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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., (© 2024 European Academy of Dermatology and Venereology.)

Background: Despite that brodalumab's efficacy and safety have been assessed in randomized clinical trials, real-life data remain scarce. BrIDGE was an observational, prospective, single-cohort, multicentre study that recruited patients with moderate-to severe plaque psoriasis in Greece., Objectives: The primary objective was to assess the proportion of patients who achieved Psoriasis Area and Severity Index (PASI)100 after 24 weeks. Other endpoints included: the maintenance of PASI90/100 through to 104 weeks, the short-term response [PASI75/90/100 and static Physician's Global Assessment (sPGA) 0/1] to brodalumab at 12-16 weeks and time to complete clearance. Moreover, we explored the change in quality of life [Dermatology Life Quality Index (DLQI) 0/1] and adherence to brodalumab., Methods: Two hundred patients who were initiating treatment with or switching to brodalumab, were recruited. Analyses were conducted using the as observed data and three imputation approaches were also applied for the missing data (last observation carried forward, 'worst case' and 'best case' scenario). Continuous variables were reported using summary statistics, whereas categorical variables were reported in frequency tables., Results: Based on the 'as observed data', 42.0% of patients achieved PASI100 at Week 24 after 25.9 ± 3.5 weeks and 65% of patients attained PASI100 at Week 104. In total, 70.2%, 47.5% and 32.0% achieved PASI75/90/100, respectively, whereas 72.6% of patients achieved sPGA 0/1, at Weeks 12-16. With respect to sPGA status 82.8%, 89.2% and 92.5% of patients achieved sPGA 0/1 at Weeks 24, 52 and 104, respectively. The time to achieve PASI100 at Weeks 12-16 was 13.7 ± 1.3, 52.1 ± 3.4 weeks at Week 52 and 105.5 ± 4.8 weeks at Week 104. Mean DLQI and Psoriasis Symptom Inventory (PSI) scores decreased by 11.4 ± 7.0 and 15.4 ± 6.5 points from baseline to Week 104, respectively. Adherence to treatment was equal to 98.9%., Conclusions: Brodalumab confers rapid and durable responses, as well as improvements in the quality of life of moderate-to-severe psoriasis patients., (© 2024 European Academy of Dermatology and Venereology.)

Background: Melanoma disease patterns vary with patient age., Aim: To evaluate sentinel lymph node biopsy (SLNB) in managing melanoma at differing patient ages., Methods: Online prediction tools were applied to compare SLNB positivity (SLNB + ) and survival risk at patient ages 20-80. Tübingen melanoma data were used to determine variations in the hazard ratio of SLNB + for mortality at different patient ages., Results: Regardless of tumour thickness, predicted SLNB + rates were markedly higher than mortality rates for 20-year-old patients. For 80-year-old patients, it is the opposite., Discussion: If 1000 20-year-olds with a 0.4 mm thickness non-ulcerated melanoma underwent SLNB, 100 would likely be positive. If all 100 were to be offered adjuvant drug therapy (ADT), fewer than three more melanoma deaths in those 1000 patients would be avoided. In total, 97 patients would have received medication they may never have needed. If 1000 80-year-olds with a 3 mm thickness non-ulcerated melanoma underwent SLNB, only 40 would likely be positive. In total, 274 patients would be predicted to die of melanoma, 245 being SLNB negative and 29 SLNB + . ADT linked to SLNB + could deny treatment to 89% of these high-risk patients., Limitations: The authors relied on published risk data., Conclusion: SLNB has poor specificity at predicting mortality in young melanoma patients and poor sensitivity in older patients. SLNB is not indicated in managing cutaneous melanoma for patients under 40 or over 60 years of age. Many such patients could be managed with wide local excision alone in their clinician's office-based practice. For all cutaneous melanoma patients at all ages, linking ADT to BAUSSS biomarker, (an algorithm of Breslow thickness, age, ulceration, subtype, sex and Site) rather than SLNB + is likely more appropriate. BAUSSS provides a more accurate melanoma-specific mortality risk assessment for patients without burdening them with added surgery, hospitalization, costs or morbidity risk., (© 2024 European Academy of Dermatology and Venereology.)

Background: Breslow thickness, patient age and ulceration are the three most valuable clinical and pathological predictors of melanoma survival. A readily available reliable online tool that accurately considers these and other predictors could be valuable for clinicians managing melanoma patients., Objective: To compare online melanoma survival prediction tools that request user input on clinical and pathological features., Methods: Search engines were used to identify available predictive nomograms. For each, clinical and pathological predictors were compared., Results: Three tools were identified. The American Joint Committee on Cancer tool inappropriately rated thin tumours as higher risk than intermediate tumours. The University of Louisville tool was found to have six shortcomings: a requirement for sentinel node biopsy, unavailable input of thin melanoma or patients over 70 years of age and less reliable hazard ratio calculations for age, ulceration and tumour thickness. The LifeMath.net tool was found to appropriately consider tumour thickness, ulceration, age, sex, site and tumour subtype in predicting survival., Limitations: The authors did not have access to the base data used to compile various prediction tools., Conclusion: The LifeMath.net prediction tool is the most reliable for clinicians in counselling patients with newly diagnosed primary cutaneous melanoma regarding their survival prospects., (© 2023 European Academy of Dermatology and Venereology.)

Background: Melanomas developing on anatomic sites other than the trunk and extremities have a special pathogenetic and mutational profile, morphologic characteristics and biologic behaviour., Objective: By retrospectively screening the databases of our centres, we aimed to investigate the dermatoscopic morphology of early scalp melanoma, including in situ and invasive tumours with a Breslow thickness up to 1 mm., Methods: The databases of three specialized centres for skin cancer diagnosis and management in Greece were retrospectively evaluated to retrieve dermatoscopic images of scalp melanomas. Patients' age and sex were recorded, as well as the precise location of the tumour, using 6 possible sub-locations: frontal, parietal, occipital, temporal, nuchal scalp and vertex. The dermatoscopic images were evaluated by 3 independent investigators for the presence of pre-defined criteria. The dermatoscopic criteria included in the evaluation were selected based on available literature and were categorized in 2 groups: 'classic melanoma criteria' and 'lentigo maligna (LM) criteria'., Results: Of 38 melanomas, 37 (97.4%) displayed brown colour and 23 (60.5%) displayed additional grey or blue colour. The most frequent dermatoscopic criteria were regression (18/38, 47.4%), grey dots/globules (17/38, 44.7%), atypical network (16/38, 42.1%), obliterated follicles (16/38, 42.1%) and angulated lines (15/38, 39.5%). Of 38 melanomas, 28 (73.7%) displayed at least 1 classic melanoma criterion plus at least 1 LM criterion. Of the remaining melanomas, 8 (21.1%) displayed only classic melanoma criteria, 1 (2.6%) only LM criteria and 1 (2.6%) did not exhibit any of the evaluated criteria., Conclusions: This study demonstrates that early scalp melanoma combines classic with LM criteria in terms of colours and structures., (© 2022 European Academy of Dermatology and Venereology.)

