Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
How do you approach patients with very low risk stage IIIA cutaneous melanoma for adjuvant immunotherapy?
Although it may seem that Stage 3A is a higher stage than Stage 2B and 2C, it must be kept in mind that according to AJCC 8 criteria, 2B and 2C melanomas are thicker (with to without ulceration), and a 3A melanoma is by definition a thinner melanoma. A thin melanoma (<2mm) is called a 3A melanoma be...
What treatments would you recommend for rosacea patients with persistent, soft/non-fibrotic cysts on the dorsal nose recalcitrant to chronic doxycycline and topical therapies?
Can consider a trial of a different oral antibiotic (such as a macrolide), or intralesional triamcinolone if lesions are discrete. However, I would likely proceed with a course of oral isotretinoin if there are no contraindications, given the recalcitrant nature of the disease. Doses usually range b...
What treatments and resources have you found helpful for ichthyosis vulgaris patients?
I also make sure to get my patients enrolled in Beiersdorf's free Aquaphor/Eucerin program. They help patients with ichthyosis by providing free products to them. Here's how to do it: Beiersdorf/Eucerin – Aquaphor has a program for families that use large amounts of Aquaphor. The company will send ...
Is there an effective treatment for severe radiation fibrosis of the skin after radiotherapy to the breast or other areas?
I have used this regimen occasionally with moderate success. Worth a try. Topical Vitamin E as well can help.
Do you treat fully resected squamous cell carcinoma of the ear with cartilage invasion with adjuvant radiation?
What were the margins? If sufficient (8-10 mm), I probably would not. I would certainly monitor the patient for lymph node metastases. Cartilage invasion is difficult to avoid for squamous cell cancer of the ear, so it is not surprising. Surgery is a better choice than radiation, unless so much cart...
When does perineural invasion for a squamous cell carcinoma of the skin of the head and neck merit adjuvant radiotherapy?
In cutaneous squamous cell carcinoma, the presence (vs absence) of perineural invasion is associated with a higher likelihood of local tumor recurrence after a margin negative excision. However, several recent studies have shown that for small caliber perineural invasion (invasion of a nerve <0.1 mm...
For a patient treated with Mohs surgery for a high risk skin cancer of the head/neck do you post-operatively treat all scars to full dose, including those created at subsequent closure?
There are a few high quality studies of adjuvant radiotherapy to the site of a primary skin cancer that help guide the answer to your question that I am aware of. Based on first principles, it would seem like the area that the tumor originated, as well as the surrounding area at risk for subclinical...
Would you take any precautions of plan radiation therapy differently for a patient with head and neck cancer who has active Bullous Pemphigoid in the mucosal area that will be radiated?
I have no idea. Probably not. I would roll on and, hopefully, not regret it.
Would you offer adjuvant radiation for a <1 cm preauricular sebaceous carcinoma after wide local excision?
I limit the use of postoperative radiation therapy to those cases where there is a moderate likelihood of residual tumor that could develop into a clinical recurrence. In this case, I would have expected the shave biopsy to have positive margins. The lesion was then widely resected by a competent EN...
When would you recommend hyperbaric oxygen treatments for skin ulceration/non-healing wounds in a radiated field?
I agree with @Dr. First Last' answer. Careful planning and attempts to avoid non-healing wounds is important, but this can happen. Conservative management should be used before hyperbaric O2 except for severe toxicities such as radiation optic neuropathy where all reasonable measures should be consi...