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Cutaneous squamous cell carcinoma (cSCC) is the second most common form of human cancer and has an increasing annual incidence. Although most cSCC is cured with office-based therapy, advanced cSCC poses a significant risk for morbidity, impact on quality of life, and death. This document provides evidence-based recommendations for the management of patients with cSCC. Topics addressed include biopsy techniques and histopathologic assessment, tumor staging, surgical and nonsurgical management, follow-up and prevention of recurrence, and management of advanced disease. The primary focus of these recommendations is on evaluation and management of primary cSCC and localized disease, but where relevant, applicability to recurrent cSCC is noted, as is general information on the management of patients with metastatic disease.

Basal cell carcinoma (BCC) is the most common form of human cancer, with a continually increasing annual incidence in the United States. When diagnosed early, the majority of BCCs are readily treated with office-based therapy, which is highly curative. In these evidence-based guidelines of care, we provide recommendations for the management of patients with BCC, as well as an in-depth review of the best available literature in support of these recommendations. We discuss biopsy techniques for a clinically suspicious lesion and offer recommendations for the histopathologic interpretation of BCC. In the absence of a formal staging system, the best available stratification based on risk for recurrence is reviewed. With regard to treatment, we provide recommendations on treatment modalities along a broad therapeutic spectrum, ranging from topical agents and superficially destructive modalities to surgical techniques and systemic therapy. Finally, we review the available literature and provide recommendations on prevention and the most appropriate follow-up for patients in whom BCC has been diagnosed.

Background The term 'flare' is used across multiple diseases, including atopic dermatitis (AD), to describe increased disease activity. While several definitions of an AD flare have been proposed, no single definition of AD flare is widely accepted and it is unclear what the term 'AD flare' means from the patient perspective. Objectives To understand AD flares from the adult patient perspective and to explore how adults with AD define an AD flare. Methods Participants were adults with AD recruited from the National Eczema Association Ambassadors programme, a volunteer patient-engagement programme. They participated in online focus groups to discuss how they describe AD flares from their perspective, how they define its start and stop, and how they relate to existing definitions of flare. Using a grounded theory approach, transcripts were analysed and coded using an iterative process to identify concepts to support a patient-centred conceptual framework of 'flare'. Results Six 90-min focus groups of 3–8 participants each were conducted with 29 US adults (≥ 18 years of age) with AD who had at least one self-reported AD flare in the past year. When participants were presented with examples of previously published definitions of AD flare, participants found them problematic and unrelatable. Specifically, they felt that flare is hard to quantify or put on a numerical scale, definitions cannot solely be about skin symptoms and clinical verbiage does not resonate with patients' lived experiences. Concepts identified by patients as important to a definition of flare were changes from patient's baseline/patient's normal, mental/emotional/social consequences, physical changes in skin, attention needed/all-consuming focus, itch–scratch–burn cycle and control/loss of control/quality of life. Figuring out the trigger that initiated a flare was an underlying concept of the experience of flare but was not considered a contributor to the definition. Conclusions The results highlight the complexity and diversity of AD flare experiences from the adult patient perspective. Previously published definitions of AD flares did not resonate with patients, suggesting a need for a patient-centred flare definition to support care conversations and AD management. [ABSTRACT FROM AUTHOR]

Atopic dermatitis is a chronic, pruritic inflammatory dermatosis that affects up to 25% of children and 2% to 3% of adults. This guideline addresses important clinical questions that arise in atopic dermatitis management and care, providing recommendations based on the available evidence. In this third of 4 sections, treatment of atopic dermatitis with phototherapy and systemic immunomodulators, antimicrobials, and antihistamines is reviewed, including indications for use and the risk-benefit profile of each treatment option.

This article explores the impact of patient knowledge and provider specialty on shared decision making (SDM) in eczema care settings. The study conducted a web-based survey of adult patients and caregivers of children with atopic dermatitis (AD) to assess their SDM experience and confidence to engage in SDM. The results showed that patients who felt well-informed about eczema had higher SDM scores and greater confidence to engage in SDM, regardless of whether they were seeing a specialist or non-specialist. The study highlights the importance of patient education in improving SDM and calls for comprehensive patient education across AD care settings. [Extracted from the article]

