The patient at 18 weeks following daily therapy with sonidegib 200 mg. Case report submitted to The Journal of Drugs in Dermatology.

A 2- to 3-cm nodular mass displaying slight erythema and telangiectases near the patient’s nasolacrimal duct. Case report submitted to The Journal of Drugs in Dermatology.

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

Sonidegib, a selective inhibitor of the hedgehog signaling pathway, exerts its therapeutic effect by binding to and inhibiting the smoothened (SMO) receptor. This blockade prevents the activation of downstream signaling events involved in cell proliferation and survival, ultimately leading to the inhibition of basal cell carcinoma growth and progression.

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

5.1 cm x 3.4 cm erythematous plaque with scale and a 3 cm x 1.5 cm central ulceration on left lateral neck

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

Aaron Farberg, MD 
Bare Dermatology
Baylor Scott & White Health System
Dallas, TX

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, July 24, 2024 -- For cutaneous squamous cell carcinoma (cSCC) of the scalp, deep histological margins &lt;1 mm do not increase the risk of recurrence as long as the margins are clear and there is no concurrent invasion of the galea aponeurotica, according to a study published online July 22 in the Journal of the European Academy of Dermatology &amp; Venereology.Júlia Verdaguer-Faja, M.D., from the Universitat Autònoma de Barcelona in Spain, and colleagues conducted a multicenter retrospective observational cohort study and multivariate competing risk analysis to examine whether clear but close deep histological margins (&lt;1 mm) confer a higher risk of recurrence in cSCCs of the scalp treated with wide local excision compared to deep histological margins of ≥1 mm. Data were included for 295 patients with 338 cSCCs.The researchers observed no association for close deep histological margins with increased cumulative incidence of recurrence (subhazard ratio, 1.96; 95 percent confidence interval, 0.87 to 4.41). However, tumors that presented concurrent invasion of the galea aponeurotica and close deep margins had increased risk of recurrence compared to tumors without these factors (subhazard ratio, 3.52; 95 percent confidence interval, 1.24 to 10.01). Higher risk of recurrence was also seen for tumors with clear but close peripheral margins (&lt;1 mm) (subhazard ratio, 5.01; 95 percent confidence interval, 1.68 to 14.97)."Surgical excision of cSCCs of the scalp should include the galea to enable complete assessment of the excised tumor and avoid complications," the authors write. "These results may not be extrapolated to cSCCs from other locations, which do not share the particular anatomical characteristics of the scalp."<a target="_blank" rel="noopener noreferrer" href="https://onlinelibrary.wiley.com/doi/full/10.1111/jdv.20250">Abstract/Full Text</a>

Risk of recurrence up for tumors that present concurrent invasion of the galea aponeurotica and close deep margins

Do Surgical Margins Affect the Risk of Recurrence in Cutaneous SCCs of the Scalp?

FRIDAY, July 19, 2024 (HealthDay News) -- With respect to their lifetime prevalence of skin cancer, sexual minority (SM) adults differ across racial and ethnic groups and among males and females, according to a study published online July 17 in JAMA Dermatology.Katelyn J. Rypka, from the University of Minnesota in Minneapolis, and colleagues examined differences in the lifetime prevalence of skin cancer among U.S. adult females and males by sexual orientation in a cross-sectional study using data from the Behavioral Risk Factor Surveillance System from Jan. 1, 2014, to Dec. 31, 2021. Of the 1,512,400 participants studied, 53.2, 2.6, 42.2 and 2.0 percent were heterosexual females, SM females, heterosexual males, and SM males, respectively.The researchers found that the lifetime prevalence of skin cancer was higher for SM males versus heterosexual males overall (7.4 versus 6.8 percent; adjusted odds ratio [aOR], 1.16), especially among Hispanic males (4.0 versus 1.6 percent; aOR, 3.81) and non-Hispanic Black males (1.0 versus 0.5 percent; aOR, 2.18). Compared with heterosexual females, lifetime prevalence rates were lower among SM females for non-Hispanic Whites (7.8 versus 8.5 percent; aOR, 0.86), while rates were higher among Hispanic SM females (2.1 versus 1.8 percent; aOR, 2.46) and non-Hispanic Black SM females (1.8 versus 0.5 percent; aOR, 2.33). "Future research and public health interventions should consider race and ethnicity and individual sexual identity when addressing skin cancer and related risk behaviors, with a particular emphasis on Black and Hispanic SM females and males and White gay males," the authors write.<a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamadermatology/article-abstract/2821288">Abstract/Full Text (subscription or payment may be required)</a>

Hispanic and non-Hispanic Black sexual minority males and females have higher rates of skin cancer than their heterosexual counterparts

Prevalence of Skin Cancer Varies for Sexual Minority, Heterosexual Adult

WEDNESDAY, July 17, 2024 -- Hematopoietic stem cell transplantation (HSCT) is associated with an increased risk for subsequent skin cancer, according to a review published online July 10 in the International Journal of Dermatology.Miguel Mansilla-Polo, M.D., from the Hospital Universitario y Politecnico La Fe in Valencia, Spain, and colleagues examined the risk for skin cancer following HSCT in a review involving 26 studies with 164,944 HSCT recipients (68,637 underwent allogeneic HSCT; 95,435 underwent autologous HSCT).The researchers found that the standardized incidence ratio (SIR) for skin cancer post-HSCT was 7.21 overall, with SIRs of 2.25 and 10.18 for autologous and allogeneic HSCT, respectively. Risk factors for skin cancer included chronic graft-versus-host-disease (hazard ratio, 2.86), especially for basal cell and squamous cell carcinoma (SCC; hazard ratios, 1.80 and 3.68, respectively), male gender, especially for SCC (hazard ratios, 1.56 and 1.70, respectively), and voriconazole exposure (hazard ratio, 2.01). No significant association was seen for total body irradiation with subsequent skin cancer. "These findings highlight the critical need for vigilant skin cancer surveillance and preventive measures in this high-risk population, particularly among men with allogeneic transplants and other identified risk factors," the authors write.

Risk factors for skin cancer include chronic graft-versus-host-disease, male gender, voriconazole exposure

Subsequent Skin Cancer Risk Increased for Stem Cell Transplant Recipients

TUESDAY, July 9, 2024 (HealthDay News) -- Urban-rural disparities in skin cancer prevalence continue to persist, according to a study published in the June issue of the Journal of Drugs in Dermatology.Rachel R. Lin, from the University of Miami Miller School of Medicine, and colleagues used data from the Behavior Risk Factor Surveillance Survey (2018 to 2021) to compare the prevalence of skin cancer by urban versus rural status.The researchers found that rural residents were significantly more likely to have a positive skin cancer history across most social determinants of health, including across all races. Compared with urban peers, rural non-Hispanic White individuals had greater odds of skin cancer history (odds ratio, 1.40). The odds of skin cancer history were nearly doubled for rural Black (odds ratio, 1.74), Hispanic (odds ratio, 2.31), and other-race, non-Hispanic individuals (odds ratio, 1.99), while the odds were 20-fold higher for Asians (odds ratio, 20.46). When household income was more than $100,000, there were no significant differences noted in prevalence or odds of skin cancer history between urban and rural settings. "Increasing awareness of vulnerable sociodemographic groups can help direct necessary attention to these communities regarding skin cancer prevention and screening," the authors write. "More research is needed to further disseminate risk and determine effective public health strategies for skin cancer among these rural communities."<a target="_blank" rel="noopener noreferrer" href="https://jddonline.com/articles/rural-health-disparities-in-skin-cancer-amplified-among-skin-of-color-S1545961624P0480X/">Abstract/Full Text</a>

Rural-urban differences magnified by lower income and race

Rural Residents Continue to Have Higher Odds of Skin Cancer

MONDAY, July 1, 2024 -- A new rules-based referral pathway is associated with improved patient stratification for skin cancer diagnoses and shorter referral to first encounter time among high-risk patients, according to a study published online June 26 in JAMA Dermatology.Yiqun Chen, Ph.D., from Stanford University in California, and colleagues examined whether a rules-based triage system was associated with better skin cancer risk stratification of patients in a retrospective quality improvement cohort study. Data were included for 37,478 patients: 12,302 seen after and 25,176 seen before the implementation of the new triage pathway. The rules-based triage system was based on previously-determined high-risk lesion characteristics.The researchers found that for patients seen after and before implementation of the new triage pathway, the rates of aggregate biopsy, malignant biopsy specimens, and melanoma were comparable. Compared with those not seen through the pathway, patients seen through the lesion pathway had a higher risk of malignancy biopsy results and melanoma (adjusted risk ratios, 1.6 and 2.0, respectively). Increased risk of skin cancer was seen in association with lesions that were concerning to referring clinicians for skin cancer (adjusted risk ratios, 2.8 and 2.02 for all skin cancer and melanoma, respectively). In the new triage pathway, the three high-risk lesion groups were seen faster (mean reduction, 26 days). "Our findings might improve in-clinic resource allocation and reduce patient wait time by prioritizing those more likely to require biopsies," the authors write.One author disclosed ties to the dermatology and biopharmaceutical industries.

Three high-risk lesion groups seen faster in the new triage pathway, with a mean reduction of 26 days

Rules-Based Triage System Improves Patient Stratification for Skin Cancer

MONDAY, July 1, 2024 (HealthDay News) -- Among patients with incompletely excised basal cell carcinoma (BCC), only about 16 percent with positive histopathologic margins have clinical recurrence, according to a study published online June 13 in Dermatology.Maria Daviti, M.D., from Aristotle University in Thessaloniki, Greece, and colleagues reported the real-life management of incompletely excised BCC in a tertiary referral center and compared recurrence rates according to management modality in a retrospective study. All BCCs with available histopathologic assay reporting at least one involved margin (lateral or deep) over a five-year period were identified. Patients were categorized into three groups: immediate re-excision (group 1; 26 patients); follow-up without any additional treatment (group 2; 40 patients); and treatment with adjuvant/complementary nonsurgical treatment (group 3; 18 patients).The researchers found that based on histopathological reports, 53.8 percent of 26 tumors in group 1 that were re-excised had residual tumor. After a mean follow-up of 17 months, a clinical recurrence occurred in 14 of 84 patients (16.7 percent), with a median of 14 months to recurrence. Recurrence developed in 25 percent of the patients without any additional treatment, compared with 11.1 percent of those receiving nonsurgical treatments. "Our study suggests that positive histopathologic margins after BCC excision result in a clinical recurrence only in a proportion of patients," the authors write. "This percentage is higher when no further treatment is applied and lower when the area is re-excised or treated with imiquimod alone or combined with cryotherapy."<a target="_blank" rel="noopener noreferrer" href="https://karger.com/drm/article/239/3/429/835928/Real-Life-Data-on-the-Management-of-Incompletely">Abstract/Full Text</a>

Recurrence developed in more patients who did not receive additional treatment and in fewer receiving nonsurgical treatments

Few Patients With Positive Margins After Basal Cell Excision Have Recurrence

MONDAY, June 24, 2024 (HealthDay News) -- For patients with resected stage III melanoma, adjuvant therapy with dabrafenib plus trametinib is associated with a nonsignificant benefit in terms of overall survival, according to a study published online June 19 in the New England Journal of Medicine.Georgina V. Long, M.D., Ph.D., from the University of Sydney, and colleagues randomly assigned 870 patients with resected stage III melanoma with BRAFV600 mutations to receive 12 months of dabrafenib plus trametinib or two matched placebos. The median duration of follow-up was 8.33 and 6.87 years for dabrafenib plus trametinib and placebo, respectively.The researchers found that for overall survival, the Kaplan-Meier estimates favored dabrafenib plus trametinib over placebo, but the benefit was not significant (hazard ratio, 0.80; 95 percent confidence interval, 0.62 to 1.01; P = 0.06). Across several prespecified subgroups, a consistent survival benefit was seen, including among 792 patients with melanoma with a BRAFV600E mutation (hazard ratio for death, 0.75; 95 percent confidence interval, 0.58 to 0.96). Significant benefits were also seen for dabrafenib plus trametinib versus placebo for relapse-free survival (hazard ratio for relapse or death, 0.52; 95 percent confidence interval, 0.43 to 0.63) and for distant metastasis-free survival (hazard ratio for distant metastasis or death, 0.56; 95 percent confidence interval, 0.44 to 0.71). There were no new reports of safety signals. "Whether or how therapies administered after relapse may have reduced the effect of adjuvant therapy on overall survival is unclear," the authors write.GlaxoSmithKline and Novartis funded the study; Novartis is the manufacturer of dabrafenib and trametinib.<a target="_blank" rel="noopener noreferrer" href="https://www.nejm.org/doi/full/10.1056/NEJMoa2404139">Abstract/Full Text (subscription or payment may be required)</a>

