Search Results (1,014)

Erythema gyratum repens (EGR) is a rare figurate erythema strongly associated with internal malignancy and recognized as one of the most specific cutaneous paraneoplastic syndromes. Its recognition is clinically important, as it frequently precedes the diagnosis of an underlying neoplasm. We report the case of an 80-year-old woman who presented to the emergency department with a rapidly progressive, intensely pruritic eruption displaying a characteristic concentric “wood-grain” pattern. Laboratory evaluation revealed iron-deficiency anemia. Contrast-enhanced computed tomography identified a right-sided colonic mass, and colonoscopy with biopsy confirmed adenocarcinoma of the cecum. The patient underwent elective laparoscopic right hemicolectomy with complete tumor resection (pT3N0, microsatellite stable). Following surgery, the cutaneous lesions resolved completely and did not recur during follow-up. This case highlights erythema gyratum repens as a clinically relevant early marker of colorectal cancer and emphasizes the importance of prompt recognition of this distinctive dermatosis to trigger urgent and comprehensive malignancy screening, enabling timely diagnosis and definitive treatment. Full article

Cutaneous T-cell lymphoma (CTCL) comprises a heterogeneous group of extranodal non-Hodgkin lymphomas. With the publication of the fifth edition of the World Health Organization Classification of Hematolymphoid Tumors, the diagnostic framework for CTCL has shifted from primarily morphologic phenotypes toward an emphasis on molecular drivers. Current research suggests that malignant clones may arise from somatic mutations at the hematopoietic stem cell stage and may follow a continuous hematogenous dissemination model with bidirectional trafficking between the skin and systemic circulation. At the molecular level, genomic instability, often associated with somatic copy-number variations, may promote activation of the janus kinase-signal transducer and activator of transcription (JAK/STAT) signaling pathway through gene-dosage effects. In parallel, chromatin remodeling linked to EZH2 overexpression and reduced special SATB1 expression may support a Th2-polarized program. This phenotype may contribute to epidermal barrier impairment via cytokines such as Interleukins-4 (IL-4) and IL-13, potentially creating conditions permissive for Staphylococcus aureus colonization. Microbial superantigens and exotoxins may further contribute to tumor progression and therapeutic resistance by reinforcing JAK/STAT signaling, particularly STAT3, and reducing CD8+ T-cell–mediated immune surveillance. In the dermis, reprogramming of cancer-associated fibroblasts and polarization of macrophages toward an M2 phenotype may collectively contribute to an immunosuppressive niche. Emerging biomarkers, including CD74, and acquired resistance mechanisms after anti-C-C chemokine receptor 4 therapy further extend the translational relevance of recent pathologic findings. Overall, CTCL evolution appears to be a systemic process shaped by interactions between tumor-intrinsic genetic alterations and the skin microenvironment. Full article

Background: Melanoma remains a leading cause of cancer-related mortality, with early detection being the primary determinant of survival. The emergence of MLLMs offers a potential paradigm shift in accessible screening. However, the diagnostic reliability and safety of these general-purpose models in oncology remain insufficiently characterized. Methods: This study performed a head-to-head comparison of GPT-5, Gemini 3, and Grok 4 to evaluate their efficacy as first-level screening tools for cutaneous melanoma. A retrospective analysis was conducted using a balanced dataset of 100 clinical images (50 histopathologically confirmed benign, 50 malignant) from the ISIC archive. Results: Gemini 3 achieved the highest overall accuracy (71%) and specificity (94%), while Grok 4 demonstrated the highest sensitivity (52%). All models exhibited a critical deficit in sensitivity, missing approximately half of the malignant lesions. Statistical testing revealed no significant performance differences between the models (p > 0.05). Notably, Gemini 3 exhibited severe overconfidence, maintaining a high CI (84.62%) even during false-negative predictions, whereas GPT-5 and Grok 4 showed better calibration with a significant drop in confidence upon incorrect diagnosis. Conclusions: While current MLLMs possess a foundational capacity for dermatological analysis, their unacceptably low sensitivity and potential for overconfident misdiagnosis render them unsafe as standalone screening tools. At present, MLLMs should only be utilized as complementary tools under strict clinical supervision. Full article

