Background and Objectives: Early identification of patients at risk of clinical deterioration is essential for optimizing therapeutic management and improving outcomes in general medicine wards. The National Early Warning Score 2 (NEWS2) is a validated tool for predicting patient worsening but integrating it with additional clinical and demographic data can enhance its predictive accuracy and support timely clinical decisions. Material and methods: In this retrospective cohort study, 2108 patients admitted to the general medicine department of the University Hospital of Siena were analyzed. Logistic regression models incorporating NEWS2 alongside key clinical variables—including age, presence of central venous catheter (CVC), and functional status measured by the Barthel Index—were developed to predict high clinical risk (HCR) and mortality. Model performance was assessed using the area under the ROC curve (AUC). Results: High clinical risk status developed in 29% of patients. Older age, presence of CVC, lower Barthel Index, and higher NEWS2 scores were significantly associated with both HCR and mortality. The integrated predictive model demonstrated good accuracy, with an AUC of 0.798 for HCR and 0.716 for mortality prediction. Conclusions: This study suggests that NEWS2, when combined with additional patient-specific variables from the electronic health record, can become a more sophisticated tool for early risk stratification. Such a tool has the potential to support timely clinical intervention and optimized therapeutic management, potentially contributing to improved patient outcomes. While the model may indirectly support nurse workload balancing by identifying patients requiring intensified care, its ultimate impact on patient outcomes requires confirmation through prospective studies.

Background/Objectives: Basal cell carcinoma (BCC) is the most common malignancy, characterised by local invasiveness and the potential for tissue destruction. Diagnosing BCC can be challenging, particularly for less experienced dermatologists. Line-field confocal optical coherence tomography (LC-OCT), a new noninvasive optical technique, has become increasingly useful in clinical practice, allowing in vivo imaging at cellular resolution. This study aimed to evaluate the impact of a 1 h structured training session on the ability of dermatology residents to diagnose BCC using LC-OCT. Methods: Eight dermatology residents with different levels of LC-OCT experience (no experienced and low experience in LC-OCT) participated alongside an expert dermatologist as a benchmark. Overall, participants evaluated 40 histopathologically confirmed lesions (20 BCC, 20 non-BCC) before and after training, with and without the inclusion of dermoscopic images. Results: We observed a significant improvement in diagnostic accuracy post-training, especially among inexperienced users, with a 20% reduction in false negatives and a 35% reduction in false positives. When the dermoscopic images were included, further improvements were noted, with the accuracy increasing by an additional 5%. The overall diagnostic rate for inexperienced readers increased from 48% to 76% after training and to 81% with the addition of dermoscopic images in the course. Conclusions: Our study highlights the effectiveness of short, targeted training in enhancing the diagnostic utility of LC-OCT, emphasising its potential for broader clinical adoption to improve BCC detection.

Background: The condition of vitamin D (25OHD) deficiency represents an important public health problem. In Europe, hypovitaminosis is common not only in the elderly population but also between 50 and 70 years, both in males and females. Data regarding vitamin D intake in the Italian population are very limited. In a recent paper, reporting data collected by a specific Frequency Food Questionnaire (FFQ), we observed in a small group of healthy subjects that the dietary consumption of vitamin D, both in females and males, was far below the average. Methods: With the aim of expanding our preliminary data, we conducted a survey on a large cohort of subjects from different areas of Northern, Central, and Southern Italy. The FFQ contained 11 different questions regarding the amount and type of intake of foods containing ergocalciferol and cholecalciferol. It was submitted to 870 subjects, 627 females and 243 males, with an age range from 40 to 80 years; 31.6% of the studied population was apparently in good health, while 68.4% were affected by different pathologies. Results: The present data confirm previous observations: the global quantity of vitamin D intake in 14 days was 70.8 μg (±1.8 SE, ±54.4 SD) in females and 87.5 μg (±1.9 SE, ±57.1 SD) in males; the mean daily intake of vitamin D in females and males was 5.05 μg (±0.5 SE, ±3.8 SD) and 6.25 μg (±0.21 SE, ±4.1 SD), respectively. In healthy subjects, a gradual decrease was observed in the overall intake of vitamin D in both females and males according to an increase in age bracket, ranging from 74.5 μg and 103.8 μg in the 40–50 age group to 54.5 μg and 87.8 μg in the 71–80 age group, respectively. Conclusions: In conclusion, the present data, collected in a large Italian cohort, underscore that the daily intake of vitamin D is far below the recommended daily average, thereby contributing to the development of potential hypovitaminosis.

