Faculty Bibliography

OBJECTIVES/OBJECTIVE:Laser and light-based therapies are widely used in dermatology, yet patients with inflammatory dermatoses are often excluded from cosmetic procedures due to concerns for disease exacerbation. This systematic review evaluated the safety and efficacy of these modalities to inform their use. METHODS:A PRISMA-guided search of PubMed, Embase, ClinicalTrials.gov, and Scopus from inception through March 1, 2026 identified studies of adults with psoriasis, atopic dermatitis, lichen sclerosus, lichen planus pigmentosus, frontal fibrosing alopecia, or cutaneous sarcoidosis treated with laser or light-based therapies. Eligible studies reported clinical outcomes and adverse events; reviews and studies without attributable outcomes were excluded. Risk of bias was assessed qualitatively, and results were synthesized descriptively. RESULTS:Fifty-seven studies including over 900 patients were analyzed, with the strongest evidence in psoriasis and lichen sclerosus. Across conditions and device types, therapies consistently demonstrated clinical improvement and were generally well tolerated. Adverse effects were predominantly localized and transient, including erythema, edema, blistering, and pigmentary changes. Serious adverse events were rare, with only isolated cases of koebnerization or disease worsening reported. Limitations include heterogeneity and predominance of small or non-randomized studies. CONCLUSIONS:These findings suggest that, in appropriately selected patients, laser and light-based therapies are safe and do not consistently precipitate disease exacerbation.

BACKGROUND:Merkel cell carcinoma (MCC) is a highly aggressive cutaneous malignancy. Guidelines recommend surgical excision with histologically negative margins for clinically node-negative disease. Adjuvant radiation therapy (aRT) is recommended for positive margins; however, its ability to offset the adverse impact of residual microscopic disease remains uncertain. OBJECTIVE:Evaluate the association between surgical margin status and oncologic outcomes among patients treated with excision and aRT. METHODS:Using the National Cancer Database (2004-2022), the authors identified patients with cN0 MCC who underwent excision followed by aRT with documented margin status. Multivariable logistic regression assessed predictors of regional lymph node metastasis, and Cox modeling evaluated all-cause mortality. RESULTS:Among 7,510 patients, 11.7% had positive surgical margins. Margin positivity was more common in older patients, head and neck tumors, and higher T-stage disease. Positive margins were independently associated with increased odds of regional lymph node metastasis (aOR 1.57, 95% confidence interval CI 1.24-1.99; p < .001) and higher all-cause mortality (HR 1.60, 95% CI 1.43-1.78; p < .001). CONCLUSION/CONCLUSIONS:Their findings suggest that positive surgical margins are an adverse prognostic factor despite aRT. Achieving histologically negative margins remains an important prognostic consideration in the management of MCC.

Platelet-rich plasma (PRP) injections are an effective and increasingly utilized treatment for androgenetic alopecia; however, the delivery of concentrated growth factors raises theoretical concerns regarding cutaneous malignancy risk in chronically ultraviolet (UV)-exposed, hair-thinning scalps. In this article, the current hypotheses linking PRP to scalp skin cancer risk are reviewed, including potential oncogenic mechanisms, such as platelet-derived growth factor (PDGF)-mediated signaling, and protective effects, such as improved hair-mediated photoprotection and antiproliferative findings from related blood products, although direct PRP-specific data remain lacking. Overall, the available evidence supports PRP safety while underscoring the need for prospective studies, routine scalp surveillance, and patient counseling regarding photoprotection.

BACKGROUND:Solid organ transplant recipients (SOTRs) face frequent advanced cutaneous malignancies, yet data guiding systemic therapy are limited. MATERIALS AND METHODS/METHODS:We conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review of immune checkpoint inhibitors (ICIs), talimogene laherparepvec (T-VEC), and Sonic Hedgehog Pathway Inhibitors (HPIs) for locally advanced or metastatic cutaneous squamous cell carcinoma, melanoma, Merkel cell carcinoma, and basal cell carcinoma in SOTRs, including a novel case from our institution. Outcomes included tumor response, graft rejection, and graft failure. RESULTS:Among 196 SOTRs treated with ICIs (101 cutaneous squamous cell carcinoma, 83 melanoma, 12 Merkel cell carcinoma), the overall response rate (ORR) was 39.3%, and lack of progression occurred in 58.0%. Graft rejection occurred in 36.9% and graft failure in 22.3%. A higher number of baseline immunosuppressive agents decreased odds of rejection (OR 0.55) and failure (OR 0.38). Tacrolimus was associated with reduced tumor response (OR 0.41), whereas mTOR-based regimens and cemiplimab were associated with fewer transplant rejection. T-VEC was reported in 10 SOTRs with an ORR of 90% and no graft rejection or failure. HPIs in six SOTRs with basal cell carcinoma demonstrated ORR of 83% without graft loss. CONCLUSION/CONCLUSIONS:ICIs provide antitumor activity but substantial graft-related risk, while T-VEC and HPIs show high response rates with no reported rejection.

Median canaliform dystrophy (MCD) of Heller is a rare nail disorder characterized by a median split and obliquely running furrows of the nail plate, often presenting in a "fir-tree" pattern. While its pathogenesis remains poorly understood, proposed etiologies include habitual trauma, iatrogenic causes, and familial predisposition. Diagnosis is generally made by clinical evaluation. There is a paucity of data regarding the histopathology of MCD. Herein, we present two cases of MCD with novel histopathologic features, broadening the understanding of the pathophysiology and potential therapeutic options for this condition. In Case 1, histopathologic evaluation revealed mild spongiosis, suggesting an inflammatory etiology. Case 2 demonstrated distinctive acantholysis. These findings suggest that MCD encompasses a spectrum of histopathologic changes. Our report contributes to the limited histopathologic characterization of MCD.