Umbilical Melanoma: Where You Least Expect It Sabina Vaccari, Martina Lambertini, Barbara Corti, Giulia Querzoli, Alessio Natale, Daniela Tassone, Emi Dika Australasian Journal of Dermatology, 2026 The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
Randomized comparative study of 5-Fluorouracil 4%, tirbanibulin, and photodynamic therapy for relapsing actinic keratoses Federico Venturi, Elisabetta Magnaterra, Alberto Gualandi, Biagio Scotti, Carlotta Baraldi, Aurora Alessandrini, Sabina Vaccari, Emi Dika Photodiagnosis and Photodynamic Therapy, 2026 BACKGROUND: Actinic keratosis (AK) reflects a field cancerization process in chronically sun-damaged skin, and relapse after diclofenac therapy is a frequent clinical scenario. Field-directed treatments such as 5-fluorouracil (5-FU), tirbanibulin, and photodynamic therapy (PDT) are widely used, yet comparative data in post-diclofenac relapse and the contribution of reflectance confocal microscopy (RCM) to therapeutic monitoring remain limited. OBJECTIVES: To compare the clinical efficacy, tolerability, and subclinical response of 5-FU 4%, tirbanibulin 1%, and PDT in relapsing AK of the scalp, integrating RCM imaging to assess field response. METHODS: A prospective randomized (1:1:1) study was conducted in 45 patients who previously achieved complete clearance with diclofenac 3% and relapsed within 12 months. Endpoints included clinical clearance at 12 weeks, RCM normalization, recurrence at 6 months, and local skin response (LSR) severity. RESULTS: Twelve-week clearance rates were 73.3% for 5-FU, 66.7% for tirbanibulin, and 80.0% for PDT (p=0.711). RCM normalization occurred in 66.7%, 60.0%, and 73.3% of patients, respectively (p=0.741). Recurrence among responders at 6 months was low and comparable (9.1%, 10.0%, and 8.3%; p=0.991). Tirbanibulin showed significantly lower LSR scores versus 5-FU and PDT (p<0.001), indicating superior tolerability. CONCLUSIONS: Short-term efficacy of 5-FU, tirbanibulin, and PDT was comparable, while tolerability differed markedly. Tirbanibulin demonstrated the most favorable inflammatory and cosmetic profile, whereas 5-FU and PDT may be preferred when a more intense field effect is desired. RCM detected subclinical persistence in select cases and may serve as an adjunctive imaging tool for monitoring and guiding retreatment in field cancerization.
Human Papillomavirus in Bowen Disease: Site-Specific Prevalence, Genotype Distribution, and Clinical Implications Across Nail Apparatus, Cutaneous, and Anogenital Sites Emi Dika, Carlotta Baraldi, Federico Venturi, Aurora Maria Alessandrini, Sabina Vaccari, Simona Venturoli, Gabriele Argenziano, Tiziano Ferrari, Tiziana Lazzarotto, Elisabetta Magnaterra International Journal of Molecular Sciences, 2026 Bowen disease (BD), or squamous cell carcinoma (SCC) in situ, represents a histologically defined but biologically heterogeneous group of intraepithelial neoplasms arising across different epithelial compartments. Human papillomavirus (HPV) plays a well-established causal role in anogenital squamous intraepithelial neoplasia, whereas its contribution to extragenital BD, including nail apparatus and general cutaneous lesions, has remained controversial. We performed a narrative review of the literature to synthesize current evidence on HPV prevalence, genotype distribution, and pathogenetic relevance in BD across three anatomical sites: nail apparatus, general cutaneous skin, and anogenital region. Available data reveal a clear site-dependent gradient of HPV involvement. Anogenital BD is overwhelmingly driven by high-risk α-HPV genotypes and shares molecular hallmarks of HPV-mediated carcinogenesis. Nail apparatus BD shows a consistently high prevalence of transforming α-HPV types, suggesting a biologically distinct subset of extragenital disease. In contrast, general cutaneous BD demonstrates highly variable HPV detection, predominantly involving β- and occasionally γ-HPV types, with evidence supporting a permissive or incidental rather than causal role. These findings indicate that BD should not be regarded as a unified viral neoplasm but as a convergent histologic phenotype arising from distinct pathogenetic pathways. Anatomical context is therefore essential for interpreting HPV detection and its diagnostic and clinical implications.