Late-stage metastatic cutaneous melanoma (MCM) and neuroblastoma (NB) are the most aggressive skin and childhood cancers with survival rates of <50%, mainly due to the emergence of resistance to available drugs, thus requiring an urgent solution. Quaternary phosphonium salts (QPSs) can exhibit strong anticancer effects, regardless of the developed resistance. Triphenyl (1) and diphenyl (3 and 4) phosphonium salts were synthesized, treating commercial triphenyl phosphine and synthesizing 11-diphenylphosphanyl-undecan-1-ol (2), respectively, with benzyl bromide. Upon full characterization, they were tested, for the first time, on MeTRAV (BRAF^V600D) and MeOV (BRAF^V600E) vemurafenib (PLX)-resistant MCM cells, etoposide (ETO)-sensitive (HTLA 230) and multidrug resistant (MDR) (HTLA ER) NB cells, non-tumorigenic human keratinocytes (HaCaT), and mouse embryonic fibroblasts (3T3), as well as red blood cells (RBCs). Viability of MeTRAV cells was decreased to 44.8% by administration of 1 (100 µM), in intermediate-time (48 h) treatments, while short-time exposure (24 h) to 3 (≥75 µM) and 4 (≥50 µM) was sufficient to reduce their viability to 33.6 and 32.2%. Viability of MeOV was decreased under 50% with 5 µM concentrations of 1 and 25 µM of 3 and 4, While cells were exterminated (26.9, 20.6, and 21.8%) with higher concentrations after 48 h exposure. Collectively, 1 was the better performing compound (IC₅₀ = 6.4 µM, 48 h). Viability of HTLA ER cells was decreased under 50% upon 72 h administrations of 1 at concentrations ≥ 50 µM, 48 h (≥75 µM) and 72 h (≥50 µM) of 3, and after 72 h (≥75 µM) of 4, but 72 h exposure and high concentrations of all compounds were necessary for their extermination (31.2, 28.7, and 29.7%). Viability of HTLA 230 cells was not <50% when 1 and 4 were administered for only 24 h, while their viability was <50% after administration of 3 at all times of exposure. At high concentrations, all compounds exterminated cells (33.6, 25.3%, 1, 48–72 h; 38.6, 30.2, and 24.7%, 3, 24–72 h; 33.2%, 4, 72 h). The best-performing compounds were 1 (IC₅₀ = 4.0 µM, HTLA 230) and 3 (IC₅₀ = 27.8 µM, HTLA ER) at 72 h exposure. The cytotoxic effects of compound 4 on MeTRAV cells, when exposed to 24/48 h treatments, were comparable to those of PLX on the same cells in 72 h treatments. Compound 1, in shorter 48 h treatments of PLX-R MeOV, was 2.5-fold more cytotoxic than PLX in 72 h ones. All compounds were not cytotoxic to 3T3 cells at all times of exposure; they had low cytotoxicity to HaCaT cells in 24 and 48 h treatments and were slightly cytotoxic to RBCs in 24 h ones. Compound 1 could be a promising platform to develop new intermediate-time therapies for PLX-R MeOV cells, while 4 could be used to develop 24 and 48 h treatments for PLX-R MeTRAV cells. Also, all compounds could be developed as new treatment options for both ETO-sensitive and MDR late-stage HR-NB cells, being even more effective than ETO by 1.2, 2.0, and 1.3 times (HTLA 230) and 3.2, 4.7, and 3.2 times (HTLA ER). All compounds have the potential to be developed as adjuvants in already existing anticancer cocktails to treat MCM and/or NB. Full article

