Pub Date : 2023-07-17DOI: 10.25251/skin.7.supp.228
S. Feldman, T. Vlahovic, Warren S Joseph, C. Daniel, B. Elewski, P. Rich, S. Lipner
Introduction: In onychomycosis management, excellent treatment adherence is necessary, and requires adequate medication supply. Efinaconazole 10% topical solution is available in 4- or 8-mL bottles; lacking published guidance, 4 mL is most often prescribed. The objective of this analysis was to use clinical data to determine monthly efinaconazole usage by patient demographics and clinical characteristics. Methods: In two identical, double-blind, phase 3 studies, adult participants with mild-to-moderate onychomycosis affecting 20-50% of ≥1 great (target) toenail were randomized 3:1 to once-daily treatment with efinaconazole 10% solution or vehicle for 48 weeks. Bottles of study product were weighed upon dispensation at each study visit (every 4 weeks) and upon return at the following visit. Monthly at-home efinaconazole use was analyzed post hoc based on number of affected toenails, percent involvement of the target toenail, body mass index (BMI), and sex. Results: Efinaconazole-treated participants in both studies (n=656 and 580) had on average 3.7-3.8 affected toenails. Among those with usage data (n=1067), over 55% had ≥4 affected toenails. For the 90% of participants with ≥2 affected nails, average usage ranged from 4.39-6.36 mL/month, corresponding to 1.10-1.59 4-mL bottles; only the 10% of participants with one affected toenail used <4 mL of efinaconazole monthly. Additional subgroup analyses revealed no meaningful differences in efinaconazole usage based on target toenail involvement, BMI, or sex; average medication use was 4.69-5.29 mL/month, corresponding to 1.17-1.32 4-mL bottles monthly. Conclusions: Given that the 4-mL bottle of efinaconazole is most commonly prescribed, patients with onychomycosis of ≥2 toenails will likely run out of medication in under a month. This can lead to gaps in onychomycosis treatment, which may affect medication efficacy and increase likelihood of relapse or reinfection. The number of affected nails should be the major consideration when determining the monthly efinaconazole quantity to prescribe. Funding: Ortho Dermatologics
{"title":"Monthly Usage of Efinaconazole 10% Solution in Two Phase 3 Randomized Trials: Is One 4-mL Bottle Enough for Proper Treatment?","authors":"S. Feldman, T. Vlahovic, Warren S Joseph, C. Daniel, B. Elewski, P. Rich, S. Lipner","doi":"10.25251/skin.7.supp.228","DOIUrl":"https://doi.org/10.25251/skin.7.supp.228","url":null,"abstract":"Introduction: In onychomycosis management, excellent treatment adherence is necessary, and requires adequate medication supply. Efinaconazole 10% topical solution is available in 4- or 8-mL bottles; lacking published guidance, 4 mL is most often prescribed. The objective of this analysis was to use clinical data to determine monthly efinaconazole usage by patient demographics and clinical characteristics. \u0000Methods: In two identical, double-blind, phase 3 studies, adult participants with mild-to-moderate onychomycosis affecting 20-50% of ≥1 great (target) toenail were randomized 3:1 to once-daily treatment with efinaconazole 10% solution or vehicle for 48 weeks. Bottles of study product were weighed upon dispensation at each study visit (every 4 weeks) and upon return at the following visit. Monthly at-home efinaconazole use was analyzed post hoc based on number of affected toenails, percent involvement of the target toenail, body mass index (BMI), and sex. \u0000Results: Efinaconazole-treated participants in both studies (n=656 and 580) had on average 3.7-3.8 affected toenails. Among those with usage data (n=1067), over 55% had ≥4 affected toenails. For the 90% of participants with ≥2 affected nails, average usage ranged from 4.39-6.36 mL/month, corresponding to 1.10-1.59 4-mL bottles; only the 10% of participants with one affected toenail used <4 mL of efinaconazole monthly. Additional subgroup analyses revealed no meaningful differences in efinaconazole usage