Spitz nevus and melanoma: evaluation with dermoscopy and reflectance confocal microscopy.

Introduction: Spitz nevi (SN) include a wide range of benign melanocytic nevi, which are controversial due to their morphologic resemblance to melanoma (MM). Aim: To describe dermoscopic and reflectance confocal microscopic (RCM) features of SN compared to MM and assess the RCM utility in the differential diagnosis. Material and methods: We performed a multicentre retrospective analysis of MM and SN evaluated with dermoscopy and reflectance confocal microscopy. Three RCM mosaics were obtained for each lesion. Nine dermoscopic and twenty-one microscopic features were assessed for each lesion. Results: A total of 26 lesions (15 SN and 11 MM) were included. Dermoscopically, most SN showed a "starburst" pattern. Asymmetry was marked in 8 MM. There were 6 dermoscopic features significantly more prevalent in MM than in SN. RCM showed that an atypical honeycomb pattern, atypical infiltration, and disarray of the epidermis were significant for MM. SN mostly revealed a typical honeycomb pattern. At the DEJ, most of SN had a meshwork pattern; MM revealed an atypical meshwork pattern. Atypical cells and sheet-like structures were observed in most MM. Conclusions: A combined approach using dermoscopy and RCM supports the differential diagnosis of SN and MM. Although our study showed some significant differences between SN and MM in RCM, further research on a larger group should be considered.

Locally advanced basal cell carcinoma: Real-life data with sonidegib.

In recent years, the category of hedgehog pathway inhibitor (HHI) has shown great results in patients with advanced basal cell carcinoma (aBCC), but few real-life data on efficacy and safety profile of sonidegib are available. We report our management of locally advanced BCCs (laBCCs) with sonidegib, also describing the favorable response of locally advanced basosquamous carcinomas (laBSCs) treated with this hedgehog signaling inhibitor. Sonidegib was generally well tolerated and it achieved high response rates, improving quality of life. Our single-center experience could be useful to better delineate long-term efficacy and tolerability profile demonstrated in the trials described in literature. Moreover, our cases provide preliminary evidence that sonidegib might be effective for laBSC.

Melanoma diagnosed on digital dermoscopy monitoring: A side-by-side image comparison is needed to improve early detection.

BACKGROUND: Digital dermoscopy monitoring (DDM) helps to recognize melanomas lacking specific dermoscopic features at baseline, but the number of melanomas eventually developing specific features is still unknown. OBJECTIVE: To assess how many melanomas are identified because they develop melanoma-specific criteria over time compared with melanomas recognized by side-by-side image comparison. METHODS: A case-control study was conducted collecting 206 melanomas: 103 melanomas diagnosed during DDM follow-up and 103 melanomas diagnosed at baseline. The control group was composed of 309 benign lesions consisting of 103 nevi excised for diagnostic reasons, 103 not excised nevi, and 103 not excised seborrheic keratoses. Dermoscopic images of all 515 lesions were randomly presented to 2 blinded experts to give a diagnosis and to score the criteria of the 7-point checklist. RESULTS: Of the 103 melanomas diagnosed at baseline, 78.6% (n = 81) were correctly identified compared with only 40.8% (n = 42) of melanomas diagnosed after DDM (P < .001). Of the 103 melanomas excised after DDM, 59.2% (n = 61), did not develop melanoma-specific criteria and were identified only because of the side-by-side image comparison. LIMITATIONS: The type of morphologic changes considered as suspicious on DDM was not assessed. CONCLUSIONS: Most melanomas are diagnosed with DDM by side-by-side image comparison.

Neoadjuvant Therapy for Non-melanoma Skin Cancer: Updated Therapeutic Approaches for Basal, Squamous, and Merkel Cell Carcinoma.

