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1.
J Gen Intern Med ; 2022 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-35710666

RESUMO

Primary care physicians (PCPs) are often the first line of defense against skin cancers. Despite this, many PCPs do not receive a comprehensive training in skin conditions. Educational interventions aimed at skin cancer screening instruction for PCPs offer an opportunity to detect skin cancer at earlier stages and subsequent improved morbidity and mortality. A scoping review was conducted to collect data about previously reported skin cancer screening interventions for PCPs. A structured literature search found 51 studies describing 37 unique educational interventions. Curriculum elements utilized by the interventions were divided into categories that would facilitate comparison including curriculum components, delivery format, delivery timing, and outcome measures. The interventions varied widely in design, including literature-based interventions, live teaching sessions, and online courses with durations ranging from 5 min to 24 months. While several interventions demonstrated improvements in skin cancer knowledge and competency by written exams, only a few revealed positive clinical practice changes by biopsy review or referral analysis. Examining successful interventions could aid in developing a skin cancer detection curriculum for PCPs that can produce positive clinical practice and population-based changes in the management of skin cancer.

2.
Arch Dermatol Res ; 314(4): 329-340, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-33913002

RESUMO

Melanoma-screening examinations support early diagnosis, yet there is a national shortage of dermatologists and most at-risk patients lack access to dermatologic care. Primary care physicians (PCPs) in the United States often bridge these access gaps, and thus, play a critical role in the early detection of melanoma. However, most PCPs do not offer skin examinations. We conducted a systematic review and searched Ovid MEDLINE, EMBASE, and the Cochrane Library from 1946 to July 2019 to identify barriers for skin screening by providers, patients, and health systems following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Of 650 abstracts initially identified, 111 publications were included for full-text review and 48 studies met the inclusion criteria. Lack of dermatologic training (89.4%), time constraints (70%), and competing comorbidities (51%) are the most common barriers reported by PCPs. Low perceived risk (69%), long delays in appointment (46%), and lack of knowledge about melanoma (34.8%) are most frequently reported patient barriers. Qualitative reported barriers for health system are lack of public awareness, social prejudice leading to tanning booth usage, public surveillance programs requiring intensive resources, and widespread ABCD evaluation causing delays in seeking medical attention for melanomas. Numerous barriers remain that prevent the implementation of skin screening practices in clinical practice. A multi-faceted combination of efforts is essential for the execution of acceptable and effective skin cancer-screening practices, thus, increasing early diagnosis and lowering mortality rates and burden of disease for melanoma.


Assuntos
Melanoma , Neoplasias Cutâneas , Atenção à Saúde , Detecção Precoce de Câncer , Pessoal de Saúde , Humanos , Melanoma/diagnóstico , Neoplasias Cutâneas/diagnóstico , Estados Unidos
5.
Clin Dermatol ; 2021 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-34979268

RESUMO

Annular lichenoid diseases encompass a diverse range of pathologies that present as circular, raised, or flat lesions that may vary in size and number. Examples include annular lichenoid dermatitis of youth, annular lichen planus, erythema dyschromicum perstans, erythema multiforme, fixed drug eruption, lichen sclerosus, neonatal lupus, porokeratosis, subacute cutaneous lupus erythematosus, and lichenoid syphilis. Clinical morphology and histopathology can differentiate these entities.

