Melasma is a common pigmentary disorder that can substantially affect a patient’s quality of life and social experiences. Using data from the multinational International Survey on Pigmentation Disorders Observational Tracking of 48 000 participants in 34 countries, we found that 11% reported melasma, with marked regional differences, a mean Dermatology Life Quality Index (DLQI) of 8.4 and more than one-third having DLQI scores above 10. Over half of affected individuals reported concealing visible lesions and one-third avoided public contact, highlighting a significant yet often under-recognized burden of stigmatization.

Invasive cutaneous squamous cell carcinoma (CSCC) is one of the most common cancers in white populations, accounting for 20% of all cutaneous malignancies. A collaboration of multidisciplinary experts from the European Association of Dermato-Oncology (EADO), the European Dermatology Forum (EDF), the European Society for Radiotherapy and Oncology (ESTRO), the European Union of Medical Specialists (UEMS)-Dermatology Venereology, and the European Organization of Research and Treatment of Cancer (EORTC), was formed to update guideline recommendations on CSCC (previous version 2023), based on current literature and expert consensus. Part 1 of the guidelines addresses diagnostics and prevention in immunocompetent as well as immunosuppressed patients. CSCC may be classified as easy-to-treat (vast majority) or difficult-to-treat, common primary CSCC, and is further defined as low risk or higher risk depending on the risk of recurrence or metastasis. A new classification of five groups of difficult-to-treat CSCC (DTT-CSCC) is proposed, published in 2025 by EADO experts and reflecting the commonly encountered clinical challenges. Difficult-to-treat (DTT) CSCC includes DTT-common CSCC groups 1 and 2 (which correspond to a subgroup of common CSCC that are complex to treat due to tumor and/or patient characteristics or multiplicity), DTT-CSCC group 3 corresponding to locally advanced CSCC, and DTT-CSCC groups 4 and 5 corresponding to CSCC with locoregional or distant metastases, respectively. The first step of diagnostics is based on clinical and dermatoscopic features, and is always confirmed by histopathology. The presence of risk factors characterizes higher risk CSCC, and the more risk factors, the higher the risk. After the histological diagnosis of CSCC has been established, the second step includes staging procedures, such as physical examination and, when indicated, imaging. In the third and final step, the clinical, histologic and radiologic findings are incorporated into staging systems. The more widely used staging systems are the American Joint Committee on Cancer 8th edition (AJCC8) and the Brigham and Women’s Hospital (BWH) systems. Prevention strategies include oral nicotinamide and sun protection measures.

Part 2 of the guideline addresses the updates on treatment recommendations in immunocompetent as well as immunosuppressed patients with invasive cutaneous squamous cell carcinoma (CSCC), based on current literature and expert consensus. A multidisciplinary panel of experts from the European Association of Dermato-Oncology (EADO), the European Dermatology Forum (EDF), the European Society for Radiotherapy and Oncology (ESTRO), the European Union of Medical Specialists (UEMS)-Dermatology Venereology and the European Organization of Research and Treatment of Cancer (EORTC), was formed to update the previous guideline on CSCC (version 2023). For common primary CSCC, first-line treatment is surgical excision with post-operative margin assessment or micrographically controlled surgery. Achieving clear histological margins is key for patients with CSCC amenable to surgery. Radiotherapy should be considered for non-surgical candidates/tumors. For patients with macroscopic regional lymph node metastases, individualized treatment should be discussed in the multidisciplinary tumor board. For patients with metastatic or locally advanced CSCC who are not candidates for curative surgery or radiotherapy, anti-PD-1 agents are the first-line systemic treatment, with cemiplimab being the approved systemic agent for advanced CSCC by the EMA. Second-line systemic treatments for advanced CSCC, include clinical trials, EGFR inhibitors (cetuximab) combined with anti-PD-1 immunotherapy, or chemotherapy or radiotherapy. The decision for adjuvant cemiplimab for CSCC at high risk of recurrence after surgery and radiotherapy should be discussed in the multidisciplinary tumor board. In addition, multidisciplinary board decisions are mandatory for all patients with advanced CSCC, considering the risks of toxicity, the age and frailty of patients and co-morbidities, including immunosuppression. Patients should be engaged in informed, shared decision-making on management and be provided with best supportive care to improve symptom management and quality of life. Frequency of follow-up visits and investigations for subsequent new CSCC depend on underlying risk characteristics.

