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Chronic wounds encompass a myriad of lesions, including venous and arterial leg ulcers, diabetic foot ulcers (DFUs), pressure ulcers, non-healing surgical wounds and others. Despite the etiological differences, chronic wounds share several features at a molecular level. The wound bed is a convenient environment for microbial adherence, colonization and infection, with the initiation of a complex host–microbiome interplay. Chronic wound infections with mono- or poly-microbial biofilms are frequent and their management is challenging due to tolerance and resistance to antimicrobial therapy (systemic antibiotic or antifungal therapy or antiseptic topicals) and to the host's immune defense mechanisms. The ideal dressing should maintain moisture, allow water and gas permeability, absorb wound exudates, protect against bacteria and other infectious agents, be biocompatible, be non-allergenic, be non-toxic and biodegradable, be easy to use and remove and, last but not least, it should be cost-efficient. Although many wound dressings possess intrinsic antimicrobial properties acting as a barrier to pathogen invasion, adding anti-infectious targeted agents to the wound dressing may increase their efficiency. Antimicrobial biomaterials may represent a potential substitute for systemic treatment of chronic wound infections. In this review, we aim to describe the available types of antimicrobial biomaterials for chronic wound care and discuss the host response and the spectrum of pathophysiologic changes resulting from the contact between biomaterials and host tissues. [ABSTRACT FROM AUTHOR]

Multiple primary cancers may occur in the same patient, with a prevalence that follows an ascendant trend. Their development is dictated by a complex interplay between a variety of factors, both patient-dependent and external. The case of a 38-year-old female patient diagnosed and treated for pancreatic cancer (PC) is presented in whom the digital dermoscopic monitoring of melanocytic nevi revealed a marked change of two nevi that acquired rapidly highly atypical features. They were surgically excised and the histopathological examination revealed two completely excised dysplastic compound nevi. Clinicians should be aware of the strong association between dysplastic nevus syndrome and PC, a malignancy associated with an extremely poor prognosis. Familial atypical multiple mole melanoma syndrome (FAMMM) predisposes to the development of melanoma, pancreatic cancer and other neoplasms. The common genetic background of PC and hereditary melanoma is discussed and the importance of regular skin checkup and screening for PC in these patients is underlined. [ABSTRACT FROM AUTHOR]

Introduction. Spitz nevus is a benign melanocytic lesion, most frequently met in children and in the young adult, at the level of the head and of the extremities, with a rapid evolution (months), that worries both the family and the doctor. Aim. To highlight the difficulties in diagnosing clinically, dermoscopically and histopathologically a lesion that may resemble to a melanoma. Material and methods. We present two cases of Spitz nevus, appeared at the age of 10 and 16, respectively, as a blackish pigmented lesion and a pink, non-pigmented one, for which a consultation at the clinic was demanded, for the suspicion of malignity. Both lesions were clinically, dermoscopically and histopathologically evaluated. Results. The suspicion of malignity being totally eliminated for the non pigmented one, classified as a classical non pigmented Spitz nevus; on the other hand, the pigmented lesion could only be classified as an atypical Spitz nevus (spitzoid tumor with uncertain malignant potential). Conclusions: Diagnosing Spitz nevus continues to be a clinical, dermoscopic and, last but not least, histopathological challenge, and the surgical excision is recommended in most cases. [ABSTRACT FROM AUTHOR]

Melanoma is one of the most aggressive forms of skin cancer, with limited therapeutic options. Since its incidence has been rapidly rising in recent years, the study of new targeted therapeutic strategies has increased. The implication of nanoscience in the development of alternative targeted therapies for melanoma has multiple benefits and could significantly improve the outcome of melanoma patients. In this paper, we review the most recent progress in the field of targeted therapies, emphasizing the impact of nanoscale materials on the targeting and controlled release of anti-tumor drugs. The applications of nanomedicine in the management of melanoma are extensive and refer to sentinel lymph node mapping, chemotherapy, and RNA interference; each of these applications harboring the potential to develop efficient and personalized diagnostic techniques and therapies. Further research, especially in clinical trials, is needed to establish whether fighting melanoma on the nanoscale level represents the key to reaching a critical inflection point in mankind's battle with metastatic melanoma. [ABSTRACT FROM AUTHOR]

