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Background: Checkpoint inhibitors provide an effective approach for the melanoma treatment. They prolong lymphocyte effects, which explains the cytotoxicity underlying immune‐related adverse events (IrAEs). Cutaneous IrAEs affect nearly 40% of PD‐1i and 50% of CTLA4i‐treated patients. Severe cutaneous irAE do not often occur but could be life‐threatening and may persist despite treatment discontinuation. Methods: We aimed to investigate cutaneous IrAEs in a cohort of patients treated with ICI across Europe in an effort to characterize the reactions in a real‐world, phase IV, post‐marketing study using a follow‐up questionnaire. Data since November 2016 until March 2021 were obtained from the Melskintox database, a European multicentric biobank dedicated to the follow‐up of melanoma and cutaneous adverse events, supported by EADO. The dermatoses reported were pooled into four categories: inflammatory dermatosis, bullous diseases, drug‐related eruptions and pigmentary diseases. Results: Inflammatory benign dermatoses (n = 63) represented the most common group of reactions (52.5%), followed by drug‐related eruptions (n = 24, 20%), pigmentary diseases (n = 23, 19.2%) and bullous diseases (n = 10, 8.3%). Grade II (n = 41, 34.2%) are represented by bullous pemphigoid, eczema, hypodermitis, lichenoid eruption, maculopapular rash, pruritus, psoriasis‐like rash, urticarial eruption and vitiligo. Grade III (n = 18, 15.0%) are represented by bullous pemphigoid, lichenoid eruption and rashes. Grade IV (n = 2, 1.7%) is only represented by bullous disease. Most cutaneous IrAEs led to immunotherapy continuation (n = 95, 88.0%). CR is associated with more severe the cutaneous irAEs. We report an average time‐to‐onset of 208 days and some late‐onset events. Conclusion: Our study has characterized the clinical spectrum of cutaneous irAEs, their timing and severity and their relationship with tumour response. Grade I–II cutaneous IrAE are easily managed allowing ongoing anticancer treatment. Severe late‐onset cutaneous irAE are not uncommon. A dermatological follow‐up helps mitigate the risk of life‐threatening adverse events. These findings highlight the importance of oncodermatological involvement in management of patients with melanoma receiving immunotherapy. [ABSTRACT FROM AUTHOR]

Background: There are currently no published population‐based data on prurigo and pruritus epidemiology in Germany. Objectives: We present the prevalence, incidence and comorbidity frequency of prurigo and pruritus in Germany. Methods: This was a retrospective healthcare research study based on anonymized routine data from the German health insurance company DAK‐Gesundheit. Evaluations were carried out for 2 006 003 adults who were insured as of 31 December 2010. Prurigo and pruritus diagnoses were based on International Classification of Diseases, Tenth Revision, German Modification (ICD‐10‐GM) codes. Results: Prevalence was determined to be 0.21% (adjusted for sex and age 0.19%) for prurigo and 2.21% (adjusted 2.14%) for pruritus in 2010. The adjusted rates extrapolated to the total German population in 2010 show that 130 685 adults would have received a prurigo diagnosis and 1 461 024 a diagnosis of pruritus. In 2011, incidence of new prurigo and pruritus cases was 0.13% (adjusted 0.12%, extrapolated 77 263 cases) and 1.51% (adjusted 1.46%, extrapolated 978 885), respectively. Adults with prurigo suffered most frequently from hypertension (35.16%), hyperlipidaemia (24.95%) and depression (21.97%); all were reported more frequently in patients with prurigo compared with the general population (P < 0.001). Similarly, adults with pruritus suffered most frequently from hypertension (31.28%), hyperlipidaemia (23.52%) and depression (18.91%) compared with patients without pruritus (P < 0.001). Conclusions: Our data show that prurigo is a relatively rare but significant disease and that pruritus is frequent and very variable in appearance, and both have a high comorbidity burden. [ABSTRACT FROM AUTHOR]

