolfine concentrations vary with patient and nail characteristics, influencing efficacy. Dermoscopy is valuable for monitoring OM treatment. [ABSTRACT FROM AUTHOR]

This document explores the use of UVF-dermoscopy, a new imaging technique, in diagnosing and distinguishing between Microsporum and Trichophyton infections of the skin. The study found that polarized dermoscopy alone may not be enough to accurately differentiate between these two types of infections, particularly in cases involving glabrous skin. However, UVF-dermoscopy, which reveals green fluorescence, showed potential in distinguishing between the two types of infections. The study acknowledges its limitations and suggests that more research is necessary to validate these findings. [Extracted from the article]

Background: Alopecia Areata (AA) is an autoimmune disease that targets hair follicles and is driven by T cells specific to that organ. As it was found that the lack of expression of VDRs is associated with reduced hair follicle growth and epidermal differentiation. The aim of this study was to evaluate the efficacy and safety of intralesional vitamin D and to assess it by the dermoscope. Methods: This study is A clinical trial study that included 20 patients with alopecia areata, who received intralesional injection of vitamin D (an aqueous preparation of cholecalciferol (Devarol ampule 200000iu/2ml, Memphis, Egypt) (2.5mg/ml) the maximum total amount of Vitamin D3 injected in every session was 1.25mg (0.5ml).Treatment of alopecia areata was done according to the study protocol and the patients were evaluated at initial Visit, every 2 weeks during treatment sessions and 3 months after completion of therapy. Results: There was no statistical significance change in SALT score among our group patients post treatment compared to pretreatment, regarding clinical response there was 10% of cases (2 patients) shows hair regrowth by >25% (A2) and majority of patients 75% (15 patients) shows minimal hair regrowth by < 25% (A1), 15% of cases (3 patients) showed no improvement at all, there was erythema, itching and pain assessed among study cases (20%, 15% and 15% respectively). Atrophy and telangiectasia were found among 5% in cases. Conclusions: Intralesional Vitamin D (cholecalciferol) is a mild effective treatment of Alopecia Areata. [ABSTRACT FROM AUTHOR]

Simple Summary: The scarcity of specific clinical and dermoscopic criteria makes solitary pink skin lesions the most challenging to diagnose. Cherry angioma, clear cell acanthoma, dermal nevus, keloid, hypertrophic scar, and Spitz nevus are the most common benign lesions that share similar clinical and dermoscopic features. Furthermore, some malignant lesions, such as basal cell carcinoma, actinic keratosis, or amelanotic melanoma, can be indistinguishable from the above-mentioned benign pinkish lesions. Several studies have demonstrated the excellent diagnostic accuracy of reflectance confocal microscopy in increasing sensitivity and specificity compared to dermoscopy alone for the diagnosis of skin cancer. This study aimed to summarize the application of dermoscopy and RCM for the differential diagnosis of benign and malignant pinkish–reddish skin lesions, although, in suspicious lesions, the final diagnosis should always be confirmed after surgical excision and histopathological evaluation. Diagnosing solitary pink skin lesions poses a significant challenge due to the scarcity of specific clinical and dermoscopic criteria. Several benign lesions, such as cherry angioma, clear cell acanthoma, dermal nevus, keloid, hypertrophic scar, and Spitz nevus, often exhibit similar clinical and dermoscopic features. This similarity extends to some malignant lesions, including basal cell carcinoma, actinic keratosis, and amelanotic melanoma, making differentiation difficult. Recent studies highlight the enhanced diagnostic accuracy of reflectance confocal microscopy (RCM), which offers increased sensitivity and specificity compared to dermoscopy alone for diagnosing skin cancer. This study aims to summarize the application of dermoscopy and RCM in distinguishing between benign and malignant pinkish–reddish skin lesions. The integration of RCM with traditional dermoscopic techniques improves the ability to accurately identify and differentiate these lesions. However, it is crucial to note that for any suspicious lesions, a final diagnosis must be confirmed through surgical excision and histopathological evaluation. This comprehensive approach ensures accurate diagnosis and appropriate treatment, highlighting the importance of combining advanced imaging techniques in clinical practice. [ABSTRACT FROM AUTHOR]

Simple Summary: Early detection of melanoma and differentiation from benign nevi can be challenging even for the most experienced dermatologists. To improve melanoma detection, artificial intelligence algorithms incorporating dermoscopy have been developed, but lack transparency and therefore have limited training value for healthcare providers. To address this, an automated approach utilizing imaging biomarker cues (IBCs), logical features extracted from images that mimic expert dermatologists' dermoscopic pattern recognition skills, was developed. This study excluded deep learning approaches to which IBCs are complementary or alternative. Ten participants assessed 78 dermoscopic images (39 melanomas and 39 nevi) first without IBCs and then with IBCs. Using IBCs significantly improved diagnostic accuracy: sensitivity increased significantly from 73.69% to 81.57% (p = 0.0051) and specificity increased from 60.50% to 67.25% (p = 0.059). These results indicate that incorporating IBCs can significantly enhance melanoma diagnosis, with potential implications for improved screening practices. Further research is needed to confirm these findings across a variety of healthcare providers. Incorporation of dermoscopy and artificial intelligence (AI) is improving healthcare professionals' ability to diagnose melanoma earlier, but these algorithms often suffer from a "black box" issue, where decision-making processes are not transparent, limiting their utility for training healthcare providers. To address this, an automated approach for generating melanoma imaging biomarker cues (IBCs), which mimics the screening cues used by expert dermoscopists, was developed. This study created a one-minute learning environment where dermatologists adopted a sensory cue integration algorithm to combine a single IBC with a risk score built on many IBCs, then immediately tested their performance in differentiating melanoma from benign nevi. Ten participants evaluated 78 dermoscopic images, comprised of 39 melanomas and 39 nevi, first without IBCs and then with IBCs. Participants classified each image as melanoma or nevus in both experimental conditions, enabling direct comparative analysis through paired data. With IBCs, average sensitivity improved significantly from 73.69% to 81.57% (p = 0.0051), and the average specificity improved from 60.50% to 67.25% (p = 0.059) for the diagnosis of melanoma. The index of discriminability (d′) increased significantly by 0.47 (p = 0.002). Therefore, the incorporation of IBCs can significantly improve physicians' sensitivity in melanoma diagnosis. While more research is needed to validate this approach across other healthcare providers, its use may positively impact melanoma screening practices. [ABSTRACT FROM AUTHOR]