Background: The dermoscopic features of classic patch stage mycosis fungoides (MF) have been described, but data on plaque and tumoral stage as well as rarer MF subtypes is limited., Objective: To evaluate dermoscopic morphology and dermoscopic-pathological correlations of classic MF stages and investigate dermoscopic features of MF variants., Methods: Patients with histopathologically confirmed lesions of classic MF (patch, plaque and tumoral stage) or folliculotropic, erythrodermic and poikilodermatous MF were included. Standardized evaluation of dermoscopic pictures of the included MF variants and comparative analysis and dermoscopic-pathological correlation assessment of different stages of classic MF were performed., Results: A total of 118 instances were included (75 classic MF, 26 folliculotropic MF, 9 erythrodermic MF and 8 poikilodermatous MF). Linear/linear-curved vessels and white scales in the skin furrows were significantly associated with patch-stage MF, while clustered dotted vessels were related to plaque-stage MF and peripheral linear vessels with branches, ulceration and red globules separated by white lines to tumour-stage MF. Moreover, patchy white scales were significantly more common in patches and plaques compared to tumours, whereas focal bright white structureless areas were related to plaque and tumoral stage. Vessels histopathologically corresponded to dilated vascular structures in the dermis, orange structureless areas to either dermal hemosiderin (patch/plaque stage) or dense cellular infiltration (tumours), bright white lines/structureless areas to dermal fibrosis and ulceration to loss of epidermis. The main dermoscopic findings of folliculotropic MF were lack of hairs, dilated follicles and follicular plugs, while erythrodermic MF was mainly characterized by linear/dotted vessels, patchy white scales and focal orange structureless areas and poikilodermatous MF by focal white and brown structureless areas, white patchy scales and brown reticular lines., Conclusion: Dermoscopy may allow a more precise characterization of classic MF and reveal clues suggestive of the main MF variants., (© 2022 European Academy of Dermatology and Venereology.)

The introduction of immune checkpoint inhibitors (ICIs) opened a new era in oncologic therapy. The favourable profile of ICIs in terms of efficacy and safety can be overshadowed by the development of immune-related adverse events (irAEs). Dermatologic irAEs (dirAEs) appear in about 40% of patients undergoing immunotherapy and mainly include maculopapular, psoriasiform, lichenoid and eczematous rashes, auto-immune bullous disorders, pigmentary disorders, pruritus, oral mucosal lesions, hair and nail changes, as well as a few rare and potentially life-threatening toxicities. The EADV task force Dermatology for Cancer Patients merged the clinical experience of the so-far published data, incorporated the quantitative and qualitative characteristics of each specific dirAEs, and released dermatology-derived, phenotype-specific treatment recommendations for cutaneous toxicities (including levels of evidence and grades of recommendation). The basic principle of management is that the interventions should be tailored to serve the equilibrium between patients' relief from the symptoms and signs of skin toxicity and the preservation of an unimpeded oncologic treatment., (© 2021 European Academy of Dermatology and Venereology.)

Background: Squamous cell carcinoma of the lip accounts for 20% of all oral carcinomas. Its diagnosis may be challenging because it clinically resembles actinic cheilitis and inflammatory lesions of the lips., Objectives: To determine clinical and dermatoscopic predictors of squamous cell carcinoma of the lip vs. other lip lesions., Methods: Multicentre retrospective morphological study, including histologically confirmed cases of squamous cell carcinoma of the lip and controls consisting of actinic cheilitis and inflammatory lesions of the lips. Clinical and dermatoscopic images were evaluated for the presence of predefined criteria. Crude and adjusted odds ratios and corresponding 95% confidence intervals were calculated by univariate and multivariate logistic regression respectively., Results: A total of 177 lip lesions were evaluated, 107 (60.5%) were squamous cell carcinomas and 70 (39.5%) were controls. The most frequent dermatoscopic criteria of lip squamous cell carcinoma were scales (100%), white halos (87.3%) and ulceration (79.4%). The majority of squamous cell carcinomas displayed polymorphic vessels (60.8%), with linear (68.6%) and hairpin (67.6%) being the most frequent types. Multivariate logistic regression analysis showed that clinical predictors of lip squamous cell carcinoma were exophytic appearance and clinical hyperkeratosis, with 43-fold and 6-fold higher probability respectively. White clods and ulceration in dermoscopy presented a 6-fold and 4-fold increased risk for squamous cell carcinoma respectively., Conclusions: A scaly lesion with exophytic growth, dermatoscopically displaying white clods, ulceration and linear and hairpin vessels is very likely a squamous cell carcinoma of the lip., (© 2021 European Academy of Dermatology and Venereology.)

Background: Thin nodular melanoma (NM) often lacks conspicuous melanoma-specific dermatoscopic criteria and escapes clinical detection until it progresses to a thicker and more advanced tumour., Objective: To investigate the dermatoscopic morphology of thin (≤2 mm Breslow thickness) vs. thick (>2 mm) NM and to identify dermatoscopic predictors of its differential diagnosis from other nodular tumours., Methods: Retrospective, morphological case-control study, conducted on behalf of the International Dermoscopy Society. Dermatoscopic images of NM and other nodular tumours from 19 skin cancer centres worldwide were collected and analysed., Results: Overall, 254 tumours were collected (69 NM of Breslow thickness ≤2 mm, 96 NM >2 mm and 89 non-melanoma nodular lesions). Light brown coloration (50.7%) and irregular brown dots/globules (42.0%) were most frequently observed in ≤2 mm NMs. Multivariate analysis revealed that dotted vessels (3.4-fold), white shiny streaks (2.9-fold) and irregular blue structureless area (2.4-fold) were predictors for thinner NM compared to non-melanoma nodular tumours. Overall, irregular blue structureless area (3.4-fold), dotted vessels (4.6-fold) and serpentine vessels (1.9-fold) were predictors of all NM compared to non-melanoma nodular lesions., Limitations: Absence of a centralized, consensus pathology review and cases selected form tertiary centres maybe not reflecting the broader community., Conclusions: Our study sheds light into the dermatoscopic morphology of thin NM in comparison to thicker NM and could provide useful clues for its differential diagnosis from other non-melanoma nodular tumours., (© 2020 European Academy of Dermatology and Venereology.)

