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Melanoma: HELP
Articles by Giovanni Pellacani
Based on 125 articles published since 2008

Between 2008 and 2019, G. Pellacani wrote the following 125 articles about Melanoma.
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5
1 Guideline Spitz/Reed nevi: proposal of management recommendations by the Dermoscopy Study Group of the Italian Society of Dermatology (SIDeMaST). 2014

Broganelli, P / Titli, S / Lallas, A / Alaibac M Annetta, A / Battarra, V / Brunetti, B / Castagno, I / Cavicchini, S / Ferrari, A / Ghigliotti, G / Landi, C / Manganoni, A / Moscarella, E / Pellacani, G / Pizzichetta, M A / Rosina, P / Rubegni, P / Satta, R / Scalvenzi, M / Stanganelli, I / Stinco, G / Zalaudek, I / Zampieri, P / Argenziano, G / Anonymous1410806. ·Department of Oncology and Hematology, Section of Dermatology, City of Health and Science Hospital of Turin, Turin, Italy - paolobroganelli@inwind.it. ·G Ital Dermatol Venereol · Pubmed #25213387.

ABSTRACT: -- No abstract --

2 Editorial Three roots of melanoma. 2008

Zalaudek, Iris / Marghoob, Ashfaq A / Scope, Alon / Leinweber, Bernd / Ferrara, Gerardo / Hofmann-Wellenhof, Rainer / Pellacani, Giovanni / Soyer, H Peter / Argenziano, Giuseppe. · ·Arch Dermatol · Pubmed #18936403.

ABSTRACT: -- No abstract --

3 Review Role of In Vivo Reflectance Confocal Microscopy in the Analysis of Melanocytic Lesions. 2018

Serban, Elena-Daniela / Farnetani, Francesca / Pellacani, Giovanni / Constantin, Maria Magdalena. ·Elena-Daniela Serban, MD, Department of Medical Oncology, University of Bologna, 40138 Bologna; Italy. ·Acta Dermatovenerol Croat · Pubmed #29782304.

ABSTRACT: Worldwide melanoma incidence and mortality are increasing (1). Despite the ongoing research, advanced melanoma is still incurable; therefore, the most appropriate solution seems to be early detection combined with complete surgical excision (2). Since the diagnostic protocol of suspicious lesions includes a complete excision with safety margins (2), the problem of unnecessary scarring is significant. The real challenge in this case is to have a properly formulated diagnosis before acquiring a biopsy. Currently available non-invasive techniques are coherence tomography, digital dermoscopy, and reflectance confocal microscopy. All these techniques allow for a presumptive diagnosis, but the most promising results are provided by reflectance confocal microscopy. Reflectance confocal microscopy (RCM) is an optical imaging technique that uses a laser diode as a source of coherent monochromatic light which penetrates the tissue and illuminates a single point. Light from the stimulated section is reflected and passes through a filter, thereby forming the image on the detector. This filter enables selective excitation of a particular point on which focus is achieved and rejects reflection from the out-of-focus area, thus obtaining a "confocal" image. Contrast is the result of differences in the refractive index of the cell organelles and microstructures, resulting in white structures on a black background. This technique allows, as opposed to conventional light microscopy, the analysis of sections obtained at a bi- or tri-dimensional level and controlling the depth of the field, permitting out-of-focus artifacts to be eliminated. In dermatology, this technique is useful for both clinical and research purposes. It is the only technique that allows horizontal viewing of the skin up to the superficial dermis (approximately 300 mm, at a cellular level resolution (0.5-1.0 μm in the lateral dimension and 4.0-5.0 μm in the axial dimension) (3). It allows both in vivo and ex vivo diagnosis, while providing the possibility for long-term monitoring. It has proved to be especially valuable for in vivo examinations of melanocytic lesions, whereas melanin and melanosomes are a powerful source of contrast, allowing the individualization of melanocytic cells (4). We report the case of a 65-year-old Caucasian woman who presented to the Dermatology Department of University of Modena and Reggio Emilia, Italy, for the examination of an atypical lesion, of unknown history, localized in the right preauricular area. The patient's personal and family histories were negative for skin malignancies and for other significant medical history. The clinical presentation was highly indicative of malignancy, as it met all the ABCD clinical criteria: an asymmetric papule composed of two areas, one pigmented and another one hypopigmented, with ill-defined borders and a diameter of approximately 2 cm. The dermatoscopic examination revealed an asymmetric multicomponent pattern with atypical network, structureless areas, peripheral irregular globules, and a blue-white veil. Because clinical and dermatoscopic features pointed towards a suspicious lesion which was situated on the face, where unnecessary scarring is unwanted, reflectance confocal microscopy (RCM) examination was proposed and performed (VivaScope 3000; MAVIG GmBH, Munich, Germany) (5). It revealed the following features: the epidermis presented a disarranged pattern; the dermo-epidermal junction and superficial dermis presented a meshwork pattern with edged AND non-edged papillae, non-homogenous junctional clusters, dense nests, dense AND sparse nests, and atypical cells in a sparse distribution (Figure 1). Figure 1. (A) Clinical examination of an atypical melanocytic lesion situated at the right preauricular area. (B) Dermatoscopic examination. (C) Confocal examination of dermo-epidermal junction and superficial dermis which reveals a meshwork pattern (yellow circle) with edged AND non-edged papillae, non-homogenous junctional clusters (yellow star), dense nests, dense AND sparse nests (red star) and atypical cells in a sparse distribution (arrow). The clinical and confocal data indicated a malignant melanocytic tumor, so an excisional biopsy with safety margins was performed. The histopathological report indicated superficial spreading melanoma with a Breslow of 0.55 mm and 0 mitosis/mm2. This case illustrates the important role confocal microscopy examination has in the management of melanocytic lesions situated in special areas like the face. Reflectance confocal microscopy is an imaging technique that allows viewing the layers of the skin up to the superficial dermis and therefore turns out to be extremely useful in obtaining a pertinent diagnosis before acquiring a biopsy. According to the data available so far, it was established that reflectance confocal microscopy increases the diagnostic accuracy for melanocytic lesions in both pigmented and hypopigmented lesions. In a study conducted by Borsari et al., reflectance confocal microscopy proved to have a sensibility and specificity of 95.3% and 83.9%, respectively (6). By improving the accuracy of clinical and dermatoscopic diagnosis, the reflectance confocal microscopy technique contributes to increasing the confidence of the clinical and dermatoscopic diagnosis (7). In this regard, confocal reflectance microscopy reduces unnecessary excisions, particularly in cases of damage to cosmetically important areas, such as the face or the neck, simultaneously detecting the malignant lesions that require a surgical approach, as seen in the case presented, where confirmation of the diagnosis by confocal microscopy allowed for a safe excision. In fact, the head and neck are the most appropriate body location for reflectance confocal examination, especially because RCM showed a high diagnostic accuracy for lesions located on sun-damaged skin, as these two areas frequently are (adjusted odds ratio (aOR), 2.13; 95% confidence interval (CI), 1.37-3.30; P=.001) (6). Reflectance confocal microscopy is very helpful in the management of special lesions, like facial lentigo maligna melanoma. This type of lesion is considered to be a real challenge for the dermatologist because of its clinical and morphological features that are similar to other lesions such as solar lentigines and pigmented actinic keratoses. In this case, reflectance confocal excels at specificity of the diagnosis, but also at to the ability to define the margins more accurately, permitting a pre-surgical mapping and for possibility of identifying the optimal site for biopsy (8,9). By improving diagnostic ability, reflectance confocal microscopy technique may contribute to the selection of lesions that may be eligible for non-surgical treatment. Facial pigmented non-melanocytic macules like solar lentigo, flat seborrheic keratosis, lichen planus-like keratosis, and pigmented actinic keratosis can mimic a lentigo maligna, or even a lentigo maligna melanoma, but with the help of the RCM, an accurate diagnosis can be established, sparing the patient can be from unwanted facial scars using a non-surgical approach (laser, cryotherapy, imiquimod) (10,11). Furthermore, reflectance confocal microscopy can be a valuable method for the monitoring of a skin lesion over time, especially melanocytic nevi, reducing unnecessary surgical excision, such as for patients with multiple atypical nevi that undergo multiple biopsies (12,13). Like all other diagnostic methods, RCM has its limitations: palmoplantar lesions (due to thickened epidermis), ulcers or crusts on a large lesion, lesions localized in inaccessible regions such as interdigital space, nasal wing (3). To summarize, reflectance confocal microscopy can improve clinical and dermatoscopic diagnosis of melanocytic lesions, detecting the lesions that need an invasive approach and preventing unnecessary excision. It has proven to be very helpful in the management of lentigo maligna and lentigo maligna melanoma, achieving high specificity in the diagnosis and simultaneously allowing an optimal approach. This technique can be a reliable bridge between dermoscopy and histopathology, being able to provide an alternative to histopathological examination. Special mention must be made of the factors that may change the result to a false negative such as hyperkeratosis, ulceration, or bleeding, so any results should be integrated with the rest of the patient's data.

