Complex Management of Basal Cell Carcinoma in a Frail Patient.

Basal cell carcinoma (BCC) is one of the most common cancers diagnosed in older patients and has low mortality. Surgical versus medical management is considered in patients with multiple comorbidities and limited life expectancy (LLE), where the risk-to-benefit ratio must be carefully assessed. Watchful waiting (WW) is a viable option for some patients with severe LLE when follow-up care can be provided vigilantly and frequently. Special consideration should be given to morbidity factors such as tumor growth, bleeding, pain, and social withdrawal that negatively affect the quality of life. We present the case of a 75-year-old male with a past medical history of multiple system atrophy, who presented with a BCC on the ear and face. We discuss the management of this patient and factors that may have led to the inappropriate use of WW.

Psoriasis and Skin Barrier Dysfunction: The Role of Gentle Cleansers and Moisturizers in Treating Psoriasis.

BACKGROUND: Psoriasis is a chronic immune-mediated dermatologic disorder with multisystemic comorbidities, which is effectively treated with a range of prescription therapies. Studies have reported epidermal barrier abnormalities in the lesional skin of psoriasis patients; however, there is currently insufficient information about skin barrier function in psoriasis patients. This review discusses the potential role of gentle cleansers and moisturizers in the management of psoriasis and in promoting a healthy skin barrier. METHODS: A literature review was followed by the authors' discussions and agreement on 5 statements to provide expert guidance for gentle cleansers and moisturizer use in psoriasis patients. RESULTS: In a workshop, the authors provided feedback on 15 draft statements created prior to the meeting, and agreed upon 5 statements. The authors agreed that guidelines rarely mention skincare for psoriasis patients, demonstrating a potential knowledge gap. Skincare may play a role in managing psoriasis as an adjuvant treatment of acute psoriasis and for maintenance treatment of healing skin during asymptomatic periods. Studies of patients with psoriasis applying topical moisturizers (such as those containing salicylic acid or ceramides) showed softened plaques, enhancing the absorption of topical treatments such as corticosteroids. Studies applying ceramide-containing skincare showed an overall improvement in the appearance of the skin and provided relief for psoriasis. CONCLUSION: The authors agreed that skincare and barrier restoration in treating psoriasis is a relatively new concept for most dermatologists. There is a need to develop a more robust body of evidence on skincare for psoriasis to influence clinical practice in a meaningful way. Kircik L, Alexis AF, Andriessen A, et al. Psoriasis and skin barrier dysfunction: the role of gentle cleansers and moisturizers in treating psoriasis. J Drugs Dermatol. 2023;22(8):773-778. doi:10.36849/JDD.7411.

Intravascular Basal Cell Carcinoma Hiding under a Keratoacanthoma.

A 79-year-old male presented for removal of what was proven to be a keratoacanthoma. Additional tissue removed deep to the initial lesion revealed intravascular basal cell carcinoma (BCC). Intravascular BCC is exceedingly rare with only 8 cases previously reported in the literature. Intravascular BCC may be associated with more aggressive subtypes. Intravascular infiltration is more common in metastatic BCC, but this finding may not imply causality. More data are required in order to determine prognostic implications of intravascular BCC and to develop a protocol for managing patients with this unique finding.

Melanoma and Thyroid Carcinoma: Our Current Understanding.

Melanoma is listed among the most common cancers in the United States, with new cases increasing steadily.1 Due to the aggressive nature of melanoma and its high risk of metastasis, early detection and treatment is essential. It is noted that the majority of unresectable and metastatic melanomas are BRAF V600-mutated.2 Recently, rates of papillary thyroid carcinoma have also been increasing. Studies have indicated BRAF V600-mutations are common in papillary thyroid carcinoma, second only to melanoma. The BRAF mutation in thyroid carcinoma similarly portends more aggressive behavior. The association between melanoma and thyroid disease was noted in several patients in our clinic and fueled our literature review in an attempt to better understand this clinical observation. A systematic English-language literature review was performed using PubMed Central and ScienceDirect online databases. Search parameters included articles published from January 2000 to July 2018 and key search terms were melanoma and thyroid carcinoma and BRAF mutation and thyroid cancer. The initial search yielded 2,470 and 234 articles in each respective database. Articles that lacked relevant information were excluded. The literature we reviewed supports our theory that thyroid dysfunction is disproportionately noted among patients with a history of melanoma. In order to detect disease early, it is critical for dermatologists, internists, family practitioners, endocrinologists, and oncologists to be aware of the association between these two primary malignancies when proceeding with appropriate screening examinations.

Etanercept: an evolving role in psoriasis and psoriatic arthritis.

Tumor necrosis factor alpha (TNFalpha) plays a key pathophysiological role in psoriasis and psoriatic arthritis (PsA). Recent interest has thus focused on the clinical potential of TNFalpha antagonists (e.g. etanercept) in these settings. In psoriasis, several large pooled analyses and well-designed clinical trials documented the significant clinical efficacy and generally favorable tolerability of etanercept for up to 96 weeks. Similarly, in PsA, a large phase III trial showed that, etanercept significantly reduced arthritic symptoms and inhibited radiographic disease progression; sustained clinical benefit was again evident for up to 2 years. Etanercept is at the forefront of psoriatic disease management, and continued evolution and evaluation of the compound - for example, in detailed comparative studies and economic analyses - is likely to confirm a key role for etanercept in the treatment of psoriasis and PsA.