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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]

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

Background: Early melanoma detection is the main factor affecting prognosis and survival. For that reason, non‐invasive technologies have been developed to provide a more accurate diagnosis. Recently, line‐field confocal optical coherence tomography (LC‐OCT) was developed to provide an in vivo, imaging device, with deep penetration and cellular resolution in three dimensions. Combining the advantages of conventional OCT and reflectance confocal microscopy, this tool seems to be particularly suitable for melanocytic lesions. Objectives: The objective of this study was to identify and describe the correlation between specific dermoscopic criteria and LC‐OCT features in three dimensions associated with melanocytic lesions. Methods: Dermoscopic and LC‐OCT images of 126 melanocytic lesions were acquired in three different centres. The following dermoscopic criteria have been considered: reticular pattern, dots and globules, structureless areas, blue‐whitish veil, regression structures, negative network, homogeneous pattern, streaks and blotches. Results: 69 (55%) benign and 57 (45%) malignant lesions were analysed. A regular reticular pattern was found associated in the 75% of the cases with the presence of elongated rete ridges with pigmented cells along the basal layer, while atypical reticular pattern showed an irregular organization of rete ridges with melanocytic hyperplasia, broadened and fused ridges and elongated nests. Both typical and atypical dots and globules were found associated with melanocytic nests in the dermis or at the dermoepidermal junction (DEJ), as well as with keratin cysts/pseudocysts. Grey globules corresponded to the presence of melanin‐containing dermal inflammatory cells (melanophages) within the papillae. Structureless brown/black areas correlated with alterations of the DEJ. We observed the same DEJ alterations, but with the presence of dermal melanophages, in 36% of the cases of blue/white/grey structureless areas. A description of each LC‐OCT/dermoscopy correlation was made. Conclusions: LC‐OCT permitted for the first time to perform an in vivo, 3D correlation between dermoscopic criteria and pathological‐like features of melanocytic lesions. [ABSTRACT FROM AUTHOR]

This article discusses a rare variant of lichen planus called lichen planus pigmentosus inversus (LPPI). LPPI is characterized by hyperchromic macules in non-sun exposed areas, typically occurring bilaterally in the axillae and groin of Caucasian patients. However, the article presents a case of LPPI with unilateral distribution in an Indian woman. The article describes the clinical features, dermoscopic evaluation, and line-field confocal optical coherence tomography (LC-OCT) findings of the case. The histopathological examination confirmed the diagnosis of LPPI. The article also discusses the differential diagnosis, etiology, and the potential use of LC-OCT as a diagnostic tool for LPPI. [Extracted from the article]

This article discusses the use of line-field confocal optical coherence tomography (LC-OCT) in diagnosing tinea capitis, a common fungal infection of the scalp hair in children. LC-OCT is a non-invasive imaging technique that allows for real-time evaluation of skin disorders with cellular resolution. The study presents a case of a 6-year-old boy with tinea capitis, where LC-OCT revealed corkscrew hairs filled with hyper-reflective structures, indicative of hair invasion by the fungus. LC-OCT shows promise as an additional tool for diagnosing tinea capitis, particularly in pediatric patients, but further research is needed to establish accurate criteria for evaluating parasitized hair. [Extracted from the article]

Acroangiodermatitis (AAD) is a rare skin condition characterized by vascular and fibrotic proliferations caused by chronic inflammation due to persistent hypoxia. There are four variants of AAD, with the Mali type being the most common. A case study is presented of a 78-year-old patient with an ulcerative lesion on the right pre-tibial area, which occurred in the context of a pigmented greyish area that had been present for nine years. Non-invasive imaging techniques, including high-frequency ultrasound and line-field optical coherence tomography, were used to diagnose AAD and rule out other conditions. This case is unique because it represents an atypical presentation of the Mali type of AAD in a patient without venous insufficiency or arteriovenous malformations. The use of non-invasive imaging techniques may help avoid skin biopsies in the future. [Extracted from the article]

Background: Line‐field confocal optical coherence tomography (LC‐OCT) is a new, valid means for a rapid and non‐invasive in vivo examination of the epidermis and upper dermis, allowing digital interpretation and measurement of high‐resolution images on a cellular level. Given these properties, it may represent a valid tool for monitoring psoriasis during treatment, allowing a new method to set a precise objective severity of the disease. Objectives: We aimed to investigate the potentialities of LC‐OCT in the non‐invasive monitoring of microscopical changes associated with moderate–severe plaque psoriasis (PP) during the treatment with the most common biological drugs. Materials and Methods: We performed LC‐OCT imaging of PP lesions from 17 patients before and after 8 weeks of treatment. The clinical severity of the single lesions was evaluated using a lesion score (LS), designed considering three parameters: erythema, desquamation and infiltration. LC‐OCT images were segmented by artificial intelligence and evaluated based on three microscopic criteria: the thickness of the stratum corneum, the thickness of the living epidermis and the undulation of the dermo‐epidermal junction. Results: Line‐field confocal optical coherence tomography digital analysis allowed recognition and quantification of the three microscopic criteria, showing a reduction of all these during the follow‐up. Furthermore, a high correlation between change in LS and the thickness of the stratum corneum and the thickness of the living epidermis was found. Conclusion: Line‐field confocal optical coherence tomography can non‐invasively monitor the response of PP to different treatments. Morphometric changes occurring in the psoriatic lesion during the 8‐week treatment period were identified by in vivo LC‐OCT and measured by using artificial intelligence. Although future studies are required, based on these preliminary results, LC‐OCT may represent a valid potential tool for precise monitoring of therapeutic response. [ABSTRACT FROM AUTHOR]