Background: Individuals with a high total naevus count (TNC) are at a higher risk to develop melanoma, and screening efforts have been largely focused on this group. However, some studies suggest that melanomas of patients with many nevi are thinner than those of patients with few nevi. Additionally, nodular melanoma has been associated with individuals with a low naevus count., Objective: To investigate the association between TNC and melanoma Breslow thickness., Methods: A two-centre retrospective study from 1 January 2016 to 1 January 2018. This included three hundred and twenty-six consecutive melanoma patients from two tertiary melanoma centres. The mean age at presentation was 58.3 years (SD = 15.9), and the majority (54.9%, N = 179) were men. Incidence of new in situ and invasive melanomas and correlation with TNC were measured., Results: The mean total naevus count for patients presenting with in situ melanoma was 57.2 (range 4-178), while for patients presenting with invasive disease was 31.5 (P = 0.01). In situ disease was associated with a higher TNC across all ages. For invasive melanoma, a positive association between age and Breslow thickness was observed, while TNC was inversely associated with Breslow thickness. Each additional naevus accounted for a 4% decreased likelihood that the subject had invasive disease., Conclusion: Patients with a higher naevus count had thinner melanomas and more melanomas in situ, independent of age and sex., (© 2020 European Academy of Dermatology and Venereology.)

Background: Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) have well-established dermatoscopic criteria that make them relatively easy to recognize on a clinical basis. However, even with the addition of dermatoscopy, a morphologic overlap between the two tumours does exist., Objectives: To analyse the dermatoscopic morphology of clinically and dermatoscopically misclassified BCCs and SCCs, to identify factors causing the erroneous clinical interpretation and, therefore, minimize the morphologic overlap between BCC and SCC., Methods: Retrospective study including histopathologically diagnosed BCCs or SCCs that had been clinically inversely diagnosed. Their dermatoscopic images were blindly evaluated for the presence of predefined criteria. Descriptive statistics were performed and univariate and multivariate predictors were calculated., Results: A total of 68 cases were included, 41 of which were BCCs and 27 SCCs. Most tumours in both groups were non-pigmented, ulcerated and displayed a polymorphous vascular pattern. The presence of erosions was positively associated to BCC (5.2-fold higher odds, P = 0.05), whereas scales/keratin masses were positively associated to SCC (3.7-fold higher odds, P = 0.07), although marginally not statistically significant., Conclusions: Clinically misclassified BCCs and SCCs are usually non-pigmented ulcerated tumours. Erosions and keratin masses/scales are more robust criteria as compared to vascular structures for the differential diagnosis between BCC and SCC., (© 2020 European Academy of Dermatology and Venereology.)

Background: Mammary Paget's disease (MPD) is a rare intraepidermal adenocarcinoma of the nipple-areola complex, associated with an underlying breast cancer in approximately 90% of cases. Delayed diagnosis of MPD is common. Its dermoscopic features have been ill defined in the literature., Objectives: To determine the clinical and dermoscopic features of MPD versus other dermatologic entities that involve nipple and areola., Methods: Members of the IDS were invited to submit any case of histologically confirmed MPD, as well as other benign and malignant dermatoses that involve the nipple and areola complex. A standardized evaluation of the dermoscopic images was performed and the results were statistically analyzed., Results: Sixty-five lesions were included in the study, 22 (33.8%) of them MPD and 43 (66.2%) controls. The most frequent dermoscopic criteria of MPD were white scales (86.4%) and pink structureless areas (81.8%), followed by dotted vessels (72.7%), erosion/ulceration (68.2%) and white shiny lines (63.6%). The multivariate analysis showed that white scales and pink structureless areas were significant predictors of MPD, posing a 68-fold and a 31-fold probability of MPD, respectively. Split of the population into pigmented and non-pigmented lesions showed that in pigmented MPD, pink structureless areas, white lines and grey granules and dots are positive predictors of the disease. Among non-pigmented lesions, pink structureless areas, white lines, erosion/ulceration and white scales served as predictors of MPD., Conclusions: The most frequent profile of an individual with MPD is an elderly female with unilateral, asymptomatic, erythematous plaque of the nipple, dermoscopically displaying pink structureless areas, fine white scales, dotted and a few short linear vessels. In case of pigmentation we may also observe brown structureless areas and pigmented granules., Limitations: Small sample size, retrospective design., (© 2019 European Academy of Dermatology and Venereology.)

Background: Pink skin tumours are difficult to differentiate, clinically and dermoscopically. In previous studies, mainly focused on pigmented lesions, pattern analysis provided the best sensitivity and specificity values, as compared to other algorithms. These findings suggest that the global dermoscopic appearance, based on the evaluation of prevalent features, could represent a valuable and practical approach even when dealing with pink lesions., Objective: In this study, we aimed to evaluate the diagnostic accuracy of a new dermoscopic approach for pink tumours based on the prevalent criterion, as compared to a standard diagnostic method (Menzies algorithm)., Methods: The databases of two referral centres were retrospectively evaluated to retrieve dermoscopic images of amelanotic/hypomelanotic skin lesions. Two experts in dermoscopy, blinded for the final diagnosis and for clinical and demographic information, evaluated separately dermoscopic pictures of 1000 lesions according to the Menzies score and to the prevalent criterion method., Results: According to the high sensitivity model of the Menzies score, 129 (12.9%) lesions were considered as non-suspicious (of which 16 were false negative) and 871 (87.1%) as suspicious (of which 212 were false positive), with 97.6% sensitivity and 34.8% specificity. According to the high specificity model, 370 (37%) lesions were evaluated as non-suspicious (of which 105 were false negative) and 630 (63%) as suspicious (of which 60 were false positive), with 84.4% sensitivity and 81.5% specificity. Concerning the prevalent criterion method, 316 (31.6%) lesions were evaluated as non-suspicious (of which 46 were false negative) and 684 (68.4) as suspicious (of which 55 were false positive), with 93.2% sensitivity and 83.1% specificity., Conclusions: This study demonstrated that focusing on the prevalent dermoscopic features could allow to detect malignant pink tumours with similar sensitivity but higher specificity than using the conventional Menzies scoring system., (© 2019 European Academy of Dermatology and Venereology.)

