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Background and objective: The COVID-19 pandemic caused upheaval of healthcare systems, with evolving consequences. The aim of this study was to evaluate the impact of the pandemic on melanoma diagnosis and management in New South Wales, Australia. Methods: In this retrospective cohort study, we analysed all new melanomas diagnosed at a tertiary care hospital over a three-year period. We compared outcomes between pre-pandemic (1 January 2019 - 30 March 2020) and pandemic (31 March 2020 - 31 December 2021) periods. Results: A total of 426 melanomas were included. No significant differences in patient demographics, Breslow thickness, ulceration, subtype or lymph node positivity were observed. During the pandemic, there was an 11% decrease in the number of melanomas diagnosed in the community (P=0.016) and an 11-day reduction in time from referral to wide local excision (P=0.013). Discussion: The prioritisation of melanoma care during the pandemic in New South Wales, Australia, has resulted in no apparent diagnostic delays. [ABSTRACT FROM AUTHOR]

Early cutaneous squamous cell carcinoma (cSCC) can be challenging to diagnose using clinical criteria as it could present similar to actinic keratosis (AK) or Bowen's disease (BD), precursors of cSCC. Currently, histopathological assessment of an invasive biopsy is the gold standard for diagnosis. A non‐invasive diagnostic approach would reduce patient and health system burden. Therefore, this study used non‐invasive sampling by tape‐stripping coupled with data‐independent acquisition mass spectrometry (DIA‐MS) proteomics to profile the proteome of histopathologically diagnosed AK, BD and cSCC, as well as matched normal samples. Proteomic data were analysed to identify proteins and biological functions that are significantly different between lesions. Additionally, a support vector machine (SVM) machine learning algorithm was used to assess the usefulness of proteomic data for the early diagnosis of cSCC. A total of 696 proteins were identified across the samples studied. A machine learning model constructed using the proteomic data classified premalignant (AK + BD) and malignant (cSCC) lesions at 77.5% accuracy. Differential abundance analysis identified 144 and 21 protein groups that were significantly changed in the cSCC, and BD samples compared to the normal skin, respectively (adj. p < 0.05). Changes in pivotal carcinogenic pathways such as LXR/RXR activation, production of reactive oxygen species, and Hippo signalling were observed that may explain the progression of cSCC from premalignant lesions. In summary, this study demonstrates that DIA‐MS analysis of tape‐stripped samples can identify non‐invasive protein biomarkers with the potential to be developed into a complementary diagnostic tool for early cSCC. [ABSTRACT FROM AUTHOR]

Despite recent developments in managing metastatic melanomas, patients' overall survival remains low. Therefore, the current study aims to understand better the proteome‐wide changes associated with melanoma metastasis that will assist with identifying targeted therapies. The latest development in mass spectrometry‐based proteomics, together with extensive bioinformatics analysis, was used to investigate the molecular changes in 60 formalin‐fixed and paraffin‐embedded samples of primary and lymph nodes (LN) and distant organ metastatic melanomas. A total of 4631 proteins were identified, of which 72 and 453 were significantly changed between the LN and distant organ metastatic melanomas compared to the primary lesions (adj. p‐value <0.05). An increase in proteins such as SLC9A3R1, CD20 and GRB2 and a decrease in CST6, SERPINB5 and ARG1 were associated with regional LN metastasis. By contrast, increased metastatic activities in distant organ metastatic melanomas were related to higher levels of CEACAM1, MC1R, AKT1 and MMP3‐9 and decreased levels of CDKN2A, SDC1 and SDC4 proteins. Furthermore, machine learning analysis classified the lesions with up to 92% accuracy based on their metastatic status. The findings from this study provide up to date proteome‐level information about the progression of melanomas to regional LN and distant organs, leading to the identification of protein signatures with potential for clinical translation. [ABSTRACT FROM AUTHOR]

