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Granuloma annulare (GA) is an inflammatory dermatosis of adults and children, arranged by groups of skin‐coloured to erythematous papules in an annular distribution. Nodular lesions may be present too. Common sites of GA are the extensor surfaces of the limbs, dorsa of hands and feet; scalp and trunk are rarely affected. The aetiology of GA is unclear, but some pathological associations have been reported, such as diabetes mellitus type 1, infections, haematological and autoimmune disorders. Four main clinical variants of GA are known: localized GA (multiple or single), subcutaneous GA, generalized GA (annular or nonannular) and perforating GA. Adjunctive rare variants are papular umbilicated GA and linear GA. Clinical features are crucial for suspecting GA, but in doubtful cases biopsy and histopathology are mandatory to confirm the diagnosis. Three main microscopic patterns have been described: palisading granulomatous, interstitial histiocytic and sarcoidal. GA is usually benign and self‐limiting so clinical follow‐up represents the first‐choice therapeutic option. Other topical or systemic measures have shown controversial results.

In spite of the large heterogeneity, limited data exist on hidradenitis suppurativa (HS) phenotypes. To identify the HS phenotypes that best explain the disease heterogeneity, a cross-sectional study using latent class (LC) analysis was conducted on a cohort of patients examined at 17 dermatological centers participating in the Italian Registry of Hidradenitis Suppurativa and being enrolled between January 2015 and January 2020. Overall, 965 patients aged 32.0 ± 12.4 years (mean ± SD) were evaluated. A three-class model in LC analysis best fitted the data. Patients in LC1 (20.1%) were females, mostly obese, with a high probability of axillary‒groin (0.85) and mammary (0.59) lesions and the highest HS severity. Patients in LC2 (29.6%) were nonobese males, with moderate disease severity; with a high probability of gluteal (0.50) and genital (0.17) lesions, besides axillary‒groin involvement; and with acne and pilonidal cysts. Patients in LC3 (50%) were nonobese females with a milder disease mostly limited to axillary (0.52) and groin (0.66) areas. The stratification of patients with HS into a severe axillary‒mammary‒groin phenotype with predominantly anterior body involvement in females, an axillary‒gluteal‒groin phenotype of intermediate severity mainly affecting males in the posterior body areas, and an axillary‒groin phenotype with mildest clinical symptoms and limited skin involvement may help in optimizing HS management.

Activation of blood coagulation has been demonstrated in bullous pemphigoid (BP), a rare autoimmune blistering disease, potentially leading to a prothrombotic state. In order to evaluate the incidence of venous thromboembolism (VTE) in BP, a cohort study was carried out on 432 BP patients (59 % females; median age 76 years, interquartile range [IQR]: 68-82). At diagnosis, autoimmune bullous skin disorder intensity score (ABSIS) was calculated. VTE incidence was standardised with rates of the general population. Multivariable Cox proportional hazard model was used to estimate the hazard ratio of VTE according to ABSIS and concomitant risk factors. During a median follow-up of 4.2 years, 31 objectively-diagnosed VTE events were recorded. The incidence rate of VTE (per 1000 patient-years) was 17.2 overall (95 % confidence interval [CI]: 11.1-23.2), 56.7 (95 % CI: 33.0-80.4) during acute phase (22 VTE) and 6.3 (95 % CI: 2.8-11.3) during remission (9 VTE). The standardised incidence ratio was 4.06 (95 % CI: 2.73-5.65), higher during the acute phase (14.86, 95 % CI: 9.20-21.88) than during remission (1.48, 0.66-2.63). The adjusted hazard ratio of VTE was 2.74 (95 % CI: 1.07-7.04) for ABSIS > 48 vs ABSIS < 28, and 2.56 (95 % CI: 1.00-6.70) in patients with >= 2 concomitant risk factors. In conclusion, BP patients have a 15-fold increased VTE risk during acute phase, proportional to disease severity and heightened by concomitant risk factors. Activation of blood coagulation has been demonstrated in bullous pemphigoid (BP), a rare autoimmune blistering disease, potentially leading to a prothrombotic state. In order to evaluate the incidence of venous thromboembolism (VTE) in BP, a cohort study was carried out on 432 BP patients (59 % females; median age 76 years, interquartile range [IQR]: 68-82). At diagnosis, autoimmune bullous skin disorder intensity score (ABSIS) was calculated. VTE incidence was standardised with rates of the general population. Multivariable Cox proportional hazard model was used to estimate the hazard ratio of VTE according to ABSIS and concomitant risk factors. During a median follow-up of 4.2 years, 31 objectively-diagnosed VTE events were recorded. The incidence rate of VTE (per 1000 patient-years) was 17.2 overall (95 % confidence interval [CI]: 11.1-23.2), 56.7 (95 %CI: 33.0-80.4) during acute phase (22 VTE) and 6.3 (95 %CI: 2.8-11.3) during remission (9 VTE). The standardised incidence ratio was 4.06 (95 %CI: 2.73-5.65), higher during the acute phase (14.86, 95 %CI: 9.20-21.88) than during remission (1.48, 0.66-2.63). The adjusted hazard ratio of VTE was 2.74 (95 %CI: 1.07-7.04) for ABSIS > 48 vs ABSIS

