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Racial differences in sun-protective behaviors: a retrospective, cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES) 2003-2018

Pulavarty, Akshay N; Doudican, Nicole; Carucci, John A; Stevenson, Mary L
PMID: 34058275
ISSN: 1097-6787
CID: 4891042

Deliberate practice-based surgical curriculum leads to enhanced technical proficiency among dermatology residents

Criscito, Maressa C; Wilken, Reason; Stevenson, Mary L; Carucci, John A
Deliberate practice-based medical education has demonstrated superiority in trainee acquisition and maintenance of skills in several surgical subspecialties. In an effort to highlight the impact of a deliberate practice-based surgical curriculum on the technical proficiency of dermatology residents, a prospective cohort study including first- and second-year dermatology residents was performed. A total of 87.5% (7 of 8) first-year dermatology residents completed three hands-on simulations at 6-week intervals. Additionally, six of eight (75.0%) second-year dermatology residents at the same institution were evaluated at a single point-in-time session without accessing the surgical curriculum prior. A 5-point global rating scale (GRS) was used to assess resident performance on six core surgical techniques. Nonparametric ANOVA statistical methods using the Kruskal-Wallis test was performed. The residents' overall GRS increased from a median of 1-2.75 after completion of the curriculum (p < 0.01). There was a significant improvement in the median scores of each tested surgical technique. The first-year residents had a greater overall GRS after completion of the curriculum compared to the second-year residents (median of 2.13 versus 1.88, p < 0.001). Limitations include the small sample size and lack of a synchronized control group. Our study highlights the use of deliberate practice-based strategies as an effective modality in teaching surgical skills to dermatology residents.
PMID: 35476153
ISSN: 1432-069x
CID: 5217482

A cohort study to determine factors associated with upstaging cutaneous squamous cell carcinoma during Mohs surgery

Canavan, Theresa N; Celen, Arda B; Frazzette, Nicholas J; Carucci, John A; Doudican, Nicole; Stevenson, Mary L
PMID: 35378171
ISSN: 1097-6787
CID: 5204802

Reconstruction of a Defect on the Dorsal Third Digit

Criscito, Maressa C; Lachman, Nirusha; Carucci, John A
PMID: 35066547
ISSN: 1524-4725
CID: 5154262

Consensus-Based Recommendations on the Prevention of Squamous Cell Carcinoma in Solid Organ Transplant Recipients: A Delphi Consensus Statement

Massey, Paul R; Schmults, Chrysalyne D; Li, Sara J; Arron, Sarah T; Asgari, Maryam M; Bouwes Bavinck, Jan Nico; Billingsley, Elizabeth; Blalock, Travis W; Blasdale, Katie; Carroll, Bryan T; Carucci, John A; Chong, Alvin H; Christensen, Sean R; Chung, Christina Lee; DeSimone, Jennifer A; Ducroux, Emilie; Escutia-Muñoz, Begoña; Ferrándiz-Pulido, Carla; Fox, Matthew C; Genders, Roel E; Geusau, Alexandra; Gjersvik, Petter; Hanlon, Allison M; Olasz Harken, Edit B; Hofbauer, Günther F L; Hopkins, R Samuel; Leitenberger, Justin J; Loss, Manisha J; Del Marmol, Veronique; Mascaró, José M; Myers, Sarah A; Nguyen, Bichchau T; Oliveira, Walmar R P; Otley, Clark C; Proby, Charlotte M; Rácz, Emoke; Ruiz-Salas, Veronica; Samie, Faramarz H; Seçkin, Deniz; Shah, Syed N; Shin, Thuzar M; Shumack, Stephen P; Soon, Seaver L; Stasko, Thomas; Zavattaro, Elisa; Zeitouni, Nathalie C; Zwald, Fiona O'Reilly; Harwood, Catherine A; Jambusaria-Pahlajani, Anokhi
Importance/UNASSIGNED:There is a paucity of evidence to guide physicians regarding prevention strategies for cutaneous squamous cell carcinoma (CSCC) in solid organ transplant recipients (SOTRs). Objective/UNASSIGNED:To examine the development and results of a Delphi process initiated to identify consensus-based medical management recommendations for prevention of CSCC in SOTRs. Evidence Review/UNASSIGNED:Dermatologists with more than 5 years' experience treating SOTRs were invited to participate. A novel actinic damage and skin cancer index (AD-SCI), consisting of 6 ordinal stages corresponding to an increasing burden of actinic damage and CSCC, was used to guide survey design. Three sequential web-based surveys were administered from January 1, 2019, to December 31, 2020. Pursuant to Delphi principles, respondents thoroughly reviewed all peer responses between rounds. Supplemental questions were also asked to better understand panelists' rationale for their responses. Findings/UNASSIGNED:The Delphi panel comprised 48 dermatologists. Respondents represented 13 countries, with 27 (56%) from the US. Twenty-nine respondents (60%) were Mohs surgeons. Consensus was reached with 80% or higher concordance among respondents when presented with a statement, question, or management strategy pertaining to prevention of CSCC in SOTRs. A near-consensus category of 70% to less than 80% concordance was also defined. The AD-SCI stage-based recommendations were established if consensus or near-consensus was achieved. The panel was able to make recommendations for 5 of 6 AD-SCI stages. Key recommendations include the following: cryotherapy for scattered actinic keratosis (AK); field therapy for AK when grouped in 1 anatomical area, unless AKs are thick in which case field therapy and cryotherapy were recommended; combination lesion directed and field therapy with fluorouracil for field cancerized skin; and initiation of acitretin therapy and discussion of immunosuppression reduction or modification for patients who develop multiple skin cancers at a high rate (10 CSCCs per year) or develop high-risk CSCC (defined by a tumor with approximately ≥20% risk of nodal metastasis). No consensus recommendation was achieved for SOTRs with a first low risk CSCC. Conclusions and Relevance/UNASSIGNED:Physicians may consider implementation of panel recommendations for prevention of CSCC in SOTRs while awaiting high-level-of-evidence data. Additional clinical trials are needed in areas where consensus was not reached.
PMID: 34468690
ISSN: 2168-6084
CID: 4998442

