Publications by authors named "Paolo Broganelli"

30 Publications

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An unusual case of pilar sheath acanthoma colliding with sebaceous hyperplasia.

Ital J Dermatol Venerol 2021 May 28. Epub 2021 May 28.

Dermatology Unit, Department of Medical Sciences, University of Turin, Turin, Italy.

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http://dx.doi.org/10.23736/S2784-8671.21.07032-8DOI Listing
May 2021

Necrotic papules of the elbows as a dermatologic manifestation of eosinophilic granulomatosis with polyangiitis.

Ital J Dermatol Venerol 2021 Apr 23. Epub 2021 Apr 23.

Dermatology Clinic, Medical Sciences Department, University of Turin, Turin, Italy.

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http://dx.doi.org/10.23736/S2784-8671.21.06902-9DOI Listing
April 2021

Skin melanoma deaths within 1 or 3 years from diagnosis in Europe.

Int J Cancer 2021 Jun 1;148(12):2898-2905. Epub 2021 Feb 1.

Piedmont Cancer Registry, Turin, Italy.

The steep increase in incidence of cutaneous malignant melanoma in white populations mainly applies to thin lesions with good survival suggesting overdiagnosis. Based on population-based cancer registries (CRs), we have investigated changes in aggressive melanoma, selecting only cases who died within 1 or 3 years after diagnosis in 11 European countries between 1995 and 2012. Trends in fatal cases were analysed by period of diagnosis, sex, tumour thickness, histologic subtype of the lesion, tumour site and CR with a multivariate generalised linear mixed effects model, where geographical area was considered as a random effect. We collected data on 123 360 invasive melanomas, with 5133 fatal cases at 1 year (4%) and 12 330 (10%) at 3 years. The number of fatal cases showed a 16% decrease at 1 year and 8% at 3 years between the first (1995-2000) and the last (2007-2012) period. The highest proportion of fatal cases was seen for men, older age (≥65 years), thick lesions (>1 mm), nodular melanoma, melanoma on the trunk and for poorly documented cases, lacking information about thickness and histologic subtype. The mixed-effects model showed a remarkable variability among European countries. The majority of registries showed a decreasing trend in fatal cases, but a few registries showed an opposite pattern. Trends in fatal melanoma cases, highlighting real changes in risk not related to overdiagnosis, showed a decrease in most European countries, with a few exceptions. Stronger efforts for early detection could lead to a more efficient treatment of melanoma in general.
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http://dx.doi.org/10.1002/ijc.33479DOI Listing
June 2021

In Vivo Observation of Cutaneous Larva Migrans by Fluorescence-Advanced Videodermatoscopy.

Emerg Infect Dis 2021 01;27(1):281-283

Fluorescence-advanced videodermatoscopy is not a widespread diagnostic technique. Its application in dermatology can facilitate the diagnosis of diseases such as cutaneous larva migrans by enabling us to recognize the precise position of larva in vivo on the skin. Using this noninvasive technique, we detected a case of cutaneous larva migrans in a patient.
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http://dx.doi.org/10.3201/eid2701.203137DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7774534PMC
January 2021

A Case of a Pigmented Epithelioid Melanocytoma on a Mucosal Site.

Dermatol Pract Concept 2020 Oct 26;10(4):e2020070. Epub 2020 Oct 26.

Dermatology Clinic and Surgical Pathology Section, Department of Medical Sciences, University of Turin, Italy.

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http://dx.doi.org/10.5826/dpc.1004a70DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7588147PMC
October 2020

Cutaneous Melanoma Arising in Congenital Melanocytic Nevus: A Retrospective Observational Study.

Dermatology 2021 14;237(3):473-478. Epub 2020 Oct 14.

Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy.

Background: Congenital melanocytic nevi (CMN) are benign proliferations of melanocytes usually present at birth. The magnitude of the melanoma risk for CMN is controversial, generating an ongoing debate on the best approach to manage these lesions.

Objective: To perform a retrospective, observational study with the aim to evaluate the prevalence of CMN-associated melanomas in tertiary referral centers, as well as the eventual correlation between clinical, dermoscopic, and histological features of CMN-associated melanomas.

Methods: A single-center retrospective observational study was performed on all clinical and dermoscopic images of histologically confirmed melanomas arising on CMN over a 14-year period (January 2005 to March 2019).

Results: Our database included 2,159 melanomas in the considered period. Of those, 27 (1.3%) were CMN-associated melanomas. The mean age of patients with CMN-associated melanoma was 33 years (range, 11-70 years). The mean diameter of CMN-associated melanoma was 18 mm (range, 6 mm to 20 cm), and 56% were located on the back. Twenty-one (77.8%) of CMN-associated melanomas arose on small CMN (<1.5 cm), 5 (18.5%) on medium-sized CMN (1.5-19.9 cm), and 1 (3.7%) on a large/giant type (≥20 cm). The majority of CMN-associated melanomas (63%) exhibited a globular dermoscopic pattern in their benign part, while a blue-white veil and irregular blotches were the most frequent dermoscopic features in the malignant part. About three quarters of melanomas occupied 10-50% of the nevus surface. Breslow thickness was higher in melanomas involving less than 10% of nevus surface (mean thickness, 1 mm) than in those affecting 10-50 and >50% of the nevus surface (0.8 and 0.7 mm, respectively).