Sun tattoos, also referred to as patterned sunburn lines, have recently emerged as a visible consequence of uneven ultraviolet (UV) exposure, increasingly shared on social media platforms, particularly by adolescents and young adults. These patterns arise from partial photoprotection by clothing, accessories, or stickers and reflect acute UV-induced inflammation and DNA damage. Although often trivialized or aestheticized online, repeated sunburns contribute to cumulative photodamage, photoaging, pigmentary disorders, and increased risk of skin cancer. This commentary examines sun tattoo lines from a behavioral dermatology perspective, highlighting how digital trends and social reinforcement may influence sun-exposure behaviors. Beyond their biomedical significance, these conspicuous lesions carry psychosocial implications and offer an opportunity for therapeutic intervention through patient education. We discuss the clinical relevance of recognizing sun tattoo lines as markers of risky UV behavior and propose their use as practical visual tools to reinforce photoprotection strategies in routine dermatologic care. Addressing such emerging behaviors requires integrating clinical prevention, patient counseling, and targeted public health communication within contemporary dermatology practice.

2538 Background: Adoptive transfer of tumor-infiltrating lymphocytes (TILs) can be effective in metastatic melanoma, but its routine use is limited by the need for lymphodepleting chemotherapy and systemic high-dose IL-2. To reduce toxicity while preserving antitumor activity, a strategy pairing TIL therapy with the oncolytic adenovirus igrelimogene litadenorepvec (TILT-123) was assessed. This virus selectively replicates in malignant tissue and drives local expression of TNF and IL-2 within tumors, functionally replacing the need for pre-infusion chemotherapy and post-infusion IL-2 administration. Methods: Seventeen patients with advanced melanoma resistant to immune checkpoint inhibitors were treated and sampled (NCT04217473). Treatment with igrelimogene litadenorepvec started upon tumor biopsy collection for TIL manufacturing took place and eventually followed by autologous TIL infusion around 36 days after. Hypotheses generated during data analysis were validated using additional patient datasets (NCT04695327, NCT05271318). Results: The regimen was well tolerated, with no dose-limiting toxicities. Objective response rate was 11.7%, with disease control in 35% by RECIST 1.1 and 47% by PET; metabolic responses were seen in 27%. Among those patients, higher baseline expression of epidermal and hepatocyte growth factors (EGF and HGF respectively) was associated with poorer prognosis. Higher than median HGF was negatively correlated with survival (p=0.032). Additionally, patients that achieved disease stabilization or better had a lower presence of circulating MDSCs (p=0.017). The link between growth hormones, MDSCs and disease progression was extrapolated to a larger dataset including other patients treated with igrelimogene litadenorepvec to find out the same trend for survival (HGF; p = 0.003, EGF; p = 0.029). In parallel, baseline circulating young memory T cells (CD27+CD28+CD8+) and an early expansion of NK cells (CD45+CD56+CD3-) correlated with a lower chance of progressing (T cells p=0.005, NK cells p=0.003). Conclusions: Combining TILT-123 with TIL therapy was safe and produced meaningful clinical activity in checkpoint inhibitor-refractory melanoma, especially in patients with lower HGF and EGF at baseline and a higher presence of young memory T cells and NK cells. In this clinical set-up, adapting the inclusion exclusion criteria to select patients with those defined immune system features, could help improve efficacy beyond. This approach may substantially broaden the feasibility and accessibility of TIL-based immunotherapy, especially due to the omission of the toxic conditioning regimens. Clinical trial information: NCT04217473 .

