Proton Beam Therapy for Breast Cancer.

Given the radiobiological and physical properties of the proton, proton beam therapy has the potential to be advantageous for many patients compared with conventional radiotherapy by limiting toxicity and improving patient outcomes in specific breast cancer scenarios.

The impact on quality-of-life following treatment of surgical facial scars with laser-based therapy: a scoping review.

Post-surgical scarring impacts quality of life (QOL) and is a significant source of morbidity. Existing treatments targeted at improving the appearance and morbidity of scarring include laser-based therapies. Although lasers are frequently used to improve scar appearance, the effects on QOL are unclear. A scoping review was conducted to assess the impact of laser-based therapy for patients with surgical facial scarring on QOL. Throughout literature review was conducted with the guidance of a medical librarian. Relevant articles underwent two rounds of screening by two, independent reviewers. Data were extracted from each article and later analyzed. Of the four articles analyzed, laser-based therapies were demonstrated as effective in improving QOL for patients with facial scars resultant from surgical intervention. Laser-based therapy should be considered when treating facial scarring resultant from surgical intervention, as it has been shown to improve patient QOL. Standardization of QOL assessment and further studies expanding scar inclusion should be pursued given the paucity of information found through this review.

Hypertrophic Scars and Keloids: Advances in Treatment and Review of Established Therapies.

Hypertrophic scars and keloids can have significant detrimental effects on patients both psychosocially and functionally. A careful identification of patient risk factors and a comprehensive management plan are necessary to optimize outcomes. Patients with a history of dystrophic scarring should avoid unnecessary procedures and enhance the wound-healing process using various preventive strategies. As there is no single, fully efficacious treatment modality, prevention remains the best approach in reducing aberrant scar formation. When prevention therapies fail, keloids have been shown to be respond to a variety of therapies including topical and injectable corticosteroids, 5-fluorouracil, radiotherapy, lasers, and surgical excision, all with varying efficacies. As such, management should be tailored to the individual patient's risk factors with the use of combination therapies to reduce recurrence rates. Still, keloid and hypertrophic scar therapies are widely diverse with novel treatment modalities providing alternatives for recurring lesions. Laser-assisted drug delivery, skin priming, and novel topical therapies may provide alternative options for the management of hypertrophic scars and keloids.

Trends in matching into Mohs Micrographic Surgery fellowship among underrepresented minority applicants from 2016 to 2020: a retrospective review study.

Disparities in racial diversity in the field of dermatology continue to persist given that dermatology has the second lowest percentage of underrepresented minorities (URM), only second to orthopedic surgery. This study aims to investigate any trends in racial representation of Mohs Micrographic Surgery (MMS) fellowship applicants over a five-year period from 2016 to 2020. Dermatology residency applicant race data were extracted from the San Francisco Match for application seasons 2016-2020 for a retrospective review study. There was an overall increase in the number of MMS fellowship applicants during the five-year study period. Prior to 2018 (midpoint of study), 6.6% of matched applicants and 10.9% of unmatched applicants identified as URMs, compared to 8.1% of matched applicants and 10.1% of unmatched applicants after 2018, but this increase was not statistically significant (p = 0.62). There is hope that Mohs Micrographic Surgery fellowship applicants are becoming more racially diverse with improved representation of underrepresented minorities.

Trends in racial diversity of dermatology residency applicants from 2016 to 2020: a retrospective review study.

Disparities in racial diversity in the field of dermatology continue to persist given that dermatology has the second lowest percentage of underrepresented minorities (URM), only second to orthopedic surgery. This study aims to investigate any trends in racial representation of dermatology residency applicants over a 5-year period from 2016 to 2020. Dermatology residency applicant race data were extracted from the Electronic Residency Application Service (ERAS) of the Association of American Medical Colleges (AAMC) for application seasons 2016-2020 for a retrospective review study. There was an overall increase in the number of dermatology residency applicants during the 5-year study period. Prior to 2018 (midpoint of the study), 14.1% of applicants identified as URM compared to 16.2% after 2018, although this difference was not statistically significant (p = 0.25). Our findings suggest that in the study period analyzed, racial representation remained relatively similar, with a non-statistically significant increase in URM applicants. Outlining the current trends in dermatology residency applicants may be helpful in identifying factors affecting the disparity in racial representation within the field. There is hope that dermatology residency applicants are becoming more racially diverse with improved representation of URMs.

