Race-Specific and Skin of Color Dermatoscopic Characteristics of Skin Cancer: A Literature Review

Introduction: Individuals with melanin-rich skin account for the majority of the world's population. However, literature data regarding dermoscopic characteristics of skin cancer in skin of color (SoC) are scarce. The dermoscopic characteristics of cutaneous tumors might differ among skin types due to heterogeneity in composition and pigmentation. Objectives: To summarize literature data on the dermoscopic findings of skin neoplasms according to the skin color and race. Methods:  The literature search was performed using the PubMed database up to December 30, 2022, and was conducted with the use of terms referring to dermoscopy, race (Caucasians, Hispanics, Asians, and Black/African), and skin cancer types (basal cell carcinoma [BCC], squamous cell carcinoma [SCC], keratoacanthoma, Bowen disease, and melanoma). Results: In total, 30 race-specific records were included. Nine SoC records for BCCs (2 BCC studies in Hispanics, 1 BCC study in Black individuals, and 6 BCC studies in Asians), 9 SoC records for SCCs ( 1 SCC study in Hispanics ,1 SCC study in Black individuals and 7 SCCs in Asian population), and 8 SoC records for melanoma (2 melanoma studies in Hispanics, 1  in Blacks, and 5  in Asians) were compared with 4 records that involved only a Caucasian population, according to their participant section as well as with studies on dermoscopy characteristics without focusing on race origins and phototype of the patient. Conclusion: Based on a review of studies including Caucasians, Hispanics, Asians and Blacks /Africans, SoC patients present with more frequent and unique dermatoscopy features of skin cancers.

Photodynamic Therapy for Field Cancerization in the Skin: Where Do We Stand?

Introduction: Photodynamic therapy (PDT) with a photosensitizer is available for the treatment of multiple actinic keratoses (AKs) in a restricted skin area or, as it is established, for the field-cancerized skin. Objectives: Our review aims to present the up-to-date literature on skin field cancerization using PDT employing different topical photosensitizers, modified light delivery protocols and combination treatments to obtain excellent efficacy and safety in everyday clinical practice. Methods: We sought PubMed, MEDLINE, Scopus, OVID, Embase, Science Direct, Cochrane Library, Research Gate and Google Scholar for [(aminolevulinic acid OR aminolevulinate) AND photodynamic therapy] with (field-directed OR field cancerization, (actinic keratosis), and (efficacy OR effectiveness OR pain OR tolerability) for studies published until February 2023. Results: Advantages of PDT compared to the other field treatments, including imiquimod, 5-fluorouracil, ingenol mebutate gel and diclofenac, reported better cosmetic outcomes and greater patient satisfaction. On the other hand, some drawbacks of field PDT include pain and treatment duration. Alternate illumination methods have also been investigated, including daylight as a light source. Pretreating the affected area may enhance photosensitizer absorption leading to better therapeutic results, while combinational treatments have also been tested. Patients prefer daylight PDT to traditional light sources since it is more well-tolerated and equally effective. Even as a preventive treatment, field PDT yields promising outcomes, especially for high-risk individuals, including organ transplant recipients. Conclusion: This review provides a thorough display of the field of PDT on cancerized skin, which will facilitate physicians in applying PDT more efficiently and intuitively

Dermoscopy in the Diagnosis of Mycosis Fungoides: Can it Help?

Introduction: The diagnosis of mycosis fungoides (MF) is challenging since it can mimic a variety of benign skin conditions. Multiple biopsies for histopathologic and immunohistochemical examination are required to diagnose MF. Dermoscopy is an affordable, non-invasive device with expanding indi-cations in dermatology, Objectives: To investigate the dermoscopic morphology of MF variants and assess the correlation between dermoscopic criteria, histopathologic, and immunohistochemical findings, Methods: We included 88 patients with several MF variants (classic, hypopigmented, hyperpigment-ed, poikilodermatous, erythrodermic, and folliculotropic).The diagnosis was histopathologically and immunohistochemically confirmed. Dermoscopic findings were collected, statistically analyzed, and correlated with the results of histopathology and immunohistochemistry, Results: All patients had MF diagnosis in H&E-stained sections.The majority revealed positive stain-ing with CD3, 4, 8 and negative CD7. Orange-red areas of discoloration, short linear, and spermato-zoa like blood vessels are the most frequent dermoscopic findings, while an analysis per MF variant was also performed.The frequently observed dermoscopic structures in classic MF were patchy whit-ish scales, dotted, short linear vessels, and spermatozoa-like vessels, Conclusions: Dermoscopy reveals a repetitive dermoscopic pattern in MF (non-homogenous pink to erythematous background, patchy areas of orange discoloration, patchy whitish scales, dotted and short linear blood vessels with some variations according to the clinical variant

