Melanoma Prevention: Comparison of Different Screening Methods for the Selection of a High Risk Population.

BACKGROUND: Guidelines recommend limiting melanoma screening in a population with known risk factors, but none indicates methods for efficient recruitment. The purpose of this study is to compare three different methods of recruiting subjects to be screened for melanoma to detect which, if any, is the most efficient. METHODS: From 2010 to 2019, subjects were recruited as follows: (1) regular skin examinations (RS), mainly conducted through the Associazione Contro il Melanoma network; (2) occasional melanoma screening (OS), during annual public campaigns; (3) and selective screening (SS), where people were invited to undergo a skin check after filling in a risk evaluation questionnaire, in cases where the assigned outcome was intermediate/high risk. Melanoma risk factors were compared across different screening methods. Generalized Linear Mixed Models were used for multivariable analysis. RESULTS: A total of 2238 subjects (62.7% women) were recruited, median age 44 years (2-85), and 1094 (48.9 %) records were collected through RS, 826 (36.9 %) through OS, and 318 (14.2 %) through SS. A total of 131 suspicious non-melanoma skin cancers were clinically diagnosed, 20 pathologically confirmed, and 2 melanomas detected. SS performed significantly better at selecting subjects with a family history of melanoma and I-II phototypes compared to OS. CONCLUSIONS: Prior evaluation of melanoma known risk factors allowed for effective selection of a population to screen at higher risk of developing a melanoma.

Pseudo-dense Hair Transplantation: Strategy of "Less Inside, More Outside" and Central Bulking with Curled Chest Hairs as Treatment for Scalp Scars.

Hair transplantation in areas of scalp scars is a clinical challenge. However, by creating the visual illusion of central bulking with the use of peripherally transplanted curled chest hairs, cicatricial alopecia can perhaps be cosmetically improved. In a case of a 34-year-old affected man, this strategic procedure was implemented with positive results, as the transplantation was successful, the scar was far less noticeable, and the patient was satisfied with the results. The "pseudo-dense hair transplantation" method can be applied to similar patients, noting that a more succinct procedure will need to be elucidated for the varying etiologies of cicatricial alopecia.

Biofibre® artificial hair implant: Retrospective study on 1,518 patients with alopecia and present role in hair surgery.

To treat alopecia, there are many surgical and nonsurgical treatments available nowadays. In the surgical one, the Biofibre® hair implantation system represents an important innovation with artificial hair with special physical, chemical, and mechanical features and the new Biofibre® Automatic device. Implant on 1,518 patients has been reported in this study where the Biofibre® hair implant technique is performed on men and women with varying degrees of baldness and for the treatment of various causes of alopecia such as androgenetic alopecia, burns, and scars. According to our experience, this technique gives immediate and visible results without scarring or hospitalization and the aesthetic results are very encouraging for both male and female patients with a rapid recovery of self-esteem and psychological well-being.

Controversial issues in vitiligo patients: a review of old and recent treatments.

Vitiligo is quite a common hypopigmentary disorder, which may affect both children and adults with important psychological effects due to the well-known leopard skin-like appearance. The authors summarize in the present study the published evidence on vitiligo with particular interest on the controversial aspects of the disease, such as its definition and the available treatments.

Intralesional triamcinolone alone or in combination with botulinium toxin A is ineffective for the treatment of formed keloid scar: A double blind controlled pilot study.

Cutaneous injury can ignite excessive fibroproliferative growth that results in keloid formation. Keloids are associated with significant morbidity related to disfigurement and/or symptoms (e.g., pain and pruritus). First-line treatment of formed keloids involves topical or intralesional steroids. Recurrent or resistant keloids are managed by surgical excision or cryotherapy, followed by steroidal application or adjuvant irradiation. Although adjuvant irradiation appears to be most efficacious, alternative therapeutic options are needed for patients without access to radiation centers. Botulinum Toxin A (BTA) appears to have similar inhibitory effects to irradiation on the cell cycle via downregulation of pathogenic cytokines. Herein, we conducted a study to compare the efficacy of intralesional triamcinolone used alone, or in combination with BTA, in the treatment of formed keloid scars. Twenty patients with a cumulative of 40 keloids completed the study. There was no significant difference between treatment arms with respect to height vascularization, pliability, and pigmentation scores. The addition of BTA resulted in significant symptomatic improvement of pain and pruritus as compared to intralesional triamcinolone alone (p < 0.001). Irradiation is only effective when administered in the adjuvant setting where inhibitory effects on cell cycle and migration are optimized. Future studies with intralesional triamcinolone and BTA should be performed adjuvantly.

