Abstract: Primary cutaneous lymphomas (PCLs) are a heterogeneous group of extranodal non-Hodgkin lymphomas presenting in the skin without evidence of extracutaneous disease at diagnosis. They encompass a broad clinicopathologic spectrum dominated by cutaneous T-cell lymphomas (CTCL), primarily mycosis fungoides (MF) and Sézary syndrome (SS), and by distinct entities of primary cutaneous B-cell lymphomas (PCBCL). Recent updates of the WHO–EORTC classification have refined disease definitions and introduced new entities and lymphoproliferative disorders, with direct consequences for prognosis and therapeutic decision-making. Parallel advances in genomics and im-munobiology have revealed recurrent alterations in T-cell receptor (TCR) signalling, JAK–STAT and NF-κB pathways, as well as hallmarks of immune evasion in the tumour microenvironment, providing a rationale for targeted and immune-based therapies. This narrative review, written from a dermatologic perspective, summarises current concepts in the classification, epidemiology and clinicopathologic features of the major PCL subtypes. We discuss key molecular drivers of CTCL and PCBCL, practical aspects of diagnosis and staging at the interface between dermatology, pathology and haematology, and the role of non-invasive imaging. We then review the contemporary therapeutic armamentarium, including skin-directed therapies, systemic biologic agents and chemotherapy, and emphasise pivotal trials of antibody-drug conjugates and immune therapies such as brentuximab vedotin and mogamulizumab. Finally, we highlight unmet needs, including diagnostic delay, real-world prognostic stratification, manage-ment of advanced and relapsed disease, and the integration of biomarkers into person-alised care. Dermatologists occupy a central role in early recognition, longitudinal monitoring and multidisciplinary management of PCLs, and ongoing collaboration between specialties is essential to translate molecular insights into improved patient outcomes.

Abstract: Desmoplastic melanoma (DM) is a rare, aggressive melanoma subtype with high local recurrence rates (20-60%) following surgical excision. This systematic review evaluated the efficacy of adjuvant radiotherapy (RT) in improving local control and survival outcomes in DM patients. Following Preferred reporting items for systematic review and meta-analyses (PRISMA) guidelines, we searched PubMed/MEDLINE, ScienceDirect, Scopus, CINAHL, and EBSCO databases from inception through December 2025.. Thirteen studies (10 retrospective cohorts, 3 prospective trials) met the inclusion criteria. quality assessment using JBI tools revealed 69% high quality and 31% moderate quality studies. Adjuvant RT significantly reduced local recurrence rates from 17.2% (surgery alone) to 7.6% (surgery plus RT), representing a 56% relative risk reduction. All hypofractionated RT (e.g. 30 Gy/5 fractions) achieved comparable local control rates (90-95% at 5 years). High-risk features including positive margins, Breslow depth ˃4 mm, and neurotropism identified patients deriving greatest benefits from RT. Adjuvant radiotherapy significantly improves local control in DM following surgical excision and should be considered standardized of care for high-risk patients. Future randomized trials are needed to established definitive treatment.

Abstract:

In endemic regions where simultaneous larval tick bites are common, early species-level information obtained from eschar lesions can meaningfully change pre-symptomatic triage. We report a 78-year-old woman found after ~24 hours of wandering with multiple clustered eschars on the legs and attached ticks on the trunk. PCR and Sanger sequencing of two removed ticks and ten representative eschars identified Amblyomma testudinarium in all samples. Because A. testudinarium is a known vector of severe fever with thrombocytopenia syndrome (SFTS) virus but not of Rickettsia japonica, we deprioritized Japanese spotted fever and focused targeted monitoring on early SFTS features. The patient remained asymptomatic and was transferred to long-term care. This case illustrates that, particularly in high-incidence settings with numerous bite sites, selective PCR of representative eschars provides a rapid and resource-sparing means to infer vector species and tailor risk assessment before symptom onset. Emphasizing eschar-based species identification in endemic areas can concentrate testing where pretest probability is highest, streamline surveillance, and support shared decision-making in frontline practice.

