BACKGROUND: Nickel is the most common cause of allergic contact dermatitis (ACD). In certain geographical locations, the prevalence of nickel dermatitis (NiACD) has changed over time; however, there is little data on the...BACKGROUND: Nickel is the most common cause of allergic contact dermatitis (ACD). In certain geographical locations, the prevalence of nickel dermatitis (NiACD) has changed over time; however, there is little data on the prevalence of NiACD in Australia. OBJECTIVES: To investigate the prevalence and trends of both nickel contact allergy and NiACD in Australia. METHODS: A retrospective audit was performed of 3582 patients patch tested to 5% nickel sulphate between 2014 and 2023. Relevance was assessed by consultant dermatologists. Patch test data was analysed using Pearson's χ test and Cochran-Armitage χ test for trend. RESULTS: 573/3582 (16.0%) of patients had nickel contact allergy based on positive patch tests, while 169 (4.7%) of patients were diagnosed with NiACD, where exposure to nickel correlated with their presenting dermatitis. There was a significant trend of decreasing NiACD from 2014 to 2023 (χ (1, N = 3582) = 14.1239, P = 0.0002, slope = -0.0045); however, there was no decline in the prevalence of nickel contact allergy (Pearson's χ test (9, N = 3582) = 13.426, p = 0.1443). Occupational NiACD was diagnosed in 20/169 (11.8%). There was a high degree of comorbid atopic dermatitis (37.3%), asthma (24.9%), and allergic rhinitis (52.1%). CONCLUSIONS: We report a declining prevalence of NiACD but a stable prevalence of nickel contact allergy in our patient population between 2014 and 2023.
Radiation therapy has undergone unprecedented advances over the past four decades, both in the understanding of radiobiologic effects and in the technical features of external beam delivery. The extent and scope of these...Radiation therapy has undergone unprecedented advances over the past four decades, both in the understanding of radiobiologic effects and in the technical features of external beam delivery. The extent and scope of these changes have largely remained unappreciated outside the specialty of radiation oncology. The net effect of these advances has been improved dosimetry whereby radiotherapy can more evenly target a planned tissue volume while sparing normal tissues. The term dosimetry describes the evenness (homogeneity) and sharpness (conformality) of photon irradiation. Improved efficacy and safety are now reliably deliverable, prompting a need for a general re-appraisal of the place of modern radiotherapy across the spectrum of skin cancer management. Improved techniques are now widely available for the treatment of high-risk or extensive skin cancers, multiple in-field tumours and severe skin field cancerization. Specialised techniques in development include the use of extended radiation field techniques for micrometastatic disease in lymphatic corridors and harnessing the immune stimulatory potential of radiotherapy, especially in conjunction with immunotherapy and targeted therapies. This review aims to provide a summary of these changes for the non-radiation oncologist. The major advances in radiotherapy most relevant to skin cancer will be discussed along with the evidence for several emerging new applications in cancer management.
