Report of a CaseAn 83-year-old man presented with a recurrent micronodular basal cell carcinoma located on the left lateral chest measuring 2.3 × 2.1 cm.His medical history was significant for coronary artery disease and the use combined clopidogrel bisulfate and aspirin antiplatelet therapy, which was maintained during surgery.The tumor was extirpated with 6 stages of Mohs micrographic surgery, producing a 10.5 × 8.9-cm defect to the deep subcutaneous tissue.The patient was adamant about returning to his recreational activities, including golf, as soon as possible.Wound management options were discussed with the patient, and the limitations of each were noted.
Objective: To determine the factors that might limit Hispanic patients from participating in dermatological clinical trials. Methods: From January 2022 to July 2022, we administered a 31-item, in-person questionnaire to patients recruited in the waiting area of the Caridad Center, one of the largest free clinics in the United States with a predominately Hispanic population, and a nearby private primary care clinic. Results: Overall, Hispanic patients agreed significantly more with statements in the domain of attitude and behavioral beliefs compared to non-Hispanic survey respondents. The Hispanic ethnicity was associated with increased odds of agreeing with the following statements: "My community would really benefit from skin cancer clinical trials" (OR=0.52; 95% CI 0.30, 0.92), "My participation in a skin cancer study would be very good" (OR=0.59; 95% CI 0.35, 0.99), and "I like to do good for others" (OR=0.41; 95% CI 0.22, 0.77). Conclusion: While the United States population is composed of 18.5% Hispanics, they only account for 1% of patients enrolled in clinical trials. This study helps identify potential motivational factors for Hispanic patients to participate in skin cancer clinical trials.
Hedgehog pathway inhibitors (HPIs) are indicated for locally advanced basal cell carcinoma (laBCC) and metastatic basal cell carcinoma with reported treatment length of 5.5 months to more than 5 years.1-3 The definition of laBCC is historically ill described and only recently has a consensus definition been proposed.1,4 Treatment is indicated until tumor resistance or adverse events cause interruption. Therefore, we do not know the length of treatment necessary for tumor clearance. We describe a patient who received a single 2-week pulse treatment of HPI therapy and subsequently experienced sustained clinical and histologic clearance of his tumor.
Excisional skin cancer surgery is a common procedure, with no formal consensus for mitigating the risk of wrong-site cutaneous surgery. To systematically consider the usefulness and feasibility of proposed methods for correct biopsy site identification in dermatology. Survey study with a formal consensus process. Item development was via a literature review and expert interviews, followed by 2 stages of a Delphi process to develop consensus recommendations. In total, 2323 articles were reviewed in the literature search, with data extraction from 14. Twenty-five experts underwent 30-minute structured interviews, which were transcribed and coded. The resulting survey was composed of 42 proposed interventions by multiple stakeholders (biopsying physicians, operating physicians, nurses, ancillary staff, patients, caregivers, and family members) at 3 time points (day of biopsy, delay and consultation period, and day of definitive surgery). Two rounds of a Delphi process with 59 experts (25 academic and 34 private practice) scored the survey. Strong consensus was obtained on 14 behaviors, and moderate consensus was obtained on 21 other behaviors. In addition, a 2-state simultaneous algorithm was developed to model surgeon behavior on the day of definitive surgery based on surgeon and patient perceptions. When definitive surgery is performed after the initial biopsy and by a different surgeon, procedures can be implemented at several time points to increase the likelihood of correct site identification. The specific circumstances of a case suggest which methods may be most appropriate and feasible, and some may be implemented. The risk of wrong-site cutaneous surgery can be reduced but not eliminated.
Cutaneous squamous cell carcinoma (CSCC) is the second most common skin cancer, with an estimated annual incidence of > 700,000 in the United States.1,2 In >95% of patients, CSCC is cured, most commonly with excision or Mohs micrographic surgery. A small percentage of patients develop advanced CSCC (locally advanced CSCC [laCSCC] or metastatic CSCC [mCSCC]), which is associated with a high mortality rate and poor prognosis, with an estimated 3-year survival of 55%.3,4 Traditional treatment options for advanced CSCC include cytotoxic chemotherapy and targeted therapy; eg, epidermal growth factor receptor inhibitors.
Lupus erythematosus lichen planus (LE-LP) overlap syndrome remains an uncommon diagnostic entity, combining both the histologic and clinical features of lupus erythematosus and lichen planus. A rare and challenging diagnosis, clinicopathologic correlation is essential for accurate and timely identification. Histologically, superficial evaluation of lupus erythematosus lichen planus overlap syndrome can mimic squamous cell carcinoma due to the presence of squamatized keratinocytes with concomitant irregular acanthosis. Here, we present a case of LE-LP overlap syndrome in a patient with long standing systemic lupus erythematosus initially misdiagnosed as squamous cell carcinoma.
The Journal of Biomedical Optics (JBO) is a Gold Open Access journal that publishes peer-reviewed papers on the use of novel optical systems and techniques for improved health care and biomedical research.
