-
Annals of Dermatology Jun 2024With the increasing demand for surgical procedures in dermatology, resident education in surgical dermatology has become important for delivering high-quality treatment....
BACKGROUND
With the increasing demand for surgical procedures in dermatology, resident education in surgical dermatology has become important for delivering high-quality treatment. However, it remains unclear if a sufficient number of residency programs with quality standards exist, as there has been little research on this subject in South Korea.
OBJECTIVE
To identify the status of surgical dermatology education among residents and assess dermatologists' perceptions of the subject.
METHODS
A 35-question survey was developed and distributed to all resident training hospitals and local clinics listed by the Korean Society of Dermatologic Surgery. Only third- and fourth-year residents were included and board-certified specialists from training hospitals and local clinics responded to the surveys.
RESULTS
Survey participants included 88 residents and 120 specialists of whom one-quarter of the residents attended regular monthly educational sessions. Most residents (93%) participated in cosmetic procedures, and many performed laser therapy. However, the opportunity for toxin or filler injection was rare, with only 12% of the residents having experience with filler injections. In response, 49% of residents and 32% of specialists said that more cosmetic training was required, whereas 28% of residents and 50% of specialists said that more training for both cosmetic and conventional surgeries was necessary.
CONCLUSION
The survey demonstrated a need for more training programs in surgical dermatology during residency and a perception gap between residents and specialists. Therefore, developing educational residency programs that focus on basic dermatologic surgery principles and their applications in cosmetic procedures is essential.
PubMed: 38816978
DOI: 10.5021/ad.23.130 -
Frontiers in Medicine 2024Fewer than 26 case reports describe hypertrophic lichen planus (HLP) misdiagnosed as cutaneous squamous cell carcinoma (cSCC). It can be difficult to distinguish between...
Fewer than 26 case reports describe hypertrophic lichen planus (HLP) misdiagnosed as cutaneous squamous cell carcinoma (cSCC). It can be difficult to distinguish between HLP and cSCC, as these two conditions share many clinical and histopathological characteristics. Patients who are misdiagnosed with cSCC often undergo unnecessary medical and/or surgical interventions before receiving a diagnosis of HLP and improving on HLP-directed therapy. This case series highlights the course of three female patients, referred to a single tertiary institution between 2018 and 2022, who were initially misdiagnosed with cSCC before receiving a diagnosis of HLP. We have emphasized the clinical and histopathological distinguishing features between HLP and cSCC, the pathogenesis of HLP, and current and new HLP-directed therapy. We hope that this case series serves as a reminder to dermatologists, dermatologic surgeons, and dermatopathologists to be aware of this diagnostic challenge.
PubMed: 38813374
DOI: 10.3389/fmed.2024.1342501 -
Clinical Kidney Journal May 2024hydrochlorothiazide (HCTZ) diuretics were correlated with an increased risk of non-melanoma skin cancer (NMSC) and melanoma in the general population. Information is a...
BACKGROUND
hydrochlorothiazide (HCTZ) diuretics were correlated with an increased risk of non-melanoma skin cancer (NMSC) and melanoma in the general population. Information is a scarce regarding this effect in kidney transplant recipients who are at increased risk of skin malignancies under immunosuppression.
METHODS
Single-center retrospective analysis of adult kidney transplant recipients between 1 January 2010 and 31 December 2015. The primary outcome of the study was the first diagnosis of skin cancer that was removed and pathologically analyzed. Exposure to thiazides was defined as HCTZ use daily for at least one year at a dose of 12.5 mg.
RESULTS
Among 520 kidney transplant recipients, 50 (9.4%) were treated with HCTZ. During a median follow-up of 9.8 years, 67 patients underwent surgical removal and pathological analysis of at least one skin cancer. Exposure to HCTZ during the 3 years following transplantation was associated with an increased risk of skin cancer ( = 0.004). In a multivariate model, there was a significant association between HCTZ exposure and NMSC (HR 2.54, 95%CI 1.26-5.15, = 0.007). There was a higher rate of basal cell carcinoma with HCTZ exposure, according to both univariate and multivariate analyses (HR 2.61, 95%CI 1.06-6.43, = 0.037) and (HR 3.03, 95%CI 1.22-7.55, = 0.017, respectively). However, no significant association was observed between HCTZ exposure and squamous cell carcinoma.