4 Review In Vivo and Ex Vivo Confocal Microscopy for Dermatologic and Mohs Surgeons. 2016

Longo, Caterina / Ragazzi, Moira / Rajadhyaksha, Milind / Nehal, Kishwer / Bennassar, Antoni / Pellacani, Giovanni / Malvehy Guilera, Josep. ·Skin Cancer Unit, Arcispedale Santa Maria Nuova-IRCCS, viale Risorgimento 80, Reggio Emilia 42100, Italy. Electronic address: longo.caterina@gmail.com. · Pathology Unit, Arcispedale Santa Maria Nuova-IRCCS, viale Risorgimento 80, Reggio Emilia 42100, Italy. · Dermatology Service, Memorial Sloan Kettering Cancer Center, 160 East 53rd Street, New York, NY 10022, USA. · Melanoma Unit, Dermatology Department, Hospital Clinic and Institut d'Investigacions Biomediques August Pi I Sunyer, Barcelona, Spain. · Dermatology Unit, UniMore, Modena, Italy. ·Dermatol Clin · Pubmed #27692455.

ABSTRACT: Confocal microscopy is a modern imaging device that has been extensively applied in skin oncology. More specifically, for tumor margin assessment, it has been used in two modalities: reflectance mode (in vivo on skin patient) and fluorescence mode (on freshly excised specimen). Although in vivo reflectance confocal microscopy is an add-on tool for lentigo maligna mapping, fluorescence confocal microscopy is far superior for basal cell carcinoma and squamous cell carcinoma margin assessment in the Mohs setting. This article provides a comprehensive overview of the use of confocal microscopy for skin cancer margin evaluation.

5 Review Melanomas. 2016

Longo, Caterina / Pellacani, Giovanni. ·Skin Cancer Unit, Arcispedale S. Maria Nuova-IRCCS, Viale Risorgimento, 80, Reggio Emilia 42100, Italy. Electronic address: longo.caterina@gmail.com. · Dermatology Unit, UniMore, via del Pozzo, 71, Modena 41121, Italy. ·Dermatol Clin · Pubmed #27692447.

ABSTRACT: Melanomas are a wide range of tumors that differ in their epidemiology, morphology, genetic profile, and biological behavior. They can be grouped as superficial spreading melanoma, lentigo maligna, and nodular melanoma. Reflectance confocal microscopy is useful for the evaluation of skin lesions that are dermoscopically doubtful by increasing diagnostic accuracy and specificity. This article provides a comprehensive overview of the different confocal main morphologies of distinct melanoma types as a function of the anatomic location of the tumor.