based on target toenail involvement, BMI, or sex; average medication use was 4.69-5.29 mL/month, corresponding to 1.17-1.32 4-mL bottles monthly. \u0000Conclusions: Given that the 4-mL bottle of efinaconazole is most commonly prescribed, patients with onychomycosis of ≥2 toenails will likely run out of medication in under a month. This can lead to gaps in onychomycosis treatment, which may affect medication efficacy and increase likelihood of relapse or reinfection. The number of affected nails should be the major consideration when determining the monthly efinaconazole quantity to prescribe. \u0000Funding: Ortho Dermatologics","PeriodicalId":74803,"journal":{"name":"Skin (Milwood, N.Y.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44358291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We present a case of an atypical diffuse cutaneous eruption due to HPV infection and Tinea in a 51-year-old male patient with a past medical history of mild cytopenia, vasectomy and difficult socio-economic situation. Differential diagnosis at initial visit included Epidermodysplasia Verruciformis vs Pityriasis Rubra Pilaris vs Secondary Syphilis vs Xanthoma Disseminatum vs atypical presentation of Tinea vs less likely other. Through clinical examination, repeat biopsy, tissue culture and extensive HPV testing, it was revealed that the patient had multiple HPV infections type FA52, 96, 16 and 13, with a possible secondary Tinea infection. The patient was treated with antifungal medications first. Topical Cidofovir was recommended but not covered by insurance. The skin eruption improved gradually highlighting the importance of additional samples, tissue culture and extensive HPV testing in such atypical cases. Our case describes the importance of multidisciplinary care to help patients with proper diagnostics and treatment regimens.
{"title":"Atypical Human Papillomavirus Infection with Secondary Tinea in a Middle-Aged Caucasian Male","authors":"M. Dhandha, Debjit Ghosh, S. Tyring, P. Rady","doi":"10.25251/skin.7.4.15","DOIUrl":"https://doi.org/10.25251/skin.7.4.15","url":null,"abstract":"We present a case of an atypical diffuse cutaneous eruption due to HPV infection and Tinea in a 51-year-old male patient with a past medical history of mild cytopenia, vasectomy and difficult socio-economic situation. Differential diagnosis at initial visit included Epidermodysplasia Verruciformis vs Pityriasis Rubra Pilaris vs Secondary Syphilis vs Xanthoma Disseminatum vs atypical presentation of Tinea vs less likely other. Through clinical examination, repeat biopsy, tissue culture and extensive HPV testing, it was revealed that the patient had multiple HPV infections type FA52, 96, 16 and 13, with a possible secondary Tinea infection. The patient was treated with antifungal medications first. Topical Cidofovir was recommended but not covered by insurance. The skin eruption improved gradually highlighting the importance of additional samples, tissue culture and extensive HPV testing in such atypical cases. Our case describes the importance of multidisciplinary care to help patients with proper diagnostics and treatment regimens.","PeriodicalId":74803,"journal":{"name":"Skin (Milwood, N.Y.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47018672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-17DOI: 10.25251/skin.7.supp.221
F. Cook-Bolden, L. Stein Gold, H. Baldwin, V. Callender, A. Alexis, N. Bhatia, J. Zeichner, E. Tanghetti, E. Guenin
