Neoadjuvant therapy for stage III melanoma, and JAK inhibitors in older adults

The edition in brief

Today's dermatology edition opens on melanoma. The updated PIVOTAL phase 3 trial of neoadjuvant intralesional daromun before surgery in resectable stage III melanoma confirmed a recurrence-free survival benefit (hazard ratio 0.59) that held at nearly three years of follow-up, with no new safety signals — a neoadjuvant option, though limited to the European Union for now. A Dutch registry of 309 children on dupilumab for atopic dermatitis showed disease stayed controlled over three years with 80% drug survival; the commonest adverse event was dupilumab-associated ocular surface disease, and the youngest children fared worst on itch and quality of life. A small intra-patient phase 2 trial found topical ruxolitinib reduced affected skin in cutaneous graft-versus-host disease versus vehicle, suggesting a steroid-sparing option. A clinic pearl reaffirms screening for latent tuberculosis and hepatitis before starting systemic immunomodulators, which matters especially in India. The practice-changer: a clinical review sets out how to use JAK inhibitors in adults 65 and older, favouring lower doses, weighing cardiovascular and cancer risk, and individualising each decision where age-stratified data are thin.