Abstract: Melanoma survival has improved markedly in the past decade with new systemic agents. A key molecular hallmark is aberrant telomerase activation, largely driven by telomerase reverse transcriptase (TERT) promoter mutations (which are present in 50–82% of cases). These mutations represent the most frequent noncoding alteration in melanoma. Telomerase activation results in replicative immortality by maintaining telomere length, so cancer cells bypass senescence and apoptosis. However, the relationship between telomerase activity and melanoma cell population doubling time remains poorly defined. Pathways linking telomerase expression to accelerated cell cycle progression require further study. While telomerase inhibitors show preclinical promise, clinical application is limited by delayed cytotoxicity and resistance mechanisms. No review has yet mapped evidence connecting telomerase activity with melanoma proliferation kinetics and doubling time. Materials and Methods: A scoping review was conducted using Scopus, ScienceDirect, MEDLINE/PubMed, and CINAHL (Cumulative Index to Nursing and Allied Health Literature). Keywords included “telomerase,” “melanoma,” “cancer,” “cell proliferation,” and “doubling time.” The PRISMA framework guided our analysis of published studies. Results: Telomerase is clinically relevant for diagnosis, prognosis, and therapy. Biomarkers such as telomere length, telomerase activity, and TERRA expression correlate with disease stage and survival. Therapeutic strategies include enzyme inhibitors (e.g., Imetelstat), cytotoxic nucleotide incorporation, telomere destabilization, and immunotherapies such as peptide or dendritic cell vaccines, DNA vaccines, and CAR-T cells. Resistance often arises through alternative telomere maintenance mechanisms. Targeting extratelomeric TERT functions offers promise but remains complex. Conclusions: Telomerase drives melanoma progression through telomere-dependent and independent mechanisms, influencing proliferation, survival, metabolism, and genome stability. Clarifying these processes is essential for developing biomarkers and therapies that effectively target telomerase, overcome resistance, limit cancer progression and potentially provide another useful therapeutic option against melanoma.

Abstract: Background: Psoriasis and psoriatic arthritis (PsA) occasionally coexist with antinu-clear antibody (ANA) positivity, cutaneous lupus erythematosus (CLE), or systemic lupus erythematosus (SLE), creating one of the most challenging therapeutic overlap scenarios in immunodermatology. Divergent immune pathways—IL-23/Th17-driven psoriatic inflammation versus type I interferon–mediated autoimmunity—generate unique vulnerabilities when systemic treatments are used. Objectives: To synthesize treatment outcomes, lupus-related safety signals, and mechanistic insights across systemic therapies in patients with psoriasis or PsA who also exhibit ANA positivity, CLE, or SLE. Methods: A systematic review following PRISMA 2020 guidelines was performed across PubMed/MEDLINE, Embase, Cochrane, Scopus, and ClinicalTrials.gov. Thir-ty-three eligible reports (29 unique clinical studies; 1,429 patients) were included and organized into six prespecified overlap subgroups. Mechanistic and translational studies—including ustekinumab and deucravacitinib SLE trial data and IL-17 inhibi-tor–induced CLE reports—were incorporated for contextual interpretation. Results: IL-23 inhibitors demonstrated the most favorable cross-disease safety, show-ing no signal for CLE worsening, SLE flares, or drug-induced autoimmunity. IL-17 in-hibitors maintained excellent psoriatic efficacy but showed a consistent association with de novo or exacerbated CLE. TNF-α inhibitors carried the highest risk for ANA seroconversion, dsDNA induction, drug-induced lupus, and lupus flares. Ustekinumab exhibited a stable safety profile across lupus-spectrum disease despite mixed efficacy in formal SLE trials. TYK2 inhibition provided dual modulation of IL-23 and type I in-terferon pathways and showed emerging utility in psoriasis/PsA with CLE or SLE. Apremilast, methotrexate, and mycophenolate mofetil remained reliable non-biologic options. Phototherapy required caution in ANA-positive or lupus-susceptible popula-tions. Conclusions: IL-23 inhibition and TYK2 inhibition appear to offer the most balanced combination of efficacy and safety for psoriatic disease complicated by lupus-spectrum autoimmunity. IL-17 inhibitors and TNF-α inhibitors warrant caution or avoidance in CLE- or SLE-prone patients. Personalized treatment should integrate psoriatic versus lupus disease dominance, ANA/ENA profile, CLE subtype, and mechanistic risk. Pro-spective, biomarker-driven studies are needed to guide therapy in this increasingly recognized overlap population. (PROSPERO registration: CRD420251241279).