OPINION STATEMENT: Recently introduced systemic therapies for locally advanced and metastatic non-melanoma skin cancers (NMSCs) are paving the way for neoadjuvant approach. Although none of the therapeutic options has currently gained indication in this setting, neoadjuvant approach for NMSCs is an open field and we are likely to see huge developments in the near future. Targeted therapy with sonic hedgehog pathway inhibitors is very effective in locally advanced or multiple basal cell carcinomas while immunotherapy with immune checkpoint inhibitors appears to be promising for advanced cutaneous squamous cell carcinoma and Merkel cell carcinoma. To date, targeted therapy and immunotherapy represent the frontiers in NMSC therapeutic management and, according to recent studies, good results can be achieved.

In vivo reflectance confocal microscopy of halo nevi.

INTRODUCTION: Halo nevi named also Sutton's nevi are uncommon melanocytic lesions occurring especially among adolescents. There are two effective diagnostic methods: dermoscopy and in vivo reflectance confocal microscopy (RCM), which can help us to observe many structural elements and characteristic features of Sutton's nevi. OBJECTIVES: The aim of this study was to describe reflectance confocal microscopy features of halo nevi. METHODS: Eleven patients with fourteen halo nevi were examined by FotoFinder Medicam 800 dermoscope and reflectance confocal microscope Viva Scope 1500 between May of 2018 and September of 2019. RESULTS: Dermoscopic examination revealed 78.6% nevi with a globular pattern, while 21.4% showed a homogenous pattern. In RCM, a typical honeycombed pattern was observed in 57.1% of nevi. 42.9% of nevi showed a disarray of the epidermis and presence of dendritic cells. 35.7% of all lesions presented roundish atypical cells in the epidermis. Roundish pagetoid cells in the dermo-epidermal junction were detected in 14.2% of nevi. Non-edged papillae were observed in 50% of lesions. In each nevus, there were dilated vessels. 50% of nevi revealed dense nests in the periphery, although in case of one lesion the dishomogeneous nests were observed. CONCLUSIONS: Halo nevi are important "melanoma simulators" in confocal microscopy.

Efficacy and safety of secukinumab in a psoriatic patient affected by comorbid metabolic disorders.

Psoriasis is a common, chronic, immune-mediated disease occurring more frequently in association with comorbid metabolic disorders. The management of patients with multiple organ dysfunction is challenging since the use of all conventional systemic agents is limited or contraindicated. In the last two decades, the introduction of biological drugs has revolutionized treatment paradigms of psoriasis and enabled numerous patients to achieve disease control with an acceptable safety profile. We reported for the first time the case of a 66-year-old female psoriatic patient affected by myocardial infarction, hypertension, chronic renal failure, hyperthyroidsm and morbid obesity, who experienced remarkable improvement in skin and joint synthoms and metabolic parameters after 48 weeks of secukinumab monotherapy. In our patient, secukinumab was well tolerated and no side effects have been observed. Our observation suggests that secukinumab could be a safe therapeutic option in patients with organ impairment or failure in which the majority of conventional systemic agents are contraindicated.

Plasma radiofrequency ablation for treatment of benign skin lesions: Clinical and reflectance confocal microscopy outcomes.

BACKGROUND: In the latest few years, plasma radiofrequency ablation has turned out a good option for treatment of several benign skin lesions. The technique can be easily performed to treat skin lesions with limited tissue invasion and no residual scars or hypo/hyperpigmentation areas. OBJECTIVE: The aim of this study was to assess the effects of plasma radiofrequency ablation in treatment of benign skin lesions, through clinical and reflectance confocal microscopy outcomes. METHODS: Six patients who presented benign skin lesions underwent long-wave plasma radiofrequency ablation treatment with DAS medical device (Technolux, Italia). Reflectance confocal microscopy analysis was performed at baseline and after 1 month. RESULTS: The treatment was well tolerated; only a slight erythema and a thin crust on the treated area were referred for 3-7 days after treatment. After one month from treatments, we observed the complete disappearance of the lesions and no significant signs of inflammation, redness, hypo/hyperpigmentation, or scars on the site of the treated areas; these clinical data were also confirmed by reflectance confocal microscopy analysis. CONCLUSIONS: Long-wave plasma radiofrequency ablation actually can be considered a well-tolerated, painless, safe, effective, and low-cost procedure for skin treatments.

