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Background: Cutaneous malignant melanoma (CMM) ranks among the five most common cancers in young people in high‐income countries and it features peculiar clinicopathological traits. Very few studies have addressed the quality of care and the costs for adolescents and young adults (AYA) population. Objective: To provide a comprehensive epidemiological and clinicopathological profile of CMM in AYA. The study also addresses the cost‐of‐illness and the diagnostic‐therapeutic performance indicators by patient age category. Methods: This population‐based cohort study included 2435 incident CMM (age range 15–65 years; age 15–39 = 394; age 40–65 = 2041), as recorded in 2015, 2017 and 2019 by the Regional Veneto Cancer Registry (Italy). Cramer's‐V tested the strength of association between pairs of variables. The Kaplan–Meier method was used to test the association between age and survival rate. The clinical performance indicators were computed using the Clopper–Pearson exact method. Results: In AYA patients (16.2%), CMM incidence rates increased significantly from 1990 to 2019. Low‐stage CMM (p = 0.007), radial growth pattern (p = 0.026) and lower Clark levels (p = 0.007) prevailed; males had less advanced malignancies (p = 0.003), with the trunk as the most common primary site (67.5%); the lower limbs (32.6%) were the most common primary site for females (p < 0.001). Overall survival was better in AYA than adults. No significant difference was detected in the clinical management of the two age groups, with the only exception of the margin in wide local excision. The care costs were lower in AYA (€195.99 vs. €258.94, p = 0.004). Conclusions: In AYA patients, the CMM clinicopathological presentation shows a distinctive profile. The present results provide critical information for optimizing primary and secondary prevention strategies and for tailoring diagnostic therapeutic procedures to the peculiar profile of AYA CMM patients. [ABSTRACT FROM AUTHOR]

Simple Summary: In-transit metastases (ITM) are a challenging aspect of advanced melanoma, traditionally treated with surgery. However, recent advances in systemic therapies, such as immune checkpoint inhibitors and targeted treatments, have significantly improved patient outcomes. These modern therapies are now often preferred over surgery alone. This article reviews the benefits of combining systemic and locoregional treatments, highlighting their potential to enhance survival and quality of life for patients with ITM. By integrating these approaches, we aim to provide a comprehensive strategy for optimizing melanoma treatment outcomes. In-transit metastases (ITM) in melanoma present a significant therapeutic challenge due to their advanced stage and complex clinical nature. From traditional management with surgical resection, ITM treatment has evolved with the advent of systemic therapies such as immune checkpoint inhibitors and targeted therapies, which have markedly improved survival outcomes. This study aims to review and highlight the efficacy of both systemic and locoregional treatment approaches for ITM. Methods include a comprehensive review of clinical studies examining the impact of treatments like immune checkpoint inhibitors, targeted therapies, Isolated Limb Perfusion, and electrochemotherapy. The results indicate that combining systemic therapies with locoregional treatments enhances both local disease control and overall survival rates. The introduction of modern immunotherapies has not diminished the effectiveness of locoregional therapies but rather improved patient outcomes when used in conjunction. The conclusions emphasize that a multidisciplinary approach integrating systemic and locoregional therapies offers a promising strategy for optimizing the management of ITM in melanoma patients. This integrated treatment model not only improves survival rates but also enhances the quality of life for patients, suggesting a shift in standard care practices toward more comprehensive therapeutic regimens. [ABSTRACT FROM AUTHOR]

Background. Basal cell carcinomas (BCCs) are common human malignancies with a rising incidence in recent years. While BCCs have a low mortality rate, they are often associated with significant local skin damage characterized by erythema, skin ulceration, and persistent pigmentation. Surgery, radiotherapy, and systemic chemotherapy have traditionally been the principal treatments for these skin injuries. However, electrochemotherapy has recently been proposed as a novel local treatment with promising results for various skin cancers, including BCC, while avoiding the side effects of conventional therapies. ECT involves a local electrical stimulus that enhances cell membrane permeability, thereby enabling the targeted intracellular accumulation of the chemotherapeutic agent. Case Report: We report a case of a 68-year-old man with an ulcerated BCC, following his progress up to 14 months post-ECT treatment, with positive outcomes. Discussion and Conclusions: We achieved a complete clinical response and noted an improvement in the patient's quality of life. This technique is fast, repeatable, requires minimal hospitalization, and reduces healthcare costs and adverse effects compared to major surgery. Therefore, it can be considered an alternative or complementary approach to traditional surgery for treating BCC of the head and neck. [ABSTRACT FROM AUTHOR]