Background: No simple staging system has emerged for basal cell carcinomas (BCCs), since they do not follow the TNM process, and practitioners failed to agree on simple clinical or pathological criteria as a basis for a classification. Operational classification of BCCs is required for decision‐making, trials and guidelines. Unsupervised clustering of real cases of difficult‐to‐treat BCCs (DTT‐BCCs; part 1) has demonstrated that experts could blindly agree on a five groups classification of DTT‐BCCs based on five patterns of clinical situations. Objective: Using this five patterns to generate an operational and comprehensive classification of BCCs. Method: Testing practitioner's agreement, when using the five patterns classification to ensure that it is robust enough to be used in the practice. Generating the first version of a staging system of BCCs based on pattern recognition. Results: Sixty‐two physicians, including 48 practitioners and the 14 experts who participated in the generation of the five different patterns of DTT‐BCCs, agreed on 90% of cases when classifying 199 DTT‐BCCs cases using the five patterns classification (part 1) attesting that this classification is understandable and usable in practice. In order to cover the whole field of BCCs, these five groups of DTT‐BCCs were added a group representing the huge number of easy‐to‐treat BCCs, for which sub‐classification has little interest, and a group of very rare metastatic cases, resulting in a four‐stage and seven‐substage staging system of BCCs. Conclusion: A practical classification adapted to the specificities of BCCs is proposed. It is the first tumour classification based on pattern recognition of clinical situations, which proves to be consistent and usable. This EADO staging system version 1 will be improved step by step and tested as a decision tool and a prognostic instrument. [ABSTRACT FROM AUTHOR]

Background Objective Method Results Conclusion There is currently no staging system for cutaneous squamous cell carcinoma (cSCC) that is adapted to decision‐making and universally used. Experts have unconscious ability to simplify the heterogeneity of clinical situations into a few relevant groups to drive their therapeutic decisions. Therefore, we have used unsupervised clustering of real cases by experts to generate an operational classification of cSCCs, an approach that was successful for basal cell carcinomas.To generate a consensual and operational classification of cSCCs.Unsupervised independent clustering of 248 cases of cSCCs considered difficult‐to‐treat. Eighteen international experts from different specialties classified these cases into what they considered homogeneous clusters useful for management, each with freedom regarding clustering criteria. Convergences and divergences between clustering were analysed using a similarity matrix, the K‐mean approach and the average silhouette method. Mathematical modelling was used to look for the best consensual clustering. The operability of the derived classification was validated on 23 new practitioners.Despite the high heterogeneity of the clinical cases, a mathematical consensus was observed. It was best represented by a partition into five clusters, which appeared a posteriori to describe different clinical scenarios. Applicability of this classification was shown by a good concordance (94%) in the allocation of cases between the new practitioners and the 18 experts. An additional group of easy‐to‐treat cSCC was included, resulting in a six‐group final classification: easy‐to‐treat/complex to treat due to tumour and/or patient characteristics/multiple/locally advanced/regional disease/visceral metastases.Given the methodology based on the convergence of unguided intuitive clustering of cases by experts, this new classification is relevant for clinical practice. It does not compete with staging systems, but they may complement each other, whether the objective is to select the best therapeutic approach in tumour boards or to design homogeneous groups for trials. [ABSTRACT FROM AUTHOR]

Delayed melanoma diagnosis in the COVID-19 era: increased breslow thickness in primary melanomas seen after the COVID-19 lockdown. In the pre-COVID era, it was reported that even patients diagnosed with melanoma did not perform skin self-examination (SSE) on a regular basis.11 During the COVID-19 pandemic, more patients may be inclined to perform SSE and to have fewer follow-up clinic visits. The impact of the COVID-19 pandemic on diagnostic delay of skin cancer: a call to restart screening activities. [Extracted from the article]