6 Review Basics of Confocal Microscopy and the Complexity of Diagnosing Skin Tumors: New Imaging Tools in Clinical Practice, Diagnostic Workflows, Cost-Estimate, and New Trends. 2016

Que, Syril Keena T / Grant-Kels, Jane M / Longo, Caterina / Pellacani, Giovanni. ·Department of Dermatology, University of Connecticut Health Center, 263 Farmington Avenue, MC 6231, Farmington, CT 06030-6231, USA. Electronic address: keenaq@gmail.com. · Department of Dermatology, University of Connecticut Health Center, 263 Farmington Avenue, MC 6231, Farmington, CT 06030-6231, USA. · Skin Cancer Unit, Arcispedale S. Maria Nuova-IRCCS, viale risorgimento, 80, 42100 Reggio Emilia, Italy. · Department of Dermatology, University of Modena and Reggio Emilia, via del Pozzo 71, Modena 41124, Italy. ·Dermatol Clin · Pubmed #27692444.

ABSTRACT: The use of reflectance confocal microscopy (RCM) and other noninvasive imaging devices can potentially streamline clinical care, leading to more precise and efficient management of skin cancer. This article explores the potential role of RCM in cutaneous oncology, as an adjunct to more established techniques of detecting and monitoring for skin cancer, such as dermoscopy and total body photography. Discussed are current barriers to the adoption of RCM, diagnostic workflows and standards of care in the United States and Europe, and medicolegal issues. The potential role of RCM and other similar technological innovations in the enhancement of dermatologic care is evaluated.

7 Review Advances in noninvasive imaging of melanoma. 2016

Menge, Tyler D / Pellacani, Giovanni. ·University of Michigan Medical School, Ann Arbor, Michigan, USA. tmenge@umich.edu. · University of Modena and Reggio Emilia, Modena, Italy. pellacani.giovanni@gmail.com. ·Semin Cutan Med Surg · Pubmed #26963113.

ABSTRACT: Melanoma is the most dangerous type of skin cancer and its incidence has risen sharply in recent decades. Early detection of disease is critical for improving patient outcomes. Any pigmented lesion that is clinically concerning must be removed by biopsy for morphologic investigation on histology. However, biopsies are invasive and can cause significant morbidity, and their accuracy in detecting melanoma may be limited by sampling error. The advent of noninvasive imaging devices has allowed for assessment of intact skin, thereby minimizing the need for biopsy; and these technologies are increasingly being used in the diagnosis and management of melanoma. Reflectance confocal microscopy, optical coherence tomography, ultrasonography, and multispectral imaging are noninvasive imaging techniques that have emerged as diagnostic aids to physical exam and/or conventional dermoscopy. This review summarizes the current knowledge about these techniques and discusses their practical applications and limitations.

8 Review Methods of Melanoma Detection. 2016

Leachman, Sancy A / Cassidy, Pamela B / Chen, Suephy C / Curiel, Clara / Geller, Alan / Gareau, Daniel / Pellacani, Giovanni / Grichnik, James M / Malvehy, Josep / North, Jeffrey / Jacques, Steven L / Petrie, Tracy / Puig, Susana / Swetter, Susan M / Tofte, Susan / Weinstock, Martin A. ·Department of Dermatology and Knight Cancer Institute, Oregon Health and Science University, 3303 SW Bond Avenue, CH16D, Portland, OR, 97239, USA. leachmas@ohsu.edu. · Department of Dermatology and Knight Cancer Institute, Oregon Health and Science University, 3125 SW Sam Jackson Park Road, L468R, Portland, OR, 97239, USA. cassidyp@ohsu.edu. · Department of Dermatology, Emory University School of Medicine, 1525 Clifton Road NE, 1st Floor, Atlanta, GA, 30322, USA. schen2@emory.edu. · Department of Dermatology and Arizona Cancer Center, University of Arizona, 1515 N Campbell Avenue, Tucson, AZ, 85721, USA. ccuriel@email.arizona.edu. · Department of Dermatology, Harvard School of Public Health and Massachusetts General Hospital, Landmark Center, 401 Park Drive, 3rd Floor East, Boston, MA, 02215, USA. ageller@hsph.harvard.edu. · Laboratory of Investigative Dermatology, The Rockefeller University, 1230 York Avenue, New York, NY, 10065, USA. daniel.gareau@rockefeller.edu. · Department of Dermatology, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, Italy. giovanni.pellacani@unimore.it. · Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Room 912, BRB (R-125), 1501 NW 10th Avenue, Miami, FL, 33136, USA. grichnik@miami.edu. · Melanoma Unit, Dermatology Department, Hospital Clinic Barcelona, Villarroel 170, 08036, Barcelona, Spain. jmalvehy@clinic.ub.es. · University of California, San Francisco, 1701 Divisadero Street, Suite 280, San Francisco, CA, 94115, USA. jeffrey.north@ucsf.edu. · Department of Biomedical Engineering and Dermatology, Oregon Health and Science University, 3303 SW Bond Avenue, CH13B, Portland, OR, 97239, USA. jacquess@ohsu.edu. · Department of Biomedical Engineering, Oregon Health and Science University, 3303 SW Bond Avenue, CH13B, Portland, OR, 97239, USA. petrie@ohsu.edu. · Melanoma Unit, Dermatology Department, Hospital Clinic Barcelona, Villarroel 170, 08036, Barcelona, Spain. spuig@clinic.ub.es. · Department of Dermatology/Cutaneous Oncology, Stanford University, 900 Blake Wilbur Drive, W3045, Stanford, CA, 94305, USA. sswetter@stanford.edu. · Department of Dermatology, Oregon Health and Science University, 3303 SW Bond Avenue, CH16D, Portland, OR, 97239, USA. toftes@ohsu.edu. · Departments of Dermatology and Epidemiology, Brown University, V A Medical Center 111D, 830 Chalkstone Avenue, Providence, RI, 02908, USA. maw@brown.edu. ·Cancer Treat Res · Pubmed #26601859.