HD-OCT (high definition optical coherence tomography) is a promising non-invasive imaging tool with demonstrated utility in the in vivo accurate diagnosis of skin cancers but with slightly reduced applicability in other skin pathology, such as inflammatory or chronic connective tissue diseases. This technique can deliver high-resolution images of the skin layers similar with the histological aspect. The present study sought to detect and describe typical features regarding the pathological micro architectural pattern of localized scleroderma using HD- OCT and to see the utility in monitoring non-invasively the effects of first line treatments over relatively short period of time in this specific disease. [ABSTRACT FROM AUTHOR]

High definition optical coherence tomography (HD-OCT) is a non-invasive imaging technique, with significant relevance in different area, mainly ophthalmology. In recent years OCT has become a promising tool also for the in vivo evaluation and diagnosis of different skin diseases, especially skin cancers. HD OCT can be used as a reliable diagnosis method that provides useful information on the architecture of cutaneous layers and sometimes on cellular morphology in the epidermis and other structures of the skin. Our work brings new information about the value of HD-OCT in describing in vivo pattern of basal cell carcinoma, one of the most frequent non-melanocytic skin cancers, compared with histopathology and dermoscopy. [ABSTRACT FROM AUTHOR]

The article offers updates on treatments based on the hereditary implication of the chronic inflammatory skin disease called psoriasis. It mentions the study at the University of Michigan Health System which discovers the involvement of psoriasis in four new susceptibility genetic loci and also identifies the pathogenesis of psoriatic arthritis. It also reveals the superior efficacy of ustekinumab compared to placebo treatments for psoriasis patients.

Atopic dermatitis is a chronic inflammatory disease, usually associated with a personal or family history of atopic diseases such as AD, allergic rhinitis or asthma that most commonly arise in childhood and present with elevated IgE serum in up to 85% of patients. The severity of AD is based on the extent of affected areas, itch intensity and appearance of skin lesions. Here, we present the case of a 21-year-old female patient with generalized erythematous eczematous skin lesions, flexural lichenifications accompanied by intense pruritus, painful fissures and erosions resulting from scratching. She also presented erythematous plaques with thin scales on the scalp. The patient had no personal or familial history of AD, allergic rhinitis or asthma and the onset of cutaneous symptoms presented severe exacerbation in the last 2 months of the last 3 years. The main laboratory findings were- high serum eosinofilia (2,400/μL) and very high total IgE serum (11449UI/L). The flare remission was induced with systemic treatment (corticotherapy, oral H1 antihistamines, and antibiotherapy) and topical therapy (UVB 311nm, topical glucocorticoids and hydration). It is very important to recognize AD as a cause of erythroderma, especially in a patient with a late onset of the disease, in order to treat it promptly and to prevent ulterior recurrences, by educating the patient to have an adequate life style and to treat the recurrences at the very first symptoms. [ABSTRACT FROM AUTHOR]

Allergic diseases have been classified in the last decades using various theories. The main classes of the newest classification in allergic respiratory diseases focus on the characterization of the endotype (which takes into account biomarkers related to determinant pathophysiological mechanisms) and of the phenotype (based on the description of the disease). Th2, Th1 and Th17 lymphocytes and the type of inflammatory response mediated by them represent the basis for Th2 and non-Th2 endotype classification. In addition, new lymphocytes were also used to characterize allergic diseases: Th9 lymphocytes, Th22 lymphocytes, T follicular helper cells (TFH) lymphocytes and invariant natural killer T (iNKT) lymphocytes. In the last decade, a growing body of evidence focused on chemokines, chemoattractant cytokines, which seems to have an important contribution to the pathogenesis of this pathology. This review presents the interactions between chemokines and Th lymphocytes in the context of Th2/non-Th2 endotype classification of respiratory allergies. [ABSTRACT FROM AUTHOR]

