Volume 10 | Issue 3
William Levis MD|No abstract details for the moment.
William D. James MD, Alan C. Geller MPH RN|No abstract details for the moment.
Ulcerated Nodular Nasal Basal Cell Carcinoma Successfully Treated With Imiquimod 5% Cream
Serial Screening for Melanoma: Measures and Strategies That Have Consistently Achieved Early Detection and Cure
Ronald N. Shore MD, Paula Shore MEd†, Noel M. Monahan MHSc PA-C, James Sundeen MD|
Objective: To determine the effectiveness of a serial screening program in achieving early detection and preventing death in patients at increased risk for melanoma. Design: Retrospective study.
Setting: Private dermatology practice.
Patients: The study included all patients at increased risk for melanoma who were screened in the program during the 17-year period, July 1, 1992-June 30, 2009 (=1108 patients per year).
Main Outcome Measures: Survival and indicators of early detection.
Results: All melanomas that developed in program participants during the 17-year period were detected early and there were no deaths, metastases, recurrences, nor need for sentinel node biopsies. An analysis of melanoma cases seen in five recent years revealed additional evidence of consistent early detection: 80 percent of the lesions were in situ, no lesions were greater than 0.15 mm in Breslow depth, and all lesions were in the radial growth phase, a stage almost always associated with cure. Four measures, often absent in mass screening programs, contributed to very early detection and cure: thorough serial examinations, biopsying suspicious lesions (particularly pigmented lesions that were highly irregular and/or approaching black in color), recalling patients every six months to detect all melanomas in the radial growth phase, and educating patients on the need to return. Conclusion: An office-based surveillance program that includes serial full skin examinations and ongoing recalls appears capable of detecting melanoma at a very early stage when cures can be realized in almost every case. Therefore, when patients present with recognized risk factors for melanoma, dermatologists should seriously consider recommending and performing such serial screening procedures.
Melanie Tuerk MD, Heidi Goodarzi MD, Summer Youker MD|Resident Rounds is a new section of the JDD dedicated to highlighting various dermatology departments with residency training programs. This section will feature three programs: (1) a program spotlight, highlighting pertinent information about the department and residency training program; (2) a section presenting study materials used by residents at the program; and (3) a section designed to highlight recent interesting cases seen at the institution. This issue of Resident Rounds features the University of California Davis program. The editor of Resident Rounds is Omar A. Ibrahimi, MD, PhD. Dr. Ibrahimi is a recent graduate of the Harvard Combined Program in Dermatology and currently a fellow in Mohs, Laser and Cosmetic Surgery at the University of California Davis. If you are interested in highlighting your training program in a future issue, please contact Dr. Ibrahimi at [email protected]
Anis Miladi MD, Jonathan Bingham MD|Mohs micrographic surgery can be unpredictable with respect to the level of difficulty of individual cases, especially when preoperative information is limited. In a retrospective study, Sahai and Walling found complex tumors as defined by requiring four or more stages to clearance to be associated with: recurrent tumors, basal cell carcinoma (BCC) with aggressive histology, tumors with a pre-operative size greater than 1 cm and tumors on the nose.1 The authors created a simplified system for “triaging” Mohs surgery cases in order to predict case complexity and, thus, be better able to manage the scheduling of those cases. Data gathered from 12 months of utilizing this system was used to validate the system’s ability to predict case complexity with respect to number of stages for tumor clearance and complexity of reconstruction.
J Drugs Dermatol. 2011;10(3):257-259.
Marko Lens MD PhD,a Marie-Helen Podesta Marty PharmDb|While there is at least one standardized test available for evaluating the antioxidant capacity of cosmetic formulations, the authors proposed a new in vivo method to determine kinetics of squalene (SQ) photo-oxidation products (squalene monohydroperoxide, SQ mOOH) as a reliable method with which to evaluate antioxidant capacity of a cosmetic formulation. Topical antioxidant formulation was applied on the foreheads of 30 volunteers. Sebum samples were collected before application of topical antioxidant and after one hour, three hours and five hours from the application of topical antioxidant. One half of the sebutape was irradiated and SQmOOH/SQ ratios in the skin lipid were analyzed using HPLC method. These results showed protective action of the topical antioxidant formulation against skin lipid peroxidation with a significant reduction of the quantity of SQmOOH (P<0.0001). Determination of the kinetics of squalene peroxidation is a reliable in vivo method in the evaluation of antioxidant capacity of cosmetic formulations.