Background: Comprehensive skin cancer screening was introduced in Germany in 2008. It is unclear whether subsequently observed changes in the epidemiology of malignant melanoma (MM), squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) are due to the screening. Simulation models are used to compare different screening scenarios with each other and with observed incidence and mortality trends., Methods: A microsimulation model for MM, SCC, and BCC was programmed and validated separately by sex on skin cancer-specific mortality data. In addition to the currently practiced screening (biennial offer, annual participation probability 15%), triennial screening, screening with increased participation, e.g., via invitation, and no screening were simulated. Incidence, mortality, costs, and life-years gained were simulated for 30 years from the start of screening., Results: Compared with no screening, mortality is reduced by 13.8% in the simulation with current conditions. This effect occurs in the first years after screening starts before reaching a stable level. More screening allows for further increases in incidence, life-years gained, and costs and decreases in mortality. Comparing simulated and observed effects shows little agreement., Conclusions: The model is useful for comparing screening scenarios to identify potential optimization opportunities in SCS. Additional, especially risk-adapted, screening scenarios should be investigated., (© 2024 The Author(s). Journal der Deutschen Dermatologischen Gesellschaft published by John Wiley & Sons Ltd on behalf of Deutsche Dermatologische Gesellschaft.)

Immune checkpoint inhibitors (ICI) have significantly improved overall survival in melanoma patients. However, 60% experience severe adverse events and early response markers are lacking. Circulating tumour DNA (ctDNA) is a promising biomarker for treatment-response and recurrence detection. The prospective PET/LIT study included 104 patients with palliative combined or adjuvant ICI. Tumour-informed sequencing panels to monitor 30 patient-specific variants were designed and 321 liquid biopsies of 87 patients sequenced. Mean sequencing depth after deduplication using UMIs was 6000x and the error rate of UMI-corrected reads was 2.47×10 -4 . Variant allele fractions correlated with PET/CT MTV (rho=0.69), S100 (rho=0.72), and LDH (rho=0.54). A decrease of allele fractions between T1 and T2 was associated with improved PFS and OS in the palliative cohort (p = 0.008 and p < 0.001). ctDNA was detected in 76.9% of adjuvant patients with relapse (n = 10/13), while all patients without progression (n = 9) remained ctDNA negative. Tumour-informed liquid biopsies are a reliable tool for monitoring treatment response and early relapse in melanoma patients with ICI., (© 2024. The Author(s).)

One in every three cancers diagnosed is a skin cancer. Europe has the global lead in the number of UV-attributable cancer cases with the highest number of melanoma cases worldwide and the second highest number of keratinocyte cancers (KC). Further increases are expected in Europe for the coming decades. Projected increases are highest for KC with increases in incidence around 40% and increases in mortality around 50%, with KC mortality in males approximating melanoma mortality in females. The two main drivers for this skin cancer epidemic are ageing of the population but especially UV exposure. In conclusion, skin cancer represents a major challenge in the cancer field in Europe today and will continue to do so in the coming decades. This calls for a European skin cancer action plan intended to reduce avoidable UV exposure and to prepare the healthcare system to safeguard early diagnosis and treatment of skin cancer., (© 2024 European Academy of Dermatology and Venereology.)

Current treatment outcome of patients with glioblastoma (GBM) remains poor. Following standard therapy, recurrence is universal with limited survival. Tumors from 173 GBM patients are analysed for somatic mutations to generate a personalized peptide vaccine targeting tumor-specific neoantigens. All patients were treated within the scope of an individual healing attempt. Among all vaccinated patients, including 70 treated prior to progression (primary) and 103 treated after progression (recurrent), the median overall survival from first diagnosis is 31.9 months (95% CI: 25.0-36.5). Adverse events are infrequent and are predominantly grade 1 or 2. A vaccine-induced immune response to at least one of the vaccinated peptides is detected in blood samples of 87 of 97 (90%) monitored patients. Vaccine-specific T-cell responses are durable in most patients. Significantly prolonged survival is observed for patients with multiple vaccine-induced T-cell responses (53 months) compared to those with no/low induced responses (27 months; P = 0.03). Altogether, our results highlight that the application of personalized neoantigen-targeting peptide vaccine is feasible and represents a promising potential treatment option for GBM patients., (© 2024. The Author(s).)

