Microwave ablation induces heating of tissue. High energy results in thermal cell death, but low energy treatment without tissue necrosis has been shown to induce cutaneous immunity in an HPV wart model. It is approved as an effective cancer treatment for solid organ cancers, and therefore it is of interest to know if microwave delivered directly to the skin holds potential for treatment of skin cancer. This pilot study focused on transcriptomic profiling of cutaneous melanoma metastases to investigate molecular changes associated with microwave therapy. Seven adult patients with skin metastases from malignant cutaneous melanoma, not resolving on standard treatment, were recruited. Microwave energy was applied to separate melanoma metastases. Morphological, histological, and transcriptomic changes assessed via tissue RNA sequencing were evaluated. Three participants showed complete response, while four showed partial response by histological assessment. In complete responders, skin lesion RNA sequencing after treatment, compared with baseline, identified increased inflammation (CXCL5, CXCL8, IL1A, COL1A1) and downregulated cancer markers (PRAME, S100B, MLANA, STK32A). Compared with partial responders, complete responders showed enrichment of FABP4 and reduced expression of cancer markers. Microwave therapy produced local tumor responses and associated inflammatory transcriptomic changes in complete responders, supporting further clinical evaluation in cutaneous melanoma metastases.

Merkel cell carcinoma (MCC) is a rare, aggressive neuroendocrine skin malignancy. We report an exceptional case of a 71-year-old female presenting with a 5.7-cm MCC in the left parotid region, representing a rare case of true direct parotid parenchymal invasion-distinguished from the more common intraparotid nodal metastasis-alongside multiple regional nodal metastases. The patient underwent wide en bloc excision, superficial parotidectomy, and selective neck dissection. Despite tumor adherence, the main facial-nerve trunk was successfully preserved. The resulting 12×11 cm composite defect was reconstructed using an anterolateral-thigh (ALT) free flap. Pathology confirmed cutaneous MCC with direct parotid parenchymal invasion, lymphovascular/perineural invasion, and metastatic nodes (Stage IIIB). Postoperatively, the flap remained viable, with successful functional preservation of facial-nerve function. Due to high-risk features, adjuvant chemoradiotherapy was initiated. This case highlights the importance of distinguishing invasion pathways for accurate staging and demonstrates that aggressive resection with functional reconstruction is feasible and effective for managing advanced craniofacial MCC. It also emphasizes the clinical importance of differentiating true parotid invasion from intraparotid nodal metastasis.

This methodology has been developed to standardize the pathology evaluation of melanoma metastasis regression in the sentinel lymph node after neoadjuvant/perioperative immunotherapy in patients with stage III resectable cutaneous melanoma. The methodology is intended for use by pathologists, clinical and surgical oncologists, and healthcare quality assessment experts. It can be implemented as a local protocol for pathological examination, as well as integrated into national clinical guidelines and relevant organizational and methodological documents.

Recent advancements in melanoma treatment have reinvigorated hope among patients, significantly shifting the therapeutic landscape. A significant advancement in patient outcomes has been realised by applying first-line treatment strategies that include Immune Checkpoint Inhibitors (ICIs) and targeted therapies. Ipilimumab combined with nivolumab has demonstrated superior outcomes, earning a median overall survival surpassing 70 months. This notable success signifies a pivotal shift in the management of advanced melanoma, reflecting effective therapeutic strategies that clinicians can leverage. The advent of new ICIs, such as relatlimab, introduces additional complexities in decision-making for first-line therapy. Understanding the nuances of various treatments will empower physicians to make informed decisions. Several important characteristics, including brain metastases, PD-L1 expression, BRAF mutation status, performance status, and any previous adjuvant treatments, influence the treatment of advanced melanoma. These factors influence the choice of therapy and the potential efficacy in individual cases, underscoring the need for personalised treatment approaches. This review also sheds light on rare melanoma subtypes, particularly uveal melanoma. The FDA approval of tebentafusp and lifileucel has demonstrated potential in extending the survival time of patients with metastatic uveal melanoma. This progress highlights the importance of innovative therapies tailored to unique cancer profiles. By providing recent insights into these evolving treatment options, this review is an invaluable resource for clinicians. It aims to facilitate informed treatment decisions and enhance understanding of the multifaceted challenges in effectively managing advanced melanoma. As new therapies emerge, continuous education and adaptability will be key to optimising patient outcomes.