Background: Cutaneous melanoma metastases (CMM) represent a clinically relevant manifestation of advanced melanoma and may constitute the first sign of disseminated disease. Their diagnosis is challenging because CMM shows highly variable clinical and dermoscopic presentations and frequently mimic other benign or malignant skin lesions. Although dermoscopy is routinely used to improve skin lesion assessment, dermoscopic criteria specific to CMM remain poorly defined and still non-standardized. Methods: We performed a narrative review of the literature to summarize dermoscopic features reported in CMM. MedLine (via PubMed) and Web of Science were searched up to 3 December 2025 using the keywords “dermoscopy” and “melanoma metastasis,” complemented by manual reference screening. Eligible studies were English-language full-text articles in peer-reviewed journals providing a complete dermoscopic description. Extracted data included patient demographics and major dermoscopic criteria, categorized as global patterns and focal dermoscopic and vascular structures. Due to heterogeneity, results were synthesized descriptively. Results: Twenty studies were included, comprising 774 patients. Dermoscopic findings were markedly heterogeneous. Globally, lesions frequently showed homogeneous pigmentation with variable colors and included amelanotic presentations. Commonly evaluated focal features included irregular dots and globules, crystalline structures, peripheral gray dots, and lacuna-like areas. Vascular patterns were prominent, particularly serpentine and corkscrew-like vessels. Conclusions: CMM dermoscopy is characterized by substantial heterogeneity and a lack of standardized criteria. Systematic classification of recurring dermoscopic features may improve diagnostic consistency and provide an interpretable framework for future artificial intelligence-based approaches supporting non-invasive recognition of melanoma metastases.

Background: Diagnosing facial melanoma, specifically lentigo maligna (LM) and lentigo maligna melanoma (LMM), is a daily clinical challenge, particularly for small or traumatized lesions. LM and LMM are part of the broader group of atypical pigmented facial lesions (aPFLs), which also includes benign look-alikes such as solar lentigo (SL), atypical nevi (AN), seborrheic keratosis (SK), and seborrheic-lichenoid keratosis (SLK), as well as pigmented actinic keratosis (PAK), a potentially premalignant keratinocytic lesion. Standard dermoscopy with handheld devices is the most widely used diagnostic tool in dermatology, but its accuracy heavily depends on the clinician’s experience and the perceived difficulty of the case. As a result, many benign aPFLs are excised for histological analysis, often leading to aesthetic concerns. Reflectance confocal microscopy (RCM) can reduce the need for biopsies, but it is limited to specialized centers and requires skilled operators. Aims: This study aimed to assess the impact of personal skill, diagnostic confidence, and perceived difficulty on the diagnostic accuracy and management in the differential dermoscopic diagnosis of aPFLs. Methods: A total of 1197 aPFLs dermoscopic images were examined on a teledermoscopic web platform by 155 dermatologists and residents with 4 skill levels (8 years). They were asked to give a diagnosis, to estimate their confidence and rate the case, and choose a management strategy: “follow-up”, “RCM” or “biopsy”. Diagnostic accuracy was examined according to the personal skill level, confidence level, and rating in three settings: (I) all seven diagnoses, (II) LM vs. PAK vs. fully benign aPFLs, (III) malignant vs benign aPFLs. The same analyses were performed for management decisions. Results: The diagnostic confidence has a certain impact on the diagnostic accuracy, both in terms of multi-class diagnosis of six aPFLs in diagnostic (setting 1) and in benign vs malignant (setting 3) or benign vs. malignant/premalignant discrimination (setting 2). The perceived difficulty influences the management of benign lesions, with easy ratings predominantly matching with “follow-up” decision in benign cases, but not that of malignant lesions assigned to “biopsy”. The experience level had an impact on the perception of the number of real easy cases and had no to minimal impact on the average diagnostic accuracy of aPFLs. It, however, has an impact on the management strategy and specifically in terms of error reduction, namely the lowest rates of missed malignant cases after 8 years of experience and the lowest rates of inappropriate biopsies of benign lesions after 1 year of experience. Conclusions: The noninvasive diagnosis and management of aPFLs rest on a daily challenge. Highlighting which specific subgroups of lesions need attention and second-level examination (RCM) or biopsy can help detect early malignant cases, and, in parallel, reduce the rate of unnecessary removal of benign lesions.