The immunopathogenesis of HS is partially understood and exhibits features of an autoinflammatory disease; it is associated with the potential involvement of B cells and the contribution of Th1 or Th17 cell subsets. Recently, the pathogenic role of both innate immunity and IL-1 family cytokines in HS has been deeply investigated. Several agents targeting the IL-1 family pathway at different levels are currently available and under investigation for the treatment of HS. HS is still characterized by unmet clinical needs and represents an expanding field in the current scientific research. The aim of this narrative review is to describe the pathological dysregulation of IL-1 family members in HS and to provide an update on therapeutic strategies targeting IL-1 family cytokine signaling. Further clinical and preclinical data may likely lead to the enrichment of the therapeutic armamentarium of HS with IL-1 family cytokine antagonists.

Citation: Cappilli S, Ribero S, Cornacchia L, et al. Melanocytic Lesions With Peripheral Globules: Proposal Of An Integrated Management Algorithm. Dermatol Pract Concept. 2023;13(1):e2023010. DOI: https://doi.org/10.5826/dpc.1301a10 Accepted: May 18, 2022; Published: January 2023 Copyright: ©2023 Cappilli et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing interests: None. Authorship: All authors have contributed significantly to this publication. Corresponding author: Simone Cappilli, MD, Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy. Largo A. Gemelli 8, 00168, Rome, Italy. Tel.: +39 06-30154227 Fax: +39 06-30154919 Email: simo.cappilli@gmail.com Citation: Cappilli S, Ribero S, Cornacchia L, et al. Melanocytic Lesions With Peripheral Globules: Proposal Of An Integrated Management Algorithm. Dermatol Pract Concept. 2023;13(1):e2023010. DOI: https://doi.org/10.5826/dpc.1301a10 Accepted: May 18, 2022; Published: January 2023 Copyright: ©2023 Cappilli et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing interests: None. Authorship: All authors have contributed significantly to this publication. Corresponding author: Simone Cappilli, MD, Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy. Largo A. Gemelli 8, 00168, Rome, Italy. Tel.: +39 06-30154227 Fax: +39 06-30154919 Email: simo.cappilli@gmail.com Introduction: A peripheral rim of globules represents a marker of horizontal growth phase in nevi and is a common feature in children and adolescents. The observation of melanocytic lesion with peripheral globules (MLPG) in adulthood deserve more attention, since a melanoma may exhibits this feature albeit rarely. Risk stratified management recommendations considering a global clinical approach are still missing. Objectives: To analyze current knowledge on MLPG and propose an integrated management algorithm stratified for age groups. Methods: We conducted a narrative review of current published data on MPLG, analyzing clinical dermoscopic and confocal distinguishing features of melanoma from bening nevi. Results: The risk of finding a melanoma when removing a MLPG increases with age especially in people >55 years old and results significantly higher on extremities, head/neck and in case of a single asymmetrical lesion, ≥6 mm in diameter. Dermoscopic features associated to melanoma diagnosis include atypical peripheral globules, asymmetrical distribution, multiple rims as well as globules reappearance after previous loss. In addition, wide blue-grey regression areas, atypical network, eccentric blotches, tan structureless peripheral areas and vascularizationare atypical dermoscopic features. Confocal worrisome findingss are represented by pagetoid cells within the epidermis, architectural disarrangement and atypical cells of the dermo-epidermal junction with irregular peripheral nests. Conclusion: We proposed a multi-step age-stratified management algorithm integrating clinical, dermoscopic and confocal findings that may increase the early recognition of melanoma and avoid surgical excision of benign nevi. Keywords : melanoma, reflectance confocal microscopy, diagnostic imaging, dermoscopy This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.