Case author Mark Lebwohl, MD, presents a case of a 86-year-old male with a progressively enlarging erythematous nodular mass with overlying telangiectases. 

Successful Management of Basal Cell Carcinoma in a Challenging Location with a Multimodal Approach

Case authors Danny Zakria, MD, MBA, Ryan Rivera-Oyola, MD, and Darrell Rigel, MD, MS, present a case of a 58-year-old male with a history of sun exposure and a skin lesion showing signs of malignancy. 

Accurately Assessing Prognosis for High-Risk Squamous Cell Carcinoma

New Checkpoint on the Block: The Latest Evidence for PD-L1 Inhibition in Cutaneous Squamous Cell Carcinoma 

Compare programmed cell death protein-1 (PD-1) inhibitors and programmed cell death ligand-1 (PD-L1) inhibitors for cutaneous squamous cell carcinoma (cSCC) based on their mechanism of action  

Review the latest clinical efficacy and safety data for PD-1 and PD-L1 inhibitors in the treatment of advanced cSCC 

FC25: ​​​New Checkpoint on the Block: The Latest Evidence for PD-L1 Inhibition in Cutaneous Squamous Cell Carcinoma: An Online Activity

Leveraging Gene Expression Profiling to Optimize Management and Empower Patients With Skin Cancers

Explain how to interpret gene expression profiling (GEP) test results used in the prognostic workup of patients with skin cancers

Discuss strategies to incorporate results from GEP testing in the clinical decision-making process for patients with skin cancers 

Describe the impact of GEP testing in skin cancer with respect to the patient diagnostic and treatment journey 

FC25: Leveraging Gene Expression Profiling to Optimize Management and Empower Patients With Skin Cancers: An Online Activity

The Clinician’s Case-Based Guide to Gene Expression Profiling in Skin Cancer Management

Describe how to interpret the results of gene expression profiling (GEP) in the early and accurate prognostic workup of skin cancer.

Explain how to incorporate the results of GEP tests into management plans for patients with skin cancer. 

PANP25: The Clinician’s Case-Based Guide to Gene Expression Profiling in Skin Cancer Management: An Online Activity

DermInsider - VGR Session 6

Describe the rationale for using image-guided superficial radiation therapy (IGSRT) in the treatment of nonmelanoma skin cancer (NMSC)


Summarize the latest clinical data for IGSRT in the treatment of NMSC

Discuss the safety considerations of incorporating IGSRT in the management of NMSC

In Safe Hands: Navigating Image-Guided Superficial Radiation Therapy for Nonmelanoma Skin Cancer

DermInsider - A Virtual Grand Rounds Series - Session 6: In Safe Hands: Navigating Image-Guided Superficial Radiation Therapy for Nonmelanoma Skin Cancer

Gene Expression Profiling in Skin Cancer: Transforming Management and Prognosis

Discuss the role of gene expression profiling (GEP) in the early detection and accurate prognostic workup of skin cancer

Identify strategies to optimize outcomes using GEP in the diagnosis and management of skin cancer 

Gene Expression Profiling in Skin Cancer: Transforming Management and Prognosis: An Online Activity

FC24: Skin Cancer Prognosis: The Tried and True and What’s New

Define the role of gene expression profiling in the prognostic workup of skin cancer  

Identify strategies to incorporate gene expression profiling into clinical practice 

FC24: Skin Cancer Prognosis: The Tried and True and What’s New: An Online Activity

Discuss the role of gene expression profiling for the management of skin cancers 

Describe how to integrate gene expression profiling for cutaneous melanoma and SCC to inform risk- and appropriate management decisions 

Optimizing The Patient Skin Cancer Journey With Gene Expression Profiling

We're going to be talking about optimizing the patient's skin cancer journey with gene expression profiling. So this is who we are, and our learning objectives are to discuss the role of gene expression profiling, which I'll call GEP for the management of skin cancers, and then to talk about how we integrate GEP into our treatment and workup for, ah, for melanoma and SCC. Okay. And this is accredited for 0.5 CME credits. Okay, so I'm going to now turn it over to Dr. Regal, who's going to start with the first case. Well, thank you so much. We have five cases. We're going to present it very quickly. This is the first case of 47 year old, the Fitzpatrick skin type. Two male with settle for a skin check, had a history of significant sun exposure, works indoors. He'd had moles removed before, but none for cancer. So the issue here is, here's the path, and as you can see, there's inflammation, but it's really indeterminate, really is not helping you with this. So how can a diagnosis be obtained with this if you're not sure the path is equivocal? Yeah, I think that this is a tough case. So these are the cases where you show them to ten different dermatopathologists and you're not going to have consensus on the answer. So a lot of times we'll start with sending these out in consult, but if we want more information, this is a place where we can use gene expression profiling to say not just what does this look like clinically or histologically, but genetically, does this look more like melanoma, like a benign lesion? So this is really an example of where you can use it. And this is just to show you, this is the test, the 23 GP test. And the data is kind of interesting because really, it's a higher number than I would have thought from this data, where the diagnosis is ambiguous for pigmented lesions. But the bottom line is that using the 23 genes in the model here for this, it classifies the patients in lesions, amlignant, indeterminate or benign, and most of them get classified in one way or the other. Basically, the one limitation with this that's important is you have to get at least 10% of the lesion in to be analyzed for this. But the bottom line, it can be performed only for non pediatric cases greater than 18 years of age. That's one of those. And it doesn't work for metastatic lesions. But bottom line, it can make a difference for this a number of clinical validation studies. And again, this is in your handout, so you can pull these, but also clinical utility. In other words, if you have the test, does it make a difference in management? That's what the utility tests do. And what it showed with this is an interesting study. They had 25 patients who were found to be benign, and they followed them, and you can see 88% of them did not have a reexcision, 12% did decide to excise anyway. But of the 25 cases, there were no recurrences or metastases reported. Any patient. These were all patients that were said they were benign from the study. And again, the whole concept of a personalized medicine, the conclusion, this is one study that came out showing that it influences the treatment of diagnostically challenging lesions, makes a difference. Okay, let's go to case two. This is a 68 year old white male with history of extensive sun exposure that presented with this lesion on the back. It was a 1.2 millimeter melanoma. How aggressively would you manage this patient? Yeah, so these are tough. So when we have a four millimeter melanoma, we know we have to be aggressive. When we look at this and we say it's probably a superficial spreading melanoma. I'm going to talk with the patient about what is the risk that this has spread? What are your next options? And so again, we can use things like nomograms, we can use things like the NCCN guidelines, but sometimes patients will really push me know, well, how likely is it that that sentinel node is going to be positive, or how likely is it that this is going to metastasize? And so that's when people want kind of a more personalized answer, that it can be helpful to have things like GEP. So basically, this is a perfect case for GP. And I think this is a 31 GP test that was developed to assess risk of recurrence for this. And there's basically, I think most of you use this at this point, but there's four different possibilities. One a, one b, two a, two b. This is actually the distribution that occurs for this. So about 10% of the cases that are tested, obviously a skewed view, but tested are actually in that highest risk group. So what's nice about this, if you compare the prediction of this versus just using the traditional AJCC eight alone, here's the value for AJCC eight. But look at how you dichotomize each of those, stage one, stage two, and stage three, into much more predictive outcomes based on having the additional data from the GEP, there have been a number of studies that have shown basically the efficacy of their test for relapse free survival and distant metastasis free survival. And again, this is a study. It was alluded to earlier today, but we'll hear about it a little more tomorrow. About a cohort of this was done at the NCI with data from the NCI, where there was GP testing data available. In other words, an independent data set that really looks at the validity of this test in a variety of ways. What was also interested in the multivariate analysis on this, you can see that the information from the GP test class was more significant, had a better ODS ratio than did the other factors we typically think of as being important. Okay, this is case three. Yeah, I thought that data was really interesting. And also, Daryl, I know when we had talked about it before that having the GEP result actually resulted in higher survival for the patients who had had the test done. So I think it's going to be neat to see how that all matures. I think it's going to be interesting. Obviously, the test is not therapeutic, so I think they're probably managed more efficiently is what happened. Right, yeah, more effective. So this is an example of a management challenge. So this is a patient who came in to see me. He's 85 years old. This was his first time ever coming to a dermatologist, because his PCP sent him, actually, for the lesion that you can see in front of his ear, which was ulcerated. And when I just sort of walked around and started looking at his skin and looked behind his ear, he had no idea that he had this very large, broad pigmented lesion. So he couldn't really give me any history, but I figured he'd probably been there a long time. And so I did biopsy it. And this was a superficial spreading melanoma. The Breslow thickness was 0.7 least. So I had a resident with me. I said, the key thing here is you really want to make sure you biopsy at least to a millimeter. You're not going to remove this entire thing. And then, of course, I did the biopsy, and I'm the one who got the positive deep margin, so it was not ulcerated, which was good. Other than that thickness, it really had lower risk features, 0 /mm squared, and the lateral and deep margins were positive. It, of course, also had an adjacent basal cell carcinoma that I couldn't even see, but that I found as part of this biopsy. So now what would you do next? Well, I think this is a perfect case where you want to look at the GP test for it, because if you don't know the thickness, that's the key here. And unfortunately, I've shaved through them, too. I think everybody in this room has shaved through a melanoma at some point and not realizing, you get that report, it's 0.7 to the base. You don't know what the real thickness is. And if you re excise it, you can't add it, you can't say, oh, it's 1.2 plus the 0.7 because there's regrowth and the tissue is growing back. So you're stuck. But with having that information, it can help you much better assess the risk for this patient in management. Yeah. So we actually brought him back in to the office and I saw him together with my mo surgeon, and I said, I can't believe I did this. But now we got to really make sure that we've accurately staged him. And how extensive is this? So we actually went and did. I'm not a fan of scouting biopsies in a primary melanoma, but it can be helpful if there's areas that were missed when you know that the diagnosis is definitely melanoma. We also wanted to see how extensive it was. And interestingly, every area that we biopsied came back as a melanoma and cyto. So now, the other challenge with this is not just does he need a sentinel node or not, but if he does, this is going to be a really tough lesion to clear. I mean, this is big. It's going behind the ear. The margins are very indistinct. So if we send him off for a sentinel node to surgical oncology, we don't have the ability to do sort of MOS or slow mos. So we said, well, let's see how high risk this really is. So we ordered a GEP test. So we ordered this, and we have now IgEP, which is an integrated result. So it's not just, is it class one a, which we did get that result. It was a class one a, so lowest risk. Interestingly, you also get a numeric score. So class one a can go from zero to zero point 41. He was 00:27 so sort of in the middle range. I could now also give him more information, like, what is your distant metastasis? Free survival, for example, was over 95%. But also, what was really key here was, what's the likelihood of this being having sent a positive sentinel node, and it was 2.9%. So when we talk about where did NCCN guidelines come from, they came from looking at the probability of a node being positive. And so the only thing you could correlate with was thickness. But in this case, we were able to say, normally, if the thickness would tell us that the likelihood of a positive node is less than 5%, we would recommend against it. Now, given the patient's age and other in the genetic features, as well as the thickness and other prognostic features, we could say his risk was below 5%. And we decided that the low possibility of missing a positive sentinel node was definitely outweighed by the great benefit of being able to have, under local anesthesia, slow mos. So he has now undergone slow mos and we've cleared this tumor, and now we get to move on to the other ten that were on his face. So I move on to my next case. So this is a 36 year old woman who came to see us eleven weeks pregnant. So, interestingly, we have a lot of access issues, so we have a pretty robust edrmatology storm forward platform that we use. And so she sent in the top photo, and she was then triaged. She came in to see us on dermascopy. This was clearly going to be a melanoma. So in this case, we were smarter. We did a narrow margin excision. So we said in that minute, we need to get this off. But this was a long discussion with the patient, because not only was she eleven weeks pregnant, she was being followed by maternal fetal medicine because she had had a previous late term pregnancy loss. So she was extremely anxious. So we biopsied this lesion and we had found that it had a Breslow thickness of 0.9 mm. So this is a t one b lesion. It is, because it's not ulcerated. The mitotic count was low. It was 1 /mm squared. So I really still consider that as a very low mitotic rate free margin. So we know we've identified this entire lesion. So now the discussion was, what do we do next? So we actually presented her at tumor board. We actually had a really robust discussion. Some people said, you know what? You should go ahead and do this. Pregnant women may have a higher risk. It clearly meets criteria. Do a sentinel node. The patient said, I don't want to do anything to risk this pregnancy. I've been through so much. So we said, why don't we discuss some other options, too? So we talked about the guidelines of care for melanoma. So this was published in the jad in 2019. In pregnant women, it is recommended that you avoid sentinel node biopsy, if possible, in the first trimester. Now, she could have waited a week or two. Our surgical oncologists can actually do this under local, apparently. So that is an option, but there is still going to be the radiation exposure. So this generated a lot of conversation. So we did get her score. So she was a class one a. And again, looking at the numerical score was helpful, because, again, that goes zero to 00:41 hers was zero point 13. We knew that her recurrence free survival was 95% distant. Metastasis free survival was over 96%. Now, her likelihood of a sentinel node being positive was 7%. So that's really a product of her age. We know that younger people are more likely to have a positive sentinel node that is probably not due to the risk of their tumor, but due to the makeup of their lymphatics. So, taking this all into consideration, we talked to her, and she elected to undergo reexcision under local and not to have the sentinel node biopsy done. So if we look at the data on this, this was a large study out of Oregon. And so this was looking at patients who had t one to t tumor, to t one t two tumors who had been referred for a sentinel node, and then looking at their class one a one b class status and their age, and looking at the probability using that to find their probability of a positive node. So we can see here that if you have patients who are older than 55, that if they have a class one a tumor, the probability of having a positive node is actually under 5%. Thinking back to those NCCN guidelines, that gives us some comfort. And then patients who have a one b or higher do have a higher probability. So we also know, again, if that patient had a two b tumor, I would be having a pretty serious discussion with her about getting that sentinel node. So how do we use these results? Class one a probability of a positive node less than 5%. We talk about potentially avoiding it. If we're in between that five to 10%, the guidelines would say discuss and consider, and if it's greater than 10%, I will nudge them in the direction. And again, with the IGEP, we get even more granular results. So in her case, it was a big benefit to be able to avoid that sentinel node. Okay, this is our last case assessing squamous cell prognosis. This was a 58 year old Fitzpatrick typesuit male, presented for a skin check. He grew up in Florida, had a lot of sun. He worked at construction with outdoors. He'd had a lot of spots frozen over the years, but never been diagnosed with a skin cancer. But he presented with this lesion and he first noticed it two years ago, but let it go. He said it itched. Occasionally it got bigger. He tried to treat it with 1% of hydrocortisone. Not pretty effective for that. I don't think so. Biopsy was showing invasive squamous cell for this comet. Yeah, I'm even more afraid of bad squamous cells sometimes than I am of melanoma, particularly intermediate thickness melanoma. So this is kind of a scary tumor. It's large, it's 5.1 cm. It looks like it's ulcerated. I'd be interested to see what kind of histologic features you have. And then again, this isn't a tough area. If you think about, do you just dive right into adjuvant therapy, like radiation? The neck is a tough area to get radiation, so I'd want to have a really informed discussion with that patient. Well, that's the challenge. And obviously, one way to use this and really cone in on what the risk is going to be is using the 40 gp test, which has been validated to predict metastatic risk for squamous cell patients. This again shows you the three different outcomes here. Class one for low biologic risk, class two a is moderate, and class three is a high biologic risk for metastatic disease. So again, the two b's have a 50% plus chance of metastatic risk to do this, putting this in a distribution, and this is not for squamous cell carcinoma site use or little ditzels or things that are kind of called aks, maybe early squamous cell. This is really for tumors with risk factors for squamous cell. But you can see in this series, about one in 18 are usually in that class two. So about 6% or whatever the number is there. Traditional staging are the two methods, AJCC and Brigham and women's hospital staging. And basically they have different high risk factors to do this. I like the brigade one because I'm quantitative, but it's a number of risk factors. It makes it pretty easy to figure out where it fits with this. But both of them work to some extent. But what's nice about this is, again, I showed you this before the data for the melanomas, but in squamous cell, the same thing. If you use that model of how many risk factors there are, again, having the data here, a two a two b or a one a really divides the initial black dots significantly in terms of assessing the risk for metas addict disease to do this. So again, you could use treatment plans here from low intensity to moderate intensity to high intensity for this. And basically it really helps in managing these patients. So we've got through these cases. Thank you very much and hope you enjoyed it. Thank you. Thank you. Thank.