ABSTRACT: Detection and removal of melanoma, before it has metastasized, dramatically improves prognosis and survival. The purpose of this chapter is to (1) summarize current methods of melanoma detection and (2) review state-of-the-art detection methods and technologies that have the potential to reduce melanoma mortality. Current strategies for the detection of melanoma range from population-based educational campaigns and screening to the use of algorithm-driven imaging technologies and performance of assays that identify markers of transformation. This chapter will begin by describing state-of-the-art methods for educating and increasing awareness of at-risk individuals and for performing comprehensive screening examinations. Standard and advanced photographic methods designed to improve reliability and reproducibility of the clinical examination will also be reviewed. Devices that magnify and/or enhance malignant features of individual melanocytic lesions (and algorithms that are available to interpret the results obtained from these devices) will be compared and contrasted. In vivo confocal microscopy and other cellular-level in vivo technologies will be compared to traditional tissue biopsy, and the role of a noninvasive "optical biopsy" in the clinical setting will be discussed. Finally, cellular and molecular methods that have been applied to the diagnosis of melanoma, such as comparative genomic hybridization (CGH), fluorescent in situ hybridization (FISH), and quantitative reverse transcriptase polymerase chain reaction (qRT-PCR), will be discussed.

9 Review Update on the use of confocal microscopy in melanoma and non-melanoma skin cancer. 2015

Guida, S / Longo, C / Casari, A / Ciardo, S / Manfredini, M / Reggiani, C / Pellacani, G / Farnetani, F. ·Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy - stefania.guida@alice.it. ·G Ital Dermatol Venereol · Pubmed #26140397.

ABSTRACT: Reflectance confocal microscopy (RCM) is a new technique enabling the visualization of the skin at a quasi-histological resolution, allowing the identification of clues for the diagnosis of skin diseases. The aim of this analysis was to provide new insights into the role of RCM in the diagnosis of skin cancers. Data comes from the most recent literature, taking into account previous essential reported information in this field. The study eligibility criteria were: studies providing update information, focusing on RCM findings in melanoma and non-melanoma skin cancers (NMSC), without restrictions for age, sex, ethnicity. Duplicated studies and single case report were excluded from this study. A search concerning the role of RCM in melanoma and NMSC was performed on the Medline. RCM clues were analyzed for different skin cancers, in particular melanoma and NMSC, in association with clinical, dermoscopic and histopathologic findings. Diagnostic accuracy, sensibility and specificity of the technique were reviewed. Furthermore, some new findings have been described and recent applications have been discussed. The selection of articles was limited in order to provide an up-to-date revision. In conclusion, several RCM features were implemented for the diagnosis of melanoma and NMSC, leading to a confocal-based classification in most cases.

10 Review Reflectance confocal microscopy in the diagnosis of solitary pink skin tumours: review of diagnostic clues. 2015

Longo, C / Moscarella, E / Argenziano, G / Lallas, A / Raucci, M / Pellacani, G / Scope, A. ·Dermatology and Skin Cancer Unit, Arcispedale S. Maria Nuova, IRCCS, Viale Risorgimento 80, 42100, Reggio Emilia, Italy. · Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy. · Department of Dermatology, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. ·Br J Dermatol · Pubmed #25640416.

ABSTRACT: Reflectance confocal microscopy (RCM) is a noninvasive tool that can be helpful in the diagnosis of nonpigmented skin tumours. As RCM enables visualization of architectural and cytological structures at near-histological resolution, it can improve the diagnostic accuracy of dermoscopically equivocal solitary pink neoplasms. For management decisions, it is important to identify specific morphological clues that allow bedside classification of nonpigmented skin neoplasms into benign vs. malignant and melanocytic vs. nonmelanocytic. More specifically, the presence of a nested melanocytic proliferation at the dermoepidermal junction or dermis level permits the clinician to ascribe a given lesion as melanocytic; the identification of basaloid bright tumour islands is a key RCM feature for the diagnosis of basal cell carcinoma; and the presence of disarrayed epidermis along with small demarcated papillae is suggestive for the diagnosis of squamous cell carcinoma. The present review offers a comprehensive description of the main RCM diagnostic clues for solitary pink neoplasms that direct clinicians to the correct diagnosis and that may serve as groundwork for future prospective studies.

11 Review Blue lesions. 2013

Longo, Caterina / Scope, Alon / Lallas, Aimilios / Zalaudek, Iris / Moscarella, Elvira / Gardini, Stefano / Argenziano, Giuseppe / Pellacani, Giovanni. ·Skin Cancer Unit, Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, Reggio Emilia 42100, Italy. Electronic address: longo.caterina@gmail.com. ·Dermatol Clin · Pubmed #24075551.

ABSTRACT: Blue color is found in a wide range of malignant and benign melanocytic and nonmelanocytic lesions and in lesions that result from penetration of exogenous materials, such as radiation or amalgam tattoo or traumatic penetration of particles. Discriminating between different diagnostic entities that display blue color relies on careful patient examination and lesion assessment. Dermoscopically, the extent, distribution, and patterns created by blue color can help diagnose lesions with specificity and differentiate between benign and malignant entities. This article provides an overview of the main diagnoses whereby blue color can be found, providing simple management rules for these lesions.

12 Review A clinico-dermoscopic approach for skin cancer screening: recommendations involving a survey of the International Dermoscopy Society. 2013

Argenziano, Giuseppe / Giacomel, Jason / Zalaudek, Iris / Blum, Andreas / Braun, Ralph P / Cabo, Horacio / Halpern, Allan / Hofmann-Wellenhof, Rainer / Malvehy, Josep / Marghoob, Ashfaq A / Menzies, Scott / Moscarella, Elvira / Pellacani, Giovanni / Puig, Susana / Rabinovitz, Harold / Saida, Toshiaki / Seidenari, Stefania / Soyer, H Peter / Stolz, Wilhelm / Thomas, Luc / Kittler, Harald. ·Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS, Viale Risorgimento 80, Reggio Emilia 42100, Italy. Electronic address: g.argenziano@gmail.com. ·Dermatol Clin · Pubmed #24075542.

ABSTRACT: Dermoscopy is useful for skin cancer screening, but a detailed approach is required that integrates this tool into a rational clinical work flow. To investigate clinician perceptions and behavior in approaching patients with skin tumors, a survey was launched by electronic mail through the International Dermoscopy Society. After 4 months, the responses were analyzed and significant findings calculated. Considering the current approach of study participants in examining patients for skin cancer, an up-to-date system of triage is presented in this review, which aims to promote an improved diagnostic accuracy and more timely management of skin malignancy.