Abstract: Background: Cutaneous wounds are common in outpatient care, but national patterns of who manages them and how antimicrobials are used remain unclear. Objectives: To characterize outpatient specialty involvement and antimicrobial use for acute and chronic cutaneous wound visits in the United States. Methods: We conducted a retrospective cross-sectional analysis of 2011–2019 National Ambulatory Medical Care Survey (NAMCS) data. Cutaneous wound visits were identified using prespecified ICD-9-CM and ICD-10-CM codes and classified as acute (open or traumatic wounds and burns) or chronic (pressure injuries and lower-limb ulcers). Survey weights were applied to estimate national visit volumes, specialty shares, and antimicrobial utilization patterns. Results: We identified 45.1 million cutaneous wound visits, representing 0.8% of all outpatient visits, of which about two thirds were acute and one third chronic. Primary care physicians accounted for the largest share of wound visits, while dermatologists managed 3.9% of overall wound visits, 2.4% of acute visits, and 7.4% of chronic visits. Among 156.6 million medications recorded at wound visits, antimicrobials represented 13.1% overall, 14.9% in acute visits, and 10.2% in chronic visits. Cephalexin accounted for 32.1% of antimicrobial medications overall and 39.2% in acute visits, whereas chronic wound visits had a more heterogeneous antimicrobial profile that included topical mupirocin, cephalexin, trimethoprim–sulfamethoxazole, and topical nystatin. Conclusions: Outpatient cutaneous wound care in the United States is delivered predominantly by primary care clinicians and relies heavily on a small set of systemic and topical antimicrobials, highlighting opportunities to strengthen antimicrobial stewardship and expand dermatology’s role in chronic wound management.

Abstract: Background: Extramammary Paget’s disease (EMPD) is a rare intraepithelial adenocar-cinoma that typically involves apocrine gland–bearing areas such as the vulva, scrotum, and perianal region. Suprapubic localization is exceptionally uncommon, particularly in male patients, often leading to delayed diagnosis due to its nonspecific presentation. Case Presentation: We report the case of an 80-year-old male presenting with a persistent erythematous, pruritic plaque in the suprapubic region that was unresponsive to topical corticosteroids and antifungal therapy. Clinical examination revealed a well-demarcated erythematous lesion with superficial erosion and scaling. Videodermoscopy and Line-Field Confocal Optical Coherence Tomography (LC-OCT) revealed features sug-gestive of intraepidermal neoplasia. Histopathological examination demonstrated large, atypical Paget cells within the epidermis, showing abundant pale cytoplasm and pleo-morphic nuclei arranged in a pagetoid distribution. Immunohistochemistry showed strong positivity for Cytokeratin 7 (CK7) and negativity for CK20 and CDX2, confirming the diagnosis of primary EMPD. The patient underwent wide local excision with clear margins, followed by an uneventful recovery. No recurrence was observed during one-year follow-up under dermatologic surveillance. Conclusion: This case highlights the diagnostic challenges of EMPD in atypical locations such as the suprapubic region. Non-specific clinical and dermoscopic features frequently result in misdiagnosis and delayed treatment. Integration of non-invasive imaging techniques like LC-OCT can assist in early detection and biopsy guidance. Histopatho-logical and immunohistochemical evaluation remain essential for accurate diagnosis and differentiation from other malignancies. Early recognition and complete surgical excision are crucial for optimal outcomes and recurrence prevention.

Abstract:

Surgery continues to represent the central curative modality for melanoma despite major advances in systemic immunotherapy and targeted treatments. Contemporary surgical strategies aim to maintain oncologic safety while minimizing functional and aesthetic morbidity through optimized excision margins, highly selective use of sentinel lymph node biopsy (SLNB), and the omission of routine completion lymph node dissection (CLND). Rapid integration of neoadjuvant and adjuvant immunotherapies has begun to redefine surgical indications, timing, and extent—particularly for intermediate-stage and locoregionally advanced disease. Parallel innovations in Mohs micrographic surgery, reconstructive flap design, lymphatic reconstruction, and minimally invasive techniques further broaden the possibilities for individualized intervention. This expanded review synthesizes current evidence, ongoing controversies, and emerging trends that are shaping the future of melanoma surgery, highlighting how precision oncology, immunologic profiling, and technological advances are transforming the surgeon’s role and enabling more tailored, less invasive, and outcomes-focused management.