The ongoing coronavirus disease 2019 (COVID-19) outbreak was declared a pandemic by the World Health organization in early March 2020. The disease typically presents with viral respiratory symptoms that could progress to acute respiratory distress syndrome. Emerging evidence suggests different possible dermatologic manifestations of COVID-19, including: acral lesions (pernio-like, pseudo-chillblain), vesicular eruptions, macular and papular exanthema, urticaria, livedoid, purpuric and petechial rashes. However, specific skin manifestations of the COVID-19 disease have not yet been clearly established and the relationship between the appearance of skin lesions and SARS-CoV-2 infection is still unclear. These highly variable skin changes could represent a direct consequence of the viral infection, an immunological response to viral nucleotides, adverse reactions to drugs frequently used for the treatment of COVID-19, or other disorders. In a global effort to comprehend the exact cutaneous features of COVID-19, several international dermatological societies have initiated nationwide studies to analyze COVID-19 cutaneous manifestations during this pandemic. This paper represents a literature review of the scientific data available on the clinical characteristics and symptoms of the cutaneous manifestations associated with COVID-19. Such findings are extremely useful in establishing if dermatological manifestations in COVID-19 patients could harbor a diagnostic significance and subsequently be used as prognostic factors for outcomes of COVID-19. [ABSTRACT FROM AUTHOR]

Juvenile xanthogranuloma represents the most common form of non-Langerhans cell histiocytosis. It is tipically a childhood disorder, over 80% of cases developing in the first year of life. Adult onset xanthogranuloma is instead exceedingly rare; our literature research revealed a total number of only 35 cases reported to date. Cases with multiple cutaneous lesions occurring during adulthood are even rarer. The pathogenesis of the disease is incompletely understood and the possibility of extracutaneous involvement is uncertain.Although adult xanthogranulomatosis is not considered a paraneoplastic phenomenon, association with haematological malignancies is very frequent, therefore patients should be thoroughly investigated and closely monitored. We report a case of multiple xanthogranulomas developing in an otherwise healthy adult female patient and review the literature regarding this uncommon disease. [ABSTRACT FROM AUTHOR]

Background: Background atopic dermatitis patients generally respond to conventional therapies. A small proportion of them have severe disease despite intensive treatment. Efficacy of intravenous immunoglobulin (IVIg) in severe, refractory atopic dermatitis has been reported. Materials and methods: We present the cases of five children with severe atopic dermatitis. All patients were previously and/or currently treated with systemic steroids, phototherapy and a large selection of topical agents. Immunosupressive therapy was refused by their legal representatives. Due to financial restraints, low dose IVIg was administered (approximately 0.3 g/kg/month for six months), while the corticosteroid dose was tapered. Disease outcome was measured using the eczema area and severity index (EASI) and the children’s dermatology life quality index (CDLQI). Results: All five patients experienced clinical improvement with significantly reduced EASI and CDLQI scores. No adverse reactions were reported. During the six months follow-up period, no disease flare occured in any of the patients. Conclusions: Adjunctive IVIg is a useful therapeutic approach in selected patients with refractory atopic dermatitis. Even if most of the reported cases refer to high dose IVIg, low dose regimens are not to be discarded, since they can provide satisfactory results with reduced in-patient costs and high compliance. [ABSTRACT FROM AUTHOR]

