Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
How would you manage a Merkel cell carcinoma that spontaneously regressed clinically in a patient medically high-risk for surgical resection/anesthesia?
Less than 5% of MCCs are T0. I’ve never seen spontaneous regression of a biopsy-proven MCC in over 45 years. That said, should lightning strike, RT to the primary site and elective RT to the regional nodes.
Do you give neoadjuvant intralesional 5FU/MTX prior to Mohs for CSCC purely to reduce scar size and improve cosmetic outcome?
No. With Mohs surgery, we know we can get high cure rates and good cosmetic outcomes.
How do you approach the management of basal cell carcinoma with single lymph node involvement?
If all the tumor has been resected, I would recommend adjuvant XRT on the nodal basin, depending on the age of the patient. For very old patients or patients with comorbidities, observation might be warranted. If there is remaining BCC visible on examination or scans, I would treat systemically with...
What is the best management for recurrent basal cell carcinoma after prior radiation and vismodegib?
Recurrent basal cell carcinoma can be challenging to manage. It is important recognize that vismodegib is FDA approved for basal cell carcinoma that is not treatable with surgery or radiation therapy. In this case, if you think radiotherapy could be given again, vismodegib should have never been us...
Is there a minimum work-up necessary in patients with an ANA greater than 1:160 and no clinical symptoms suggestive of lupus (i.e., specific antibodies, UA)?
My personal practice has been to get the "ANA subtypes" and a UA for prot/Cr ratio, but I do this with the idea of needing to have a complete picture. Clinical symptoms are still king.
What is your approach to evaluation in patients who present with erythromelalgia?
Erythromelalgia is a tough condition to treat. I usually break it down into diagnostic workup and treatment as follows: Diagnostic workup: I usually just get a CBC yearly to look for myeloproliferative disorders. Treatment: I have not had a lot of luck with topicals being too effective, so I usuall...
If you have clinical suspicion for a paraneoplastic process (e.g. dermatomyositis or pemphigus), what work-up do you pursue?
This continues to be a topic of high interest. The first-ever evidence and consensus-based recommendations were recently drafted by an expert international committee under the auspices of the International Myositis Assessment and Clinical Studies (IMACS) group (in preparation). These recommendations...
When would you recommend adjuvant radiation therapy for a patient with a completely resected (negative margins) dermatofibrosarcoma protuberans?
Agree, we usually do not. Especially if these patients are completely cleared with Mohs surgery, which is found to have lower recurrence rates than WLE.
Would you offer adjuvant immunotherapy in an elderly patient with stage IIB desmoplastic melanoma post resection with underlying autoimmune disease?
As discussed with our desmoplastic melanoma expert at The Ohio State University, Kari L. Kendra, MD - "Because some patients are potentially "cured" with surgical resection alone and this patient has an autoimmune disease, would not treat in the adjuvant setting. If there is local recurrence, would ...
What is your approach to management of hyperlipidemia in patients taking JAK inhibitors?
The ORAL Surveillance Study published in the NEJM in 2022 was a phase IIIb/IV open-label noninferiority study in RA patients over the age of 50 with at least one cardiovascular risk factor. The aim was to demonstrate that JAK inhibitors were non-inferior in terms of major adverse cardiovascular even...