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Our results suggest that IRF4 rs12203592 is associated with poorer melanoma-specific survival, largely mediated through Breslow thickness, reinforcing our previous findings related to rs12203592*T and tumour thickness. 1 This variant's adverse effect on survival may occur through its functional effect on IRF4 expression. The SNP is known to modulate IRF4 enhancer-mediated transcriptional regulation in melanocytes, and it may play a similar role in immune cells. 6 Increased IRF4 expression in immune cells and the subsequent activation of the TERT promoter has been shown to increase telomerase activity, which in turn has been associated with increased Breslow thickness and tumour progression. 7,8 In lymphocytes, rs12203592*T results in higher IRF4 expression, and it has been suggested that this may enable suppressive regulatory T cells to inhibit the immune response, enabling an acceleration in tumour growth and progression. 2 In conclusion, IRF4 rs12203592 appears to play a role in melanoma prognosis, which is seemingly mediated by the SNP's association with Breslow thickness at diagnosis. The effect on survival does not appear to be site specific. Further studies are now required to confirm the pathway and mechanism by which this SNP affects survival, and to determine the potential clinical and prognostic utility of these findings.

Summary Over the past 15 years, the spectrum of systemic antipsoriatic treatments has dramatically expanded. Until the end of the last millennium, systemic therapy had been restricted to four oral agents: methotrexate, cyclosporine, acitretin, and fumaric acid esters. Today, there are additionally seven biologics and one new oral antipsoriatic drug, as well as the first available biosimilars. Six more biologics with novel target structures and at least four biosimilars are currently being developed (phase III). This progress has been based on new insights into the pathogenesis of psoriasis, in which tumor necrosis factor and especially Th17 immune responses with their associated cytokines interleukin 23 and 17 play a key role. The development of new‐generation biologics as well as immunomodulatory small molecules can be attributed to these pathophysiological findings. Phosphodiesterase 4 inhibitors, dimethyl fumarate, and Janus kinase inhibitors all interact with Th17 immune responses. Some of these drugs are in advanced clinical development and are also beneficial in psoriatic arthritis. Today, psoriasis and psoriatic arthritis therefore rank among the most readily treatable inflammatory autoimmune disorders. Dermatology is increasingly becoming a specialty of modern targeted immunotherapies.

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Background: Dermatomyositis belongs to the rare idiopathic, inflammatory myositis group. A previously postulated link between some cases of dermatomyositis and malignancy has been established in recent years. Criteria suggestive of a malignancy association are still being explored. Patients and Methods:We retrospectively analyzed data from 63 patients with dermatomyositis over a period of 15 years. Results:The following criteria argue for cancer-associated dermatomyositis: older age (> 52 years [P = 0.001], > 65 years [P = 0.002], ≥ 75 years [P = 0.002]), shorter time between manifestation and diagnosis of dermatomyositis (malignancy group: 59 days vs. non-malignancy group: 137 days [P = 0.022]), typical skin involvement such as Gottron sign (P = 0.045), centrofacial erythema (P = 0.036) and typical erythema on the upper arms and forearms (P = 0.019), oropharyngeal involvement (P = 0.015) and increased ALT (P = 0.031). The following criteria argue for non-cancer-associated dermatomyositis: younger age (≤ 52 years [P = 0.001], 40-65 years [P = 0.045]) and pruritus (P = 0.026). Conclusions:The aforementioned criteria have been documented in the literature, but reported findings are heterogenous concerning the suitability of their markers for malignancy association. Small study populations, few prospective controlled studies, summarization of different forms of myositis and inconsistent use nomenclature contribute to biased results. Our study aims to make an important contribution toward the identification of risk factors in cancer-associated dermatomyositis.