Consistent survival benefit seen across several prespecified subgroups, including those with a BRAFV600E mutation

Nonsignificant Survival Benefit Seen for Dabrafenib, Trametinib in Melanoma

WEDNESDAY, June 26, 2024 (HealthDay News) -- For localized adnexal carcinomas, age, tumor size, and immunosuppression are associated with survival, according to a study published online June 12 in JEADV.Robin Zagala, from the Centre Hospitalier de Pau in France, and colleagues examined prognostic factors for outcomes in skin adnexal carcinomas based on data from the CAncers RAres DERMatologiques (CARADERM) database. Demographic data, tumor types, and therapeutic characteristics were obtained for all patients included in the CARADERM database with at least one informative follow-up visit. Analyses were conducted among three populations: patients with complete resection of the primary tumor (ADJ/primary population), patients achieving complete remission after complete resection of a recurrent tumor (ADJ/recurrent population), and patients with unresectable locally advanced or metastatic tumors (ADV/MET population).The researchers found that in the ADJ/primary population, radiotherapy did not affect overall survival (OS); however, adjusted recurrence-free survival (RFS) was significantly lower in the radiotherapy group. Significantly poorer OS and RFS were seen for older patients. Significant associations were seen for tumor size and immunosuppression with poorer RFS only. In the ADJ/recurrent population, radiotherapy had no effect on OS or RFS. The only factor associated with poorer OS was age. In an age- and sex-adjusted analysis in the ADV/MET population, significant associations were seen for radiotherapy with longer progression-free survival, with no effect on OS. "Radiotherapy could be considered as an alternative treatment option for patients with locally advanced, incompletely resected or oligometastatic skin adnexal carcinomas," the authors write.<a target="_blank" rel="noopener noreferrer" href="https://onlinelibrary.wiley.com/doi/10.1111/jdv.20155">Abstract/Full Text</a>

Radiotherapy only associated with longer progression-free survival in patients with unresectable locally advanced or metastatic tumors

Study Identifies Prognostic Factors for Localized Adnexal Carcinomas

WEDNESDAY, June 26, 2024 (HealthDay News) -- Excision of melanoma in situ (MIS) with a 5-mm margin on low-risk body sites has a low rate of recurrence, according to a study published online June 26 in JAMA Dermatology.Cong Sun, M.D., from the Mater Hospital Brisbane Raymond Terrace in Australia, and colleagues examined the rate of recurrence of MIS excised with a 5-mm margin in a case series that examined all MIS lesions from a single private dermatology clinic between Jan. 1, 2011, and Nov. 30, 2018. Data were included from 351 MISs from 292 patients: 50.4, 30.5, and 19.1 percent of the lesions were superficial spreading melanoma, lentigo maligna, and lentiginous MIS, respectively.The lesions were most commonly located on the trunk, followed by upper limb and lower limb (47.9, 27.4, and 16.8 percent, respectively); only two lesions (0.6 percent) were located on the scalp. The researchers found that most of the lesions were small; 78.1 and 88.9 percent had a length &lt;10 mm and a width &lt;10 mm, respectively. Following the current guidelines, after excision with a 5-mm clinical margin, 99.1 percent of the lesions did not have clinical recurrence. Only three lesions (0.9 percent) had local recurrence, with no metastatic spread observed. "This shows that using a 5-mm margin for MIS of smaller size (&lt;10 mm) may reduce morbidity and cost associated with treatment without compromising patient outcomes in a selected population of lesions," the authors write.<a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamadermatology/article-abstract/2820187">Abstract/Full Text (subscription or payment may be required)</a><a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamadermatology/article-abstract/2820186">Editorial (subscription or payment may be required)</a>

99.1 percent of the 351 MISs identified from 292 patients did not have clinical recurrence after excision

Low Recurrence Seen for Excision of Melanoma in Situ With 5-mm Margin

WEDNESDAY, June 19, 2024 -- For cemiplimab-treated cutaneous squamous cell carcinoma (cSCC), prior radiotherapy is associated with improved progression-free survival, according to a study published online June 15 in the Journal of the American Academy of Dermatology.Valerio Nardone, M.D., from the University of Campania "Luigi Vanvitelli" in Naples, Italy, and colleagues conducted a retrospective study aimed at assessing the real-world treatment patterns and outcomes in patients with cSCC treated with cemiplimab at a single institution. Data were included for 45 patients (median age, 77 years); 73.3 percent were men.The researchers found that median progression-free survival and overall survival were not reached after 18 months of follow-up, with a mean of 21.3 ± 2.2 and 25.3 ± 2.1 months, respectively. Significant correlations were only seen between progression-free survival and previous radiotherapy in univariate and multivariate analyses."This study reveals a notable correlation between prior radiotherapy and enhanced progression-free survival in individuals with advanced cSCC treated with cemiplimab," the authors write. "By validating the established synergies between radiotherapy and immunotherapy from both preclinical and clinical perspectives, our findings underscore the potential benefits of combining radiotherapy with cemiplimab."

In univariate and multivariate analyses, significant correlations only seen between progression-free survival, previous radiotherapy

Prior Radiotherapy Linked to Improved PFS for Cemiplimab-Treated cSCC

WEDNESDAY, June 12, 2024 -- Melanomas arising in giant pigmented nevi (MGPNs) occur at a younger age than other melanomas and have high disease-specific (DSS) and overall survival (OS) rates, according to a study published online June 4 in the Journal of the American Academy of Dermatology.Nelson Ugwu, M.D., from the Harvard Combined Dermatology Residency Training Program in Boston, and colleagues utilized the Surveillance, Epidemiology, and End Results database to analyze data on MGPNs diagnosed between 2000 and 2020.The researchers identified 1,666 MGPNs during the study period, 57 percent of which were diagnosed in men. The trunk, upper limbs and shoulders, and head and neck were the most common anatomical sites involved (47.8, 22.6, and 14.7 percent, respectively). MGPN diagnoses occurred at a younger age than other melanomas, with 27 percent of MGPNs diagnosed in patients younger than 40 years compared with 12 percent of all melanomas diagnosed in patients aged 44 years and younger. The median age at diagnosis was 52 years for MGPNs versus 66 years for all melanomas. Seventy-one percent of tumors were localized at the time of diagnosis, with regional and distant disease seen in 7 and 1.4 percent, respectively. The five-year DSS was 94 percent (92 and 97 percent in male and female patients, respectively), similar to that seen for all melanomas. The five-year OS rate was 90 percent (87 and 94 percent for male and female patients, respectively). MGPNs were more aggressive for patients diagnosed in childhood, with increased odds of regional disease and metastatic disease (odds ratios, 4.3 and 14.1, respectively)."Further studies are needed to identify risk factors that may influence transformation of giant melanocytic nevi into malignant melanomas, or portend a more aggressive course," the authors write.One author disclosed ties to Apogee and Skin Analytics.

MGPN diagnoses occur at younger age than other melanomas; disease-specific, overall survival rates comparable to other melanomas

Study Identifies Characteristics of Melanomas in Giant Pigmented Nevi

WEDNESDAY, June 5, 2024 (HealthDay News) -- Neoadjuvant ipilimumab plus nivolumab followed by surgery results in longer event-free survival than surgery followed by adjuvant nivolumab among patients with resectable, macroscopic stage III melanoma, according to a study published online June 2 in the New England Journal of Medicine to coincide with the annual meeting of the American Society of Clinical Oncology, held from May 31 to June 4 in Chicago.Christian U. Blank, M.D., Ph.D., from the Netherlands Cancer Institute in Amsterdam, and colleagues randomly assigned 423 patients with resectable, macroscopic stage III melanoma to receive two cycles of neoadjuvant ipilimumab plus nivolumab and then undergo surgery or to undergo surgery and then receive 12 cycles of adjuvant nivolumab in a 1:1 ratio.The researchers found that the estimated 12-month event-free survival was 83.7 and 57.2 percent in the neoadjuvant and adjuvant groups, respectively, at a median follow-up of 9.9 months. There was an eight-month difference in restricted mean survival (hazard ratio for progression, recurrence, or death, 0.32). In the neoadjuvant group, 59.0, 8.0, 26.4, and 2.4 percent of patients had a major pathological response, partial response, nonresponse, and progression, respectively; surgery had not yet been performed or was omitted in 4.2 percent. The estimated 12-month recurrence-free survival was 95.1, 76.1, and 57.0 percent among patients in the neoadjuvant group with a major pathological response, partial response, and nonresponse, respectively."Two cycles of neoadjuvant ipilimumab plus nivolumab was safe and resulted in longer event-free survival than adjuvant nivolumab among patients with resectable, macroscopic stage III melanoma," the authors write.The study was funded in part by Bristol Myers Squibb, the manufacturer of ipilimumab and nivolumab.<a target="_blank" rel="noopener noreferrer" href="https://www.nejm.org/doi/full/10.1056/NEJMoa2402604">Abstract/Full Text (subscription or payment may be required)</a><a target="_blank" rel="noopener noreferrer" href="https://conferences.asco.org/am/attend">More Information</a>

Neoadjuvant treatment followed by surgery results in longer event-free survival for resectable, macroscopic stage III melanoma

ASCO: Neoadjuvant Ipilimumab + Nivolumab Ups Survival in Resectable Melanoma

WEDNESDAY, June 5, 2024 -- Solid organ transplant recipients (SOTRs) have a high risk for cutaneous squamous cell carcinoma (cSCC) metastases, according to a study published in the June issue of the Journal of the American Academy of Dermatology.Estella de Jong, M.D., from the Leiden University Medical Center in the Netherlands, and colleagues conducted a prospective cohort study in 19 specialist dermatology outpatient clinics in 15 countries to examine the incidence and associated risk factors of metastatic cSCC among SOTRs.The researchers found that 514 SOTRs presented with 623 primary cSCCs; metastases developed in 37 patients, for a two-year patient-based cumulative incidence of 6.2 percent. Location in the head and neck area, local recurrence, size &gt;2 cm, clinical ulceration, poor differentiation grade, perineural invasion, and deep invasion were risk factors for metastases. The highest risk for metastases was seen for a high-stage tumor that is also ulcerative, with a two-year cumulative incidence of 46.2 percent."Because of the study design and complex nature of the different immunosuppressive regimens, it was not possible to draw firm conclusions on their risk of cSCC metastases, and future studies are necessary to investigate the association in more depth," the authors write.

Risk factors for metastases include location in head and neck area, local recurrence, size &gt;2 cm, clinical ulceration

Risk for cSCC Metastases Increased for Solid Organ Transplant Recipients

TUESDAY, May 28, 2024 -- Germline pathogenic/likely pathogenic (P/LP) variants occur in 15.3 percent of individuals with melanoma, according to a study published online March 19 in the Journal of the American Academy of Dermatology.Pauline Funchain, M.D., from the Cleveland Clinic Foundation, and colleagues examined the incidence of hereditary melanoma and characterized the spectrum of cancer predisposition genes that may increase melanoma risk. Germline testing of more than 80 cancer predisposition genes was performed in 400 individuals with melanoma and a personal or family history of cancers.The researchers found that 61 individuals (15.3 percent) with melanoma had germline P/LP variants. Most of these variants (67 percent) involved genes that were considered unrelated to melanoma, including BLM, BRIP1, CHEK2, MLH1, MSH2, PMS2, and RAD51C, while 33 percent were in genes previously associated with familial melanoma (BAP1, BRCA2, CDKN2A, MITF, and TP53). Overall, 46.9 percent of the P/LP variants were in homologous repair deficiency genes. In validation cohorts, P/LP rates were 10.6, 15.8, and 14.5 percent from an unselected oncologic cohort, a selected commercial testing cohort, and a highly selected dermatologic study, respectively."The prevalence of hereditary predisposition to cancer in individuals with melanoma is substantially higher than historical estimates and involves genes of clinical importance for the treatment and surveillance of both melanoma and noncutaneous cancers," the authors write.Several authors disclosed ties to the pharmaceutical industry.