Abstract: Background: Folliculitis is a common inflammatory condition for which non-antibiotic topical options remain limited. This pilot study evaluated the performance and safety of a medical device gel containing hyaluronic acid and hydrogen peroxide, already in use in dermatologic practice. The study generated preliminary efficacy outcomes and assessed the viability for a future comparative trial on folliculitis.Methods: This open-label, non-comparative, post-marketing clinical follow-up study enrolled adults (aged 18–45 years) diagnosed with folliculitis. Patients applied the gel at home for eight weeks following the device’s instructions for use. Efficacy was assessed by the number of lesions, Total Severity Score (TSS), Investigator Global Assessment of Performance (IGAP), patient satisfaction, and Dermatology Life Quality Index (DLQI). Safety was evaluated by recording adverse events (AEs).Results: Thirteen patients (mean age 30.1 ± 7.72) were included. The duration of enrollment and its rate met the assumptions for carrying out the future comparative trial. The mean number of lesions decreased three-fold from baseline to week 8 (p = 0.005), while TSS improved by 66.6% (p = 0.002). All participants reported high or very high treatment satisfaction. The mean IGAP at week 8 was 1.39 ± 0.65, and DLQI scores indicated a marked improvement in quality of life. Two mild, transient site effects were recorded.Conclusions: This pilot study confirmed favorable safety and performance outcomes for the hyaluronic acid/hydrogen peroxide gel in patients with folliculitis. The findings support its use in daily dermatologic practice and provide feasibility data for a future randomized comparative trial.

Abstract: Verrucous carcinoma is a rare subtype of squamous cell carcinoma can occur anywhere of our body. Differential diagnosis between verrucous carcinoma and benign lesions like squamous cell papilloma is crucial to avoid inappropriate treatment. Surgical excision with reconstruction offers favorable outcomes, emphasizing the significance of compre-hensive management and long-term follow-up to monitor recurrence. Increased aware-ness of verrucous carcinoma’s clinical features and diagnostic challenges is essential for early detection and effective treatment, ultimately improving patient outcomes and re-ducing morbidity associated with this rare malignancy.

Abstract: (1) Background: Studying the incidence of Kaposi sarcoma in relation to key variables can guide targeted research and subtype-specific clinical interventions. (2) Methods: We reviewed the records of all patients who visited our hospital’s dermatology outpatient clinic, and patients who were clinically and histopathologically diagnosed with Kaposi sarcoma were included in the study. The age, gender, lesion location, anti-HIV test results, and comorbidities of the patients were recorded. (3) Results: Thirty-three patients with Kaposi sarcoma were identified. Male-female ratio was 2.7:1. The Kaposi sarcoma lesions were statistically significantly more prevalent in the lower extremities of HIV-negative patients (p=0.005). Receiver Operating Characteristic (ROC) curve analysis identified 59 years as the optimal age cutoff for distinguishing between HIV-positive and HIV-negative patients. Anti-HIV positivity was significantly higher in individuals aged 59 and younger compared to those aged 60 and older (p < 0.001). (4) Conclusions: To the best of our knowledge, this is the first study to demonstrate a statistically significant higher prevalence of lower extremity lesions among HIV-negative patients and to identify 59 years as the optimal age cutoff for distinguishing between HIV-positive and HIV-negative Kaposi sarcoma patients using ROC curve analysis. The age-related patterns observed in this study warrant further investigation.

Abstract: Introduction Onychomycosis is an often chronic fungal infection of the toenail. Conventional treatment strategies are limited due to drug interactions, side effects, lack of effectiveness, and difficulty with long-term treatment adherence, resulting in an unmet clinical need for safe and effective options suitable for long-term use. FunghiClear® is a plant-based blend with key ingredient of high-triketone Manuka oil, supported by basil, lavender and peppermint oil. The aim of this study was to assess the safety, efficacy and convenience of FunghiClear® in dermatophyte onychomycosis. Methods A 12-week study of adults aged 18-65 was undertaken in the Netherlands and Belgium, the UK, Taiwan, and Scandinavia. Participants sprayed FunghiClear® twice per day on the affected toenail(s) and surrounding skin, with standard hygiene protocol provided by their footcare professional at baseline, 6 and 12 weeks. Objective measurements of efficacy were assessed by the footcare professional through the Onychomycosis Severity Index (OSI) and a five-stage scale of Toenail Rating. Subjective measures of efficacy were assessed through perceived efficacy by the footcare professional and the participant. Safety and convenience were assessed through questionnaires. Results In total, 192 participants completed the study. After 12 weeks of using FunghiClear®, mean OSI score and Toenail Rating improved significantly. An improved OSI score was found in 129 participants (67%), while an additional 35 participants (18%) had no change in OSI. Of those that showed improved score, mean OSI improved by 8.82 points (44%), and Toenail Rating improved by 0.96 stages (44%). The mean convenience rating by participants was 4.4/5. No serious adverse events were reported, and one participant reported mild discomfort upon application. Conclusion Refocusing treatment toward long-term management and healthy nail regrowth may provide a more rounded approach to dermatophyte onychomycosis. The results of this clinical study suggest that FunghiClear®, along with standard hygiene protocol provided by footcare professional, is safe, effective and convenient to manage dermatophyte onychomycosis. This is an ongoing study with plans to expand the study and refine the protocol. This is an ongoing study with intentions to involve new participants and further extend the findings.

