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Reiter O, Kurtansky N, Musthaq S, Dusza S, Halpern A, Marchetti M, Marghoob A, Scope A, Rotemberg V. The long-term evolution of melanocytic nevi among high-risk adults. J Eur Acad Dermatol Venereol 2022; 36:2379-2387. [PMID: 35881111 PMCID: PMC9804380 DOI: 10.1111/jdv.18470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/15/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND There is little understanding regarding the long-term natural history of melanocytic nevi among adults. OBJECTIVE The objective of the study was to describe the long-term natural history of individual nevi located on the torso of high-risk patients. METHODS All patients attending Memorial Sloan Kettering Cancer Center (MSKCC) who underwent two total body photography (TBP) sessions 15+ years apart were included ('retrospective' group). To account for a potential selection bias, we also included consecutive patients who had TBP 15+ years ago and consented to undergo follow-up TBP ('prospective' group). We compared baseline and follow-up torso images on the TBPs and evaluated the number of total, new and disappearing nevi; number of seborrheic keratoses and actinic keratoses; each nevus' diameter at both time points; each nevus' colour change; the presence of clinical atypia; and when dermoscopy was available, the dermoscopic features at each time point. RESULTS One hundred six patients were included in the study. Although the average age of the patients was 40 at baseline TBP, most patients developed new nevi between imaging sessions (median 16.4 years) with an average of 2.6 (SD = 4.8) nevi per participant. The average number of disappearing nevi was 0.3 (SD = 0.6). In addition, 62/106 (58%) patients had an absolute increase, and 9/106 (8%) patients had an absolute decrease in their total nevus count. Roughly half (49%: 1416/2890) of the nevi that could be evaluated at both time points increased in diameter by at least 25%. Only 6% (159/2890) of nevi shrunk in diameter by at least 25%. Patients with a history of melanoma had a higher rate of disappearing nevi, and their nevi were more likely to grow. Most nevi demonstrated no significant dermoscopic changes. CONCLUSIONS High-risk patients acquire new nevi throughout life with very few nevi disappearing over time. Contrary to prior reports, most nevi in adults increase in diameter, while few nevi shrink.
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Affiliation(s)
- O. Reiter
- Dermatology ServiceMemorial Sloan Kettering Cancer CenterNew YorkNYUSA,Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - N.R. Kurtansky
- Dermatology ServiceMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
| | - S.T. Musthaq
- Dermatology ServiceMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
| | - S. Dusza
- Dermatology ServiceMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
| | - A.C. Halpern
- Dermatology ServiceMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
| | - M.A. Marchetti
- Dermatology ServiceMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
| | - A.A. Marghoob
- Dermatology ServiceMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
| | - A. Scope
- Dermatology ServiceMemorial Sloan Kettering Cancer CenterNew YorkNYUSA,Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael,The Kittner Skin Cancer Screening and Research InstituteSheba Medical CenterRamat GanIsrael
| | - V. Rotemberg
- Dermatology ServiceMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
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Reiter O, Musthaq S, Kurtansky NR, Barrios DM, Halpern AC, Marchetti MA, Marghoob AA, Nanda JK, Stoll J, Rotemberg V. Suggested methodology for longitudinal evaluation of nevi based on clinical images. Skin Res Technol 2021; 28:71-74. [PMID: 34455638 PMCID: PMC9907704 DOI: 10.1111/srt.13092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 07/31/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Melanoma screening includes the assessment of changes in melanocytic lesions using images. However, previous studies of normal nevus temporal changes showed variable results and the optimal method for evaluating these changes remains unclear. Our aim was to evaluate the reproducibility of (a) nevus count done at a single time point (method I) versus two time points (method II); and (b) manual and automated nevus diameter measurements. MATERIALS AND METHODS In a first experiment, participants used either a single time point or a two time point annotation method to evaluate the total number and size of nevi on the back of an atypical mole syndrome patient. A Monte Carlo simulation was used to calculate the variance observed. In a second experiment, manual measurements of nevi on 2D images were compared to an automated measurement on 3D images. Percent difference in the paired manual and automated measurements was calculated. RESULTS Mean nevus count was 137 in method I and 115.5 in method II. The standard deviation was greater in method I (38.80) than in method II (4.65) (p = 0.0025). Manual diameter measurements had intraclass correlation coefficient of 0.88. The observed mean percent difference between manual and automated diameter measurements was 1.5%. Lightly pigmented and laterally located nevi had a higher percent difference. CONCLUSIONS Comparison of nevi from two different time points is more consistent than nevus count performed separately at each time point. In addition, except for selected cases, automated measurements of nevus diameter on 3D images can be used as a time-saving reproducible substitute for manual measurement on 2D images.