67 percent are in genes considered unrelated to melanoma

15.3 Percent With Melanoma Have Germline Likely/Pathogenic Variants

WEDNESDAY, May 22, 2024 -- Women who harbor a mutation in BRCA1 or BRCA2 have a slightly elevated risk for melanoma, but no increased risk for nonmelanoma skin cancer, according to a study published online May 13 in Hereditary Cancer in Clinical Practice.Steven A. Narod, M.D., from the Women's College Research Institute in Toronto, and colleagues report on findings of a prospective cohort study of 6,207 women from North America who harbored BRCA1 or BRCA2 mutations (3,623 and 2,584, respectively). Women were followed from baseline to skin cancer diagnosis, age 80 years, death from any cause, or last follow-up.The researchers found that 3.7 percent of women with a BRCA1 mutation and 3.8 percent of those with a BRCA2 mutation reported skin cancer diagnosis (both keratinocyte carcinomas and melanoma). From age 20 to 80 years, the cumulative risk for all types of skin cancer was 14.1 and 10.7 percent for BRCA1 and BRCA2 carriers, respectively. The cumulative risk for melanoma was 2.5 and 2.3 percent for BRCA1 and BRCA2 carriers, respectively, compared with 1.5 percent for women in the general U.S. population. A prior diagnosis of skin cancer was the strongest risk factor for skin cancer."We suggest a referral for skin exam to a primary care provider for BRCA mutation carriers with a prior history of skin cancer for annual skin examination and counselling around protection from UV exposure, use of sunscreen, and self-screening to recognize the early signs of melanoma," the authors write.

No increased risk for nonmelanoma skin cancer observed, but risk for melanoma slightly elevated

Little or No Increased Risk for Skin Cancer Seen for Women With BRCA Mutations

WEDNESDAY, May 15, 2024 -- Patients with head and neck (hn) Merkel cell carcinoma (MCC) have poorer survival outcomes than patients with MCC affecting other body regions (oMCC), according to a research letter published online May 13 in SKIN.Marcus L. Elias, M.D., from the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell in New Hyde Park, New York, and colleagues evaluated overall survival (OS) in a retrospective cohort study of patients with cutaneous stage I to IV MCC between 2004 and 2017.A total of 4,808 hnMCC and 5,790 oMCC cases were analyzed. In a univariate analysis, the researchers found significant differences in OS for oMCC and hnMCC (one-year OS: 86.9 versus 82.7 percent; five-year OS: 47.3 versus 38.7 percent). A significantly increased risk for death was seen for hnMCC versus oMCC on Cox regression analysis (hazard ratio, 1.09). Scalp and neck MCC showed lower OS versus MCC in other head regions MCC (one-year OS: 76.6 versus 84.4 percent; five-year OS: 29.6 versus 41.3 percent). An independent association was seen for scalp and neck MCC primary site versus MCC in other head regions with an increased risk for death (hazard ratio, 1.297)."As one of the largest studies of MCC patients, our results provide evidence that tumor location is a vital factor for prognostic indication when evaluating patients," the authors write. "Our results may be utilized by patients and physicians to assess risk and prognosis, which also influences treatment modality decision-making."

Risk for death significantly increased for head and neck MCC compared with other body regions

Poorer Survival Outcomes Seen for Head and Neck Merkel Cell Carcinoma

WEDNESDAY, May 15, 2024 (HealthDay News) -- Non-Hispanic Black (NHB) melanoma patients have distinct tumor characteristics, presenting with more advanced disease and exhibiting worse outcomes, according to a study published in the May issue of the Journal of Surgical Oncology.Jessica A. Steadman, M.B.B.S., from the Mayo Clinic in Rochester, Minnesota, and colleagues examined features of melanoma within NHB patients to inform strategies for earlier detection and treatment. Nonmetastatic melanoma patients with known TN category and race were identified from 2004 to 2019 Surveillance, Epidemiology, and End Results data.Of the 492,597 patients, 0.3 percent were NHB. Compared with non-Hispanic White (NHW) patients, NHB patients were younger (21 versus 17 percent aged younger than 50 years) and were more often female (54 versus 41 percent). The researchers found that lower extremity was the most common site for NHBs (52 versus 15 percent for NHWs); in addition, T category was higher (Tis to T1 and T3 to T4: 55 and 27 percent versus 82 and 8 percent, respectively) and stage at presentation was higher (stage III, 19 versus 6 percent). Among NHB patients, men were older than women and they were more often node-positive. After adjustment for age and clinical node status, five-year stage III cancer-specific survival was 42 percent for NHB men versus 71 percent for women."Our contemporary overview of nonmetastatic cutaneous melanoma highlights that NHB patients present with more advanced disease and exhibit inferior outcomes," the authors write. "This is most notable among older male NHB patients."<a target="_blank" rel="noopener noreferrer" href="https://onlinelibrary.wiley.com/doi/epdf/10.1002/jso.27608">Abstract/Full Text (subscription or payment may be required)</a>

T category and stage at presentation higher for non-Hispanic Black patients

Non-Hispanic Black Melanoma Patients Present With Advanced Disease

WEDNESDAY, May 8, 2024 -- A reconstruction algorithm with a 50 percent cutoff value is suggested for lip squamous cell carcinoma (SCC), according to a study published online March 5 in the Journal of Dermatology.Jung Won Park, M.D., Ph.D., from the Yonsei University College of Medicine in Seoul, South Korea, and colleagues retrospectively analyzed 34 patients with lip SCC who underwent reconstruction after Mohs micrographic surgery between January 2006 and March 2022. Seven and 27 tumors were on the upper lip and lower lip, respectively.Twenty-five, eight, and one defects were located on the mucosal lip, the mucosal and cutaneous lips, and the cutaneous lip only, respectively. The researchers found that 18 and 16 defects were smaller and larger than 50 percent of the total lip size, respectively. Primary closure was mainly performed for defects smaller than 50 percent of the lip size, while local flap was performed for larger defects according to the location and defect size. Postoperative complications occurred in 13 patients; except for one patient, all improved within one year after surgery. The investigators recommend a reconstruction algorithm with a 50 percent cutoff value."Defects smaller than 50 percent of the lip size could be reconstructed by primary closure," the authors write. "Even larger defects could be reconstructed by creation of a local flap from the remaining adjacent tissue with minimal postoperative complications."

Reconstruction algorithm with a 50 percent cutoff value is suggested based on cohort of 34 patients

Study Addresses Clinical Features, Surgical Management of Lip Squamous Cell Carcinoma

WEDNESDAY, May 1, 2024 -- Melanoma incidence in Denmark increased during 1999 to 2011, with no change in mortality, according to a study published online April 24 in the British Journal of Dermatology.Jesper Bo Nielsen, Ph.D., from the University of Southern Denmark in Odense, and colleagues examined factors that may influence melanoma incidence and mortality in Denmark in a register study based on comprehensive national pathology and mortality databases for 1999 to 2019. Melanocyte-related diagnoses and mortality were investigated in a population of 5.5 million.Overall, 1,434,798 biopsies were taken from 704,682 individuals. The researchers found that the incidence of invasive melanoma increased by 87 percent during 1999 to 2011 among men and women. The incidence increased 9 percent in men but remained unchanged in women during the subsequent period. The incidence of melanoma in situ increased by 476 and 357 percent in men and women, respectively, during the study period; for atypical melanocytic lesions, increases were 1,928 and 1,686 percent, respectively. From 1999 to 2011, biopsy rates increased 153 percent for men and 118 percent for women, then decreased 20 and 22 percent, respectively, during the subsequent period. Year-to-year variation was seen in mortality, with no significant time trend for men or women. During the last 30 years, no evidence of increased ultraviolet exposure was seen."The findings of the present study indicate that changes in melanoma incidence may be explained by the interaction among sun exposure, the propensity to remove suspected melanoma lesions, lowered diagnostic thresholds, and overdiagnosis," the authors write.

Subsequent increase seen for men, no change for women; no temporal trends in mortality noted during 1999 to 2019

Increase Seen in Melanoma Incidence With No Increase in Mortality

WEDNESDAY, April 24, 2024 -- Patients receiving facial skin cancer surgery have low scores for perceived stigmatization and body image concerns, and surgery does not influence quality of life, according to a study published online April 22 in the Journal of the European Academy of Dermatology and Venereology.Nick Marsidi, M.D., from the Leiden University Medical Center in the Netherlands, and colleagues measured the psychological impact of facial skin cancer surgery during a one-year period in an observational study involving patients who had Mohs micrographic surgery (MMS; 154 patients) or conventional excision (CE; 74 patients). Five surveys were conducted to measure quality of life, perceived stigmatization, body image, satisfaction with facial appearance, and psychosocial distress preoperatively and at one week, three months, and one year postoperatively.The researchers found that the scores for quality of life did not change significantly in the year after surgery, but over time, changes were seen in stigmatization, body image concerns, satisfaction with facial appearance, and psychological distress (d = −0.07, −0.014, 0.43, and −0.15, respectively). Scores after one year were not significantly affected by use of MMS or CE."Patients receiving facial skin cancer surgery exhibited low scores for perceived stigmatization and body image concerns. Their quality of life was not statistically influenced by facial surgery, and their satisfaction with facial appearance and psychosocial distress even improved after one year," the authors write. "The overall results can assist in counselling strategies to improve expectations for patients receiving facial surgery."

Low scores seen for perceived stigmatization and body image concerns; satisfaction with facial appearance, psychological distress improved

Facial Skin Cancer Surgery Does Not Influence Quality of Life

WEDNESDAY, April 17, 2024 -- For detection of malignant melanoma (MM), performance is more consistent when clinicians' work is supported by artificial intelligence (AI), according to a review published online April 8 in Cancers.Ian Miller, from Southern Cross University in Bilinga, Australia, and colleagues conducted a systematic review to report the performance metrics of commercially available convolutional neural networks tasked with detecting MM. Data were included from 16 articles reporting MM, with 1,160 melanomas detected and 33,010 nonmelanoma lesions.The researchers found that for classification of melanoma, performance of market-approved technology and clinician performance were highly heterogeneous, with sensitivity, specificity, and accuracy ranging from 16.4 to 100.0 percent, 40.0 to 98.3 percent, and 44.0 to 92.0 percent, respectively. When clinicians worked together with AI, less heterogeneity was seen, with sensitivity, specificity, and accuracy varying from 83.3 to 100.0 percent, 83.7 to 87.3 percent, and 86.4 to 86.9 percent, respectively."The implementation of AI in clinical practice to assist in the early detection of melanoma remains promising, particularly with the prospect of improved diagnostic accuracy," the authors write. "However, the heterogeneity of studies reporting on AI performance for classifying melanoma in clinical practice indicates it currently cannot be recommended as a reliable tool for clinicians."

Less heterogeneity in sensitivity, specificity, accuracy seen when clinicians worked in unison with artificial intelligence

Best Results for Classifying Malignant Melanoma Seen When Clinicians Work With AI

WEDNESDAY, April 3, 2024 -- A prediction model and nomogram can predict the risk for five-year recurrence-free and melanoma-specific survival, according to a study published in the April issue of The Lancet Oncology.Robert C. Stassen, M.D., from the Erasmus Medical Centre Cancer Institute in Rotterdam, Netherlands, and colleagues developed a tool to predict patient-specific outcomes in people with melanoma rather than classification according to disease stage. Patients with confirmed primary melanoma were included in the development cohort (4,071 patients), and external validation was performed (4,822 patients). In patients with stage pT1b or higher melanomas, a prognostic model and nomogram were developed to predict five-year recurrence-free survival.The researchers found that five-year recurrence-free survival was 73.5 percent and five-year melanoma-specific survival was 86.5 percent in the development cohort. The corresponding estimates were 66.1 and 83.3 percent in the validation cohort. Six prognostic factors were included in the final model: sentinel node status, Breslow thickness, presence of ulceration, age at sentinel lymph node biopsy, primary tumor location, and maximum diameter of the largest sentinel node metastasis. The area under the receiver operating characteristic curve (AUC) was 0.80 and 0.81 for prediction of recurrence-free and melanoma-specific survival, respectively, in the development cohort. External validations showed good calibration, with AUCs of 0.73 and 0.76, respectively."The model that we developed not only offers patient-specific risk predictions for recurrence-free and melanoma-specific survival but will also enable physicians to calculate the risk of recurrence at which it is judged necessary to start adjuvant therapy," the authors write.Several authors disclosed ties to the pharmaceutical industry.