This guideline was developed in close collaboration with multidisciplinary experts from the European Association of Dermato-Oncology (EADO), the European Dermatology Forum (EDF) and the European Organization for Research and Treatment of Cancer (EORTC). Recommendations for the diagnosis and treatment of melanoma were developed on the basis of systematic literature research and consensus conferences. Cutaneous melanoma (CM) is the most dangerous form of skin tumor and accounts for 90% of skin cancer mortality. The diagnosis of melanoma can be made clinically and must always be confirmed by dermoscopy. If melanoma is suspected, a histopathological examination is always required. Sequential digital dermoscopy and whole-body photography can be used in high-risk patients to improve the detection of early-stage melanoma. If available, confocal reflectance microscopy can also improve the clinical diagnosis in special cases. Melanoma is classified according to the 8th version of the American Joint Committee on Cancer classification. For thin melanomas up to a tumor thickness of 0.8 mm, no further diagnostic imaging is required. From stage IB, lymph node sonography is recommended, but no further imaging examinations. From stage IIB/C, whole-body examinations with computed tomography or positron emission tomography CT in combination with magnetic resonance imaging of the brain are recommended. From stage IIB/C and higher, a mutation test is recommended, especially for the BRAF V600 mutation. It is important to perform a structured follow-up to detect relapses and secondary primary melanomas as early as possible. A stage-based follow-up regimen is proposed, which in the experience of the guideline group covers the optimal requirements, although further studies may be considered. This guideline is valid until the end of 2026.

This study conducted a comprehensive online survey across 17 countries to assess the influence of fear of skin cancer versus fear of photoaging on photoprotection practices. Revealing significant differences in sun protection behaviors, the research found that individuals concerned about photoaging are more likely to adopt comprehensive sun protection measures compared to those fearful of skin cancer. The findings highlight the potential for integrating concerns about photoaging into skin cancer awareness campaigns to enhance public health strategies for sun protection.

BACKGROUND:Solar factors play no role in the development of acral melanoma (AM). AM is characterized by low cumulative solar damage (low CSD). Responses to immunotherapy are correlated with mutational load, which, in turn, is correlated with high cumulative sun damage (CSD). This suggests that AM patients may have poor responses to immunotherapy. The clinical benefit and safety profile of adjuvant immunotherapies in AM treatment have not been fully investigated. OBJECTIVES:To investigate whether the use of adjuvant immunotherapy for treating patients with AM in Stages IIb, IIc, III and IV NED (no evidence of disease) improves distant metastasis-free survival. METHODS:Among the 1005 AM patients in the RIC-Mel melanoma database, 64 AM patients who were treated with adjuvant immunotherapy were included in this study. We then calculated a propensity score to make the adjuvant immunotherapy-treated (n = 64) group and the untreated group (n = 64) comparable in all respects. RESULTS:The use of adjuvant immunotherapy for treating AM offers no clear benefit in terms of relapse-free survival or distant metastasis-free survival (RFS: HR = 0.84 [0.534, 1.324, 95% CI] and DMFS: HR = 0.94 [0.565, 1.562, 95% CI]). Among the AM patients who received adjuvant immune checkpoint inhibitors (ICI), 18.8% experienced severe (Grades 3-4) immune-related adverse events. CONCLUSIONS:The benefit-risk balance must be carefully weighed, including the relapse-free survival (RFS), distant metastasis-free survival (DMFS) and rate of severe immune-related adverse events (irAE) occurrence. Other therapeutic strategies should be investigated in larger studies to confirm the potential limited clinical benefit of this treatment strategy.

The International Survey on Pigmentation Disorders Observational Tracking (ISPOT) study, conducted across 48 000 participants in 34 countries, assessed stigmatization in pigmentation disorders using the Patient Unique Holistic Stigmatization in Dermatology questionnaire. Findings reveal high stigmatization levels, particularly for vitiligo and melasma, with greater impact among younger individuals and those with fair skin.

