Semin Cutan Med Surg
· 2019 Mar · PMID 31051028
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The incidence of advanced cutaneous squamous cell carcinoma (cSCC) is increasing; of the 1.3 million nonmelanoma skin cancers that arise each year, approximately 20% are cSCC, and between 2-5% of these cases ultimately m...The incidence of advanced cutaneous squamous cell carcinoma (cSCC) is increasing; of the 1.3 million nonmelanoma skin cancers that arise each year, approximately 20% are cSCC, and between 2-5% of these cases ultimately metastasize. However, there is no established consensus on first-line systemic treatment for those patients who have locally advanced or metastatic disease. Major classes of systemic agents include chemotherapy, epidermal growth factor receptor (EGFR)-targeted therapy, and immunotherapy; each is associated with a distinct set of adverse effects, and availability of data from randomized controlled trials (RCTs) to definitively guide treatment are limited. While several chemotherapeutic agents have been described in case studies or small patient cohorts, only one RCT has been conducted, demonstrating a 34% overall response rate for a cisplatin-based regimen. EGFR-inhibitors evaluated for use in cSCC by RCT include cetuximab, panitumumab, and gefitinib; response rates ranged from 15-31% for these agents. Inhibitors of the immune checkpoint programmed death-1 (PD-1) have yielded promising outcomes in advanced cSCC; indeed, the PD-1 inhibitor cemiplimab recently received FDA approval for use in advanced cSCC. Despite these advances, the preferred regimen for systemic treatment of cSCC remains unclear, particularly in immunocompromised populations. Herein we provide a review of the literature supporting the use of these modalities and a discussion of their clinical utility.
Semin Cutan Med Surg
· 2019 Mar · PMID 31051027
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Atypical fibroxanthoma (AFX) is a dermal spindle-cell sarcoma that is considered a superficial and clinically benign presentation of pleomorphic dermal sarcoma, malignant fibrous histiocytoma, and undifferentiated pleomo...Atypical fibroxanthoma (AFX) is a dermal spindle-cell sarcoma that is considered a superficial and clinically benign presentation of pleomorphic dermal sarcoma, malignant fibrous histiocytoma, and undifferentiated pleomorphic sarcoma. AFX appears clinically as a discrete red or pink nodule or papule, most commonly on the head and neck region of sun-damaged elderly patients. Histologic findings on routine hematoxylin and eosin staining reveal spindle-shaped, large, and pleomorphic tumor cells throughout the dermis. Immunohistochemistry is not specific for AFX, and the diagnosis is generally one of exclusion. AFX is best treated by complete surgical excision, with Mohs micrographic surgery considered the treatment of choice. Metastasis rarely occurs, but there is a high rate of local recurrence, especially in patients who are immunosuppressed.
Semin Cutan Med Surg
· 2019 Mar · PMID 31051025
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Emerging technology is fundamentally changing how individuals interact with the health care system. Web-based searches, mobile applications, social media, and directto- consumer genetic testing companies are facilitating...Emerging technology is fundamentally changing how individuals interact with the health care system. Web-based searches, mobile applications, social media, and directto- consumer genetic testing companies are facilitating information exchange at a higher rate than ever before, creating a macroscopic shift in the mechanisms by which individuals seek health information. The visual nature of skin disease enables individuals to browse, share, and search based on images, adding another dimension to how dermatological information is transferred. These trends carry important implications on user health care behavior, and so it is vital for health care professionals to stay attuned to the morphing characteristics of their patients' health management in order to continue to provide high-quality, patient-centered care.
