Questions discussed in this category

Do you first try adding topicals or UV? At what point do you decide to switch biologics and at that point do you try to class switch to a different MO...

In which situations or patient populations do you find this useful? How is it sterilized?

Have you had experience continuing low dose Accutane past the goal dosage recommendation? 

What specific settings and devices do you prefer to use? 

What topical therapies have you found most effective? Have you found laser therapy to be effective?

What side effects do you highlight in conversation with them? How do you approach toxicity monitoring?

Relatively newly diagnosed RNA Pol 3+ dcSSc with rapidly progressive skin involvement now on methotrexate 20mg/week and tocilizumab for concurrent inf...

Mother's insurance plan has a high deductible and phototherapy is inconvenient (family lives 50 minutes away). 

For instance - any tips regarding coordination of care/transportation, associated lymphedema management, wound care, and pain control would be welcome...

I have an elderly patient with a history of biopsy-proven psoriasis on IL-17 biologic therapy. She has developed an intense itch without a primary ras...

Do you empirically treat itchy patients -with a non specific rash- for scabies without obvious clinical findings for scabies? 

Do you order blood work to evaluate for underlying dyslipidemia or other metabolic diseases?

Do you favor one treatment over the other?  Do you find one treatment more effective than the other?

When do you switch to steroid-sparing medications? What steroid-sparing therapies do you prefer?

Have you had success with deroofing or surgical excision? Is ILK the best option?

If so, what dose-fractionation do you utilize? What other factors do you take into consideration?

Do you taper one DMARD as you uptitrate another versus do you stop the first DMARD and quickly uptitrate another one?

Is a BM biopsy a must when there is skin involvement? If tryptase level is mildly elevated but less than 20 would you recommend a BM biopsy?

Do you frequently order liver biopsies for these patients?This question is part of a collaboration with RheumMadness and is specifically in reference ...

Have you recommended supplementing less common supplements such as zinc or selenium?

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...

Will you still favor starting with steroids and traditional immunosuppressive agents, move IVIG earlier in your treatment strategy, or start with IVIG...

Do your recommendations differ depending on the fragrance category (i.e fragrance mix I, II or balsam of Peru)?

Do you utilize a standardized script or questionnaire and if so, what types of questions are you including? Would you use JAK inhibitors in patients w...

Do you recommend a six-month wait period? Have you had patients that developed poor outcomes due to pursuing cosmetic procedures too early after compl...

How do you compare safety to other oral immunosuppressants such as Methotrexate, CellCept, or Azathioprine?

What special considerations or couseling do you provide for pediatric patients that are different from adult patients?

This question is part of a collaboration with RheumMadness and is in reference to Pathogenic ANCA (RAVE Trial).

Are you less likely to prescribe it for patients with dyslipidemia or autoimmune disease?

The SWOG 1801 trial showed improved event-free survival (EFS) in patients receiving neoadjuvant pembrolizumab followed by 15 cycles of adjuvant pembro...

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

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

How does the timeframe affect your management? Is there always a concern for infection?

Very-low-risk stage IIIA disease includes non-ulcerated lesions, primary ≤2 mm thickness, SLN metastasis <1 mm. Per NCCN the toxicity of adjuvan...

Do you have a preference for biologics or phosphodiesterase inhibitors? 

Definitive radiation therapy > 5 years ago. Positive margins, PNI of 0.1 mm. What volume would you cover? Dose/fractionation? 

Do anti-inflammatory topicals such as niacinamide or sulfur-based products help with this type of rosacea?

And if so, what is your approach to the diagnosis?

Do you recommend any dietary changes or supplements? Do you modify your recommendations if the patient is breast feeding?

If there were negative margins, what other factors would you consider to add adjuvant RT? Size of the tumor or depth of invasion?

Porcine xenografts are no longer available and I am wondering what alternative dressings are other surgeons using.

Do you typically order a systemic workup? And, after topical corticosteroids, what other treatment options do you prefer?

Might a prior SJ incident pre-dispose to SJ reaction to radiation? Would you be more or less apt to treat with RT for grade 2 DCIS with refusal of pr...

Do you do blood work? Or do you rely on review of systems?

