Skin and Cancer Foundation

Niemann-Pick disease type C (NP-C) is the fifth most prevalent lysosomal disorder in Australia. Diagnostic delay is common, impacted by disease heterogeneity, limited awareness within clinical gateway services and exclusion from state-based newborn screening programmes. A formal diagnosis, once established, places a substantial burden on the whole family, the negative impact of which is far-reaching. A clear understanding of diagnostic pathways and management objectives in NP-C is critical for optimal care. To develop an Australian standard of care for individuals diagnosed with NP-C and their families, reflecting international best practice and tailored to the Australian healthcare system. The Australian NPC Disease Foundation Inc. convened a national, multidisciplinary collaboration including NP-C treating clinicians, allied health professionals and a community advisory group. Using an iterative consensus approach, published international guidance statements were reviewed, ratified, excluded or modified to align with the Australian context. Consensus outputs included a diagnostic algorithm, a multidisciplinary care framework and management-centred management statements. The collaborative process resulted in a unified Australian standard of care for NP-C. This framework incorporates the carer perspective, emphasises shared decision-making and situates NP-C within the broader context of 'childhood dementias.' Consensus statements provide practical, evidence-aligned guidance on early recognition, diagnostic referral pathways and multidisciplinary management throughout disease progression. This initiative represents the first Australia-specific standard of care for NP-C. It is hoped that adoption of the framework will lead to improved experiences for Australians living with NP-C and their carers as they navigate the healthcare setting.

The rising incidence of skin cancer places a significant burden on Australia's health workforce. To support workforce planning, we estimated the supply of dermatologists and general practitioners (GP) working in skin cancer medicine, service demand and need across Queensland in 2023. We built a supply-, demand- and needs-based health workforce model using publicly available data. We collated data on the numbers of clinicians and clinical full-time equivalents (FTE), Medicare-reported skin cancer services and melanoma incidence. We quantified health workforce supply and clinical workload, clinical FTE per 100,000 population, number of Medicare claims for skin cancer services per clinical FTE and incident cases of melanoma per clinical FTE for all of Queensland and across 19 Level 4 Statistical Areas. Queensland had 7179 GPs (852 adjusted FTE) and 124 (71 adjusted FTE) dermatologists servicing 5,527,369 residents, with an estimated 17 FTE skin cancer clinicians per 100,000 population. Ten (53%) SA4 areas had no dermatologists, with none residing in central or western Queensland. Seven of the nine SA4 levels with dermatologists were in southeast Queensland (78%), and 47% of all FTE dermatologists practised in Brisbane Inner City. GPs were well distributed relative to population size. Access to dermatology services is limited for Queensland residents living outside the southeast region, with few providers available within reasonable proximity. GPs are managing a growing skin cancer workload in Queensland. This could be eased by increased use of telemedicine, upskilling other health professionals in skin cancer medicine and improving care efficiency.

IntroductionCardiovascular disease is a leading co-morbidity in psoriasis patients. The cutaneous benefits of biologic therapies for severe plaque psoriasis are well-established, but the impact of biologics on major adverse cardiovascular events (MACE) in psoriatic patients requires further elucidation. This study aimed to investigate the impact of biologic therapies on the risk of MACE in patients with chronic plaque psoriasis.MethodsWe conducted a systematic review and meta-analysis on 10 May 2022, using Medline, PubMed, Cochrane Central Register of Controlled Trials (CCTR), Cochrane Database of Systematic Reviews (CDSR) and EMBASE databases for relevant studies. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) methodology was applied, and all studies were critically appraised. All studies selected for inclusion were randomised control trials (RCTs) that contained data on MACE and compared licensed biologic therapies with placebo or other biologics in adults with moderate-severe plaque psoriasis.ResultsThe search of the databases revealed 36 papers (reporting on 43 RCTs) which met the inclusion criteria. No statistically significant difference in the risk for MACE between biologic therapies and placebo was found [Peto odds ratio (POR) 1.26, 95% confidence interval (CI) 0.53–3.01, P = 0.59]. A comparison of specific types of biologics also revealed no significant effect in adult patients with moderate-to-severe plaque psoriasis: tumour necrosis factor (TNF)-alpha inhibitors (adalimumab, infliximab, etanercept) (POR 1.13, 95% CI 0.29–4.32 P = 0.86), interleukin (IL)-17 inhibitors (secukinumab, ixekizumab, brodalumab, bimekizumab) (POR 0.60, 95% CI 0.16–2.25, P = 0.45); IL 12/23 inhibitors (usetekinumab) (POR 3.80, 95% CI 0.37–39.44, P = 0.26) and IL-23 (guselkumab, risankizumab, tildrakizumab) (POR 1.75, 95% CI 0.25–12.43 P = 0.58).ConclusionsAnti-psoriatic biologics were not associated with an increased risk of MACE in psoriasis patients. Given that most included RCTs were of relatively short duration, longer-term studies and post-marketing surveillance are needed to clarify the cardiovascular safety profile of biologic therapies. Further large-scale studies with extended follow-up are warranted.Study registrationThis study was prospectively registered on PROSPERO (identification number CRD42022325792).Supplementary InformationThe online version contains supplementary material available at 10.1007/s13555-025-01529-5.

