Technology in Practical Dermatology: Non-Invasive Imaging, Lasers and Ulcer Management

Preface
Contents
Part I: Imaging Techniques for the Evaluation of Skin Diseases
	1: Dermoscopy: Fundamentals and Technology Advances
		1.1	 Introduction
		1.2	 History of Dermoscopy
		1.3	 Hand-Held Dermoscope: Contact, Polarized, Hybrid
			1.3.1	 Contact Dermoscopy
			1.3.2	 Polarized Dermoscopy
			1.3.3	 Hybrid Dermoscopy
		1.4	 Portable Hand-Held Dermoscope/Camera Systems
		1.5	 Video-Dermoscopy and High-Resolution Dermoscopy
		1.6	 Evolution of Dermoscopic “Language”
			1.6.1	 Pattern Analysis
				1.6.1.1	 Age
				1.6.1.2	 Skin Type
			1.6.2	 Lesion-Specific Features: The Analytic Approach
			1.6.3	 Color and Symmetry: The Heuristic Approach
				1.6.3.1	 Color
				1.6.3.2	 Symmetry
			1.6.4	 Analytic vs. Heuristic Approach
			1.6.5	 Dermoscopy Consensus in the Years 2000–2018
		1.7	 Dermoscopy at Special Body Sites
			1.7.1	 Palmoplantar Skin
			1.7.2	 Facial Skin
				1.7.2.1	 Pigmented Flat Lesions
				1.7.2.2	 Palpable and Nodular Lesions
			1.7.3	 Nipple and Areola
			1.7.4	 Oral and Anogenital Mucosa
			1.7.5	 Conjunctiva/Sclera
		1.8	 Dermoscopy of the Nails and Hairs
			1.8.1	 Onichoscopy
			1.8.2	 Trichoscopy
		References
	2: Dermoscopy for Benign Melanocytic Skin Tumors
		2.1 Junctional Nevi
		2.2 Dermal Nevi
		2.3 Compound Nevi
		2.4 Congenital Melanocytic Nevi
		2.5 Blue Nevi
		2.6 Spitz Nevi
		2.7 Meyerson’s Nevi (Eczematous Nevi)
		2.8 Desmoplastic Nevi
		2.9 Balloon Cell Nevi
		2.10 Sclerosing Nevi with Pseudomelanomatous Features
		2.11 Targetoid Hemosiderotic Nevi
		References
	3: Dermoscopy for Melanoma
		3.1	 Introduction
		3.2	 Non-glabrous Skin Melanoma
		3.3	 Melanoma on Facial Skin
		3.4	 Acral Melanoma
		3.5	 Nail Melanoma
		3.6	 Nodular Melanoma
		3.7	 Amelanotic and Hypomelanotic Melanoma
		3.8	 Follow-up or Excision?
		References
	4: Dermoscopy for Non-melanocytic Benign Skin Tumors
		4.1	 Epithelial Tumors
			4.1.1	 Seborrheic Keratosis
			4.1.2	 Solar Lentigo
			4.1.3	 Lichen Planus-like Keratosis
			4.1.4	 Clear Cell Acanthoma
		4.2	 Vascular Tumors
			4.2.1	 “Cherry” Angioma
			4.2.2	 Angiokeratoma
			4.2.3	 Pyogenic Granuloma
		4.3	 Connective Tissue Tumors
			4.3.1	 Dermatofibroma
			4.3.2	 Lymphangioma
		4.4	 Adnexal Tumors
			4.4.1	 Sebaceous Hyperplasia
			4.4.2	 Eccrine Poroma
		References
	5: Dermoscopy for Non-melanocytic Malignant Skin Tumors
		5.1	 Dermoscopic Criteria of BCC
			5.1.1	 Vascular Structures
				5.1.1.1	 Arborizing Vessels (Branched Vessels)
				5.1.1.2	 Short Fine Telangiectasias (Serpentine Vessels)
			5.1.2	 Structures Related to Pigment
				5.1.2.1	 Blue-Gray Ovoid Nests (Blue, Gray Clods)
				5.1.2.2	 Multiple Blue-Gray Globules
				5.1.2.3	 In-Focus Dots
				5.1.2.4	 Spoke Wheel Areas (Radial Lines that Converge at a Central Dot or Clod)
				5.1.2.5	 Maple Leaf-like Areas (Peripheral Radial Lines with a Common Base)
				5.1.2.6	 Concentric Structures
			5.1.3	 Non-Vascular Non-Pigmented Structures
				5.1.3.1	 Ulceration
				5.1.3.2	 Multiple Small Erosions
				5.1.3.3	 Shiny White-Red Structureless Areas
				5.1.3.4	 Chrysalis or White Streaks (White Lines)