Background: Clinical quality registries aim to identify significant variations in care and provide anonymised feedback to institutions to improve patient outcomes. Thirty‐six Australian organisations with an interest in melanoma, raised funds through three consecutive Melanoma Marches, organised by Melanoma Institute Australia, to create a national Melanoma Clinical Outcomes Registry (MelCOR). This study aimed to formally develop valid clinical quality indicators for the diagnosis and early management of cutaneous melanoma as an important step in creating the registry. Methods: Potential clinical quality indicators were identified by examining the literature, including Australian and international melanoma guidelines, and by consulting with key melanoma and registry opinion leaders. A modified two‐round Delphi survey method was used, with participants invited from relevant health professions routinely managing melanoma as well as relevant consumer organisations. Results: Nineteen participants completed at least one round of the Delphi process. 12 of 13 proposed clinical quality indictors met the validity criteria. The clinical quality indicators included acceptable biopsy method, appropriate excision margins, standardised pathology reporting, indications for sentinel lymph node biopsy, and involvement of multidisciplinary care and referrals. Conclusion: This study provides a multi‐stakeholder consensus for important clinical quality indicators that define optimal practice that will now be used in the Australian Melanoma Clinical Outcomes Registry (MelCOR). [ABSTRACT FROM AUTHOR]

Background: Dermatology consultation has been shown to have a significant beneficial impact on admitted hospital patients with concurrent or newly diagnosed skin conditions. This study aimed to determine the change in diagnosis and management after dermatology consultation in a tertiary Australian referral hospital. Methods: A retrospective analysis of dermatology consultations for hospital inpatients from June 1, 2018, through November 11, 2019, was performed. Demographic and clinical data were extracted from electronic medical records, and a chi‐squared test was used to analyze categorical variables. Results: There were 306 consultations during the period of interest. The male to female ratio was 1:1 with a median age of 63. Consultations were most often requested by medical teams (69%), and the majority of patients seen in the emergency department were discharged home (86%). In 44% of cases, the requesting team did not provide a diagnosis; in the cases where it did provide a diagnosis, it was changed 57.9% of the time. The most commonly misdiagnosed conditions were dermatitis and skin infections. Dermatologists established or changed management in 82% of cases, and a total of 676 suggestions were made for management. Conclusion: The results of this review reinforce the value of dermatology input in the diagnosis and management of hospital in patients. Ensuring maintained presence of hospital‐based dermatologists has the potential to improve diagnosis and management of cutaneous issues early on; by extension, this can minimize unnecessary investigations, improve the quality of healthcare, reduce hospital burden, and facilitate outpatient follow‐up. [ABSTRACT FROM AUTHOR]

Dermatology consultation is a valuable inpatient service in Australian hospitals. Adherence rates to consultative advice in international literature range between 67.4% and 93%. This study identifies that adherence rates to suggested investigations and management in a tertiary Australian hospital are at the lower end of the range reported in previous literature. [ABSTRACT FROM AUTHOR]

Background: Reflectance confocal microscopy (RCM) is a useful tool for many skin cancers, allowing non‐invasive evaluation over time and identifying areas of active disease. Its role to follow‐up mycosis fungoides (MF) patients has not yet been evaluated. Objective: To assess the level of agreement between RCM and histopathology and to develop a RCM checklist that could help monitoring MF patients. Method: Prospective study in a cutaneous lymphoma clinic of a tertiary hospital in Australia. RCM and biopsies were performed on the same area at baseline, before commencing or changing treatment, and at 6 months after starting treatment. Normal skin sites were also analysed and acted as controls. RCM features and histopathological findings were blindly evaluated by the confocalist and pathologist. Correlation between RCM and histology was measured by overall per cent of agreement (OPA), kappa and ROC curves. Additionally, RCM images before and after treatment were assessed blinded from clinical information and correlated to clinical assessment. Results: Thirty‐eight MF lesions were included. Nineteen of these 38 were re‐assessed by RCM 6 months later. Fifty biopsies were performed (38 at baseline and 12 after 6 months). The combination of four RCM features corresponding to Pautrier's microabscess, epidermal and junctional lymphocytes and interface dermatitis formed the RCM checklist for MF that predicted the severity of disease with AUC of 0.95 (P =.003). Conclusion: Reflectance confocal microscopy can assess activity within a lesion and over time and assist in the clinical management of patients with MF. [ABSTRACT FROM AUTHOR]

