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BACKGROUND: According to the curriculum guidelines of the Accreditation Council of Graduate Medical Education and the American Board of Dermatology, Mohs micrographic surgery & dermatologic oncology (MSDO) fellows must demonstrate competency in the use of oral skin cancer chemoprophylaxis. The current level of education in this area is unknown. OBJECTIVE: To characterize oral skin cancer chemoprophylaxis education for acitretin and nicotinamide among current MSDO fellows and to compare the clinical indications felt most appropriate for prescribing to a previously published expert consensus. METHODS: An electronic survey was distributed to all active MSDO fellows by the American College of Mohs Surgery. RESULTS: Responses were received from 63 (69.2%) MSDO fellows. Twenty (31.7%) and 37 (58.7%) fellows reported receiving fellowship training on acitretin and nicotinamide, respectively. Fifty-seven (90.5%) intend to prescribe chemoprophylaxis after training. Sixteen (28.1%) and 43 (75.4%) report feeling very comfortable prescribing acitretin and nicotinamide, respectively. Fellow concordance with a previously published expert consensus opinion on appropriate prescribing indications is variable. Forty-one (65.1%) indicated that additional education would increase the likelihood to prescribe after training. CONCLUSION: Although most MSDO fellows intend to prescribe oral skin cancer chemoprophylaxis, a standardized curriculum may promote increased use and concordance with expert consensus recommendations. [ABSTRACT FROM AUTHOR]

The article presents two case studies of patients with cutaneous squamous-cell carcinoma after ruxolitinib and belumosidil treatments. Topics discussed include the first patient's 6-month ruxolitinib treatment with results showing no bone invasion or lymphadenopathy, and the second patient's belumosidil treatment and death 2 weeks later from sequelae of liver failure. Also noted is the advisability of expedited Mohs excisions to treat these cancers while they remain operable.

Background: COVID-19 has significantly impacted cancer care. While previous studies have emphasized treatment modification and prioritized the delivery of cancer care, few have examined this issue from the public perspective. Materials and methods: In the following study, we examine how public interest in various forms of cancer treatment has evolved during the pandemic using Google Trends. One-way ANOVA and linear regression tests were used to compare the mean search volume indices of three periods: pre-lockdown, lockdown, and reopening. Results/Conclusions: Our findings suggest that public interest in cancer treatments decreased during lockdown and returned after reopening but, in general, is still lower than pre-lockdown levels. Despite that, healthcare professionals should strive to provide timely cancer care, assuage patients’ fears of healthcare settings, and encourage patients to continue proper cancer screenings. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. BACKGROUND: Desmoplastic melanoma (DM) is a rare variant of cutaneous melanoma with a high rate of local recurrence. Recent studies have indicated a potential benefit in local control with the addition of adjuvant radiotherapy (RT). OBJECTIVE: This study sought to evaluate the outcomes of adjuvant RT for patients with DM. MATERIALS AND METHODS: The National Cancer Database was queried (2004–2015) for patients with newly diagnosed, nonmetastatic DM. Patients were divided into 2 groups based on the adjuvant therapy they received: RT or observation. Statistics included multivariable logistic regression to determine factors predictive of receiving adjuvant RT, Kaplan–Meier analysis to evaluate overall survival (OS), and Cox proportional hazards modeling to determine variables associated with OS. RESULTS: There was no difference in median OS between patients treated with RT when compared with patients observed (111.4 months vs 133.9 months, p =.1312). On multivariable analysis, older age, T stage ≥2, N stage ≥1, and no receipt of immunotherapy were associated with worse OS. CONCLUSION: In this large study evaluating efficacy of adjuvant RT in DM, no overall survival benefit was observed among patients receiving adjuvant RT. [ABSTRACT FROM AUTHOR]

The article presents a study of cutaneous adverse events associated with programmed death-1 (PD-1) and PD-ligand 1 (PD-L1) inhibitor therapy in people of color (POC) and ethnically white patients. Topics discussed include the emergence of eczematous dermatitis as the most common cutaneous adverse event, reason behind the large number of POC patients with cutaneous adverse events compared with white patients, and lack of correlation between inhibitor treatment and adverse events.