		5.2	 Basosquamous Carcinoma
		5.3	 Squamous Cell Carcinoma
			5.3.1	 Bowen’s Disease (BD)
			5.3.2	 Non-pigmented BD
			5.3.3	 Pigmented BD
			5.3.4	 Keratoacanthoma (KA)
			5.3.5	 Invasive Squamous Cell Carcinoma
			5.3.6	 Pigmented Squamous Cell Carcinoma
			5.3.7	 Merkel Cell Carcinoma (MCC)
			5.3.8	 Dermoscopic Criteria of MCC
			5.3.9	 Milky Red Background
			5.3.10	 Polymorphous Vascular Pattern
		References
	6: Dermoscopy for Inflammatory Diseases
		6.1	 Introduction
		6.2	 Darier’s Disease
		6.3	 Discoid Lupus Erythematosus
		6.4	 Eczematous Dermatitis
		6.5	 Erythemato-Telangiectatic Rosacea
		6.6	 Granulomatous Diseases
		6.7	 Lichen Planus
		6.8	 Lichen Sclerosus
		6.9	 Pigmented Purpuric Dermatoses
		6.10	 Pityriasis Lichenoides
		6.11	 Pityriasis Rosea
		6.12	 Porokeratosis
		6.13	 Psoriasis
		6.14	 Urticaria Pigmentosa
		6.15	 Zoon’s Mucositis
		References
	7: Dermoscopy for Infectious Diseases
		7.1	 Introduction
		7.2	 Parasitic Disorders
			7.2.1	 Scabies
			7.2.2	 Pediculosis
			7.2.3	 Pediculosis of the Scalp
			7.2.4	 Phthiriasis
			7.2.5	 Tungiasis
			7.2.6	 Cutaneous Leishmaniasis
			7.2.7	 Cutaneous Larva Migrans
			7.2.8	 Tick Bites
		7.3	 Viral Disorders
			7.3.1	 Cutaneous and Anogenital Warts
			7.3.2	 Molluscum Contagiosum
		7.4	 Fungal Disorders
			7.4.1	 Tinea Capitis
			7.4.2	 Tinea Nigra
		7.5	 Bacterial Disorders
			7.5.1	 Syphilitic Alopecia
		References
	8: Digital Dermoscopy Analysis
		8.1	 Computer-Assisted Diagnosis (CAD): Basics and Introduction
		8.2	 Digital Dermoscopy Analysis (DDA) and CAD
		8.3	 DDA Siena Experience: The DB-Mips® Software
		8.4	 DDA Focused on Early Melanoma and Dysplastic Nevi
		8.5	 DDA and Spitz Nevus/Atypical Spitz Tumors
		8.6	 DDA and Regressing Nevi/MM with Regression
		8.7	 DDA and Palmoplantar Lesions
		8.8	 Real-Time Artificial Intelligence and ­Pre-selection Aid in the Daily Routine (già detto sopra)
		8.9	 Integration of Clinical-Personal Objective Variables into DDA: The i-DDA 2015 Study
		8.10	 Evolution of DDA Software
		8.11	 Integration of Clinical–Personal and Dermoscopical Variables into DDA: The i-DDA 2018 Study
		8.12	 Future Perspective in the Aided Diagnosis
		References
	9: Optical Super-High Magnification Dermoscopy
		References
	10: Fluorescence Videodermoscopy
		10.1	 Fluorescence Advanced Videodermatoscopy
		References
	11: Total Body Photography and Sequential Digital Dermoscopy for Melanoma Diagnosis
		11.1	 Introduction
		11.2	 Total Body Photography
		11.3	 Sequential Digital Dermoscopy
		11.4	 Choosing between TBP and SDD
		11.5	 Confocal Microscopy
		11.6	 Conclusions
		References
	12: History and Fundamentals of Reflectance Confocal Microscopy
		12.1	 Reflectance Confocal Microscopy: From the Past to the Present
		12.2	 Physical and Optical Principles
		12.3	 Practical Aspects for Obtaining a High-Quality Image
			12.3.1	 Obtaining Images with Wide-Probe Confocal Device (Fig. 12.3)
			12.3.2	 Obtaining Images with Hand-Held Confocal Device
		12.4	 Conclusions: Summary and Future in RCM Technique
		References
	13: In Vivo Reflectance Confocal Microscopy for Benign Melanocytic Skin Tumors
