Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
How do you approach patients with metastatic uveal melanoma not a candidate for tebentafusp-tebn?
I perform genomics and try to find a clinical trial that fits the patient. Including local liver therapies, such as the Delcath catheter treatment if available. Isolated liver lesion could also be resectable, so I request a surgical opinion. If nothing is available, then I offer ipilimumab/nivolumab...
How do you approach postoperative radiation therapy in a patient with head and neck cancer who has high risk of recurrence in the setting of active epidermolysis bullosa?
Epidermolysis bullosa is a rare genetic entity characterized by collagen mutations affecting the attachment of epithelial cells to the basement membrane of the skin and mucosa, manifesting in blistering and non-healing skin wounds and mucosal strictures in the GI tract. There is a risk of non-healin...
In what situations would you recommend adjuvant radiation therapy for patients with locally advanced and/or recurrent basal cell carcinoma that receive vismodegib followed by surgery?
Adjuvant radiation therapy should be considered for locally advanced basal cell carcinomas when surgical margins are positive, or when there is perineural invasion, particularly in high-risk anatomical locations such as the face. This recommendation is endorsed by both the NCCN and the American Acad...
How would you approach the radiation treatment of multiple recurrent lentigo maligna on the sole of the foot in an active patient not desiring further surgery?
While surgery remains the gold standard in the management of lentigo maligna (LM), radiotherapy has been used for decades as an alternative, particularly in those patients with surgical comorbidities or where surgery may result in poor functional or cosmetic outcomes. Additionally, radiotherapy is o...
Would you give lung SBRT to a patient with bullous pemphigoid on the chest and torso?
If this patient has a clinically relevant lung cancer (which, by the clinical description, it sounds like it is felt they do) then I would feel comfortable treating them with SBRT. The very focal nature of SBRT makes this a very different scenario than large-field radiation. There is minimal data ov...
Would you be comfortable using isotretinoin in a female teenage patient who has a history of depression that is now stable but with a prior suicide attempt two years ago?
Yes. There is ample evidence that isotretinoin does not cause depression. In the large Canadian study, there was a slightly negative association with suicide. As the good doctors noted above, using appropriate step therapy, with informed consent (especially regarding pregnancy and birth defects), is...
What treatment combination approach would you recommend for mucous membrane pemphigoid?
First, it is important to know the extent and severity of the disease (oral, ocular, esophageal); the type of inflammatory infiltrate on histopathology (neutrophils, eosinophils, or cell-poor); and the results of salt split skin and antibody titers on monkey esophagus and/or target antigens (collage...
How do you treat molluscum on the eyelid in a child or an adult?
Usually, I don't treat molluscum in this area due to sensitivity, especially in kids. It's been decades since I encountered MC on the eyelid of an adult, but if bothersome, and the patient is cooperative, I would numb the sites and remove larger lesions with an iris scissors. Last week, Zelsuvmi top...
What therapies have you found most effective in treating teenagers with recurrent CARP?
I have found CARP to be uniformly responsive to minocycline. In my experience, the incidence of recurrence is low and normally responds to minocycline.
How do you counsel patients with AKs such that they are motivated to improve or optimize sun protection behaviors?
Some thoughts and approaches that may help: It is very challenging (possibly close to impossible!) to induce behavior change in anyone, much less someone not motivated to change, so recognize your role as being a teacher/provider of information and do not assume a sense of personal responsibility f...