Host and primary tumor factors for the development of multiple cutaneous squamous cell carcinomas among a retrospective cohort in Rhode Island.

INTRODUCTION: Risk factors for a primary cutaneous squamous cell carcinoma (CSCC) are well-established; however, the host and primary tumor risk factors for subsequent CSCC have not been fully explored. METHODS: We performed a retrospective chart review of patients diagnosed with CSCC in an academic dermatology clinic in Rhode Island from 2016-2019. Logistic regression was used to evaluate the associations between host factors and multiple CSCC and between primary tumor characteristics and the risk of subsequent CSCC. Adjusted odds ratios (aORs) and 95% CIs were calculated. RESULTS: A total of 1312 patients with CSCC diagnoses were included. Host risk factors significantly associated with multiple CSCCs included: aged >80 years (aOR, 2.18; 95% CI, 1.46-3.31); history of: solid organ transplant (aOR, 2.41; 95% CI, 1.20-4.80); skin cancer (aOR, 1.96; 95% CI, 1.52-2.54); other cancer (aOR, 1.49; 95% CI, 1.11-2.00); family history of skin cancer (aOR, 1.36; 95% CI, 1.03-1.78); and actinic keratosis (aOR, 1.52; 95% CI, 1.18-1.95). Tumor location, diameter, histologic differentiation, and treatment were not significant predictors of subsequent CSCCs. LIMITATIONS: Study patients were predominantly White and from a single institution, limiting the generalizability of results. CONCLUSIONS: Certain host characteristics were associated with the development of subsequent CSCC, which may inform clinical guidelines for follow-up.

Examining the Constructs of Burnout, Compassion Fatigue, Secondary Traumatic Stress in Physicians Using Factor Analyses.

Background: Adverse affective experiences have been well-documented in healthcare providers. Research describes them under a variety of terms, including burnout, secondary traumatic stress (STS), and compassion fatigue (CF). The present study evaluates conflicting models of STS, CF, and burnout constructs in physicians. Methods: Surveys were mailed to all allopathic physicians with active Rhode Island medical licenses. Three hundred and seventy-five complete responses were received. The survey included common measures of STS, CF, and burnout. Confirmatory Factor Analysis (CFA) was used to evaluate discriminant validity of the three constructs and test 5 a priori (1-, 2-, and 3-factor) theoretical models, and Exploratory Factor Analysis (EFA) was planned assess underlying factor structure in the case that CFA did not provide evidence supporting any existing model. Results: By CFA, all five a priori models of burnout, CF, and STS fail to demonstrate adequate model fit (Standardized Root Mean Square Residual >0.10, Tucker-Lewis Index <0.90). EFA with parallel analysis extracts four factors underlying the three burnout, STS, and CF measures. The four factors describe 54.3% of variance and can be described as (1) depressive mood; (2) primary traumatic stress-like symptoms; (3) responses to patients' trauma; and (4) sleep disturbances. Conclusion: In spite of abundant discussion surrounding burnout, CF, and STS in physicians, measures of these constructs did not uphold their theoretical factor structures in the present study. Future research might explore other constructs and measures that may describe adverse affective physician experiences.

Sweet's syndrome in the setting of newly initiated risankizumab therapy for pre-existing psoriasis.

Sweet's syndrome (acute febrile neutrophilic dermatosis) is a rare disorder of unclear aetiology characterised by painful cutaneous lesions, sometimes accompanied by systemic symptoms. It has been associated with several autoimmune conditions, drugs, malignancies and infections, though many cases are idiopathic. We describe a case of Sweet's syndrome in a 49-year-old man with pre-existing psoriasis following recent initiation of risankizumab therapy. There are very few reported cases of Sweet's syndrome in association with psoriasis and no existing reports in association with an IL-23 inhibiting medication. Further investigation of the potentially overlapping immunologic pathways implicated in cutaneous reactions to biologic agents and autoimmune conditions such as psoriasis may yield insights into the pathogenesis of such conditions and guide advancements in the rapidly evolving field of targeted biologic therapies.