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.

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.

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.

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.

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.