Cristina Soare

Background: Actinic keratosis (AK) is a common UV-induced intraepidermal neoplasm and a precursor to cutaneous squamous cell carcinoma (cSCC). Accurate, non-invasive assessment of AK severity is crucial for early intervention and risk stratification. Objective: To evaluate the relationship between clinical severity of AK, as defined by the Olsen grading scale, and predefined dermoscopic and reflectance confocal microscopy (RCM) features. Methods: This cross-sectional study enrolled 50 patients with clinically diagnosed AK at a tertiary dermatology center between April 2024 and July 2025. Each lesion was assessed clinically using the Olsen scale (grades 1–3), dermoscopically (five features scored 0–3; total score 0–15), and via RCM (five RCM parameters scored 0–3; total score 0–15). Statistical correlations between clinical grade and imaging features were analyzed using Pearson’s χ² test with effect size metrics. Results: Diffuse erythema (p < 0.001), micro-erosions (p = 0.002), strawberry pattern (p = 0.038), and scales (p = 0.012) correlated significantly with Olsen grade, whereas vessels (p = 0.566) did not. All five RCM parameters showed strong associations with clinical severity. Composite dermoscopic and RCM scores correlated with Olsen grade (both p < 0.001). Abnormal honeycomb pattern, parakeratosis, inflammation, and solar elastosis were the best RCM predictors of high dermoscopic severity (all p < 0.001); conversely, erosions, erythema, and scales were the strongest dermoscopic predictors of high RCM severity (all p < 0.001). Conclusions: This study demonstrates strong, statistically significant associations between clinical, dermoscopic, and confocal features of AK. This supports the integration of multimodal scoring into unified AK severity frameworks.

Background/Objectives: Actinic keratosis (AK) is considered to be the most common form of in situ carcinoma and typically arises on skin that has been chronically exposed to ultraviolet radiation. The need for early diagnosis, using non-invasive methods, has allowed for a non-surgical approach to these conditions with a significant impact on the quality of life of patients. Methods: A retrospective study was conducted on 58 patients diagnosed with AK who underwent surgical excision at a tertiary center in Bucharest, Romania between 2018 and 2023. Clinical parameters (age, sex, lesion size, anatomical location, comorbidities) and histopathological variables (AK subtype, KIN grade, pleomorphism, solar elastosis, inflammatory infiltrate) were analyzed. Statistical associations between histological findings and clinical features were assessed using Fisher’s exact test. Conclusions: The study confirmed a predominance of AK among elderly patients, with hypertrophic lesions and moderate dysplasia (KIN II) being most common. Higher KIN grades correlated significantly with more severe pleomorphism, solar elastosis, and inflammatory response, suggesting progressive UV-induced skin damage. The findings underscore the importance of clinicopathological correlation for risk stratification and support the integration of non-invasive diagnostic tools to improve early detection and management of AK.

Non-melanocytic skin cancers represent an important public health problem due to the increasing incidence and the important local destructive potential. Thus, the early diagnosis and treatment of precancerous lesions (actinic keratoses) is a priority for the dermatologist. In recent years, non-invasive skin imaging methods have seen an important development, moving from simple observational methods used in clinical research, to true diagnostic and treatment methods that make the dermatologist’s life easier. Given the frequency of these precancerous lesions, their location on photo-exposed areas, as well as the long treatment periods, with variable, imprecise end-points, the need to use non-invasive imaging devices is increasingly evident to complete the clinical observations in the diagnosis and treatment of these lesions, with the aim of increasing accuracy and decreasing the adverse effects due to long treatment duration. This is the first review that brings together all skin imaging methods (dermoscopy, reflectance confocal microscopy, ultrasonography, dermoscopy-guided high frequency ultrasonography, and optical coherence tomography) used in the evaluation of actinic keratoses and their response to different treatment regimens.

The skin’s recognised functions may undergo physiological alterations due to ageing, manifesting as varying degrees of facial wrinkles, diminished tautness, density, and volume. Additionally, these functions can be disrupted (patho)physiologically through various physical and chemical injuries, including surgical trauma, accidents, or chronic conditions like ulcers associated with diabetes mellitus, venous insufficiency, or obesity. Advancements in therapeutic interventions that boost the skin’s innate regenerative abilities could significantly enhance patient care protocols. The application of Platelet-Rich Plasma (PRP) is widely recognized for its aesthetic and functional benefits to the skin. Yet, the endorsement of PRP’s advantages often borders on the dogmatic, with its efficacy commonly ascribed solely to the activation of fibroblasts by the factors contained within platelet granules. PRP therapy is a cornerstone of regenerative medicine which involves the autologous delivery of conditioned plasma enriched by platelets. This is achieved by centrifugation, removing erythrocytes while retaining platelets and their granules. Despite its widespread use, the precise sequences of cellular activation, the specific cellular players, and the molecular machinery that drive PRP-facilitated healing are still enigmatic. There is still a paucity of definitive and robust studies elucidating these mechanisms. In recent years, telocytes (TCs)—a unique dermal cell population—have shown promising potential for tissue regeneration in various organs, including the dermis. TCs’ participation in neo-angiogenesis, akin to that attributed to PRP, and their role in tissue remodelling and repair processes within the interstitia of several organs (including the dermis), offer intriguing insights. Their potential to contribute to, or possibly orchestrate, the skin regeneration process following PRP treatment has elicited considerable interest. Therefore, pursuing a comprehensive understanding of the cellular and molecular mechanisms at work, particularly those involving TCs, their temporal involvement in structural recovery following injury, and the interconnected biological events in skin wound healing and regeneration represents a compelling field of study.

