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Ex vivo confocal microscope (EVCM) rapidly images freshly excised tissue at a histopathological resolution. EVCM features of keratinocyte skin cancers are well‐established, but those of benign clinical mimickers remain scarce. We describe EVCM features of common benign lesions and compare them with their malignant differentials. EVCM was used to image 14 benign and 3 cancer tissues. We compared EVCM features of benign lesions with corresponding histopathology and with those of keratinocyte cancers. Key features of benign lesions were identified and differentiated from malignant lesions. Elastin and fat appeared prominent in EVCM; while koilocytes and melanin were difficult to identify. Visualization of entire epidermis was challenging due to difficulty of tissue flattening during imaging. Benign lesions can be differentiated from keratinocyte cancers with EVCM. Using EVCM, a rapid, bedside diagnosis and management of skin neoplasms is possible, especially in a remote location without a histopathology lab. [ABSTRACT FROM AUTHOR]

Background: Reflectance confocal microscopy (RCM) has quickly transitioned from a research tool to an adjunct diagnostic bedside tool, providing the opportunity for noninvasive evaluation of skin lesions with histologic resolution. RCM is an optical imaging technique that uses near‐infrared excitation wavelengths and safe low‐power lasers. En‐face images of different skin layers (up to the superficial dermis) are acquired in grayscale based on the reflective indices of tissue components. Melanin has the highest reflective index (contrast) and appears bright on RCM. Aims: We present a review of the current literature on the use of RCM in the diagnosis and management of pigmentary disorders. Methods: We reviewed PubMed and Ovid Medline databases from January 2000 to June 2021, using MeSH key terms: "reflectance confocal microscopy, confocal laser scanning microscopy, pigmentary disorders, treatment, melasma, vitiligo, freckles, solar lentigo, lentigo, tattoo, complications, melanoma, skin cancers, pigmented lesions, post inflammatory, melanin, photoaging" to identify studies and review articles discussing the use of RCM in the diagnosis and management of pigmentary disorders. Results: RCM findings of pigmentary disorders were divided into the following categories: (1) disorders of increased pigmentation (post‐inflammatory hyperpigmentation, melasma, Riehl's melanosis, solar lentigines, ephelides, hori nevus, naevus of Ota, café‐au‐lait macules, melanocytic nevus, melanoma, nevus spilus, labial mucosal melanosis, and mucosal melanoma), (2) disorders of decreased pigmentation or depigmentation (post‐inflammatory hypopigmentation, vitiligo, nevus depigmentosus, halo nevus), and (3) exogenous pigmentation (tattoo, ochronosis). Conclusion: RCM has been explored and proven valuable for the evaluation and management of pigmentary disorders including melasma, vitiligo, solar lentigines, tattoo, and tattoo‐related complications. [ABSTRACT FROM AUTHOR]

Line-field confocal optical coherence tomography (LC-OCT) is a non-invasive imaging technique that allows for high-resolution visualization of the skin. It has been used to evaluate various skin lesions, but there is limited research on its use for treatment monitoring. Actinic keratosis (AK) is a precancerous skin lesion that can progress to squamous cell carcinoma. This study aimed to assess the effectiveness of LC-OCT in monitoring AK lesions undergoing cryotherapy treatment. The study found that LC-OCT imaging could identify histopathological changes in AK lesions before and after treatment, including reductions in hyperkeratosis, acanthosis, and keratinocytic atypia. LC-OCT has the potential to be a valuable tool for treatment monitoring, but further research is needed to confirm these findings. [Extracted from the article]

This article discusses the use of mobile applications in dermatology to bridge the gap between drug development and clinical practice. The authors conducted a review of 632 mobile health applications specific to dermatology and found that only 17 of them were provider-facing and included information about treatment options for dermatological conditions. These applications, such as VisualDx, iDoc Academy, Top Derm, and HumazeMD, offer features like evidence-based treatment options, virtual courses, interactive medical video games, and a platform for clinicians to organize and showcase patient procedures. However, the authors emphasize the need for a more comprehensive dermatological application that provides the latest drug development information, treatment guidelines, and educational tools for effective patient care and physician education. [Extracted from the article]

