A tool to assess patients at high-risk for cutaneous squamous cell carcinoma
According to a report in JAAD, the Field Cancerization Severity Tool (FAST) was developed to identify patients at high-risk for keratinocyte carcinoma (KC) and cutaneous squamous cell carcinoma (cSCC). Patients diagnosed with AKs on the scalp or face were included in the study. There are three stages: FAST 1: Evidence of photodamage but no AK. FAST 2: Discrete AK without confluent lesions. FAST 3: Confluent AK and/or SCC in situ in a large area and inability to identify discrete lesions.
[5-FU in patients with squamous cell carcinoma in situ. Read more.]
The proportion of patients who developed a KC or cSCC on the face or scalp significantly increased with higher FAST stages. There was no association between FAST stage and BCC. The odds of facial cSCC were associated with FAST stages 2 and 3. Odds of scalp KC remained significantly associated with FAST stage 3 but not FAST 2. The authors concluded that patients at FAST 3 are at high-risk of cSCC and may benefit from more aggressive therapy and close follow up.
DermWorld Insights and Inquiries: Chanarin-Dorfman syndrome — Shifting out of neutral
To date, a total of (at least) 147 patients with Chanarin-Dorfman syndrome (CDS) have been identified — as expected with an autosomal recessive disorder, males and females are equally affected. Approximately 90% of reported cases are from countries bordering the Mediterranean Sea and Middle Eastern countries, especially Turkey. Typically, CDS patients present with ichthyosis, hepatomegaly, cirrhosis, cardiomyopathy, splenomegaly, and myopathy. There is no curative treatment for CDS patients. Lipid vacuoles (Jordans’ anomaly) in white blood cells in patients with ichthyotic disorders (resembling nonbullous congenital erythroderma or the erythrokeratodermas) are indicative — but not pathognomonic — of CDS. Topical therapy with creams containing cholesterol, urea, or lipids may be beneficial. In documented cases of CDS, acitretin may be used with caution. Keep reading!
Carbon dioxide laser and triamcinolone acetonide for keloid and hypertrophic scar treatment
Authors of a study published in JAAD reviewed the safety and efficacy of CO2 laser-assisted deliver of triamcinolone acetonide (TAC) in treating keloids and hypertrophic scars. Patients underwent an average of five treatment sessions with a CO2 laser. TAC (10-40 mg/mL) was administered topically or intralesionally. Improvements were observed in overall appearance (42.1%), texture (51.4%), pigmentation (31.7%), and size reduction (52.4%).
[Experts discuss current approaches to scar management. Read more.]
Intralesional TAC had slightly better efficacy compared to topical TAC. Adverse effects occurred in 33.1% of patients receiving combination therapy, including recurrence (4.6%), telangiectasias (1.9%), hypopigmentation/depigmentation (1.7%), and hyperpigmentation (2.1%). According to the authors, CO2-TAC may offer more rapid and robust responses, reducing adverse effects by up to 60%, compared to monotherapies.
Authors of an article published in the Journal of Cosmetic Dermatology evaluated the long-term efficacy of azathioprine as monotherapy for moderate-to-severe alopecia areata. A total of 63 patients with a minimum six-month history of alopecia areata were included.
[Comparing efficacy of JAK inhibitors used in alopecia areata. Read more.]
The mean percentage of hair regrowth was 92.7%. The mean percentage of hair loss decreased from 74.2% before treatment to 5.2% after 10 years of azathioprine treatment, a highly significant statistical improvement.
Derm Coding Consult: More carriers implementing E/M code level reviews
Several insurance payers are expanding pre-payment claim reviews for higher-level evaluation and management (E/M) services. These reviews often target level 4 and 5 visits and may result in downcoding.
The AADA continues to engage with payers to address program criteria, processes, and physician concerns arising from these edits. The Academy has provided a detailed review of these E/M editing programs as well as recommendations for practices and a variety of other Academy resources to help you navigate these changes. Learn more about individual review programs and what practices need to know.
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