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

This article discusses the case of a 44-year-old woman with hyperimmunoglobulinemia D periodic fever syndrome (HIDS) who also developed hidradenitis suppurativa (HS). HIDS is a rare autoinflammatory disorder caused by mutations in the MVK gene, while HS is a chronic skin disease characterized by recurrent nodules, abscesses, and scars. The article suggests that the coexistence of HIDS and HS may provide insights into the molecular pathways underlying autoinflammation and could potentially lead to new therapeutic strategies for both conditions. [Extracted from the article]

This article discusses a new dermoscopic criterion for diagnosing basal cell carcinoma (BCC) called "negative maple-leaf-like areas" (NMLLAs). NMLLAs are round, nonpigmented structures with a whitish background and well-defined borders. They are associated with superficial BCC and correspond to non-pigmented tumor nests at the dermal-epidermal junction level. The article also introduces a new technology called line-field confocal optical coherence tomography (LC-OCT), which combines the advantages of reflectance confocal microscopy (RCM) and conventional OCT. LC-OCT allows for a precise correlation of dermoscopic criteria with skin images. The article presents a case study that demonstrates the correlation between NMLLAs seen in dermoscopy and hemispheric BCC lobules observed with LC-OCT. The use of LC-OCT may help clinicians identify NMLLAs, which can be difficult to recognize. Further studies are needed to confirm this hypothesis. [Extracted from the article]

Introduction: Dermoscopic predictors of lentigo maligna (LM) and lentigo maligna melanoma (LMM) have been recently reported, but these have not been reported in reflectance confocal microscopy (RCM). Objectives: (i) To validate dermoscopic predictors for LM/LMM, (ii) to identify RCM patterns in LM and LMM, and (iii) correlations between dermoscopic and RCM features in LM and LMM. Materials and Methods: A retrospective, multicentre study of consecutive lesions with histologically proven LM or LMM subtypes of the head and face, with complete sets of dermoscopic and RCM images. Results: A total of 180 lesions were included (n = 40 LMM). Previously reported differential dermoscopic features for LM subtypes were confirmed. Other features significantly associated with LMM diagnosis included irregular hyperpigmented areas, shiny white streaks, atypical vessels and light brown colour at dermoscopy and medusa head‐like structures, dermal nests and nucleated cells within the papillae at RCM (p < 0.05). Correlations among LM lesions between dermoscopic and RCM features included brown to‐grey dots and atypical cells (epidermis), grey colour and inflammation and obliterated follicles and medusa head‐like structures. Among LMM lesions, significant correlations included obliterated follicles with folliculotropism, both irregular hyperpigmented areas and irregular blotches with widespread atypical cell distribution (epidermis), dermal nests and nucleated cells within the papillae (dermis). Irregular blotches were also associated with medusa head‐like structures (dermal epidermal junction [DEJ]). Conclusions: Dermoscopic and RCM features can assist in the in vivo identification of LM and LMM and many are correlated. RCM three‐dimensional analysis of skin layers allows the identification of invasive components in the DEJ and dermis. [ABSTRACT FROM AUTHOR]

Scale bar = 100 m. Tumour lobule, defined under LC-OCT as roundish, elongated and hemispheric tumour island corresponds to RCM bright tumour island or dark silhouette. Dear Editor, Reflectance confocal microscopy (RCM) and line-field confocal optical coherence tomography (LC-OCT) are non-invasive imaging techniques that can help the clinical diagnosis of basal cell carcinoma (BCC).[[1], [3], [5]] Although LC-OCT and RCM have been compared for the identification of squamous cell carcinomas,[4] no comparative studies on BCC diagnostic criteria are available. Our results confirm that both RCM and LC-OCT can help in the non-invasive identification of BCC with an excellent agreement for the presence of tumour lobules in all of their characterizations. [Extracted from the article]

Line-field confocal optical coherence tomography (LC-OCT) is a non-invasive technique that can be used to differentiate infiltrative basal cell carcinoma (iBCC) from scar-like lesions. This study describes the LC-OCT features of scar-like lesions and demonstrates that the absence of typical BCC lobules and the presence of dense collagen fibers in the dermis can be used as criteria to rule out iBCC. LC-OCT can enhance the differential diagnosis of BCC and should be included in the diagnostic process to avoid unnecessary invasive procedures. However, it is important to note that LC-OCT may have limitations in detecting unusually deep tumors. [Extracted from the article]

This article discusses the use of line-field confocal optical coherence tomography (LC-OCT) in diagnosing graphite tattoos. Graphite tattoos are exogenous lesions that occur when graphite from a pencil penetrates the skin or mucosa. The diagnosis of graphite tattoos is typically based on patient history and clinical examination, but LC-OCT can provide additional information by showing hyper-reflective particles in the mid dermis. This non-invasive imaging technique could be a useful tool in identifying graphite tattoos, particularly in children, and reducing the need for invasive procedures. [Extracted from the article]

