The Journal of dermatology最新文献

This revision work was commissioned by the Japanese Dermatological Association (JDA) and was undertaken by a committee of experts in related fields. The committee prepared comprehensive, evidence-based guidelines by thoroughly reviewing and systematizing a wide range of literature on cutaneous squamous cell carcinoma. The literature search was conducted by the Japan Medical Library Association. Recommendations were prepared using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) scheme. These guidelines were prepared in accordance with the "Minds Clinical Practice Guideline Preparation Manual 2020 ver. 3.0". Six clinical questions were established, and corresponding recommendations were described for each. CQs addressed the following: (1) the treatment of early lesions, (2) the possibility of reduction surgery for primary lesions, (3) the significance of sentinel lymph node biopsy, (4) the possibility of non-surgical treatment as an alternative to surgical treatment, (5) follow-ups after treatment, and (6) drug treatment for advanced stages. We are confident that the JDA Clinical Practice Guidelines for Cutaneous Squamous Cell Carcinoma will contribute to improving the treatment of cutaneous squamous cell carcinoma in Japan and worldwide.

Psoriatic arthritis (PsA) is a chronic immune-mediated disease with heterogeneous joint and skin manifestations. Although biologic therapies targeting TNFα, IL-17, and IL-23 have transformed PsA management, sex-specific differences in efficacy and treatment persistence remain underexplored. Previous registry and real-world data suggest that women may experience greater pain, lower treatment response, and shorter drug survival, but evidence integrating both articular and cutaneous outcomes is limited. This retrospective cohort study investigated whether female sex independently predicts reduced clinical response and persistence with biologic therapy in PsA, focusing on composite outcomes at week 52. A total of 134 patients (87 men, 47 women) who initiated biologics between 2011 and 2024 were analyzed. Diagnoses were confirmed according to CASPAR by board-certified dermatologists, with rheumatologic confirmation when required. Propensity scores derived from baseline age, BMI, duration of psoriasis, duration of PsA, baseline Psoriasis Area and Severity Index (PASI), baseline Disease Activity index for Psoriatic Arthritis (DAPSA), comorbidities, NSAID use, and biologic class were incorporated into covariate-adjusted ANCOVA models. At week 52, simultaneous achievement of PASI90 and DAPSA remission was observed in 51.2% of men versus 19.2% of women (p = 0.025). Female sex remained an independent negative predictor of response (adjusted OR = 0.19; 95% CI: 0.074-0.468; p = 0.0001). Kaplan-Meier analysis demonstrated shorter treatment persistence in women (log-rank p = 0.0099; adjusted HR = 0.316, 95% CI: 0.119-0.841). Although only a few women (n = 3) cited financial burden as a reason for not re-initiating biologics after discontinuation, this observation may still reflect underlying socioeconomic influences. Even small numbers of such cases can exemplify practical and economic barriers-often compounded by caregiving responsibilities or lower household income-that disproportionately affect women. Early and proactive intervention, prevention of unnecessary discontinuation, and timely re-initiation upon relapse are essential to optimize outcomes in women with PsA.

Primary malignant melanoma of the esophagus (PMME) accounts for only 0.5% of all melanomas but is associated with the shortest interval to disease progression and the highest metastasis rate. The optimal treatment for PMME remains elusive. The present study aimed to assess the utility of screening as a means of predicting the prognosis of PMME and to determine the efficacy of surgery and immune checkpoint inhibitors (ICIs) against this disease. Fifty-two patients with PMME treated at the National Cancer Center Hospital in Japan between 2010 and 2023 were enrolled. Survival analysis was performed for (i) patients with PMME (n = 52); (ii) resectable cases at the initial presentation (n = 36); and (iii) cases with systemic therapy (n = 37). The 5-year overall survival (OS) rate was 45.0%, and the median OS was 55.8 months. The 5-year OS rate of the patients in whom PMME was detected by screening and those in whom it was diagnosed clinically was 54.7% and 40.1%, respectively (p = 0.255). The presence of a lymph node metastasis was associated with a significantly higher recurrence and poorer prognosis. The 3-year RFS rate of the patients at the local and nodal stage was 57.8% and 6.9%, respectively (p < 0.0001). At surgery, the rate of lymph node metastasis in the recurrence group and the nonrecurrence group was 68% and 10%, respectively (p = 0.0027). In the patients who received ICI therapy, the 3-year OS was 33.3%, the median OS was 15.0 months, and the overall response rate was 23.5%. Our findings suggested that ICI therapy may improve survival in patients with advanced PMME. However, further research is warranted to identify both the clinical and molecular predictors of the treatment response as a means of improving patient selection.

Pathological information is critical to patient management in melanoma. A uniform approach based on current evidence is crucial and is summarized in this paper. Essential clinical and pathological parameters to report are the BAUSSS biomarker prognostic criteria, that is, Breslow thickness, patient age, presence of ulceration, melanoma subtype, patient sex, and anatomic site. Other important parameters to include are adnexal and periadnexal extension, tumor infiltrating lymphocytes, intravascular and abluminal lymphovascular invasion, microsatellites, in-transit metastases, perineural invasion, and margins. Additional parameters that have been recommended for inclusion are mitotic activity, regression, association with nevi and atypical melanocytic hyperplasia. The significance of special stains and genetic studies is also discussed.