Risk factors for subsequent primary melanoma in patients with previous melanoma
An article published in the British Journal of Dermatologyanalyzed data from 27 studies to identify risk factors for developing subsequent primary melanoma among individuals with a history of melanoma. Independent risk factors identified include CDKN2A mutation, higher/moderate nevus count, presence of atypical nevus, increasing age, and male gender. The authors conclude that these findings can assist in stratifying risk of subsequent melanoma and tailoring skin check schedules.
DermWorld Insights and Inquiries: Wolf’s isotopic response — Where and when
Wolf’s isotopic response (WIR) has been a mysterious and controversial dermatological sign for almost 40 years. In 1984, the Doctors Wolf (Ronni and Danny) described two cases — a 52-year-old man and a 12-year-old girl — both of whom developed tinea infection corresponding to the site of prior herpes zoster (HZ). The overwhelming initial rash in WIR is HZ, although other dermatoses such as tinea corporis or allergic contact dermatitis have been observed. Secondary disorders may appear days to months after the primary disease, including inflammatory diseases (granulomatous disorders, allergic contact dermatitis, lichen planus, lichen simplex chronicus, psoriasis, pityriasis rosea, discoid lupus, morphea, graft-versus-host disease, reactive perforating collagenosis, erythema annulare centrifugum, and bullous pemphigoid), acquired tufted angiomas, xanthomas, cutaneous infections, and malignancies (including leukemia cutis). Keep reading!
Derm Coding Consult: Q&A on repair of contiguous defect in multiple anatomic locations
Learn about coding for the repair of contiguous defects across multiple anatomical sites and more in this new Q&A. Read more.
Advocacy win: FDA extends flexibilities for iPLEDGE REMS Program
In a recent advocacy win, the FDA announced it will continue to exercise flexibility and allow at-home and other non-CLIA pregnancy tests in the iPLEDGE REMS Program indefinitely. The pre-treatment, confirmatory pregnancy test must be performed in a medical setting, but additional pregnancy tests may be performed at home or other settings. The AADA has long advocated for this flexibility to remain and testified in March at an FDA advisory committee hearing, coordinated with several stakeholder societies, sent numerous letters, and engaged members, resulting in over 700 letters to the FDA.
FDA approves nivolumab for adjuvant treatment of Stage IIB/C melanoma
The FDA recently approved nivolumab for the adjuvant treatment of completely resected Stage IIB/C melanoma in patients 12 years and older. Efficacy was evaluated in CHECKMATE-76K (NCT04099251), a randomized, double-blind trial enrolling 790 patients with Stage IIB/C melanoma. Patients were randomized (2:1) to nivolumab 480 mg or placebo by intravenous infusion every four weeks for up to one year or until disease recurrence or unacceptable toxicity.
The major efficacy outcome measure was recurrence-free survival. Median RFS was not reached in either the nivolumab arm or in the placebo arm. The recommended nivolumab dose for patients weighing 40 kg or greater is 240 mg every two weeks or 480 mg every four weeks until disease progression or unacceptable toxicity for up to one year. The recommended dose for pediatric patients weighing less than 40 kg is three mg/kg every two weeks or six mg/kg every four weeks until disease progression or unacceptable toxicity for up to one year.
The most common adverse reactions, reported in ≥20% of patients, were fatigue, musculoskeletal pain, rash, diarrhea, and pruritus.
AADA advocacy results in House Committee to hold Medicare physician payment hearing
As a direct result of AADA’s ongoing advocacy for Medicare physician payment reform, the House Energy & Commerce Health Subcommittee will hold a legislative hearing on Medicare payment on Oct. 19. The hearing will review how physicians are currently paid by Medicare to maintain accountability, including draft legislation regarding budget neutrality that affects Medicare payment determination for specialty physicians. The AADA advocates for fair reimbursement for the value of dermatology services while limiting administrative burdens on practices.
The hearing will review critical draft legislation of the Provider Reimbursement Stability Act of 2023, which addresses budget neutrality policy and is intended to launch further discussions on MACRA reform. The bill would provide more flexibility in how much money CMS can spend, which is currently limited by a budget neutrality requirement. It would also update Medicare’s calculation of how much it costs to run a practice; physicians have voiced concern about steadily declining Medicare rates since 2015 when Congress last addressed the issue. This bill and hearing are a huge advocacy win, as AADA members have been pressuring Congress to act on reforming Medicare physician payment.
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