Conclusions: In our series, small CMN was the most frequent type of CMN-associated melanoma. Although the risk of melanoma is increasing by the increasing size of CMN, our finding is definitely related to the much higher prevalence of small CMN in the general population as compared to the prevalence of intermediate-sized and large CMN.

Limitations: Small sample size, single-center experience, retrospective design.
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http://dx.doi.org/10.1159/000510221DOI Listing
October 2020

Reply to E. Hindié.

J Clin Oncol 2020 09 23;38(27):3238-3240. Epub 2020 Jul 23.

Andrea Maurichi, MD, Melanoma and Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy; Rosalba Miceli, PhD, Medical Statistics, Biometry and Bioinformatics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy; Hanna Eriksson, MD, PhD, Department of Oncology, Theme Cancer, Karolinska University Hospital, and Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden; Julia Newton-Bishop, MD, FRCP; Jérémie Nsengimana, PhD; and May Chan, PGD, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, United Kingdom; Andrew J. Hayes, MA, MBBS, MD, PhD and Kara Heelan, MB, BCH, BAO, MRCPI, MD, Sarcoma and Melanoma Units and Skin Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom; David Adams, PhD, Experimental Cancer Genetics, Wellcome Trust Sanger Institute, Hinxton, United Kingdom; Roberto Patuzzo, MD, Melanoma and Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy; Francesco Barretta, MS, PhD, Medical Statistics, Biometry and Bioinformatics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy; Gianfranco Gallino, MD, Melanoma and Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy; Catherine Harwood, MA, MD, PhD, FRCP and Daniele Bergamaschi, PhD, Queen Mary University of London, London, United Kingdom; Dorothy Bennett, FMedSci, PhD, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, United Kingdom; Konstantinos Lasithiotakis, MD, PhD, York Teaching Hospital NHS Foundation Trust, York, United Kingdom and Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy; Paola Ghiorzo, MD, PhD and Bruna Dalmasso, MD, University Hospital of Genoa, Genoa, Italy; Ausilia Manganoni, MD and Francesca Consoli, MD, University Hospital of Brescia, Brescia, Italy; Ilaria Mattavelli, MD; Consuelo Barbieri, MD; and Andrea Leva, MD, Melanoma and Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy; Umberto Cortinovis, MD, Plastic and Reconstructive Surgical Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy; Vittoria Espeli, MD and Cristina Mangas, MD, PhD, Istituto Oncologico Svizzera Italiana, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland; Pietro Quaglino, MD; Simone Ribero, MD, PhD; and Paolo Broganelli, MD, University Hospital of Turin, Turin, Italy; Giovanni Pellacani, MD, University Hospital of Modena, Modena, Italy; Caterina Longo, MD, Arcispedale S. Maria Nuova, Reggio Emilia, Italy; Corrado Del Forno, MD, University Hospital of Pavia, Pavia, Italy; Lorenzo Borgognoni, MD and Serena Sestini, MD, Ospedale S. Maria Annunziata, Tuscan Cancer Institute, Florence, Italy; Nicola Pimpinelli, MD, PhD and Sara Fortunato, MD, Division of Dermatology, University of Florence, Florence, Italy; Alessandra Chiarugi, MD and Paolo Nardini, MD, Institute for Cancer Research and Prevention, Florence, Italy; Elena Morittu, PhD and Antonio Florita, PhD, Scientific Director's Office, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy; Mara Cossa, MD, PhD; Barbara Valeri, MD; Massimo Milione, MD, PhD; and Giancarlo Pruneri, MD, Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy; Odysseas Zoras, MD, PhD, University Hospital of Heraklion, Heraklion, Greece; Andrea Anichini, PhD and Roberta Mortarini, PhD, Immunobiology of Human Cancers Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy; and Mario Santinami, MD, Melanoma and Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.

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http://dx.doi.org/10.1200/JCO.20.01460DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7499609PMC
September 2020

In Vivo Observation of Trombiculosis with Fluorescence-Advanced Videodermatoscopy.

Emerg Infect Dis 2020 08;26(8):1904-1905

Trombiculosis is a skin infestation by larvae of mites of the Trombiculidae family. We used fluorescence-advanced videodermatoscopy to diagnose trombiculosis in a woman in Italy with targetoid patches. This method might be useful for identifying atypical manifestations of trombiculosis.
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http://dx.doi.org/10.3201/eid2608.200077DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7392407PMC
August 2020

Factors Affecting Sentinel Node Metastasis in Thin (T1) Cutaneous Melanomas: Development and External Validation of a Predictive Nomogram.

J Clin Oncol 2020 05 13;38(14):1591-1601. Epub 2020 Mar 13.

University Hospital of Modena, Modena, Italy.