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Affiliation(s)
- Ofer Reiter
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, USA.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shenara Musthaq
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | | | - Dulce M Barrios
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Allan C Halpern
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | | | - Ashfaq A Marghoob
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Japbani K Nanda
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Joseph Stoll
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Veronica Rotemberg
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, USA
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Ribero S, Zugna D, Spector T, Bataille V. Natural history of naevi: a two‐wave study. Br J Dermatol 2021; 184:289-295. [DOI: 10.1111/bjd.19171] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2020] [Indexed: 12/27/2022]
Affiliation(s)
- S. Ribero
- Department of Twin Research and Genetic Epidemiology King's College London London UK
- Dermatology Clinic University of TurinTurin Italy
| | - D. Zugna
- Section of Statistics Department of Medical Sciences University of Turin Turin Italy
| | - T. Spector
- Department of Twin Research and Genetic Epidemiology King's College London London UK
| | - V. Bataille
- Department of Twin Research and Genetic Epidemiology King's College London London UK
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Scope A, Farnetani F, Haupt S, Schechtman E, Longo C, Pellacani G. Dermoscopic and clinical predictors of reflectance confocal microscopy patterns of typical nevi on the back and legs: A cross-sectional study. J Am Acad Dermatol 2020; 85:1240-1247. [PMID: 32534083 DOI: 10.1016/j.jaad.2020.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/23/2020] [Accepted: 06/04/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Nevus phenotype is a marker of melanoma risk. In vivo prediction of microscopic pattern is needed to more precisely classify nevi. OBJECTIVE To identify dermoscopic and clinical predictors of microscopic patterns of typical nevi. METHODS We used reflectance confocal microscopy (RCM) to classify microscopic patterns of nevi. We prospectively accrued adults presenting for periodic skin screening and imaged, with dermoscopy and RCM, 3 randomly selected nevi from the upper and lower back and lower extremity. RCM patterns were classified into ring, clod, meshwork, and composite types. Logistic regression was used to identify best predictors of RCM pattern. RESULTS The study included 310 nevi from 112 participants (mean age 44 years; 51 women). Dermoscopic reticular pattern correlated most frequently (59.9%) with RCM ring pattern, dermoscopic globular with RCM composite (56.6%) and RCM clod (35.9%), dermoscopic complex with RCM composite (76.3%), and dermoscopic homogenous with RCM clod (50.8%). Integrating dermoscopic pattern with contour, diameter, color, and anatomic location of nevi improved prediction of microscopic patterns beyond dermoscopy alone. The dermoscopic clinical regression model correctly classified lesions to RCM ring versus RCM clod in 90% and to RCM ring versus RCM composite patterns in 81%. LIMITATIONS The study was restricted to adults, back and lower extremities, and typical nevi. CONCLUSIONS Integrating dermoscopic patterns with clinical attributes may improve prediction of microscopic patterns of nevi.