Polarized dermoscopy 30× highlights the presence of clods (asterisks) and curved vessels (arrowheads) along the pustules margin (d) and all over the erythematous halo around the pustule (f). We read with interest the paper from Abadías-Granado et al.[1] reporting on two patients aged 64 and 60 years who experienced generalized pustular figurate erythema (GPFE) after the instart (2 and 3 weeks, respectively) of the same protocol for SARS-CoV-2 pneumonia, consisting of hydroxychloroquine (400 mg/day) plus lopinavir/ritonavir, teicoplanin ± azithromycin; the report also raises attention on a possible coexistence of COVID-19 skin manifestation. Skin biopsies revealed subcorneal/intraepidermal pustular dermatosis with oedema and lympho-histiocytic infiltrates in supper dermis (Figures 1c and 2f) consistent with a GPFE picture.[[1], [3]] Patients underwent topical and systemic steroids treatment for 4 and 5 weeks. [Extracted from the article]

Background: Amelanotic/hypomelanotic lentigo maligna and lentigo maligna melanoma (AHLM/LMM) may be very difficult to diagnose at an early stage. Objectives: To quantify the predictive value of dermoscopic and reflectance confocal microscopy (RCM) features for AHLM/LMM. Methods: Dermoscopic and RCM images of histopathologically diagnosed AHLM/LMM, amelanotic/hypomelanotic benign lesions (AHBL), and amelanotic/hypomelanotic basal and squamous cell carcinomas (AHBCC/AHSCC) of the head and neck from consecutive patients were retrospectively collected and blindly evaluated by three observers to assess presence or absence of dermoscopic and RCM criteria. Results: Overall, 224 lesions in 216 patients including LM/LMM (n = 55, 24.6%), AHBL (n = 107, 47.8%) and AHBCC/AHSCC (n = 62, 27.7%) were analysed. Multivariable analysis showed that milky‐red areas (OR = 5.46; 95% CI: 1.51–19.75), peripheral light brown structureless areas (OR = 19.10; 4.45–81.96), linear irregular vessels (OR = 5.44; 1.45–20.40), and asymmetric pigmented follicles (OR = 14.45; 2.77–75.44) at dermoscopy, and ≥3 atypical cells in five fields (OR = 10.12; 3.00–34.12) and focal follicular localization of atypical cells at dermo‐epidermal junction (DEJ) (OR = 10.48; 1.10–99.81) at RCM were significantly independent diagnostic factors for AHLM/LMM vs. AHBL. In comparison with AHBCC/AHSCC, peripheral light brown structureless area (OR = 7.11; 1.53–32.96), pseudonetwork around hair follicles (OR = 16.69; 2.73–102.07), and annular granular structures (OR = 42.36; 3.51–511.16) at dermoscopy and large dendritic (OR = 6.86; 3.15–38.28) and round pagetoid cells (OR = 26.78; 3.15–227.98) at RCM led to a significantly increased risk of diagnosing AHLM/LMM. Conclusions: Amelanotic/hypomelanotic lentigo maligna and lentigo maligna melanoma may have the same dermoscopic features of AHM on other body sites, such as milky red areas, peripheral light brown structureless areas and linear irregular vessels. These features, asymmetric pigmented follicles and at RCM ≥ 3 atypical cells in five fields and focal follicular extension of atypical cells at DEJ may help in recognizing AHLM/LMM even when LM conventional features (e.g., obliteration of hair follicles under dermoscopy and large pagetoid cells under RCM) are absent or present only in very small areas of the lesion. [ABSTRACT FROM AUTHOR]

Although clinical trials[5] and real-world studies[[6], [8], [10]] have investigated its role in these patients, there are no comparative studies specifically evaluating the efficacy of Risankizumab according to body mass index (BMI). All these data lead us to postulate that Risankizumab represents an optimal molecule for the management of patients with moderate-to-severe psoriasis, regardless of BMI. Real-life effectiveness of Risankizumab according to body mass index: Results of an Italian multicentre retrospective study. [Extracted from the article]

In addition, the integrated dermoscopic camera allowed to exactly identify the areas to be examined by LC-OCT characterized by polygonal, yellowish/brownish structures.[1] This is the first study describing the LC-OCT aspects of Darier's disease. 9 Di Stefani A, Cappilli S, Ricci C, Costantini A, Paradisi A, Peris K. Line-field confocal optical coherence tomography (LC-OCT) in Hailey-Hailey disease: another brick in the wall. 2015; 73 (3): e97 - 9. 2 Ruini C, Schuh S, Sattler E, Welzel J. Line-field confocal optical coherence tomography-practical applications in dermatology and comparison with established imaging methods. [Extracted from the article]

Fibroepithelioma of Pinkus (FeP) is a rare cutaneous tumour traditionally considered a low-risk variant of basal cell carcinoma (BCC), even though controversy was risen in the past decade whether it is really a BCC or a trichoblastoma form.[1] FeP is commonly diagnosed in females after the 4th-5th decades of life, clinically appearing as a slow-growing, flesh-coloured to hypopigmented, dome-shaped sessile papule or nodule with a predilection for the inferior trunk.[[1]] Since numerous skin lesions can clinically mimic FeP, including BCC, intradermal nevus, pedunculated fibroma, acrochordon, seborrheic keratosis and amelanotic melanoma, histopathology is mandatory for a definite diagnosis.[[1]] Histology is characterized by anastomosing epithelial strands and basaloid buds extending into the dermis within a myxoid stroma, delineating the so-called fenestrated pattern.[3] Confocal microscopy proved to support the correct identification of FeP thanks to the recognition of specific findings, highly correspondent to histopathological features.[4] Line-field confocal optical coherence tomography (LC-OCT; DAMAE Medical®) is a newly in vivo technique producing "virtual biopsy", due to the acquisition of optical images with horizontal confocal-like resolution (axial resolution 1.1 m, lateral resolution 1.3 m) and vertical OCT-like depth ( 500 m). Line-field optical coherence tomography: in vivo diagnosis of basal cell carcinoma subtypes compared with histopathology. In- deep technical details of the device are described elsewhere.[5] After the description of BCC morphological criteria, recent studies investigated the potential diagnostic of LC-OCT to discriminate different BCC subtypes.[[6], [8]] Herein, we describe for the first time LC-OCT criteria of FeP and their correlation with histopathology. [Extracted from the article]