Background Atopic dermatitis (AD) flares and their management are a significant unmet research and treatment need. The term "flare" is commonly used to describe AD disease activity, but there has been little work done to understand the meaning of this term from the patient perspective in research or clinical settings, hindering an effective patient-healthcare provider (HCP) relationship and patient-centered care. The potential for, and recurrence of flares contributes to marked patient anxiety and negative emotional sentiment, making flare reduction a highly sought-after treatment outcome for patients. Objectives The objective of this study is to establish patient-reported attributes associated with AD flares to develop a more patient-centered definition to support real-world decision-making and enhance AD outcomes. Methods Following in-depth qualitative work with patients to develop Delphi items, a modified eDelphi process was conducted January-June 2023 with focus group participants recruited from the National Eczema Association (NEA) Ambassador program. The aim of the Delphi was to determine the most/least important aspects of an AD flare from their perspective. Participants rated 98 flare-related statements on a 1-9 scale (1-3 = not important, 4-6 = important but not critical, 7-9 = critically important), indicating their importance to defining AD flares, alongside several other questions about flaring. Consensus for a statement was defined a-priori as ≥70% rating 7-9 and <15% rating 1-3. Statements reaching consensus were subsequently evaluated by participants in a ranked pair exercise resulting in a final list of statements important to include in a definition of flare from the patient perspective. A subsequent national survey distributed by NEA assessed broader patient agreement with the working concepts essential to a definition identified in the modified eDelphi exercise, with stratified analysis to assess variations in agreement among respondent sub-groups. Results Twenty-six participants completed the eDelphi process, with 15/98 statements achieving ranked consensus on critical flare attributes. Survey responses (n=631) confirmed agreement with 12/15 statements; no statement received 100% agreement by all participants. The 3 statements with the highest agreement were: "when my symptoms take significantly more of my attention than normal," "a worsening of physical symptoms associated with AD," and "a worsening of itching associated with AD." Statements ranked as the most important to a definition were "acute worsening of AD symptoms", "a change in physical health that interrupts my day-to-day", and "an "eruption" on the body". Consensus results were similar across most subgroups of interest with the exception of those whose eczema was mild, those who completed some high school, and those who identified as Native American/Alaskan Native. Most participants (80%; 503/631) found existing flare definitions inadequate, with only 53% (334/631) indicating agreement with their HCP on what an AD flare is. Conclusion This study found that current definitions of AD flare based on HCP assessment of signs or the clinical reaction to AD (e.g. treatment escalation) resonate poorly with most adult AD patients and differ from concepts achieving consensus by study participants. The patient perspective deviated most significantly from existing definitions in terms of how a flare can negatively impact lifestyle and be associated with greater preoccupation. However, despite achieving conceptual agreement for several statements, patient perspectives varied, highlighting the importance of individualized discussions in clinical settings. This study suggests that a patient-centered flare definition can potentially enhance care and treatment efficacy in AD management as current definitions fail to capture what is meaningful to patients. Understanding nuanced patient perspectives is vital for individualized care and shared decision-making. Future efforts should focus on developing assessment tools and outcome measures based on patient-identified flare attributes, facilitating better treatment monitoring and personalized care delivery. [ABSTRACT FROM AUTHOR]

Introduction/Background There is evidence of disparities in healthcare utilization for patients with atopic dermatitis (AD), but research exploring differences in patient treatment satisfaction and patient perception of interactions with their AD healthcare provider (HCP) by race and ethnicity is limited. Objectives The primary study objectives were to understand racial and ethnic differences in adult patients with AD for treatment use, treatment satisfaction, and patient perceptions on HCP interactions. Methods Adult patients living with self-reported AD in the United States (US) were recruited through the National Eczema Association (NEA) and the AmeriSpeak panel, a national sample of US adults. Sampling targets were used to achieve condition-based population proportions across multiple racial and ethnic categories. Patients completed an 80- to 110-item electronic one-time survey including questions on overall AD severity over the last month, current AD treatment, current AD treatment satisfaction, AD provider type, and perceptions of their interactions with HCPs. Data are reported using descriptive statistics. Results Overall, 260 patients (NEA n=18; AmeriSpeak n=242) completed the survey (mean age 40.6 years; 66.2% female; 55.0% White, 23.5% Black/African American, 11.5% Asian, and 10.0% American Indian/Alaskan Native, Native Hawaiian or Other Pacific Islander, or multiple-races (i.e. other races (OtR)); 13.5% Hispanic/Latino). Nearly half (49.6%) reported severity as mild, 43.1% moderate, and 7.3% severe. Overall, 63.8% of patients were using over-the-counter ointments/creams/lotions/gels for their AD, while 62.6% were using prescription creams/lotions. 28.2% reported being dissatisfied/very dissatisfied with their current treatment regimen, with treatment dissatisfaction was highest among Black/African American patients (36.2%) and lowest among OtR patients (21.7%). Additionally, 22.6% of patients reported that in the past year they or a household member had been unable to get medicine or any healthcare (medical, dental, mental health, vision); this was reported by 32.2% Black/African American, 21.1% White, 19.2% OtR, 13.3% Asian, 20.0% Hispanic/Latino, and 23.0% Non-Hispanic/Non-Latino. 49.2% indicated that a dermatologist was the provider they primarily saw for medications to treat their AD. This was followed by primary care providers (33.1%), those who did not see a provider for their AD (10.4%), and allergists (4.2%). Of those who indicated they saw a provider for their AD, 39.1% of patients report their HCP listened to their AD concerns 'somewhat' or 'a little bit'; Asian (61.6%), White (38.9%), Black/African American (32.7%), and OtR (30.4%). 43.3% of Hispanic/Latino and 38.5% of Non-Hispanic/Non-Latino patients reported their HCP listened 'somewhat' or 'a little bit.' Only 1.3% of all patients reported their HCPs did not listen to their concerns 'at all.' When asked how much they thought their AD HCP understood their perspective on their AD, 42.4% of all patients chose 'somewhat' or 'a little bit.' This was reported by 46.2% Asian patients, 44.4% White patients, 41.7% OtR patients, 36.4% Black/African American patients, 53.1% Hispanic/Latino patients, and 40.7% Non-Hispanic/Non-Latino patients. Additionally, 42.1% of all patients reported they 'somewhat' or 'a little bit' trust that their HCP effectively treats their AD. This was reported by 50.0% Asian patients, 45.3% White patients, 34.6% Black/African American patients, 33.3% OtR patients, 43.8% Hispanic/Latino patients, and 41.8% Non-Hispanic/Non-Latino patients. Overall, 3% of patients reported they did not trust their HCP to effectively treat their AD 'at all' and 1.3% reported their HCPs did not understand their perspective 'at all.' Conclusions Nearly a quarter of patients living with AD reported not being able to access medicine or healthcare in the past year. Although there were differences in the percentages reported by race and ethnicity, some patients indicated there were gaps with regards to the patient-physician relationship around not feeling completely listened to, understood, or trusting HCPs treating AD. These findings may help inform clinical practice considerations in AD. [ABSTRACT FROM AUTHOR]