Describe the current recommendations of the National Academies on the effect of UV filters on aquatic environment and health


Explain the concept of personalized photoprotection

Recognize why sunscreens fail and how they should be applied for optimal photoprotection

Explain why sunscreens produce heat on the skin surface 

2023 Virtual Grand Rounds Session 8: May 31, 2023 - Skin Cancer Prevention

Skin Cancer

WEDNESDAY, Jan. 28, 2026 (HealthDay News) -- Individuals consuming an inflammation- and oxidation-promoting diet are more likely to develop <a href="/conditions/skin-cancer" target="_blank" rel="noopener noreferrer">skin cancer</a>, with accelerated biological aging partially mediating the association, according to a study published online Dec. 28 in Cancers.Shiqi Hui, from the Beijing Tongren Eye Center, and colleagues explored the associations of PhenoAge, dietary inflammatory index (DII), and dietary oxidative balance index (DOBS) with skin cancer risk. Data were included for 474 individuals aged older than 20 years with self-reported skin cancer and 16,154 individuals without skin cancer. The combination of DII/DOBS was classified as an inflammation- and oxidation-promoting diet, inflammation- and oxidation-reducing diet, and composite diet.The researchers observed an association for PhenoAge, a measure of biological aging, with an increased likelihood of skin cancer (odds ratio, 1.07). DII and DOBS were associated with PhenoAge advancement, with odds ratios of 1.28 and 0.95, respectively. The comparison between the inflammation- and oxidation-promoting diet and the inflammation- and oxidation-reducing diet had a positive relationship with skin cancer after adjustment for all covariates (odds ratio, 2.19). The associations between DII/DOBS and skin cancer were partially mediated by PhenoAge (28.06 percent). In a subgroup analysis, the association persisted."The result of this study highlights the importance of dietary patterns and biological age in individuals with skin cancer," the authors write. "These results provide a foundation for developing hypotheses regarding specific characteristics and underlying mechanisms by which diet influences skin cancer, to be explored in future research."<a target="_blank" rel="noopener noreferrer" href="https://www.mdpi.com/2072-6694/18/1/111">Abstract/Full Text</a>

28.06 percent of the association between DII/DOBS and skin cancer was mediated by PhenoAge

Inflammation-, Oxidation-Promoting Diet Linked to Skin Cancer

WEDNESDAY, Jan. 21, 2026 (HealthDay News) -- Circulating tumor DNA (ctDNA) can detect Merkel cell <a href="/conditions/skin-cancer" target="_blank" rel="noopener noreferrer">carcinoma</a> (MCC) recurrence, according to a study published in the February issue of the Journal of the American Academy of Dermatology.Tomoko Akaike, M.D., from the University of Washington in Seattle, and colleagues examined the timing and prognostic significance of ctDNA levels relative to clinical recurrence in a multicenter prospective study of 669 tumor-informed ctDNA tests from 215 MCC patients with stage I to IV MCC, without clinically evident disease after treatment.The researchers found that compared with ctDNA-negative patients, patients with at least one positive ctDNA test were more likely to experience recurrence (hazard ratio, 18.1); by one year, 77 percent developed clinically evident disease. Between the first positive ctDNA test and clinical recurrence, the median lead time was 2.7 months. Clinical recurrences usually occurred within three months, within six months, and within nine months for ctDNA levels above 10 molecules/mL, between 1 and 10 molecules/mL, and below 1 molecule/mL, respectively."Understanding the lead time between the first ctDNA positivity and clinical recurrence can help tailor follow-up frequency and urgency, optimizing patient-specific care," the authors write. "This approach offers an opportunity to de-escalate imaging frequency for ctDNA-negative patients, reducing unnecessary interventions while maintaining vigilance in higher-risk individuals."<a target="_blank" rel="noopener noreferrer" href="https://www.jaad.org/article/S0190-9622(25)02991-3/fulltext">Abstract/Full Text</a>

Median lead time 2.7 months between first positive ctDNA and clinical recurrence

Circulating Tumor DNA Detects Merkel Cell Carcinoma Recurrence

MONDAY, Dec. 22, 2025 (HealthDay News) -- For adults with Bowen disease (BD), the additional risk for recurrence after 5-fluorouracil (5FU) and surgical excision (SE) and the risk for developing a cutaneous squamous cell <a href="/conditions/skin-cancer" target="_blank" rel="noopener noreferrer">carcinoma</a> during long-term follow-up after treatment are insignificant, according to a study published online Dec. 12 in the Journal of the American Academy of Dermatology.Myrthe M.G. Moermans, M.D., from Maastricht University Medical Center in the Netherlands, and colleagues compared the long-term efficacy of 5FU, methylaminolevulinate photodynamic therapy (MAL-PDT), and SE in a multicenter, noninferiority randomized controlled trial involving 250 adults older than 18 years with BD (82 in 5FU group, 84 in MAL-PDT group, and 84 in SE group). Participants were invited for long-term follow-up three to five years after treatment.Treatment failure was observed in 27 patients during the first year of follow-up. Only one additional patient developed a recurrence during long-term follow-up, five years after MAL-PDT. The researchers found that the four-year cumulative probability of tumor-free survival was 97.5, 86.2, and 82.7 percent for SE, 5FU, and MAL-PDT, respectively. None of the patients developed a cutaneous squamous cell carcinoma in the treated area."Based on the one-year results of this trial, it was concluded that 5FU was noninferior to excision, but for MAL-PDT noninferiority could not be concluded," the authors write. "The lack of any additional recurrences three to five years posttreatment in the current study indicates that these conclusions remain valid in the long term."Abstract/Full Text (subscription or payment may be required)

Negligible additional risk for recurrence seen after 5FU or surgical excision; negligible risk for cutaneous squamous cell carcinoma reported from treated BD

5-Fluorouracil Successful for Bowen Disease in Long Term

WEDNESDAY, Dec. 10, 2025 (HealthDay News) -- For patients with advanced <a href="/conditions/skin-cancer" target="_blank" rel="noopener noreferrer">cutaneous squamous cell carcinoma</a> (CSCC), long-term durable responses are seen with cemiplimab, according to a study published online Nov. 28 in the Journal of the American Academy of Dermatology.Catherine Bennett, M.B.Ch.B., from the Peter MacCallum Cancer Centre in Melbourne, Australia, and colleagues examined outcomes for patients in Australia treated in phase 2 of the EMPOWER-CSCC-1 study, which established the programmed cell death protein-1 inhibitor cemiplimab as standard of care for patients with locally advanced or metastatic CSCC, beyond trial protocol follow-up. Patients who progressed after completing fixed-duration treatment received cemiplimab retreatment.Fifty-four patients were identified, with a median follow-up of 77 months. The researchers found that five-year duration of response was 65 percent among the 39 responders (72 percent). The median progression-free survival was 56.4 months, while median overall survival was not reached; the five-year progression-free and overall survival was 48 and 60 percent, respectively. Three of the four patients receiving retreatment with cemiplimab remained progression-free at data cutoff."Our study with the longest reported follow-up demonstrates patients in Australia with advanced CSCC responding to cemiplimab have durable responses, with the majority of progression occurring within three years of treatment initiation," the authors write.Several authors disclosed ties to the biopharmaceutical industry, including Regeneron Pharmaceuticals, which manufactures cemiplimab and endorsed this study.<a target="_blank" rel="noopener noreferrer" href="https://www.jaad.org/article/S0190-9622(25)03293-1/fulltext">Abstract/Full Text</a>

Of four patients receiving retreatment with cemiplimab, three remained progression-free at data cutoff

Long-Term Durable Responses to Cemiplimab Seen in Advanced CSCC

WEDNESDAY, Dec. 3, 2025 (HealthDay News) -- The U.S. Food and Drug Administration has approved an updated label for Unloxcyt (cosibelimab-ipdl) for the treatment of adults with metastatic or locally advanced cutaneous squamous cell <a href="/conditions/skin-cancer" target="_blank" rel="noopener noreferrer">carcinoma</a> (CSCC) who are not candidates for curative surgery or curative radiation.The updated label incorporates long-term follow-up data from the pivotal CK-301-101 trial, which included 109 patients (31 with locally advanced and 78 with metastatic CSCC). Results showed patients receiving Unloxcyt experienced durable clinical responses, including for the primary end point of objective response rate, in which at least 50 percent of patients achieved an objective response. In addition, 14 percent of patients with metastatic CSCC and 32 percent of patient with locally advanced CSCC achieved stable disease. The median duration of response had not been reached in either group at the time of analysis. A rapid response was seen, with a median time to response of 1.9 months (range, 1.6 to 16.9) and 3.6 months (range, 1.7 to 10.1) in metastatic and locally advanced disease, respectively.There were no changes to the safety profile of Unloxcyt in this label update, including immune-mediated adverse reactions, which occurred in 24 percent of participants. The most common adverse reactions (≥10 percent) included fatigue, musculoskeletal pain, rash, diarrhea, hypothyroidism, constipation, nausea, headache, pruritus, edema, localized infection, and urinary tract infection."This label update reinforces the importance of therapeutic diversity in advanced CSCC," David Miller, M.D., Ph.D., from the Mass General Brigham Cancer Institute, said in a statement. "Having access to a treatment option that works in a different way than other checkpoint inhibitors can only benefit patients who are fighting this disease and demand an efficacious treatment with acceptable tolerability."This approval was granted to Sun Pharma.<a target="_blank" rel="noopener noreferrer" href="https://sunpharma.com/usa/wp-content/uploads/sites/2/2025/11/UNLOXCYT-sBLA-Press-Release_FINAL.pdf">More Information</a>

Approval is for adults with metastatic or locally advanced cutaneous squamous cell carcinoma who are not candidates for curative surgery or curative radiation

FDA Approves Updated Label for Unloxcyt

WEDNESDAY, Nov. 19, 2025 (HealthDay News) -- The prevalence of primary epithelioid sarcoma (PES) is 0.49 per 100,000 in the United States and is highest among those aged 35 to 39 years, according to a study published online in the November issue of SKIN.Shangyi Fu, from the Baylor College of Medicine in Houston, and colleagues examined the prevalence of PES in the U.S. population using data from the Surveillance, Epidemiology, and End Results program. Disease occurrence patterns were identified from 2017 to 2018.The analysis identified 217.2 cases of PES, corresponding to an overall prevalence of 0.49 per 100,000. The researchers found that prevalence was highest among individuals of White race aged 25 to 59 years, and the second-highest prevalence was seen among individuals of Black race aged 30 to 64 years. The highest prevalence rate was seen among those aged 35 to 39 years. For 2017 to 2018, prevalence was highest among Whites and lowest among American Indians."Our data suggests that the prevalence of PES is least prevalent in American Indian populations and most prevalent among White populations," the authors write. "Further epidemiological studies that do not rely solely on billing code are needed to validate these findings and provide a clearer understanding of PES prevalence across diverse populations."<a target="_blank" rel="noopener noreferrer" href="https://skin.dermsquared.com/skin/article/view/2960">Abstract/Full Text</a>

Prevalence was highest among Whites, lowest among American Indians; highest prevalence seen for those aged 35 to 39 years

Prevalence of Primary Epithelioid Sarcoma Is 0.49 per 100,000 in the U.S.