Background: Clinical differentiation of erythroplasia of Queyrat (EQ) and chronic forms of balanitis may be challenging, especially in early phases or in overlapping cases. Dermoscopy has been shown to be a useful supportive tool in facilitating the distinction between tumoral and inflammatory skin conditions; yet, data on EQ and balanitis are scarce or sparse., Objectives: To systematically assess the dermoscopic features of both EQ and common forms of chronic balanitis and to investigate the accuracy of dermoscopy in distinguishing these conditions., Methods: Subjects with EQ or chronic balanitis confirmed histologically or microbiologically (for infectious forms) were recruited. A representative dermoscopic image of a target lesion was retrospectively assessed for the presence of specific morphological findings. A correlation matrix was created using Spearman's rho. Proportions of dermoscopic variables scoring among different conditions were compared with the non-parametric Pearson's chi-square test., Results: A total of 81 lesions (14 EQ, 23 psoriasis, 31 Zoon plasma cell balanitis and 13 candidal balanitis) from 81 patients were included in the study. Glomerular vessels (both clustered and diffusely distributed) were highly predictive for the diagnosis of EQ, while diffuse dotted vessels were strongly associated with psoriatic balanitis. Finally, Zoon plasma cell balanitis was characterized by orange structureless areas (focal or diffuse) and focused linear curved vessels, whereas cottage cheese-like structures (sparse white coating corresponding to Candida yeast colonies growth) showed a strong correlation with candidal balanitis., Conclusions: Erythroplasia of Queyrat and balanitis may display different dermoscopic patterns, thereby bearing the usefulness of dermoscopy as a supportive non-invasive tool for the recognition and differential diagnosis of such conditions., (© 2018 European Academy of Dermatology and Venereology.)

Background: Topical methyl aminolevulinate photodynamic therapy (MAL-PDT) with 3 h incubation is recommended as a field directed treatment. Skin pretreatment with ablative CO 2 fractional laser (AFXL) prior to MAL-PDT enhances drug penetration and could minimize incubation time., Objectives: To evaluate and compare the safety and the preventive effect in the development of new non-melanocytic skin cancers (NMSCs) of AFXL-assisted MAL-PDT with 1-h incubation with that of conventional MAL-PDT in patients with clinical and histological signs of field cancerization., Methods: Forty-two patients with two mirror cancerized areas of face or scalp were randomized to field treatment with 1-h incubation AFXL-assisted PDT or conventional PDT (CPDT). All patients underwent two treatment sessions 1 week apart. Irradiation was performed using a red light-emitting diode lamp at 37 J/cm 2 . Patients were followed up at 3, 6, 9 and 12 months for the evaluation of development of new NMSCs lesions., Results: All patients completed the study. There was no statistically significant difference with respect to the total number of new actinic keratoses at any point of follow-up as well as to the mean time of occurrence of new lesions between treatment fields. Both treatment regimens were safe and well tolerated., Conclusion: Ablative CO 2 fractional laser pretreatment may be considered as an option for reducing photosensitizer occlusion time while providing the same preventative efficacy as CPDT in patients with field-cancerized skin., (© 2018 European Academy of Dermatology and Venereology.)

Background: Acquired naevi often present in childhood and increase in number and size during early and middle life. As naevi represent potential mimickers of melanoma, the knowledge of their epidemiologic and morphologic characteristics is essential., Objective: In this study, we intend to determine the prevalence of dermoscopic patterns of naevi, as well their association with environmental and constitutional factors., Methods: Cross-sectional data derived from a population-based cohort of children and adolescents aged 6-18 years, from 12 different schools in Thessaloniki, Greece. For each participant, a consent form and a questionnaire were completed, which included data on age, sex, phototype, sun sensitivity, sun exposure, sunscreen use and previous sunburn history. All naevi, their body distribution, and their dermoscopic patterns were recorded., Results: Two thousand and five hundred and five (2505) subjects were enrolled into the study (47.8% males and 52.2% females). The mean number of MN counted in a single person was 29.11 (SD = ±23.863). TNC increased continuously with higher age. Males were found to have a significantly increased number on the trunk (11.7 ± 11.2 and 10.0 ± 8.7, respectively, P < 0.001) and face and neck (6.2 ± 5.3 and 5.1 ± 4.3, respectively, P < 0.001) while females on the upper (10.3 ± 10.1 and 9.3 ± 9.4, respectively, P = 0.008) and lower extremities (2.8 ± 3.4 and 2.5 ± 3.2, respectively, P = 0.008). Globular pattern was the most frequent dominant pattern in lower age groups, and its percentage fell as age increased. On the contrary, the reticular pattern was more often documented in individuals in adolescence., Conclusion: This first study of MN in our young population aims to be the basis of further investigation for the MM preventive policy of our state., (© 2018 European Academy of Dermatology and Venereology.)

Background: The dermoscopic features of superficial basal cell carcinoma (sBCC) and Bowen's disease (BD) have been extensively investigated, and dermoscopy was shown to significantly improve their recognition. However, incorrectly diagnosed cases still exist, with a considerable number of sBCCs dermoscopically interpreted as BD. Our aim was to investigate the dermoscopic variability in sBCC and BD on different anatomic sites, to identify potent dermoscopic predictors for each diagnosis and to investigate the potential source of the inaccurate clinico-dermoscopic diagnosis of some sBCCs., Methods: Dermoscopic images of histopathologically diagnosed sBCC and BD were evaluated by three independent investigators for the presence of predefined criteria. Subsequently, three independent investigators with expertise in dermoscopy classified the tumours as sBCC or BD based on the dermoscopic image. Diagnostic accuracy scores were calculated and crude and adjusted odds ratios, and 95% confidence intervals were calculated by univariate and conditional multivariate logistic regression, respectively., Results: A total of 283 lesions were included in the study (194 sBCCs and 89 BD). The main dermoscopic predictors of BD were dotted vessels (7.5-fold) and glomerular vessels (12.7-fold). The presence of leaf-like areas/spoke-wheel areas/concentric structures (OR = 0.027) and arborizing vessels (OR = 0.065) has predicted sBCC. Multivariate risk factors for sBCC misclassification were the location on lower extremities (OR = 5.5), the presence of dotted vessels (OR = 59.5) and the presence of large ulceration (OR = 6.4). In contrast, the presence of brown-coloured pigmentation was a protective predictor for misdiagnosis (OR = 0.007). Finally, a subgroup analysis of lesions located on lower extremities revealed two additional potent predictors of sBCC: superficial fine telangiectasia (SFT) and whity shiny blotches/strands., Conclusions: Dotted and glomerular vessels are strong predictors of BD. When located on the lower extremities, sBCC may also display dotted vessels, rendering its recognition problematic. On the latter anatomic site, clinicians should consider SFT and whity shiny blotches/strands as additional sBCC predictors., (© 2018 European Academy of Dermatology and Venereology.)