Background: The spectrum of pustular skin disorders (PSD) is large and particularly challenging, including inflammatory, infectious and amicrobial diseases. Moreover, although pustules represent the unifying clinical feature, they can be absent or not fully developed in the early stage of the disease. The line‐field confocal optical coherence tomography (LC‐OCT) is a recently developed imaging technique able to perform a non‐invasive, in vivo, examination of the epidermis and upper dermis, reaching very high image resolution and virtual histology. Objectives: We aimed to investigate the potentialities of LC‐OCT in the non‐invasive differential diagnosis of a series of 11 PSD with different aetiology, microscopic features, body location and incidence rates. Materials and Methods: Complete LC‐OCT imaging (i.e. 2D/3D frames, videos) was performed on a total of 19 patients (10 females and 9 males) aged between 35 and 79 years. Images were blindly evaluated and compared with corresponding histopathologic findings. Results: The LC‐OCT imaging was able to detect with high accuracy the pustule structure including shape, margins, morphology and cellular content, along with peculiar epidermal and adnexal alterations in each condition, including: Acute Generalized Exanthematous Pustulosis, Generalized pustular psoriasis, Generalized pustular figurate erythema, Subcorneal Pustular Dermatosis, Intraepidermal IgA pustulosis, Palmoplantar pustulosis, Palmoplantar pustular psoriasis. Herpetic whitlow, Acrodermatitis continua of Hallopeau, Vesicopustular Sweet syndrome and Vesicopustular Eosinophilic cellulitis, with pustular appearance, were also compared. Conclusions: The new LC‐OCT can represent a rapid, non‐invasive and painless tool which can help differentiating among PSD of different aetiology and microscopic morphology in clinical mimickers in daily practice. [ABSTRACT FROM AUTHOR]

Background: Basosquamous carcinoma (BSC) is a rare and potentially aggressive cutaneous neoplasm combining histopathological features of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Line‐field confocal optical coherence tomography (LC‐OCT) is a new, non‐invasive imaging technique featuring excellent resolution and penetration. To date, studies about the use of LC‐OCT in the BCC and SCC fields are available, but similar investigations are lacking in the BSC field. Objective: The goal of the present study was to identify/describe LC‐OCT criteria of BSC. Methods: Consecutively enrolled BSCs were imaged with dermoscopy and LC‐OCT prior to surgical excision. Dermoscopic and LC‐OCT images were evaluated, and histopathological slides were reviewed. Results: Six BSCs from six patients [four (66.7%) males and two (33.3%) females; mean age 76.5 (62–96) years] were included. Identified LC‐OCT criteria for BSC included BCC‐associated (dermal lobules with millefeuille pattern, dilated vessels, bright cells within the epidermis, bright cells within lobules, stromal stretching, stromal brightness) and SCC‐associated features (acanthosis, hyperkeratosis, disarranged epidermal architecture, broad strands, elastosis and glomerular vessels). Interruption of the dermal–epidermal junction and ulceration represented overlapping criteria. Conclusion: Line‐field confocal‐OCT is a new promising technique that may support the non‐invasive recognition of BSC through the simultaneous detection of BCC‐associated and SCC‐associated features. We hypothesize that the use of LC‐OCT might be helpful not only in the diagnostic setting but also in the follow‐up surveillance for an early identification of recurrences. Further larger studies are needed to prove this hypothesis. [ABSTRACT FROM AUTHOR]

We read with interest the article by Solimani I et al i ,1 who reported a case of pemphigus vulgaris developed 5 days after the first administration of SARS-CoV-2 vaccination with the mRNA vaccine BNT162b2 (Comirnaty", Biontech/Pfizer). Reply to 'development of severe pemphigus vulgaris following SARS-CoV-2 vaccination with BNT162b2' by Solimani F et al References 1 Solimani F, Mansour Y, Didona D, Dilling A, Ghoreschi K, Meier K. Development of severe pemphigus vulgaris following SARS-CoV-2 vaccination with BNT162b2. [Extracted from the article]

