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Background: Comprehensive treatment recommendations for Merkel cell carcinoma are complex. We aimed to systematically review the published data on recurrence and mortality rates associated with various treatment approaches for Merkel cell carcinoma. Methods: Search of MEDLINE, Embase, Web of Science, and Scopus from inception to August 2015. Studies were included that reported comparative survival and recurrence data for two or more treatment modalities. Two reviewers independently reviewed and abstracted recurrence and mortality rates. Event rates for individual treatment arms in each study were pooled and meta‐analyzed across studies using a random‐effects model. Results: Fifty‐two retrospective studies met inclusion criteria, revealing a total of 1,804 patients with primary Merkel cell carcinoma with data available for analyses. The recurrence rate was higher for surgery alone (55.0%) versus a combination of surgery and radiotherapy (39.0%) (odds ratio, 2.089; 95% CI, 1.374–3.177; P < 0.001). Combination therapy including surgery, radiotherapy, and chemotherapy had a higher mortality rate (44.6%) than did combined surgery and radiotherapy (23.2%) (odds ratio, 2.688; 95% CI, 1.196–6.037; P = 0.02). Conclusions: The treatment of Merkel cell carcinoma with surgery plus adjuvant radiotherapy may produce lower recurrence rates. [ABSTRACT FROM AUTHOR]

During the coronavirus disease 2019 (COVID-19) pandemic, providers and patients must engage in shared decision making regarding the pros and cons of early versus delayed interventions for localized skin cancer. Patients at highest risk of COVID-19 complications are older; are immunosuppressed; and have diabetes, cancer, or cardiopulmonary disease, with multiple comorbidities associated with worse outcomes. Physicians must weigh the patient's risk of COVID-19 complications in the event of exposure against the risk of worse oncologic outcomes from delaying cancer therapy. Herein, the authors have summarized current data regarding the risk of COVID-19 complications and mortality based on age and comorbidities and have reviewed the literature assessing how treatment delays affect oncologic outcomes. They also have provided multidisciplinary recommendations regarding the timing of local therapy for early-stage skin cancers during this pandemic with input from experts at 11 different institutions. For patients with Merkel cell carcinoma, the authors recommend prioritizing treatment, but a short delay can be considered for patients with favorable T1 disease who are at higher risk of COVID-19 complications. For patients with melanoma, the authors recommend delaying the treatment of patients with T0 to T1 disease for 3 months if there is no macroscopic residual disease at the time of biopsy. Treatment of tumors ≥T2 can be delayed for 3 months if the biopsy margins are negative. For patients with cutaneous squamous cell carcinoma, those with Brigham and Women's Hospital T1 to T2a disease can have their treatment delayed for 2 to 3 months unless there is rapid growth, symptomatic lesions, or the patient is immunocompromised. The treatment of tumors ≥T2b should be prioritized, but a 1-month to 2-month delay is unlikely to worsen disease-specific mortality. For patients with squamous cell carcinoma in situ and basal cell carcinoma, treatment can be deferred for 3 months unless the individual is highly symptomatic. [ABSTRACT FROM AUTHOR]

Background: Previous wide local excision prior to sentinel lymph node biopsy (SLNB) may have the potential to disrupt lymphatic channels, thus incorrectly identifying the sentinel node. The purpose of this study was to investigate: (1) regional recurrence rates of prior wide local excision compared to other biopsy techniques and (2) survival outcomes in patients with melanoma of the head and neck. Methods: Between the years 2000 and 2016, 391 cases were reviewed with a median follow‐up time of 30 months in a large tertiary care center. Biopsy practices included shave, punch, wide local excision, and narrow margin excisional/Mohs, and associations with time to local or regional relapse and death from melanoma were evaluated. Main outcomes included identification of sentinel lymph nodes, overall survival, and melanoma‐specific survival. Results: Of the 391 patients, biopsy patterns were as follows: 77 (19%) unknown biopsy, 30 (8%) prior wide local excision (WLE), 105 (27%) narrow margin excisional biopsy, 69 (18%) punch biopsy, and 110 (28%) shave biopsy. SLNB was successfully identified in all 30 patients whom had a prior WLE. There were 50 regional recurrences in the neck and 27 local recurrences with the median (IQR) at 1.2 years and 1.0 years, respectively. Multivariable associations of type of prior biopsy, depth of invasion, and nodal status with time to regional recurrence, local recurrence, overall survival, and melanoma‐specific survival were not significantly different. Conclusions: Sentinel lymph node biopsy for melanoma of the head and neck can be successfully performed in patients after previous wide local excision. [ABSTRACT FROM AUTHOR]

