Editor’s Choice
Authors: John Ingram
Journal: British Journal of Dermatology (2021)

Linked Article: Gault et al. Br J Dermatol 2021; 185:263–271. The August issue of BJD has a focus on melanoma, with four scholarly reviews coordinated by the guest editor, Professor Hensin Tsao. The reviews cover melanoma genomics and pathology, therapy for tumours exhibiting BRAF mutations, and cutaneous immune-related adverse events (IrAEs) associated with checkpoint inhibitors (CPIs). The latter review highlights that cytotoxic T-lymphocyte-associated protein 4 therapy has a higher associated rate of IrAEs than programmed death 1/programmed death ligand 1 therapies. It discusses issues around delayed reactions, which can pose difficulty in distinguishing IrAEs from coincidental dermatological disease. The review confirms that vitiligo-like depigmentation due to CPIs is a good prognostic indicator and that, overall, IrAEs are relatively common and best managed in a multidisciplinary setting. Linked Article: Marley et al. Br J Dermatol 2021; 185:353–362. Citrus products contain psoralen, a known photocarcinogen; however, evidence to date is mixed about whether citrus consumption alters melanoma risk. An authorship group from Indianapolis, USA used UK Biobank data to investigate further. They included more than 1500 cases of melanoma and nearly 200 000 controls, who each provided five rounds of 24-h recall answers regarding citrus consumption. After adjustment for potential confounders, those consuming > 2 citrus servings per day had an odds ratio for melanoma of 1.63 (95% confidence interval 1.24–2.12) relative to those with no consumption. The risk was compounded even further in those of fair or very fair skin complexion, with a nearly doubled risk of melanoma (odds ratio 1.75, 95% confidence interval 1.31–2.29). Linked Article: Thaçi et al. Br J Dermatol 2021; 185:323–334. This issue of the BJD includes the final readouts from two phase III trials of the anti-interleukin-23p19 monoclonal antibody tildrakizumab (TIL) for adults with moderate-to-severe chronic plaque psoriasis. Efficacy and safety data at 5 years are reported at the end of an open-label treatment extension phase following the initial randomized phase lasting 28 weeks. Treatment included TIL 100 mg, TIL 200 mg and placebo arms in reSURFACE 1, with reSURFACE 2 also including an etanercept (ETN) comparator arm. Etanercept partial and nonresponders switched to TIL 200 mg at week 28. The safety profile was reassuring from a total TIL exposure of over 5400 patient-years. The proportions of patients with ≥ 75% improvement in Psoriasis Area and Severity Index after 5 years were 88.7%, 92.5% and 81.3% for the TIL 100 mg, TIL 200 mg, and initial ETN switched to TIL 200 mg arms, respectively. Linked Article: Oei et al. Br J Dermatol 2021; 185:371–379. Larger congenital melanocytic naevi (CMN) may produce a psychosocial burden on patients and families and are associated with increased risk of developing melanoma or neurological symptoms. To prevent heterogeneity in outcome measures, a core domain set collaboration was formed to guide future research. From a systematic review and patient focus groups, followed by e-Delphi surveys involving 144 stakeholders from 27 countries and then an online consensus meeting, six domains (the ‘what to measure’) were finalized. Four domains apply to both care and research, namely ‘quality of life’, ‘neoplasms’, ‘nervous system’ and ‘anatomy of skin’. ‘Adverse events’ was specific to care and ‘pathology’ to research. The next steps are to reach consensus on the specific outcomes for each of the domains and to decide which instruments should be used to measure the outcomes.