A report published in the British Journal of Dermatology analyzed existing staging systems for cutaneous squamous cell carcinoma (cSCC) for their ability to predict metastasis as well as highlighting the strengths and weaknesses of each system. The authors examined the American Joint Committee on Cancer 8th edition (AJCC8), the Brigham and Women’s Hospital (BWH) system, the Tübingen University staging system, and the Salamanca T3 refinement.
[Changes to TNM system enhance prognostication for cutaneous cancers. Read more in DermWorld.]
A total of 887 cases of metastatic cSCC and 887 nonmetastatic cSCC control patients were included in the study. In an analysis across all body sites, the BWH system performed the best in terms of specificity (92.8%), positive predictive value (13.2%), and concordance index (0.84). Compared with BWH and Tübingen systems, the AJCC8 showed better negative predictive value, homogeneity, and monotonicity across all body sites. There was not an improvement over the AJCC8 system with the Salamanca T3 refinement for tumors of all body sites. The AJCC8 was originally developed for head and neck cSCC, although it performed more poorly in analysis of cSCC of the head and neck than it did in the analysis of all body sites.
Two days from now there will be tears of joy and sorrow in our medical schools, especially for those applying for a dermatology residency. I congratulate those who have matched successfully and welcome you to a marvelous discipline. For those who did not secure a dermatology residency, there may be little solace in knowing that many other well-qualified candidates share the same fate and are hearing the homily that “life works out for the best.” I wish every graduate a fulfilling career of success, regardless of the direction it takes.
Four years ago, I wrote an editorial titled “Dermatology Match Day: The Ecstasy and the Agony,” commenting on the absurdity of the hyper-competitive world of securing a dermatology residency and offering perspectives on multiple issues of the application process. This commentary will focus on one aspect only — the advisability of recommending a gap year to bolster the dermatology residency candidate’s chances of matching.Keep reading!
DermWorld Young Physician Focus: Talking points
I’m sure we’ve all experienced some version of this story: a new patient comes in and tells you an outlandish story about a treatment recommended by their previous dermatologist. You request the patient’s medical records, only to find that the patient was advised the exact opposite of what they told you! With many studies demonstrating that patients only retain a small fraction of what they’re told during medical appointments, it’s a wonder anyone follows their prescribed treatment at all. Read more from DermWorld Young Physician Advisor Jenna O’Neill, MD, FAAD.
Potassium monitoring in women on spironolactone
A study published inJAADreviewed charts of female patients taking oral spironolactone for the diagnosis of acne, androgenetic alopecia, hirsutism, or hidradenitis suppurativa. Of 195 women treated with spironolactone between 2012 and 2020, 150 underwent lab monitoring and five were diagnosed with hyperkalemia. Of these five patients, only three had mild hyperkalemia from spironolactone use.
[Is spironolactone use associated with risk of cancer? Find out inDermWorld Weekly.]
Two were younger than 40 years of age and their hyperkalemia resolved on repeat testing. The third patient was 65 years old and taking losartan. Her hyperkalemia resolved with dose adjustment. The authors conclude that spironolactone rarely causes mild hyperkalemia in low-risk patients treated for dermatologic conditions, so routine potassium monitoring may not be necessary.
Not the usual suspects. Read more about drugs you never thought you’d use in dermatology inDermWorld.
Using medical cannabis to treat dermatologic conditions
An article in the Journal of Drugs in Dermatologyexplored consumer use and perspectives of medical cannabis products for dermatologic indications. A survey of 504 users of medical cannabis products found that nearly 18% used an over-the-counter (OTC) cannabis product without a dermatologist recommendation to treat a skin condition. The most common indications were acne (28%) and psoriasis (26%).
Of those who had seen a dermatologist, 15% used an OTC product while nearly 8% used a medical cannabis product requiring a department of health-approved card per their dermatologist’s recommendations. The most common indications were acne (68%) and psoriasis (28%). About 12% of respondents were not comfortable seeing a dermatologist who recommended medical cannabis products.
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