Editor’s Choice Articles

Background: Melanoma of unknown primary (MUP) is a rare and distinct clinical subtype of metastatic melanoma, in which no identifiable primary tumor is found. The prognosis of MUP compared to melanoma with known primary (MKP) remains unclear, especially in the era of novel therapies like immune checkpoint inhibitors (ICIs) and targeted therapies. This meta-analysis aims to compare the overall survival (OS) of MUP and MKP patients under these therapies. Methods: This systematic review was conducted in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). A systematic search of major databases was conducted, yielding six eligible studies (nine study arms) that assessed the survival outcomes of MUP and MKP patients treated with immunotherapies and targeted therapies. We pooled the hazard ratios (HRs) for OS using both fixed and random effects models. Heterogeneity was assessed with the I² statistic followed by a Baujat plot, and publication bias was evaluated using funnel plots and Egger’s test. Results: Our analysis revealed a borderline significant HR of 0.90 (95% CI: [0.81, 1.00], p = 0.04) under the fixed effect model, suggesting a potential survival benefit for MUP patients. However, the random effects model, accounting for study heterogeneity, showed no significant difference in OS between MUP and MKP (HR = 0.87, 95% CI: [0.73, 1.05], p = 0.15). Significant heterogeneity (I² = 66.9%, p = 0.0022) was observed across studies. No substantial publication bias was detected. Conclusion: While the trend observed in the fixed effect model suggests a potential benefit for MUP patients, the random effects analysis indicates no significant difference between MUP and MKP in terms of OS. These findings underscore the importance of accounting for study heterogeneity and highlight the need for further prospective studies to better understand the impact of novel therapies on MUP. Full article

Background/objectives: According to the Chapel Hill Consensus Conference nomenclature, single-organ cutaneous small vessel vasculitis (SOCV) is defined histopathologically by immune complex-mediated vasculitis of the dermal capillaries/venules without systemic involvement. There is a lack of investigations studying predictors of SOCV outcomes. This multicenter retrospective study aimed to assess whether baseline serum liver scores could predict SOCV recurrence. Methods: Data from 204 inpatients with histopathologically confirmed idiopathic SOCV treated between 2000 and 2022 were analyzed. All patients had baseline blood tests for platelets and liver parameters; those with systemic diseases were excluded. The study evaluated the AST to Platelet Ratio Index (APRI), Fibrosis-4 (FIB-4) index, and De Ritis ratio (DRR). Results: Recurrence was observed in 17.6% of patients. Univariable analysis identified hospital stay length, DRR, cutaneous extent, and cardiovascular comorbidities as predictors, but logistic regression confirmed only cutaneous extent and DRR as independent predictors of disease recurrence. Conclusions: A higher DRR (cut-off > 1.13) may indicate necrosis from reduced blood flow, making it a potential predictor of SOCV recurrence. Full article

The concept of gender has evolved significantly in recent decades, moving from a binary status to a multiplicity of gender types. In today’s world, the new reality of the concept of masculinity, as defined socially and historically, must be recognized and accepted by aesthetic medicine. Consequently, aesthetic doctors will have to adapt the views and treatment plans that they propose in their consultations to the ideals of beauty, as well as with the roles, behaviors, and attributes considered masculine within their society. Each facial feature suggests a personality characteristic that represents that individual. This expert opinion article aims to assess Caucasian male gender-related anatomical facial features and achieve an expert agreement on the association of specific features with the perception of attractiveness, masculinity, and personality traits in order to cover the wide range of current male representations, as well as to provide orientation for clinical practice improvement in the contemporary landscape of facial masculinization. Full article

Image-guided superficial radiation therapy (IGSRT) combines superficial radiation therapy (SRT) with full dermal visualization (FDV) via high-resolution dermal ultrasound (HRDUS) for the treatment of non-melanoma skin cancer (NMSC). The gold standard for IGSRT delivery includes a comprehensive cancer care model with support for dermatologists from a multidisciplinary team. When delivered in this model, IGSRT can achieve cure rates of 99% for treatment of NMSC. This paper focuses on the benefits of HRDUS used in conjunction with SRT for NMSC. Medical records from 7 dermatology clinics of 883 patients with 1507 cases of NMSC treated with IGSRT between 2017 and 2018 were retrospectively reviewed. In total, 92% of the NMSC lesions showed daily depth fluctuations, 60.32% of lesions did not require changes during therapy, and nearly 40% of lesions required at least one compensatory change during therapy. In total, 83% of NMSC lesions were labeled as high risk based on the 2024 NCCN guidelines. Increasing and decreasing tumor depth measurements during IGSRT inform dermatologists when adaptive changes in energy (kV), TDF, and dose will result in more efficacy and less toxicity, respectively. Full article