PLA accurately differentiated melanoma from nonmelanoma skin cancers/lesions. LINC00518 is expressed at least three times higher in melanoma cell lines than in epidermal melanocytes and has been shown to promote metastasis of melanoma cells.[5] This case series sought to compare the concordance of non-invasive testing (RCM and 2-GEP PLA) with clinical evaluation and histologic diagnosis in lesions suspicious for melanoma. PLA correctly excluded melanoma which corresponded to lack of PRAME expression on IHC. [Extracted from the article]

Key Clinical Message: For practitioners experiencing worsening psoriasis, subacute cutaneous lupus erythematosus (SCLE) with a psoriasiform presentation should be ruled out. Initial treatment for a presumptive diagnosis of psoriasis using hydroxychloroquine or ultraviolet phototherapy may cause SCLE to worsen. Psoriasiform subacute cutaneous lupus erythematosus is an unusual presentation scarcely reported in literature. We report a case of a 54‐year‐old man who presented with an itchy, papulosquamous rash of the upper extremities and face for 7 months. The initial physical examination revealed the classical morphology of psoriasis. One and a half years after the diagnosis of clinical worsening, the patient noticed a new papular eruption on the right posterior upper arm. A skin biopsy was performed, confirming a diagnosis of subacute cutaneous lupus erythematosus. This case report highlights the importance of considering rare presentations of cutaneous lupus erythematosus and therapeutic challenges in management. [ABSTRACT FROM AUTHOR]

Background: Vivascope 2500 ex vivo confocal microscopy (EVCM) is an emerging optical imaging device that allows nuclear level resolution of freshly excised tissues. EVCM provides, rapid real‐time pathological examination in many subspecialties of pathology including skin, prostate, breast, liver, etc. In contrast to traditional time‐consuming frozen sectioning and histological analysis. Aims: To evaluate the current state of EVCM utilization. Materials and Methods: This study highlights the advantages, limitations, and prospects of EVCM in skin pathology. Results: Our findings demonstrate that EVCM is a promising adjunctive tool to assess margins in Mohs surgery and to provide rapid, accurate diagnosis of cutaneous tumors, infectious and inflammatory diseases. Conclusion: EVCM is a revolutionary device that can be used as an adjunct to paraffin‐fixed, hematoxylin and eosin‐stained slides and frozen sectioning. Additional refinements are required before EVCM can be used as an alternative to frozen sectioning or traditional tissue processing. [ABSTRACT FROM AUTHOR]

Background: Ten‐year survival rates in mycosis fungoides (MF) broadly varies, however, there is no standardized prognostic index available. This is presumably due to low prevalence, heterogeneity, and diagnostic challenges in MF. Recent studies have focused on identifying objective prognostic indices by using different parameters for survival determinants. The Cutaneous Lymphoma International Prognostic Index (CLIPI) and the Prospective Cutaneous Lymphoma International Prognostic Index (PROCLIPI) represent prototypical studies that identify prognostic factors, seeking to improve management and outcomes in early‐stage MF. Detecting these factors and stratifying MF patients according to their disease progression risk may help to manage these patients more efficiently. Aims: Review the current literature to determine the risk factors determining prognosis in MF. Methodology: A Comprehensive literature search was performed using electronic online databases "PubMed" and "Google Scholar" using key words 'prognostic factor', 'prognostic indicator', 'mycosis fungoides', 'Sezary syndrome', 'Skin Lymphoma', 'Cutaneous Lymphoma'. Articles published in English language were considered for the review. Results: The strongest prognostic factor in MF patients is the stage of the disease. T stage and the presence of extracutaneous disease are the most important factors for survival. Other factors that are associated with worse prognosis are male gender, age >60, presence of plaques, folliculotropism, eosinophilia and lymph node stage above N1/Nx. Elevated LDH was associated with later tumor stages and large cell phenotype at diagnosis had a better prognosis. KIR3DL2 was associated with malignant transformation. Conclusion: The PROCLIPI study has assessed risk factors collected in MF patients from different countries and across different ethnicities following a rigorous clinicopathologic process. The findings presented here illustrated that disease prognosis in early stages depends on many contributing factors. Detection and stratification of such factors may allow a personalized approach to management of these patients. [ABSTRACT FROM AUTHOR]

