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In this original research, we present the results in terms of effectiveness and safety of bimekizumab for hidradenitis suppurativa in real clinical practice. Results indicated significant improvement in all activity scores and patient‐reported outcomes at week 16, including a notable decrease in mean IHS4 from 27.1 to 15.6 (p < 0.001), HS‐PGA from 5.1 to 3.2 (p < 0.001), VAS pain from 8.3 to 4.7 (p < 0.001) and DLQI from 21.6 to 12.6 (p < 0.001). Bimekizumab, administered every 2 or 4 weeks, was well‐tolerated with no discontinuations and no new safety concerns identified. These findings corroborate the drug's effectiveness and favourable safety profile observed in phase 3 clinical trials, supporting its use in real‐world clinical practice for treating HS. [ABSTRACT FROM AUTHOR]

The article discusses the treatment of palmoplantar psoriasis (PP) with oral roflumilast, a phosphodiesterase-4 inhibitor. A case series of 27 patients with PP treated with oral roflumilast showed improvements in severity scores, pain, and itch at 12 and 24 weeks. Side effects were mild and self-resolved, with 19% of patients withdrawing from treatment due to side effects or inefficacy. Oral roflumilast may be a viable treatment option for PP, especially in cases resistant to other therapies or with contraindications to methotrexate. Controlled studies are needed to confirm these findings. [Extracted from the article]

This article discusses the effectiveness, safety, and satisfaction of 1% tirbanibulin ointment in the treatment of actinic keratoses (AK). AK is a common skin disorder, and traditional therapies for AK often have low adherence and frequent local skin reactions. Tirbanibulin has shown promising results in efficacy and safety in previous studies. The study evaluated the effectiveness of tirbanibulin in real clinical practice and found that it was effective in reducing the number of lesions and achieving clearance. The treatment was well-tolerated and had a high satisfaction rate among patients. However, the study had limitations such as a small sample size and short-term follow-up. Overall, tirbanibulin is considered an effective, safe, and satisfactory treatment for AK on the face and scalp. [Extracted from the article]

This medical case study, published in Clinical & Experimental Dermatology, identifies a specific genetic variant in the PTEN gene as the causative factor for Cowden syndrome, a rare autosomal dominant genetic disorder characterized by multiple hamartomas and benign tumors in various organs and tissues. The study describes the case of a 47-year-old man with multiple flesh-colored papules on his face and other clinical features consistent with Cowden syndrome. A genetic study confirmed the presence of the PTEN variant in the patient and his affected son, who was diagnosed with Bannayan-Riley-Ruvalcaba syndrome, another manifestation within the PTEN spectrum. The study highlights the importance of early recognition and surveillance for managing the syndrome effectively. Treatment options, such as sirolimus, are also discussed. [Extracted from the article]

This article discusses a case of cutaneous tuberculosis (CTB), a rare form of tuberculosis that affects the skin. The patient, a 55-year-old male from Nigeria living in Spain, presented with skin lesions characterized by erythematous papules with a necrotic center. Laboratory tests and imaging revealed signs of tuberculosis, and a biopsy confirmed the presence of Mycobacterium tuberculosis DNA. The patient was treated with a combination of medications and successfully recovered. The article emphasizes the importance of considering CTB as a possibility, even when initial tests are negative, and highlights the need for early diagnosis and treatment. [Extracted from the article]

Introduction: There is still a need to develop a simple algorithm to identify patients likely to need complex Mohs micrographic surgery (MMS) and optimize MMS schedule. The main objectives of this study are to identify factors associated with a complex MMS and develop a predictor model of the number of stages needed in surgery and the need for a complex closure. Materials and Methods: A nationwide prospective cohort study (REGESMOHS, the Spanish Mohs surgery registry) was conducted including all patients with a histological diagnosis of basal cell carcinoma (BCC). Factors related to three or more stages and a complex closure (that needing a flap and/or a graft) were explored and predictive models were constructed and validated to construct the REGESMOSH scale. Results: A total of 5226 patients that underwent MMS were included in the REGESMOHS registry, with 4402 (84%) having a histological diagnosis of BCC. A total of 3689 (88.9%) surgeries only needed one or two stages and 460 (11.1%) required three or more stages. A model to predict the need for three or more stages included tumour dimension, immunosuppression, recurrence, location in risk areas, histological aggressiveness and previous surgery. Regarding the closure type, 1616 (38.8%) surgeries were closed using a non‐complex closure technique and 2552 (61.2%) needed a complex closure. A model to predict the need for a complex closure included histological aggressiveness, evolution time, patient age, maximum tumour dimension and location. Conclusion: We present a model to predict MMS needing ≥3 stages and a complex closure based on epidemiological and clinical data validated in a large population (with real practice variability) including different centres that could be easily implemented in clinical practice. This model could be used to optimize surgery schedule and properly inform patients about the surgery duration. [ABSTRACT FROM AUTHOR]

