Faculty Bibliography

BACKGROUND: With increasing frequency, patients with cancer and their family members are turning to the Internet to educate themselves about their disease and treatment options, including complementary and alternative medicine (CAM) and supportive care. However, very little is known about how national leading cancer centers represent these therapies via their websites. METHODS: Simulating the perspective of an information-seeking patient or family member, we performed a systematic analysis of the websites of 41 National Cancer Institute designated comprehensive cancer centers. Two researchers independently evaluated websites, recorded CAM information, and rated quality of the websites using a 4-item Likert scale (overall, information, presentation, and navigation) with Cronbach's alpha = 0.97. Rating was adequately correlated between the two raters (correlation coefficient 0.8). RESULTS: Of 41 centers, 12 (29%) did not have functional websites with regard to information related to CAM. The most common CAM approaches mentioned were: acupuncture (59%), meditation/nutrition/spiritual support/yoga (56% for each), massage therapy (54%), and music therapy (51%). Twenty-three (23; 56%) presented information on support groups, 19 (46%) on patient seminars, 18 (44%) on survivorship effort, and 17 (41%) on symptom management clinics. Twenty-nine (29) (71%) of these websites had a telephone number available, 22 (54%) mentioned at least one ongoing research opportunity, and 19 (46%) provided links to the National Center for Complementary and Alternative Medicine website. Median rating of the quality of websites was 50 of 100, with only 7 (17%) of centers receiving a composite score 80 (excellent) or better. CONCLUSIONS: While a growing number of leading cancer centers provide information about CAM and supportive oncology information for patients via their websites, the quality and ease of navigation of these sites remain highly variable. Effective development and redesign of many of the websites is needed to better inform and empower patients and families seeking CAM and supportive care information.

BACKGROUND: Differences in risk factors for metastases at different time intervals after treatment have been described in several malignancies; however, to the authors' knowledge, no extensive study examining this issue in melanoma has been conducted to date. METHODS: The authors performed a nested case-control study of patients with melanoma who presented with only local disease. Patients in the case group included 549 patients who developed metastases > or =6 months after surgery. Of these, 320 patients developed metastasis within 3 years after undergoing definitive surgery (early metastases [EM]), and 70 patients developed metastasis > or =8 years after undergoing definitive surgery (late metastases [LM]). For each case, a control patient was chosen who had melanoma but who did not develop metastases in the same interval. Univariate and conditional multivariate logistic regression were used in the analysis of 34 clinical and tumor characteristics. RESULTS: Multivariate analysis confirmed previously established risk factors for metastases, such as increasing tumor thickness. In addition, the authors discovered that a personal history of nonmelanoma skin cancer (P = .006) and a history of cancer other than skin cancer (P = .020) also were associated with metastasis. In comparing the 320 EM patients with the 70 LM patients, EM patients were more likely to have thicker lesions (P < .001), ulcerated lesions (P = .016), and a history of nonmelanoma skin cancer (P = .024). CONCLUSIONS: In this study, 2 potentially novel risk factors for melanoma metastases were identified, and different profiles of risk factors were constructed for EM versus LM. These differences may be important in future risk identification and stratification for clinical trials and for the management and treatment of patients with melanoma.

The field of nonsurgical laser resurfacing for aesthetic enhancement continues to improve with new research and technological advances. Since its beginnings in the 1980s, the laser-resurfacing industry has produced a multitude of devices employing ablative, nonablative, and fractional ablative technologies. The three approaches largely differ in their method of thermal damage, weighing degrees of efficacy, downtime, and side effect profiles against each other. Nonablative technologies generate some interest, although only for those patient populations seeking mild improvements. Fractional technologies, however, have gained dramatic ground on fully ablative resurfacing. Fractional laser resurfacing, while exhibiting results that fall just short of the ideal outcomes of fully ablative treatments, is an increasingly attractive alternative because of its far more favorable side effect profile, reduced recovery time, and significant clinical outcome.

A 78-year-old man presented with an eight-month history of folliculocentric, pink, hyperkeratotic papules and plaques with thick white scale that involved the entire body, with confluence on the buttocks and genitalia. A biopsy specimen demonstrated superficial and focal, mild perivascular and perifollicular, band-like lymphocytic infiltrate and eosinophils. There were lymphocytes extending to the dermo-epidermal junction with vacuolar changes. A diagnosis of lichenoid drug eruption secondary to a proton-pump inhibitor was made. To the best of our knowledge, only one other case of lichenoid drug eruption secondary to a proton-pump inhibitor has been reported

BACKGROUND: Complementary and alternative medicine (CAM) is commonly used for a variety of diseases in the United States. Limited population-based data exist on CAM use among patients with dermatologic conditions OBJECTIVE: We sought to determine the extent and the nature of CAM use in the United States among people with skin problems. METHODS: We conducted a cross-sectional survey using the 2002 National Health Interview Survey and the Alternative Health Supplement. RESULTS: Among those reporting skin problems in the past year, 49.4% (95% confidence interval 47.2-51.6) had used CAM. Only 6.0% of this group (95% confidence interval 4.2-7.7) used CAM specifically for skin disease. Those reporting skin problems were more likely to use CAM than those who did not report skin problems (odds ratio 1.7, P < or = .001, 95% confidence interval 1.6-1.8). The most commonly used CAM modality was nonvitamin, nonmineral, natural products (ie, herbals). LIMITATIONS: Because of the nature of a cross-sectional study, it is not possible to know whether the skin problem or the CAM use came first (except in situations where they used CAM specifically for skin problems). Because this is not a dermatology-focused database, the definition of skin disease is vague. CONCLUSION: CAM use among adults with skin problems in the Unites States is common. Dermatologists should have candid discussions with their patients regarding CAM use.

BACKGROUND: The characteristics and prevalence of dermatologists reading dermatopathology slides are not well understood. METHODS: We surveyed 1406 members of the American Academy of Dermatology (AAD), including all 497 who were also members of the American Society of Dermatopathology (ASDP) along with a random sample of the remaining AAD members who were not ASDP members. Seven hundred and thirty of 1406 (51.9%) responded with a usable survey. Logistic regression was used to analyze responses by ASDP member dermatologists, non-ASDP member dermatologists and in a weighted analysis for dermatologists as a whole. RESULTS: A total of 32.7% of dermatologists as a whole generated at least one final microscopic diagnosis in the preceding year. Multivariate analysis demonstrated that men were significantly more likely to read dermatopathology slides (odds ratio (OR) = 1.90; 95% confidence interval (CI) 1.16-3.12; p = 0.01). Additionally, there was significant variation by region (p < 0.001); compared with dermatologists in the Midwest, dermatologists in the Southeast (OR = 0.39; 95% CI 0.19-0.80) were significantly less likely to read slides, while those in the Mountain (OR = 3.09; 95% CI 1.10-8.72) and West (OR = 2.01; 95% CI 1.04-3.90) regions were significantly more likely. There were no significant associations found between reading slides and the year of residency completion, the number of patients seen per week or being primarily in academics. CONCLUSIONS: The practice of dermatologists reading dermatopathology slides is relatively common, with significant regional and sex differences.