Background/Objectives: Accurate target delineation is critical in radiotherapy for head and neck non-melanoma skin cancer (NMSC), where tumor depth and subclinical extension are often underestimated by clinical and dermoscopic assessment alone. While high frequency ultrasound has shown value in surface-based radiotherapy techniques, the role of ultra-high frequency ultrasound (UHFUS) within external beam radiotherapy (EBRT) workflows remains poorly defined. Methods: We conducted a single-institution observational feasibility study including all consecutive patients with head and neck NMSC treated with definitive or adjuvant radiotherapy between July 2022 and July 2023 using a structured multidisciplinary workflow integrating pre-treatment UHFUS. UHFUS was systematically performed prior to CT simulation and incorporated into radiotherapy planning. The primary endpoint was the impact of UHFUS on radiotherapy decision-making, predefined as modification of target delineation, treatment intent, or beam modality selection. Secondary endpoints included feasibility, early local control, and late toxicity (descriptive). Results: Thirty patients were included (median age 85 years; range 66–99). UHFUS influenced at least one decision endpoint in 13 patients (43.3%). In the definitive radiotherapy cohort (n = 18), UHFUS modified gross tumor volume delineation in eight patients (44.4%), with an increase in median GTV from 17.5 cm³ to 24.3 cm³. Among patients initially referred for adjuvant radiotherapy (n = 12), UHFUS identified macroscopic residual disease in two cases, leading to a change in treatment intent from adjuvant to definitive radiotherapy. UHFUS supported beam modality selection in three patients by enabling safe use of electron therapy for superficial lesions. After a median follow-up of 24 months (range 12–24), no local recurrences were observed. Late toxicity was limited to grade 1 cutaneous events. Conclusions: Integration of UHFUS into EBRT planning for head and neck NMSC is feasible and clinically informative. UHFUS acts as a decision-shaping tool, influencing target delineation, treatment intent, and modality selection within a multidisciplinary workflow. These findings support further prospective evaluation of UHFUS-guided radiotherapy planning to standardize decision algorithms and assess long-term clinical impact. Full article

Facial vascularized composite allotransplantation (fVCA) is one of the most complex forms of vascularized composite allotransplantation and requires lifelong immunosuppression to ensure graft survival. Despite significant advances in surgical techniques and postoperative care over the past two decades, the true incidence of cutaneous malignancies in fVCA recipients remains poorly characterized due to the limited number of procedures, heterogeneous immunosuppressive protocols, and relatively short follow-up. This narrative review summarizes current evidence on oncologic risk in facial VCA, focusing on the effects of different immunosuppressive regimens and the challenges posed by the high immunogenicity of skin and mucosa. Available data indicate that malignancies, including cutaneous and other neoplasms, occur in approximately 10% of recipients, based on heterogeneous case-series data with immunosuppressive therapies largely extrapolated from solid organ transplantation. Calcineurin inhibitors, corticosteroids, and azathioprine are associated with increased oncologic risk, whereas mycophenolate mofetil and mTOR inhibitors may confer a more favorable profile. Overall, fVCA, unlike solid organ transplantation, is a life-enhancing procedure, highlighting the need for tailored immunosuppressive strategies, rigorous dermatologic surveillance, and further research supported by dedicated registries to better define long-term malignancy risk. Full article

Cutaneous squamous cell carcinoma (cSCC) is the second most prevalent skin cancer diagnosed worldwide after basal cell carcinoma. CSCC represents a growing global public health challenge due to its higher potential of local invasion, recurrence, and metastasis. Incidence rates of cSCC are projected to increase due to rising exposures to risks factors. Ultraviolet light exposure is the primary cause, and lighter skin pigmentation, immunosuppressive conditions and skin phototype are the primary risk factors. CSCC typically presents as a red, scaly, flat lesion (in situ tumors) or a red, firm, raised lesion with scale or erosion (invasive tumors). Surgical excision remains the standard-of-care for localized cSCC and is often curative. Although, most patients achieve favorable outcomes, a subset of cSCC exhibits a highly aggressive and metastatic phenotype (postoperative recurrence rates are approximately 5%). Addressing the clinical challenge posed by these high-risk cases requires a more comprehensive understanding of the underlying molecular drivers. This review examines the interaction between transglutaminase 2 (TG2) and the G-protein-coupled receptor 56 (GPR56) as a pivotal driver of the aggressive cSCC phenotype. This molecular axis is particularly significant for its role in the maintenance of epidermal cancer stem (ECS) cells, which contribute to tumor progression and therapy resistance. While the definitive link between the TG2-GPR56 complex and systemic metastasis in cSCC is currently being elucidated, significant evidence from analogous malignancies and in vitro keratinocyte models provides a clear mechanistic roadmap for its involvement in tumor invasion. Full article