Background: Large prospective studies on the safety of Mohs micrographic (MMS) surgery are scarce, and most focus on a single type of surgical adverse event. Mid-term scar alterations and functional loss have not been described. Objectives: To describe the risk of MMS complications and the risk factors for them. Methods: A nationwide prospective cohort collected all adverse events on consecutive patients in 22 specialised centres. We used multilevel mixed-effects logistic regression to find out factors associated with adverse events. Results: 5,017 patients were included, with 14,421 patient-years of follow-up. 7.0% had some perioperative morbidity and 6.5% had mid-term and scar-related complications. The overall risk of complications was mainly associated with use of antiaggregant/anticoagulant and larger tumours, affecting deeper structures, not reaching a tumour-free border, and requiring complex repair. Age and outpatient setting were not linked to the incidence of adverse events. Risk factors for haemorrhage (0.9%) were therapy with antiaggregant/anticoagulants, tumour size, duration of surgery, and unfinished surgery. Wound necrosis (1.9%) and dehiscence (1.0%) were associated with larger defects and complex closures. Immunosuppression was only associated with an increased risk of necrosis. Surgeries reaching deeper structures, larger tumours and previous surgical treatments were associated with wound infection (0.9%). Aesthetic scar alterations (5.4%) were more common in younger patients, with larger tumours, in H-area, and in flap and complex closures. Risk factors for functional scar alterations (1.7%) were the need for general anaesthesia, larger tumours that had received previous surgery, and flaps or complex closures. Conclusions: MMS shows a low risk of complications. Most of the risk factors for complications were related to tumour size and depth, and the resulting need for complex surgery. Antiaggregant/anticoagulant intake was associated with a small increase in the risk of haemorrhage, that probably does not justify withdrawal. Age and outpatient setting were not linked to the risk of adverse events. [ABSTRACT FROM AUTHOR]

Three‐dimensional (3D) wound measurement lacks a gold standard to test accuracy. It is useful to develop procedures to scan wounds and reconstruct their 3D model with low‐cost techniques. We present a new procedure (Structure from Motion [SfM]‐3DULC) that uses photographs for measuring nine wound variables. We also propose a new variant of ImageJ in which an orthophoto is used to measure the projected area (Ortho‐ImageJ). In addition, we compare the wound measurements made by dermatologists and non‐experts. A group of five experts in dermatology and five non‐specialists measured 33 leg wounds five times per procedure. Intra‐rater and inter‐rater reliability scores of SfM‐3DULC were evaluated with the intraclass correlation coefficient (ICC 2,1). The accuracy of the two new procedures (SfM‐3DULC and Ortho‐ImageJ) in the measurement of projected area was assessed by comparing their values with those obtained using ImageJ, with the Wilcoxon matched‐pairs signed rank test (α = 0.05). This test was also used to analyse the differences between the measurements made by dermatologists and non‐experts. All the variables measured by dermatologists using SfM‐3DULC showed excellent scores of intra‐rater reliability (ICC > 0.99) and inter‐rater reliability (ICC > 0.98). No significant differences between the three procedures were found when comparing their projected area values. Significant differences between the measurements of dermatologists and non‐experts were found in most of the variables: circularity coefficient, perimeter, projected area, surface area, and reference surface area. The wound measurement procedure SfM‐3DULC has an excellent reliability, is accurate for the measurement of projected area, and can be used by dermatologists for wound monitoring in everyday clinical practice. [ABSTRACT FROM AUTHOR]

Characterization of patients, surgery procedures and the risk factors for dermatofibrosarcoma protuberans (DFSP) recurrences is poorly defined. In this study, we aimed to describe the demographics, tumor characteristics and interventions of DFSP treated with Mohs micrographic surgery (MSS) to determine the rate and risk factors for recurrence. Data were collected from REGESMOHS, a nationwide prospective cohort study of patients treated with MMS in Spain. From July 2013 to February 2020, 163 patients with DFSP who underwent MMS were included. DFSP was mostly located on trunk and extremities. Recurrent tumors had deeper tumor invasion and required higher number of MMS stages. Paraffin MMS was the most frequently used technique. Overall recurrence rate was 0.97 cases/100 person‐years (95% IC = 0.36–2.57). No differences were found in epidemiological, tumor, surgery characteristics or surgical technique (frozen or paraffin MMS [p = 0.6641]) in terms of recurrence. Median follow‐up time was 28.6 months with 414 patient‐years of follow‐up. In conclusion, we found an overall low recurrence rate of DFSP treated with MMS. None of the studied risk factors, including MMS techniques, was associated with higher risk for recurrence. [ABSTRACT FROM AUTHOR]

