Jie Liu

Background and Objectives: Folliculotropic mycosis fungoides (FMF) is a rare variant of mycosis fungoides with diverse clinical manifestations and heterogeneous outcomes. An FMF-specific clinicopathologic staging system has been proposed; however, its utility remains insufficiently validated, particularly in Asian populations. This study aimed to characterize clinicopathologic features of FMF and explore associations between this staging system and survival outcomes in a Chinese cohort. Materials and Methods: This retrospective study included patients diagnosed with FMF at a tertiary center from 1 January 2013 to 1 January 2026. After blinded histopathologic review by two dermatopathologists, patients were classified as early skin-limited (ES), advanced skin-limited (AS), or extracutaneous (EC) according to the FMF-specific staging system. Progression-free survival (PFS) was the primary endpoint; overall survival (OS) was secondary. Analyses used Kaplan–Meier estimation, log-rank tests, and univariable Cox regression. An exploratory plaque-stage subgroup analysis was performed. Results: Among 32 patients, 22 (68.8%) were male; median age at diagnosis was 48.5 years. Furthermore, 9 patients had ES, 20 AS, and 3 EC disease. Moreover, 18 (56.3%) patients had prior misdiagnoses, and 27 (84.4%) had head and/or neck involvement. During a median follow-up of 29 months, 20 PFS events and 3 deaths occurred. PFS differed significantly among clinicopathologic stages (p = 0.004). Median PFS was not reached in ES, compared with 15 months in AS and 9 months in EC stage. Older age, advanced FMF-specific stage, advanced TNMB stage, and angioinvasion/angiodestruction were associated with shorter PFS in univariable analyses. OS did not differ significantly across stages (p = 0.430). Among 15 plaque-stage patients (6 ES, 9 AS), AS had a higher estimated hazard of progression, without statistical significance (HR, 2.91; 95%CI, 0.55–15.28; p = 0.206). Conclusions: FMF-specific clinicopathologic staging was associated with PFS in this Chinese cohort. These exploratory findings support further evaluation of histopathologic stratification, particularly in plaque-stage disease.

Background: Accurate assessment of hidradenitis suppurativa (HS) severity is crucial for individualized management, yet conventional clinical grading may underestimate disease extent due to subclinical lesions. Ultrasound enables visualization of deep abscesses and tunnels and may provide additional prognostic information. Materials and Methods: Sixty‐eight patients with HS underwent standardized clinical and ultrasonographic evaluation. Disease severity was classified using the International Hidradenitis Suppurativa Severity Score System (IHS4) and the modified Sonographic Scoring of HS (mSOS‐HS). Concordance between the two systems was assessed, and ultrasonographic grading and features were analyzed in relation to achievement of IHS4‐55 at week 12. Results: The mSOS‐HS classified 18 patients (26.5%) as having more severe disease than IHS4. The two grading systems showed statistically significant agreement, with the Kappa value approaching the threshold for moderate agreement (Kappa = 0.395, 95% CI: 0.204–0.586, p < 0.001). Patients with higher mSOS‐HS grades were less likely to achieve IHS4‐55 at week 12 ( p = 0.014). Among specific ultrasonographic features, the railway sign, defined as parallel hyperechoic lines within tunnel‐like structures, was significantly associated with failure to achieve IHS4‐55 ( p = 0.003). Conclusion: Ultrasonography reveals subclinical HS involvement beyond clinical examination and provides prognostic information for treatment response. The mSOS‐HS complements IHS4 for comprehensive disease staging, while the railway sign may serve as an imaging biomarker for unfavorable response across real‐world treatment settings.