Repair of a Large Brow Defect

Canavan, Theresa N; Stevenson, Mary L; Carucci, John A
PMID: 31895182
ISSN: 1524-4725
CID: 4251602

Deep learning automated pathology in ex vivo microscopy

Combalia, Marc; Garcia, Sergio; Malvehy, Josep; Puig, Susana; Mülberger, Alba Guembe; Browning, James; Garcet, Sandra; Krueger, James G; Lish, Samantha R; Lax, Rivka; Ren, Jeannie; Stevenson, Mary; Doudican, Nicole; Carucci, John A; Jain, Manu; White, Kevin; Rakos, Jaroslav; Gareau, Daniel S
Standard histopathology is currently the gold standard for assessment of margin status in Mohs surgical removal of skin cancer. Ex vivo confocal microscopy (XVM) is potentially faster, less costly and inherently 3D/digital compared to standard histopathology. Despite these advantages, XVM use is not widespread due, in part, to the need for pathologists to retrain to interpret XVM images. We developed artificial intelligence (AI)-driven XVM pathology by implementing algorithms that render intuitive XVM pathology images identical to standard histopathology and produce automated tumor positivity maps. XVM images have fluorescence labeling of cellular and nuclear biology on the background of endogenous (unstained) reflectance contrast as a grounding counter-contrast. XVM images of 26 surgical excision specimens discarded after Mohs micrographic surgery were used to develop an XVM data pipeline with 4 stages: flattening, colorizing, enhancement and automated diagnosis. The first two stages were novel, deterministic image processing algorithms, and the second two were AI algorithms. Diagnostic sensitivity and specificity were calculated for basal cell carcinoma detection as proof of principal for the XVM image processing pipeline. The resulting diagnostic readouts mimicked the appearance of histopathology and found tumor positivity that required first collapsing the confocal stack to a 2D image optimized for cellular fluorescence contrast, then a dark field-to-bright field colorizing transformation, then either an AI image transformation for visual inspection or an AI diagnostic binary image segmentation of tumor obtaining a diagnostic sensitivity and specificity of 88% and 91% respectively. These results show that video-assisted micrographic XVM pathology could feasibly aid margin status determination in micrographic surgery of skin cancer.
PMID: 34221648
ISSN: 2156-7085
CID: 4932872

Skin Cancers and Lung Transplant

Wilken, Reason; Carucci, John; Stevenson, Mary L
It is well known that solid-organ transplant recipients (SOTRs) have a 65- to 100-fold increase in the risk of developing skin cancer, namely, nonmelanoma skin cancers (NMSCs) such as cutaneous squamous cell carcinoma (cSCC) and basal cell carcinoma (BCC). In addition, these patients are also at increased risk for development of melanoma as well as other less common cutaneous malignancies (Merkel's cell carcinoma, Kaposi's sarcoma). SOTRs with NMSC (namely cSCC) are also at significantly increased risk of poor clinical outcomes including local recurrence, nodal and distant metastasis, and disease-specific death relative to patients who are not immunosuppressed. Increased surveillance and monitoring in patients at risk of aggressive disease and poor outcomes who are on immunosuppression is essential in patients with lung transplants given the high degree of immunosuppression. Increased awareness of risks, treatments, and management allows for improved outcomes in these patients. This article will provide an overview of the risk factors for the development of cutaneous malignancies in organ transplant recipients as well as a detailed discussion of various immunosuppressant and prophylactic medications used in this patient population that contribute to the risk of developing cutaneous malignancies, with an emphasis on NMSC (cSCC and BCC) in lung transplant recipients. Finally, this article includes a discussion on the clinical and dermatologic management of this high-risk immunosuppressed population including a review of topical and systemic agents for field therapy of actinic damage and chemoprevention of keratinocyte carcinomas. In addition, indications for additional treatment and preventive measures such as adjuvant radiation treatment after surgical management of cutaneous malignancies and potential modification of immunosuppressive medication regimens are discussed.
PMID: 34030209
ISSN: 1098-9048
CID: 4904942

Scalp nodule in a 59-year-old female

Wilken, Reason; Carucci, John A; Brinster, Nooshin K; Stevenson, Mary L
PMID: 32639032
ISSN: 1365-4632
CID: 4517322

Current concepts and approaches to merkel cell carcinoma

Babadzhanov, Marianna; Doudican, Nicole; Wilken, Reason; Stevenson, Mary; Pavlick, Anna; Carucci, John
Merkel cell carcinoma (MCC) is an aggressive and rare cutaneous cancer of the mechanoreceptor unit of the skin with a neuroendocrine origin. MCC incidence has been on the rise over the past two decades. Risk factors include old age, chronic UV exposure, and immunosuppression. Although MCC is a cutaneous malignancy that is often misdiagnosed as a benign nodule at the time of diagnosis, it has an aggressive disease course due to its high recurrence and metastatic potential. The PD-1/PD-L1 checkpoint blockade has recently shown promising results in the management of advanced MCC. Avelumab and pembrolizumab are considered the new standard of care for metastatic MCC. Despite advances in the field, studies are needed to elucidate the role of immunotherapy for patients who are resistant to treatment. Most ongoing clinical trials aim to assess the efficacy of checkpoint inhibitor combination therapies. This article reviews the most current literature on the surgical and medical management of MCC.
PMID: 32666149
ISSN: 1432-069x
CID: 4533282