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ImportanceTherapy for advanced melanoma has transformed during the past decade, but early detection and prognostic assessment of cutaneous melanoma (CM) remain paramount goals. Best practices for screening and use of pigmented lesion evaluation tools and gene expression profile (GEP) testing in CM remain to be defined.ObjectiveTo provide consensus recommendations on optimal screening practices and prebiopsy diagnostic, postbiopsy diagnostic, and prognostic assessment of CM.Evidence reviewCase scenarios were interrogated using a modified Delphi consensus method. Melanoma panelists (n = 60) were invited to vote on hypothetical scenarios via an emailed survey (n = 42), which was followed by a consensus conference (n = 51) that reviewed the literature and the rationale for survey answers. Panelists participated in a follow-up survey for final recommendations on the scenarios (n = 45).FindingsThe panelists reached consensus (≥70% agreement) in supporting a risk-stratified approach to melanoma screening in clinical settings and public screening events, screening personnel recommendations (self/partner, primary care provider, general dermatologist, and pigmented lesion expert), screening intervals, and acceptable appointment wait times. Participants also reached consensus that visual and dermoscopic examination are sufficient for evaluation and follow-up of melanocytic skin lesions deemed innocuous. The panelists reached consensus on interpreting reflectance confocal microscopy and some but not all results from epidermal tape stripping, but they did not reach consensus on use of certain pigmented lesion evaluation tools, such as electrical impedance spectroscopy. Regarding GEP scores, the panelists reached consensus that a low-risk prognostic GEP score should not outweigh concerning histologic features when selecting patients to undergo sentinel lymph node biopsy but did not reach consensus on imaging recommendations in the setting of a high-risk prognostic GEP score and low-risk histology and/or negative nodal status.Conclusions and relevanceFor this consensus statement, panelists reached consensus on aspects of a risk-stratified approach to melanoma screening and follow-up as well as use of visual examination and dermoscopy. These findings support a practical approach to diagnosing and evaluating CM. Panelists did not reach consensus on a clearly defined role for GEP testing in clinical decision-making, citing the need for additional studies to establish the clinical use of existing GEP assays.

ImportanceUse of prognostic gene expression profile (GEP) testing in cutaneous melanoma (CM) is rising despite a lack of endorsement as standard of care.ObjectiveTo develop guidelines within the national Melanoma Prevention Working Group (MPWG) on integration of GEP testing into the management of patients with CM, including (1) review of published data using GEP tests, (2) definition of acceptable performance criteria, (3) current recommendations for use of GEP testing in clinical practice, and (4) considerations for future studies.Evidence reviewThe MPWG members and other international melanoma specialists participated in 2 online surveys and then convened a summit meeting. Published data and meeting abstracts from 2015 to 2019 were reviewed.FindingsThe MPWG members are optimistic about the future use of prognostic GEP testing to improve risk stratification and enhance clinical decision-making but acknowledge that current utility is limited by test performance in patients with stage I disease. Published studies of GEP testing have not evaluated results in the context of all relevant clinicopathologic factors or as predictors of regional nodal metastasis to replace sentinel lymph node biopsy (SLNB). The performance of GEP tests has generally been reported for small groups of patients representing particular tumor stages or in aggregate form, such that stage-specific performance cannot be ascertained, and without survival outcomes compared with data from the American Joint Committee on Cancer 8th edition melanoma staging system international database. There are significant challenges to performing clinical trials incorporating GEP testing with SLNB and adjuvant therapy. The MPWG members favor conducting retrospective studies that evaluate multiple GEP testing platforms on fully annotated archived samples before embarking on costly prospective studies and recommend avoiding routine use of GEP testing to direct patient management until prospective studies support their clinical utility.Conclusions and relevanceMore evidence is needed to support using GEP testing to inform recommendations regarding SLNB, intensity of follow-up or imaging surveillance, and postoperative adjuvant therapy. The MPWG recommends further research to assess the validity and clinical applicability of existing and emerging GEP tests. Decisions on performing GEP testing and patient management based on these results should only be made in the context of discussion of testing limitations with the patient or within a multidisciplinary group.

Background: A common terminology for diagnosis is critically important for clinical communication, education, research and artificial intelligence. Prevailing lexicons are limited in fully representing skin neoplasms. Objectives: To achieve expert consensus on diagnostic terms for skin neoplasms and their hierarchical mapping. Methods: Diagnostic terms were extracted from textbooks, publications and extant diagnostic codes. Terms were hierarchically mapped to super‐categories (e.g. 'benign') and cellular/tissue‐differentiation categories (e.g. 'melanocytic'), and appended with pertinent‐modifiers and synonyms. These terms were evaluated using a modified‐Delphi consensus approach. Experts from the International‐Skin‐Imaging‐Collaboration (ISIC) were surveyed on agreement with terms and their hierarchical mapping; they could suggest modifying, deleting or adding terms. Consensus threshold was >75% for the initial rounds and >50% for the final round. Results: Eighteen experts completed all Delphi rounds. Of 379 terms, 356 (94%) reached consensus in round one. Eleven of 226 (5%) benign‐category terms, 6/140 (4%) malignant‐category terms and 6/13 (46%) indeterminate‐category terms did not reach initial agreement. Following three rounds, final consensus consisted of 362 terms mapped to 3 super‐categories and 41 cellular/tissue‐differentiation categories. Conclusions: We have created, agreed upon, and made public a taxonomy for skin neoplasms and their hierarchical mapping. Further study will be needed to evaluate the utility and completeness of the lexicon. [ABSTRACT FROM AUTHOR]

Small bowel adenocarcinoma (SBA) is a rare primary gastrointestinal malignancy. We present a 60-year old man who developed a cutaneous metastasis of jejunal adenocarcinoma to his neck. This case highlights the clinicopathologic and immunophenotypic features of this uncommon cutaneous metastasis.

Although the therapeutic benefit of oral antimalarials in various types of sarcoidosis is well described, their reported use specifically in subcutaneous sarcoidosis (Darier-Roussy type sarcoidosis) is limited. We describe the cases of two patients with subcutaneous sarcoidosis treated with hydroxychloroquine, suggesting that it may represent an alternative first-line treatment for patients in whom steroid-sparing therapy is desired.

Numerous medications have been associated with the development of subacute cutaneous lupus erythematosus. A mechanism explaining how unrelated drug classes can lead to subacute cutaneous lupus erythematosus has remained elusive, suggesting that there may be multiple etiologic pathways. Taxanes (docetaxel, paclitaxel, and cabazitaxel) inhibit cell mitosis through microtubule stabilization and their use has uncommonly been associated with subacute cutaneous lupus erythematosus. Recently the antigen recognized by anti-Ro/SS-A antibody (Ro52) has been localized to the cytoplasmic microtubule network. A case report of docetaxel exacerbated subacute cutaneous lupus erythematosus is presented and literature review performed, revealing 11 additional cases of taxane associated subacute cutaneous lupus erythematosus. Taxanes are proposed to exacerbate or induce subacute cutaneous lupus erythematosus in immunogenetically predisposed patients by stabilizing microtubules and affecting Ro/SS-A antigen (Ro52) expression. This may be an under recognized adverse drug reaction because taxanes are used for a defined period and the cutaneous eruption tends to spontaneously improve. Studies analyzing how particular drug classes affect Ro/SS-A antigen expression may be useful in identifying mechanisms of action in drug-induced subacute cutaneous lupus erythematosus.