Background: Early diagnosis and subtype classification of basal cell carcinoma (BCC) are crucial to reduce morbidity and optimize treatment. Good accuracy in differentiating BCC from clinical imitators has been achieved with existing diagnostic strategies but lower performance in discriminating BCC subtypes. Line‐field confocal optical coherence tomography (LC‐OCT) is a new technology able to combine the technical advantages of reflectance confocal microscopy and OCT. Objectives: To identify and describe LC‐OCT criteria associated with BCC and explore their association with BCC subtypes. Methods: Basal cell carcinoma were imaged with a handheld LC‐OCT device before surgical excision. LC‐OCT images were retrospectively evaluated by three observers for presence/absence of criteria for BCC. Multivariate logistic regression models were used to find independent predictors of BCC subtypes. Results: Eighty‐nine histopathologically proven BCCs were included, of which 66 (74.2%) were pure subtypes [superficial BCC (sBCC): 19/66 (28.8%); nodular BCC (nBCC): 31/66 (47.0%); infiltrative BCC (iBCC): 16/66 (24.2%)]. Lobules, blood vessels and small bright cells within epidermis/lobules were the most frequent criteria for BCC. LC‐OCT criteria independently associated with sBCC were presence of hemispheric lobules, absence of lobule separation from the epidermis, absence of stretching of the stroma; with nBCC were presence of macrolobules, absence of lobule connection to the epidermis; and with iBCC were presence of branched lobules. Conclusions: This was the first study describing the characteristics of BCC under LC‐OCT examination. We proposed morphologic criteria, which could be potentially useful for diagnosis and subtype classification of BCC, as well as for its therapeutic management. Future studies are needed to assess these hypotheses. [ABSTRACT FROM AUTHOR]

Background: The anatomical location of atypical melanocytic skin lesion (aMSL) was never combined into an algorithm for discriminating early melanomas (EM) from atypical nevi (AN). Aims: To investigate the impact of body location on the intuitive diagnosis performed in teledermoscopy by dermatologists of different skill levels. A further aim was to evaluate how the integration of the body location could improve an algorithm‐aided diagnosis. Methods: We retrospectively collected 980 standardized dermoscopic images of aMSL cases (663 AN, 317 EM): data on the anatomical location were collected according to 15 body sites classified into 4 macro‐areas of chronically/frequently/seldom/rarely exposure. Through a teledermatology web platform, 111 variously skilled dermoscopists performed either the intuitive diagnosis and 3 algorithm‐assisted diagnostic tests (i.e. iDScore, 7‐point checklist, ABCD rule) on each case, for a total of 3330 examinations. Results: In the rarely photoexposed area (side, bottom, abdomen), AN were the most tricky (i.e. highest quote of false positives), due to a frequent recognition of dermoscopic features usually considered as suggestive for melanoma in these lesions; the EM at these sites received the highest quote of false negatives, being generally interpreted as 'featureless' according to these traditional parameters, that were more frequently displayed on the chronically photoexposed area. In rarely and seldom photoexposed area, intuitive diagnosis fails to achieve adequate accuracy for all aMSLs, as the ABCD rule and the 7‐point checklist; by applying the iDScore algorithm the diagnostic performance was increased by 15% in young and 17% in experts. Conclusions: The body location of an aMSL can affect the quality of intuitive dermoscopic diagnosis, especially in sun‐protected areas. Accuracy can be improved by using the iDScore algorithm that assigns a different partial score of each body site. Linked Commentary: T. Deinlein. J Eur Acad Dermatol Venereol 2021; 35: 566. https://doi.org/10.1111/jdv.17141. [ABSTRACT FROM AUTHOR]

Cutaneous lesions of Anderson-Fabry disease examined with a novel technique: Line-field confocal optical coherence tomography The new non-invasive imaging technique line-field confocal optical coherence tomography (LC-OCT) ( I DeepLive i - I DAMAE Medical SP ® sp , Paris, France i )3 was performed over lesional and perilesional skin, in both vertical and horizontal mode, and compared with corresponding polarized dermoscopic images.4 LC-OCT allowed to observe the 3D morphology of AKs in different maturation stages, e.g. unique (Fig. Characterization of Fabry disease in 352 pediatric patients in the Fabry registry. [Extracted from the article]

Background: Line‐field confocal optical coherence tomography (LC‐OCT) is a non‐invasive optical technique recently developed for skin examination in vivo. It provides real‐time, high‐resolution vertical images with an isotropic resolution of ~1 µm and a penetration depth of ~500 µm. Objectives: Study goals were to qualitatively/quantitatively characterize healthy skin at different body sites using LC‐OCT. Methods: The skin of young healthy volunteers was imaged with a handheld LC‐OCT imaging device. Seven body sites (back of the hand, forehead, cheek, nose, chest, forearm and back) were investigated. An independent qualitative [cutaneous structures' description; visibility of keratinocytes' nuclei and dermal–epidermal junction (DEJ)] and quantitative [stratum corneum (SC)/epidermal thicknesses; height of dermal papillae] assessment of the LC‐OCT images was performed. Results: A total of 88 LC‐OCT images were collected from 29 participants (20 females; nine males; mean age 25.9 years). Keratinocytes' nuclei and DEJ were visible in the totality of images. The different layers of the epidermis and the remaining cutaneous structures/findings were visualized. Body sites‐related variability was detected for SC/epidermal thicknesses and height of dermal papillae. Inter‐observer agreement was excellent (SC thickness), good‐to‐excellent (epidermal thickness) and moderate‐to‐good (papillae). Conclusions: Line‐field confocal‐OCT provides non‐invasive, real‐time imaging of the skin in vivo with deep penetration and high resolution, enabling the visualization of single cells. The histology‐like vertical view provides an easy way to recognize/measure different cutaneous structures/findings. LC‐OCT appears as a promising technique for the examination of physiological/pathological skin. [ABSTRACT FROM AUTHOR]