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Affiliation(s)
- Alon Scope
- Kittner Skin Cancer Screening & Research Institute, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Francesca Farnetani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Sara Haupt
- Kittner Skin Cancer Screening & Research Institute, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Edna Schechtman
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Caterina Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy; Azienda Unità Sanitaria Locale-Istituto Di Ricovero e Cura a Carattere Scientifico di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
| | - Giovanni Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
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Koh U, Janda M, Aitken JF, Duffy DL, Menzies S, Sturm RA, Schaider H, Betz-Stablein B, Prow T, Soyer HP, Green AC. 'Mind your Moles' study: protocol of a prospective cohort study of melanocytic naevi. BMJ Open 2018; 8:e025857. [PMID: 30232117 PMCID: PMC6150134 DOI: 10.1136/bmjopen-2018-025857] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Having many melanocytic naevi or 'moles' on the skin is the strongest predictor of melanoma; thus, much can be learnt from investigating naevi in the general population. We aim to improve the understanding of the epidemiology and biology of naevi by conducting a 3-year prospective study of melanocytic naevi in adults. METHODS AND ANALYSIS This is a population-based cohort study of melanocytic naevi in 200 adults aged 20-69 years recruited via the Australian electoral roll. At baseline, participants will complete a questionnaire on their sun behaviour and health and undergo a clinical examination. Three-dimensional (3D) total-body photography will be used to record the images of skin lesions. Pigmented naevi will be analysed in terms of number, diameter, colour and border irregularity using automated analysis software (excluding scalp, beneath underwear and soles of feet). All naevi ≥5 mm will be recorded using the integrated dermoscopy photographic system. A saliva sample will be obtained at baseline for genomic DNA analysis of pigmentation, naevus and melanoma-associated genes using the Illumina HumanCoreExome platform. The sun behaviour and health follow-up questionnaire, clinical examination and 3D total-body photography will be repeated every 6 months for 3 years. The first 50 participants will also undergo manual counts of naevi ≥2 mm and ≥5 mm at baseline, 6-month and 12-month follow-ups. Microbiopsy and excision of naevi of research interest is planned to commence at the 18-month time point among those who agree to donate samples for detailed histopathological and molecular assessment. ETHICS AND DISSEMINATION This study was approved by the Metro South Health Human Research Ethics Committee in April 2016 (approval number: HREC/16/QPAH/125). The findings will be disseminated through peer-reviewed and non-peer-reviewed publications and presentations at conferences.
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Affiliation(s)
- Uyen Koh
- Centre of Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Monika Janda
- Centre of Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Joanne F Aitken
- Australian Childhood Cancer Registry, Cancer Council Queensland, Brisbane, Queensland, Australia
- Institute for Resilient Regions, University of Southern Queensland, Brisbane, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - David L Duffy
- Genetic Epidemiology, Molecular Epidemiology and Neurogenetics Laboratories, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
| | - Scott Menzies
- Sydney Medical School (Discipline of Dermatology), The University of Sydney, Sydney, New South Wales, Australia
| | - Richard A Sturm
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
| | - Helmut Schaider
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
- Dermatology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Brigid Betz-Stablein
- Cancer and Population Studies, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Tarl Prow
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
- Future Industries Institute, University of South Australia, Adelaide, South Australia, Australia
| | - H Peter Soyer
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
- Dermatology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Australian Skin and Skin Cancer Research Centre, Brisbane, Queensland, Australia
| | - Adele C Green
- Cancer and Population Studies, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- Australian Skin and Skin Cancer Research Centre, Brisbane, Queensland, Australia
- CRUK Manchester Institute and University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
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Choi SD, D'Souza MI, Menzies SW, Weninger W. A prospective observational study of pigmented naevi changes in psoriasis patients on biologic therapy. Australas J Dermatol 2018; 60:e14-e19. [PMID: 29797312 DOI: 10.1111/ajd.12838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 03/21/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Patients on biologic therapy are thought to be at increased risk of developing non-melanoma skin cancers and melanomas. It is unknown whether biologic therapy alters the natural history of melanocytic naevi. Therefore, a prospective observational study was conducted to determine whether psoriasis patients on biologic therapy develop changes in naevi. METHODS Clinical and dermoscopic assessment of all melanocytic naevi was performed in 45 psoriasis patients on biologic therapy versus a control cohort of 43 subjects, using sequential digital dermoscopic imaging and total body photography. The mean follow-up period was 1.5 years. RESULTS The study and control patients had comparable age, gender, previous and family history of non-melanoma skin cancers and melanomas, as well as previous sun exposure and total number of naevi. The number of naevi with major dermoscopic changes was 3% in the study and 1.9% in the control group, with an adjusted incidence rate ratio of 1.45 (95% confidence interval 0.90-2.33; P = 0.125). The rate of minor changes was 15.9% in the study group versus 19.4% in the control (adjusted incidence rate ratio 0.77, 95% confidence interval 0.57-1.08; P = 0.14). There were six new dysplastic naevi in 4/45 biologic patients and four in 4/43 controls; however, the difference was not significant (relative risk 0.96, 95% confidence interval -0.12 to 0.12; P = 0.95). There were no melanomas in either group. CONCLUSION Over a mean follow-up period of 1.5 years there was no evidence of significantly different changes in naevi or development of new dysplastic naevi in psoriasis patients on biologic treatment compared to controls.