Cancers of the skin are the most commonly occurring cancers in humans. In fair-skinned populations, up to 95% of keratinocyte skin cancers and 70-95% of cutaneous melanomas are caused by ultraviolet radiation and are thus theoretically preventable. Currently, however, there is no comprehensive global advice on practical steps to be taken to reduce the toll of skin cancer. To address this gap, an expert working group comprising clinicians and researchers from Africa, America, Asia, Australia, and Europe, together with learned societies (European Association of Dermato-Oncology, Euromelanoma, Euroskin, European Union of Medical Specialists, and the Melanoma World Society) reviewed the extant evidence and issued the following evidence-based recommendations for photoprotection as a strategy to prevent skin cancer. Fair skinned people, especially children, should minimise their exposure to ultraviolet radiation, and are advised to use protective measures when the UV index is forecast to reach 3 or higher. Protective measures include a combination of seeking shade, physical protection (e.g. clothing, hat, sunglasses), and applying broad-spectrum, SPF 30 + sunscreens to uncovered skin. Intentional exposure to solar ultraviolet radiation for the purpose of sunbathing and tanning is considered an unhealthy behaviour and should be avoided. Similarly, use of solaria and other artificial sources of ultraviolet radiation to encourage tanning should be strongly discouraged, through regulation if necessary. Primary prevention of skin cancer has a positive return on investment. We encourage policymakers to communicate these messages to the general public and promote their wider implementation., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests., (Copyright © 2024. Published by Elsevier Ltd.)

Background: Treatment with encorafenib plus binimetinib and encorafenib monotherapy is associated with improved progression-free survival (PFS) and overall survival (OS) compared with vemurafenib in patients with BRAF V600E/K-mutant metastatic melanoma. We report results from the 7-year analysis of COLUMBUS part 1 (NCT01909453) at 99.7 months (median duration between randomization and data cutoff)., Methods: 577 patients with locally advanced unresectable or metastatic BRAF V600E/K-mutant melanoma who were treatment-naive or progressed after first-line immunotherapy were randomized 1:1:1 to encorafenib 450 mg once daily (QD) plus binimetinib 45 mg twice daily (BID) (n = 192), vemurafenib 960 mg BID (n = 191), or encorafenib monotherapy 300 mg QD (n = 194). No prior BRAF/MEK inhibitor was allowed., Results: Seven-year PFS and OS rates (95 % CI) were 21.2 % (14.7-28.4 %) and 27.4 % (21.2-33.9%) in the encorafenib plus binimetinib arm and 6.4 % (2.1-14.0 %) and 18.2 % (12.8-24.3 %) in the vemurafenib arm, respectively. Median melanoma-specific survival (95 % CI) was 36.8 months (27.7-51.5 months) in the encorafenib plus binimetinib arm and 19.3 months (14.8-25.9 months) in the vemurafenib arm. Thirty-four long-term responders (complete/partial response ongoing at 7 years) were identified across arms., Conclusions: This is the longest follow-up from a phase III trial of BRAF/MEK inhibitor combination in BRAF V600E/K-mutant metastatic melanoma. Safety results were consistent with the known tolerability profile of encorafenib plus binimetinib. Results support the long-term efficacy and known safety of encorafenib plus binimetinib in this population and provide new insights on long-term responders. Interactive