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Click here for the corresponding questions to this CME article. [ABSTRACT FROM AUTHOR]

Summary: Background: Whether melanoma in histological contiguity with a naevus [naevus‐associated melanoma (NAM)] is distinctly different from melanoma arising de novo remains unclear. Objectives: To determine whether the characteristics of de novo melanoma differ from NAM and are not due to naevus obliteration in thicker tumours. Methods: We conducted a multicentre retrospective study of de novo melanoma and NAM in seven referral centres in Europe, Australia and the USA between 2006 and 2015. Results: In a total of 9474 localized melanomas, de novo melanoma was associated with thicker tumours and body site differences compared with NAM. In the subset of T1 melanomas (n = 5307), similar body site differences were found in multivariate analysis by body site. When compared with NAM, de novo melanoma was more likely to affect older individuals (≥ 70 years) when located on the head/neck [odds ratio (OR) 4·65, 95% confidence interval (CI) 2·55–8·46], the trunk (OR 1·82, 95% CI 1·40–2·36) or the upper extremity (OR 1·69, 95% CI 1·14–2·50), was more likely to affect female patients when located on the lower extremities (OR 1·36, 95% CI 1·03–1·80), and was more likely to be of the nodular melanoma subtype (OR 2·23, 95% CI 1·14–4·35) when located on the trunk. De novo melanoma was less likely to have regression present compared with NAM. Conclusions: Clinicopathological and body site differences between de novo melanoma and NAM support the divergent pathway model of development. These differences were also found in thin melanomas, suggesting that de novo melanomas are different from NAM and their differences are not due to the obliteration of naevus remnants in thicker tumours. What is already known about this topic? Cutaneous melanoma appears de novo in approximately 70% of cases and has adjacent naevus remnants on histological examination [naevus‐associated melanoma (NAM)] in the remaining 30% of cases.Whether melanoma arising de novo is a biological type distinct from NAM remains unclear.Robust conclusions on the differences between de novo melanoma and NAM have been hindered by the possible obliteration of naevus in thicker melanomas. What does this study add? In 9474 patients with localized melanoma there were body site differences for de novo melanoma compared with NAM, supporting the divergent pathway model of melanoma development.In 5307 T1 melanomas there were similar body site associations for de novo melanoma and older age at diagnosis, female sex, the nodular subtype and absence of regression.These findings suggest that de novo melanomas are different from NAM and the differences are not due to the obliteration of naevus remnants in thicker tumours. Linked Comment: J. Wiggins and D. Polsky. Br J Dermatol 2021; 185:9–10. [ABSTRACT FROM AUTHOR]

Summary: Background: Over the last few years, several articles on dermoscopy of non‐neoplastic dermatoses have been published, yet there is poor consistency in the terminology among different studies. Objectives: We aimed to standardize the dermoscopic terminology and identify basic parameters to evaluate in non‐neoplastic dermatoses through an expert consensus. Methods: The modified Delphi method was followed, with two phases: (i) identification of a list of possible items based on a systematic literature review and (ii) selection of parameters by a panel of experts through a three‐step iterative procedure (blinded e‐mail interaction in rounds 1 and 3 and a face‐to‐face meeting in round 2). Initial panellists were recruited via e‐mail from all over the world based on their expertise on dermoscopy of non‐neoplastic dermatoses. Results: Twenty‐four international experts took part in all rounds of the consensus and 13 further international participants were also involved in round 2. Five standardized basic parameters were identified: (i) vessels (including morphology and distribution); (ii) scales (including colour and distribution); (iii) follicular findings; (iv) 'other structures' (including colour and morphology); and (v) 'specific clues'. For each of them, possible variables were selected, with a total of 31 different subitems reaching agreement at the end of the consensus (all of the 29 proposed initially plus two more added in the course of the consensus procedure). Conclusions: This expert consensus provides a set of standardized basic dermoscopic parameters to follow when evaluating inflammatory, infiltrative and infectious dermatoses. This tool, if adopted by clinicians and researchers in this field, is likely to enhance the reproducibility and comparability of existing and future research findings and uniformly expand the universal knowledge on dermoscopy in general dermatology. What's already known about this topic? Over the last few years, several papers have been published attempting to describe the dermoscopic features of non‐neoplastic dermatoses, yet there is poor consistency in the terminology among different studies. What does this study add? The present expert consensus provides a set of standardized basic dermoscopic parameters to follow when evaluating inflammatory, infiltrative and infectious dermatoses.This consensus should enhance the reproducibility and comparability of existing and future research findings and uniformly expand the universal knowledge on dermoscopy in general dermatology. Linked Editorial: Bahadoran. Br J Dermatol 2020; 182:260–261. Plain language summary available online [ABSTRACT FROM AUTHOR]

Imiquimod monotherapy resulted in complete clinical response in 71-4% of treated patients, consistent with previous studies.3-5 These findings (and those of other studies) support surgery as the primary treatment for LM in operable patients, not only because of the higher cure rates, but also because it allows for complete histopathological evaluation and detection of possible microinvasion. Patient demographic characteristics and tumour baseline characteristics for each study group are shown in Table 1. Dear Editor, As lentigo maligna (LM) has a tendency for subclinical extension, staged excisions with margin control achieve lower recurrence rates than conventional wide local excision (0-9-5% vs. 8-20%).1,2 However, these surgical techniques are limited by the requirements of time, cost and training. [Extracted from the article]

Dear Editor, Artificial intelligence (AI) has emerged as a hot topic within dermatology, and during recent years several studies have demonstrated its benefits in a research setting. While 85-1% of respondents were aware of AI as an emerging topic in dermatology, only 23-8% had either good or excellent knowledge about AI within dermatology. [Extracted from the article]

Linked Articles: Taibjee et al. Br J Dermatol 2019; 181:1343–1345; Conforti et al. Br J Dermatol 2019; 181:1345–1346. [ABSTRACT FROM AUTHOR]

Summary: Pigmented Bowen disease (pBD) is an uncommon variant of squamous cell carcinoma in situ. Sometimes it can show clinical and dermoscopic features that are seen in other pigmented lesions of the skin and mucosa, making the diagnosis difficult. We report six cases of pBD occurring on the anogenital area, and discuss the importance of dermoscopy for improving the diagnostic accuracy in pBD. [ABSTRACT FROM AUTHOR]

Summary: Dermoscopy is widely used in dermatological practice. The method increases the accuracy of basal cell carcinoma (BCC) detection. Pigmented and nonpigmented variants of basal cell carcinoma present different dermoscopic features. Specific dermoscopy criteria have been recognized in different subtypes of BCC. Differentiation of superficial BCC from other subtypes is the most important issue, as it may determine further management decisions. [ABSTRACT FROM AUTHOR]