Purpose: Thin melanomas (T1; ≤ 1 mm) constitute 70% of newly diagnosed cutaneous melanomas. Regional node metastasis determined by sentinel node biopsy (SNB) is an important prognostic factor for T1 melanoma. However, current melanoma guidelines do not provide clear indications on when to perform SNB in T1 disease and stress an individualized approach to SNB that considers all clinicopathologic risk factors. We aimed to identify determinants of sentinel node (SN) status for incorporation into an externally validated nomogram to better select patients with T1 disease for SNB.

Patients And Methods: The development cohort comprised 3,666 patients with T1 disease consecutively treated at the Istituto Nazionale Tumori (Milan, Italy) between 2001 and 2018; 4,227 patients with T1 disease treated at 13 other European centers over the same period formed the validation cohort. A random forest procedure was applied to the development data set to select characteristics associated with SN status for inclusion in a multiple binary logistic model from which a nomogram was elaborated. Decision curve analyses assessed the clinical utility of the nomogram.

Results: Of patients in the development cohort, 1,635 underwent SNB; 108 patients (6.6%) were SN positive. By univariable analysis, age, growth phase, Breslow thickness, ulceration, mitotic rate, regression, and lymphovascular invasion were significantly associated with SN status. The random forest procedure selected 6 variables (not growth phase) for inclusion in the logistic model and nomogram. The nomogram proved well calibrated and had good discriminative ability in both cohorts. Decision curve analyses revealed the superior net benefit of the nomogram compared with each individual variable included in it as well as with variables suggested by current guidelines.

Conclusion: We propose the nomogram as a decision aid in all patients with T1 melanoma being considered for SNB.
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http://dx.doi.org/10.1200/JCO.19.01902DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7213590PMC
May 2020

Neurothekeomas: Dermoscopic Features of 3 Cases.

Dermatol Pract Concept 2019 Oct 31;9(4):322-324. Epub 2019 Oct 31.

Dermatology Section, Department of Medical Science, Surgery and Neurological Sciences, University of Siena, Siena, Italy.

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http://dx.doi.org/10.5826/dpc.0904a21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6830546PMC
October 2019

Patient-centered management of actinic keratosis. Results of a multi-center clinical consensus analyzing non-melanoma skin cancer patient profiles and field-treatment strategies.

J Dermatolog Treat 2020 Sep 23;31(6):576-582. Epub 2019 Oct 23.

Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany.

Actinic keratosis (AK) is a chronic skin condition that can be a precursor to cutaneous squamous cell carcinoma. AK can recur and patients are likely to undergo multiple treatments. It is important that AK lesions are managed appropriately, and that patients are involved in treatment decisions. The Supporting Professional Expertise in AK (SPEAK) program aims to facilitate this patient-centered care by identifying patient needs and aiding healthcare practitioners (HCPs) in selecting optimal treatment and communication strategies for different types of patients. Twenty-two dermato-oncologists with established expertise in the treatment of AK collaborated to describe commonly encountered psychosocial patient profiles, and to develop respective communication and treatment strategies. Six patient profiles were defined based on different psychosocial characteristics and were used to develop appropriate management approaches. We provide a systematic way of identifying these patient profiles in clinical practice and we outline communication strategies tailored to the primary needs of each type of patient. In addition, we provide recommendations for potential field-treatments that may be best suited for each profile. The recommendations provided here may help improve the communication and relationship between patients and HCPs, resulting in higher treatment adherence and improved patient outcomes.
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http://dx.doi.org/10.1080/09546634.2019.1679335DOI Listing
September 2020

Clinical and Pathological Relevance of Drug-induced Vitiligo in Patients Treated for Metastatic Melanoma with Anti-PD1 or BRAF/MEK Inhibitors.

Acta Derm Venereol 2020 01 7;100(1):adv00001. Epub 2020 Jan 7.

Department of Medical Sciences, Dermatologic Clinic, Turin, Italy.

Current therapies for metastatic melanoma (anti-PD1 and BRAF/MEK inhibitors) can cause drug-induced vitiligo. The aim of this study is to dermatologically define and histologically characterize this new type of vitiligo, and assess the clinical course of the disease. Fourteen patients with metastatic melanoma treated with immune or targeted therapy were included in a dataset evaluating clinical data, vitiligo description and histopathological features. Vitiligo-like lesions occurred after a mean of 7.5 months from the start of the therapies (range 1-42 months), with a prevalence of the non-segmental variant (71.4%). Fifty percent of patients showed a clinical response (4 complete response and 3 partial response), 35.7% had stable disease, and one patient died after disease progression. Median survival from the start of the therapies was 32.5 months. Drug-induced vitiligo can be related to both immune and targeted therapies, is associated with a favourable prognosis, and has clinical characteristics different from the classical form.
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http://dx.doi.org/10.2340/00015555-3319DOI Listing
January 2020

Fluorescence-advanced videodermatoscopy: A promising and potential technique for the in vivo evaluation of vitiligo.

Dermatol Ther 2019 05 18;32(3):e12863. Epub 2019 Mar 18.