WEDNESDAY, Oct. 29, 2025 (HealthDay News) -- An artificial intelligence (AI) assistant for <a href="/conditions/skin-cancer" target="_blank" rel="noopener noreferrer">basal cell carcinoma</a> (BCC) diagnosis with line-field confocal optical coherence tomography (LC-OCT) improves dermatologists' diagnostic performance, according to a study published online Oct. 19 in the Journal of the European Academy of Dermatology &amp; Venereology.Sébastien Fischman, from Damae Medical in Paris, and colleagues presented a real-time AI assistant for BCC diagnosis with LC-OCT. The model's effectiveness was quantified when used by dermatologists with different levels of expertise, and its performance was compared to that of traditional methods and unassisted LC-OCT in a retrospective cohort study. The study involved 43 dermatologists in a double-rounded quiz on 200 equivocal BCC lesions.The researchers found significant improvement in dermatologists' diagnostic performance for detection of BCC with AI-assisted LC-OCT (+25.8 and +16.8 points in sensitivity and specificity, respectively, compared with clinical and dermoscopic images). The benefit was more apparent in those with less LC-OCT experience, effectively bridging a two-year gap of expertise."Our research highlights the benefit of AI assistance for all user levels, with novices and intermediates improving the most on a large range of pathologies. It also boosts dermatologists' confidence without slowing the diagnostic process," the authors write.<a target="_blank" rel="noopener noreferrer" href="https://onlinelibrary.wiley.com/doi/10.1111/jdv.70099">Abstract/Full Text</a>

Particular benefit seen for those with less LC-OCT experience, bridging a two-year gap of expertise

AI-Assisted LC-OCT Improves Dermatologists' Diagnostic Performance for BCC

THURSDAY, Oct. 23, 2025 (HealthDay News) -- For patients with resected <a href="/conditions/skin-cancer" target="_blank" rel="noopener noreferrer">Merkel cell carcinoma</a> (MCC), adjuvant pembrolizumab yields a trend toward improved recurrence-free survival (RFS), according to a study presented at the annual meeting of the European Society for Medical Oncology, held from Oct. 17 to 21 in Berlin.Janice Mehnert, M.D., from NYU Langone Health in New York, and colleagues examined the role of adjuvant pembrolizumab in patients with resected MCC in a phase 3 trial. Patients with resected MCC were randomly assigned to arm A (adjuvant pembrolizumab 200 mg every three weeks for 17 doses; 147 patients) or arm B (observation; 146 patients) stratified by disease stage and intention to treat with radiation.The researchers found that at final analysis, RFS was numerically higher in arm A than arm B (42 versus 48 recurrence events), but the difference was not statistically significant. One- and two-year RFS rates were 83 and 73 percent in arm A and 71 and 66 percent in arm B, respectively, with a median follow-up of 40 months. Significantly higher distant metastasis-free survival was seen in arm A (hazard ratio, 0.58). Among patients who did not receive adjuvant radiation, RFS was numerically but not significantly higher in arm A. Safety events were consistent with known toxicities for pembrolizumab and radiation."Our study provides the first solid evidence that immunotherapy with pembrolizumab postsurgery may help people with Merkel cell carcinoma by preventing their cancer from returning in organs considered distant from the site of the original disease," Mehnert said in a statement. "This is a positive development for people who are living with the highly aggressive cancer that is Merkel cell carcinoma."<a target="_blank" rel="noopener noreferrer" href="https://nyulangone.org/news/immunotherapy-after-surgery-shows-promise-treating-rare-aggressive-skin-cancer">Press Release</a><a target="_blank" rel="noopener noreferrer" href="https://www.esmo.org/meeting-calendar/esmo-congress-2025">More Information</a>

Recurrence-free survival was numerically higher with adjuvant pembrolizumab, but difference was not significant

Trend Seen for Improved Recurrence-Free Survival With Pembrolizumab in Merkel Cell Carcinoma

WEDNESDAY, Oct. 15, 2025 (HealthDay News) -- Among solid organ transplant (SOT) recipients, a modified Skin and Ultraviolet Neoplasia Transplant Risk Assessment Calculator (SUNTRAC)-based surveillance program is associated with improved <a href="/conditions/skin-cancer" target="_blank" rel="noopener noreferrer">skin cancer</a> screening rates and detection, according to a study published online Oct. 15 in JAMA Dermatology.David S. Lee, M.D., from Kaiser Permanente Northern California in Pleasanton, and colleagues examined skin cancer risk among SOT recipients and assessed the impact of the SUNTRAC-based surveillance program on screening rates in a retrospective cohort study involving participants identified from the transplant registry of Kaiser Permanente (KP) Northern California. The study period was divided into preimplementation of the modified SUNTRAC (KP-SUNTRAC) program (2016 to 2021) and postimplementation (2022 to 2024).The analysis included 2,083 SOT recipients matched with 26,199 nonrecipients. The researchers found that the SOT recipients had a significantly increased risk for developing skin cancer posttransplant compared with nonrecipients (hazard ratio, 7.78). The risk for first detected skin cancer was significantly higher in the postimplementation group after implementation of the modified SUNTRAC program (hazard ratio, 2.57). Screening rates improved significantly among the high- and very high-risk groups during the postimplementation period versus the preimplemenation period (hazard ratios, 1.98 and 2.17, respectively). There was no increase in health care utilization after KP-SUNTRAC implementation."SUNTRAC has been helpful in identifying the highest-risk SOT recipients, those who benefit from early screening," writes Anokhi Jambusaria-Pahlajani, M.D., from the University of Texas at Austin Dell Medical School and the author of an accompanying editorial. "Although the instrument was originally developed to be used by transplant teams to send timely referrals, this study demonstrates that dermatologists and primary care teams may also use SUNTRAC to triage SOT recipients and encourage timely skin cancer screening visits."<a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamadermatology/fullarticle/2840146">Abstract/Full Text</a><a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamadermatology/fullarticle/2840151">Editorial</a>

KP-SUNTRAC associated with improved skin cancer screening rates and detection among solid organ transplant recipients

Skin Cancer Surveillance Program Improves Screening for Solid Organ Transplant Recipients

WEDNESDAY, Oct. 8, 2025 (HealthDay News) -- For patients with advanced cutaneous squamous cell carcinoma (mCSCC), cosibelimab is associated with robust long-term responses, according to a study published online Sept. 29 in the Journal of the American Academy of Dermatology.Emily S. Ruiz, M.D., from Brigham and Women's Hospital in Boston, and colleagues report long-term efficacy and safety outcomes from a pivotal study of cosibelimab in mCSCC (78 individuals) or locally advanced CSCC (laCSCC; 31 individuals).The researchers found that during a median follow-up of 29.3 months for patients with mCSCC, the objective response rate was 50.0 percent and the complete response was 12.8 percent. The median duration of response (DOR) was not reached, and estimated 24-month DOR was 72.1 percent. For patients with laCSCC followed for a median of 24.1 months, the objective response rate was 54.8 percent and the complete response was 25.8 percent. Similarly, a median DOR was not reached, and the estimated 24-month DOR was 80.2 percent. For immune-related adverse events, the rate was 27.6 percent (3.6 percent were grade 3)."These results provide additional support for the use of cosibelimab in patients with mCSCC and laCSCC," the authors write.Several authors disclosed ties to pharmaceutical companies, including Checkpoint Therapeutics, which manufactures cosibelimab and funded the study.<a target="_blank" rel="noopener noreferrer" href="https://www.jaad.org/article/S0190-9622(25)02791-4/fulltext">Abstract/Full Text</a>

Findings seen for patients with metastatic or locally advanced disease, with low rates of severe immune-related adverse events

Cosibelimab Tied to Robust, Durable Response for Cutaneous Squamous Cell Carcinoma

WEDNESDAY, Sept. 24, 2025 (HealthDay News) -- Painful, blistering, and/or severe sunburn is associated with significantly increased odds of <a href="/conditions/skin-cancer" target="_blank" rel="noopener noreferrer">cutaneous squamous cell carcinoma</a> (cSCC), according to a review published online Sept. 24 in JAMA Dermatology.Isaac Weber, M.D., from the University of Texas MD Anderson Cancer Center in Houston, and colleagues conducted a systematic literature review to examine the association between sunburn history and the risk for developing cSCC.Based on 17 studies (321,473 participants), the researchers found that in pooled analyses of the most adjusted results, there were significantly increased odds for developing cSCC with medium (odds ratio, 1.51) and high (odds ratio, 1.69) lifetime painful, blistering, and/or severe sunburn frequencies. High frequencies of painful, blistering, and/or severe sunburn in childhood also were significantly associated with increased cSCC odds (odds ratio, 3.11). Similarly, a history of any painful, blistering, and/or severe sunburn was significantly associated with increased odds of cSCC (odds ratio, 1.38)."This study further emphasizes the importance of effective sunburn prevention strategies, especially against painful, blistering, and/or severe burns," the authors write. "Future research could focus on developing standardized, quantifiable sunburn metrics and consistently adjusting for key confounding variables such as skin color and ultraviolet index or geographic region."<a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamadermatology/article-abstract/2839012">Abstract/Full Text</a><a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamadermatology/article-abstract/2839015">Editor's Note</a>

Findings seen for any history of severe sunburn, including during childhood

Painful, Blistering, Severe Sunburn Tied to Higher Risk for Squamous Cell Carcinoma

THURSDAY, Sept. 18, 2025 (HealthDay News) -- For patients treated with nicotinamide, the risk for skin cancer is reduced, especially when initiated after a first skin cancer, according to a study published online Sept. 17 in JAMA Dermatology.Kimberly F. Breglio, M.D., D.Phil., from Durham VA Medical Center in North Carolina, and colleagues conducted a retrospective cohort study to examine the clinical efficacy of nicotinamide supplementation for skin cancer prevention in the general population and in solid organ transplant recipients. The study included 12,287 patients exposed to oral nicotinamide 500 mg twice daily for more than 30 days and 21,479 matched unexposed patients.The researchers found 10,994 instances of basal cell carcinoma and 12,551 cutaneous squamous cell carcinomas (cSCCs) after nicotinamide exposure within the matched dataset. In the matched cohort, 1,334 (3.9 percent) were solid organ transplant recipients. A significant 14 percent reduction in skin cancer risk was seen overall. The risk reduction increased to 54 percent when nicotinamide was initiated after a first skin cancer; with initiation following subsequent skin cancers, this benefit declined. The reduction in risk was seen for skin cancers overall, basal cell carcinoma, and cSCC; the greatest reduction was seen for cSCC. No overall significant risk reduction was observed among solid organ transplant recipients; reduced cSCC incidence was seen in association with early nicotinamide use."The growing body of literature suggests that we should routinely recommend nicotinamide as secondary prevention for all patients with skin cancer and that earlier initiation will have a stronger effect," Sarah T. Arron, M.D., Ph.D., from the Palo Alto Foundation Medical Group in California, writes in an accompanying editorial. "Integrating this new information into patient counseling can be straightforward in the context of the skin cancer treatment. Consider the phone call to a patient with a first diagnosis of skin cancer. ... This is an ideal time to recommend nicotinamide, as the patient may be most receptive to the information."<a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamadermatology/article-abstract/2838591">Abstract/Full Text</a><a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamadermatology/article-abstract/2838594">Editorial</a>

Greatest effect was seen when nicotinamide was initiated after the first skin cancer

Skin Cancer Risk Reduced for Patients Treated With Nicotinamide

WEDNESDAY, Sept. 17, 2025 (HealthDay News) -- A convolutional neural network (CNN) model performs similarly to dermatologists for discriminating between well versus moderately and poorly differentiated <a href="/conditions/skin-cancer" target="_blank" rel="noopener noreferrer">cutaneous squamous cell carcinomas</a> (cSCCs), according to a study to be published in the December issue of the Journal of the American Academy of Dermatology International.Victor Liang, M.D., from Sahlgrenska Academy in Gothenburg, Sweden, and colleagues examined how a CNN performed in discriminating between well versus moderately and poorly differentiated cSCCs in a retrospective study. A de novo CNN was trained on 1,829 clinical close-up images of cSCCs: 1,254 well-differentiated and 575 moderately or poorly differentiated. The images were randomized into training, validation, and test sets (1,329, 200, and 300 images, respectively). Performance of the CNN was compared to combined assessment of seven independent readers (one senior resident and six board-certified dermatologists with four to 25 years of experience).The researchers found that the CNN model yielded an area under the receiver operating characteristic curve of 0.69 compared with 0.70 for the combined dermatologists' assessment. In assessment of cSCC differentiation, the interobserver agreement was moderate (κ = 0.44). For clinical features, interobserver agreement ranged from fair to substantial. In moderately or poorly differentiated tumors, ulceration and flat surface topography were more common, with odds ratios of 2.34 and 2.94, respectively."The model we've developed needs further refinement and testing, but the way forward is clear -- AI [artificial intelligence] should be integrated where it actually adds value to decision-making processes within health care," lead author Sam Polesie, M.D., Ph.D., also from Sahlgrenska Academy, said in a statement.<a target="_blank" rel="noopener noreferrer" href="https://www.jaadinternational.org/article/S2666-3287(25)00081-1/fulltext">Abstract/Full Text</a>

CNN model yielded area under the curve of 0.69 compared with 0.70 for combined dermatologists' assessment

CNN Model Performs Similarly to Dermatologists for Differentiating cSCCs

WEDNESDAY, Aug. 27, 2025 (HealthDay News) -- For patients with superficial <a href="/conditions/skin-cancer" target="_blank" rel="noopener noreferrer">basal cell carcinoma</a> (sBCC), red-light photodynamic therapy (PDT) with 10 percent 5-aminolevulinic acid (ALA) gel yields higher clearance rates than vehicle, according to a study published online Aug. 24 in the Journal of the American Academy of Dermatology.Todd Schlesinger, M.D., from the Clinical Research Center of the Carolinas in Charleston, South Carolina, and colleagues examined the efficacy and safety of red-light PDT with 10 percent ALA gel versus vehicle for the treatment of sBCC in a randomized, phase 3 study conducted at 21 U.S. centers. Eligible participants had one or more naive sBCC and received one to two PDT cycles.Of the 187 randomly assigned participants, 145 and 42 received PDT with 10 percent ALA and vehicle, respectively. The researchers found that histological clearance was 75.9 and 19.0 percent with 10 percent ALA gel and vehicle, respectively, and clinical clearance was 83.4 and 21.4 percent, respectively. The esthetic outcome was rated as very good or good in 88.1 percent of participants treated with 10 percent ALA gel. There were no previously unknown adverse events reported."The high efficacy, good tolerability and cosmetic benefits demonstrated in our study reinforce the value of red-light PDT with 10 percent ALA gel as a highly suitable alternative to surgical excision for the treatment of sBCC, especially for multiple or large lesions, in low-risk areas, or where patients oppose surgery," the authors write.Several authors disclosed ties to the pharmaceutical industry.<a target="_blank" rel="noopener noreferrer" href="https://www.jaad.org/article/S0190-9622(25)02656-8/fulltext">Abstract/Full Text</a>