Background: Ingenol mebutate (IngMeb) 0.015% gel is an approved field treatment option for non-hyperkeratotic non-hypertrophic actinic keratosis (AK) of face and scalp. Efficacy of IngMeb has been assessed only on a clinical ground, in the majority of studies. Dermoscopy is a pivotal tool for the diagnosis of AK, while its role in evaluating the response to non-surgical therapies for AK has not been fully defined., Objectives: Our study aims to determine whether some dermoscopic features of AK of the face and scalp areas may independently predict the response to IngMeb therapy., Methods: Clinical and dermoscopic responses, 1 month after 0.015% IngMeb therapy, were retrospectively evaluated using a per-patient and per-lesion approach. Safety was evaluated through local skin reaction composite score calculation. Demographic, clinical and dermoscopic factors were then evaluated via univariate and multivariate logistic regression analysis to assess independent predictors of response., Results: Fifty-five patients with 245 AKs were enrolled. Clinically, per-patient response evaluation identified 25 (45.4%) poor/partial and 30 (54.5%) complete responders, corresponding on a per-lesion approach to 66 (26.9%) and 179 (73.1%) AKs, respectively. Dermoscopy reclassified 14 patients in the per-patient and 48 AKs in the per-lesion analysis from complete to poor/partial responders. Multivariate logistic regression analysis showed that AKs dermoscopically characterized by red pseudonetwork and located on the face were independently associated with a complete dermoscopic response to 0.015% IngMeb therapy, while microerosions were negative predictors., Conclusion: Specific dermoscopic features of AK may predict the response to 0.015% IngMeb therapy, together with the location on the face., (© 2018 European Academy of Dermatology and Venereology.)

Dermoscopy has been documented to increase the diagnostic accuracy of clinicians evaluating skin tumours, improving their ability to detect skin cancer and better recognize benign moles. However, dermoscopically 'false-positive' and 'false-negative' tumours do exist. False-positive diagnosis usually leads to unnecessary excisions. False-negative diagnosis is much more dangerous, as it might result in overlooking a cancer, with severe undesirable consequences for the patient and the physician. Therefore, management strategies should mainly focus on addressing the risk of dermoscopically false-negative tumours. The most frequent benign tumours that might acquire dermatoscopic characteristics suggestive of malignancy are seborrhoeic keratosis (SK), including solar lentigo, melanoacanthoma, irritated, clonal and regressive SK, angioma (mainly thrombosed angioma and angiokeratoma), dermatofibroma, benign adnexal tumours and naevi (Clark, Spitz, recurrent, combined, sclerosing). The most useful clues to recognize these tumours are the following: solar lentigo - broad network; melanoacanthoma - sharp border; irritated SK - regularly distributed white perivascular halos; clonal SK - classic SK criteria; regressive SK - remnants of SK; targetoid haemosiderotic haemangioma - dark centre and reddish periphery; thrombosed angioma - sharp demarcation; angiokeratoma - dark lacunae; atypical dermatofibromas - palpation; follicular tumours - white colour; sebaceous tumours - yellow colour; Clark naevi - clinical context; Spitz/Reed naevi - age; combined naevi - blue central area; recurrent naevi - pigmentation within the scar; sclerosing naevi - age and location on the upper back; blue naevi - history. Malignant tumours that might mimic benign ones and escape detection are melanoma (in situ, nevoid, spitzoid, verrucous, regressive, amelanotic), squamous cell carcinoma (mainly well-differentiated variants) and rarely basal cell carcinoma (non-pigmented variants). The most useful clues to recognize the peculiar melanoma subtypes are as follows: melanoma in situ - irregular hyperpigmented areas; nevoid melanoma - history of growth; spitzoid melanoma - age; verrucous melanoma - blue-black sign; regressive melanoma - peppering or scar-like depigmentation; amelanotic melanoma - pink colour, linear irregular vessels, dotted vessels. In this article, we summarized the most frequent dermoscopic variations of common skin tumours that are often misinterpreted, aiming to assist clinicians to reduce the number of false diagnoses., (© 2018 European Academy of Dermatology and Venereology.)

Introduction: Daylight PDT (DLPDT) is a new PDT procedure. Several trials demonstrate that DLPDT achieves similar response rates with conventional PDT (CPDT) in the treatment of non-hyperkeratotic actinic keratoses (AKs) in a nearly painless way. It seems that DLPDT represents a more convenient and equally effective treatment modality. Data on long-term efficacy of DLPDT are limited., Objective: To compare short- and long-term efficacy, safety and tolerability of DLPDT with that of CPDT in face and scalp AKs., Methods: The study, an intra-individual right-left comparison study, was conducted in three centres in North, Center and South Greece. Eligible patients received either DLPDT or CPDT randomly allocated to alternate sides of face or scalp. Patients were evaluated at baseline, 3 and 12 months after treatment. Assessments included lesion response at 3 and 12 months, PDT-associated pain during PDT session, local skin reactions 3 days after treatment as well as patients' preference 3 months after treatment., Results: A total of 46 patients completed the study. Three months after treatment, the overall lesion complete response rate was 78% for DLPDT and 80.6% for CPDT. At the 12-month follow-up, response rate decreased to 71.8% and 73.7% for DLPDT and CPDT accordingly. Regarding response based on lesion grade, response rates obtained in grade-I lesions were higher with DLPDT, while treatment with CPDT resulted to higher rates of cured grade-II lesions at both follow-up visits. Results were not supported by statistical significance. DLPDT was associated with significantly lower pain and reduced severity of local skin reactions. Patients' preference favoured DLPDT., Conclusions: Our study demonstrated that DLPDT is similar to CPDT in terms of long-term efficacy and recurrence rates in the treatment of face and scalp AKs. DLPDT demonstrated a better tolerability profile as it was associated with lower pain and less severe adverse events., (© 2017 European Academy of Dermatology and Venereology.)