Recycling of Previously Transplanted Hair: A Novel Indication for Follicular Unit Extraction.

BACKGROUND: Hair transplantation has enhanced the realm of procedural dermatology. Before the advent of follicular transplantation, androgenetic alopecia was a difficult disease to manage, as there is a limited armamentarium of topical and systemic pharmaceuticals. However, as with other novel surgical procedures, there is a steep learning curve, that may result in poor transplantation or cosmesis. CASE REPORT: We present a case of androgenetic alopecia, where previously, poorly implanted hairs were recycled by follicular unit extraction to increase hair density at the vertex of the scalp, which resulted in improved cosmesis and patient satisfaction. CONCLUSION: We have demonstrated that re-transplantation is not only feasible but is effective; therefore redesigning of previous transplantations should be considered as a possible indication follicle unit extraction, particularly in the setting of scarce follicular reserves. The utility of our recycling method may also inspire hope in patients that have undergone failed or unsatisfactory hair transplantations.

Successful Craniotomy for Advanced Basal Cell Carcinomas with Cranial Bone Invasion and Dura Mater Infiltration - Unique Presentation in a Bulgarian Patient.

BACKGROUND: Basal cell carcinomas (BCC) located in the sun-exposed regions are a serious therapeutic challenge. Therefore early diagnosis and adequate therapy should be of a high priority for every dermatologic surgeon. CASE PRESENTATION: We are presenting a patient with multiple BCCs, located on the area of the scalp, who had been treated several years ago with electrocautery and curettage after histopathological verification. However, the last few years the tumours have advanced, infiltrating firstly the tabula external and a year later the tabula interna of the cranium. A computed -tomography (CT) imaging and radiography of the skull were performed to reveal the definite tumour localisation, needed for planning an one - step surgical intervention. Both of the instrumental examinations confirmed the existence of osteolytic tumour lesions. Craniotomy with precise removal of the BCCs infiltrating the cranial bone in all of its thickness was performed. Partial resection of dura mater was also performed also because intraoperative findings established the involvement of the dura. Histopathological verification revealed bone and dural invasion with clean resection margins. The bone defect was recovered with hydroxyapatite cement. Reconstruction as the shape of the skull was carefully modified and adapted to its initial size and form. Layered closure of the skin and soft tissues were performed after the complete removal of the BCCs. The postoperative period had no serious complications. CONCLUSION: Precisely managed therapy of BCC is curative in most of the cases as it ensures good prognosis for the patient.

Successful Treatment with UVA 1 Laser of Non - Responder Vitiligo Patients.

The Authors discuss their experience in treating non-responder vitiligo patients with a UVA-1 laser. Laser Alba 355® is an innovative device of target UVA - 1 phototherapy. The present report suggests that UVA1 laser could be an applicable therapeutic option in patients with vitiligo, also for the ones who did not respond to the more conventional phototherapies.

Micro - Focused Phototherapy Associated To Janus Kinase Inhibitor: A Promising Valid Therapeutic Option for Patients with Localized Vitiligo.