data visualization is available at the COLUMBUS dashboard (https://clinical-trials.dimensions.ai/columbus7/)., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dirk Schadendorf. Honoraria: Roche/Genentech, Novartis, Bristol Myers Squibb, MSD, Immunocore, Merck Serono, Array BioPharma, Pfizer, Pierre Fabre, Philogen, Regeneron, 4SC, Sanofi/Regeneron, NeraCare GmbH, Sun Pharma, Inflarx GmbH, Ultimovacs, Sandoz, Amgen, Daiichi Sankyo Japan, LabCorp, Nektar, Replimune. Consulting or Advisory Role: Roche/Genentech, Novartis, Bristol Myers Squibb, MSD, Merck Serono, 4SC, Pierre Fabre, Sanofi/Regeneron, Nektar. Speakers’ Bureau: Bristol Myers Squibb, MSD, Novartis, Pierre Fabre, Sanofi/Regeneron, Merck KGaA. Research Funding: Bristol Myers Squibb (Inst), Novartis (Inst), Roche (Inst), MSD Oncology (Inst), Array BioPharma/Pfizer (Inst), Amgen (Inst). Travel, Accommodations, Expenses: Roche/Genentech, Bristol Myers Squibb, Merck Serono, Novartis, MSD, Pierre Fabre, Sanofi/Regeneron. Reinhard Dummer. Honoraria: Roche, Novartis, Bristol Myers Squibb, MSD, Amgen, Takeda, Pierre Fabre, Sun Pharma, Sanofi, CatalYm, Second Genome, Regeneron, Alligator Bioscience, MaxiVAX, touchIME, T3 Pharmaceuticals, Pfizer. Consulting or Advisory Role: Roche, Bristol Myers Squibb, MSD, Novartis, Amgen, Takeda, Pierre Fabre, Sun Pharma, Sanofi, CatalYm, Second Genome, Alligator Bioscience, touchIME, MaxiVAX, Regeneron, Pfizer, T3 Pharmaceuticals. Research Funding: Roche (Inst), Bristol Myers Squibb (Inst), Novartis (Inst), MSD (Inst), Amgen (Inst). Keith T. Flaherty. Stock and Other Ownership Interests: Clovis Oncology, Loxo, X4 Pharma, Strata Oncology, PIC Therapeutics, Apricity Health, Oncoceutics, FogPharma, Tvardi Therapeutics, Checkmate Pharmaceuticals, Kinnate Biopharma, Scorpion Therapeutics, ALX Oncology, xCures, Monopteros Therapeutics, Vibliome Therapeutics, Transcode Therapeutics, Soley Therapeutics, Nextech Invest. Consulting or Advisory Role: Novartis, Lilly, Oncoceutics, Tvardi Therapeutics, Takeda, Debiopharm Group. Caroline Robert. Stock and Other Ownership Interests: Ribonexus. Consulting or Advisory Role: Bristol Myers Squibb, Roche, Novartis, Pierre Fabre, MSD, Sanofi, AstraZeneca, Pfizer. Research Funding: Novartis (Inst). Ana Arance. Consulting or Advisory Role: Bristol Myers Squibb, Roche, Novartis, Pierre Fabre, MSD, Merck, Sanofi. Speakers’ Bureau: Pierre Fabre, Novartis, MSD, Bristol Myers Squibb, Roche, Merck, Sanofi Research Funding: Pierre Fabre (Inst), Novartis (Inst), Roche (Inst), Bristol Myers Squibb (Inst), MSD (Inst), Merck (Inst), Sanofi (Inst). Travel, Accommodations, Expenses: Bristol Myers Squibb, MSD, Novartis, Pierre Fabre. Jan Willem B. de Groot. Consulting or Advisory Role: Bristol Myers Squibb, Pierre Fabre, Servier. Claus Garbe. Honoraria: CeCaVa, MSD Oncology, NeraCare GmbH, Philogen. Consulting or Advisory Role: CeCaVa, MSD Oncology, NeraCare GmbH, Philogen. Helen J. Gogas. Consulting or Advisory Role: Bristol Myers Squibb, MSD, Pierre Fabre, Sanofi. Speakers’ Bureau: Bristol Myers Squibb, MSD, Novartis, Pierre Fabre, Sanofi. Steering Committee Member: Amgen, Replimune. Research Funding: Amgen (Inst), Bayer (Inst), Bristol Myers Squibb (Inst), Iovance (Inst), Lilly (Inst), MSD (Inst), Pfizer (Inst), Pierre Fabre (Inst). Ralf Gutzmer. Honoraria: Bristol Myers Squibb, Merck Sharp & Dohme, Novartis, Merck Serono, Almirall Hermal GmbH, Amgen, Sun Pharma, Pierre Fabre, Sanofi/Regeneron, Immunocore. Consulting or Advisory Role: Bristol Myers Squibb, Merck Sharp & Dohme, Novartis, Almirall Hermal GmbH, 4SC, Amgen, Pierre Fabre, Merck Serono, Sun Pharma, Sanofi/Regeneron, Immunocore, Delcath. Research Funding: Amgen (Inst), Merck Serono (Inst), Sun Pharma (Inst), Sanofi/Regeneron (Inst), Kyowa Kirin (Inst), Almirall Hermal GmbH (Inst). Travel, Accommodations, Expenses: Pierre Fabre, Sun Pharma, Boehringer Ingelheim. Ivana Krajsová. No disclosures or conflicts of interest to report. Gabriella Liszkay. Consulting or Advisory Role: Roche, MSD, Novartis, Bristol Myers Squibb/Pfizer, Sanofi, Pfizer. Speakers’ Bureau: Bristol Myers Squibb, MSD Oncology (Inst), Sanofi. Research Funding: Roche, Novartis (Inst), Incyte Corporation (Inst). Carmen Loquai. Consulting or Advisory Role: Bristol Myers Squibb (Inst), MSD (Inst), BioNTech (Inst), Novartis (Inst), Sanofi (Inst), Pierre Fabre (Inst), Almirall Hermal GmbH (Inst), Sun Pharma (Inst), Merck (Inst), Roche (Inst), Kyowa Kirin International (Inst). Travel, Accommodations, Expenses: Bristol Myers Squibb (Inst), MSD (Inst), BioNTech (Inst), Novartis (Inst), Sanofi (Inst), Pierre Fabre (Inst), Almirall Hermal GmbH (Inst), Sun Pharma (Inst), Merck (Inst), Roche (Inst), Kyowa Kirin International (Inst). Mario Mandalà. Honoraria: MSD Oncology, Novartis, Pierre Fabre, Sanofi/Aventis, Bristol Myers Squibb/Sanofi. Consulting or Advisory Role: Bristol Myers Squibb, MSD Oncology, Novartis, Pierre Fabre. Research Funding: Novartis (Inst). Naoya Yamazaki. Consulting or Advisory Role: Ono Pharmaceutical, Chugai Pharma, MSD. Speakers’ Bureau: Ono Pharmaceutical, Bristol Myers Squibb Japan, Novartis, MSD. Research Funding: Ono Pharmaceutical (Inst), Bristol Myers Squibb Japan (Inst), Novartis (Inst), Astellas Amgen BioPharma (Inst), Merck Serono (Inst), Takara Bio (Inst). Paola Queirolo. Consulting or Advisory Role: Pierre Fabre, Roche, Novartis, MSD, Bristol Myers Squibb, Sun Pharma, Sanofi/Regeneron, Merck Serono. Carolin Guenzel. Stock and Other Ownership Interests: Pfizer. Honoraria: Pfizer. Anna Polli. Stock and Other Ownership Interests: Pfizer. Honoraria: Pfizer. Mahgull Thakur. Employment: Formerly Pfizer. Alessandra di Pietro. Stock and Other Ownership Interests: Pfizer. Honoraria: Pfizer. Paolo A. Ascierto. Stock and Other Ownership Interests: PrimeVAX. Consulting or Advisory Role: Bristol Myers Squibb, Roche/Genentech, MSD, Novartis, Array BioPharma, Merck Serono, Pierre Fabre, Incyte, MedImmune, AstraZeneca, Sun Pharma, Sanofi, Idera, Ultimovacs, Sandoz, Immunocore, 4SC, Alkermes, Italfarmaco, Nektar, Boehringer Ingelheim, Eisai, Regeneron, Daiichi Sankyo, Pfizer, OncoSec, Nouscom, Takis Biotech, Lunaphore Technologies, Seagen, ITeos Therapeutics, Medicenna, Bio-Al Health. Research Funding: Bristol Myers Squibb (Inst), Roche/Genentech (Inst), Array BioPharma (Inst), Sanofi (Inst). Travel, Accommodations, Expenses: MSD., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

A collaboration of multidisciplinary experts from the European Association of Dermato-Oncology, the European Dermatology Forum, the European Academy of Dermatology and Venereology, and the European Union of Medical Specialists was formed to develop European recommendations on AK diagnosis and treatment, based on current literature and expert consensus. This guideline addresses the epidemiology, diagnostics, risk stratification and treatments in immunocompetent as well as immunosuppressed patients. Actinic keratoses (AK) are potential precursors of cutaneous squamous cell carcinoma (cSCC) and display typical histopathologic and immunohistochemical