Pérez-Pastor G, Perosanz Lobo D, Ciudad Blanco C
… +8 more, Fernández de Misa Cabrera R, Vilchez-Marquez F, Bonfill Ortí M, Gonzalez-Delgado V, Yébenes Marsal M, Samaniego González E, García-Fernández L, Martínez-Domenech A
BACKGROUND: Gorlin syndrome (GS) is a hereditary genodermatosis characterised by the development of multiple basal cell carcinomas (BCC). The hedgehog pathway inhibitors (HPI) like sonidegib have been shown to be effecti...BACKGROUND: Gorlin syndrome (GS) is a hereditary genodermatosis characterised by the development of multiple basal cell carcinomas (BCC). The hedgehog pathway inhibitors (HPI) like sonidegib have been shown to be effective, but the frequency of adverse events (AE) limits their long-term use. Dose modifications and off-therapy periods are frequently necessary to improve tolerability. OBJECTIVES: To describe the dosing regimens employed during treatment with sonidegib for GS in clinical practice and evaluate the efficacy and tolerability of its long-term use. METHODS: Multicenter retrospective study involving 10 referral centres in Spain including patients with GS who received treatment with sonidegib for at least 12 weeks. RESULTS: Twenty-four patients were included: 11 (45.8%) women and 13 (54.2%) men, with a mean age of 50.7 ± 12.1 years. The mean duration of treatment with sonidegib was 10.4 ± 5.1 months. Sonidegib was started at 200 mg daily in 22 (91.7%) patients. Thirteen (59.1%) of them switched to alternate-day dosing motivated most frequently by the development of AEs (76.9%), and less frequently by dosing convenience (23.1%). Two patients followed on-off regimens. Four patients received an off-label regimen of 2-3 tablets per week. Nine (37.5%) of the 24 patients achieved a complete response, 13 (54.2%) a partial response and 2 (8.3%) presented stable disease. Twenty (83.3%) patients presented at least one AE, the most frequent being alopecia (45.8%), followed by muscle cramps (37.5%), dysgeusia (29.2%), asthenia (29.2%), weight-loss (20.8%), diarrhoea (12.5%) and nausea (8.3%). CONCLUSIONS: Our data on the use of sonidegib for GS in clinical practice show similar response rates to those reported in previous studies and improved tolerability compared to pivotal studies. Regimen modifications are frequently used in clinical practice to improve AEs. Although the alternate-day dose is the most common modification, dermatologists also resort to off-label regimens for this purpose.
BACKGROUND/OBJECTIVES: Mohs micrographic surgery (MMS) is integral to skin cancer management due to its benefits in margin control and tissue conservation. In Australia, it is predominantly performed in the private setti...BACKGROUND/OBJECTIVES: Mohs micrographic surgery (MMS) is integral to skin cancer management due to its benefits in margin control and tissue conservation. In Australia, it is predominantly performed in the private setting, with Royal North Shore Hospital being the sole provider in the public system. This study presented an analysis of MMS within the Australian public health system and a review of local literature. METHODS: Conducting a retrospective chart review, we examined patients undergoing MMS between January 2018 and December 2022. Data encompassed patient demographics, tumour characteristics and surgical outcomes. Four electronic databases were searched for Australian literature on MMS. RESULTS: A total of 344 MMS procedures involving 299 patients were conducted at Royal North Shore Hospital. Patients averaging 66.4 years of age (range 19-92 years) predominantly presented with basal cell carcinomas (92.2%) and squamous cell carcinomas (6.4%). 98.2% of tumours were found on the head and neck, genitalia, hands, digits and below the knee. The mean [standard deviation (SD)], pre-operative tumour and defect sizes were 1.75 cm [SD 1.01] and 2.30 cm [SD 1.35] in maximum diameter, respectively. Our tumour and defect sizes were smaller compared to MMS procedures conducted in the public system 30 years ago. Review of local literature resulted in 11 relevant studies, of which 10 came from the private setting. CONCLUSIONS: This study provided crucial insights into MMS referral patterns, utilisation and outcomes, demonstrating that the use of MMS aligns with local and international best practice.
Lichen planus pigmentosus (LPP) is a rare variant of lichen planus that presents as hyperpigmented patches, most commonly in individuals with darker skin tones, and is difficult to treat effectively. We report a case of...Lichen planus pigmentosus (LPP) is a rare variant of lichen planus that presents as hyperpigmented patches, most commonly in individuals with darker skin tones, and is difficult to treat effectively. We report a case of a 22-year-old Korean male with LPP who showed considerable improvement following combination therapy with trifarotene and a picosecond neodymium-doped yttrium-aluminium-garnet (Nd:YAG) laser. Considering the inherently variable clinical course of LPP and the challenges associated with its treatment, the combination of topical retinoids and picosecond Nd:YAG lasers appears to be a promising therapeutic approach.