CONCLUSIONS
These findings suggest a benefit of increased frequency of dermatologist inspection in kidney transplant recipients receiving HCTZ especially in increased ultraviolet exposure area.
PubMed: 38812910
DOI: 10.1093/ckj/sfae126 -
Melanoma Management 2024Cutaneous melanocytic neoplasms with diagnostic and/or clinical ambiguity pose patient management challenges. Six randomized case scenarios with diagnostic/clinical...
Cutaneous melanocytic neoplasms with diagnostic and/or clinical ambiguity pose patient management challenges. Six randomized case scenarios with diagnostic/clinical uncertainty were described with/without a benign or malignant diagnostic gene expression profile (GEP) result. Clinical impact was assessed by reporting the mean increase/decrease of management changes normalized to baseline (n = 32 dermatologists). Benign GEP results prompted clinicians to decrease surgical margins (84.2%). Malignant GEP results escalated surgical excision recommendations (100%). A majority (72.2%) reduced and nearly all (98.9%) increased follow-up frequency for benign or malignant GEP results, respectively. There was an overall increase in management plan confidence with GEP results. Diagnostic GEP tests help guide clinical decision-making in a variety of diagnostically ambiguous or clinicopathologically discordant scenarios.
PubMed: 38812731
DOI: 10.2217/mmt-2023-0002 -
Dermatology and Therapy Jun 2024Atopic dermatitis (AD) is a highly heterogeneous chronic inflammatory skin disorder that is frequently associated with a plethora of comorbidities. AD is, therefore,... (Review)
Review
Atopic dermatitis (AD) is a highly heterogeneous chronic inflammatory skin disorder that is frequently associated with a plethora of comorbidities. AD is, therefore, considered a systemic disease impacted by a considerable burden and leading to poor quality of life, especially in patients with moderate-to-severe disease. Since atopic and non-atopic comorbidities can further worsen the disease course, accurate establishment of the patient's individual intrinsic risk profile and needs is crucial and may help in guiding the selection of the best treatment option. Better quality of care for patients with AD can be delivered through a multidisciplinary team led by a dermatologist, for comprehensive patient management. The implementation of a multidisciplinary approach for AD could enhance the delivery of optimised and safe treatments, improve the standard of care and patient outcomes in the short and long term, and prevent or delay the lifelong impact of uncontrolled AD. Understanding the unmet needs, assessing correctly the patient risk profile and enhancing the shared patient-physician decision-making process can lead to disease control and quality-of-life improvement, especially in the context of the introduction of newer treatment for AD. This narrative review is a call for more data to establish standardised patient profiles and multidisciplinary strategies in AD management. In view on the fast-evolving treatments for AD, this review aims at highlighting the importance of a multidisciplinary approach to a comprehensive assessment and holistic care in patients with moderate-to-severe AD.
PubMed: 38811470
DOI: 10.1007/s13555-024-01185-1 -
Dermatology Practical & Conceptual Apr 2024Scientific evidence supports dermoscopy as an essential tool in dermatological diagnosis.
INTRODUCTION
Scientific evidence supports dermoscopy as an essential tool in dermatological diagnosis.
OBJECTIVES
The objective is to know the factors that influence its use in Chilean dermatologists.
METHODS
Analytical cross-sectional study. An adapted version of the survey was submitted from the pan-European study by Forsea et al to members of the Chilean Society of Dermatology, between September and December 2020. Analysis using descriptive statistics and multivariate analysis with ordinal logistic regression looking for factors associated with greater use of.
