The Clinical Definition and Characterization of Field of Cancerization in Patients with Actinic Keratoses

Introduction: Chronic UV radiation affects the entire area of skin exposed, leading to visible actinic keratoses (AK) and subclinical changes in the surrounding skin. AKs are hyperkeratotic lesions, with a 0.025-16% risk of transforming into squamous cell carcinoma (SCC).1 Cellular atypia around AKs is the field of cancerization (FOC). Topical AK therapies can treat the FOC, while destructive treatments address visible lesions. FDA-approved products may be approved for field sizes up to 25 cm2.1,2 Objective: To characterize the FOC and assess the correlation between the FOC and number of AKs. Methods: 100 patients with AKs were recruited. FOC was defined by a dermatologist. The size of the FOC was quantified to determine if FOC meets FDA-recommended AK topical treatment criteria. Results: 100 patients (mean age 71.2 years; 23% female) with AKs were enrolled, with 148 FOC. The mean AKs per field was 6.8 (SD=7.3). Mean size of the FOC was 75.3cm2 (SD=75). 111 of the 148 fields (75%) exceeded 25cm2. Number of AKs positively correlated with the size of the FOC. Mean FOC size and the mean number of AKs differed based on the body region affected (p=0.0337; p=0.0087). Conclusion: Cellular atypia changes due to UV radiation are important because if the surrounding area of atypia is not treated along with the visible AK, patients remain at risk for AK recurrence and progression to SCCs. Results suggest treating FOC of 25 cm2 may not be adequate for patients. AK therapy should consider FOC size, number of AKs, and patient preferences

Barriers to Dermatological Care in Patients who Received Extensive Mohs Surgery - An In-Depth Qualitative Analysis

Background: Dermatological care needs to be accessible for the elderly, but they face prominent challenges contributing to delays in diagnosis and treatment. Prolonged management of may lead to widespread cutaneous malignancies, necessitating extensive Mohs surgery. Objective: To identify areas for early intervention in the geriatric population who have undergone extensive Mohs surgery. Methods: We performed a qualitative study on 10 patients 65 years and older (68-91) from Atrium Health Wake Forest Baptist dermatology clinics between December 2022 and February 2023, who had extensive Mohs surgery (3 or more layers removed). Results: Three major areas for potential intervention for cutaneous carcinoma identified in our study were lack of knowledge, delayed care, and relationships. Discussion: Early cutaneous carcinoma intervention is essential to avoid extensive Mohs micrographic surgery and the associated risks, and to optimize patient health outcomes

Supplementary Material 1 - Supplemental material for Relationship Between Number of Actinic Keratosis and Size of Field of Photodamage

Supplemental material, Supplementary Material 1, for Relationship Between Number of Actinic Keratosis and Size of Field of Photodamage by Lillian McCampbell, Mallory Zaino, Stuti Prajapati, Christina Kontzias and Steven R. Feldman in Journal of Cutaneous Medicine and Surgery</p

Monitoring adherence to vulvar lichen sclerosus treatment – a prospective study

AbstractBackground: Vulvar lichen sclerosus treatment consists of topical corticosteroids followed by maintenance therapy. Self-reported adherence to topical corticosteroids in vulvar lichen sclerosus is approximately 66-70.4% and adherence to chronic topical medications is poor.Objective: To measure treatment adherence for vulvar lichen sclerosus.Methods: Adults with vulvar lichen sclerosus who were receiving or who were candidates to receive treatment with topical clobetasol propionate 0.05% ointment twice daily received medication tubes equipped with adherence monitors capturing the time and amount of dose dispensed. After 2 months, monitors were returned, and patients were surveyed regarding their adherence.Results: Ten patients participated for a median (range) of 8.5 (7–11) weeks. Eight (80%) and 7 (70%) caps captured medication timing and dosing events, respectively. Median (interquartile range) adherence was 65% (42–77) and median (interquartile range) medication dispensed per use was 0.15 (0.14 − 0.5) grams. Of the 8 patients using active adherence monitors, 2 did not clinically improve; adherence rates and mean quantity dispensed for these two patients were 31% and 0.13 grams, and 9% and 0.74 grams, respectively.Conclusion: Poor adherence to both twice daily application and prescribed medication quantity occurred frequently. Factors related to self-reported non-adherence included perceived greater efficacy, inconvenience, and time-constraints. Patient adherence to recommended treatment and clinical outcomes are areas for improvement in patients with vulvar lichen sclerosus

sj-docx-1-cms-10.1177_12034754241229369 – Supplemental material for The Effect of Anchoring on Atopic Dermatitis Patients’ Likeliness to Take an Injection Treatment

Supplemental material, sj-docx-1-cms-10.1177_12034754241229369 for The Effect of Anchoring on Atopic Dermatitis Patients’ Likeliness to Take an Injection Treatment by Brett R. Shaffer, Mallory Zaino, Stuti Prajapati, Rithi J. Chandy and Steven R. Feldman in Journal of Cutaneous Medicine and Surgery</p

Figure S1 - Supplemental material for A Survey Assessing Counseling Strategies to Increase Sunscreen Use

Supplemental material, Figure S1, for A Survey Assessing Counseling Strategies to Increase Sunscreen Use by Mallory L. Zaino, Caitlin Purvis, Esther A. Balogh, Elise D. Martin, E. J. Masicampo and Steven R. Feldman in Journal of Cutaneous Medicine and Surgery</p