Erectile dysfunction, hidradenitis, immunotherapy, lymphedema, scrotum, surgery Keywords: erectile dysfunction; hidradenitis; immunotherapy; lymphedema; scrotum; surgery EN erectile dysfunction hidradenitis immunotherapy lymphedema scrotum surgery e184 e186 3 05/20/22 20220501 NES 220501 Hidradenitis suppurativa (HS) involving the anogenital and inguinal regions can cause considerable morbidity. Persistent poorly controlled HS results in diffuse scarring, fibrosis and lymphoedema that can impact micturition, social and sexual functioning.2 Tumour necrosis factor-alpha inhibitors, namely adalimumab, have significantly improved the management of severe HS. [Extracted from the article]

As found in the Victorian study, fragrance allergens were frequently missed relevant reactions.2 Fragrance allergy is not reliably detected by testing with the fragrance mixes.8 Toluenesulfonamide formaldehyde resin, a cause of contact allergy to nail polish, was recently removed from the ABS. A North American study found that 50% of positive reactions were to baseline series allergens (series size 20 allergens).5 Patel and Belsito found, using a screening series of 28 allergens, that 27.6% had all allergens identified and 49.9% had some but not all allergens identified.6 Testing with a larger number of allergens improves accuracy of patch testing and testing with a standard series alone is seldom adequate.7 Our findings support this; supplementation with special series' depending on the clinical scenario is required. The Australian baseline series (ABS) was created by expert consensus and review of relevant allergens in a population from Victoria.1 In a recent follow-up study, Dear and colleagues reported the performance of the ABS.2 Further validation of the ABS is required in populations from other regions in Australia. [Extracted from the article]

Background: Reflectance confocal microscopy (RCM) is a non‐invasive imaging technique that provides dynamic information and allows in vivo monitoring, with excellent histologic correlation. In the last decade, the use of RCM for cutaneous T‐cell lymphomas (CTCL) has been reported. CTCL may require multiple biopsies for diagnosis due to its equivocal clinical presentation. RCM was described as a possible tool to help determine the best site for skin biopsy. This study aims to systematically review all RCM features reported in literature for CTCL. Method: A systematic literature search concerning CTCL evaluated by RCM was performed in eight electronic databases until May 2019 following PRISMA‐DTA quality assessment. Results: Eighteen RCM features were described in patients with CTCL. The most frequent were: interface dermatitis (89%), epidermal lymphocytes (82%), epidermal architectural disarray (81%), and vesicle‐like structure (Pautrier microabscess) (51%). Conclusion: In order to establish comparable parameters among the studies identified, we proposed descriptors for CTCL features and a grading system to quantify them. This will facilitate to define the role of RCM in the diagnosis and monitoring of CTCL patients. [ABSTRACT FROM AUTHOR]

Background: The etiology of cheilitis includes endogenous, irritant, and allergic dermatitis; lichenoid and granulomatous disorders; infection; trauma; and actinic damage. Patch testing is indicated for refractory cases (other than actinic cheilitis). Objective: The aim of the study was to review demographics and allergens in patients patch tested for cheilitis at 2 sites in Sydney, Australia. Methods: Records for patients patch tested for a 10-year period from 2007 to 2017 were reviewed. Baseline characteristics and patch test results were compared for patients with and without cheilitis. Conclusions: There were 1584 patients including 91 with cheilitis. Patients with cheilitis were more likely to be female, younger, and atopic and have concurrent eyelid involvement than those presenting with other dermatoses. Seventeen percent of patients with cheilitis had a post–patch test diagnosis of allergic contact cheilitis, and the most frequent relevant reactions were to patients' own products, fragrances, and sunscreens. Those with cheilitis had more positive reactions to sunscreens, especially benzophenones, compared with those without cheilitis (P < 0.001). This is an important finding in Australia where high rates of melanoma and nonmelanoma skin cancer necessitate promotion of strict sun protection measures. [ABSTRACT FROM AUTHOR]

The article offers information on influence of social media on the sociocultural norms regarding tanned skin. It mentions Social media platforms have the capacity to amplify tanning ideals by combining peer and media influences; views on mass media skin cancer prevention campaigns; and posting selfies was associated with positive tanning attitudes as per study.