		13.1	 Correlations of Dermoscopic Features with In Vivo Confocal Microscopy and Histopathology
			13.1.1	 Common Nevi
				13.1.1.1	 Pigment Network
				13.1.1.2	 Pigment globules
				13.1.1.3	 Pigment Dots
				13.1.1.4	 Peripheral Structures
				13.1.1.5	 Diffuse Pigmentation
			13.1.2	 Special Nevi
				13.1.2.1	 Blue Nevus
				13.1.2.2	 Spitz Nevus
				13.1.2.3	 Dysplastic Nevus
				13.1.2.4	 Acral Nevus
				13.1.2.5	 Combined Nevus
				13.1.2.6	 Recurrent Nevi
				13.1.2.7	 Sclerosing Nevi with Pseudomelanomatous Features
				13.1.2.8	 Sutton Nevus
				13.1.2.9	 Meyerson’s Nevus (Eczematous Nevus)
				13.1.2.10	 Nevus of Ota
		References
	14: In Vivo Reflectance Confocal Microscopy for Melanoma
		14.1	 RCM Features According to Melanoma Subtype
			14.1.1	 Superficial Spreading Melanoma
			14.1.2	 Nodular Melanoma
			14.1.3	 Lentigo Maligna and Lentigo Maligna Melanoma
			14.1.4	 Acral Lentiginous Melanoma
			14.1.5	 Desmoplastic Melanoma
			14.1.6	 Amelanotic Melanoma
			14.1.7	 RCM Diagnostic Algorithms for Melanoma Diagnosis
			14.1.8	 Clinical Application of RCM for LM/LMM
			14.1.9	 Guide for Biopsies
			14.1.10 Preoperative Mapping
			14.1.11 Monitoring of Nonsurgical Therapies
		References
	15: In Vivo Reflectance Confocal Microscopy for Nonmelanocytic Benign Skin Tumors
		15.1	 Solar Lentigo
		15.2	 Seborrheic Keratosis
		15.3	 Lichen Planus-Like Keratosis
		15.4	 Dermatofibroma
		References
	16: In Vivo Reflectance Confocal Microscopy for Non-Melanocytic Malignant Skin Tumours
		16.1	 Introduction
		16.2	 Basal Cell Carcinoma
		16.3	 Actinic Keratosis
		16.4	 Squamous Cell Carcinoma
		References
	17: In Vivo Reflectance Confocal Microscopy for Inflammatory Diseases
		17.1	 Reflectance Confocal Microscopy: The Device
		17.2	 Reflectance Confocal Microscopy: From Skin Cancer to Inflammatory Diseases
		17.3	 Clinical Applications in Inflammatory Skin Diseases
		17.4	 Description of the RCM Features of the Main Groups of Inflammatory Skin Diseases and the Distinctive Patterns Useful for Differential Diagnosis
			17.4.1	 Spongiotic Dermatitis
			17.4.2	 Psoriasiform Dermatitis
			17.4.3	 Interface Dermatitis
			17.4.4	 Therapeutic Follow-Up and Biopsy Site Selection
		17.5	 Limits
		References
	18: In Vivo Reflectance Confocal Microscopy for Infectious Diseases
		18.1	 Introduction
		18.2	 Reflectance Confocal Microscopy for Parasitosis
		18.3	 Reflectance Confocal Microscopy and Superficial Mycosis
		18.4	 Reflectance Confocal Microscopy and Cutaneous Bacterial Infections
		18.5	 Reflectance Confocal Microscopy and Viral Infections
		18.6	 Reflectance Confocal Microscopy for the Diagnosis of Virus-Induced Neoplasia and Neuropathy
		18.7	 Conclusions
		References
	19: In Vivo Reflectance Confocal Microscopy for Mucous Membranes
		19.1	 Normal Ocular Surface
		19.2	 Conjunctival Tumors
		19.3	 Healthy Oral Mucosa
		19.4	 Oral Tumors
		19.5	 Healthy Genital Mucosa
		19.6	 Genital Tumors
		References
	20: Ex Vivo Confocal Microscopy
		20.1	 Introduction
		20.2	 Standard Operating Procedure of FCM
		20.3	 Ex Vivo Applications of FCM
			20.3.1	 Basal Cell Carcinoma
			20.3.2	 Squamous Cell Carcinoma
		20.4	 Other Tumors
		20.5	 Conclusions
		References