Final model composed of six prognostic factors showed good prediction in development cohort and external validation

Model, Nomogram Predict Recurrence-Free, Melanoma-Specific Survival

WEDNESDAY, April 3, 2024 (HealthDay News) -- Patients with primary cutaneous B-cell lymphomas (PCBCLs) have an increased risk for second primary malignancies (SPMs), according to a study published online March 19 in the Journal of the American Academy of Dermatology.Lauren Banner, from Thomas Jefferson University in Philadelphia, and colleagues used the Surveillance, Epidemiology, and End Results database from 2000 to 2020 to generate a cohort of 5,435 PCBCL patients to examine their risk for development of subsequent cancers, defined as SPM.The researchers found that 16 percent of the patients received diagnoses of a second malignancy, which was higher than in the general population (standardized incidence ratio, 1.54). Women had an increased risk for thyroid, renal, and lung cancers (standardized incidence ratios, 3.06, 2.13, and 1.69, respectively). Men had the highest risk for melanoma, bladder, and prostate cancers (standardized incidence ratios, 1.49, 1.42, and 1.29, respectively). The risks for all SPMs were highest within the first year of PCBCL diagnosis and decreased with time (standardized incidence ratios within the first year: 21.11 for thyroid cancer for women; 2.09 for prostate cancer for men). The risk for all SPMs decreased with patient age; a threefold higher risk for all SPMs was seen for patients aged 40 to 49 years (standardized incidence ratio, 3.07)."Dermatologists may educate PCBCL patients on the symptoms and screening guidelines for these six malignancies and refer for further consultation if concerning symptoms are present," the authors write.<a target="_blank" rel="noopener noreferrer" href="https://www.jaad.org/article/S0190-9622(24)00505-X/abstract">Abstract/Full Text (subscription or payment may be required)</a>

Women have increased risk for thyroid, renal, lung cancers; men have highest risk for melanoma, bladder, prostate cancers

Second Primary Malignancy Risk Increased After Cutaneous B-Cell Lymphoma

WEDNESDAY, March 27, 2024 -- For patients with primary cutaneous melanoma undergoing sentinel lymph node (SLN) biopsy and for those who progressed to an unresectable stage, regression of melanoma is associated with improved prognosis, according to a study published in the April issue of the Journal of the American Academy of Dermatology.Nikolaus B. Wagner, M.D., from Kantonsspital St. Gallen in Switzerland, and colleagues conducted a retrospective review of 1,179 patients with newly diagnosed melanoma undergoing SLN biopsy between 2010 and 2015 and with available information on histopathologic regression.The researchers found that patients with regressive melanoma showed favorable relapse-free, distant metastasis-free, and melanoma-specific survival (hazard ratios, 0.52, 0.56, and 0.35, respectively). There was an association observed for regression with negative SLN (odds ratio, 0.48). Regression was associated with favorable progression-free survival under immune checkpoint inhibition (hazard ratio, 0.43) in patients who progressed to an unresectable stage, but not under targeted therapy or chemotherapy."In our opinion, presence or absence of regression could be used to improve prognostic risk stratification in patients who are candidates for SLN biopsy," the authors write.Several authors disclosed ties to the pharmaceutical industry.

Findings seen in patients with primary cutaneous melanoma undergoing SLN biopsy and those who progressed to unresectable stage

Improved Prognosis Seen With Regression of Primary Cutaneous Melanoma

WEDNESDAY, March 20, 2024 -- A wearable ultraviolet (UV) dosimeter may reduce the incidence of nonmelanoma skin cancer among elderly patients with a history of actinic keratoses (AK), according to a study published online March 1 in Frontiers in Medicine.Emmanuel L.P. Dumont, Ph.D., from Shade in Nutley, New Jersey, and colleagues conducted a prospective randomized trial involving 97 elderly patients with a history of AK who were followed over six months. Fifty of the patients received a wearable UV dosimeter that provided real-time and cumulative UV exposure as well as UV counseling from a dermatologist, while 47 received only UV counseling from a dermatologist.More than 75 percent of the participants recorded UV exposure once a week or more during the summer. The researchers found that after six months of intervention, there was a nonsignificant 20 percent lower ratio of incidence rates of AKs when comparing the device group with the control group and a significant 95 percent lower ratio of incidence rates of nonmelanoma skin cancer. There was a significant increase of 1.2 observed in the control groups' score in self-perceived ability to participate in social activities, while the score decreased nonsignificantly, by 0.9, in the device group. No changes or between-group differences were seen in anxiety and depression surveys."The clinical advantages observed in this pilot study indicate that using wearable UV sensors could enhance traditional UV-prevention strategies," the authors write.Several authors are shareholders of Shade, a startup manufacturing wearable UV sensors and the sponsor of this clinical trial.

No significant reduction seen in incidence rates of actinic keratoses; no changes observed in anxiety, depression surveys

Wearable UV Dosimeter May Reduce Nonmelanoma Skin Cancer in Elderly

WEDNESDAY, March 13, 2024 -- Melanoma patients face an increased risk for developing second primary malignancy (SPM), according to a study presented at the annual meeting of the American Academy of Dermatology, held from March 8 to 12 in San Diego.Using data from Surveillance, Epidemiology, and End Results-17 cancer registries, Thomas Z. Rohan, from Thomas Jefferson University in Philadelphia, and colleagues describe the risk for SPM after a melanoma diagnosis (January 2000 to December 2020). Data were included for 283,435 primary melanoma patients. The standardized incidence ratio (SIR) of observed to expected cases was used to calculate relative risk.The researchers found that 16.3 percent of the primary melanoma patients developed an SPM. The risk for developing any subsequent cancer was increased compared with the general population (SIR, 1.57). Overall, 61.5 percent of the patients received their cancer diagnosis between the ages of 50 and 79 years; there was an inverse relationship noted between the risk for SPM and age at melanoma diagnosis until age 80+ years. More than half of the melanomas were on the trunk or upper limbs; head and neck was the location associated with the highest risk for developing an SPM (SIR,1.65). There was a positive correlation seen for initial tumor thickness with SIR. Melanoma survivors had the greatest risk for cutaneous melanoma, ocular melanoma, thyroid, brain, and prostate cancers (SIRs, 9.65, 2.31, 1.89, 1.3, and 1.22, respectively)."Melanoma patients should remain under continued surveillance for both subsequent melanoma and other cancers," the authors write.

Melanoma survivors at greatest risk for cutaneous melanoma, ocular melanoma, thyroid, brain, prostate cancers

AAD: Risk for Second Primary Malignancy Increased for Melanoma Patients

WEDNESDAY, March 6, 2024 -- There has been a considerable increase in the use of immunohistochemistry (IHC) staining for melanoma diagnosis, according to a study published online March 6 in JAMA Dermatology.Kenechukwu Ojukwu, M.D., from the David Geffen School of Medicine at the University of California in Los Angeles, and colleagues examined trends in the use of IHC for examination of skin biopsies in incident melanoma cases diagnosed between January 2000 and December 2017 in a retrospective cross-sectional study. The analysis used the Surveillance Epidemiology, and End Results-Medicare linked database, which included data from 17 population-based registries, and focused on melanoma diagnosed in patients aged 65 years and older.The final sample included 132,547 melanomas in 116,117 distinct patients. The researchers found that 33 percent of these diagnoses had accompanying IHC claims. Among these cases, 65 percent were diagnosed in men and 44, 38, and 18 percent were diagnosed in patients aged 65 to 74, 75 to 84, and 85 years and older, respectively. Overall, 11 percent of melanoma cases had claims for IHC at or near the time of diagnosis in 2000; this proportion increased annually and reached 51 percent in 2017. Increasing use of IHC was seen for all melanoma stages, including in situ melanoma. In all 17 registries, claims for ICH increased, but at different rates. Across registries, use of IHC for melanoma diagnosis varied from 39 to 68 percent in 2017."Given the extensive use of IHC in clinical practice, studies examining the resulting outcomes of IHC on different domains, such as symptom burden, quality of life, and mortality, are crucial," the authors write.

11 percent of melanoma cases had claims for ICH at or near diagnosis in 2000; this number increased to 51 percent in 2017

Use of Immunohistochemistry in Melanoma Diagnosis Increased From 2000 to 2017

WEDNESDAY, Feb. 28, 2024 -- To achieve tumor clearance, melanoma in situ (MIS) on the head and neck often requires margins &gt;5 mm, according to a study published online Jan. 20 in the Journal of the American Academy of Dermatology.Jesalyn A. Tate, M.D., from the University of Texas Southwestern Medical Center in Dallas, and colleagues examined margins required for optimal cure rates with excision of MIS on the head and neck in a retrospective chart review performed on 846 MIS cases on the head and neck treated during a 126-month period.The researchers found that 62 percent of the MIS cases were cleared with 5-mm margins. To achieve a 97 percent clearance rate, 15-mm margins were required. There was a significant difference observed in clearance rates between margin thresholds. There was a correlation seen for tumor location on the cheek and larger preoperative size with requiring &gt;5-mm margins to achieve tumor clearance."This study demonstrates that MIS on the head and neck often requires margins &gt;5 mm to achieve tumor clearance," the authors write. "When Mohs micrographic surgery is not possible, excision margins of ≥10 mm are likely necessary for head and neck tumors."

Tumor location on cheek, larger preoperative size linked to requiring margins &gt;5 mm to achieve tumor clearance

Margins >5 mm Often Needed to Achieve Tumor Clearance for Melanoma in Situ

WEDNESDAY, Feb. 21, 2024 -- The risk for subsequent cutaneous squamous cell carcinomas (cSCCs) increases with the number of prior cSCCs, while the time interval decreases with each subsequent cSCC, according to a study published in the March issue of the Journal of the American Academy of Dermatology.Celeste J. Eggermont, M.D., from the Erasmus MC Cancer Institute in Rotterdam, Netherlands, and colleagues examined the cumulative incidence and timing of subsequent cSCCs using data from patients with a first cSCC in 2007 to 2008 from the Netherlands Cancer Registry linked to the Netherlands Pathology Registry for subsequent cSCCs and the Netherlands Organ Transplant Registry.The researchers found that 4,325; 2,010; 1,138; 739; and 501 of the 12,345 patients had second to sixth cSCCs, with median time intervals of 1.4, 1.2, 0.9, 0.6, and 0.5 years, respectively, after the previous cSCC. At five years, the cumulative incidences of a subsequent cSCC increased from 28 to 67 percent for the second to sixth cSCC. The cumulative incidences increased from 74 to 92 percent for solid organ transplant recipients and from 41 to 64 percent for patients with hematologic malignancy."The majority of nonimmunocompromised patients with cSCC could benefit from more personalized follow-up schedules, taking into account the number of prior cSCCs and potentially reducing the total volume of follow-up visits," the authors write.One author disclosed ties to Sanofi Genzyme.

Median time interval after the previous cutaneous squamous cell carcinoma decreases after each subsequent cutaneous squamous cell carcinoma

Risk for Subsequent Squamous Cell Carcinomas Rises With Number of Prior Ones

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</div>Iovance Biotherapeutics, Inc, has achieved a significant milestone with the FDA approval of its revolutionary T cell therapy, AMTAGVI (lifileucel). This therapy marks the first FDA-approved T cell treatment for solid tumor cancer, specifically addressing advanced melanoma following anti-PD-1 and targeted therapy.&nbsp;AMTAGVI utilizes tumor-infiltrating lymphocytes (TIL) to recognize and combat cancer. The treatment, administered through intravenous infusion, is a one-time, individualized T cell therapy, making it a unique and personalized approach for patients.&nbsp;The therapy is designed for adult patients with unresectable or metastatic melanoma who have previously received PD-1 blocking antibody treatment, and if BRAF V600-mutation positive, a BRAF inhibitor with or without a MEK inhibitor.&nbsp;Clinical trial insights&nbsp;Accelerated approval by the FDA was supported by results from the C-144-01 trial, a global, multicenter Phase 2 study that enrolled patients with metastatic melanoma who had been previously treated with at least one systemic therapy, including a PD-1 blocking antibody, and if BRAF V600 mutation positive, a BRAF inhibitor or BRAF inhibitor with MEK inhibitor.&nbsp;Approval was supported by the overall response rate and duration of response seen in clinical trials, and ongoing trials, such as TILVANCE-301, aim to confirm its clinical benefits.&nbsp;Mechanism of action&nbsp;AMTAGVI is manufactured using a proprietary process to collect and expand a patient’s unique T cells from a portion of their tumor. AMTAGVI returns billions of the patient’s T cells back to the body to fight their cancer. The specific mechanism of action is unknown.&nbsp;Safety profile&nbsp;Safety considerations include warnings for treatment-related mortality, prolonged severe cytopenia, severe infection, and cardiopulmonary and renal impairment.&nbsp;Future outlook&nbsp;AMTAGVI will be manufactured in Philadelphia at the Iovance Cell Therapy Center, with plans for significant expansion to accommodate more patients in the coming years. The therapy will be administered in Authorized Treatment Centers (ATCs), and over 30 ATCs are prepared to collect and ship tumor tissue for AMTAGVI manufacturing.