Nevus-Associated and De Novo Melanoma: A Cross-Sectional Study on Prognostic Differences Emi Dika, Federico Venturi, Biagio Scotti, Alberto Gualandi, Carlotta Baraldi, Sabina Vaccari, Sebastiano Posenato, Corrado Zengarini, Aurora Alessandrini, Leonardo Veneziano, Marco Ardigò, Elisabetta Magnaterra Cancers, 2025 Background/Objectives: Melanomas may develop de novo or in association with a pre-existing nevus (nevus-associated melanoma, NAM). Whether these subtypes differ in their clinical and biological behavior remains uncertain. We aimed to compare the clinicopathologic features and outcomes of NAM and de novo melanoma (DNM) in a large single-center cohort. Methods: We retrospectively analyzed 378 patients with invasive melanoma diagnosed between 2007 and 2021 at a tertiary referral center. Tumors were classified as NAM when histopathologic continuity with a nevus was present, and as DNM otherwise. Clinical, histologic, and prognostic variables were compared using univariate and multivariate analyses. Results: Of 378 melanomas, 90 (24%) were NAM and 288 (76%) were DNM. Patients with NAM were slightly younger (mean 52 vs. 54 years) and more often presented with tumors on the trunk (65.6% vs. 51.7%). NAMs exhibited lower Breslow thickness (0.55 vs. 0.84 mm), reduced mitotic activity (0.17 vs. 1.21/mm2), and less frequent ulceration (2.2% vs. 9.4%). Distant metastases occurred only in DNM (6.6%). Sentinel lymph node positivity (1.1% vs. 6.3%) and melanoma-specific mortality (0% vs. 0.69%) did not differ significantly. Multivariate analysis identified Breslow thickness and mitotic rate as independent predictors of subtype. Conclusions: NAMs present with more favorable histopathologic features than DNMs, yet long-term outcomes appear similar. These findings support divergent pathways of melanoma development and underscore the need for molecular and imaging studies to refine risk stratification and guide management.
From Slide to Insight: The Emerging Alliance of Digital Pathology and AI in Melanoma Diagnostics Federico Venturi, Giulia Veronesi, Alberto Gualandi, Elisabetta Magnaterra, Biagio Scotti, Ina Sotiri, Carlotta Baraldi, Aurora Maria Alessandrini, Leonardo Veneziano, Sabina Vaccari, Elena Maria Cama, Daniela Tassone, Barbara Corti, Emi Dika Cancers, 2025 Background: Cutaneous melanoma (CM) poses significant diagnostic challenges due to its biological heterogeneity and the subjective interpretation of histopathologic criteria. While early and accurate diagnosis remains critical for patient outcomes, conventional pathology is limited by interobserver variability and diagnostic ambiguity, especially in borderline lesions. Objective: This narrative review explores the integration of digital pathology (DP) and artificial intelligence (AI)—including deep learning (DL), machine learning (ML), and interpretable models—into the histopathologic workflow for CM diagnosis. Methods: We systematically searched PubMed, Scopus, and Web of Science (2013–2025) for studies using whole slide imaging (WSI) and AI to assist melanoma diagnosis. We categorized findings across five domains: WSI-based classification models, feature extraction (e.g., mitoses, ulceration), spatial modeling and TIL analysis, molecular prediction (e.g., BRAF mutation), and interpretable pipelines based on nuclei morphology. Results: We included 87 studies with diverse AI methodologies. Convolutional neural networks (CNNs) achieved diagnostic accuracy comparable to expert dermatopathologists. U-Net and Mask R-CNN models enabled robust detection of critical histologic features, while nuclei-level analyses offered explainable classification strategies. Spatial and morphometric modeling allowed quantification of tumor–immune interactions, and select models inferred molecular alterations directly from H&E slides. However, generalizability remains limited due to small, homogeneous datasets and lack of external validation. Conclusions: AI-enhanced digital pathology holds transformative potential in CM diagnosis, offering accuracy, reproducibility, and interpretability. Yet, clinical integration requires multicentric validation, standardized protocols, and attention to workflow, ethical, and medico-legal challenges. Future developments, including multimodal AI and integration into molecular tumor boards, may redefine diagnostic precision in melanoma.
Squamous Cell Carcinoma of the Nail Unit: A Comprehensive Review of Clinical Features, Diagnostic Workflow, Management Strategies and Therapeutic Options Federico Venturi, Elisabetta Magnaterra, Biagio Scotti, Aurora Alessandrini, Leonardo Veneziano, Sabina Vaccari, Carlotta Baraldi, Emi Dika Diagnostics, 2025 Background/Objectives: Squamous cell carcinoma of the nail unit (SCCNU) is a rare yet often underrecognized malignancy that can lead to delayed diagnosis and significant functional morbidity. This review aims to comprehensively summarize the current understanding of SCCNU, focusing on its clinical, dermoscopic, and molecular features, diagnostic approaches, and evolving management strategies, including the role of emerging technologies and immunotherapy. Methods: A detailed literature review was conducted using peer-reviewed publications, case series, and institutional guidelines related to SCCNU. Emphasis was placed on studies addressing clinical presentation, dermoscopic patterns, molecular pathology, histologic subtypes, imaging, biopsy techniques, staging systems, and both conventional and novel therapeutic approaches. Comparative analyses of histopathological variants and diagnostic algorithms were included. Results: SCCNU presents in patients with diverse clinical manifestations, often mimicking benign nail disorders, leading to diagnostic delays. Dermoscopy improves lesion visualization, revealing features such as vascular changes and onycholysis. Histologically, SCCNU exhibits two main subtypes: basaloid (HPV-related) and keratinizing (HPV-negative) types. Molecular analyses have identified TP53 as the most frequently mutated gene, with additional alterations in HRAS, BRAF, and TERT. Imaging modalities such as MRI and LC-OCT aid in staging and surgical planning. Management is centered on complete excision—often via Mohs micrographic surgery—while topical, intralesional, and HPV-directed therapies are under investigation. Immunohistochemical markers (p16, Ki-67, AE1/AE3) and neoadjuvant immunotherapy represent promising adjuncts. Conclusions: Early diagnosis through non-invasive imaging, improved molecular characterization, and personalized treatment strategies are essential to advancing care in SCCNU. Future directions include clinical trials evaluating immunotherapy, vaccine strategies, and precision-guided surgical approaches to preserve function and minimize recurrence.