	21: Ultrasound
		21.1	 Ultrasound for Skin Imaging
		21.2	 US in General and Geriatric Dermatology
		21.3	 US for Skin Tumors
		21.4	 US in Dermosurgery
		21.5	 US for Infective Dermatoses
		21.6	 US for Hidradenitis Suppurativa and  Autoinflammatory Diseases
		21.7	 US for Scleroderma, Scleroderma-Like Diseases, Fat Necrosis, and Rare Conditions
		References
	22: Optical Coherence Tomography
		22.1	 Introduction
			22.1.1	 Instrument
		22.2	 Indications
			22.2.1	 Normal Skin and Healthy Nails
			22.2.2	 Basal Cell Carcinoma (BCC)
			22.2.3	 Actinic Keratoses (AKs) and Squamous Cell Carcinoma (SCC)
			22.2.4	 Nevi and Melanoma
			22.2.5	 Psoriasis
			22.2.6	 Bullous Diseases
			22.2.7	 Wounds
			22.2.8	 Hair
			22.2.9	 Nail Diseases
			22.2.10 Quantification of Skin Changes and Therapy Monitoring
		22.3	 Conclusion
		References
	23: High-Definition Optical Coherence Tomography
		23.1	 Introduction
		23.2	 Technical Characteristics of HD-OCT
		23.3	 Normal Skin
		23.4	 Non-melanoma Skin Cancer
			23.4.1	 Basal Cell Carcinoma
			23.4.2	 Actinic Keratosis/Squamous Cell Carcinoma
		23.5	 Other Applications in Dermatology
			23.5.1	 Melanocytic Lesions
			23.5.2	 Inflammatory Diseases
			23.5.3	 Contact Dermatitis
			23.5.4	 Autoimmune Diseases
			23.5.5	 Granulomatous Reactions
			23.5.6	 Zoonoses
			23.5.7	 Skin Graft Evaluation
			23.5.8	 Skin Ageing
			23.5.9	 Optical Properties of Skin Conditions
		23.6	 Conclusions
		References
	24: 3D Imaging
		24.1	 Introduction
		24.2	 3D Surface-Imaging Systems for the Face and Small Body Parts Based on Stereovision
		24.3	 3D Reconstruction from 2D Image Analysis
		24.4	 3D Cameras for Close-up Images of Small Body Areas
		24.5	 Other Cameras for the Whole Face Surface
		24.6	 3D Total Body Photography
		References
	25: Raman Spectroscopy
		25.1	 Introduction
		25.2	 Main Ex vivo Skin Applications
		25.3	 Main In vivo Skin Applications
		25.4	 Skin Cancer Diagnosis
		25.5	 Conclusions
		References
	26: Multispectral and Hyperspectral Imaging for Skin Acquisition and Analysis
		26.1	 Introduction
		26.2	 Spectral Imaging Techniques
		26.3	 Spectral Images of Normal and Pathological Skin
		26.4	 Spectral Image Analysis
		26.5	 Conclusion
		References
	27: Electrical Impedance in Dermatology
		27.1	 Introduction
			27.1.1	 Principle of Electrical Impedance Spectroscopy (EIS) in the Skin
			27.1.2	 Electrical Impedance Measurements
				27.1.2.1	 Electrical Impedance Spectrometer
					Microinvasive Electrode
				27.1.2.2	 General Examination Procedure
				27.1.2.3	 Clinical Studies of EIS in Dermatology
					Studies in Non-tumour Diseases
				27.1.2.4	 Clinical Studies of EIS in Skin Cancer
		27.2	 Conclusions
		References
Part II: Lasers and Light Sources Technologies in Dermatology
	28: Laser Light and Light–tissue Interaction
		28.1	 Introduction
		28.2	 Laser Operating Regimes
		28.3	 Fundamentals of Laser–tissue Interaction
		28.4	 Laser-Selective Photothermolysis
			28.4.1	 Treatment of Vascular Lesions
			28.4.2	 Tattoo Removal
		28.5	 Conclusions
		References
	29: Laser and Light Sources: Safety and Organization Issues
		29.1	 Introduction
		29.2	 Operating with a Medical Laser Light Source
