This month’s news from across the specialty
What’s hot
May 1, 2025
In this monthly column, members of the DermWorld Editorial Advisory Workgroup identify exciting news from across the specialty.
Dermatopathologists always welcome clues to help make diagnoses, especially ones that suggest a specific culprit medication in a cutaneous drug reaction! Mitotic figures within the epidermis have emerged as a helpful clue in the diagnosis of cutaneous adverse reactions to enfortumab vedotin (JAAD. 2021 85(6):1610-1611), a newer antibody-drug conjugate medication which is FDA-approved for treatment of advanced urothelial carcinoma. Enfortumab vedotin consists of a monoclonal antibody directed against the tumor-associated antigen nectin-4, linked to the antimitotic agent monomethyl auristatin E. The presence of ring and starburst mitotic figures within epidermal keratinocytes is attributed to microtubule disruption by monomethyl auristatin E.
Recently, Iwahashi and colleagues compared the histopathologic features in cutaneous reactions associated with enfortumab vedotin, brentuximab vedotin (composed of an anti-CD30 monoclonal antibody linked to monomethyl auristatin E), and two taxane chemotherapy agents in a small study (Am J. Dermatopathol. 2025. 47(3):191-6). The medications share similar mechanisms, as they all disrupt microtubule function. The authors found that mitotic figures, particularly ring mitotic figures, were more frequently observed in the enfortumab vedotin-associated eruptions compared to brentuximab vedotin and taxane-associated reactions. Since nectin-4 is expressed in normal skin epithelium, the targeted delivery of monomethyl auristatin E by enfortumab vedotin may account for the increased frequency of this histopathologic finding. The presence of such mitotic figures, in the setting of an interface dermatitis, narrows the list of culprit medications for diagnosticians.
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The substantial impact of hidradenitis suppurativa (HS) on patients’ overall physical, mental, and psychological health, as well as skin-specific quality of life (QoL) domain, results in the patients being at greater risk for substance use disorder (SUD).
A recent JAAD Game Changer commentary highlighted findings from an older study that evaluated SUD among HS patients in the U.S. The original study was a cross-sectional analysis of multi-health system data analytics of 32,625 adult HS patients. Of the 32,625 HS patients identified from the database, the prevalence of SUD was 4%, compared to 2% without HS. The most common substance misuse among patients with HS was alcohol, followed by opioids and cannabis respectively. The prevalence of SUD among patients with HS was highest among males, 45 to 64 years of age, those with depressive disorder, anxiety disorder, and Medicaid patients. Within each demographic subgroup, patients with HS had significantly greater odds of SUD compared to those without HS.
A comprehensive, multidisciplinary approach to the management of HS from the onset by engaging primary care, pain management, weight management, surgery, and mental health, as indicated, may decrease the incidence of SUD among HS patients. Periodic screening for pain, psychological comorbidities, QoL decline, and substance use may be beneficial. Patients should be continuously educated on the long-term effect/sequalae of substance misuse on their disease course versus short-term gains.
Accurate staging of cutaneous squamous cell carcinomas (SCC) is critical for proper disease prognostication and treatment. The two major systems commonly used are the American Joint Committee on Cancer Staging 8th Edition (AJCC8) and Brigham and Women’s Hospital (BWH) systems. However, prior studies have shown that even identically staged SCCs can have disparate clinical outcomes (10.1001/jamadermatol.2019.0032).
To design a more comprehensive staging tool that could better stratify and prognosticate SCC tumors, the riSCC Working Group (RWG) analyzed 23,166 cutaneous SCC tumors. This retrospective, multinational cohort study collected significant data from each tumor case, including patient immune status (and reason for immunosuppression), surgical treatment (excision versus Mohs micrographic surgery), and use of adjuvant therapy. The median follow-up was 27.4 months.
The final criteria found to be significant — and therefore included in the riSCC staging calculator — were age, sex, immunosuppression, tumor diameter, tumor differentiation, any perineural invasion, lymphovascular invasion, tumor anatomic depth, tumor location (head and neck versus other), and recurrence status. The riSCC calculator was compared to BWH and AJCC8 with respect to staging system prediction of localized recurrence, in-transit metastasis, nodal metastasis, distant metastasis, and disease-specific death.
The riSCC model demonstrated higher discriminatory power than AJCC8 and BWH T staging for all clinical outcomes and time points (3 and 5 years). riSCC also helped to substratify SCCs, showing high discriminatory power between identically staged SCCs (AJCC8/BWH) that had differing clinical outcomes. riSCC can be utilized for free on the web or via application for iPhone/Android.
More What’s Hot!
Check out more What’s Hot columns from the DermWorld Editorial Advisory Workgroup.
Concern has been raised regarding elevated concentrations of benzene, a known human carcinogen, in some but not all, benzoyl peroxide (BP)-containing skin care products. The potential contributing factors that lead to high benzene concentrations, however, have not been well characterized, making patient counseling difficult. Barbieri JS et al recently analyzed the association of various BP formulations with benzene concentrations (doi:10.1001/jamadermatol.2024.6443).
The authors identified that compared to cleanser/wash formulations, leave-on products had significantly lower concentrations of benzene. In multivariable analyses, they further identified that conditions consistent with hot processing were associated with increased benzene concentrations. In contrast, antioxidants (like butylated hydroxytoluene) and benzoic acid (greater acidity leading to quenching of benzoate free radicals) were found in formulations with lower benzene concentrations. Based on their findings, the authors concluded that formulation, production, and distribution account for substantially more variation of benzene concentration than the product age (days until expiration date). These findings will hopefully inform future strategies to reduce benzene in BP-containing skin care products but can also be incorporated into treatment recommendations for patients.
