Diagnosis of cutaneous T-cell lymphoma by insurance type before and after the Affordable Care Act: a national database study

The Affordable Care Act (ACT) was implemented to increase health care access and reduce the uninsured in the age group between pediatric and Medicare populations (18-64). The association of the ACA with insurance type upon diagnosis (uninsured, Medicaid, non-Medicaid) has been investigated for otolaryngologic, gynecologic, and the top five non-skin malignancies. Such studies for cutaneous malignancies are lacking. We conducted a retrospective analysis of the prospective National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) cancer database to assess the impact of the ACA on new diagnoses of cutaneous T-cell lymphoma (CTCL) by insurance type. Unlike prior studies of other malignancies, we did not observe significant differences between rate of diagnosis of CTCL by insurance type before and after full implementation of the ACA in all states, expansion states, and non-expansion states. Skin cancers do not have screening guidelines and CTCL is an uncommon malignancy, both of which may contribute to these findings. However, Medicaid-expansion states were much closer to reducing the percentage of newly diagnosed uninsured patients with CTCL than non-expansion states. As such, it may be prudent to investigate intrinsic socioeconomic barriers to care in Medicaid patients to improve their access to care to decrease the uninsured population and improve outcomes

Harm to the global commons on trial: The role of the prevention principle in international climate adjudication

Although the climate crisis is the result of a failure to prevent environmental harm, the principle of prevention has thus far remained discrete in domestic climate litigation. Similarly, in the context of international climate adjudication, reliance on the prevention principle could seem limited by two main obstacles: its anchor in bilateralism and its normative indeterminacy. This article argues that, on the contrary, the prevention principle could serve important functions in international climate adjudication. First, it shows that climate change falls within the reach of the prevention principle, which aims to protect the environment per se as a community interest. Then it explores two argumentative scenarios that are based on different constructions of the prevention principle, conceived either as a customary duty or as a general principle of international law. In both cases, recourse to the prevention principle can offer numerous advantages, which vary depending on the objectives strategically pursued

Development of Sézary syndrome following the administration of dupilumab

Dupilumab is a monoclonal antibody that inhibits interleukin-4 and interleukin-13 signaling. It is the first biologic agent to demonstrate efficacy in treating moderate-to-severe refractory atopic dermatitis [1, 2]. Although dupilumab provides promise for the treatment of atopic and allergic conditions, clinicians should take into account its novelty and the potential for unexpected adverse events. We present a patient who developed Sézary syndrome following the initiation of dupilumab

Clinical Efficacy of Romidepsin in Tumor Stage and Folliculotropic Mycosis Fungoides

AbstractBackgroundTumor stage and folliculotropic mycosis fungoides are uncommon subtypes of cutaneous T-cell lymphoma (CTCL) with an aggressive disease course. Romidepsin is a histone deacetylase inhibitor approved by the US Food and Drug Administration for patients with CTCL who have received ≥ 1 previous systemic therapy. In the present study, we examined the efficacy and safety of romidepsin in patients from the pivotal, single-arm, open-label, phase II study of relapsed or refractory CTCL with cutaneous tumors and/or folliculotropic disease involvement.Materials and MethodsPatients with CTCL who had received ≥ 1 previous systemic therapy received romidepsin at 14 mg/m2 on days 1, 8, and 15 of 28-day cycles. Responses were determined by a composite endpoint (assessments of the skin, blood, and lymph nodes). Patients with cutaneous tumors and/or folliculotropic disease involvement were identified by review of diagnosis and histology reports.ResultsThe objective response rate to romidepsin was 45% in patients with cutaneous tumors (n = 20) and 60% in patients with folliculotropic disease involvement (n = 10).ConclusionRomidepsin is active in subtypes of CTCL with less favorable outcomes, such as tumor stage and folliculotropic mycosis fungoides

White-light oblique-incidence diffuse reflectance spectroscopy for classification of in-vivo pigmented skin lesions

A study of in-vivo classification of pigmented skin lesions using oblique-incidence diffuse reflectance spectroscopy is presented. Spatio-spectral data in the wavelength range from 455 to 765 nm are collected from 111 pigmented lesions including 10 histopathologically diagnosed as melanoma. The first 67 lesions are used for training the classifiers, and 44 lesions are used for testing. The first classifier separates (1) malignant melanoma and severe dysplastic nevi from (2) moderate and mild dysplastic nevi, common nevi, actinic and seborrheic keratoses. The second classifier next distinguishes between (a) moderate and mild dysplastic nevi, common nevi from (b) actinic and seborrheic keratoses. The third classifier further separates (I) moderate and mild dysplastic nevi from (II) common nevi. The first classifier performs with 100% sensitivity and 91% specificity with overall classification rates of 93% and 95 % for the training and testing sets, respectively. The second classifier has classification rates of 95% and 97 % for the training and testing sets, respectively, whereas the third classifier has classification rates of 98% and 94 % for the training and testing sets, respectively