Cutaneous Disease of Penoscrotal Skin Part I: Benign and Neoplastic Lesions.

Penoscrotal skin diseases encompass an array of pathologies that present with unique clinical features. A patient-tailored approach to management is necessary. This article, part of a continuing medical education series, is dedicated to offering insights for managing penoscrotal dermatoses. The first article will provide an overview of normal variations, benign lesions, and malignant growths. We will then highlight up-to-date diagnostic and treatment protocols. In the second article, we will discuss inflammatory and infectious conditions, reviewing common diseases such as syphilis, human papilloma virus, and psoriasis, as well as rarer, difficult to treat diseases such as lichen sclerosus, lichen planus, and genital dyesthesias. Considering 70% of patients with genital skin diseases report that physicians lack awareness of these conditions,1 this CME series will help practitioners identify penoscrotal diseases, expand differential diagnoses, and discuss appropriate and emerging therapies.

Sun-protective behaviors and sunburn among US adults.

Individuals can reduce the risk of developing skin cancer by minimizing ultraviolet sunlight exposure, though recent trends in sun-protective behaviors remain to be investigated. To evaluate sun-protective behaviors and sunburn among US adults. We analyzed data from the 2010, 2015, and 2020 National Health Interview Survey (NHIS), an annual, cross-sectional survey conducted by the US Census Bureau. Multivariable regression models were stratified by demographic variables and constructed to evaluate sun-protective behaviors and sunburn avoidance across time. From 2010 through 2020, US adults had significantly increased prevalence of seeking shade (p value, 0.003), wearing wide-brimmed hats (< 0.001), wearing long-sleeved shirts (< 0.001), using sunscreen (< 0.001), and avoiding sunburns (< 0.001) and significantly decreased prevalence of sun avoidance (< 0.001). Disparities in sun-protective behaviors also exist among different sexes, ages, education levels, and those reporting higher sun sensitivity. This cross-sectional study found that by 2020, US adults had an increased prevalence of wearing sun-protective clothing and sunscreen use, though decreased prevalence of sun avoidance. Although certain sun-protective behaviors have become more prevalent, the incidence of skin cancer continues to rise. Efforts to understand drivers of sun-protective behaviors and targeted intervention efforts are needed.

An Overview of Penile and Scrotal Dermatoses.

There are a number of dermatoses that manifest in the genital region. Urologists are often the first point of contact for patients with such disorders. These can be isolated genital conditions or manifestations of a more widespread cutaneous disease. Though similar appearing, there are often key clinical findings that aid in in diagnosis. In general, genital dermatoses can be classified as physiologic variants, inflammatory, neoplastic, or infectious in etiology. This article provides a broad overview for urologists in addressing both common and rarer penile and scrotal dermatoses. Emphasis is placed on characteristic clinical findings to aid in diagnosis. Recommendations for diagnostic evaluation, treatment, and appropriate follow-up are discussed.

Demographics of Men and Minorities in Cosmetic Clinical Trials of Botulinum Toxin and Hyaluronic Acid Fillers.

BACKGROUND: The demographics of men and minorities in clinical studies of nonsurgical cosmetic procedures have not been well described. There is a growing interest in nonsurgical cosmetic procedures. The patients studied in clinical trials may not be reflective of the real-world demographic of patients seeking nonsurgical cosmetic procedures. OBJECTIVE: To examine the demographics of men and minorities in clinical studies of nonsurgical cosmetic procedures. METHODS: A systematic review of clinical trials of botulinum toxin A (BTX-A) for facial rhytides and hyaluronic acid (HA) injectable fillers for soft-tissue augmentation was performed. Data on ethnicity and sex were collected and examined. RESULTS: Nineteen randomized controlled trials (RCTs) on BTX-A and 22 RCTs on HA were included for analysis. Men represented 11.8% of all participants. Men were more represented in the BTX-A RCTs (13.9%) compared with the HA RCTs (6.4%). Caucasian patients represented 67.1% of the total patients. Asian, Hispanic, and black patients represented 16.8%, 6.5%, and 5.4% of study participants, respectively. CONCLUSION: The proportion of men in clinical trials of BTX-A and HA reflects the real-world demographics of men undergoing these procedures. Hispanic and black patients were underrepresented in clinical trials.

Mirtazapine for the Treatment of Chronic Pruritus.

Background: Chronic pruritus is a debilitating condition associated with a wide range of dermatologic, systemic and psychogenic etiologies. In patients with chronic pruritus that is refractory to conventional therapy, symptoms can significantly decrease quality of life by contributing to anxiety, sleep disturbances, and in many cases depression. Recent studies have demonstrated the effectiveness of mirtazapine in relieving chronic itch that is refractory to standard first-line therapies. Methods: We searched PubMed for English-language articles containing the words ("pruritus" or "itch") AND "antidepressant" and then conducted a systematic review of the current literature to summarize the efficacy of mirtazapine in treating chronic itch. Results: All studies reported a reduction in itch intensity following the administration of mirtazapine. Conclusion: Collectively, these studies suggest the potential for mirtazapine to relieve chronic itch attributed to dermatological causes and malignancies. As, such mirtazapine may be an option for patients with chronic pruritus that is refractory to typical first-line treatments.

