Patient Perception of Skin Cancer Reduction by Nicotinamide Correlates With Use.

Introduction Nicotinamide (Vitamin B3) has been shown to reduce the rate of non-melanoma skin cancers by 23%, yet most patients do not know that this supplement reduces skin cancer. Understanding patient beliefs about skin cancer reduction attributed to nicotinamide is important to appropriately counsel patients on oral supplement use and ultimately to prevent non-melanoma skin cancers. Objective The objective of this study was to determine the association between nicotinamide use and perceived efficacy in skin cancer reduction. Methods Patients who underwent Mohs surgery in 2019 were sent an online survey assessing nicotinamide use, efficacy compared to sunscreen, and perceived skin cancer risk reduction. Results Data from 50 surveys revealed a perceived risk reduction attributed to nicotinamide of 31.2% for basal cell carcinoma (BCC), 30.2% for squamous cell carcinoma (SCC), and 24.3% for melanoma. In the subset of respondents taking nicotinamide, the perceived risk reduction was significantly higher at 41.2% for BCC and 38.3% for SCC (p<0.05) and positively correlated with reported nicotinamide use (p<0.05). The perceived risk reduction of melanoma was not significantly increased in patients taking nicotinamide (31.6%); however, the perceived risk reduction was correlated with nicotinamide use (p<0.05). In addition, 15.6% of respondents believed that nicotinamide was more effective than sunscreen at preventing skin cancer. Conclusion A larger perceived reduction of non-melanoma skin cancers attributed to nicotinamide is associated with increased oral nicotinamide use. Better patient education regarding the reduction of skin cancers with oral nicotinamide will need to be implemented to change patients' perceptions of the value of nicotinamide.

Diagnosis of Skin Disease in Moderately to Highly Pigmented Skin by Artificial Intelligence.

BACKGROUND: Triage of patients with skin diseases often includes an initial assessment by a nurse or general practitioner, followed by a dermatologist. Artificial intelligence (AI) systems have been reported to improve clinician ability to diagnose and triage skin conditions. Previous studies have also shown that diagnosis in patients with skin of color can be more challenging. PURPOSE: This study seeks to determine the performance of AI in the screening and triage of benign-neoplastic, malignant-neoplastic, and non-neoplastic skin conditions for Fitzpatrick skin types IV-VI. METHODS: A set of 163 non-standardized clinical photographs of skin disease manifestations from patients with Fitzpatrick skin types IV-VI were obtained through a publicly available dataset (Scale AI and MIT Research Lab, “Fitzpatrick 17 Dataset”). All photos were diagnosed by a specialist and categorized into three disease classes: benign-neoplastic, malignant-neoplastic, or non-neoplastic. There were 23, 14, and 122 cases of each disease class, respectively. RESULTS: Overall, the AI was able to classify the disease classes with a high degree of accuracy for the Top 1 diagnosis (86.50%). Based on its first prediction, the AI demonstrated the greatest accuracy when classifying non-neoplastic conditions (90.98%), high accuracy in detecting malignant-neoplastic conditions (77.78%), and moderate accuracy of classifying benign-neoplastic conditions (69.57%). CONCLUSION: The AI had an overall accuracy of 86.50% in diagnosing skin disease in Fitzpatrick skin types IV to VI. This is an improvement over reported clinician diagnostic accuracy of 44.3% in darker skin types. Incorporating AI into front-line screening of skin conditions could thereby assist in patient triage and shorten the time to accurate diagnosis. Schneider LG, Mamelak AJ, Tejani I, et al. Diagnosis of skin disease in moderately to highly pigmented skin by artificial intelligence. J Drugs Dermatol. 2023;22(7):647-652. doi:10.36849/JDD.7581.

Artificial Intelligence vs Medical Providers in the Dermoscopic Diagnosis of Melanoma.

Early diagnosis of melanoma drastically reduces morbidity and mortality; however, most skin lesions are not initially evaluated by dermatologists, and some patients may require a referral. This study sought to determine the performance of an artificial intelligence (AI) application in classifying lesions as benign or malignant to determine whether AI could assist in screening potential melanoma cases. One hundred dermoscopic images (80 benign nevi and 20 biopsy-verified malignant melanomas) were assessed by an AI application as well as 23 dermatologists, 7 family physicians, and 12 primary care mid-level providers. The AI's high accuracy and positive predictive value (PPV) demonstrate that this AI application could be a reliable melanoma screening tool for providers.

Preventative Options and the Future of Chemoprevention for Cutaneous Tumors.

Chemoprophylaxis against nonmelanoma skin cancer (NMSC) should be considered in high-risk populations such as those with certain genetic disorders, immunosuppressive states, chronic radiation, excessive UV exposure, or extensive personal or family history of NMSC. The methods for chemoprevention have progressed beyond traditional sunscreen into more effective strategies including DNA repair enzymes, nicotinamide, systemic retinoids, and nonsteroidal anti-inflammatory drugs. Other therapies are still being investigated and include treatments that target premalignant lesions, capecitabine, hedgehog inhibitors, difluoromethylornithine, metformin, and nutritional factors.