Background: Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) are the first-line treatment for patients with non-small cell lung cancer (NSCLC) harboring EGFR mutations. Although EGFR-TKIs can cause various adverse events (AEs), their profiles have not been fully elucidated in Thai patients. This study aimed to determine the incidence, characteristics, severity, and duration of the first AEs and to evaluate their association with tumor response in patients with NSCLC receiving EGFR-TKIs. Method: This retrospective cohort study was conducted at a super-tertiary care hospital in Thailand. Patients with NSCLC who received EGFR-TKIs between August 2021 and July 2024 were included. Descriptive statistics were used to summarize safety profiles and tumor response. The association between AEs and objective response was assessed using logistic regression. Results: A total of 187 patients were included in this study. Overall, 177 AEs were observed in patients receiving erlotinib, osimertinib, or gefitinib. The most common cutaneous AEs were rash (30.7%), xerosis (24.1%), and acneiform rash (19.3%), while diarrhea (20.3%) was the most frequent gastrointestinal toxicity. Most AEs were grade 1–2 and occurred within 1 month after treatment initiation. In multivariable logistic regression analysis, pruritus (OR 8.26, 95% CI: 1.00–67.75, p = 0.049) and treatment line (OR 0.27, 95% CI: 0.10–0.68, p = 0.006) were independently associated with objective response. Conclusion: Most of the AEs occurred early during EGFR-TKI therapy, with cutaneous reactions being the most common and generally mild to moderate. Pruritus and treatment line were independently associated with objective response, suggesting that pruritus may serve as a potential clinical indicator of treatment response and highlighting the importance of monitoring of the EGFR-TKI-related AEs during therapy. Full article

Background/Objective: Although most melanocytic lesions are diagnosed as benign or malignant by histopathologic evaluation, with or without the aid of immunohistochemistry, diagnosis may remain uncertain in a minority of cases. Assessment of copy number abnormalities (CNAs) may provide sufficient additional evidence to favor either a benign or malignant diagnosis in both pediatric and adult cases and in melanocytic lesions of various subtypes, including Spitzoid, mucosal, and acral. CNAs are common in melanomas, while they are rare, with few exceptions, in benign lesions. Detection of CNAs by fluorescence in situ hybridization (FISH) and chromosomal microarray (CMA) has been well established for melanocytic lesions, with advantages and disadvantages for each. The objective of this meta-analysis was to evaluate the utility of CNA testing for the diagnosis of melanoma, across subtypes, when a lesion remains ambiguous after histopathologic and immunohistochemical assessment. In addition, the utility of CNAs to determine prognosis in established diagnoses of melanoma was also evaluated. Methods: The Cancer Genomics Consortium Working Group for Melanocytic Lesions reviewed published data from January 1998 through September 2022 of CNAs in melanocytic lesions detected by either FISH or CMA and conducted a meta-analysis of the findings. Results: Specific abnormalities common in primary cutaneous melanomas of various subtypes and uveal melanomas were enumerated. Differences in CNAs found in primary versus metastatic lesions were also determined, and published evidence for prognosis was summarized. Conclusions: The working group established evidence-based recommendations for the use of CNA testing for evaluation of ambiguous melanocytic lesions. Full article

