Australasian Journal of Dermatology最新文献

Background: Skin cancer rates are high in Australians, outdoor workers and physically active people. Australia is currently preparing a roadmap to better assess high risk groups for consideration of more targeted skin screening.

Methods: The membership of the Australian Cricketers Association (ACA), both current and retired cricketers, was invited to participate in a questionnaire survey to assess self-reported rates of skin cancer (and associated risk factors).

Results: Response rate was 451 subjects (29% of 1530 invited participants), of which 39% were female. Cohort self-reported melanoma rates were 1% for < 30 year olds, 8% for 51-60 year olds and 20% for those over 70 years old. BCC (basal cell carcinoma) rates for < 30 year olds were 1%, 33% for 51-60 year olds and 55% for those over 70 years old. SCC (squamous cell carcinoma) rates for < 30 year olds were 0%, 23% for 51-60 year olds and 38% for those over 70 years old. Very fair- or fair-skinned players (compared to medium- or dark-skinned players) and those who lived in lower latitudes (sunnier regions) as an adult experienced higher rates of all skin cancers. Females were less likely to have reported BCCs compared to males. The most common body area for skin cancer in cricketers (slightly over half of all cases) was the head/face/neck region.

Conclusion: The rates of BCC, SCC and melanoma in cricketers were high for almost all age groups. This is likely to represent a combination of true increase (due to a combination of sporting and leisure-time exposure) and bias due to methodological limitations. Fair-skinned cricketers can reasonably be considered a high-risk population in Australia who should exercise lifetime vigilance.

Through a multidisciplinary quality improvement initiative, the Pre-Immunosuppression (Pre-IS) Clinic was created at a tertiary referral institution to ensure appropriate vaccination and infectious disease screening for patients on immunosuppressive medications. Consensus guidelines on immunisation and infectious disease screening for immunosuppressed patients were created through a multidisciplinary committee. The guidelines included three sections: (1) screening recommendations for chronic/latent infections prior to immunosuppression, (2) immunisation recommendations for immunosuppressed patients and (3) recommendations for household contacts of immunosuppressed patients. The workflow to the Pre-IS Clinic was optimised. We present the vaccination guidelines and workflow as an effective example of a multidisciplinary qualitive improvement initiative.

Background: Dermatofibrosarcoma protuberans (DFSP) is a rare cutaneous tumour with a locally infiltrative growth pattern that has high rates of recurrence. Mohs micrographic surgery is recommended as the gold-standard treatment over wide local excision (WLE) due to tissue-sparing and reduced recurrence rates. No previous data on surgical outcomes following Mohs Micrographic Surgery (MMS) for DFSP have been reported in Australia to date. This study aims to review the outcomes of DFSP treated with frozen-section MMS across three centres in New South Wales (NSW), Australia, and compare these outcomes with those in the current literature.

Methods: A retrospective review of patients who underwent MMS for DFSP between 2010 and 2023 was performed. Patient demographics, histological findings, surgical treatment and follow-up data were collected. Recurrence was assessed through electronic medical records, clinical assessments by a dermatologist or general practitioner, and patient self-report.

Results: In all, 38 cases of DFSP were included (27 female, 11 male; median age 39 years, range 16-64). The trunk was the most common site. Clinical margins and Mohs stages were recorded in 37 of 38 cases, with 73% of cases cleared with clinical margins of ≤ 20 mm. Clinical or self-reported follow-up was available for 28 of 38 patients (73.6%) over a mean of 51 months (range, 5-132 months). No local recurrences were identified during this period.

Conclusion: This is the first Australian case series on MMS for DFSP. Our findings demonstrate no recurrences with follow-up and demonstrate that MMS may achieve clearance with smaller clinical margins than WLE. These results support international guidelines recommending MMS as the gold-standard treatment and highlight the need to improve access to MMS in Australia.

