Are changes still immediate with SKS6
No, when apply from sks or try to close sks before saving, you will be asked if you want to save changes.
Save button
There is no save button, to save need to go to File on menu bar and click save skin, you need to close the window for section you are working on to enable menu bar.
I just apply, yes to save changes, then I still have window open to tweak change if it needs it.