6.
Dermatol Pract Concept ; 10(4): e2020088, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33150029

RESUMO

BACKGROUND: Accurate medical image interpretation is an essential proficiency for multiple medical specialties, including dermatologists and primary care providers. A dermatoscope, a ×10-×20 magnifying lens paired with a light source, enables enhanced visualization of skin cancer structures beyond standard visual inspection. Skilled interpretation of dermoscopic images improves diagnostic accuracy for skin cancer. OBJECTIVE: Design and validation of Cutaneous Neoplasm Diagnostic Self-Efficacy Instrument (CNDSEI)-a new tool to assess dermatology residents' confidence in dermoscopic diagnosis of skin tumors. METHODS: In the 2018-2019 academic year, the authors administered the CNDSEI and the Long Dermoscopy Assessment (LDA), to measure dermoscopic image interpretation accuracy, to residents in 9 dermatology residency programs prior to dermoscopy educational intervention exposure. The authors conducted CNDSEI item analysis with inspection of response distribution histograms, assessed internal reliability using Cronbach's coefficient alpha (α) and construct validity by comparing baseline CNDSEI and LDA results for corresponding lesions with one-way analysis of variance (ANOVA). RESULTS: At baseline, residents respectively demonstrated significantly higher and lower CNDSEI scores for correctly and incorrectly diagnosed lesions on the LDA (P = 0.001). The internal consistency reliability of CNDSEI responses for the majority (13/15) of the lesion types was excellent (α ≥ 0.9) or good (0.8≥ α <0.9). CONCLUSIONS: The CNDSEI pilot established that the tool reliably measures user dermoscopic image interpretation confidence and that self-efficacy correlates with diagnostic accuracy. Precise alignment of medical image diagnostic performance and the self-efficacy instrument content offers opportunity for construct validation of novel medical image interpretation self-efficacy instruments.

7.
Dermatol Online J ; 26(8)2020 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-32941718

RESUMO

Tuberculosis is a fairly common disease in the United States and around the world, newly infecting ten million people throughout the world per year. Despite the pervasiveness of tuberculosis, cutaneous tuberculosis (CTB) rarely manifests worldwide. Tuberculous infections of the skin arise in several distinct variants that can be classified as either multibacillary or paucibacillary; each subtype within these categories presents with its own morphological and histological findings. The diagnosis of CTB can prove clinically challenging as its variants mimic many conditions dermatologist encounter on a daily basis. Additionally, tissue confirmation is difficult. We report a case of CTB which evolved from a lupus vulgaris presentation to the metastatic tuberculous abscess variant.


Assuntos
Pele/patologia , Tuberculose Cutânea/diagnóstico , Idoso , Biópsia , Diagnóstico Diferencial , Progressão da Doença , Feminino , Humanos , Lúpus Vulgar/complicações , Linfoma não Hodgkin/complicações , Mycobacterium/isolamento & purificação , Tuberculose Cutânea/diagnóstico por imagem , Tuberculose Cutânea/patologia
10.
Dermatol Online J ; 26(12)2020 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-33423417

RESUMO

Burnout is increasingly common in the medical field. In dermatology, burnout is attributed to high patient volume and excessive time spent on electronic medical record system activities. The shortage of the dermatology workforce in academic medicine is well-known. Studies have yet to examine the relationship between well-being during dermatology residency and the pursuit of academia. OBJECTIVE: To assess the well-being of dermatology residents in the United States, identify barriers/enablers to well-being, and determine the implications of these measures. METHODS: A cross-sectional survey was distributed to program coordinators of 136 accredited dermatology programs with instructions to forward to their current dermatology residents. Residents provided self-reported ratings on validated scales measuring burnout, depression, anxiety, fatigue, and quality of life. Descriptive statistics and correlations were examined. RESULTS: Residents with higher levels of burnout reported they were significantly less likely to pursue academia, full-time work, clinical research, and fellowships after residency. The results showed opposite effects for residents with higher qualities of life. CONCLUSIONS: This study showed that resident well-being can have a significant impact on residents' future career plans, including pursuing academic dermatology, clinical research, and fellowship. Addressing burnout in the field of dermatology offers an opportunity to increase the academic dermatology workforce.