Multicentric reticulohistiocytosis (MRH) is an insidious‐onset, non‐Langerhans‐cell histiocytosis (NLCH) affecting the joints and skin. Early diagnosis is important to prevent destructive arthritis and disease‐related complications. Reflectance confocal microscopy (RCM) is a technique that allows the visualization of the epidermis and superficial dermis noninvasively on a horizontal plane with quasi‐histologic images of the skin. RCM features of NLCH including Rosai‐Dorfman disease, adult xanthogranuloma (AXG), and juvenile xanthogranuloma (JXG) have been reported. However, RCM features of MRH have not been described previously. Here we present the RCM features of a case of MRH with dermoscopic and histopathologic features. [ABSTRACT FROM AUTHOR]

Dermatofibrosarcoma protuberans (DFSP) is an overall rare malignancy yet is one of the most common cutaneous sarcomas. The diagnosis of DFSP is typically made following histopathologic examination of the lesion, classically revealing a storiform pattern of spindle cells with elongated nuclei infiltrating the dermis and subcutis. Surgical excision is the standard treatment. Local recurrence is estimated to occur in 20−50% of cases, thus frequent postsurgical monitoring is required. Noninvasive imaging modalities offer a potential alternative to multiple repeat biopsies. We report the first case where reflectance confocal microscopy accompanied clinical examination in monitoring for DFSP recurrence postsurgical excision. [ABSTRACT FROM AUTHOR]

BNT162B2 mRNA vaccine, Schamber disease, COVID-19 vaccine, cutaneous adverse event, pigmented purpuric dermatosis Keywords: BNT162B2 mRNA vaccine; COVID-19 vaccine; cutaneous adverse event; pigmented purpuric dermatosis; Schamber disease EN BNT162B2 mRNA vaccine COVID-19 vaccine cutaneous adverse event pigmented purpuric dermatosis Schamber disease 435 437 3 02/07/22 20220201 NES 220201 CONFLICT OF INTEREST Babar K. Rao is a consultant for CaliberID (manufacturer of the VivaScope). Dear Editor, Several cutaneous adverse reactions (ARs) secondary to COVID-19 vaccines have been reported after emergency use authorization of the coronavirus disease 2019 (COVID-19) vaccines. [Extracted from the article]

Favipiravir is an antiviral agent used in the treatment of COVID-19 infection, and related cutaneous adverse events are rare.1 Acute generalized exanthematous pustulosis (AGEP) has been reported in COVID-19 patients, mostly associated with hydroxychloroquine (HCQ). Acute generalized exanthematous pustulosis following treatment with favipiravir in a patient with COVID-19 without hydroxychloroquine use: Report of the first case Medical records showed that our patient did not take any drugs other than favipiravir in the last 8 weeks and the patient denied any medication intake in the last 8 weeks including over the counter medications. [Extracted from the article]

The rim and deep margin MMS technique can be employed for cutaneous surgery of patients on anticoagulant or antithrombotic agents, with large tumors, or with tumors in highly vascular locations. A retrospective analysis of complication rates in Mohs micrographic surgery patients with clinically large tumors and tumors with aggressive subclinical extension. Tumor characteristics of Mohs surgery patients in Ottawa, Canada versus Houston, Texas-a consequence of access to care?. [Extracted from the article]

Background There is an increased demand for soft tissue augmentation procedures. A wide range of products can provide correction through different mechanisms and it is important for clinicians to understand the biological pathways of each material. This study presents a systematic review of the pathways of commonly used fillers, with consideration of the complications associated with each. Methods The PubMed (National Library of Medicine) database was searched for MeSH headings for different types of fillers, including trade names, between January 1, 2000, and January 1, 2013. Article titles were screened, and only studies designed to determine the mechanism of action and histopathology of complications were included. Results When restricted to studies on biological mechanisms, 109 manuscripts were identified and the mechanisms of action of short-term and long-term degradable as well as permanent fillers were reviewed. Hyaluronic acid fillers, which are the most commonly used, form a fibrous capsule and induce limited de novo collagen. Poly-Llactic acid and calcium hydroxylapatite are semipermanent fillers that provide longterm restoration of tissue volume by stimulating fibroblasts to lay down a matrix of collagen and elastic fibers. Polymethyl methacrylate is the only FDA-approved permanent implant that is held in place by encapsulation, providing a scaffold upon which the dermis can recover to its original thickness. Discussion Soft tissue augmentation products are variable, and no single product can be considered the most effective or ideal. An understanding of biological mechanisms may help guide physicians choose the best suited product among the various options available while minimizing the occurrence of complications. [ABSTRACT FROM AUTHOR]

