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Background: The distinction between in situ melanoma (MIS) and invasive melanoma is challenging even for expert dermatologists. The use of pretrained convolutional neural networks (CNNs) as ancillary decision systems needs further research., Aim: To develop, validate and compare three deep transfer learning (DTL) algorithms to predict MIS vs. invasive melanoma and melanoma with a Breslow thickness (BT) of < 0.8 mm vs. ≥ 0.8 mm., Methods: A dataset of 1315 dermoscopic images of histopathologically confirmed melanomas was created from Virgen del Rocio University Hospital and open repositories of the International Skin Imaging Collaboration archive and Polesie S et al. (Dermatol Pract Concept 2021; 11:e2021079). The images were labelled as MIS or invasive melanoma and < 0.8 mm or ≥ 0.8 mm of BT. We conducted three trainings, and overall means for receiver operating characteristic (ROC) curves, sensitivity, specificity, positive and negative predictive value, and balanced diagnostic accuracy outcomes were evaluated on the test set with ResNetV2, EfficientNetB6 and InceptionV3. The results of 10 dermatologists were compared with the algorithms. Grad-CAM gradient maps were generated, highlighting relevant areas considered by the CNNs within the images., Results: EfficientNetB6 achieved the highest diagnostic accuracy for the comparison between MIS vs. invasive melanoma (61%) and BT < 0.8 mm vs. ≥ 0.8 mm (75%). For the BT comparison, ResNetV2 with an area under the ROC curve of 0.76 and InceptionV3 with an area under the ROC curve of 0.75, outperformed the results obtained by the dermatologist group with an area under the ROC curve of 0.70., Conclusion: EfficientNetB6 recorded the best prediction results, outperforming the dermatologists for the comparison of 0.8 mm of BT. DTL could be an ancillary aid to support dermatologists' decisions in the near future., Competing Interests: Conflicts of interest The authors declare they have no conflicts of interest., (© The Author(s) 2023. Published by Oxford University Press on behalf of British Association of Dermatologists. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Recent studies suggest that cutaneous melanoma mortality rates in Spain are stabilizing and even decreasing in younger cohorts., Objectives: To analyse mortality rates of melanoma from the last 40 years, focusing on changes related with the development of new therapeutic approaches., Methods: Death records and mid-year population data were collected from the National Statistics Institute. By using the direct method, age-standardized mortality rates were calculated for overall population and for each sex and age group. Significant changes in mortality trends were identified by Joinpoint regressions. The independent effects of age, period and cohort (APC) and potential years of life lost (PYLL) due to melanoma were also analysed., Results: Age-standardized melanoma mortality rates rose in Spain from 0.78 to 2.13 deaths per 100 000 from the first to the last quinquennium of the study (1979-1983 to 2014-2018) for the overall population. After a marked increase until 1995, mortality rates levelled off. Following this stabilization, from 2015 to 2018 there was a decrease in mortality rates for the overall population (average annual per cent change (AAPC): -4.3, not significant), more accused in males over 64 years old (yo). A period effect was observed from the beginning of 21st century, with mortality rates dropping to date., Conclusions: There is a decrease in melanoma mortality rates from 2015 in all age groups that confirms previous trends in mortality in younger cohorts. Improvement in diagnosis and development of new therapies for advanced melanoma may have a crucial role in this event. Close monitoring of melanoma mortality rates is necessary to confirm these trends., (© 2020 European Academy of Dermatology and Venereology.)

Malignant melanoma accounts for 80% of deaths due to skin cancer. Its incidence is globally increasing. However, melanoma mortality seems to be decreasing. The aim of this study was to analyze mortality rates due to melanoma in Andalusia between 1979 and 2018. Deaths due to melanoma and mid-year population in Andalusia were collected from the National Institute of Statistics. Age-adjusted mortality rates were calculated for overall population and for each sex and age group. Regression models were used to calculate significant points of change. Sex ratio and the independent effects of age, period, and cohort were also analyzed. Age-adjusted mortality due to melanoma rose from 0.61 to 1.94 deaths per 100.000 from 1979 to 2018 for the overall population. A significant change of trends was detected around 1994 when, after a steady rise from 1979, mortality rates stabilized up to the end of the period studied. The cited increase was more pronounced in >64 year males. From the end of the 2000s, there was a decrease in mortality rates to date in all population groups, producing a period effect. A stabilization in melanoma mortality rates was observed in Andalusia from 1994 with a decrease in some groups at the beginning of the 21st century. Trends observed in Andalusia do not differ substantially from those in Spain. The development of new therapies and an earlier diagnosis may have an influence in those changes. Studies that compare differences between Spanish regions are needed to define better prevention strategies., (© 2020 Wiley Periodicals LLC.)