Department of Surgery and Translational Medicine, Division of Dermatology, University of Florence, Florence, Italy.

Fluorescence advanced videodermatoscopy (FAV) has been proposed recently to be a new, noninvasive method for in vivo skin examination at high magnification. The working principle underlying FAV relates to the ability of endogenous molecules to absorb specific wavelengths and emit fluorescence. Herein we report our experience with FAV in the study of active, non-segmental vitiligo treated with narrowband UVB. Our findings indicate that FAV has the potential for application in the clinical follow-up, disease prognosis, and therapeutic monitoring of vitiligo.
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http://dx.doi.org/10.1111/dth.12863DOI Listing
May 2019

Prevalence and risk factors of actinic keratosis in patients attending Italian dermatology clinics.

Eur J Dermatol 2017 Dec;27(6):599-608

Department of Dermatology, Catholic University of the Sacred Heart, Rome, Italy.

Actinic keratosis (AK) is a common keratinocyte intra-epidermal neoplasia. To assess AK prevalence and potential risk factors in patients attending Italian general dermatology clinics. This retrospective study was conducted on clinical data from consecutive white outpatients aged ≥30 years, attending 24 general dermatology clinics between December 2014 and February 2015. AK prevalence (entire population) and multivariate risk factor analysis (patients with current/previous AK and complete data) are presented. AK prevalence in 7,284 patients was 27.4% (95% CI: 26.4-28.4%); 34.3% in men and 20.0% in women (p<0.001). Independent AK risk factors in 4,604 patients were: age (OR: 4.8 [95% CI: 3.5-6.5] for 46-60 years, increasing with older age to OR: 41.5 [95% CI: 29.5-58.2] for >70 years), history of other non-melanoma skin cancers (OR: 2.7 [2.2-3.3]), residence in southern Italy/Sardinia (OR: 2.6 [2.1-3.0]), working outdoors >6 hours/day (OR: 1.9 [1.4-2.4]), male gender (OR: 1.7 [1.4-2.0]), facial solar lentigos (OR: 1.6 [1.4-1.9]), light hair colour (OR: 1.5 [1.2-1.8]), prolonged outdoor recreational activities (OR: 1.4 [1.2-1.7]), light eye colour (OR: 1.3 [1.1-1.6]), skin type I/II (OR: 1.3 [1.1-1.6]), and alcohol consumption (OR: 1.2 [1.0-3.3]). BMI ≥25.0 (OR: 0.6 [0.5-0.7]), regular sunscreen use (OR: 0.7 [0.6-0.8]), and a lower level of education (OR: 0.8 [0.7-1.0]) were independent protective factors. AK prevalence was high in Italian dermatology outpatients. We confirm several well-known AK risk factors and reveal possible novel risk and protective factors. Our results may inform on the design and implementation of AK screening and educational programmes.
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http://dx.doi.org/10.1684/ejd.2017.3126DOI Listing
December 2017

The large spectrum of Spitzoid tumors: a retrospective survival study.

G Ital Dermatol Venereol 2019 Jun 11;154(3):315-320. Epub 2017 Jul 11.

Dermatologic Clinic Department of Medical Sciences, University of Turin, Turin, Italy.

Background: There is no universally-accepted classification of Spitzoid tumors. This makes it difficult to assign a correct diagnosis and select a treatment that minimizes the risk of overestimating, or worse, underestimating, the malignant potential of these tumors. The aim of this study was to describe the clinical-pathological and epidemiological features of Spitzoid tumors, as well as to assess mortality in these patients.

Methods: This retrospective cohort study looked at data on Spitzoid tumors excised in 1999-2012 at the Dermatologic Clinic of the Turin University Hospital. Spitzoid melanoma specific survival curves were generated with the Kaplan-Meier method and compared using the log-rank test.

Results: In this time period, 1663 lesion were described at the pathologic report as Spitzoid. 262 (15.75%) were Spitz nevi, 307 (18.46%) Reed nevi, 827 (49.73%), 810 (48.71%) Spitzoid dysplastic nevi, 17(1.02%) atypical Spitzoid tumors, and 267 (16.06%) Spitzoid melanomas. Median follow-up time was 9 years. Out of the entire cohort only 24 patients died from melanoma. All of them received a diagnosis of Spitzoid melanoma. None of the patients with a diagnosis of not melanoma Spitz tumor died for melanoma during the follow-up.

Conclusions: In the large majority of the cases, Spitz tumor should be considered as benign lesion and excised only if melanoma features are seen. The used clinical pathological classification avoid misdiagnoses, inappropriate treatment and the risk of death for melanoma.
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http://dx.doi.org/10.23736/S0392-0488.17.05575-4DOI Listing
June 2019

Dermoscopic Clues for Diagnosing Melanomas That Resemble Seborrheic Keratosis.

JAMA Dermatol 2017 06;153(6):544-551

Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria.

Importance: Melanomas that clinically mimic seborrheic keratosis (SK) can delay diagnosis and adequate treatment. However, little is known about the value of dermoscopy in recognizing these difficult-to-diagnose melanomas.

