Riccardo Pampena

Correlations between Psoriasis and Inflammatory Bowel Diseases

For a long time the relationship between inflammatory bowel diseases (IBDs) and psoriasis has been investigated by epidemiological studies. It is only starting from the 1990s that genetic and immunological aspects have been focused on. Psoriasis and IBD are strictly related inflammatory diseases. Skin and bowel represent, at the same time, barrier and connection between the inner and the outer sides of the body. The most important genetic correlations involve the chromosomal loci 6p22, 16q, 1p31, and 5q33 which map several genes involved in innate and adaptive immunity. The genetic background represents the substrate to the common immune processes involved in psoriasis and IBD. In the past, psoriasis and IBD were considered Th1-related disorders. Nowadays the role of new T cells populations has been highlighted. A key role is played by Th17 and T-regs cells as by the balance between these two cells types. New cytokines and T cells populations, as IL-17A, IL-22, and Th22 cells, could play an important pathogenetic role in psoriasis and IBD. The therapeutic overlaps further support the hypothesis of a common pathogenesis.

Clinical Indications for Use of Reflectance Confocal Microscopy for Skin Cancer Diagnosis

Importance Reflectance confocal microscopy (RCM) improves diagnostic accuracy in skin cancer detection when combined with dermoscopy; however, little evidence has been gathered regarding its real impact on routine clinical workflow, and, to our knowledge, no studies have defined the terms for its optimal application. Objective To identify lesions on which RCM performs better in terms of diagnostic accuracy and consequently to outline the best indications for use of RCM. Design, Setting, and Participants Prospectively acquired and evaluated RCM images from consecutive patients with at least 1 clinically and/or dermoscopically equivocal skin lesion referred to RCM imaging, from January 2012 to October 2014, carried out in a tertiary referral academic center. Main Outcomes and Measures A total of 1279 equivocal skin lesions were sent for RCM imaging. Spearman correlation, univariate, and multivariate regression models were performed to find features significantly correlated with RCM outcome. Results In a total of 1279 lesions in 1147 patients, RCM sensitivity and specificity were 95.3% and 83.9%, respectively. The number of lesions needed to excise to rule out a melanoma was 2.4. After univariate and multivariate regression analysis, head and neck resulted as the most appropriate body location for confocal examination; RCM showed a high diagnostic accuracy for lesions located on sun-damaged skin (adjusted odds ratio [aOR], 2.13; 95% CI, 1.37-3.30; P=.001) and typified by dermoscopic regression (aOR, 2.13; 95% CI, 1.31-3.47; P=.002) or basal-cell carcinoma specific criteria (aOR, 9.35; 95% CI, 1.28-68.58; P=.03). Conclusions and Relevance Lesions located on the head and neck, damaged by chronic sun-exposure, and dermoscopically typified by regression represent best indications for the use of RCM.

Orthovoltage radiotherapy for nonmelanoma skin cancer (NMSC): Comparison between 2 different schedules.

BACKGROUND Radiotherapy is an established treatment for some types of patients with nonmelanoma skin cancer. A hypofractionated schedule has been proposed as a valuable option for elderly disabled patients to minimize the number of hospital visits. OBJECTIVE We sought to compare a weekly hypofractionated orthovoltage radiotherapy regimen with a standard daily one for the treatment of nonmelanoma skin cancer. METHODS A retrospective cohort study was performed on 436 tumors. Overall survival, disease-free survival, and cosmetic outcome were measured. Life-table analysis, Kaplan-Meier survival analysis, and multivariate Cox regression model were performed. RESULTS The hypofractionated regimen was not associated with increased recurrence rates and mortality, or with a poorer cosmetic outcome, when compared with the daily schedule. LIMITATIONS Absence of complete information about acute treatment toxicity and a shorter follow-up time for patients receiving the weekly schedule are limitations of this study. CONCLUSIONS A weekly hypofractionated regimen of orthovoltage radiotherapy seems to be the most appropriate approach in elderly disabled patients with nonmelanoma skin cancers.

A meta-analysis of nevus-associated melanoma: Prevalence and practical implications

&NA; The reported prevalence of nevus‐associated melanoma varies substantially. We performed a systematic review and meta‐analysis to determine the incidence and prevalence of this disease; we also performed subanalyses considering age, tumor thickness, and nevus‐type classification. In 38 observational cohort and case‐control studies, 29.1% of melanomas likely arose from a preexisting nevus and 70.9% de novo. Any given melanoma was 64% less likely to be nevus‐associated than de novo (risk ratio 0.36, 95% confidence interval [CI] 0.29–0.44; P < .001; I2 = 99%); nevus‐associated melanomas had a lower mean Breslow thickness than de novo melanomas (mean difference ‐0.39 mm; 95% CI ‐0.60 to ‐0.18; P = .0003; I2 = 66%). No significant differences were noted regarding the association of nevus‐associated melanomas with nondysplastic nevi or dysplastic nevi (risk ratio 0.77, 95% CI 0.49–1.20; P = .24; I2 = 98%).

