Surgical excision vs. 5-FU vs. PDT in treating Bowen’s disease
An article published in JAAD compared 5-fluorouracil cream (5-FU), methylaminolevulinate photodynamic therapy (MAL-PDT), and surgical excision in patients with Bowen’s disease. In this multicenter randomized controlled trial, 250 patients with histologically proven Bowen’s disease were treated with excision with a 5-mm margin, 5% 5-FU cream twice daily for four weeks, or two sessions of MAL-PDT with a one-week interval. The percentage of patients with sustained clearance at 12 months was 97.4% after excision, 85.7% after 5-FU therapy, and 82.1% after MAL-PDT. Cosmetic outcomes were better with the noninvasive treatments. Based on a noninferiority margin of 22%, 5-FU therapy was noninferior to excision, whereas noninferiority of MAL-PDT to excision could not be concluded.
“I have several women with diffuse AKs, SCC in situ, and superficial BCC on the lower legs. I have tried 5-FU, LN2, 20% TCA to no avail. They still keep developing BCC and SCC.” Read more and participate in the AAD’s Clinical Community.
DermWorld Insights and Inquiries: Holiday Greeting 2023
I always look forward to writing my annual holiday greeting, but admittedly, doing so this year has been a source of angst and consternation. The past few years have been about the SARS-Cov-2 virus, but this year, it is virulence — in our political climate, social fabric, college campuses, climate, medical economics, tensions with China, and the ongoing wars between Ukraine and Russia and Israel and Hamas. We, as physicians and dermatologists, can start by taking solace and pride in our mission to provide care for our patients. Every day, we improve the lives of those in need and, in turn, the lives of their loved ones. Keep reading!
Association between JAK inhibitors and acne
A study published in JAMA Dermatology investigated the scope of acne as an adverse reaction to the use of JAK inhibitors (“JAKne”). This systematic review and meta-analysis assessed data from phase II and III placebo-controlled randomized clinical trials of JAK inhibitors regarding the risk of acne as an adverse effect of using JAK inhibitors. The analysis included 25 studies and showed elevated odds ratios for the incidence of acne following the use of JAK inhibitors, namely, abrocitinib, baricitinib, upadacitinib, deucravacitinib, and deuruxolitinib. Higher odds ratios were found in studies examining JAK inhibitors for dermatologic conditions compared with nondermatologic conditions as well as for JAK1-specific inhibitors, combined JAK1 and JAK2 inhibitors, and TYK2 inhibitors. The authors conclude that patients should receive counseling about acne as a potential side effect prior to starting a JAK inhibitor.
Risk of mortality after melanoma in situ diagnosis
A study published in JAMA Dermatology evaluated the mortality and factors associated with mortality after a diagnosis of melanoma in situ. This retrospective cohort study included 137,872 U.S. patients with a first primary melanoma in situ (MIS) to investigate the risk of mortality in these patients compared with the general population. The analysis found that the 15-year melanoma-specific survival rate in this patient population was 98.4%. These patients also lived longer than people in the general population. The authors conclude that patients with MIS have a low risk of dying from their disease; however, the risk is slightly higher in older patients and those with acral lentiginous histology.
Can computer algorithms improve dermatologists’ accuracy when diagnosing melanoma? Read more.
Postoperative bleeding complications associated with novel oral anticoagulants in patients who underwent Mohs surgery
A study published in Dermatologic Surgery assessed the risk of postoperative bleeding in patients taking novel oral anticoagulants (NOACs) compared with patients taking no antithrombotic medications. In this retrospective chart review of 2,181 Mohs micrographic surgery cases, patients were on at least one antithrombotic medication in 32% of the cases. Bleeding complications were noted in 1% of the cases, and patients on antithrombotic medications were more likely to experience bleeding complications. NOAC monotherapy was not associated with an increased bleeding risk, while patients on NOAC and aspirin or multiple other antithrombotic agents experienced an increased risk of bleeding events.
Dermatologists discuss perioperative management of patients on anticoagulant therapy. Read more in DermWorld.
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