Objective: To describe the dermoscopic features of SK-like melanomas to understand their clinical morphology.

Design, Setting, And Participants: This observational retrospective study used 134 clinical and dermoscopic images of histopathologically proven melanomas in 134 patients treated in 9 skin cancer centers in Spain, France, Italy, and Austria. Without knowledge that the definite diagnosis for all the lesions was melanoma, 2 dermoscopy-trained observers evaluated the clinical descriptions and 48 dermoscopic features (including all melanocytic and nonmelanocytic criteria) of all 134 images and classified each dermoscopically as SK or not SK. The total dermoscopy score and the 7-point checklist score were assessed. Images of the lesions and patient data were collected from July 15, 2013, through July 31, 2014.

Main Outcomes And Measures: Frequencies of specific morphologic patterns of (clinically and dermoscopically) SK-like melanomas, patient demographics, and interobserver agreement of criteria were evaluated.

Results: Of the 134 cases collected from 72 men and 61 women, all of whom were white and who had a mean (SD) age of 55.6 (17.5) years, 110 (82.1%) revealed dermoscopic features suggestive of melanoma, including pigment network (74 [55.2%]), blue-white veil (72 [53.7%]), globules and dots (68 [50.7%]), pseudopods or streaks (47 [35.1%]), and blue-black sign (43 [32.3%]). The remaining 24 cases (17.9%) were considered likely SKs, even by dermoscopy. Overall, lesions showed a scaly and hyperkeratotic surface (45 [33.6%]), yellowish keratin (42 [31.3%]), comedo-like openings (41 [30.5%]), and milia-like cysts (30 [22.4%]). The entire sample achieved a mean (SD) total dermoscopy score of 4.7 (1.6) and a 7-point checklist score of 4.4 (2.3), while dermoscopically SK-like melanomas achieved a total dermoscopy score of only 4.2 (1.3) and a 7-point checklist score of 2.0 (1.9), both in the range of benignity. The most helpful criteria in correctly diagnosing SK-like melanomas were the presence of blue-white veil, pseudopods or streaks, and pigment network. Multivariate analysis found only the blue-black sign to be significantly associated with a correct diagnosis, while hyperkeratosis and fissures and ridges were independent risk markers of dermoscopically SK-like melanomas.

Conclusions And Relevance: Seborrheic keratosis-like melanomas can be dermoscopically challenging, but the presence of the blue-black sign, pigment network, pseudopods or streaks, and/or blue-white veil, despite the presence of other SK features, allows the correct diagnosis of most of the difficult melanoma cases.
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http://dx.doi.org/10.1001/jamadermatol.2017.0129DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5540029PMC
June 2017

Clinical and dermoscopic features of atypical Spitz tumors: A multicenter, retrospective, case-control study.

J Am Acad Dermatol 2015 Nov;73(5):777-84

Dermatology Unit, Second University of Naples, Naples, Italy. Electronic address:

Background: Few studies have described the clinical and dermoscopic features of atypical Spitz tumors.

Objective: We sought to describe the clinical and dermoscopic features of a series of atypical Spitz tumors as compared with those of conventional Spitz nevi.

Methods: This was a multicenter, retrospective, case-control study, analyzing the clinical and dermoscopic characteristics of 55 atypical Spitz tumors and 110 Spitz nevi that were excised and diagnosed histopathologically.

Results: The majority of atypical Spitz tumors presented clinically as a plaque or nodule, dermoscopically typified by a multicomponent or nonspecific pattern. A proportion of lesions (16.4%) exhibited the typical nonpigmented Spitzoid pattern of dotted vessels and white lines under dermoscopy. Nodularity, ulceration, linear vessels, polymorphic vessels, white lines, and blue-white veil were associated with atypical Spitz tumors by univariate analysis, but only nodularity and white lines remained significant after multivariate analysis. In contrast, a pigmented typical Spitzoid pattern was a potent predictor of Spitz nevi, associated with 6.5-fold increased probability.

Limitations: Differentiation from Spitzoid melanoma and other nonmelanocytic lesions was not investigated.

Conclusion: Atypical Spitz tumors are polymorphic melanocytic proliferations with a nodular clinical appearance. Dermoscopically they demonstrate a multicomponent and nonspecific pattern. A typical nonpigmented Spitzoid pattern on dermoscopy (with dotted vessels and white lines) does not exclude atypical Spitz tumors.
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http://dx.doi.org/10.1016/j.jaad.2015.08.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4806681PMC
November 2015

Usefulness of Photodynamic Therapy as a Possible Therapeutic Alternative in the Treatment of Basal Cell Carcinoma.

Int J Mol Sci 2015 Sep 28;16(10):23300-17. Epub 2015 Sep 28.

Città della Salute e della Scienza, Turin 10126, Italy.

