Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
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...
Do you adjust PSA for finasteride use when determining prostate cancer stage and risk category?
We generally use the rule of 50% (real PSA is twice the lab value when on Finasteride).
Do you continue hydroxychloroquine in lupus patients who develop cardiomyopathy?
The short answer is yes, in that most lupus patients with cardiomyopathy do not have hydroxychloroquine drug induced cardiac injury. That is to say most of these patients either have ischemic cardiomyopathy or non-drug NICM. With that said, antimalarials can produce adverse effects both on the cardi...
What is your preferred setup/immobilization for patients with cutaneous malignancy of the toe involving the medial aspect of the digit?
I prefer surgery.
How would you approach a patient with metastatic Merkel cell carcinoma to the axillary/supraclavicular lymph nodes of unknown primary?
It's important to note that the first step is to thoroughly stage the patient - PET/CT (additional imaging as warranted) and a skin survey. For a patient with a nodal-only disease, I would approach this as a potentially curative case. While it's possible that the risk of distant metastatic disease i...