13 Review Early diagnosis of melanoma: what is the impact of dermoscopy? 2012

Argenziano, Giuseppe / Albertini, Giuseppe / Castagnetti, Fabio / De Pace, Barbara / Di Lernia, Vito / Longo, Caterina / Pellacani, Giovanni / Piana, Simonetta / Ricci, Cinzia / Zalaudek, Iris. ·Dermatology Unit, Medical Department, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. g.argenziano@gmail.com ·Dermatol Ther · Pubmed #23046019.

ABSTRACT: There are three possible explanations for the improved melanoma recognition when a clinician uses dermoscopy: first, the presence of early dermoscopy signs that become visible in melanoma much before the appearance of the classical clinical features; second, an increased attitude of clinicians to check more closely clinically banal-looking lesions; and third, an improved attitude of clinicians to monitor their patients. In this review, the light and the dark sides of melanoma screening are briefly discussed, including the need to find better strategies to decrease the number of unnecessary excision of benign lesions on one hand, and to finally decrease melanoma mortality rates on the other.

14 Review New directions in dermatopathology: in vivo confocal microscopy in clinical practice. 2012

Longo, Caterina / Zalaudek, Iris / Argenziano, Giuseppe / Pellacani, Giovanni. ·Dermatology and Skin Care Unit, Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42100 Reggio Emilia, Italy. ·Dermatol Clin · Pubmed #23021059.

ABSTRACT: In vivo confocal microscopy represents a new device that generates a virtual skin biopsy at cytologic resolution. This article describes the most relevant confocal findings and their histopathologic correlates in skin oncology and inflammatory diseases. The light and dark of confocal microscopy are briefly discussed in relation with its clinical applications.

15 Review Improving triage and management of patients with skin cancer: challenges and considerations for the future. 2012

Argenziano, Giuseppe / Giacomel, Jason / Abramavicus, Alexandre / Pellacani, Giovanni / Longo, Caterina / De Pace, Barbara / Albertini, Giuseppe / Cristofolini, Mario / Zalaudek, Iris. ·Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS, Viale Risorgimento 80, Reggio Emilia, Italy. g.argenziano@gmail.com ·Expert Rev Anticancer Ther · Pubmed #22594896.

ABSTRACT: Skin cancer is the most common malignancy in humans, thus representing a major health concern. Because of the increasing attention to skin cancer prevention, there has been a growing workload for dermatology clinics, with patients referred from primary care requiring assessment of suspicious skin tumors. This places a strain on limited specialist resources and can create a paradoxical situation wherein an early diagnosis becomes increasingly difficult for those patients who actually do suffer from skin cancer. The aim of these recommendations is to propose an updated, rational system of triage, involving improved accuracy of diagnosis and more timely management of skin cancer by both general practitioners and dermatologists.

16 Review Reflectance confocal microscopy for in vivo skin imaging. 2008

Calzavara-Pinton, Piergiacomo / Longo, Caterina / Venturini, Marina / Sala, Raffaella / Pellacani, Giovanni. ·Department of Dermatology, University of Brescia, Brescia, Italy. calzavar@med.unibs.it ·Photochem Photobiol · Pubmed #19067964.

ABSTRACT: Reflectance confocal microscopy (RCM) is a novel noninvasive technique for "in vivo" examination of the skin. In a confocal microscope, near- infrared light from a diode laser is focused on a microscopic skin target. As this light passes between cellular structures having different refraction indexes, it is naturally reflected, and this reflected light is then captured and recomposed into a two-dimensional gray scale image by computer software. Focusing the microscope (adjusting the focal point on the z-axis) allows images to be obtained of different levels within the skin. Commercially available microscope systems of this type can create images with enough detail for use in histological analysis. The first investigations using these microscopes served to identify the appearance of the various cell populations living in the different layers of normal skin. Today, the main interest has become focused on the use of these microscopes as a diagnostic tool: a means of investigating benign and malignant tumors of melanocytes and keratinocytes, and, more importantly, the findings of this field of study can be used to develop a diagnostic algorithm which would be not only highly sensitive but specific as well. The aim of the paper is to provide an updated literature review and an in-depth critique of the state-of-the-art of RCM for skin cancer imaging with a critical discussion of the possibilities and limitations for clinical use.

17 Clinical Trial The somatic affairs of BRAF: tailored therapies for advanced malignant melanoma and orphan non-V600E (V600R-M) mutations. 2013

Ponti, Giovanni / Pellacani, Giovanni / Tomasi, Aldo / Gelsomino, Fabio / Spallanzani, Andrea / Depenni, Roberta / Al Jalbout, Samer / Simi, Lisa / Garagnani, Lorella / Borsari, Stefania / Conti, Andrea / Ruini, Cristel / Fontana, Annalisa / Luppi, Gabriele. ·Department of Clinical and Diagnostic Medicine and Public Health, University Hospital of Modena and Reggio Emilia, Modena, Italy. giovanni.ponti@unimore.it ·J Clin Pathol · Pubmed #23463675.

ABSTRACT: BRAF V600R-M-D are uncommon mutations, not included in the experimental protocols of BRAF selective inhibitors. We report the evaluation of correlations among different types of BRAF somatic mutations in melanoma and their management with BRAF inhibitors. 21 patients with BRAF mutated metastatic melanoma were enrolled in the protocol with BRAF inhibitors for compassionate use at the University of Modena. Hot spot V600E mutations were found in 19 patients. V600R mutation and double (V600E -V600M) mutation were identified in two melanomas. In one case, V600K mutation was found. Two screening failures were noted. Mean progression free survival at follow-up of to 8 weeks, was 7.6 months. Five patients had a very short follow-up and the experimental protocol is still ongoing, so we cannot provide complete follow-up data. However, all of them are still under treatment and disease progression free. An objective response with few side effects was observed in all patients. in vitro studies with the aim of testing drug sensitivity.