Assuntos
Esgotamento Profissional , Escolha da Profissão , Dermatologia/educação , Internato e Residência , Estudos Transversais , Humanos , Qualidade de Vida , Inquéritos e Questionários , Estados Unidos
13.
Clin Dermatol ; 37(5): 447-467, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31896402

RESUMO

Gradations in skin color are a consequence of differing amounts of melanin and their varying distribution. Although many darkly pigmented skin lesions are melanocytic and can be attributed to melanin content, the color of a black lesion can also be due to blood, necrotic tissue, or exogenous pigment. The source, pattern, and distribution of the color in black lesions usually offer important insight into its etiology. This contribution reviews conditions that can take on a black color, discussing the cause of the hue and any additional impact sun exposure may have.


Assuntos
Hiperpigmentação/diagnóstico , Hiperpigmentação/etiologia , Lúpus Eritematoso Discoide/diagnóstico , Melanoma/diagnóstico , Nevo Azul/diagnóstico , Neoplasias Cutâneas/diagnóstico , Acantose Nigricans/diagnóstico , Acantose Nigricans/etiologia , Acantose Nigricans/terapia , Calciofilaxia/diagnóstico , Calciofilaxia/tratamento farmacológico , Carcinoma Basocelular/diagnóstico , Carcinoma Basocelular/patologia , Dermatomicoses/complicações , Dermatomicoses/diagnóstico , Diagnóstico Diferencial , Humanos , Hiperpigmentação/terapia , Ceratose Seborreica/diagnóstico , Lúpus Eritematoso Discoide/tratamento farmacológico , Melanoma/etiologia , Melanoma/terapia , Mucormicose/complicações , Mucormicose/diagnóstico , Mucormicose/terapia , Membrana Mucosa , Doenças da Unha/diagnóstico , Nevo Azul/cirurgia , Nevo Fusocelular/diagnóstico , Nevo Fusocelular/patologia , Ocronose/diagnóstico , Ocronose/etiologia , Placa Aterosclerótica/complicações , Placa Aterosclerótica/diagnóstico , Prognóstico , Dermatopatias Papuloescamosas/diagnóstico , Dermatopatias Papuloescamosas/etiologia , Neoplasias Cutâneas/etiologia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgia , Tatuagem
14.
Clin Dermatol ; 37(5): 561-579, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31896410

RESUMO

White diseases are a heterogenous group characterized by hypopigmentation or depigmentation. Skin and eye color are determined by the number and size of melanosomes present. Melanin is produced by melanosomes in the melanocytes present within the epidermis of the skin, uvea, and retinal pigmented epithelium (RPE). Conditions altering the number of melanocytes or concentration of melanin result in a lack of pigmentation, appearing as "white diseases" ranging from the well-known albinism and vitiligo to more esoteric white hand syndrome and Degos disease.


Assuntos
Hipopigmentação/diagnóstico , Hipopigmentação/etiologia , Albinismo/diagnóstico , Albinismo/etiologia , Albinismo/terapia , Cor , Cosméticos/efeitos adversos , Diagnóstico Diferencial , Humanos , Hipopigmentação/patologia , Hipopigmentação/terapia , Inflamação/complicações , Líquen Escleroso e Atrófico/diagnóstico , Líquen Escleroso e Atrófico/etiologia , Líquen Escleroso e Atrófico/patologia , Líquen Escleroso e Atrófico/terapia , Papulose Atrófica Maligna/diagnóstico , Papulose Atrófica Maligna/etiologia , Papulose Atrófica Maligna/patologia , Membrana Mucosa , Doenças da Unha/etiologia , Nevo com Halo/diagnóstico , Nevo com Halo/etiologia , Nevo com Halo/patologia , Pitiríase Liquenoide/diagnóstico , Pitiríase Liquenoide/etiologia , Pitiríase Liquenoide/terapia , Prognóstico , Preparações Clareadoras de Pele/efeitos adversos , Tinha Versicolor/diagnóstico , Tinha Versicolor/tratamento farmacológico , Tinha Versicolor/etiologia , Vibração/efeitos adversos , Vitiligo/diagnóstico , Vitiligo/etiologia , Vitiligo/terapia , Síndrome de Waardenburg/diagnóstico , Síndrome de Waardenburg/etiologia
15.
Case Rep Dermatol Med ; 2018: 5235246, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30581634

RESUMO

Mycosis fungoides (MF) is a rare cutaneous T-cell lymphoma (CTCL) which can cause significant morbidity. During the disease course, it classically will progress through three clinical stages in the skin: patch-, plaque-, and tumor-stage. The early stages exhibit various histopathological mimics that often lead to misdiagnosis. It rarely affects the oral cavity. Oral MF is historically associated with poor prognosis. We present a rare case of MF afflicting the dorsal tongue and extremities of a 72-year-old male.