Objectives: Study of aquaporin 1 (AQP1) and aquaporin 3 (AQP3) expression to understand its potential role in the pathophysiology of skin cancer., Methods: Analysis of AQP1 and AQP3 expression by immunohistochemistry of 72 skin biopsy specimens from melanocytic skin tumors, nonmelanocytic tumors, or healthy samples., Results: AQP1 showed strong labeling in 100% of benign common melanocytic nevi. Small blood vessels, stroma, and melanophages surrounding different types of melanomas tumors also were positive. Tumoral melanocytes in atypical nevi and melanomas were negative for AQP1. AQP3 showed strong labeling in 100% of melanocytic nevi, 100% of atypical melanocytic nevi, and 100% of melanomas. In all basal cell carcinomas and squamous cell carcinomas, staining for AQP3 was positive., Conclusions: To our knowledge, this work represents the first demonstration of AQP1/AQP3 expression in human melanocytic skin tumors. More studies are needed to understand the underlying molecular mechanisms of expression of both AQPs in melanocytic tumors and their potential as molecular therapeutic targets., (© American Society for Clinical Pathology, 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Importance: The main high-penetrance melanoma susceptibility gene is CDKN2A, encoding p16INK4A and p14ARF. The gene MITF variant p.E318K also predisposes to melanoma and renal cell carcinoma. To date, the prevalence of MITF p.E318K and its clinical and phenotypical implications has not been previously assessed in a single cohort of Spanish patients with melanoma or in p16INK4A mutation carriers., Objectives: To evaluate the prevalence of MITF p.E318K in Spanish patients with melanoma and assess the association with clinical and phenotypic features., Design, Setting, and Participants: A hospital-based, case-control study was conducted at the Melanoma Unit of Hospital Clinic of Barcelona, with MITF p.E318K genotyped in all patients using TaqMan probes. We included 531 patients: 271 patients with multiple primary melanoma (MPM) without mutations affecting p16INK4A (wild-type p16INK4A); 191 probands from melanoma-prone families with a single melanoma diagnosis and without mutations affecting p16INK4A, and 69 probands from different families carrying CDKN2A mutations affecting p16INK4A. A population-based series of 499 age- and sex-matched cancer-free individuals from the Spanish National Bank of DNA were included as controls. Patients were recruited between January 1, 1992, and June 30, 2014; data analysis was conducted from September 1 to November 30, 2014., Main Outcomes and Measures: The genetic results of the MITF p.E318K variant were correlated with clinical and phenotypic features., Results: Among the 531 patients, the prevalence of the MITF p.E318K variant was calculated among the different subsets of patients included and was 1.9% (9 of 462) in all melanoma patients with wild-type p16INK4A, 2.6% (7 of 271) in those with MPM, and 2.9% (2 of 69) in the probands of families with p16INK4A mutations. With results reported as odds ratio (95% CI), the MITF p.E318K was associated with an increased melanoma risk (3.3 [1.43-7.43]; P < .01), especially in MPM (4.5 [1.83-11.01]; P < .01) and high nevi count (>200 nevi) (8.4 [2.14-33.19]; P < .01). Two fast-growing melanomas were detected among 2 MITF p.E318K carriers during dermatologic digital follow-up., Conclusions and Relevance: In addition to melanoma risk, MITF p.E318K is associated with a high nevi count and could play a role in fast-growing melanomas. Testing for MITF p.E318K should not exclude patients with known mutations in p16INK4A. Strict dermatologic surveillance, periodic self-examination, and renal cell carcinoma surveillance should be encouraged in this context.

Spain has one of Europe's lowest melanoma incidence and mortality rates. Nevertheless, it is one of the fastest-growing pathologies in our country, with a 181.3% increase in the incidence rate in men and 205.3% increase in women. It represents 1.3% and 2.5% of malignant tumors in men and women, respectively, while the current standardized worldwide rate is respectively 2.4% and 4.9%. The highest incidence levels correspond to Tarragona for men (6.81%) and Gerona for women (8.24%), and lowest to the Canary Islands and Zaragoza (3.55% and 4.27% for women and men, respectively). This higher incidence among females differentiates Spain from the rest of Europe, where the opposite occurs. Mortality has also increased in Spain in the last few decades (1.76% in males and 1.26% in females), although this rising trend has stabilized in recent years. Spain's mortality rate is the lowest in Europe, as the EUROCARE-III study revealed. This study found an increase of 70.4% in the survival rate for men and 84.1% for women in the 1980s, while the figures for the 1990s were 73.9% for men and 89.8% for women. This low mortality rate in Spain may be due to the increase in thin melanomas, due to early diagnosis and surgical treatment.