Introduction: Post-inflammatory hyperpigmentation (PIH) that results from acne in patients with skin of color may be more distressing than the acne itself, and likely impacts patients with higher skin phototypes more greatly than those with lower skin phototypes. Topical retinoids, a mainstay of acne treatment, can also reduce hyperpigmentation. For example, significant PIH improvements with a cream formulation of the retinoid tazarotene (0.1%) were observed following 16 weeks of treatment in patients with acne. However, skin irritation and other skin reactions may limit use of some tazarotene gel and cream formulations. A hydrating, lower-dose tazarotene 0.045% lotion formulation utilizes polymeric emulsion technology to allow for more efficient delivery of tazarotene into dermal layers while reducing potential for skin irritation. This pooled, post hoc analysis evaluates safety of tazarotene 0.045% lotion and its effect on hyperpigmentation in Black individuals with acne. Methods: In two identical phase 3 randomized, double-blind, vehicle-controlled, studies (NCT03168321; NCT03168334), participants aged ≥9 years with moderate-to-severe acne (Evaluator's Global Severity Score of 3/4) were randomized (1:1) to once-daily tazarotene 0.045% or vehicle lotion for 12 weeks. Safety evaluations included adverse events (AEs) reports and investigator-assessed hyperpigmentation (4-point scale: 0 [none] to 3 [severe]). Post hoc analyses were based on participants’ self-identification of race, including ‘Black or African American’ (herein referred to as Black). Results: Of 1,614 participants randomized in the two phase 3 studies, 262 (16%) self-identified as Black. The safety population comprised 253 Black participants. The most common TEAEs with tazarotene 0.045% lotion were at the application site: pain (6.6%), exfoliation (5.0%), and dryness (3.3%). No Black participants reported application site irritation or dermatitis with tazarotene lotion. Hyperpigmentation rates in Black participants, which were high at baseline, decreased by week 12 with tazarotene treatment (40.5% to 31.4%) compared to vehicle (37.9% to 37.2%). Conclusions: Acne regimens that maximize efficacy while mitigating irritation is key to managing acne in patients with skin of color, given the higher pigmentary alteration risk in melanin-rich skin. Tazarotene 0.045% lotion was safe and well tolerated in Black participants, with no application-site irritation or dermatitis after 12 weeks of once-daily treatment. Tazarotene also led to improvements in hyperpigmentation, an inflammation-associated sequala of acne. As PIH can take longer than 12 weeks to resolve with treatment, additional improvements in hyperpigmentation may be expected with continued tazarotene 0.045% lotion use. Support: Ortho Dermatologics.
{"title":"Safety of Tazarotene 0.045% Lotion and Hyperpigmentation Improvements in Black Participants With Moderate-to-Severe Acne","authors":"F. Cook-Bolden, L. Stein Gold, H. Baldwin, V. Callender, A. Alexis, N. Bhatia, J. Zeichner, E. Tanghetti, E. Guenin","doi":"10.25251/skin.7.supp.221","DOIUrl":"https://doi.org/10.25251/skin.7.supp.221","url":null,"abstract":"Introduction: Post-inflammatory hyperpigmentation (PIH) that results from acne in patients with skin of color may be more distressing than the acne itself, and likely impacts patients with higher skin phototypes more greatly than those with lower skin phototypes. Topical retinoids, a mainstay of acne treatment, can also reduce hyperpigmentation. For example, significant PIH improvements with a cream formulation of the retinoid tazarotene (0.1%) were observed following 16 weeks of treatment in patients with acne. However, skin irritation and other skin reactions may limit use of some tazarotene gel and cream formulations. A hydrating, lower-dose tazarotene 0.045% lotion formulation utilizes polymeric emulsion technology to allow for more efficient delivery of tazarotene into dermal layers while reducing potential for skin irritation. This pooled, post hoc analysis evaluates safety of tazarotene 0.045% lotion and its effect on hyperpigmentation in Black individuals with acne. \u0000Methods: In two identical phase 3 randomized, double-blind, vehicle-controlled, studies (NCT03168321; NCT03168334), participants aged ≥9 years with moderate-to-severe acne (Evaluator's Global Severity Score of 3/4) were randomized (1:1) to once-daily tazarotene 0.045% or vehicle lotion for 12 weeks. Safety evaluations included adverse events (AEs) reports and investigator-assessed hyperpigmentation (4-point scale: 0 [none] to 3 [severe]). Post hoc analyses were based on