Drug-induced vasculitis and anticoagulant-related skin reactions are commonly encountered in the inpatient and outpatient settings. The spectrum of clinical presentation is broad and ranges from focal, skin-limited disease, to more extensive cutaneous and soft tissue necrosis, to potentially fatal systemic involvement. The prompt recognition of these adverse events can have a significant impact on patient morbidity and mortality. We highlight the key features of the clinical presentation with an emphasis on primary lesion morphology, distribution, and epidemiology of purpuric drug reactions. The proposed pathophysiology, histologic findings, and therapeutic interventions of these potentially life-threatening diseases are discussed. [ABSTRACT FROM AUTHOR]

Scholarly productivity is an assessment metric for dermatology residents and faculty. How the bibliometric h-index, a publicly available metric that incorporates the quantity and quality of publications, relates to early career choices of dermatologists has not been investigated. We determined the h-indices of the 2017 diplomates of the American Board of Dermatology to ascertain its association with career choice. A cross-sectional analysis was performed using the published list of the 2017 diplomates. Gender and PhD status were compiled. The Scopus database was queried for publications and h-indices. The primary outcome was the pursuit of an academic position, nonacademic position, or fellowship after board certification. Among 475 (96%) diplomates, the median (range) h-index was 2 (0–14). Those with MD and PhD degrees had greater h-indices (6.4 ± 3.1 vs. 2.3 ± 2.3, P <.05). There was a difference (P <.05) in h-index between diplomates pursuing an academic position (3.6 ± 3.1), non-procedural fellowship (3.3 ± 3.1), procedural fellowship (2.5 ± 2.0), and non-academic position (2.1 ± 2.1). The h-index quantifies academic productivity and may predict early career choices in dermatology. [ABSTRACT FROM AUTHOR]

BACKGROUND The V-Y island advancement flap is a useful reconstruction technique for nasal alar defects, but flap mobility is limited by the insertion of the muscles of facial expression into the dermis of the alae. OBJECTIVE To describe a V-Y muscle sling myocutaneous island advancement flap (SMIAF) for improved mobility and intrasubunit reconstruction of alar defects. MATERIALS AND METHODS A retrospective review of patient records and preoperative and postoperative photographs was performed on all patients with alar defects repaired with the SMIAF between April 2008 and October 2017. Patients and physicians rated aesthetic outcomes with the Patient and Observer Scar Assessment Scale (POSAS). RESULTS A total of 18 nasal alar defects were repaired with the SMIAF after Mohs micrographic surgery. All defects were located on the anterior two-thirds of the alar lobule and had a mean surface area of 0.42 6 0.19 cm2. No patients experienced flap necrosis. Patients and 3 independent dermatologic surgeons rated favorable aesthetic outcomes. CONCLUSION The SMIAF is a reliable reconstruction option with good aesthetic outcomes for small defects on the anterior two-thirds of the nasal ala. [ABSTRACT FROM AUTHOR]