Background: Nail disorders, comprising around 10% of dermatological cases, can arise at any age. There is no current data on the management patterns of Filipino dermatologists regarding nail diseases in the Philippines. Aims: This study aims to identify the management patterns of board-certified Filipino dermatologists categorized as private practice dermatologist, public government dermatologist, and combined practice dermatologist for common nail diseases and assess whether their approaches align with current clinical guidelines. Settings and Design: A cross-sectional analytic design was employed, with data collected through a validated online questionnaire distributed to Philippine Dermatological Society board-certified dermatologists. Materials and Methods: A structured questionnaire was electronically distributed to Filipino dermatologists, gathering data on the types of nail conditions encountered and the treatment modalities employed, from July to October 2022. Statistical Analysis Used: Sample size was calculated with a 95% confidence level and an 8% margin of error, yielding 159 participants. Descriptive statistics using frequency and percentage were used to summarize the data. STATA 15.0 was utilized for analysis. Results: There were 221 dermatologists who participated; 65.2% are in private practice, 5.4% work exclusively for the government, and 29.4% are in both private and public practice. The most common nail disorders managed were onychomycosis, periungual warts, and nail psoriasis. Management approaches varied by practice setting. Discrepancies between practice habits and guidelines, particularly in treating conditions such as paronychia and antifungal use, highlight the need for updated information and access to advanced treatments, especially in resource-limited settings. Conclusions: Filipino dermatologists generally follow global guidelines for managing nail diseases, but treatment choices are influenced by factors such as clinical presentation and resource availability, which differ between private, government, and combined practices. While private practitioners often refer to surgical cases such as onychocryptosis, government dermatologists tend to handle them themselves. Despite these challenges, dermatologists adapt pragmatically to provide effective care.

BackgroundAvailable network meta-analyses (NMAs) comparing the efficacy of biologics in nail psoriasis (NP) have not included recently approved biologics such as bimekizumab nor have they provided comparisons up to 1 year.ObjectiveWe conducted two NMAs that update and extend results from a previous NMA comparing biologics for achieving complete resolution of NP.MethodsBayesian NMAs were performed using a generalized linear model with a logit link to model the binary outcome of nail clearance at weeks 24–28 and 48–52.ResultsFor the NMA at weeks 24–28, which included seven biologics and placebo, the absolute probability of achieving complete resolution of NP was highest for ixekizumab (46.4%; 95% credibility interval [CrI] 35.2–58.0), followed by brodalumab (37.1%; 95% CrI 17.1–62.2) and bimekizumab (30.3%; 95% CrI 12.7–53.9). For the NMA at weeks 48–52, which included six biologics, the absolute probability was highest for ixekizumab (77.2%; 95% CrI 51.1–93.4), followed by adalimumab (75.6%; 95% CrI 61.5–87.3) and brodalumab (71.9%; 95% CrI 38.4–93.2).ConclusionAmong biologics included in these two NMAs, ixekizumab has the highest absolute probability of achieving complete resolution of NP. Results may help to inform treatment decisions for patients with NP.