Recent progress in the treatment of advanced melanoma has led to unprecedented improvements in overall survival and, as these new melanoma treatments have been developed and deployed in the clinic, much has been learned about the natural history of the disease. Now is the time to apply that knowledge toward the design and clinical evaluation of new chemoprevention agents. Melanoma chemoprevention has the potential to reduce dramatically both the morbidity and the high costs associated with treating patients who have metastatic disease. In this work, scientific and clinical melanoma experts from the national Melanoma Prevention Working Group, composed of National Cancer Trials Network investigators, discuss research aimed at discovering and developing (or repurposing) drugs and natural products for the prevention of melanoma and propose an updated pipeline for translating the most promising agents into the clinic. The mechanism of action, preclinical data, epidemiological evidence, and results from available clinical trials are discussed for each class of compounds. Selected keratinocyte carcinoma chemoprevention studies also are considered, and a rationale for their inclusion is presented. These data are summarized in a table that lists the type and level of evidence available for each class of agents. Also included in the discussion is an assessment of additional research necessary and the likelihood that a given compound may be a suitable candidate for a phase 3 clinical trial within the next 5 years. [ABSTRACT FROM AUTHOR]

Abstract: Background: Conflicting data have been published on whether an association exists between atopic dermatitis (AD) and nonmelanoma skin cancer. This study aimed to determine whether individuals with AD had an increased risk of squamous cell carcinoma (SCC) development. Methods: We conducted a retrospective, case–control study of patients residing in Olmsted County, Minnesota. Cases were selected from patients seen at Mayo Clinic (Rochester, Minnesota) who had an initial SCC diagnosis (either invasive SCC or SCC in situ) from January 1, 1996, through December 23, 2010. Age‐ and sex‐matched controls were selected from patients seen at Mayo Clinic with no history of SCC before the case event date. Results: Three hundred ninety‐nine individuals with a documented history of SCC were identified and matched with 780 controls who did not have a history of SCC. After adjusting for race, smoking history, ionizing radiation exposure, corticosteroid and cyclosporine use, and non‐SCC skin cancers, the odds ratio for SCC development between patients with history of AD versus patients without history of AD was 1.75 (95% CI, 1.05–2.93). Conclusions: Our findings support an increased risk of SCC development in the setting of AD. [ABSTRACT FROM AUTHOR]

Background Second hematologic cancers in patients with chronic lymphocytic leukemia/small lymphocytic lymphoma ( CLL) are well documented and include Hodgkin lymphoma, therapy-related acute myeloid leukemia/myelodysplastic syndromes, and transformation to diffuse large B-cell lymphoma. Although cutaneous T-cell lymphoma ( CTCL) has been reported in patients with CLL, the incidence and comparison to expected rates are unknown. We evaluated the incidence of CTCL among patients with CLL or other non-Hodgkin lymphoma ( NHL) subtypes using data from the Surveillance, Epidemiology, and End Results ( SEER) Program. Methods We searched the SEER 13 registries for patients with a diagnosis of CLL and NHL between 1992 and 2008. Among patients identified, we evaluated the incidence of CTCL. Results Among 31,286 patients with CLL, the incidence of CTCL was not significantly higher in men than women: 104.2 (95% CI, 50.0-191.8) and 28.1 (95% CI, 3.4-101.3) per 1,000,000 person-years, respectively ( P = 0.06). Among 97,691 patients with NHL, the incidence of CTCL was similar in men and women (97.9 [95% CI, 62.0-146.9] and 92.0 [95% CI, 56.2-142.1] per 1,000,000 person-years, respectively; P = 0.84). The incidence of CTCL among males with CLL (standardized incidence ratio [SIR], 3.0 [95% CI, 1.4-5.5]), males with NHL ( SIR, 3.7 [95% CI, 2.3-5.5]), and females with NHL ( SIR, 5.9 [95% CI, 3.6-9.1]) was significantly higher than expected in the general population (all P < 0.001). Conclusion The risk of CTCL is greater in men with CLL than in the general population. In patients with NHL, both men and women are at greater risk for CTCL than in the general population. [ABSTRACT FROM AUTHOR]

