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Background Oral target therapy with hedgehog-pathway inhibitors has revolutionized the standard of care for patients with advanced basal cell carcinoma. These patients are frail and elderly patients with various comorbidities and on pharmacological polytherapy. This scenario requires the clinician to manage the adverse events that can have a significant impact on therapeutic adherence. Objectives We evaluated the impact of caregivers in the treatment of patients with advanced BCC under treatment in terms of continuation of therapy over time. Methods All patients included in this observational prospective study have histologically confirmed metastatic or locally advanced basal cell carcinoma and were treated with hedgehog-pathway inhibitors from January 2016 to December 2021 at the Department of Dermatology at the University of Florence, Italy. The collected patient data included age, sex, BCC site and extension, number of cycles, dose, duration and tolerability of the therapy, marital status (single, divorced, married/live-in, widow/widower), and information such as living with someone, and the presence of any caregivers. Results Of the 34 patients included, 33 had a LaBCC and 1 metastatic BCC. There were 11 females (32.4%) and 23 males (67.6%). Among Basal Cell Carcinoma patients treated with hedgehog-pathway inhibitors, patients who were married or lived with a care-giver could better tolerate the therapy relative to single patients who live alone. Indeed, married/live-in patients and/or those with an adequate caregiver experienced greater therapeutic adherence and tolerated adverse events better. Conclusions Given the greater therapeutic adherence of married/live-in patients whose caregiver is the partner, it is essential to consider patient’s marital status. It is advisable to involve the caregiver upon enrollment. There should be a training discussion on the various possible adverse events and the best way to mitigate them. Success in therapy is linked not only to an informed patient but also to a trained caregiver.

We have read with great interest the paper by Kesić, V. et al. entitled "Early Diagnostics of Vulvar Intraepithelial Neoplasia" [...].

The scrotum is a rare site for metastases and represents less than 1% of the body's total surface area. Clinically, metastatic deposits in the scrotum can present in a variety of ways. They may appear as solitary cutaneous nodules, papules, plaques, or generalized induration or edema. Indeed, scrotum metastasis may be mistaken for other skin lesions since several dermatologic conditions can present with inflammation or dermatitis of the scrotum. Properly diagnosing cutaneous metastasis requires histopathological examination since the clinical appearances are, as described, highly variable and non-specific. We present a 63-year-old man with painless nodules on the scrotal skin. Excisional biopsy of the nodules revealed a metastasis from rectal squamous cell carcinoma. The incidence of this kind of tumors is estimated around 0.1-0.25 per 1000 colorectal neoplasms.

Background: The management of difficult-to-treat periocular basal cell carcinoma becomes very challenging in cases of delayed diagnosis, leading to the development of locally advanced basal cell carcinoma.Objective: The aim of this study was to evaluate the outcomes of Hedgehog pathway inhibitors (vismodegib and sonidegib) treatment in patients affected by periocular locally advanced basal cell carcinoma. We focused on the common adverse events and their correlation with the administration schedule in order to determine a management protocol specific for the periocular area.Methods: This observational prospective study included a single-center case series with patients who were histologically confirmed to have periocular or orbital locally advanced basal cell carcinoma, treated with Hedgehog pathway inhibitors.Results: All patients benefitted in terms of regression or stabilization of the neoplasm. In the first months of treatment, the HPIs were well tolerated, and the first important side effects appeared after about 5 months of continuous use of the drug.Conclusion: These data could lead to a new type of therapeutic scheme where neoadjuvant therapy could be followed by pulse therapy as an adjuvant to surgery.

Despite recent progress and the publishing of several clinical guidelines on the management of advanced basal cell carcinoma, there is still no comprehensive set of clinical guidelines addressing the complexity inherent to the use of Hedgehog pathway inhibitors in the treatment of advanced basal cell carcinoma in real-world clinical practice. To develop practical and valuable tools that help specialists improve the clinical management of these patients, we sought the opinion of expert physicians with extensive knowledge and experience in the treatment of advanced basal cell carcinoma.