Madanchi M, Curatolo R, Pelloni LS
… +1 more, Juratli HA
Australas J Dermatol
· 2025 Dec · PMID 41074452
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Sycosis barbae (SB) is a chronic, potentially scarring alopecia that primarily affects the beard. We report a unique case of refractory SB in a 31-year-old male successfully treated with bimekizumab, a dual inhibitor of...Sycosis barbae (SB) is a chronic, potentially scarring alopecia that primarily affects the beard. We report a unique case of refractory SB in a 31-year-old male successfully treated with bimekizumab, a dual inhibitor of interleukin (IL)-17A and IL-17F. Significant clinical improvement was observed after the second injection, with complete remission achieved after 4 months, highlighting the potential of this novel therapeutic approach for SB.
Kushnir-Grinbaum D, Bokhari L, Frewen J
… +17 more, Moussa A, Triwongwaranat D, Ghiya R, Dias FR, Yong SS, Bhoyrul B, Dabbagh Z, Kazmi A, Daunton A, Li J, Yip L, Lai V, York K, Cranwell W, Wall D, Eisman S, Sinclair R
Australas J Dermatol
· 2025 Nov · PMID 41024743
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Over 5000 patients are newly diagnosed with Alopecia areata (AA) in Australia each year. AA severity varies from a single small patch to complete loss of scalp hair, body hair including eyelashes and eyebrows. Approximat...Over 5000 patients are newly diagnosed with Alopecia areata (AA) in Australia each year. AA severity varies from a single small patch to complete loss of scalp hair, body hair including eyelashes and eyebrows. Approximately 40% of affected individuals experience only a single patch and achieve spontaneous, complete and durable remission within 6 months (acute AA). A further 27% develop additional patches but still attain complete remission within 12 months (chronic AA). Chronic persistent AA (CPAA) is defined by an episode duration of > 12 months and occurs in approximately 33% of patients. Without systemic treatment, 55% of individuals with CPAA will have persistent multifocal relapsing and remitting disease, 30% will progress to alopecia totalis (AT) and 15% will ultimately develop alopecia universalis (AU). The physical disfigurement, unpredictable course, social isolation and rejection contribute to the psychological distress attributable to AA. A wide range of topical, intralesional and systemic agents used to treat AA were evaluated in the 2018 Australian expert consensus statement. In 2020, the international Alopecia Areata Consensus of Experts (ACE) publication stated that if reimbursed, Janus Kinase inhibitors (JAKi's) would be an ideal systemic treatment for adults with AA. TGA approval of baricitinib in 2023 and ritlecitinib in 2024 for severe AA is the first step on the pathway for these systemic medications to be reimbursed on the Australian Government Pharmaceutical Benefits Scheme (PBS). Reimbursement would significantly transform the Australian therapeutic landscape for AA. The purpose of this 2025 Update on the Australian Expert Consensus Statement on the treatment of chronic, moderate to severe AA is to augment the 2018 treatment algorithm to include these TGA-approved medications and to address indications for initiation, continuation and dose titration of systemic JAKi treatment, appropriate choice of agent, satisfactory outcome measures and to provide guidance on when to discontinue successful or unsuccessful treatment.
Bettolini L, Maione V, Carugno A
… +6 more, Fratton Z, Errichetti E, Arisi M, Zerbinati N, Ghini I, Bighetti S
Australas J Dermatol
· 2025 Dec · PMID 41002112
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Nested melanoma, a relatively new subtype of melanoma first reported in 2012, is characterised by neoplastic cells organised into nests. We present a unique case of yellow nested melanoma, detailing its clinical, dermosc...Nested melanoma, a relatively new subtype of melanoma first reported in 2012, is characterised by neoplastic cells organised into nests. We present a unique case of yellow nested melanoma, detailing its clinical, dermoscopic, RCM, and, for the first time to our knowledge, LC-OCT features. Alongside a comprehensive review of the literature, our findings challenge the traditional associations with advanced age and sun-damaged skin, advocating for the term 'nested melanoma' to better reflect its characteristics.