Women diagnosed with cutaneous melanoma have a survival advantage compared to men, which has been hypothesized to be due to difference in behavior and/or biology (sex hormones). It remains controversial whether this advantage is dependent on age or stage of disease. We sought to compare melanoma-specific survival between females in pre, peri, and postmenopausal age groups to males in the same age group, adjusting for stage of disease. This is a retrospective population-based cohort study using the Surveillance, Epidemiology, and End Results (SEER) database. Patients diagnosed from 1 January 1992 through 31 January 2011 with primary invasive cutaneous melanoma were included in our cohort. Melanoma-specific survival was the main outcome studied. Of the 106,511 subjects that were included, 45% were female. Females in all age groups (18-45, 46-54, and ≥55) with localized and regional disease, were less likely to die from melanoma compared to males in the same age group. Among patients with localized and regional disease, the relative risk of death due to melanoma increased with advancing age at diagnosis; this increase was more pronounced among females than males. In contrast, we observed no female survival advantage among patients with distant disease and no effect of age on relative risk of death from melanoma. Females with localized and regional melanoma have a decreased risk of death compared to males within all age groups. Our data show no differences in survival between men and women with metastatic melanoma, indicating that the influence of sex on survival is limited to early stage disease but not confined to pre or perimenopausal age groups. [ABSTRACT FROM AUTHOR]

Background The association of atypical nevi with melanoma and other forms of skin cancer has not been clearly defined. Methods We studied 631 patients with first lifetime diagnosis of mild, moderate or severely atypical nevus from 2000 through 2005, identified through a population-based approach. Results Age at first diagnosis differed significantly between men and women (p<.001). Incidence rates peaked in the second through fourth decades in women and in the third, sixth and seventh decades in men. From 2000 through 2005, the overall age- and sex-adjusted incidence rate of all degrees of atypical nevi was 76.0 per 100,000 person-years. There were no statistically significant associations identified between the degree of atypia and the future development of basal cell carcinoma, squamous cell carcinoma or MM (p = 0.51, p = 0.28 and p = 0.19, respectively). Conclusion There is no association between atypical nevi and the subsequent development of non-melanoma skin cancer and MM. Incidence rates of atypical nevi are higher among younger women and older men. The association between degree of atypia and malignant melanoma warrants further study. [ABSTRACT FROM AUTHOR]

Background Merkel cell carcinoma (MCC) is a rare, aggressive, often cutaneous malignancy. The incidence has been estimated from national registries in the USA and elsewhere, and data indicate variations depending on the region studied. The objective of this study was to determine the incidence of MCC in Olmsted County (MN, USA). Methods Using the Rochester Epidemiology Project, which contains health records for all the residents of Olmsted County, we retrospectively reviewed the records for all cases of MCC from 1976 to 2011. Results The overall annual age- and sex-adjusted incidence of MCC in Olmsted County during 1976-2011 was 0.35 per 100,000 person-years (95% CI, 0.14-0.57). The incidence tended to be higher among men than women with 0.69 per 100,000 (95% CI, 0.24-1.14) and 0.10 per 100,000 (95% CI, 0-0.24), respectively. Conclusions These data are within the range of previous MCC incidence reports, and the incidence of MCC in Olmsted County is consistent with rates reported in the remainder of the USA. [ABSTRACT FROM AUTHOR]

Background Hailey-Hailey disease ( HHD) is an autosomal dominant genodermatosis that leads to skin breakdown and blister formation, usually in intertriginous areas. Laser ablation is a known surgical treatment for HHD. Objectives We report outcomes in a series of patients with HHD treated with carbon dioxide ( CO2) laser ablation. Methods A retrospective chart review of data for 13 patients who underwent CO2 laser ablation for HHD was conducted. Questionnaires assessing effectiveness, pain, healing time, recurrence, new disease, complications, additional ablation, improvement in quality of life (QoL), and overall satisfaction were completed by all patients. Results All patients had been recalcitrant to previous treatments prior to CO2 laser ablation. Anatomic sites treated and anesthesia techniques for the procedure varied. The mean ± standard deviation ( SD) score for the effectiveness of CO2 laser ablation for HHD was 9.3 ± 0.9 (maximum: 10). All patients reported improved QoL. No patient had recurring disease within the treatment field. Five patients underwent additional CO2 laser treatments at new sites. One patient reported postoperative infection. No other complications were identified. The mean ± SD score for overall satisfaction with CO2 laser ablation was 8.9 ± 1.1. Conclusions Treatment with CO2 laser ablation is very effective and can lead to prolonged or permanent remission in most HHD patients. Patients are highly satisfied with the results and report a substantial improvement in QoL. [ABSTRACT FROM AUTHOR]

