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Predictors for the use of systemic therapy in stage IB Mycosis fungoides [Letter]

Rodriguez, Elijah; Needle, Carli D; Martinez, Michael J; Nohria, Ambika; Xing, Yiping; Song, Clara; Betensky, Rebecca; Latkowski, Jo-Ann; Adotama, Prince
BACKGROUND:The PROspective Cutaneous Lymphoma International Prognostic Index (PROCLIPI) study is aprospective analysis of an international database. Here we examine front-line treatments and quality of life (QoL) inpatients with newly diagnosed mycosis fungoides (MF). OBJECTIVES/OBJECTIVE:To identify (i) differences in first-line approaches according to tumour-nodes-metastasis-blood (TNMB)staging; (ii) parameters related to a first-line systemic approach and (iii) response rates and QoL measures. METHODS:In total, 395 newly diagnosed patients with early-stage MF (stage IA-IIA) were recruited from 41 centresin 17 countries between 1 January 2015 and 31 December 2018 following central clinicopathological review. RESULTS:The most common first-line therapy was skin-directed therapy (SDT) (322 cases, 81·5%), while a smallerpercentage (44 cases, 11·1%) received systemic therapy. Expectant observation was used in 7·3%. In univariateanalysis, the use of systemic therapy was significantly associated with higher clinical stage (IA, 6%; IB, 14%; IIA,20%; IA-IB vs. IIA, P < 0·001), presence of plaques (T1a/T2a, 5%; T1b/T2b, 17%; P < 0·001), higher modified Severity Weighted Assessment Tool (> 10, 15%; ≤ 10, 7%; P = 0·01) and folliculotropic MF (FMF) (24% vs. 12%, P = 0·001). Multivariate analysis demonstrated significant associations with the presence of plaques (T1b/T2b vs.T1a/T2a, odds ratio 3·07) and FMF (odds ratio 2·83). The overall response rate (ORR) to first-line SDT was 73%,while the ORR to first-line systemic treatments was lower (57%) (P = 0·027). Health-related QoL improvedsignificantly both in patients with responsive disease and in those with stable disease. CONCLUSIONS:Disease characteristics such as presence of plaques and FMF influence physician treatment choices,and SDT was superior to systemic therapy even in patients with such disease characteristics. Consequently, futuretreatment guidelines for early-stage MF need to address these issues.
PMID: 38844623
ISSN: 1432-069x
CID: 5665772

Tache and talon noir in patient with mycosis fungoides on acitretin

Obijiofor, Chinemelum; Yin, Emily; Shvartsbeyn, Marianna; Latkowski, Jo-Ann; Ahearn, Ian; Gutierrez, Daniel
PMID: 37921829
ISSN: 1087-2108
CID: 5614492

Clinical decision-making bias in darker skin types: a prospective survey study identifying diagnostic bias in decision to biopsy [Letter]

Krueger, Loren; Hijab, Eman; Latkowski, Jo-Ann; Elbuluk, Nada
PMID: 35388461
ISSN: 1365-4632
CID: 5232762

Diversifying the dermatology workforce: Physician characteristics vary by race/ethnicity

Akoh, Christine C; Shankar, Shruthi; Strachan, Dina D; Latkowski, Jo-Ann M
BACKGROUND:In the United States (US), dermatology remains one of the least diverse specialties in medicine. Increasing the diversity of the dermatology workforce is essential for reducing health disparities. OBJECTIVE:To describe the experiences of racially and ethnically diverse physicians in the US who successfully matched into dermatology. METHODS:Board-certified dermatologists and dermatology residents were recruited to participate in an anonymous, online survey in which self-reported demographic, socioeconomic, pre-residency, and post-residency career data were obtained. RESULTS:Of the 100 participants included in the study, 30% were dermatology residents and 25% belonged to a group underrepresented in medicine (UIM). Black physicians were 3.69 times more likely to select dermatology prior to medical school (odds ratio [OR], 3.69; 95% confidence interval [CI], 1.04 - 13.0) compared to non-Black physicians. UIM dermatologists and trainees were more likely to receive a need-based scholarship in medical school (OR, 4.37; 95% CI, 1.30 - 14.7), graduate from a private medical institution (OR, 6.49; 95% CI, 1.95 - 21.6), and have at least one UIM dermatology mentor during medical school (adjusted OR, 13.1; 95% CI, 2.77 - 61.5) compared to non-UIM physicians. CONCLUSIONS:A holistic review of dermatology applicants by residency programs may reduce racial/ethnic disparities in the admission process. Our data provide further evidence in support of pre-medical outreach programs, mentorship, and institutional funding to promote diversity in dermatology.
PMID: 35337662
ISSN: 1943-4693
CID: 5200722

