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Uveal melanoma is the most common intraocular malignancy and has a poor prognosis compared to other melanoma subtypes with a median overall survival of 6-10 months. With immune checkpoint inhibitor therapy, either PD-1 inhibitor alone or combination ipilimumab/nivolumab (anti-CTLA-4/anti-PD-1), responses are rare and often not durable. We present a case report of a now 66-year-old woman with diffuse metastatic uveal melanoma previously treated with a combination of ipilimumab/nivolumab, followed by maintenance nivolumab. Almost complete resolution of all sites of metastatic disease was observed except for one liver metastasis which regressed partially on immunotherapy. Notably, the patient had a significantly elevated BMI and developed widespread vitiligo on treatment. Whole-genome and transcriptome analysis was performed on the residual liver biopsy and molecular markers that may have contributed to the exceptional response were investigated. Several alterations were observed in genes involved in T-cell responses. Estimates of tumour infiltrating immune cells indicated a high level of plasma cells compared to other uveal melanoma cases, a finding previously associated with indolent disease. The patient also carried several germline SNPs that may have contributed to her treatment response as well as widespread vitiligo. Whole-genome and transcriptome sequencing have provided insight into potential molecular underpinnings of an exceptional treatment response in a tumour type typically associated with poor prognosis. Immunological findings suggest a role for plasma cells in the tumour microenvironment. Elevated BMI and the development of vitiligo may be clinically relevant factors for predicting response to immune checkpoint inhibitor therapy, warranting further studies in patients with uveal melanoma.

This retrospective cohort study examined the factors for patients with metastatic vulvar and vaginal melanomas on immune checkpoint inhibitors. The study included all patients over the age of 18 who received either anti-cytotoxic T-lymphocyte-4 (anti-CTLA-4) therapy or anti-programmed cell death protein-1 (anti-PD-1) therapy at the Sunnybrook Hospital from June 2012 to December 2018. There were 11 patients with vulvar or vaginal melanoma on immune checkpoint inhibitor therapy. The main sites of metastasis included the lungs, lymph nodes, soft tissues, and liver. The majority of patients received prior radiation therapy (7/11) and prior surgical therapy (9/11). There were no differences in overall survival for vulvar or vaginal melanomas on anti-PD-1 vs. anti-CTLA-4 therapy (p > 0.05). There were no significant differences in overall survival for vulvar and vaginal vs. cutaneous melanoma (p > 0.5). There were no significant differences in overall survival in patients with vulvar and vaginal melanoma in the presence vs. absence of immune-related adverse events (p > 0.05), yet there was a significant difference in patients with cutaneous melanoma in the presence vs. absence of immune-related adverse events (p < 0.05). Knowledge of the presentation and outcome of vulvar and vaginal melanomas is important for clinical practice in gynecology.

This review examines the clinical, morphological, and systemic factors related to coronavirus disease 2019 (COVID-19) cutaneous manifestations. The EMBASE, Medline, and Pubmed Central databases were searched from February 1, 2020 until April 25, 2020, using the search words “(COVID-19 OR SARS-CoV-2 OR coronavirus-19) AND (skin OR cutaneous OR dermatologic)”. Cutaneous manifestations of COVID-19 were included. The cutaneous manifestations can be classified into 2 types. Patients with inflammatory reactions consisted of morbilliform, varicella-like, urticarial eruptions, and vesiculobullous manifestations. These manifestations were mainly found on the trunk, limbs, and faces of patients and had mainly positive COVID-19 polymerase chain reaction findings (97.7%). Furthermore, there were 516 patients with acral vascular lesions: chilblains, livedo lesions, cutaneous small-vessel vasculitis, and other noninflammatory purpura. These were often nonpruritic (88%) and not seen in severe disease (88.7%). The cutaneous lesions have potential for early diagnosis of COVID-19 and prevention of disease transmission. The implications of COVID-19 in the field of dermatology continue to evolve as more clinical data becomes available.

Aim of the study: In this retrospective cohort study we have examined differences in survival profiles with respect to the body mass index in patients with mucosal melanoma on immune checkpoint inhibitor therapy. Materials and methods: The primary outcome included the association between the body mass index and overall survival in patients with metastatic mucosal melanoma. The secondary outcomes included the clinical presentation and management of vulvar and vaginal melanomas with oral and anorectal mucosal melanomas, as well as the surgical and radiological management of vulvar and vaginal melanomas. Kaplan–Meier analysis and log-rank test were used for the assessment of overall survival. Results: The results showed that patients with mucosal melanoma whose body mass index was ≥25 had better overall survival (p = 0.02). Overall survival was different between vulvar/vaginal vs. oral mucosal melanoma (p = 0.02). Overall survival was not different between vulvar/vaginal vs. anorectal melanoma (p = 0.77). Some immune toxicities were specific to patients with vulvar/vaginal melanoma. Conclusions: Obesity is associated with improved survival in patients with metastatic mucosal melanoma, although findings can be heterogeneous depending on the subtype of mucosal melanoma.

