Faculty Bibliography

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.

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.

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.

Lymphomatoid papulosis is often regarded as a low-grade variant of cutaneous T cell lymphoma (CTCL). Given the excellent long-term prognosis, recent consensus guidelines indicate that patients can be monitored off therapy. We report a case of a 67-year-old man who presented with lymphomatoid papulosis, with necrotic papules that have been intermittently present for over forty years.