Spitzoid lesions represent a challenging and controversial group of tumours, in terms of clinical recognition, biological behaviour and management strategies. Although Spitz naevi are considered benign tumours, their clinical and dermoscopic morphological overlap with spitzoid melanoma renders the management of spitzoid lesions particularly difficult. The controversy deepens because of the existence of tumours that cannot be safely histopathologically diagnosed as naevi or melanomas (atypical Spitz tumours). The dual objective of the present study was to provide an updated classification on dermoscopy of Spitz naevi, and management recommendations of spitzoid-looking lesions based on a consensus among experts in the field. After a detailed search of the literature for eligible studies, a data synthesis was performed from 15 studies on dermoscopy of Spitz naevi. Dermoscopically, Spitz naevi are typified by three main patterns: starburst pattern (51%), a pattern of regularly distributed dotted vessels (19%) and globular pattern with reticular depigmentation (17%). A consensus-based algorithm for the management of spitzoid lesions is proposed. According to it, dermoscopically asymmetric lesions with spitzoid features (both flat/raised and nodular) should be excised to rule out melanoma. Dermoscopically symmetric spitzoid nodules should also be excised or closely monitored, irrespective of age, to rule out atypical Spitz tumours. Dermoscopically symmetric, flat spitzoid lesions should be managed according to the age of the patient. Finally, the histopathological diagnosis of atypical Spitz tumour should warrant wide excision but not a sentinel lymph-node biopsy. [ABSTRACT FROM AUTHOR]

Background When used correctly, dermoscopy is an essential tool for helping clinicians in the diagnosis of skin diseases and the early detection of skin cancers. Despite its proven benefits, there is a lack of data about how European dermatologists use dermoscopy in everyday practice. Objectives To identify the motivations, obstacles and modifiable factors influencing the use of dermoscopy in daily dermatology practice across Europe. Methods All registered dermatologists in 32 European countries were invited to complete an online survey of 20 questions regarding demographic and practice characteristics, dermoscopy training and self-confidence in dermoscopic skills, patterns of dermoscopy use, reasons for not using dermoscopy and attitudes relating to dermoscopy utility. Results We collected 7480 valid answers, of which 89% reported use of dermoscopy. The main reasons for not using dermoscopy were lack of equipment (58% of nonusers) and lack of training (42%). Dermoscopy training during residency was reported by 41% of dermoscopy users and by 12% of nonusers ( P < 0·001). Dermatologists working in public hospitals were the least likely to use dermoscopy. High use of dermoscopy across the spectrum of skin diseases was reported by 62% of dermoscopy users and was associated with dermoscopy training during residency, the use of polarized light and digital dermoscopy devices, longer dermoscopy practice, younger age and female gender. Conclusions Expanding access to dermoscopy equipment, especially in public healthcare facilities and establishing dermoscopy training during dermatology residency would further enhance the substantially high dermoscopy use across European countries. [ABSTRACT FROM AUTHOR]

Background Prediction of the histopathological subtype of basal cell carcinoma ( BCC) is important for tailoring optimal treatment, especially in patients with suspected superficial BCC ( sBCC). Objectives To assess the accuracy of the preoperative prediction of subtypes of BCC in clinical practice, to evaluate whether dermoscopic examination enhances accuracy and to find dermoscopic criteria for discriminating sBCC from other subtypes. Materials and methods The main presurgical diagnosis was compared with the histopathological, postoperative diagnosis of routinely excised skin tumours in a predominantly fair-skinned patient cohort of northern Europe during a study period of 3 years (2011-13). The study period was split in two: during period 1, dermoscopy was optional (850 cases with a pre- or postoperative diagnosis of BCC), while during period 2 (after an educational dermoscopic update) dermoscopy was mandatory (651 cases). A classification tree based on clinical and dermoscopic features for prediction of sBCC was applied. Results For a total of 3544 excised skin tumours, the sensitivity for the diagnosis of BCC (any subtype) was 93·3%, specificity 91·8%, and the positive predictive value ( PPV) 89·0%. The diagnostic accuracy as well as the PPV and the positive likelihood ratio for sBCC were significantly higher when dermoscopy was mandatory. A flat surface and multiple small erosions predicted sBCC. Conclusions The study shows a high accuracy for an overall diagnosis of BCC and increased accuracy in prediction of sBCC for the period when dermoscopy was applied in all cases. The most discriminating findings for sBCC, based on clinical and dermoscopic features in this fair-skinned population, were a flat surface and multiple small erosions. [ABSTRACT FROM AUTHOR]

Background Dermoscopy is limited in differentiating accurately between pigmented lentigo maligna ( LM) and pigmented actinic keratosis ( PAK). This might be related to the fact that most studies have focused on pigmented criteria only, without considering additional recognizable features. Objectives To investigate the diagnostic accuracy of established dermoscopic criteria for pigmented LM and PAK, but including in the evaluation features previously associated with nonpigmented facial actinic keratosis. Methods Retrospectively enrolled cases of histopathologically diagnosed LM, PAK and solar lentigo/early seborrhoeic keratosis ( SL/ SK) were dermoscopically evaluated for the presence of predefined criteria. Univariate and multivariate regression analyses were performed and receiver operating characteristic curves were used. Results The study sample consisted of 70 LMs, 56 PAKs and 18 SL/ SKs. In a multivariate analysis, the most potent predictors of LM were grey rhomboids (sixfold increased probability of LM), nonevident follicles (fourfold) and intense pigmentation (twofold). In contrast, white circles, scales and red colour were significantly correlated with PAK, posing a 14-fold, eightfold and fourfold probability for PAK, respectively. The absence of evident follicles also represented a frequent LM criterion, characterizing 71% of LMs. Conclusions White and evident follicles, scales and red colour represent significant diagnostic clues for PAK. Conversely, intense pigmentation and grey rhomboidal lines appear highly suggestive of LM. [ABSTRACT FROM AUTHOR]

Background The parallel ridge pattern ( PRP) is considered the dermoscopic hallmark of acral melanoma ( AM). However, it was recently shown that approximately one-third of AMs do not display a PRP dermoscopically, rendering their detection more troublesome. Objectives To investigate the diagnostic accuracy of dermoscopic criteria for the diagnosis of AM. Methods Dermoscopic images of consecutive cases of histopathologically diagnosed AMs and acral naevi with histopathological diagnosis or with at least 1 year of follow-up were evaluated by three independent investigators for the presence of predefined criteria. Crude and adjusted odds ratios and their corresponding 95% confidence intervals were calculated by univariate and multivariate logistic regression, respectively. Receiver operating characteristic curves were used to choose among competing classification schemes. Results In total 603 lesions (472 naevi and 131 AMs) were included in the study. A scoring system (named BRAAFF) composed of six variables was associated with optimal area under the curve and sensitivity for the diagnosis of AM. This method includes four positive (irregular blotches, ridge pattern, asymmetry of structures and asymmetry of colours) and two negative predictors (furrow pattern and fibrillar pattern). Conclusions The BRAAFF checklist significantly improves the diagnostic accuracy of dermoscopy for the diagnosis of AM. [ABSTRACT FROM AUTHOR]