Graphical abstract

Supplemental material, Online supplementary file 1, for Impact of COVID-19 on Access to Care: A National Patient Survey by Sheida Naderi-Azad, Rachael Manion and Raed Alhusayen in Journal of Cutaneous Medicine and Surgery

Introduction/Background Few studies to date have comprehensively examined all immune-related adverse events (irAEs) in vulvovaginal and cutaneous melanoma patients on immune checkpoint inhibitors (ICIs). Methodology We retrospectively analyzed 169 patients with advanced-stage vulvovaginal or cutaneous melanoma who received at least one dose of ICI between June 2012 to December 2018. Descriptive statistics were used to summarize the baseline characteristics, disease outcomes, and toxicity profiles. Chi-square statistical analysis was used to examine associations between irAEs and pre-existing conditions, as well as irAEs and treatment response. P-values Results Overall, 53.8% of patients with vulvovaginal melanoma developed irAEs, compared to a similar percentage of 51.9% for patients with cutaneous melanoma. Yet the most common types of irAEs differed between patients. The most common irAEs for patients with vulvovaginal melanoma were gastrointestinal disorders (44.4%), hypothyroidism (22.2%), and renal and urinary disorders (22.2%). On the other hand, the most common irAEs for patients with cutaneous melanoma on ICIs were gastrointestinal disorders (21.7%), cutaneous adverse events (17.9%) and pneumonitis (18.75%). Cutaneous adverse events were overall the most common irAEs, and were significantly associated with patient response to ICIs (p = 0.01). Conclusion Nuanced differences in the clinical presentation of irAEs in patients with vulvovaginal vs. cutaneous melanoma are important considerations for initiating ICIs in accordance with melanoma type. Furthermore, cutaneous adverse events were the most common irAEs overall, and were significantly associated with response to ICIs in patients with metastatic melanoma. Disclosures I have no conflicts of interest.

This review examines the clinical, morphological, and systemic factors related to coronavirus disease 2019 (COVID-19) cutaneous manifestations. The EMBASE, Medline, and Pubmed Central databases were searched from February 1, 2020 until April 25, 2020, using the search words "(COVID-19 OR SARS-CoV-2 OR coronavirus-19) AND (skin OR cutaneous OR dermatologic)". Cutaneous manifestations of COVID-19 were included. The cutaneous manifestations can be classified into 2 types. Patients with inflammatory reactions consisted of morbilliform, varicella-like, urticarial eruptions, and vesiculobullous manifestations. These manifestations were mainly found on the trunk, limbs, and faces of patients and had mainly positive COVID-19 polymerase chain reaction findings (97.7%). Furthermore, there were 516 patients with acral vascular lesions: chilblains, livedo lesions, cutaneous small-vessel vasculitis, and other noninflammatory purpura. These were often nonpruritic (88%) and not seen in severe disease (88.7%). The cutaneous lesions have potential for early diagnosis of COVID-19 and prevention of disease transmission. The implications of COVID-19 in the field of dermatology continue to evolve as more clinical data becomes available.

This article aims to address updates on recent clinical trial findings (April 2019 to April 2020) regarding biologic therapy initiation and maintenance for adult patients. Prescribers should use this update as guidance for determining the appropriate biologic class based on patient characteristics and for approaching biologic-experienced patients with refractory psoriasis. This update also may serve as a reference for the recommended dosing regimens of the 11 approved biologics.

Significance: Pyoderma gangrenosum (PG) is a rare neutrophilic ulcerative dermatosis that poses a high burden of morbidity due to underdiagnosis, resistance to therapy, and limited therapeutic options. Optimization of wound care strategies and multimodal anti-inflammatory approaches are necessary to mitigate multiple converging pathways of inflammation leading to delayed healing, which is further complicated by additional factors such as pathergy. Recent Advances: PG treatment typically involves reducing inflammation, controlling pain, promoting wound healing, and treating the underlying etiology. Recent advances have been made with regard to targeted therapies for PG with topical, intralesional, and systemic medications. Wound management includes gentle cleansing without sharp debridement, limited topical antibacterial use, and maintenance of a moist environment to promote epithelial migration. Critical Issues: Wound dressings and compression therapy, in particular, introduce a wide variety of therapeutic options. Dressings should aim to target the specific PG wound type, depending on the depth and exudative nature of the wound, as well as local secondary factors. Superficial wounds, eschar, exudative wounds, granulating wounds, and colonized wounds are managed with variable approaches to the same underlying principles of pathergy avoidance, moisture balance, and reduction of immunogenic inflammatory stimuli. The importance of compression therapy to decrease edema and overgranulation fits within this treatment paradigm. Future Directions: As each of these treatment modalities offers a complex mixture of advantages and limitations, development of a systematic treatment algorithm in the future can help direct a more tailored path toward wound healing.

Introduction: Immune checkpoint inhibitor therapy and BRAF-targeted therapy have been developed for the treatment of metastatic melanoma. The optimal use of these agents, either in sequence or comb...