European e-Delphi process to define expert consensus on electrochemotherapy treatment indications, procedural aspects, and quality indicators in melanoma.

BACKGROUND: Skin metastases are an important co-morbidity in melanoma. Despite broad adoption, electrochemotherapy implementation is hindered by a lack of treatment indications, uncertainty regarding procedural aspects, and the absence of quality indicators. An expert consensus may harmonize the approach among centres and facilitate comparison with other therapies. METHODS: An interdisciplinary panel was recruited for a three-round e-Delphi survey. A literature-based 113-item questionnaire was proposed to 160 professionals from 53 European centres. Participants rated each item for relevance and degree of agreement on a five-point Likert scale, and received anonymous controlled feedback to allow revision. The items that reached concordant agreement in two successive iterations were included in the final consensus list. In the third round, quality indicator benchmarks were defined using a real-time Delphi method. RESULTS: The initial working group included 122 respondents, of whom 100 (82 per cent) completed the first round, thus qualifying for inclusion in the expert panel (49 surgeons, 29 dermatologists, 15 medical oncologists, three radiotherapists, two nurse specialists, two clinician scientists). The completion rate was 97 per cent (97 of 100) and 93 per cent (90 of 97) in the second and third rounds respectively. The final consensus list included 54 statements with benchmarks (treatment indications, (37); procedural aspects, (1); quality indicators, (16)). CONCLUSION: An expert panel achieved consensus on the use of electrochemotherapy in melanoma, with a core set of statements providing general direction to electrochemotherapy users to refine indications, align clinical practices, and promote quality assurance programmes and local audits. The residual controversial topics set future research priorities to improve patient care.

Electrochemotherapy is an effective locoregional therapy for skin metastases from melanoma, a problem faced by almost half of patients with metastatic disease. The lack of comparative studies and the heterogeneity of its clinical application among centres make it challenging to support consistent, evidence-based recommendations. To address this unmet need, a three-round online survey was conducted to establish a consensus on treatment indications, standard operating procedures, and quality indicators. In the survey, a panel of 100 European melanoma experts agreed on 56 statements that can be used to improve patient selection, homogenize treatment application, and monitor outcomes.

[Surgical treatment of hidradenitis suppurativa]. / Prise en charge chirurgicale de l'hidradénite suppurée.

Hidradenitis suppurativa (HS) is a chronic relapsing inflammatory disease that primarily affects the apocrine skin glands. Management options include risk factor modification, pharmacologic agents, and surgery. Many surgical management techniques exist, including incision and drainage, laser hair removal, deroofing, limited or wide local excision. Deroofing is an interesting alternative for simple superficial fistulas and potentially even for more complex lesions. Surgical treatment can be combined with drug treatment. The indication depends on a comprehensive and multidisciplinary assessment considering the severity and number of target lesions.

L'hidradénite suppurée (HS) est une maladie inflammatoire chronique récurrente qui affecte principalement les glandes cutanées apocrines. Les options de prise en charge comprennent la modification des facteurs de risque, les agents pharmacologiques et la chirurgie. De nombreuses techniques de prise en charge chirurgicale existent, notamment l'incision et le drainage, la thérapie au laser épilatoire, le deroofing et l'excision limitée ou large. Le deroofing est une alternative intéressante pour les fistules simples superficielles et, potentiellement, pour les lésions plus complexes. Le traitement chirurgical peut être combiné au traitement médicamenteux. L'indication dépend d'une évaluation globale et pluridisciplinaire prenant en compte la sévérité et le nombre de lésions.

[Micrographic surgery and its variants]. / La chirurgie micrographique et ses variantes.

Cutaneous tumours can be ill-delineated and subclinical tumour can be missed when using the usual methods of pathology processing because only less than 1 % of the margin is examined. Micrographic surgery was developed to allow for examination of 100 % of the margin. It reduces the recurrence rate and spares healthy tissue thus reducing lesion size and facilitating reconstruction. This method is particularly suitable for peri-orificial cutaneous tumours of the face with high rates of local recurrence. Mohs micrographic surgery is the main technique for frozen tissue and there are other often under-recognized variations using permanent paraffin sections known as the «â€…collerette ¼ ( spaghetti), «â€…muffin ¼ or the «â€…Tübinger Torte ¼ method.

Certaines tumeurs cutanées ont des ramifications infracliniques ponctuelles qui peuvent être non visualisées en histologie classique, puisque moins de 1 % des marges sont observées. La chirurgie micrographique s'est développée dans le but d'obtenir un contrôle histologique de 100 % des marges d'excision, aboutissant à un faible taux de récidive, tout en permettant une épargne des tissus sains. Les pertes de substance étant moins grandes, les reconstructions sont moins lourdes. Cette méthode s'applique tout particulièrement aux tumeurs péri-orificielles du visage à haut risque de récidive. Parmi les techniques sur tissu congelé, la plus connue est celle selon Mohs. Il existe d'autres variantes avec technique de fixation au formol, souvent méconnues et sous-utilisées, telles que la méthode de la collerette ( spaghetti), le muffin ou en gâteau.