Perioperative anticoagulation recommendations for cutaneous oncologic surgery: a review of the literature.

Consistent perioperative management is important to the practice of dermatologic surgery. With the widespread use of anticoagulant medications, such as aspirin, warfarin, clopidogrel, factor Xa inhibitors, and thrombin inhibitors for a number of cardiovascular indications, it is important to standardize the use of these drugs in the setting of skin cancer surgery. Limited literature is available, however, regarding recommendations for dermatological perioperative anticoagulation management. Most published manuscripts involving anticoagulation and skin cancer surgery focus on complications and outcomes rather than providing guidelines for decision-making. In addition, survey studies have largely shown that even with existing recommendations in the literature, many dermatologists continue to have varying management of these medications. Overall, this review finds compelling evidence to support the safety of continuing anticoagulation therapy, such as warfarin, aspirin, and clopidogrel throughout treatment for cutaneous malignancies. It is important that dermatologists, while having primary care and cardiology available for consultation, are aware of the safety data and feel comfortable managing their patients perioperatively.

Review of the current antibiotic guidelines used in dermatologic surgery.

Antibiotics have been used as a prophylaxis for dermatologic procedures. We will review the various procedures that specific antibiotics with dosages are used for, depending on the procedure, diagnosis, and circumstance of the patient. We will examine the current and updated guidelines used in dermatologic surgery and the overlapping guidelines across other fields. Physicians must consider the side effects of antibiotics and the resistance that may occur as a result before using the class or level of prophylaxis. Initial evaluation for alcohol, chlorhexidine, or iodine should be measured as well. Updated guidelines aim to address the contraindications of antibiotics, yet further research is needed to avoid antibiotic resistance and to explore alternative methods of antibiotic application, such as intranasal and intravenous.

Analysis of fibroblast pen usage amongst TikTok social media users.

Social media networks serve as convenient platforms for the dissemination of information, including that which pertains to healthcare. However, social media networks may also disseminate incorrect information, and may even propagate potentially harmful skincare trends. Since its inception in 2016, TikTok, a social media platform wherein users can create and share videos, has served as a tool for the propagation of multiple, potentially dangerous cosmetic trends, most recently the usage of fibroblast pens. Fibroblast pens, also known as plasma pens, are toted to produce a variety of skincare benefits. However, many of the pens being sold commercially, and subsequently used on TikTok, are not FDA-regulated. Potential adverse effects include the development of dyspigmentation, scarring, and mechanical burns of the skin. This study assessed social media content to improve our understanding of fibroblast pen usage amongst TikTok creators. An initial search of public TikTok posts tagged with "#PlasmaPen," "#PlasmaPenTreatment," "#FibroblastPlasma," or "#FibroblastPlasmaPen" identified 200 posts, of which 78 were eliminated after accounting for overlapping posts between hashtags, posts that were later deleted by the user, and those in languages other than English. We analyzed posts according to creator type and classified them into four main themes. The 78 videos were later re-viewed to provide more detailed subdivisions within the four main themes. Analysis showed that 36% of the posts were created by lay-person TikTok users, followed by 25% of posts being created by self-proclaimed fibroblast skin tightening specialists. Major themes include advertisement of the fibroblast pen (61%), experience with the fibroblast pen (26%), education on the fibroblast pen's uses and benefits (6.5%), and warnings related to usage of the pen (6.5%). TikTok users are more likely to encounter a post regarding fibroblast pen usage from uncredentialled, non-medical professional accounts. Only 6.5% of posts were created with the intention of serving as a warning to users, with most of these posts being created by medical doctors. Dermatologists should be aware of the misinformation regarding fibroblast pens and consider posting on social media to raise awareness about this potentially dangerous skincare trend.

Laser tattoo removal: laser principles and an updated guide for clinicians.

