Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
How should medical oncologists and dermatologists communicate about patients with at least Stage IIB/III cutaneous melanoma regarding neoadjuvant immunotherapy?
Only melanoma patients with stage III or resectable stage IV disease should be treated with standard-of-care neoadjuvant immunotherapy. These patients should see a medical oncologist first (and no longer last, as is the current process). I would recommend that the schedulers at your institution be e...
When would you offer neoadjuvant immunotherapy prior to Mohs surgery in a locally advanced squamous cell carcinoma for which clearance may require enucleation?
I would flip this question around and answer that radiotherapy is often a terrific option around the eyes, and it should always be considered in this area, especially when a radical surgical procedure is being entertained. Between en face therapy with a shield (superficial, electrons) and IMRT/VMAT,...
What’s your immediate post-procedure protocol for fractionated laser resurfacing (i.e., Sciton Pro-fractional Laser)?
My immediate post procedure protocol for fractionated laser resurfacing is to decrease stinging with the Zimmer chiller (approximately 10-30 minutes followed by the application of Vaseline. I have not seen significant pinpoint bleeding while treating acne scarring (Lumenis Encore laser) but have see...
In what situation would you recommend ipilimumab + nivolumab over relatlimab + nivolumab in the treatment of metastatic melanoma?
There is no clinical trial to provide a direct comparison between the two regimens, hence the answer to this question is usually driven by personal interpretation of the data and patient preference. The data for both regimens show a statistically significant PFS benefit and a superior response rate ...
How do you counsel patients regarding the improvement they can expect when starting nemolizumab?
I tell patients that this medicine is a relatively newly approved medication in dermatology, although we have had significant experience with it in veterinary medicine for years. I state that the benefits of this drug go beyond just improving itch and skin clearance, but also have a role in impactin...
In what circumstances would you recommend adjuvant radiation for a keratocanthoma with SCC after resection?
KA by itself (in the absence of SCC) is at the interface of benign and malignant. In a pure KA, if margins are negative, no further RT is needed. If there is SCC mixed, as can happen even with BCCs, the adjuvant RT indication rules pertaining to SCC prevail.
What is your approach to prescribing JAK inhibitors in patients with alopecia areata who have a prior history of cutaneous malignancy, such as DFSP?
For something like DFSP, it would depend on how long it has been since their diagnosis, and a shared decision-making process with the patient. Close monitoring with skin checks would be recommended.
What is your approach to management of patients with recurrent orolabial herpes?
Recurrent orolabial herpes is fundamentally a disease of viral latency with episodic reactivation, so my approach focuses less on “treating infection” and more on reducing recurrence burden, shortening symptom duration, and improving quality of life. First, I make sure we are actually dealing with H...
How do you approach managing nausea and GI side effects when initiating methotrexate?
There are several strategies to minimize nausea and gastrointestinal symptoms with the use of methotrexate. The medication can be taken with food, just not with caffeine. The dose can be split throughout the day it is taken such as half the dose in the morning and the other half in the evening. The ...
What topical therapies and procedures do you recommend for patients with atrophic acne scarring?
If the patient has hyperpigmentation, then some sort of topical lightening approach (i.e., tretinoin/kojic acid/niacinamide/Vit C/tranexamic acid, etc) or chemical peels. For the actual scarring, assuming that the acne process has burned out, the most ideal procedure depends on the particular type o...