Background: Individuals with medical history of non-melanoma skin cancers (NMSCs) usually develop multiple and/or recurrent malignant lesions around the site of the primary neoplasm. The latter represents the clinical expression of the 'field cancerization' theory; supporting the presence of multiple malignant clones of dysplastic keratinocytes over the entire epithelium that potentially can progress into clinical lesions. Taking into consideration that the burden of NMSCs on public health and health-care cost is high, adequate control of recurrences and management of field change is challenging., Objectives: To compare the safety and efficacy of daylight photodynamic therapy (DL-PDT) vs. conventional photodynamic therapy (C-PDT) in the prevention of occurrence of new NMSCs in patients with clinical and histological signs of actinic field damage., Methods: Twenty-six patients, with personal history of NMSCs on the face or scalp and actinic keratosis (AK) on the same fields, were randomized for DL-PDT on one side and C-PDT on the other. For a 12-month period, individuals were clinically evaluated for development of new NMSCs., Results: The total number of new AKs and the mean time of their development did not significantly differ between the treated sides. Local adverse events were more intense with C-PDT, and patients' preference was more for DL-PDT compared to C-PDT., Conclusions: The current findings suggest equal preventive potential of DL-PDT vs. C-PDT against the formation of new NMSCs in patients exhibiting actinic field damage., (© 2017 European Academy of Dermatology and Venereology.)

Background: The scalp is a frequent and difficult-to-treat localization of psoriasis. Little evidence exists regarding the use of biologic agents in recalcitrant cases of scalp psoriasis that are resistant to other treatment options., Objectives: To evaluate and compare the efficacy of currently available biologic agents (infliximab, etanercept, adalimumab, ustekinumab) in the treatment of scalp symptoms in patients suffering from moderate to severe plaque psoriasis., Materials and Methods: This retrospective cohort study consisted of a review of the database of all psoriasis patients who suffered from scalp symptoms and received biologic treatment between January 2012 and December 2014. The patients were divided into four groups based on the drug administered. Scalp psoriasis severity was assessed by the Psoriasis Scalp Severity Index (PSSI) at baseline and at weeks 4, 12, 24 and 48. Psoriasis severity was evaluated with the Psoriasis Area and Severity Index (PASI) at the same time points., Results: In total, 145 patients were enroled in the study (infliximab n = 35, etanercept n = 30, adalimumab n = 39, ustekinumab n = 41). At week 4, the infliximab group achieved a 74% mean decrease in the PSSI (ΔPSSI), followed by mean decreases of 61.7%, 53.1% and 53.7% in the ustekinumab, etanercept and adalimumab groups respectively. The differences in the ΔPSSI were lower at week 48: ustekinumab 94.9%, infliximab 94.3%, etanercept 83.1% and adalimumab 89.0%. The PASI score improved sufficiently in all treatment groups. Infliximab and ustekinumab exhibited greater efficacy at weeks 4 and 12. This difference was not as prominent as that revealed by the PSSI. At week 48, the differences in the ΔPASI were barely statistically significant (P = 0.048)., Conclusions: All four biologic agents yielded significant improvement in both scalp and skin lesions. Ustekinumab and infliximab exhibited the greatest efficacy, which was clinically meaningful from the early stages of the study. Adalimumab and etanercept followed, yielding satisfactory improvement rates., (© 2016 European Academy of Dermatology and Venereology.)

Background: Ultraviolet radiation plays an important role in the pathogenesis of non-melanoma skin cancer. Outdoor workers, including farmers, experience higher exposure levels compared to the general population. Available literature data suggest that occupational ultraviolet exposure represents an independent risk factor for squamous cell carcinoma; whereas for basal cell carcinoma (BCC) this association still remains unclarified., Objectives: To analyse the epidemiological, clinical and histological data of patients diagnosed with BCC, and correlate them with outdoor occupation in farmers., Methods: Individuals with histologically diagnosed BCCs, between September 2013 and September 2015, were included in the study. Their medical data, including epidemiological, clinical and histological characteristics, were recorded and analysed in conjunction with the occupation. Farmers were identified based on their specific public health insurance., Results: Three hundred and forty patients, with 542 BCCs were included in the study. One hundred and twenty (35.3%) were farmers. Mean age of farmers was lower than non-farmers (66.0 ± 9.1 years vs. 75 ± 6.6 years, Mann-Whitney U-test, P < 0.001). Farmers had a sixfold higher probability for exhibiting photodamaged skin (OR = 6.02, 95% CI: 3.66-9.90, P < 0.001). Farmer workers were more likely to exhibit infiltrative or morpheaform BCC, but less likely to develop superficial BCC., Conclusion: Our results indicate a higher risk of earlier development of more aggressive histological subtypes of BCCs in farmers. Photodamage was also more common in this group. Primary and secondary prevention strategies focusing on outdoor workers, including farmers, are mandatory., (© 2016 European Academy of Dermatology and Venereology.)

Background: Actinic damage is responsible for the development of multiple, recurrent non-melanoma skin cancers (NMSCs), including actinic keratoses (AKs). Photodynamic therapy (PDT) and imiquimod cream (IMIQ) 5% are recommended as field-directed treatment options., Objectives: To compare efficacy and safety of methyl aminolevulinate (MAL)-PDT vs. IMIQ 5% in the prevention of new NMSCs development patients with field changes., Methods: Patients with field cancerization of the face or scalp were randomized to receive MAL-PDT on one side, and IMIQ 5% on the mirror field. The primary endpoint was the number of new lesions on the treated fields during a 12-month follow-up period. Secondary assessments included adverse events and patient preference., Results: Forty-four patients completed the study. MAL-PDT and IMIQ did not differ concerning the primary endpoint, as there was no statistically significant difference in terms of development of new NMSCs at any point of follow-up. Both treatment regimens were safe and well tolerated. Patients' preference based on the procedure, response rates and future choice favoured MAL-PDT., Conclusions: MAL-PDT and IMIQ 5% are safe and well-tolerated treatments that equally prevent development of new AKs in patients suffering from field changes. MAL-PDT treatment appears to be superior in terms of patients' preference., (© 2014 European Academy of Dermatology and Venereology.)

