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Melanoma is the deadliest form of skin cancer and one of the few malignancies whose incidence is on the rise. The treatment of metastatic melanoma continues to be quite challenging, although in recent years, there has been significant progress. Current National Comprehensive Cancer Network guidelines list immunotherapy, chemotherapy, surgery and clinical trials as potential options for patients with metastatic disease but do not clearly recommend which is superior. Additionally, when utilizing combined modality treatment there are no clear guidelines for the optimal timing of surgery in the treatment of metastatic melanoma. In this paper we sought to compile the current evidence and on-going trials in order to provide a comprehensive review of the different options available and underway in regards to the treatment of metastatic melanoma. It is clear that with the responses now seen with systemic immunotherapies and targeted therapies, an expanded role for surgery is the logical next step.

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Hidradenitis suppurativa (HS) is a chronic inflammatory disease that affects the follicular unit in apocrine glandbearing skin, resulting in deep-seated nodules, sinus tracts, abscesses, and ultimately scarring. HS is a highly distressing condition, and has one of the highest impacts on quality of life compared to other dermatologic diseases. Various topical therapies have been described that may be used alone or in conjunction with systemic or physical modalities for HS. Additionally, proper wound care is essential to the successful management of HS, particularly given the suppurative nature of the disease. However, limited evidence exists regarding the optimal regimen for topical therapy and wound care. On the basis of existing literature, we provide a comprehensive review of topical management and wound care.

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Click https://www.wileyhealthlearning.com/ced.aspx for the corresponding questions to this CME article.

Importance: Dyskeratosis congenita is a rare disorder that often leads to early death owing to a variety of complications and associated disorders. Early diagnosis and intervention is important in care for patients affected by this disease. Observations:We describe a patient with dyskeratosis congenita (DC) in a child. Our patient had a 3-year history of transaminitis that was felt to be the result of biopsy proven progressive fibrosis of the liver beginning at age 3. He was referred to the dermatology department because of a chronic, evolving eruption with the hope of establishing a unifying diagnosis. Further examination revealed dystrophic nails, numerous dental caries, and blepharitis. Chromosomal analysis on leukocytes showed significant telomere shortening consistent with DC.Conclusions and Relevance: Early recognition and long term care is important in patients with DC because of their propensity to develop malignancy, hematologic abnormalities, and infection. Better understanding of this disease may lead to insights into other disorders associated with abnormal telomere maintenance.