BACKGROUND:Mohs micrographic surgery (MMS) achieves high cure rates for basal cell carcinoma (BCC) but may require multiple stages when tumors extend beyond clinically visible margins. Preoperative biopsy subtype information may help identify cases most likely to require additional stages and therefore benefit from adjunctive presurgical imaging. METHODS:In this retrospective single-center cohort of 1541 BCCs treated with MMS, we evaluated clinicopathologic features in relation to first-stage positivity (defined as requiring two or more stages) and to the total number of Mohs stages, using univariate tests and multivariable logistic and negative binomial regression. RESULTS:Four hundred tumors (26%) required two or more stages. First-stage positivity was highest in infiltrative-only tumors (40.7%) and lowest in nodular-only tumors (21.1%). High-risk BCCs with an infiltrative or micronodular component had higher first-stage positivity (29.7%) than low-risk tumors (22.5%). Larger tumors and H-zone location also required more stages. After mutual adjustment, an infiltrative component (odds ratio [OR] 1.50, 95% confidence interval [95% CI] 1.11-2.03), tumor diameter (OR 1.23 per cm, 1.05-1.43) and H-zone location (OR 1.95, 1.26-3.03) remained independently associated with first-stage positivity. CONCLUSIONS:Biopsy-reported histology, tumor size, and anatomic risk zone independently stratify the risk of additional MMS stages and can guide targeted preoperative imaging. Even "low-risk" tumors with superficial components show notable first-stage positivity.
A 53-year-old man from northeast Mexico presented with acute painful violaceous plaques, hemorrhagic bullae and stellate necrotic eschars on the lower limbs, dorsal hands and external ears. Examination also revealed diffuse non-nodular cutaneous infiltration, madarosis and milphosis, and generalized hypoesthesia-subtle signs of underlying diffuse lepromatous leprosy. IgG anticardiolipin antibodies were positive, raising the possibility of antiphospholipid syndrome. Skin biopsy with Fite-Faraco staining showed endothelial colonization by acid-fast bacilli and polymerase chain reaction (PCR) confirmed Mycobacterium leprae, establishing the diagnosis of Lucio's phenomenon-a rare necrotizing vasculopathy occurring in untreated diffuse lepromatous leprosy. This case illustrates how positive serological mimickers can mislead the workup away from a mycobacterial cause and underscores the need for prompt initiation of multibacillary multidrug once the diagnosis is confirmed.
Dissecting cellulitis of the scalp (DC) and hidradenitis suppurativa (HS) share follicular occlusion, rupture, suppuration, tunnel formation, and scarring, yet are usually classified as separate diseases. Whether DC represents a site-modified scalp phenotype of the same core inflammatory process remains unresolved. To examine the DC-HS boundary and assess whether current evidence favors two distinct diseases or one follicular-occlusion spectrum, we performed a structured PubMed-based critical narrative review through June 25, 2026, evaluating direct comparative evidence and five prespecified domains: clinical morphology, topography, histopathology/pathobiology, follicular-occlusion clustering, and therapeutic response. Direct comparative evidence remains limited. A prospective trichoscopy study identified DC-compatible findings in 8 of 23 men with HS (35%). Across independent domains, however, the convergent pattern is more consistent with a shared core follicular-occlusion pathology whose phenotype may be modified by anatomical site than with two wholly unrelated processes. The current operational definition of scalp HS also creates a diagnostic paradox: an apparently similar scalp phenotype may be labeled scalp HS when intertriginous HS is present, but DC when it is isolated. This supports testing whether extra-scalp HS is a contextual classifier rather than a biological discriminator. We propose DC as a plausible scalp-predominant, site-modified phenotype within the HS/follicular-occlusion spectrum, while emphasizing that molecular equivalence is not yet proven. Resolving this distinction could affect trial eligibility, testing of HS-targeted therapies in DC, reciprocal screening, and outcome-measure development.
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.