J Drugs Dermatol. 2011;10(3):262-267.
Salicylic Acid 6% in an Ammonium Lactate Emollient Foam Vehicle in the Treatment of Mild-to-Moderate Scalp Psoriasis
Leon Kircik MD|Scalp psoriasis is a common life-altering skin condition causing a great deal of distress. It significantly affects quality of life and is difficult to manage. Treatment can provide variable results, often impacting patient compliance with therapy. Salicylic acid is used as adjunctive therapy to other topical treatments because of its marked keratolytic effect. Its effectiveness as a monotherapy is not fully understood. An emollient foam formulation of 6% salicylic acid (Salkera) in an ammonium lactate vehicle has recently become available. Efficacy, tolerability and patient acceptability of salicylic acid 6% emollient foam were assessed in an open-label pilot study of 10 subjects with scalp psoriasis. All psoriasis severity parameters were reduced with a significant decrease in Psoriasis Scalp Severity Index (PSSI) score from 15.3 to 3.0 after four weeks of monotherapy (P<0.001). Sixty percent of subjects were either "completely cleared" or “almost cleared” of their psoriasis. No adverse events (AEs) were reported. All signs and symptom tolerability measures demonstrated statistically significant score decreases with the exception of oiliness severity and patient-reported burning tolerability. Salicylic acid 6% emollient foam provides a useful option in the treatment of psoriasis that is highly effective, well tolerated and acceptable to patients.
J Drugs Dermatol. 2011;10(3):270-273.
Edward J. Shannon PhD, Felipe G. Sandoval BS, Melvyn J. Morales MS|Erythema nodosum leprosum (ENL) is an inflammatory reaction that may occur in multibacillary leprosy patients, and thalidomide is the treatment of choice. Its cause and the mechanism by which thalidomide suppresses ENL are not known. In the skin lesions, immune complexes and split products of complement are found. The activation of complement could precipitate ENL, and thalidomide could suppress the inflammation by inhibiting the activation of complement. To determine if thalidomide could suppress the activation of complement, we first incubated normal serum with thalidomide and with M. leprae or zymosan. The amount of residual functional complement was then assessed by determining the dilution of serum required to lyses sheep erythrocytes sensitized by rabbit antibodies (CH50 Assay). M. leprae and zymosan activated complement. The residual complement activity in the serum incubated with M. leprae or with zymosan was equivalent to that incubated with M. leprae or zymosan in the presence of thalidomide, hydrolyzed thalidomide and metabolites of thalidomide. Thalidomide did not inhibit the activation of complement by zymosan, a known initiator of complement activation by the alternative pathway, or by M. leprae. J Drugs Dermatol. 2011;10(3):274-278.
Meng Chen MD, Michael J. Holland MD, Mohsin R. Mir MD, Michael G.Wong BA, Brian P. Kelley MD, Kelli D. Grim MD, Sunaina S. Bhuchar MD, Sylvia Hsu MD|Tumor necrosis factor-α (TNF-α) inhibitors are biologic agents that are currently in wide use for the treatment of psoriasis as well as other inflammatory diseases. Following reports of thrombocytopenia as a potential adverse effect of anti-TNF-α therapy, we performed a retrospective study to determine the frequency of thrombocytopenia, defined as a platelet count <50x109 cells/L, in a cohort of 187 psoriatic patients treated with anti-TNF-α agents over a nine-year period. Although none of our patients met serologic criteria for thrombocytopenia or displayed clinical manifestations of thrombocytopenia, two patients developed platelet counts below 100×109 cells/L. Thrombocytopenia induced by anti-TNF-α agents is a potential adverse effect, it is a rare occurrence that will require further investigation in large, placebo-controlled, double-blind, prospective studies.
J Drugs Dermatol. 2011;10(3):280-284.
Clinical Trial Safety and Mortality Analyses in Patients Receiving EtanerceptAcross Approved Indications
Alice B. Gottlieb MD PhD,a Kenneth Gordon MD,b Edward H. Giannini MSc DrPH,c Philip Mease MD,d Juan Li PhD,e Yun Chon PhD,e Judy Maddox DO,e Haoling H. Weng MD MHS,e Joseph Wajdula PhD,f Shao-Lee Lin MD PhD,e Scott W. Baumgartner MDe|Objectives: Assessment of associations between etanercept treatment and rare adverse events has been limited by the size of clinical trial populations. The authors examined the collective safety of etanercept in clinical trials across approved indications.