RESULTS
One hundred and ninety-eight responses, mean age 46.3 years and 14.6 years on average practicing as dermatologists. 61.6% trained in dermoscopy during their residency. 98% use a dermatoscope. More than 80% consider dermoscopy useful for the diagnosis of melanomas, follow-up of melanocytic lesions, and diagnosis of pigmented and non-pigmented tumors. Between 50% and 70% consider it useful for monitoring non-melanocytic lesions, nail and hair pathologies. Greater confidence when evaluating pigmented and non-pigmented tumors and capillary pathology. Adjusting for age, sex, confidence, and education, participation in teaching was associated with greater use of dermoscopy in non-pigmented and pigmented tumors, and capillary pathology.
CONCLUSIONS
Percentage of participation in the survey and training in dermoscopy higher than in the reference study, recognizing the usefulness of dermoscopy for the diagnosis and follow-up of tumor pathologies. Participating in teaching is a strong independent factor that is associated with a greater use of dermoscopy in Chile. Dermoscopy is positioned as a tool widely used by Chilean dermatologists in their daily practice.
PubMed: 38810061
DOI: 10.5826/dpc.1402a71 -
Dermatology Practical & Conceptual Apr 2024Dermoscopy has evolved over the years beyond distinguishing benign pigmented lesions from melanoma to diagnosing virtually all diseases in dermatology. Overwhelming...
INTRODUCTION
Dermoscopy has evolved over the years beyond distinguishing benign pigmented lesions from melanoma to diagnosing virtually all diseases in dermatology. Overwhelming evidence demonstrates its utility in improving diagnostic accuracy, reducing unnecessary biopsies and lesion monitoring. Dermoscopy is widely used in Western nations, hence most descriptions of lesions in literature are predominantly on Fitzpatrick skin types I-III. Current evidence shows that there are unique dermoscopic features in the dark skin as a result of pigment and pathological reactions. Nationwide surveys and reports have been conducted across several continents to highlight prevalence and factors influencing dermoscopy use with the hope of maximizing its apparent benefits. There are currently no such reports from Africa.
OBJECTIVES
To evaluate dermoscopy use and its determinants among dermatologists in Africa.
METHODS
A cross-sectional study. Online forms were e-mailed to individual practicing dermatologists and members of the African Society of Dermatologists and Venereologists.
RESULTS
There were 196 respondents from 24 African countries. Half of them used dermoscopy. Training, practice settings and location, provision of dermatoscopes by institutions and knowledge of criteria were notable significant determinants. Multiple training exposures, knowledge of criteria, availability of dermatoscopes, use of both hand-held and videodermatoscopes, average number of patients seen per day, and a positive outlook towards dermoscopy were significant determinants of frequency of use. Leading impediments were lack of training and inadequate dermatoscopes in practice.
CONCLUSIONS
Dermoscopy use in Africa is relatively low. Incorporating dermoscopy training into the curriculum with provision of dermatoscopes by training institutions will promote wider usage.
PubMed: 38810048
DOI: 10.5826/dpc.1402a98 -
Dermatology Practical & Conceptual Apr 2024The oral health of psoriatic patients seems to be compromised compared to that of control individuals: many published studies have investigated the relationship between... (Review)
Review
INTRODUCTION
The oral health of psoriatic patients seems to be compromised compared to that of control individuals: many published studies have investigated the relationship between psoriatic disease and gingivitis, periodontitis, and missing teeth. However, data from these studies are not consistent nor exhaustive. Moreover, no study has considered the possible specific effects of conventional and biological systemic psoriatic treatments.
OBJECTIVE
We report a narrative review of the literature about the possible link between anti-psoriatic drugs and oral disease onset and present case series of patients that have experienced oral disease during systemic therapy for psoriasis.
METHODS
This is a narrative review. The literature search was performed using the MEDLINE database. From the selected articles, additional references were identified by a manual search among the cited literature.
RESULTS
Oral adverse events during psoriatic therapies can be found in sporadic cases. The specific mechanisms of interplay between oral anatomic structures and the pathway targeted by the systemic agents will be investigated in depth.