FDA grants accelerated approval for the first T cell therapy for a solid tumor cancer

LAUNCH ALERT: Lifileucel (AMTAGVI) Approved for Treatment of Advanced Melanoma 

WEDNESDAY, Feb. 14, 2024 -- Many survivors of localized melanoma have a clinical fear of cancer recurrence, according to a study published online Feb. 14 in JAMA Dermatology.Ayisha N. Mahama, M.D., M.P.H., from the Dell Medical School at the University of Texas in Austin, and colleagues explored the lived experiences and fear of cancer recurrence among survivors of localized cutaneous melanoma in a qualitative and survey-based study using semistructured interviews and the Fear of Cancer Recurrence Inventory short form (FCRI-SF) survey tool.Fifty-one patients with a history of localized melanoma completed the interview and survey; 33 percent had survived a diagnosis of stage 0 melanoma and the rest had at least one invasive melanoma (stage I to IIA) diagnosis. The researchers identified themes in the semistructured interviews: emotions surrounding follow-up appointments; intensity of melanoma surveillance; lifestyle change relating to sun exposure; and thoughts regarding life and death. Of the participants, 38 had an FCRI-SF score above the threshold for clinical fear of cancer recurrence."These findings underscore the importance of addressing the psychological well-being of patients with early melanoma and potentially implementing supportive interventions," the authors write.

Thirty-eight of 51 survivors had FCRI-SF score above the threshold for clinical fear of cancer recurrence

Many Survivors of Localized Melanoma Fear Recurrence

MONDAY, Feb. 12, 2024 (HealthDay News) -- For patients with clinical stage I and II melanoma, smoking is associated with an increased risk for melanoma-associated death, according to a study published online Feb. 6 in JAMA Network Open.Katherine M. Jackson, M.D., from the Saint John's Cancer Institute at Providence Saint John's Health Center in Santa Monica, California, and colleagues examined the association of smoking with survival in patients with early-stage primary cutaneous melanoma in a post-hoc analysis of data from the randomized, multinational first and second Multicenter Selective Lymphadenectomy Trials. Participants were aged 18 to 75 years and had clinical stages I or II melanoma with a Breslow thickness of 1.00 mm or greater or Clark level IV to V. Data were included for 6,279 patients: 17.2, 27.0, and 55.9 percent were current, former, and never smokers, respectively.The researchers found that in a multivariable analysis for the entire study, current smoking was associated with a greater risk for melanoma-associated death (hazard ratio, 1.48), but former smoking was not. Patients with sentinel lymph node biopsy (SLNB)-negative melanoma had the greatest increased risk for melanoma-specific mortality associated with current smoking (hazard ratio, 1.85), and an increased risk was also seen for patients with SLNB-positive melanoma and nodal observation (hazard ratios, 1.29 and 1.68, respectively). For patients with SLNB-negative disease, smoking at least 20 cigarettes per day doubled the risk for death due to melanoma (hazard ratio, 2.06)."Because smoking could be considered a risk factor for disease progression, increased vigilance in the management of patients who smoke may be warranted," the authors write.Several authors disclosed ties to the pharmaceutical industry.<a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2814571">Abstract/Full Text</a><a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2814573">Editorial</a>

Greatest increased risk for melanoma-specific mortality seen for patients with SLNB-negative disease

Smoking Linked to Melanoma-Associated Death in Early-Stage Melanoma

WEDNESDAY, Feb. 7, 2024 -- Adjunctive, handheld reflectance confocal microscopy (RCM) improves diagnostic accuracy of lesions clinically suspicious for basal cell carcinoma (BCC), according to a study published online Jan. 29 in the Journal of the American Academy of Dermatology.Caterina Longo, M.D., Ph.D., from the University of Modena and Reggio Emilia in Italy, and colleagues examined the additional benefit of handheld RCM in terms of diagnostic accuracy for skin cancer in a prospective study conducted in three skin cancer reference centers in Italy. A total of 1,005 lesions with clinical-dermoscopic suspicion of BCC were included.The researchers found that of the lesions, 474 were histopathologically confirmed and 531 were diagnosed by clinical-dermoscopic-RCM correlation, confirmed with two years of follow-up. Seven hundred forty of the lesions were confirmed BCCs. For dermoscopy alone, the sensitivity and specificity were 93.2 and 51.7 percent, respectively, with a positive predictive value (PPV) and negative predictive value (NPV) of 84.4 and 73.3, respectively. Higher rates were seen with adjunctive RCM, with sensitivity and specificity of 97.8 and 86.8 percent, respectively, and PPV and NPV of 95.4 and 93.5, respectively."The results of our prospective, multicenter study, carried out on 1,005 lesions suspicious of BCC at clinical examination, provides real-life diagnostic accuracy of dermoscopy for BCC, as a standalone tool and with adjunctive handheld-RCM assessment," the authors write.

Adjunctive handheld RCM improves diagnostic accuracy of lesions clinically suspicious for basal cell carcinoma

Does Reflectance Confocal Microscopy Increase Diagnostic Accuracy for BCC?

FRIDAY, Feb. 2, 2024 (HealthDay News) -- Within the sexual and gender minority (SGM) population, gender minority adults are more likely to report discomfort during full body skin examinations (FBSEs), according to a research letter published online Jan. 31 in JAMA Dermatology.Michelle Verghese, from the Pritzker School of Medicine at the University of Chicago, and colleagues used data from a sample of SGM individuals aged 18 years or older to examine perspectives surrounding FBSEs.Overall, 175 participants completed the survey and 42.8 percent reported ever having had a FBSE. The researchers found that 33.3 percent of those who underwent a FBSE reported discomfort during the examination. Discomfort was more likely to be reported by gender nonconforming, gender queer, and nonbinary (gender queer) and transgender individuals compared with sexual minority cisgender females and males (57.7 versus 25.6 percent). Compared with sexual minority cisgender males, sexual minority cisgender females were also more likely to report discomfort (37.5 versus 11.1 percent). Reasons related to undressing during the examination were more likely to be a reason for discomfort among gender queer, sexual minority cisgender female, and transgender respondents than sexual minority cisgender males; they were also more likely to report discrimination or nonaffirming interactions with medical practitioners and staff. Gender queer and transgender respondents were more likely to cite being misgendered during the appointment and to experience uncomfortable examination maneuvers."Our findings suggest that stigma and discrimination can negatively affect skin cancer screening experiences for SGM patients, serving as a substantial barrier," the authors write.<a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamadermatology/article-abstract/2814375">Abstract/Full Text (subscription or payment may be required)</a>

Gender queer and transgender individuals more likely to report discomfort than sexual minority cisgender females, males

Gender Minority Adults Are Vulnerable During Full Body Skin Exam

MONDAY, Jan. 29, 2024 (HealthDay News) -- For patients with advanced melanoma, early 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) imaging can identify metabolic changes that may predict response to pembrolizumab, according to a study published online Jan. 24 in Clinical Cancer Research.Thomas M. Anderson, M.D., from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, and colleagues prospectively enrolled 19 patients with advanced melanoma scheduled to receive pembrolizumab. At baseline and approximately one week after starting treatment, FDG PET/CT imaging was performed. These scans were assessed for changes in the maximum standardized uptake value (SUVmax); receiver operating curve analysis was used to identify thresholds, with metabolic flare (MF) defined as &gt;70 percent increase in tumor SUVmax and metabolic response (MR) defined as &gt;30 percent decrease in tumor SUVmax.The researchers found that six of 11 responders and zero of eight nonresponders had an MF or MR, with an objective response rate of 100 and 38 percent in the MF-MR group and the stable metabolism (SM) groups, respectively. There was an association seen for MF or MR with T-cell reinvigoration in the peripheral blood and immune infiltration in the tumor. Overall survival at three years was 83 and 62 percent in the MF-MR and SM groups, respectively. The median progression-free survival was &gt;38 and 2.8 months in the MF-MR and SM groups, respectively."An MF or MR was predictive of response, and strongly correlated with progression-free survival, suggesting that response assessment by early FDG PET/CT is robust," the authors write.Several authors disclosed ties to pharmaceutical companies, including Merck, which manufactures pembrolizumab and funded the study.<a target="_blank" rel="noopener noreferrer" href="https://aacrjournals.org/clincancerres/article-abstract/doi/10.1158/1078-0432.CCR-23-2390/733627/FDG-PET-CT-Imaging-1-Week-after-a-Single-Dose-of">Abstract/Full Text (subscription or payment may be required)</a>

Metabolic changes associated with progression-free survival in patients receiving pembrolizumab

Early FDG PET/CT Can ID Metabolic Changes in Advanced Melanoma

WEDNESDAY, Jan. 24, 2024 -- Among Black patients, most melanomas are located on acral skin, according to a study published online Jan. 24 in JAMA Dermatology.Sophia N. Wix, from the University of Texas Southwestern Medical Center in Dallas, and colleagues identified patient- and tumor-level characteristics of melanoma in Black patients in a case series conducted at two tertiary care centers affiliated with a single institution. Data were included for 48 Black patients (median age at diagnosis, 62 years).The researchers found that 30 of the 40 primary cutaneous melanomas were located on acral skin, although only 10 of these 30 were histologically classified as acral lentiginous melanomas. Patients with nonacral cutaneous melanoma were more likely to be immunocompromised (40 versus 7 percent) or have a personal history of cancer (60 versus 17 percent) than those with acral disease; all three patients with superficial spreading melanoma had a history of both. None of the patients had more than one confirmed primary melanoma. Overall, 27 percent of Black patients with melanoma developed stage IV disease; 12 of these 13 patients died due to disease progression. None of the patients with nonacral cutaneous melanomas developed distant metastases or died of melanoma. Patients with advanced acral melanoma, mucosal/ocular melanoma, or melanoma of unknown primary did not have actionable sequence variations, were not responsive to immunotherapy, and had the worst outcomes."Focusing research efforts to improve therapeutic and prevention strategies for these poorly studied subtypes has potential to improve melanoma mortality in Black patients," the authors write.

Patients with nonacral cutaneous melanomas more likely to be immunocompromised, have personal history of cancer

Most Melanomas in Black Patients Located on Acral Skin

THURSDAY, Jan. 18, 2024 (HealthDay News) -- The first medical device powered by artificial intelligence and designed to help doctors catch skin cancer has been approved by the U.S. Food and Drug Administration.Although not meant to be used as a primary screening tool, the technology further evaluates skin lesions that doctors have already flagged as suspicious, the FDA noted in an agency <a target="_blank" rel="noopener noreferrer" href="https://www.fda.gov/news-events/press-announcements/fda-roundup-january-16-2024">news release</a>. &nbsp;The handheld device uses AI-powered spectroscopy to assess the characteristics of lesions at both the cellular level and beneath the skin's surface.“We are entering the golden age of predictive and generative artificial intelligence in healthcare, and these capabilities are being paired with novel types of technology, like spectroscopy and genetic sequencing, to optimize disease detection and care,” DermaSensor Inc. co-founder and CEO Cody Simmons said in a company <a target="_blank" rel="noopener noreferrer" href="https://www.businesswire.com/news/home/20240117116417/en/FDA-Clearance-Granted-for-First-AI-Powered-Medical-Device-to-Detect-All-Three-Common-Skin-Cancers-Melanoma-Basal-Cell-Carcinoma-and-Squamous-Cell-Carcinoma">news release</a>. “Equipping PCPs [primary care physicians], the most abundant clinicians in the country, to better evaluate the most common cancer in the country has been a major, long-standing unmet need in medicine.”The device, also called DermaSensor, provides real-time results using an algorithm based on data culled from more than 4,000 malignant and benign lesions, according to the company."The device should be used in conjunction with the totality of clinically relevant information from the clinical assessment, including visual analysis of the lesion, by physicians who are not dermatologists," the FDA said, adding that DermaSensor is for use in patients ages 40 and up.Along with helping to spot melanoma, the most deadly form of skin cancer, the device can also assess moles for basal cell carcinoma and squamous cell carcinoma.One in five Americans will have developed a form of skin cancer by the age of 70, according to the <a target="_blank" rel="noopener noreferrer" href="https://www.aad.org/media/stats-skin-cancer">American Academy of Dermatology</a>, which puts the cost of treatment in the United States at more than $8 billion. Most skin cancers are curable if detected early.The FDA added that it is requiring additional validation testing in patients from representative demographic groups, including those who are at lower risk of skin cancer.More informationThe Skin Cancer Foundation has more on<a target="_blank" rel="noopener noreferrer" href="https://www.skincancer.org/"> skin cancer</a>.SOURCE: U.S. Food and Drug Administration, news release, Jan. 16, 2024; DermaSensor Inc., news release, Jan. 17, 2024

The first medical device powered by artificial intelligence and designed to help doctors catch skin cancer has been approved by the U.S. Food and Drug Administration

FDA Approves AI Device That Helps Spot Skin Cancer

WEDNESDAY, Jan. 17, 2024 -- For patients with nonmelanoma skin cancers (NMSCs), hypofractionated superficial X-ray therapy (SXRT), administered at an average dose of 35.7 Gy over 5.47 fractions, yields tumor recurrence rates of up to 10.5 percent at 10 years, according to a research letter published online Jan. 12 in the Journal of the American Academy of Dermatology.Alexzandra Mattia, from the Florida State University College of Medicine in Tallahassee, and colleagues evaluated the use of hypofractionated SXRT in the management of nonaggressive NMSCs in a single-institution 22-year retrospective analysis of 2,490 biopsy-proven NMSCs from 1,082 elderly patients treated between Jan. 1, 2000, and June 1, 2022.The researchers found that during a span of 22 years, the two-, five-, and 10-year tumor recurrence rates were 2.2, 6.0, and 10.5 percent, respectively. The average dose administered was 35.7 Gy over 5.47 fractions; most of the treatment protocols used 40 to 45 Gy over 10 to 15 fractions."Our study highlights the utility of hypofractionated SXRT as a well-tolerated and less expensive treatment alternative for select NMSCs in nonsurgical patients," the authors write.