Especially in cases where the MIS portion is obvious but the dermal component may not be.

Are dilute bleach baths enough? Should they use any topical therapies? Is there a need for Staph decolonization with something like mupirocin?

In patients with no apparent skin involvement but lymph-node showing basal cell carcinoma with extracapsular extension. Would this warrant radiation o...

Do you typically start the patient on hydroxychloroquine?  What work-up do you perform?

Majority of patients on the seminal trial (Gross et al., PMID 36094839) had tumors isolated to head & neck, what was the rationale for this?

Do you base your decision on extent of residual disease?  Does the use of (neo)adjuvant immunotherapy have an impact on surgical site size or he...

Are there ways to overcome barriers in insurance coverage of this combination of treatments?

Do you use it for excisions to determine if margins are clear? Do you use it for all melanocytic biopsies? How do you balance using PRAME with the...

Do you prescribe JAK inhibitors as first-line treatments?  Do you perform any lab monitoring?

What dose and margins would you use? The patient is s/p a liver transplant on immunosuppression. 

Do you have an age cutoff? I see 16-18 years olds on occasion who are already developing androgenetic alopecia. I'm curious to know if other dermatol...

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

What labs do you order? How often do you order labs?  Have you ever needed to discontinue isotretinoin due to lab abnormalities?

Do you find absorbable sutures more inflammatory? What factors (cost, erythema, long-term appearance) contribute to your epidermal suture selection?

4 cutaneous biopsies with no evidence of vasculitis. Sjogren’s diagnosis based prominent sicca symptoms and a significantly elevated SSA. 

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

Groomed facial hair is an increasingly common style for men. Accordingly, there are patients who require treatment of the head and neck who become ups...

There have been reports suggesting that patients with CTCL may be at increased risk for other malignancies. 

Assume a mild but diffuse case of lichens sclerosis with involvement of the ipsilateral breast. If node negative disease, would you recommend she unde...

Are there cases where food or environmental allergies significantly worsen eczema in children?

Does your treatment management differs for oral erosive lichen planus? How would you approach patients with active malignancy on chemo and radiation?...

If so, where can patients find it? And besides topical clindamycin, what other topicals do you find helpful for individual lesions?

I have heard of long-term pentoxifylline and Vitamin E daily combination that can prevent and even reverse radiation fibrosis (Delanian et al., PMID 1...

The symptoms can be really miserable.I try to control it with antihistamines (don't find these helpful in most cases) and topical steroids, but that d...

Isotretinoin provides a permanent benefit to acne because it atrophies sebaceous glands. My assumption is that it leaves the skin and eyes permanently...

Is long-term oral ivermectin ok? What topical therapies other than topical ivermectin do you recommend/prescribe?

Do you refer them to Ophthalmology? Have you had to switch patients off of Dupixent due to their ocular side effects?

There have been reports of pembrolizumab leading to lichen planus (my understanding is lichen planus pathophysiology unclear, but potentially autoimmu...

The lesion is still ulcerative despite wound care for two months. Would you treat immediately or wait for healing? Would hyperbaric oxygen to heal ful...

Are there particular indications you use for RT? i.e. multiply recurrent, refractory to other therapies, near critical structures, unresectable (or re...

When tumors come close to chest wall, how do you define skin contour?  

This is an elderly patient with a BCC/SCC over the shin who is not eligible for Mohs due to concern for wound-healing issues. Orthovoltage/superficial...

I prefer dutasteride for its safety and efficacy compared with minoxidil which can interact with different drugs and food. Also, minoxidil is a hyper...

Are there any medications that surgeons like discontinued before their procedure?

Does topical 5FU cause eruptive keratoacanthomas or have any other concerning side effects?

Do you recommend any changes to their personal hygiene practices? or changes to their environment?

What recommendations do you provide if there is concern that the patient is beginning to flare? Have you prescribed any of the new JAK inhibitors?

Any indications for triple therapy in the patients with subclinical ILD associated with MDA-5 dermatomyositis?

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

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 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? 

Would you switch to itraconazole or perform fungal cultures? When would you consider repeating the course of treatment? 

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...

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...

This question is part of a collaboration with RheumMadness and is specifically in reference to: ADIRA Diet

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

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...

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

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