participants’ self-identification of race, including ‘Black or African American’ (herein referred to as Black). \u0000Results: Of 1,614 participants randomized in the two phase 3 studies, 262 (16%) self-identified as Black. The safety population comprised 253 Black participants. The most common TEAEs with tazarotene 0.045% lotion were at the application site: pain (6.6%), exfoliation (5.0%), and dryness (3.3%). No Black participants reported application site irritation or dermatitis with tazarotene lotion. Hyperpigmentation rates in Black participants, which were high at baseline, decreased by week 12 with tazarotene treatment (40.5% to 31.4%) compared to vehicle (37.9% to 37.2%). \u0000Conclusions: Acne regimens that maximize efficacy while mitigating irritation is key to managing acne in patients with skin of color, given the higher pigmentary alteration risk in melanin-rich skin. Tazarotene 0.045% lotion was safe and well tolerated in Black participants, with no application-site irritation or dermatitis after 12 weeks of once-daily treatment. Tazarotene also led to improvements in hyperpigmentation, an inflammation-associated sequala of acne. As PIH can take longer than 12 weeks to resolve with treatment, additional improvements in hyperpigmentation may be expected with continued tazarotene 0.045% lotion use. \u0000Support: Ortho Dermatologics.","PeriodicalId":74803,"journal":{"name":"Skin (Milwood, N.Y.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43438577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Covid-19 vaccination is a crucial component of the public health response to reduce the spread of Covid-19. Although well-tolerated, Covid-19 vaccination is associated with several cutaneous adverse reactions. Here, we document a case of a young man who developed numerous halo nevi at sites of pre-existing nevi following Covid-19 vaccination. Our patient is a 21-year-old male who presented to clinic after noticing a recent change in his moles. Three months after receiving the Johnson & Johnson (J&J) Covid-19 vaccine, the patient reported that he developed a ring of “vitiligo” surrounding each of his existing moles. He also received the Moderna Covid-19 booster 8 months after receiving the J&J vaccine and contracted Covid-19 two months later, with no additional change in his moles. The patient was otherwise well with no past medical or family medical history of skin cancer. On examination, the patient was found to have numerous halo nevi that had developed at sites of pre-existing nevi and were distributed over his face, neck, trunk, and extremities. Examination of his scalp revealed patches of white hair, underneath which were additional halo nevi. The development of vitiligo in the setting of Covid-19 vaccination is thought to be related to the activation of autoimmunity. Autoimmunity secondary to Covid-19 vaccination may be the cause of this patient’s halo nevi, given the patient’s age and absence of any systemic symptoms.
{"title":"Halo Nevi After Covid-19 Vaccination: Molecular Mimicry Attributed Cutaneous Side-Effect?","authors":"K. Owens, Jeffery T. Kwock, Matilda W. Nicholas","doi":"10.25251/skin.7.4.17","DOIUrl":"https://doi.org/10.25251/skin.7.4.17","url":null,"abstract":"Covid-19 vaccination is a crucial component of the public health response to reduce the spread of Covid-19. Although well-tolerated, Covid-19 vaccination is associated with several cutaneous adverse reactions. Here, we document a case of a young man who developed numerous halo nevi at sites of pre-existing nevi following Covid-19 vaccination. Our patient is a 21-year-old male who presented to clinic after noticing a recent change in his moles. Three months after receiving the Johnson & Johnson (J&J) Covid-19 vaccine, the patient reported that he developed a ring of “vitiligo” surrounding each of his existing moles. He also received the Moderna Covid-19 booster 8 months after receiving the J&J vaccine and contracted Covid-19 two months later, with no additional change in his moles. The patient was otherwise