This Week in Dermatology — Oct 2, 2026

This AudioScholar briefing is generated by artificial intelligence for healthcare professionals and trainees. It is not medical advice.

Welcome to This Week in Dermatology. This week we're covering 10 notable papers spanning skin cancer and immunotherapy, immune-related toxicities, and practical consensus guidance for infections, inflammatory disease and hair loss. Let's dive in.

We start with cutaneous oncology, where two large datasets are sharpening how we stage and treat. In Nature Medicine, Long and colleagues from the International Neoadjuvant Melanoma Consortium pooled 1,038 patients with resectable stage three melanoma treated before surgery across 26 international sites [1]. Anti-PD-1 combined with another immunotherapy agent produced a major pathological response in about 61 percent of patients, compared with about half of patients on anti-PD-1 alone. Five-year recurrence-free survival was roughly three quarters with the combination, about 61 percent with anti-PD-1 alone, and only about 37 percent with BRAF and MEK inhibitors. The most striking signal concerns patients who achieved a major pathological response on checkpoint inhibitors: five-year overall survival was close to 98 percent, and continuing immunotherapy after surgery added no benefit for them. Because this is a pooled analysis mixing trial and real-world patients, it is not randomized evidence, but it strengthens the case for response-adapted de-escalation of adjuvant therapy and flags targeted therapy alone as a weak neoadjuvant option. Responses also occurred in acral, in-transit and BRAF-mutant disease, though those subgroups were small. Turning to keratinocyte cancer, Shahwan and colleagues, in the Journal of the American Academy of Dermatology, used nearly 21,000 primary cutaneous squamous cell carcinomas from 12 international centres to build a new points-based staging system called COMPASS-SCC [2]. It scores tumour diameter, depth beyond fat or more than six millimetres, differentiation, large-calibre perineural invasion and lymphovascular invasion, sorting tumours from T1 to T4. Sensitivity, negative predictive value and discrimination for metastasis and disease-specific death were significantly better than with both the AJCC eighth edition and Brigham and Women's systems. The data are retrospective and the system still needs external validation before it displaces existing staging, but the sample size is unusually large for this question.

Our second theme is immune-related toxicity, where immunotherapy's reach into the skin keeps widening. In Clinical and Experimental Dermatology, Cull and colleagues reviewed 44 patients with biopsy-confirmed autoimmune blistering disease attributed to checkpoint inhibitors at a single centre over more than a decade [3]. Bullous pemphigoid made up about four in five cases, followed by lichen planus pemphigoides, with single cases of mucous membrane pemphigoid and linear IgA disease. Most patients were managed with topical or systemic corticosteroids, half received doxycycline, and a handful received dupilumab, rituximab or immunoglobulin. Sixteen patients needed at least temporary interruption of immunotherapy, three needed permanent discontinuation, and most patients achieved stabilization or remission while many continued their cancer treatment. It is a small descriptive series without a comparison group, so it describes practice rather than proving which treatment works best. A parallel story comes from the Journal of the European Academy of Dermatology and Venereology, where Neubauer and colleagues in the French cutaneous lymphoma group examined mogamulizumab, an anti-CCR4 antibody for mycosis fungoides and Sézary syndrome that also depletes regulatory T cells [4]. Among 403 treated patients, about 8 percent developed at least one immune-related adverse event beyond the familiar drug rash, most often endocrine, skin and liver events. About a third of these events were severe or serious, and they often appeared after several months, frequently in patients who were responding. The authors argue this warrants checkpoint-style surveillance, though the retrospective design likely undercounts milder events.