Background Objectives Methods Results Conclusions Immunosuppressed (IS) patients, particularly solid organ transplant recipients and those on immunosuppressive therapy, face a higher incidence and recurrence of nonmelanoma skin cancers (NMSC), including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Mohs micrographic surgery (MMS) is the preferred treatment for high‐risk NMSC due to its high cure rate and margin examination capabilities. However, IS patients may experience more complications, such as surgical site infections, and a greater risk of recurrence, making their outcomes a subject of interest.This study aimed to compare IS and immunocompetent (IC) patients undergoing MMS for NMSC in terms of baseline characteristics, intra‐ and post‐surgical complications, and postoperative recurrence rates.The study utilized data from the REGESMOHS registry, a 7‐year prospective cohort study in Spain. It included 5226 patients, categorizing them into IC (5069) and IS (157) groups. IS patients included solid organ transplant recipients, those on immunosuppressive treatments, individuals with haematological tumours and HIV‐positive patients. Patient data, tumour characteristics, surgical details and outcomes were collected and analysed.IS patients demonstrated a higher proportion of SCC, multiple synchronous tumours and tumours invading deeper structures. Complex closures, unfinished MMS and more surgical sections were observed in the IS group. Although intra‐operative morbidity was higher among IS patients, this difference became non‐significant when adjusted for other variables such as year of surgery, antiplatelet/anticoagulant treatment or type of closure. Importantly, IS patients had a substantially higher recurrence rate (IRR 2.79) compared to IC patients.This study suggests that IS patients may be at a higher risk of development of AE such as bleeding or tumour necrosis and are at a higher risk of tumour recurrence. Close follow‐up and consideration of the specific characteristics of NMSC in IS patients are crucial. Further research with extended follow‐up is needed to better understand the long‐term outcomes for this patient group. [ABSTRACT FROM AUTHOR]

Spitz nevus is a benign melanocytic proliferation that shows relatively characteristic clinicopathologic features. Despite this, Spitz nevus is clinically confused with many other lesions, and histopathologically it is sometimes difficult to distinguish it from melanoma. However, Spitz nevus rarely causes differential diagnostic problems with granulomatous dermatitis. This article describes an 8-year-old girl who presented with a nodule on her right arm, a clinical appearance of a pyogenic granuloma. Histopathologically, there was a dermal lesion composed of aggregates of large epithelioid cells surrounded by a heavy inflammatory infiltrate, mimicking a sarcoid-like granulomatous dermatitis. Immunohistochemistry showed epithelioid cells with strong nuclear and cytoplasmic staining with S-i 00 protein, thus establishing the diagnosis of a melanocytic tumor. The heavy T-cell lymphocytic infiltrate that accompanies the large epithelioid cells caused its granulomatous appearance. Molecular assessment showed H27H mutation in the HRC4S gene. We suggest the term `pseudogranulomatous' for this variant of Spitz nevus because it indicates that the lesion is not authentically granulomatous and simply mimics a granulomatous dermatitis. [ABSTRACT FROM AUTHOR]

Background: The use of Mohs micrographic surgery (MMS) for rare cutaneous tumors is poorly defined. We aim to describe the demographics, tumor presentation and topography, surgery characteristics and complications of MMS for rare cutaneous tumors in a national registry., Methods: Prospective cohort study of patients treated with MMS in Spain between July 2013 and June 2018. The inclusion criteria were patients with cutaneous tumors with final diagnosis different from basal cell carcinoma, squamous cell carcinoma, dermatofibrosarcoma protuberans, or any kind of melanoma., Results: Five thousand and ninety patients were recorded in the registry, from which only 73 tumors (1.4%) fulfilled the inclusion criteria: atypical fibroxanthoma (18), microcystic adnexal carcinoma (10), extramammary Paget's disease (7), Merkel cell carcinoma (5), dermatofibroma (4), trichilemmal carcinoma (4), desmoplastic trichoepithelioma (4), sebaceous carcinoma (3), leiomyosarcoma (2), porocarcinoma (2), angiosarcoma (2), trichoblastoma (1), superficial acral fibromyxoma (1), and others (10). No intra-surgery morbidity was registered. Postsurgery complications appeared in six patients (9%) and were considered mild. Median follow-up time was 0.9 years during which three Merkel cell carcinomas, one angiosarcoma, one microcystic adnexal carcinoma, and four others recurred (12.3%)., Conclusion: This national registry shows that rare cutaneous tumors represent a negligible part of the total MMS performed in our country with a low complication rate., (© 2019 The International Society of Dermatology.)