Jing, Frank Z.

ABSTRACT The recent inclusion of the Merlin clinicopathologic–gene expression profile (CP‐GEP) assay in the National Comprehensive Cancer Network (NCCN) Melanoma Guidelines represents an important milestone in the clinical integration of molecular testing for cutaneous melanoma. Unlike earlier melanoma gene expression profile (GEP) assays, which focused primarily on prognostic risk stratification, CP‐GEP was specifically developed to predict sentinel lymph node (SLN) metastasis risk by identifying early metastatic competence within primary melanomas, with additional prognostic utility. This review discusses the biological evidence supporting CP‐GEP and examines how unbiased transcriptomic discovery converged with established insights from cancer cell biology, integrin signaling, focal adhesions, and extracellular matrix (ECM) remodeling to shape its conceptual framework. We further discuss how CP‐GEP captures a transformation‐associated biological state centered on an integrin‐ and TGF‐β–dependent signaling axis ( ITGB3 , TGFBR1 ) that promotes pericellular proteolysis and ECM remodeling ( PLAT , SERPINE2 , LOXL4 ), inflammatory and angiogenic signaling ( CXCL8 , GDF15 ), and melanocytic lineage identity ( MLANA ). Collectively, these genes identify a dissemination‐competent phenotype that is detectable within primary tumors before clinically apparent metastasis. Overall, the biological framework supporting CP‐GEP reinforces the concept that altered adhesion signaling and ECM remodeling are central drivers of early melanoma metastasis and represent clinically actionable biomarkers for individualized melanoma management. image

BACKGROUND The most common complication after interpolated forehead flap repair is postoperative bleeding from the pedicle. Reconstructive surgeons should focus on minimizing postoperative bleeding while ensuring the blood supply and integrity of the flap are preserved. OBJECTIVE To provide a comprehensive review of the various methods to reduce the risk of bleeding after interpolated forehead flap repair. METHODS A comprehensive literature review of PubMed articles discussing strategies to reduce postoperative bleeding specifically in interpolated forehead flap repair was performed. RESULTS A total of 9 unique techniques were apparent from the literature, including use of hydrophilic polymer and potassium ferrate, ferric subsulfate 20% solution, oxidized regenerated cellulose gauze, gelatin sponges, thrombin-based hemostatic agents, aluminum chloride, cyanoacrylate, skin graft, and tranexamic acid. CONCLUSION Reconstructive surgeons should be knowledgeable of the various techniques to reduce bleeding after interpolated forehead flap repair, as bleeding can result in patient dissatisfaction and often requires intervention. Each technique identified in the literature offers its own advantages and drawbacks; its choice should be tailored to the needs of each patient.

ABSTRACT The stromal tumor environment (STE) plays a vital yet often underrecognized role in cancer progression, shaping tumor development. It influences complex interactions among stromal cells, immune cells, extracellular matrix (ECM) components, and signaling molecules. Stromal cells regulate integrin signaling and are involved in remodeling the tumor microenvironment, driving critical processes such as cell migration, survival, angiogenesis, and proliferation. Advances in understanding the STE are creating new opportunities for early cancer detection and treatment. Innovations in molecular imaging, particularly for melanoma, are transforming cancer diagnostics by providing deeper insights into tumor biology, cellular interactions, and angiogenesis, paving the way for more personalized and timely therapeutic interventions. Among these advancements, in vivo skin fluorescent imaging (SFI) stands out as a powerful tool, offering real‐time molecular insights at the point of care with the ability to improve patient management.

AbstractBackgroundInfantile hemangiomas (IHs), the most prevalent vascular tumors in infancy, are generally understood to be absent at birth, appearing in the initial weeks of life during their proliferative stage. While the classic presentation is recognizable, the precursor lesion of IHs may be misinterpreted as other entities, including vascular malformations.MethodsA retrospective, single‐center study was conducted, examining neonates with photographed IH precursor lesions on day of life (DOL) 1 and matured classical IHs. The study spanned from 2017 to 2023.ResultsThe case series is comprised of nine neonates all exhibiting precursor lesions on DOL 1. A comparative display of photographs featuring precursor lesions and classic IH is presented. Further tabulated information for each case includes IH locations, subsequent treatment modalities, and further diagnostic workup if necessary.ConclusionsImproving recognition of precursor lesions increases diagnostic accuracy, decreasing unnecessary workup. This, in turn, allows dermatologists to confidently employ close follow‐up management strategies. Additionally, in cases of extensive involvement, recognition of the precursor lesion allows for expedited investigation for syndromes such as PHACE (posterior fossa malformations, hemangioma, arterial anomalies, coarctation of the aorta/cardiac defects, and eye abnormalities) and LUMBAR (lower body IH, urogential anomalies, ulceration, myelopathy, bony deformities, anorectal malformations, arterial anomalies, and renal anomalies).

AbstractBackgroundCutaneous melanoma (CM) is a significant health concern because of its high metastatic potential. Gene Expression Profile (GEP) testing, particularly the 31‐GEP test (DecisionDx‐Melanoma), has been increasingly used for risk stratification in CM patients. This study aimed to evaluate the clinical utility and performance of the 31‐GEP test in a real‐world setting.MethodsPatients with CM who underwent 31‐GEP testing from August 2014 to August 2022 at our institution were identified through searches of electronic health records. The study analyzed the influence of 31‐GEP testing on clinical decision‐making related to sentinel lymph node biopsy (SLNB), medical oncology referral, and postdiagnosis surveillance. Kaplan–Meier curves and Cox proportional hazard models were used to elucidate the test's performance, focusing on relapse‐free survival (RFS) and melanoma‐specific survival (MSS).ResultsThe study included 65 CM patients. Dermatologists ordered more than 80% of 31‐GEP tests. In 81.5% of cases, 31‐GEP results did not alter standard clinical management. SLNB decisions were unaffected in 92% of patients with pre‐SLNB 31‐GEP results. Among patients with stage I‐IIA melanoma, 25% of those with high‐risk 31‐GEP results were referred to medical oncology. Contrary to expectations, the rate of nodal metastasis was higher in low‐risk than in high‐risk 31‐GEP cases. Survival analysis showed overlapping RFS and MSS curves between different 31‐GEP classes, suggesting limited prognostic value.ConclusionsThe 31‐GEP test has a limited impact on clinical management decisions and shows limited prognostic value.

AbstractA 61‐year‐old female presented with progressive plaques on the left forehead and right labia.