Background Little is known about the variability of the dermoscopic criteria of squamous cell carcinoma ( SCC) according to the histopathological differentiation grade. Objectives To evaluate whether specific dermoscopic criteria can predict the diagnosis of poorly differentiated SCC compared with well- and moderately differentiated SCC. Methods Clinical and dermoscopic images of SCCs were retrospectively evaluated for the presence of predefined criteria. Univariate and adjusted odds ratios were calculated. Discriminant functions were used to plot receiver-operator characteristic curves. Results Of 143 SCCs included, 48 (33·5%) were well differentiated, 45 (31·5%) were moderately differentiated and 50 (35·0%) were poorly differentiated. Flat tumours had a fourfold increased probability of being poorly differentiated. Dermoscopically, the presence of a predominantly red colour posed a 13-fold possibility of poor differentiation, whereas a predominantly white and white-yellow colour decreased the odds of poorly differentiated SCC by 97% each. The presence of vessels in more than 50% of the tumour's surface, a diffuse distribution of vessels and bleeding were significantly associated with poor differentiation, while scale/keratin was a potent predictor of well- or moderately differentiated tumours. Conclusions Dermoscopy may be regarded as a reliable preoperative tool to distinguish poorly from well- and moderately differentiated SCC. Given that poor differentiation of SCC represents an independent risk factor for recurrence, metastasis and disease-specific death, identifying poorly differentiated tumours in vivo may enhance their appropriate management. [ABSTRACT FROM AUTHOR]

Background Naevoid melanoma (NeM), a rare variant of melanoma, can be difficult to detect as its clinical and histopathological morphology can simulate a naevus. Objectives To describe the clinical and dermoscopic features associated with NeM. Methods Lesions with a histopathological diagnosis of NeM were collected via an e-mail request sent to all members of the International Dermoscopy Society. All lesions were histopathologically reviewed and only lesions fulfilling a set of predefined histopathological criteria were included in the study and analysed for their clinical and dermoscopic features. Results Twenty-seven of 58 cases (47%) fulfilled the predefined histopathological criteria for NeM and were included in the study. Clinically, 16 of the 27 NeMs presented as a nodular lesion (59%), eight (30%) as plaque type and three (11%) as papular. Analysis of the global dermoscopic pattern identified three types of NeM. The first were naevus-like tumours ( n = 13, 48%), typified by a papillomatous surface resembling a dermal naevus. In these lesions local dermoscopic features included irregular dots/globules (46%), multiple milia-like cysts (38%) and atypical vascular structures (46%). The second type were amelanotic tumours ( n = 8, 30%), typified by an atypical vascular pattern (75%). The third type consisted of tumours displaying a multicomponent pattern ( n = 4, 15%), characterized by classical local melanoma-specific criteria. Two lesions (7%) were classified as mixed-pattern tumours as they did not manifest any of the aforementioned patterns. Conclusions While NeMs may be clinically difficult to differentiate from naevi, any papillomatous lesion displaying dermoscopically atypical vessels and/or irregular dots/globules should prompt consideration for the possible diagnosis of NeM. [ABSTRACT FROM AUTHOR]

Background Spitz naevi may present a wide spectrum of morphologies. Histopathologically, many variants, including desmoplastic, angiomatoid, verrucous/polypoid, plexiform, pagetoid, halo, myxoid, granulomatous and tubular Spitz naevi have been described. Clinical and dermoscopic features of these unusual variants of Spitz naevi have been reported only rarely. Objectives The aim of this study is to describe clinical, dermoscopic and histopathological features of uncommon morphological variants of Spitz naevi in order to raise awareness among clinicians about their peculiar patterns of presentation. Methods We searched our image database retrospectively from 2004 to 2014 for images of excised tumours using Spitz/Reed naevus as a keyword. Results A total of 307 excised skin lesions with a histopathological diagnosis of Spitz/Reed naevus were found. Among those we identified 13 uncommon variants of Spitz naevi including six cases of desmoplastic Spitz naevus, five cases of angiomatoid Spitz naevus and two cases of verrucous Spitz naevus. These lesions did not fulfil the already described dermoscopic criteria of Spitz naevi, with the exception of angiomatoid Spitz naevi, exhibiting a pinkish background and dotted vessels in dermoscopy. Desmoplastic Spitz naevi may be difficult to differentiate from dermatofibroma clinically, and from melanoma under dermoscopic examination. Verrucous Spitz naevi, despite their relatively unusual clinical features, show reassuring morphological clues histologically, which allows the differential diagnosis from an atypical spitzoid tumour. Conclusions In all cases an atypical melanocytic lesion could not be excluded under dermoscopy, thus warranting excision and histopathological examination. [ABSTRACT FROM AUTHOR]

The article presents several case study of patients with Histocytic disorders. Topics discussed include a 50-year-old male patient showed Langerhans cell histiocytosis treated with prednisone and improvement in the cutaneous papules; a 14-year-old female patient lesions exhibited structureless yellow areas with an overlying thick pigment network; and a 63-year-old male patient showed single yellow-red nodule in his left axilla and reticulohistiocytoma was noted.

The article offers information on a research letter which uses reflectance confocal microscopy (RCM) as a noninvasive complementary tool in the diagnosis of psoriatic balanitis. It also discusses the analysis of RCM features of biopsy-proven psoriatic balanitis in patients with no other skin involvement from psoriasis, with dermoscopic and histopathological correlation.

Background Fluorescence confocal microscopy ( FCM) is an emerging technology for rapid imaging of excised tissue, without the need for frozen- or fixed-section processing. Basal cell carcinomas ( BCCs) can be detected in Mohs excisions although few studies have described the major BCC findings as seen on FCM. Objectives To describe the major BCC findings of excised tissue during Mohs surgery and to correlate them with histopathology. Methods Freshly excised tumours and frozen-thawed discarded tissue of BCC during Mohs surgery were analysed by means of FCM. A side-by-side correlation between FCM images and histological sections was performed. The FCM features of overlying skin and adnexal structures were also described. Results Sixty-four BCC cases were analysed. Distinct BCC types appeared unique in terms of shape and size of tumour islands [bigger in nodular (18/25), smaller and rounded in micronodular (7/7) and tiny cords for infiltrative ones (24/30)] and for the presence of clefting, palisading and increased nucleus/cytoplasm ratio. An excellent correlation was found between FCM and histological findings (Cohen's κ statistics = 0·9). In six cases, the presence of sebaceous glands and intense stroma reaction represented possible confounders. Conclusions Fluorescence confocal microscopy is a fast and new imaging technique that allows an excellent visualization of skin structures and BCC findings during Mohs surgery. [ABSTRACT FROM AUTHOR]

Background Recent research suggests that scalp naevi differ with respect to their epidemiology, patient characteristics and morphological patterns, but currently a classification of scalp naevi is lacking. Objectives To investigate the prevalence, together with clinical and dermoscopic features, of scalp naevi detected in persons attending a skin cancer screening programme, and to elaborate a classification of scalp naevi based on their most common morphological patterns. Methods Participants were recruited during the melanoma prevention programme 'sun watch' of Austrian Cancer Aid in Styria. Each participant received a clinical and dermoscopic total-body skin examination including the scalp. For each participant, demographics and clinical characteristics including number of scalp naevi were recorded. Clinical and dermoscopic photographs of at least one scalp naevus per participant were taken and evaluated for specific clinical and dermoscopic features. Results In total 867 subjects, including 119 participants (13·7%) with scalp naevi, participated in the study. Compared with those without scalp naevi, subjects with scalp naevi were significantly younger, were more often men and more often exhibited congenital naevi on the body ( P < 0·01 for all). Analysis of the clinical and dermoscopic variability of scalp naevi allowed for a proposal to classify scalp naevi into six main groups, namely common, papillomatous, eclipse, congenital, blue and atypical naevus. Conclusions Scalp naevi can be classified into six morphological groups; scalp lesions deviating from these six main patterns should be carefully managed to rule out melanoma. [ABSTRACT FROM AUTHOR]