Petrie T, Samatham R, Goodyear SM
… +2 more, Webster DE, Leachman SA
Semin Cutan Med Surg
· 2019 Mar · PMID 31051024
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Advancements in smartphone technologies and the use of specialized health care applications offer an exciting new era to promote melanoma awareness to the public and improve education and prevention strategies. These app...Advancements in smartphone technologies and the use of specialized health care applications offer an exciting new era to promote melanoma awareness to the public and improve education and prevention strategies. These applications also afford an opportunity to power meaningful research aimed at improving image diagnostics and early melanoma detection. Here, we summarize our experience associated with developing and managing the implementation of MoleMapper™, a research-based application that not only provides an efficient way for users to digitally track images of moles and facilitate skin self-examinations but also provides a platform to crowdsource research participants and the curation of mole images in efforts to advance melanoma research. Obtaining electronic consent, safeguarding participant data, and employing a framework to ensure collection of meaningful data represent a few of the inherent difficulties associated with orchestrating such a wide-scale research enterprise. In this review, we discuss strategies to overcome these and other challenges leading to the implementation of MoleMapper™.
Semin Cutan Med Surg
· 2019 Mar · PMID 31051023
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In this chapter, we present the use of whole slide imaging (WSI) and dermoscopy in the field of dermatology. Image digitization has allowed for increasing computer-assisted clinical decision-making. An introduction to co...In this chapter, we present the use of whole slide imaging (WSI) and dermoscopy in the field of dermatology. Image digitization has allowed for increasing computer-assisted clinical decision-making. An introduction to common digital imaging data sources such as WSI and dermoscopy is provided. We also review some commonly used image quantification methods and their potential applications in dermatology. Finally, we review how machine learning approaches utilize novel large dermatology image datasets.
Rotemberg V, Halpern A, Dusza S
… +1 more, Codella NC
Semin Cutan Med Surg
· 2019 Mar · PMID 31051022
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In the past decade, machine learning and artificial intelligence have made significant advancements in pattern analysis, including speech and natural language processing, image recognition, object detection, facial recog...In the past decade, machine learning and artificial intelligence have made significant advancements in pattern analysis, including speech and natural language processing, image recognition, object detection, facial recognition, and action categorization. Indeed, in many of these applications, accuracy has reached or exceeded human levels of performance. Subsequently, a multitude of studies have begun to examine the application of these technologies to health care, and in particular, medical image analysis. Perhaps the most difficult subdomain involves skin imaging because of the lack of standards around imaging hardware, technique, color, and lighting conditions. In addition, unlike radiological images, skin image appearance can be significantly affected by skin tone as well as the broad range of diseases. Furthermore, automated algorithm development relies on large high-quality annotated image data sets that incorporate the breadth of this circumstantial and diagnostic variety. These issues, in combination with unique complexities regarding integrating artificial intelligence systems into a clinical workflow, have led to difficulty in using these systems to improve sensitivity and specificity of skin diagnostics in health care networks around the world. In this article, we summarize recent advancements in machine learning, with a focused perspective on the role of public challenges and data sets on the progression of these technologies in skin imaging. In addition, we highlight the remaining hurdles toward effective implementation of technologies to the clinical workflow and discuss how public challenges and data sets can catalyze the development of solutions.
Schlessinger DI, Chhor G, Gevaert O
… +3 more, Swetter SM, Ko J, Novoa RA
Semin Cutan Med Surg
· 2019 Mar · PMID 31051021
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The application of artificial intelligence (AI) to medicine has considerable potential within dermatology, where the majority of diagnoses are based on visual pattern recognition. Opportunities for AI in dermatology incl...The application of artificial intelligence (AI) to medicine has considerable potential within dermatology, where the majority of diagnoses are based on visual pattern recognition. Opportunities for AI in dermatology include the potential to automate repetitive tasks; optimize time-consuming tasks; extend limited medical resources; improve interobserver reliability issues; and expand the diagnostic toolbox of dermatologists. To achieve the full potential of AI, however, developers must aim to create algorithms representing diverse patient populations; ensure algorithm output is ultimately interpretable; validate algorithm performance prospectively; preserve human-patient interaction when necessary; and demonstrate validity in the eyes of regulatory bodies.