		29.3	 Accommodating and Operating with a Laser Or High Energy Light Source
		29.4	 Classification of Lasers
			29.4.1	 Training
			29.4.2	 The Class 4 Medical Lasers: Operative Setting
			29.4.3	 The Main Concern Using a Medical Laser: To Protect the Eye
			29.4.4	 Ocular Protection for the Patient
			29.4.5	 Ocular Protection for the Operator, the Assistants, and Other Individuals in the Laser-Controlled Area
			29.4.6	 Extraocular Dangers Related to Class 4 Laser or IPLs
		29.5	 Conclusions
		References
	30: Intense Polychromatic Lights: What’s New
		30.1	 General IPL Characteristics
		30.2	 IPL–Tissue Interaction
		30.3	 Mechanism of Action of IPL
		30.4	 Acne
		30.5	 Vascular Lesions
		30.6	 Rosacea
		30.7	 Telangiectasia
		30.8	 Port-Wine Stains
		30.9	 Venous Malformations
		30.10	 Poikiloderma of Civatte
		30.11	 Skin Photorejuvenation
		30.12	 Hair Removal
		References
	31: Vascular Lasers: Tips and Protocols
		31.1	 Introduction
		31.2	 Epidermal Cooling
		31.3	 Main Laser Sources for Vascular Surgery
			31.3.1	 Pulsed Dye Laser (PDL)
			31.3.2	 Neodymium:Yttrium-Aluminum-Garnet (Nd:YAG) Laser
			31.3.3	 Doubled 532-nm Nd:YAG Laser
		31.4	 Operative Management
			31.4.1	 Patients’ Selection and Main Contraindications to Vascular Laser Surgery
			31.4.2	 Pre-laser Treatment Care
			31.4.3	 Post-laser Treatment Care
			31.4.4	 Side Effects
		31.5	 Main Vascular Disorders Responsive to Vascular Surgery
			31.5.1	 Vascular Malformations: PWSs
			31.5.2	 Infantile Hemangiomas (IH)
			31.5.3	 Telangiectasias
			31.5.4	 Rosacea-Associated Telangiectasia
			31.5.5	 Poikiloderma of Civatte
			31.5.6	 Spider Nevus
			31.5.7	 Venous Lake
			31.5.8	 Leg Veins and Telangiectasias
		References
	32: Broadband Intense Pulsed Lights for Vascular Malformations
		32.1	 Broadband Intense Pulsed Lights for Vascular Malformations
		32.2	 Advices for Treatment of Vascular Malformations with IPL
		32.3	 Telangiectasias
		32.4	 Poikiloderma of Civatte
		32.5	 Port Wine Stains
		32.6	 Rosacea
		32.7	 Spider Angioma
		32.8	 Conclusions
		References
	33: Pigment-Specific Lasers for Benign Skin Lesions and Tattoos: Long Pulsed, Nanosecond, and Picosecond Lasers
		33.1	 Treatment of Benign Pigment Lesions
			33.1.1	 QS Laser Treatment
			33.1.2	 PS Laser Treatment
			33.1.3	 LP Laser Treatment
			33.1.4	 Side Effects
		33.2	 Treatment of Tattoos
			33.2.1	 Classification of Tattoos
			33.2.2	 Treatment Protocol
			33.2.3	 Choosing Correct Wavelength
			33.2.4	 Side Effects
		References
	34: Skin Resurfacing: Ablative and Non-ablative Lasers
		34.1	 Introduction
		34.2	 Laser–Tissue Interactions for Carbon Dioxide and Erbium:YAG Lasers
			34.2.1	 Carbon Dioxide (CO2)
			34.2.2	 Erbium
			34.2.3	 Other Lasers
		34.3	 Operative Considerations
			34.3.1	 Patient Selection
			34.3.2	 Perioperative Management
			34.3.3	 Anesthesia
			34.3.4	 Complications
		34.4	 Indications for Ablative Lasers
			34.4.1	 Aging Signs
			34.4.2	 Scarring
			34.4.3	 Skin Lesions
			34.4.4	 Rhinophyma
		34.5	 Fractional Laser Resurfacing
			34.5.1	 Non-ablative
			34.5.2	 Ablative
		34.6	 Indications for Fractional Laser Resurfacing
			34.6.1	 Aging Signs
