We have recently noticed an outbreak of chilblain-like lesions in Italy contemporarily to COVID-19 epidemic. Due to the wellknown lockdown-related difficulties to visit the patients, 1 we created a Google form aimed to collect information about patients presenting with these singular clinical findings. An easy to access and quick tool was chosen by the investigators in order to permit the other colleagues to spend the least amount of time, given the severe health emergency. The form was submitted through social media and email to hundreds of Italian dermatologists and paediatricians. In 5 days, we collected 63 patients through the form, but data are still going to be collected. Here the first preliminary results. No significant difference in gender was noticed (57.4% females vs 47.6% males). The median age was 14 years (IQR: 12-16). Feet alone were mostly affected (85.7%) followed by feet/hands together (7%) and hands alone (6%). Pictures of patients were uploaded in 54 patients, with 31/ 54 presenting with erythematous-oedematous lesions (Fig. 1) and 23/54 with blistering lesions (Fig. 2). Pain and itch were equally observed (27% vs. 27%), followed by pain/itch together shown in 20.6% of patients. Asymptomatic lesions were present in 25.4%. Median time from the onset to clinical diagnosis was 10 days (IQR: 6-15). At time of diagnosis, most patients pre-

Epiluminescence microscopy (ELM, skin surface microscopy, dermoscopy, dermatoscopy) is a valuable method for improving the diagnostic accuracy in pigmented skin lesions. Specific ELM criteria are already recognized for differentiating pigmented Spitz naevi (PSN) from cutaneous melanomas (CM). Our purpose was to describe the ELM appearance of a series of PSN with emphasis on PSN and CM with overlapping features. Thirty-six consecutive patients with PSN, and three cases of CM (selected from a larger database) exhibiting ELM 'spitzoid' features, were evaluated clinically, dermatoscopically and histopathologically. Most PSN (27 of 36; 75%) displayed two typical ELM patterns, namely, the starburst (19 of 36; 53%) or the globular pattern (eight of 36; 22%), which were correlated to different histopathological findings. In nine of 36 (25%) PSN, atypical ELM features which are more commonly seen in CM were observed. These PSN with an atypical pattern were characterized by an uneven distribution of colours and structures, and an irregular diffuse pigmentation resembling blue-white veil or irregular extensions (black blotches). These atypical lesions mostly occurred in children and showed no history of growth. In contrast, in three examples of CM, the typical ELM criteria of malignancy were less recognizable and either the characteristic starburst or globular pattern usually seen in PSN was present. These three lesions occurred in adults and had a recent history of change in colour, shape or size. The overlap in ELM features of some PSN and CM represents a major diagnostic pitfall when ELM examination is considered alone. In these atypical cases, clinical history including the age of the patient may be the only clue to enable a correct diagnosis.

BACKGROUNDDermoscopy (dermatoscopy, epiluminescence microscopy) is increasingly employed for the preoperative detection of cutaneous melanoma; dermoscopic features of pigmented skin lesions have been previously defined using histopathology as the key to the code. In a preliminary study on 10 cases evaluated by nine dermoscopists and nine histopathologists, the authors experienced that when at least two dermoscopists disagree in evaluating a melanocytic lesion, even histopathologic consultations may give equivocal results.METHODSOne hundred seven melanocytic skin lesions, consecutively excised because of equivocal clinical and/or dermoscopic features, were retrospectively examined by eight dermoscopists and eight histopathologists; the diagnostic interobserver agreement was calculated by means of the Schouten k statistics. After histopathologic consultations, all 107 lesions underwent unblinded dermoscopic re‐evaluation in order to find which dermoscopic features had given rise to histopathologic diagnostic difficulties.RESULTSThe interobserver ageement was good for both dermoscopy (k = 0.53) and histopathology (k = 0.74). Out of 48 cases evaluated by the dermoscopists in complete accordance, only 8 (16.7%) received at least one conflicting histopathologic diagnosis. Instead, among the remaining 59 cases with at least one disagreeing dermoscopic diagnosis, 21 (35.6%) received at least one disagreeing histopathologic diagnosis. The unblinded dermoscopic re‐evaluation showed that five out of seven lesions with clear‐cut regression structures were histopathologically controversial.CONCLUSIONSAt least for selected and reasonably difficult lesions, a diagnostic discrepancy among formally trained dermoscopists seems to be predictive for a diagnostic disagreement among histopathologists. Lesions showing clear‐cut regression structures are prone to give some histopathologic disagreement. Cancer 2002;95:1094–1100. © 2002 American Cancer Society.DOI 10.1002/cncr.10768

Our results underline that teledermoscopy of 'pink' lesions does not provide a similar degree of diagnostic accuracy as otherwise in face-to-face diagnosis perhaps due to the absence of typical criteria. Atypical skin lesions are characterized by the absence of typical dermoscopic patterns, and their teleconsultation does not always increase the diagnostic accuracy.

Background: The natural evolution of melanocytic nevi is a complex, multifactorial process that can be studied by monitoring nevi on a long-term basis. Methods: To assess the evolution pathway of Spitz nevi, lesions with clinical and dermoscopic features suggestive of Spitz nevi were monitored and baseline and follow-up images compared. Results: Sixty-four patients (mean age 10.4 years) with lesions suggestive of Spitz nevi were included. Lesions were monitored for a mean follow-up period of 25 months. Upon side-by-side evaluation of baseline and follow-up images, 51 (79.7%) lesions showed an involution pattern and 13 (20.3%) lesions showed a growing or stable pattern. No significant differences were found between growing and involving lesions in terms of patient age and sex and the location and palpability of lesions. The great majority of growing lesions were pigmented or partially pigmented (92.3%), whereas 47.1% of lesions in involution were amelanotic (p = 0.005). Conclusion: In this series of lesions clinically and dermoscopically diagnosed as Spitz nevi, spontaneous involution seems to be the most common biologic behavior.