Background: The predictors of readmission in Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) have not been characterized.Objective: To determine the variables predictive of 30-day readmission after SJS/TEN hospitalization.Methods: We performed a cross-sectional study of the 2010-2014 Nationwide Readmissions Database. Bivariate and multivariable logistic regression was used to evaluate associations of patient demographics, comorbidities, and hospital characteristics with readmission. Aggregate and per-readmission costs were calculated.Results: There were 8837 index admissions with SJS/TEN reported; of these, 910 (10.3%) were readmitted, with diagnoses including systemic infection (22.0%), SJS/TEN (20.6%), and cutaneous infection (9.1%). Associated characteristics included age 45 to 64 years (odds ratio [OR], 1.88; 95% confidence interval [CI], 1.43-2.49), Medicaid insurance (OR, 1.83; 95% CI, 1.48-2.27), and nonmetropolitan hospital admission (OR, 1.67; 95% CI, 1.31-2.13). Associated comorbidities included HIV/AIDS (OR, 2.48; 95% CI, 1.63-3.75), collagen vascular disease (OR, 2.38; 95% CI, 1.88-3.00), and metastatic cancer (OR, 2.16; 95% CI, 1.35-3.46). The median per-readmission cost was $10,019 (interquartile range, $4,788-$16,485).Limitations: The Nationwide Readmissions Database lacks the ability to track the same patient across calendar years. The diagnostic code lacks specificity for hospitalizations <3 days.Conclusions: Thirty-day readmissions after SJS/TEN hospitalizations are common. Dedicated efforts to identify at-risk patients may improve peridischarge continuity. [ABSTRACT FROM AUTHOR]

Background: Potassium hydroxide preparations (KOH) and tissue examinations for ova and parasites (O&P) are cost‐effective office‐based tests. No studies have quantified their utilization and economic impact. Methods: The objective is to determine the billing patterns and costs of office‐based diagnostic procedures in the Medicare population. We conducted a cross sectional study using the Part B National Summary Data File (2000–2016) and the Physician and Other Supplier Public Use File (2012–2015) released by the Centers for Medicare & Medicaid Services. Results: In 2016, the total number of claims among all providers was 28,432 (KOH) and 52,182 (O&P), representing a decrease since 2000 (KOH, −41.8%; O&P, −43.4%). The total claims for in‐office procedures by dermatologists per 10,000 beneficiaries decreased between 2012 and 2015 (KOH, −18.8%; O&P, −26.6%). Fewer dermatologists submitted claims for the tests (KOH, −11.3%; O&P, −16.6%). The total single (SB) and multiple (MB) biopsy claims by dermatologists per 10,000 beneficiaries decreased between 2012 and 2015 (SB, −1.8%; MB, −2.7%). The 2016 aggregate payments (% change since 2000) for KOH and O&P were $163,127.75 (−60.4%) and $299,074.18 (−61.6%), respectively; for SB and MB, they were $240,047,487.98 (+142.3%) and $38,214,117.22 (+79.2%), respectively. Conclusion: Fewer dermatologists submit claims for KOH and O&P each year. Future studies should evaluate whether this is due to a loss of cost‐efficacy, and secondly, if it is related to decreased reimbursement, burdensome in‐office laboratory regulations, or changing provider preferences. [ABSTRACT FROM AUTHOR]

Dear Editor, Since the emergence of the novel coronavirus SARS-CoV-2, the cause of COVID-19, heavy attention has been paid to its life-threatening pulmonary and cardiovascular manifestations.1 However, cutaneous signs and symptoms of disease have also been described and may significantly impact patients.2 While preliminary characterizations have aptly set expectations for acute disease course, it is imperative to establish similar familiarity with late-course and postinfectious manifestations to guide appropriate treatment and patient education. In the ambulatory dermatology clinic, one such increasingly apparent manifestation has been new onset diffuse hair loss in patients previously infected with SARS-CoV-2, clinically compatible with telogen effluvium (TE). The telogen phase lasts approximately 3 months, after which excessive hair loss ensues.3 Herein, we present 10 patients with concerns of increased hair loss following SARS-CoV-2 infection (Table 1). [Extracted from the article]

YouTube, one of the most popular online platforms worldwide, contains a burgeoning number of videos promoting medical information from a variety of sources including physicians, pharmaceutical companies, and patients. The YouTube search feature was queried for the treatment of common dermatologic conditions including: I acne i , I actinic keratosis i , I nonmelanoma skin cancer i , I contact dermatitis i , I seborrheic dermatitis i , I viral warts i , I psoriasis i , I rosacea i , I epidermoid cyst i , and I seborrheic keratosis i . The mean ± SD overall DISCERN score was 1.6 ± 0.9; videos related to nonmelanoma skin cancer treatment received the highest mean ± SD overall score (2.3 ± 1.5), and those related to epidermoid cyst treatment received the lowest (1.1 ± 0.3). However, the majority of YouTube videos related to dermatologic treatment are from third parties and suffer from bias, incomplete information, lack of citable source material, and poor overall quality. [Extracted from the article]