features of this malignancy in an early stage. They can develop into cSSC in situ and become invasive in a low percentage of cases. AK is the most frequent neoplasia in white populations, frequently occurring within a cancerous field induced by ultraviolet radiation. Since it cannot be predicted, which lesion will progress to cSCC and when treatment is usually recommended. The diagnosis of AK and field cancerization is made by clinical examination. Dermatoscopy, confocal microscopy, optical coherence tomography or line-field confocal-OCT can help in the differential diagnosis of AK and other skin neoplasms. A biopsy is indicated in clinically and/or dermatoscopically suspicious and/or treatment-refractory lesions. The choice of treatment depends on patients' and lesion characteristics. For single non-hyperkeratotic lesions, the treatment can be started upon patient's request with destructive treatments or topical treatments. For multiple lesions, field cancerization treatment is advised with topical treatments and photodynamic therapy. Preventive measures such as sun protection, self-examination and repeated field cancerization treatments of previously affected skin areas in high-risk patients are advised., (© 2024 European Academy of Dermatology and Venereology.)

Background: Histopathologic regression of cutaneous melanoma is considered a favorable prognostic factor, but its significance in clinical practice remains controversial., Objective: To investigate the prognostic importance of regression in patients with primary cutaneous melanoma undergoing sentinel lymph node (SLN) biopsy and to assess its significance in patients progressing to an unresectable stage requiring systemic therapy., Methods: We retrospectively reviewed patients with newly diagnosed melanoma undergoing SLN biopsy between 2010 and 2015 and available information on histopathologic regression (n = 1179). Survival data and associations of clinical variables with SLN status were assessed., Results: Patients with regressive melanoma showed favorable relapse-free (hazard ratio [HR], 0.52; P = .00013), distant metastasis-free (HR, 0.56; P = .0020), and melanoma-specific survival (HR, 0.35; P = .00053). Regression was associated with negative SLN (odds ratio, 0.48; P = .0077). In patients who progressed to an unresectable stage, regression was associated with favorable progression-free survival under immune checkpoint inhibition (HR, 0.43; P = .031) but not under targeted therapy (HR, 1.14; P = .73) or chemotherapy (HR, 3.65; P = .0095)., Limitations: Retrospective, single-institutional design., Conclusions: Regression of cutaneous melanoma is associated with improved prognosis in patients eligible for SLN biopsy as well as in patients with unresectable disease receiving systemic therapy with immune checkpoint inhibitors., Competing Interests: Conflicts of interest Dr Wagner reports advisory board meetings for Pierre Fabre and honoraria and speaker’s fees from Novartis and Sanofi outside the submitted work. Dr Forschner reports honoraria for presentations from BMS, MSD, Novartis, Pierre Fabre; travel support and congress participation support from BMS, Pierre Fabre, Novartis; advisory board participation for MSD, BMS, Novartis, Pierre Fabre, Immunocore; and institutional funding from BMS and Stiftung Immunonkologie outside the submitted work. Dr Leiter has received consultancy fees from MSD, Novartis, and Roche; has participated in advisory board meetings for MSD, Novartis, Sun Pharma, Almirall Hermal, and Roche; has