Background: Several common inflammatory dermatoses, such as rosacea, seborrheic dermatitis (SD), discoid lupus erythematosus (DLE) and granulomatous skin diseases manifest as erythematous macules or plaques on the facial skin. Although clinical examination represents the cornerstone of diagnosis, the broad variety of clinical features and uncommon presentations of these diseases may cause at times diagnostic and therapeutic uncertainty. Dermoscopy, in addition to its well-documented value in evaluation of skin tumours, is continuously gaining appreciation also in the field of general dermatology., Objective: To describe and compare the dermoscopic patterns of common facial inflammatory skin diseases including SD, erythematotelangiectatic rosacea (ER), sarcoidosis, lupus vulgaris (LV), DLE and granuloma faciale (GF)., Methods: Dermoscopic images of lesions from patients with histopathologically confirmed diagnosis of SD, ER, sarcoidosis, LV, DLE or GF were retrospectively evaluated for the presence of several criteria. Selection of the dermoscopic variables included in the evaluation process was based on the data available in the literature and on our preliminary observations., Results: One hundred and fifteen dermoscopic images were included in the study. SD was dermoscopically characterized by dotted vessels and yellow scales, whereas ER was typified by a characteristic pattern of vascular polygons. Sarcoidosis and LV very commonly exhibited orange-yellowish areas and linear branching vessels. Features related to follicle abnormalities and linear branching vessels were the most common dermoscopic criteria of DLE and GF., Conclusions: This study provides new insights into the dermoscopic variability in common facial inflammatory dermatoses., (© 2013 The Authors Journal of the European Academy of Dermatology and Venereology © 2013 European Academy of Dermatology and Venereology.)

Background: Little is currently known about the dermoscopic patterns of genital and extragenital lichen sclerosus (LS). In order to evaluate and compare the dermoscopic and histopathologic patterns of genital and extragenital lichen sclerosus, a retrospective analysis of clinical, dermoscopic and histopathologic features of genital and extragenital LS, collected between March 2010 and December 2011 at four dermatology clinics in Greece, Italy, Serbia and Uruguay was performed., Observations: A total of 29 lesions from 14 (mean age 62.8 years) and 12 (mean age 53.5 years) patients with genital and extragenital LS, respectively were analyzed. Mean duration of disease was 3.5 years for genital and 1.8 years for extragenital LS. White-yellowish structureless areas were seen in all cases of genital and extragenital LS; however linear vessels occurred at higher frequency in genital than in extragenital lesions (85.7% vs. 33.3%, respectively). Extragenital LS revealed two different time-related patterns: keratotic plugs were more prevalent in lesions with short duration (<2 years), whereas longer persisting lesions appeared atrophic and revealed fine chrysalis structures., Conclusions: Our morphologic study provides novel insights into the morphologic diversity of LS at different body sites and different stages of progression., (© 2012 The Authors. Journal of the European Academy of Dermatology and Venereology © 2012 European Academy of Dermatology and Venereology.)

Background: Both chronic plaque psoriasis and periodontitis have an increasing prevalence worldwide and have been associated with the metabolic syndrome; however limited information is available on their association., Objective: To evaluate the possible association of severe periodontitis and chronic plaque psoriasis., Methods: This was a hospital based case-control study. Chronic plaque psoriasis patients and age- and gender-matched controls have been recruited. Baseline demographic data have been recorded. To explore correlations between different dichotomous variables the Sperman Rho correlation coefficient was used. Correlations were further explored non-parametrically and univariate and multivariate logistic regression was utilized after adjustment for the effect of confounders., Results: During the study enrollment period 100 patients with CPP and 100 age- and gender-matched controls were included in this study. Mean age for both groups was 57.2 ± 5.3 years. 43% of patients and controls were males. Significant correlations where noted between psoriasis and 1) periodontitis (rho = 0.219, P = 0.02) and 2) metabolic syndrome (rho = 0.191, P = 0.07) using Spearman's Rho correlation co-efficient. Univariate logistic regression reported significant relations between psoriasis and periodontitis (OR = 3.329, 95%CI: 1.513-7.324, P = 0.003) and psoriasis and metabolic syndrome (OR = 2.293, 95%CI: 1.250-4.207, P = 0.007). On the contrary, a non-significant relation between psoriasis and active smoking status was detected (OR = 1.041, 95%CI: 0.597-1.817, P = 0.887). In a multivariate analysis model we found a significant correlation of psoriasis and periodontitis when controlled for the presence of metabolic syndrome (OR: 2.486, 95%CI: 1.002-5.842, P = 0.049)., Conclusion: Periodontitis may be associated with psoriasis but further studies are required to elucidate their relationship in the context of the biologic plausibility., (© 2012 The Authors. Journal of the European Academy of Dermatology and Venereology © 2012 European Academy of Dermatology and Venereology.)

Background: Early stage mycosis fungoides (MF) is difficult to be clinically differentiated from chronic dermatitis (CD) in a high proportion of patients. Dermoscopy is a rapid, cheep, non-invasive and widely used method for the evaluation of skin tumours and, recently, of inflammatory skin diseases, as well., Objective: To describe the dermoscopic pattern of early stage MF and compare it with the dermoscopic features observed in CD., Methods: This was a retrospective study. Dermoscopic images of lesions that were clinically equivocal between MF and CD were evaluated for the presence of predefined morphologic criteria. Diagnosis had been histopathologically and immunohistochemically confirmed in all cases. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for predefined dermoscopic criteria in relation to the diagnosis of mycosis fungoides., Results: A total of 67 dermoscopic images were selected for dermoscopic evaluation. Mycosis fungoides lesions exhibited a characteristic dermoscopic pattern consisting of fine short linear vessels (sensitivity 93.7%, specificity 97.1%) and orange-yellowish patchy areas (sensitivity 90.6%, specificity 99.7%). A characteristic vascular structure resembling spermatozoa was also found to be highly specific for the diagnosis of mycosis fungoides. CD was typified by a different dermoscopic pattern, usually consisting of dotted vessels., Conclusions: These observations provide a first indication that early stage MF exhibits a characteristic dermoscopic pattern which is different from CD. Prospective studies with long term follow-up are needed to determine the value of these dermoscopic criteria in the differentiation between the two entities in the daily routine., (© 2012 The Authors. Journal of the European Academy of Dermatology and Venereology © 2012 European Academy of Dermatology and Venereology.)