Abstract: Topical cantharidin is a commonly used treatment for molluscum contagiosum (MC). However, studies validating its safety and efficacy are limited. We conducted a 6‐week, randomized, double‐blind, placebo‐controlled trial with subsequent open‐label extension to assess the safety and effectiveness of cantharidin in treating pediatric MC. Ninety‐four participants with MC were randomized to receive cantharidin or placebo, with or without occlusion. The primary outcome was complete lesion clearance. Secondary outcomes included post‐treatment lesion count, adverse events, and side effects. No significant differences between the study arms, including baseline lesion count, were observed. The overall mean (SD) baseline lesion count was 22.2 (12.9). The number of participants achieving total clearance is as follows: 7/23 (30.4%) in the cantharidin only arm, 10/24 (41.7%) in the cantharidin with occlusion arm, 2/25 (8.0%) in the placebo with occlusion arm, and 3/22 (13.6%) in the placebo only arm. Post hoc analysis demonstrated that 17/47 (36.2%) participants in the combined cantharidin arms achieved clearance compared to 5/47 (10.6%) in the placebo arms (P = 0.0065). The mean (SD) lesion count change from baseline was −5.1 (12.2) in the placebo only arm; the mean change (SD) was −17.4 (12.8) in the cantharidin only arm (P = 0.0033) and −15.9 (11.6) in the cantharidin with occlusion arm (P = 0.0101). No serious adverse events or side effects were observed. Topical cantharidin was well‐tolerated and associated with the resolution of MC. [ABSTRACT FROM AUTHOR]

Demodex spp. mites are a common colonizer of sebaceous adult skin. Though usually clinically insignificant, demodicosis may be associated with a wide spectrum of skin diseases in immunocompetent hosts, such as erythematotelangiectatic and papulopustular rosacea, Demodex folliculorum, and blepharitis. We present a case of a healthy 9‐year‐old boy with an exuberant, inflammatory, Demodex‐associated pustular eruption of the face, induced by the use of a high‐potency topical steroid and successfully treated with oral ivermectin. [ABSTRACT FROM AUTHOR]

Summary Efficiency of reprogramming of human cells into induced pluripotent stem cells (iPSCs) has remained low. We report that individual adult human CD49f+ long-term hematopoietic stem cells (LT-HSCs) can be reprogrammed into iPSCs at close to 50% efficiency using Sendai virus transduction. This exquisite sensitivity to reprogramming is specific to LT-HSCs, since it progressively decreases in committed progenitors. LT-HSC reprogramming can follow multiple paths and is most efficient when transduction is performed after the cells have exited G 0. Sequencing of 75 paired skin fibroblasts/LT-HSC samples collected from nine individuals revealed that LT-HSCs contain a lower load of somatic single-nucleotide variants (SNVs) and indels than skin fibroblasts and accumulate about 12 SNVs/year. Mutation analysis revealed that LT-HSCs and fibroblasts have very different somatic mutation signatures and that somatic mutations in iPSCs generally exist prior to reprogramming. LT-HSCs may become the preferred cell source for the production of clinical-grade iPSCs. Graphical Abstract Highlights • Single adult human LT-HSCs can be reprogrammed into iPSCs at close to 50% efficiency. • LT-HSCs contain less somatic variants than skin fibroblasts. • LT-HSCs may become the preferred source for the production of clinical-grade iPSCs. Wang et al. show that single adult human long-term hematopoietic stem cells can be reprogrammed into induced pluripotent stem cells at close to 50% efficiency and contain fewer somatic single-nucleotide variants and indels than skin fibroblasts. They may become the preferred source for the production of clinical-grade iPSCs. [ABSTRACT FROM AUTHOR]