Abstract: Cutaneous squamous cell carcinoma (cSCC) is the second most common skin cancer worldwide, with a steadily increasing incidence in aging populations, particularly among older and immunocompromised individuals. Early-stage cSCC disease is usually managed with surgery or radiotherapy; however, advanced or unresectable cases remain therapeutically challenging. The advent of immune checkpoint inhibitors (ICIs), especially programmed cell death protein 1 inhibitors, such as cemiplimab and pembrolizumab, has markedly improved outcomes in advanced cSCC. Nevertheless, resistance to immunotherapy, management of frail or super-aged patients, and optimal integration of systemic therapy with radiotherapy continue to pose important clinical questions. This review provides an updated overview of the current treatment strategies for cSCC, with particular attention to recent advances in systemic therapy and the application of geriatric oncology principles. We emphasize the considerations relevant to East Asian practices, especially in Japan, where the demographic shift toward a super-aged society magnifies the need for tailored approaches. Although most pivotal clinical trials have been conducted in Western populations, emerging real-world data from East Asia have demonstrated comparable efficacy and safety of ICIs, underscoring the global relevance of immunotherapy in diverse patient groups. By incorporating a structured frailty assessment, individualized treatment goals, and proactive management of immune-related adverse events, this review highlights practical strategies for optimizing cSCC care in older patients. We conclude by outlining future directions, including predictive biomarker development; refinement of treatment sequencing; and multidisciplinary collaboration among oncology, dermatology, and geriatrics to adapt cSCC management to aging societies.

Abstract: Background/Objectives: Pressure ulcers are an important patient safety healthcare concern. While staging frameworks guide clinical management, the association of the anatomical site, stage, and multiple PU presence, with outcomes such as length of stay (LOS) and mortality in Medicare patients has not been fully characterized. The study objective is to examine the relationship between PU site, stage, and multiplicity with inpatient LOS and mortality among hospitalized Medicare patients. Methods: This cross-sectional study was conducted with 1,123,121 inpatient Medicare admissions from a CMS medical claims dataset. PUs were identified using ICD-10-CM codes, classified by anatomical site and stage (1 though 4, unstageable, unspecified). Multivariate models examined associations of PU characteristics with LOS and mortality, adjusting for age, sex, primary diagnosis, and hospital transfer. Results: Overall, 3.7% of admissions included at least one PU (n=41,525). Stage 2 ulcers were the most common (28.6%), while unstageable or unspecified ulcers were frequent in heels and head. The sacral region was the most common anatomical site, followed by buttocks and heels. LOS gradually increased from Stage 1 (9.4 days) to Stage 4 (15.2 days). While death rate did not increase consistently with stage, it was highest for upper back (14%), head (12.8%), and unspecified hip (12.8%) sites. Multivariate analyses found sacral, hip, head, buttock, upper back ulcers and ulcers to be associated with prolonged LOS and increased mortality. Conclusions: PU anatomical site and multiple PU presence were stronger predictors of adverse outcomes than stage alone. These findings emphasize the importance of systematic documentation, early detection, and patient safety protocols to reduce the clinical and systemic burden of PUs.

