Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
How would you approach treatment of a patient with asymptomatic, oligometastatic basal cell carcinoma?
This is an unusual situation. I would want to clarify whether this is regional versus distant metastasis, and what is meant by "oligometastatic". I would also want the diagnosis of metastatic basal cell carcinoma confirmed histopathologically (and possibly even molecularly) for both a putative prima...
How would you treat a patient with an keratoacanthoma of the right nasal ala?
In my experience, these patients are treated surgically and radiation does not play a role.
How would you approach refractory gangrenous Raynaud's secondary to type one cryoglobulins?
Type I cryoglobulins are monoclonal immunoglobulins, and typically occur in the context of a hematologic disorder such as MGUS, multiple myeloma, Waldenstrom macroglobulinemia, or lymphoma. Vascular occlusions due to the cryoglobulins may occur and lead to digital ischemia.The patient should be eval...
Would you offer adjuvant radiation therapy for a Merkel cell carcinoma limited to the epidermis with close margins?
I would review this case with a dermatopathology expert before making any decisions. The reason is that normal Merkel cells usually lie in very close proximity to the basement membrane. My understanding is that a skin neoplasm that is limited to the epidermis does not broach the basement membrane, a...
How would you manage a patient with cutaneous SCC of the lower extremity with isolated inguinal nodal involvement?
Good timing for this question, since I’m currently treating a similar case of Merkel Cell Carcinoma (MCC) on dorsal skin of wrist with isolated axillary nodal involvement. The same oncologic principles should apply for SqCC as well: As far as surgery is concerned, wide local excision (WLE) for the ...
What therapies have you had the most success with for calcinosis cutis in dermatomyositis patients?
Treatment of calcinosis cutis is difficult with therapy aimed at the underlying condition. Many of the treatments that have been tried in the literature have been reported in small case reports/series and have had variable success rates. I have tried diltiazem (limited by lightheadedness and fatigue...
When is it necessary to monitor the QTc interval in patients on hydroxychloroquine?
The answer to this question is not straightforward mainly because there are limited data in this area. Hydroxychloroquine and Chloroquine directly affect cardiac repolarization and are associated with QT prolongation. Given this, there is an argument for getting a baseline ECG for patients initiatin...
What surveillance plan would you recommend for stage IV melanoma patients who achieve a CR or stable PR response with immunotherapy?
If melanoma patients have achieved CR or PR after a year of immunotherapy treatment, I highly recommend participation in this ongoing ECOG cooperative study: EA6192 / PET-Stop Educational Materials - ECOG-ACRIN Cancer Research Group (NCT04462406). The study uses PET scans in combination with contras...
Does calcinosis appear differently in patients with dermatomyositis compared to systemic sclerosis?
Classically, calcinosis in dermatomyositis and scleroderma are different with dermatomyositis having more typical sheet-like calcinosis in the muscles whereas in scleroderma it is more typical on the fingers, extensor surfaces of the forearm, olecranon, knee, and shins. However, many sclerodermas al...
What is your methotrexate initiation strategy in DMARD-naive RA patients?
Best final dose is 20 to 25 mg per week, not 15 mg per week. D Furst