Background: Atypical Spitz tumor (AST) is an intermediate category among Spitz melanocytic neoplasms. Sentinel node biopsy (SNB) has been proposed in the clinical management of AST patients, but this approach remains the subject of debate. This systematic review aims to summarize the available evidence on SNB procedures in AST patients. Methods: A comprehensive search was conducted, including MEDLINE/Pubmed, EMBASE, and SCOPUS, through April 2023. Case series, cohort studies, and case–control studies of AST patients were eligible for inclusion. PRISMA guidelines were followed. Results: Twenty-two studies with a total of 756 AST patients were included. The pooled SNB prevalence was 54% (95% CI 32 to 75%), with substantial heterogeneity (I2 90%). The pooled SNB+ prevalence was 35% (95% CI 25 to 46%) with moderate heterogeneity (I2 39%). Lymphadenectomy was performed in 0–100% of SNB+ patients. Overall survival rates ranged from 93% to 100%, and disease-free survival ranged from 87% to 100% in AST patients. Overall and disease-free survival rates were 100% in SNB patients. Pooled survival estimates were not calculated due to the heterogeneous timing of the survival assessment and/or the small size of the subgroups. All studies clearly reported inclusion criteria and measured the condition in a standard way for all participants, but only 50% indicated valid methods for the identification of the condition. Conclusions: The oncologic behavior of AST is related to an almost always favorable outcome. SNB does not seem to be relevant as a staging or prognostic procedure, and its indication remains debatable and controversial. [ABSTRACT FROM AUTHOR]

Simple Summary: This review focusing on gender differences in the incidence of soft tissue and bone sarcomas. Sarcomas are rare cancers arising from mesenchymal tissues, which are different from the epithelial tissues and originate from the embryonic mesodermal layer. These cancers can be classified into bone or soft tissue sarcomas. Most sarcomas occur without known causes; however, certain genetic syndromes and environmental factors are known to be associated with these malignancies. Studies have indicated a male predominance in sarcoma incidence, which is also seen in other cancers like colorectal and lung cancers. Notably, childhood sarcomas exhibit significant gender differences, with a stronger association with the male sex, particularly in soft tissue sarcomas. The biological reasons for these sex differences are not well understood, and this review seeks to shed light on these underlying factors to aid in prevention and treatment strategies. Sarcomas, uncommon malignancies, stem from mesenchymal tissues, distinct from epithelial tissues, originating in the embryonic mesodermal layer. These sarcomas have been categorized as either bone or soft tissue sarcomas, depending on their originating tissue. The majority of sarcomas occur sporadically with their etiology being unknown, but there are several, well-established genetic predisposition syndromes and some environmental exposures associated with specific sarcomas. Recently, many studies have shown that sarcomas, in analogy with colorectal, skin, head and neck, esophageal, lung, and liver carcinomas, also have a male sex predilection. Significant gender differences have already been observed in childhood sarcomas. Among the tumors strongly associated with the male sex, childhood sarcomas have been identified as being particularly sensitive to the biological differences between the sexes, with special regard to soft tissue sarcomas. As the biological mechanisms underlying the sex differences in the incidence of soft tissue sarcomas remain largely unexplored, this review aims to highlight the factors underlying these differences to inform prevention and treatment. [ABSTRACT FROM AUTHOR]

Background: Pancreatic cancer is notorious for its aggressive nature and low survival rate, with less than 10% of patients surviving beyond five years. Early detection is difficult, but skin metastases can be a rare but significant indicator. This systematic review focuses on the epidemiology, clinical features, and histology of skin metastases from pancreatic cancer to determine their importance in early diagnosis and overall management of the disease. Materials and methods: Following PRISMA guidelines, we conducted an exhaustive search of MEDLINE/PubMed, EMBASE, and SCOPUS databases up to June 2023, using specific keywords. Four independent investigators screened the studies using predefined criteria, and two investigators checked the accuracy and consistency of the data extraction. We assessed the quality of the trials using adapted criteria from the Joanna Briggs Institute. A narrative synthesis rather than a meta-analysis was chosen because of the different study designs. Results: The final analysis included 57 patients with skin metastases from pancreatic cancer. Cutaneous metastases, although rare, presented with approximately equal gender distribution and a mean age of 63.4 years. Predominantly non-umbilical (77%), these metastases showed clinical diversity, ranging from asymptomatic nodules to painful or ulcerated lesions. Notably, skin metastases often preceded the diagnosis of primary pancreatic cancer (58%). Primary tumor characteristics revealed different localizations, with adenocarcinoma being the most prevalent histological type (77%). A significant association (p = 0.008) was observed between pancreatic tumor location and the timing of presentation of skin metastases. Tumors located in the body and tail of the pancreas were more likely to manifest skin metastases as an initial clinical manifestation (62.2%) than those in the head of the pancreas (20.8%). Conclusions: In conclusion, although skin metastases are rare, they are important indicators of pancreatic cancer, highlighting the need for multidisciplinary healthcare collaboration and thorough skin examination. Recognizing them could lead to earlier diagnosis, which is crucial in a cancer with limited treatment options. [ABSTRACT FROM AUTHOR]