Background Applicability of dermoscopy in evaluation of outcome and monitoring of superficial basal cell carcinoma (s BCC) after nonablative therapies has not been sufficiently assessed. Objectives Certain dermoscopic criteria, namely pigmented structures, ulceration and arborizing vessels, have been suggested to predict the presence of residual disease [residual disease-associated dermoscopic criteria ( RDADC)]. We aimed to assess this hypothesis. Patients and methods Lesions exhibiting RDADC 3 months after treatment were biopsied and in the case of histopathological confirmation were excised. Lesions characterized by white/red structureless areas, superficial fine telangiectasias, or lacking any dermoscopic criterion, were monitored for 12 months. Results At the 3-month evaluation, one or more of the RDADC were detected in 25/98 (25·5%) s BCCs, in which histology confirmed tumour persistence. In 45 (61·6%) of the 73 remaining lesions, dermoscopy showed white/red structureless areas and/or superficial fine telangiectasias. Twenty-eight lacked any dermoscopic criterion of s BCC. The two latter groups entered follow-up. In total, disease recurred in 13 (17·8%) of the 73 lesions. Conclusions RDADC accurately predict residual disease. Absence of dermoscopic criteria of s BCC safely predicts complete histopathological clearance. Detection of white/red structureless areas and/or superficial fine telangiectasias warrants close monitoring to recognize early recurrence. [ABSTRACT FROM AUTHOR]

In addition to its well-documented value in improving the diagnosis of skin tumours, dermoscopy is continually gaining appreciation in the field of general dermatology. Dermoscopy has been shown to facilitate the clinical recognition of several inflammatory and infectious diseases, as well as their discrimination from skin tumours. Moreover, recent data indicate that it might also be profitable in assessing the outcome and adverse effects of various treatments. Application of dermoscopy should follow the standard procedure of acquiring information from patient history and clinically evaluating the number, location and morphology of the lesion(s). Four parameters should be assessed when applying dermoscopy in the realm of inflammatory and infectious diseases: (i) morphological vascular patterns; (ii) arrangement of vascular structures; (iii) colours; and (iv) follicular abnormalities, while the presence of other specific features (clues) should also be evaluated. It must be underlined that dermoscopic findings should always be interpreted within the overall clinical context of the patient, integrated with information from the history and the macroscopic examination. With new evidence continuously being gathered, the dermatoscope gradually acquires a role similar to the stethoscope of general practitioners, becoming an irreplaceable clinical tool for dermatologists. In this article, we provide a succinct summary of existing data on dermoscopy in general dermatology. Practical tips are suggested, which can assist clinicians in profitably utilizing and applying the available knowledge in their everyday practice. [ABSTRACT FROM AUTHOR]

Background The presence of pigmentation might influence the management of basal cell carcinoma ( BCC), with pigmented BCC responding poorly to certain treatments. Clinical studies report on a generally lower frequency of pigmentation compared with dermoscopic and histopathological studies, but the true frequency at which pigmentation occurs in clinically nonpigmented BCC has not been studied in detail. Objectives To compare the clinical and dermoscopic frequency of pigmentation in a series of histopathologically diagnosed BCCs and to correlate it with patient demographics, tumour location and histopathological subtype. Methods Clinical and dermoscopic images of histopathologically confirmed BCCs were retrospectively evaluated for the presence of pigmentation. Dichotomous outcome variables were clinically pigmented and dermoscopically pigmented BCC. All separate dermoscopic variables were included in the analysis. Differences in proportions were evaluated using Pearson's chi-square test. Results Five hundred and seven BCCs from 507 patients with a mean age of 67 years and a male-to-female ratio of 1·35 : 1 were included in the study. Clinically, 295 tumours were judged as nonpigmented. Of those, dermoscopy disclosed pigmentation in 88 cases (29·8%). Overall, blue-grey ovoid nests were the most frequent dermoscopic pattern ( n = 184, 36·3%), followed by multiple blue-grey dots/globules ( n = 147, 29%) and maple-leaf-like areas ( n = 70, 13·8%). Superficial tumours exhibited mainly maple-leaf-like areas, spoke-wheel areas and brown dots, whereas pigmented nodular BCC was most frequently typified by the presence of blue-grey ovoid nests. Conclusions Dermoscopy allows detection of pigmentation in about 30% of clinically nonpigmented BCCs, providing additional information that may aid the clinical choice of adequate treatment modalities. [ABSTRACT FROM AUTHOR]

Background Basosquamous carcinoma ( BSC) is a rare and potentially aggressive tumour, characterized by clinical and pathological features of both basal cell carcinoma ( BCC) and squamous cell carcinoma ( SCC). It is reported to have a nonspecific clinical presentation, which makes naked-eye diagnosis a challenge. Objectives To describe the dermoscopic patterns of BSC, which may facilitate early diagnosis and accurate management. Methods This was a retrospective evaluation of clinical and dermoscopic images of histopathologically proven BSC, collected from skin cancer centres in Australia (Perth), Greece (Thessaloniki) and Italy (Naples, Reggio Emilia). Results Twenty-two tumours were included in the study. Our analysis revealed that the dermoscopic pattern of BSC comprises BCC-related criteria, as well as features that are known to characterize invasive SCC. The most frequently detected criteria were: unfocused (peripheral) arborizing vessels (73%), keratin masses (73%), white structureless areas (73%), superficial scale (68%), ulceration or blood crusts (68%), white structures (64%), blue-grey blotches (59%) and blood spots in keratin masses (55%). Notably, all but one of the tumours exhibited at least one BCC-related plus one SCC-related dermoscopic feature. Conclusions BSC appears to have overlapping dermoscopic features of BCC and invasive SCC, and detection of at least one dermoscopic criterion of both BCC and SCC should raise suspicion for the tumour. Appreciation of the dermoscopic patterns of BSC might assist in the timely and accurate diagnosis and subsequent optimal management of this unusual and potentially metastatic skin tumour. [ABSTRACT FROM AUTHOR]