BACKGROUND: MAS063DP cream has received marketing authorization in the USA and the EU as a medical device for the relief of symptoms of atopic dermatitis (AD) and contact dermatitis. OBJECTIVE: Review of technical and clinical data in the literature on MAS063DP to evaluate the role that MAS063DP (Sinclair Pharmaceuticals Ltd) holds in the management of patients affected by AD. METHODS: We explored the characteristics and efficacy of the product by a wide-ranging search of the medical and scientific studies in the literature and drew our conclusions also on the basis of our medical practice and knowledge concerning the treatment guidelines and therapy options of AD. CONCLUSION: MAS063DP is a product dermatologists could enroll in the treatment of signs and symptoms of mild-to-moderate AD in adult and pediatric patients.

In 2184 young children aged 13-24 months with atopic dermatitis (SCORAD 5-59) serum IgE antibodies to a standard panel of food and inhalant allergens were assayed. The frequency of positive IgE responses ( > 0.35 kU/1) increased with greater severity of skin disease. A significant minority of infants had levels of IgE antibody to foods to suggest they were at risk of acute reaction to those foods (7% to hen's egg, 3% to cow's milk, 4% to peanut). Our findings indicate that the frequency of positive IgE responses is related to disease severity and suggest that differences in the time course of the development of IgE responses to food, which are at maximum prevalence within the first year of life, while inhalant allergies, are still developing between 1 and 2 yr and beyond.

The natural evolution of Spitz-Reed nevi is poorly understood, owing to the lack of studies investigating their longterm clinical evolution and the fact that most of the lesions are surgically excised. The surgical approach is indicated because of the clinical and histopathologic similarities with melanoma that may create diagnostic confusion in some cases. Hence nowadays, due to the low incidence of melanoma in children and the development of diagnostic dermoscopic criteria, a less aggressive approach to SRN may be reserved, especially in cases with typical features. We report a case of a pigmented lesion that showed gradual changes, from a Spitz Reed Nevus with typical clinical and dermoscopic features, to a common nevus.

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BACKGROUND: Nail psoriasis occurs in about 50% of psoriatic patients and can be psychologically devastating since it appears on visible areas. Up to now there is no evidence about what biological drugs is the most effective on nail psoriasis. OBJECTIVES: The aim of our study was to determine if one of the four biological drugs approved in our country (infliximab, adalimumab, etanercept, ustekinumab) is more effective than the others for nail psoriasis. MATERIALS AND METHODS: A single-center, retrospective study was conducted to assess the efficacy of biological therapies in patients with moderate to severe psoriasis with nail involvement. NAPSI was evaluated in all psoriatic patients. Kruskal-Wallis and Fisher's exact tests were used to analyze the data. RESULTS: A global statistically significant improvement in mean NAPSI from baseline to 12, 24 and 36 weeks was observed in all patients. At 12 weeks 27.78% of the patients reach NAPSI 75, at 24 weeks 81.48% and at 36 weeks 88.89%. The improvement in nail psoriasis is not significantly different between groups. An improvement in the mean Psoriasis Area and Severity Index score was also achieved CONCLUSIONS: Biological therapies have shown to ameliorate psoriatic nail lesions. We did not find any statistically significant differences between the four biological drugs investigated.

