Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
Do you recommend a workup for POEMS and/or amyloidosis for IgM monoclonal gammopathies associated with neuropathy?
While IgM monoclonal disorders, amyloidosis, and POEMS syndrome may all be associated with peripheral neuropathy, they are not often confused with one another. A patient with a peripheral neuropathy can be diagnosed most simply by a serum protein electrophoresis. The presence of a monoclonal IgM spi...
How would you manage a patient who presents with hair loss that began after they started a GLP-1 inhibitor?
If it fits with telogen effluvium, I recommend monitoring. Many patients will improve after this initial shedding and will not have long-term shedding or long-term thinning. If there is any underlying androgenetic alopecia or pattern hair loss, then starting treatment as you normally would is also r...
How do you explain the use of an AI scribe to patients the first time it is used in their care?
I use an AI scribe in my outpatient clinic, and around 90–95% of my patients agree to it. I obtain consent at the start of each visit and make it clear that it's completely optional—that they can say no at the start or change their mind at any point in the visit, with no impact on their care. I also...
When would you offer neoadjuvant immunotherapy prior to Mohs surgery in a locally advanced squamous cell carcinoma for which clearance may require enucleation?
I would flip this question around and answer that radiotherapy is often a terrific option around the eyes, and it should always be considered in this area, especially when a radical surgical procedure is being entertained. Between en face therapy with a shield (superficial, electrons) and IMRT/VMAT,...
How would you treat a patient with basal cell carcinoma of the medial canthus, with ultimately negative margins after Moh’s surgery, if tumor was “peeled off bone?”
I would treat this patient based on a conversation with the dermatologist, not the PA or other assistant. I'd tell the office that I need the dermatologist to give me 15 minutes and to have all the slides ready for review of what was actually removed, as the periosteum is a good barrier. I reckon th...
What preoperative printed materials would you provide to a patient, if any, to prepare them to have Mohs surgery?
We provide patients with a written preoperative packet that explains what Mohs surgery is, what to expect on the day of surgery, and basic preoperative instructions such as taking their usual medications unless otherwise directed, wearing comfortable clothing, and eating breakfast. You can also incl...
How would you manage a patient with FFA that is refractory to intralesional steroids, dutasteride, hydroxychloroquine, systemic retinoids and methotrexate?
Oral minoxidil (≤5 mg daily) serves as a reasonable adjunctive therapy for refractory FFA, primarily targeting hair regrowth in non-scarred areas rather than reversing follicular destruction, though evidence remains limited to case series and retrospective studies. Low-dose oral minoxidil has demons...
Do you recommend checking anti-drug antibodies for patients on TNF inhibitors?
This is a very good question with direct clinical practice implications. I do not check or follow anti-drug antibodies when using TNF inhibitors for the treatment of rheumatoid arthritis or psoriatic arthritis. There are reports that suggest, on a group level, that these antibodies, if present, impa...
Would you irradiate elective lymph nodes for a T1 Merkel cell carcinoma of the head and neck with a negative sentinel lymph node?
In general, I would not irradiate due to the negative sentinel lymph node biopsy (SLNBx). Either one trusts the prognostication of a SNLBx and obtains one, or not. If one does not trust the process of SLNBx, then you should not obtain one and electively treat. I do not see the utility in obtaining a...
Would you recommend sentinel lymph node biopsy at the time of wide excision for a 3 mm Merkel cell carcinoma of the cheek/lateral canthus?
Unlike melanoma and certainly NMSC, MCC is highly unpredictable in nature, with clinical lesion size having little clinical prognostic value. As such, it appears that SLNB is valuable in many cases for the purposes of prognosis and in determining the need for adjuvant systemic therapy and radiation....