Background Nodular lesions pose diagnostic challenges because nodular melanoma may simulate all kinds of melanocytic and nonmelanocytic lesions. Reflectance confocal microscopy ( RCM) is a novel technique that allows visualization of the skin at nearly histological resolution although limited laser depth penetration hampers visualization of the deep dermis. Objectives We sought to assess whether the diagnostic accuracy of RCM was comparable to histopathology for the diagnosis of nodular lesions, and to identify possible limitations of this technique. Methods We retrospectively evaluated 140 nodules by means of RCM while blinded from the histopathological diagnosis. At the end of the study the patient codes were broken and the evaluations were matched with histopathological diagnosis before performing statistical analysis. Results The study consisted of 140 nodular lesions (23 'pure' nodular melanomas, nine melanoma metastases, 28 BCCs, six invasive SCCs, 32 naevi, 14 seborrhoeic keratoses, 17 dermatofibromas, five vascular lesions and six other lesions). RCM correctly diagnosed 121 of 140 lesions (86·4%); eight of 140 (5·7%) lesions revealed discordance between histopathology and confocal microscopy. Eight of the 140 (5·7%) cases were not evaluable by means of RCM due to the presence of ulceration or hyperkeratosis and three cases showed a nonspecific pattern. Interestingly, confocal microscopy reached a 96·5% sensitivity and 94·1% specificity (area under curve 0·970) (95% CI 0·924-1·015) ( P < 0·001) for the diagnosis of melanoma. Conclusions The study is retrospective and lesions were not included on the basis of their diagnostic difficulty. Despite the limited laser depth penetration of RCM, this imaging tool represents an effective instrument in diagnosing nodular lesions; however, for fully ulcerated lesions or when a marked hyperkeratosis is present, biopsy should always be performed. Prospective studies on difficult-to-diagnose nodules should be performed to analyse further the pros and cons of RCM in skin cancer diagnosis. [ABSTRACT FROM AUTHOR]

Background Small-diameter melanocytic lesions represent a diagnostic challenge for clinicians, as they do not follow the ABCD rule for diagnosis and do not always display reliable histopathological criteria. Objectives To analyse the confocal features of small-diameter lesions (naevi and melanomas with diameter ≤ 5 mm) to determine whether they show specific morphological criteria. Methods Twenty-four melanomas and 72 naevi were subjected to dermoscopic and confocal evaluation along with histopathology. Significant dermoscopic and confocal differences between melanomas and naevi were evaluated by means of the Pearson χ2 test. Odds ratios and 95% confidence intervals were calculated for each parameter. Binary logistic regression was performed to identify the reflectance confocal microscopy (RCM) independently significant features for melanoma diagnosis. Results The seven-point checklist dermoscopic score was ≥ 3 in 22 melanomas and in 33 naevi. The combination of cells' pleomorphism and architectural disorder (i.e. nonspecific pattern or irregular junctional nests upon confocal examination) are the most striking criteria for consistent diagnosis of small melanoma. The presence of atypical cells, more than five atypical cells per mm2, and roundish atypical cells at the dermoepidermal junction showed the highest odds ratios. From logistic regression, the presence of at least five pagetoid cells per mm2, tangled lines within the epidermis, and atypical roundish cells at the dermoepidermal junction resulted in the three independent confocal parameters that characterized small melanomas. Conclusions Small melanomas frequently reveal specific dermoscopic and confocal features. Moreover, the combination of dermoscopy and RCM can lead to a correct diagnosis of a number of naevi that share some morphological aspects with melanomas. [ABSTRACT FROM AUTHOR]

Background Early recognition and prompt excision is to date the only available strategy for reducing mortality from melanoma. Little is known about the accuracy of melanoma detection in children and adolescents. Objectives To assess the accuracy of melanoma detection in a paediatric population. Methods From the Department of Dermatology, Medical University of Graz, Austria, we reviewed the dermatopathology reports of naevi and melanomas excised in patients younger than 20 years over a 10-year period (1998-2007). Patients were subdivided into four age groups: 0-4, 5-9, 10-14 and 15-19 years. Results Accuracy in melanoma detection was tested using the number needed to excise (NNE) value that is obtained by dividing the total number of excised lesions by the number of melanomas. A total of 22 564 lesions were reviewed, disclosing 22 526 naevi and 38 melanomas, for an overall NNE value of 593·8. Five melanomas were excised in children aged 10-14 years (NNE 1141) and 33 in children aged 15-19 years (NNE 479·8), whereas no melanomas were found among 1026 lesions excised in children younger than 10 years. In children aged 0-4 years, congenital and Spitz/Reed naevi accounted for 34·5% and 20% of lesions, respectively. These percentages decreased progressively when moving to older age groups ( P < 0·0001). In contrast, the percentage of dermal and compound naevi rose in direct proportion with age, being 3·4% and 20·7%, respectively, in the youngest age group, and 36·7% and 31·9%, respectively, among the oldest patients ( P < 0·0001). Conclusions The overall NNE value in paediatric patients over the 10-year study period was 593·8, meaning that about 594 lesions were excised to find one melanoma. This value is 20 times higher than the rates found in adult patients. [ABSTRACT FROM AUTHOR]

Background Dermoscopy is useful in evaluating skin tumours, but its applicability extends also to the field of inflammatory skin disorders. Plaque psoriasis (PP), dermatitis, lichen planus (LP) and pityriasis rosea (PR) are common inflammatory skin diseases, but little is currently known about their dermoscopic features. Objectives To determine and compare the dermoscopic patterns associated with PP, dermatitis, LP and PR and to assess the validity of certain dermoscopic criteria in the diagnosis of PP. Methods Patients with PP, dermatitis, LP and PR were prospectively enrolled. The single most recently developed lesion was examined dermoscopically and histopathologically. Variables included vascular morphology, vascular arrangement, background colour, scale colour, scale distribution and presence of Wickham striae. Univariate and adjusted odds ratios were calculated. Discriminant functions were used to plot receiver-operator characteristic curves. Results Eighty-three patients with PP and 86 patients with either dermatitis, LP or PR were included in the study. Dotted vessels in a regular arrangement over a light red background and white scales were highly predictive for the diagnosis of PP, whereas dermatitis more commonly showed yellow scales and dotted vessels in a patchy arrangement. PR was characterized by yellowish background, dotted vessels and peripheral scales; whitish lines (Wickham striae) were seen exclusively in LP. Conclusions PP, LP, PR and dermatitis show specific dermoscopic patterns that may aid their clinical diagnosis. Certain combinations of dermoscopic features can reliably predict the diagnosis of PP. [ABSTRACT FROM AUTHOR]

Background Melanomas vary in growth rate from rapidly developing nodular melanomas to slow-growing melanomas (SGM) that hardly change over years. Objectives To evaluate longitudinal changes in dermoscopic findings of SGM. Methods We retrospectively analysed a dermoscopic image dataset from 15 pigmented lesion clinics, of SGM that were followed sequentially by digital dermoscopy for at least 1 year. We evaluated baseline and follow-up images for changes in global pattern, organization, colours, structure and size. Results Our series consisted of 92 SGM. On follow-up, these melanomas developed the following dermoscopic findings: more homogeneous and less reticular global dermoscopic pattern; more frequent disorganization of pattern (baseline, 67% vs. follow-up, 79%); decreased prominence of light brown colour, increased prominence of dark brown colour, and increased frequency of the colours red, white, grey, blue and black (baseline: 29%, 3%, 18%, 6% and 33% vs. follow-up: 41%, 10%, 31%, 13% and 45%, respectively); decrease in prominence of dermoscopic structure of pigmented network, with a concomitant increase in prominence of structureless areas; and increased prominence or new appearance of melanoma-specific dermoscopic structures, including negative network, blue-white structures and blotches. The majority of lesions (75%) remained the same size or grew by < 2 mm in diameter. An increase in lesion size was associated with change in the total number of colours and structures (χ2 = 14·3, P = 0·027) at follow-up. Conclusions While their diameter changed minimally over time, most SGM became more disorganized, revealed loss of network in favour of structureless areas, and developed new colours. [ABSTRACT FROM AUTHOR]

