Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
Would you offer adjuvant radiation therapy for a Merkel cell carcinoma limited to the epidermis with close margins?
I would review this case with a dermatopathology expert before making any decisions. The reason is that normal Merkel cells usually lie in very close proximity to the basement membrane. My understanding is that a skin neoplasm that is limited to the epidermis does not broach the basement membrane, a...
How would you manage a patient with cutaneous SCC of the lower extremity with isolated inguinal nodal involvement?
Good timing for this question, since I’m currently treating a similar case of Merkel Cell Carcinoma (MCC) on dorsal skin of wrist with isolated axillary nodal involvement. The same oncologic principles should apply for SqCC as well: As far as surgery is concerned, wide local excision (WLE) for the ...
What therapies have you had the most success with for calcinosis cutis in dermatomyositis patients?
Treatment of calcinosis cutis is difficult with therapy aimed at the underlying condition. Many of the treatments that have been tried in the literature have been reported in small case reports/series and have had variable success rates. I have tried diltiazem (limited by lightheadedness and fatigue...
When is it necessary to monitor the QTc interval in patients on hydroxychloroquine?
The answer to this question is not straightforward mainly because there are limited data in this area. Hydroxychloroquine and Chloroquine directly affect cardiac repolarization and are associated with QT prolongation. Given this, there is an argument for getting a baseline ECG for patients initiatin...
What surveillance plan would you recommend for stage IV melanoma patients who achieve a CR or stable PR response with immunotherapy?
If melanoma patients have achieved CR or PR after a year of immunotherapy treatment, I highly recommend participation in this ongoing ECOG cooperative study: EA6192 / PET-Stop Educational Materials - ECOG-ACRIN Cancer Research Group (NCT04462406). The study uses PET scans in combination with contras...
Does calcinosis appear differently in patients with dermatomyositis compared to systemic sclerosis?
Classically, calcinosis in dermatomyositis and scleroderma are different with dermatomyositis having more typical sheet-like calcinosis in the muscles whereas in scleroderma it is more typical on the fingers, extensor surfaces of the forearm, olecranon, knee, and shins. However, many sclerodermas al...
What is your methotrexate initiation strategy in DMARD-naive RA patients?
Best final dose is 20 to 25 mg per week, not 15 mg per week. D Furst
How do you choose between oral and IV cyclophosphamide for the treatment of ANCA-associated vasculitis?
When considering cyclophosphamide for induction in severe AAV, both oral and IV regimens are reasonable routes of administration. In the CYCLOPS trial (DeGroot, Ann Int Med, 2009), oral cyclophosphamide 2mg/kg/d was compared with IV CYC 15mg/kg q 2 weeks for the first three pulses, then every 3 week...
How do you approach patients with ANCA vasculitis who had partial response, but continue to have disease activity on q 6 month maintenance rituximab and remain on steroids?
This question raises some fundamental issues about the management of patients with ANCA-associated vasculitis (as well as other vasculitides or chronic inflammatory disorders), including i) the need to consider the potential contribution of comorbidities to clinical signs or symptoms suggestive of v...
How do you approach breast conserving therapy in a woman who has formed bothersome keloids after prior surgeries?
I have only seen a few patients who developed keloids following breast surgery, whether or not they received radiation therapy. That also is true of individuals who have had keloids on other parts of their body. Hence, this fortunately seems to be a rare event, and I do not think prophylactic steroi...