RESUMEN
The field of macrophage biology is rapidly growing. Recent studies have shifted focus from classic wound healing roles to newly identified roles in dermatologic pathology. These studies have identified pathogenic roles of macrophages in relatively common conditions, such as psoriasis, skin cancer, and cutaneous T-cell lymphoma. Selective depletion of these cells or their associated cytokines leads to improved clinical outcome. Herein, we review recent animal and human studies that have elucidated novel pathogenic roles of macrophages in conditions frequently encountered by dermatologists and discuss clinically relevant macrophage-targeted therapies.
Asunto(s)
Linfoma Cutáneo de Células T/patología , Macrófagos/metabolismo , Psoriasis/patología , Neoplasias Cutáneas/patología , Humanos , Cicatrización de HeridasAsunto(s)
Carcinoma Basocelular/diagnóstico , Peca Melanótica de Hutchinson/diagnóstico , Neoplasias Nasales/diagnóstico , Rinofima/cirugía , Neoplasias Cutáneas/diagnóstico , Anciano , Carcinoma Basocelular/complicaciones , Carcinoma Basocelular/patología , Procedimientos Quirúrgicos de Citorreducción , Humanos , Peca Melanótica de Hutchinson/complicaciones , Peca Melanótica de Hutchinson/patología , Hallazgos Incidentales , Masculino , Persona de Mediana Edad , Neoplasias Nasales/complicaciones , Neoplasias Nasales/patología , Rinofima/complicaciones , Rinofima/patología , Piel/patología , Neoplasias Cutáneas/complicaciones , Neoplasias Cutáneas/patologíaRESUMEN
Lasers are being used in ever-expanding roles in dermatology. As our understanding of laser energy grew, the need for safety guidelines became apparent. The US Food and Drug Administration (FDA) published the first safety guidelines in 1984, which are updated on a regular basis. However, these are just guidelines, and their implementation is voluntary by the laser practitioner. In this article, we discuss the 4 regulatory entities for laser safety in the United States, laser principles in general, ocular hazards, laser-generated airborne contaminants (LGACs), fires, and unintended laser beam injuries. We also review the use of checklists in reducing adverse outcomes and the need for safety protocols for laser practitioners. We provide a modifiable checklist, which pertains specifically to lasers and can be customized to meet the needs of the individual laser practitioner.
Asunto(s)
Terapia por Láser/métodos , Rayos Láser/normas , Guías de Práctica Clínica como Asunto , Lista de Verificación , Dermatología/legislación & jurisprudencia , Dermatología/métodos , Seguridad de Equipos , Humanos , Terapia por Láser/efectos adversos , Rayos Láser/efectos adversos , Estados Unidos , United States Food and Drug AdministrationAsunto(s)
Micosis Fungoide/epidemiología , Neoplasias Primarias Secundarias/epidemiología , Síndrome de Sézary/epidemiología , Neoplasias Cutáneas/epidemiología , Estudios de Cohortes , Femenino , Humanos , Incidencia , Masculino , Medición de Riesgo/estadística & datos numéricos , Gestión de Riesgos , Programa de VERF/estadística & datos numéricos , Factores Sexuales , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: The treatment of nonmelanoma skin cancer (NMSC) in the elderly population is a source of significant debate. Mohs micrographic surgery (MMS) is a highly effective treatment option yet not every patient with a cutaneous malignancy that meets appropriate use criteria (AUC) should be treated with surgery. OBJECTIVE: The purpose of this study was to use the Karnofsky Performance Status (KPS) scale to categorize the functional status of patients aged 75 years and older who required treatment of NMSC. The authors wanted to see whether functionality played a role on the treatment selection. METHODS: Patients aged 75 years and older presenting for biopsy of a suspected NMSC that met AUC for MMS were included in the study. Trained medical assistants used the KPS scale to assess patient functionality. Treatment modality was recorded once the biopsy confirmed the NMSC. RESULTS: A cohort of 203 subjects met inclusion criteria for the study. There was a statistically significant difference in utilization of surgical treatments between high and low functionality patients (p = .03). CONCLUSION: Dermatologists consider patient functionality when selecting a treatment for NMSC and use less invasive modalities for patients with poor functional status, even when the tumor meets AUC.
Asunto(s)
Estado de Ejecución de Karnofsky , Neoplasias Cutáneas/terapia , Anciano , Anciano de 80 o más Años , Biopsia , Carcinoma Basocelular/terapia , Carcinoma de Células Escamosas/terapia , Femenino , Evaluación Geriátrica , Humanos , Masculino , Cirugía de Mohs , Selección de Paciente , Estudios Prospectivos , Estados UnidosRESUMEN
Mentoring is enriching for both the mentor and mentee, but often getting started can be a primary obstacle to this useful tool. This contribution focuses on how to embark on a mentoring relationship with a junior colleague. In addition to describing various approaches to being a mentor, it outlines unproductive traps to avoid, steps to establishing a successful mentoring relationship, including conversation starters, and professional skills one can continue to develop to improve mentoring outcomes.
