Australasian Journal of Dermatology最新文献

Background: There is a paucity of data on scalp keratinocyte carcinomas (KCs) referred for Mohs micrographic surgery (MMS). This study aimed to perform a descriptive analysis of scalp KCs-specifically basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs)-treated with MMS at The Skin Hospital in Sydney, Australia.

Methods: We performed a retrospective analysis of all scalp KCs treated with MMS from October 2012 to September 2022 from an electronic database. Extracted data included age, sex, tumour histology and aggressiveness, anatomical location, preoperative tumour size, final defect size, number of MMS stages and sections, extensive subclinical spread and repair method.

Results: We identified 1177 scalp KCs treated with MMS in 889 patients, consisting of 948 BCCs (80.5%) and 229 SCCs (19.5%). The median age of patients with BCCs was significantly younger (60 years) than that of SCCs (73 years) (p < 0.001). SCCs were more commonly found in males (182/229, 79%) (p < 0.001). The majority of KCs were located on the frontal scalp (948/1177, 55%). BCCs were more likely to be of an aggressive subtype (58%, 512/876) than SCCs (21%, 44/212) (p < 0.001). The median largest tumour and defect diameter was larger for SCCs than for BCCs (p < 0.001). There was no significant difference in the median number of MMS stages for tumour type (p = 0.121). Extensive subclinical spread was more common for aggressive SCCs (13/44, 29.5%) than for BCCs (84/511, 16.4%) (p = 0.028). Primary closure repair was most common (55%, 644/1177).

Conclusion: The observed differences in patient, tumour and treatment characteristics may help inform clinical practice and inspire further research.

Tebentafusp, a bispecific TCR-anti-CD3 fusion protein targeting gp100-HLA-A02:01 complexes, is approved for the treatment of unresectable/metastatic uveal melanoma (MUM). In this retrospective, single-centre series, five HLA-A02:01-positive patients received tebentafusp. Four developed cutaneous toxicity (80%) within hours of the first infusion, primarily symmetric erythematoedematous truncal plaques. Other findings included acral xerosis/exfoliation and vitiligo-like lesions. Histology revealed spongiosis with subcorneal pustules, which have not been previously reported. No patients discontinued treatment due to skin toxicity and lesions resolved in a mean of 14.5 days. One patient died due to disease progression. Dermatological events are likely to be on-target effects of gp100+ melanocyte targeting and correlate with CD8+ T cell infiltration. Dermatological involvement is common and manageable, highlighting the need for early dermatological input in patients receiving tebentafusp. Emerging data suggest a possible association between rash and response, which warrants further investigation.

Sebaceous neoplasms are rare skin tumours linked with Lynch syndrome (LS), particularly the Muir-Torre syndrome (MTS) variant. They present an opportunity for early LS detection due to their association with mismatch repair (MMR) gene pathogenic variants. This study aims to provide an accurate estimate of LS prevalence among patients with sebaceous adenomas and carcinomas. We performed a systematic review and meta-analysis of studies published between 2005 and 2024. Eligible studies utilised germline testing for MMR mutations. The studies were stratified by diagnostic approach and analysed using proportional meta-analysis to determine LS prevalence. Subgroup analyses were conducted by population characteristics and diagnostic criteria. Lynch Syndrome prevalence among patients with sebaceous neoplasms varied across the 9 studies that met eligibility criteria, ranging from 0.8% to 29.0%. LS among patients with sebaceous carcinomas was 6.6% (95% CI: 3.6%-9.5%). Population-based studies had a higher LS identification rate (10.6%), while multi-centre and single-centre studies reported lower rates. Studies using a history suggestive of MTS or MMR-deficient tumours as criteria showed the highest LS prevalence. Male patients had higher sebaceous neoplasms prevalence, with LS-positive cases presenting at a younger age than typical sporadic cases. Our findings highlight the potential for LS detection in patients with sebaceous neoplasms, particularly those with MMR deficiency or a suggestive MTS history. Increased testing in this group could facilitate early LS detection, improving outcomes through screening and preventive strategies. Universal MMR testing for sebaceous tumours warrants consideration as a strategy to capture at-risk LS patients.

Actinic prurigo (AP) is a rare, idiopathic, acquired photodermatosis predominantly affecting indigenous populations in North, Central and South America. It is characterised by intensely pruritic papules and nodules on sun-exposed skin, with potential involvement of the lips and conjunctivae. Treatment options are limited and often ineffective or associated with an unacceptable safety profile. This systematic review evaluates the existing evidence on the use of dupilumab and Janus kinase (JAK) inhibitors for AP management. A literature search was performed in MEDLINE, Google Scholar, ScienceDirect and Embase, for English-language publications mentioning the use of dupilumab or JAK inhibitors for AP. Eligible studies included case reports, case series, observational studies, clinical trials, consensus statements and guidelines. Two independent reviewers assessed the manuscripts. The search yielded 125 results, with seven publications meeting eligibility criteria, comprising six case reports and one case series. Four publications described three patients successfully treated with dupilumab, demonstrating significant improvement within weeks of initiation. Three reports detailed the successful use of the JAK inhibitors tofacitinib and baricitinib in three patients, leading to rapid symptom resolution. Emerging evidence suggests that dupilumab and JAK inhibitors may be effective in AP treatment. Evidence is limited to case reports with short follow-up durations. Further studies are necessary to establish the efficacy, safety and long-term outcomes of these novel therapies.

Despite the high prevalence of scabies, acute rheumatic fever (ARF) and rheumatic heart disease (RHD) in regions such as Oceania, few studies have addressed the evidence for a causal relationship of scabies with ARF and RHD. In this study, we evaluate the relationship of scabies with GAS and subsequently ARF and RHD, as it could lead to an additional strategy for ARF/RHD prevention. Databases (PubMed, Web of Science and Scopus) were accessed to identify and include studies that investigated the association between scabies, ARF and RHD. Seventy-three articles investigating a potential link between scabies, GAS skin infections and ARF/RHD were included in this review. Most of these studies were from Australasia. Epidemiological and microbiological evidence consistently support the hypothesis that scabies increases the risk of Group A streptococcal (GAS) infection, which, in turn, leads to ARF and RHD. Many studies found shared risk factors and a strong association between scabies and ARF/RHD. The available evidence supports a role of scabies and GAS skin infection in the pathogenesis of ARF/RHD. Large-scale observational studies should be conducted to further define the relationship between these conditions. Based on the evidence presented here, we believe it is likely that improving scabies diagnosis and treatment would reduce the incidence of ARF/RHD.