Faculty Bibliography

PURPOSE/OBJECTIVE:To assess whether patients with lichen planus (LP) show increased prevalence and odds of autoimmune and viral comorbidities compared with matched controls using real-world data. METHODS:We analyzed TriNetX Linked Network electronic health records and claims data from 2016 to 2024 (more than 112 million patients). LP was defined by at least 2 International Classification of Diseases, Tenth Revision, Clinical Modification codes (excluding drug-induced variants) and matched 1:1 to controls on age, sex, and race. We calculated odds ratios (ORs), 95% confidence intervals, prevalence, and absolute risk differences (ARDs). RESULTS:The matched cohort included 43 458 LP and control patients (mean age, 53.8 years; 64.4% female). LP was associated with higher prevalence of autoimmune conditions, including psoriasis (6.59% versus 2.54%; ARD, 4.05%; OR, 2.71), lupus erythematosus (2.87% versus 1.13%; ARD, 1.74%; OR, 2.58), and autoimmune thyroiditis (3.09% versus 1.61%; ARD, 1.48%; OR, 1.95). Associations were also seen for Sjögren syndrome, alopecia areata, localized scleroderma, and vitiligo. Hepatitis C virus was more common in LP (2.95% versus 2.03%; ARD, 0.92%) but with a lower OR (1.47). CONCLUSION/CONCLUSIONS:LP was associated with substantially higher odds and prevalence of several autoimmune comorbidities, exceeding those for viral infections such as hepatitis C. These findings inform LP pathogenesis and comorbidity patterns but do not support changes to clinical management.

The early detection of cutaneous melanoma is critical to survival outcomes. Because less than one half of melanomas in the United States are diagnosed by dermatologists, the ABCD (asymmetry, border irregularity, color variation, diameter >6 mm) acronym, created 40 years ago with the later addition of "E" for evolution (ABCDE), was developed for nondermatologist health care professionals and the public to simplify and enhance the diagnosis of early melanoma. It continues to be the global, naked-eye, nondevice-assisted standard for initial triage of pigmented lesions. This clinical review discusses the changing clinical diagnostic landscape and examines the currently available first-line and second-line detection modalities for melanoma. It also provides updates to the first-line triage approach and discusses the challenges of regulatory agency oversight for the safe and effective use of current and emerging skin cancer detection technologies. It is critical that health care professionals globally have knowledge of these technologies to enhance their diagnosis of melanoma.

INTRODUCTION/BACKGROUND:Sonidegib and vismodegib are Hedgehog pathway inhibitors (HHIs) approved for the treatment of locally advanced basal cell carcinoma (laBCC), as well as metastatic basal cell carcinoma (mBCC) for vismodegib. Few studies have compared real-world treatment patterns associated with HHI treatment. The objective of this study was to investigate the real-world treatment patterns and conditions of patients receiving HHIs for BCC. METHODS:In this longitudinal study, claims from the Komodo Health Claims Database (between 2016 and 2023) were used to identify patients. Baseline characteristics and comorbidities of patients were assessed. Time to treatment discontinuation (TTD), odds of discontinuation, and clinical conditions experienced during treatment were analyzed. RESULTS:Patients who received sonidegib remained on treatment longer than those on vismodegib (log-rank test; P = 0.041) and were 23% less likely (P = 0.036) and 32% less likely (P = 0.013) to discontinue treatment at 6 and 9 months, respectively. Sonidegib-treated patients were less likely to experience gastrointestinal-related conditions (33% less likely; P = 0.045), taste- and smell-related conditions (71% less likely; P = 0.048), and muscle spasms (52% less likely; P = 0.009) during treatment compared with patients who received vismodegib. CONCLUSION/CONCLUSIONS:In the real-world setting, sonidegib-treated patients remained on treatment longer than vismodegib-treated patients and were less likely to experience pharmacologically relevant clinical conditions.

Purpose To review published literature on the clinical efficacy, use, and accuracy of the 31-gene expression profiling (31-GEP) test for prognostic information in invasive melanoma. Methods A comprehensive literature search used keywords "31-gene expression profiling," "melanoma," "prognosis," "clinical efficacy," and "clinical utility." A panel of 10 dermatologists with expertise in melanoma management reviewed the articles and created consensus statements. A modified Delphi process approved each statement, requiring supermajority approval through multiple rounds of real-time voting, with strength of recommendation assigned. Results The search produced 150 articles; 26 met inclusion criteria. The panel unanimously voted to adopt 9 consensus statements and recommendations regarding 31-GEP testing: 8 with strength "A" and 1 with strength "C." Conclusion The panel agreed there is strong support for using 31-GEP testing to provide prognostic information for invasive melanoma. The test provides prognostic information when thickness and other traditional factors are unknown, improves prognosis assessment when added to American Joint Committee on Cancer 8th edition staging system, and is associated with improved melanoma-specific mortality and overall survival. The panel concluded that the robust existing literature strongly supports its use as a best practice for appropriate patients with melanoma.

Melanoma, an aggressive skin cancer, requires timely diagnostics for improved patient outcomes. The ABCDE criteria-assessing asymmetry, borders, color, diameter, and evolution-serve as foundational guidelines for early detection. Non-invasive tools like dermoscopy, total body photography, and advanced imaging techniques enhance visualization of skin lesions, while artificial intelligence-driven algorithms improve diagnostic accuracy. Despite these advancements, biopsy remains the gold standard for definitive diagnosis. This multifaceted approach highlights the need for integrating traditional methods with innovative technologies to optimize melanoma evaluation and management, ultimately leading to better patient outcomes.

Genomic advancements have transformed melanoma prognosis by identifying key genetic alterations that influence disease progression and treatment outcomes. Gene expression profiling (GEP) tests, including the 31-GEP, 11-GEP, and 8-GEP + CP, refine traditional staging by stratifying patients based on recurrence and metastasis risk. These tests enhance clinical decision-making by guiding sentinel lymph node biopsy selection, surveillance intensity, and adjuvant therapy use. Studies confirm their prognostic accuracy, linking GEP results to survival outcomes. Despite their potential, challenges like cost and validation limit widespread adoption. As research progresses, integrating genomic data with traditional staging could further personalize melanoma management.