Gu Y, Sebaratnam DF, Makhija M
… +1 more, Farrell J
Australas J Dermatol
· 2025 Dec · PMID 40944329
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A systemic review was completed of primary research articles reporting patient outcomes in paradoxical psoriatic alopecia in association with biologic therapy. Our search strategy identified 96 patients from 45 studies i...A systemic review was completed of primary research articles reporting patient outcomes in paradoxical psoriatic alopecia in association with biologic therapy. Our search strategy identified 96 patients from 45 studies in addition to our own case. Our review indicates a higher prevalence of paradoxical psoriatic alopecia in younger female patients, most commonly secondary to TNF-alpha inhibitors. Unlike alopecia secondary to psoriasis vulgaris, a mixed inflammatory infiltrate featuring lymphocytes, plasma cells and eosinophils was observed. Remission was observed in most patients, including approximately a third of whom continued biologic therapy. Trial Registration: PROSPERO registration number: CRD42023471174.
Caffery LJ, Taylor ML, Abbott LM
… +9 more, Janda M, Guitera P, Mar V, Bennett H, Arnold C, Shumack S, Caccetta T, Miller R, Soyer HP
Australas J Dermatol
· 2025 Dec · PMID 40936368
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In 2020, [the Australasian College of Dermatologists] released its first teledermatology practice guidelines for Australia, with a commitment to regular updates. This article presents the revised guidelines, aimed at edu...In 2020, [the Australasian College of Dermatologists] released its first teledermatology practice guidelines for Australia, with a commitment to regular updates. This article presents the revised guidelines, aimed at educating dermatologists on the benefits and limitations of telehealth, while promoting safer, higher-quality patient care. The updated guidelines harmonise with the Medical Board of Australia's 2023 telehealth guidelines. They address the growing use of telephone consultations-boosted by Medicare subsidies introduced during the COVID-19 pandemic. The latest guidelines provide recommendations on the appropriate choice of modality (telephone versus video) for teleconsultation. They also include updated guidance on clinical image acquisition. The guidelines are divided into two parts: (1) core recommendations and (2) supporting notes for practical application. Topics covered include teledermatology modalities, patient selection and consent, imaging standards, quality and safety, privacy and security, communication, and documentation, including image retention.
Managing moderate-to-severe psoriasis in patients with current or past malignancy remains a therapeutic challenge. We conducted a multicentre, retrospective real-world study to assess the safety and effectiveness of guse...Managing moderate-to-severe psoriasis in patients with current or past malignancy remains a therapeutic challenge. We conducted a multicentre, retrospective real-world study to assess the safety and effectiveness of guselkumab in this complex population. Thirty patients were included, of whom 11 had active cancer at the time of guselkumab initiation. After 52 weeks of follow-up, guselkumab achieved sustained clinical improvement in skin and joint symptoms, with no observed cases of cancer progression or recurrence. Two patients developed new malignancies during treatment, but guselkumab was not discontinued. These findings support the use of IL-23 inhibitors as a safe therapeutic option in this complex patient population.
Teh N, Byth L, Loh V
… +2 more, Krishnaswamy M, Zagarella S
Australas J Dermatol
· 2025 Sep · PMID 40923237
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We report a case of zosteriform PCMZL presenting in a T3-T4 dermatomal distribution not previously described in the literature. Although the varicella zoster virus was not detected in this case, late diagnosis of the acu...We report a case of zosteriform PCMZL presenting in a T3-T4 dermatomal distribution not previously described in the literature. Although the varicella zoster virus was not detected in this case, late diagnosis of the acute eruption of zoster or even preceding zoster 'sine herpete' cannot be excluded as antigenic triggers.
Intravascular invasion of basal cell carcinoma is an exceedingly rare finding during Mohs' micrographic surgery. We present three cases and discuss its significance and management implications.Intravascular invasion of basal cell carcinoma is an exceedingly rare finding during Mohs' micrographic surgery. We present three cases and discuss its significance and management implications.