Management of hidradenitis suppurativa in pregnancy.

Hidradenitis suppurativa is a debilitating inflammatory skin disease with a chronic course and often disappointing response to treatment. Though a minority of persons (20%) reports symptom remission during pregnancy, the vast majority experiences no relief (72%), and few experience clinical deterioration (8%). Disease flares are also observed post-partum. The pathophysiological basis for pregnancy-associated fluctuations in clinical status is currently unknown. Because most women with HS require ongoing management throughout pregnancy, it is important to evaluate the suitability and safety of current treatment options for pregnant women. The following review will outline current management strategies for HS and their compatibility with pregnancy and lactation.

A map of mobile DNA insertions in the NCI-60 human cancer cell panel.

BACKGROUND: The National Cancer Institute-60 (NCI-60) cell lines are among the most widely used models of human cancer. They provide a platform to integrate DNA sequence information, epigenetic data, RNA and protein expression, and pharmacologic susceptibilities in studies of cancer cell biology. Genome-wide studies of the complete panel have included exome sequencing, karyotyping, and copy number analyses but have not targeted repetitive sequences. Interspersed repeats derived from mobile DNAs are a significant source of heritable genetic variation, and insertions of active elements can occur somatically in malignancy. METHOD: We used Transposon Insertion Profiling by microarray (TIP-chip) to map Long INterspersed Element-1 (LINE-1, L1) and Alu Short INterspersed Element (SINE) insertions in cancer genes in NCI-60 cells. We focused this discovery effort on annotated Cancer Gene Index loci. RESULTS: We catalogued a total of 749 and 2,100 loci corresponding to candidate LINE-1 and Alu insertion sites, respectively. As expected, these numbers encompass previously known insertions, polymorphisms shared in unrelated tumor cell lines, as well as unique, potentially tumor-specific insertions. We also conducted association analyses relating individual insertions to a variety of cellular phenotypes. CONCLUSIONS: These data provide a resource for investigators with interests in specific cancer gene loci or mobile element insertion effects more broadly. Our data underscore that significant genetic variation in cancer genomes is owed to LINE-1 and Alu retrotransposons. Our findings also indicate that as large numbers of cancer genomes become available, it will be possible to associate individual transposable element insertion variants with molecular and phenotypic features of these malignancies.

Translocation junctions in TCF3-PBX1 acute lymphoblastic leukemia/lymphoma cluster near transposable elements.

BACKGROUND: Hematolymphoid neoplasms frequently harbor recurrent genetic abnormalities. Some of the most well recognized lesions are chromosomal translocations, and many of these are known to play pivotal roles in pathogenesis. In lymphoid malignancies, some translocations result from erroneous V(D)J-type events. However, other translocation junctions appear randomly positioned and their underlying mechanisms are not understood. RESULTS: We tested the hypothesis that genomic repeats, including both simple tandem and interspersed repeats, are involved in chromosomal translocations arising in hematopoietic malignancies. Using a database of translocation junctions and RepeatMasker annotations of the reference genome assembly, we measured the proximity of translocation sites to their nearest repeat. We examined 1,174 translocation breakpoints from 10 classifications of hematolymphoid neoplasms. We measured significance using Student's t-test, and we determined a false discovery rate using a random permutation statistics technique. CONCLUSIONS: Most translocations showed no propensity to involve genomic repeats. However, translocation junctions at the transcription factor 3 (TCF3)/E2A immunoglobulin enhancer binding factors E12/E47 (E2A) locus clustered within, or in proximity to, transposable element sequences. Nearly half of reported TCF3 translocations involve a MER20 DNA transposon. Based on this observation, we propose this sequence is important for the oncogenesis of TCF3-PBX1 acute lymphoblastic leukemia.

Racial differences in mycosis fungoides: a retrospective study with a focus on eosinophilia.

BACKGROUND: Mycosis fungoides (MF) is often associated with eosinophilia and portends a poorer prognosis. MF is more common in blacks and follows a more aggressive course compared with whites. OBJECTIVE: We further elucidate racial differences between blacks and whites with MF, focusing on blood eosinophilia. METHODS: The records of 345 patients with MF were reviewed for demographic, clinical, and pathologic data and evaluated by analysis of variance. RESULTS: The average age at diagnosis for blacks was 45 years and was 55 years for white patients (P < .001). In the cohorts of patients with and without blood eosinophilia, the average maximum blood eosinophil count had a greater range in blacks. Independent of race, blood eosinophilia was predictive of more advanced disease (P < .0001), increased number of treatment types (P < .002), and less responsiveness to treatment (P < .0006). LIMITATIONS: This was a retrospective study at a single institution. CONCLUSIONS: These differences observed in eosinophil values may highlight disparities in MF diagnosis or a difference in pathophysiology between races.