Intravascular papillary endothelial hyperplasia (IPEH) is an uncommon benign vascular lesion generated by an exaggerated endothelial proliferative response to vascular injury. It represents 2-4% of vascular tumors arising in the skin and soft tissue. Complete surgical excision is curative. Unfortunately, it is frequently confused with other vascular or soft tissue tumors. Therefore, promptly establishing the correct diagnosis helps avoid useless extensive investigations and overtreatment. We report a case of IPEH that developed on the skin of the lower left abdominal area in a 40-year-old female patient in the absence of previous local trauma or vascular anomalies. [ABSTRACT FROM AUTHOR]

Background: Erythroderma may be secondary to several skin diseases, drug reactions, infections, and internal malignancies. Skin lesions usually have an unfavorable course until the underlying disease is treated, therefore a thorough search for the cause of erythroderma is mandatory. Case report: We present the case of a 51-year-old female patient who presented with an erythroderma of unknown etiology of 6 months duration. Extensive screening for the cause of erythroderma lead to the diagnosis of left ovarian papillary serous carcinoma invasive to the epiploon, parietal peritoneum and the wall of the urinary bladder, stage IIC FIGO, pT2c pN0 cM0. The patient underwent surgery, followed by multiple lines of chemotherapy. Whole body computed tomography scan, measurement of serum levels of tumoral markers and dermatologic reevaluation were performed every 3 months. Results: The course of skin lesions paralleled that of the subjacent malignancy and was most favorable under platinum plus gemcitabinum and platinum plus taxanes based chemotherapy that also best controlled the neoplastic process. Conclusion: The parallel evolution of the ovarian carcinoma and cutaneous lesions firmly supports the diagnosis of paraneoplastic erythroderma in our patient. Screening for internal neoplasia should be performed in all cases of erythroderma of unknown etiology. [ABSTRACT FROM AUTHOR]

Intravascular papillary endothelial hyperplasia (IPEH) is an uncommon benign vascular lesion generated by an exaggerated endothelial proliferative response to vascular injury. It represents 2-4% of vascular tumors arising in the skin and soft tissue. Complete surgical excision is curative. Unfortunately, it is frequently confused with other vascular or soft tissue tumors. Therefore, promptly establishing the correct diagnosis helps avoid useless extensive investigations and overtreatment. We report a case of IPEH that developed on the skin of the lower left abdominal area in a 40-year-old female patient in the absence of previous local trauma or vascular anomalies. [ABSTRACT FROM AUTHOR]

Basal cell carcinoma is a slow growing non-melanoma skin cancer appearing as a non-healing, painless, and sometimes pruriginous sore, usually on sun-exposed areas. Although it rarely metastasizes, BCC diagnosis and treatment should not be delayed due to its local invasive potential. Currently, dermatoscopy is a well propagated and commonly employed tool in clinical practice, providing a fast and handy approach to clinical diagnosis, without the significant financial costs associated with other more sophisticated diagnostic means. Since the very first dermatoscopic descriptions of basal cell carcinoma, the list of dermatoscopic diagnostic criteria has been updated and renewed numerous times. Dermatoscopy significantly augments basal cell carcinoma detection by its capability of discriminating it from other skin lesions and inflammatory skin conditions. Moreover, current evidence suggests that this noninvasive, real-time imaging technique is also valuable in tumor management, seeing that it provides additional information related to histopathological subtype, presence or lack of pigmentation, lateral tumor extension, and tumor response to non-surgical treatments. In this paper, we aim to summarize time-honored as well as current knowledge on the value of dermatoscopy in the diagnosis, classification, and treatment of basal cell carcinoma. [ABSTRACT FROM AUTHOR]