Extramammary Paget's disease is a rare neoplasm of apocrine gland-bearing areas of the skin. The most common site of presentation is the vulva. Surgery is the most frequently reported therapy so far; however, it is invasive and it is complicated by a high rate of recurrence. For this reason, several less-invasive treatments have been recently proposed, including photodynamic therapy. We describe in this article the case of an 84-year-old patient with a noninvasive vulvar extramammary Paget's disease successfully treated with methyl-aminolevulinic acid photodynamic therapy associated with topical tretinoin.

Background Recent findings have shown that psoriasis is frequently associated with atherosclerosis. Intima-media thickness (IMT) is a surrogate marker of atherosclerosis damage. Psoriasis patients had impaired endothelial function and thicker IMT of the carotid artery, compared with the healthy control subjects. Objectives The aim of our study is to evaluate the prevalence of subclinical atherosclerosis in patients affected by cutaneous psoriasis without arthritis, considering the IMT as a subclinical feature of atherosclerosis. Methods Intima-media thickness of the common carotid artery was measured using High-resolution B-mode ultrasound in 40 psoriasis patients and 40 control patients matched for age and gender. We also measured triglycerides, PASI, total cholesterol, LDL cholesterol and BMI. Pearson's partial correlation test was used to determine the correlation between each variable. Results Intima-media thickness in subjects with psoriasis was statistically higher than those in the control subjects (1.465 mm, P value

Infantile hemangiomas (IHs) are the most common tumors of infancy and are usually characterized by a pattern of rapid proliferation, followed by a slower period of involution. In most cases, IHs do not require any treatment because they spontaneously regress over the years. However, in a minority of patients, a therapy is mandatory and should be started early to avoid functional and esthetic impairment or even severe systemic complications. Currently, no medications exist that are specifically labeled to treat his; however, because the serendipitous discovery of the efficacy of propranolol in the treatment of IHs at the Dermatologic Department of the University of Bologna, β-blocker therapy has become the first-line therapy in severe and/or complicated hemangiomas. This is a practical review reporting our approach to IHs in our daily practice.

Inflammatory linear verrucous epidermal nevus (ILVEN) is normally associated with the failure of topical and systemic treatments and with recurrences on interruption of therapy. Many physical approaches have been used, but they generally resulted in varying rates of recurrence and unacceptable scarring. We reported a case of ILVEN treated with a single session CO(2) laser treatment. In our experience, CO(2) laser was quick, easy, effective, and safe; we therefore believe that this approach should be considered as a first-line surgical option in the treatment of genital ILVEN, particularly in cases of mucosal involvement.

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Anecdotal reports have shown that tumour necrosis factor (TNF)-alpha inhibition may cause unchecked superficial infection with the microorganisms responsible for pityriasis versicolor (PV). We observed several cases of PV, which is frequently resistant to topical therapies, in psoriatic patients undergoing anti-TNF-α monoclonal antibody therapy. To evaluate the incidence and the therapeutic management of PV in this group of individuals, between 1 January and 27 December 2010, we examined 153 psoriatic patients for the hypopigmented/hyperpigmented macular and scaling lesions associated with PV. All patients positive for PV were given topical therapy with miconazole nitrate cream twice daily for 28 days, after which they were re-evaluated. In patients non-responsive to topical therapy, we started systemic therapy with fluconazole, 300 mg week for 3 weeks. We diagnosed seven cases of PV. At the end of topical treatment, complete healing of lesions was observed in only one patient. In the other six patients, systemic treatment led to complete resolution of the infection. Although the onset of PV during anti-TNF-alpha; therapy is seldom reported, it is not likely to be rare, but rather under-reported because of its limited pathological significance. In our opinion, the therapeutic management of this condition deserves greater consideration, as the use of topical treatments alone is largely ineffective compared with systemic treatment.