Background Emerging tools for the diagnosis of skin cancer are non-invasive imaging devices that allow for skin visualization without biopsy. While the capabilities of non-invasive imaging tools are far-reaching, each varies in its resolution depth, image clarity, clinical applicability, accuracy, sensitivity, and specificity. Objective The objective of this review is to evaluate non-invasive imaging modalities, and examine their capabilities, conditions for use, clinical applications, and limitations. Materials and methods A literature review was conducted on Pubmed using the search term 'non-invasive diagnostic imaging tools and skin'. Relevant citations suggested by Pubmed were included. Each non-invasive imaging tool evaluated was also used as a search term along with the word 'skin'. Results While some tools are meant to be aids to histology like dermoscopy and optical coherence tomography, other tools, like confocal microscopy and tape stripping mRNA, show the potential to surpass histology and become the new 'gold standard'. Experience with use of these instruments plays a large role in their utility value. While digital multispectral dermoscopy is able to generate a diagnosis, other tools like dermoscopy and confocal microscopy require learning and clinical experience. Limitations A search was conducted using only one search engine. Only English language articles were considered. Conclusions How useful these tools are to dermatologists is dependent on their understanding of how the tools can aid them in diagnosis and their confidence in the results. Further research in this field will solidify non-invasive imaging tools as reliable tools in skin cancer diagnosis. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 65-year-old African American retired nurse who was taken to the hospital because of chronic dermatitis. After several physical examinations, the patient was diagnosed with necrolytic acral erythema (NAE). It also presents another case of a patient with NAE and hypozincemia and hyperzincturia. The author presents oral zinc therapy and the routine measurement of zinc levels of the skin, serum and other tissues.

Abstract Background Fixed drug eruption (FDE) is a common cutaneous disorder which develops within hours of taking the offending drug and recurs at the same site with subsequent exposure to the same drug. Non-steroidal anti-inflammatory drugs (NSAIDs) are common offending drugs. Methods A 14-year-old girl initially presented with a 1-year history of a recurrent reddish-brown plaque around her right areola. The lesion became pruritic and raised during menses, and subsided during the remainder of her menstrual cycle with the exception of persistent residual hyperpigmentation. The patient had a pattern of naproxen use during menses for dysmenorrhea. Results The skin biopsy specimen revealed focal bullae formation and scattered necrotic keratinocytes in epidermis, hydropic degeneration of the basal cell layer, pigmentary incontinence and a perivascular infiltrate composed of lymphocytes and eosinophils. These changes confirmed the diagnosis of fixed drug eruption. Conclusion Fixed drug eruption to nonsteroidal anti-inflammatory drugs is common. However, FDE due to naproxen, one of the NSAIDs, is rarely reported. We describe an unusual case of FDE, which recurred at each menses. [ABSTRACT FROM AUTHOR]