Asunto(s)
Competencia Clínica , Educación de Postgrado en Medicina/organización & administración , Mentores , Oftalmología/educación , Humanos , Internado y Residencia/organización & administración , Relaciones Interprofesionales , MasculinoAsunto(s)
Investigación Biomédica/organización & administración , Dermatología/organización & administración , Becas/organización & administración , Fundaciones/organización & administración , Apoyo a la Investigación como Asunto/organización & administración , Fundaciones/tendencias , Humanos , Estados UnidosRESUMEN
Composite lymphoma of T-cell and B-cell type is uncommon, and the one occurring primarily on skin is extremely rare. Herein, we report a unique case of composite lymphoma of mycosis fungoides and cutaneous small B-cell lymphoma in a 73-year-old male patient. The patient presented with multiple erythematous patches, plaques, and nodules on the upper arms, scalp, and trunk. Four punch biopsies of arm and scalp lesions demonstrated lymphoid infiltrate in superficial to deep dermis with a characteristic zone distribution of T-cell and B-cell components. T cells were distributed in papillary and perifollicular dermis and displayed a larger size with convoluted nuclei, whereas B cells were small sized, assuming nodular infiltrate in mid-deep dermis with coexpression of CD5. Molecular test detected clonal rearrangement of both TCRG and IGH/K genes with identical amplicons for each gene in all 4 biopsies. Clinical staging revealed no extracutaneous lesions. A multidisplinary approach is emphasized to establish a definitive diagnosis.
Asunto(s)
Linfoma Compuesto/patología , Linfoma de Células B/patología , Micosis Fungoide/patología , Neoplasias Cutáneas/patología , Anciano , Linfocitos B/metabolismo , Linfocitos B/patología , Biomarcadores de Tumor/metabolismo , Antígenos CD5/metabolismo , Células Clonales , Terapia Combinada , Linfoma Compuesto/genética , Linfoma Compuesto/metabolismo , Linfoma Compuesto/terapia , Reordenamiento Génico , Genes Codificadores de la Cadena gamma de los Receptores de Linfocito T , Humanos , Inmunoglobulinas/genética , Linfoma de Células B/genética , Linfoma de Células B/metabolismo , Linfoma de Células B/terapia , Masculino , Micosis Fungoide/genética , Micosis Fungoide/metabolismo , Micosis Fungoide/terapia , Neoplasias Cutáneas/genética , Neoplasias Cutáneas/metabolismo , Neoplasias Cutáneas/terapia , Linfocitos T/metabolismo , Linfocitos T/patología , Resultado del TratamientoRESUMEN
The appropriate use criteria process synthesizes evidence-based medicine, clinical practice experience, and expert judgment. The American Academy of Dermatology in collaboration with the American College of Mohs Surgery, the American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery has developed appropriate use criteria for 270 scenarios for which Mohs micrographic surgery (MMS) is frequently considered based on tumor and patient characteristics. This document reflects the rating of appropriateness of MMS for each of these clinical scenarios by a ratings panel in a process based on the appropriateness method developed by the RAND Corp (Santa Monica, CA)/University of California-Los Angeles (RAND/UCLA). At the conclusion of the rating process, consensus was reached for all 270 (100%) scenarios by the Ratings Panel, with 200 (74.07%) deemed as appropriate, 24 (8.89%) as uncertain, and 46 (17.04%) as inappropriate. For the 69 basal cell carcinoma scenarios, 53 were deemed appropriate, 6 uncertain, and 10 inappropriate. For the 143 squamous cell carcinoma scenarios, 102 were deemed appropriate, 7 uncertain, and 34 inappropriate. For the 12 lentigo maligna and melanoma in situ scenarios, 10 were deemed appropriate, 2 uncertain, and 0 inappropriate. For the 46 rare cutaneous malignancies scenarios, 35 were deemed appropriate, 9 uncertain, and 2 inappropriate. These appropriate use criteria have the potential to impact health care delivery, reimbursement policy, and physician decision making on patient selection for MMS, and aim to optimize the use of MMS for scenarios in which the expected clinical benefit is anticipated to be the greatest. In addition, recognition of those scenarios rated as uncertain facilitates an understanding of areas that would benefit from further research. Each clinical scenario identified in this document is crafted for the average patient and not the exception. Thus, the ultimate decision regarding the appropriateness of MMS should be determined by the expertise and clinical experience of the physician.