Cutaneous squamous cell carcinoma (cSCC) is the second most common skin cancer, originating from keratinocytes of the spinous layer. Numerous risk factors have been discovered for the initiation and growth of this type of cancer, such as exposure to UV and ionizing radiation, chemical carcinogens, the presence of immunosuppression states, chronic inflammation, infections with high-risk viral strains, and, last but not least, the presence of diseases associated with genetic alterations. The important socio-economic impact, as well as the difficulty associated with therapy for advanced forms, has made the molecular mechanisms underlying this neoplasia more and more intensively studied, with the intention of achieving a better understanding and advancing the treatment of this pathology. This review aims to provide a brief foray into the molecular, genetic, and epigenetic aspects of this cancer, as well as the treatment methods, ranging from the first used to the latest targeted therapies.

High-frequency ultrasonography (HF-USG) is a relatively new imaging method that allows the evaluation in a non-invasive manner of the skin layers and skin appendages. It is a diagnostic tool with increasing usefulness in numerous dermatological pathologies. High reproducibility, non-invasiveness and short diagnostic time make this method an increasingly used tool in dermatological practice. The subepidermal low-echogenic band is a relatively newly described parameter that seems to be a marker not only of intrinsic and extrinsic skin aging, but also of inflammatory processes taking place at the skin level. This systematic review aims to evaluate the role that SLEB has in the diagnosis and monitoring of the treatment of some inflammatory and non-inflammatory dermatological conditions, as well as its utility as a disease marker.

Mycosis fungoides represents the most common cutaneous T-cell lymphoma, clinically manifested with evolving skin lesions, including patches, plaques, tumors, and erythroderma. Early diagnosis remains difficult to establish because it mimics several benign skin conditions, but maintaining a high index of suspicion for the disease is essential in preventing the progression of a potentially fatal disease. We report the case of a 69-year-old female who presented in our dermatology clinic in 2018 with scaly, indurated, itchy erythematous-violaceus patches and plaques, and tumors disseminated throughout the skin evolving for nine years. Skin biopsy supplemented with immunohistochemical staining established the diagnosis of mycosis fungoides. Due to the equivocal clinical presentation and the lack of extracutaneous manifestations, the patient received conventional therapy according to the stage of the disease. The rapidly progressive evolution of the cutaneous lesions in the last year of the disease determined the patient’s death despite instituting systemic chemotherapy. Patient follow-up and a multidisciplinary approach are essential to diagnose and manage this disease in its early stages. This will prevent the progression to a life-threatening malignancy and the use of immunosuppressive therapy, which can cause serious side effects.

Melanomas of the skin are poorly circumscribed lesions, very frequently asymptomatic but unfortunately with a continuous growing incidence. In this landscape, one can distinguish melanomas originating in the mucous membranes and located in areas not exposed to the sun, namely the vulvo-vaginal melanomas. By contrast with cutaneous melanomas, the incidence of these types of melanomas is constant, being diagnosed in females in their late sixties. While hairy skin and glabrous skin melanomas of the vulva account for 5% of all cancers located in the vulva, melanomas of the vagina and urethra are particularly rare conditions. The location in areas less accessible to periodic inspection determines their diagnosis in advanced stages, often metastatic. Moreover, despite the large number of drugs newly approved in recent decades for the treatment of cutaneous melanoma, especially in the category of biological drugs, the mortality of vulvo-vaginal melanomas has remained almost constant. This, together with the absence of specific treatment guidelines due to the lack of a sufficient number of cases to conduct randomized clinical trials, makes melanomas with this localization a discouraging diagnosis, associated with a very poor prognosis. Our aim is therefore to draw attention to this oftentimes overlooked entity in order to encourage the community to employ various strategies meant to increase research in this area. By highlighting the main risk factors of vulvar and vaginal melanomas, as well as the clinical manifestations and molecular changes underlying these neoplasms, ideally novel therapeutic schemes will, in time, be brought into effect.

In vivo reflectance confocal microscopy (RCM) is an emerging non-invasive imaging technique which produces horizontal greyscale images of the skin at various depths, allowing the visualisation of epidermis and superficial dermis at cellular resolution facilitating the diagnosis of several cutaneous disorders including skin cancers4–7 and inflammatory skin diseases.8 RCM has previously been employed in the diagnosis of scabies, proving its ability to demonstrate the mite within the epidermis, where the adult women dig burrows and spawn.3 9–11