AIM: Actinic keratoses (AKs) are the most common type of keratinocytic lesions worldwide. The skin areas affected by the so called "field cancerization" harbor mutagenetic risks for the development of squamous cell carcinoma (SCC). METHODS: We retrospectively investigated the histopathological reports and clinical charts of 672 patients affected by multiple AKs, presenting at least 5 years of follow-up. The frequency of Non-Melanoma-Skin-Cancers (NMSC) (SCCs and Basal Cell Carcinomas (BCCs)) and Malignant Melanomas (Mms), in patients affected by multiple AKs, were analyzed. RESULTS: More than 40% of patients with a previous diagnosis of multiple AKs developed an NMSC (SCC or BCC), or an MM, during a follow-up period of 5 to 11 years. The risk of developing another skin malignancy appeared to be higher in the age range between 61 and 80 years. The relative risk of developing a BCC and/or an MM in patients with a previous AK diagnosis was found to be 4.52. CONCLUSION: The presence of multiple AKs and "field cancerization" seems to be associated with a high risk not only of Non-Melanoma-Skin-Cancers, such as Squamous Cell Carcinomas and Basal Cell Carcinomas, but also of Malignant Melanoma. An adequate follow-up should be performed in these groups of patients.

We reviewed literature data in order to better define clinical features of Spitz nevi in children. Lots of interest has been given in the past decade to these neoplasms that due the clinical course and sometime the rapid onset, may often cause worrisome consultations. Dermoscopy has played an important role in the improved diagnostic capability of clinicians, regarding all melanocytic neoplasms and also spitz nevi. The description of specific and typical dermoscopic patterns is largely reviewed as well as the new laboratory diagnostic tools in the field of dermatopathology.

We reviewed literature data in order to better define clinical features of Spitz nevi (SNi) in children. Lots of interest has been given in the past decade to these neoplasms that due the clinical course and sometime the rapid onset, may often cause worrisome consultations. Dermoscopy has played an important role in the improved diagnostic capability of clinicians, regarding all melanocytic neoplasms and also SNi. The description of specific and typical dermoscopic patterns is largely reviewed as well as the new laboratory diagnostic tools in the field of dermatopathology.

I tumori cutanei maligni non melanocitari, ovvero non melanoma skin cancer (NMSC), sono un gruppo frequente di neoplasie ad eziologia multifattoriale, con un’incidenza in significativo aumento. Le forme epiteliali, in particolare il carcinoma basocellulare (CBC) ed il carcinoma squamocellulare (CSC), rappresentano in assoluto le neoplasie più frequenti nella razza caucasica. Il razionale del follow-up per i malati di NMSC dovrebbe essere basato sul rischio di tre eventi distinti: recidiva del tumore, metastasi e sviluppo di successivi tumori cutanei. Ad oggi, si riscontra una significativa variabilità tra i programmi di follow-up proposti dalle raccomandazioni di varie organizzazioni nazionali, europee ed extraeuropee. Per il CBC, la non univocità di comportamento è testimoniata da studi che caldeggiano un piano di follow-up ed altri che invece non ne rilevano la necessità, particolarmente in caso di CBC completamente asportato. Riguardo al CSC, non sono stati condotti studi riguardo alla strategia ottimale di followup, e non ci sono dati che definiscano il profilo dei pazienti che possano trarne beneficio.

Pyogenic granuloma is a benign, rapidly growing, acquired vascular tumor, usually presenting as a sessile or polypoid nodule that can often bleed or ulcerate. It is commonly located on the skin of the trunk and the extremities, but it can also originate from the mucous membranes. It may rarely be subcutaneous or intravascular. It typically appears as a red papule or nodule, and it frequently involves the nail, including the nail bed and the periungual tissues. Its etiology and pathogenesis are not completely understood. The condition may be either idiopathic, or it may occur after acute and chronic traumas, during pregnancy, because of inflammatory systemic diseases, or because of the administration of some systemic medications.1 Drug-induced pyogenic granulomas have been frequently reported; the most frequently involved drugs are likely to be retinoids, antiretroviral agents, and antitumoral drugs.1 In particular, among the latter, epidermal growth factor receptor inhibitors