BACKGROUND: Vitiligo is an acquired pigmentary cutaneous disease, characterised by the progressive loss of melanocytes, resulting in hypopigmented skin areas which progressively become amelanotic. Classically, vitiligo treatments are unsatisfactory and challenging. Despite the continuous introduction of new therapies, phototherapy is still the mainstay for vitiligo repigmentation. AIM: The aim of this multicenter observational retrospective study was to evaluate the efficacy and safety of the nb - UVB micro - phototherapy (BIOSKIN EVOLUTION®), used alone or in associations with an oral Janus kinase inhibitor (Tofacitinib citrate), in the treatment of stable or active forms of localised vitiligo. MATERIAL AND METHODS: Fifty eight patients had been treated with n-UVB micro-photootherapy (Group A); 9 patients had been treated with phototherapy plus Tofacitinb citrate (Group B). RESULTS: Among Group A, 42 patients (72%) obtained a re-pigmentation rate higher than 75%, with a medium value of 77%. 11 patients (19%) achieved a marked improvement of the clinical findings with a repigmentation rate between 50-75%; 4 patients (8%) showed a moderate response with a lesional repigmentation of 25-50%. Only one patient (1%) had a poor response to the phototherapeutic treatment. CONCLUSION: Nb - UVB micro-focused phototherapy is one of the most effective therapeutic options for vitiligo treatment. The association of micro-focused phototherapy to Tofacitinib citrate seems to provide better clinical results in term of repigmentation rate.

An Innovative Therapeutic Protocol for Vitiligo: Experience with the Use of Fraxel Herbium Laser, Topical Latanoprost and Successive Irradiation with UVA - 1 Laser.

Despite the continuous introduction of innovative therapies for vitiligo, today none of them provide constant and excellent results in term of repigmentation. The authors report their experience in treating a localised form of vitiligo with a new protocol consisting in the use of a Fraxel Herbium laser, and in the following application of topical Latanoprost solution and, one day after, in lesional irradiation with UVA1 laser.

A "Yellow Submarine" in Dermoscopy.

BACKGROUND: Histiocytic sarcoma (HS) is an extremely rare, non-Langerhans cell tumor. HS affects especially adults, its etiology is unknown yet. Skin could be interested by papules or nodules, single or multiple. CASE REPORT: A Caucasian man in his late 40s came to our clinic for a naevi evaluation. During the visit, a rose papulonodular lesion was observed in the lumbar region. This lesion was completely asymptomatic, and it had been there for an indefinite period. The clinical evaluation revealed that the lesion appeared elevated, of 9 x 15 mm in dimension, symmetrical and of a homogeneous pinkish colour. The videodermoscopical evaluation revealed a homogeneous yellow central pattern, polymorphic vessels, an eccentric peripheral pigmentation and a white collar. An excisional biopsy was performed. The morphology and the expression of CD163, CD68 and/or lysozyme to the immunophenotypic analysis, revealed the true nature of the lesion. CONCLUSION: HS is usually diagnosed at an already advanced clinical stage and it has a high mortality rate even today. Dermoscopy, showing a yellow and distributed homogeneously colour, can facilitate its hard diagnosis.

Neglected Under Lip Cancer.

The lip represents an anatomical area of the interface between the skin and oral mucosa. It is, therefore, not entirely surprising that SCC of the lip exhibits mixed features between cutaneous and oral mucosal SCC, namely regarding risk factors and biological behaviour. The main risk factors for lip SCC include ultraviolet radiation exposure, low phototype, tobacco and alcohol use, and immunosuppression. Lip SCC usually presents clinically as a nodule or a tumour with a keratotic surface that commonly ulcerates. There is often a background of actinic cheilitis. The particularly exuberant presentation of our case can most probably be explained by the long evolution of a tumour before the patient reached medical attention. Patients with regional lymph node metastasis are usually offered regional lymph node dissection (usually of the neck). Radiotherapy and/or chemotherapy may be used in advanced cases, particularly in unresectable tumours, tumours with high-risk features and metastatic disease. The large size of a tumour in our case, most probably due to its long evolution, highlights the importance of timely diagnosis to avoid such extreme presentations and the consequent need for more aggressive treatment.

Sweet's Syndrome (SS) in the Course of Acute Myeloid Leukaemia (AML).