Patients and Methods: Forty-nine U.S. and non-U.S. trials of etanercept, involving up to 13,977 patients for approved indications, with final trial reports as of May 2006, were selected from the Amgen Inc. clinical trials database. Exposure-adjusted rates of serious infections, opportunistic infections, malignancies and deaths were reported by trial, indication and dosage.
Results: Rates of serious infections were generally similar between etanercept and controls. Overall rates of opportunistic infections and tuberculosis were low. The standardized incidence ratio (SIR) (95% CI) for malignancy was 1.00 (0.83–1.19) for all etanercept patients across all indications. The SIR for lymphoma for patients with rheumatoid arthritis was 3.45 (1.83-5.89); all other indications reported SIRs similar to those observed in the general population. The SIRs for cutaneous squamous cell carcinoma in patients with psoriasis relative to the general population with high or low sun exposure were 2.09 (1.27-3.22) and 4.96 (3.03-7.66), respectively. SIRs were less than 1.0 for all other indications regardless of sun exposure. Rates of melanoma and basal cell carcinoma were not significantly different from those in the general population. There was no increase in mortality associated with etanercept use relative to control populations.
Conclusion: These data support the overall tolerability of etanercept across approved indications.
J Drugs Dermatol. 2011;10(3):289-300.
Victoria R. Sharon MD|Reported adverse effects of isotretinoin and corticosteroids are numerous. In order to facilitate comprehensive recall, these pictorial representations (Figures 1 and 2) were created for rapid review. They may be best committed to memory cephalad to caudad.
Melanie J.Tuerk MD, Thomas H. Konia MD, Philina M. Lamb MD|No abstract details for the moment.
Clinical Trial Review is a JDD department designed to provide physicians with information on drugs and devices undergoing clinical testing. It is our goal to inform the reader of the status of select drug and device studies relevant to the practice of dermatology before this information is available through standard channels. To participate in or learn more about these and additional trials, visit www.clinicaltrials.gov.
News, Views and Reviews provides focused updates, topic reviews and editorials concerning the latest developments in dermatologic therapy.
Regression of Internal Melanoma Metastases Following Application of Topical Imiquimod to Overlying Skin
Anne K. Miller BS, Reginald Dusing MD, Aaron Meggison MD, Daniel Aires MD|
The prognosis for metastatic melanoma is grim, and treatment options are limited. Imiquimod is a topically applied immunemodulatorthat has been used to treat superficial cutaneous melanoma, but has not been reported to treat metastatic melanoma. We report a patient whose liver and iliac fossa melanoma metastases regressed after topical application of imiquimod cream to overlying skin. This supports further investigation of the potential use of imiquimod for metastatic melanoma.
J Drugs Dermatol. 2011;10(3):302-305.
Eruptive Squamous Cell Carcinomas With Keratoacanthoma-like Features in a Patient Treated with SorafenibSorafenib is a multikinase inhibitor that displays antiproliferative and antiangiogenic properties in the treatment of solid tumors. Commonly administered for the treatment of metastatic or unresectable hepatocellular carcinoma and advanced renal cell carcinoma, sorafenib has demonstrated remarkable survival benefits for those where curative surgery is not an option. Although generally having a mild side effect profile, sorafenib has been linked to a variety of dermatologic disorders, including most commonly acneiform rash, hand-foot-skin reactions, facial erythema, splinter subungual hemorrhages, alopecia or pruritus. The authors describe a case of sorafenib-induced eruptive squamous cell carcinomas with keratoacanthoma-like features in a patient with hepatocellular carcinoma. This case adds to the growing literature suggesting a strong correlation between sorafenib and non-melanoma skin cancers including keratoacanthoma and squamous cell carcinoma. Routine dermatologic monitoring of these patients to ensure early detection is highly recommended.
J Drugs Dermatol. 2011;10(3):308-310.
Pipeline Previews brings to you information on the newest drugs and medical products as they become available to the dermatologic community. This department may include additional information from the manufacturers, plus reports from physicians who wish to share their clinical experience with these new products. In addition, we will inform our readers about the latest drugs receiving Food and Drug Administration (FDA) approval. We trust you will find this information beneficial to your practice and research.