Background Patients with chronic lymphocytic leukemia ( CLL), small lymphocytic lymphoma ( SLL), or non-Hodgkin lymphoma ( NHL) are at increased risk for the development of skin malignancies. Objectives This study was conducted to estimate the incidences of rare skin malignancies in patients with CLL/ SLL or NHL. Methods Patients with a diagnosis of CLL/ SLL or NHL recorded in the Surveillance, Epidemiology and End Results ( SEER) database during 1992-2007 were identified. Diagnoses of specific skin malignancies were identified from SEER files. Results During 1992-2007, a total of 128,674 patients with first diagnoses of CLL/ SLL or NHL were recorded in SEER; 4743 were excluded because follow-up data were unavailable. Among the remaining 123,931 patients, 28,964 had CLL/ SLL and 94,967 had NHL. Standardized incidence ratios ( SIRs) for invasive malignant melanoma, Merkel cell carcinoma, malignant fibrous histiocytoma, dermatofibrosarcoma protuberans, Kaposi's sarcoma, and sebaceous carcinoma were 2.3, 8.2, 3.6, 2.5, 2.9, and 1.4, respectively, in CLL/ SLL patients and 1.6, 3.2, 1.5, 1.3, 17.6, and 0.8, respectively, in NHL patients. When invasive melanoma was stratified by patient age and sex, the highest SIR (17.8) was found in men aged 0-49 years with CLL ( P < 0.001). Conclusions Patients with CLL/ SLL or NHL have a higher risk for the subsequent development of rare skin cancers. Given the more aggressive nature of these malignancies in this setting, regular monitoring for the development and prompt treatment of cutaneous malignancy is prudent in patients with NHL and particularly in patients with CLL. Regular use of sun protection may decrease the morbidity associated with skin cancer in this immunosuppressed population. [ABSTRACT FROM AUTHOR]

Background Basosquamous carcinoma ( BSC) and metatypical basal cell carcinoma ( MBCC) are uncommon tumors poorly defined in the literature. Available studies suggest these tumors carry a greater risk of recurrence and metastases than basal cell carcinomas ( BCCs) and, in some studies, squamous cell carcinomas. Formal treatment recommendations are not fully established. Objective To analyze BSC and MBCC separately, evaluate whether they are distinct tumor subtypes, and analyze Mohs micrographic surgery ( MMS) efficacy for BSC and MBCC. Methods Retrospective review of medical records and histologic specimens was conducted for 293 patients with 303 biopsy-proven BSCs or MBCCs treated with MMS between 1996 and 2004. In total, 32 BSCs and 128 MBCCs were identified. Surgical and follow-up data were analyzed. Results Kaplan-Meier estimates of recurrence-free survival after MMS were 100% at one year for both tumor subtypes and were 100% for BSC and 93.8% for MBCC at 5 years. Initial mean sizes were 1.5 cm for BSC and 1.3 cm for MBCC. Approximately 7% represented recurrent tumors at surgery. Of six patients with recurrences, none had known metastatic disease. Limitations Limitations include retrospective design, analysis of only head and neck sites, and small sample sizes. Conclusion BSC and MBCC showed no significant distinguishing characteristics to separate them into two BCC subtypes. Reported recurrence rates for BSC and MBCC are 12-45% with wide local excision; estimated recurrence rates are 4.1% with MMS. Our study showed recurrence-free survival of 95.1% at five years. Hence, MMS is effective in treating these BCC subtypes. [ABSTRACT FROM AUTHOR]

