Search

Basal cell carcinoma (BCC) is highly curable by surgical excision or radiation. In rare cases, BCC can be locally destructive or difficult to surgically remove. Hedgehog inhibition (HHI) with vismodegib or sonidegib induces a 50–60% response rate. Long-term toxicity includes muscle spasms and weight loss leading to dose decreases. This retrospective chart review also investigates the impact of CoQ10 and calcium supplementation in patients treated with HHI drugs at a single academic medical center from 2012 to 2022. We reviewed the charts of adult patients diagnosed with locally advanced or metastatic BCC treated with vismodegib or sonidegib primarily for progression-free survival (PFS). Secondary objectives included overall survival, BCC-specific survival, time to and reasons for discontinuation, overall response rate, safety and tolerability, use of CoQ10 and calcium supplements, and insurance coverage. Of 55 patients assessable for outcome, 34 (61.8%) had an overall clinical benefit, with 25 (45.4%) having a complete response and 9 (16.3%) a partial response. Stable disease was seen in 14 (25.4%) and 7 (12.7%) progressed. Of the 34 patients who responded to treatment, 9 recurred. Patients who were rechallenged with HHI could respond again. The median overall BCC-specific survival rate at 5 years is 89%. Dose reductions or discontinuations for vismodegib and sonidegib occurred in 59% versus 24% of cases, or 30% versus 9% of cases, respectively. With CoQ10 and calcium supplementation, only 17% required a dose reduction versus 42% without. HHI is highly effective for treating advanced BCC but may require dosing decreases. Sonidegib was better tolerated than vismodegib. CoQ10 and calcium supplementation can effectively prevent muscle spasms. [ABSTRACT FROM AUTHOR]

Dermatologists frequently see patients with clinically atypical nevi and dermatopathologists interpret histologically dysplastic nevi on a near-daily basis, but there is great variability in the definition and management of such lesions. This part of the CME review focuses on information published since the previous comprehensive review (2012), with emphasis on molecular and genetic attributes of histologically dysplastic nevi and clinical management. [ABSTRACT FROM AUTHOR]

Dear Editor, Up to one-third of hospitalized patients have significant skin findings.[1] While inpatient dermatology consultations allow for efficient, accurate diagnosis and treatment,[1] access to these services is often limited outside of academic institutions.[2] Even when dermatology consultations are available, suspected skin cancers are commonly deferred for outpatient evaluation and management. We found 82 consults placed to evaluate these incidental lesions from 2011 to 2017, with 41 involving inpatient biopsies and 22 referrals for outpatient biopsy; 19 cases were excluded as the biopsy or need for biopsy was declined after evaluation (Table 1). Nine out of 16 patients who received outpatient biopsies of malignant lesions initiated treatment compared to 26 out of 29 patients who had inpatient biopsies (Table 2). [Extracted from the article]

Cellulitis is a common dermatologic indication for hospitalization in the United States, resulting in approximately 650,000 admissions and costing $3.7 billion annually.1 However, the cellulitis diagnosis may be overused in the inpatient setting due to a lack of readily available dermatologic expertise.2 It is important to identify and understand this possible phenomenon because misdiagnosed cellulitis treated with unnecessary antibiotics can lead to kidney injury, nosocomial infections, and drug reactions.3 To this end, we assessed whether the availability of dermatology training programs was associated with the number of cellulitis diagnoses rendered at a given hospital. As exposure to inpatient consultations is a required part of ACGME-accredited dermatology residency programs, we aimed to compare hospitals in Ohio where dermatologic consultations may be informal or unavailable to those with dermatologic residency programs. Impact of dermatology and teledermatology consultations for patients admitted with cellulitis: a pilot study. [Extracted from the article]

Of the 22 patients without preexisting skin disease, the most common diagnoses were drug eruption ( I n i = 11), contact dermatitis ( I n i = 2), and Sezary syndrome ( I n i = 2). Dear Editor, Erythroderma is characterized by erythema of greater than 80-90% of the skin surface.1,2 While preexisting dermatoses are the most commonly implicated causes, other etiologies include infections, malignancies, and drug reactions.1,3 Unclassified cases are deemed idiopathic.3 In this cross-sectional study, we evaluated the etiologies, hospital courses, and outcomes of patients with erythroderma. In conclusion, our study found that preexisting dermatoses, most often psoriasis, were responsible for erythroderma in about half of patients. [Extracted from the article]

Primary cutaneous lymphomas (PCLs) include both cutaneous T-cell and B-cell lymphomas and comprise the second most common type of extra-nodal non-Hodgkin's lymphomas. The treatment and prognosis of PCLs typically depend on the extent of disease. In evaluating extent of disease in oncological processes, computed tomography (CT) provides a purely anatomical assessment of disease. In comparison, [(18)F]-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) both visualizes and quantifies the biological processes occurring in the disease at the cellular level. This paper reviews the available literature addressing the clinical role of (18)F-FDG PET both alone and in combination with CT in PCLs and draws several conclusions. While (18)F-FDG PET seems superior to CT in its detection of nodal and cutaneous PCL lesions, (18)F-FDG PET does not seem to adequately detect erythroderma, plaque, or patch cutaneous PCL lesions. In addition, several case series have demonstrated that physicians may be able to use the semi-quantitative measurement of (18)F-FDG uptake provided by (18)F-FDG PET to predict which lesions are most aggressive. Other case series have shown that the integrated (18)F-FDG PET/CT may provide an objective measure of treatment response in patients with PCLs.