Over 22 years, two-, five-, and 10-year tumor recurrence rates were 2.2, 6.0, and 10.5 percent, respectively

What Are the Skin Cancer Recurrence Rates for Superficial X-Ray Therapy?

WEDNESDAY, Jan. 10, 2024 -- A considerable number of patients with advanced melanoma start systemic therapy in the 30 days or three months before death, according to a study published online Dec. 11 in the Journal of Dermatology.Pieter E.A. van Lith, from the Netherlands Comprehensive Cancer Organization in Utrecht, and colleagues examined the timing of systemic therapies within 30 days and three months before death in patients diagnosed with advanced melanoma (July 2017 to June 2020) who died before July 2020.Sixty-eight percent of the 1,097 patients received systemic therapy. Almost 25 and 10 percent started a new therapy within 90 and 30 days before death, respectively. The researchers found that the odds of receiving immune therapy were reduced in association with female sex, elevated lactate dehydrogenase, BRAF mutation, poor Eastern Cooperative Oncology Group performance status, and high comorbidity index. The odds of receiving both targeted and immune therapies were highest for patients younger than 40 years."It is crucial to carefully consider the potential benefits and drawbacks of initiating these novel therapies in the final stages of life, emphasizing the importance of shared decision-making between patients and their health care providers," the authors write.One author disclosed ties to the pharmaceutical industry.

Reduced odds of receiving immune therapy seen in association with female sex, elevated LDH, BRAF mutation, poor ECOG performance status

Some Advanced Melanoma Patients Start Systemic Therapy Shortly Before Death

WEDNESDAY, Jan. 3, 2024 -- Variants in certain DNA repair and cancer-predisposing genes are associated with early-onset Merkel cell carcinoma (MCC), according to a study published online Jan. 3 in JAMA Dermatology.Noreen Mohsin, M.D., from the National Institutes of Health in Bethesda, Maryland, and colleagues prospectively enrolled participants with early-onset and later-onset MCC, defined as disease occurring in individuals younger than 50 years and at age 50 years or older, respectively, to identify genetic risk factors for early onset MCC via genomic sequencing. The analysis included 37 participants with early-onset MCC, 45 with later-onset MCC, and 930 unrelated controls.The researchers found that 19 percent of the patients with early-onset MCC had well-described variants in genes associated with cancer predisposition; six of the seven patients had variants associated with hereditary cancer syndromes (ATM, BRCA1, BRCA2, and TP53), and one had a variant associated with immunodeficiency and lymphoma (MAGT1). The early-onset cohort was significantly enriched for cancer-predisposing pathogenic or likely pathogenic variants in these five genes compared with unrelated controls (odds ratio, 30.35). In the patients with later-onset MCC, no germline disease variants were identified in these genes. Among patients with MCC, additional variants were identified in DNA repair genes."Genetic counseling and cascade testing of potentially affected family members should be considered for patients diagnosed with MCC at age younger than 50 years, with a focus on detecting pathogenic variants in ATM, BRCA1, BRCA2, TP53, MAGT1, or DNA repair genes," the authors write.One author disclosed being the founder of Moonlight Bio.

19 percent of patients with early-onset Merkel cell carcinoma have well-described variants in genes associated with cancer predisposition

Variants in Cancer-Predisposing Genes Linked to Early-Onset Merkel Cell Carcinoma

MONDAY, Dec. 18, 2023 (HealthDay News) -- Patients with lower extremity (LE) lymphedema have an increased risk for skin cancer, especially basal cell carcinoma, according to a study published online in the November issue of Mayo Clinic Proceedings.Nimay C. Anand, M.D., from Meharry Medical College in Nashville, Tennessee, and colleagues conducted a retrospective cohort study including patients with LE lymphedema examined from Jan. 1, 2000, through Dec. 31, 2020. The study included 4,437 patients with LE lymphedema and age-, race-, and sex-matched controls without lymphedema. The time to development of the first skin cancer was compared for the lymphedema and control cohorts.The researchers found that the lymphedema group had a significantly increased risk for skin cancer compared with the matched control group. The lymphedematous extremity was 2.65 times as likely as the nonlymphedematous LE to have skin cancer, especially basal cell carcinoma, in a subset of patients with unilateral lymphedema."Future studies are needed to understand the pathogenesis of cancer in this population and to help guide individualized management of skin cancer in patients with lymphedema, particularly to determine whether cancers on lymphedematous LEs are histologically and prognostically different from cancers on nonlymphedematous LEs," the authors write.Several authors disclosed ties to the pharmaceutical industry.<a target="_blank" rel="noopener noreferrer" href="https://www.mayoclinicproceedings.org/article/S0025-6196(23)00117-9/fulltext">Abstract/Full Text (subscription or payment may be required)</a>

Lymphedematous extremity 2.65 times as likely as the nonlymphedematous extremity to have skin cancer

Risk for Skin Cancer Increased for Patients With Lower Extremity Lymphedema

WEDNESDAY, Dec. 13, 2023 -- Phototherapy is not associated with an increased risk for skin cancer, according to a study published online Dec. 7 in the Journal of the American Academy of Dermatology.Elle Wang, from the University of British Columbia in Vancouver, Canada, and colleagues conducted a retrospective cohort study of patients treated at a teaching-hospital phototherapy center from 1977 to 2018. Age-standardized incidence rates (ASIR) of skin cancer were assessed for gender, skin phototype, diagnosis, ultraviolet modality, and anatomical site and were compared with provincial population incidence rates. Data were included for 3,506 patients treated with broadband-ultraviolet-B (UVB), narrowband-UVB, and/or combined UVAB, who were followed for a mean of 7.3 years.Most patients had psoriasis or eczema (60.9 and 26.4 percent, respectively); patients received a median of 43 treatments. The researchers identified 170 skin cancers in 79 patients (17 melanoma, 33 squamous cell carcinoma [SCC], and 120 basal cell carcinoma [BCC]). The patient- and tumor-based ASIR of skin cancer was 149 and 264 per 100,000 person-years, respectively. No significant difference was seen between tumor-based ASIRs for melanoma, SCC, and BCC versus the general population, or in patients with psoriasis or eczema, or in those using immunosuppressants. There was no cumulative dose-response correlation noted between UVB and skin cancer."No increased risk of melanoma, SCC, and BCC compared to the general population was found in patients receiving phototherapy," the authors write. "This suggests ultraviolet phototherapy can be considered a relatively safe treatment option."

No significant difference seen between tumor-based age-standardized incidence rates of skin cancer compared with general population

Is Phototherapy Linked to Increased Risk for Skin Cancer?

WEDNESDAY, Dec. 6, 2023 -- An elastic-scattering spectroscopy (ESS) device can aid skin cancer detection, according to a study published online Oct. 10 in JAAD International.Danielle Manolakos, D.O., M.P.H., from the Gold Coast Dermatology Center in Delray Beach, Florida, and colleagues examined the safety and effectiveness of an ESS device in evaluating lesions that are suggestive of skin cancer in a prospective, multicenter clinical validation study. Patients with skin lesions suggestive of melanoma and nonmelanoma skin cancers were assessed clinically by expert dermatologists and with a device using artificial intelligence algorithms comparing current ESS lesion readings with training data sets.The researchers found that overall device sensitivity was 97.04 percent, with subgroup sensitivity of 96.67, 97.22, and 97.01 percent for melanoma, basal cell carcinoma, and squamous cell carcinoma, respectively. The device and dermatologist performance did not differ significantly. Overall device specificity was 26.22 percent, and negative and positive predictive values were 89.58 and 57.54 percent, respectively."The ESS device is an intuitive, noninvasive, safe, and effective handheld device that may assist primary care clinicians in the assessment of clinically suspicious lesions," the authors write. "Proper use of this device may aid in the reduction of morbidity and mortality associated with skin cancer through expedited and enhanced detection and intervention."Several authors disclosed financial ties to DermaSensor, which developed the ESS device used in the study and provided funding.

Device has high sensitivity for detection of melanoma, basal cell carcinoma, squamous cell carcinoma

Can an Elastic-Scattering Spectroscopy Device Aid Skin Cancer Detection?

WEDNESDAY, Nov. 29, 2023 (HealthDay News) -- A mobile phone-powered artificial intelligence (AI) technology is effective for diagnosing suspicious skin lesions, according to a study published in the October issue of The Lancet Digital Health.Scott W. Menzies, Ph.D., from the University of Sydney, and colleagues compared the accuracy of AI algorithms and clinicians for the diagnosis and management of pigmented skin lesions. For the diagnostic study, the analysis included 172 suspicious pigmented lesions from 124 patients, while the management study included 5,696 pigmented lesions from 66 high-risk patients. &nbsp;The researchers found that the diagnoses of the seven-class AI algorithm were similar to the specialists' diagnoses (absolute accuracy difference, 1.2 percent) and significantly superior to the novice clinicians' diagnoses (21.5 percent). Diagnoses based on the International Skin Imaging Collaboration AI algorithm were significantly inferior to the specialists' diagnoses (–11.6 percent) but significantly superior to the novices' diagnoses (8.7 percent). The best seven-class management AI was significantly worse than specialists' management (absolute accuracy difference in correct management decision, –0.5 percent for dismissal and –0.4 percent for biopsy). For novice clinicians' management, the seven-class management AI was significantly inferior (–0.4 percent for dismissal), but significantly superior (0.4 percent) for biopsy."An AI algorithm that was superior in experimental studies was significantly inferior to specialists in a real-world scenario, suggesting that caution is needed when extrapolating results of experimental studies to clinical practice," the authors write.The study was funded by MetaOptima Technology.

AI may be less accurate than clinicians in usage for management decisions

AI Accurate in Diagnosing Suspicious Skin Lesions

WEDNESDAY, Nov. 29, 2023 -- Age-adjusted incidence rates of keratinocyte carcinomas (KC) are much lower for patients with skin of color than non-Hispanic Whites, according to a research letter published online Nov. 29 in JAMA Dermatology.Lucy J. Navsaria, M.B.B.Ch., M.P.H., from the University of Texas MD Anderson Cancer Center in Houston, and colleagues reported KC incidence and patient demographics by race and ethnicity among a random sample of Medicare beneficiaries age 65 years or older with claims from 2009 to 2018.The researchers found that 15.7 percent of the 4,999,999 eligible beneficiaries had at least one treated KC; 97.6 and 2.4 percent were non-Hispanic White and had skin of color, respectively. Compared with non-Hispanic White patients, those with skin of color were more likely to be female (55.2 versus 51.9 percent) and older at first KC diagnosis (mean age, 77.7 versus 76.7 years). Overall, 2,498,805 KCs were identified: 98.3 and 1.7 percent in non-Hispanic Whites and patients with skin of color, respectively. The age-adjusted incidence was 1,158.2 and 11,493.2 per 100,000 person-years in patients with skin of color and non-Hispanic Whites, respectively. The age-adjusted incidence rates for basal cell carcinoma were 378.9 and 3,492.0 per 100,000 person-years for patients with skin of color and non-Hispanic Whites, respectively; the corresponding rates for squamous cell carcinoma were 453.5 and 4,881.2."We found differences in demographics and KC incidence between non-Hispanic White patients and patients with skin of color," the authors write. "This finding may be valuable in KC surveillance and risk factor differentiation."

Incidence rates in patients with skin of color are about 10 percent of that seen for non-Hispanic Whites

Is the Incidence of Keratinocyte Carcinoma Lower for Patients of Color?

