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This article provides an overview of tumoural melanosis (TM), a rare condition characterized by the regression of cutaneous melanoma. The authors present four cases of TM from Greece and discuss the clinical, dermatoscopic, and histopathologic characteristics of the condition. They highlight the importance of clinicopathologic correlation in diagnosing TM and recommend aggressive management due to the poor outcomes associated with the condition. Dermatoscopic findings, such as "peppering," whitish or pinkish structureless areas, and blue/grey areas, can assist in the diagnosis of TM. The article includes images to illustrate the cases and provide visual examples of the diagnostic findings. [Extracted from the article]

This article presents the findings of a retrospective study conducted in Greece to evaluate the utilization trends of biologics in patients with psoriasis. The study analyzed data from 2015 to 2020 and found that the number of psoriasis patients receiving biologic treatment more than doubled during this period. There was a decrease in the use of anti-TNF agents and an increase in the use of anti-IL prescriptions. The study also observed variations in the most prescribed drugs for different patient groups. The findings align with global trends of increasing biologic use and the gradual replacement of TNF inhibitors with IL inhibitors. The study was supported by a research grant from LEO Pharma, but the company had no involvement in the study design or data analysis. [Extracted from the article]

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

Elizabeth Lazaridou,1 Chrysovalantis Korfitis,2 Christina Kemanetzi,1 Elena Sotiriou,1 Zoe Apalla,1 Efstratios Vakirlis,1 Christina Fotiadou,1 Aimilios Lallas,1 Demetrios Ioannides1 1First Department of Dermatology and Venereology, Aristotle University Medical School, Thessaloniki, Greece; 2Department of Dermatology, 401 General Army Hospital, Athens, Greece Abstract: Rosacea is a chronic skin disease characterized by facial erythema and telangiectasia. Despite the fact that many hypotheses have been proposed, its etiology remains unknown. In the present review, the possible link and clinical significance of Helicobacter pylori in the pathogenesis of rosacea are being sought. A PubMed and Google Scholar search was performed using the terms “rosacea”, “H.pylori”, “gastrointestinal disorders and H.pylori”, “microorganisms and rosacea”, “pathogenesis and treatment of rosacea”, and “risk factors of rosacea”, and selected publications were studied and referenced in text. Although a possible pathogenetic link between H. pylori and rosacea is advocated by many authors, evidence is still interpreted differently by others. We conclude that further studies are needed in order to fully elucidate the pathogenesis of rosacea. Keywords: eradication, Helicobacter pylori, pathogenesis, rosacea

Zoe Apalla,1 Chrysoula Papageorgiou,1 Aimilios Lallas,1 Elena Sotiriou,1 Elizabeth Lazaridou,1 Efstratios Vakirlis,1 Athanassios Kyrgidis,2 Demetrios Ioannides1 1First Department of Dermatology, Aristotle University, 2Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Aristotle University, Thessaloniki, Greece Abstract: Vismodegib is approved for the treatment of adult patients with metastatic (mBCC) or locally advanced basal cell carcinoma (laBCC) that have recurred following surgery or for those who are not good candidates for surgery (risk/benefit ratio is against patient’s benefit, either because of the general condition or because of the expected morbidity from the surgery) or radiation therapy. This article provides an evidence-based review of its current place in therapy. Analytically, the clinical implications in the management of laBCCs and mBCCs and possible new indications, including the neoadjuvant use before surgical excision, are discussed, while in the end, the challenges regarding class-related adverse events and their optimal management are highlighted. Keywords: vismodegib, sonic hedgehog inhibitors, basal cell carcinoma, treatment, review

Efstratios Vakirlis, Grigorios Theodosiou, Zoe Apalla, Michael Arabatzis, Elizabeth Lazaridou, Elena Sotiriou, Aimilios Lallas, Demetrios Ioannides First Department of Dermatology, Aristotle University Medical School, Thessaloniki, Greece Background: The incidence of skin diseases in children is influenced by hereditary, social, and environmental factors. The objective of this study was to determine the incidence of pediatric dermatoses at a University Hospital in Northern Greece. Patients and methods: We reviewed epidemiologic data of 940 patients, aged 0–18 years, who were referred to the outpatient clinic of a University Hospital between January 2013 and December 2015. Demographic data and the frequency of the various diagnoses in various age groups were studied. Results: Nine hundred and forty children and adolescents with 1020 diagnoses were included in the study (52.8% females and 47.2% males). The 10 most frequent diagnoses were: dermatitis/eczema (31.5%), viral infections (12.5%), pigmentary disorders (7.4%), melanocytic nevi (5.8%), alopecia areata (5.8%), acne (5.6%), nail disorders (3.3%), vascular malformations and hemangiomas (2.9%), psoriasis (2.6%), and bacterial infections (2.6%). Atopic dermatitis was the most prevalent dermatosis in all age groups accounting for a total of 20.9% of the study population. A remarkably high incidence of various forms of mastocytosis (2.2%) was seen in our data. Conclusion: Atopic dermatitis is the most frequent pediatric dermatosis in all age groups. Viral infections, pigmentary disorders, and nevi account for a significant proportion of the referrals. The high incidence of mastocytosis in our study may be attributed to overdiagnosis, overestimation due to the relatively small study population, or it may represent the real incidence of mastocytosis in our region. The low incidence of acne in our study may be attributed to the fact that only severe cases are referred to our hospital. Keywords: epidemiology, pediatric dermatology, atopic dermatitis, infection-viral, mastocytosis