Dermoscopy of Cutaneous Lymphoproliferative Disorders: Where Are We Now?

The prompt identification of cutaneous lymphoproliferative disorders (CLD) has always been a challenge in dermatological practice, due to the rarity of this group of diseases, the heterogeneity in clinical presentation, and plenty of variants described in the literature so far. The strict cooperation between dermatologist and pathologist is the key element for the correct diagnosis of CLD deriving from the perfect integration of clinical and histopathological features. In this complex context, dermoscopy could play an adjuvant role in the achievement of the diagnosis, as it fits itself as the third diagnostic tool in the paraphernalia of the dermatologist between the clinical and histopathological examination. This review provides the state of art of dermoscopy of CLD.

Clinical and instrumental evaluation of the efficacy of a new depigmenting agent containing a combination of a retinoid, a phenolic agent and an antioxidant for the treatment of solar lentigines.

BACKGROUND: Solar lentigines are common benign macular hyperpigmented lesions localized on sun-exposed areas. OBJECTIVE: To evaluate the efficacy and safety of a new depigmenting agent containing a retinoid (retinaldehyde), a new phenolic agent (4-(1-phenylethyl)-resorcinol) and a reducing agent (δ-tocopheryl-ß-D-glucopyranoside) in the topical treatment of solar lentigines. PATIENTS AND METHODS: Twenty patients with solar lentigines of the face and hands applied the depigmenting agent on each lentigo once daily for 12 weeks. The outcome was evaluated at 45 days (T1) and 3 months (T2) after the end of treatment compared to baseline (T0) by means of clinical evaluation, Mexameter® and Visioface devices for digital and ultraviolet computerized image analysis of skin color as well as in vivo reflectance confocal microscopy. RESULTS: Image analysis and confocal laser reflectance microscopy showed that hyperpigmentation was significantly reduced at T2 compared to baseline and to controls. CONCLUSION: The study treatment was well tolerated and showed significant improvement in the depigmentation of solar lentigines.

Reflectance confocal microscopy features of seborrheic dermatitis for plaque psoriasis differentiation.

BACKGROUND: Plaque psoriasis (PP) and seborrheic dermatitis (SD) are chronic inflammatory skin diseases with similar clinical and pathological features. Differential diagnosis can be difficult, especially when particular skin areas of the face are involved. Reflectance confocal microscopy (RCM) has been demonstrated to be useful for 'real-time' diagnosis of skin inflammatory diseases. OBJECTIVE: To define distinctive confocal criteria of SD and to evaluate the usefulness of this technique for noninvasive differential diagnosis with PP. METHODS: A total of 40 patients affected by PP and 19 patients by SD involving the face were recruited and subjected to RCM evaluation. Univariate and adjusted odds ratios were calculated. Discriminant functions were used to plot ROC curves. RESULTS: The results disclosed specific patterns for SD and PP. The following distinctive confocal features for SD have been identified: spongiosis, dermal inflammation and horizontal orientation of dilated blood vessels. CONCLUSION: SD has a specific and easily recognizable confocal pattern supporting clinical differentiation with PP.

Unraveling the Complex Nexus of Human Papillomavirus (HPV) in Extragenital Keratinocyte Skin Tumors: A Comprehensive Analysis of Bowen's Disease and In Situ Squamous-Cell Carcinoma.

This comprehensive study delves into the intricate landscape surrounding the role of human papillomavirus (HPV) in extragenital keratinocyte skin tumors, specifically exploring Bowen's disease (BD) and in situ squamous-cell carcinoma (iSCC). Through a multifaceted examination, this research study elucidates the nuanced interplay of HPV, gender dynamics, anatomical site variations, and potential implications for the etiopathogenesis of these malignancies.

Concordance between in vivo reflectance confocal microscopy and optical histology of lymphomatoid papulosis.

