JDD Corner

Journal Review Series: July-September 2018

Derm In-Review Advisory Council Member, Dr. Ramya Kollipara, searched the journals so that you don’t have to! She reports on important take-aways from different dermatology journals for the months of July, August, and September of 2018.

It is key to keep in mind that “important” is subjective and what is contained in this review is one person’s view of what should be remembered from these months of the literature.

Best of July 2018

Contribution by MC1R variants to melanoma risk in males and females.
Wendt et al. JAMA Dermatol 2018;154(7):789-95.
In females, having the M1CR red hair variant is an independent risk factor for melanoma. In males M1CR red hair variants, only signs of actinic damage, including lentigines on the back and hands, wrinkling on the neck and sunburns were significant risk factors. https://jamanetwork.com/journals/jamadermatology/article-abstract/2683528

Inflammatory arthritis in pediatric patients with morphea. Kashem et al. JAAD 2018;79(1):47-51.
Retrospective review that showed that 11/53 patients had polyarthritis of joints unrelated to the location of cutaneous morphea. These patients were mostly girls with linear or generalized morphea. Serum ANA was more highly elevated in patients with arthritis.

High neutrophil-to-lymphocyte ratio before starting anti-programmed cell death 1 immunotherapy predicts poor outcome in patients with metastatic melanoma.
Garnier et al. JAAD 2018;79(1):165-7.
Retrospective study that showed the outcome described above. It accounted for corticosteroid use and other prognostic factors for poor survival. The study suggests that this ratio can be used a biomarker to provide indications for anti-PD1 therapy.

The risk of cardiovascular events in psoriasis patients treated with tumor necrosis factor- alpha inhibitors versus phototherapy: an observational study.
Wu et al. JAAD 2018;79(1):60-68.
Patients on TNF inhibitors had a lower risk of cardiovascular events compared to patients on phototherapy (harzard ratio of 0.77). The risk reduction after 6 months of exposure was 11.2% higher for TNF inhibitor patients versus phototherapy patients. https://www.jaad.org/article/S0190-9622(18)30335-9/fulltext

Best of August 2018

Rate of recurrence of lentigo maligna treated with off-label neoadjuvant topical imiquimod, 5% cream prior to conservatively staged excision.
Donigan et al. JAMA Dermatol 2018;(154)8:885-889.
Retrospective review of 345 biopsy-confirmed LM treated with imiquimod 5% cream 5 nights a week for 2-3 months prior to conservative staged excision (beginning at 2mm). Those with inadequate inflammatory response were also treated with tazarotene 0.1% gel twice weekly. Median final margin on excision was 2mm and rate of recurrence was 3.9%, similar to the recurrence rate reported with Mohs staged excisions or en face permanent sections. The mean time to recurrence was 4.3 years and follow up was for a mean of 5.5 years. https://jamanetwork.com/journals/jamadermatology/article-abstract/2682576

Similar survival of patients with multiple versus single primary melanomas based on Utah Surveillance, Epidemiology, and End Results Data (1973-2011).
Grossman et al. JAAD 2018;78(2):238-244.
Retrospective study that found that there is no significant survival difference between patients with multiple primary melanomas and those with a single primary melanoma. Multivariate analysis of just the invasive melanoma also yielded no difference in survival times. https://www.jaad.org/article/S0190-9622(18)30341-4/fulltext

Factors related to nevus-associated cutaneous melanoma: a case-case study.
Pandeya et al. JID 2018;138(8):1816-1824.
Nevus associated melanomas were associated with a younger age at presentation, non-brown eye color, trunk site, thickness less than 0.5mm and BRAF V600E mutation. These patients also reported many moles as a teenager, had high total nevus counts. On histology, these nevus associated melanomas had less dermal elastosis in adjacent skin in comparison to de novo melanomas. This study emphasizes the different molecular pathways involved in de novo vs. nevus associated melanomas.