Rationale. Psoriasis is a prevalent chronic inflammatory disease with worldwide distribution affecting approximately 2% of the Caucasian population. There have been many population- and family-based studies that agree on the strong genetic component of this disease. Several studies have investigated the relationship between cytokine gene polymorphisms, psoriasis, and the occurrence of comorbidities but their data are conflicting. Objective. This study examines cytokine gene single-nucleotide polymorphisms (SNPs) in the context of psoriasis and metabolic syndrome, with a focus on the occurrence of comorbidities in psoriasis patients. The working hypothesis is that particular SNPs may predispose to an accelerated disease course and more comorbidities in psoriasis patients. Methods. This cross-sectional study was carried out in 2016 in the Dermatology Department of "Elias" University Emergency Hospital, Bucharest and included 82 psoriasis patients. Several clinical and laboratory parameters were recorded, and the presence of metabolic syndrome (MetS) was noted. Using real-time PCR, we tested for the following SNPs: rs361525, rs1800629, rs1800896, rs610604, rs17782313. Results. Disease severity was not significantly influenced by any of the five studied SNPs. Gene polymorphism of rs17782313 was found to influence the occurrence of psoriatic arthritis. In these patients, rs610604 and rs17782313 polymorphisms were associated with the presence of diabetes mellitus. Furthermore, rs17782313 influenced the presence of obesity, heterozygotes being more at risk. Our data suggested that MetS occurred independently of the five studied SNPs. Discussion. The influence of certain cytokine gene polymorphisms on multiple organ systems is justification enough for further analysis of the genetic and molecular mechanisms of metabolic syndrome development in psoriasis patients. [ABSTRACT FROM AUTHOR]

Background: Psoriasis vulgaris is a chronic inflammatory hyper-proliferative disease of the skin, scalp, nails, and joints. It has been hypothesized that prolactin (PRL) may modulate the skin immune system and be involved in the pathogenesis of psoriasis. Psoriasis exerts significant, negative impact on patients' quality of life. Relatively high rates of depression are reported in patients with psoriasis. Objectives: The aim of this work was to study the possible role of PRL in the pathogenesis of psoriasis and its correlation with the disease activity, clinically, molecular and emotional status of patients. Subjects and methods: A total of 41 samples were analyzed - 21 new patients with psoriasis vulgaris before treatment and 20 after therapy - were included in this study. In all patients, we determined skin disease activity according to the PASI index, the psychological impact measured with HAMA and HAMD scales and the quality of their life measured by DLQI. The concentration of prolactin in the serum was measured by enzyme-linked immunosorbent assay (ELISA), and the concentration of soluble receptor of IL-2 was measured with automated immune chemiluminescent system - IMMULITE procedure. Results: The PRL and sIL2R serum levels were significantly decreased after three months of therapy, at least 50% with a p value <0.00001. Clinical, hormonal, molecular correlations between before and after therapy were measured with a statistically significant result. Correlations between HAMA-PRL and DLQI-PRL before therapy were not statistically significant, only the relationship between HAMD and PRL was demonstrated. After treatment, we obtained a significant clinical, psychological and paraclinical (especially serum levels of prolactin and sIL2R) decreased and relevant response on all the patients treated and analyzed. Conclusion: Prolactin seems to have a role in the pathogenesis of psoriasis and may represent a cause and/or a consequence of psoriasis pathology. The most likely scenario is that PRL enhances interferon-induced chemokine production in keratinocytes, thereby facilitating cutaneous T-cell infiltration. This raises the intriguing light that PRL may offer a novel future therapeutic target in psoriasis and other skin diseases that worsen in response to psychological distress. [ABSTRACT FROM AUTHOR]

