Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
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...
What risk factors prompt you to treat an early-stage nasal squamous cell carcinoma of the skin with post-operative radiation to the primary and/or elective nodal radiation?
I would probably treat the site of the primary tumor if margins were positive and further surgery was not planned, tumor invaded to a depth of 6 mm or more, or there was perineural invasion of a nerve 0.1 mm or greater in diameter. I would probably not recommend elective nodal irradiation unless th...
Would you recommend surgery +/- adjuvant XRT or definitive XRT in elderly patients with recurrent squamous cell carcinoma of the ear with direct invasion through the cartilage of the helix?
It depends on co-morbidities and functional outcome of surgery. Preferably surgery and postoperative radiotherapy. However, if surgery is not in the cards, radiation alone to 70 Gy in 35 fractions or the equivalent using altered fractionation.
In which clinical situations, if any, would you use imiquimod for treatment of breast cancer skin metastases?
Imiquimod is synthetic toll-like receptor (TLR)7 agonist that has immunostimulatory effects when applied topically. Topical application can enhance clearance of human papillomavirus (HPV)-​related genital warts, and might lower cancers associated with HPV, and is approved for that purpose. It has ...
Is there a role for treating actinic keratosis with superficial radiation therapy to widespread areas on scalp?
No.
Would you offer adjuvant radiation to the surgical bed for a Merkel cell carcinoma of the upper extremity with low-risk features as per the NCCN Guidelines?
There is no clear role for adjuvant RT here. This is a low risk situation and may be safely observed.
How would you manage a high risk SCC of the scalp that has wound healing issues after Mohs surgery?
Refer the patient to plastic surgeon for wound repair. Indicate that the cancer is high risk for recurrence and warrants adjuvant RT (sooner rather than later), and that a vascularized reconstruction is preferable for that reason. In our experience, 60 Gy in 30 fractions is effective to prevent loca...
Would you offer adjuvant RT for a small merkel cell carcinoma of the lateral canthus with a close margin?
Yes. The low rates of local recurrence after excision that I am familiar with are all after a "wide" excision is performed. In our institutional analyses that demonstrated a low rate of local recurrence after surgery without adjuvant radiotherapy to the site of the resected primary tumor, the median...