Best of September 2018

CARD14-associated papulosquamous eruption: A spectrum including features of psoriasis and pityriasis rubra pilaris.
Craiglow et al. JAAD 2018;79(3):487-94.
Subjects with CARD14 mutation associated papulosquamous eruption have characteristics of both psoriasis and PRP. These include early age of onset, prominent involvement of cheek, chin and ears, family history of psoriasis or PRP, minimal response to topical or systemic conventional psoriasis therapies and improvement with Stelara.

Timing of onset of adverse cutaneous reactions associated with programmed cell death protein 1 inhibitor therapy.
Wang et al. JAMA Dermatol 2018;154(9):1057-61.
Study of 17 patients with metastatic melanoma and biopsy-proven adverse reactions from programed cell death inhibitor treatment. Reactions included lichenoid dermatitis, bullous pemphigoid, erythema multiforme, eczema, lupus and sarcoidosis. Twelve patients had cutaneous drug reactions that presented a median of 4.2 months after drug initiation. In the other 5 cases, the reactions presented after the PD-1 inhibitor was stopped. Thus, cutaneous adverse events from PD-1 therapy can be delayed onset and may even present after discontinuation of therapy.

A split-face, single-blinded, randomized controlled comparison of alexandrite 755-nm picosecond laser versus alexandrite 755nm nanosecond laser in the treatment of acquried bilateral nevus of Ota-like macules.
Yu et al. JAAD 2018;79(3): 479-486
Thirty patients in a split face study that showed that the picosecond-treated side had better clearance and less severe pain. The incidence of PIH was lower (27% vs. 54%) and the duration of PIH was shorter (1.32 vs. 1.74 months) for the picosecond treated side.

Measuring the depth of perineural invasion in cutaneous squamous cell carcinoma: implications for biopsy technique.
Tang et al. Dermatologic Surgery 2018;44(9):1170-73.
Retrospective review of cutaneous squamous cell carcinoma specimens with perineural invasion (PNI). Mean histologic depth of PNI was 2.7mm but varied based on location. On the head, PNI depth was 2.2mm on average and on the trunk the average PNI depth was 4.3mm. PNI depth correlated with clinical tumor diameter and 44% of tumors with PNI had a clinical diameter of at least 2 cm. Thus, the greatest chance of detecting PNI is using a biopsy technique that goes 3-4mm deep. https://journals.lww.com/dermatologicsurgery/Abstract/2018/09000/Measuring_the_Depth_of_Perineural_Invasion_in.2.aspx


Hand-picked by Dr. Adam Friedman, Senior Editor of Derm-In Review (part of ODAC’s “Journal of Drugs in Dermatology (JDD): A Year in Review” lecture)


Clinical Characteristics of Lower Extremity Surgical Site Infections in Dermatologic Surgery Based Upon 24-Month Retrospective Review
Bari et al. JDD 17.7 (2018): 766-771.
Within 14 days of the lower extremity procedure, 2.3% MMS and 8.3% WLE developed SSI. Two big take aways:
Subcuticular sutures and vertical mattress sutures as a group were associated with reduced 30-day infection rate (P=0.006). Prophylactic antibiotics did not reveal a statistically significant difference in infection rate.


Artificial Intelligence for the Objective Evaluation of Acne Investigator Global Assessment
Melina et al. JDD 17.9 (2018): 1006-1009.
The Artificial Intelligence recognized the IGA of a patient with an accuracy of 0.854 and a correlation between manual and automatized evaluation of r=0.958 (P < .001 )

The Potential Role of Botulinum Toxin in Improving Superficial Cutaneous Scarring: A Review
Dhawan et al. JDD 17.9 (2018): 956-958
MOA: decreasing the dynamic tension of a wound by denervating the underlying muscle. Histologic and clinical evidence indicates that botulinum toxin has a positive effect on wound healing and scar appearance. BUT: ALL THEORETICAL.

Did you enjoy this Journal Review Series? Find previous ones here.