Introduction: The polypeptide hormone prolactin (PRL) represents the pituitary modulator of lactation and reproduction. Currently, we discuss the wide range of PRL actions "beyond the mammary horizon". Multiple studies had showed the role of PRL as a cytokine, with comparable structural motifs, similar receptor structures and signal transduction pathways. Almost two decades ago it was first hypothesized that PRL acts as a neuroendocrine modulator of both skin epithelial growth and the skin immune system. Moreover, it was described the PRL circuit between the skin and the central nervous system. Psoriasis vulgaris, an immunologically mediated skin disease, is a common disorder, having as main pathogenetic mechanisms the chronic inflammation and keratinocytes hyperproliferation. Psoriasis vulgaris is not a life threatening disease, but affects seriously the quality of life; there is still no causative treatment. Methods: After we describe the essentials of general PRL biology, the almost ubiquitous distribution of its receptors and the vast list of extrapituitary PRL-expressing tissues, our aim is to summarize clinical observations that provide insights into how PRL may impact on the psoriatic skin and define research for better characterize the complex role of PRL in human skin biology and pathology. Results: Focusing on psoriasis, as a stress-related disease, we then discuss the possible role of PRL/ PRLR in its pathology and may identify one potential biological marker and therapeutic targets for the management of this autoimmune skin disorder. Conclusion: This theory/concept can now be integrated into current views on the multilevel neuroendocrine-immune communication along the brain-skin axis in health and disease. Due to the pathogenic complexity, there is no curative treatment for psoriasis and pharmacological modulation of PRL may represent a future target to restrict the lesions in psoriatic patients. [ABSTRACT FROM AUTHOR]

Human dirofilariasis is a zoonotic infectious disease caused by the filarial nematodes of dogs Dirofilaria repens and Dirofilaria immitis. Depending on the species involved, human infections usually manifest as one cutaneous or visceral larva migrans that forms a painless nodule in the later course of disease. Dirofilariae are endemic in the Mediterranean, particularly in Italy. They are considered as emerging pathogens currently increasing their geographical range. We present one of the few known cases of human dirofilariasis caused by D. repens in Romania. The patient developed unusual and severe clinical manifestations that mimicked pathological conditions like cellulitis or deep venous thrombosis. [ABSTRACT FROM AUTHOR]

Context: Optical coherence tomography (OCT) is an emergent imaging technique, based on the interference of infrared radiation and living tissues, that allows the in vivo visualization of the skin structures, at high resolution and up to 1.6 mm depth. As such, there is mounting evidence that OCT may be an interesting technique for the diagnosis of skin diseases, including the noninvasive early detection of cutaneous tumors. Objective: We aimed to investigate the utility of OCT for the diagnosis of non-melanocytic, non-pigmented cutaneous tumors. Methods: Preliminary results are presented from an initiated study. Fifteen consecutive patients with clinical suspicion of epithelial cancers and precancers registered over one week in a university dermatologic department were included. As control were selected 7 patients with inflammatory skin diseases (psoriasis, lichen planus, cutaneous lupus erythematosus). In all study and control patients, the lesions and samples of normal, perilesional skin were documented by clinical digital photography, contact dermoscopy with digital image capture and OCT with central wavelength of 930 nm. Final diagnosis was certified by histopathological analysis. Results: We could identify morphological features in OCT examination that distinguished between normal and lesional skin, and between neoplastic vs. inflammatory lesions. In the same time, combining OCT and dermatoscopical evaluation of a lesion improved the performance of diagnosis when compared to clinical diagnosis alone and with either OCT or dermoscopy imaging used alone. Conclusions: OCT appears as a promising method of in vivo diagnosis of early neoplastic cutaneous lesions with equivocal clinical and/or dermoscopic aspect. Continuation of our study as well as other larger investigation will be able to contribute with new insights in the role of OCT in the non-invasive diagnosis of skin disease. [ABSTRACT FROM AUTHOR]

Background: Erythroderma may be secondary to several skin diseases, drug reactions, infections, and internal malignancies. Skin lesions usually have an unfavorable course until the underlying disease is treated, therefore a thorough search for the cause of erythroderma is mandatory. Case report: We present the case of a 51-year-old female patient who presented with an erythroderma of unknown etiology of 6 months duration. Extensive screening for the cause of erythroderma lead to the diagnosis of left ovarian papillary serous carcinoma invasive to the epiploon, parietal peritoneum and the wall of the urinary bladder, stage IIC FIGO, pT2c pN0 cM0. The patient underwent surgery, followed by multiple lines of chemotherapy. Whole body computed tomography scan, measurement of serum levels of tumoral markers and dermatologic reevaluation were performed every 3 months. Results: The course of skin lesions paralleled that of the subjacent malignancy and was most favorable under platinum plus gemcitabinum and platinum plus taxanes based chemotherapy that also best controlled the neoplastic process. Conclusion: The parallel evolution of the ovarian carcinoma and cutaneous lesions firmly supports the diagnosis of paraneoplastic erythroderma in our patient. Screening for internal neoplasia should be performed in all cases of erythroderma of unknown etiology. [ABSTRACT FROM AUTHOR]