This article discusses the correlation between the diameter and Breslow thickness of melanoma, a type of skin cancer. Traditionally, the diameter has been used as a diagnostic criterion for melanoma, but new imaging techniques have challenged this approach. The study found that there is a weak correlation between diameter and Breslow thickness, suggesting that a small diameter does not necessarily indicate a low risk of invasiveness. The authors argue that using diameter as a diagnostic criterion may lead to the overlooking of invasive melanomas. [Extracted from the article]

Sentinel lymph node biopsy is now identified as a far less accurate method of predicting melanoma survival and selecting patients for adjuvant drug therapy. 3 Moody JA, Ali RF, Carbone AC, Singh S, Hardwicke JT. Complications of sentinel lymph node biopsy for melanoma - a systematic review of the literature. [Extracted from the article]

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

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

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

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

Summary: Scalp dysaesthesia, considered a variant of the cutaneous dysaesthesia syndrome, is characterized by chronic sensory symptoms, including pruritus, pain, burning and stinging in a well‐defined location, without objective findings. Its aetiology is not well elucidated and treatment options are limited, thus it can be challenging and frustrating for both patient and physician. It can be associated with lichen simplex chronicus. In this paper, we review the literature on the pathogenetic factors, diagnostic methods and therapeutic options in the management of scalp dysaesthesia. Dissociation, cervical spine disease and muscle tension seem to be the most important pathogenetic factors. Trichoscopy, reflectance confocal microscopy and biopsy are all helpful for the diagnosis of the disease. Therapies include high‐potency topical or intralesional corticosteroids, capsaicin and topical anaesthetics, sedative antihistamines, tricyclic antidepressants, transcutaneous electric nerve stimulation, botulinum toxin and vitamin B12. [ABSTRACT FROM AUTHOR]

1, new recurrences were observed in two out of nine patients (22.2%) that received acitretin and in five out of seven patients (71.4%) that received TCi as maintenance treatment. Acitretin was continued after TS withdrawal as maintenance treatment; (ii) a cycle of TS followed by TCi as maintenance treatment; (iii) TCi in combination with 25 mg of acitretin, both in continuous application. Erosive pustular dermatosis of the scalp (EPDS) is an inflammatory dermatosis, characterized by erosions, pustules and crusts.1-7 Risk factors include elderly age, actinic damage, androgenetic alopecia and preceding trauma.1-7 We retrospectively analysed data of clinically and histologically diagnosed EPDS patients, to assess disease characteristics and efficacy of different therapies and to explore various associations. .000 ht GLO:3NZ/01nov21:jdv17455-fig-0001.jpg PHOTO (COLOR): 1 Treatment flowchart. gl After treatment cessation, 18 out of 23 patients (78.3%) experienced a recurrence/deterioration at a median time of 8 weeks (IQR = 4-12, range = 2-16). [Extracted from the article]

A total of 40 specimens were collected as follows: thirty (75%) patients had patch type AA, seven (17.5%) had diffuse AA, and three (7.5%) had alopecia totalis. I Editor i Alopecia areata ( ) is an inflammatory disease of the hair follicle unit characterized by non-scarring hair loss. In the acute stage of our AA cases, pDCs were found in 30.8% which implies that the recruitment of pDCs in AA may appear gradually and then subside throughout the chronic stage. [Extracted from the article]

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

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

Background: Malar rash is one of the three cutaneous diagnostic criteria of systemic lupus erythematosus (SLE). Although its clinical recognition is often straightforward, the differential diagnosis with erythematotelangiectatic rosacea may sometimes be challenging. Objective: To describe dermoscopic features of SLE malar rash and investigate the accuracy of dermoscopy for the differential diagnosis with erythematotelangiectatic rosacea. Methods: A representative dermoscopic image of target areas was evaluated for the presence of specific features. Fisher's test was used to compare their prevalence between the two cohorts, and accuracy parameters (specificity, sensitivity, and positive and negative predictive values) were evaluated. Results: Twenty-eight patients were included in the analysis, of which 13 had SLE malar rash and 15 erythematotelangiectatic rosacea. The main dermoscopic features of malar rash were reddish/salmon-coloured follicular dots surrounded by white halos ('inverse strawberry' pattern), being present in 53.9% of the cases, while network-like vessels (vascular polygons) turned out to be the main feature of erythematotelangiectatic rosacea, with a prevalence of 93.3%. The comparative analysis showed that the 'inverse strawberry' pattern was significantly more common in SLE malar rash, with a specificity of 86.7%, while vascular polygons were significantly more frequent in rosacea, with a specificity of 92.3%. Conclusion: Dermoscopy may be a useful support to distinguish SLE malar rash and erythematotelangiectatic rosacea by showing peculiar features. [ABSTRACT FROM AUTHOR]