Background and Objectives: Artificial intelligence (AI) has transitioned to an integral part of dermatology in only few years, yet perceptions of its use vary widely, reflecting diverse hopes, concerns, and perceived clinical utility. Materials and Methods: In this study, 300 dermatologists from 13 countries, representing a range of experience levels and AI usage statuses, were surveyed regarding the characteristics and applications of AI in dermatology. Results: Among respondents, 61.33% reported having used AI tools in clinical practice. Adoption of AI was observed across all age groups, countries, and experience levels. Analysis of the types of AI tools used revealed a strong reliance on general-purpose large language models (LLMs), with chatbots being the most frequently cited category, utilized by 58.15% of users. Younger clinicians demonstrated a significant preference for chatbots (p < 0.05). Country-specific patterns in AI adoption were also noted. The most highly rated expected benefit of AI in dermatology was improved diagnostic accuracy, while the primary concern centered on regulatory and ethical limitations, suggesting that the “AI revolution” in dermatology is currently constrained less by technical barriers and more by regulation considerations. Use of consent forms when AI use takes place was more frequently reported as mandatory by dermatologists who had never used AI, reflecting heightened caution among non-users (p = 0.03). Additionally, 75% of respondents agreed that formal training in AI is necessary, highlighting a significant gap in traditional medical education regarding emerging technologies.

Lentigo maligna (LM) is a subtype of cutaneous melanoma in situ that develops on chronically sun‐damaged skin in elderly individuals. Its diagnosis and management remain challenging due to its slow progression, frequent occurrence on cosmetically sensitive areas in frail individuals, and tendency for subclinical peripheral extension. Despite its potential for invasive transformation, the natural history of LM remains incompletely understood and evidence‐based management strategies for this specific entity remain limited. This work aims to bridge the gap between scarce high‐quality evidence and the clinicians' need for practical guidance on LM management by formulating evidence‐based and expert consensus‐driven recommendations for diagnosis, treatment and follow‐up. Under the coordination of the International Dermoscopy Society, a global, multidisciplinary consortium of 53 experts—including dermatologists, dermato‐oncologists, dermatologic surgeons, radiologists, radiotherapists, pathologists and epidemiologists—formulated recommendations through structured consensus, informed by a comprehensive review of current scientific evidence and clinical practice standards. Optimal management of LM requires accurate diagnosis and individualized treatment planning. Non‐invasive skin imaging techniques, especially dermoscopy and reflectance confocal microscopy, aid in diagnosis, biopsy orientation, lesion delineation and post‐treatment monitoring. Multiple partial biopsies help confirm diagnosis and rule out invasion. Complete surgical excision remains the first treatment option. No definitive safety margins can be recommended for standard surgery; margin‐controlled techniques are preferable for large or ill‐defined lesions. Topical imiquimod and radiotherapy are effective alternatives where surgery is unsuitable. Topical imiquimod is useful as primary, adjuvant or neoadjuvant therapy. Blind destructive methods should be avoided. Close clinical and imaging follow‐up is needed. Patient‐centred care, shared decision‐making, and a multidisciplinary approach are critical for optimal outcomes. These international consensus recommendations summarize current best practices for LM management, offering practical, evidence‐informed guidance to clinicians while acknowledging the potential of future research in refining these conclusions.

Folliculotropic mycosis fungoides (FMF) is a rare subtype of MF, characterized by prominent folliculotropism in histopathology. Clinically, FMF exhibits polymorphic presentations, mainly including follicular papules, plaques, alopecia, and other nonspecific lesions, with a predilection for the head and neck region, leading to frequent misdiagnosis. Historically, FMF was perceived as an aggressive subtype with an unfavorable prognosis, often regarded as advanced‐stage MF requiring aggressive combination therapies. However, recent studies have identified a subset of FMF with indolent progression and favorable prognosis, which can achieve remission through skin‐directed therapies (SDTs). Therefore, FMF treatment strategies should follow the stage‐adapted principles such as classical MF, with individualized regimens based on disease staging. This review comprehensively elaborates the diagnostic criteria and clinicopathological staging system of FMF, with a focus on stage‐based therapeutic principles, aiming to guide clinical practice.