A 69-year-old White man was referred to a dermatologist with an asymptomatic lesion on the nape of his neck. The lesion was a cherry-red plaque with no surface change. The patient had no history of trauma, skin cancer, or immunocompromisation. A biopsy revealed sun-damaged skin with thin-walled vessels and a mild lymphocytic infiltrate, leading to a diagnosis of acquired elastotic haemangioma (AEH). AEH is a rare condition that typically presents as a slow-growing plaque or patch on sun-exposed skin in older individuals. Treatment is not necessary, but excision may be performed for diagnostic purposes. [Extracted from the article]

Dermoscopy has seen increased use in the diagnosis of hypopigmentary disorders. As a quick and effective adjunct to the clinician's toolbox, dermoscopy offers the opportunity to differentiate between hypopigmentary lesions that ostensibly present with clinically similar morphology on the macroscopic scale. The focus of this article is to review the various dermoscopic signs and patterns that have been elucidated for these disorders. [ABSTRACT FROM AUTHOR]

Dermoscopy is a noninvasive, efficient and inexpensive tool used to aid diagnosis of skin conditions such as vitiligo. Furthermore, it aids in tracking patient progress, treatment response and disease activity. Vitiligo can be diagnosed on dermoscopy by the presence of white structureless areas signifying hypopigmentation with a typical glowing appearance. Other typical features are perilesional and perifollicular hyperpigmentation, pigmentation networks and leucotrichia. In total, 15 studies were reviewed to determine the dermoscopic signs of the three main stages of disease activity: active, stable and repigmenting vitiligo. Features that differentiate active, stable and repigmenting vitiligo are reviewed and discussed in this article. Notably, there is a conflict in the literature between various dermoscopic features and which type of vitiligo they are truly indicative of. However, dermoscopy can be coupled with other clinical, biological and physiological markers to strengthen diagnostic accuracy. [ABSTRACT FROM AUTHOR]

Melasma is a common acquired hyperpigmentation disorder that predominantly affects females with skin of colour. It is difficult to treat and impacts on people's quality of life, owing to its predilection for the face. In addition to helping make the correct diagnosis, dermoscopy can assist in the exclusion of differential diagnoses, to inform treatment decision-making and to recognize treatment-related adverse effects. [ABSTRACT FROM AUTHOR]

Skin scar formation following Bacille Calmette-Guérin (BCG) or smallpox (Vaccinia) vaccination is an established marker of successful vaccination and ‘vaccine take’. Potent pathogen-specific (tuberculosis; smallpox) and pathogen-agnostic (protection from diseases unrelated to the intentionally targeted pathogen) effects of BCG and smallpox vaccines hold significant translational potential. Yet despite their use for centuries, how scar formation occurs and how local skin-based events relate to systemic effects that allow these two vaccines to deliver powerful health promoting effects has not yet been determined. We review here what is known about the events occurring in the skin and place this knowledge in the context of the overall impact of these two vaccines on human health with a particular focus on maternal-child health. [ABSTRACT FROM AUTHOR]

Acne scarring is a common sequela of acne vulgaris, which seriously affects facial esthetics. The treatment options for acne scars vary depending on the development stage, color, type, and location of scarring. The objective and precise assessment of acne scars is a prerequisite for treatment, and it is also an important means of monitoring the treatment effect. The traditional methods to evaluate the types and severity grade of acne scars are primarily based on subjective assessment by physicians, which lacks objectivity and accuracy. Novel noninvasive skin imaging techniques, such as skin surface imaging analysis systems, dermoscopy, reflectance confocal microscopy (RCM), high-frequency ultrasound (HFUS), optical coherence tomography (OCT), and multiphoton tomography (MPT), provide new tools for the rapid and objective assessment of acne scars. This article reviews the progress of skin imaging techniques in the diagnosis, classification, and efficacy evaluation of acne scars. [ABSTRACT FROM AUTHOR]

Lentigo maligna (LM) is a subtype of lentiginous melanoma confined to the epidermis, which is associated with chronic sun exposure. Its clinical, dermatoscopic, and histopathological diagnosis can be challenging, particularly in the early and advanced stages, requiring appropriate clinicopathological correlation. This article reviews the clinical presentation, diagnosis through noninvasive methods (dermoscopy and confocal microscopy), and provides insights for diagnosis of extrafacial LM through the presentation of four representative clinical cases from different phases of a theoretical–practical progression model. Recognizing these lesions is crucial, as once they invade the dermis, they can behave like any other type of melanoma. [ABSTRACT FROM AUTHOR]