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Background Reflectance confocal microscopy (RCM) is increasingly used for noninvasive in vivo diagnosis of skin cancers. We seek to determine if RCM is useful for the diagnosis and follow‐up of squamous cell carcinoma in situ (SCCIS) posttreatment to document clearance. Methods A pilot prospective study enrolled 10 patients with a total of 11 SCCIS lesions. Clinical, confocal, histological features and fluorescence diagnosis (FD) were recorded pre‐ and posttreatment. Results Four SCCIS lesions underwent RCM imaging prior to biopsy, while 11 SCCIS lesions were followed up with RCM imaging. Clinical features of persistent SCCIS post‐PDT in four out of 11 follow‐up cases were confirmed with RCM and FD. There were no RCM features of SCCIS in seven lesions which were clinically cured. All eight (four new SCCIS and four follow‐up) cases displayed atypical honeycomb pattern. Two cases (25%) showed numerous epidermal dendritic cells, while small bright refractive cells were present in the epidermis in two lesions (25%). Round blood vessels in the superficial dermis were seen in four lesions (50%), while three lesions (37.5%) showed dermal inflammatory cells. Conclusion There was good correlation between histological and confocal features in patients who underwent RCM imaging prior to biopsy. RCM may be a complementary tool in diagnosing SCCIS and to monitor response to nonsurgical treatment by avoiding unnecessary biopsies especially in lesions with persistent residual postinflammatory erythema.

Introduction: Pruritus in elderly patients can have a significant impact on the quality of life but may be underestimated and poorly addressed by healthcare professionals. Materials and Methods: From March to May 2010, a structured interview questionnaire including the Dermatology Life Quality Index (DLQI) was administered to all patients admitted to the geriatric ward in Changi General Hospital, Singapore, except for those with cognitive impairment. Results: A total of 194 patients were enrolled in the study; 94 patients (48.5%) were experiencing itch at the point of the interview; mean DLQI score for patients with itch was 6.7; 35.1% of patients experienced sleep disruption whilst 30.9% reported impairment of concentration levels as a consequence of their itch. Of the patients who had informed their doctor about the problem, 73.7% felt that doctors had not adequately addressed the cause of the itch. Among patients who reported itch, the DLQI score correlates with the severity of pruritus with a regression coefficient of 0.2737 (P <0.001); 9.6% of patients with itch were independent with their activities of daily living compared to 21% of patients who did not experience itch. Conclusion: Almost half of the subjects in our study experienced itch and a third of them reported impairment of quality of life. Patients who were independent of their activities of daily living were also less likely to experience itch. This study highlights the importance of increasing awareness of pruritus among physicians as pruritus can have adverse consequences on patients’ quality of life when left unaddressed. Key words: Concentration, Geriatric, Inpatient pruritus, Quality of life, Sleep

Clinicians should be aware that cutaneous PAN can present with significant extracutaneous and constitutional symptoms which make it hard to differentiate from systemic PAN. The condition can also rarely be associated with NTM infections.