The bidirectional communication between the skin and brain has emerged as a promising scientific paradigm in dermatology and cosmetic medicine. Neurocosmetics, a frontier at the intersection of neuroscience, dermatology, and psychodermatology, aims to target this skin-brain axis to enhance not only skin health but also emotional well being. This commentary explores the underlying neurocutaneous and neuroimmune mechanisms, the emerging role of the skin microbiome in emotion-linked skin responses, and how artificial intelligence technologies can help personalize these strategies. The convergence of neuroscience and dermatology may pave the way for a new generation of evidence-based skincare with psychophysiological impact, a transformative concept in clinical and cosmetic practice.

Background Skin cancer prevention remains a critical public health challenge, particularly in fair-skinned populations in Europe, the United States and Australia, where incidence rates of keratinocyte skin cancer and melanoma continue to rise despite decades of public education on ultraviolet-radiation (UVR) protection. Although progress has been observed in Oceania, the overall effectiveness of current prevention strategies remains insufficient. This paper aims to refine and disseminate more effective UVR protection messages by developing an evidence-based, internationally adaptable public education leaflet.Methods The development of this educational material followed the current guidelines for the development of health promotion materials and effective public education. Based on the scientific evidence, a plain-language message has been drafted. It was subsequently revised through multiple rounds of multi-stakeholder feedback from dermato-oncology, epidemiology, public health experts, patient organizations representatives and NGOs involved in prevention and health promotion.Results The final educational leaflet emphasizes three core messages: avoiding intentional sun exposure and tanning, utilizing shade and protective clothing as primary UV protection strategies and using sunscreen as a supplementary protective measure. Additional recommendations address childhood sun protection, the dangers of tanning beds and the importance of monitoring skin for early signs of cancer. Common concerns such as vitamin D synthesis and sunscreen safety are also addressed with evidence-based responses.Discussion This initiative highlights the necessity of shifting public attitudes towards UVR exposure and developing tailored, culturally sensitive communication strategies. The freely available leaflet will be distributed through professional associations and online platforms. Future efforts should involve policymakers in implementing structural changes, such as enhancing public shade availability and regulating tanning facilities, to promote long-term behavioural shifts in UV protection.

ABSTRACT Advances in dermatology are embracing a patient‐centered, proactive approach through the ‘4P model’: Personalized, Predictive, Preventive, and Participatory care. This shift aims to improve treatment efficacy and safety as well as patient's quality of life. This review explores the applications of ‘4P medicine’ in dermatology, highlighting key concepts and examples like innovations in onco‐dermatology and the skin microbiome. In onco‐dermatology, molecular profiling guides targeted treatments, while genetic insights improve risk prediction and prevention. Genetic profiling, such as the identification of BRAF mutations in melanoma, has enabled targeted therapies like BRAF/MEK inhibitors to improve patient outcomes. Predictive technologies, including machine learning, are enabling early detection and risk assessment for both melanoma and non‐melanoma skin cancers. Preventive strategies focus on proactive skin care, with public education campaigns and digital tools to increase sun protection behaviors and early detection. Participatory care engages patients in decision making, leading to better adherence and outcomes. This integrated approach optimizes outcomes and reduces the burden of skin cancer. Microbiome research has also transformed dermatology, enabling personalized treatments that target microbial imbalances in conditions such as atopic dermatitis, psoriasis and acne. Predictive dermatology uses microbiome signatures to forecast disease risk and response to treatment, enabling earlier intervention. Preventive strategies aim to maintain a healthy microbiome and prevent disease exacerbations. Participatory dermatology encourages patients to engage in microbiome‐focused skin care to optimize outcomes. However, challenges remain in terms of treatment optimization, economic sustainability, ethical considerations and equitable access to care. Addressing these challenges requires innovative solutions, collaborative research, and strategies to ensure the accessibility and cost‐effectiveness of dermatologic care.