International Journal of Dermatology最新文献

Background: Melanoma in young adults causes substantial years of life lost because deaths occur early. Detection pathways, reasons for consultation, and sex differences may influence tumor thickness and prognosis, but evidence in this age group remains limited.

Methods: We conducted a retrospective cohort study of patients aged 18-44 years with primary cutaneous melanoma diagnosed between 1993 and 2022, with a median follow-up of 142 months. Detection source was classified as self, relatives/friends, or healthcare professionals, and reasons for consultation were recorded for self-detected cases. Outcomes included Breslow thickness (> 2 mm), metastasis, melanoma-related death, survival, and years of life lost. Multivariable logistic regression, Kaplan-Meier analyses, and exploratory Cox regression were performed.

Results: Among 316 patients, self-detection was the most common pathway (58.9%). Thick melanoma was more frequent in self-detected cases than in those detected by relatives or healthcare professionals (p = 0.003). Male sex and self-detection were independently associated with thick melanoma. Among self-detected cases, nodularity and bleeding were the strongest predictors. Men had higher metastatic progression (33.1% vs. 18.1%, p = 0.002) and melanoma-related mortality (18.7% vs. 11.3%, p = 0.049). Median years of life lost among melanoma deaths was 29.15 years.

Conclusions: In young adults, melanoma prognosis is strongly linked to detection pathway, consultation triggers, and sex. Earlier professional evaluation, especially in young men and in lesions with high-risk features, may reduce advanced disease and years of life lost.

Background: Merkel cell carcinoma (MCC) is a rare and highly aggressive neuroendocrine tumor that frequently arises in the head and neck region. While known risk factors include advanced age, Merkel cell polyomavirus infection, immunodeficiency, and ultraviolet exposure, the impact of anatomic subsite on disease behavior and prognosis remains poorly defined.

Methods: We performed a retrospective cohort study of 46 patients with head and neck MCC treated by head and neck surgeons at Roswell Park Comprehensive Cancer Center between 2008 and 2022. Patients were identified using ICD-9 and ICD-10 codes. Clinical staging, pathologic findings, treatment modalities, recurrence rates, and survival outcomes were analyzed. Recurrence-free survival and overall survival were evaluated using Kaplan-Meier analysis.

Results: Among 46 patients with head and neck MCC, the cheek was the most common subsite (39.1%). Cheek MCC was associated with significantly higher rates of parotid involvement and lymph node metastasis compared with other subsites (69.2% vs. 25%, Fisher p = 0.03). In multivariable analysis adjusting for age and immunosuppression, cheek location was an independent predictor of nodal positivity (adjusted odds ratio [OR] 7.4, 95% confidence interval [CI] 1.4-41.0, p = 0.02). Among patients who recurred, cheek primaries tended to recur earlier (median 4 vs. 12 months), though this trend was not statistically significant. No statistically significant difference was observed in 3-year overall or recurrence-free survival across subsites on Kaplan-Meier analysis.

Conclusions: Merkel cell carcinoma of the cheek is associated with increased parotid involvement, higher rates of nodal metastasis compared with other head and neck subsites, and cheek location was an independent predictor of nodal positivity. These findings suggest that anatomic subsite may influence disease behavior and highlight the need for larger studies to determine whether subsite-specific management strategies are warranted.

Bereavement is a biologically active stress state and disease modifier that influences atopic dermatitis, psoriasis, and melanoma detection and prognosis. Dermatologists should consider bereavement in patients with atopic dermatitis or psoriasis flares, reinforce skin cancer surveillance in bereaved patients, and consider recent bereavement when initiating or escalating therapy.

Skin-related neglected tropical diseases (skin NTDs) remain visible markers of health-system inequity. The World Health Organization (WHO) road map for neglected tropical diseases 2021-2030, its 2022 strategic framework for skin NTDs, and the WHO Global Report on Neglected Tropical Diseases 2025 already establish integration, primary-care mainstreaming, and improved access to diagnostics and medicines as global priorities. Drawing on Workshop 1 of the 4th International League of Dermatological Societies (ILDS) World Skin Summit, this viewpoint positions the Cape Town Action Plan not as a competing policy framework, but as an implementation compact for translating existing commitments into locally owned service readiness, accountable delivery, and measurable follow-through.

Linear focal elastosis (LFE) is a rare elastic tissue disorder characterized by palpable, yellowish, linear or band-like striae. We propose a practical clinicopathologic framework comprising a clinical classification, working diagnostic criteria, and a stepwise diagnostic algorithm to guide recognition, biopsy decisions, and management in routine practice. We categorize LFE into two clinical types: Classic truncal and atypical. As working diagnostic criteria, we suggest that a definitive diagnosis may be supported by at least two major criteria or one major and two minor criteria. The accompanying algorithm stratifies atypical or progressive presentations toward histopathologic confirmation. This framework is supported by a systematic review of 43 publications (88 patients) and an institutional series of 7 cases from two tertiary centers (total: 95 patients). Across both sources, male predominance, lower back involvement, and deep dermal elastosis were consistently observed. Most patients were asymptomatic and had stable outcomes with conservative management. By prioritizing structured diagnostic tools over descriptive case aggregation, this framework enables clinicians to confidently recognize LFE, avoid misdiagnosis, and prevent unnecessary interventions.

"Special," "sensitive," and "difficult-to-treat" areas are frequently used interchangeably in atopic dermatitis despite describing distinct clinical constructs. Sensitive sites reflect disproportionate psychosocial and functional vulnerability, whereas difficult-to-treat areas denote therapeutic refractoriness. This distinction is clinically relevant because involvement of these locations may support consideration of systemic therapy independently of the Eczema Area and Severity Index (EASI) score or body surface area. Precise terminology should guide, rather than obscure, therapeutic decision-making.