Tattoos have become ingrained in our society and have served varied purposes throughout human civilization. So long as tattoos have existed, there has been demand for their removal. Lasers are currently the modality of choice in the removal of tattoos, as they are more efficacious than previously used methods. The most common lasers are the 532 nm and 1064 nm neodymium-doped yttrium aluminum garnet lasers, the quality-switched 694 nm Ruby laser, and the quality-switched 755 nm alexandrite laser. However, picosecond lasers are rapidly gaining favor in tattoo removal. An in-depth understanding of laser principles and how they can be applied in the setting of tattoo removal is key. Also, a greater understanding of the origin of and colors within a tattoo, the presence of tattoo layering, and a patient's Fitzpatrick skin type increase the odds of satisfactory results. This review provides dermatologists with a comprehensive summary on laser fundamentals, an overview on treatment principles, and recent developments in the field of laser tattoo removal.

Basal cell carcinoma: An updated review of pathogenesis and treatment options.

Basal cell carcinoma (BCC) remains the most common malignancy worldwide. BCC pathogenesis is a result of the interplay between one's environment, genetics, and phenotypic factors. BCC has a low mortality but given its increasing incidence and potential to cause local destruction thus resulting in significant morbidity, it is vital for dermatologists to remain up to date with recent updates in this malignancy's pathogenesis and treatment. This article provides a comprehensive review of the pathogenesis of BCC as well as the current treatments available and clinical trials underway. We also touch upon the updated National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology in respect to BCC's recommended treatment modalities.

Squamous cell carcinoma: 2021 updated review of treatment.

Squamous cell carcinoma is the second most common cutaneous malignancy, requiring early diagnosis to prevent metastasis. Updated guidelines in the definition of clinical features, diagnostic modalities, grading, staging, surgical, and nonsurgical treatment methods are necessary. Diagnostic methods from biopsy, dermoscopy, and reflectance confocal microscopy have improved to include high-frequency ultrasonography, optical coherence tomography, and computed tomography. Non-surgical treatment methods include topical therapy, cryosurgery, photodynamic therapy, and radiation. Surgical treatment methods include surgical excision with margins and Mohs surgery. Clinical trials encourage further research to address the knowledge base of genetic variations and lymph node metastasis.

Merkel cell carcinoma: An updated review of pathogenesis, diagnosis, and treatment options.

Merkel cell carcinoma is a rare neuroendocrine carcinoma that typically appears in sun-exposed areas of the elderly. It has a poor prognosis and with its incidence projected to increase, it is vital for dermatologists to remain up to date with recent updates in this malignancy's pathogenesis and treatment. In the past few decades Merkel cell carcinoma's pathogenesis, more specifically its relation to the Merkel cell polyomavirus, has sparked further interest in the study of this carcinoma. Most cases are attributed to malignant transformation secondary to the Merkel cell polyomavirus, with a minority derived from DNA damage resulting from ultraviolet radiation. Investigators have also determined that there are immunologic influences in the development and prognosis of Merkel cell carcinoma, as individuals with HIV, solid organ transplants, and lymphoproliferative malignancies are at a greater risk of developing this carcinoma. In addition, this immunologic link carries treatment value, as immunologic therapies are currently being investigated. This article provides a comprehensive review of the epidemiology and pathogenesis of Merkel cell carcinoma as well as the current treatments available and clinical trials underway. We also touch upon the updated National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology in respect to its diagnosis and recommended treatment modalities.

Dietary Considerations for Inflammatory Bowel Disease Are Useful for Treatment of Checkpoint Inhibitor-Induced Colitis.

Checkpoint molecules are cell surface receptors on immune cells that mitigate excessive immune responses, but they have increased expression levels in cancer to facilitate immune escape. Checkpoint blockade therapies (e.g., anti-PD-1, anti-CTLA-4, and anti-LAG-3 therapy, among others) have been developed for multiple cancers. Colitis associated with checkpoint blockade therapy has pathophysiological similarities to inflammatory bowel disease (IBD), such as Crohn's disease and ulcerative colitis. Current therapeutic guidelines for checkpoint blockade-induced colitis include corticosteroids and, if the patient is refractory to steroids, immunomodulating antibodies, such as anti-TNF and anti-integrin agents. Interestingly, immunomodulatory molecules, such as TNFα, are upregulated in both IBD and checkpoint-mediated colitis. The inflammatory colitis toxicity symptoms from checkpoint blockade are similar to clinical symptoms experienced by patients with IBD. The pathophysiologic, dietary, and genetic factors associated with IBD will be reviewed. We will then explain how the principles developed for the treatment of IBD can be applied to patients experiencing inflammatory bowel toxicity secondary to checkpoint blockade.