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Le neoplasie cutanee di tipo non-melanoma (non-melanoma skin cancers, NMSCs), quali il carcinoma a cellule basali (basal cell carcinoma, BCC) e il carcinoma a cellule squamose (squamous cell carcinoma, SCC) possono mostrare invasività locale e alto tasso di recidiva. La chirurgia microscopicamente controllata di Mohs (Mohs micrographic surgery, MMS) permette di eseguire una valutazione istologica immediata dei margini chirurgici delle neoplasie contestualmente alla loro escissione. Nel nostro studio abbiamo valutato del ruolo delle tecnologie in vivo (dermatoscopia e microscopia confocale a riflettanza, MCR) nella definizione dei margini preoperatori di NMSC ad alto rischio del volto e descritto la nostra esperienza con chirurgia tradizionale e MMS. Sono stati valutati 234 pazienti operati nel triennio 2019-2021: 39 con MMS e guida videodermatoscopica (Gruppo 1) e 195 con chirurgia tradizionale e guida videodermatoscopica (Gruppo 2). I pazienti operati nel periodo 2013-2018 (con MMS, Gruppo 3 (n = 241), e con chirurgia tradizionale, Gruppo 4 (n = 1086)) sono stati usati come confronto. La radicalità chirurgica è stata ottenuta nel Gruppo 1 nel 92,3% dei casi, con 1,2 steps in media di MMS (versus 1,7 nel Gruppo 3), nel Gruppo 2 nell’84,5% dei casi. La percentuale di non radicalità è stata: 7,7% nel Gruppo 1, 15,9% nel Gruppo 2, 6,2% nel Gruppo 3, 17,9% nel Gruppo 4. I tassi di recidiva sono stati: 5,1% nel Gruppo 1, 3,6% nel Gruppo 2, 4,1% nel Gruppo 3, 5,9% nel Gruppo 4, soprattutto in BCC di tipo sclerodermiforme e infiltrante. La MCR prechirurgica è stata utilizzata in 11 pazienti, con alcuni limiti nel delineare BCC di tipo sclerodermiforme e infiltrante. In conclusione, la videodermatoscopia e la MCR appaiono valide tecniche ancillari alla MMS e anche alla chirurgia tradizionale nel trattamento dei NMSCs. La MMS appare indicata soprattutto nei pazienti giovani e salvaguarda l’outcome estetico e funzionale., Non-melanoma skin cancers (NMSCs) such as high risk basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) may be difficult to treat, due to a tendency to local tissue invasion and high recurrence rate. Mohs micrographic surgery (MMS) allows margin mapping of the NMSC and immediate margin evaluation. In our study we aimed to evaluate the role of videodermoscopy and reflectance confocal microscopy (RCM) in the preoperative evaluation of surgical margins of high risk NMSCs of the face; to describe our experience with traditional surgery and MMS. We evaluated 234 patients treated in the years 2019-2022: 39 were operated with MMS assisted by videodermoscopy (Group 1), 195 with traditional surgery assisted by videodermoscopy (Group 2). Data were compared with patients treated in the years 2013-2018 (with MMS, Group 3 (n = 241) and with traditional surgery, Group 4 (n = 1086)). Radical excision was obtained in 92,3% of cases in Group 1, with a mean of 1,2 steps of MMS (versus 1,7 in Group 3), and in 84,5% of cases in Group 2. Groups 1 and 3 showed similar rates of incomplete excision (7,7% and 6,2%), while Group 2 showed a sensible reduction of incomplete excision rate compared with Group 4 (15,9% versus 17,9%). Recurrence rates were: 5,1% in Group 1, 3,6% in Group 2, 4,1% in Group 3, 5,9% in Group 4. Recurrence was common in infiltrative and morpheiform BCCs, in elderlies and male patients. In conclusion, videodermoscopy and MCR, even if more recent, represent valid ancillary techniques to both MMS and traditional surgery. MMS is mostly suitable for young patients and guarantees an acceptable cosmetic and functional outcome.

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

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

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

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