A 77-year-old man was referred for treatment of a type 3 lesion located on the greater curvature of the gastric angle, which was detected by esophagogastroduodenoscopy. CT imaging showed no evidence of lymph node metastasis or distant metastases; and the clinical stage was cT2N0M0, cStage Ⅰ. The patient had a complex surgical history, including radical cystectomy with ileal conduit creation for invasive bladder cancer, followed by emergency surgeries for rectal perforation, which was managed with peritoneal lavage and drainage, and sigmoid colostomy. He also had another emergency surgery for perforation of sigmoid colon. Negative pressure wound therapy and subsequent skin grafting were performed for abdominal closure. Comorbidities included variant angina, asthma, and restrictive pulmonary dysfunction. Due to anticipated extensive adhesions, the limited access to the abdominal cavity, and the patient's poor ADL, a standard gastrectomy was not feasible. Local gastrectomy with limited lymphadenectomy was successfully performed. Pathology revealed adenocarcinoma, pT3N0M0, pStage ⅡA. The patient recovered without major complications. This case highlights the feasibility of performing local gastrectomy in high-risk patients with limited surgical access.

Tebentafusp is an immune-mobilizing monoclonal T-cell receptor approved for the treatment of metastatic uveal melanoma. While this agent improves outcomes in patients with unresectable or metastatic uveal melanoma, tebentafusp commonly results in dermatologic cutaneous toxicities. Herein, we present a case of a 32-year-old patient diagnosed with juxtapapillary choroidal melanoma of the left eye with metastases to the liver who developed a diffuse urticarial skin reaction to tebentafusp that was successfully treated with omalizumab.

Cutaneous metastases from breast cancer (CMBC), including those involving the scalp, are typically observed in advanced stages of the disease and are relatively uncommon, particularly in hormone receptor-positive subtypes. We present the case of a 68-year-old woman with breast cancer metastatic to the skin, characterized by multiple firm, hyperpigmented, painless nodules distributed over the body, including the scalp. The patient has been treated with a CDK4/6 inhibitor (ribociclib) in combination with endocrine therapy (ET) (letrozole) since April 2024. During follow-up, all subcutaneous nodular lesions showed significant regression. By April 2026, skin color had returned to normal in most previously affected areas, and the majority of nodules had resolved. The scalp lesion completely disappeared, with full hair regrowth at the affected site. Treatment of CMBC with CDK4/6 inhibitor-based therapy has been scarcely reported, with most cases describing ET alone. This case highlights the potential role of CDK4/6 inhibitors and documents a notable response in the scalp, skin, and subcutaneous tissue, which has not been widely described.

Pregnancy-associated melanoma is one of the more frequently encountered malignancies during gestation, although its overall incidence remains low. Current evidence suggests that pregnancy itself does not adversely affect melanoma-specific survival when the tumour stage is considered, yet clinical management remains challenging. Physiological skin changes can obscure early detection, and limitations on imaging modalities and systemic therapies restrict standard diagnostic and treatment options. Additional uncertainty surrounds the safety and timing of sentinel lymph node biopsy during pregnancy. Although metastases to the placenta or foetus are exceedingly rare, placental histopathological examination is recommended in cases of advanced maternal disease to ensure appropriate follow-up. Optimal care relies on applying standard melanoma treatment principles with thoughtful adjustments to safeguard foetal well-being. Continued research and larger, higher-quality datasets are essential to improve prognostic accuracy and guide evidence-based management in this complex and clinically sensitive setting, supporting clinicians in delivering safer care for affected pregnant patients.

Phyllodes tumors are uncommon fibroepithelial breast neoplasms with variable biologic behavior. Synchronous bilateral phyllodes tumors are exceptionally rare, and the interpretation of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET-CT) may be confounded by tumor necrosis and inflammation, leading to false-positive nodal staging.

Metastatic melanoma has historically had a poor prognosis; however, survival has improved with immunotherapies, such as PD-1 and CTLA-4 inhibitors, and molecular targeted therapies for BRAF-mutant tumors. The combination of nivolumab and ipilimumab is highly effective, though with increased rates of toxicity. In Italy, since January 2022, such therapeutic combination has been approved and reimbursed only for metastatic melanoma patients with brain metastases or with PD-L1 expression <1%.

