Multiple primary melanomas: Is there a correlation between dermoscopic features and germline mutations?

% of MPMs. 8 Colombino et al. reported a higher concordance rate (66.7%) but limited to only 12 patients. In our study, the concordance rate was 55.7%, consistently with previous studies. 9 This was higher in males (61.5%) than in females (38.5%). One of the main aims of CM follow- up programs is to ensure a prompt detection and excision of atypical lesions. CM subjects may show a considerable number of nevi, often in a multiple dysplastic nevus syndrome. Considering that more than half of MPMs patients show a concordance between dermoscopic patterns, we believe that knowing the dermoscopic features of the first diagnosed CM may help the clinicians in the evaluation and decisional process of doubtful lesions. Though the germline mutational status does not appear to be correlated with a concordance in MPM dermoscopic presentation, but further studies are warranted

were evaluated in random order by 4 expert dermatologists (G.V., M.M., F.T., E.D.). The following dermoscopic criteria were assessed: regression structures, atypical network, structureless areas, irregular vessels, inverse network and blue-white veil, irregular dots/globules and streaks. Each dermatologist compared the images of every single patient to detect any criteria concordance, defined as the presence of at least 4/8 analogue criteria in both CMs ( Figure 1). Data regarding germline mutations in CDKN2A, CDKN2B, CDK4 and MITF genes were evaluated: overall, 106 patients were included, 65 males and 41 females, with a total of 254 CMs (Table 1).
Statistical analysis did not show any significant association between concordance of dermoscopic criteria and sex, synchronicity of MPMs and anatomical site.
Currently, a possible association between germline mutations and dermoscopic features has been proposed. 5,6 Structureless areas are often detected in case of CDKN2A mutations with a couple of variants of MC1R of the RHC type and streaks/pigmented networks in their absence. OncoKB (Likely Oncogenic); CKB (Unknown protein effect); Clinvar (Likely pathogenic); Polyphen (score 1 -Probably damaging (HumVar)); Leiden database (VUS).

T A B L E 1 Continued
MITF-mutated subjects may show a nonspecific pattern (amelanotic/hypomelanotic nodular CM) with atypical polymorphic vessels. 6,7 RHC MC1R variants were reported to influence CM features, reducing the pigmentation and the development of dermoscopic structures, including a lower number of blotches, due to the reduced synthesis of eumelanin. Non-carriers of RHC variants were shown to have darker shades of colours, asymmetry and more structures. 6 Specific genetic variants in MTAP (allele rs10811629_G, rs2218220_T and rs7023329_G) were correlated with regression structures (peppering, mixed regression), blue-whitish veil, shiny white structures and pigment network, while others in PAX3 (allele rs132985_T), PLA2G6 (rs7600206_C), IRF4 (rs12203592_T) with shiny white structures or mixed regression. 6 In our series, structureless areas and irregular vessels (both 3/3, 100%) were the most common patterns in MITF-mutated patients compared to 37.80% and 21.26% in the whole group (p = 0.045 and 0.008, respectively), while the atypical network was the most common pattern in CDKN2A-mutated cases or in those with polymorphism, though the difference was not statistically significative (5/6 in c.442G>A and 2/3 in c.249C>A; p = 0.482 and 0.614, respectively). Moreover, 2/3 MITF-mutated patients developed a nodular amelanotic CM after a pT1a cM during the longitudinal follow-up.
We detected no correlation between the germline mutational status and the MPM concordance, even considering the low rate of mutated cases.
Moscarella et al. reported a concordance rate respectively in 53.0% and 38.7% of MPMs. 8 Colombino et al. reported a higher concordance rate (66.7%) but limited to only 12 patients. In our study, the concordance rate was 55.7%, consistently with previous studies. 9 This was higher in males (61.5%) than in females (38.5%). One of the main aims of CM follow-up programs is to ensure a prompt detection and excision of atypical lesions. CM subjects may show a considerable number of nevi, often in a multiple dysplastic nevus syndrome. Considering that more than half of MPMs patients show a concordance between dermoscopic patterns, we believe that knowing the dermoscopic features of the first diagnosed CM may help the clinicians in the evaluation and decisional process of doubtful lesions. Though the germline mutational status does not appear to be correlated with a concordance in MPM dermoscopic presentation, but further studies are warranted.

FUNDING INFORMATION
The work reported in this publication was funded by the Italian Ministry of Health, RC-2022-2773478 Project.

Evaluation of teledermatology during a pandemic: Assessing patient satisfaction, cost evaluation and clinical effectiveness
In this report, we evaluate teledermatology during a pandemic by assessing clinical effectiveness, cost, quality of life and patient satisfaction in an Australian context. This single-centre cross-sectional study of teledermatology was conducted at an Australian tertiary hospital using a three-part questionnaire-dermatology life quality index (DLQI), patient satisfaction questionnaire (PSQ) and cost evaluation questionnaire-between 17 February and 24 December 2020, after HREC approval (Melbourne Health HREC/61778/MH-2020). From the group of teledermatology patients, patients with psoriasis on biologic therapy were analysed as a sub-cohort. The primary outcome was patient satisfaction. The secondary outcomes were clinical effectiveness, cost and waiting time for appointments and waiting time in waiting area.
The DLQI score was calculated by summing the score of each question (0-30). The scores were divided into two categories-'moderate to large effect' (6-30) and 'no to mild effect' (0-5).
The 12-item PSQ (adapted from a validated 15-item questionnaire) evaluates patient satisfaction. 1 The response scale was divided into 'disagree', 'no opinion' and 'agree'. Negatively worded satisfaction items were recorded in reverse, so that a higher score reflects greater satisfaction. The PSQ was divided into four categories: positive attitude, hotel aspects, photo anxiety and interaction. 1 The Spearman rank-order correlation coefficient was used to measure the association between DLQI and PSQ.
A cost evaluation questionnaire was created to evaluate costs saved attending teledermatology appointments and analysed using descriptive statistics.
Clinical effectiveness was evaluated by comparing PASI and DLQI in patients on ongoing biologic therapy