Basal cell carcinoma (BCC) is the most common cancer in individuals with fair skin type (I-II) and steadily increasing in incidence (70% of skin malignancy). It is locally invasive but metastasis is usually very rare, with an estimated incidence of 0.0028%-0.55%. Conventional therapy is surgery, especially for the H region of the face and infiltrative lesions; in case of inoperable tumors, radiotherapy is a valid option. Recently, topical photodynamic therapy (PDT) has become an effective treatment in the management of superficial and small nodular BCC. PDT is a minimally invasive procedure that involves the administration of a photo-sensibilizing agent followed by irradiation at a pre-defined wavelength; this determines the creation of reactive oxygen species that specifically destroy target cells. The only major side effect is pain, reported by some patients during the irradiation. The high cure rate and excellent cosmetic outcome requires considering this possibility for the management of patients with both sporadic and hereditary BCC. In this article, an extensive review of the recent literature was made, in order to clarify the role of PDT as a possible alternative therapeutic option in the treatment of BCC.
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http://dx.doi.org/10.3390/ijms161023300DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4632699PMC
September 2015

Dermoscopy of melanocytic lesions in patients affected by oculocutaneous albinism: a case series.

Dermatology 2013 29;226(4):358-61. Epub 2013 Jun 29.

Department of Dermatology, Catholic University of the Sacred Heart, Rome, Italy.

Background: Although the majority of skin cancers in albino patients consists of squamous and basal cell carcinomas, malignant melanomas have also been described, albeit less frequently.

Objective: The aim of our study was to evaluate melanocytic lesions in albino patients to look for any recurrent dermoscopic pattern.

Methods: We enrolled 12 consecutive albino patients presenting to our department and examined each patient for the presence of melanocytic nevi with the unaided eye and then with dermoscopy. Melanocytic lesions with suspicious clinical or dermoscopic features were excised and histopathologically evaluated.

Results: Analysis of the recorded images permitted us to find two main dermoscopic patterns in this group of patients. The first one was represented by a homogeneous light-brown yellowish pattern associated with comma-like and dotted vessels; the second one consisted of a classical brown reticular pattern frequently associated with central depigmentation and with comma-like vessels. Moreover, based on some atypical dermoscopic features, in 2 patients we excised 3 melanomas in situ (in the same patient) and a thick melanoma (3.2 mm).

Conclusions: Dermoscopy may represent a useful tool for the evaluation of melanocytic lesions in albino patients, permitting an early diagnosis of melanoma.
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http://dx.doi.org/10.1159/000351315DOI Listing
May 2014

Intralesional cidofovir for the treatment of multiple and recalcitrant cutaneous viral warts.

Dermatol Ther 2012 Sep-Oct;25(5):468-71

Department of Oncology and Dermatology, University of Turin, Turin, Italy.

Cidofovir is a nucleoside analog of deoxycytidine with a strong activity against a broad spectrum of DNA viruses, including human papillomavirus. The first objective was to evaluate efficacy of cidofovir for the treatment of cutaneous viral warts, recalcitrant after conventional therapies or where the surgery approach is difficult for their location or extension. Second, the present authors propose to point out possible local and systemic side effects consequent to treatment. Two-hundred eighty patients affected by recalcitrant cutaneous viral warts, were treated with intralesional cidofovir 15 mg/mL once a month. The present authors stated that candidates were those who had made before at least two other treatments reported in the guideline for management of cutaneous viral warts. In 276 cases, warts completely cleared: 158 of those have a follow-up period longer than 12 months and 118 have a follow-up of 6 months. On the average, 3,2 injections were enough to solve the problem. Local side effects consisted of pain and burning sensation during the injections; itching, erythema, and post-inflammatory hyperpigmentation were observed. No cases of systemic side effects were noted. The treatment was well tolerated, and the warts were completely cleared without relapses. Intralesional cidofovir is emerging as an effective therapeutic alternative for warts that are unresponsive to conventional treatments.
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http://dx.doi.org/10.1111/j.1529-8019.2012.01477.xDOI Listing
March 2013

Total body skin examination for skin cancer screening in patients with focused symptoms.

J Am Acad Dermatol 2012 Feb 14;66(2):212-9. Epub 2011 Jul 14.

Department of Dermatology, Second University of Naples, Naples, Italy.

Background: The value of total body skin examination (TBSE) for skin cancer screening is controversial.

Objective: We sought to determine whether TBSE could be helpful in patients with focused skin symptoms who would not otherwise have undergone TBSE.

Methods: In a prospective, multicenter, cross-sectional study consecutive adult patients were recruited during a period of 18 months. Physicians first inspected problem areas and uncovered areas and then performed TBSE. Equivocal lesions detected in both steps were excised or biopsied. Primary outcomes were the absolute and relative risks of missing skin cancer and the number of patients needed to examine to detect melanoma or another malignancy. A secondary outcome was the proportion of false-positive results obtained by TBSE.