Seasonal allergic rhinitis (SAR) is one of the most frequent chronic conditions of the modern world. Pollen carried by the wind from pollinated trees is a major source of SAR. Betulaceae, Oleaceae and Platanus are the most important sources of airway sensitization with regard to tree pollen and, therefore, they are included in the official recommendations of skin prick testing by different official societies. Salicaceae pollen is a moderate source of pollen sensitization. Conversely, large areas are covered with poplars and willows around the world. A number of studies from many countries showed that in some particular situations (large and compacted areas covered by Salicaceae, weather conditions, air pollution, urban ornamental vegetation), poplar and willow pollens may become of local importance in producing SAR. The aim of this review was to present a synthesis of information regarding Salicaceae pollen allergy showing that, if various unfavorable aspects are brought together, a minor problem (Salicaceae sensitization) can became a public health problem. [ABSTRACT FROM AUTHOR]

Respiratory allergies represent a major public health issue in the modern world. Pollens are among the most significant causes of seasonal allergic rhinitis, with pollens of wind-pollinated trees representing an important cause. Members of the Platanaceae family (Platanus acerifolia, Platanus orientalis) are well-recognized sources of allergenic pollens worldwide, due to their high capacity of sensitization and widespread usage as ornamental urban trees. Air pollution, characteristic to all important urban conglomerates in the world and provoked by diesel exhaust gases, industrial and domestic fumes, and biogenic volatile organic compounds represents another major public health issue. Plane trees, along with other species of trees, are one of the main sources of volatile compounds. Recent studies have demonstrated a strong correlation between air pollution and respiratory allergies, with airway chemical compounds intensifying the capacity of sensitization to allergenic pollens. This study presents an overview of the known negative elements on public health of the Platanus family. [ABSTRACT FROM AUTHOR]

Current national and European guidelines recommend distinct management approaches for basal cell carcinoma (BCC) based on tumor location, size, and histopathological subtype. In vivo reflectance confocal microscopy (RCM) is a non-invasive skin imaging technique which may change the diagnostic pathway for BCC patients. This study aimed to determine the sensitivity and specificity of RCM for BCC diagnosis, assess the predictive values of several confocal criteria in correctly classifying BCC subtypes, and evaluate the intraobserver reliability of RCM diagnosis for BCC. We conducted a retrospective study in two tertiary care centers in Bucharest, Romania. We included adults with clinically and dermoscopic suspect BCCs who underwent RCM and histopathological examination of excision specimens. For RCM examinations, we used the VivaScope 1500 and histopathology of the surgical excision specimen was the reference standard. Of the 123 cases included in the analysis, BCC was confirmed in 104 and excluded in 19 cases. RCM showed both high sensitivity (97.1%, 95% CI (91.80, 99.40)) and specificity (78.95%, 95% CI (54.43, 93.95)) for detecting BCC. Several RCM criteria were highly predictive for BCC subtypes: cords connected to the epidermis for superficial BCC, big tumor islands, peritumoral collagen bundles and increased vascularization for nodular BCC, and hyporefractile silhouettes for aggressive BCC. Excellent intraobserver agreement (κ = 0.909, p < 0.001) was observed. This data suggests that RCM could be used for preoperative diagnosis and BCC subtype classification in patients with suspected BCCs seen in tertiary care centers. [ABSTRACT FROM AUTHOR]