Summary Background Dermoscopy improves melanoma recognition, but most criteria were described in the context of superficial spreading melanoma. Objectives To test whether pigmented nodular melanoma could be recognized dermoscopically by the presence of a combination of blue and black colour within the lesion. Methods Dermoscopic images of histopathologically diagnosed pigmented nodular tumours with no (or only minimal) flat component were evaluated for the presence of standard melanoma criteria and for the presence of a new feature named blue-black (BB) colour. Sensitivity, specificity, positive predictive value and negative predictive value were calculated for standard criteria and BB feature in relation to the diagnosis of melanoma and to diagnosis of malignancy. Results Of 283 lesions, 160 were malignant, including 78 (27·6%) melanomas, and 123 were benign. The BB feature and the standard criteria had 78·2% and 43·6% sensitivity for melanoma, respectively, whereas a combined method based on the presence of either the BB feature or one (or more) of the standard criteria reached 84·6% sensitivity, with 80·5% specificity and 93·2% negative predictive value. Sensitivity values for malignant lesions were only 24·4%, 56·9% and 60% for standard criteria, BB feature and the combined method, respectively. However, the combined method gave 91·9% specificity and 90·6% positive predictive value for malignancy. Conclusions Using a method based on the BB feature or one of the standard melanoma criteria, only 9·4% of positive pigmented nodular lesions were found to be benign and only 6·8% of negative lesions were found to be melanoma histopathologically. [ABSTRACT FROM AUTHOR]

Summary [ABSTRACT FROM AUTHOR]

Most dermoscopic algorithms to diagnose melanoma were established more than 10 years ago and have been tested primarily on clear-cut melanomas and excised melanocytic naevi. To assess the diagnostic performance of pattern analysis and seven-point checklist on lesions that reflect the current clinical setting, compared with a revised seven-point checklist with a lower threshold for excision. Eight experienced dermatologists viewed dermoscopic images of 100 excised melanomas, 100 excised naevi and 100 monitored naevi. Each lesion was evaluated by pattern analysis and scored as naevus, melanoma or lesion to be excised. Images were then evaluated using the seven-point criteria, with both standard and revised thresholds for excision. Pooled data using the pattern analysis algorithm showed that 82% of melanomas and 87·5% of monitored naevi were correctly scored as lesion to be excised and benign naevus, respectively. Using the standard and revised thresholds for the seven-point checklist, excision was recommended for 77·9% and 87·8% of the lesions in the melanoma set, respectively. The standard threshold produced 'no excision' recommendations for 85·6% of the monitored naevi, compared with 74·5% using the revised threshold. Pattern analysis, standard seven-point and revised seven-point algorithms resulted in recommendations of 'excision' for 63·6%, 60·3% and 72·0% of the excised naevi, respectively. The diagnostic approach to naevi and melanoma should be adapted to the current clinical setting, in which patients may present with early-stage melanomas and multiple atypical naevi. To increase sensitivity, a revised seven-point checklist with a lower threshold for excision should be used. [ABSTRACT FROM AUTHOR]

Pyogenic granuloma is a common, benign, vascular lesion of the skin and mucous membranes which is a simulator of amelanotic/hypomelanotic melanoma and other tumours. To determine the diagnostic significance of dermoscopic structures and patterns associated with pyogenic granulomas in a large series of cases. Digital dermoscopic images of histopathologically proven cases of 122 pyogenic granulomas and 140 other tumours (28 amelanotic melanomas, seven melanoma metastases, 22 basal cell carcinomas and 83 other tumours) were collected from university hospitals in Spain, Italy, Austria and Turkey. The frequency, sensitivity, specificity, positive predictive value, negative predictive value, intraobserver agreement and interobserver agreement of the dermoscopic structures and patterns associated with pyogenic granulomas were calculated. Vascular structures were observed in 45% of pyogenic granulomas (sensitivity of 45·1% and specificity of 17·9%; both P < 0·001). Seven exclusive patterns were made up from the combination of the structures 'reddish homogeneous area' (RHA), 'white collarette' (WC), 'white rail lines' (WRL) and 'vascular structures' (VS). The pattern composed of RHA, WC and WRL showed the highest sensitivity (22·1%; P < 0·001) and a specificity of 100% ( P < 0·001) for pyogenic granulomas. Two other patterns (RHA + WC and RHA + WC + WRL + VS) showed 100% specificity when compared with melanoma ( P < 0·001 and P < 0·05, respectively). Even though some dermoscopic patterns are useful in the recognition of pyogenic granulomas, dermoscopy is not a substitute for histology, mostly when vessels are present, as melanoma cannot be ruled out. [ABSTRACT FROM AUTHOR]

Background Recent evidence suggests that melanoma is a family of different tumours with varying abilities to grow and metastasize. Trends in melanoma epidemiology show a strong increase in the incidence of thin melanoma, with no corresponding increase in mortality or incidence of thick melanoma. We initially evaluated five cases and found that none had baseline features suggestive of melanoma; excision was performed based on slight changes visible only in side-by-side comparisons of dermoscopic images. Objectives To assess the clinico-dermoscopic features and the growth patterns of melanomas that were excised after a follow-up of 1 year or more due to their inconspicuous features at the baseline consultation. Methods In a multicentre, retrospective study of histopathologically confirmed melanomas excised after follow-up, we analysed dermoscopic images obtained at the initial consultation and compared them with images obtained at the last follow-up consultation. Images were analysed and graded using standard algorithms and scored for changes in size, symmetrical or asymmetrical structural change, and development of new melanoma-specific criteria. An overall score reflecting the amount of change was calculated for each lesion. Results Our series consisted of 103 melanomas. After a median follow-up of 20 months, most lesions were still in situ or early invasive (median Breslow thickness of 0·48 mm), with only three lesions showing tumour thickness of 1 mm or more. The most frequent baseline characteristics were asymmetrical pigmentation (78·6% of lesions), reticular overall pattern (62·1%), and regression features (35·9%). Most melanomas (58·3%) showed minor to moderate changes over time, with < 2 mm size increase, with asymmetrical structural change, and without development of new melanoma-specific criteria. Major changes were visible only after a mean follow-up of 33 months. Conclusions This study provides evidence for the existence of a subgroup of slow-growing melanomas, which may explain the increase in the incidence of thin melanoma, despite stable rates of thick melanoma and melanoma-associated mortality. [ABSTRACT FROM AUTHOR]