Abstract: Numerous ingredients in trichological shampoos are advertised as “active against hair loss”, however, the body of evidence behind such claims seems very limited or, in many cases, nonexistent. The aim of this study was to compile an inventory of substances advertised by shampoo manufacturers as “active” against hair loss, and systematically review available evidence from clinical trials that would corroborate such claims. We screened declared compositions of trichological shampoos for ingredients advertised as active against hair loss or promoting hair growth. The second step was a systematic review of clinical trials of these substances used topically in the treatment of hair loss. A query in PubMed, Scopus, and Web of Science followed PRISMA and PICO guidelines with the strength of evidence assessed according to GRADE guidelines. We identified 43 trichological shampoos in which 112 individual ingredients were advertised as “active”. Of these, 36 ingredients were indicated as “active” in at least two shampoos and were subject to further study. In the search for evidence, 103,639 articles were screened for relevant information. Ultimately, we identified 29 clinical trials which tested 16 of the 36 ingredients for efficacy against hair loss. Only 4 ingredients were tested individually: caffeine (9 trials; highest strength of evidence: moderate), adenosine (6; moderate); placental protein (3; moderate), and melatonin (1; moderate). Another 12 ingredients of interest were only tested as parts of complex preparations: Achillea millefolium extract, arginine, biotin, hydrolyzed wheat protein, hydrolyzed soy protein, Panax ginseng, panthenol, piroctone olamine, Prunus amygdalus dulcis, Rosmarinus officinalis, Serenoa serrulata, and Urtica dioica. Such study design made it impossible to attribute the observed effects to any specific ingredient. No clinical trials of efficacy could be found for the remaining 20 (55.6%) substances repeatedly cited as “active”. At present stage, scientific evidence for the efficacy against hair loss is available only for caffeine, adenosine, placental proteins and melatonin, but the overall strength of evidence is very low. Moreover, a substantial majority of topical ingredients promoted as “active against hair loss” were actually never tested in clinical trials to verify such claims. While unsubstantiated claims of supposed beneficial properties often refer to alleged scientific evidence, there are major gaps to be filled in the field of non-prescription treatments of hair loss.

Abstract: Acne is a multifactorial skin condition characterized by an infection in the pilosebaceous units in the skin. Patients with acne suffer from comedones, papules, pustules and nodules or cysts in severe cases. These clinical features might cause disfigurmentation, depression, anxiety and significantly impact the quality of life of patients. Systemic and continuous exposure of antibiotics put patients at risk of developing systemic toxicity, bacterial resistance and gut dysbiosis. Microneedles offer an innovative approach of providing targeted topical delivery of minocycline while insuring efficient permeation through skin layers. Methods: minocycline microneedles were formulated using casting method and characterized for insertion ability, mechanical strength, drug content, antibacterial activities, deposition and dissolution behavior using ex vivo full-thickness rat skin. Results: Insertion tests confirmed effective skin penetration and mechanical integrity with only 9.5% height reduction. Drug content was 673.06 ± 5.34 µg/array. Dissolution occurred within 2 minutes in skin, indicating user-friendly wear time. Ex vivo Franz diffusion studies showed 26% of the drug deposited into the skin, significantly higher (p = 0.0068) than the 18.3% that permeated through it. Antibacterial testing revealed strong activity against S. aureus, S. epidermidis, and C. acnes, with MIC values <0.146 µg/mL and MBC values ranging from 9.375–18.75 µg/mL. Conclusion: The result of this research demonstrate that minocycline microneedles effectively deliver minocycline into the skin highlighting their potential as a safer and more efficient alternative for acne therapy.

Abstract: Skin scars represent a complex therapeutic challenge, with significant functional, aesthetic and psychological implications. Despite advances in laser therapy, monotherapy has significant limitations, particularly in complex scars with atrophic, hypertrophic, vascular and pigmentary components. The combined use of multiple laser sources, in sequential or simultaneous mode, allows selective targeting of different tissue targets and improves clinical efficacy while maintaining a good safety profile. This narrative review critically analyses the available evidence on combination therapies for atrophic, hypertrophic, keloid, post-surgical and burn scars. Protocols combining ablative lasers (CO₂, Er:YAG), non-ablative lasers (1540–1550 nm), vascular lasers (PDL, Nd:YAG) and intense pulsed light (IPL) are reported. Possible integrations with adjuvant techniques, such as radiofrequency, PRP and laser-assisted drug delivery, are also mentioned as areas for future development. Available data suggest a promising role for multimodal strategies, but the literature remains limited by small cohorts, heterogeneous protocols and short follow-up periods. Further prospective and multicentre studies are needed to define standardised protocols and consolidate the role of combination therapies in the management of scars.