Histologic and clinical clearance higher with photodynamic therapy with 10 percent ALA gel versus vehicle

High Clearance of Superficial BCC Seen With Photodynamic Therapy With 10% 5-Aminolevulinic Acid Gel

FRIDAY, Aug. 1, 2025 (HealthDay News) -- Occupation as a firefighter is associated with elevated cancer mortality, especially for <a href="/conditions/skin-cancer" target="_blank" rel="noopener noreferrer">skin</a> and kidney cancer, according to a study published online July 29 in the International Journal of Epidemiology.Lauren R. Teras, Ph.D., from the American Cancer Society in Atlanta, and colleagues used data from more than 470,000 men enrolled in a population-based prospective cohort to examine associations between occupation as a firefighter and cancer mortality. Survival time was compared among firefighters and other male participants in the American Cancer Society Cancer Prevention Study-II Cohort using data obtained from surveys conducted among cancer-free individuals with 36 years of follow-up (1982 to 2018).The researchers observed an association for occupation as a firefighter (compared with other career professionals) with most cancers, which was strongest for skin and kidney cancer mortality (hazard ratios, 1.72 and 1.39, respectively). For prostate and colorectal cancer mortality, suggestive increases were observed with more years as a firefighter. Only after three decades of follow-up was an association with lung cancer apparent. With control for confounders and changes in the referent group to include all nonfirefighter occupations, most associations were attenuated, but associations with skin and kidney cancers persisted."Although this isn't favorable news, this study shines a spotlight on the long-term risks firefighters face beyond the immediate dangers of fighting a fire," Teras said in a statement. "Continued efforts to safeguard the health of firefighters by increasing access to cancer screening, early detection, and prevention are paramount."One author disclosed ties to the pharmaceutical and biotechnology industries.<a target="_blank" rel="noopener noreferrer" href="https://academic.oup.com/ije/article-abstract/54/4/dyaf104/8214913">Abstract/Full Text</a>

Suggestive increases for prostate and colorectal cancer mortality observed with more years as a firefighter

Firefighters Face Elevated Mortality Rates for Skin and Kidney Cancer

WEDNESDAY, Aug. 6, 2025 (HealthDay News) -- When using the 40-gene expression profile (GEP) test to assess the risk for cutaneous squamous cell <a href="/conditions/skin-cancer" target="_blank" rel="noopener noreferrer">carcinoma</a> (cSCC) progression, clinicians recommend surveillance imaging and adjuvant radiation therapy (ART) at risk thresholds of 10 and 20 percent, respectively, for local recurrence or regional/distant metastasis, according to a study published in the July issue of <a target="_blank" rel="noopener noreferrer" href="https://skin.dermsquared.com/">SKIN</a>.Milaan Shah, M.D., from the Medical University of South Carolina in Charleston, and colleagues examined the actionable clinical risk thresholds for patients with high-risk cSCC that clinicians use to guide ART and surveillance imaging decisions and how management decisions are impacted by use of the 40-GEP test. A total of 244 physicians, physician's assistants, and nurse practitioners with at least 10 recent or 12 total 40-GEP requisitions completed an online survey.The researchers found that the preferred formalized staging or risk assessment strategies were highly variable. Clinicians most commonly reported recommending ART and surveillance imaging at 20 and 10 percent risk, respectively, for local recurrence or regional/distant metastasis. At a minimum risk threshold of 10 percent for local recurrence or regional/distant metastasis, ART was considered. The top two most important high-risk factors for ART and surveillance imaging decision-making included a 40-GEP Class 2B result, along with extensive perineural invasion."Based on previous data confirming the independent risk stratification of the 40-GEP, clinicians should use 40-GEP testing to inform ART and surveillance imaging to identify patients above and below established risk thresholds to more closely risk-align established management strategies to improve outcomes for patients with high-risk cSCC," the authors write.Several authors are employees and shareholders of Castle Biosciences, which provided materials and funding for the study.<a target="_blank" rel="noopener noreferrer" href="https://skin.dermsquared.com/skin/article/view/3563">Abstract/Full Text</a>

40-gene expression profiling can inform adjuvant radiation therapy and surveillance imaging decision-making

Researchers Identify Risk Thresholds Using 40-GEP to Manage Decisions for cSCC

WEDNESDAY, July 30, 2025 (HealthDay News) -- The <a href="/videos/dermbits/how-does-the-40-gep-test-work" target="_blank" rel="noopener noreferrer">40-gene expression profile (GEP)</a> stratifies local recurrence-free survival (LRFS) and metastasis-free survival (MFS) in patients with National Comprehensive Cancer Network (NCCN) high-risk (HR) <a href="/conditions/skin-cancer" target="_blank" rel="noopener noreferrer">cutaneous squamous cell carcinoma</a> (cSCC) who have negative margins after surgical resection, according to a study published in the July issue of <a target="_blank" rel="noopener noreferrer" href="https://skin.dermsquared.com/">SKIN</a>.Désirée Ratner, M.D., from the NYU Grossman School of Medicine in New York City, and colleagues validated use of the 40-GEP to identify patients with NCCN HR cSCC who had negative margins after surgical resection and have an increased risk for LR and metastasis. Data were included from 414 patients with definitive negative margin Mohs surgery from a previously published cohort who were analyzed for risk prediction of LRFS and MFS.The researchers found that 40-GEP stratified patients, with higher three-year LRFS and MFS for low-risk class 1 patients versus class 2A or class 2B patients (LRFS: 95.3 versus 85.5 versus 71.4 percent; MFS: 97.1 versus 89.3 versus 57.1 percent, respectively). LRFS and MFS could not be stratified by the Brigham and Women's Hospital and American Joint Committee on Cancer staging systems. Significant predictors of LR risk included class 2A, class 2B, perineural invasion, and immunosuppression."The results of this study therefore validate the extended utility of the 40-GEP test within the NCCN HR patient cohort by providing information that not only predicts metastasis and response to adjuvant radiation therapy but also extends to prediction of LR," the authors write.Several authors disclosed ties to Castle Biosciences, which funded the study.<a target="_blank" rel="noopener noreferrer" href="https://skin.dermsquared.com/skin/article/view/3561">Abstract/Full Text</a>

Three-year local recurrence-free survival, metastasis-free survival higher for class 1 versus class 2A or 2B patients

40-Gene Expression Profile Predicts Local Recurrence in High-Risk cSCC

WEDNESDAY, July 2, 2025 (HealthDay News) -- For patients with BRAF V600E/K-positive, completely resected stage III <a href="/conditions/cutaneous-melanoma" target="_blank" rel="noopener noreferrer">melanoma</a>, extending adjuvant dabrafenib and trametinib beyond one year was associated with significantly better relapse-free survival (RFS), according to a study published online May 13 in The Journal of Dermatology.Dong-Dong Jia, from the Chinese Academy of Sciences in Hangzhou, and colleagues reviewed medical records from six centers to examine whether extending dabrafenib plus trametinib beyond one year offers additional clinical benefit in adults with BRAF V600E/K-positive, completely resected stage III melanoma. Patients were classified as those who received 12 months of adjuvant dabrafenib plus trametinib and those who received more than one year of therapy. The primary end point was RFS.One hundred twenty-two patients were included, of whom 77 received more than one year of adjuvant therapy. The researchers found that the group receiving more than one year of adjuvant therapy experienced significantly better RFS; in a multivariate analysis, longer therapy independently reduced recurrence risk (hazard ratio, 2.42). There was no difference seen in adverse event profiles between the groups; toxicity-related treatment modifications mainly occurred within the first year."To our knowledge, this is the first study to highlight the feasibility of prolonging adjuvant dabrafenib plus trametinib in resected stage III melanoma, which may provide a basis for future prospective research," the authors write.<a target="_blank" rel="noopener noreferrer" href="https://onlinelibrary.wiley.com/doi/10.1111/1346-8138.17779">Abstract/Full Text</a>

Extending adjuvant dabrafenib + trametinib beyond one year linked to better relapse-free survival

Extending Dabrafenib + Trametinib Beneficial in Stage III Melanoma

WEDNESDAY, June 25, 2025 (HealthDay News) -- Cellular discohesion forming clefts, 'clefting', is associated with malignancy in <a href="/conditions/skin-cancer" target="_blank" rel="noopener noreferrer">melanocytic lesions</a>, according to a study published online June 11 in the Journal of the European Academy of Dermatology &amp; Venereology.Javiera Pérez-Anker, M.D., Ph.D., from the Hospital Clínic de Barcelona in Spain, and colleagues examined clefting in melanocytic lesions and the correlation with histopathology and reflectance confocal microscopy. Consecutive benign, atypical, and malignant melanocytic lesions were scanned with line-field confocal optical coherence tomography (LC-OCT) at three hospitals. Two hundred lesions with univocal or unambiguous diagnosis (clinically or histologically) were selected.The researchers identified clefting in 36 lesions: 28 of 70 <a href="/conditions/cutaneous-melanoma" target="_blank" rel="noopener noreferrer">melanomas</a> and eight of 130 benign lesions (40 and 6 percent, respectively). The odds ratio was 10.03 for malignancy associated with the presence of clefting in a melanocytic lesion. Significant differences were seen in the magnitude of clefting: marked clefting was present in 17 melanomas and two benign lesions (24 and 2 percent), with an odds ratio of 20.22. There were no differences seen in terms of the presence of clefting in different locations. Clefting was strongly associated with other malignant features, including epidermal consumption, nests in the epidermis, and disruption of the dermo-epidermal junction"Clefting is not an artefact created by sample preparation in melanocytic lesions, but a specific feature related to malignancy," the authors write. "The use of LC-OCT offers a promising approach for identifying and evaluating clefting, providing valuable information for the diagnosis, invasiveness, and prognosis of melanocytic lesions."One author disclosed ties to DAMAE Medical.<a target="_blank" rel="noopener noreferrer" href="https://onlinelibrary.wiley.com/doi/abs/10.1111/jdv.20761">Abstract/Full Text</a>

Clefting identified in 40 percent of melanomas and 6 percent of benign lesions

'Clefting' Linked to Malignancy in Melanocytic Lesions

THURSDAY, June 12, 2025 (HealthDay News) -- For patients with metastatic <a href="/conditions/skin-cancer" target="_blank" rel="noopener noreferrer">melanoma</a>, mitochondrial (MT) haplogroup T (HG-T) is associated with resistance to an anti-programmed cell death protein-1-based immune checkpoint inhibitor (ICI), according to a study published online June 5 in Nature Medicine.Kelsey R. Monson, Ph.D., from the Perlmutter Cancer Center at NYU Langone Health in New York City, and colleagues examined the association of host MT genetics with ICI efficacy in 1,225 ICI-treated patients with metastatic melanoma.The researchers discovered and validated significant associations of MT HG-T with resistance to an anti-programmed cell death protein-1-based ICI, both as a single agent and in combination; HG-T was found to be independent of established tumor predictors. A unique nivolumab-resistant baseline peripheral CD8+ T-cell repertoire was exhibited by patients belonging to HG-T compared with other MT haplogroups (pooled odds ratio, 3.46). This was validated in a clinical trial and in an independent standard-of-care ICI cohort."Checkpoint immunotherapy has become the mainstay in cancer care in the past decade, especially for those with metastatic melanoma, but until now, it has never been clearly explained why nearly half will not respond to treatment," Monson said in a statement.Several authors disclosed ties to the biopharmaceutical industry.<a target="_blank" rel="noopener noreferrer" href="https://www.nature.com/articles/s41591-025-03699-3">Abstract/Full Text</a>

Patients belonging to haplogroup T exhibit unique nivolumab-resistant baseline peripheral CD8+ T-cell repertoire

Mitochondrial Genetics Key to Metastatic Melanoma Immunotherapy Resistance

TUESDAY, June 17, 2025 (HealthDay News) -- The PanDerm artificial intelligence (AI) model improves <a href="/conditions/skin-cancer" target="_blank" rel="noopener noreferrer">skin cancer</a> diagnosis when used by doctors, according to a research article published online June 6 in Nature Medicine.Siyuan Yan, from Monash University in Melbourne, Australia, and colleagues developed PanDerm, which was pretrained through self-supervised learning on more than 2 million real-world skin disease images from 11 clinical institutions across four imaging modalities. Then, PanDerm was evaluated using 28 diverse benchmarks, including skin cancer screening, risk stratification, differential diagnosis of common and rare skin conditions, lesion segmentation, longitudinal monitoring, and metastasis prediction and prognosis.The researchers found that PanDerm's performance across all evaluated tasks was state-of-the-art, even outperforming existing models when using only 10 percent of labeled data. PanDerm outperformed clinicians by 10.2 percent in early-stage melanoma detection through a longitudinal analysis, improved clinicians' skin cancer diagnostic accuracy by 11 percent on dermoscopy images, and enhanced nondermatologist health care providers' differential diagnosis by 16.5 percent across 128 skin conditions on clinical photographs."Previous AI models have struggled to integrate and process various data types and imaging methods, reducing their usefulness to doctors in different real-world settings," co-lead author Zongyuan Ge, Ph.D., also from Monash University, said in a statement. "PanDerm is a tool designed to work alongside clinicians, helping them interpret complex imaging data and make informed decisions with more confidence."Several authors disclosed ties to the pharmaceutical and biotechnology industries.<a target="_blank" rel="noopener noreferrer" href="https://www.nature.com/articles/s41591-025-03747-y">Abstract/Full Text</a>

