Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
Are there guidlines for elective coverage of nodal basins in head and neck for skin cancer removed in the area?
Practically, I find the following tool from Aukland very helpful.They mapped melanoma lymphoscintigraphy data onto an interactive tool that allows you to select different locations and estimate the nodal drainage. https://sites.bioeng.auckland.ac.nz/hrey004/head/ https://sites.bioeng.auckland.ac....
Would you favor radiation or immune modulating treatment like imiquimod to treat an uncomplicated basal cell carcinoma on the nose in an elderly patient for whom you'd like to avoid surgery?
If my patient was concerned about deformity, with 10 to 15 years of life remaining, unquestionably, I would recommend radiation.
How do you work with your patients to ensure good coordination of care if they are seeing multiple providers within your specialty?
It's important to first explore the patient's reasons for seeing multiple dermatologists across different states—are there specific concerns, preferences, or barriers driving this pattern? Open a discussion with the patient to understand their perspective and emphasize the critical importance of com...
What factors do you weigh most heavily in the selection of radiotherapy versus topical treatments for lentigo maligna in a patient who is not a surgical candidate?
The ability of a patient to travel to multiple sessions of radiotherapy would play a major role in making this decision. If the patient is frail and has someone who could reliably to topical therapy, it might make me lean towards topical therapy.
How do you think about biologic use in patients with underlying HIV infection?
This is always a difficult problem, and a tough clinical call. However, over the years of seeing these people, I have come to realize that following their viral load and CD4 counts while looking for immunologic recovery allows us as Rheumatologists a lot of opportunities to treat. While I have class...
In your practice or during fellowship training, do you perform curettage of cutaneous carcinomas to define subclinical borders prior to Mohs?
RCT trial done by Huang et al., PMID 15389195 many years ago showed that curettage decreases layers and increases the size of defect but does not increase the number of flaps/grafts (this is all off memory, someone may want to check). So I curettage if I don't think a larger initial layer will chang...
How do you manage alopecia areata in children with >50% of hair loss that is unresponsive to intralesional or topical steroids?
Treatment typically varies depending on the age of the child and the impact on the child's quality of life. Some options include adding topical minoxidil or compounded topical JAK inhibitors such as topical tofacitinib. In more severe cases, I offer oral minoxidil, monthly pulse prednisone, systemic...
What therapies do you most commonly recommend for prevention of NMSC in organ transplant patients?
First and foremost, we assess transplant patients and circle, number, and label all their skin cancers so we can catalogue them. We then prioritize their skin cancers in order to remove them in order of "worst first". We immediately start field therapy with calcipitrione and 5-FU twice a day for a w...
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...
How do you counsel male patients with Androgenetic Alopecia who are trying to conceive about using dutasteride or finasteride?
I advise against dutasteride for those trying to conceive or who might have unprotected intercourse with pregnant women since dutasteride is in the semen. For 5 alpha-reductase inhibitors in general, the effects on sperm count and sperm motility are very well characterized. There is a reduction in s...