Semin Cutan Med Surg
· 2019 Mar · PMID 31051020
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The influences of information technology have touched almost all aspects of our lives, and health care delivery has been no exception. Law, policy, and regulation have driven the adoption of electronic medical records, p...The influences of information technology have touched almost all aspects of our lives, and health care delivery has been no exception. Law, policy, and regulation have driven the adoption of electronic medical records, particularly over the past decade, driving fundamental changes to the practice of medicine in general and dermatology in particular. This article reviews the history of these changes, the regulations that drove these changes, the intended and unintended consequences of these initiatives, and our insights into the appropriate roles for policy and regulation to drive positive change.
Daneshjou R, Huddart R, Klein TE
… +1 more, Altman RB
Semin Cutan Med Surg
· 2019 Mar · PMID 31051019
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Pharmacogenomics aims to associate human genetic variability with differences in drug phenotypes in order to tailor drug treatment to individual patients. The massive amount of genetic data generated from large cohorts o...Pharmacogenomics aims to associate human genetic variability with differences in drug phenotypes in order to tailor drug treatment to individual patients. The massive amount of genetic data generated from large cohorts of patients with variable drug phenotypes have led to advances in this field. Understanding the application of pharmacogenomics in dermatology could inform clinical practice and provide insight for future research. The Pharmacogenomics Knowledge Base and the Clinical Pharmacogenetics Implementation Consortium are among the resources to help clinicians and researchers navigate the many gene-drug associations that have already been discovered. The implementation of clinical pharmacogenomics within health care systems remains an area of ongoing development. This review provides an introduction to the field of pharmacogenomics and to current pharmacogenomics resources using examples of gene-drug associations relevant to the field of dermatology.
Semin Cutan Med Surg
· 2019 Mar · PMID 31051018
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Skinomics is a field of bioinformatics applied specifically to skin biology and, by extension, to dermatology. Skinomics has been expanding into extensive genome-wide association studies, eg, of psoriasis, proteomics, li...Skinomics is a field of bioinformatics applied specifically to skin biology and, by extension, to dermatology. Skinomics has been expanding into extensive genome-wide association studies, eg, of psoriasis, proteomics, lipidomics, metabolomics, metagenomics, and the studies of the microbiome. Here, the current state of the field of transcriptomics is reviewed, including the studies of the gene expression in human skin under several healthy and disease conditions. Specifically, transcriptional studies of epidermal differentiation, skin aging, effects of cytokines, inflammation with emphases on psoriasis and atopic dermatitis, and wound healing are reviewed. The transition from microarrays to NextGen sequencing is noted and potential future directions suggested.
Semin Cutan Med Surg
· 2019 Mar · PMID 31051017
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Bioinformatics uses computationally intensive approaches to make sense of complex biological data sets. Here we review the role of bioinformatics in 3 areas of biology: genetics, transcriptomics, and microbiomics. Exampl...Bioinformatics uses computationally intensive approaches to make sense of complex biological data sets. Here we review the role of bioinformatics in 3 areas of biology: genetics, transcriptomics, and microbiomics. Examples of bioinformatics in each area are given with respect to psoriasis and psoriatic arthritis, related inflammatory disorders at the forefront of bioinformatic research in dermatology. While bioinformatic technologies and analyses have traditionally been developed and deployed in siloes, the field of integrative omics is on the horizon. Powered by the advent of machine learning, bioinformatic integration of large data sets has the potential to dramatically revolutionize our knowledge of pathogenetic mechanisms and therapeutic targets.
