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Harvey JA, Severson KJ, Brumfiel CM, Patel MH, Butterfield RJ, Nelson SA, Sekulic A, Pittelkow MR, Mangold AR. Necrobiosis lipoidica-associated cutaneous malignancy. J Am Acad Dermatol 2021; 86:1428-1429. [PMID: 34153393 DOI: 10.1016/j.jaad.2021.06.848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/07/2021] [Accepted: 06/13/2021] [Indexed: 11/30/2022]
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Brumfiel CM, Patel MH, DiCaudo DJ, Rosenthal AC, Pittelkow MR, Mangold AR. Recurrence of primary cutaneous CD30-positive lymphoproliferative disorder following COVID-19 vaccination. Leuk Lymphoma 2021; 62:2554-2555. [PMID: 33974494 DOI: 10.1080/10428194.2021.1924371] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Besch-Stokes JG, Costello CM, Severson KJ, Bhullar P, Montoya J, Butterfield RJ, DiCaudo DJ, Comfere N, Sluzevich J, Rule W, Craig FE, Rosenthal A, Pittelkow MR, Mangold AR. Primary cutaneous CD4 + small/medium T-cell lymphoproliferative disorder: Diagnosis and management. J Am Acad Dermatol 2021; 86:1167-1169. [PMID: 33915243 DOI: 10.1016/j.jaad.2021.04.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 02/26/2021] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
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Severson KJ, Costello CM, Brumfiel CM, Patel MH, Butterfield RJ, Nelson SA, Pittelkow MR, Mangold AR. Clinical and morphological features of necrobiosis lipoidica. J Am Acad Dermatol 2021; 86:1133-1135. [PMID: 33878403 DOI: 10.1016/j.jaad.2021.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 03/13/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
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Breen ID, Brumfiel CM, Patel MH, Butterfield RJ, VanderPluym JH, Griffing L, Pittelkow MR, Mangold AR. Evaluation of the Safety of Calcitonin Gene-Related Peptide Antagonists for Migraine Treatment Among Adults With Raynaud Phenomenon. JAMA Netw Open 2021; 4:e217934. [PMID: 33871613 PMCID: PMC8056280 DOI: 10.1001/jamanetworkopen.2021.7934] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
IMPORTANCE Calcitonin gene-related peptide (CGRP) antagonists have demonstrated tremendous promise in migraine management. However, these medications decrease reflex vasodilatory response, which may lead to exacerbation of microvascular disease in susceptible patients, such as patients with Raynaud phenomenon (RP). OBJECTIVE To investigate the microvascular complications of CGRP antagonists in patients with underlying RP. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study was performed from May 18, 2018, to September 15, 2020, in Mayo Clinic Health System patients with Raynaud phenomenon while undergoing CGRP antagonist therapy to treat migraine. Inclusion criteria were age older than 18 years, history of migraine, past or current treatment with CGRP antagonists, and diagnosis of primary or secondary RP. EXPOSURE Treatment with CGRP antagonists. MAIN OUTCOMES AND MEASURES The main outcome measure was microvascular complications (eg, worsening RP, digital ulcerations, and gangrenous necrosis) after initiation of treatment with a CGRP antagonist. Patient demographic and clinical characteristics were compared between those who experienced complications and those who did not. RESULTS A total of 169 patients (163 [96.4%] female; 151 [89.3%] non-Hispanic White; mean [SD] age, 46 [13] years) were identified. Of the 169 patients, 9 (5.3%) exhibited microvascular complications, ranging from worsening RP to gangrene and autonecrosis that required distal digit amputation. Comparative analysis did not find statistically significant differences in demographic or clinical characteristics between the 2 cohorts. All 9 patients with complications were female (mean [SD] age, 40 [12] years). Five of the 9 patients (55.6%) had previously diagnosed RP; in 3 the RP was primary, and 2 it was secondary to scleroderma. The other 4 patients (44.4%) were newly diagnosed with RP. Eight of the 9 patients (88.9%) had chronic migraine; 4 had migraine with aura, and 5 had migraine without aura. The CGRP antagonist agents temporally associated with the microvascular complications included galcanezumab (in 3 patients), erenumab (in 5 patients), and fremanezumab (in 1 patient). CONCLUSIONS AND RELEVANCE The results of this study indicate that microvascular complications of CGRP antagonist use in patients with underlying RP are uncommon. The incidence of serious adverse events, although rare, warrant caution when considering the use of these agents in patients with RP.