Background Dermoscopy is a noninvasive method of evaluation of the colors and microstructures of the epidermis, dermo-epidermal junction, and papillary dermis not visible to the naked eye. These structures are correlated with histologic features and used to assess whether a lesion is benign or malignant, further indicating whether or not the lesion should be biopsied. Objective To obtain a better understanding of how many dermatologists are utilizing dermoscopy and their reasons for doing or not doing so. Method A survey was conducted focusing on the prevalence of the use of dermoscopy by US dermatologists, the method by which they learned dermoscopy, how often they use or do not use it, and whether or not they feel it is effective. The survey was distributed to dermatologists attending a dermoscopy seminar at the American Academy of Dermatology's (AAD's) Summer Academy Meeting in 2007, as well as to dermatologists who expressed an interest in dermoscopy. E-mail addresses were also obtained from dermatologists who attended the AAD's Summer Academy Meeting, and subsequent surveys were e-mailed to them as a secondary means of obtaining the data. The survey was conducted online through a website: . One hundred and five dermatologists started the survey and ninety-seven finished it, a completion percentage of 92.4%. Results Of the 105 dermatologists who began the survey, the majority (63; 60%) had training or experience in dermoscopy, and 42 (40%) did not. Of the 63 individuals who responded positively to having training or experience in dermoscopy, the majority (41; 69.5%) learned dermoscopy through attendance of a seminar; reading a book and spending time with an experienced dermatologist were the second most popular methods of learning dermoscopy. The frequency of dermoscopy was evaluated, and it was found that 44 (42.7%) dermatologists used dermoscopy more than once daily, but 44 (42.7%) dermatologists reported never having used dermoscopy. Further information was obtained with regard to whether or not published algorithms were used by dermatologists to diagnose pigmented lesions. Pattern analysis was the most common algorithm used by 51 (89.5%) dermatologists questioned. The dermatologists were also questioned as to why they thought dermoscopy was effective or ineffective. The majority of dermatologists (32; 61.5%) believed that it was effective because it reduced patient anxiety. Helping to detect melanoma early was the second most popular reason for believing dermoscopy to be effective. Twenty-three (62.2%) dermatologists thought dermoscopy was ineffective as it was not more useful for detecting melanoma earlier than traditional methods. Eleven (29.7%) dermatologists said that they thought that dermoscopy took too long, which made it ineffective. To build on this, an additional question was asked: how long does dermoscopy take? The overwhelming response of dermatologists (52; 82.5%) was that dermoscopy took less than 1 min to evaluate one lesion. Conclusion Dermoscopy is a widely used tool for the diagnosis of pigmented skin lesions. The use of dermoscopy is increasing in popularity amongst dermatologists, making it necessary to better understand dermoscopy and to analyse why physicians use it or do not use it. The survey indicated that the majority of physicians used dermoscopy in order to reduce patient anxiety and to detect melanoma early. The main reason why dermatologists found dermoscopy to be ineffective was that they felt that it was not useful in detecting melanoma earlier than traditional methods; 35% of dermatologists surveyed believed that dermoscopy required excessive training. These results imply that current training methods need to be modified. Training is limited to large dermatology centers and is not being transferred to general centers, which would allow it to be more accessible to a larger group of dermatologists in training. [ABSTRACT FROM AUTHOR]

Pemphigus represents a spectrum of potentially life-threatening autoimmune-mediated skin blistering conditions caused by antibody production against desmoglein 1 and 3 (anti-DSG 1 and 3) in keratinocytes. Greater than 50% of pemphigus patients experience relapse, which complicates long-term medical management, including risks associated with re-treatment and complications such as infection and dehydration. This review aims to elucidate mechanisms, risk factors, and medications associated with pemphigus relapse. Mechanisms of relapse include the persistence of auto-reactive B-cell populations post-treatment and CD20- B-cell populations that reactivate after B-cell depletion therapy. Risk factors for relapse include high body surface area (BSA) of pemphigus involvement, high body mass index, high severity according to the Pemphigus Disease Area Index (PDAI) at onset, treatment delay, and high anti-DSG1 and DSG3 titers post-treatment. Targeted B-cell localization is associated with better clinical outcomes, including less frequent relapses. Rituximab is currently the gold standard of treatment for moderate-severe pemphigus and has relapse rates of 11%-44% in selected studies, with a mean time to relapse of 5.8 months to 36 months following treatment. Relapse rates across lymphoma dosing (375 mg/m 2 ) versus rheumatoid arthritis dosing (1 g dosing weekly) was inconsistent; however, more frequent dosing, earlier treatment, and higher cumulative dosing were associated with lower relapse rates. Alternative agents that have clinical efficacy include corticosteroid monotherapy, mycophenolate mofetil, azathioprine, and intravenous immunoglobulin. Future studies should include head-to-head comparators over long follow-up periods to identify the best treatment agents associated with the least relapse risk., (© 2024 The Author(s). The Journal of Dermatology published by John Wiley & Sons Australia, Ltd on behalf of Japanese Dermatological Association.)