Many factors may worsen atopic dermatitis (AD) including sweating, skin infections, food, inhalant allergens, climatic conditions, stress, and chemical or physical irritants. Especially in children, clothing can be an effective barrier against flare-inducing factors and persistent scratching, allowing more rapid improvement of the eczematous lesions. On the contrary, some fabrics used for clothing may exacerbate skin conditions due to their rough fibers, such as wool and nylon. Conventional silk has smooth fibers that are generally woven for textiles in the manufacturing of clothes, but this material is not particularly useful in the management of children with AD since it reduces transpiration and may cause discomfort. Herein, we evaluate the data concerning a special silk fabric (MICROAIR DermaSilk®) shown to be suitable for patients with AD. The unique properties of this knitted silk allow the skin to breathe and lack irritative potential. Moreover, this fabric is treated with a water-resistant antimicrobial finish known as AEGIS AEM 5772/5. This novel knitted silk fabric appears to be useful in managing children with AD due to its non-irritating and antibacterial features. Additionally, a synthetic silk-like fabric (DermaTherapy®) has received US FDA clearance as a Class I medical device and is commercially available as bedding; their use by AD patients has shown interesting results.

To the Editor.— Although the majority of cases are idiopathic, the papular or papulovesicular acrolocated syndromes (PAS) that were first described by Crosti and Gianotti in 1964 1 are associated with hepatitis B surface antigenemia and a variety of other conditions, including Henoch-Schonlein purpura, 2 smallpox and poliovirus vaccinations, and numerous viral illnesses. 3,4 Rotavirus has not been associated with PAS, or recognized as a cause of viral exanthem in childhood. We describe two children with acute rotavirus gastroenteritis associated with PAS. Report of Cases.— An 18-month-old boy and a 19-month-old girl were seen with a PAS of three and seven days duration, respectively. The lesions had started on the lower legs in both patients and in a few days had spread to the face, arms, and buttocks. There was no history of fever, but both patients showed diarrhea four and seven days prior to the onset of the eruption.

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Le lesioni della mucosa orale in corso di malattia bollosa autoimmune sono tra le più difficili da gestire e tendono a recidivare con maggiore frequenza rispetto alle lesioni cutanee, con notevole impatto sulla qualità di vita. Attualmente il PRP è stato approvato anche per le lesioni aperte cutanee e mucose. Il meccanismo d'azione si basa sull nota capacità riparativa, strutturale e funzionale, e sull sua capacità di stimolare la proliferazione e la rigenerazione tissutale. Si tratta inoltre di una tecnica sicura che finora non ha mostrato alcun effetto collaterale. Attualmente abbiamo utilizzato il gel piastrinico su 10 pazienti affetti da MBA e, nonostante il numero ridotto, è stato possibile effettuare una prima valutazione circa l’efficacia ma anche i limiti di tale trattamento. Tutti i pazienti hanno mostrato un rapido miglioramento della sintomatologia dolorosa con conseguente miglioramento della qualità della vita., Mucosal Lesions in patients with autoimmune bullous diseases are the most difficult to manage and tend to relapse more frequently than skin lesions. Consequentially, these lesions have a very important impact on quality of life of affected patients. PRP has recently been approved for the treatment of dermatological diseases characterized by difficult-to-treat mucosal and cutaneous ulcerated lesions. The mechanism of action is based on the its well-known repairing capacity (structural and functional) and on its ability to stimulate tissue proliferation and regeneration. PRP is very safety and side effects have not been described so far. We have currently used platelet gel on 10 patients with MBA and, despite the small number, it was possible to observe an initial assessment of the effectiveness but also the limits of this treatment. All patients showed a rapid improvement in pain symptoms with a consequent improvement in the quality of life.

Background Atypical lentiginous melanocytic nevi (ALMNs) are atypical pigmented lesions with histopathological features similar to those of dysplastic nevi, with a lentiginous pattern. Variable histopathological features of ALMNs were observed in our practice. Methods We described the histopathological features of ALMNs diagnosed in the period 2009-2015. Our cases were divided into 2 groups: Group 1: ALMNs showing the same histopathological features as previously described in the literature; Group 2: ALMNs with different features. Results Twenty-nine ALMNs were diagnosed; 2 groups of ALMNs were identified. Group 1 ALMNs showed a constant, mild epidermal acanthosis; frequently, an inflammatory infiltrate and dermal fibrosis, cytological atypia and mild architectural atypia. Group 2 ALMNs showed a constant psoriasis-like acanthosis with a hypercellularity of the rete ridges; cytological atypia was rare, whereas architectural atypia was constantly observed. Immunohistochemistry (MART-1 staining) revealed that the melanocytes were localized at the dermo-epidermal junction in both groups. ALMNs showed a broad spectrum of histopathological features. Conclusions Our main finding was a constant architectural atypia in all lesions of Group 2. The identification of a unique type of ALMN seems no longer possible. The correct recognition of such benign, though atypical, melanocytic lesions is important in order to avoid an overdiagnosis of cutaneous melanoma and to prevent their potential evolution to the latter.

