THERAPEUTIC HOTLINE: SHORT PAPERS Dermoscopy and reflectance confocal microscopy for monitoring the treatment of actinic cheilitis with ingenol mebutate gel: Report of three cases E. Benati 1 | R. Pampena 1 | C. Bombonato 1 | S. Borsari 1 | M. Lombardi 1 | C. Longo 1,2 1 Dermatology and Skin Cancer Unit, Arcispedale S. Maria Nuova-IRCCS, Reggio Emilia, Italy 2 Dermatology Department, University of Modena and Reggio Emilia, Modena, Italy Correspondence Elisa Benati, MD, Skin Cancer Unit, Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42100, Reggio Emilia, Italy. Email: dott.benati.elisa@gmail.com Abstract Actinic cheilitis (AC) can precede the development of squamous cell carcinoma (SCC) of the lip, a location with higher risk of invasiveness and metastasis. Herein, we reported the use of ingenol mebutate (IngMeb) 0.015% gel on three consecutive days to treat three patients suffering from AC. All the three patients achieved complete clearance of AC with rapid clinical effect, favorable safety profile, good patient’s compliance related to short time of applications, and few local skin reactions. So IngMeb is an attractive new therapy for AC. Moreover, the present case report adds further evidence to the usefulness of dermoscopy and Reflectance confocal microscopy (RCM) in the assessment and monitoring of treatment outcome. KEYWORDS actinic cheilitis, ingenol mebutate, reflectance confocal microscopy 1 | INTRODUCTION There is no agreement on the frequency in which actinic cheilitis (AC) becomes squamous cell carcinoma (SCC), but SCC of the lip is a high- risk body site for metastatic progression (11% vs. 1% in other locations) and recurrences (Barrado Solís et al., 2015; Benati, Persechino, & Piana, 2017). Thus, it is crucial to treat AC adequately. The treatment options for AC include several modalities with distinct advantages and draw- backs. Cryosurgery and electrocautery can be effective for focal areas of AC, but they are painful and cause postoperative edema and long- term scarring. Surgery is highly efficacious but it is a scarring modality (Shah, Doherty, & Rosen, 2010). Also, photodynamic therapy has demonstrated to be effective, but it is frequently associated with a significant level of pain (Casta~ no et al., 2009). Ingenol mebutate (IngMeb) gel has proved to be effective for the field treatment of actinic keratosis with only two or three daily applica- tions, according to the body site. It causes local short-term side effects well tolerated by most patients (Lebwohl et al., 2013). Local skin response (LSR) score include erythema, flaking or scaling, crusting, swelling, vesciculation, pustulation, and erosion or ulceration (Rosen, Marmur, Anderson, Welburn, & Katsamas, 2014). Few case series examined the effectiveness of IngMeb for the treatment of AC using clinical and dermoscopy examination (Barrado Solís et al., 2015; Fl orez, Batalla, & De La Torre, 2017; Tzika, Masouy e, M€ uhlstädt, & Laffitte, 2016). Dermoscopy and reflectance confocal microscopy (RCM) are currently the most used noninvasive imaging techniques that help clinicians not only to achieve high diagnostic accuracy for skin cancer diagnosis but also to monitor treatments over time (Fargnoli, Kostaki, & Piccioni, 2012; Longo et al., 2012; Maher et al., 2016). Herein, we report three cases of AC treated with IngMeb 0.015% gel on three consecutive days and monitored over time by means of dermoscopy and RCM to assess skin changes and treatment response. All patients were monitored clinically, dermoscopically and with RCM before therapy, at 7 and 28 days, respectively. Informed consent has been obtained before treatments. 2 | CASE 1 The first patient was a woman in her 78s with skin phototype II never subjected to AC treatments previously. At baseline she showed AC on the upper lip, which was clinically typified by a whitish area with scales of the vermilion; dermoscopically, it was characterized by white struc- tureless areas and scales. RCM revealed atypical honeycomb pattern with cells irregular in size and shape, scales and parakeratosis. AC was Dermatologic Therapy. 2018;e12613. https://doi.org/10.1111/dth.12613 wileyonlinelibrary.com/journal/dth V C 2018 Wiley Periodicals, Inc. | 1 of 5 Received: 24 November 2017 | Accepted: 18 March 2018 DOI: 10.1111/dth.12613