BackgroundRisk prediction tools have been developed for keratinocyte cancers (KCs) to effectively categorize individuals with different levels of skin cancer burden. Few have been clinically validated nor routinely used in clinical settings.ObjectivesTo assess whether risk prediction tool categories associate with interventions including chemoprophylaxis for skin cancer, and health‐care costs in a dermatologist‐run screening clinic.MethodsAdult participants who presented to a walk‐in screening facility were invited to participate. A self‐completed KC risk prediction tool was used to classify participants into one of the five risk categories. Participants subsequently underwent full skin examination by a dermatologist. Dermatological interventions and skin cancer‐related medical prescriptions were documented. Total health‐care costs, both to the health‐care system and patients were evaluated.ResultsOf the 507 participants recruited, 5‐fluorouracil cream and nicotinamide were more frequently prescribed in the higher risk groups as chemoprophylaxis (p < 0.005). A significant association with high predicted risk was also observed in the use of cryotherapy and curettage and cautery (p < 0.05). The average health‐care costs associated with a skin check visit increased from $90 ± 37 (standard deviation) in the lowest risk group to $149 ± 97 in the highest risk group (p < 0.0001).ConclusionsWe observed a positive association between higher predicted risk of skin cancer and the prescription of chemoprophylaxis and health‐care costs involved with opportunistic community skin cancer screening. A clinical use of risk stratification may be to provide an opportunity for clinicians to discuss skin cancer prevention and chemoprophylaxis with individual patients.

The number of melanocytic naevi is a major risk factor for melanoma. The divergent pathway hypothesis proposes that the propensity for naevus proliferation and malignant transformation may differ by body site and exposure to ultraviolet (UV) radiation. This scoping review aimed to summarise the evidence on the number and distribution of naevi (≥ 2 mm) on the body overall and by individual anatomical sites in Caucasian adults, and to assess whether studies used the International Agency for Research on Cancer (IARC) protocol to guide naevus counting processes. Systematic searches of Embase and PubMed identified 661 potentially relevant studies, and 12 remained eligible after full-text review. Studies varied widely in their counting protocols, reporting of naevus counts overall and by body sites, and used counting personnel with differing qualifications. Only one study used the IARC protocol. Studies reported that the highest number of naevi was on the trunk in males and on the arms in females. Body sites which receive intermittent exposure to UV radiation had higher density of naevi. Larger naevi (≥ 5 mm) were detected mostly on body sites intermittently exposed to UV radiation, and smaller naevi (< 5 mm) on chronically exposed sites. Studies reported that environmental and behavioural aspects related to UV radiation exposure, as well as genetic factors, all impact body site and size distribution of naevi. This review found that to overcome limitations of the current evidence, future studies should use consistent naevus counting protocols. Skin surface imaging could improve the reliability of findings. An updated IARC protocol is required that integrates these emerging standards and technologies to guide reliable and reproducible naevus counting in the future.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13555-022-00806-x.

Sunscreen use has been shown to reduce the incidence of skin cancers. Internet purchasing allows access to internationally sourced sunscreens, despite varying accepted active ingredients and regulations around the world. To determine the compliance of international sunscreen products advertised on the internet with the current Australian sunscreen standard (AS/NZS 2604:2012). Six sunscreen-related search queries were executed on Google between January-November 2018. Qualitative analysis of the search results to determine compliance with the current Australian sunscreen standard (AS/NZS 2604:2012) was performed by collecting descriptive data, including listed active ingredients of each advertised product. These were compared against the AS/NZS 2604:2012 list of permitted active ingredients. The compliance status of each product, and reasons for non-compliance were annotated. A multiple regression contingency table test was performed to determine whether compliance was associated with the products' country of origin, and a post hoc analysis was performed to identify countries with significant differences in discrepancy in compliance rate. Execution of the sunscreen-related search queries on Google generated 1350 results. Only 613 of the 1291 (47.5%) included products were compliant with the AS/NZS 2604:2012 permitted sunscreen active ingredients. 552 of 1291 products were non-compliant due to insufficient information advertised. Australia, India and South Korea had significantly lower than expected compliance rates. Online marketing of sunscreen products from other countries has a significantly lower than expected compliance rate with the AS/NZS 2604:2012 permitted sunscreen active ingredients, with many lacking the disclosure of the active ingredients. Advertising regulations for online suppliers need to be tightened to ensure that online consumers purchasing sunscreen products can make informed decisions, as the international E-commerce market rapidly expands.

The data that support the findings of this study are available from the corresponding author upon reasonable request.