Our third theme covers inflammatory disease and infection, beginning with a therapeutic advance in hidradenitis suppurativa. In the phase two MIRA trial, published in the Journal of the American Academy of Dermatology, Kimball and colleagues randomized 234 adults with moderate-to-severe disease to sonelokimab, a nanobody blocking both interleukin 17A and 17F, at two doses, or placebo, with an adalimumab reference arm [5]. At week twelve, about 43 percent of patients on the 120 milligram dose reached the demanding HiSCR75 endpoint, against 15 percent on placebo, and the 240 milligram dose was also significantly better. Responses held or improved through week 24 with no new safety signals. This is a 24-week phase two result, so durability and comparative positioning await the phase three program. On the infectious side, an Indian consensus in the Journal of the European Academy of Dermatology and Venereology from Khurana and colleagues addresses Trichophyton indotineae, the terbinafine-resistant dermatophyte now spreading beyond South Asia [6]. Using a modified Delphi process with 14 dermatologists, two mycologists and a pharmacologist, the panel favoured itraconazole as first-line systemic therapy, higher-dose terbinafine as second line, a change of agent if response is inadequate at four weeks, and treatment continued until cure. This is expert opinion rather than trial evidence, and it comes from an endemic setting, but it is among the more structured guidance available. Looking further ahead, Fernando and colleagues, in Science Translational Medicine, tested a topical combination of abametapir, which kills eggs, and flavesone, which rapidly kills mites, in a pig model that closely mimics human scabies [7]. A single four-hour application eradicated all live mites and eggs in severe disease and outperformed two doses of oral ivermectin. This is preclinical, and human trials are needed before it informs care. Finally in this theme, Kong and colleagues in Acta Dermato-Venereologica synthesized 14 guidelines and reviews into 28 evidence statements on wound care in Stevens-Johnson syndrome and toxic epidermal necrolysis, spanning assessment, conservative versus surgical approaches, dressings, pain and infection control [8]. Only 11 of those statements were graded strong, which itself highlights how thin the evidence base remains.

Two final papers address the whole patient. In JAMA Dermatology, Akiska and colleagues report an international Delphi consensus on low-dose oral minoxidil in children under twelve, drawing on 50 experts from nine countries [9]. The panel supported use from age four for miniaturization, hair cycle disorders and hair shaft disorders, endorsed either fixed weight-banded dosing or a starting dose of 0.01 to 0.02 milligrams per kilogram per day, and listed pericardial effusion and pheochromocytoma as contraindications. Panellists did not consider routine baseline testing or blood pressure monitoring universally necessary in low-risk children, a position that rests on expert judgement rather than prospective safety data. And in the Journal of the American Academy of Dermatology, Ajmani and colleagues offer a review of psychodermatology built on the 2023 European two-category classification, separating primary psychiatric disorders with skin signs from skin diseases with psychiatric impact, and setting out which psychotropic prescribing falls within a dermatologist's scope [10]. It is narrative guidance, but it addresses a population the authors estimate at about a third of dermatology patients.

If you only have time for one paper this week, make it the hidradenitis suppurativa MIRA trial [5]. It adds a dual interleukin 17A and 17F option with high-threshold responses in a disease where effective therapies remain scarce, and it reopens the question of how far deeper IL-17 blockade can push outcomes.

Here is what this week's evidence adds up to in Dermatology. First, pooled neoadjuvant melanoma data show that patients with a major pathological response to checkpoint inhibitors have near-universal five-year survival and gain nothing from adjuvant continuation, a strong observational signal that awaits prospective confirmation. Second, a large retrospective model suggests COMPASS-SCC stages squamous cell carcinoma more accurately than current systems, pending external validation. Third, immune-related toxicity extends beyond checkpoint inhibitors to mogamulizumab, and late, sometimes severe events appear in both settings, based on retrospective series. Fourth, dual IL-17 blockade shows promising phase two efficacy in hidradenitis, with phase three data still to come. And fifth, consensus statements on Trichophyton indotineae and pediatric oral minoxidil offer structure where trials are lacking, but they remain expert opinion.

That's your roundup for This Week in Dermatology. The full transcript and references are available on the episode page in your AudioScholar library. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.

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This is an automated summary generated by artificial intelligence, which can make mistakes. Always review the original source materials.