18 Article Lesions Mimicking Melanoma at Dermoscopy Confirmed Basal Cell Carcinoma: Evaluation with Reflectance Confocal Microscopy. 2019

Peccerillo, Francesca / Mandel, Victor Desmond / Di Tullio, Francesca / Ciardo, Silvana / Chester, Johanna / Kaleci, Shaniko / de Carvalho, Nathalie / Del Duca, Ester / Giannetti, Luca / Mazzoni, Laura / Nisticò, Steven Paul / Stanganelli, Ignazio / Pellacani, Giovanni / Farnetani, Francesca. ·Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences with Interest Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy. · Department of Surgical, Medical, Dental and Morphological Sciences with Interest Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy. · Division of Dermatology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy. · Skin Cancer Unit, Scientific Institute of Romagna for the Study and Treatment of Cancer, IRCSS, IRST, Meldola, Italy. · Dermatology Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy. · Department of Dermatology, University of Parma, Parma, Italy. · Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences with Interest Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy, farnetani.francesca@gmail.com. ·Dermatology · Pubmed #30404078.

ABSTRACT: BACKGROUND: Atypical basal cell carcinoma (BCC), characterized by equivocal dermoscopic features typical of malignant melanoma (MM), can be difficult to diagnose. Reflectance confocal microscopy (RCM) enables in vivo imaging at nearly histological resolution. OBJECTIVES: To evaluate with RCM atypical melanocytic lesions identified in dermoscopy, according to common RCM criteria for the differential diagnosis of BCC, and to identify representative RCM parameters for superficial (sBCCs) and nonsuperficial (nsBCCs) basal cell carcinomas (BCCs). METHODS: A retrospective analysis of consecutive patients evaluated with RCM, selecting excised lesions classified at dermoscopy with ≥1 score from the re visited 7-point checklist, mimicking melanoma, registered between 2010 and 2016. Cluster analysis identified BCC subclassifications. RESULTS: Of 178 atypical lesions, 34 lesions were diagnosed as BCCs with RCM. Lesions were confirmed BCCs with histopathology. Dermoscopic features included atypical network (55.9%) and regression structures (35.5%) associated with sBCCs, and an atypical vascular pattern (58.8%) and irregular blotches (58.8%) with nsBCCs. Hierarchical cluster analysis identified 2 clusters: cluster 1 (100% sBCCs) was characterized by the presence of cords connected to the epidermis (90%, p < 0.001), tumor islands located in the epidermis (100%, p < 0.001), smaller vascular diameter (100%, p < 0.001) and solar elastosis (90%, p = 0.017), and cluster 2 (nsBCCs 85%) was defined by the dermic location of tumor islands (87.5%, p < 0.001) with branch-like structures (70.8%, p = 0.007) and surrounding collagen (83.3%, p = 0.012), peripheral palisading (83.3%, p = 0.012) and coiled vascular morphology (79.2%, p < 0.001) with a larger vascular diameter (50%, p < 0.001). CONCLUSIONS: RCM is able to diagnose BCCs mimicking melanoma at dermoscopy and seems able to identify sBCCs and nsBCCs.

19 Article Dabrafenib-trametinib combination in 'field-practice': an Italian experience. 2018

Depenni, Roberta / De Rosa, Francesco / Greco, Stefano / Ridolfi, Laura / Pellacani, Giovanni / Ponti, Giovanni / Cascinu, Stefano / Guidoboni, Massimo. ·Division of Oncology, Department of Oncology & Hematology, University of Modena & Reggio Emilia, Modena, Italy. · Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy. · Department of Dermatology, University of Modena & Reggio Emilia, Modena, Italy. · Department of Diagnostic, Clinical Medicine & Public Health, Clinical Pathology Unit, University of Modena & Reggio Emilia, Modena, Italy. ·Future Oncol · Pubmed #30081673.

ABSTRACT: AIM: This observational study investigates the effectiveness and safety of dabrafenib/trametinib combination in patients with metastatic melanoma. PATIENTS & METHODS: Seventy-six patients treated with dabrafenib/trametinib (150 mg twice daily/2 mg once daily) were included. RESULTS: Median progression-free survival was 9 months (95% CI: 7-11) and median overall survival was 14 months (11-16); disease control rate was 72%. Nine patients (12%) experienced a complete response. Of these, seven presented one metastatic site, none had lung or CNS metastasis, and none had elevated baseline lactate dehydrogenase (LDH) levels. Overall, subgroup analysis for patients with adverse prognostic features led to similar results. No new safety signals were reported. CONCLUSION: Dabrafenib/trametinib combination can be effective and well-tolerated also in a heterogeneous 'real life' population comprising patients with adverse prognostic features.

20 Article Nevus-Associated Melanoma: Patient Phenotype and Potential Biological Implications. 2018

Pampena, Riccardo / Pellacani, Giovanni / Longo, Caterina. ·Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Italy. Electronic address: riccardopampena@gmail.com. · Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy. · Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Italy; Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy. ·J Invest Dermatol · Pubmed #30032788.

ABSTRACT: Pandeya et al. report that nevus-associated melanoma is associated with a specific phenotype, namely, young age, high number of nevi, non-brown eye color and slight dermal elastosis. Potential implications regarding differences between nevus-associated melanomas and de novo melanomas are discussed.

21 Article An integrated clinical-dermoscopic risk scoring system for the differentiation between early melanoma and atypical nevi: the iDScore. 2018

Tognetti, L / Cevenini, G / Moscarella, E / Cinotti, E / Farnetani, F / Mahlvey, J / Perrot, J L / Longo, C / Pellacani, G / Argenziano, G / Fimiani, M / Rubegni, P. ·Dermatology Unit, Department of Medical, Surgical and NeuroSciences, University of Siena, Siena, Italy. · Department of Medical Biotechnologies, University of Siena, Siena, Italy. · Dermatology Unit, University of Campania, Naples, Italy. · Skin Cancer Unit Arcispedale S. Maria Nuova-IRCCS, Reggio Emilia, Italy. · Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy. · Melanoma Unit, Department of Dermatology, University of Barcelona, Barcelona, Spain. · Dermatology Unit, University Hospital of St-Etienne, Saint Etienne, France. ·J Eur Acad Dermatol Venereol · Pubmed #29888421.

