Faculty Bibliography

BACKGROUND:Persistent chemotherapy-induced alopecia (pCIA) is a distressing side effect of antineoplastic agents, imposing significant psychological burdens on cancer survivors. Despite its impact, there are no standardized guidelines for diagnosis, prevention or management. OBJECTIVES/OBJECTIVE:To establish consensus-based definitions, diagnostic criteria, grading systems and management recommendations for pCIA. METHODS:A two-round Delphi method was conducted with 15 international experts in supportive oncodermatology and hair diseases from both Europe and the Americas. Statements were rated on a 5-point Likert scale, with a strong consensus defined as ≥75% agreement. Statements that did not achieve strong consensus in the first round were revised based on expert feedback and re-evaluated in a second-round survey. RESULTS:Strong consensus was reached on 47 statements (75.8%). pCIA was defined as non-scarring alopecia persisting beyond 6 months post-chemotherapy. Causes were attributed to the destruction of hair follicle stem cells, with taxanes, thiotepa and anthracyclines identified as key contributors. Consensus emphasized the importance of prevention of pCIA through scalp cooling devices, and the early intervention with topical or low-dose oral minoxidil was also recommended. Interestingly, the experts did not recommend the use of bicalutamide, oral finasteride and dutasteride (including in mesotherapy) for breast cancer patients with pCIA, citing potential safety concerns. CONCLUSIONS:This Delphi study established unified guidelines for pCIA, providing clinicians with a clear framework for diagnosis and treatment. Highlighting prevention through scalp cooling and timely interventions may improve outcomes for cancer survivors. Further research is necessary to assess new treatments and the long-term impact of chemotherapy on hair follicles.

BACKGROUND AND OBJECTIVES/OBJECTIVE:Histiocytoses are diverse hematopoietic diseases with disabling neurologic involvement. Recently, targeted mitogen-activated protein kinase pathway inhibitors have been used with clinical and radiologic response; however, some patients are unable to tolerate these treatments or have isolated and/or refractory neurologic, ocular, or head and neck (NOHN) disease. Intra-arterial administration of chemotherapy has conferred favorable responses in various neoplasms; however, treatment and outcomes across histiocytosis subtypes have not been examined. METHODS:Patients with biopsy-proven histiocytosis involving NOHN structures underwent an outpatient interventional procedure with angiography, selective catheterization, and intra-arterial infusion of melphalan, with target arteries depending on the site of disease. Patients were followed with radiologic (i.e., PET/CT, CT, MRI, or ophthalmic ultrasound and optical coherence tomography) and quantified functional assessments (i.e., vision, speech, or balance) as appropriate. Complete or partial radiologic and functional response rates were captured as well as frequency of subsequent progression. RESULTS:Eighteen patients underwent 74 total treatment instances. For 14 patients with radiologically evaluable tumorous disease, 10 (71%) had partial or complete response and the remaining 4 had stable disease; 3 of 14 (21%) had subsequent radiologic progression. Of 13 functionally evaluable patients, including 6 with neurodegenerative histiocytosis, 12 (92%) experienced functional improvement; 7 of 13 (54%) had subsequent functional worsening consistent with disease progression. There were no intraprocedural complications; 3 patients required hospitalization following treatment, including 1 patient with allergic reaction to melphalan. DISCUSSION/CONCLUSIONS:For patients with tumorous and neurodegenerative histiocytosis, intra-arterial melphalan represents a safe and highly effective treatment with potential to improve neurologic function. Additional study may clarify patients most suitable for this intervention. This novel treatment modality may represent a practice-changing innovation for refractory histiocytosis involving neurologic and ocular structures, as well as neurodegenerative forms. The treatment delivery form is novel, and future work should be directed at studying the efficacy of this modality to other forms of neurologic, ocular, head, and neck cancers. CLASSIFICATION OF EVIDENCE/METHODS:This study provides Class IV evidence that in patients with tumorous or neurodegenerative histiocytosis, selective angiographic catheterization and intra-arterial infusion of melphalan result in radiologic and functional improvement.

