Dear or not Dear Mr. Smith?
Dear Mr. / Mrs. / Miss Smith…
As in any language, in a formal correspondence written in Italian we use words in Salutation that express Kindness: Caro (male), Cara (female), Gentile (addressing both male and female), Gentilissimo / Gentilissima (Gent.mo / Gent.ma) meaning Most Kind; Respect: Spettabile / Spett.le, Egregio / Egr. (male only), used mainly in business:
Caro Signor Smith (abbreviation Sig.)
Gentile Signora / Signorina Smith (abbreviation Sig.ra / Sig.na)
No Ms. in Italian
Esteemed…
Spettabile Sig. Smith (abbreviation Spett.le)
Adding his title before the last name: Egregio Dottor Smith (abbreviation Egr. Dott.)
Similar words in Italian and English can have opposite meaning:
—The title Dottore / Dott., which means Doctor in English, in Italy is used for any person holding an academic title. Understandably so, this confuses foreigners very easily. A matter of cultural difference!
—When speaking more than one language, it is common to translate from one’s native language and make a basic mistake to use words that appear similar in another language, but with opposite meaning. This is the case of the Italian word Egregio vs. the English word Egregious:
Egregio (Egr.) vs. Egregious
Meaning: Illustrious, eminent, excellent vs. Meaning: Offensive, outrageous, shameful
So, you are correct when you write to a gentleman in Italian and address him using the word Egregio to indicate respect. If you do so in English, it will be improper and offensive. It could be a disastrous approach when trying to initiate or establish any communication with an American business enterprise. To avoid this unfortunate and costly mishap, remember to use words that convey the meaning as intended in both your native language and the language in which you are communicating.
You are the best! And I congratulate you on your foreign language expertise! Complimenti!

Photo Courtesy of Lee DeMilo, Guest Speaker of Greater Norwalk Chamber of Commerce https://www.greaternorwalkchamber.com at The Norwalk Inn and Conference Center https://norwalkinn.com on the subject: Italy as travel destination, Italy's regional cultures, traditions, dialects, local art and cuisine, and the Italians' passion for the so-called "la dolce vita" (the sweet life) and "il dolce far niente" (the sweetness of doing nothing) with emphasis on the Region Campania and the breathtaking Amalfi Coast.
My gratitude goes to both the Norwalk Greater Chamber of Commerce and the Norwalk Inn for the opportunity given me to also share on a more personal level the beauty, the history and the traditions of my birthplace. Mille grazie! Lee