MONDAY, Nov. 20, 2023 (HealthDay News) -- Occupational exposure to solar ultraviolet radiation (UVR) is associated with a substantial burden of nonmelanoma skin cancer (NMSC), according to a study published in the November issue of Environment International.Frank Pega, from the World Health Organization in Geneva, and colleagues presented WHO and International Labour Organization (ILO) estimates of global, regional, national, and subnational occupational exposures to UVR for 195 countries/regions and the global, regional, and national attributable burdens of NMSC for 183 countries for 2000, 2010, and 2019. Using 166 million observations from 763 cross-sectional surveys for 96 countries/areas, occupational exposure to UVR was modeled via proxy of occupation with outdoor work. By applying population-attributable fractions (PAFs) from estimates of the population occupationally exposed to UVR and the risk ratio for NMSC, the attributable NMSC burden was estimated.The researchers found that in 2019, 1.6 billion workers were occupationally exposed to UVR globally, representing 28.4 percent of the working-age population. The PAFs for NMSC deaths and disability-adjusted life years (DALYs) were 29.0 and 30.4 percent, respectively; attributable burdens were 18,960 deaths and 0.5 million DALYs. A larger burden was seen for men and older age groups. Attributable deaths and DALYs almost doubled during 2000 to 2019."WHO and the ILO estimate that occupational exposure to UVR is common and leads to substantial numbers of deaths and of DALYs from NMSC," the authors write.

Attributable burdens were 18,960 deaths and 0.5 million disability-adjusted life years, which almost doubled from 2000 to 2019

Occupational Exposure to Solar UVR Linked to Nonmelanoma Skin Cancer

MONDAY, Nov. 20, 2023 -- For patients with clinically localized Merkel cell carcinoma, preoperative staging with cross-sectional imaging does not influence surgical management, according to a study published in the November issue of SKIN.Natalie Garcia, from the University of Alabama at Birmingham Heersink School of Medicine, and colleagues examined how preoperative staging with cross-sectional imaging influences management of patients with clinically localized Merkel cell carcinoma in a study involving 97 patients evaluated between Jan. 1, 2012, and Dec. 31, 2020. Eighty-four of the patients had preoperative staging studies.The researchers found that the clinical characteristics of the patients did not differ based on whether staging was performed. Positron emission tomography/computed tomography (PET/CT), CT, and magnetic resonance imaging were performed in 52, 51, and 31 patients (67, 62, and 41 percent, respectively). Five patients had indeterminate findings (all on PET/CT); no patients were identified for whom preoperative staging changed the plan for surgical resection."Based on these findings, more selective use of preoperative imaging staging may be warranted," the authors write. "Future work should seek to characterize risk factors for clinically occult metastases which could be used to refine current guidelines for preoperative staging."

Preoperative staging with cross-sectional imaging does not influence management in localized Merkel cell carcinoma

Does Preop Staging With Imaging Impact Management of Merkel Cell Carcinoma?

WEDNESDAY, Nov. 15, 2023 -- The Mohs appropriate use criteria (AUC) score can help to ascertain whether a keratinocyte carcinoma (KC) warrants Mohs micrographic surgery (MMS), according to a review published in the November issue of SKIN.Richard H. Hope, M.D., from Texas Tech University Sciences Center in Lubbock, and colleagues conducted a retrospective review of 11,145 consecutive KCs between January 2017 and December 2021 to stratify KC by treatment modality and compare the associated Mohs AUC score with the treatment modality.The researchers found that the average Mohs AUC score was 7.1 for all KCs combined, with 78.2 percent of the KCs qualifying for MMS via AUC score. However, only 32.3 percent of KCs underwent MMS. Of the KCs, excisional surgery was used to treat 41.1 percent; 24.9 percent were treated with electrodesiccation and curettage (ED&amp;C), and 6.6 percent were treated with biopsy only. Overall, 70.7, 70.7, and 72.4 percent of those KCs treated with excision, ED&amp;C, or biopsy, respectively, reached an "appropriate" Mohs AUC sore for MMS."We can determine that just because a KC reaches the Mohs AUC score for MMS does not necessarily mean that MMS is the best treatment option for that particular patient and tumor based on the patient's clinical status and the clinician's evaluation [of] the lesion," the authors write.

Mohs micrographic surgery was only done on 32.3 percent of the keratinocyte carcinomas that qualified based on AUC score

Can Mohs Appropriate Use Criteria Score Help Determine Keratinocyte Carcinoma Treatment?

FRIDAY, Nov. 3, 2023 (HealthDay News) -- Artificial intelligence (AI) is increasingly accurate in detecting skin cancer, according to a study presented at the annual meeting of the European Academy of Dermatology and Venereology, held from Oct. 11 to 14 in Berlin.Kashini Andrew, M.B.B.S., from the University Hospitals Birmingham NHS Foundation Trust in the United Kingdom, and colleagues examined improvement in the sensitivity of the detection of skin cancers with continued improvement of the AI algorithm (upgraded twice since May 2020) using previously collected data (22,356 patients assessed over 2.6 years).The researchers found that the latest version of AI software was highly sensitive in detecting all skin cancers (99.5 percent), precancers (92.5 percent), and melanoma (100 percent), with improved sensitivity observed over time. Out of 190 cancers, AI missed one cancer diagnosis -- a basal cell carcinoma identified at the second read by the safety-net dermatologist. The latest algorithm also showed a high specificity in identifying benign lesions (75.3 percent). Compared with version 1, the researchers note a slight drop in specificity for benign lesions, a potential trade-off for increased sensitivity for malignant lesions. The rate of overturn of the diagnosis from benign to skin cancer was 0.1 percent, which was a significant improvement from version 1. The investigators estimated that the latest version prevented more than 2,000 face-to-face appointments in secondary care."The role of AI in dermatology and the most appropriate pathway are debated," Andrew said in a statement. "Further research with appropriate clinical oversight may allow the deployment of AI as a triage tool. However, any pathway must demonstrate cost-effectiveness, and AI is currently not a standalone tool in dermatology. Our data shows the great promise of AI in future provision of health care."

Software improvements show high sensitivity across skin cancer types, including melanoma

AI Getting Better at Detecting Skin Cancer

WEDNESDAY, Oct. 25, 2023 -- For patients with basal cell carcinoma (BCC) unable to tolerate the traditional vismodegib dosing regimen, an alternative regimen provides therapeutic effects without intolerable side effects, according to a research letter published in the September issue of SKIN.Timothy Orlowski, M.D., from the University of Alabama at Birmingham, and colleagues conducted a retrospective review of side effects, safety, and efficacy of an alternative vismodegib dosing pattern in six patients from a single institution who were unable to tolerate the traditional dosing regimen. The patients were prescribed vismodegib 150 mg daily for seven days, followed by a 21-day drug holiday.The researchers found that improvement or resolution of adverse events was reported by all patients on this alternative treatment regimen; patients continued on this regimen for an average of 30.7 months. No new BCC development was seen for four patients, and their existing BCCs shrunk in size. A single BCC was developed by one patient with basal cell nevus syndrome 24 months into treatment; another patient developed a single BCC during a drug holiday for radiation therapy of lung squamous cell carcinoma."Our alternative long-term dosing schedule of vismodegib 150 mg daily for seven days followed by a 21-day drug holiday may provide therapeutic effects without intolerable side effects," the authors write. "It's not clear what maintenance schedule of vismodegib is ideal for patients requiring long-term treatment; however, future prospective studies may elucidate a regimen that minimizes both BCC burden and adverse effects."

Alternative regimen of vismodegib 150 mg daily for seven days followed by 21-day drug holiday provides therapeutic effect

Is Alternative Vismodegib Dosing Regimen Tolerable for Basal Cell Carcinoma?

WEDNESDAY, Oct. 18, 2023 (HealthDay News) -- The U.S. Food and Drug Administration has approved Opdivo (nivolumab) for the adjuvant treatment of completely resected stage IIB/C melanoma in patients ages 12 years and older.The approval was based on results from the CHECKMATE-76K randomized, double-blind trial. The trial included 790 patients with stage IIB/C melanoma who were randomly assigned (2:1) to nivolumab 480 mg or placebo by intravenous infusion every four weeks for up to one year or until disease recurrence or unacceptable toxicity. At the time of the approval, median recurrence-free survival was not reached in either the nivolumab arm or the placebo arm.The recommended nivolumab dose for patients weighing ≥40 kg is 240 mg every two weeks or 480 mg every four weeks until disease progression or unacceptable toxicity for up to one year. For pediatric patients weighing &lt;40 kg, the recommended dose is 3 mg/kg every two weeks or 6 mg/kg every four weeks.The most common adverse reactions (reported in at least 20 percent of patients) included fatigue, musculoskeletal pain, rash, diarrhea, and pruritis.Approval of nivolumab was granted to Bristol Myers Squibb.

Approval granted for patients aged 12 years and older with stage IIB/C disease

FDA Approves Nivolumab as Adjuvant Treatment for Melanoma

WEDNESDAY, Oct. 18, 2023 -- The global melanoma incidence in 2020 was 324,635, resulting in 57,043 deaths, while nonmelanoma skin cancer (NMSC) led to 63,731 deaths, according to a study presented at the annual meeting of the European Academy of Dermatology and Venereology, held from Oct. 11 to 14 in Berlin.Samir Salah, from Laboratoire Dermatologique La Roche-Posay in Levallois Perret, France, and colleagues conducted an epidemiological analysis of skin cancer using World Health Organization International Agency for Research on Cancer data.The researchers found that global melanoma incidence was 324,635 in 2020, resulting in 57,043 deaths. Europe bore the heaviest burden (150,000 cases and 26,360 deaths), while Africa had the highest mortality-to-incidence ratio (0.25 versus 0.026 for Europe). Despite the lower mortality likelihood, NMSC led to 63,731 deaths in 2020 due to a significantly higher incidence; there were 11,281 deaths in Africa. There was wide variation seen in dermatologist densities among 59 countries with data (0.33 per 100,000 in Pakistan to 15.15 in Greece), with no linear correlation to wealth or melanoma incidence noted. Countries with fair-skinned and elderly populations had high skin cancer incidence, including the United States, Germany, and the United Kingdom. Higher mortality-to-incidence ratios were seen in countries with low dermatologist density (India, China, Turkey, Korea, and Morocco), while high ratios were seen in Japan, Russia, and Argentina, despite high dermatologist density."We have to get the message out that not only melanoma can be fatal, but NMSC also," coauthor Thierry Passeron, M.D., Ph.D., from the Nice University Hospital Center in France, said in a statement. "It's crucial to note that individuals with melanin rich skin are also at risk and are dying from skin cancer."This work was conducted by the L'Oréal Dermatological Beauty Corporate and Social Responsibility team, in conjunction with La Roche-Posay experts.

Global melanoma incidence was 324,635 in 2020, resulting in 57,043 deaths, while 63,731 NMSC deaths were reported

Is Nonmelanoma Skin Cancer Causing More Deaths Than Melanoma?

WEDNESDAY, Oct. 18, 2023 -- Extensive perineural invasion (ePNI) seems to be the best prognostic measure for cutaneous squamous cell carcinoma (CSCC), according to a study published online Oct. 18 in JAMA Dermatology.Paul R. Massey, M.D., M.P.H., from the Cheyenne Skin Clinic in Wyoming, and colleagues compared four assessments of PNI (nerve caliber, number of involved nerves per section, PNI maximal depth, and PNI location) with respect to tumor in patients with primary, localized, invasive CSCC in a retrospective cohort study performed at a single tertiary care institution. Data were included for 140 patients with CSCC.The researchers found that only involvement of multiple nerves was associated with poor outcomes. Independent associations were seen for PNI of five or more distinct nerves (ePNI) with local recurrence, disease-specific death, and any poor outcome (subhazard ratios, 13.83, 6.20, 10.21, respectively). Compared with current Brigham and Women's Hospital (BWH) staging criteria that use nerve caliber as the measure of PNI, a revised BWH staging system with substitution of ePNI for large-caliber PNI resulted in improved area under the curve and test characteristics."Although these findings require further validation in other cohorts, inclusion of ePNI as a high-risk factor in CSCC staging may optimize recurrence risk assessment and patient selection for surgical treatment modality and postoperative adjuvant interventions," the authors write.One author disclosed ties to the pharmaceutical industry.

Perineural invasion of five or more nerves independently linked to local recurrence, disease-specific death, any poor outcome

Is Extensive Perineural Invasion Best Prognostic Measure for Cutaneous Squamous Cell Carcinoma?