PanDerm was evaluated on a wide range of clinical tasks and trained on multiple image types

AI Model Can Aid Physicians in Skin Cancer Diagnoses

WEDNESDAY, June 18, 2025 (HealthDay News) -- A novel system outperforms current prognostication systems for predicting poor outcomes in <a href="/conditions/skin-cancer" target="_blank" rel="noopener noreferrer">cutaneous squamous cell carcinoma</a> (cSCC), according to research published online June 11 in JAMA Dermatology.Neil K. Jairath, M.D., from the New York University Grossman School of Medicine in New York City, and colleagues examined whether a customized generative pretrained transformer model could be used to develop a novel class-based risk stratification system that would outperform the current standard. A systematic review of the literature was conducted that assessed risk factors for poor outcomes in <a href="/conditions/skin-cancer" target="_blank" rel="noopener noreferrer">cSCC</a> to build the retrieval augmented generation (RAG) knowledge base. A novel class-based risk stratification system was developed using the RAG-enabled generative pretrained transformer (GPT) model that assigned point values for risk factors, culminating in a GPT-based prognostication system called the artificial intelligence-derived risk score (AIRIS). Performance of the system was validated on a combined prospective and retrospective cohort of 2,379 primary cSCC tumors.The researchers found the AIRIS prognostication system showed superior sensitivity across all outcomes (locoregional recurrence [LR], 49.1 percent; nodal metastasis [NM], 73.7 percent; distant metastasis [DM], 82.5 percent; and disease-specific death [DSD], 72.2 percent), and it had the highest area under the receiver operating characteristic curve values (0.69, 0.81, 0.85, and 0.80 for LR, NM, DM, and DSD, respectively); compared with the Brigham and Women's Hospital and American Joint Committee on Cancer Staging Manual, eighth edition, discriminative ability was significantly enhanced."Leveraging large language models in developing risk stratification systems represents a promising avenue for advancing patient care and delivering insights into trends not yet capitalized on," the authors write.Two authors disclosed ties to the biopharmaceutical industry; one author holds a patent for methods and materials for assessing and treating cSCC.<a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamadermatology/article-abstract/2835069">Abstract/Full Text</a><a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamadermatology/article-abstract/2835073">Editorial</a>

Artificial intelligence-derived risk score prognostication system demonstrated superior sensitivity across all outcomes

Novel System Outperforms Existing Prognostication Models for Squamous Cell Carcinoma

WEDNESDAY, June 11, 2025 (HealthDay News) -- For patients with stage III to IV <a href="/conditions/cutaneous-melanoma" target="_blank" rel="noopener noreferrer">melanoma</a>, a second course of adjuvant treatment is feasible, but recurrence-free survival is lower with anti-programmed cell death 1 (PD-1) checkpoint inhibitors versus BRAF + MEK inhibitors, according to a study published online May 7 in the Journal of the European Academy of Dermatology and Venereology.Katharina Schumann, Ph.D., from the Technical University of Munich in Germany, and colleagues conducted a multicenter, retrospective study examining a second course of adjuvant therapy after recurrence and surgery in patients with stage III to IV <a href="/conditions/skin-cancer" target="_blank" rel="noopener noreferrer">melanoma</a>. Between January 2017 and October 2021, patients received nivolumab (NIV), pembrolizumab (PEM; both PD-1 checkpoint inhibitors), or dabrafenib plus trametinib (D + T; a BRAF inhibitor and an MEK inhibitor, respectively). Twelve-month recurrence-free survival for the second-course of adjuvant treatment (RFS2) was the primary end point.The study included 62 patients; 32, nine, and 25 received D+T, PEM, and NIV, respectively. The researchers found that RFS2 showed superiority for adjuvant BRAF + MEK over PD-1 therapy (12-month RFS2: 90.6 versus 70.6 percent; hazard ratio, 4.226; 24-month RFS2: 71.9 versus 52.9 percent; hazard ratio, 3.154). No significant decrease was seen in overall survival with either BRAF + MEK or PD-1 treatment. Among patients with BRAF V600 mutations, RFS2 was significantly improved for those with a class switch from PD-1 to BRAF + MEK versus from BRAF + MEK to PD-1 (hazard ratio, 4.40)."The study provides first data that a class switch of PD-1 to BRAF + MEK inhibition provides improved RFS compared to a switch from BRAF + MEK to anti-PD-1 treatment in an adjuvant setting," the authors write.Several authors disclosed ties to the biopharmaceutical industry.<a target="_blank" rel="noopener noreferrer" href="https://onlinelibrary.wiley.com/doi/10.1111/jdv.20708">Abstract/Full Text</a>

Recurrence-free survival for second course of adjuvant treatment is lower with PD-1 checkpoint inhibitors versus BRAF + MEK inhibitors

Second Course of Adjuvant Treatment Feasible in Stage III to IV Melanoma

FRIDAY, May 30, 2025 (HealthDay News) -- Older adults have a substantial and increasing burden of skin cancer, according to a study published online May 21 in JAMA Dermatology.Ruiyao Wang, M.D., from The First Affiliated Hospital of Chongqing Medical University in China, and colleagues examined the global burden of skin cancer among adults aged 65 years or older from 1990 to 2021, and projected change to 2050 in a study using data from the Global Burden of Diseases Study 2021, which covers 204 countries and territories.The researchers estimated 153,993 melanoma, 1,463,424 squamous cell carcinoma (SCC), and 2,802,354 basal cell carcinoma (BCC) instances worldwide for 2021. The highest age-standardized rate of prevalence, deaths, and disability-adjusted life-years (DALYs) were seen for SCC (236.91, 6.16, and 95.50 per 100,000 population, respectively), while the highest incidence rate was seen for BCC (371.97 per 100,000). Compared with females, the disease burden was notably greater in males. A general upward trend was seen for the global burden of skin cancer among older people during the observation period. The primary contributor to this increase was population growth. A disproportionately higher burden was shouldered by countries with higher sociodemographic index levels. By 2050, only incidence and prevalence rates attributable to keratinocyte cancer, along with the DALYs rate related to BCC, would increase."Our results underscore the urgency to enact prevention and treatment strategies tailored to high-risk older populations," the authors write.<a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamadermatology/fullarticle/2834545">Abstract/Full Text</a>

Only incidence and prevalence rates attributable to keratinocyte cancer, DALYs attributable to BCC would increase by 2050

Substantial and Increasing Burden of Skin Cancer Seen in Older Adults

WEDNESDAY, June 4, 2025 (HealthDay News) -- For patients with advanced cutaneous squamous cell carcinoma (cSCC), avelumab plus cetuximab significantly improves progression-free survival compared with avelumab alone, according to a study published online May 31 in the Journal of Clinical Oncology to coincide with the annual meeting of the American Society of Clinical Oncology, held from May 31 to June 4 in Chicago.Dan P. Zandberg, M.D., from the Hillman Cancer Center at the University of Pittsburgh, and colleagues conducted a randomized phase 2 trial of avelumab plus cetuximab versus avelumab alone once every two weeks for up to two years in patients with advanced cSCC. Sixty patients with distant metastatic or unresectable locally advanced cSCC were enrolled and randomly assigned to avelumab plus cetuximab or avelumab alone; 57 patients were evaluable. Crossover to avelumab + cetuximab was allowed at progression.The researchers found that progression-free survival improved significantly with avelumab + cetuximab versus avelumab alone (median, 11.1 versus 3.0 months; hazard ratio, 0.48). The nine avelumab patients who crossed over to combination had a median progression-free survival of 11.3 months after crossover. The confirmed objective response rate was 27.6 versus 21.4 percent with avelumab + cetuximab versus avelumab alone. Grade 3 treatment-related adverse events occurred in 48.3 and 21.5 percent of patients with avelumab + cetuximab and avelumab alone, respectively."These results show that combining immune checkpoint inhibition targeting the PD-1: PD-L1 pathway with avelumab plus EGFR-targeted IgG1 monoclonal antibody cetuximab can provide meaningful clinical benefit compared to avelumab alone for patients with advanced cSCC," Zandberg said in a statement. "It opens the door to future research and new strategies for improving outcomes in this difficult disease."Several authors disclosed ties to the biopharmaceutical industry.<a target="_blank" rel="noopener noreferrer" href="https://ascopubs.org/doi/10.1200/JCO-25-00759">Abstract/Full Text</a><a target="_blank" rel="noopener noreferrer" href="https://www.asco.org/annual-meeting">More Information</a>

Progression-free survival significantly improved with avelumab + cetuximab versus avelumab alone

Avelumab + Cetuximab Ups Survival in Advanced Cutaneous Squamous Cell Carcinoma

WEDNESDAY, May 28, 2025 (HealthDay News) -- A simple scoring tool, the iDScore_plantar model, can help discriminate plantar atypical melanocytic lesions (pAMLs), according to a study published online May 20 in the Journal of the European Academy of Dermatology and Venereology.Linda Tognetti, M.D., from the University of Siena in Italy, and colleagues developed a clinical-dermoscopic risk-scoring model to help discriminate pAMLs. A total of 490 pAMLs (98 plantar early melanomas [pEM] and 392 plantar atypical nevi [pAN]) were collected and paired with histopathological diagnosis, dermoscopic and clinical image, maximum lesion diameter, plantar location, and age and sex of the patient. The dataset was divided into training, validation, and testing subsets (261, 174, and 55 pAMLs, respectively). A blinded teledermoscopic test was performed by 104 dermatologists and 56 residents; the test included intuitive diagnosis, pattern analysis, rating of case difficulty, diagnostic confidence assessment, and management decision.Overall, 2,887 dermoscopic evaluations were obtained. The average area under the receiver operating characteristic curve was 0.95 for the iDScore_plantar model compared with 0.77 for pattern analysis. The score was composed of the sum of five scores; decisions regarding long/short follow-up, biopsy, and excision were matched with four risk score ranges: no risk, low-medium risk, medium-high risk, and very high risk. The researchers found that participants would have reduced the number of misdiagnosed pAN and the number of pAN excised by −25.5 and −27.7 percent, respectively, by applying the model, and would have increased the number of correctly diagnosed pEM by +18.5 percent and the number of pEM recommended for surgical excision and recommended directly for surgical excision instead of biopsy by +8.5 and +16.15 percent, respectively."This tool may be suitable for use by residents and specialists, as both appear to benefit from it in terms of correct classification and appropriate management," the authors write.<a target="_blank" rel="noopener noreferrer" href="https://onlinelibrary.wiley.com/doi/10.1111/jdv.20740">Abstract/Full Text</a>

Applying model reduces number of misdiagnosed plantar atypical nevi and number of plantar atypical nevi excised

Clinical-Dermoscopic Risk Score Discriminates Plantar Atypical Melanocytic Lesions

WEDNESDAY, May 21, 2025 (HealthDay News) -- Mastocytosis is associated with an increased risk for skin cancer, especially malignant melanoma (MM), according to a research letter published online May 19 in the Journal of the American Academy of Dermatology.Anna Bergström, M.D., from Uppsala University in Sweden, and colleagues conducted a retrospective, propensity score-matched cohort study to examine the risk for skin cancer associated with mastocytosis. A total of 20,119 patients with mastocytosis were matched in a 1:1 ratio with controls based on age, sex, family history of cancer, and skin disease. Outcomes included MM, squamous cell carcinoma (SCC), and basal cell carcinoma (BCC) and were assessed during three follow-up periods: one year, five years, and lifetime risk.The researchers found that compared with controls, patients with mastocytosis had significantly elevated lifetime risks for all skin cancers, with the highest risk for MM, followed by SCC and BCC (hazard ratios, 2.49, 2.15, and 1.92, respectively). In all sensitivity analyses, these associations persisted. For MM, the risk was highest within the first year after mastocytosis diagnosis, followed by SCC and BCC (hazard ratios, 3.54, 1.97, and 1.60, respectively). All risks remained significantly elevated when excluding the first 30 days after mastocytosis diagnosis, except for BCC, suggesting that the observed association may be partially explained by early detection bias."Our findings provide evidence that mastocytosis patients are at an increased risk of skin cancer, warranting heightened dermatologic surveillance, patient education on ultraviolet protection, and avoidance of ultraviolet-based therapies," the authors write.<a target="_blank" rel="noopener noreferrer" href="https://www.jaad.org/article/S0190-9622(25)02174-7/fulltext">Abstract/Full Text</a>

Except for basal cell carcinoma, all risks remained significantly elevated when excluding the first 30 days after diagnosis

Mastocytosis Tied to Increased Risk for Skin Cancer, Especially Malignant Melanoma

WEDNESDAY, May 14, 2025 (HealthDay News) -- Age and comorbidity scores are significant prognostic factors for skin appendage carcinoma (SAC), with older age and higher scores linked to decreased survival, according to a study published in the May issue of SKIN.Xinxin Wu, from the Creighton University School of Medicine in Omaha, Nebraska, and colleagues analyzed data from the National Cancer Database to identify factors affecting SAC mortality in a retrospective study of patients diagnosed with histologically confirmed SAC between 2004 and 2019. The final cohort included 815 patients.The researchers found that SAC was slightly more common in men than women and often occurs in the face, scalp, and neck regions. Significant prognostic factors included age and Charlson-Deyo comorbidity scores; older age and higher scores were linked to reduced survival. Better survival was predicted by private insurance compared with Medicaid, Medicare, or no insurance."Age, Charlson-Deyo comorbidity scores, and insurance status are critical predictors of survival, emphasizing the need for prompt and comprehensive care for older patients and those with higher comorbidities," the authors write. "These findings underscore the importance of individualized clinical interventions, considering patients' specific health profiles and ensuring equitable access to health care resources for the individual."<a target="_blank" rel="noopener noreferrer" href="https://skin.dermsquared.com/skin/article/view/2888">Abstract/Full Text</a>

Better survival predicted with private insurance compared with Medicaid, Medicare, no insurance