Background: This study aimed to improve the understanding of the prognostic value of tumor mitotic rate (TMR) in cutaneous melanoma and assessed its significance as a predictor for overall, melanoma‐specific, and recurrence‐free survival. Patients and Methods: This is a retrospective multicenter Italian cohort study of 13,016 patients diagnosed with and treated for invasive primary melanoma between 2005 and 2020 with median follow‐up of 5.5 years. The survival probability was assessed by Kaplan–Meier method, hazard ratios (HRs), and corresponding 95% confidence interval (CI) of all‐cause mortality and recurrence/death by multivariable Cox proportional hazards models. Results: Higher dermal mitoses number was associated with decreased overall survival. Among patients with TMR 0/mm2, 1/mm2, 2/mm2–3/mm2, 4/mm2–10/mm2, and >10/mm2, 5‐year overall survival (OS) was 97.3%, 93.6%, 88.3%, 73.0%, and 60.9%, respectively. In multivariate analyses, compared to TMR of 0/mm2, HRs for all‐cause mortality were 1.35 (95% CI, 1.08–1.68), 1.70 (95% CI, 1.40–2.07), 2.04 (95% CI, 1.67–2.49), and 2.39 (95% CI, 1.90–3.00) for 1 mitoses/mm2, 2 mitoses/mm2–3 mitoses/mm2, 4 mitoses/mm2–10 mitoses/mm2, and >10 mitoses/mm2, respectively. A similar increase in risks was observed in melanoma‐specific survival (MSS) and recurrence‐free survival (RFS). The HRs for MSS and RFS for the highest compared to the lowest TMR category were 3.01 (95% CI, 2.20–4.11) and 2.26 (95% CI, 1.88–2.73), respectively. Sentinel lymph‐node biopsy positivity was significantly associated with TMR increase even with adjustment for several potential confounders. Conclusions: A clear association was demonstrated between an increasing TMR and decreased OS, MSS, and RFS, suggesting a reconsideration of TMR prognostic role for future inclusion in the melanoma staging system. Plain Language Summary: The 8th American Joint Committee on Cancer for melanoma staging removed tumor mitotic rate (TMR) from the staging criteria for T1 melanomas, giving way to ulceration and tumor thickness as stronger prognostic predictors.However, it is still recommended that TMR should be assessed and recorded in all primary invasive melanomas.In a large retrospective multicenter study on primary invasive melanomas, we investigated the prognostic value of TMR to assess its significance as survival predictor.Our results showed a clear association between increasing TMR and decreased patients' survival, suggesting that TMR should be considered for inclusion in the melanoma staging system. Increasing tumor mitotic rate (TMR) is clearly associated with decreased overall, melanoma‐specific, and recurrence‐free survival. Our results suggest that the prognostic role of TMR should be reconsidered, and dermal mitotic rate should be assessed and recorded for all primary melanomas. [ABSTRACT FROM AUTHOR]

Simple Summary: Sarcoma may show similarities to malignant melanoma, making it difficult to differentiate between these two neoplasms. This systematic review summarizes evidence on cases of sarcoma that were initially diagnosed as melanoma to help clinicians in the diagnostic process. A comprehensive search of key databases identified 23 case reports and 4 case series with a total of 34 patients. Heterogeneous clinical presentation and frequent immunohistochemistry positivity contributed to the initial misdiagnosis. The second assessment was performed due to unusual presentation or uncertain diagnosis, and the final diagnosis was clear cell sarcoma (50%) or other soft tissue sarcomas (50%). EWSR1 translocation was investigated in 50% of cases, among which 94% were found to be positive. This systematic review suggests that a second diagnosis should be considered in cases of atypical lesions, and ESWR1 translocation should be investigated. Background: Sarcoma may show similarities to malignant melanoma in terms of morphologic and immunohistochemical aspects, making it difficult to differentiate between these two neoplasms during the diagnostic process. This systematic review aims to summarize available evidence on cases of sarcoma that were initially diagnosed as melanoma. Methods: A comprehensive search of the MEDLINE/Pubmed, EMBASE, and SCOPUS databases was conducted through March 2023. We included case series and case reports of sarcoma patients that were initially diagnosed as malignant melanoma. PRISMA guidelines were followed. Results: Twenty-three case reports and four case series with a total of 34 patients were included. The clinical presentation was heterogeneous, and the most involved anatomical regions were lower limbs (24%), head/neck (24%), and upper limbs (21%). IHC positivity was reported for S100 (69%), HMB45 (63%), MelanA (31%), and MiTF (3%). The main reasons for a second assessment were unusual presentation (48%) and uncertain diagnosis (28%). EWSR1 translocation was investigated in 17/34 patients (50%) and found to be positive in 16/17 (94%). The final diagnosis was clear cell sarcoma (50%) or other soft tissue sarcomas (50%). Conclusions: Melanoma and some histotypes of sarcoma share many similarities. In cases of atypical lesions, a second diagnosis should be considered, and ESWR1 translocation should be investigated. [ABSTRACT FROM AUTHOR]