well with no past medical or family medical history of skin cancer. On examination, the patient was found to have numerous halo nevi that had developed at sites of pre-existing nevi and were distributed over his face, neck, trunk, and extremities. Examination of his scalp revealed patches of white hair, underneath which were additional halo nevi. The development of vitiligo in the setting of Covid-19 vaccination is thought to be related to the activation of autoimmunity. Autoimmunity secondary to Covid-19 vaccination may be the cause of this patient’s halo nevi, given the patient’s age and absence of any systemic symptoms.","PeriodicalId":74803,"journal":{"name":"Skin (Milwood, N.Y.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47031270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-17DOI: 10.25251/skin.7.supp.223
D. Hyams, J. Byun, B. Martin, Christine N. Bailey, Timothy Stumpf, V. Petkov
Introduction: Management guidelines for cutaneous melanoma (CM) are based on patients’ recurrence risk by stage. Most newly diagnosed patients (88%) will be categorized as node-negative (stage I-II) and will be considered low-risk. However, because of the size of this group, the small percentage of stage I-II individuals who do die of melanoma account for the majority of melanoma-associated deaths. In collaboration with the Surveillance, Epidemiology, and End Results (SEER) program, we demonstrated, in a large, unselected cohort of clinically tested patients, that the 31-GEP test identifies those individuals with stage I-II disease, who have higher risk of melanoma-specific death and who may benefit from more aggressive management. Methods: SEER registries linked individuals diagnosed with CM between 2013-2018 were linked to data for 31-GEP-tested patients (N=9,207 after exclusions). For this study, analysis focused on the subset reported as node-negative (N=6,301). Patient 5-year melanoma-specific survival (MSS) was estimated using Kaplan-Meier analysis and the log-rank test for patients considered by the 31-GEP to be low-risk (Class 1A), intermediate-risk (Class 1B/2A), or high-risk (Class 2B). Multivariable Cox regression analysis was used to evaluate significant predictors of melanoma-specific death. Notably, at the time of diagnosis, none of the immune checkpoint inhibitor or targeted signal transduction therapies were approved for use in node-negative patients, providing a largely contemporary therapy naïve cohort. Results: Patients with a Class 2B 31-GEP result had significantly lower 5-year MSS than patients with Class 1B/2A or Class 1A results (85.0% vs. 95.6% vs. 97.9%, p<0.001). The 31-GEP Class 2B result (HR=4.08, p<0.001) was the strongest predictor of melanoma-specific death. Breslow thickness (HR=1.16, p=0.002), presence of ulceration (HR=2.10, p=0.006), and age (HR=1.05, p<0.001) were also significant predictors of melanoma-specific death. The 31-GEP had a sensitivity of 78.4% and a negative predictive value (NPV) of 99.4%. Combining the 31-GEP Class result with AJCC staging could increase the sensitivity to 82.0% while maintaining a high NPV (99.4%). Conclusion: In a large, unselected cohort of patients with stage I-II CM, the 31-GEP Class 2B identified patients with a high risk of progression and death from melanoma who should be considered for more aggressive management. Conversely, the high NPV suggests that the 31-GEP reliably identifies patients at low risk of tumor progression who could safely avoid intensive surveillance and intervention.
简介:皮肤黑色素瘤(CM)的管理指南是基于患者分期的复发风险。大多数新诊断的患者(88%)将被归类为淋巴结阴性(I-II期)，并被认为是低风险的。然而，由于这一群体的规模，一小部分I-II期患者死于黑色素瘤，这占了黑色素瘤相关死亡的大部分。在监测、流行病学和最终结果(SEER)项目的合作下，我们在大量未选择的临床测试患者队列中证明，31-GEP测试可以识别出那些患有I-II期疾病的个体，这些患者有更高的黑色素瘤特异性死亡风险，并且可能从更积极的治疗中受益。方法:将2013-2018年诊断为CM的个体与31例gep检测患者的数据(排除后N= 9207例)相关联。在本研究中，分析集中在报告为节点阴性的子集(N= 6301)。使用Kaplan-Meier分析和log-rank检验对31-GEP认为为低风险(1A类)、中风险(1B/2A类)或高风险(2B类)的患者进行5年黑色素瘤特异性生存率(MSS)的估计。采用多变量Cox回归分析评估黑色素瘤特异性死亡的重要预测因素。值得注意的是，在诊断时，没有一种免疫检查点抑制剂或靶向信号转导疗法被批准用于淋巴结阴性患者，提供了一个主要的当代治疗naïve队列。结果:2B类31-GEP患者的5年MSS显著低于1B/2A类或1A类患者(85.0% vs. 95.6% vs. 97.9%， p<0.001)。31-GEP 2B级结果(HR=4.08, p<0.001)是黑色素瘤特异性死亡的最强预测因子。brreslow厚度(HR=1.16, p=0.002)、溃疡的存在(HR=2.10, p=0.006)和年龄(HR=1.05, p<0.001)也是黑色素瘤特异性死亡的重要预测因素。31-GEP敏感性为78.4%，阴性预测值(NPV)为99.4%。将31-GEP分级结果与AJCC分期相结合，可将敏感性提高至82.0%，同时保持较高的NPV(99.4%)。结论:在一个大型的未选择的I-II期CM患者队列中，31-GEP 2B类确定了黑色素瘤进展和死亡风险高的患者，应考虑采取更积极的治疗。相反，高NPV表明31-GEP可靠地识别出肿瘤进展风险低的患者，这些患者可以安全地避免强化监测和干预。