Age, Comorbidity Score Prognostic for Skin Appendage Carcinoma

TUESDAY, April 29, 2025 (HealthDay News) -- Leveraging whole slide embedding from pretrained foundation models (FMs) improves nonmelanoma skin cancer (NMSC) diagnosis, according to a study presented at the annual meeting of the American Association for Cancer Research, held from April 25 to 30 in Chicago.Spencer Ellis, from the University of Chicago, and colleagues examined the effectiveness of general purpose FMs for diagnosis of NMSC, specifically in resource-constrained environments. Three pathology FMs (UNI, PRISM, and Prov-GigaPath) were evaluated, as was a ResNet18 baseline model. Data were included for 2,130 whole-slide images from 553 suspected NMSC biopsy samples from 455 participants: 706 normal tissue; 638 Bowen disease; 575 basal cell carcinoma; and 211 invasive squamous cell carcinoma.The researchers found that all three FMs significantly outperformed ResNet18 (mean area under the receiver operating characteristic curve [AUROC], 0.805). The overall best model used the PRISM tile embeddings aggregated using PRISM's intrinsic Perceiver network, which trained a multilayer perceptron (MLP) model to predict the subtype of NMSC (AUROC, 0.925). Using attention-based multi-instance learning to aggregate tile embeddings to train an MLP model was optimal for the UNI and Prov-GigaPath models (mean AUROCs, 0.913 and 0.908, respectively). The simplest method with logistic regression of global average pooling aggregated embeddings could attain reasonable results for PRISM, UNI, and Prov-GigaPath (mean AUROCs, 0.882, 0.865, and 0.855, respectively)."Our results demonstrate that pretrained machine learning models have the potential to aid diagnosis of NMSC, which might be particularly beneficial in resource-limited settings," coauthor Steven Song, from the Pritzker School of Medicine at the University of Chicago, said in a statement.<a target="_blank" rel="noopener noreferrer" href="https://www.aacr.org/about-the-aacr/newsroom/news-releases/pretrained-machine-learning-models-may-help-accurately-diagnose-nonmelanoma-skin-cancer-in-resource-limited-settings/">Press Release</a><a target="_blank" rel="noopener noreferrer" href="https://www.aacr.org/meeting/aacr-annual-meeting-2025/">More Information</a>

Leveraging whole slide embeddings from pretrained machine learning models can improve diagnosis of nonmelanoma skin cancer

AACR: Pretrained Machine Learning Models Help Diagnose Nonmelanoma Skin Cancer

WEDNESDAY, April 30, 2025 (HealthDay News) -- Patients with primary cutaneous B-cell lymphomas (pCBCL) have an increased risk for secondary hematologic and prostate cancers, according to a research letter published online April 30 in JAMA Dermatology.Vrusha K. Shah, M.P.H., from the University of Pittsburgh School of Medicine, and colleagues examined second primary solid and hematologic cancer risk and demographic factors in patients with pCBCL in a U.S. patient cohort. Data were obtained from 17 Surveillance, Epidemiology, and End Results cancer registries.The researchers found that among 3,757 patients with pCBCL, 343 (9.1 percent) had secondary cancers. Of these, 65.0 and 32.4 percent had solid tumor cancers and hematologic cancers, respectively. Patients had an elevated risk for prostate cancer and lymphoma. Compared with those without, patients with secondary cancers often were of White race (90.7 versus 82.5 percent), were aged 50 to 74 years (68.2 versus 48.4 percent), and had stage I (62.4 versus 47.5 percent) or stage II (5.5 versus 3.4 percent) lymphoma. Latency to secondary cancers was shorter for women than men (9.9 versus 12.2 years)."Patients with pCBCL have increased second primary hematologic and prostate cancer risk," the authors write. "Future studies should consider patient factors associated with secondary cancers when developing screening guidelines."<a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamadermatology/fullarticle/2833319">Abstract/Full Text</a>

Patients with pCBCL have increased risk for second primary prostate cancer and lymphoma

Risk for Secondary Cancer Higher for Primary Cutaneous B-Cell Lymphoma

WEDNESDAY, April 23, 2025 (HealthDay News) -- Imaging often reveals unexpected findings in high-risk cutaneous squamous cell carcinoma (cSCC), leading to altered clinical management in about half of cases, according to a study published online April 17 in the Journal of the American Academy of Dermatology.Angela H. Wei, M.D., from the Cleveland Clinic Lerner College of Medicine, and colleagues examined the utilization of radiologic imaging and its impact on management in high-risk cSCC in a retrospective cohort analysis of invasive cSCC during a 25-year period. Patients with primary Brigham and Women's Hospital (BWH) T stage 2a high, T2b, T3, and recurrent cSCC tumors were included and stratified into two cohorts: imaged and nonimaged (138 and 256 tumors, respectively).The researchers found that compared with nonimaged tumors, imaged tumors were more likely to be BWH T2b/T3, located on the head and neck/trunk, and moderately or poorly differentiated, and were more likely to have a larger diameter, depth beyond fat, and perineural involvement. In 49 percent of imaged tumors, unexpected imaging findings were observed, most often local invasion beyond clinical expectations and nodal metastasis (23 and 18 percent, respectively). Clinical management was altered by imaging results in 47 percent of cases, often by altering the surgical approach."These findings reinforce the need for consistent imaging, particularly of the local site and nodal basins, in the evaluation of all high-risk cSCCs to aid accurate staging and treatment planning," the authors write.<a target="_blank" rel="noopener noreferrer" href="https://www.jaad.org/article/S0190-9622(25)00622-X/fulltext">Abstract/Full Text</a>

Unexpected imaging findings seen in 49 percent of imaged tumors, resulting in changed management in 47 percent of cases

Imaging Aids Management in High-Risk Cutaneous Squamous Cell Carcinoma

WEDNESDAY, April 16, 2025 (HealthDay News) -- Droplet digital polymerase chain reaction (PCR) measurements of cell-free, circulating tumor DNA (ctDNA) can identify patients with melanoma and a high risk for recurrence before adjuvant targeted therapy, according to a study published online April 15 in The Lancet Oncology.Mahrukh M. Syeda, from NYU Langone Health in New York City, and colleagues examined whether ctDNA measurements could predict survival outcomes during adjuvant therapy or placebo treatment in stage III melanoma. BRAFV600E or BRAFV600K ctDNA was measured using mutation-specific droplet digital PCR assays in patients aged 18 years or older who were enrolled in the COMBI-AD trial, a double-blind study of oral dabrafenib plus oral trametinib combination therapy versus two matched placebos in resected BRAFV600-mutant stage III melanoma.The researchers found that ctDNA was detectable in 79 of 597 baseline samples (13 percent). Patients with higher disease substages had a significantly higher ctDNA positivity rate and mutant copies per mL plasma. ctDNA detection as a binary variable was associated with worse recurrence-free survival (hazard ratios, 2.91 and 2.98 in the placebo and combination groups, respectively) and overall survival (hazard ratios, 3.35 and 4.27, respectively). Compared with interferon gamma gene expression or tumor mutational burden, baseline ctDNA was more strongly associated with survival outcomes. Compared with patients with favorable kinetics, those with adverse longitudinal ctDNA kinetics had markedly shorter median recurrence-free survival."These findings provide a strong rationale for additional research to improve the clinical sensitivity of these assays and advance clinical trials that investigate the clinical use of incorporating ctDNA measurements into treatment decisions," the authors write.Several authors disclosed ties to biopharmaceutical companies, including Novartis, which funded the study.<a target="_blank" rel="noopener noreferrer" href="https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(25)00139-1/abstract">Abstract/Full Text</a><a target="_blank" rel="noopener noreferrer" href="https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(25)00195-0/abstract">Editorial</a>

ctDNA detection at baseline was associated with worse recurrence-free, overall survival in BRAFV600-mutant stage III melanoma

Circulating Tumor DNA Can ID Outcomes for Patients With Melanoma

WEDNESDAY, April 16, 2025 (HealthDay News) -- For patients with advanced melanoma, immune checkpoint inhibitor treatment is associated with a reduced risk for melanoma brain metastases (MBM), according to a study published online April 11 in BJC Reports.Anna Fager, M.D., from Sahlgrenska University Hospital in Gothenburg, Sweden, and colleagues conducted a retrospective study involving patients diagnosed with advanced melanoma (unresectable stages III and IV [M1a-c]) between 2013 and 2019 to examine factors associated with MBM development.Ninety-one of the 395 patients subsequently developed MBM. The researchers found that the risk for MBM development was reduced among patients who received an immune checkpoint inhibitor as first-line treatment. Of the 11 patients who received CTLA-4 inhibitors as monotherapy or in combination with PD-1 inhibitors as first-line treatment, none developed brain metastases. An increased risk for MBM development was seen in association with elevated plasma levels of S100B and higher metastatic stage."The potential prevention of MBM development as observed here is considered to be of major clinical benefit and warrants further investigations, providing additional data addressing brain metastases development in different populations and cohorts," the authors write.<a target="_blank" rel="noopener noreferrer" href="https://www.nature.com/articles/s44276-025-00137-2">Abstract/Full Text</a>

Risk for brain metastases development increased in association with elevated plasma levels of S100B, higher metastatic stage

Melanoma Brain Metastases Risk Reduced With Immune Checkpoint Treatment

WEDNESDAY, April 9, 2025 -- An autonomous total body photography (TBP) and dermoscopic device produces images of comparable quality to standard dermoscopic techniques, with shorter imaging time, according to a study published online April 9 in JAMA Dermatology.Pau Rosés-Gibert, M.D., from the University of Barcelona in Spain, and colleagues conducted a prospective cohort study from March 1, 2023, to Oct. 30, 2023, to compare image quality and time efficiency of an autonomous TBP and dermoscopic device with traditional manual digital dermoscopic techniques among 316 patients (105 male and 211 female) with atypical mole syndrome.The researchers found that the mean quality score for the autonomous TBP and dermoscopic device was 9.84 compared with 9.44 for manual digital dermoscopy; no significant difference was seen by body site or lesion type. The diagnostic classification agreement was 91.60 percent between the two methods; most discrepancies were related to small benign lesions. For the autonomous device, the mean imaging time was 570 seconds, compared with 606 seconds for the manual method."These findings suggest that this autonomous device may have potential value in improving workflow efficiency, especially in high-volume settings," the authors write.Several authors disclosed ties to the pharmaceutical industry; two authors hold related patents.

Quality of images produced by autonomous TBP and dermoscopic device comparable to standard dermoscopic techniques

High Quality Images Seen With Autonomous Total Body Photography + Dermoscopic Device

TUESDAY, April 1, 2025 (HealthDay News) -- Some commonly prescribed photosensitizing drugs increase skin cancer risk, according to a study published online March 18 in Photodermatology, Photoimmunology &amp; Photomedicine.Gustav Boelsgaard Christensen, from Skåne University Hospital in Lund, Sweden, and colleagues assessed whether the use of commonly prescribed photosensitizing drugs increases skin cancer risk.The researchers found that hormone replacement therapy significantly increased the risk for basal cell carcinoma (BCC; hazard ratio [HR], 1.24), cutaneous squamous cell carcinoma (cSCC; HR 1.23), and cutaneous malignant melanoma (cM; HR, 1.31), with estrogen driving the risk. There was a trend observed between a higher risk for BCC and cM and higher doses of estrogen treatment. Among individuals using diuretics, loop diuretics were associated with increased cSCC risk (HR, 1.6), including a positive association between risk and dose. Thiazide use was tied to increased risks for BCC (HR, 1.25) and cM (HR, 1.41). There was a possible curvilinear association between nonsteroidal anti-inflammatory drugs and BCC and cSCC."We suggest that physicians should advise female patients prescribed estrogen, thiazides, or loop diuretics to limit their sun exposure," the authors write. "Future well-designed prospective studies are warranted to further investigate the relationships between common photosensitizing drugs and the risk of skin cancer."Several authors disclosed ties to the pharmaceutical industry.<a target="_blank" rel="noopener noreferrer" href="https://onlinelibrary.wiley.com/doi/10.1111/phpp.70013">Abstract/Full Text</a>

<div class="p-alt arr--sub-headline arrow-component subheadline-m_subheadline__3fd7z subheadline-m_dark__28u00" style="-webkit-line-clamp:none;" data-test-id="subheadline">Estrogen treatment increased the risk for all investigated skin cancers</div>

Common Photosensitizing Drugs Increase Skin Cancer Risk

WEDNESDAY, April 2, 2025 -- Tumor-infiltrating lymphocyte (TIL) scoring improves risk stratification in stage II melanomas, according to a study published online March 21 in the Journal of the American Academy of Dermatology.George Adigbli, M.B.B.S., D.Phil., from the University of Oxford in the United Kingdom, and colleagues examined American Joint Committee on Cancer substaging and TIL scoring as predictors of progression in stage II melanoma. The authors conducted a retrospective cohort study of 366 sentinel lymph node negative (SLN-negative) patients with long-term follow-up from four U.K. hospitals.The researchers found that at a median follow-up of 9.5 years, 23 percent of melanomas progressed. Of these, 41.5, 41.5, and 17.1 percent were stage IIA, IIB, and IIC, respectively. Progression risk was independently predicted by TIL scoring (nonbrisk versus brisk: odds ratio, 0.298; nonbrisk versus absent: odds ratio, 0.436), as was progression-free survival. Nonbrisk TILs denoted high risk and were present in 80 percent of progressing tumors. Across substages, TIL scoring split patients into high and low risk; similar five-year progression-free survival was seen for stage IIA patients with nonbrisk TILs and stage IIB/IIC patients with absent/brisk TILs."Our study demonstrates that TIL scoring, particularly the assessment of TIL function, is a valuable, cost-effective prognostic tool for refining risk stratification in SLN-negative stage II melanoma patients," the authors write. "Amidst the rapid move toward earlier adjuvant immunotherapies, this marks a meaningful step forward in personalized cancer care."