ABSTRACT: BACKGROUND: Dermoscopy revealed to be extremely useful in the diagnosis of early melanoma, the most important limitation being its subjectivity in giving a final diagnosis. To overcome this problem, several algorithms and checklists have been proposed. However, they generally demonstrated modest level of diagnostic accuracy, unsatisfactory concordance between dermoscopists and/or poor specificity. OBJECTIVE: To test a new methodological approach for the differentiation between early melanoma and atypical nevi, based on an integrated clinical-anamnestic dermoscopic risk scoring system (iDScore). METHODS: We selected a total of 435 standardized dermoscopic images of clinically atypical melanocytic skin lesion (MSL) excised in the suspect of malignancy (i.e. 134 early melanomas - MM - and 301 atypical nevi). Data concerning patient age and sex and lesion dimension and site were collected. A scoring classifier was designed based on this data set integrated with the dermoscopic evaluations performed by three experts blinded to histological diagnosis. RESULTS: A total of seven dermoscopic structures, three age groups (30-40 years, 41-60 years and >60 years), two maximum diameter categories (5-10 mm and >10 mm) and three body areas (i.e. frequently, chronically and seldom photoexposed sites) were selected by the scoring classifier as interdependently significant variables. The total risk score (S) of a lesion resulted from the simple sum of partial scores assigned to each selected variable. The iDScore-aided diagnosis showed an high accuracy (receiver operating characteristic-area under the curve = 0.903; IC: 95% = 0.887-0.918). A risk-based criticality scale corresponding to different S ranges was proposed. CONCLUSION: The iDScore checklist is proposed as a feasible and efficient tool to support dermatologists in non-invasive differentiation between atypical nevi and early MM on the basis of few selected clinical-anamnestic data and standardized dermoscopic features.

22 Article The smart approach: feasibility of lentigo maligna superficial margin assessment with hand-held reflectance confocal microscopy technology. 2018

Pellacani, G / De Carvalho, N / Ciardo, S / Ferrari, B / Cesinaro, A M / Farnetani, F / Bassoli, S / Guitera, P / Star, P / Rawson, R / Rossi, E / Magnoni, C / Gualdi, G / Longo, C / Scope, A. ·Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy. · Department of Pathology, University of Modena and Reggio Emilia, Modena, Italy. · Melanoma Institute Australia, Sydney, NSW, Australia. · The University of Sydney, Sydney, NSW, Australia. · Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia. · Department of Dermatolgy, Spedali Civili di Brescia, Brescia, Italy. · Skin Cancer Unit, IRCCS - Santa Maria Nuova, Reggio Emilia, Italy. · Medical Screening Institute, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. ·J Eur Acad Dermatol Venereol · Pubmed #29704275.

ABSTRACT: BACKGROUND: Lentigo maligna may be challenging to clear surgically. OBJECTIVE: To evaluate feasibility of using superficial skin cuts as RCM imaging anchors for attaining negative surgical margins in lentigo maligna. METHODS: Included patients presented with lentigo maligna near cosmetically sensitive facial structures. We evaluated, with hand-held-RCM, microscopic clearance of melanoma beyond its dermoscopically detected edges. Evaluated margins were annotated using shallow skin cuts. If a margin was positive at 'first-step' RCM evaluation, we sequentially advanced the margin radially outward at that segment by 2-mm intervals until an RCM-negative margin was identified. Prior to final surgical excision, we placed sutures at the outmost skin cuts to allow comparison of RCM and histopathological margin assessments. Primary outcome measure was histopathological verification that RCM-negative margins were clear of melanoma. RESULTS: The study included 126 first-step margin evaluations in 23 patients, median age 70 years (range: 43-91). Seventeen patients (74%) had primary in-situ melanoma and six (26%) invasive melanoma, mean thickness 0.3 mm (range 0.2-0.4 mm). Six cases (26%) showed complete negative RCM margins on 'first-step', 11 (48%) were negative at 'second-step', and four (17%) at 'third-step'. In two additional cases (9%), margins clearance could not be determined via RCM due to widespread dendritic cells proliferation. The RCM-negative margins in all 21 cases proved clear of melanoma on histopathology. Of the 15 cases that returned at 1-year follow-up, none showed any residual melanoma on dermoscopic and RCM examinations. Interobserver reproducibility showed fair agreement between bedside RCM reader and blinded remote-site reader, with Spearman's rho of 0.48 and Cohen's kappa of 0.43; using bedside reader as reference, the remote reader's sensitivity was 92% and specificity 57% in positive margin detection. CONCLUSIONS: Margin mapping of lentigo maligna with hand-held-RCM, using superficial skin cuts, appears feasible. This approach needs validation by larger studies.

23 Article Seborrheic keratoses mimicking melanoma unveiled by in vivo reflectance confocal microscopy. 2018

Pezzini, C / Mandel, V D / Persechino, F / Ciardo, S / Kaleci, S / Chester, J / De Carvalho, N / Persechino, S / Pellacani, G / Farnetani, F. ·Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy. · Dermatology Unit, NESMOS Department, S. Andrea Hospital, University of Rome "Sapienza", Rome, Italy. ·Skin Res Technol · Pubmed #29363175.

