Tazarotene is as effective and tolerable as imiquimod in the treatment of verruca plana, a comparative randomized clinical trial.

BACKGROUND: Plane warts when multiple and recurrent present a therapeutic challenge acting as a source of reinfection causing frustration and affecting patient's quality of life. For lesions of large numbers in cosmetically significant sites, topical treatment is preferred to avoid potential sequelae. OBJECTIVES: To evaluate and compare the efficacy and tolerability of tazarotene 0.1% gel versus imiquimod 5% cream for the treatment of plane warts. METHODS: In a parallel three-arm randomized controlled trial, 60 patients were randomized into imiquimod, tazarotene or placebo groups. Patients applied the corresponding treatment once daily at night for a maximum of 12 weeks. Primary outcomes were percentage of respondents with complete clearance in the three studied groups, the type and frequency of side effects in each group. RESULTS: Both active treatments resulted in significant improvement compared to baseline and to placebo group (P=0.001). Imiquimod 5% treated group showed complete clearance in 50% of cases, partial response in 15%, and no response in 35%. Tazarotene 0.1% gel showed complete clearance in 40% of cases, partial response in 40%, and no response in 20%. No significant difference was detected between imiquimod and tazarotene groups (P=0.190). CONCLUSIONS: Compared to imiquimod, tazarotene 0.1% gel for the treatment of plane warts seems to offer equivalent treatment response, maintained efficacy without recurrence, safer profile regarding dyspigmentation with an advantageous cheaper cost.

Personal history of cancer as a risk factor for second primary lung cancer: Implications for lung cancer screening.

BACKGROUND: Personal history of cancer is an independent risk factor for lung cancer but is omitted from existing lung cancer screening eligibility criteria. In this study, we assess the lung cancer risk among cancer survivors and discuss potential implications for screening. METHODS: This was a retrospective, secondary analysis of data from the Surveillance, Epidemiology and End Results (SEER) registry and the MD Anderson Cancer Center (MDACC). We estimated the standardized incidence ratios (SIRs) for lung cancer by site of first primary cancer using data from SEER. We assessed the lung cancer risk among head and neck cancer survivors from MDACC using cumulative incidence and compared the risk ratios (RR) by individuals' screening eligibility status. RESULTS: Other than first primary lung cancer (SIR: 5.10, 95% CI: 5.01-5.18), cancer survivors in SEER with personal history of head and neck cancer (SIR: 3.71, 95% CI: 3.63-3.80) had the highest risk of developing second primary lung cancer, followed by bladder (SIR: 1.86, 95% CI: 1.81-1.90) and esophageal cancers (SIR: 1.78, 95% CI: 1.61-1.96). Head and neck cancer survivors had higher risk to develop lung cancer compared to the National Lung Screening Trial's subjects, (781 vs. 572 per 100,000 person-years, respectively). Head and neck cancer survivors ineligible for lung cancer screening seen at MDACC had significantly higher lung cancer risk than head and neck cancer survivors from SEER (RR: 1.9, p < 0.001). CONCLUSION: Personal history of cancer, primarily head and neck cancer, is an independent risk factor for lung cancer and may be considered as an eligibility criterion in future lung cancer screening recommendations.

Development of an Online Curriculum for Surgeons on the Use of Pelvic Magnetic Resonance Imaging in Rectal Cancer and Results of a Pilot Study.

BACKGROUND: High-resolution pelvic magnetic resonance imaging (MRI) is a critical tool in the management of patients with rectal cancer. An on-line curriculum was developed for surgical trainees on the interpretation of pelvic MRI in rectal cancer for clinical staging and surgical planning. METHODS: The online curriculum was developed using the six-step approach to curriculum development for medical education. The curriculum incorporated case-based learning, annotated videos, and narrated presentations on key aspects of pelvic MRI in rectal cancer. A pilot study was conducted to assess curriculum effectiveness among Complex General Surgical Oncology (CGSO) fellows using pre- and post-intervention assessments. RESULTS: Of 15 eligible fellows, nine completed the pilot study (60%). The fellows' median confidence score after completing the online curriculum (40, IQR: 33-46) was significantly higher than their baseline median confidence score (23, IQR: 14-30), P = 0.0039. The total practical assessment score significantly increased from a pre-median score of 9 (IQR: 8-11) to a post-median score of 14 (IQR: 13-14), P = 0.0078. A subgroup analysis revealed a significant change in the knowledge assessment with a median score of 7 compared to a baseline median score of 4, Z = 2.64, P = 0.0078. However, the skills assessment showed no significant change. CONCLUSIONS: The case-based online curriculum had a positive impact on CGSO fellows' knowledge and confidence in the utilization of pelvic MRI for patients with rectal cancer. This unique on-line curriculum demonstrates a mechanism to enhance shared educational collaboration across CGSO fellowships and other surgical training programs.

Residents entering Complex General Surgical Oncology fellowship lack confidence with pelvic MRI for rectal cancer: Results of a needs assessment survey.

BACKGROUND: Magnetic resonance imaging (MRI) is essential for the multidisciplinary treatment of rectal cancer. However, baseline experience of surgical residents with MRI is unknown. Therefore, a needs assessment survey was conducted to examine confidence with pelvic MRI for residents entering Complex General Surgical Oncology (CSGO) fellowships. METHODS: A multi-institutional survey evaluated incoming CGSO fellows' experience with pelvic MRI for rectal cancer in residency. Additionally, confidence was assessed for essential components of pelvic MRI including T- and N-stage, circumferential resection margin (CRM), extramural venous invasion (EMVI), and pelvic anatomy. RESULTS: Of the twenty-four incoming fellows who completed the survey (response rate = 44%), 20 reported frequent use of pelvic MRI for rectal cancer in residency, but 16 reported rarely/never interpreting images themselves for staging or operative planning. Most respondents reported low confidence for T-stage, N-stage, CRM, EMVI, as well as pelvic anatomy, particularly for lateral and posterior pelvis. CONCLUSIONS: The development of a pelvic MRI curriculum for residents entering CGSO fellowships could enhance their clinical training in the multidisciplinary management of patients with rectal cancer.