Background: In the year 2000, the European Academy of Dermatology and Venereology initiated a campaign, called "Euromelanoma Day," for the early detection of melanoma., Objective: To discuss the results of "Euromelanoma Day" in Spain for the campaigns carried out in 2000, 2001 and 2002., Material and Methods: Participating members of the Spanish Academy of Dermatology examined everyone who requested an appointment, free of charge, in order to detect suspicious lesions. Four months after the visit, telephone contact was made with all patients who had been diagnosed with suspected melanoma to ask them whether the lesions had been excised, and if so, the result of the histological study of the specimen., Results: 33,750 calls to set up an appointment were received, and 12,487 patients were examined. The average participation by dermatologists was 399 academy members per year. A total of 164 lesions suspected of being melanoma were detected, above all in Andalusia and Catalonia, and the diagnosis was histologically confirmed in 31 cases. The clinicopathological correlation was 23.3 %, a higher figure than the one for the USA and similar to the one for Mediterranean countries. The average thickness of the tumors was 0.93 mm., Conclusions: Although these campaigns have the drawback of possible bias in the findings and may cause some degree of public alarm, the benefit to the population was unquestionable in terms of heightening awareness of a health problem.

Background: There have been suggestions that mortality from cutaneous malignant melanoma (CMM) is starting to level off in the European Union., Objectives: To analyse changes in CMM mortality trends in Spain during 1975-2001 using joinpoint regression models., Methods: Mortality data were obtained from the National Statistics Institute. For each gender, age group-specific and standardized (overall and truncated) rates were calculated by the direct method (using the world standard population). The joinpoint analysis was used to identify the best-fitting points where a statistically significant change in the trend occurred., Results: In women, there was a marked increase from 1975 to 1994 in age-adjusted (overall and truncated) CMM mortality rates [estimated annual percentage change (EAPC) 6.6% and 7.0%, respectively; P < 0.05], followed by a levelling off (EAPC - 0.3% and - 1.3%, respectively; not significant). In men, age-adjusted (35-64 years) mortality rates increased steadily from 1975 to 1991 (EAPC 9.1%, P < 0.05) and then levelled off., Conclusions: We confirmed that CMM mortality rates in Spain rose dramatically from the mid-1970s to the beginning of the 1990s, but we also found that mortality rates are now levelling off in middle-aged adults (35-64 years), following a similar tendency to that observed in other countries.

A 45-year-old male, with a history of malignant melanoma on the thorax excised 4 years ago, presented a sudden eruption of more than 300 pigmented lesions. Fifteen excisions of tumors in different stages were carried out on four different dates. Dermatopathological examinations revealed features of primary as well as metastatic malignant melanomas. We suggest that besides the extensive dissemination there was also an activation of the resting melanocytes, that led to the formation of multiple primary melanomas.

A 45-years-old woman affected of Acute febrile neutrophilic syndrome is presented, with no reliable etiology. In a rutinary control, a pigmented ledion of one year of evolution was observed and a surgical excision was performed, with histological diagnosis of spreading superficial melanoma. In the next weeks of post-operatory, the Sweet's syndrome was decreased, disappearing completely two months later. No recurrences of Sweet's syndrome or malignant melanoma were observed after two years of follow-up. Association between Sweet's syndrome and neoplasias, in particular solid tumors, is commented, and the literature is reviewed.

Plasma lipid bound sialic acid (LSA) was measurement in 41 patients with malignant melanoma to determine the utility of this biochemical marker in the stating and in monitoring the post-operative follow-up. LSA was determined in 26 cases pre and post-operation, and in 15 cases only post-operation. Multiple determinations was done in 12 cases during two years of post-operative follow-up. Patients with preoperatory determination exhibited LSA levels significantly higher (p 0.0001) than the healthy control group. Relationship between LSA highest levels and tumoral size up 2 cm. in diameter was found (p 0.02). A second determination after 2 months of cases. LSA multiple post-operative controls showed continuing elevation of LSA levels up the normal rates was corresponding with metastasis in 100% of cases.