ABSTRACT: BACKGROUND: Seborrheic keratoses (SebK) with atypical dermoscopy presentation are increasingly reported. These lesions do not exhibit typical dermoscopy features of SebK and sometimes mimic melanoma, thus complicating the differential diagnosis. Reflectance confocal microscopy (RCM) is a non-invasive tool, which allows an in vivo imaging of the skin. The study objectives were to evaluate the agreement between RCM classification and histological diagnoses, and the reliability of well-known RCM criteria for SebK in the identification of SebK with atypical dermoscopy presentation. MATERIALS AND METHODS: We retrospectively analysed at RCM excised lesions presenting in dermoscopy ≥1 score at revisited 7-point checklist. The study population consisted of cases showing no melanocytic RCM findings. Lesions were investigated for distinct non-melanocytic RCM features, blinded from histopathology diagnoses. Histopathology matching was then performed before statistical analysis. RESULTS: The study consisted of 117 cases, classified at RCM as SebK (71 cases), dermatofibroma (18 cases), basal cell carcinoma (13 cases), squamous cell carcinoma (2 cases), and "non-specific" (13 cases). Overall K strength of agreement at histopathology matching proved 0.76. Of the 71 cases classified at RCM with SebK, agreement was achieved in 97%. CONCLUSION: Reflectance confocal microscopy classification proved high agreement with histopathology for SebK with atypical dermoscopy presentations, allowing an early differential diagnosis. RCM features in this group of lesions were similar to those described for typical cases of SebK, and may assist clinician therapy decision making, whilst avoiding unnecessary excisions.

24 Article The value of fluorimetry (Qubit) and spectrophotometry (NanoDrop) in the quantification of cell-free DNA (cfDNA) in malignant melanoma and prostate cancer patients. 2018

Ponti, Giovanni / Maccaferri, Monia / Manfredini, Marco / Kaleci, Shaniko / Mandrioli, Mauro / Pellacani, Giovanni / Ozben, Tomris / Depenni, Roberta / Bianchi, Giampaolo / Pirola, Giacomo Maria / Tomasi, Aldo. ·Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Italy. Electronic address: giovanni.ponti@unimore.it. · Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Italy. · Department of Life Sciences, University of Modena and Reggio Emilia, Italy. · Biochemistry Dept. Akdeniz University, Antalya, Turkey. · Department of Oncology, University of Modena and Reggio Emilia, Italy. · Department of Diagnostic and clinical medicine and public health, University of Modena and Reggio Emilia, Italy. ·Clin Chim Acta · Pubmed #29309771.

ABSTRACT: BACKGROUND: Circulating cell-free tumor DNA (cfDNA) is of crucial interest in oncology. cfDNA constitutes a potential prognostic and therapeutic marker for different solid tumors and can be used in the diagnostic and therapeutic management of cancer patients for which nowadays there are no valid laboratory markers. In the present study, the quality and quantity of the cfDNA were assessed by different quantification procedures, in order to identify the potential applications of these techniques in the preliminary cfDNA quantification. METHODS: Qubit with single (ss) and double strand (ds) DNA assay kits, NanoDrop and quantitative Real Time PCR (qPCR), were adopted to assess the cfDNA in the blood samples of 18 melanoma patients, 67 prostate cancer patients and 15 healthy controls. RESULTS: The quantification by NanoDrop (average value 8.48ng/μl, 95% confidence limit (CL)=7.23-9.73), Qubit ssDNA (average value 23.08ng/μl, CL=19.88-26.28), dsDNA (average value 4.32ng/μl, CL=3.52-5.12) assay kits and qPCR (average value 0.39ng/μl, CL=0.31-0.47) revealed differences among the four procedures. Qubit 2.0 ss-DNA kit gave higher cfDNA concentration values for all the samples analyzed. In detail, Qubit ssDNA assay revealed higher sensitivity in the quantification of small amounts of pure ss-DNA and ds-DNA, while NanoDrop allowed the assessment of the purity of cfDNA samples. CONCLUSIONS: The NanoDrop and Qubit 2.0 measurements were analyzed in order to define their correlation with qPCR cfDNA assessment, showing good correlation values with the qPCR that should be considered the "gold standard". In our proposal, the sequential combination of NanoDrop and Qubit ssDNA methods should be adopted for a cost-effective preliminary assessment of total circulating cfDNA in melanoma and prostate cancer patients, and only discordant values should undergo qPCR assessment.

25 Article Folliculotropism in pigmented facial macules: Differential diagnosis with reflectance confocal microscopy. 2018

Persechino, Flavia / De Carvalho, Nathalie / Ciardo, Silvana / De Pace, Barbara / Casari, Alice / Chester, Johanna / Kaleci, Shaniko / Stanganelli, Ignazio / Longo, Caterina / Farnetani, Francesca / Pellacani, Giovanni. ·Dermatology Department, University of Modena and Reggio Emilia, Modena, Italy. · Skin Cancer Unit Scientific Institute of Romagna for The study and Treatment of Cancer, IRCSS, IRST, Meldola, Italy. · Skin Cancer Unit, IRCCS Santa Maria Nuova, Reggio Emilia, Italy. ·Exp Dermatol · Pubmed #29274094.

ABSTRACT: Pigmented facial macules are common on sun damage skin. The diagnosis of early stage lentigo maligna (LM) and lentigo maligna melanoma (LMM) is challenging. Reflectance confocal microscopy (RCM) has been proven to increase diagnostic accuracy of facial lesions. A total of 154 pigmented facial macules, retrospectively collected, were evaluated for the presence of already-described RCM features and new parameters depicting aspects of the follicle. Melanocytic nests, roundish pagetoid cells, follicular infiltration, bulgings from the follicles and many bright dendrites and infiltration of the hair follicle (ie, folliculotropism) were found to be indicative of LM/LMM compared to non-melanocytic skin neoplasms (NMSNs), with an overall sensitivity of 96% and specificity of 83%. Concerning NMSNs, solar lentigo and lichen planus-like keratosis resulted better distinguishable from LM/LMM because usually lacking malignant features and presenting characteristic diagnostic parameters, such as epidermal cobblestone pattern and polycyclic papillary contours. On the other hand, distinction of pigmented actinic keratosis (PAK) resulted more difficult, and needing evaluation of hair follicle infiltration and bulging structures, due to the frequent observation of few bright dendrites in the epidermis, but predominantly not infiltrating the hair follicle (estimated specificity for PAK 53%). A detailed evaluation of the components of the folliculotropism may help to improve the diagnostic accuracy. The classification of the type, distribution and amount of cells, and the presence of bulging around the follicles seem to represent important tools for the differentiation between PAK and LM/LMM at RCM analysis.