Consistency in Distribution of Facial Skin Cancers Treated With Mohs Micrographic Surgery.

Mohs micrographic surgery (MMS) has become the standard of treatment for skin malignancies of the head and neck. However, there is a paucity of literature describing facial distributions of MMS. Anatomical location of skin cancer is an important feature to study as it can affect prognosis as well as pathogenesis of skin cancers. This study aims to analyze consistency in head and neck MMS anatomical distributions and compare differences between multiple centers. The study retrospectively reviews 5871 MMS cases performed at a single center in Chevy Chase, Maryland from January 2014 through December 2019. Results show distributions of skin cancers on the face treated with MMS consistently occur at the same anatomical sites year after year with minimal variance. This knowledge of consistency provides a foundation for future studies because it allows for comparison. Comparing and contrasting data across multiple centers can elucidate regional characteristics that may impact the pathogenesis and distribution of facial skin tumors. Many regional or demographical factors may be important in the development of cutaneous malignancies. This information should be considered when assessing risk factors for cancerous skin lesions.J Drugs Dermatol. 2022;21(5):506-509. doi:10.36849/JDD.6143.

Development of an Eczema Area and Severity Index Atlas for Diverse Skin Types.

Background: Current guidance for using Eczema Area and Severity Index (EASI) implementation is limited to lighter skin phototypes. We developed an EASI lesion severity atlas and refined guidance for investigators and clinicians to use across diverse patient populations. Methods: A review was performed of clinical images from internal atopic dermatitis (AD) photorepositories. Representative images of the 4 AD signs included in EASI were selected for different physician-assessed skin phototypes. Images were excluded if they had low resolution, poor focus, or lighting. Discrepancies regarding skin pigmentation and AD severity were resolved by consensus between authors. Results: Over 3000 clinical photographs were reviewed. Final images were selected using an iterative review process and consensus. Two different versions of the atlas were created across 6 physician-assessed phototypes (I-VI) and 3 skin complexions (light, medium, and dark). We propose guidance language for erythema to reflect the range of colors encountered across different skin complexions (shades of red, purple, and brown). Conclusion: We created a photographic atlas and updated guidance language for implementing EASI in diverse populations, including those with higher skin phototypes.

Functional Effects of Cuprizone-Induced Demyelination in the Presence of the mTOR-Inhibitor Rapamycin.

Persistent demyelination has been implicated in axon damage and functional deficits underlying neurodegenerative diseases such as multiple sclerosis. The cuprizone diet model of demyelination allows for the investigation of mechanisms underlying timed and reproducible demyelination and remyelination. However, spontaneous oligodendrocyte (OL) progenitor (OPC) proliferation, OPC differentiation, and axon remyelination during cuprizone diet may convolute the understanding of remyelinating events. The Akt (a serine/threonine kinase)/mTOR (the mammalian target of rapamycin) signaling pathway in OLs regulates intermediate steps during myelination. Thus, in an effort to inhibit spontaneous remyelination, the mTOR inhibitor rapamycin has been administered during cuprizone diet. Intrigued by the potential for rapamycin to optimize the cuprizone model by producing more complete demyelination, we sought to characterize the effects of rapamycin on axonal function and myelination. Functional remyelination was assessed by callosal compound action potential (CAP) recordings along with immunohistochemistry in mice treated with rapamycin during cuprizone diet. Rapamycin groups exhibited similar myelination, but significantly increased axonal damage and inflammation compared to non-rapamycin groups. There was minimal change in CAP amplitude between groups, however, a significant decrease in conduction velocity of the slower, non-myelinated CAP component was observed in the rapamycin group relative to the non-rapamycin group. During remyelination, rapamycin groups showed a significant decrease in OPC proliferation and mature OLs, suggesting a delay in OPC differentiation kinetics. In conclusion, we question the use of rapamycin to produce consistent demyelination as rapamycin increased inflammation and axonal damage, without affecting myelination.