Multicenter, prospective feasibility study of Nano-Pulse Stimulation™ technology for the treatment of both nodular and superficial low-risk basal cell carcinoma.

Background: Nano-Pulse Stimulation™ (NPS™) therapy is a new, non-thermal bioelectric modality that applies ultrashort pulses of electric energy to trigger regulated cell death (RCD) in treated tissues. Instead of initiating necrosis by heating or freezing, NPS therapy permeabilizes intracellular organelles to activate the cell's own self-destruct pathway of programmed or regulated cell death. Unlike cryotherapeutic procedures that can both damage structural tissues and diffuse into the periphery beyond the margins of the lesion, NPS therapy only affects cells within the treated zone leaving surrounding tissue and acellular components unaffected. Methods: In this study we treated 37 basal cell carcinoma lesions on 30 subjects (NCT04918381). The treated lesions were photographed on 3-, 7-, 14-, 30- and 60-days after treatment. All subjects then underwent surgical excision for histological examination of the treated tissue. Results: 92% of the BCC lesions (34 of 37) showed complete histological clearance of BCC. Histologic analysis of the 3 cases where residual BCC was noted indicated that full energy coverage was not achieved, which could be remedied with an improved treatment guide to standardize and optimize the CellFX® procedure based on NPS technology. Conclusion: The CellFX procedure was shown to be safe and effective for the treatment of low-risk nodular and superficial BCC lesions.

The Second of Two One-Year, Multicenter, Open-Label, Repeat-Dose, Phase II Safety Studies of PrabotulinumtoxinA for the Treatment of Moderate to Severe Glabellar Lines in Adult Patients.

BACKGROUND: PrabotulinumtoxinA is a 900-kDa botulinum toxin type A produced by Clostridium botulinum. OBJECTIVES: The authors sought to investigate the safety of prabotulinumtoxinA for treatment of glabellar lines. METHODS: This was a multicenter, open-label, repeat-dose, 1-year phase II safety study. Adults with moderate to severe glabellar lines at maximum frown, as independently assessed by both investigator and patient on the validated 4-point photonumeric Glabellar Line Scale (0 = no lines, 1 = mild, 2 = moderate, 3 = severe), were enrolled. On day 0, patients received an initial treatment (IT) of 20 U prabotulinumtoxinA (4 U/0.1 mL final vacuum-dried formulation injected into 5 glabellar sites). On and after day 90, patients received a repeat treatment (RT) if their Glabellar Line Scale score was ≥2 at maximum frown by investigator assessment. Safety outcomes were evaluated throughout the study. RESULTS: The 570 study patients received a median total dose of 60 U, that is, 3 treatments. Sixty-one patients (10.7%) experienced adverse events (AEs) assessed as possibly study drug related; 6.5% experienced study drug-related AEs after the IT. With each RT, progressively lower percentages of patients experienced study drug-related AEs. Eight patients (1.4%) experienced study drug-related AEs of special interest: 5 experienced eyelid ptosis (0.9%), 3 eyebrow ptosis (0.5%), 1 blepharospasm (0.2%), and 1 blurred vision (0.2%). Seven patients (1.2%) experienced serious AEs, but none were study drug related. A total of 4060 serum samples were tested for antibotulinum toxin antibodies; no seroconversion was observed. CONCLUSIONS: The safety of RTs of 20 U of prabotulinumtoxinA for moderate to severe glabellar lines was confirmed in this second phase II study based on a broad range of outcomes.

Management of skin thinning and aging: review of therapies for neocollagenesis; hormones and energy devices.

BACKGROUND: Hormone replacement therapy and various devices exist to treat signs of aging, such as skin thinning, yet there are no reviews summarizing or evaluating their role in neocollagenesis and the associated increase in skin thickness. OBJECTIVE: To review the literature regarding stimulation and generation of new collagen in the dermis in two parts. Part 2 reviews oral and topical hormone replacement therapy as well as energy-based devices. METHODS: The PubMed database was searched for related literature. Studies involving the use of hormone supplements and energy devices with a resultant change in collagen production or skin thickness were obtained and reviewed for evidence. RESULTS: Hormones, including estrogen, testosterone, and dehydroepiandrosterone, and human growth hormone have been reported with substantiating evidence for neocollagenesis and dermal thickening. Energy devices, including radiofrequency, ultrasound, and laser therapy, have also been reported to stimulate neocollagenesis. LIMITATIONS: The results presented in certain literature are not based on randomized controlled trials. CONCLUSION: Hormone deficient individuals can regain skin thickness with hormone replacement therapy. Dermal heating can provide a substantial amount of neocollagenesis; however, laser technology, specifically CO2 , appears to be the most effective at increasing skin collagen and tightening.