Corrigendum to "Diversifying the dermatology workforce: Physician characteristics vary by race/ethnicity" [Journal of the National Medical Association (2022); S0027-9684(22)00047-5]

Akoh, Christine C; Shankar, Shruthi; Strachan, Dina D; Latkowski, Jo-Ann M
PMID: 35428515
ISSN: 1943-4693
CID: 5219152

Residency Roundup: Introducing a New Partnership Between Cutis and the APD-RPDS [Editorial]

Worswick, Scott; Latkowski, Jo-Ann M
PMID: 35659842
ISSN: 2326-6929
CID: 5236262

Multimodal single-cell analysis of cutaneous T cell lymphoma reveals distinct sub-clonal tissue-dependent signatures

Herrera, Alberto; Cheng, Anthony; Mimitou, Eleni P; Seffens, Angelina; George, Dean David; Bar-Natan, Michal; Heguy, Adriana; Ruggles, Kelly V; Scher, Jose U; Hymes, Kenneth; Latkowski, Jo-Ann; Odum, Niels; Kadin, Marshall E; Ouyang, Zhengqing; Geskin, Larissa; Smibert, Peter; Buus, Terkild B; Koralov, Sergei
Cutaneous T cell lymphoma (CTCL) is a heterogeneous group of mature T cell neoplasms characterized by the accumulation of clonal malignant CD4+ T cells in the skin. The most common variant of CTCL, Mycosis Fungoides, is confined to the skin in early stages but can be accompanied by extracutaneous dissemination of malignant T cells to the blood and lymph nodes in advanced stages of disease. Sézary Syndrome, a leukemic form of disease is characterized by significant blood involvement. Little is known about the transcriptional and genomic relationship between skin and blood residing malignant T cells in CTCL. To identify and interrogate malignant clones in matched skin and blood from leukemic MF and SS patients, we combine T cell receptor clonotyping, with quantification of gene expression and cell surface markers at the single cell level. Our data reveals clonal evolution at a transcriptional and genetic level within the malignant populations of individual patients. We highlight highly consistent transcriptional signatures delineating skin-derived and blood-derived malignant T cells. Analysis of these two populations suggests that environmental cues, along with genetic aberrations, contribute to transcriptional profiles of malignant T cells. Our findings indicate that the skin microenvironment in CTCL promotes a transcriptional response supporting rapid malignant expansion, as opposed to the quiescent state observed in the blood, potentially influencing efficacy of therapies. These results provide insight into tissue-specific characteristics of cancerous cells and underscore the need to address the patients' individual malignant profiles at the time of therapy to eliminate all sub-clones.
PMID: 34232982
ISSN: 1528-0020
CID: 4932182

A case of primary cutaneous marginal zone lymphoma presenting with rosacea-like eruption [Case Report]

Agnihotri, Tanvir; Adotama, Prince; Kalowitz-Bieber, Amy; Stokar, Evan; Meehan, Shane A; Latkowski, Jo-Ann
PMID: 32875041
ISSN: 2352-5126
CID: 4615402

Cutaneous T Cell Lymphoma: A Difficult Diagnosis Demystified

Peterson, Erik; Weed, Jason; Lo Sicco, Kristen; Latkowski, Jo-Ann
Cutaneous T cell lymphoma (CTCL) represents a heterogeneous group of extranodal non-Hodgkin lymphomas in which monoclonal T lymphocytes infiltrate the skin. The mechanism of CTCL development is not fully understood, but likely involves dysregulation of various genes and signaling pathways. A variety of treatment modalities are available, and although they can induce remission in most patients, the disease may recur after treatment cessation. Owing to relatively low incidence and significant chronicity of disease, and the high morbidity of some therapeutic regimens, further clinical trials are warranted to better define the ideal treatment option for each subtype of CTCL.
PMID: 31466586
ISSN: 1558-0520
CID: 4066502

Skin Associated Staphylococcus Aureus Contributes to Disease Progression in CTCL [Meeting Abstract]

Tegla, Cosmin A.; Herrera, Alberto M.; Seffens, Angelina M.; Fanok, Melania H.; Dean, George; Kawaoka, John; Laird, Mary E.; Fulmer, Yi; Willerslev-Olsen, Andreas; Hymes, Kenneth B.; Latkowski, Jo-Ann; Odum, Niels; Feske, Stefan; Shopsin, Bo; Torres, Victor; Kadin, Marshall E.; Geskin, Larisa J.; Koralov, Sergei B.
ISSN: 0006-4971
CID: 4505432