			34.6.2	 Scars
			34.6.3	 Other
		References
	35: Photorejuvenation: Concepts, Practice, Perspectives
		35.1	 Introduction
		35.2	 Photorejuvenation: Definition
		35.3	 Vascular Lasers, PCLs, and Photorejuvenation
		35.4	 Pigment Specific Lasers and Skin Rejuvenation
		35.5	 Subsurfacing with Near-IR Light Sources and Skin Rejuvenation with Q-Switched, Submillisecond, and Long Pulsed Nd: YAG Laser
		35.6	 Combination of Light Sources for Photorejuvenation
		35.7	 Pretreatment Precautions
		References
	36: Laser Hair Removal: Updates
		36.1	 Introduction
		36.2	 Principles of Epilation
		36.3	 Preparation for Treatment
		36.4	 Ruby Laser
		36.5	 Alexandrite Laser
		36.6	 Diode Laser
		36.7	 Nd: YAG (Neodymium-Doped Yttrium Aluminum Garnet) Laser
		36.8	 Postoperative Results
		References
	37: Biophotonic Therapy Induced Photobiomodulation
		37.1	 Introduction
		37.2	 The Electromagnetic Spectrum: The Light Around Us
		37.3	 Biophotonics: The Merging of Photonics and Biology
			37.3.1	 Photomedicine: The Therapeutic Effect of Light
			37.3.2	 Photobiomodulation
			37.3.3	 Proposed Mechanisms of Photobiomodulation
		37.4	 What Is Fluorescent Light Energy?
			37.4.1	 Fluorescent Light Energy: A Unique Mechanism
		37.5	 Light–Tissue Interaction
			37.5.1	 Photobiological Events
		37.6	 The Application of Photobiomodulation for Skin Rejuvenation
			37.6.1	 Treating Inflammatory Skin Conditions with Fluorescent Light Energy
			37.6.2	 Some Anti-inflammatory Mechanisms of Fluorescent Light Energy
			37.6.3	 Treating Rosacea and Beyond with Fluorescent Light Energy
			37.6.4	 How Does Fluorescent Light Energy Induce a Unique Form of Photobiomodulation?
			37.6.5	 Fluorescent Light Energy: A Combination Treatment
		37.7	 Conclusion
		References
	38: Photodynamic Therapy (PDT)
		38.1	 Background
		38.2	 Physical Bases of PDT
		38.3	 Chemical Bases of PDT
		38.4	 Irradiance
		38.5	 Photosensitizers (PS)
		38.6	 Light Sources
		38.7	 Clinical Applications
			38.7.1	 Actinic Keratosis (AK)
			38.7.2	 Basal Cell Carcinoma (BCC)
			38.7.3	 Acne and Acne Scarring
			38.7.4	 Viral Warts
			38.7.5	 Skin Rejuvenation
			38.7.6	 Psoriasis
			38.7.7	 Localized Scleroderma
			38.7.8	 Keloids
			38.7.9	 Port-Wine Stains
		38.8	 Future Strategies
		References
Part III: Technological Advances in Wound Management
	39: Temporary Dressing
		39.1	 Background
		39.2	 Classification of Wound Dressing
		39.3	 Selection of Wound Dressing
		39.4	 Type of Temporary Wound Dressing
		References
	40: Extracellular Matrices
		40.1	 Introduction
		40.2	 Extracellular Matrix in Chronic Wounds
		40.3	 The Ideal Extracellular Matrix
		40.4	 Preparation of the Dermal Matrix
		40.5	 Extracellular Matrices Registered
		40.6	 ECM Derived from Allogeneic Skin
		40.7	 ECM Derived from Human Placenta
		40.8	 ECM Derived from Xenogen Fabrics
		40.9	 Biosynthetic ECM Scaffolds
		40.10	 Conclusions
		References
	41: Skin Bank Bioproducts: The Basics
		41.1	 Skin Bank Development and Organization
		41.2	 Skin Bank Procedures: Donor Screening, Skin Procurement and Processing
		41.3	 Skin Bank Bioproducts and Storage Methods
			41.3.1	 Viable Skin Grafts
