32622 Imaging technologies for presurgical margin assessment of basal cell carcinoma

Basal cell carcinoma (BCC) is the most common skin cancer worldwide. Mohs micrographic surgery is a highly used BCC treatment, involving staged resection of the tumor with complete histologic evaluation of the peripheral margins. A reduction in the number of Mohs stages would significantly improve care and could result in substantial economic benefits, estimated at $36 million USD in savings per annum. Noninvasive imaging modalities can potentially streamline the surgical management of skin cancers by refining presurgical assessments of tumor size. We assessed the current imaging techniques in dermatology and their application for tumor margin assessment of BCCs prior to Mohs micrographic surgery. These include dermoscopy, photodynamic diagnosis (PDD), high-frequency ultrasound (HFUS), optical coherence tomography (OCT), reflectance confocal microscopy (RCM), and optical polarization imaging (OPI). Each technology is limited or strengthened by its resolution, depth, speed of imaging, field of view, maneuverability, and billing. RCM, and a combination of RCM with video mosaicking technique and OCT, appear to be promising imaging techniques in pre-surgical margin assessment because of the superior resolution of RCM and the enhanced depth of imaging of OCT. OPI is also favorable for margin assessment based on its field of view and maneuverability. Further research and efficacy studies are necessary before such techniques can be implemented widely. It is imperative that general dermatologists and Mohs surgeons alike are well informed regarding the existing technologies given the increasing incidence of skin cancer and the associated rising costs

Clinical Outcomes Associated With Melanocytic Lesions Assessed Via Ancillary Gene Expression Profiling (GEP)

Aims/Objectives: Compare GEP assay prediction of 434 melanocytic lesions with dermatopathologist interpretation. Methods: Sensitivity and specificity of assay were calculated based on disagreement of assay prediction with dermatopathologist interpretation. Histologic features were recorded in disagreeing cases. Results: Eighty-five percent of lesions (369/434) had sufficient RNA for scoring. 74.2% 274/369 lesions were classified as “benign”, 11.9% (44/369) “indeterminate”, and 13.8% (51/369) “malignant”. 38/51 of lesions rendered “malignant” by dermatopathologists were classified “malignant” by assay (sensitivity = 74.5%). Lesions rendered by assay as “benign” but “malignant” by dermatopathologists were more likely to have rarer cytologic features. (13/51) lesions rendered “malignant” by dermatopathologists were classified by assay as “benign,” (4/13) or “indeterminate” (9/13). 270/318 lesions rendered “benign” by dermatopathologists were “benign” by assay (specificity = 84.9%). Of 44/369 “indeterminate” lesions, dermatopathologists rendered 9/44

The Dermatologist\u27s Guide to Beards: A Review of Structure, Function, Care, and Pathology

Facial hair is a commonly desired feature for many individuals. Despite a breadth of dermatology literature covering strategies for removing facial hair, there are no known articles summarizing strategies for facial hair growth or reviewing common facial hair pathologies. Here, we assess Google Trends to describe significant increases in terms related to facial hair growth and maintenance over the last decade, suggesting an increased public interest on this topic. Next, we review ethnic differences in facial hair growth that may affect facial hair distribution, growth, and predisposition to certain facial hair pathologies. Lastly, we review studies on agents used for facial hair growth and review common facial hair pathologies

Evaluating the United States Population\u27s Interest in Sunscreen: A Google Trend Analysis

Broad-spectrum sunscreen remains an important component of photoprotection against deleterious effects of ultraviolet (UV) radiation.(1) The advances made in the field of photoprotection has resulted in an expansion of various sunscreen formulations, providing numerous options to consumers. In the past several years, there has been a growing concern regarding the potential environmental and health impacts of certain UVR filters, which has resulted in public confusion on the use of sunscreen as a photoprotective measure.(1,2)

Safety of conventional immunosuppressive therapies for patients with dermatological conditions and coronavirus disease 2019: A review of current evidence

The effect of coronavirus disease 2019 (COVID-19) on patients receiving conventional immunosuppressive (IS) therapy has yet to be fully determined; however, research on using IS therapy for treating COVID-19 in acutely ill patients is increasing. While some believe that IS therapy may be protective, others argue that these agents may make patients more susceptible to COVID-19 infection and morbidity and advocate for a more cautious, individualized approach to determining continuation, reduction, or discontinuation of therapy. In this review, we aim to provide an overview of COVID-19 risk in dermatological patients who are receiving conventional IS therapies, including mycophenolate mofetil, methotrexate, cyclosporine, azathioprine, apremilast, JAK inhibitors, and systemic steroids. Additionally, we provide recommendations for management of these medications for dermatological patients during the COVID-19 pandemic. Treatment of dermatological disease during the COVID-19 pandemic should involve shared decision-making between the patient and provider, with consideration of each patient\u27s comorbidities and the severity of the patient\u27s dermatological disease

Safety of conventional immunosuppressive therapies for patients with dermatological conditions and coronavirus disease 2019: A review of current evidence

The effect of coronavirus disease 2019 (COVID-19) on patients receiving conventional immunosuppressive (IS) therapy has yet to be fully determined; however, research on using IS therapy for treating COVID-19 in acutely ill patients is increasing. While some believe that IS therapy may be protective, others argue that these agents may make patients more susceptible to COVID-19 infection and morbidity and advocate for a more cautious, individualized approach to determining continuation, reduction, or discontinuation of therapy. In this review, we aim to provide an overview of COVID-19 risk in dermatological patients who are receiving conventional IS therapies, including mycophenolate mofetil, methotrexate, cyclosporine, azathioprine, apremilast, JAK inhibitors, and systemic steroids. Additionally, we provide recommendations for management of these medications for dermatological patients during the COVID-19 pandemic. Treatment of dermatological disease during the COVID-19 pandemic should involve shared decision-making between the patient and provider, with consideration of each patient\u27s comorbidities and the severity of the patient\u27s dermatological disease

The Relationship between Leptin, the Leptin Receptor and FGFR1 in Primary Human Breast Tumors

Obesity is associated with increased breast cancer risk and poorer cancer outcomes; however, the precise etiology of these observations has not been fully identified. Our previous research suggests that adipose tissue-derived fibroblast growth factor-2 (FGF2) promotes the malignant transformation of epithelial cells through the activation of fibroblast growth factor receptor-1 (FGFR1). FGF2 is increased in the context of obesity, and increased sera levels have been associated with endocrine-resistant breast cancer. Leptin is a marker of obesity and promotes breast carcinogenesis through several mechanisms. In this study, we leverage public gene expression datasets to evaluate the associations between FGFR1, leptin, and the leptin receptor (LepR) in breast cancer. We show a positive association between FGFR1 and leptin protein copy number in primary breast tumors. These observations coincided with a positive association between Janus kinase 2 (Jak2) mRNA with both leptin receptor (LepR) mRNA and FGFR1 mRNA. Moreover, two separate Jak2 inhibitors attenuated both leptin+FGF2-stimulated and mouse adipose tissue-stimulated MCF-10A transformation. These results demonstrate how elevated sera FGF2 and leptin in obese patients may promote cancer progression in tumors that express elevated FGFR1 and LepR through Jak2 signaling. Therefore, Jak2 is a potential therapeutic target for FGFR1 amplified breast cancer, especially in the context of obesity