Despite the need for improved eczema therapies and a rapid increase in available eczema clinical trials, participation remains low. The aim of this study was to identify factors associated with clinical trial awareness, interest, and barriers to enrolment and participation. An online survey, administered 1 May to 6 June 2020 to adults (≥18 years) with eczema in the USA, was analysed. Among 800 patients included, mean age was 49.4 years, most respondents were female (78.1%), White (75.4%), non-Hispanic (91.4%), and geographically living in an urban/suburban area (Rural-Urban Continuum Codes (RUCC) 1–3, 90.8%). Only 9.7% of respondents reported previous participation in clinical trials, while 57.1% had considered participation and 33.2% never considered participation. Higher satisfaction with current eczema therapy, clinical trial literacy, and confidence in finding eczema trial information were all associated with clinical trial awareness, interest, and successful participation. Younger age and having atopic dermatitis were associated with increased awareness, while female gender was a barrier to interest and successful participation. [ABSTRACT FROM AUTHOR]

Background: Atopic dermatitis (AD) is associated with substantial financial cost, including increased out-of-pocket (OOP) expenses. Associations and impact of OOP costs are poorly understood. Objective: The aim of the study was to characterize the impact and associations of OOP health care expenses for AD. Methods: A 25-question online survey was administered to National Eczema Association members (N = 113,502). Inclusion criteria (US residents aged ≥18 years; self-reported AD or primary caregiver of individual with AD) were met by 77.3% (1118 of 1447). Results: Respondents with monthly OOP expenses greater than $200 were more likely to have increased AD severity, flares, health care provider visits, prescription polypharmacy, use of step-up therapy, frequent skin infections, and poorer disease control (P < 0.005 for all). Respondents with OOP yearly expenditures greater than $1000 had similar associations and additionally increased rates of comorbid asthma, allergic rhinitis, and anxiety/depression (P < 0.005 for all). A total of 64.6% (n = 624) reported harmful household financial impact of OOP expenses. Predictors of harmful impact included severe AD (adjusted odds ratio [95% confidence interval], 2.62 [1.11–6.19], P = 0.04), comorbid asthma (1.42 [1.07–1.87], P = 0.03), 5 health care provider visits or more in a year (2.80 [1.62–4.82], P = 0.0007), greater than $200 OOP monthly expenditures (2.16 [1.45–3.22], 0.0006), and $1000 annual OOP expenditures or more (4.56 [3.31–6.27], P < 0.0001). Conclusions: Out-of-pocket expenses for AD significantly impact household finances. Clinical interventions are needed to minimize OOP expenses while optimizing care outcomes. Capsule Summary: • Atopic dermatitis (AD) is associated with significant financial cost, including increased out-of-pocket (OOP) expenses, although the impact and associations of OOP health care expenses for AD management are not well understood. • The OOP health care expenses related to AD are associated with increased disease severity and health care utilization and significantly impact the household finances of patients and caregivers. • Health care providers should be mindful of the OOP financial burden related to AD management and engage in shared decision making to create a treatment plan that is practical and effective and minimizes household financial impact. [ABSTRACT FROM AUTHOR]