These technical characteristics make the LC-OCT a valuable tool for the examination of physiological skin2 as well as for the diagnosis of different types of skin lesions.3-9 Actinic keratosis (AK) is the most common precancerous cutaneous lesion and is mainly observed on chronically sun-exposed skin. GLO:3NZ/01dec21:jdv17548-fig-0002.jpg PHOTO (COLOR): 2 LC-OCT and histopathological presentation of four different subtypes of actinic keratoses (AKs): atrophic AK on the right temple of a 77-year-old woman (a, b); hypertrophic AK on the left leg of a 55-year-old man (c, d); proliferative AK on the left breast of a 71-year-old man (e, f); and acantholytic AK on the nose dorsum of a 77-year-old woman (g, h). GLO:3NZ/01dec21:jdv17548-fig-0001.jpg PHOTO (COLOR): 1 Actinic keratosis (AK) on the right upper-lip of a 74-year-old woman: clinical (a), dermoscopic (b), line-field confocal optical coherence tomography (LC-OCT) (c) and histopathological (d) presentation; squamous cell carcinoma (SCC) on the left cheek of an 82-year-old man: clinical (e), dermoscopic (f), LC-OCT (g) and histopathological (h) presentation. [Extracted from the article]

Background: Reflectance confocal microscopy (RCM) is particularly suitable for the study of skin ageing because it provides nearly histological information in vivo and non‐invasively. However, there are no studies that evaluated RCM skin features of a large population older than 70 years. Objectives: The aim of our investigation was to study age‐related skin changes in an elderly population by RCM and to evaluate their topographical and gender differences. Methods: We obtained RCM images of photoprotected (volar arm) and chronic (face) and intermittently photoexposed (dorsal forearm) body sites of 209 volunteers (105 women and 104 men, mean age: 77.5, range 74–81 years). 15 previously reported and new RCM parameters related to skin ageing were assessed. Results: Photoexposed sites had thicker suprapapillary epidermis, more linear, distant and thin furrows, higher presence of mottled pigmentation, polycyclic papillae and coarse and huddled collagen and lower presence of dermal papillae than the photoprotected site. Irregular honeycomb pattern was not higher in photoexposed sites, indicating that it is probably more dependent on intrinsic ageing. Two ageing scores defined for facial skin ageing (epidermal disarray score and epidermal hyperplasia score) were found useful for the identification of photoageing. Gender differences only concerned some RCM parameters (i.e. thickness of different layers of the epidermis, furrows and collagen score) and some body sites, in line with the fact that women and men of our cohort had no major differences in clinically visible skin ageing. Conclusions: Our study confirmed that RCM is a powerful non‐invasive technique to microscopically quantify ageing signs and our observations contribute to highlight the differences between intrinsic and extrinsic ageing. [ABSTRACT FROM AUTHOR]

Background: Although live and teledermoscopic examination has been successfully used to achieve non‐invasive diagnosis of melanocytic skin lesions (MSLs), early melanoma (EM) and atypical nevi (AN) continue to be a challenge, and none of the various algorithms proposed have been sufficiently accurate. We designed a scoring classifier diagnostic method, the iDScore that combines clinical data of the patient with dermoscopic features of the MSL. Objective: To test the accuracy of the iDScore in differentiating EM from AN in a teledermoscopy setting and to compare it with intuitive diagnosis, the ABCD rule and the seven‐point checklist. Materials and methods: A dedicated teledermoscopy web platform was designed. This involved the following: (i) collecting a large integrated clinical–historical–dermoscopic data set of difficult MSLs from eight European dermatology centres; (ii) online testing, education and training in using the iDScore. A total of 904 images were combined with age, sex, lesion diameter and body site data and evaluated on the platform by 111 participants with four levels of skill in dermoscopy. Each testing session consisted of 30 blind cases to examine consecutively by the above four methods. 'Management decisions' and personal participant data were also recorded. Results: iDScore‐aided diagnosis achieved satisfactory diagnostic accuracy for all lesions, irrespective of centre of affiliation, showing an average AUC of 0.776 in all participant testing sessions. All skill groups improved their accuracy by 10–16% with respect to intuitive diagnosis and the other methods, showing high concordance and avoiding wrong management decisions. Conclusion: We demonstrated the validity of the iDScore method for managing suspicious MSLs in a large multicentric data set and a teledermoscopic setting. The platform designed for the iDScore project provides ready support for physicians of any dermoscopy skill level and is useful for education and training. [ABSTRACT FROM AUTHOR]

Aicardi-Goutières syndrome: a possible explanation of angiokeratoma of Mibelli The patients in this manuscript have given written informed consent to the publication of their case details. A skin biopsy showed angiokeratomas (AKs) and a thrombotic lymphocyte vasculitis of small vessels (Fig. [Extracted from the article]

Absence of large, pleomorphic, hyper-reflective cells in the epidermis and the lobules, which would suggest nests of atypical melanocytic cells. Line-field confocal optical coherence tomography (LC-OCT) is a newly developed non-invasive imaging technique that combines high penetration depth (500 µm, similar to conventional OCT) with high isotropic resolution (lateral 1.3 µm, axial 1.1 µm, similar to reflectance confocal microscopy [RCM]).1 Moreover, with its ability to produce images in both vertical and horizontal planes, it enables a tridimensional (3D) analysis of the skin, which can prove very useful for assessing physiological2 and pathological skin.3-5Sebaceous hyperplasia (SH) is one of the most common lesions that dermatologists can encounter especially on the face of middle-aged to elderly patients. In dermal nevus, a wave-like pattern can be visualized as ill-defined lobules/strands in the dermis corresponding to melanocytic nests (i). gl Previous attempts to define specific criteria in order to recognize SH upon older non-invasive imaging techniques were too often unreliable in daily practice due to technical limitations. [Extracted from the article]