Topical imiquimod and in situ vulvar melanoma: A promising therapy? Francesca Pepe, Flavia Silvestri, Eleonora Petra Preti, Anna Daniela Iacobone, Gianluigi Radici, Sabina Vaccari, Paola Queirolo, Giulio Tosti International Journal of Gynecology and Obstetrics, 2025 ObjectivesVulvar melanoma is a rare type of cancer that affects mainly postmenopausal women. There are no established protocols for the treatment of vulvar melanoma. From data extrapolated from the literature on cutaneous melanoma, surgical excision remains the best option for the resectable disease. Imiquimod, a topical immunomodulator, has been used in selected cases of in situ vulvar melanoma.Methods and ResultsWe reported two cases of in situ vulvar melanoma treated with topical imiquimod 5%, either as first‐line therapy or adjuvant treatment, that showed a complete clinical response to topical treatment.ConclusionImiquimod's beneficial and adverse effects in in situ vulvar melanoma treatment are examined.
Merkel Cell Carcinoma: An Updated Review Focused on Bone and Bone Marrow Metastases Biagio Scotti, Elisabetta Broseghini, Costantino Ricci, Barbara Corti, Costanza Viola, Cosimo Misciali, Carlotta Baraldi, Sabina Vaccari, Martina Lambertini, Federico Venturi, Elisabetta Magnaterra, Aurora Alessandrini, Tiziano Ferrari, Massimo Lepri, Gabriele Argenziano, Barbara Melotti, Elena Campione, Davide Campana, Manuela Ferracin, Emi Dika Cancers, 2025
Association of miR-146a-5p and miR-21-5p with Prognostic Features in Melanomas Maria Naddeo, Elisabetta Broseghini, Federico Venturi, Sabina Vaccari, Barbara Corti, Martina Lambertini, Costantino Ricci, Beatrice Fontana, Giorgio Durante, Milena Pariali, Biagio Scotti, Giulia Milani, Elena Campione, Manuela Ferracin, Emi Dika Cancers, 2024
"Your Skin Tells You" Campaign for Keratinocyte Cancers: When Individuals' Selection Makes the Difference Maria Concetta Fargnoli, Paolo Antonetti, Laura Atzori, Paolo Taddeucci, Alessandro Di Stefani, Vieri Grandi, Lucia Lospalluti, Francesco Lacarrubba, Sabina Vaccari, Paolo Amerio, Gabriella Fabbrocini, Mariateresa Rossi, Elena Campione, Raffaele Dante Caposiena Caro, Elvira Moscarella, Franco Rongioletti, Cristina Pellegrini, Ketty Peris, Discab Dermatology, 2023
Merkel cell carcinoma: a prompt diagnosis to increase survival M.A. Chessa, M. Malosso, F. Pepe, A. Patrizi, S. Telo, V. Ambrosini, S. Fanti, M. Magnano, C. Baraldi, B. Corti, F. Filippi, S. Vaccari, A. Pileri, F. Bardazzi Journal of the European Academy of Dermatology and Venereology, 2019
Photodynamic therapy: An option in mycosis fungoides Alessandro Pileri, Paola Sgubbi, Claudio Agostinelli, Salvatore Domenico Infusino, Sabina Vaccari, Annalisa Patrizi Photodiagnosis and Photodynamic Therapy, 2017
Prevalence and risk factors of actinic keratosis in patients attending Italian dermatology clinics Maria Concetta Fargnoli, Gianfranco Altomare, Elisa Benati, Francesco Borgia, Paolo Broganelli, Anna Carbone, Sergio Chimenti, Sergio Donato, Giampiero Girolomoni, Giuseppe Micali, Erica Moggio, Aurora Parodi, Stefano Piaserico, Giuseppe Pistone, Concetta Potenza, Mario Puviani, Margherita Raucci, Sabina Vaccari, Stefano Veglio, Andrea Zanca, Ketty Peris European Journal of Dermatology, 2017
Successful treatment of face actinic keratosis with Imiquimod cream 5% (Aldara®) Giornale Italiano Di Dermatologia E Venereologia, 2002
Allergic contact dermatitis from methylene-4,4′-diphenyldiisocyanate in a student of chemistry Annali Italiani Di Dermatologia Allergologica Clinica E Sperimentale, 2001
Acquired Acrodermatitis enteropathica: A case report Chronica Dermatologica, 1997
