Surgery Alone (Without Adjuvant Radiation) Adequately Treats Histologic Perineural Basal Cell Carcinomas: A Systematic Review With Meta-Analysis.

BACKGROUND: Histologic perineural invasion (PNI) in basal cell carcinomas (BCC) lacks evidence-based treatment guidelines. OBJECTIVE: Systematically review and analyze treatment outcomes of BCC with histologic PNI (PNBCC). MATERIALS AND METHODS: PubMed, Embase, and Cochrane Reviews were searched through June 25, 2021. Thirteen eligible cohort studies were meta-analyzed. RESULTS: 502 of 713 PNBCC were treated with Mohs Surgery (MMS), wide local excision (WLE), or surgery (MMS or WLE) with adjuvant radiation (Surg + RT). Overall 5-year local control (LC) was 97.2% and cancer-specific survival (CSS) was 99.6%. Surg and Surg + RT did not differ in recurrence (2.1% vs 4.7%; p-value 0.56; RR 1.51 [0.37, 6.20]), LC (97.9% vs 96.2%; p-value 0.19; RR 0.98 [0.96, 1.01]) or CSS (100% vs 99.1%; p-value 0.40; RR 0.99 [0.95, 1.02]). LIMITATIONS: No randomized controlled trials were found. Outcome data were often lacking. CONCLUSION: Overall LC and CSS were high at median 5-year follow-up for surgery alone and Surg + RT. Surgery alone and Surg + RT demonstrated statistically equivalent outcomes. We do not recommend adjuvant radiation therapy for solely histologic PNBCC if clear margins are achieved.

Angioedema: A potential complication of dupilumab in atopic dermatitis.

Dupilumab is a relatively new and quite effective medication for recalcitrant atopic dermatitis in patients over 6 years of age. Here, we present a 12-year-old girl with progressively worsening episodic facial swelling and erythema while treated with dupilumab. This case highlights the possibility of angioedema as an adverse effect of dupilumab treatment.

Dermatology residency applications: correlation of applicant personal statement content with match result.

The personal statement is a narrative written by an applicant to residency programs to discuss his/her interests and express his/her personality, but it is unclear how the personal statement impacts the dermatology residency application process. The aim of this study was to analyze personal statements from applicants to a dermatology program at a major academic institution to identify common themes and determine if certain themes were associated with successful matching. All personal statements submitted to the dermatology residency program at UNC School of Medicine (Chapel Hill, North Carolina) during the 2012 application cycle (N=422) were analyzed to identify 9 common themes of content. Certain themes differed in prevalence between matched and unmatched applicants. Further investigation is needed to elucidate the impact of personal statement themes and other application content on the residency selection process.

What's eating you? millipede burns.

Millipedes often are regarded as harmless but are capable of causing adverse reactions through the secretion of toxic chemicals. Millipede burns cause localized pigmentary changes that may be associated with pain or burning in some patients. Clinical suspicion and physical examination are paramount to the diagnosis of millipede burns.

The safety of treatments used in pyoderma gangrenosum.

INTRODUCTION: Pyoderma gangrenosum (PG) is a severe ulcerating orphan dermatosis characterized by painful and rapidly progressive skin ulcers often associated with underlying inflammatory disease. AREAS COVERED: In this article, we review and analyze the literature regarding treatment options for patients with PG, with particular attention to the efficacy and safety of therapies. Despite the significance of this problem, there are few studies devoted to the efficacy or safety of therapeutics in PG. We aim to present and evaluate existing studies and reports, and to make treatment recommendations based on the efficacy and safety data reviewed. EXPERT OPINION: All patients with PG should be counseled on avoiding trauma, optimizing glycemic control, and smoking cessation. Proper local wound care and surveillance of superimposed infection is essential to healing. Control of underlying inflammatory conditions should be co-managed with appropriate specialists. Patients with limited disease should consider high potency topical steroid or topical calcineurin inhibitors. For systemic therapy, the best evidence supports the use of systemic steroids or cyclosporine. Biologic therapy should be reserved in patients as a third line therapy or in patients with underlying systemic inflammatory disease. There is an existing need for well-designed studies to evaluate the efficacy and safety of therapeutics in PG.