Background/Objectives: Vitamin D (VD), through the interaction with its receptor (VDR), plays essential roles in the skin. VDR-mediated signaling prevents cancer development and improves prognosis, making it an appealing target for therapy. However, VD cutaneous synthesis begins with solar exposure, which is the first etiological factor for cutaneous cancer and increases oxidative stress (OS). This complicates the dermatologist’s perspective when advising photoprotective strategies while aiming to consider the benefits of VD signaling. In this context, and in the absence of cutaneous data to date, this research aims to address VDR dynamics in skin cells and tissue subjected to OS. It also explores the potential of a natural photoprotectant with antioxidant properties (a specific combination of Polypodium leucotomos and Aspalathus linearis extracts) in preventing VDR depletion. Methods: HaCaT cell cultures and skin explants were used as experimental models. OS was induced by treatments with hydrogen peroxide (H₂O₂). The proteins of interest (VDR and Nuclear Factor Erythroid 2-Related Factor 2 (NRF2)) were analyzed by immunostaining. Cell viability, nuclear counterstaining, and Haematoxylin/Eosin staining were used as cyto/histochemical controls. Results: In both experimental models, we observed the reduction of VDR under OS. Pre-treatments with the botanical ingredient preserved VDR levels from that decline, probably through a mechanism involving NRF2. Conclusions: Cutaneous VDR levels are altered under oxidative stress, and certain photoprotectants could preserve them. This opens the door to preserving the benefits of VDR signaling while preventing solar radiation damage, bringing a new viewpoint for designing future strategies in skin cancer prevention and treatment. Full article

Cutaneous melanoma is an aggressive form of cancer that accounts for approximately 80% of skin cancer-associated mortality. Treatment strategies for melanoma have been rapidly evolving over the past two decades. Clinical outcomes for advanced melanoma patients have improved with the use of immune checkpoint inhibitors and targeted therapies, including combination therapies. In this review, we primarily focus on the evolution of novel therapies for advanced melanoma patients, existing and emerging melanoma biomarkers, and the most up-to-date treatment recommendations. Furthermore, we summarise ongoing studies, clinical trials, and emerging therapeutic strategies. In this review, we will walk you through how cutaneous melanoma treatment strategies have evolved over the past 50 years. We will provide background on how those strategies were developed, how they function, their pros and cons, and their performance in terms of clinical benefits. Lastly, we will provide insights into potential therapies and research areas. In summary, improving the efficacy of immune checkpoint blockade remains the most promising approach for improving cutaneous melanoma management. However, strategies such as CAR-T/NK, PROTAC, or extracellular vesicle-based therapies are also worth further investigation. Full article

Invasive conjunctival squamous cell carcinoma (CSCC) is an aggressive, ocular surface malignancy. The mean annual age-standardised incidence rate of 0.45 cases per million per year is increasing with an average annual percent rise of 4.5% and occurs mainly in over 65-year-olds in temperate climates but in a younger demographic in the tropics. Invasive CSCC can lead to vision loss either from the destructive effects of the tumour or side effects of therapy, facial disfigurement from radical surgery, and death from metastases. There is no standardised treatment and not all cases are referred to a specialist ocular oncology centre. Recent progress in cancer immunology and genetics has revolutionised the treatment of cutaneous and head and neck SCCs, which share some similarities to invasive CSCC. A better understanding of invasive CSCC and its preinvasive intraepithelial lesions is required to lead to the development of novel targeted and immunotherapies both for local tumour control, globe sparing alternatives and to prevent disseminated disease. This review aims to provide a comprehensive clinical overview of the current knowledge regarding CSSC, its epidemiology, pathogenesis, presentation, diagnosis, management, recent advances in targeted and immunotherapies for personalised treatment of this disease, and early diagnosis strategies to improve patient outcomes. Full article