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Severson KJ, Patel MH, Brumfiel CM, Breen I, Butterfield RJ, Nelson SA, Sekulic A, Pittelkow MR, Mangold AR. Comorbidities and diabetic complications in patients with necrobiosis lipoidica. J Am Acad Dermatol 2021; 86:891-894. [PMID: 33722550 DOI: 10.1016/j.jaad.2021.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/02/2021] [Accepted: 03/06/2021] [Indexed: 10/21/2022]
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Breen ID, Brumfiel CM, Patel MH, Rosenthal AC, Rule WG, DiCaudo DJ, Craig FE, Pittelkow MR, Mangold AR. Mogamulizumab-induced interface dermatitis drug rash treated successfully with methotrexate and extracorporeal photopheresis in a patient with Sézary syndrome. JAAD Case Rep 2021; 9:24-27. [PMID: 33604439 PMCID: PMC7873348 DOI: 10.1016/j.jdcr.2020.12.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Severson KJ, Cumsky HJL, Brumfiel CM, Janeczek MC, Ginos BF, Kosiorek HE, Besch-Stokes J, Patel MH, Rule WG, DiCaudo DJ, Rosenthal AC, Pittelkow MR, Mangold AR. Blue light photodynamic therapy with 5-aminolevulinic acid in refractory mycosis fungoides: A prospective, open-label study. J Am Acad Dermatol 2021; 85:969-971. [PMID: 33493572 DOI: 10.1016/j.jaad.2021.01.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 10/22/2022]
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Besch-Stokes J, Costello CM, Bhullar P, Maly C, DiCaudo DJ, Comfere N, Rule WG, Craig FE, Rosenthal A, Pittelkow MR, Mangold AR. 15591 CD4+ small/medium T-cell lymphoproliferative disorder: A Mayo Enterprise experience. J Am Acad Dermatol 2020. [DOI: 10.1016/j.jaad.2020.06.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ederaine SA, Costello CM, Maly C, Severson K, Ochoa SA, Pittelkow MR, Sekulic A, Mangold AR. 15348 Cutaneous squamous cell carcinoma in nonwhite individuals: A single-institution case-control study. J Am Acad Dermatol 2020. [DOI: 10.1016/j.jaad.2020.06.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Puri P, Baliga S, Pittelkow MR, Bhullar PK, Mangold AR. Use of Skin Cancer Procedures, Medicare Reimbursement, and Overall Expenditures, 2012-2017. JAMA Netw Open 2020; 3:e2025139. [PMID: 33170260 PMCID: PMC7656278 DOI: 10.1001/jamanetworkopen.2020.25139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This cohort study describes recent trends in use and payment rates and in overall expenditure for skin cancer procedures in the Medicare Part B population in the United States.
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Eggermont AMM, Bellomo D, Arias-Mejias SM, Quattrocchi E, Sominidi-Damodaran S, Bridges AG, Lehman JS, Hieken TJ, Jakub JW, Murphree DH, Pittelkow MR, Sluzevich JC, Cappel MA, Bagaria SP, Perniciaro C, Tjien-Fooh FJ, Rentroia-Pacheco B, Wever R, van Vliet MH, Dwarkasing J, Meves A. Identification of stage I/IIA melanoma patients at high risk for disease relapse using a clinicopathologic and gene expression model. Eur J Cancer 2020; 140:11-18. [PMID: 33032086 PMCID: PMC7655519 DOI: 10.1016/j.ejca.2020.08.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/09/2020] [Accepted: 08/16/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE Patients with stage I/IIA cutaneous melanoma (CM) are currently not eligible for adjuvant therapies despite uncertainty in relapse risk. Here, we studied the ability of a recently developed model which combines clinicopathologic and gene expression variables (CP-GEP) to identify stage I/IIA melanoma patients who have a high risk for disease relapse. PATIENTS AND METHODS Archival specimens from a cohort of 837 consecutive primary CMs were used for assessing the prognostic performance of CP-GEP. The CP-GEP model combines Breslow thickness and patient age, with the expression of eight genes in the primary tumour. Our specific patient group, represented by 580 stage I/IIA patients, was stratified based on their risk of relapse: CP-GEP High Risk and CP-GEP Low Risk. The main clinical end-point of this study was five-year relapse-free survival (RFS). RESULTS Within the stage I/IIA melanoma group, CP-GEP identified a high-risk patient group (47% of total stage I/IIA patients) which had a considerably worse five-year RFS than the low-risk patient group; 74% (95% confidence interval [CI]: 67%-80%) versus 89% (95% CI: 84%-93%); hazard ratio [HR] = 2.98 (95% CI: 1.78-4.98); P < 0.0001. Of patients in the high-risk group, those who relapsed were most likely to do so within the first 3 years. CONCLUSION The CP-GEP model can be used to identify stage I/IIA patients who have a high risk for disease relapse. These patients may benefit from adjuvant therapy.
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Puri P, Comfere N, Pittelkow MR, Bezalel SA, Murphree DH. COVID-19: An opportunity to build dermatology's digital future. Dermatol Ther 2020; 33:e14149. [PMID: 32767453 PMCID: PMC7435563 DOI: 10.1111/dth.14149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/03/2020] [Indexed: 01/11/2023]
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Snider S, Costello CM, Ederaine S, Besch-Stokes J, Severson KJ, DiCaudo DJ, Pittelkow MR, Mangold AR. A case of pediatric lymphomatoid papulosis treated with photodynamic therapy and narrowband ultraviolet B. Pediatr Dermatol 2020; 37:881-883. [PMID: 32618378 DOI: 10.1111/pde.14244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/07/2020] [Accepted: 05/18/2020] [Indexed: 11/30/2022]
Abstract
We report a case of a 13-year-old boy with extensive lymphomatoid papulosis (LyP) involving his elbows, forearms, proximal thighs, and right hip, with treatment-resistant nodules on his right forearm. He was treated with full-body narrowband ultraviolet B and targeted photodynamic therapy (PDT) with 20% aminolevulinic acid (ALA). After two months, there was complete resolution of the right forearm nodules. Due to its minimal toxicity, PDT offers unique advantages and may be considered for pediatric LyP patients with symptomatic, localized disease resistant to conventional treatments.