Background: Mycophenolate mofetil (MMF) has been lately proposed as one of the most promising steroid-sparing agent in pemphigus., Objective: To compare effectiveness and adverse events of two different therapeutic protocols for pemphigus: methylprednisolone alone vs. the combination of methylprednisolone and Mycophenolate mofetil., Methods: A randomized prospective non-blinded trial was performed in a tertiary care medical centre. Forty-seven of 52 initially evaluated patients with newly diagnosed pemphigus vulgaris or pemphigus foliaceous that had not previously been treated with systemic corticosteroids or immunosuppressive drugs were randomly assigned to treatment with either methylprednisolone (prednisone equivalent, 1 mg/kg) or methylprednisolone plus mycophenolate mofetil (3 g/day, 1.5 g twice daily). Patients were followed up for clinical outcome based on time required until the achievement of control of disease activity, induction of partial and complete remissions on or off minimal therapy, total amount of corticosteroids administered, frequency of relapses and development of side-effects and complications., Results: The two groups were similar in terms of demographics and baseline disease characteristics. There was no difference between groups in any of the variables used to measure response to treatment or total amount of corticosteroids administered. Side-effects did not differ significantly., Conclusion: Combination treatment with corticosteroids and mycophenolate mofetil, 3 g/day, offers no advantage over monotherapy treatment with corticosteroids in patients with pemphigus., (© 2011 The Authors. Journal of the European Academy of Dermatology and Venereology © 2011 European Academy of Dermatology and Venereology.)

Objective: To compare the efficacy and tolerability of a single ALA-PDT illumination scheme with that of a fractionated ALA-PDT illumination scheme in face and scalp actinic keratoses (AKs)., Methods: Eligible patients received either a single ALA-PDT illumination or a fractionated illumination scheme randomly allocated to alternate sides of face/scalp. The side allocated to a single illumination received 75 J/cm(2). This side received 2 sessions performed 7 days apart. Lesions on the fractionated illumination scheme side received 20 and 80 J/cm(2), 4 and 6 hours after a single ALA application. Patients were evaluated at baseline, at 3 and 12 months after treatment. Efficacy end point included the individual AK lesion clearance rate., Results: Thirty three patients with 266 lesions were enrolled in the study. Three months after treatment the overall lesion complete response rate was 89.05% for the single scheme and 96.12% for the fractionation scheme while at the 12-months follow-up response rate decreased to 85.4% for the single illumination and to 93.79% for the fractionated illumination group. Looking at lesion response based on lesion grade fractionated photodynamic therapy (PDT) resulted in larger rates of cured grade I as well as grade II lesions. Recorded adverse events were transient and did not demand additional therapy., Conclusions: Our results demonstrate that higher responses are achieved with fractionated PDT compared with single illumination PDT. The study data indicate that fewer treatment sessions may be needed with fractionated PDT increasing that way the comfort of the patient regarding number of visits, treatment cost and treatment-related downtime., (© 2011 The Authors. Journal of the European Academy of Dermatology and Venereology © 2011 European Academy of Dermatology and Venereology.)

Background: The prevalence of ophthalmic involvement in rosacea is probably higher than previously presumed and varies considerably among several studies., Objective: This study aimed to determine the incidence of ocular disease among a population of rosacea patients in Northern Greece, to objectively determine the presence of eye dryness in rosacea patients with and without clinical ophthalmic involvement and correlate the severity of ocular disease with the severity of cutaneous rosacea., Methods: One hundred patients with rosacea were assessed for the stage of their disease and examined for ocular symptoms and signs. In 24 of them the tear break up time (TBUT) and Schirmer test were performed in each eye, along with 24 controls., Results: A total of 33 patients (33%) were positive for ophthalmic findings. The most frequent symptoms and signs were burning sensation and tearing, and conjunctivitis and blepharitis, respectively. Eleven patients with ophthalmic manifestations had mild to moderate erythematotelangiectatic rosacea, 17 had moderate papulopustular rosacea and four exhibited findings of phymatous rosacea. The total mean value of patients' Schirmer tests was significantly lower compared with the healthy controls (P < 0.0001). Mean TBUT was shorter in the rosacea group than that in the age-matched controls (P < 0.0001)., Conclusion: Ocular involvement in rosacea is a common phenomenon with eye dryness being an early sign. Tear function tests, like Schirmer test and TBUT, although not specific, could contribute to the screening and early diagnosis of the disease, to prevent the potential development of sight-threatening conditions., (© 2011 The Authors. Journal of the European Academy of Dermatology and Venereology © 2011 European Academy of Dermatology and Venereology.)

Background: Steroids are considered the cornerstone in the treatment of pemphigus vulgaris. However, subsequent morbidity of their use has led to the development of combined therapeutic protocols, using steroid sparing agents., Objectives: The aim of this study was to compare tolerability and efficacy of high dose oral prednisone daily, vs. low dose oral prednisone on alternate days plus azathioprine every day (Lever's mini treatment: LMT) in oral pemphigus., Patients and Methods: Data of 36 patients with oral pemphigus vulgaris, treated with either 1.5 mg/kg/day of oral prednisone daily, or LMT were re-evaluated and statistically analysed. Primary endpoints were time required to control disease activity, prednisone dose required until the end of consolidation phase, cumulative prednisone dose and rates of remission. Secondary endpoints were time to complete (CR) or partial remission (PR) on/off therapy, treatment-associated morbidity and days of hospitalization., Results: Both treatments resulted in high rates of clinical response. The mean prednisone dose required until the end of consolidation phase, and until CR or PR, on/off minimal therapy, was significantly lower in LMT group. However, the mean time required until the control of disease activity and CR or PR, for the same group, was significantly higher. Adverse events were more frequent among patients under daily prednisone. Mean time of hospitalization was also longer in the latter group., Conclusions: Both treatments seem efficacious. Rapidly progressive lesions necessitate high prednisone dose for early and adequate control of the disease. Patients with impaired physical status, especially those with relatively stable lesions, at baseline might safely and effectively be treated with LMT., (© 2010 The Authors. Journal of the European Academy of Dermatology and Venereology © 2010 European Academy of Dermatology and Venereology.)