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Preventing DHS in Patients With Leprosy
Dapsone hypersensitivity syndrome (DHS) is the most serious adverse event associated with dapsone administration and a major cause of death in patients with leprosy. In this cohort study of 1539 Chinese patients, Liu et al found that DHS did not develop in any HLA-B*13:01–negative patients treated with dapsone. Prospective HLA-B*13:01 screening may reduce DHS incidence in the Chinese population.
Metastatic Melanoma Timing and Outcomes
Although the kinetics of metastatic disease seem to be correlated with survival, progression of the localized disease is unpredictable. In this cohort study of 638 adults with unresectable stage III or IV melanoma treated with first-line immunotherapies, targeted therapies, or chemotherapy, Vallet et al assessed whether the progression of metastatic disease was associated with the time to the first distant melanoma recurrence. They found no evidence of such association. Time to recurrence of metastatic melanoma appears unrelated to progression-free survival or overall survival. Coit provides an Editorial.
Editorial and Related Articles 1 and 2
Lymphatic and Hematogenous Melanoma Recurrence
Melanoma metastasis through lymphatic and the hematogenous pathways has been proposed, but its mechanisms not well studied. In this cohort study of patients with stage I or II melanoma, Calomarde-Rees found that age, primary tumor site and thickness, and vascular invasion were associated with lymphatic recurrence, while thickness, absence of regression, TERT promoter, and BRAF mutation were associated with hematogenous metastasis. These findings suggest that follow-up and adjuvant treatment strategies should be adapted to individual characteristics. Coit provides an Editorial.
Recurrence After High-Risk Primary Melanoma
With systemic treatments emerging for metastatic melanoma, early detection of recurrence is increasingly important. In this cohort study of patients with high-risk primary melanoma, von Schuckmann et al evaluate recurrence patterns and report that more than 13% developed melanoma recurrence within 2 years. Most recurrences were at locoregional sites, and the others at distant sites. After surgery for locoregional recurrence, a small majority of patients remained disease free at 2 years, but about 42% developed recurrence. Understanding the patterns of melanoma recurrence can inform clinical follow-up recommendations. Coit provides an Editorial.
Genetics and Psoriasis Ustekinumab Response
Some differential response of psoriasis to ustekinumab therapy based on HLA-C*06:02 status has been reported but generally not well studied. In this systematic review and meta-analysis, van Vugt et al found that 75% improvement rate in PASI score (PASI75) was 92% for HLA-C*06:02–positive patients and 67% for HLA-C*06:02–negative patients. Nonetheless, the authors conclude that, given the high PASI75 in both groups, there appears to be no rationale for excluding patients from ustekinumab treatment based on a negative HLA-C*06:02 status.
Continuing Medical Education
Highlights. JAMA Dermatol. 2019;155(6):649. doi:10.1001/jamadermatol.2018.3518
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