			41.3.2	 Unviable Skin Grafts
		41.4	 Skin Grafts: Classification and Techniques
		References
	42: Clinical Applications of Skin Bank Bioproducts
		42.1	 Clinical Advantages of Skin Bank Bioproducts in Wound Healing
		42.2	 Clinical Use of Skin Bank Bioproducts in Wound Healing
		42.3	 A 3-Step Approach to Hard-to-Heal Wounds
		42.4	 Homologous Skin/Dermal Grafts for Cutaneous HHWs
		42.5	 Homologous Skin/Dermal Grafts for HHWs of the Head
		References
	43: Negative Pressure Wound Therapy
		43.1	 History of Negative Pressure Wound Therapy
		43.2	 Description of the Device and Mechanism of Action
		43.3	 Physiopathological Effects
		43.4	 Clinical Evidence on NPWT
		43.5	 Indications and Contraindications
		43.6	 Portable NPWT Systems
		43.7	 Conclusions
		References
	44: Tissue-Engineered Skin Substitutes
		44.1	 Introduction
		44.2	 Classifications
			44.2.1	 Biomaterial Type and Scaffold Architecture
			44.2.2	 Growth Factors
			44.2.3	 Cells
			44.2.4	 Cellular and Acellular Skin Substitutes
			44.2.5	 Anatomical Structure of Substitutes
		44.3	 Commercially Available Skin Substitutes
			44.3.1	 Epidermal Substitutes
			44.3.2	 Dermal Substitutes
			44.3.3	 Dermoepidermal (Composite) Substitutes
		44.4	 Conclusions
		References
	45: Biologics in Wound Management
		45.1	 Introduction
		45.2	 Part One
			45.2.1	 Tumor Necrosis Factor Alpha (TNF-α)
			45.2.2	 Interleukin-1 (IL-1)
			45.2.3	 Interleukin-12/23 (IL-12/23)
			45.2.4	 Interleukin-6 (IL-6)
			45.2.5	 Phosphodiesterase 4 (PDE4)
		45.3	 Part Two
			45.3.1	 Pyoderma Gangrenosum
			45.3.2	 Vasculitic Ulcers
		References
	46: Stem Cell in Wound Healing
		46.1	 Introduction
		46.2	 Biological Process of Wound Healing
			46.2.1	 Inflammation
			46.2.2	 Proliferation
			46.2.3	 Remodeling
		46.3	 Stem Cells Meet Wound Healing
		46.4	 Adult Mesenchymal Stem Cells in Wound Management and Tissue Engineering
			46.4.1	 Bone Marrow-Derived Mesenchymal Stem Cells (BM-MSCs)
			46.4.2	 Adipose-Derived Stem Cells (ADSCs)
		46.5	 Adjunctive Treatment Modalities for Wound Healings
			46.5.1	 LASER and LED
			46.5.2	 Hyperbaric Oxygen Therapy (HBOT)
			46.5.3	 Electrical Stimulation (ES)
			46.5.4	 Growth Factors and Cytokines
		46.6	 Discussion and Conclusion
		References
Part IV: New Complementary Tools for Dermatologic Diagnosis
	47: Microbiopsy in Dermatology
		47.1	 Introduction
		47.2	 Microbiopsy: Device and Technique
		47.3	 Microbiopsy Application in Skin Oncology
		47.4	 Detection of HPV DNA by Microbiopsy in Viral Warts
		47.5	 Microbiopsy and Leishmaniasis
		References
	48: Noninvasive Genetic Testing: Adhesive Patch-Based Skin Biopsy and Buccal Swab
		48.1	 Introduction
		48.2	 Adhesive Patch-Based Skin Biopsy
		48.3	 Buccal Swab
		48.4	 Unrevealing Mosaicism Through Buccal Swab
		48.5	 What About Noninvasive Skin Biopsy Advantages and Disadvantages?
		References
	49: Liquid Biopsies
		49.1	 A Bit of History
		49.2	 Cell-Free DNA
		49.3	 Circulating Tumor Cells, Circulating Endothelial Cells, and Exosomes
		49.4	 Clinical Use of Liquid Biopsy
		49.5	 What About Liquid Biopsy Advantages and Disadvantages?
		49.6	 Method
		49.7	 Liquid Biopsy for Melanoma
		References