Background Dermoscopic monitoring of melanocytic lesions increases the likelihood that featureless melanomas are not overlooked and minimizes the excision of benign lesions. Objective To examine clinical outcome and patient compliance using different follow-up protocols. Methods A retrospective analysis of 600 lesions from 405 patients (aged 6–79 years) was performed to examine patient compliance and clinical outcome in patients with multiple atypical melanocytic lesions undergoing sequential dermoscopy imaging during short-, medium- or long-term follow-up. Based on the degree of dermoscopic atypical features, patients were scheduled for short-term monitoring with follow-up after 3 months, medium-term monitoring with follow-up after 6 months or long-term monitoring with annual follow-up. Criteria leading to excision of monitored lesions differed according to the follow-up protocol. Results In a median follow-up period of 23 months, 54 (9%) lesions were excised, revealing 12 early melanomas (occurring in 3% of monitored patients), one basal cell carcinoma and 41 melanocytic naevi. The melanoma/benign ratio of excised lesions was 1 : 3·4. Seven of 12 melanomas showed changes after two to four visits, corresponding to 8–54 months of follow-up. Patient compliance was 84% for short-term monitoring, 63% for medium-term monitoring and 30% for long-term monitoring. Conclusions In patients with multiple naevi sequential dermoscopy imaging is a useful strategy to avoid missing melanomas while minimizing unnecessary excision of benign lesions. For better compliance, the first re-examination should be scheduled at 3 months after the baseline visit. Regular annual follow-up monitoring is also needed to detect slow-growing melanomas in which subtle changes may become apparent only over time. [ABSTRACT FROM AUTHOR]

The lack of consensus among clinicians and pathologists due to the mixture of clinical and histopathological features used to define the various melanocytic naevi underscores the need of a better classification system for these benign lesions. We describe a dermoscopic classification system for melanocytic naevi that is directed to clinicians dealing with the early diagnosis of melanoma, as well to pathologists, in order to promote better communication between these different specialists. [ABSTRACT FROM AUTHOR]

Dear Editor, In nonpigmented skin tumours the diagnosis is based mainly on the evaluation of the vascular morphology and vessels' distribution dermoscopically.[[1], [3]] However, to date, no study has formally correlated the prevailing vascular morphology with the Breslow thickness of the melanoma and the amount of pigmentation. Firstly, polymorphous vessels were significantly associated with melanomas > 1-3 mm, as 55% of all melanomas showing polymorphous vessels had a tumour thickness > 1-3 mm (71 of 129; I P i < 0-012). [Extracted from the article]

Background The accuracy of clinical diagnosis of nonpigmented, facial actinic keratosis (AK) is often suboptimal, even for experienced clinicians. Objectives To investigate the dermoscopic features of nonpigmented AK located on the head/neck that may assist the clinical diagnosis. Methods Forty-one nonpigmented AKs on facial sites were examined by dermoscopy for any consistent underlying features. Lesions were gathered from skin cancer centres in Australia, Austria, Italy and the U.S.A. All cases were diagnosed histopathologically. Results Four essential dermoscopic features were observed in facial AK: (i) erythema, revealing a marked pink-to-red ‘pseudonetwork’ surrounding the hair follicles (95%); (ii) white-to-yellow surface scale (85%); (iii) fine, linear-wavy vessels surrounding the hair follicles (81%); and (vi) hair follicle openings filled with yellowish keratotic plugs (66%) and/or surrounded by a white halo (100%). These features combined, in 95% of cases, to produce a peculiar ‘strawberry’ appearance. Conclusions A dermoscopic model of ‘strawberry’ pattern is presented, which may prove helpful in the in vivo diagnosis of nonpigmented, facial AK. A limitation of this study is the lack of testing of the specificity of the described dermoscopic criteria in differentiating nonpigmented AKs from other nonpigmented skin lesions at this site. [ABSTRACT FROM AUTHOR]

Background In a pilot study, the three-point checklist of dermoscopy has been shown to represent a valid and reproducible tool with high sensitivity for the diagnosis of skin cancer in the hands of a small group of nonexperts. Objectives To re-evaluate these preliminary results in a large number of observers independently from their profession and expertise in dermoscopy. Methods The study was conducted via the internet to provide worldwide access for participants. After a short web-based tutorial, the participants evaluated dermoscopic images of 165 (116 benign and 49 malignant) skin lesions (15 training and 150 test lesions). For each lesion participants scored the presence of the three-point checklist criteria (asymmetry, atypical network and blue-white structures). Kappa values, odds ratios, sensitivity, specificity and likelihood ratios were estimated. Results Overall, 150 participants joined the study. The three-point checklist showed good interobserver reproducibility (kappa value: 0.53). Sensitivity for skin cancer (melanoma and basal cell carcinoma) was 91.0% and this value remained basically uninfluenced by the observers' professional profile. Only 20 participants lacking any experience in dermoscopy performed significantly more poorly, but the sensitivity was still remarkably high (86.7%) when considering that they were untrained novices in dermoscopy. The specificity was 71.9% and was significantly influenced by the profession, with dermatologists performing best. Conclusions Our study confirms that the three-point checklist is a feasible, simple, accurate and reproducible skin cancer screening tool. [ABSTRACT FROM AUTHOR]

Background Based on the dermoscopic classification of acquired melanocytic naevi, six different dermoscopic types can be distinguished by morphology (globular, globular-reticular, globular-homogeneous, reticular, reticular-homogeneous, homogeneous) and by pigment distribution (uniform, central hyperpigmentation, central hypopigmentation, peripheral hyperpigmentation, peripheral hypopigmentation, multifocal hyper/hypopigmentation). It has been suggested that most individuals harbour one predominant dermoscopic type among their naevi. Objectives To evaluate whether the age of the patient influences the predominant naevus pattern observed in individuals with multiple acquired melanocytic naevi. Methods Individuals were recruited from the pigmented skin lesion clinic in Graz between July 2000 and February 2001. Individuals with at least 10 melanocytic naevi were selected consecutively until a total of 10 individuals in each of five age groups was obtained. Age groups were: 0-15 years, 16-30 years, 31-45 years, 46-60 years and > 60 years. Digitized images of acquired melanocytic naevi, defined as benign melanocytic proliferations having a diameter of at least 5 mm with a macular component and which were not apparent within the first year of life, were evaluated by dermoscopic criteria. The associations of dermoscopic features as a function of patient age were analysed. We calculated absolute numbers and frequencies, given as percentages, as well as predominance of the dermoscopic types of naevi in the different age groups. Results Analysis of 1268 naevi revealed that the globular pattern predominated in the youngest age group. By contrast, the reticular and/or homogeneous patterns were increasingly exhibited in naevi from older individuals (older than 15 years). Uniform pigmentation was most common in melanocytic naevi in the youngest age group, while central hyperpigmentation was predominantly seen in the group of individuals aged 16-30 years. Conclusions The predominance of dermoscopic types of melanocytic naevi varies according to the individual's age. Awareness of the age-related dermoscopic predominance of melanocytic naevi might allow more accurate recognition of dermoscopic patterns of melanocytic skin lesions that are unusual with respect to the individual's age. This observation may help in the early recognition of some `banal'-appearing melanomas. Furthermore, the observations made in this study raise interesting questions regarding naevus evolution. [ABSTRACT FROM AUTHOR]