received honoraria from MSD, Novartis, Sun Pharma, Almirall Hermal, and Roche; and has received travel support from Sun Pharma and Pierre Fabre. Dr Amaral reports institutional grants from SkylineDx, institutional grants and personal fees from Novartis, institutional grants from NeraCare, personal fees from BMS, institutional grants from Sanofi, personal fees from CeCaVa, and personal fees from Pierre Fabre, all outside the submitted work. Dr Amaral serves as the current Chair of the ESMO Fellowship Development Committee and was previously the Chair of the ESMO Young Oncologists Committee. Dr Garbe reports personal fees from CeCaVa, personal fees from MSD, personal fees from NeraCare, and personal fees from Philogen, outside the submitted work. Dr Eigentler reports consultant fees from and an advisory role for Philogen, Bristol-Myers Squibb, Novartis, Roche, and Sanofi. Dr Forchhammer reports personal fees from Kyowa Kirin and Recordati Rare Diseases (speaker’s honoraria) as well as institutional grants from NeraCare, SkylineDx, and BioNTech outside the submitted work. Dr Flatz reports grants from the Swiss National Science Foundation, Swiss Cancer League, Hookipa Pharma, and Novartis Foundation outside the submitted work and an advisory role for Novartis and Bristol-Myers Squibb. Ms Knierim and Drs Luttermann, Metzler, Yazdi, Bauer, and Gassenmaier have no conflicts of interest to declare., (Copyright © 2023 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Melanoma disease patterns vary with patient age., Aim: To evaluate sentinel lymph node biopsy (SLNB) in managing melanoma at differing patient ages., Methods: Online prediction tools were applied to compare SLNB positivity (SLNB + ) and survival risk at patient ages 20-80. Tübingen melanoma data were used to determine variations in the hazard ratio of SLNB + for mortality at different patient ages., Results: Regardless of tumour thickness, predicted SLNB + rates were markedly higher than mortality rates for 20-year-old patients. For 80-year-old patients, it is the opposite., Discussion: If 1000 20-year-olds with a 0.4 mm thickness non-ulcerated melanoma underwent SLNB, 100 would likely be positive. If all 100 were to be offered adjuvant drug therapy (ADT), fewer than three more melanoma deaths in those 1000 patients would be avoided. In total, 97 patients would have received medication they may never have needed. If 1000 80-year-olds with a 3 mm thickness non-ulcerated melanoma underwent SLNB, only 40 would likely be positive. In total, 274 patients would be predicted to die of melanoma, 245 being SLNB negative and 29 SLNB + . ADT linked to SLNB + could deny treatment to 89% of these high-risk patients., Limitations: The authors relied on published risk data., Conclusion: SLNB has poor specificity at predicting mortality in young melanoma patients and poor sensitivity in older patients. SLNB is not indicated in managing cutaneous melanoma for patients under 40 or over 60 years of age. Many such patients could be managed with wide local excision alone in their clinician's office-based practice. For all cutaneous melanoma patients at all ages, linking ADT to BAUSSS biomarker, (an algorithm of Breslow thickness, age, ulceration, subtype, sex and Site) rather than SLNB + is likely more appropriate. BAUSSS provides a more accurate melanoma-specific mortality risk assessment for patients without burdening them with added surgery, hospitalization, costs or morbidity risk., (© 2024 European Academy of Dermatology and Venereology.)