This month’s news from across the specialty
What’s hot
April 1, 2026
In this monthly column, members of the DermWorld Editorial Advisory Workgroup identify exciting news from across the specialty.
Immune checkpoint inhibitors (ICIs) have dramatically improved prognosis for melanoma and other cancers. Once nearly always fatal, advanced melanoma treated with nivolumab plus ipilimumab now has 10-year rates of melanoma-specific survival around 50%.
Lack of response to ICIs occurs if the immune system is not primed to attack cancer cells. That lack of readiness is thought to result from tumors themselves, which can produce immunosuppressive “tumor microenvironments.”
Highly immunogenic personalized mRNA vaccines are being investigated as a method for preparing the immune system for battle, so that ICIs can then unleash the immune system’s full potential. However, producing them is expensive, complex, and time intensive.
It turns out that off-the-shelf mRNA vaccines — specifically, mRNA COVID-19 vaccines — might do the trick. These vaccines are known to generally activate antigen-presenting cells throughout the body. According to a report in Nature, receipt of an mRNA COVID-19 vaccine within 100 days of starting an ICI was associated with improved survival in both melanoma and non-small cell lung cancer.
In animal models, the study showed, mRNA COVID-19 vaccines induced increases in type 1 interferon, which in turn boosted the immune system’s ability to target tumor-associated antigens. The effect was strongest when ICIs were administered concomitantly. ICIs already have demonstrated effectiveness for advanced melanoma and other cancers. Adding a COVID mRNA vaccine to the regimen seems like a very promising, readily available addition.
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A 65-year-old woman was hospitalized for a diffuse, morbilliform eruption on her trunk and extremities. Her face was erythematous and her eyelids were so swollen that she could barely open them. She had a low-grade fever and transaminitis. The patient had started taking sulfamethoxazole/trimethoprim for a swollen joint two weeks prior to the onset of her eruption. Based on the patient’s RegiSCAR score, the dermatology consult team deemed that this was not a case of drug reaction with eosinophilia and systemic symptoms (DRESS), but instead, this was a case of viral exanthem.
The RegiSCAR score is most reliable when used retrospectively when there is diagnostic uncertainty. When used at initial presentation or early in the disease course, results should be interpreted with caution, as several criteria cannot be assessed initially or may not yet have had sufficient time to develop. One of the features to be assessed in the scoring tool is: “resolution in >15 days.” This feature cannot be assessed when one is evaluating a new onset case of DRESS. Another criterion is: “biopsy suggesting DRESS.” This feature cannot be assessed when evaluating a patient for the first time, since the biopsy has not been performed yet. Moreover, often a biopsy is not performed because the diagnosis is made based on the constellation of clinical findings and the history of a highly culprit drug. Another criterion is: “alternative diagnosis excluded by ≥3 biological investigations.” This criterion cannot be assessed when initially evaluating the patient, since these tests (HAV, HBC, HCV, mycoplasma, chlamydia) often have not been ordered yet. Evaluate the patient clinically instead of over-relying on a score. This patient should not take sulfamethoxazole/trimethoprim again.
The chemopreventive role of nicotinamide, a vitamin B3 derivative available over the counter, was first established in the ONTRAC trial published in The New England Journal of Medicine in 2015 (N Engl J Med. 2015; 373:1618-26). This randomized controlled trial demonstrated that nicotinamide 500 mg twice daily reduced the incidence of nonmelanoma skin cancer (NMSC) by 23% in immunocompetent patients with a history of at least two prior NMSCs. Although nicotinamide is now widely recommended by dermatologists for skin cancer prevention, the optimal timing of initiation has remained unclear until recently.
A recent retrospective cohort study in JAMA Dermatology by Breglio et al. analyzed electronic health record data from 33,822 patients in the Veterans Affairs Corporate Data Warehouse. Using propensity score matching based on the number and year of prior skin cancers and other relevant risk factors, nicotinamide exposure was associated with a 14% overall reduction in NMSC and a 22% reduction in cutaneous squamous cell carcinoma (cSCC). Importantly, timing of initiation significantly influenced outcomes, with a 54% risk reduction when nicotinamide was started after the first skin cancer diagnosis and diminishing benefit when initiated after subsequent tumors.
Managing Basal Cell Nevus Syndrome (BCNS) requires a paradigm shift from treating sporadic tumors to managing a lifelong, high-burden condition. A multidisciplinary panel of over 130 experts recently released 47 evidence-based recommendations in JAAD addressing the clinical and psychosocial challenges of BCNS. The guidelines utilize a modified GRADE approach, integrating systematic reviews with structured patient interviews to ensure the burden of treatment is central to the recommendations.
The guidelines move beyond simple tumor clearance, introducing the concept of “surgical fatigue” as a primary clinical consideration. Notable clinical pearls include:
Hedgehog inhibitors (HHIs): Recommended as first-line systemic therapy, but with a strong emphasis on intermittent dosing and treatment holidays to improve long-term tolerability.
Genetics: HHIs are likely ineffective for patients with SUFU mutations; genetic testing is now recommended for all suspected cases.
Laser and energy devices: These are strictly categorized as adjunctive, not first-line therapies. Vascular or ablative lasers may only be considered in addition to first-line treatments for low-risk tumors.
Contraindications: Radiation therapy is absolutely contraindicated in pediatric patients due to the risk of inducing further BCCs and other radiation-induced malignancies such as meningiomas and medulloblastomas.
For the board-certified dermatologist, the goal in BCNS is rarely “total cure” but rather a “therapeutic alliance” focused on preserving quality of life and function. Clinicians should prioritize multimodal strategies — combining conservative surgery with field therapies like 5-FU, imiquimod, or PDT — while incorporating formal psychosocial support into the care plan.
More What’s Hot!
Check out more What’s Hot columns from the DermWorld Editorial Advisory Workgroup.