Nonbrisk tumor-infiltrating lymphocytes denoted high risk and were present in 80 percent of progressing tumors

Tumor-Infiltrating Lymphocyte Score Prognostic in Stage II Melanoma 

WEDNESDAY, March 19, 2025 -- For patients with cutaneous squamous cell carcinoma (cSCC), the number of risk factors (RFs) is associated with recurrence, metastasis, and disease-related death, according to a study published online March 19 in JAMA Dermatology.Nina A. Ran, M.D., from Brigham and Women's Hospital in Boston, and colleagues examined how RF number is associated with the risk for recurrence, metastasis, and disease-related death in a retrospective multination cohort study of cSCCs diagnosed between Oct. 1, 1991, and July 19, 2023. A total of 16,844 cSCCs with confirmed negative margins were included.Overall, 75.1, 17.2, 6.0, 1.3, and 0.3 percent of the tumors had zero, one, two, three, or four RFs, respectively (diameter of 2 cm or larger; poorly differentiated histology; tumor extension beyond subcutaneous fat; and large caliber nerve invasion). The researchers found that the risk for local recurrence increased as the number of RFs increased from zero to one, two, three, and four (1.7, 5.0, 8.8, 16.0, and 33.0 percent, respectively). Corresponding increases were also seen for nodal metastasis (0.6, 3.6, 11.0, 20.0, and 28.0 percent), distant metastasis (0.2, 1.1, 2.3, 7.9, and 8.4 percent), and disease-specific death (0.3, 1.9, 5.4, 11.0, and 25 percent). Higher cumulative incidences of local recurrence, nodal metastasis, distant metastasis, and disease-specific death were seen for cSCCs with three versus two RFs (1.6-, 1.9-, 4.3-, and 1.9-fold higher, respectively)."Considering the number of RFs, not just tumor stage, may aid in clinical decision-making," the authors write. "Future studies may consider refinements of staging systems based on the number of RFs."Several authors disclosed ties to the biopharmaceutical industry.

Risks for local recurrence, nodal metastases, distant metastases, disease-specific death increase as risk factor number increases

Number of Risk Factors Linked to Recurrence, Metastasis, Death in cSCC

FRIDAY, March 7, 2025 (HealthDay News) -- Tattooed individuals have an increased risk for lymphoma and skin cancers, according to a study recently published in BMC Public Health.Signe Bedsted Clemmensen, from the University of Southern Denmark in Odense, and colleagues conducted two designs of twin studies to examine the potential association between tattoo ink exposure and development of certain types of cancers: a cohort study including 2,367 randomly selected twins and a case-control study involving 316 twins born from 1960 to 1996.The researchers found that the risk for skin cancer (any type except basal cell carcinoma) was 1.62 times higher among tattooed individuals in the case-control study (95 percent confidence interval, 1.08 to 2.41). The hazard ratio was 1.33 (95 percent confidence interval, 0.46 to 3.84) for a twin-matched analysis of 14 twin pairs discordant for tattoo ink exposure and skin cancer. Increased hazards were found for tattoos larger than the palm of a hand for skin cancer and lymphoma (hazard ratios [95 percent confidence intervals], 2.37 [1.11 to 5.06] and 2.73 [1.33 to 5.60], respectively). An individual-level analysis resulted in hazard ratios of 3.91 (95 percent confidence interval, 1.42 to 10.8) and 2.83 (95 percent confidence interval, 1.30 to 6.16) for skin cancer and basal cell carcinoma, respectively, in the cohort study design."We are concerned that tattoo ink has severe public health consequences since tattooing is abundant among the younger generation," the authors write. "Studies that pinpoint the etiological pathway of tattoo ink-induced carcinogenesis are recommended."<a target="_blank" rel="noopener noreferrer" href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-025-21413-3">Abstract/Full Text</a>

Increased risks seen based on twin cohort and case-cotwin studies

Risk for Lymphoma, Skin Cancer Increased in Individuals With Tattoos 

WEDNESDAY, March 12, 2025 -- In a review and meta-analysis published online March 12 in JAMA Dermatology, several risk prediction models are identified and externally validated for sentinel lymph node biopsy (SLNB) positivity in melanoma.Bryan Ma, M.D., from the University of Calgary in Alberta, Canada, and colleagues reviewed the characteristics and discriminatory performance of existing risk prediction models for SLNB positivity in melanoma. Twenty-three articles describing development of 21 different risk prediction models were identified, in addition to 20 external validations of eight different risk prediction models; nine models included sufficient information to obtain individualized patient risk estimates in routine preprocedural clinical practice.The researchers found that the pooled weighted C statistic was 0.78 among all risk prediction models, with significant heterogeneity (I2 = 97.4 percent) that was not explained in meta-regression. The most frequently externally validated models were the Memorial Sloan Kettering Cancer Center and Melanoma Institute of Australia models, both of which had strong and comparable discriminative performance (pooled weighted C-statistics, 0.73 and 0.70, respectively). There was no significant difference seen in discrimination between models that included gene expression profiles and those using only clinicopathologic features (pooled C statistics, 0.83 and 0.77, respectively)."These findings may guide subsequent comparative studies to ensure that these models have adequate discrimination and calibration for recommendation as part of routine preoperative clinical assessments," the authors write.

Memorial Sloan Kettering Cancer Center and Melanoma Institute of Australia models are most frequently externally validated&nbsp;

Several Models Externally Validated for Sentinel Lymph Node Biopsy Positivity in Melanoma

WEDNESDAY, March 5, 2025 -- Handheld reflectance confocal microscopy (HH-RCM) is promising for detecting subclinical lentigo maligna (melanoma; LM/LMM), according to a study published in the March issue of the Journal of the European Academy of Dermatology &amp; Venereology.Yannick S. Elshot, from the Netherlands Cancer Institute in Amsterdam, and colleagues examined the effects of presurgical mapping using HH-RCM in 117 consecutive LM/LMM cases from 2015 to 2023. The diagnostic accuracy of HH-RCM in detecting subclinical LM was examined. Margin and follow-up outcomes were compared to those of a historical cohort of 94 patients (2003 to 2014).The researchers found that in 60 percent of cases, subclinical LM was detected by HH-RCM. The mapping procedure resulted in modified management in 33 patients (27 percent), most consisting of limited surgery with adjuvant imiquimod or imiquimod monotherapy (15 and 14 patients, respectively). The remaining 84 cases underwent HH-RCM-assisted surgery. In 96.5 percent of patients, histological margins were cleared, with a median histological margin of 3.0 mm, which was significantly higher than in the historical cohort (81 percent; margin of 2.0 mm). For detecting the extent of subclinical LM, the sensitivity was 94 percent and the specificity was 84 percent. For detection of LMM, the negative predictive value was 94 percent; 75 percent of the initially missed LMM were identified during the HH-RCM mapping procedure. The local recurrence rate was 1.6 percent compared with 25 percent in the historical cohort."Our findings support the efficacy of HH-RCM for precisely identifying surgical margins, reducing recurrence rates, and detecting subclinical LMM," the authors write. "This allows for an informed selection of patients suitable for nonsurgical treatment."

HH-RCM can precisely identify surgical margins and is associated with a reduction in recurrence rates of lentigo maligna (melanoma)

Handheld Reflectance Confocal Microscopy Efficacious for Detecting Lentigo Maligna (Melanoma)

WEDNESDAY, Feb. 26, 2025 -- For patients with primary anogenital squamous cell carcinoma (SCC), Mohs micrographic surgery (MMS) yields lower rates of local recurrence compared with wide local excision (WLE) and vulvectomy, according to a review published online Feb. 23 in the International Journal of Dermatology.Sujitha Yadlapat, M.D., from the HCA Corpus Christi Medical Center in McAllen, Texas, and colleagues systematically reviewed surgical modalities for the management of anogenital SCC. Seventy studies met the inclusion criteria: 46 examined WLE patients, eight utilized vulvectomy, and 24 examined patients who underwent MMS.The researchers found that local recurrence rates were lower for MMS patients, while regional and distant recurrence rates did not differ. For WLE, the local, regional, and distant recurrence rates were 17.5, 5.1, and 6.0 percent, respectively, compared with 5.0, 3.8, and 4.3 percent for MMS. Patients treated with WLE were significantly more likely to have local recurrence, but not regional or distant recurrence."Our study demonstrates that MMS may lead to a lower local recurrence rate when compared to WLE," the authors write. "Therefore, it should be considered a viable option that can achieve superior outcomes with more precise tissue loss and possibly improved quality of life."One author disclosed ties to CASTLE Biosciences, Kerecis, and Boehringer Ingelheim.

Local recurrence rates lower compared with wide local excision, but no difference seen in regional, distant recurrence

Mohs Surgery Best for Local Recurrence in Anogenital Squamous Cell Carcinoma

WEDNESDAY, Feb. 19, 2025 -- For treatment of primary high-stage cutaneous squamous cell carcinoma (cSCC), Mohs surgery is associated with improved outcomes compared with wide-lesion excision (WLE), according to a study published online Feb. 19 in JAMA Dermatology.David M. Wang, M.D., from Brigham and Women's Hospital in Boston, and colleagues examined the outcomes of primary high-stage cSCC among patients treated with Mohs surgery versus WLE in a retrospective cohort study using propensity score weighting. The study included 216 patients with high-stage cSCC (mean age, 73.5 years), with a median follow-up of 33.1 months.The researchers found that in the inverse probability of treatment weighting competing risk model, the three-year cumulative incidence of all adverse outcomes was greater among patients in the WLE group versus the Mohs surgery group, including local recurrence, nodal metastasis, distant metastasis, any recurrence, and disease-specific death (weighted cause-specific hazard ratios, 2.33, 1.80, 2.10, 2.38, and 2.74, respectively)."The findings of this cohort study suggest that Mohs surgery may be superior to WLE for the treatment of high-stage cSCC," the authors write. "The propensity score-weighted analysis demonstrated a halving of three-year cumulative incidence of recurrence, metastasis, and disease-specific death for tumors treated with Mohs surgery compared with WLE."Several authors disclosed ties to the biopharmaceutical industry.

Improved outcomes seen in local recurrence, nodal metastasis, distant metastasis, any recurrence, disease-specific death

Mohs Surgery Linked to Improved Outcomes for Primary High-Stage cSCC

WEDNESDAY, Feb. 5, 2025 -- Patients with hematologic malignancies, especially those with chronic lymphocytic leukemia (CLL), have an increased risk for developing skin cancer, according to a study published online Jan. 24 in the British Journal of Dermatology.Celeste J. Eggermont, from the Erasmus MC Cancer Institute in Rotterdam, Netherlands, and colleagues examined population-based risk estimates for cutaneous squamous cell carcinoma (CSCC), malignant melanoma (MM), Merkel cell carcinoma (MCC), and basal cell carcinoma (BCC) among patients with hematologic malignancies in a nationwide population-based epidemiologic cohort study using data for 210,794 patients diagnosed with a hematologic malignancy between 1989 and 2020.The researchers found that the overall 10-year cumulative incidence of developing a first skin cancer was 2.6, 0.5, 0.05, and 4.8 percent for CSCC, MM, MCC, and BCC, respectively. Nearly all hematologic malignancy subtypes showed more than a twofold increased risk for CSCC, MM, MCC, and BCC compared with the general population. For each of the four skin cancers, the highest risks were seen for patients with CLL (standardized incidence ratios, 4.4, 2.7, 9.3, and 2.6 for CSCC, MM, MCC, and BCC, respectively). These elevated risks persisted for more than 30 years."Patients and physicians should be educated about the high and lifelong risk of skin cancer in this patient population, also with regard to less common but highly aggressive cancers, such as MCC," the authors write. "Sun protective measures should be strongly recommended, along with instructions on how to recognize the different types of skin cancer and on how to perform regular skin self-examinations."One author disclosed ties to Sanofi, Regeneron, and SunPharma.

Increased risks seen for cutaneous squamous cell carcinoma, malignant melanoma, Merkel cell carcinoma, basal cell carcinoma

Risk for Skin Cancers Higher for Patients With Hematologic Malignancies

WEDNESDAY, Jan. 29, 2025 -- For patients with nodular basal cell carcinoma (nBCC), it cannot be concluded that superficial curettage (SC) plus imiquimod cream, 5 percent, is noninferior to surgical excision (SE) after five years of treatment, according to a study published online Jan. 29 in JAMA Dermatology.Babette J.A. Verkouteren, M.D., Ph.D., from Maastricht University Medical Centre in the Netherlands, and colleagues conducted a secondary analysis of a noninferiority trial to examine whether SC followed by imiquimod cream, 5 percent, is noninferior to SE in nBCC after five years of treatment. Patients with a primary nBCC of 4 to 20 mm were assigned to either SC plus imiquimod, 5 percent, or SE (73 and 72 patients, respectively) between Jan. 1, 2016, and Nov. 30, 2017.The researchers found 15 treatment failures in the SC plus imiquimod group and one treatment failure in the SE group. The five-year probability of remaining free from treatment failure was 77.8 and 98.2 percent after SC plus imiquimod and SE, respectively. The relative risk for treatment failure was 15.93 (95 percent confidence interval, 2.10 to 120.64); the 95 percent confidence interval did not exclude the noninferiority margin of 5.22."The information in this trial can be used to counsel patients on the relative benefits and trade-offs of the different treatment options for nBCC," the authors write.Two authors disclosed ties to the pharmaceutical industry.

Researchers could not conclude that superficial curettage plus imiquimod is noninferior to surgical excision at five years after treatment

Superficial Curettage May Not Be Noninferior to Excision for Nodular BCC

WEDNESDAY, Jan. 22, 2025 -- Exposure to particulate matter (PM) with diameters of 10 µm (PM10) or with diameters that are 2.5 µm or smaller (PM2.5) seems to have a protective effect on melanoma risk, potentially due to the reduction in ultraviolet radiation exposure, according to a study published online Jan. 17 in the Journal of the European Academy of Dermatology and Venereology.Francesco Bellinato, M.D., from the University of Verona in Italy, and colleagues conducted a case-control study involving 2,575 participants (1,473 melanoma patients and 1,102 healthy controls) to examine the association between PM10 and PM2.5 long-term exposure and melanoma risk.The researchers found that most melanoma patients had Fitzpatrick phenotypes 2 and 3 (59 and 36 percent, respectively). The average melanoma Breslow thickness was 1.01 mm; 68.15 percent of cases were diagnosed at stage 0 or IA. Higher PM10 and PM2.5 levels had a protective effect in multivariate logistic regression (odds ratios, 0.89 and 0.72, respectively). A reduced risk for melanoma was also seen in association with darker skin phototypes (Fitzpatrick 4) and cigarette smoking."Our findings suggest a neutral or even beneficial effect of exposure to higher PM10 and PM2.5 levels on melanoma risk," the authors write. "These results are preliminary and should be interpreted with caution because of many potential residual confounding factors."