Herein, we report the case of a woman in her mid-forties with stage IIB cervical squamous cancer status post-chemoradiation and brachytherapy with curative intent one year prior, who subsequently presented with lacy red to violaceous patches on the forehead, abdomen, back, and legs, as well as mildly tender, ill-defined, purpuric dermal nodules on the right upper back and right inner thigh. Hypercoagulability work-up was negative, and biopsy was consistent with metastatic, intravascular squamous cell carcinoma of cervical origin. This prompted repeat imaging, which was suspicious for metastatic disease to lymph nodes, lungs, and pericardium with multiple bilateral acute/subacute embolic brain infarcts and left ventricular thrombus, and the patient was subsequently started on pembrolizumab, carboplatin, and paclitaxel. Dermatology recommended warming the skin during infusions to promote vasodilation and improve intravascular medication distribution. Despite almost complete resolution of purpuric skin findings and initial improvement in metastatic bone and lymph node disease, the patient had disease progression with worsening bone and new leptomeningeal metastases, as well as subcutaneous metastatic nodules, and was switched to second-line immunotherapy, tisotumab and bevacizumab. Unfortunately, the patient continued to have progressive metastatic disease, leading to multiple complications and hospitalizations, and was ultimately transitioned to hospice care. She passed eleven months post-presentation. Our case highlights the importance of considering retiform purpura as a rare manifestation of intravascular metastases in patients with cervical squamous cell carcinoma, the value of cutaneous metastases in the management of oncologic patients, and the need to further assess the prognostic utility of cutaneous metastases in the era of immunotherapy, which, based on our case, appears to remain a poor prognostic sign.

Background and Objectives: Cutaneous squamous cell carcinoma (cSCC) displays heterogeneous metastatic potential, and the role of sentinel lymph node biopsy (SLNB) in clinically node-negative patients remains debated. To evaluate tumor thickness and histological grade as predictors of sentinel lymph node (SLN) metastasis in high-risk cSCC and to assess the performance of a simplified pathology-based predictive model. Materials and Methods: This retrospective single-center study included consecutive patients with high-risk cSCC and clinically N0 status who underwent SLNB. Associations were examined using univariate and multivariable logistic regression, ROC analysis with bootstrap internal validation (2000 iterations), and decision curve analysis. Results: Thirty-four patients were analyzed; 12 (35.3%) had SLN metastases. SLN-positive patients had greater tumor thickness (median 5.5 mm vs. 3.0 mm, p = 0.006) and higher frequency of G2-G3 histological grade (91.7% vs. 45.5%, p = 0.011). Histological grade was the strongest independent predictor in multivariable analysis (OR 14.61, 95% CI 1.63-131.12). The combined model demonstrated apparently high discrimination in this small cohort (AUC 0.91; bootstrap 95% CI 0.79-0.99), though this estimate should be interpreted with caution given the limited number of events. A 4.0-mm threshold yielded sensitivity 83.3% and NPV 86.7%. Conclusions: In this exploratory single-center study, tumor thickness and histological grade were complementary predictors of SLN metastasis in cSCC. These findings are preliminary and require validation in larger prospective cohorts.

Integrative multiscale imaging bridges the gap between macroscopic organ structures and microscopic cellular processes, enabling holistic visualization of anatomy and function across scales. Photoacoustic imaging (PAI) leverages melanin's potent contrast for label-free melanoma detection, yet its potential in lung imaging, challenged by air-tissue acoustic impedance mismatch, remains unexplored for melanoma lung metastases (MLMs). We used hierarchical multiscale PAI, transitioning from whole-body macroscale to localized mesoscale and single-cell-resolution microscale. PAI also guided photoablation interventions in the first and second near-infrared windows, requiring only 10.4 pg intracellular melanin/cell. Bioinformatic analysis of human MLM tissues revealed perturbed signaling pathways compared with normal skin and lung tissues, accounting for dysfunctional melanogenesis to enable label-free PAI with high sensitivity and specificity. Malignant MLM lesions in living mice, resected mouse lungs, and human lungs were delineated with margins closely conforming to histology. The high sensitivity allowed visualization of low-cellularity microsatellite foci down to a few tens of cell clusters, with sufficient penetration in the lungs of mice and Bama minipigs. The multiscale imaging methodology streamlines a theranostic workflow and specifically identifies MLM burden in a progressive, label-free manner, which may aid real-time tumor ablation in the future.

Bispecific T cell engagers (BTEs) induce MHC-independent cytotoxicity by bridging T cells to tumor cells via binding a T cell-activating receptor and a tumor-associated antigen. BTEs have proven effective in hematologic malignancies and some solid tumors, yet their potential in glioblastoma (GBM) is largely unexplored. We developed a fully humanized BTE (hBTE) targeting interleukin-13 receptor alpha 2 (IL13RA2), a tumor-associated antigen widely expressed in GBM and associated with poor prognosis. In vitro, hBTE activated T cells and induced antigen-dependent cytokine release and cytotoxicity against IL13RA2-positive GBM cells. In vivo, hBTE showed robust target-specific activity and markedly prolonged survival in primary and recurrent GBM xenograft models, without detectable off-target local or systemic toxicity. Beyond GBM, hBTE also exhibited antitumor activity in IL13RA2-expressing solid tumors, demonstrating selective tumor accumulation and therapeutic efficacy in models of breast cancer brain metastases and extracranial lung cancer. This work highlights the therapeutic potential of BTEs in IL13RA2-expressing tumors and establishes a strong preclinical rationale for advancing hBTE therapy toward clinical translation in GBM and other tumors.