Dermatology   

Questions discussed in this category



Does your evaluation hinge on nonresolution with warming? How extensive is your workup?

If not, what tumor characteristics prompt you to collect debulking specimens for paraffin or frozen section staining? 

In your experience, do specific patient features predict a better response?

For example, in the setting of cirrhosis incidentally found on imaging.

For kids experiencing moderate to severe urticaria that improve with single-dose antihistamine, do you scale up the manufacturer packaging dosages up ...

Mycosis fungoides and Sezary syndrome are thought to be distinct genotypically and phenotypically. It is my understanding that Sezary syndrome typical...

Other than inflammatory markers and following symptoms/exam, do you need any other specific monitoring for progression to systemic disease? 

Are there specific cases where you would or would not consider early flap division?

Assuming it has previously been treated with excision and steroid injections? Is it reasonable to treat a bothersome keloid in a pediatric patient aft...

(Refractory to mycophenolate, azathioprine, and methotrexate. UpToDate suggests thalidomide or IVIG with mixed efficacy, while there are some case rep...

What are your preferred treatment methods other than topical Vitamin E and azole antifungals?

Several speakers at ACR 2021 commented on the important role of drug levels in the management of these patients and cautioned against adding medicatio...

If so, how long after phototherapy (eg. NB-UVB) is it safe to proceed with RT? See: Systemic review of phototherapy for pruritic skin disorders

Do you obtain vascular imaging routinely in these cases, and if so, do you use cross-sectional or invasive angiography?

In a patient who would be otherwise fit for surgery +/- adjuvant RT, and the delay is caused by COVID-related OR staffing issues, what would be your a...

In other words, do we think of TNFi induced lupus and TNFi induced psoriasis as a drug effect or a class effect? 

Is there any alteration in approach from the medical, surgical, or radiation oncology perspective that can mitigate the risk of forming keloids withou...

Specifically: starting dose, rapidity of up-titration, frequency of lab monitoring, frequency of office visits, and timing of assessment for treatment...

What is the role and sequence of surgery and/or RT? Which nodal levels would you include in your RT field(s)?

E.g., MPO vs PR3, newly diagnosed vs relapsed, renal involvement. Acknowledge that the ADVOCATE study was not powered to detect these differences, but...

What if the patient has MGUS? Do patients with type 1 cryoglobulins need a bone marrow biopsy as part of the work up?

Post-auricular cutaneous angiosarcoma, pT1 (19 mm) with negative margins. Unclear if there is any indication for systemic therapy, given early stage a...

What approaches (surgical vs non-surgical) offer the best cosmesis for keratoacanthoma (low grade squamous cell carcinoma) ? 

Is there a role for radiation? Does your approach differ depending on site(s) of  disease, and/or if the patient has Basal-Cell Nevus (Gorlin) sy...

If so, are there specific patient populations for which you would use this metric?

In general, how would you approach such a case with regards to creation of your treatment volumes and dose-fractionation? 

Would you recommend radiation therapy or immunotherapy? If proceeding with radiation therapy, what dose-fractionation and technique would you utilize?

When do you electively treat the ipsilateral versus ipsi- and contralateral neck?

This particular case involves a patient with a frontal scalp low grade eccrine carcinoma status-post excision with positive margin complicated by...

Would you recommend locoregional radiation therapy or systemic or immunotherapy alone? If you would consider radiation therapy, what would be your rec...

Would you treat the primary site alone, include the hand and arm lymphatics to the epitrochlear nodes (one continious treatment volume from hand to el...

Given the location but no other high risk features would you offer RT?  If so, what dose and fields? 

What pathologic features are most important when evaluating the possible need for adjuvant therapy?

*Negative margins, <1cm in size, no LVI, negative SLNB, not immunocompromised, no prior surgery (as well as a negative PET/CT scan).

NCCN lists only substantial perineural invasion.  What about other high-risk adverse features such as histologic subtype, multiple recurrences, d...

When elective nodal radiation is recommended, which nodes would you treat (i.e. facial, pre-auricular, peri-parotid, levels I-III, etc.)?

Patient underwent a shave biopsy of a 6x5x2mm preauricular lesion that showed moderatley differentiated sebaceous carcinoma with deep and lateral marg...

What dose/fractionation would yield the lowest risk of graft failure? Does your treatment management change based of location, ex the ear vs back?

If so, how large of a margin would you place on the primary lesion and would you incorporate any adjacent lymph node levels?

Following Mohs surgery and in the absence of other high risk features, do you offer RT for any PNI?  A single nerve < 0.1 mm? A single ne...

Would re-irradiation be an appropriate option? What dose/field would you incorporate? If treating with standard fractionation, would you take the enti...

I have seen some patients who may undergo large complex closures (sometimes as a separate procedure) for smaller lesions with resulting scars that sig...

Is modern surgical/reconstruction treatment superior to radiation therapy? If contact brachytherapy or superficial (orthovoltage) therapy isnt possib...