Results: We examined 14,381 patients and detected 40 (0.3%) patients with melanoma and 299 (2.1%) with at least one nonmelanoma skin cancer by TBSE. In 195 (1.3%) patients equivocal lesions found by TBSE turned out to be benign. We calculated that 47 patients need to be examined by TBSE to find one skin malignancy and 400 patients to detect one melanoma. The risk of missing one malignancy if not performing TBSE was 2.17% (95% confidence interval 1.25-3.74). Factors significantly increasing the chance to find a skin cancer were age, male gender, previous nonmelanoma skin cancer, fair skin type, skin tumor as the reason for consultation, and presence of an equivocal lesion on problem/uncovered areas.

Limitations: The impact of TBSE on skin cancer mortality was not evaluated.

Conclusions: TBSE improves skin cancer detection in patients with focused skin symptoms and shows a low rate of false-positive results.
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http://dx.doi.org/10.1016/j.jaad.2010.12.039DOI Listing
February 2012

Natural evolution of Spitz nevi.

Dermatology 2011 13;222(3):256-60. Epub 2011 Apr 13.

Dermatology Unit, 1st Medical Department, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.

Background: The natural evolution of melanocytic nevi is a complex, multifactorial process that can be studied by monitoring nevi on a long-term basis.

Methods: To assess the evolution pathway of Spitz nevi, lesions with clinical and dermoscopic features suggestive of Spitz nevi were monitored and baseline and follow-up images compared.

Results: Sixty-four patients (mean age 10.4 years) with lesions suggestive of Spitz nevi were included. Lesions were monitored for a mean follow-up period of 25 months. Upon side-by-side evaluation of baseline and follow-up images, 51 (79.7%) lesions showed an involution pattern and 13 (20.3%) lesions showed a growing or stable pattern. No significant differences were found between growing and involving lesions in terms of patient age and sex and the location and palpability of lesions. The great majority of growing lesions were pigmented or partially pigmented (92.3%), whereas 47.1% of lesions in involution were amelanotic (p = 0.005).

Conclusion: In this series of lesions clinically and dermoscopically diagnosed as Spitz nevi, spontaneous involution seems to be the most common biologic behavior.
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http://dx.doi.org/10.1159/000326109DOI Listing
November 2011

Sclerosing nevus with pseudomelanomatous features (nevus with regression-like fibrosis): clinical and dermoscopic features of a recently characterized histopathologic entity.

Dermatology 2009 8;219(3):202-8. Epub 2009 Jul 8.

Department of Oncology, Pathologic Anatomy Unit, Gaetano Rummo General Hospital, Benevento, Italy.

Background: Sclerosing nevi with pseudomelanomatous features or, else, nevi with regression-like fibrosis (NRLF) are histopathologic simulators of regressing melanoma.

Objective: We aimed at evaluating the clinical features in a series of NRLF.

Methods: Dermoscopic images of NRLF were re-evaluated according to the amount of regression, the presence of white/blue areas and the 7-point checklist.

Results: Forty-six lesions from 44 patients (M:F = 3.4:1; mean age: 42 years) were evaluated. Thirty-seven lesions were excised from the back, mostly from the scapular area. All the lesions were dermoscopically atypical, with large amounts of regression (>10% in 43 cases) and with coexistence of white and blue areas (41 cases). According to the 7-point checklist, 25 lesions were labeled as benign, probably because regression obscured other dermoscopic features of atypia.

Conclusion: NRLF are mostly found in the convex area of the back. A better recognition of their clinicopathologic features can allow a more conservative management.
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http://dx.doi.org/10.1159/000228317DOI Listing
January 2010

Dermoscopy patterns of fibroepithelioma of pinkus.

Arch Dermatol 2006 Oct;142(10):1318-22

Department of Dermatology, Medical University of Graz, Graz, Austria.

Background: Fibroepithelioma of Pinkus (FeP) is a rare variant of basal cell carcinoma that may clinically mimic a number of benign skin tumors. While the dermoscopic features of basal cell carcinoma have been studied extensively, little is known about the dermoscopic features of FeP.

Observations: Retrospective evaluation of clinical records and digital clinical dermoscopic images of 10 histopathologically proved FePs (6 nonpigmented and 4 pigmented) was performed. Clinically, no FeP was correctly identified and, in half of all patients, a clinical differential diagnosis of purely benign skin lesions was made. Dermoscopy enabled the correct diagnosis in 9 of 10 FePs, based on the presence of fine arborizing vessels, either alone or associated with dotted vessels, and white streaks (in 100%, 70%, and 90% of lesions, respectively). In the 4 pigmented FePs, a structureless gray-brown area of pigmentation and variable numbers of gray-blue dots were observed, in addition.

Conclusions: Dermoscopy is helpful in diagnosing FeP and in differentiating this variant of basal cell carcinoma from other benign skin tumors commonly included in the clinical differential diagnosis. This presumes, however, that dermoscopy is used as a first-line examination for all skin lesions, not only for those that are clinically suspect.
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http://dx.doi.org/10.1001/archderm.142.10.1318DOI Listing
October 2006

Baseline factors influencing decisions on digital follow-up of melanocytic lesions in daily practice: an Italian multicenter survey.