Upon LC-OCT examination, dermal nevi are characterized by the presence in the papillary and reticular dermis of alternating undulated hyper-reflective and hypo-reflective lines corresponding to melanocytic strands/cords/nests in the dermis. We hereby report the main LC-OCT features of dermal nevi and of the dermal component of compound nevi, which we observed in seven histopathologically confirmed cases. Line-field confocal optical coherence tomography (LC-OCT) is a recently developed non-invasive imaging technique able to combine the technical principles of conventional OCT (high in-tissue penetration and visualization of the vertical plane) and reflectance confocal microscopy (high resolution).1-3 Indeed, LC-OCT provides tridimensional images of the skin (vertical and horizontal planes) up to a 500-µm depth and features excellent isotropic resolution (lateral: 1.3 µm; axial: 1.1 µm). [Extracted from the article]

The differential diagnosis of nipple and areola complex (NAC) lesions encompasses a large spectrum of conditions from benign tumours to inflammatory diseases that could be challenging to recognize on clinical ground. While melanoma (MM) of the NAC is exceedingly rare, benign lesions are more frequent but could be difficult to distinguish from MM. Besides MM, other malignant tumours can affect this area and in particular Paget's disease (PD). For clinically doubtful lesions, biopsy is required, with possible functional and aesthetic consequences in this sensitive area. Dermoscopy and reflectance confocal microscopy (RCM) are widely used techniques for the diagnosis of many skin lesions, but their use for NAC lesions is not well established. The objective of this study was to evaluate current literature on these imaging techniques for NAC lesions. We searched in Medline, PubMed and Cochrane database all studies up to November 2018 dealing with dermoscopy, RCM and this special site. We found that the most described malignant tumour was PD and that only two primary MMs of the NAC have been reported with these imaging techniques. Although there are few data on diagnostic accuracy of non‐invasive imaging techniques for NAC lesions, it seems that dermoscopy and RCM can add relevant information to be integrated with clinical examination for the diagnosis of NAC lesions and in particular for the differential diagnosis of PD and eczema. [ABSTRACT FROM AUTHOR]

Background: Cutaneous malignant melanoma metastases differential diagnosis is challenging, as clinical and dermoscopic features can simulate primary melanoma or other benign or malignant skin neoplasms, and in‐vivo reflectance confocal microscopy could assist. Our aim was to identify specific reflectance confocal microscopy features for cutaneous malignant melanoma metastases, and epidermal and dermal involvement. Methods: A retrospective, multicentre observational study of lesions with proven cutaneous malignant melanoma metastases diagnosis between January 2005 and December 2016. Lesions were retrospectively assessed according to morphological features observed at reflectance confocal microscopy. Potential homogeneous subgroups of epidermal or dermal involvement were investigated with cluster analysis. Results: Cutaneous malignant melanoma metastases (51 lesions in 29 patients) exhibited different frequencies of features according to metastasis dermoscopy patterns. Lesions classified at dermoscopy with nevus‐like globular and non‐globular patterns were more likely to be epidermotropic, showing characteristics of epidermal and dermal involvement at reflectance confocal microscopy. Other dermoscopy pattern classifications were more likely to be dermotropic, showing characteristics od dermal involvement at reflectance confocal microscopy. Distinguishing features at reflectance confocal microscopy included irregular (78%) and altered (63%) epidermis, pagetoid infiltration (51%), disarranged junctional architecture (63%), non‐edged papillae (76%), dense and sparse, and cerebriform nests in the upper dermis (74%), and vascularity (51%). Cluster analysis identified three groups, which were retrospectively correlated with histopathological diagnoses of dermotropic and epidermotropic diagnoses (P < 0.001). The third cluster represents lesions with deep dermis morphological changes, which were too deep for evaluation with reflectance confocal microscopy. Conclusions: Specific reflectance confocal microscopy features of cutaneous malignant melanoma metastases for correct diagnosis, and subtype diagnosis, seem achievable in most cases where morphological alterations are located above the deep dermis. [ABSTRACT FROM AUTHOR]

Background: Patients with multiple actinic keratoses (AKs) should be treated with field‐directed therapy. Such treatments challenge patients' adherence due to out‐of‐pocket costs, length of treatment and severity of local skin reactions (LSRs). Effective physician–patient communication (PPC) may buffer therapy‐related distress, thus improving quality of life, treatment satisfaction and adherence. Objectives: We evaluated the interplay between PPC, LSR intensity (safety) and lesion clearance rates (effectiveness) on treatment satisfaction, quality of life and treatment adherence among patients with multiple AKs receiving topical field‐directed therapies. Methods: In this observational, multicentre, longitudinal, cohort study, we included 1136 adult patients with discrete, clinically detectable, visible, multiple (three or more lesions in a 25 cm2 area), Grade I/II AKs, for whom the attending dermatologist has prescribed treatment with a topical field‐directed therapy. We matched self‐reported data and medical information recorded by dermatologists in standard clinical forms. Patients were followed up at two time points (T1: 8 days; T2: 25–30 days) Results: Most patients were elderly, married, men with poor socio‐economic status and multiple lesions of the scalp or face. The majority (n = 961) had a prescription of ingenol mebutate (IMB) and 175 received either diclofenac 3% in hyaluronic acid (DHA) or imiquimod 5% (IMQ). Clearance rate at 1 month was 84%. Most patients felt very supported (n = 819, 73%) and rated dermatologist's explanations very clear (n = 608, 54%). Treatment satisfaction (effectiveness and convenience scales) increased along the follow‐up, especially for those on IMB (Δpre‐post = −4.00; other: Δpre‐post = −0.25; interaction P < 0.001). Communication clarity was associated with higher treatment satisfaction scores (β = 0.4–0.6, P < 0.01) and lower risk of non‐adherence among IMB patients (risk difference: 16%, P < 0.01). Conclusion: Communication clarity was associated with patient‐reported outcomes and adherence beyond AK‐related clinical parameters. Our study questions the current episodic approach to AK management and provides the rationale to develop chronic care models fostering patients' engagement and treatment alliance. [ABSTRACT FROM AUTHOR]

