Opinion statementRecently introduced systemic therapies for locally advanced and metastatic non-melanoma skin cancers (NMSCs) are paving the way for neoadjuvant approach. Although none of the therapeutic options has currently gained indication in this setting, neoadjuvant approach for NMSCs is an open field and we are likely to see huge developments in the near future. Targeted therapy with sonic hedgehog pathway inhibitors is very effective in locally advanced or multiple basal cell carcinomas while immunotherapy with immune checkpoint inhibitors appears to be promising for advanced cutaneous squamous cell carcinoma and Merkel cell carcinoma. To date, targeted therapy and immunotherapy represent the frontiers in NMSC therapeutic management and, according to recent studies, good results can be achieved.

Background: Non-melanoma skin cancer (NMSC) stands as an umbrella term for common cutaneous malignancies, including basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC), together with rarer cutaneous cancers, such as Merkel cell carcinoma (MCC) and other forms of adnexal cancers. The majority of NMSCs can be successfully treated with surgery or radiotherapy, but advanced and metastatic stages may require systemic approaches such as immunotherapy with immune checkpoint inhibitors (ICIs). Summary: Since immunotherapy is not effective in all patients and can potentially lead to severe adverse effects, an important clinical question is how to properly identify those who could be suitable candidates for this therapeutic choice. In this paper, we review the potential features and biomarkers used to predict the outcome of ICIs therapy for NMSCs. Moreover, we analyze the role of immunotherapy in special populations, such as the elderly, immunocompromised patients, organ transplant recipients, and subjects suffering from autoimmune conditions. Key messages: Many clinical, serum, histopathological, and genetic features have been investigated as potential predictors of response in NMSCs treated with ICIs. Although this field of research is very promising, definitive, cost-effective, and reproducible biomarkers are still lacking and further efforts are needed to validate the suggested predictors in larger cohorts.

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To date, cases of spondylodiscitis occurring in patients with erythrodermic psoriasis on treatment with anti-tumour necrosis factor alpha (anti-TNF-α) adalimumab have not been reported in the literature. We present the case of a 70-year-old man admitted to our Dermatology Department for the sudden development of erythrodermic psoriasis, on treatment for a month with adalimumab (40 mg every other week) for the severe clinical manifestations. During hospitalization, he developed a methicillin-susceptible Staphylococcus aureus bacteremia of unknown origin site, which was treated with oxacillin 2 g six times a day. Furthermore, the patient developed an insidious low back pain, accompanied by reduced lumbar range of motion, bilaterally positive Lasegue's sign and negative Wasserman's sign. Paresthesias and bilateral weakness in upper extremity were not noticed. After the

Neoplastic alopecia (NA) is defined as an organized hair loss in single or multiple areas of the scalp caused by a primary tumor that has metastasized to the skin of the scalp. Due to its localization and clinical appearance, NA should be placed in differential diagnosis with alopecia areata or other entities. To date, pathognomonic dermoscopic criteria of NA have not yet been described: the absence of classical criteria of other scalp diseases in addition to a major neovascularization with on-focus arborizing vessels and erosions or ulcerations may help the clinician to suspect a diagnosis of secondary alopecia. Dermatologists should pay more attention to these rare forms of secondarism because in exceptional cases, a simple alopecia of the scalp can hide a new, relapsing or metastatic neoplasia.

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There is no evidence of genotype-phenotype correlations, and there are no criteria to predict the severity of hair loss. This suggests that other gene modifiers might play a role in phenotypic variability. 1 Histologically, there is no decrease in total hair count, but there is a remarkable miniaturization and an increased telogen/anagen hair ratio. 5 Spontaneous improvement has been described, and the effectiveness of topical minoxidil in the treatment of ARWH/H and other monogenic hair disorders has also been noted. 5 However, topical minoxidil was not an effective treatment in these patients. We report two heterozygous mutations (one of them previously reported and the other novel) of the LPAR6 gene in dizygotic twins with ARWH. Molecular identification of hair growthregulating pathways and its mutations offers an opportunity for new therapeutic approaches to hair loss.