Eccrine poroma (EP) is a benign sweat gland neoplasm that represents roughly 10% of sweat gland tumours and appears predominantly between the fourth and sixth decades of life. Also seen were perivascular whitish halos, which represent a sign of keratinization, and the presence of vascular structures resembling the lacunas of angioma.[1] Therefore, these dermoscopic findings should lead to biopsy. Currently the data in literature are restricted by a low number of reports, in this way EP, as the case retracted, may demonstrate vascular pattern resembling non-pigmented skin tumours. [Extracted from the article]

Linked Articles: Taibjee et al. Br J Dermatol 2019; 181:1343–1345; Conforti et al. Br J Dermatol 2019; 181:1309–1311 [ABSTRACT FROM AUTHOR]

Dermoscopy improves the diagnostic accuracy in pigmented skin lesions, but it is also useful in the evaluation of nonpigmented skin tumours as it allows the recognition of vascular structures that are not visible to the naked eye. Bowen's disease (BD) or squamous cell carcinoma in situ is usually nonpigmented, but may also rarely be pigmented. To describe the dermoscopic features in a series of pigmented and nonpigmented BD. Dermoscopic images of 21 histopathologically proven BD were evaluated for the presence of various dermoscopic features. Each lesion was photographed using the Dermaphot (Heine Optotechnik, Herrsching, Germany), at 10-fold magnification, and the colour slides were scanned to digital format using a Kodak Photo CD system. The majority of cases of BD revealed a peculiar dermoscopic pattern characterized by glomerular vessels (90%) and a scaly surface (90%). In addition, in pigmented BD small brown globules regularly packed in a patchy distribution (90%), and structureless grey to brown pigmentation (80%) were observed. Dermoscopy can be helpful for diagnosing BD because of the presence of repetitive morphological findings such as glomerular vessels and a scaly surface. In pigmented BD, small brown globules and/or homogeneous pigmentation can be seen as well. [ABSTRACT FROM AUTHOR]

Benign melanocytic skin lesions may be difficult to differentiate from melanoma both clinically and dermoscopically. One of the most confounding dermoscopic features, commonly seen in melanoma but in our experience also in melanocytic naevi, is represented by the so-called blue–white structures (BWS). To evaluate diagnostic significance and histopathological correlates of BWS seen by dermoscopy in a series of clinically equivocal melanocytic skin lesions that were excised. Patients were recruited from six specialized pigmented lesion clinics in Austria, Italy and Spain over a period of 9 months. All consecutive patients showing one or more melanocytic lesions with BWS, but not classified as melanoma dermoscopically, were included. Each lesion was photographed clinically and dermoscopically. All images were reviewed by one of us and the degree, type and location of BWS evaluated for each lesion. A panel of four experienced dermatopathologists independently reviewed all specimens for diagnosis and one of them evaluated presence and degree of melanosis and/or fibrosis. The main outcome measures were the percentage and histopathological correlates of lesions with different degree, type and location of BWS. All included lesions with BWS ( n = 158) showed partial or focal regression histopathologically. One hundred and thirty-five (85·4%) lesions were diagnosed as melanocytic naevi (complete histopathological interobserver agreement), whereas 23 (14·6%) were defined as equivocal because at least one of four pathologists diagnosed the given lesion as melanoma. Only one lesion was diagnosed as melanoma by all four pathologists. The majority of naevi exhibited blue areas (84·4%) with a central distribution (57%) and involving < 50% of the lesion surface (89·6%). By contrast, 78·3% of equivocal lesions revealed a combination of white and blue areas with an irregular distribution (60·9%) and involving > 50% of the lesion surface (47·8%). Using degree and type of BWS, an algorithm was constructed that can be applied for the management of lesions exhibiting dermoscopic features of regression. [ABSTRACT FROM AUTHOR]

Summary Background Melanoma in situ (MIS) occurs on various body sites, in various age groups, and is managed by a variety of treatment modalities. Despite early treatment, recurrences may be encountered. Objectives To evaluate the influence of sex, age, body site and treatment modalities on recurrence rate in MIS. Methods Histologically confirmed cases of MIS from our dermatopathological database (n = 1351) from 1990 to 2000 were statistically analysed with respect to epidemiological characteristics, treatment modalities and outcome. Treatment modalities of the included MIS were evaluated by searching for data in the medical records and histopathological data sheets. Results There was a predominance of female patients (60·8%), and of involvement of the head and neck (53·4%). Total excision was performed in 95·9% of all patients; the remainder received cryotherapy, laser therapy or radiotherapy. In 265 patients, no data on definitive treatment were available. Alternatives to total excision were particularly performed in patients with advanced age and with lesions localized on the face. The mean ± SD 5-year recurrence rate was 6·8 ± 1·3% for surgically removed lesions, but was 31·3 ± 8·5% for lesions treated by other modalities (log rank test: P < 0·0001). In a multivariate approach, mode of therapy and site of involvement, but not age, were significant prognostic variables (Cox proportional hazard model: P < 0·01). Conclusions In MIS, treatment modalities other than surgical excision may be used in certain situations, but carry a significantly increased risk of local recurrence. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which discusses the histological study aimed at identifying the dermoscopic patterns of granuloma annulare (GA) and necrobiosis lipodica (NL), which were the common granulomatous skin diseases (GSD).

A letter to the editor is presented which discusses the detection of Demodex folliculorum mites through confocal microscopy.

Linked Article: Errichetti et al. Br J Dermatol 2020; 182:454–467 [ABSTRACT FROM AUTHOR]

Summary: Dermoscopy is a technique using a handheld magnifying device called a dermatoscope that allows doctors to see structures in the skin that are not visible to the naked eye. This helps with the diagnosis of skin diseases and reduces the need for biopsies (removal of a small sample of skin to be examined under a microscope). Its main use is for skin tumours (e.g. skin cancers), but it is increasingly used also in other skin diseases, especially inflammatory and infectious skin diseases. Over the last few years, several articles on dermoscopy of non‐tumoural (i.e. not cancer) skin diseases have been published, yet there is poor consistency in the terminology (language) used among the different studies. The present study, involving a total of 37 international experts from all over the world on behalf of the International Dermoscopy Society, aimed to identify uniform terms and basic parameters (what doctors should look for) to adopt/evaluate when using dermoscopy in non‐tumoral skin diseases. This aim was achieved by using a standardized agreement procedure (called "modified DELPHI method"). The authors identified five standardized basic parameters. For each of them, possible variables were selected, with a total of 31 different sub‐items. Adopting a structured and uniform method to describe dermoscopic findings will help researchers and will allow different studies to be compared. This is particularly relevant for future studies on dermoscopy in general dermatology, which the authors strongly recommend should be designed using the terminology and parameters outlined in this study. This summary relates to the study: Standardization of dermoscopic terminology and basic dermoscopic parameters to evaluate in general dermatology (non‐neoplastic dermatoses): an expert consensus on behalf of the International Dermoscopy Society Linked Article: Errichetti et al. Br J Dermatol 2020; 182:454–467 [ABSTRACT FROM AUTHOR]