Background: Dermoscopy revealed to be extremely useful in the diagnosis of early melanoma, the most important limitation being its subjectivity in giving a final diagnosis. To overcome this problem, several algorithms and checklists have been proposed. However, they generally demonstrated modest level of diagnostic accuracy, unsatisfactory concordance between dermoscopists and/or poor specificity. Objective: To test a new methodological approach for the differentiation between early melanoma and atypical nevi, based on an integrated clinical‐anamnestic dermoscopic risk scoring system (iDScore). Methods: We selected a total of 435 standardized dermoscopic images of clinically atypical melanocytic skin lesion (MSL) excised in the suspect of malignancy (i.e. 134 early melanomas – MM – and 301 atypical nevi). Data concerning patient age and sex and lesion dimension and site were collected. A scoring classifier was designed based on this data set integrated with the dermoscopic evaluations performed by three experts blinded to histological diagnosis. Results: A total of seven dermoscopic structures, three age groups (30–40 years, 41–60 years and >60 years), two maximum diameter categories (5–10 mm and >10 mm) and three body areas (i.e. frequently, chronically and seldom photoexposed sites) were selected by the scoring classifier as interdependently significant variables. The total risk score (S) of a lesion resulted from the simple sum of partial scores assigned to each selected variable. The iDScore‐aided diagnosis showed an high accuracy (receiver operating characteristic‐area under the curve = 0.903; IC: 95% = 0.887–0.918). A risk‐based criticality scale corresponding to different S ranges was proposed. Conclusion: The iDScore checklist is proposed as a feasible and efficient tool to support dermatologists in non‐invasive differentiation between atypical nevi and early MM on the basis of few selected clinical‐anamnestic data and standardized dermoscopic features. [ABSTRACT FROM AUTHOR]

Dermoscopy is becoming increasingly useful in diagnosing inflammatory dermatoses,[1] since it can provide diagnostic clues to the diagnosis, particularly when it comes to facial dermatosis for which it would be advisable to avoid not strictly necessary skin biopsies. Conventional dermoscopy showed only erythema, follicular plugs, white scales and follicles dilatation commonly found in many facial dermatoses.[1] Switch to 400x magnification dermoscopy allowed us to clearly identify some Demodex mites within the follicles and a wandering mite on the skin surface leading to the diagnosis of demodicosis. Although dermoscopic features of demodicosis and rosacea have been described,[3] there is evidence that conventional dermoscopy could not be so effective in the detection of demodex and that standardized skin surface biopsy or RCM could be necessary.[4] Recently, ultraviolet dermoscopy has been reported to be effective in detecting demodex mites in rosacea.[5] However, to our best knowledge, there are no data in the literature on the use of super-high magnification dermoscopy in the detection of I Demodex folliculorum i . [Extracted from the article]

In relation to the clinical presentation, the imaging results and histopathological examination, the sample were tested for orthopoxvirus DNA and cowpox virus, which were detected by polymerase chain reaction (PCR). Line-field confocal optical coherence tomography imaging of human cowpox virus skin infection I Editor i , Human cowpox is a rare zoonotic infection that evokes a self-limited disease, except for immunocompromised and eczematous patients, particularly children, where it can become a severe, even fatal infection.1 During the last decade, there has been an increasing number of reports on human cowpox infection in Europe.1 Cowpox virus (CPXV), genus orthopoxvirus, family Poxviridae, is a DNA virus with rodent reservoir being exclusively human pathogen. [Extracted from the article]

Onychomatricoma is a rare tumour that derives from the nail matrix and grows within the nail plate. The clinical presentation can mimic many other tumours and conditions, and surgical biopsy and histopathological examination are necessary to confirm the diagnosis. As nail surgery is a painful experience for the patient and sometimes can leave permanent onychodistrophy, more precise preoperative diagnosis is needed to distinguish onychomatricoma from other nail diseases more accurately and to limit surgical interventions. The objective of this study was to evaluate current literature on imaging techniques for the diagnosis of onychomatricoma in order to understand how this technology can help the presurgical diagnosis of this tumour. We searched in the Cochrane Skin Group Specialised library, Medline, Embase and LILACS databases all studies evaluating imaging technique for the diagnosis of onychomatricoma up to February 2018. We found that not only nail dermoscopy, but also reflectance confocal microscopy, optical coherence tomography, ultrasonography and magnetic resonance can be useful in this field. [ABSTRACT FROM AUTHOR]