Isotretinoin for the treatment of squamous cell carcinoma arising on an epidermoid cyst.

A 63‐year‐old man showed multiple concentric erythemato‐nodular lesions of approximately 1.5–3 cm in diameter, located in the parietal and temporal region. The skin biopsy allowed histological diagnosis of infundibular epidermal cyst associated with chronic granulomatous flogosis; in one of these, a well‐differentiated squamous cell carcinoma arising from the cyst wall was found. The patient received isotretinoin at the daily dosage of 0.5 mg/kg/day for 5 months. During 1‐year follow‐up, laboratory tests, computed tomography scans, and control histology were all in the normal range, with a good improvement of the lesions. Epidermal cysts and squamous cell carcinoma are both commonly encountered in practice. However, the association of epidermal inclusion cysts and squamous cell carcinoma in the skin is very rare. In some cases, including the present one, more potent chemopreventive strategies, such as the use of systemic retinoids, must be considered. Systemic retinoids are the most heavily researched chemopreventive agents and have shown promise for multiple types of cancer, including bladder and head and neck carcinomas. We would like to recommend the possibility to administer retinoids in a squamous cell carcinoma, achieving very satisfactory results; in our case, a complete remission of malignant lesion and an improvement of epidermal cysts were made, without the development of side effects associated with retinoids.

In vivo dermoscopic and confocal microscopy multistep algorithm to detect in situ melanomas

Although several dermoscopic features of in situ melanoma have been identified, data on confocal features of in situ melanoma are still lacking.

Fully regressive lesions: how dermoscopy can help us?

and a markedly increased bilateral pigmentation of the ocular fundus. The family history was unremarkable. In consideration of all findings and available information a diagnosis of PS was made. Phacomatosis spilorosea represents a distinct type within the group of phacomatosis pigmentovascularis (PPV). It is defined by a coexistence of segmental nevus spilus of the macular type and nevus roseus. The exact pathogenesis of PPV remains unclear. The hypothesis of non-allelic twin spotting as previously proposed by one of us has recently been withdrawn by the author. Until 2005, this phenotype was called PPV type III. PS is a very rare entity with only a few cases described in the available literature. It may occur with or without extracutaneous pathologies (Table 1). A thorough examination of our patient revealed several unreported findings including delay of speech, language, gross and fine motor skills, cognitive development, macrocephaly, obesity, muscular hypotonia, and irregular astigmatism. So far, however, we cannot exclude that some of these pathologies may simply represent incidental findings. The scoliosis of our patient was the only feature being previously reported in association with PS. Our patient was examined every 6 months without any newly occurring systemic findings over the past years. Periodic followup examinations of the pigmented skin lesions by digital dermoscopy in combination with total body photography seem necessary, due to a malignant transformation rate of 25% in large macular nevus spilus. Ergotherapeutic and logopedic treatment over several years led to a complete normalization of earlier restrictions concerning speech and motor skills. In conclusion, knowledge of diagnostic criteria and frequently associated systemic findings of PS may prove to be helpful for clinicians to recommend diagnostic procedures and periodic follow-up examinations.

Cardiovascular Risk in Psoriatic Patients Detected by Heart Rate Variability (HRV) Analysis

Postmarketing Phase IV

Tracking actinic keratosis of face and scalp treated with 0.015% ingenol mebutate to identify clinical and dermoscopic predictors of treatment response

Ingenol mebutate (IngMeb) 0.015% gel is an approved field treatment option for non‐hyperkeratotic non‐hypertrophic actinic keratosis (AK) of face and scalp. Efficacy of IngMeb has been assessed only on a clinical ground, in the majority of studies. Dermoscopy is a pivotal tool for the diagnosis of AK, while its role in evaluating the response to non‐surgical therapies for AK has not been fully defined.

Integration of dermoscopy and reflectance confocal microscopy for distinguishing melanomas from nevi of the breast area

Nevi of special sites encompass a class of benign lesions characterized by the presence of atypical clinical and histopathological features that can be difficult to distinguish from melanoma. Dermoscopy and reflectance confocal microscopy may improve the clinical assessment of melanocytic lesions to avoid unnecessary excisions.