Dermatology   

Questions discussed in this category



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...

What specific settings and devices do you prefer to use? 

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...

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

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

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...

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

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...

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

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?

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?

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

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

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...


Papers discussed in this category


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Cureus, 2019 Jun 18

PloS one, 2015

Journal of the American Academy of Dermatology, 2018-11

Am. J. Surg. Pathol.,

Cancer,

Am. J. Surg. Pathol.,

Ann Diagn Pathol,

The British journal of dermatology, 2019-02

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

Medicine (Baltimore),

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

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N Engl J Med, 2022 Oct 06

J. Am. Coll. Cardiol.,

The Journal of dermatologic surgery and oncology, 1978-08

Br J Dermatol, 2014 Oct 01

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Arthritis and rheumatism, 2012-08

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Ann. Rheum. Dis., 2018 Apr 25

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Arthritis and rheumatism, 2010-01

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JAMA ophthalmology, 2014-12

Can J Ophthalmol,

J Am Acad Dermatol, 2016 Feb 03

JAMA network open, 2018-11-02

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J Cosmet Dermatol, 2022 Oct 07

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N Engl J Med, 2022 Sep 12

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Br J Dermatol, 2015 Aug 08

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Rheumatology (Oxford),

Journal of psoriasis and psoriatic arthritis, 2019-04

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JAMA Dermatol,

Mod Rheumatol, 2020 Sep 17

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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

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Lupus science & medicine, 2018

Arthritis care & research, 2019-07

Clin Pharmacol Ther, 2018 Jun

Lupus Sci Med, 2016

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

J Dermatolog Treat, 2020 Apr 23

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

Head Neck, 2021 Jun 07

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,

J Am Acad Dermatol, 2021 Jul 02

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

Dermatol Surg,

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,

J Immunother Cancer,

JAMA Dermatol, 2022 Mar 01

Cureus, 2021 Jun 03

JAAD Case Rep, 2022 Aug 11

Am J Clin Dermatol,

Arthritis care & research, 2014-08

Intern Med J, 2022 Mar 16

Int J Radiat Oncol Biol Phys,

Mod Pathol, 2020 Feb 17

Support Care Cancer, 2019 Dec 13

Journal of the American Academy of Dermatology, 2014-01

Dermatol Ther (Heidelb), 2015 Aug 25

JAAD Case Rep, 2021 Aug 18

Clin Oncol (R Coll Radiol), 2004-06-01

G Ital Dermatol Venereol, 2014 Feb

Eur J Dermatol,

Arthritis Res Ther, 2021 Sep 04

Melanoma research, 2017-10

Cancer, 2011-04-15

JAAD Int, 2022 Mar 29

Dermatology, 2021 Aug 04

Dermatol Ther, 2020 Sep 15

Journal of the American Academy of Dermatology, 2011-05

Lupus, 2016 May 27

Clin Exp Rheumatol, 2013 Aug 02

J Rheumatol, 2022 Aug 01

Dermatol Ther, 2014 Aug 12

Clinical cancer research : an official journal of the American Association for Cancer Research, 2020 Sep 09

Medicine (Baltimore), 2019 Dec

J Clin Invest, 2013 Nov 15

JAMA dermatology, 2017-08-01

JAMA oncology, 2018-12-01

JAMA oncology, 2018-12-01

J Radiat Res, 2018 Nov 01

Clinical pharmacokinetics, 2018-12

Frontiers in immunology, 2018

Clinical immunology (Orlando, Fla.), 2020 Jul 15

The Pediatric infectious disease journal, 2018 Oct

Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 2017 Nov 03

The Journal of rheumatology, 2012-01

JAAD Case Rep, 2019 Oct 10

European journal of cancer (Oxford, England : 1990), 2017-04

Arthritis Care Res (Hoboken), 2022 Aug 04

JAMA dermatology, 2018-10-01

Archives of dermatology, 2002 Sep

American journal of clinical oncology, 2005-12

Head & neck, 2016-01

The Laryngoscope, 1994-02

Oral and maxillofacial surgery, 2023 Apr 05

JAMA dermatology, 2018-12-01

J Am Acad Dermatol, 2020 May 07

J Dermatolog Treat, 2022 May 23

Cutis, 2008-02

International journal of medical physics, clinical engineering and radiation oncology, 2014-08

Technol Cancer Res Treat, 2005 Oct

Int. J. Radiat. Oncol. Biol. Phys.,

JAMA Dermatol,

J Cutan Aesthet Surg, 2019 Apr-Jun

Ann Acad Med Singap, 2012 Sep

JAMA Dermatol, 2022 Aug 01

Lupus, 2017 May 08

Arthritis care & research, 2018-10

Breast Care (Basel), 2019 Aug 16

Oncologist, 2020 Oct 28

JAMA Dermatol, 2017 Jul 01

Dermatol Ther, 2021 May

Arch Dermatol, 2010 Jul 19

J. Clin. Oncol., 2018 Mar 14

Current rheumatology reviews, 2019

Am J Clin Dermatol, 2022 Jun 23

The New England journal of medicine, 2017-11-09

N Engl J Med, 2018 Apr 15

Ann Afr Med, 2020 Jul-Sep

Arch Dermatol, 2006 Mar

Clin Rev Allergy Immunol, 2010 Apr

Lupus, 2020 Mar 19

The New England journal of medicine, 1993-12-30

Clinical rheumatology, 1988 Sep

Journal of the American Academy of Dermatology, 1987 Apr

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J Rheumatol, 2022 May 15

American journal of clinical oncology, 2014-10

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JAAD case reports, 2019 Mar 01

Dermatologic therapy, 2020 May 03

The Journal of allergy and clinical immunology, 2012 Feb 14

Clinical cancer research : an official journal of the American Association for Cancer Research, 2018-02-15

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Cancer, 2023 Mar 04

Journal for immunotherapy of cancer, 2022 Aug

Lupus, 2019-05

Journal of the American Academy of Dermatology, 2020 Apr 28

The British journal of dermatology, 2003 Jul

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JAAD case reports, 2019 May 08

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