We read the paper by Katsarelias et al. with great interest, regarding the effect of beta-adrenergic blocking agents on cutaneous melanoma [1]. However, the study presents some methodology biases that do not allow us to support the authors' conclusions. The paper suffers from the unification and evaluation of multiple registries, which do not provide essential data for any of the targets for research. Unlike studies in the literature [...].

IMPORTANCE: Vulvar melanosis is a common pigmentary change that accounts for most pigmented vulvar lesions. It presents as single or multiple asymptomatic macules or patches of varying size and color that may be asymmetric with poorly defined borders. The differential diagnosis of melanocytic lesions includes melanoma, which creates anxiety for patients and the physicians who diagnose the condition and treat the patients. OBJECTIVE: To evaluate the clinical and dermoscopic features of vulvar melanosis and their changes over time. DESIGN, SETTING, AND PARTICIPANTS: In this cohort study, patients with vulvar melanosis were recruited and followed up in the Department of Dermatology, University of Florence, Florence, Italy, between January 1, 1998, and June 30, 2019. Data on patient characteristics and on both the clinical and dermoscopic features of the vulvar lesions were collected. Each lesion was photographed clinically and dermoscopically at initial evaluation and at annual follow-up visits. MAIN OUTCOMES AND MEASURES: The clinical, dermoscopic, and histopathologic features of vulvar melanosis and their changes over time. RESULTS: This cohort study included 129 women (mean age at diagnosis, 46 years [range, 19-83 years]) with vulvar melanosis. A total of 87 patients (67%) with vulvar melanotic lesions were premenopausal, and 84 patients (65%) had received some type of hormone therapy. The most frequent location for vulvar melanosis was the labia minora (55 [43%]), followed by the labia majora (33 [26%]). In 39 of 129 cases (30%), the lesions increased in size and changed color after initial evaluation but ultimately stabilized. No malignant evolution was documented in any patient during a median follow-up of 13 years (range, 5-20 years). CONCLUSIONS AND RELEVANCE: This study suggests that vulvar melanosis was a benign entity, and changes in lesions over time did not signify malignant transformation. An association between hormonal status and vulvar melanosis may be hypothesized.

Cutaneous leiomyosarcoma is a rare malignant mesenchymal tumor of smooth muscle origin of unknown etiology. Leiomyosarcomas located on the skin include superficial leiomyosarcomas and metastatic leiomyosarcomas. Superficial leiomyosarcomas represent 7-10% of all cases of leiomyosarcoma and are subdivided into cutaneous and subcutaneous lesions based on skin location. We report a case of an 81-year-old woman who presented a slow growing tender single nodule on the left thigh and describe its clinical and dermoscopic features.

A large body of evidence in the scientific literature suggests that the numbers of common and atypical nevi are strong, independent risk factors for the occurrence of cutaneous malignant melanoma. Furthermore, some studies recently found an association between high nevus counts and an improved melanoma prognosis. The aim of this study was to investigate a possible relationship between the number of common and atypical nevi and melanoma prognostic factors. We carried out a retrospective analysis of patients with a histopathologically confirmed diagnosis of melanoma. These patients were treated at the Dermatology Clinic of the University of Florence from January 2000 to December 2013. The main analysis investigated the association of common and atypical nevi with Breslow thickness and ulceration. The number of nevi was investigated as a continuous variable and a categorical variable considering the median number of common nevi, given the skewness of the distribution of common nevi. We analyzed 818 melanoma patients treated from January 2000 to December 2013. We found a sex and nevi interaction: among women, thick melanomas occur more frequently in patients with a low common nevi count (10); no association was found in men. This sex and nevi interaction was also found considering the association with very thick melanomas (Breslow 4 mm). Moreover, the presence of an increasing number of atypical nevi was associated with increased risk of ulceration in both sexes. These data provide new perspectives in the differential sex-related biological behavior of melanoma among females and males.

We present a highly integrated add/drop multiplexer, where the contra-directional coupling is realized by phase matching two photonic crystal waveguides. The device band structure, the corresponding transmission and drop spectra, and the coupling length are carefully analysed. Different device configurations are discussed and by tailoring the coupling factor, we optimize the frequency response of the filter, obtaining a μ-sized channel selector, characterized by a very high drop efficiency.