Thin melanoma, defined as tumour thickness ≤1.0 mm, and melanoma in situ are increasingly diagnosed. However, acral-predominant Asian populations appear to experience higher rates of adverse outcomes than Western cohorts. This study aimed to identify prognostic factors among Taiwanese patients with early-stage melanoma. We reviewed 178 melanoma in situ/thin melanoma cases diagnosed from 1995 to 2025 at a tertiary centre and analysed overall survival, melanoma specific survival, recurrence-free survival, and distant metastasis-free survival using Cox and Fine-Gray competing-risk models. During a mean follow-up of 81 months, adverse events were not uncommon, including recurrence (8.8%), distant metastasis (4.7%) and melanoma-specific mortality (5.1%). Age was the most consistent predictor across endpoints in both Cox and competing-risk analyses. A Breslow thickness ≥0.8 mm independently increased the risk of melanoma-specific mortality, whereas ulceration and mitotic activity were not significant predictors. In conclusion, melanoma in situ and thin melanoma in this acral-predominant Asian cohort are not uniformly low risk. Older patients or those with tumours approaching or exceeding 0.8 mm in thickness warrant closer, risk-adapted surveillance.

A 51-year-old woman was admitted with a malodorous ulceration covering the whole area of both breasts, without visible breast contour or remnants of breast tissue. After excision of a skin nodule an invasive ductal carcinoma was diagnosed; grade-2, hormone receptor (HR)-positive, HER2-negative, Ki-67 at 25%. Computed tomography of the thorax and abdomen showed pulmonary and osseous metastases. Six cycles of systemic chemotherapy with epirubicin and cyclophosphamide at three-week intervals were administered, followed by endocrine therapy with letrozole. Almost four years later, palbociclib became available and it was added to the patient's treatment. Loco-regional and distant disease control was achieved attaining maximum response at 11 months after initial diagnosis and since then the patient remains progression-free with good quality of life for more than eight years. This is to the best of our knowledge an extreme case of primary metastatic ulcerative breast cancer with complete local tissue destruction and markedly prolonged progression-free survival. As this is a single-case clinical observation, any conclusions have limited generalizability. Given the rarity of primary metastatic ulcerative breast cancer there are no specific evidence-based treatment guidelines available and published studies have high heterogeneity and low level of evidence, necessitating multidisciplinary approach on a case-by-case basis.

Background and Clinical Significance: Advanced-stage and recurrent metastatic endometrial cancer (EC) is a complex and challenging disease with a poor prognosis. Immunotherapy is a promising treatment for advanced and recurrent mismatch repair deficiency (MMRd) EC. Case Presentation: A 57-year-old female patient with stage 2 dedifferentiated EC with MMRd (immunohistochemistry revealed PMS2 loss) and stage 1 renal clear cell carcinoma received neoadjuvant chemotherapy, underwent radical hysterectomy, received adjuvant chemotherapy and radiotherapy, and underwent partial nephrectomy. Disease progression with recurrent metastases to the third rib and T12 + L1 vertebrae was observed by positron emission tomography-computed tomography (PET-CT) in April 2024. She also had concurrent papillary thyroid carcinoma. Genetic testing confirmed sensitivity to dostarlimab-gxly and pembrolizumab, leading to the initiation of pembrolizumab (200 mg Q3W) and lenvatinib (20 mg QD) in June 2024 after spine surgery. Treatment-related skin toxicities prompted a dose reduction to pembrolizumab 100 mg and lenvatinib 10 mg, but persistent discomfort led to lenvatinib discontinuation in December 2024, with symptom improvement. PET-CT in October 2024 revealed significant improvement in metastatic disease, with probable residual malignancy in the left third rib and posterior pleura, whereas recent follow-up PET-CTs in April and November 2025 showed significantly decreased [18]F-fluorodeoxyglucose avidity in the spine and ribs compared with prior studies. She was admitted for her 30th Keytruda cycle in February 2026, with stable vital signs, normal tumor markers, and no post-infusion adverse reactions. Conclusions: We present a 57-year-old female patient initially diagnosed with FIGO Stage 2 EC, who subsequently developed distant metastases and was restaged as FIGO Stage 4B recurrent disease. The management of this patient illustrates the multimodal treatment approach and the critical role of molecular subtyping in guiding immunotherapeutic strategies for recurrent advanced EC.

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.

Psoriasis is a chronic autoimmune skin disease that may be triggered or exacerbated by medications, including targeted oncologic therapies. Pemigatinib is a fibroblast growth factor receptor inhibitor used for the treatment of cholangiocarcinoma. We present the case of a 61-year-old woman with unresectable cholangiocarcinoma and lung metastases who developed psoriatic plaques after four cycles of pemigatinib. She had a remote history of limited psoriasis but no other new triggers. Her presentation included occipital scalp and leg plaques. Topical therapies were prescribed; however, follow-up revealed persistent disease and uncertain treatment adherence. The patient ultimately deprioritized dermatologic symptoms in the context of systemic illness. To our knowledge, based on searches in PubMed and other databases, this represents the first reported case of pemigatinib-induced psoriasis. Recognition and management of dermatologic adverse effects are critical to minimizing morbidity in the setting of life-prolonging oncologic treatments. Given the limitations of a single-case inference, further surveillance and study are needed to determine whether patients with pre-existing psoriasis may be at increased risk.