Semin Cutan Med Surg
· 2018 Dec · PMID 30605493
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Psoriasis is a chronic skin condition that is associated with several comorbidities and co-manifestations that reduce patient quality of life. Psoriatic arthritis (PsA) is a form of spondyloarthritis that is associated w...Psoriasis is a chronic skin condition that is associated with several comorbidities and co-manifestations that reduce patient quality of life. Psoriatic arthritis (PsA) is a form of spondyloarthritis that is associated with psoriasis and typically involves peripheral disease, axial disease, enthesitis, dactylitis, and skin and nail lesions. Psoriatic arthritis is associated with a substantial psychosocial and functional burden and can lead to irreversible joint damage if left untreated. Early and accurate diagnosis of PsA is critical. The symptoms of PsA span the fields of dermatology and rheumatology, and professional societies recommend co-management between rheumatologists and dermatologists to optimally treat the condition. Dermatologists must be familiar with the hallmarks of PsA, while rheumatologists should understand the impact that cutaneous manifestations of PsA can have on quality of life. Current models of co-management include combined clinics and virtual clinics, which have had success in case reports. Co-management of PsA has been associated with more use of biologics, better preventive care, and higher patient satisfaction.
Semin Cutan Med Surg
· 2018 Dec · PMID 30475935
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Melasma is a common, acquired, chronic cutaneous pigment disorder that is often difficult to treat and has a high recurrence rate. The goal of a melasma treatment regimen is to decrease pigment production and increase el...Melasma is a common, acquired, chronic cutaneous pigment disorder that is often difficult to treat and has a high recurrence rate. The goal of a melasma treatment regimen is to decrease pigment production and increase elimination. Topical tyrosinase inhibitors block melanin synthesis and thereby reduce pigment production. Peels and laserand light-based devices increase melanin elimination. A multimodality treatment approach targeting both pigment production and elimination is necessary to achieve equilibrium and disease remission. Maintenance treatments are often necessary due to the high recurrence rate. Strict photoprotection is critical to prevent melanogenesis and rebound. Targeting the vasculature via pulsed dye laser or tranexamic acid is another approach to treatment.
Semin Cutan Med Surg
· 2018 Dec · PMID 30475934
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Many medical conditions can cross over the territories of various specialties. These conditions may benefit from, or even require, a multidisciplinary approach. While ideally this leads to a collaborative and coveted pat...Many medical conditions can cross over the territories of various specialties. These conditions may benefit from, or even require, a multidisciplinary approach. While ideally this leads to a collaborative and coveted patient-centered care model, it can also give rise to competitive turf wars. A popular topic that has entered the turf wars is vaginal rejuvenation. Vaginal rejuvenation through light- and energy-based devices is a rapidly expanding field, quickly gaining the attention of dermatologists and gynecologists alike. Dermatology has the most experience and expertise with lasers and energy-based devices for rejuvenation, whereas gynecology has the advanced knowledge of the vaginal anatomy, tissue structure, and function. We herein argue that a collaborative effort between dermatology and gynecology is most appropriate for proper care of our patients and for the advancement of this growing niche.
Semin Cutan Med Surg
· 2018 Dec · PMID 30475932
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Dermatologists were the pioneers in the development of laser technology and have the most experience using these lasers to treat the external genitalia for many cutaneous disorders. Dermatologists who have experience and...Dermatologists were the pioneers in the development of laser technology and have the most experience using these lasers to treat the external genitalia for many cutaneous disorders. Dermatologists who have experience and expertise using lasers and devices, are already using them to treat the external genitalia, and are comfortable performing female gynecologic exams may want to explore the wide range of options that are available to treat the functional and aesthetic needs of the female population. Dermatologists should work with obstetricians and gynecologists to ensure that patients are proper candidates for the procedures.
Semin Cutan Med Surg
· 2018 Dec · PMID 30475930
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Cellulite is a common dermatologic condition and frequent cause of cosmetic concern among women. This paper aims to update what is known about the pathogenesis of cellulite and reviews targeted treatment modalities that...Cellulite is a common dermatologic condition and frequent cause of cosmetic concern among women. This paper aims to update what is known about the pathogenesis of cellulite and reviews targeted treatment modalities that address its underlying components of microvascular dysfunction, endocrine-mediated inflammation, and connective tissue fibrosclerosis.