Advances in the Field of Cutaneous Malignancies: Background and Clinical Management

Cutaneous malignancies constitute a growing clinical and public health burden, encompassing common keratinocyte carcinomas, melanomas, and a heterogeneous group of rare neoplasms. Their management increasingly depends not only on early recognition but also on precise characterization, appropriate staging, and individualized treatment selection [1,2,3,4,5,6]. Recent advances in non-invasive imaging, teledermatology, and artificial intelligence (AI) are expanding the information available before biopsy or treatment and are helping integrate diagnosis with therapeutic planning [6,7,8,9,10].

This Special Issue, “Advances in the Field of Cutaneous Malignancies: Background and Clinical Management”, brings together five contributions that reflect this evolution across diagnosis, characterization, and treatment. The included articles address periocular tumor imaging, teledermatology-based melanoma referral, a rare aggressive cutaneous lymphoma, field-directed therapy for actinic keratoses, and sentinel lymph node biopsy in head and neck melanoma.

Earlier and more accurate diagnosis remains a central objective in dermato-oncology. Chello et al. review reflectance confocal microscopy, optical coherence tomography, and line-field confocal optical coherence tomography for periocular skin tumors [11]. In this anatomically sensitive region, non-invasive imaging may increase diagnostic confidence, provide complementary information on lesion architecture, and support tissue-sparing management. However, the authors appropriately emphasize that the available evidence remains limited and that these modalities should complement rather than replace histopathology [11,12,13,14,15,16,17,18,19].

These observations are consistent with broader evidence showing that multimodal assessment may be more informative than reliance on a single technique [7,20,21,22]. Similarly, non-invasive imaging may increasingly assist basal cell carcinoma subtyping, which is clinically relevant because subtype influences treatment selection and recurrence risk [23,24,25].

Access to specialist assessment is another determinant of timely diagnosis. Cebolla-Verdugo et al. compared melanomas diagnosed through conventional face-to-face referral with those identified through a teledermatology-based pathway [26]. The teledermatology cohort showed a more favorable clinicopathological profile, including lower Breslow thickness, although the observational design and comparison of different time periods preclude causal conclusions [26]. Their findings complement the meta-analysis by Martyin et al., which found high diagnostic concordance for teledermatology and showed that adding dermoscopy significantly improved concordance for skin cancer [27]. Together, these studies support the structured integration of teledermatology into referral pathways while emphasizing the importance of image quality, clinical information, and appropriate escalation to in-person assessment.

Technological progress does not diminish the importance of clinicopathological expertise. Jaramillo et al. describe primary cutaneous CD8-positive aggressive epidermotropic cytotoxic T-cell lymphoma, a rare neoplasm characterized by rapid progression and limited therapeutic options [28]. The case illustrates how diagnostic delay may arise when uncommon malignancies mimic infectious or inflammatory disorders. It also underscores the continuing need for careful clinical correlation, histopathology, immunophenotyping, and multidisciplinary evaluation [28,29].

Cantisani et al. report their experience with topical 4% 5-fluorouracil in patients with actinic keratoses, observing high clearance and acceptable tolerability [30]. These findings reinforce the established role of 5-fluorouracil as a field-directed treatment, particularly in patients with extensive actinic damage [4,31,32].

Lázár et al. evaluate sentinel lymph node biopsy for head and neck melanoma in a medium-volume regional center and report complete sentinel-node identification without major complications [33]. Their study supports the feasibility of multidisciplinary staging outside high-volume centers and highlights the contemporary role of sentinel-node status in prognosis and selection for adjuvant therapy [1,34,35,36,37].

Collectively, the articles in this Special Issue demonstrate that progress in cutaneous oncology depends on combining innovation with clinical judgment. Non-invasive imaging, teledermatology, pathology, field therapy, and surgical staging address different points along the same patient pathway. AI may further connect these domains through multimodal analysis and decision support, but prospective validation, standardized protocols, transparency, and equitable implementation remain essential [8,38,39,40,41,42]. We thank the authors for their valuable contributions and the reviewers for their careful evaluations. We hope that this collection will encourage further multidisciplinary research and support increasingly precise, accessible, and patient-centered care for cutaneous malignancies.