Background/Objectives: Atypical fibroxanthoma (AFX) and cutaneous undifferentiated pleomorphic sarcoma (cUPS)/pleomorphic dermal sarcoma (PDS) are related dermal neoplasms of uncertain histogenesis that occupy opposite ends of a shared clinical and histopathologic spectrum, with AFX displaying typically low-grade behavior and PDS representing its more aggressive counterpart. The recent literature has confirmed that AFX and PDS also overlap at the molecular and genomic levels; however, little is known about their gene-expression profiles. Methods: We performed gene-expression profiling using RNA sequencing with a Pan-Cancer RNA Panel on a small series of AFX and PDS samples. Results: Unsupervised cluster analysis showed a clear separation between the two groups. We confirmed a TP53 UV-radiation signature in both. However, while AFX and PDS share common DNA mutation profiles in our cohort, RNA sequencing reveals distinct gene-expression signatures that may aid in differentiating these related tumors. In particular, the MAPK pathway, cell adhesion, DNA repair, EMT-like signatures and inflammatory responses play key roles in distinguishing the two groups, at least in our limited cohort, consistent with their differing biological behavior. Differences in the expression of receptor tyrosine kinases were also observed. Conclusions: Gene-expression profiling have the potential to be a valuable tool for distinguishing AFX from PDS, clarifying their positions at opposite ends of a spectrum and providing deeper insight into the biology of these neoplasms. Full article

Prostate cancer is the most common non-cutaneous malignancy in men and is the second leading cause of male cancer-related mortality. Unlike many cancers, prostate cancer lacks clear genetic driver mutations, suggesting that factors in the tumor microenvironment contribute to the genesis and progression of this disease. Hypoxia, or a physiological state of low oxygen, is a universal characteristic of solid tumors that enhances disease progression and therapeutic resistance. Prostate cancer develops in a hypoxic microenvironment and primarily metastasizes to bone, where oxygen availability is similarly limited. Therefore, hypoxia is a major obstacle to the effective treatment of prostate cancer across all disease stages. Clinically, hypoxia is correlated with worse patient outcomes, largely because it drives resistance to the frontline therapies used to treat both primary and metastatic prostate cancer. Despite the established role of hypoxia in prostate cancer progression and drug resistance, it has not been successfully targeted therapeutically. Emerging evidence indicates that exposure to distinct temporal patterns of hypoxia (acute, cyclic, and chronic) elicits unique cellular adaptations that dictate tumor growth and survival. This review synthesizes current evidence regarding the role of hypoxia in promoting resistance to therapy in prostate cancer. Full article

Background and Objectives: Melanoma is the leading cause of skin cancer-related mortality due to its high propensity for early metastasis, although survival rates have improved with the advent of targeted and immune-based therapies. Accurate detection of targetable mutations and assessment of tumor mutational burden are essential for informed therapeutic decision-making. Mutation profiling is routinely performed using next-generation sequencing (NGS). The Oncomine Focus Assay (OFA) detects common alterations in 52 genes across various tumor entities, whereas MelArray is a melanoma-specific NGS panel covering mutations in 190 melanoma-relevant genes and providing a genome-wide copy number analysis. Moreover, tumor mutational burden is being assessed. Materials and Methods: In this retrospective study, we analyzed the phenotypic characteristics of 100 patients with cutaneous melanoma who underwent NGS testing using either OFA or MelArray. The aims were to compare the diagnostic yield of the two panels and to investigate potential associations between mutational profiles and clinicopathological features of melanoma. Results: Tumor location, ulceration, and Breslow thickness showed significant correlations with the melanoma subtypes. BRAF mutations were the most frequent driver alterations across all cutaneous melanoma subtypes; however, no significant correlation between specific driver mutations and phenotypic characteristics was identified. MelArray detected a notably high number of alterations in the TERT promoter and CDKN2A genes, which were not captured by OFA and are of potential therapeutic relevance. Conclusions: In conclusion, MelArray enables a more comprehensive molecular characterization of cutaneous melanoma compared with a small generic cancer panel and may support more personalized therapeutic decision-making. Full article