Background We examined the course of cutaneous T-cell lymphoma ( CTCL), which has been associated with chronic lymphocytic leukemia ( CLL) in patients with CLL. Materials and methods A search was conducted of the master diagnosis index at our institution to identify patients with both CLL and CTCL from 1980 to 2010. A retrospective chart review was then conducted. Results Of the 14 patients with CTCL and CLL, eight had mycosis fungoides ( MF; two with patch stage, two with plaque stage, two with tumor stage, and two with erythrodermic stage), four had Sézary syndrome, one had natural killer cell lymphoma involving the skin, and one had peripheral T-cell lymphoma involving the skin. Eight had concurrent diagnoses, five received a CLL diagnosis first, and one received a CTCL diagnosis first. Ten patients were deceased at the time of data abstraction due to unknown causes ( n = 4), lymphoma ( n = 2), pneumonia ( n = 2), MF ( n = 1), or respiratory failure ( n = 1). Of the nine patients with concurrent or prior CTCL, seven were deceased, with a median time to death of 10.2 months (range, 6-89 months). Of the five patients with CLL prior to CTCL, three were deceased at 18, 27, and 47 months, respectively, after the CTCL diagnosis. The median survival for the two groups was 12 and 47 months, respectively. Conclusions Patients with CTCL concurrent with or prior to CLL have a worse overall survival than patients with CLL in whom CTCL later develops. Larger studies are needed. [ABSTRACT FROM AUTHOR]

The link between immunosuppression and skin cancer has been well described. The two most common situations involving immunosuppression-associated skin cancer are solid organ transplantation and non-Hodgkin lymphoma ( NHL), including chronic lymphocytic leukemia ( CLL). Patients with lymphoma are more likely to have development of a secondary malignancy, with skin cancer being the most common. The most common types of skin cancer in patients with NHL/ CLL include melanoma, squamous cell carcinoma, basal cell carcinoma, and Merkel cell carcinoma. Many skin cancers demonstrate increased aggressiveness in patients with NHL/ CLL and are associated with higher recurrence rates, increased regional metastasis, and death secondary to skin cancer metastases. This review delineates the current research regarding the relationship between NHL/ CLL and cutaneous malignancy. Immunosuppressed patients with skin cancer should be treated promptly and aggressively to decrease recurrence and metastases. Regular skin self-examinations, dermatologic examinations, sun-protective habits, and education may prove beneficial in this high-risk patient population. [ABSTRACT FROM AUTHOR]

Objectives Non-Hodgkin lymphoma is a hematologic malignancy associated with the more aggressive behavior of some forms of skin cancer. An association between sebaceous carcinoma and immunosuppression has been identified, but the behavior of sebaceous carcinoma in the setting of non-Hodgkin lymphoma has not been studied. This study aimed to increase understanding of the behavior of sebaceous carcinoma in patients with concomitant non-Hodgkin lymphoma. Methods Six patients diagnosed with sebaceous carcinoma and non-Hodgkin lymphoma from 1976 to 2008 were identified at the Mayo Clinic in Rochester, Minnesota. Their charts were reviewed retrospectively. Results All six patients were male and White and presented with sebaceous carcinoma on non-eyelid regions of the head and neck. Two patients had Muir-Torre syndrome; four had secondary cancers that included colon, prostate, transitional cell, and urothelial cancers. Skin cancers other than sebaceous carcinoma included basal cell carcinoma and squamous cell carcinoma. Three patients died of causes unrelated to sebaceous carcinoma; one died of an unknown cause and two were alive at the time of the study. Conclusions Sebaceous carcinoma does not appear to behave more aggressively in the setting of non-Hodgkin lymphoma. Larger studies are needed to definitively understand how sebaceous carcinoma behaves in patients with lymphoma. [ABSTRACT FROM AUTHOR]

Cutaneous metastases are common sequelae of primary malignant melanoma. Because patients with melanoma are examined frequently after diagnosis, it is important that dermatologists are aware of the range of findings that may represent metastatic disease. Many case reports and a few retrospective series have been published detailing the wide variety of clinical presentations of cutaneous metastatic melanoma. This article reviews the various manifestations of metastatic melanoma of the skin and oral mucous membranes and summarizes treatment options for metastatic disease. [ABSTRACT FROM AUTHOR]