WEDNESDAY, Sept. 27, 2023 -- Clinical and dermatoscopic examination combined with optical coherence tomography (CDE-OCT) has higher ability to detect recurrent/residual basal cell carcinoma (BCC) than CDE alone after topical treatment, according to a study published in the October issue of the Journal of the American Academy of Dermatology.Tom Wolswijk, M.D., from Maastricht University Medical Center in the Netherlands, and colleagues compared the diagnostic accuracy of CDE to that of CDE-OCT for detecting recurrent/residual BCC after topical treatment of superficial BCC in 100 patients. The suspicion level for recurrence or residue was recorded on a 5-point confidence scale. Patients with high suspicion were referred for punch biopsy, while those with low suspicion were asked to undergo a control biopsy. Verification of CDE and CDE-OCT diagnoses was based on histopathological results of the biopsy.A histopathological recurrent/residual BCC was detected in 20 patients. The researchers found that sensitivity for recurrence or residue detection was 100 and 60 percent, respectively, for CDE-OCT and CDE, and specificity was 95 and 96.3 percent, respectively. The area under the curve was 0.98 and 0.77 for CDE-OCT and CDE, respectively."Use of CDE-OCT at the follow-up appointment after topical treatment may result in the detection of subclinical recurrences or residues," the authors write. "Early detection of recurrent or residual BCC may prevent tumor progression and may prevent additional follow-up appointments if no recurrence or residue is seen."

Area under curve 0.98 for clinical and dermatoscopic examination combined with OCT and 0.77 for clinical and dermatoscopic examination alone

Does Adding Optical Coherence Tomography Increase Detection of Recurrent, Residual BCC?

FRIDAY, Aug. 18, 2023 (HealthDay News) -- Since 1996, there has been an increase in the percentage of women in Mohs micrographic surgery (MMS) fellowships and program directors (PDs), according to a research letter published online Aug. 9 in JAMA Dermatology.Sophie Gart, from the University of Nebraska Medical Center College of Medicine in Omaha, and colleagues examined trends in the percentage of women comprising MMS matriculants and PDs using self-reported gender data from Accreditation Council for Graduate Medical Education (ACGME)-registered dermatology residents and fellows from 1996 to 2021. In addition, MMS PDs' and fellows' genders were retrieved from the American College of Mohs Surgery (ACMS) for 1996 to 2022.The researchers found that female representation within all groups increased over time. The total number of MMS ACMS fellows increased from 29 in 1996 to 84 in 2021; the percentage of female fellows increased from 24 to 42 percent. Female MMS ACGME fellows increased from 20 in 2004 to 78 in 2021, and female MMS PDs increased from 30 to 83. The percentage of female PDs increased from 3 to 28 percent during the study period. Within all groups, there was a significant positive trend observed between the percentage of female representation and year."This study shows the significant demographic shift for women in MMS fellowship and PD roles," the authors write. "The increase in percentage of female PDs is particularly encouraging, as having females in leadership positions positively correlates with more females in faculty positions."One author disclosed receiving grants from Castle Biosciences.

Significant positive trend seen between percentage of female representation and year since 1996

Percentage of Women Mohs Fellows, Program Directors Has Increased

WEDNESDAY, Aug. 9, 2023 (HealthDay News) -- Incorporating human preferences into an image-based diagnostic algorithm can improve artificial intelligence (AI)-based decision support, according to a study published online July 27 in Nature Medicine.Catarina Barata, Ph.D., from the Instituto Superior Técnico in Lisbon, Portugal, and colleagues examined whether human preferences can improve diagnostic AI-based decision support using the example of skin cancer diagnosis. Nonuniform rewards and penalties based on expert-generated tables were utilized, balancing the benefits and harms of diagnostic errors; these were applied using reinforcement learning to find a strategy that maximized cumulative rewards while considering both clinician and patient preferences.The researchers found that the reinforcement learning model improved the sensitivity for melanoma from 61.4 to 79.5 percent and for basal cell carcinoma from 79.4 to 87.1 percent compared with supervised learning. There was a reduction noted in AI overconfidence, while accuracy was maintained. The rate of correct diagnoses made by dermatologists increased by 12.0 percent with reinforcement learning; the rate of optimal management decisions increased from 57.4 to 65.3 percent."The AI learned to take into account not only image-based features, but also consequences of misdiagnosis in the assessment of benign and malignant skin manifestations," lead author Harald Kittler, M.D., from the Medical University of Vienna, said in a statement. "This, in turn, helps physicians make more accurate decisions tailored to individual patients in complex medical scenarios."Several authors disclosed financial ties to medical technology companies.

Correct diagnoses made by dermatologists increased with reinforcement learning, incorporating human preferences into AI model

Reinforced Learning Model Can Improve Sensitivity of Skin Cancer Diagnosis

WEDNESDAY, Aug. 2, 2023 -- For patients with nonfacial basal cell carcinomas (BCCs), curettage and cryosurgery with standardized protocols provide excellent clinical clearance rates with one and two freeze-thaw cycles, according to a research letter published online June 8 in the Journal of the American Academy of Dermatology.Eva Backman, M.D., from the University of Gothenburg in Sweden, and colleagues compared clearance rates after one year for curettage and cryosurgery in one (C&amp;Cx1) versus two free-thaw cycles (C&amp;Cx2) for nonfacial BCCs with clinically nodular features. Curettage with a 4-mm or 7-mm curette was followed by cryosurgery with an open-cone spray technique, aiming for a halo thaw time of ≥60 seconds. The second freeze was performed after complete thawing of the lesion in lesions randomly assigned to C&amp;Cx2. The analysis included 202 lesions in 116 patients.The researchers identified a single recurrence in the C&amp;Cx1 group at one year, resulting in clearance rates of 99 versus 100 percent, proving noninferiority with an absolute difference of &lt;8 percent. For oozing wounds, the mean time was 1.0 and 1.2 weeks for C&amp;Cx1 and C&amp;Cx2. Overall, 71 percent of the wounds still had crusts, 13 percent still had oozing, and 11 percent were completely healed at four to six weeks, with no significant differences noted between the groups. The only relevant factor that significantly increased wound healing times was larger lesion size. After one year, 105, one, and four patients reported satisfaction with their scars, were unsatisfied, and felt neutral, respectively."This investigation increases the evidence for curettage plus cryosurgery, a low-cost and time-saving treatment for BCCs with nodular features," the authors write.

Curettage and cryosurgery provide excellent clinical clearance rates with one and two free-thaw cycles in nonfacial basal cell carcinomas

Do Curettage and Cryosurgery Provide Clearance for Basal Cell Carcinomas?

WEDNESDAY, July 19, 2023 -- Organ transplant recipients (OTRs) with cutaneous squamous cell carcinoma (cSCC) have increased rates of second cSCC, metastasis, and death from cSCC, according to a study published online July 19 in JAMA Dermatology.Petter Gjersvik, M.D., Ph.D., from the University of Oslo in Norway, and colleagues examined the rates of second cSCC, metastasis, and death from cSCC in patients with and without organ transplant-associated immunosuppressive treatment in a population-based nationwide cohort study involving 47,992 individuals diagnosed with cSCC at age 18 years or older. Data were included for 1,208 OTRs and 46,784 non-OTRs.The researchers found that the rate of a second cSCC was 30.9 and 250.6 per 1,000 person-years in non-OTRs and OTRs, respectively, with a 4.3-fold increased rate for OTRs in the adjusted analysis. Per 1,000 person-years, the metastasis rate was 2.8 and 4.8 in non-OTRs and OTRs, respectively, with a 1.5-fold increased rate for OTRs in the adjusted analysis. There were 30,451 deaths reported; 98.2 percent were from causes other than cSCC. Death from cSCC was seen in 1.1 and 3.3 percent of non-OTRs and OTRs, respectively. The rate of death from cSCC was 1.7 and 5.4 per 1,000 person-years in non-OTRs and OTRs, respectively, with a 5.5-fold increased rate among OTRs in the adjusted analysis."These findings have implications for the clinical follow-up of individual patients and for skin cancer care policies," the authors write.

Transplant recipients have increased rates of second cutaneous squamous cell carcinoma, metastasis, death from cutaneous squamous cell carcinoma

 Do Organ Transplant Recipients With cSCC Have Worse Outcomes?

WEDNESDAY, July 5, 2023 -- The perceived risk of opioid addiction affects patients' choice of pain medications after Mohs surgery, with patients favoring over-the-counter medications (OTCs) if the opioid addiction risk profile was high, according to a study published online July 5 in JAMA Dermatology.Shannon T. Nugent, M.D., from the Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, and colleagues examined patient preferences for pain management with only OTCs or OTCs plus opioids among patients undergoing Mohs surgery in a prospective discrete choice experiment.The researchers found that of the 295 respondents, 34 percent stated that they would never consider opioids for pain management, regardless of the level of pain experienced; 50 percent expressed concern regarding possible opioid addiction. Overall, 76 percent of respondents preferred only OTCs versus OTCs plus opioids for pain control across all scenarios. Given pain levels of 6.5 on a 10-point scale, half of the respondents expressed a preference for OTCs plus opioids when the theoretical risk of addiction was low (0 percent). At higher opioid addiction risk profiles (2, 6, and 12 percent), the preference for OTCs plus opioids and only OTCs was not equal; patients favored only OTCs despite experiencing high levels of pain in these scenarios."These findings may spur research investigating the risk of long-term opioid use after Mohs micrographic surgery and provide a framework for Mohs surgeons to engage in shared decision-making discussions with patients moving forward," the authors write.One author disclosed ties to Regeneron.

Half of patients with pain level of 6.5 of 10 expressed preference for OTCs plus opioids when theoretical risk of addiction was low

Does Addiction Risk Affect Patient Choice of Pain Meds After Mohs Surgery?

WEDNESDAY, June 14, 2023 -- Squamous cell carcinomas (SCCs) in organ transplant recipients (OTRs) have worse prognostic features than SCCs in the general population, according to a study published online June 14 in JAMA Dermatology.Nirmala Pandeya, Ph.D., from the QIMR Berghofer Medical Research Institute in Brisbane, Australia, and colleagues examined the extent to which major high-risk features of SCC in OTRs differ from SCCs in the general population in a dual-cohort study, which included one cohort of OTRs at high risk for skin cancer (Skin Tumours in Allograft Recipients study) and a population-based cohort (QSkin Sun and Health Study). A total of 741 SCCs excised from 191 OTRs and 2,558 SCCs from 1,507 persons in the general population were included.The researchers found that in OTRs, the SCCs developed most frequently on the head/neck (38.6 percent), while in the general population, they developed most frequently on arms/hands (35.2 percent). Perineural invasion was more than twice as common in OTRs as in population cases after adjusting for age and sex (prevalence ratio, 2.37), as was invasion to/beyond subcutaneous fat (prevalence ratio, 2.37). OTRs had more than a threefold increased prevalence of poorly versus well-differentiated SCCs (prevalence ratio, 3.45), while the prevalence of tumors &gt;20 mm versus ≤20 mm was moderately higher in OTRs (prevalence ratio, 1.52)."This finding, along with the greater multiplicity of SCCs in OTRs, warrants intensive surveillance of affected OTRs optimally with multidisciplinary specialist care, at the same time recognizing that all SCCs with high-risk features warrant intensive therapy and follow-up," the authors write.Several authors disclosed ties to industry; one author holds a patent.

Organ transplant recipients have increased prevalence of poorly versus well-differentiated SCCs, and of tumors >20 mm versus ≤20 mm

Do SCCs Have Worse Prognostic Features in Organ Transplant Recipients?

WEDNESDAY, May 24, 2023 (HealthDay News) -- For patients undergoing skin cancer surgery, microdosed incisional clindamycin reduces the rate of surgical site infections (SSIs), according to a study published online May 24 in JAMA Surgery.Maple Goh, M.B.Ch.B., from the University of Auckland in New Zealand, and colleagues conducted a randomized controlled trial to examine whether microdosed incisional antibiotics reduce the rate of SSIs among adult patients undergoing any form of skin cancer surgery. Patients received an incision site injection of buffered local anesthetic alone (control) or buffered local anesthetic with microdosed flucloxacillin (500 μg/mL) or microdosed clindamycin (500 μg/mL). A total of 681 patients returned for postoperative assessments (721 presentations and 1,133 total lesions).The researchers found that the proportion of lesions exhibiting a postoperative wound infection score of 5 or greater was 5.7, 5.3, and 2.1 percent in the control, flucloxacillin, and clindamycin arms, respectively. After adjustment for baseline differences among the arms, the results were similar. Significantly fewer lesions in the clindamycin and flucloxacillin arms required postoperative systemic antibiotics compared with lesions in the control arm (2.1 and 4.0 percent, respectively, versus 8.0 percent)."These results establish evidence-based guidelines for antibiotic prophylaxis in one of the most common surgical interventions performed worldwide, where they have been previously absent," the authors write.

Significantly fewer lesions receiving microdosed clindamycin, flucloxacillin required postoperative systemic antibiotics

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