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Affiliation(s)
- Seohee Deanne Choi
- Department of Dermatology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Discipline of Dermatology, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Mario I D'Souza
- Sydney Local Health District Clinical Research Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Scott W Menzies
- Discipline of Dermatology, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Wolfgang Weninger
- Department of Dermatology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Discipline of Dermatology, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Immune Imaging Program, Centenary Institute, Newtown, NSW, Australia
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Stark MS, Tan JM, Tom L, Jagirdar K, Lambie D, Schaider H, Soyer HP, Sturm RA. Whole-Exome Sequencing of Acquired Nevi Identifies Mechanisms for Development and Maintenance of Benign Neoplasms. J Invest Dermatol 2018; 138:1636-1644. [PMID: 29476775 DOI: 10.1016/j.jid.2018.02.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 02/06/2018] [Accepted: 02/13/2018] [Indexed: 01/08/2023]
Abstract
The melanoma transformation rate of an individual nevus is very low despite the detection of oncogenic BRAF or NRAS mutations in 100% of nevi. Acquired melanocytic nevi do, however, mimic melanoma, and approximately 30% of all melanomas arise within pre-existing nevi. Using whole-exome sequencing of 30 matched nevi, adjacent normal skin, and saliva we sought to identify the underlying genetic mechanisms for nevus development. All nevi were clinically, dermoscopically, and histopathologically documented. In addition to identifying somatic mutations, we found mutational signatures relating to UVR mirroring those found in cutaneous melanoma. In nevi we frequently observed the presence of the UVR mutation signature compared with adjacent normal skin (97% vs. 10%, respectively). Copy number aberration analysis showed that for nevi with copy number loss of tumor suppressor genes, this loss was balanced by loss of potent oncogenes. Moreover, reticular and nonspecific patterned nevi showed an increased (P < 0.0001) number of copy number aberrations compared with globular nevi. The mutation signature data generated in this study confirms that UVR strongly contributes to nevogenesis. Copy number changes reflect at a genomic level the dermoscopic differences of acquired melanocytic nevi. Finally, we propose that the balanced loss of tumor suppressor genes and oncogenes is a protective mechanism of acquired melanocytic nevi.
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Affiliation(s)
- Mitchell S Stark
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Queensland, Australia.
| | - Jean-Marie Tan
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Queensland, Australia
| | - Lisa Tom
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Queensland, Australia
| | - Kasturee Jagirdar
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Queensland, Australia
| | | | - Helmut Schaider
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Queensland, Australia; Department of Dermatology, Princess Alexandra Hospital, Brisbane, Australia
| | - H Peter Soyer
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Queensland, Australia; Department of Dermatology, Princess Alexandra Hospital, Brisbane, Australia
| | - Richard A Sturm
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Queensland, Australia
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Plasmeijer EI, Nguyen TMU, Olsen CM, Janda M, Soyer HP, Green AC. The Natural History of Common Melanocytic Nevi: A Systematic Review of Longitudinal Studies in the General Population. J Invest Dermatol 2017; 137:2017-2018. [PMID: 28528913 DOI: 10.1016/j.jid.2017.03.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 03/23/2017] [Accepted: 03/28/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Elsemieke I Plasmeijer
- QIMR Berghofer Medical Research Institute, Cancer and Population studies, Brisbane, Queensland, Australia.
| | - Thi-My-Uyen Nguyen
- Queensland University of Technology, Institute of Health and Biomedical Innovation, Brisbane, Queensland, Australia
| | - Catherine M Olsen
- QIMR Berghofer Medical Research Institute, Cancer Control Group, Brisbane, Queensland, Australia; School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Monika Janda
- Queensland University of Technology, Institute of Health and Biomedical Innovation, Brisbane, Queensland, Australia
| | - H Peter Soyer
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Queensland; Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Adele C Green
- QIMR Berghofer Medical Research Institute, Cancer and Population studies, Brisbane, Queensland, Australia; Cancer Research UK Manchester Institute and University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
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Russo T, Piccolo V, Lallas A, Giacomel J, Moscarella E, Alfano R, Argenziano G. Dermoscopy of Malignant Skin Tumours: What's New? Dermatology 2017; 233:64-73. [PMID: 28486238 DOI: 10.1159/000472253] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 03/27/2017] [Indexed: 12/14/2022] Open
Abstract
Dermoscopy represents a new and effective tool that assists dermatologists in improving the accuracy of clinical diagnosis in onco-dermatology. The aim of this article is to provide an overview of the latest and important dermoscopic progress and observations in this ever-evolving field of dermatology.
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Affiliation(s)
- Teresa Russo
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
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