Basal cell carcinomas (BCCs) are the most common type of skin cancer.BCCs are unlikely to metastasize; however, locally advanced, metastatic, and refractory BCCs not amendable to surgery or radiation therapy can be destructive. 1Systemic treatment with vismodegib, a hedgehog pathway inhibitor, has been shown to have excellent efficacy in minimizing BCC disease burden.Although efficacious, vismodigeb's side effect profile on the recommended 150 mg once daily dosing regimen can be a treatment limiting factor. 2 Adverse effects include muscle spasms, dysgeusia, alopecia, fatigue, weight loss, nausea, anorexia, and rarely amenorrhea. 1,2For many patients, this dosing regimen is not sustainable and ABSTRACT Background: Although basal cell carcinomas (BCCs) rarely metastasize and recur, locally advanced, metastatic, and refractory disease can be devastating.Systemic treatment with vismodegib, a hedgehog pathway inhibitor, has been shown to have excellent efficacy in minimizing BCC disease burden; however, recommended dosing patterns have led to a myriad of adverse effects.Methods: In this single institution case series, we retrospectively reviewed side effects, safety, and efficacy for an alternative vismodegib dosing pattern.Six patients unable to tolerate the traditional dosing regimen were prescribed vismodegib 150 mg daily for 7 days followed by a 21-day drug holiday and were monitored for adverse events and disease progression.Results: All patients reported improvement or resolution of adverse events on this alternative treatment regimen and continued on this regimen for an average of 30.7 months.Four patients had no new BCC development and existing BCCs shrunk in size.One patient with basal cell nevus syndrome developed a single BCC twenty-four months into treatment and another developed a single BCC during a drug holiday for radiation therapy of squamous cell carcinoma of the lung.Conclusion: A dosing schedule of vismodegib 150 mg daily for seven days followed by a 21day drug holiday may provide therapeutic effects without intolerable side effects for patients who require long-term dosing.
Nevoid basal cell carcinoma syndrome (NBCCS), or Gorlin Syndrome, is a neurocutaneous disorder caused by mutations in the PTCH1 or, less commonly, SUFU genes. Mutations in these genes lead to malfunction of the sonic hedgehog pathway, causing unregulated cell proliferation and differentiation. As the sonic hedgehog pathway affects hair follicle growth and development, PTCH1 mutations could lead to unregulated hair follicle proliferation. We present the case of a patient whose discrete tufts of hair led to the diagnosis of NBCCS. This case demonstrates that NBCCS should be considered within the differential diagnosis of localized hypertrichosis, as this patient is the sixth case to demonstrate this finding as an early cutaneous sign of BCNS.
Abstract Objective To explore if antiplatelet or anticoagulant therapy increases the risk of transfusion requirement or postoperative hematoma formation in patients undergoing microvascular reconstruction for head and neck defects. Study Design Retrospective cohort study. Setting Departments of Otolaryngology–Head and Neck Surgery at the University of Alabama at Birmingham, the University of Colorado, and the University of California Irvine. Methods A multi‐institutional, retrospective review on microvascular reconstruction of the head and neck between August 2013 to July 2021. Perioperative antithrombotic data were collected to examine predictors of postoperative transfusion and hematoma. Results A total of 843 free flaps were performed. Preoperative hemoglobin, hematocrit, operative time, and flap type were positive predictors of postoperative transfusion in both bivariate ( P < .0001) and multivariate analyses ( P < .0001). However, neither anticoagulation nor antiplatelet therapy were predictive of postoperative transfusion rates and hematoma formation. Conclusion Antithrombotic regimens do not increase the risk of postoperative transfusion or hematoma in head and neck microvascular reconstruction. Based on this limited data, perioperative antithrombotic regimens can be considered in patients who may otherwise be at risk for these postoperative complications.
Dehydrated human amnion chorion membrane (dHACM) allografts are synthetic skin substitutes derived from placental tissue. dHACM allografts are used for replacing lost or damaged dermal tissue, as they contain many of the components found within the extracellular matrix that are beneficial in wound healing. Common uses of dHACM allografts include the healing of diabetic and non-diabetic foot and leg ulcers, decubitus ulcers, and wounds following debridement. While these grafts have been proven to be beneficial in other disciplines of medicine, their potential for use in the field of dermatology is emerging.