CONCLUSION
All psoriatic patients who are candidates for conventional or biological systemic therapy should have regular oral health check-ups with a dentist and a dermatologist to prevent oral complications. Dermatologists and oral medicine specialists should be ready to recognize and manage this increasing number of oral adverse drug reactions during systemic treatments for psoriatic disease so as to provide patients with sufficient information about this risk and to stress the fundamental importance of regular dental assessments and good oral hygiene.
PubMed: 38810043
DOI: 10.5826/dpc.1402a107 -
Asian Pacific Journal of Cancer... May 2024Skin cancer diagnosis challenges dermatologists due to its complex visual variations across diagnostic categories. Convolutional neural networks (CNNs), specifically the...
BACKGROUND
Skin cancer diagnosis challenges dermatologists due to its complex visual variations across diagnostic categories. Convolutional neural networks (CNNs), specifically the Efficient Net B0-B7 series, have shown superiority in multiclass skin cancer classification. This study addresses the limitations of visual examination by presenting a tailored preprocessing pipeline designed for Efficient Net models. Leveraging transfer learning with pre-trained ImageNet weights, the research aims to enhance diagnostic accuracy in an imbalanced multiclass classification context.
METHODS
The study develops a specialized image preprocessing pipeline involving image scaling, dataset augmentation, and artifact removal tailored to the nuances of Efficient Net models. Using the Efficient Net B0-B7 dataset, transfer learning fine-tunes CNNs with pre-trained ImageNet weights. Rigorous evaluation employs key metrics like Precision, Recall, Accuracy, F1 Score, and Confusion Matrices to assess the impact of transfer learning and fine-tuning on each Efficient Net variant's performance in classifying diverse skin cancer categories.
RESULTS
The research showcases the effectiveness of the tailored preprocessing pipeline for Efficient Net models. Transfer learning and fine-tuning significantly enhance the models' ability to discern diverse skin cancer categories. The evaluation of eight Efficient Net models (B0-B7) for skin cancer classification reveals distinct performance patterns across various cancer classes. While the majority class, Benign Kertosis, achieves high accuracy (>87%), challenges arise in accurately classifying Eczema classes. Melanoma, despite its minority representation (2.42% of images), attains an average accuracy of 80.51% across all models. However, suboptimal performance is observed in predicting warts molluscum (90.7%) and psoriasis (84.2%) instances, highlighting the need for targeted improvements in accurately identifying specific skin cancer types.
CONCLUSION
The study on skin cancer classification utilizes EfficientNets B0-B7 with transfer learning from ImageNet weights. The pinnacle performance is observed with EfficientNet-B7, achieving a groundbreaking top-1 accuracy of 84.4% and top-5 accuracy of 97.1%. Remarkably efficient, it is 8.4 times smaller than the leading CNN. Detailed per-class classification exactitudes through Confusion Matrices affirm its proficiency, signaling the potential of EfficientNets for precise dermatological image analysis.
Topics: Humans; Skin Neoplasms; Neural Networks, Computer; Image Processing, Computer-Assisted; Deep Learning
PubMed: 38809652
DOI: 10.31557/APJCP.2024.25.5.1795 -
Cureus Apr 2024Here, we describe a case of a 48-year-old caucasian female with no significant past medical history who presented to the outpatient dermatology clinic with an extremely...
Here, we describe a case of a 48-year-old caucasian female with no significant past medical history who presented to the outpatient dermatology clinic with an extremely painful and significant phytophotodermatitis (PPD) reaction to over 30% of her body surface area. The patient presented after partaking in a ritualistic ceremony where she was exposed to plant and citrus juices and subsequently sunbathed while on a tropical vacation. While not an infrequent diagnosis, this patient presented to the dermatologist in extreme pain after having no education on avoiding such triggers. This diagnosis is relatively underdiagnosed and leads to a lack of patient counseling on the hazards of UV exposure secondary to contact with certain plant and fruit juices. Lack of patient awareness leads to an increase in disease burden. Furthermore, this patient suffered a large body surface area reaction in contrast to the pathognomonic description of phytophotodermatitis secondary to the exposure to lime juice which causes relatively less total body surface area exposure.
PubMed: 38807796
DOI: 10.7759/cureus.59199