Faculty Bibliography

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.

Mohs micrographic surgery (MMS) is a tissue-sparing surgical technique that is the standard of care for treatment of several cutaneous malignancies. Current US and international guidelines recommend wide local excision as the first-line surgical therapy for noninvasive melanoma, and use of MMS may be appropriate for melanoma-in-situ, lentigo maligna, and potentially thin invasive malignant melanoma. Based on available literature, MMS can potentially result in lower recurrence rates of melanoma, especially when using immunostaining. This chapter explores the existing evidence supporting MMS for treatment of melanoma as well as its challenges.

Metastatic melanoma is an aggressive and treatment-resistant skin cancer with a low 5-year survival rate of 27%. Historically considered radioresistant, melanoma's response to radiation therapy (RT) has evolved, especially when integrated with systemic therapies like immune checkpoint inhibitors (ICIs). RT is now recognized for its utility in local control, palliative care, and brain metastasis management. Emerging evidence shows RT's synergy with ICIs through mechanisms like the abscopal effect. This article explores RT's evolving role in metastatic melanoma treatment, focusing on integration with modern therapies and ongoing research into optimizing outcomes.

Melanoma is a type of cutaneous malignancy responsible for thousands of deaths every year. Despite improvements in therapuetics and identification, incidence rate and the total number of associated deaths for melanoma continue to increase annually. Melanoma outcomes are impacted by numerous variables, and sex, age, race, socioeconomic status, and tanning bed use have been studied extensively as they relate to melanoma. Additionally, this article explores the trends in the changing melanoma incidence and mortality rates per modifiable variable and subpopulation.

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.