Pemphigus is a class of rare autoimmune diseases that causes incredibly painful blistering of the skin and significantly impacts patients' day-to-day lives and well-being. Many strides have been made in treating pemphigus; however, no comprehensive literature exists on how to treat the pain that accompanies the disease. It is important to remember that treating pemphigus involves a two-fold treatment plan assessing both the underlying autoimmune disease and the pain involved with the lesions. This literature review explores novel therapies that have been shown to be effective in treating pain in pemphigus.
Introduction: Outdoor workers are at increased risk for developing skin cancer compared to the general population due to environmental conditions at work sites and riskier behavior regarding skin cancer risk factors. In many populations, sun protection education is associated with increased use of sun protective measures. This study aimed to assess outdoor workers’ knowledge of sun safety and evaluate the impact of educational measures on the awareness of photoprotection practices.
Methods: A group of medical students visited construction sites in Birmingham, AL, to deliver 15-minute presentations on the risks of prolonged UV exposure and the prevention of photodamage. Identical 10-question surveys were given to each participant before and after the presentation. Participants rated their level of agreement with statements on photoprotection and skin cancer.
Results: The survey response rate was 79%. Analysis revealed an average pre-presentation score of 3.01 and a post-presentation score of 3.73. Two-sample paired t-tests for each question yielded statistically significant results (p <0.05).
Conclusion: Outdoor occupational workers reported a better understanding of the risks of UV exposure and a greater willingness to engage in sun-protective practices following a brief educational intervention. These findings suggest that community-based education may improve awareness regarding photoprotection and skin cancer risk.
Background Cancer centers provide superior care but are less accessible to rural populations. Health systems that integrate a cancer center may provide broader access to quality surgical care, but penetration to rural hospitals is unknown. Methods Cancer center data were linked to health system data to describe health systems based on whether they included at least one accredited cancer center. Health systems with and without cancer centers were compared based on rural hospital presence. Bivariate tests and multivariable logistic regression were used with results reported as P-values and odds ratios (OR) with 95% confidence intervals (CIs). Results Ninety percent of cancer centers are in a health system, and 72% of health systems (434/607) have a cancer center. Larger health systems ( P = .03) with more trainees ( P = .03) more often have cancer centers but are no more likely to include rural hospitals (11% vs 6%, P = .43; adjusted OR .69, 95% CI .28-1.70). The minority of cancer centers not in health systems (N = 95) more often serve low complexity patient populations ( P = .02) in non-metropolitan areas ( P = .03). Discussion Health systems with rural hospitals are no more likely to have a cancer center. Ongoing health system integration will not necessarily expand rural patients’ access to surgical care under existing health policy infrastructure and incentives.
Immediate breast reconstruction after mastectomy has increased in recent years when compared with delayed reconstruction. Despite this encouraging trend, racial and socioeconomic disparities in the receipt of postmastectomy breast reconstruction have been well documented. We sought to assess the effect of race, socioeconomic status, and patient comorbidities on muscle sparing transverse rectus abdominis myocutaneous outcomes at our safety net hospital institution in the southeast.The database of a tertiary referral center was queried for patients who received free transverse rectus abdominis myocutaneous flaps for immediate reconstruction after mastectomy meeting inclusion criteria from 2006 to 2020. Patient demographics and outcomes were compared based on socioeconomic status. The primary outcome (reconstructive success) was defined as breast reconstruction without flap loss. Statistical analysis included analysis of variance and χ2 tests were appropriate using Rstudio.Three-hundred fourteen patients were included in the study, with 76% White, 16% Black, and 8% other. Overall complication rate at our institution was 17% and reconstructive success was 94%. Non-White race, older age at time of breast cancer diagnosis, higher body mass index, and presence of comorbid conditions including current smoking and hypertension were all associated with low socioeconomic status. Despite this, surgical complication rates were not predicted by non-White race, older age, or presence of diabetes mellitus. When analyzing major and minor complications based on radiation received or reconstructive success, there was no significant difference regardless of radiation treatment with the group overall achieving a 94% success rate (P = 0.229).This study aimed to characterize the impact of socioeconomic status and race/ethnic status of patients on breast reconstruction outcomes at an institution in the South. We found that despite the greater morbidity in low income and ethnic/minority patients that when treated by a comprehensive safety net institution, they had excellent reconstructive outcomes due to low complications and minimal reoperations.