Asunto(s)
Carcinoma Basocelular/cirugía , Carcinoma de Células Escamosas/cirugía , Melanoma/cirugía , Cirugía de Mohs/normas , Neoplasias Cutáneas/cirugía , HumanosRESUMEN
The appropriate use criteria process synthesizes evidence-based medicine, clinical practice experience, and expert judgment. The American Academy of Dermatology in collaboration with the American College of Mohs Surgery, the American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery has developed appropriate use criteria for 270 scenarios for which Mohs micrographic surgery (MMS) is frequently considered based on tumor and patient characteristics. This document reflects the rating of appropriateness of MMS for each of these clinical scenarios by a ratings panel in a process based on the appropriateness method developed by the RAND Corp (Santa Monica, CA)/University of California-Los Angeles (RAND/UCLA). At the conclusion of the rating process, consensus was reached for all 270 (100%) scenarios by the Ratings Panel, with 200 (74.07%) deemed as appropriate, 24 (8.89%) as uncertain, and 46 (17.04%) as inappropriate. For the 69 basal cell carcinoma scenarios, 53 were deemed appropriate, 6 uncertain, and 10 inappropriate. For the 143 squamous cell carcinoma scenarios, 102 were deemed appropriate, 7 uncertain, and 34 inappropriate. For the 12 lentigo maligna and melanoma in situ scenarios, 10 were deemed appropriate, 2 uncertain, and 0 inappropriate. For the 46 rare cutaneous malignancies scenarios, 35 were deemed appropriate, 9 uncertain, and 2 inappropriate. These appropriate use criteria have the potential to impact health care delivery, reimbursement policy, and physician decision making on patient selection for MMS, and aim to optimize the use of MMS for scenarios in which the expected clinical benefit is anticipated to be the greatest. In addition, recognition of those scenarios rated as uncertain facilitates an understanding of areas that would benefit from further research. Each clinical scenario identified in this document is crafted for the average patient and not the exception. Thus, the ultimate decision regarding the appropriateness of MMS should be determined by the expertise and clinical experience of the physician.
Asunto(s)
Dermatología/normas , Melanoma/cirugía , Cirugía de Mohs/normas , Guías de Práctica Clínica como Asunto , Neoplasias Cutáneas/cirugía , Carcinoma in Situ/cirugía , Carcinoma Basocelular/cirugía , Carcinoma de Células Escamosas/cirugía , Humanos , Peca Melanótica de Hutchinson/cirugíaRESUMEN
There are many types of skin disease that fit into the classification of cutaneous lymphoma, but mycosis fungoides is by far the most common of this group. It is a non-Hodgkin's lymphoma of T-cell origin that presents in the skin. Mycosis fungoides often evolves for years without a specific diagnosis because it can present as an eczematous or psoriasiform eruption. Patients identified in the early stages and treated appropriately have a normal life expectancy.
Asunto(s)
Micosis Fungoide/patología , Neoplasias Cutáneas/patología , Piel/patología , Adolescente , Biopsia , Diagnóstico Diferencial , Humanos , Masculino , Micosis Fungoide/diagnóstico , Micosis Fungoide/tratamiento farmacológico , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/tratamiento farmacológicoRESUMEN
A variety of neoplasms may occur in association with neurofibromatosis type 1 (NF1). We describe a patient with NF1 and mycosis fungoides. Recommendations for the initial and long-term evaluations of patients with neurofibromatosis are presented.
Asunto(s)
Micosis Fungoide/complicaciones , Neurofibromatosis 1/complicaciones , Neoplasias Cutáneas/complicaciones , Neoplasias Cutáneas/patología , Anciano , Biopsia con Aguja , Humanos , Inmunohistoquímica , Masculino , Micosis Fungoide/patología , Neurofibromatosis 1/diagnóstico , Pronóstico , Medición de Riesgo , Índice de Severidad de la EnfermedadRESUMEN
Despite cutaneous B-cell lymphoma often having a relatively indolent course and low mortality, it is often resistant to conventional therapy and frequently relapses. We describe a patient with widespread cutaneous B-cell lymphoma who was treated successfully with a recently approved chimeric monoclonal antibody directed against the CD20 antigen (rituximab) and the CD20-negative relapse that resulted.
Asunto(s)
Anticuerpos Monoclonales/uso terapéutico , Antígenos CD20/análisis , Antineoplásicos/uso terapéutico , Linfoma de Células B/terapia , Neoplasias Cutáneas/terapia , Anciano , Anticuerpos Monoclonales de Origen Murino , Femenino , Humanos , Linfoma de Células B/inmunología , Linfoma de Células B/patología , Rituximab , Piel/patología , Neoplasias Cutáneas/inmunología , Neoplasias Cutáneas/patologíaRESUMEN
Laser skin surgery is not without risk and some degree of downtime in most situations. Patient satisfaction is key to the perceived success of the procedure. Therefore, the physician must fully explain all risks, potential complications, and expected morbidity associated with any laser treatment to be performed. Although many side effects can be avoided by use of appropriate intraoperative technique and adequate postoperative management, untoward effects may still occur and must be promptly identified and addressed. An informed patient is an important factor in the healing process and contributes to the success of the procedure.