Dermoscopic Ulceration is a Predictor of Basal Cell Carcinoma Response to Imiquimod: A Retrospective Study

Imiquimod is considered one of the treatments of choice for low-risk superficial basal cell carcinoma (sBCC) and an alternative option for non-superficial tumours when surgery is contraindicated or not feasible (1\u20133). In addition to its well-known value in the diagnosis of BCC, dermoscopy has recently been shown to provide valid information about the histopathological subtype or the presence of clinically undetectable pigmentation (4\u20136). The aim of the present study was to investigate whether dermoscopic criteria (especially ulceration) of the primary tumour can predict a favourable response of BCC to imiquimod

Likelihood of finding melanoma when removing a Spitzoid-looking lesion in patients aged 12 years or older

Dermoscopy improves the recognition of melanoma and Spitz nevus but occasionally melanoma may exhibit a symmetric pattern mimicking Spitz nevus

Indications for Digital Monitoring of Patients With Multiple Nevi: Recommendations from the International Dermoscopy Society

Introduction: In patients with multiple nevi, sequential imaging using total body skin photography (TBSP) coupled with digital dermoscopy (DD) documentation reduces unnecessary excisions and improves the early detection of melanoma. Correct patient selection is essential for optimizing the efficacy of this diagnostic approach. Objectives: The purpose of the study was to identify, via expert consensus, the best indications for TBSP and DD follow-up. Methods: This study was performed on behalf of the International Dermoscopy Society (IDS). We attained consensus by using an e-Delphi methodology. The panel of participants included international experts in dermoscopy. In each Delphi round, experts were asked to select from a list of indications for TBSP and DD. Results: Expert consensus was attained after 3 rounds of Delphi. Participants considered a total nevus count of 60 or more nevi or the presence of a CDKN2A mutation sufficient to refer the patient for digital monitoring.  Patients with more than 40 nevi were only considered an indication in case of personal history of melanoma or red hair and/or a MC1R mutation or history of organ transplantation. Conclusions: Our recommendations support clinicians in choosing appropriate follow-up regimens for patients with multiple nevi and in applying the time-consuming procedure of sequential imaging more efficiently. Further studies and real-life data are needed to confirm the usefulness of this list of indications in clinical practice

Seven Plus One Steps to Assess Pigmented Nail Bands (Melanonychia Striata Longitudinalis)

Melanonychia striata longitudinalis might involve one or more fingers and/or toes and might result from several different causes, including benign and malignant tumors, trauma, infections, and acti-vation of melanocytes that might be reactive or related to the pigmentary trait,drugs and some rare syndromes.This broad differential diagnosis renders the clinical assessment of melanonychia striata particularly challenging. Nail matrix melanoma is relatively rare, occurs almost always in adults in-volves more frequently the first toe or thumb.The most common nail unit cancer,squamous cell carcinoma / Bowen disease (SCC) of the nail matrix is seldom pigmented. Histopathologic examina-tion remains the gold standard for melanoma and SCC diagnosis,but excisional or partial biopsies from the nail matrix require training and is not routinely performed by the majority of clinicians.Furthermore, the histopathologic evaluation of melanocytic lesions of the nail matrix is particularly challenging, since early melanoma has only bland histopathologic alterations. Dermatoscopy of the nail plate and its free edge significantly improves the clinical diagnosis, since specific patterns have been associated to each one of the causes of melanonychia. Based on knowledge generated and pub-lished in the last decades, we propose herein a stepwise diagnostic approach for melanonychia striata longitudinalis: 1) Hemorrhage first 2) Age matters 3) Number of nails matters 4) Free edge matters 5) Brown or gray? 6) Size matters 7) Regular or irregular and, finally,“follow back”