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Omalizumab is a monoclonal antibody, targeting Fc receptor of IgE, approved for the treatment of allergic asthma and chronic spontaneous urticaria. Its utility in atopic dermatitis appears controversial from data in literature since the molecule is well tolerated but it seems less effective than other medications used in adult patients (eg, Dupilumab). At present, the use of Dupilumab is not approved in pediatric patients therefore there are no second level treatments available in this age group. Here we report two clinical cases of patients (15 and 16 years old) suffering from both atopic dermatitis and asthma, treated with Omalizumab. Our experience suggests that atopic eczema of young patients with allergic comorbidities can benefit from asthma treatment with Omalizumab observing improvement on both conditions.

Cephalic melanocytic lesions can have misleading clinical and dermoscopic features. Different body regions present microanatomic diversity such as epidermal thickness, appendage distribution, dermal-epidermal junction structure, dermal architecture, and blood supply. 1 Therefore, when evaluating melanocytic lesions, site is as important as clinical presentation and dermoscopy. The diagnosis and follow-up of Spitz nevi (SN) occurring on special sites can be particularly challenging. 2,3 These lesions can present both clinical and histological atypia.Spitz nevi usually arise on the face in children and on the lower extremities in young women, 4 but when they appear in complex locations, such as the ear, they can raise concern. Reports in the literature about Spitz nevi of the ear (SNE) are scant. At the same time, melanoma of the external ear represents from 1% to 4% of all cutaneous melanomas and from 7% to 20% of melanomas of head and neck. 5 When spitzoid lesions of the ear are observed in young patients, it is necessary to consider pediatric melanoma even if it represents <1% of all melanoma diagnoses. 6 | C A S E REP ORTWe performed a retrospective analysis of the clinical macroscopic and digital dermoscopic images of histopathologically confirmed cases of SNE collected between March 2002 and March 2016 at two pigmented lesion clinics in Italy and Austria. Clinical data were obtained for each case, including age and gender of the patients, presentation and dimensions of the lesions, anatomical locations (helix, anthelix, lobule), and differential diagnosis.Six cases from patients aged from 8 to 17 years were identified and five were males (Table 1). Four out of 6 nevi were located on the helix, one on the anthelix, and one on the lobule. All lesions were pigmented, round, and well-demarcated, ranging from 2 to 5 mm in diameter. Half were flat (macules) (Figure 1A), the other half were raised (papules/nodules) (Figures 2A and 3A). In some cases, the borders were irregular, and color appeared uneven. Five nevi had a smooth surface.Three main dermoscopic features were identified: pseudonetwork (n = 3), structureless areas (n = 2), and cobblestone pattern (n = 1) (Table 1). The former pattern was characterized by a dark

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