J Am Acad Dermatol 2006 Aug 12;55(2):256-62. Epub 2006 Jun 12.

Department of Dermatology, University of Florence, Italy.

Background: Guidelines for optimized use of digital follow-up of melanocytic lesions are not yet available, and little is known about inclusion criteria adopted in clinical practice.

Objective: Our purpose was to describe the frequency of digital follow-up adoption in melanoma screening, the characteristics of patients and lesions selected, and the predictors of duration of the intervals of digital follow-up.

Methods: Baseline characteristics of patients and lesions selected for digital follow-up in 12 Italian pigmented lesion clinics were examined. Predictors of a short follow-up interval (
Results: Out of 2116 subjects consecutively examined, 409 were submitted to digital follow-up (19.3%), with 1.6 mean lesions found per patient (range, 1-9; median, 1). According to an a posteriori analysis, 15.2% of the lesions were diagnostically equivocal and 7.8% of lesions had a total dermoscopy score (TDS) suggestive of malignancy. However, large differences in the TDS were found among the participating centers. Determinants of a short follow-up interval, adopted in 40.8% of patients, were the personal history of melanoma (odds ratio [OR] 2.56, 95% confidence interval [CI] 1.09-5.99) and the presence of atypical nevi (at least one atypical nevus (OR 4.54, 95% CI 2.45-8.42). Unexpectedly, the dermoscopic atypia of the lesion (TDS >4.75) was associated only with a marginal effect on the scheduled duration of follow-up interval (OR 1.34, 95% CI 0.97-1.86). These findings were confirmed by a multivariate analysis.

Limitations: The adoption of different digital dermoscopy systems in the participating centers may have limited the reliability of the TDS assigned by a central group to dermoscopy images.

Conclusions: Practicing dermatologists who use digital epiluminescence microscopy in screening for melanoma decided to submit at least one melanocytic lesion to digital follow-up for approximately 1 patient for every 5 examined. This implies costs and time spent that need to be evaluated together with the benefits of this procedure from a large-scale perspective. The lack of well-defined guidelines for inclusion and exclusion criteria may hamper optimized use of digital follow-up in daily practice.
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http://dx.doi.org/10.1016/j.jaad.2005.12.026DOI Listing
August 2006

Targetoid hemosiderotic nevus. A trauma-induced simulator of malignant melanoma.

Dermatology 2005 ;210(3):200-5

Department of Dermatology, University of Turin, IT-10126 Turin, Italy.

Background: Simulators of malignant melanoma comprise a heterogenous group of melanocytic and nonmelanocytic lesions of the skin. Among frequent clinical mimickers of melanoma are injured melanocytic nevi. Any change in the clinical appearance of a pre-existing nevus should alert the clinician to exclude the possibility of malignant transformation in order to early identify a lesion at a stage when complete cure can still be achieved.

Objective: The purpose of this study was to present the clinical, dermoscopic and histopathologic findings of a series of acquired melanocytic nevi which abruptly developed a pigmented peripheral halo, presumably following minor trauma.

Methods: A series of 6 cases of acquired melanocytic nevi which suddenly developed a targetoid halo were included in the study. All lesions were evaluated by dermoscopy. Three cases were surgically removed at different stages of evolution and submitted to histopathologic examination. In all cases, follow-up was obtained.

Results: All the lesions arose on trauma-prone skin sites of young women. The sudden development of an asymptomatic, targetoid halo on a long-lasting, acquired exophytic nevus was the main presentation. Whereas the central nevus persisted, the ecchymotic halo ultimately disappeared. Histopathologic examination disclosed changes of the traumatized nevus in the central part, whereas the ring showed hemorrhage and hemosiderin deposits. Increased numbers of small vessels with hobnail characteristics were associated features.

Conclusions: Targetoid hemosiderotic nevus is a distinctive clinicopathologic variant of traumatized acquired melanocytic nevus which should be included in the list of clinical simulators of melanoma.
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http://dx.doi.org/10.1159/000083510DOI Listing
June 2005

Psoriasis-like dermoscopic pattern of clear cell acanthoma.

J Eur Acad Dermatol Venereol 2003 Jul;17(4):452-5

Dermatology Unit, A. Murri Hospital Via dei Colli, 52 60035 Jesi-AN-Italy.

Background: Dermoscopy provides additional criteria for the diagnosis of skin lesions.

Objective: To investigate the dermoscopic aspect of clear cell acanthoma (CCA).

Methods: Six consecutive cases of CCAs were observed under conventional dermoscopy (Case 1-4) or videodermoscopy (Case 5-6).

Results: Common dermoscopic findings were: (i) squamous surface with translucid collarette; (ii) dilated capillary loops, mainly perpendicularly orientated to the skin surface, as dotted, pinpoint-like structures, regularly distributed in a reticular array over the surface.

Conclusions: The vascular psoriasis-like dermoscopic findings seem to be a clue for CCA and provide evidence of an inflammatory process for CCA formation.
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http://dx.doi.org/10.1046/j.1468-3083.2003.00754.xDOI Listing
July 2003
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