Abstract: The important athero-protective role of prostacyclin is becoming increasingly evident as recent studies have revealed adverse cardiovascular effects in mice lacking the prostacyclin receptor, in patients taking selective COX-2 inhibitors, and in patients in the presence of a dysfunctional prostacyclin receptor genetic variant. We have recently reported that this protective mechanism includes the promotion of a quiescent differentiated phenotype in human vascular smooth muscle cells (VSMC). Herein, we address the intriguing question of how localized endothelial release of the very unstable eicosanoid, prostacyclin, exerts a profound effect on the vascular media, often 30 cell layers thick. We report a novel PKA-, Akt-1- and ERK1/2-dependent prostacyclin-induced prostacyclin release that appears to play an important role in propagation of the quiescent, differentiated phenotype through adjacent arterial smooth muscle cells in the vascular media. Treating VSMC with the prostacyclin analog iloprost induced differentiation (contractile protein expression and contractile morphology), and also up-regulated COX-2 expression, leading to prostacyclin release by VSMC. This paracrine prostacyclin release, in turn, promoted differentiation and COX-2 induction in neighboring VSMC that were not exposed to iloprost. Using siRNA and pharmacologic inhibitors, we report that this positive feedback mechanism, prostacyclin-induced prostacyclin release, is mediated by cAMP/PKA signaling, ERK1/2 activation, and a novel prostacyclin receptor signaling pathway, inhibition of Akt-1. Furthermore, these pathways appear to be regulated by the prostacyclin receptor independently of one another. We conclude that prevention of de-differentiation and proliferation through a paracrine positive feedback mechanism is a major cardioprotective function of prostacyclin. [Copyright &y& Elsevier]

Based on surveys by Robinson1&nbsp;in 2001 and Trimble and Cherpeli2&nbsp;in 2013, Immunohistochemistry (IHC) utilization in Mohs micrographic surgery (MMS) has been rising. Although these surveys provided important subjective data regarding IHC use in MMS, there is a paucity of objective data describing its current utilization patterns. The objective of this study is to characterize IHC utilization during MMS by Mohs surgeons in the treatment of Medicare beneficiaries from 2012-2017.

Competing Interests: Dr Guzman discloses the receipt of travel reimbursement from Verrica Pharmaceuticals and has served as an advisory board participant for Johnson & Johnson. These do not pose any conflict of interest. Author Lally and Drs Balagula, Dewall, and Jacobson have no conflicts of interest to declare.

Objective: The adipocyte-secreted hormone adiponectin exerts important cardioprotective and antidiabetic effects. Little is known about its effect on vascular smooth muscle cells (VSMC), key cells in restenosis, hypertension, and atherosclerosis., Methods and Results: Using human coronary artery VSMC, we found that recombinant adiponectin in the high-molecular-weight or trimeric forms but not the globular form induced VSMC differentiation through a mechanism similar to the classic feedback signaling used by rapamycin, a drug known to effectively inhibit restenosis on drug-eluting stents. Using a combination of pharmacological agents, small interfering RNA, and overexpression approaches, we demonstrated that adiponectin activated 5'-AMP-activated protein kinase α2 isoform, leading to inhibition of mammalian target of rapamycin complex 1 and S6K1. This in turn stabilized insulin receptor substrate-1, driving Akt2-mediated inhibition of FoxO4 and subsequent contractile protein induction. Although adiponectin and rapamycin have similarly beneficial effects on VSMC phenotype in both cell and organ culture, a direct comparison of the effects of rapamycin versus adiponectin on endothelial cells revealed distinct differences: rapamycin inhibited Akt phosphorylation, whereas adiponectin maintained it. Importantly, Akt activity preserves endothelial function., Conclusion: Adiponectin promotes VSMC differentiation and preserves endothelial cell Akt signaling, suggesting that targeting the adiponectin pathway may have advantages over rapamycin in developing new drug-eluting stent therapeutics.