Darker skin phototypes and cigarette smoking were also associated with reduced melanoma risk

Air Pollution Exposure May Be Protective for Melanoma Risk

WEDNESDAY, Jan. 15, 2025 (HealthDay News) -- A machine learning model can make accurate survival predictions for Merkel cell carcinoma (MCC), according to a study published online Jan. 8 in npj Digital Medicine.Noting there are no personalized prognostic tools in use in MCC, Tom W. Andrew, from Newcastle University in the United Kingdom, and colleagues employed explainability analysis to examine insights into mortality risk factors for MCC. Deep learning feature selection was combined with a modified XGBoost framework to develop a web-based prognostic tool for MCC.The researchers found that the tool, termed DeepMerkel, can make accurate, personalized, time-dependent survival predictions from readily available clinical information. The tool demonstrated generalizability through high predictive performance in an international clinical cohort, and outperformed current prognostic staging systems."DeepMerkel can make time-dependent survival predictions providing personalized prognostication and clinical guidance in MCC," the authors write. "This hybrid approach uses applied models which have been specifically adapted and integrated for disease-specific survival predictions and has demonstrated generalizability through high predictive performance in an international clinical cohort, outperforming current population-based prognostic staging systems."<a target="_blank" rel="noopener noreferrer" href="https://www.nature.com/articles/s41746-024-01329-9">Abstract/Full Text</a>

Tool demonstrated generalizability through high predictive performance in international clinical cohort

Machine Learning Model Accurately Predicts Survival in Merkel Cell Cancer

WEDNESDAY, Jan. 15, 2025 -- The female survival advantage seen in melanoma is mainly a result of an indirect effect of sex mediated by clinicopathological features, according to a study published online Jan. 12 in JNCI Cancer Spectrum.Noting that women have a survival advantage in melanoma, Tharani Murali, from the School of Medicine at the University of New Mexico in Albuquerque, and colleagues examined the relationship between sex, clinicopathologic variables, and melanoma-specific survival in 1,753 single primary melanomas.The researchers found that the effect of sex on survival was largely explained by differences in clinicopathological features of tumors at diagnosis. Differences in age at diagnosis, Breslow thickness, ulceration, mitoses, and site accounted for 86.5 percent of the effect of sex on melanoma survival."Our results indicate that the female survival advantage in melanoma is largely due to mediating effects of clinicopathologic features of male and female tumors at the time of diagnosis," the authors write.

Differences in age at diagnosis, Breslow thickness, ulceration, mitoses, and site account for 86.5 percent of effect of sex on survival

Effect of Sex on Melanoma Survival Due to Clinicopathological Features

WEDNESDAY, Jan. 8, 2025 -- Metformin has a potentially protective effect against skin cancer, according to a study published online Dec. 8 in the Journal of Drugs in Dermatology.Zaim Haq, from the Warren Albert Medical School at Brown University in Providence, Rhode Island, and colleagues examined the potential of metformin for reducing the risk for nonmelanoma skin cancers using the All of Us research database. Propensity score matching and multivariable regression analyses were conducted to assess the impact of metformin on squamous cell carcinoma (SCC) and basal cell carcinoma (BCC).The researchers found that in individuals diagnosed with SCC and BCC, the risk for nonmelanoma skin cancer was reduced following exposure to metformin. In subgroup analyses, metformin exposure was associated with a reduced risk for BCC across sex and ethnicity groups. A significantly lower risk for SCC was seen in association with metformin use, with consistently reduced odds in univariable and multivariable odds ratios. In African American patients, metformin exposure was not significantly associated with reduced SCC risk."While these findings suggest a potential protective role of metformin, further prospective studies are warranted to confirm these findings in skin-of-color patients," the authors write.

Significantly lower risk for SCC seen in univariable and multivariable analyses, but not in African American patients

Metformin Potentially Protective Against Nonmelanoma Skin Cancer

MONDAY, Dec. 30, 2024 -- Watchful waiting is a reasonable management option for cutaneous squamous cell carcinoma determined clinically resolved at follow-up, according to a study published online Dec. 18 in the Journal of the American Academy of Dermatology.In a retrospective cohort study, Blake Boudreaux, M.D., from the University of Vermont Medical Center in Burlington, and colleagues describe oncologic outcomes for patients diagnosed with cutaneous squamous cell carcinoma that was determined clinically resolved at follow-up and managed by watchful waiting. Cases occurred from Jan. 1, 2013, to April 30, 2023, and required clinical resolution more than four weeks after biopsy, watchful waiting management, and follow-up of at least 12 months.The researchers observed two cases of local recurrence among 148 tumors managed by watchful waiting and no cases of nodal metastasis, distant metastasis, or disease-specific death. Immunocompromised participants and those with rheumatologic disease had a significantly increased risk for recurrence (hazard ratios, 12.87 and 16.18, respectively)."The distinguishing feature of this study is preselection for a well-healed biopsy site," the authors write. "A skilled physical examination capable of distinguishing healthy scar tissue from residual cutaneous squamous cell carcinoma is crucial to select appropriate patients for which watchful waiting may yield a very low risk of local recurrence."

In study, authors describe only two cases of local recurrence among 148 tumors managed by watchful waiting after clinical resolution

Watchful Waiting Reasonable for Surgically Managed Cutaneous Squamous Cell Carcinoma 

MONDAY, Dec. 23, 2024 -- Specific cancers are associated with an increased risk for developing subsequent cutaneous melanoma, according to a study published in the January issue of JID Innovations.Thomas Z. Rohan, from the Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, and colleagues used data from the Surveillance, Epidemiology, and End Results database to examine the risk for developing cutaneous melanoma among survivors of the 20 most common cancers in the United States.The researchers identified nine primary cancers linked to an increased risk for developing a subsequent cutaneous melanoma: cutaneous melanoma, leukemia, non-Hodgkin lymphoma, thyroid cancer, brain and nervous system cancer, myeloma, breast cancer, oral cavity/pharynx cancer, and prostate cancer (standardized incidence ratios, 9.65, 1.76, 1.33, 1.32, 1.31, 1.23, 1.13, 1.12, and 1.03, respectively). The highest risk for developing melanoma was seen one to five years after diagnosis of most primary cancers. A 14-fold increased risk was seen for individuals aged younger than 50 years with a prior melanoma."Obtaining a detailed oncological history pertaining to the nine cancer types with increased risk of subsequent melanoma may help dermatologists in risk-stratifying patients for skin cancer screenings," the authors write.One author disclosed ties to Helsinn Therapeutics and Kyowa Hakko Kirin.

Increased risk seen in association with nine primary cancers, with highest risk at one to five years after diagnosis of primary cancer

Cutaneous Melanoma Risk Elevated for Survivors of Specific Cancers

WEDNESDAY, Dec. 11, 2024 &nbsp;-- Indoor tanning exposure is not associated with tumor mutational burden (TMB) in cutaneous melanoma, according to a study published online Dec. 11 in JAMA Dermatology.Grace B. Hanrahan, from the Dana-Farber Cancer Institute in Boston, and colleagues examined the association between cutaneous melanoma TMB and indoor tanning exposure in a retrospective cohort study. Inverse probability of treatment-weighted, multivariable modeling was used to model the association of tanning bed use with TMB.The researchers observed no association between indoor tanning exposure and TMB among 617 patients after adjustment for demographic, tumor, and dermatologic characteristics. However, higher TMB was significantly associated with older age at diagnosis, history of nonmelanoma skin cancer, and head and neck tumors relative to other primary sites. In patients with a history of abnormal nevi, average TMB was significantly lower."This cohort study with adjustment for demographics, tumor characteristics and skin risk factors did not show an association between indoor tanning and melanoma TMB despite the known association between indoor tanning and melanoma risk," the authors write. "This suggests that cumulative lifetime sun exposure may be a greater primary driver of TMB than intermittent radiation during indoor tanning."

TMB significantly associated with older age at diagnosis, history of nonmelanoma skin cancer, head and neck tumors &nbsp;

Indoor Tanning Not Linked to Tumor Mutational Burden in Melanoma

WEDNESDAY, Nov. 27, 2024 -- Most Merkel cell carcinoma (MCC) cases in the United States are attributable to ambient ultraviolent radiation (UVR) exposure or Merkel cell polyomavirus (MCPyV), while only a small fraction of cases are attributable to immunosuppressive conditions, according to a study published online Nov. 27 in .Jacob T. Tribble, from the National Institutes of Health in Rockville, Maryland, and colleagues estimated the population attributable fraction of MCC cases in the United States that were attributable to major immunosuppressive conditions. Overall, 38,020 MCCs were diagnosed in the United States. The researchers found that MCC incidence was increased among people with HIV, organ transplant recipients, and patients with chronic lymphocytic leukemia (CLL) compared with the general U.S. population (standardized incidence ratios, 2.78, 13.1, and 5.75, respectively). Due to the rarity of these conditions, only 0.2, 1.5, and 0.8 percent of MCC cases were attributable to HIV, solid organ transplant, and CLL, respectively. MCC incidence was elevated among non-Hispanic White individuals compared with individuals of racial and ethnic minority groups at lower and higher ambient UVR exposure levels (incidence rate ratios, 4.05 and 4.91, respectively, for MCC on the head and neck). Almost two-thirds (65.1 percent) of MCCs were attributable to UVR; 63.8 percent of MCCs were attributable to MCPyV based on a meta-analysis of 19 case series."Although MCC risk is substantially elevated among people with HIV, a solid organ transplant, or CLL, only 2.5 percent of MCC cases were attributable to these three immunosuppressive conditions due to their low prevalence in the general population," the authors write.

Most Merkel cell carcinoma cases are due to ambient ultraviolet radiation, Merkel cell polyomavirus

Small Fraction of Merkel Cell Carcinomas Due to Immunosuppressive Conditions

WEDNESDAY, Nov. 20, 2024 (HealthDay News) -- Teledermoscopy has high accuracy for detecting skin cancers, according to a research letter published online Nov. 9 in the Journal of the American Academy of Dermatology.Jenne P. Ingrassia, from New York Medical College in Valhalla, and colleagues conducted a prospective diagnostic accuracy study to compare the accuracy of telemedicine-based skin cancer detection to in-person evaluations. In addition, off-label use of Nevisense, a device to assess melanocytic skin lesions suspicious for melanoma for use in dermatologists' offices, was evaluated for improving accuracy of teledermoscopy. A total of 147 participants with 375 self-identified skin lesions were assessed.The researchers found that 97 percent of the skin lesions were benign. The most common diagnoses were seborrheic keratosis, common melanocytic nevus, solar lentigo, other, and hemangioma (38, 19, 10, 8, and 4 percent, respectively). Overall, 13 participants had a malignant neoplasm, with two melanomas. Eleven of 13 skin cancers were detected in face-to-face examination, with accuracy of 93 percent. The TeleTeam detected 11/13 skin cancers with clinical photos and dermoscopy alone (accuracy of 91 percent). The TeleTeam detected 12/13 skin cancers with Nevisense, but due to lower specificity, a high prevalence of benign lesions, and the rarity of atypical nevi and early-stage melanomas, accuracy decreased to 83 percent. Overall, 89 percent of participants who completed a postintervention questionnaire agreed or strongly agreed that they would feel more at ease having their worrisome spot examined by a teledermatologist versus not examined."Our results support the potential utility of teledermoscopy to safely triage patient- and primary-care clinician-identified skin lesions for in-person evaluation," the authors write.<a target="_blank" rel="noopener noreferrer" href="https://www.jaad.org/article/S0190-9622(24)03115-3/abstract">Abstract/Full Text (subscription or payment may be required)</a>

TeleTeam detected 11 of 13 skin cancers with clinical photos, dermoscopy alone, with accuracy of 91 percent

Teledermoscopy Accurate for Detecting Skin Cancers

WEDNESDAY, Nov. 13, 2024 -- Diagnostic accuracy for skin cancer differs significantly when comparing examination methods and physician specialty and experience, according to a review published online Nov. 13 in JAMA Dermatology.Jennifer Y. Chen, M.D., from the San Francisco Veterans Affairs Health Care System, and colleagues conducted a systematic review and meta-analysis to examine the accuracy of skin cancer diagnosis by lesion type, physician specialty and experience, and physical examination method. One hundred studies were included in the analysis.The researchers found that the sensitivity and specificity for diagnosing keratinocytic carcinomas was 79.0 and 89.1 percent, respectively, for experienced dermatologists using clinical examination and clinical images; 83.7 and 87.4 percent, respectively, using dermoscopy and dermoscopic images; and 81.4 and 80.1 percent, respectively, for primary care physicians (PCPs). The odds of an accurate diagnosis of keratinocytic carcinomas were 2.5-fold higher for experienced dermatologists using in-person dermoscopy and dermoscopic images compared with in-person clinical examination and images. When examining for melanoma using clinical examination and images, sensitivity and specificity were 76.9 and 89.1 percent, 78.3 and 66.2 percent, and 37.5 and 84.6 percent for experienced dermatologists, inexperienced dermatologists, and PCPs, respectively; when using dermoscopy and dermoscopic images, the corresponding sensitivity and specificity were 85.7 and 81.3 percent, 78.0 and 69.5 percent, and 49.5 and 91.3 percent. The odds of accurate diagnosis of melanoma using dermoscopy versus clinical examination were 5.7-fold higher for experienced dermatologists."These results suggest that clinical examination combined with dermoscopy likely yields better accuracy than either method alone," the authors write.

Significant differences seen for diagnostic accuracy when specialty, experience, and examination methods are considered

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