Melasma is a chronic hyperpigmentation disorder that disproportionately affects women and individuals with darker skin types, leading to a significant psychosocial burden. This meta-analysis aims to evaluate the safety and efficacy of the 755-nm picosecond alexandrite laser (PSAL) compared with conventional therapies in the management of melasma. PubMed, Ovid Medline, Embase, Cochrane Library, and Google Scholar were searched from inception to April 10, 2025, in accordance with PRISMA guidelines. Randomised controlled trials (RCTs) assessing PSAL versus control comparators in adults with melasma and reporting Melasma Area and Severity Index (MASI) or Modified MASI outcomes were included. The review was registered prospectively on PROSPERO (CRD420251022381). Risk of bias was assessed using ROB2. Pooled effect sizes were calculated using a random-effects model. Five RCTs (n = 139 patients) were included. Change in MASI favoured triple combination cream (TCC) over PSAL therapy (MD = 1.82, 95% CI: 1.11, 2.52, I² = 0%). Post-inflammatory hyperpigmentation was more common in the PSAL group compared to topical creams (OR = 6.86, 95% CI: 1.47, 32.07, I² = 0%) but had no difference with the Q-switched lasers (OR = 4.09, 95% CI: 0.62, 26.97, I² = 0%). There was no incidence of hypopigmentation or infection reported. PSAL appears inferior to the TCC in reducing MASI scores. Overall certainty is low due to small, heterogenous trials. Low rates of irreversible adverse events with PSAL may support trials in refractory cases, but long-term RCTs with larger sample sizes are required to evaluate durability and recurrence outcomes.

Full-thickness skin grafts (FTSGs) provide superior aesthetic outcomes compared to split-thickness grafts, but harvesting large FTSGs is often limited by donor site morbidity, tension, and tissue waste. In this manuscript, we describe the 'slide-by-side' technique that improves tissue economy, decreases closure tension, and reduces donor site morbidity, enabling reconstruction of large defects with the cosmetic advantages of FTSGs.

Dermatofibrosarcoma protuberans is a rare, locally aggressive cutaneous sarcoma characterised by slow progression and often nonspecific clinical features. Early-stage lesions may resemble benign or pigmented dermatoses, leading to diagnostic delays. We conducted a systematic review of 17 publications reporting dermoscopic findings of DFSP and added three additional histologically confirmed cases from our center, totaling 45 cases. The most common findings included vascular structures (80%), pigmented networks (73%), and a pink background (64%). Nodular lesions displayed a greater variety of dermoscopic patterns, while plaque-type lesions were more frequently associated with pigmented networks. Notably, in Bednar tumours, bluish pigmentation and blue-white veil-like structures were observed more commonly, possibly reflecting melanin-laden dendritic cells and increased collagen content. Atrophic variants occasionally presented with yellowish, structureless areas, potentially due to the enhanced visibility of subcutaneous fat. Although no pathognomonic features were identified, certain dermoscopic patterns were more prevalent in specific subtypes of dermatofibrosarcoma protuberans. The presence of multiple dermoscopic features, particularly in early or non-protuberant lesions, may increase clinical suspicion. Dermoscopy remains a valuable non-invasive tool that aids in the early recognition of skin conditions and informs biopsy decisions.

Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disease estimated to affect approximately 30% of children and 10%-15% of adults in Australia. Of those with this condition, one in five is estimated to have moderate-to-severe disease. Treatment guidelines for patients with moderate-to-severe AD recommend adding or switching to a targeted systemic medication if the disease is not well controlled with topical treatment. Without access to these medications, healthcare providers are limited in their ability to effectively treat moderate-to-severe AD. Availability of these guideline-recommended targeted systemic agents varies across the globe because of differences in both approval and reimbursement decisions. Patients in Australia should have funded or subsidised access to these highly effective, well-tolerated medications for moderate-to-severe AD. To highlight the importance of this, and to better understand potential barriers to such access in Australia, we conducted a narrative review of health technology assessment processes and the availability of funded/subsidised targeted systemic therapies for moderate-to-severe AD in patients aged ≥ 12 years in Australia and in countries with comparable healthcare systems, such as the United Kingdom, Canada, New Zealand and France. To provide context for this, we summarised current international guideline-recommended treatment for moderate-to-severe AD and considered healthcare resource utilisation in moderate-to-severe AD, both in Australia and internationally. In Australia, patients only have access to a limited selection of medicines launched globally. This suggests that national healthcare systems should consider updating health technology assessment procedures to better align with the current targeted high-cost therapeutics environment.