Interest in artificial intelligence for the diagnosis of non-melanoma skin cancer: a survey among French general practitioners

General practitioners (GPs) are playing a key role in skin cancer screening. Non-melanoma skin cancer is frequent and difficult to diagnose. We aimed to assess whether GPs are facing difficulties in diagnosing non-pigmented skin tumours (NPSTs) and whether they would be interested in artificial intelligence (AI) software that could help them with this task. A questionnaire addressing the difficulties in diagnosing NPST and the potential interest in AI as a tool to help diagnose these tumours was emailed to GPs working in two French regions. In total, 147 respondents (98%) had faced difficulties diagnosing NPSTs; 86% agreed that an AI diagnostic tool could be useful in a GP's office and 83% agreed that it could change their practice. Nevertheless, 68% would not be willing to pay for this kind of software. GPs are facing difficulties in diagnosing NPSTs and would be interested in an AI tool that could help them achieve this. As referral to dermatology practices can be trying, AI diagnostic aids should be developed to help GPs in their gatekeeping task, however at limited cost to the GP

Panniculitis does not predict clinical response in patients with advanced melanoma under targeted therapy

International audienceBackground: BRAF and MEK inhibitors have changed the landscape of treatment for advanced melanoma. Among their side effects, panniculitis has been hypothesized to be associated with better survival.Objectives: In this study, we aimed to explore the association between the occurrence of panniculitis during targeted therapy and outcome of metastatic melanoma.Materials & methods: This was a retrospective single-centre comparative study from 2014 to 2019. An English literature review was also conducted to further our understanding of the mechanism(s) involved and identify characteristics of this association, in order to support better management.Results: Ten patients who developed panniculitis during treatment were matched to 26 controls based on potential confounders at treatment introduction. The prevalence of panniculitis was 5.3%. Median progression-free survival (PFS) for all patients was 8.5 months (range: 3.0-94.0). The median PFS for the group with panniculitis was 10.5 months (7.0-undefined) and 7.0 months (6.0-32.0) for controls (p=0.39). According to the scientific literature, panniculitis occurring during targeted therapy affects mainly young people, predominantly women, with variable delay to onset (with half reported cases occurring in the first month). In addition, panniculitis usually only affects the lower limbs or is associated with other clinical signs (fever, arthralgia), without histological specificity. Discontinuation of targeted therapy is not required as spontaneous remission is usually experienced. Symptomatic treatment may be administered but systemic corticosteroids have not been proven to be effective.Conclusion: In contrast to the belief that there is a link between panniculitis and clinical response to targeted therapy according to the literature, our results show that there is no significant association between the two

Anti-PD-1 for the treatment of advanced cutaneous squamous cell carcinoma in elderly patients: a French multicenter retrospective survey

International audienceBackground: Anti-PD1 agents are currently recommended as first-line treatment in advanced cutaneous squamous cell carcinoma (acSCC) by updated European guidelines. Although acSCC frequently affects elderly patients with multiple comorbidities, this subset of patients is often excluded of registration clinical trials.Purpose: To assess anti-PD-1 efficacy and safety in elderly acSCC patients in real-life conditions and describe this specific population with oncogeriatric evaluation tools.Methods: A multicenter retrospective study including acSCC patients at least 70 years old treated with PD-1 inhibitors was conducted in French referral centers. The primary endpoint was the overall response rate (ORR). Secondary endpoints included safety data, time to response (TTR), duration of response (DOR), overall survival (OS), and progression-free survival (PFS).Results: 63 patients were included. ORR was 57.1% (95% CI 44.0-69.5), median TTR and DOR were 3 and 5.5 months respectively. Median OS was not reached (95% CI 12.5 months-not reached) at data cut-off after a median follow-up of 8 months while median PFS was 8 months. (95% CI 5 months-not reached). Grade 3-5 adverse effects occurred in 47.6% of patients. 41.3% of patients experienced degradation of ECOG performance status during anti-PD-1 treatment. Nutritional state worsened in 27% of patients and 57.1% lost weight during treatment.Conclusion: In this particular subset of acSCC patients PD-1 inhibitors obtain results similar to those obtained in younger populations included in pivotal clinical trials, with acceptable safety. A specific oncogeriatric evaluation at treatment initiation and during follow-up appears important in this setting most notably to help manage toxicity