Faculty Bibliography

Importance/UNASSIGNED:Use of prognostic gene expression profile (GEP) testing in cutaneous melanoma (CM) is rising despite a lack of endorsement as standard of care. Objective/UNASSIGNED:To develop guidelines within the national Melanoma Prevention Working Group (MPWG) on integration of GEP testing into the management of patients with CM, including (1) review of published data using GEP tests, (2) definition of acceptable performance criteria, (3) current recommendations for use of GEP testing in clinical practice, and (4) considerations for future studies. Evidence Review/UNASSIGNED:The MPWG members and other international melanoma specialists participated in 2 online surveys and then convened a summit meeting. Published data and meeting abstracts from 2015 to 2019 were reviewed. Findings/UNASSIGNED:The MPWG members are optimistic about the future use of prognostic GEP testing to improve risk stratification and enhance clinical decision-making but acknowledge that current utility is limited by test performance in patients with stage I disease. Published studies of GEP testing have not evaluated results in the context of all relevant clinicopathologic factors or as predictors of regional nodal metastasis to replace sentinel lymph node biopsy (SLNB). The performance of GEP tests has generally been reported for small groups of patients representing particular tumor stages or in aggregate form, such that stage-specific performance cannot be ascertained, and without survival outcomes compared with data from the American Joint Committee on Cancer 8th edition melanoma staging system international database. There are significant challenges to performing clinical trials incorporating GEP testing with SLNB and adjuvant therapy. The MPWG members favor conducting retrospective studies that evaluate multiple GEP testing platforms on fully annotated archived samples before embarking on costly prospective studies and recommend avoiding routine use of GEP testing to direct patient management until prospective studies support their clinical utility. Conclusions and Relevance/UNASSIGNED:More evidence is needed to support using GEP testing to inform recommendations regarding SLNB, intensity of follow-up or imaging surveillance, and postoperative adjuvant therapy. The MPWG recommends further research to assess the validity and clinical applicability of existing and emerging GEP tests. Decisions on performing GEP testing and patient management based on these results should only be made in the context of discussion of testing limitations with the patient or within a multidisciplinary group.

Physician-industry interactions are prevalent. Accurate reporting allows for transparency regarding potential conflicts of interest. We sought to compare the self-reported interactions in the American Academy of Dermatology (AAD) Annual Meeting disclosures with the industry-reported interactions in the Open Payments (OP) database. We performed a retrospective review of the 2014 OP database and the presenter disclosures for the AAD 73rd Annual Meeting in 2015. We examined general, research, and associated research payments for 768 dermatologists, totaling $35,627,365 in 2014. Although differences in the categorization and requirements for disclosure between the AAD and the OP database may account for much of the discordance, dermatologists should be aware of potentially negative public perceptions regarding transparency and prevalence of physician-industry interaction. Dermatologists should review their industry-reported interactions listed in the OP database and continue to disclose conflicts of interest as accurately as possible.

Objectives. To determine the effect of new therapies and trends toward reduced mortality rates of melanoma.Methods. We reviewed melanoma incidence and mortality among Whites (the group most affected by melanoma) in 9 US Surveillance, Epidemiology, and End Results registry areas that recorded data between 1986 and 2016.Results. From 1986 to 2013, overall mortality rates increased by 7.5%. Beginning in 2011, the US Food and Drug Administration approved 10 new treatments for metastatic melanoma. From 2013 to 2016, overall mortality decreased by 17.9% (annual percent change [APC] = -6.2%; 95% confidence interval [CI] = -8.7%, -3.7%) with sharp declines among men aged 50 years or older (APC = -8.3%; 95% CI = -12.2%, -4.1%) starting in 2014. This recent, multiyear decline is the largest and most sustained improvement in melanoma mortality ever observed and is unprecedented in cancer medicine.Conclusions. The introduction of new therapies for metastatic melanoma was associated with a significant reduction in population-level mortality. Future research should focus on developing even more effective treatments, identifying biomarkers to select patients most likely to benefit, and renewing emphasis on public health approaches to reduce the number of patients with advanced disease. (Am J Public Health. Published online ahead of print March 19, 2020: e1-e3. doi:10.2105/AJPH.2020.305567).

Vulvar malignancies represent a serious gynecologic health concern, especially given the increasing incidence over the past several decades. Squamous cell carcinoma and melanoma are common subtypes, although other neoplasms such as basal cell carcinoma and Paget's disease of the vulva may be seen. Many vulvar cancers are initially misdiagnosed as inflammatory conditions, delaying diagnosis and worsening prognosis. It is essential that dermatologists are familiar with characteristic findings for each malignancy in order to ensure appropriate diagnosis and management. Herein, we review the unique epidemiologic and clinical characteristics of each major vulvar malignancy, as well as discuss their respective prognoses and current management recommendations.

BACKGROUND:Skin cancer is the most common malignancy affecting solid organ transplant recipients (SOTR), and SOTR experience an increased skin cancer-associated in morbidity and mortality. There are no formal multidisciplinary guidelines for skin cancer screening after transplant, and current practices are widely variable. METHODS:We conducted three rounds of Delphi-method surveys with a panel of 84 U.S. dermatologists and transplant physicians to establish skin cancer screening recommendations for SOTR. RESULTS:The transplant team should risk stratify SOTR for screening, and dermatologists should perform skin cancer screening by full body skin examination. SOTR with a history of skin cancer should continue regular follow-up with dermatology for skin cancer surveillance post-transplant. High-risk patients include thoracic organ recipients, SOTR age 50 and above, and male SOTR. High-risk Caucasian patients should be screened within 2 years after transplant, all Caucasian, Asian, Hispanic, and high-risk African American patients should be screened within 5 years after transplant. No consensus was reached regarding screening for low-risk African American SOTR. CONCLUSION/CONCLUSIONS:We propose a standardized approach to skin cancer screening in SOTR based on multi-disciplinary expert consensus. These guidelines prioritize and emphasize the need for screening for SOTR at greatest risk for skin cancer.

Acral lentiginous melanoma (ALM) is a rare but aggressive subtype of melanoma often associated with poor prognosis. Although overall incidence is rare, ALM accounts for a larger proportion of melanomas among black, Asian, and Hispanic individuals than among white individuals. Similarly, the proportion of acral melanocytic nevi tends to be greater in ethnic skin despite a lower overall nevi count. Dermoscopy can help differentiate between benign and malignant acral melanocytic lesions. Herein, we discuss the population trends of acral melanocytic lesions in patients with skin of color. We also examine the diagnostic challenges of acral lesions and review the dermoscopic patterns unique to acral volar skin.