PURPOSE/OBJECTIVE:The dermatological management of cancer patients with cutaneous adverse events occurring during and after oncologic treatment is known as supportive oncodermatology. This includes prevention, early identification, and mitigation of dermatologic toxicities. The aim of the international RESCUE (Residents' survey on training of dermatology residents in supportive oncodermatology) study was to ascertain the current level of expertise in supportive oncodermatology among dermatology residents. METHODS:The European Task Force "Dermatology for cancer patients" and the US Oncodermatology Society developed an online questionnaire with 30 multiple-choice items. Responses were collected using qualitative ordinal data (yes/no, 1-5 ratings) and multiple-choice options. Ordinal range results were analyzed by aggregating responses 1 + 2 + 3 versus 4 + 5, with 5 representing the highest grade ("extremely confident" or "full training"). RESULTS:A total of 442 dermatology residents from 20 countries replied. These participants reported receiving less comprehensive training in supportive oncodermatology (only 41% receiving complete training) compared to immunodermatology (75%), cutaneous oncology (75%), dermoscopy (64%), and dermatologic surgery (50%). Only 17% of the residents reported feeling confident in managing the dermatological toxicities associated with anticancer treatments. Residents also indicated receiving less education regarding toxicities related to endocrine therapies (28%). In particular, lower levels of competence were reported in managing nail, hair, and oral toxicities. A significant majority of residents (98%) deemed it essential to enhance training in dermatological toxicities associated with anticancer therapies during their oncology residency. CONCLUSION/CONCLUSIONS:The RESCUE study represents the first project assessing residents' education in supportive oncodermatology. To enable future generations of dermatologists to provide enhanced care for cancer patients, supportive oncodermatology training should be integrated in residency programs worldwide, corresponding to training in other subspecialties. A more practical approach should also be incorporated, including extended training in hair, nail, and oral toxicities, enhancing the competencies of dermatology residents in all countries.

BACKGROUND:Cancer-treatment-related cutaneous adverse events (cAEs) are common and may severely impact quality of life (QoL) and decrease treatment outcomes. The Latin American Cutaneous Oncology Management (LACOM) project provides clinical insights into cancer-treatment-related cAEs, offering tools for preventing and managing cAEs. METHODS:LACOM I focuses on integrating education, prophylactic measures, and skincare in cancer treatment to improve treatment adherence, outcomes, and patients' and survivors' QoL. RESULTS:The LACOM panel provides evidence and opinion-based best practice recommendations for oncology skincare programs to support all stakeholders in the Latin American healthcare setting (Argentina, Chili, Colombia, Ecuador, Panama, Peru, and Mexico) working with oncology patients throughout the entire continuum of care to achieve optimal outcomes, improving cancer patients and survivors' QoL. Oncology skincare programs comprise hygiene, moisturization, and sun protection with products that should be safe and help to minimize cAEs and improve skin conditions. CONCLUSIONS:Integrating education, general measures, and skincare programs into cancer treatment should encourage the adoption of a proactive role of skincare from the beginning of treatment and ongoing, supporting optimal outcomes and improving cancer patients' and survivors' QoL. J Drugs Dermatol. 2025;24(3):262-268. doi:10.36849/JDD.8565.

BACKGROUND:New anticancer therapies have improved patient outcomes but associated dermatologic adverse events (AEs) may cause morbidity and treatment discontinuation. A comprehensive estimation of associations between cancer drugs and skin AEs is lacking. METHODS:This study utilized the Food and Drug Administartion (FDA)'s Adverse Event Reporting System database (January 2013-September 2022), with 3,399,830 reports involving 3084 drugs and 16,348 AEs. A nearest neighbor matching model was employed to select 10 controls for each case report, utilizing the cosine similarity of demographic and AE severity factors to minimize false positives/negatives. RESULTS:There were 10,698 unique anticancer drugs (n = 212) to skin AE (n = 873) pairs, of which 676 had significant reporting odds ratios (ROR) > 1, comprising 113 drugs and 144 AEs. The minimum ROR was 1.25, and 50% of associations displayed a ROR >10. The most common were rash (51 agents) and dry skin (28 drugs). Methotrexate induced the most distinct AEs (34), then mechlorethamine (33), and vemurafenib (24). Targeted therapies accounted for 49% of pairs, cytotoxic chemotherapies for 35.9%, and immunotherapies for 11%. CONCLUSIONS:A total of 113 anticancer drugs were identified as significantly associated with skin AEs, most frequently rash and dry skin. Data are likely under-reported but enable quick postmarketing identification of skin toxicity signals.