Prevention of Scarring With Intraoperative Erbium: YAG Laser Treatment.

BACKGROUND: Scars can develop as a result of surgical incisions and pose psychological, cosmetic, and physical stress to the patients affected. Lasers have been used for scar revision, but little information exists regarding intraoperative use and efficacy. OBJECTIVE: To evaluate a 2,940-nm fractional erbium:YAG laser to improve scar appearance when used immediately after skin closure. METHODS AND MATERIALS: Patients undergoing complex closures of at least 1.5 cm in length were recruited. Half of the wound received treatment with 2,940 erbium:YAG laser immediately after skin closure. Follow up occurred at 1 week and 12 weeks, postoperatively. Patient self-assessment was performed at the final visit. Photographs were evaluated by three blinded dermatologic surgeons. RESULTS: 18 patients completed the treatment protocol and follow-up. 61.1% of patients reported that the treated side was cosmetically superior to the control side. A majority of patients said the treated side was superior in elevation, erythema, and similarity to normal skin. Physician evaluation showed that the treated half was cosmetically superior in 12 of 18 patients (66.7%). CONCLUSIONS: This study demonstrates that a 2,940-nm erbium:YAG laser treatment, performed immediately after surgery, can improve the appearance of a surgical scar. J Drugs Dermatol. 2020;19(11): 1040-1043. doi:10.36849/JDD.2020.5244.

A Randomized, Controlled, Split-Face Study of the Efficacy of a Picosecond Laser in the Treatment of Melasma

Introduction: Melasma is a common disorder where patients develop hyperpigmented macules and patches on the face and is thought to be the result of sun exposure and hormonal contributions, although the pathogenesis is not completely understood. Lasers have been used for melasma treatment with varying degrees of success. Objectives: The objective of this study was to examine the safety and efficacy of a novel picosecond laser for the treatment of melasma. Materials and Methods: Ten subjects received nine weekly laser treatments with a picosecond laser to a randomized half of their face. A lightening cream was applied to the entire face to serve as a control. The primary outcome measure was clinical efficacy measured by a patient-reported outcome survey, the Melasma Quality of Life (MELASQOL) questionnaire, and physician assessment with the Global Aesthetic Improvement Scale (GAIS). The secondary outcome measure was safety, which was assessed by monitoring for adverse events. Photos were taken before every treatment and at a 1-week follow-up. Results: Ninety percent of subjects rated their melasma as at least slightly better, and 90% percent of subjects would recommend this laser treatment to others with melasma. MELASQoL questionnaire scores improved by an average of 5.7 points after laser treatment. Assessments by two board-certified dermatologists using the GAIS revealed an overall improvement in 80% of patients on the laser treatment side versus 20% on the control side. Side effects, including erythema and discomfort, were minimal and transient post-treatment. Conclusions: This study suggests that picosecond laser treatments are a safe and efficacious way to treat melasma. J Drugs Dermatol. 2019;18(11):1104-1107.

Noninvasive Analysis of High-Risk Driver Mutations and Gene Expression Profiles in Primary Cutaneous Melanoma.

Tools that help reduce the number of surgical biopsies performed on benign lesions have the potential to improve patient care. The pigmented lesion assay (PLA) is a noninvasive tool validated against histopathology that helps rule out melanoma and the need for surgical biopsies of atypical pigmented skin lesions. Genetic information is collected using adhesive patches and the expression of two genes, LINC and PRAME, is measured. By using genetic material collected noninvasively and to further validate the PLA, somatic hotspot mutations in genes known to be drivers of early melanoma development (BRAF other than V600E, NRAS, and the TERT promoter) can also be identified. The frequency of these hotspot mutations in samples of early melanoma was 77%, which is higher than the 14% found in nonmelanoma samples (P < 0.0001). TERT promoter mutations were the most prevalent mutation type in PLA-positive melanomas; 82% of PLA-negative lesions had no mutations, and 97% of histopathologically confirmed melanomas were PLA and/or mutation positive (cohort 1, n = 103). Mutation frequencies were similar in prospectively collected real-world PLA samples (cohort 2, n = 519), in which 88% of PLA-negative samples had no mutations. Combining gene expression and mutation analyses enhances the ability to noninvasively detect early cutaneous melanoma.

Novel Modality for Neck Rejuvenation: A Prospective Multicenter Trial of Percutaneous Radiofrequency Ablation of the Cervical Branch of the Facial Nerve.