Abstract: Skin bleaching is common worldwide and particularly in the Caribbean, the practice involves using strong chemicals and substances—often self-concocted—containing ingredients such as hydroquinone and topical steroids, which are melanin inhibitors. This results in the damaged appearance of the skin barrier with prolonged exposure. This literature will investigate the main impulses behind skin bleaching and its potential association with premature aging. Documented evidence illustrates that many skin-bleaching products contain heavy metals, chief among them being mercury, which when coupled with hydroquinone can cause dermatological issues and could even lead to systemic toxicity. Skin bleaching destroys structural proteins that provide the skin with elasticity and tenacity. Compromising these proteins may cause increased susceptibility and vulnerability to infections, skin cancers and potentially accelerate skin aging. Tackling this issue warrants a comprehensive strategy of supplementing medical education especially among low socioeconomic groups, about the impact of skin bleaching and its close correlation with premature skin aging. This literature emphasizes the need for further study to comprehend and attenuate the health consequences of skin bleaching in the Caribbean.

Abstract:

Background: In regenerative medicine, there is interest in using acellular therapy based on the secretome of mesenchymal stem cells (MSC) to promote wound healing. Wharton's jelly cells (WJ-MSCs) are a readily available source. Their secretion has been optimized when stimulated with bFGF and EGF to induce proliferation and prevent senescence. Therefore, evaluating the effect on proliferation and wound closure of human fibroblasts in vitro with different concentrations of the secretome of WJ-MSCs stimulated with growth factors is necessary to identify the most efficient work concentration. Methods: The secretome of human WJ-MSC was collected from passage 1 to passage 2 stimulated with bFGF and EGF (W bFGF/EGF) and the unstimulated secretome (WO bFGF/EGF). The immunophenotype of WJ-MSCs after stimulation was evaluated by flow cytometry for the markers: CD105+, CD73+, CD90+, HLA-ABC+, CD44+, HLA-DR-, CD34-, CD11b-, CD19-, and CD45-. The presence of 14 growth factors in the secretome was evaluated using LEGENDplex through flow cytometry. Fibroblasts were cultured, and their culture medium was supplemented with two different concentrations: one of 1.25 mg/ml and another of 6.25 mg/ml of both stimulated and unstimulated secretome. Proliferation, cellular metabolism, and wound closure were evaluated in vitro. Results: The immunophenotype of WJ-MSCs after stimulation remained unchanged, and the production of growth-assessed factors was increased in stimulated WJ-MSCs. The optimal concentration that induced proliferation and wound closure in vitro was 1.25mg/ml of stimulated WJ-MSC secretome. Conclusions: This study demonstrates that stimulation of WJ-MSCs with FGF and EGF enhances the secretion of growth factors, and that a concentration of 1.25 mg/ml of their secretome promotes optimal fibroblast proliferation and wound closure in vitro. These findings support the potential of optimized WJ-MSC secretome as a promising acellular strategy for regenerative medicine.

Abstract: Background: Melanoma is among the most lethal skin cancers, with survival heavily dependent on early detection, yet diagnosis remains challenging due to its resemblance to benign nevi. Despite their success in automated dermoscopy, convolutional neural networks remain limited by their focus on local features and their dependence on fixed input sizes, which can constrain generalization. Vision Transformers, which model global image context through self-attention, offer a promising alternative. Methods: A ViT-L/16 model was fine-tuned using the ISIC 2019 dataset of over 25,000 dermoscopic images. To expand the dataset and balance class representation, synthetic nevus and melanoma images were generated with StyleGAN2-ADA, with only high-confidence outputs retained. Performance was assessed on an external biopsy-confirmed dataset (MN187) and compared with CNN baselines (ResNet-152, DenseNet-201, EfficientNet-B7, ConvNeXt-XL, ViT-B/16) and the commercial MoleAnalyzer Pro system using ROC-AUC and DeLong’s test. Results: The ViT-L/16 model achieved the highest baseline ROC-AUC of 0.902 on MN187, exceeding the performance of CNN models and MoleAnalyzer Pro, though this difference was not statistically significant (p = 0.07). The incorporation of 46,000 confidence-filtered GAN-generated images increased the ROC-AUC to 0.915, producing a statistically significant improvement (p = 0.032). Conclusions: Vision Transformers show strong potential for melanoma classification, especially when combined with GAN-based augmentation, offering advantages in global feature representation and data expansion that support the development of reliable AI-driven clinical decision-support systems.