16.
Dermatol Online J ; 23(12)2018 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-29447653

RESUMO

Rituximab and intravenous immunoglobulin [IVIg] have recently emerged as effective treatments for pemphigus refractory to corticosteroids [CS]. This case series sought to compare the clinical, serologic,and adverse effects of CS, IVIg, and rituximab in patients with pemphigus. A retrospective review of 63 patients with pemphigus vulgaris (PV), pemphigus foliaceus (PF), or paraneoplastic pemphigus (PNP)was performed. Clinical remission (CR), serologic remission (SR), and adverse effects were evaluated. Three study groups were compared: patients treated with systemic CS, refractory patients treated withIVIg, and refractory patients treated with rituximab. The overall number of adverse effects was not significantly different between the groups but those observed in patients treated with systemic CS weremore severe. CR was less likely in the patients treated with systemic CS than in patients treated with IVIg or rituximab, P-value = 0.000467. SR was more likely in patients treated with systemic CS or rituximab thanin patients treated with IVIg, P-value = 0.002118. These results suggest that the clinical efficacy of IVIg is not correlated with an expected concomitant SR. Frequently reserved for refractory pemphigus,IVIg and rituximab are significantly more likely to produce clinical remission than systemic CS therapy, suggesting their utility as first-line treatments.


Assuntos
Corticosteroides/uso terapêutico , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Pênfigo/tratamento farmacológico , Rituximab/uso terapêutico , Corticosteroides/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Autoanticorpos/sangue , Resistência a Medicamentos , Feminino , Humanos , Imunoglobulinas Intravenosas/efeitos adversos , Fatores Imunológicos/efeitos adversos , Masculino , Pessoa de Meia-Idade , Síndromes Paraneoplásicas/tratamento farmacológico , Pênfigo/imunologia , Indução de Remissão , Estudos Retrospectivos , Rituximab/efeitos adversos , Adulto Jovem
17.
Cytojournal ; 14: 4, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28331529

RESUMO

OBJECTIVE: BRAF mutations using cellular DNA from fine-needle aspiration (FNA) specimens are commonly used to support the diagnosis of papillary thyroid carcinoma (PTC). The goal of this study was to preliminarily evaluate the diagnostic utility of detecting BRAF mutations in the routinely discarded FNA specimen supernatant fluid. MATERIALS AND METHODS: Seventy-eight FNAs of thyroid lesions were evaluated for BRAF mutations using both cellular and supernatant DNA. BRAF mutation data were correlated with cytology and surgical pathology. RESULTS: Of the 78 samples evaluated, 68 (87%) had amplifiable DNA in the supernatant with 2 (3%) positive for BRAF mutations. These two samples showed no mutations in the cellular counterpart. Among the 11 samples showing morphologic findings (FNA/surgical pathology) suspicious/diagnostic of PTC, 6 (55%) samples (one supernatant and five cellulars) were positive for BRAF mutations. This suggests that testing supernatant DNA in FNA specimens may increase the diagnostic yield by 1/11 (9%) in this setting. CONCLUSIONS: The vast majority of routinely discarded FNA supernatants contain amplifiable DNA. In addition, profiling the mutations of BRAF and other genes using supernatant DNA may provide valuable diagnostic information to assist the diagnosis of PTC in patients with clinical/morphologic findings suspicious for malignancies and cellular DNA showing no mutations.

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