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

Background Photodynamic therapy (PDT) is a well-known and effective treatment for non-melanoma skin-cancer. Numerous studies have also shown its effectiveness in mycosis fungoides. The aim of the study was to analyse MF patients treated with PDT at the Dermatology Unit of Bologna University. Methods We retrospectively analysed MF patients treated with PDT over the last ten years. Each PDT protocol consisted of the appliance for 3 h under an occlusive film dressing on each lesion of a one-mm-thick layer of 16% methyl aminolaevulinate (MAL) 160 mg/g cream (Metvix ® , Galderma, Paris, France). The cream was then removed and the skin was exposed to 630 nm red light from a diode lamp (Aktilite ® , Galderma Benelux, Rotterdam, the Netherlands), with a total radiation dose of 37 J/cm2 for 9 mins. A protocol of one session every month was scheduled. The treated lesions were clinically examined, before each treatment. Results Four cases, three male and one female, had been treated with PDT. Two patch lesions on the plantar area, one leg and the pubic area were treated. The number of PDT sessions ranged from 4 to 9. Two complete remissions and two partial remissions were observed. A low-to-mild burning sensation was reported during the treatment, and persisted over the next day; no further side effects were observed. Conclusions Our series shows that PDT can be considered an effective second-line treatment in patients characterised by a disease located in difficult-to-treat anatomical areas such as the feet and the pubic area.

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In the last 5 years, several cases of the drug-induced variant have been reported during treatment of metastatic disease with immunotherapy and targeted therapy.The pathogenesis of targeted therapy-associated Sweet syndrome and its significance as a putative marker of therapeutic response remain to be ascertained. Our patient’s skin eruption was temporally related to the beginning of targeted therapy treatment and meets allthe criteria for the drug-induced form.The molecular mechanisms leading to Sweet syndrome during melanoma could differ depending on the types of treatment.

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Spitz nevi are benign melanocytic neoplasms characterized by epithelioid or spindle melanocytes or both. In some rare cases their presentation overlaps with the clinical and histopathologic features of malignant melanoma, so a differential diagnosis can be difficult to make. Intermediate forms between Spitz nevi and malignant melanoma, with unpredictable behavior, have been called atypical Spitz tumors. A literature search was performed to review the clinical, dermoscopic, genetic, and histopathologic aspects of spitzoid tumors. Spitz nevi mainly occur in children, with no predilection for sex, and in young women. Common sites are the head and lower arms, where Spitz nevi present as pink nodules or hyperpigmented plaques. Spitzoid lesions may have diverse dermoscopic patterns: vascular, starburst, globular, atypical, reticular, negative homogeneous, or targetoid. The management of spitzoid lesions can be invasive or conservative; surgical excision is usually reserved for those with doubtful features, whereas clinical and dermoscopic follow-up is preferred for typical pediatric Spitz nevi. The role of sentinel lymph node biopsy in atypical Spitz tumors is debated. Immunohistochemistry and new molecular techniques such as comparative genomic hybridization, polymerase chain reaction, and fluorescence in situ hybridization offer new diagnostic perspectives, investigating genetic alterations that are specific for malignant melanoma or for Spitz nevi.