Papers discussed in this category


Br J Radiol,

Burns, 2014 Apr 24

Pediatrics, 2013-01

Pediatrics, 2016-02

International journal of radiation oncology, biology, physics, 2018-09-01

Cancer, 1995 May 1

Ann Surg Oncol, 2003 May

American journal of surgery, 2001-12

World J Surg, 1992 Mar-Apr

Cancer, 2005-10-01

Journal of contemporary brachytherapy, 2017-04

Melanoma research, 2015-04

Nature, 2018-01-18

Cureus, 2019 Jun 18

PloS one, 2015

The British journal of dermatology, 2019-02

JAAD Case Rep, 2019 Jun 26

The New England journal of medicine, 2010-07-15

Medicine (Baltimore),

The New England journal of medicine, 2010-07-15

,

, 2016 Aug 30

J. Am. Coll. Cardiol.,

Arthritis and rheumatism, 1982-11

Arthritis and rheumatism, 2012-08

, 2019 Aug 06

Arthritis Rheum.,

Ann. Rheum. Dis., 2018 Apr 25

Ann. Rheum. Dis., 2017 May 25

Ann. Rheum. Dis., 2018 May 03

Medicine, 1976-05

Arthritis and rheumatism, 2010-01

J. Rheumatol., 2019 Sep 01

Pract Radiat Oncol, 2019 Dec 09

Annals of the rheumatic diseases, 2009-03

JAMA ophthalmology, 2014-12

Can J Ophthalmol,

J Am Acad Dermatol, 2016 Feb 03

JAMA network open, 2018-11-02

Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases, 2008-10

Clin Rheumatol, 2006 Dec 21

Rheumatol Int, 2020 Sep 18

Arthritis Rheumatol, 2016 Jan

Kidney international reports, 2018-03

N Engl J Med, 2020 Feb 13

Rheumatology (Oxford),

Journal of psoriasis and psoriatic arthritis, 2019-04

Front Pharmacol, 2019 Mar 26

Nat Rev Dis Primers, 2018 Aug 02

N Engl J Med, 2021 Feb 18

Int J Clin Pract, 2021 Mar 24

Mod Rheumatol, 2021 Feb 09

Heart Rhythm, 2020 Jun 28

Arthritis care & research, 2018-03

J Clin Rheumatol, 2020 Sep 18

Cureus, 2020 Aug 02

Ann Intern Med,

Ann Rheum Dis, 2011 Nov 29

Lancet Oncol, 2019 Dec

Respir Med, 2012 Apr 09

Am J Respir Crit Care Med,

Seminars in arthritis and rheumatism, 2010-12

Clin Exp Rheumatol, 2012 Oct 17

Inflamm Bowel Dis,

Am J Clin Dermatol,

Radiographics : a review publication of the Radiological Society of North America, Inc, 2001

International journal of clinical rheumatology, 2010

Lupus science & medicine, 2014

The Journal of rheumatology, 2015-11

Ophthalmology, 2016-06

Lupus science & medicine, 2017

Journal of immunology research, 2017

Lupus science & medicine, 2018

Arthritis care & research, 2019-07

Clin Pharmacol Ther, 2018 Jun

Lupus Sci Med, 2016

Rev Med Interne, 2016 Oct 13

JAMA Dermatol,

Lupus Sci Med, 2016 Feb 01

Lupus Sci Med,

ACR Open Rheumatol, 2020 Oct 12

Arthritis Rheumatol, 2021 May 02

Ann Rheum Dis, 2012 Nov 10

Arthritis Rheum,

Lupus,

Arthritis Rheumatol, 2020 Jan 07

Lupus Sci Med, 2019

Journal of medical case reports, 2010-05-22

Ann Med Surg (Lond), 2017 Jun 20

Case Rep Oncol, 2021 May 10

J Clin Oncol,

Acta Gastroenterol Belg,

Int J Dermatol,

J Am Acad Dermatol,

Br J Dermatol, 2018 Oct 10

Dermatologic therapy, 2018-11

Dermatol Ther (Heidelb), 2019 Nov 20

J Am Acad Dermatol, 2019 Mar 11

J Am Acad Dermatol, 2019 May 13

Dermatology,

Best practice & research. Clinical rheumatology, 2013-06

Dermatol Ther, 2016 Apr 12

The Lancet. Respiratory medicine, 2016-09

Journal of the American College of Surgeons, 2011-04

Am J Surg,

J Immunother Cancer,

Journal of the American Academy of Dermatology, 2011-07

JAMA Dermatol,

J Dermatol,

N Engl J Med,

Minerva Gastroenterol Dietol, 2016 Sep 07

Free Radic Biol Med,

Ann Plast Surg,

Journal of psychiatric practice, 2018-11

Journal of the American Academy of Dermatology, 2019-05

Med Hypotheses, 2006 Nov 28

J Am Acad Dermatol, 2021 Apr 18

Prog Neuropsychopharmacol Biol Psychiatry,

Antimicrob Agents Chemother, 2008 Nov 17

Journal of investigational allergology & clinical immunology, 2007

Int Arch Allergy Immunol, 2018 Sep 25

Eur J Dermatol,

Rheum Dis Clin North Am, 2020 Aug

Rheumatology (Oxford),

Dermatol Clin,

J Am Acad Dermatol, 2014 Sep 19

Br J Dermatol,

East Afr Med J,

Int J Dermatol,

J Pathol,

Sci Rep, 2021 Oct 12

Acta Derm Venereol,

Br J Dermatol, 2019 Sep 18

Br J Dermatol, 2019 Oct 16

The British journal of dermatology, 2019-11

Frontiers in immunology, 2019

J Am Acad Dermatol, 2020 Sep 04

Rheumatology (Oxford),

Case reports in rheumatology, 2017

Contact Dermatitis,

Oral Surg Oral Med Oral Pathol Oral Radiol, 2012 Mar 26

J Am Dent Assoc,

Oral Oncol, 2006 Nov 16

Am J Clin Dermatol,

The American Journal of dermatopathology, 2013-07

The American journal of surgical pathology, 2018-03

The American journal of surgical pathology, 2018-11

Appl Immunohistochem Mol Morphol,

Pathology, 2016 Aug 28

Am J Dermatopathol,

Am J Dermatopathol,

J Am Acad Dermatol, 2022 Jun 23

Dermatol Surg,

Arch Dermatol,