{"title":"Combining the 31-gene expression profile test for cutaneous melanoma with the American Joint Committee on Cancer staging identifies the highest-risk patients with stage I-II disease","authors":"D. Hyams, J. Byun, B. Martin, Christine N. Bailey, Timothy Stumpf, V. Petkov","doi":"10.25251/skin.7.supp.223","DOIUrl":"https://doi.org/10.25251/skin.7.supp.223","url":null,"abstract":"Introduction: Management guidelines for cutaneous melanoma (CM) are based on patients’ recurrence risk by stage. Most newly diagnosed patients (88%) will be categorized as node-negative (stage I-II) and will be considered low-risk. However, because of the size of this group, the small percentage of stage I-II individuals who do die of melanoma account for the majority of melanoma-associated deaths. In collaboration with the Surveillance, Epidemiology, and End Results (SEER) program, we demonstrated, in a large, unselected cohort of clinically tested patients, that the 31-GEP test identifies those individuals with stage I-II disease, who have higher risk of melanoma-specific death and who may benefit from more aggressive management. \u0000Methods: SEER registries linked individuals diagnosed with CM between 2013-2018 were linked to data for 31-GEP-tested patients (N=9,207 after exclusions). For this study, analysis focused on the subset reported as node-negative (N=6,301). Patient 5-year melanoma-specific survival (MSS) was estimated using Kaplan-Meier analysis and the log-rank test for patients considered by the 31-GEP to be low-risk (Class 1A), intermediate-risk (Class 1B/2A), or high-risk (Class 2B). Multivariable Cox regression analysis was used to evaluate significant predictors of melanoma-specific death. Notably, at the time of diagnosis, none of the immune checkpoint inhibitor or targeted signal transduction therapies were approved for use in node-negative patients, providing a largely contemporary therapy naïve cohort. \u0000Results: Patients with a Class 2B 31-GEP result had significantly lower 5-year MSS than patients with Class 1B/2A or Class 1A results (85.0% vs. 95.6% vs. 97.9%, p<0.001). The 31-GEP Class 2B result (HR=4.08, p<0.001) was the strongest predictor of melanoma-specific death. Breslow thickness (HR=1.16, p=0.002), presence of ulceration (HR=2.10, p=0.006), and age (HR=1.05, p<0.001) were also significant predictors of melanoma-specific death. The 31-GEP had a sensitivity of 78.4% and a negative predictive value (NPV) of 99.4%. Combining the 31-GEP Class result with AJCC staging could increase the sensitivity to 82.0% while maintaining a high NPV (99.4%). \u0000Conclusion: In a large, unselected cohort of patients with stage I-II CM, the 31-GEP Class 2B identified patients with a high risk of progression and death from melanoma who should be considered for more aggressive management. Conversely, the high NPV suggests that the 31-GEP reliably identifies patients at low risk of tumor progression who could safely avoid intensive surveillance and intervention. ","PeriodicalId":74803,"journal":{"name":"Skin (Milwood, N.Y.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46239361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tirbanibulin 1% ointment (Klisyri), an FDA-approved topical treatment for actinic keratosis, is advertised to serve as a first-in-class topical with high efficacy and low adverse effects compared to other field therapies. We report a case of severe bullous eruption associated with application of tirbanibulin in an adult female. Though application of tirbanibulin did resolve the actinic keratoses on the patient’s chest, the severe local skin reaction precludes future use of tirbanibulin in her case.