BACKGROUND: Lymphomatoid papulosis is a primary cutaneous CD30+ T-cell lymphoma clinically characterized by a benign, chronic, recurrent course with self-limited papulo-nodular skin lesion eruption. In vivo Reflectance Confocal Microscopy is a non-invasive technique for real-time imaging of the superficial layers of the skin down to the superficial dermis with cellular-level resolution close to conventional histopathology. RCM has been previously reported to be useful in the in vivo evaluation of inflammatory diseases, skin tumours and also cutaneous lymphomas. Only two articles have been published on cutaneous lymphomas and none detailing confocal features of LyP. The aim of this manuscript was to describe the confocal features of LyP and their histological correlation to evaluate the possible application of this non-invasive tool in this T-cell lymphoma subtype clinical management. METHODS: Five patients with histological diagnosis of LyP were imaged with RCM, followed by a skin biopsy on a clinically selected lesion. RESULTS: High grade of correspondence between RCM and histopathology of LyP was observed, disclosing the potential rule of RCM at least for biopsy site selection. CONCLUSION: Future studies on RCM for LyP vs. other cutaneous T-cells lymphomas and inflammatory skin diseases are needed to assess specificity and sensibility of our preliminary data.

Psoriasis plaque test with confocal microscopy: evaluation of different microscopic response pathways in NSAID and steroid treated lesions.

BACKGROUND: Pathophysiology of psoriasis is complex and characterized by microscopic, specific changes. In vivo reflectance confocal microscopy (RCM) provides tissue and cell morphology information in non-invasive way, generating quasi-histologic resolution. Concerning plaque psoriasis, confocal criteria have been described disclosing high agreement between RCM and conventional histology. OBJECTIVE: We sought to evaluate the in vivo microscopic changes in plaque psoriasis occurring during treatment with two distinct actives (aceclofenac and betamethason). METHODS: A total of 32 patients with psoriasis were recruited. Two lesions from the same body area or symmetrical were evaluated at baseline and after 3-6 weeks by RCM. RESULTS: Aceclofenac induced clinical improvement in 32% of patients after 3 weeks and in 76% after 6 weeks. With betamethason, at the end of the 3rd week, the 45% of patients showed improvement that increased to 81% at the end of the study. Single confocal criteria was evaluated and results underwent to statistical analysis considering the modification of the microscopical changes during the two treatments. CONCLUSION: RCM followed the microscopic changes during treatment and enabled to differentiate effects of different actives. Although data are preliminary and based on a limited sample, aceclofenac seems to be effective in the treatment for psoriasis.

In vivo characterization of healthy oral mucosa by reflectance confocal microscopy: a translational research for optical biopsy.

PURPOSE: To characterize in vivo microscopic features of healthy oral mucosa by noninvasive, real-time reflectance confocal microscopy (RCM). MATERIAL AND METHODS: One hundred healthy mucosal sites (38 lips, 24 cheeks, 10 gingivae, and 28 tongues) from 50 randomly selected volunteers were imaged by a commercially available in vivo RCM (Vivascope3000, Lucid, Rochester, NY). Morphological results were described and correlated with conventional histology. RESULTS: Specific microscopic parameters (cellular morphology, anatomical structures features, architectural patterns) were identified by RCM for each mucosal site. CONCLUSIONS: RCM features reproducibility in different mucosal sites and subjects, which suggests that RCM can be an adjunct tool for clinical management in stomatology.

Reflectance confocal microscopy for the evaluation of solitary red nodules.

The correct assessment of a solitary red nodule in clinical practice is of crucial importance, amelanotic melanoma being the most important differential diagnosis. Dermoscopy is nowadays a pivotal tool in the management of skin tumors, however it has some limitations in the evaluation of nonpigmented lesions, in which the diagnosis is merely based on the evaluation of the vascular pattern. Recently, reflectance confocal microscopy has been introduced as a new, noninvasive technique for the diagnosis of skin lesions. Confocal microscopy provides skin imaging in vivo at cellular level resolution, close to conventional histology. We present a series of clinical scenarios of red nodules, including melanoma metastasis, pyogenic granuloma, eccrine poroma, Spitz nevus and dermatofibroma. Reflectance confocal microscopy examination added important information to the clinical diagnosis and subsequent management in all cases except for dermatofibroma. We discuss the advantages and limitations of this technique in this particular field of application.