May 19, 2021
IN THIS ISSUE / May 19, 2021
Differentiating early squamous cell carcinoma from actinic keratosis
Authors of an article in JAAD investigated the clinical and dermatoscopic criteria that may aid in discriminating between early squamous cell carcinoma (SCC) and actinic keratosis (AK) to better guide clinical management decisions.
[Dermatologists have good options for treating AK, but price fluctuations make picking the highest-value option difficult. Read more in DermWorld.]
They identified three main positive dermatoscopic predictors of early SCC and one negative SCC predictor (AK positive predictor). Dermatoscopic findings associated with a pathologic diagnosis of SCC were hairpin vessels, dotted/glomerular vessels, and white structureless areas, while background erythema was strongly suggestive of AK.
Access the full actinic keratosis guideline or get the highlights.
DermWorld Insights and Inquiries: Epidemic of melanoma or epidemic of scrutiny?
The goal of population screening is to detect cancers at their early stages to prevent the associated morbidity and mortality of the late stages. The efforts to detect melanoma in its early stages went into full gear over 30 years ago. In the early 80s, the late A. B. Ackerman pronounced that, “Malignant melanoma can be diagnosed clinically and histologically when it is small, flat, and confined to the epidermis.” There was well-deliberated promotion of skin cancer screenings and public campaigns to increase melanoma awareness. The widespread adoption of dermatoscopy, a diagnostic technique promoted to detect incipient and incognito melanomas, further contributed to the detection of even earlier melanomas. The incidence of melanoma in situ has dramatically increased from 28,600 in 2000 to 101,280 in 2021. All the efforts to detect early melanomas appear to have been highly successful as Stage I disease makes up the majority of the melanomas and the mortality has been stable for the last 40 years.
From an epidemiologic perspective, the sharp rise in the incidence of melanoma in the face of stable mortality for the past 40 years signify the epidemiologic signature of overdiagnosis. For the current trends in melanoma to be valid, there are two possible prevailing explanations. The first explanation is that our specialty was able to identify and cure all aggressive forms of melanoma in its early stages, preventing any rise in mortality in the backdrop of seeing less than 10% of the population at risk each year. This would take incredible luck — winning the lottery kind of luck.
The second explanation is that the sharp rise in the incidence of early-stage melanomas represent indolent or biologically benign forms, which are not the obligate precursors to the deadly forms of melanoma, and the stable mortality reflects the stable incidence of the deadly forms of melanoma that have occurred all along, a trend that fulfills the epidemiologic phenomenon of overdiagnosis. Keep reading!
AAD Board selects Keyvan Nouri, MD, MBA, as next assistant secretary-treasurer
The Board of Directors of the American Academy of Dermatology has selected Keyvan Nouri, MD, MBA, as the Academy’s next assistant secretary-treasurer. He will succeed Daniel D. Bennett, MD, for a three-year term that will begin at the conclusion of the March 2022 Annual Meeting. (Dr. Bennett will become secretary-treasurer at that time.)
Dr. Nouri is Louis C. Skinner, Jr., MD Endowed Chair of Dermatology, Richard Helfman Professor of Dermatologic Surgery, chair of the University of Miami Medical Group, and director of Mohs, dermatologic, and laser surgery and director of surgical training for the University of Miami department of dermatology. He completed his dermatology residency at the University of Miami followed by Mohs/Dermatologic surgery fellowship at New York University.
Dr. Nouri has published 12 well-known textbooks in dermatology/dermatologic surgery,
currently serves as editor-in-chief of Lasers in Medical Science and is a member of the AAD’s Advanced Leadership Forum Workgroup, having previously served on the Education and Volunteers Abroad Committee and World Congress Fund Review Task Force.
Showcase your leadership skills and be part of a diverse and inclusive culture that helps the Academy advance its strategic goals on issues that are important to the specialty. Apply for a 2022 committee, council, or task force position by June 30.
DermWorld Young Physician Focus: Coming through the other side
As most of the country basks in the spring sun, it feels especially bright this year as we finally get a handle on the COVID-19 pandemic. It seems we may actually have a chance at a “new normal” summer as vaccination rates increase and vulnerable populations such as the elderly have embraced getting vaccinated. Don’t get me wrong, I am painfully aware that the pandemic rages on around the globe, and we still have a long way to go here in the United States as well.
But looking back on this time last year, I am definitely more hopeful. Read more from DermWorld Young Physician Advisor Jenna O'Neill, MD.
Older Americans turn to online ratings to choose physicians
According to survey data published in the Annals of Internal Medicine, more than 40% of older adults (50 to 80 years old) in the United States said they’ve used online ratings or reviews when choosing a physician. The online ratings were ranked as “very important” — nearly as much as recommendations from family and friends.
[If your business has two negative reviews on the first page of search results, you risk losing 44% of potential customers. Here’s how to increase your positive reviews.]
Online ratings were perceived to be “very important” more often among racial and ethnic minorities. Online ratings were perceived to be “very important” less often among respondents with at least a bachelor’s degree.
“There is often a perception that online information sources are more used by, and useful to, younger patients, but our results suggest that many older patients are engaging with this information too,” said Jeffrey T. Kullgren, MD, MS, MPH, one of the study’s authors.
Caring for older patients during COVID-19. Here’s what you should know.
Apply for a research grant to support understudied hair disorders
Dermatologists, researchers, and trainees in the United States are encouraged to apply for the AAD Hair Loss and Alopecia Initiative in Research (HAIR) Grant Program. HAIR research grants will be awarded for research projects that address gaps in hair disorder research, with an emphasis on hair disorders in diverse populations. Learn more and apply for the AAD’s HAIR Grant Program.
FDA publishes notice about environmental impact of certain sunscreen ingredients
Last week, the U.S. Food and Drug Administration (FDA) published a notice that it intends to consider the potential environmental impact associated with oxybenzone and octinoxate in sunscreen products, a step required by federal environmental law before proposing rules and orders. The purpose of this notice is to indicate that the FDA is working to complete the sunscreen ingredient monograph, required to be released by Sept. 27, 2021, under the CARES Act.
As a reminder, in 2019, the FDA issued its draft sunscreen monograph, which encompasses the sunscreen ingredients on the market that are generally recognized as safe and effective (GRASE), meaning that they can be included in sunscreen products up to a specified concentration. In the proposed sunscreen monograph rule, the FDA proposed that more safety data is required for 12 sunscreen ingredients, seven of which are commonly used in the United States: ensulizole, homosalate, octinoxate, octisalate, octocrylene, oxybenzone, and avobenzone.
[Take a deeper dive into the FDA's proposed rule on the over-the-counter sunscreen monograph in DermWorld.]
The AADA continues to track the agency’s actions on sunscreen and plans to submit a comment letter.