Background Psoriasis is a common, chronic, hyperproliferative disease of the skin characterized by overexpression of type 1 cytokines, including tumor necrosis factor α. There is concern that antitumor necrosis factor agents such as etanercept may increase the incidence of cutaneous malignancies; however, the data are conflicting. Our objective was to further understand the characteristics and association of squamous cell carcinoma (SCC) development in patients with psoriasis who used etanercept. Methods Four patients with psoriasis were identified as having SCCs in the setting of etanercept. The histories of these patients were reviewed retrospectively. Results All four patients had lifelong psoriasis. The mean time of SCC onset was 11 months after etanercept therapy was begun (range, 1-17 months), and the number of SCCs in each patient ranged from five to more than 50. Conclusions Currently, reports are conflicting about the effect of etanercept on SCC development. We present the first case series of patients in whom SCC developed in the setting of etanercept therapy. More research is needed to better characterize the effects of etanercept on the development and behavior of SCC in patients with psoriasis. [ABSTRACT FROM AUTHOR]

Background The incidence of melanoma has been rising in the United States, with conflicting evidence regarding trends in children. Methods We identified patients 0 to 17 years old with a diagnosis of melanoma from January 1, 1970, through December 31, 2010, in Olmsted County, Minnesota. Information on survival and demographic characteristics was abstracted, and estimates of true incidence were calculated. Results The estimated true incidence of melanoma in children from 1970 to 2010 was found to be 0.62 per 100,000 girls and 0.45 per 100,000 boys. The incidence of melanoma in this population did not increase with time after adjusting for age and sex. Only one case of metastatic disease (lymph node) was identified. Girls were more commonly affected and the mean age of disease onset was 14 years. Five of the seven melanomas in this population arose in association with a nevus, and none involved the trunk. Overall and disease-specific survival rates were not calculated because all patients studied were alive at the last follow-up. Conclusion The estimated true incidence rates of pediatric melanoma from our population-based study in Olmsted County, Minnesota, appear stable. This finding is in contrast to our prior research showing rapidly increasing incidence rates of melanoma in young and middle-aged adults from the same population. [ABSTRACT FROM AUTHOR]

The article describes the case of a 30-year-old female patient who developed cutaneous squamous cell carcinoma (SCC) following solid organ transplantation. Topics discussed include the reasons for solid organ transplant recipients' (SOTR) susceptibility to secondary nonmelanomatous skin cancer, the features of SCC and the use of oral capecitabine to control recurrent SCCs.

The article describes a case study of chronic lymphocytic leukemia (CLL) associated with nodular cutaneous amyloidosis (NCA) in a 58-year-old man. The patient presented with digital clubbing that has progressed over the past year, as well as erythema and inflammation of his ears and distal nose. Other topics discussed include the clinical history of the patient, findings of physical and histopathology examinations, and the prevalence of CLL and NCA.

Background Compensatory hyperhidrosis due to the treatment for focal primary hyperhidrosis can be devastating and life-altering. Objective The purpose of this paper is to discuss use of the iodine starch test and dilute botulinum toxin to decrease compensatory hyperhidrosis over large surface areas. Methods A large area of the trunk affected by compensatory hyperhidrosis was treated with dilute botulinum toxin therapy using a starch iodine test for localization. Results The patient had exceptional results with his compensatory truncal sweating returning to normal and remaining stable for multiple months. Conclusion Treating compensatory hyperhidrosis of large surface areas with dilute botulinum toxin therapy is effective and safe. [ABSTRACT FROM AUTHOR]

The article describes the case of a 46-year-old man who developed a darkly pigmented nevus following hair removal from his back by diode laser. The patient had Fitzpatrick skin type II, a history of a moderately atypical nevus, a family history of skin cancer and a significant amount of truncal dark terminal hair. Histologic evaluation of a biopsy of the nevus indicated epidermal and superficial dermal changes of electrical and thermal injury and adjacent junctional melanocytic proliferation.

The article focuses on the case of a 21 year old man diagnosed with distichiasis-lymphedema syndrome, a rare disorder characterized by distichiasis and lower extremity lymphedema. Topics discussed include the signs and symptoms experienced by the patient, as well as his medical history, the usual presentation of lymphedema in late childhood or puberty and the common management of the disease that is centered on relieving symptoms of ocular irritation and chronic leg swelling.

A letter to the editor is presented about erosions induced by patch testing in a woman with Hailey-Hailey disease.