The global burden of cancer continues to rise, and immunotherapy is rapidly consolidating its position as a cornerstone of modern oncologic treatment. Consequently, an increasing number of patients are exposed to immune checkpoint inhibitors, with a parallel and inevitable rise in immune-related adverse events, particularly involving the skin. In this evolving scenario, dermatologic expertise is no longer ancillary but essential. Cutaneous immune-related adverse events (cirAEs) largely reflect the activation of autoimmune and inflammatory dermatoses, requiring diagnostic and therapeutic competencies that cannot be delegated to oncologists 1. Dermatologists are therefore increasingly called upon to contribute to multidisciplinary decision-making, ensuring both appropriate management of adverse events and continuity of life-saving anticancer therapies 2. The review by Kamińska-Winciorek et al. provides a valuable contribution by focusing on the dermatoscopic features of cirAEs 3. One of the most clinically relevant messages emerging from this work is that dermatoscopic patterns of cirAEs closely mirror those observed in their classical counterparts. This observation reinforces the concept that these manifestations should not be regarded as entirely novel entities, but rather as immune-driven variants of familiar dermatologic diseases. This point carries important practical implications. First, it suggests that even dermatologists without specific expertise in supportive oncodermatology may play a meaningful role in the early recognition of cirAEs, provided they are familiar with standard dermatoscopic criteria. This is particularly relevant considering the current shortage of dermatologists experienced in the management of oncologic patients and treatment-related toxicities 4. In such a context, dermatoscopy emerges as an accessible and reproducible tool that may help bridge this gap. At the same time, dermatoscopy should be positioned within a broader diagnostic framework. While it can significantly enhance clinical assessment, particularly in inflammatory dermatoses, it cannot replace histopathological evaluation in severe, atypical, or diagnostically challenging cases. Rather, its strength lies in supporting rapid bedside decision-making, guiding the indication for biopsy, and, importantly, assisting in the selection of the most representative site for histopathological sampling. The early recognition of specific dermatoscopic patterns allows clinicians to establish a prompt diagnosis, enabling timely initiation of appropriate therapy. This, in turn, facilitates the optimal management of cirAEs while preserving the continuity of anticancer treatment, a key objective in the care of oncologic patients. Another key aspect is the role of dermatoscopy in differential diagnosis. In routine clinical practice, cancer patients may develop concomitant cirAEs (Figure 1) or even unrelated to immunotherapy dermatological conditions. The ability to identify complex cases of co-existing cirAEs is extremely important, since their management should be individualized, depending on the clinical and inflammatory profile of each toxicity. In the same context, distinguishing between cirAEs and unrelated dermatoses is crucial to avoid inappropriate therapeutic modifications or unnecessary discontinuation of effective oncologic treatments. Beyond its immediate clinical utility, dermatoscopy may also serve as a gateway to more advanced non-invasive imaging techniques. Its integration with modalities such as reflectance confocal microscopy and line-field confocal optical coherence tomography (LC-OCT) holds promise for a more refined, real-time characterization of inflammatory and autoimmune processes in vivo 5. Despite these strengths, the current evidence remains limited. Available data are largely derived from small case series and heterogeneous observations, with a lack of standardized terminology and imaging protocols. Larger, prospective studies are needed to validate dermatoscopic criteria, assess their reproducibility, and clarify their clinical applicability in this rapidly evolving field. In conclusion, dermatoscopy represents a valuable adjunct in the management of cirAEs. In an era where immuno-oncology is rapidly expanding, dermatologists will be increasingly involved in patient care. Within this framework, dermatoscopy offers a widely available tool to support early diagnosis, refine clinical reasoning, and strengthen the integration of dermatology into multidisciplinary oncologic practice. All authors read and approved the final version of the manuscript. The authors have nothing to report. The authors have nothing to report. All patients in this manuscript have given written informed consent for participation in the study and the use of their de-identified, anonymized, aggregated data and their case details (including photographs) for publication. Ethical Approval: not applicable. The authors declare no conflicts of interest. The data that support the findings of this study are available from the corresponding author upon reasonable request.
Fattore et al. (Sun,) studied this question.