Introduction and Objectives: Nail apparatus melanoma (NAM) is an uncommon tumor, especially in Caucasians. The prognosis of patients affected by NAM was analyzed and correlated with the histopathological criteria and the surgical management of the tumors. Materials and Methods: We collected data regarding NAM referred to the Skin Cancer Unit of the Dermatology Department of the University of Bologna, from 1992 to January 2012. Results: Out of 1,327 melanoma cases diagnosed between 1992 and 2012, 42 patients were affected by NAM (2.93%). All the patients were Caucasian. Two deceased patients with insufficient medical records and 1 woman with a personal history of breast cancer were excluded. Thirty-nine cases entered this study: 24 were women (67%) and 15 men (33%). The mean age at diagnosis of NAM was 57.3 years (range 29-88 years). Statistical analyses showed that prognosis was significantly correlated with the Breslow thickness (≥/Conclusions: In our experience, the surgical management (disarticulation with respect to functional surgical excision) did not influence the prognosis of NAM patients. The latter was affected by the histopathological characteristics (Breslow thickness, regression and mitoses) and location (fingers vs. foot).

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In-transit (IT) metastases refer to cutaneous or subcutaneous melanoma spread or recurrence, more than 2 cm away from the primary tumor but not beyond the draining regional lymph nodes. IT metastases treatment is challenging, owing to a wide range of clinical presentations, and the overall prognosis is quite poor (the 5-year survival ranges between 20 and 60%), since their appearance preludes systemic involvement

Nevus comedonicus is a rare, benign hamartoma of the pilosebaceous unit that may be isolated or part of the nevus comedonicus syndrome. Although rare in children, complication by hidradenitis suppurativa-like lesions has been described. We present a report of a 9-year-old girl in whom surgical excision was curative, with a review of the relevant literature.

Purpose Advanced-stage mycosis fungoides (MF; stage IIB to IV) and Sézary syndrome (SS) are aggressive lymphomas with a median survival of 1 to 5 years. Clinical management is stage based; however, there is wide range of outcome within stages. Published prognostic studies in MF/SS have been single-center trials. Because of the rarity of MF/SS, only a large collaboration would power a study to identify independent prognostic markers. Patients and Methods Literature review identified the following 10 candidate markers: stage, age, sex, cutaneous histologic features of folliculotropism, CD30 positivity, proliferation index, large-cell transformation, WBC/lymphocyte count, serum lactate dehydrogenase, and identical T-cell clone in blood and skin. Data were collected at specialist centers on patients diagnosed with advanced-stage MF/SS from 2007. Each parameter recorded at diagnosis was tested against overall survival (OS). Results Staging data on 1,275 patients with advanced MF/SS from 29 international sites were included for survival analysis. The median OS was 63 months, with 2- and 5-year survival rates of 77% and 52%, respectively. The median OS for patients with stage IIB disease was 68 months, but patients diagnosed with stage III disease had slightly improved survival compared with patients with stage IIB, although patients diagnosed with stage IV disease had significantly worse survival (48 months for stage IVA and 33 months for stage IVB). Of the 10 variables tested, four (stage IV, age > 60 years, large-cell transformation, and increased lactate dehydrogenase) were independent prognostic markers for a worse survival. Combining these four factors in a prognostic index model identified the following three risk groups across stages with significantly different 5-year survival rates: low risk (68%), intermediate risk (44%), and high risk (28%). Conclusion To our knowledge, this study includes the largest cohort of patients with advanced-stage MF/SS and identifies markers with independent prognostic value, which, used together in a prognostic index, may be useful to stratify advanced-stage patients.

Background Pyogenic granuloma (PG) is a common, acquired, benign vascular neoplasm of the skin and mucous membranes. It occurs most often in children and adolescents. First-line treatment options for PG are based on destructive approaches. Pain, permanent scarring, and pigmentation are potential complications of these therapies. Methods This single-arm, open-label, prospective study evaluated the efficacy of topical propranolol for treatment of PGs in children. All patients clinically diagnosed with cutaneous PG consecutively at the Dermatology Pediatric Outpatient Service of the University of Bologna from January 2010 to December 2010 received a compounded formulation of propranolol ointment 1%. Results We found propranolol ointment to be effective in consecutive patients; 59.0% completely regressed in a mean of 66 days, 18.2% remained stable, and 22.7% did not respond. No side effects (eg, skin irritation, allergy, bleeding) were observed. Conclusion Topical propranolol ointment 1% with occlusion appears to be an effective treatment for PGs in children. Early treatment was associated with a more favorable outcome.