JEADV clinical practice最新文献

Background

Hidradenitis suppurativa (HS) can be a difficult disease to manage, especially in patients with prominent disease. CO₂ laser can be used for the treatment of recurrent HS lesions with or without simultaneous systemic treatment. There is a lack of evidence for the validity of CO₂ laser treatment as well as the rate of complications.

Objectives

Our study aimed to evaluate CO₂ laser treatment on multiple aspects, including patient-reported outcomes such as quality of life before and after treatment, complications and recurrence of HS in CO₂ laser-treated areas.

Methods

The study was performed as a prospective cohort study focusing on patient-reported outcomes. We collected preoperative interviews before CO₂ laser treatment with follow-up at approximately Week 2, 6 and 12 post-procedure. Fifty-three patients were successfully included.

Results

CO₂ laser treatment resulted in a significantly improved quality of life in both ΔDLQI 3.5 (1.6−5.4 95% CI, p < 0.0002) and ΔHiSQOL 7.1 (3.1−11.1 95% CI, p < 0.006) when comparing baseline data with data 12 weeks post-procedure.

We observed a low risk of infection (5.8%) as well as a low risk of severe bleeding (7.7%) and sensory disturbance post-procedure (7.7%).

We found a moderate risk of recurrence of HS at the edge of the treated area (26.9%) and prolonged healing > 12 weeks (26.9%). Moreover, a higher BMI and biological treatment simultaneously with treatment appear to result in prolonged wound healing.

Conclusions

This study is to our knowledge one of the largest prospective study evaluating CO₂ laser treatment in HS patients and demonstrates that CO₂ laser treatment of recurrent HS elements improve quality of life in HS patients significantly. The most common complications are prolonged wound healing and recurrence of HS in the treatment edge.

Background

Cutaneous squamous cell carcinoma (cSCC) remains poorly understood at the molecular level, both in the immunocompetent and immunosuppressed population with skin of colour. Data on the diversity of viruses found in cSCC is also lacking.

Objectives

We aimed to characterise the immunological and molecular profiles of cSCC in organ transplant recipients (OTR) and non-transplant recipients in an Asian cohort (n = 53) and explore the diversity of viruses detected.

Methods

Gene expression analysis was performed on snap-frozen cSCC tissues using the NanoString PanCancer IO360 panel. Viral detection was performed using the Twist Comprehensive Viral Research Panel.

Results

cSCC presented dysregulation of immune response pathways and tumour microenvironment remodelling compared to adjacent normal skin tissue. Cell-type profiling based on gene expression profiles showed higher levels of exhausted CD8 cells, neutrophils, and cytotoxic cells in tumour cells. Furthermore, three distinct clusters of cSCC gene signatures could be observed, where Cluster 3 with the highest Tumour inflammation signature (TIS) scores displayed distinct upregulation of most pathways suggesting a more inflamed or “hot” tumour phenotype. cSCC of OTR exhibited greater expression of tumour markers (AQP9, SERPINA1) and reduced expression of T-cell cytokines (CXCL10, CXCL11). Viruses were particularly enriched in tumour tissue, as compared with normal skin. In addition, there was an enrichment of detectable viruses in transplant-associated cSCC, with several tumours harbouring multiple viruses (HPV, EBV, MCV, and TTV).

Conclusions

cSCC is marked by a pro-tumorigenic immune environment with altered immune cell populations. These findings support the potential for stratified, immune-tailored treatment approaches for cSCC, especially in OTR who have a higher disease burden. Future studies on the possible oncogenic role of the detected viruses can be undertaken.

Background

The COVID-19 pandemic has significantly disrupted global healthcare systems. Melanoma, a highly aggressive skin cancer whose prognosis is closely tied to early detection, has been particularly impacted. Lockdowns, changes to healthcare resource reallocation and patient hesitancy in seeking care have all contributed to delays in melanoma diagnoses and treatment modifications. Understanding the extent of this disruption is crucial to inform future healthcare planning during global crises.

Objectives

To evaluate the impact of the COVID-19 pandemic on melanoma incidence, diagnostic delays and disease severity by comparing findings from pre-pandemic and pandemic periods through a systematic review of existing literature.

Methods

A systematic search was conducted across PubMed, Scopus, Web of Science and Cochrane Library in September 2024, adhering to PRISMA guidelines. Eligible studies included clinical trials, observational studies, reviews and case series that reported melanoma incidence, diagnostic delays or changes in treatment between pre-COVID-19 (2015−2019) and COVID-19/post-COVID-19 (2019−2024) periods. Data extraction focused on incidence rates, Breslow thickness, ulceration, treatment changes and patient outcomes. Study quality was assessed using the Newcastle−Ottawa Scale and Joanna Briggs Institute tools.

Results

Out of 503 studies screened, 55 met the inclusion criteria. Most studies reported a decline in diagnosed melanoma cases during the pandemic, accompanied by an increase in Breslow thickness and ulceration rates, indicating delayed presentations and more advanced disease. Significant disruptions in treatment pathways, including reduced surgical excisions, were frequently noted.

Conclusions

The COVID-19 pandemic contributed to delayed melanoma diagnoses and a shift towards more advanced disease at presentation. These findings highlight the critical need for resilient cancer care systems to maintain timely diagnostic and treatment services during future public health emergencies.

Background

Sex-based differences in melanocytic nevus patterns are recognized, yet their phenotypic characteristics across the body remain incompletely understood, especially in individuals at high risk for melanoma. Advances in imaging technology, such as 3D total body imaging, enable more accurate and comprehensive nevus assessment.

Objectives

This study aimed to investigate sex-based differences in nevus phenotype using automated 3D total body imaging in a high-risk melanoma population.

Methods

A total of 72 participants (34 females and 38 males) underwent 3D total body imaging, resulting in the analysis of 27,622 individual nevi. Nevus characteristics, including size and distribution, were compared between sexes, with statistical adjustments for body surface area.

Results

Males exhibited significantly larger nevi than females across most body sites, particularly on the back and anterior torso. The average lesion diameter was 3.27 mm in males compared to 3.01 mm in females (p < 0.001). Males were more likely to have nevi larger than 5 mm (OR = 1.65; 95% CI: 1.52–1.78), while females had a higher proportion of smaller nevi (2–3 mm). Females also showed a nonsignificant trend toward greater nevus density on the extremities. These differences remained significant after adjusting for body surface area.

Conclusions

Sex-related differences in nevus phenotype, particularly in nevus size and distribution, are evident and not solely attributable to anatomical differences. The use of high-resolution 3D imaging enhances phenotypic precision and supports the hypothesis that hormonal or developmental factors may contribute to sexually dimorphic nevus patterns.