Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
How would you manage treatment of keloid that is so large it requests a graft?
16 Gy/4 fractions
How would you manage eccrine porocarcinoma of the great toe with positive superficial groin and pelvic lymph nodes s/p toe amputation and pelvic lymph node dissection?
Eccrine porocarcinoma (EPC) is an aggressive but rare skin malignancy, let alone one occurring at the great toe! A meta-analysis (Salih et al., PMID 28721214) of worldwide reports on EPC prior to 2016 offered a good overview of the disease’s natural history. It was noted that 31% had metastasis upon...
After diagnosing genital warts (condyloma accuminatum), do you order an STI panel?
Only sometimes. Not sure why I don't more often.
Are there certain disease domains in a patient with psoriatic arthritis that will make bimekizumab a particularly good option?
Bimekizumab has shown comparable efficacy in PsA patients who are TNFi naive and TNFi inadequate responders. Therefore, I would choose bimekizumab in bDMARD-IR patients. My second answer might surprise you - I would choose bimekizumab in a PsA patient with recurrent uveitis.
Should TNF inhibitors be held in patients undergoing radiation therapy?
We do not hold TNF inhibitors when needed for patients undergoing radiation therapy.
What is the role of radiotherapy in cutaneous pseudolymphoma?
I generally like the term "Cutaneous B-cell lymphoid hyperplasia" to describe this entity which is characterized by a reactive B-cell proliferation within the dermis developing in response to an adverse stimulus (medication, insect bite, etc.). Sometimes the antigenic stimulus can't be identified. ...
How would you manage a patient who developed stage III melanoma while receiving cemiplimab (cycle 10) for locally advanced cutaneous squamous cell carcinoma?
That depends on whether you want to manage the stage III melanoma in the adjuvant vs neoadjuvant setting. If adjuvant, can likely continue cemiplimab (off-label for melanoma) as it has the same MoA as other anti-PD-1 ICI. If intending to manage stage III melanoma in neoadjuvant setting, consider swi...
How do you prefer to repair skin cancer excisions done on lower extremities?
The approach to repairing on the lower legs after Mohs surgery often depends on the size and depth of the surgical defect, as well as patient-specific factors such as vascular status and mobility. I typically discuss the available options with the patient, outlining the pros and cons of each. On the...
Would you continue adjuvant nivolumab or pembrolizumab in a resected stage III melanoma patient that developed local-only recurrence at the site of previous surgery?
I am presuming that the patient is experiencing an in-transit recurrence while receiving anti-PD-1 monotherapy. Whilst, the intention for anti-PD1 monotherapy in the adjuvant setting is to prevent distant relapses, an in-transit recurrence is the most difficult to treat with systemic therapy. In our...
How do you manage injection site reactions in patients on subcutaneous biologics such as TNF inhibitors?
Injection site reactions are not infrequent, though the majority are self-limited and do not result in discontinuation of the drug. For those uncommon few individuals whose skin lesions are more prominent and symptoms (such as pain and itch) are aggravating, I first review that they are properly sel...