Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What are your recommendations for managing perivascular dermatitis with eosinophils unresponsive to high-dose antihistamines, a prednisone taper, and topical steroids?
I would check and treat for scabies.
What is your treatment algorithm for excoriation disorder?
Neurotic excoriation, also known as skin-picking disorder or excoriation disorder, is part of the obsessive–compulsive spectrum. There is no FDA-approved pharmacological treatment. The gold standard, evidence-based therapy is Habit Reversal Therapy (HRT), a form of cognitive behavioral therapy that ...
How would you approach treatment of an elderly patient with recurrent atypical fibroxanthoma (malignant spindle cell neoplasm) after Mohs surgery?
We published our experience of 8 cases of scalp atypical fibroxanthoma treated with XOFT 50 KeV photons as primary therapy. At 24 months, there was one failure which occurred in the only patient who was not debulked prior to radiation therapy.Treating with low energy photons or electrons after the r...
What is your preferred stain for melanocytic lesions?
Our lab uses all the listed stains. Which one(s) depends on context + question. Results will inevitably vary between labs. Currently, PRAME and SOX-10 are our two most popular. Nevus vs melanoma. PRAME, as an ancillary diagnostic test. Definitive confirmation of melanocytes (vs non-melanocytes) bey...
Are there guidlines for elective coverage of nodal basins in head and neck for skin cancer removed in the area?
Practically, I find the following tool from Aukland very helpful.They mapped melanoma lymphoscintigraphy data onto an interactive tool that allows you to select different locations and estimate the nodal drainage. https://sites.bioeng.auckland.ac.nz/hrey004/head/ https://sites.bioeng.auckland.ac....
Would you favor radiation or immune modulating treatment like imiquimod to treat an uncomplicated basal cell carcinoma on the nose in an elderly patient for whom you'd like to avoid surgery?
If my patient was concerned about deformity, with 10 to 15 years of life remaining, unquestionably, I would recommend radiation.
How do you work with your patients to ensure good coordination of care if they are seeing multiple providers within your specialty?
It's important to first explore the patient's reasons for seeing multiple dermatologists across different states—are there specific concerns, preferences, or barriers driving this pattern? Open a discussion with the patient to understand their perspective and emphasize the critical importance of com...
What factors do you weigh most heavily in the selection of radiotherapy versus topical treatments for lentigo maligna in a patient who is not a surgical candidate?
The ability of a patient to travel to multiple sessions of radiotherapy would play a major role in making this decision. If the patient is frail and has someone who could reliably to topical therapy, it might make me lean towards topical therapy.
How do you think about biologic use in patients with underlying HIV infection?
This is always a difficult problem, and a tough clinical call. However, over the years of seeing these people, I have come to realize that following their viral load and CD4 counts while looking for immunologic recovery allows us as Rheumatologists a lot of opportunities to treat. While I have class...
In your practice or during fellowship training, do you perform curettage of cutaneous carcinomas to define subclinical borders prior to Mohs?
RCT trial done by Huang et al., PMID 15389195 many years ago showed that curettage decreases layers and increases the size of defect but does not increase the number of flaps/grafts (this is all off memory, someone may want to check). So I curettage if I don't think a larger initial layer will chang...