Skin Cancer Screening Practices Among Dermatologists: A Survey Study.

BACKGROUND: The United States Preventative Task Force (USPTF) has concluded that the benefit of skin cancer screenings is inconclusive. A systematic review found that implementing skin cancer screening increased detection of in situ and thin melanoma, increased incidence of non-melanoma skin cancer detection, and decreased rates of thick melanoma. However, only one of the studies reviewed found a reduction in melanoma mortality. Evidence is notably unclear for the exact benefits of preventative skin cancer screening. OBJECTIVE: This study intends to discover the current skin cancer screening practices and recommendations of dermatologists. METHODS: A 20-question “Skin Cancer Screening Survey” was developed and sent to the American College of Mohs Surgery. RESULTS: 124 dermatologists completed the survey. The majority of physicians (77.4%) said they perform routine skin cancer screening exams. 37.9 % of respondents noted that they recommend routine skin cancer screenings to all their patients, while 27.4 % of participants recommend screening only patients with a risk factor. Most of the respondents (52.4%) stated that they do not follow any specific guidelines regarding routine skin cancer screenings. The majority selected that they usually perform full body skin exams (69.4%). Of those who answered that they do follow guidelines, most followed the American Academy of Dermatology guidelines (48.5%). 42.7% of respondents were aware of the USPTF recommendations regarding routine skin cancer screening. DISCUSSION: The results demonstrate variability in real world practice of skin cancer screening exams. There is imperative need for evidence-based uniform guidelines to drive accurate and unbiased preventative practice behaviors in the United States. J Drugs Dermatol. 2022;21(11):1235-1241. doi:10.36849/JDD.6660.

Cutaneous squamous cell carcinoma staging may influence management in users: A survey study.

PURPOSE: This study aims to determine whether there is consensus regarding staging and management of cutaneous squamous cell carcinoma (CSCC) across the various specialties that manage this disease. MATERIALS AND METHODS: A survey regarding CSCC high-risk features, staging, and management was created and emailed to cutaneous oncology experts including dermatology, head and neck surgery/surgical oncology, radiation oncology, and medical oncology. RESULTS: One hundred fifty-six (46%) of 357 invited physicians completed the survey. Depth of invasion (92%), perineural invasion (99%), histologic differentiation (85%), and patient immunosuppression (90%) achieved consensus (>80%) as high-risk features of CSCC. Dermatologists were more likely to also choose clinical tumor diameter (79% vs. 54%) and histology (99% vs. 66%) as a high-risk feature. Dermatologists were also more likely to utilize the Brigham and Women's Hospital (BWH) staging system alone or in conjunction with American Joint Committee on Cancer (AJCC) (71%), whereas other cancer specialists (OCS) tend to use only AJCC (71%). Respondents considered AJCC T3 and higher (90%) and BWH T2b and higher (100%) to be high risk and when they consider radiologic imaging, sentinel lymph node biopsy, post-operative radiation therapy, and increased follow-up. Notably, a large number of respondents do not use staging systems or tumor stage to determine treatment options beyond surgery in high-risk CSCC. CONCLUSION: This survey study highlights areas of consensus and differences regarding the definition of high-risk features of CSCC, staging approaches, and management patterns between dermatologists and OCS. High-risk CSCC is defined as, but not limited to, BWH T2b and higher and AJCC T3 and higher, and these thresholds can be used to identify cases for which treatment beyond surgery may be considered. Dermatologists are more likely to utilize BWH staging, likely because BWH validation studies showing advantages over AJCC were published in dermatology journals and discussed at dermatology meetings. Additional data are necessary to develop a comprehensive risk-based management approach for CSCC.

Vaccines do not cause atopic dermatitis: A systematic review and meta-analysis.

BACKGROUND: Previous studies found conflicting results about the association of vaccinations and likelihood of atopic dermatitis (AD). OBJECTIVES: To determine whether vaccinations increase the likelihood of AD. METHODS: A systematic review was performed of all published studies in MEDLINE, EMBASE, LILACS, Scopus, and Web of Science databases. At least 2 reviewers conducted title/abstract, full-text review, and data extraction. Quality of evidence was assessed using the Newcastle-Ottawa Scale (NOS). RESULTS: Forty-four studies met inclusion criteria; 37 had sufficient data for meta-analysis. There were no associations any vaccine regimen (random-effects logistic regression: odds ratio [95% confidence interval]: 0.961 [0.822-1.124]; n = 21 studies) BCG (0.927 [0.701-1.226]; n = 8), pertussis (0.790 [0.416-1.499]; n = 4), single (1.031 [0.920-1.155]; n = 17) or multiple vaccines (0.902 [0.608-1.338]; n = 7) with likelihood of AD. This remained true in studies with high-quality (NOS ≥ 7) (OR [95% CI]: 0.941 [0.793-1.117]; n = 13 studies) or low-quality (NOS < 7) (OR [95% CI]: 1.058 [0.669-1.674]; n = 8 studies). LIMITATIONS: No randomized controlled trials. CONCLUSIONS: No vaccine regimen was consistently associated with developing AD.