Dermoscopy improves the recognition of melanoma and Spitz nevus but occasionally melanoma may exhibit a symmetric pattern mimicking Spitz nevus. We sought to investigate the likelihood of finding melanoma when excising a symmetric Spitzoid-looking lesion in patients aged 12 years or older. This study included patients aged 12 years or older with symmetric, Spitzoid-looking lesions that were diagnosed histopathologically as Spitz nevus or melanoma. Demographic, clinical, and dermoscopic variables were included in the analysis. We used χ(2) for nonparametric comparisons. Crude odds ratios and 95% confidence intervals were calculated by univariate logistic regression. Of 384 included lesions, 333 (86.7%) were histopathologically diagnosed as Spitz nevus and 51 (13.3%) as melanoma. The risk of melanoma significantly increased with increasing age, being 50% or higher after the age of 50 years. Limitations are retrospective design, exclusion of patients younger than 12 years, lack of detailed histopathologic data, and limited sample size. Our results confirm the observation that melanoma may be dermoscopically indistinguishable from Spitz nevi, strongly suggesting that the only safe strategy not to miss melanoma is to excise all Spitzoid-looking lesions in patients aged 12 years or older.

Background: Recurrent aphthous stomatitis consists of the presence of abrasions or ulcerations located on mucosae (oral or genital). Objectives: The aim of this article is to review the current literature providing the main causes related to recurrent aphthous stomatitis and insights into treatment and management of this clinical condition Methods: Articles matching terms that correlated with “recurrent aphthous stomatitis” were searched on PubMed, EMBASE, and Cochrane Library and selected according to their pertinence. Results: Several forms of aphthous stomatitis have been described, based on the extent (minor, major), morphology (herpetiform), and associations to other signs (Behçet syndrome or more complex inflammatory syndromes). Topical as well as systemic treatments have been described to obtain a faster remission of the aphthosis or to reduce associated symptoms such as pain. Conclusions: Recurrent aphthous stomatitis can have a mild-to-severe clinical appearance, being mainly localized on the oral mucosa or at the level of the genital area. Different strategies have been described so far for its management and treatment.

BACKGROUND: Diluted/hyperdiluted calcium hydroxylapatite (CaHA) represents an emerging biostimulatory treatment. However, limited data concerning the effects of this agent on the face have been provided so far. OBJECTIVE: To investigate the efficacy and safety of hyperdiluted CaHA 1:2 treatment for mid and lower face rejuvenation. PATIENTS AND METHODS: A retrospective study of 40 patients seeking skin rejuvenation for mid and lower face, treated with hyperdiluted CaHA 1:2 technique at baseline (T0), was performed. Patients were classified according to validated scales of aging in the mid to lower face at T0 and efficacy was established with scales calculated again at 4-month post-treatment (T1). In addition, efficacy was assessed by blinded evaluation of T0/T1 clinical pictures, non-invasive skin imaging and patient satisfaction. Safety was assessed through pain scale and minor/major adverse events. RESULTS: Hyperdiluted CaHA 1:2 successfully decreased aging severity scores of the mid and lower face. Variations of collagen morphology and increased vessel density at T1 were observed with noninvasive skin imaging. Most patients were very satisfied. Mean pain score was low and only minor adverse events were reported. CONCLUSION: Hyperdiluted CaHA 1:2 technique seems to be effective and safe for mid and lower face skin rejuvenation.

Skin aging is a complex process that causes morphologic variations. Some of these variations havebeen hypothesized to be involved in skin cancer development. This paper reviews current knowledgeof the features of aged skin as seen with reflectance confocal microscopy (RCM). Basic principles ofthe technique are described, and the RCM features of healthy skin and skin cancer are briefly discussed.Moreover, the RCM features at different layers of young and elderly skin are described, as arethe variations that occur with passing years and in relation to sun exposure that contribute to photoagingand the development of skin cancer. RCM enables the noninvasive evaluation, at quasi-histologicresolution, of aging-related skin changes, some of which are shared with skin cancer; this ability helpsavoid skin biopsy. Further research is needed to understand the relation between skin aging and skincancer development.

Background: Several systematic reviews (SRs) assessing the use of telemedicine for musculoskeletal conditions have been published in recent years. However, the landscape of evidence on multiple clinical outcomes remains unclear. Objective: We aimed to summarize the available evidence from SRs on telemedicine for musculoskeletal disorders. Methods: We conducted an umbrella review of SRs with and without meta-analysis by searching PubMed and EMBASE up to July 25, 2022, for SRs of randomized controlled trials assessing telemedicine. We collected any kind of patient-reported outcome measures (PROMs), patient-reported experience measures (PREMs), and objective measures, including direct and indirect costs. We assessed the methodological quality with the AMSTAR 2 tool (A Measurement Tool to Assess systematic Reviews 2). Findings were reported qualitatively. Results: Overall, 35 SRs published between 2015 and 2022 were included. Most reviews (n=24, 69%) were rated as critically low quality by AMSTAR 2. The majority of reviews assessed “telerehabilitation” (n=29) in patients with osteoarthritis (n=13) using PROMs (n=142 outcomes mapped with n=60 meta-analyses). A substantive body of evidence from meta-analyses found telemedicine to be beneficial or equal in terms of PROMs compared to conventional care (n=57 meta-analyses). Meta-analyses showed no differences between groups in PREMs (n=4), while objectives measures (ie, “physical function”) were mainly in favor of telemedicine or showed no difference (9/13). All SRs showed notably lower costs for telemedicine compared to in-person visits. Conclusions: Telemedicine can provide more accessible health care with noninferior results for various clinical outcomes in comparison with conventional care. The assessment of telemedicine is largely represented by PROMs, with some gaps for PREMs, objective measures, and costs. Trial Registration: PROSPERO CRD42022347366; https://osf.io/pxedm/