Firstly described by Robert Douglas Sweet in 1964, febrile neutrophilic dermatosis is a disabling, not only cutaneous disorder, clinically characterised by fever and painful erythematous nodules, with a typical background of neutrophilia. Sweet's syndrome (SS) is a chronic inflammatory reactive disorder of unknown cause and incompletely established pathogenesis, although an interplay between genetic and environmental factors, including infections, is likely to occur. A significant part of cases has been demonstrated to be linked with malignancies, especially in the hematologic setting. Because of the underlying disease and related therapeutic measures, SS may present atypical clinical course, whereas the response to treatment is strictly dependent on the concurrent hematologic disease. Herein we describe a case of a lady who had a refractory form of SS, resulted in a paraneoplastic cutaneous disease, and AML. Surprisingly, clinical remission of SS followed cytotoxic chemotherapy while hematologic disorder obtained a further complete response.

Once in a Blue Moon Rare Adnexal Tumor: From the Clinical and Videodermoscopical Aspects to the Mohs Surgery and the Histological Diagnosis.

The adnexal tumours are a very heterogeneous group of lesions, more and more studied in the literature. The squamoid eccrine ductal carcinoma (SEDC) is a rare malignant variant that combines ductal structures with squamous differentiation. We report a case of dermoscopic and histological diagnosis of SEDC, treated with Mohs Surgery and with no recurrence of a tumour after 12 months of follow up.

Health and Illness in History, Science and Society.

Health is a fundamental human right. The World Health Organization defines it as a "state of complete physical, psychological and social well - being and not merely the absence of disease or infirmity". The health of individuals, however, is also linked to the environment in which they live and especially to their ability to adapt and integrate into their life context. The relationship with the environment is extremely important because it is that interaction that outlines the concept of normality compared to pathology. Such normality needs to be contextualised by gender, geographical origin and by the individuals' living conditions: as a matter of fact, what is normal for a young person may differ from what is normal for a senior one. That is to say, the concept of health is indeed relative and it is the result of an interesting evolution of the concept of illness. From the first approaches - dealing with the mere treatment of the symptoms - to the promise of a free-from-pain society, science and economics have played a significant role in redefining the dualism health/ illness. The article reflects on these two concepts, health and illness, in history and nowadays, and discusses the future of the medical science.

Unconventional Treatments for Vitiligo: Are They (Un) Satisfactory?

The authors show a brief overview of the vitiligo's unconventional therapies. A part for well-documented effectiveness of L-phenylalanine, PGE2 and antioxidant agents in the treatment of vitiligo, for the other therapeutical approaches more investigations are needed.

Arthrospira Platensis - Potential in Dermatology and Beyond.

The search for natural products with benefits for health in general and of potential for treating human disease has gained wider interest world-wide. Here, we analyse current data on the microalga Arthrospira platensis (AP), that has been used in nutrition since ancient times in Fare East and African communities, for medical purposes with a focus on dermatology. Extracts of AP have been investigated in vitro and in vivo. The alga is rich in proteins, lipopolysaccharides and gamma-linolenic acid. AP extracts, phycocyanin compounds and polysaccharide calcium spirulan (Ca-SP) have been evaluated in various models. It could be demonstrated, that AP has significant antioxidant activity, prevents viruses from entry into target cells and inhibits the colonisation of wounds by multi-resistant bacteria. Furthermore, anti-cancer activity was documented in models of oral cancer, melanoma, and UV-induced non-melanoma skin cancer.

Vitiligo in Children: A Better Understanding of the Disease.

Vitiligo is an important skin disease of childhood. The authors briefly discuss the etiopathobiology, clinics and comorbidities of the disease.

Integrative Dermatology - The Use of Herbals and Nutritional Supplements to Treat Dermatological Conditions.

From humble beginnings at the dawn of time to it's advanced and successful status today, this essay traces the history of natural medicine and the development of integrated dermatology to what it is today. Some of the most well-known natural (international and Australian) products with an application in dermatology are discussed. The history and functions of the Psoriasis Eczema Clinic and the products developed by its founder, Prof. Michael Tirant, are explained.

Herbal Compounds for the Treatment of Vitiligo: A Review.

An overview of unconventional therapies for vitiligo is presented. Some herbal compounds may be considered as valid therapeutic tools for the treatment of vitiligo.