Cutaneous melanoma is the most severe form of skin cancer. The incidence of the disease has been increasing in the last decades, largely due to increased ultraviolet radiation exposure. A comprehensive understanding of the complex biological processes involved in melanoma development and progression is essential for advancing patient care. Improvement in surveillance strategies, widespread use of sentinel lymph node biopsy, and breakthroughs in systemic therapy have all contributed considerably to enhancing patient outcomes and survival. Rapid advancements in melanoma management are expected to continue, particularly through innovations in molecular biology and genetics. These emerging technologies aim to enhance diagnostic accuracy, predict disease progression, and improve prognosis. Staying informed about these evolving developments is essential for professionals dealing with melanoma patients. This narrative review provides a comprehensive overview of the current state of cutaneous melanoma, covering fundamental areas, such as histopathology, genetics, epidemiology, diagnosis, and staging. It provides a foundation to enhance understanding of current treatment approaches and the principles behind emerging technologies. This review also highlights future directions in melanoma care, including improvements in neoadjuvant therapy, use of artificial intelligence-based algorithms, use of molecular biomarkers to improve diagnosis and prognosis, and development of personalized neoantigen mRNA vaccines. Ultimately, this review aims to support clinicians in understanding the current landscape and anticipated innovations in melanoma management to improve clinical decision-making.

Basosquamous carcinoma (BSC), an uncommon and aggressive nonmelanoma skin cancer exhibiting characteristics ranging from basal cell carcinoma (BCC) to squamous cell carcinoma (SCC), is a subject of controversy in terms of its classification, pathogenesis, histologic morphology, biologic behavior, prognosis, and management. This narrative review is based on an electronic search of English-language articles in PubMed that included the terms “basosquamous carcinoma” and/or “metatypical carcinoma of the skin” in their titles. The review aims to succinctly present and assess current data on the epidemiology, clinical presentation, dermoscopic, LC-OCT, and histopathologic characteristics, as well as the genetics and management of BSC, providing insight into this intriguing entity. As a conclusion, dermoscopy, deep incisional biopsies, and immunohistologic techniques should be applied in clinically suspicious lesions to achieve an early diagnosis and better prognosis of this tumor. Surgical treatments, including wide excision and Mohs’ micrographic surgery, remain the treatment of choice. Finally, Hedgehog pathway inhibitors and checkpoint inhibitors, must be thoroughly investigated with large controlled trials, since they may offer an alternative solution to irresectable or difficult-to-treat locally advanced cases of basosquamous carcinoma.

Nevoid basal cell carcinoma syndrome (NBCCS), also known as Gorlin syndrome (GS), is a genetic disorder characterized by the development of multiple cutaneous BCCs due to mutations in the hedgehog signaling pathway. The use of hedgehog pathway inhibitors—vismodegib and sonidegib—has emerged as a promising therapeutic strategy for managing BCCs in individuals with GS. In a retrospective study conducted between March 2012 and January 2024, a cohort of 16 Gorlin syndrome patients who received treatment with either sonidegib or vismodegib were analyzed. The primary objectives of the study were to evaluate the efficacy, safety profile, and duration of response to oral hedgehog inhibitors in this patient population. The study assessed various parameters, including the number of new BCCs that developed before and after treatment initiation, the duration and sustainability of treatment responses, as well as the incidence of adverse effects associated with hedgehog inhibitor therapy. The findings of the study revealed that sustained treatment with hedgehog inhibitors could effectively suppress the progression of both new and existing BCCs. Furthermore, the results indicated that sonidegib exhibited superior efficacy and safety compared to vismodegib in the treatment of BCCs in individuals with GS. Notably, adjustments to the administration schedule of sonidegib were found to improve tolerability without compromising therapeutic efficacy, potentially leading to prolonged durations of treatment response and disease control.

Psoriasis is a chronic immune-mediated disease that is linked to an increased risk of cancer. Although numerous studies have explored whether neoplasms are concurrent conditions or are induced by psoriasis, a definitive definition remains elusive. In this study, we conducted a comprehensive narrative literature review to offer practical guidance to oncologists and dermatologists regarding the initiation and discontinuation of biologics for psoriasis. The findings indicate that a customized approach is recommended for each patient, and that a history of malignancies does not constitute an absolute contraindication for biologics. Growing evidence supports the treatment of selected patients, emphasizing a nuanced assessment of benefits and risks. There is a lack of data specifying a safe timeframe to initiate biologics following a neoplasm diagnosis due to influences from cancer-related and patient-specific characteristics impacting prognosis. Some patients may continue anti-psoriasis therapy during cancer treatments. Enhanced comprehension of the biological mechanisms in cancer progression and the immune microenvironment of psoriasis holds promise for refining therapeutic strategies. In conclusion, a personalized treatment approach necessitates collaboration between oncologists and dermatologists, considering factors such as cancer prognosis, psoriasis clinical manifestations, patient characteristics, and preferences when making treatment decisions.

This case series highlights the complexity of sarcoidosis‐like reactions (SLRs) during cancer treatment, specifically in patients receiving immunotherapy or targeted therapies for melanoma. SLRs can either mimic disease progression or present as part of the clinical manifestation, making diagnosis and treatment challenging. Our study reviewed the medical records of 31 patients who were candidates for postoperative treatment between June 2022 and June 2024. Out of these, three patients developed SLRs during their treatment. A 55‐year‐old woman with Stage IIIb cutaneous melanoma, receiving adjuvant therapy with anti‐PD‐1, after seven cycles of pembrolizumab, developed mediastinal node enlargement and skin hypodermic nodes. A biopsy of the hypodermic node revealed granulomatous infiltrates with sparse lymphocytes, consistent with sarcoidosis. A low dose of steroids was administered, resulting in a dramatic improvement. A 48‐year‐old woman with Stage IIIb BRAF wild‐type melanoma, receiving nivolumab every 4 weeks, developed systemic sarcoidosis after seven cycles, primarily affecting extrapulmonary sites. Despite the immune‐induced sarcoidosis, her treatment was not stopped, as decided by the multidisciplinary team (MDT). A 65‐year‐old man with Stage IIIb BRAF‐mutant melanoma, receiving dabrafenib and trametinib, developed lung and cutaneous sarcoidosis, presenting with symptoms that led to emergency department admission. In all cases, the MDT played a crucial role in determining the course of treatment and balancing the risks of continuing or suspending cancer therapies while managing SLRs. National and international guidelines were consulted, but tailored decisions by the MDT were essential for optimizing patient care.

Basal cell carcinoma (BCC) is the most common non-melanoma skin cancer. BCCs are categorized into “easy-to-treat” and “difficult-to-treat” groups, with the latter including all BCCs that are challenging to manage due to technical, patient-related, or tumor-related factors, such as locally advanced BCCs. In this report, we describe an 84-year-old patient with an extensive, unilateral BCC. Following a decision by the multidisciplinary skin cancer board, the patient was successfully treated with a daily dose of 200 mg of sonidegib, an inhibitor of the Hedgehog pathway, for eight months, acquiring complete clinical and histopathological remission. No significant side effects were reported. The follow-up period of 24 months has shown no negative results.