{"title":"Bullous Eruption after Off-label Use of Topical Tirbanibulin on the Chest","authors":"Jessica Kim, Onyebuchi Neita, Joseph M. Dyer","doi":"10.25251/skin.7.4.13","DOIUrl":"https://doi.org/10.25251/skin.7.4.13","url":null,"abstract":"Tirbanibulin 1% ointment (Klisyri), an FDA-approved topical treatment for actinic keratosis, is advertised to serve as a first-in-class topical with high efficacy and low adverse effects compared to other field therapies. We report a case of severe bullous eruption associated with application of tirbanibulin in an adult female. Though application of tirbanibulin did resolve the actinic keratoses on the patient’s chest, the severe local skin reaction precludes future use of tirbanibulin in her case.","PeriodicalId":74803,"journal":{"name":"Skin (Milwood, N.Y.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47112325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cryoglobulinemia is a form of vasculitis causing inflammation of the blood vessels due to aggregated proteins that clump together at cold temperatures, causing damage to skin, muscles, nerves, and other organs. An elderly black female presented with superficial ulceration with overlying eschar within areas of retiform purpura of her bilateral thighs present for 8 months. She was previously diagnosed with vaso-occlusive disease before presenting to our clinic for further evaluation and management. Upon investigation, we have concluded that the patient has cryoglobulinemia type I.
{"title":"Cryoglobulinemia Type I in Patient with History of Monoclonal Gammopathy of Unknown Significance: A Case Report","authors":"A. Mathis, S. Marrone","doi":"10.25251/skin.7.4.9","DOIUrl":"https://doi.org/10.25251/skin.7.4.9","url":null,"abstract":"Cryoglobulinemia is a form of vasculitis causing inflammation of the blood vessels due to aggregated proteins that clump together at cold temperatures, causing damage to skin, muscles, nerves, and other organs. An elderly black female presented with superficial ulceration with overlying eschar within areas of retiform purpura of her bilateral thighs present for 8 months. She was previously diagnosed with vaso-occlusive disease before presenting to our clinic for further evaluation and management. Upon investigation, we have concluded that the patient has cryoglobulinemia type I. ","PeriodicalId":74803,"journal":{"name":"Skin (Milwood, N.Y.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41580519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Bilateral Upper Extremities Linear Eruption in a 12-year-old Boy","authors":"Faraz Yousefian, A. Apple, A. Lin","doi":"10.25251/skin.7.4.19","DOIUrl":"https://doi.org/10.25251/skin.7.4.19","url":null,"abstract":"","PeriodicalId":74803,"journal":{"name":"Skin (Milwood, N.Y.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46621999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shivani Thacker, M. Chakkalakal, Zachary Goldstein, K. D. Macknet
We report a case of a malignant melanoma clinically mimicking a blue nevus. The patient presented for evaluation of a “seborrheic keratosis” status post cryotherapy that clinically resembled a blue nevus albeit with concerning clinical course prompting biopsy. Histopathologic examination revealed malignant melanoma in association with a melanocytic nevus to include areas resembling tumoral melanosis which likely contributed to clinical presentation. We conclude this report with a brief review on the topic of melanoma masquerading as benign lesions (e.g., blue nevus), underscoring the importance of clinical history and histological examination in the evaluation of this entity.
{"title":"Beware of the “Blue Nevus”: A Case Report","authors":"Shivani Thacker, M. Chakkalakal, Zachary Goldstein, K. D. Macknet","doi":"10.25251/skin.7.4.8","DOIUrl":"https://doi.org/10.25251/skin.7.4.8","url":null,"abstract":"We report a case of a malignant melanoma clinically mimicking a blue nevus. The patient presented for evaluation of a “seborrheic keratosis” status post cryotherapy that clinically resembled a blue nevus albeit with concerning clinical course prompting biopsy. Histopathologic examination revealed malignant melanoma in association with a melanocytic nevus to include areas resembling tumoral melanosis which likely contributed to clinical presentation. We conclude this report with a brief review on the topic of melanoma masquerading as benign lesions (e.g., blue nevus), underscoring the importance of clinical history and histological examination in the evaluation of this entity.","PeriodicalId":74803,"journal":{"name":"Skin (Milwood, N.Y.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42127873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Generalized Eruptive Keratoacanthomas of Grzybowski and the Sign of Zorro","authors":"P. Cohen","doi":"10.25251/skin.7.4.22","DOIUrl":"https://doi.org/10.25251/skin.7.4.22","url":null,"abstract":"","PeriodicalId":74803,"journal":{"name":"Skin (Milwood, N.Y.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48457379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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