BACKGROUND: Neck rejuvenation offers few modalities of treatments limited to either invasive plastic surgery or temporary neuromodulation using botulinum toxin. OBJECTIVE: To access the efficacy, longevity, and safety of percutaneous monopolar radiofrequency (RF) ablation of the cervical branch of the facial nerve innervating the platysma for neck rejuvenation. MATERIALS AND METHODS: This prospective, multicenter trial enrolled 19 adult patients with noticeable platysmal banding at 2 different centers. All patients underwent RF ablation on the cervical branch of the facial nerve. Response was assessed immediately after treatment and then at 1, 4, 12, and 24 weeks after the procedure using photography. Masked investigators compared baseline photography and follow-up intervals to evaluate the results. RESULTS: Seventeen of the 18 patients had improvement in the platysmal banding. One patient was disqualified after ablation. Long-term sequalae such as scarring, burns, ulceration, hypopigmentation, or hyperpigmentation were not reported. CONCLUSION: The results of this multicenter study support that RF ablation of the cervical branch of the facial nerve is a novel technique that results in improvement of platysmal banding. This technique is an emerging alternative, nonsurgical option for neck rejuvenation that is relatively safe, with little downtime for the patient.

Male Surgical Neck Rejuvenation.

BACKGROUND: Patients who are aging, with weight gain, and increased skin laxity, request dermatologists to improve their neck area. Surgical and nonsurgical options are reviewed as well as benefits and side effects. This article will focus on how surgical techniques can be applied for male patients in particular. OBJECTIVE: To review surgical neck rejuvenation therapies available currently to find the best option for male patients. CONCLUSION: Surgical treatment of the male neck to improve mandibular contour and loose neck skin requires tightening of the platysmal muscle and usually skin removal in the postauricular sulcus and into the hairline. Most patients choose to have this performed underline tumescent anesthesia when given the choice of sedation versus local anesthesia. The other surgical variations of improving the neck contour on a male include using a direct excision by a midline incision starting in the submental crease and extending down the anterior neck. This approach allows for maximum tightening of the platysmal bands. The incision line can be minimized using intraoperative laser resurfacing immediately after suturing. Chin implants are necessary in some patients to give good neck improvement. The isolated neck lift is one the most common procedures requested by men asking for neck improvement.

Sandalwood Album Oil as a Botanical Therapeutic in Dermatology.

Many skin conditions and diseases are characterized by inflammation, infection, and hyperplasia. Safe and effective topical treatment options that can be used long-term are needed. Traditional botanical medicines, which are often complex mixtures that exert their biological activities via multiple mechanisms of action, are being studied as potential new active ingredients in dermatology. Sandalwood album oil (SAO), also known as East Indian sandalwood oil (EISO), is an essential oil distilled from the Santalum album tree and has demonstrated biological activity as an anti-inflammatory, anti-microbial, and anti-proliferative agent. Sandalwood album oil has also shown promise in clinical trials for treatment of acne, psoriasis, eczema, common warts, and molluscum contagiosum. The favorable safety profile, ease of topical use, and recent availability of pharmaceutical-grade sandalwood album oil support its broader use as the basis of novel therapies in dermatology.

Improvement in Atrophic Acne Scars Using Topical Synthetic Epidermal Growth Factor (EGF) Serum: A Pilot Study.

BACKGROUND: Atrophic acne scars are a common and psychologically devastating sequela of acne vulgaris that are refractory to the vast majority of topical treatments. OBJECTIVE: We evaluated the efficacy of a topically applied synthetic epidermal growth factor (EGF) serum in reducing the appearance of atrophic acne scars. METHODS: A single-center clinical trial was performed on nine self-selected male and female patients with Goodman & Baron grade II-IV atrophic acne scars. Subjects followed a standardized treatment regimen, including twice-daily application of EGF serum to scarred areas over 12 weeks. Subject progress was evaluated at baseline and 4-week intervals by clinical photography, Investigator Global Assessment (IGA), Goodman grade and patient self-assessment. Final patient perceptions were shared by written self-assessment at the end of the study. Before and after photographs were also evaluated by a blind investigator. RESULTS: Eight subjects completed the trial. Compared to baseline, there was an improvement in mean IGA score from 2.875 (SEM= .327) to 2.38 (SEM = .375). Mean Goodman grade was reduced from 3.00 (SEM = .309) to 2.75 (SEM = .25). Of the eight pairs of before and after photographs given to a blind investigator, five were correctly chosen as the post-treatment image. Two were assessed as "excellent" (76-100%) improvement and three were assessed as "good" (50-75%) improvement. A one-tailed paired student t-test (α = .05) using blind investigator ratings of scar severity for each before and after photograph yielded a P-value of .0019, confirming the difference as statistically significant. On final self-assessment, all but one patient reported "good" to "excellent" improvement in their scars compared to baseline. 75% of patients who received alternative treatments in prior years reported EGF serum to be more efficacious. CONCLUSION: These results suggest that topical EGF may improve the appearance of atrophic acne scars, though further study and more objective evaluation measures are required for definitive conclusions to be drawn.