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Puri P, Baliga S, Pittelkow MR. Trends in Medicare utilization and reimbursement for electronic brachytherapy following 2016 billing code changes. J Am Acad Dermatol 2020; 84:1154-1155. [PMID: 32682891 DOI: 10.1016/j.jaad.2020.07.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/11/2020] [Accepted: 07/14/2020] [Indexed: 10/23/2022]
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Bellomo D, Arias-Mejias SM, Ramana C, Heim JB, Quattrocchi E, Sominidi-Damodaran S, Bridges AG, Lehman JS, Hieken TJ, Jakub JW, Pittelkow MR, DiCaudo DJ, Pockaj BA, Sluzevich JC, Cappel MA, Bagaria SP, Perniciaro C, Tjien-Fooh FJ, van Vliet MH, Dwarkasing J, Meves A. Model Combining Tumor Molecular and Clinicopathologic Risk Factors Predicts Sentinel Lymph Node Metastasis in Primary Cutaneous Melanoma. JCO Precis Oncol 2020; 4:319-334. [PMID: 32405608 PMCID: PMC7220172 DOI: 10.1200/po.19.00206] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Purpose More than 80% of patients who undergo sentinel lymph node (SLN) biopsy have no nodal metastasis. Here we describe a model that combines clinicopathologic and molecular variables to identify patients with thin and intermediate thickness melanomas who may forgo the SLN biopsy procedure due to their low risk of nodal metastasis. Patients and Methods Genes with functional roles in melanoma metastasis were discovered by analysis of next generation sequencing data and case control studies. We then used PCR to quantify gene expression in diagnostic biopsy tissue across a prospectively designed archival cohort of 754 consecutive thin and intermediate thickness primary cutaneous melanomas. Outcome of interest was SLN biopsy metastasis within 90 days of melanoma diagnosis. A penalized maximum likelihood estimation algorithm was used to train logistic regression models in a repeated cross validation scheme to predict the presence of SLN metastasis from molecular, clinical and histologic variables. Results Expression of genes with roles in epithelial-to-mesenchymal transition (glia derived nexin, growth differentiation factor 15, integrin β3, interleukin 8, lysyl oxidase homolog 4, TGFβ receptor type 1 and tissue-type plasminogen activator) and melanosome function (melanoma antigen recognized by T cells 1) were associated with SLN metastasis. The predictive ability of a model that only considered clinicopathologic or gene expression variables was outperformed by a model which included molecular variables in combination with the clinicopathologic predictors Breslow thickness and patient age; AUC, 0.82; 95% CI, 0.78-0.86; SLN biopsy reduction rate of 42% at a negative predictive value of 96%. Conclusion A combined model including clinicopathologic and gene expression variables improved the identification of melanoma patients who may forgo the SLN biopsy procedure due to their low risk of nodal metastasis.
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Yang YW, Lehrer MD, Mangold AR, Yiannias JA, Nelson SA, Pittelkow MR. Treatment of granuloma annulare and related granulomatous diseases with sulphasalazine: a series of 16 cases. J Eur Acad Dermatol Venereol 2020; 35:211-215. [PMID: 32216136 DOI: 10.1111/jdv.16356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 02/21/2020] [Accepted: 02/28/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Granuloma annulare (GA) and the related annular elastolytic giant cell granuloma (AEGCG) and interstitial granulomatous dermatitis (IGD) are idiopathic histiocytic inflammatory disorders, which are frequently recalcitrant to treatment. OBJECTIVES Evaluate the efficacy of sulphasalazine in treating GA, AEGCG and IGD. METHODS Sixteen patients were identified with granulomatous disease who were treated with sulphasalazine between September 2015 and September 2019. Outcomes were based on patients' and providers' subjective evaluations. RESULTS Sixteen patients were included in the study (ages 56-89, four male and twelve female). Previous treatments were attempted in fifteen patients. Clinical improvement was seen in fourteen patients (87.5%). Initial improvement was noted within a mean (SD) of 66.4 (35.1) days after starting therapy, with increasing benefits over time. Ten patients (62.5%) reported complete or near-complete clearance, three patients (18.8%) reported significant improvement, and one (6.3%) reported partial improvement. Twelve patients elected to stop or reduce therapy, resulting in relapse or worsening in five patients. CONCLUSIONS Sulphasalazine may be considered as treatment for GA and GA-related conditions.
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Costello CM, Maly CJ, Snider S, Severson KJ, DiCaudo DJ, Rosenthal AC, Northfelt DW, Rule W, Craig FE, Pittelkow MR, Mangold AR. Immunosuppression-associated primary cutaneous plasmablastic lymphoma secondary to romidepsin. JAAD Case Rep 2019; 6:19-22. [PMID: 31909131 PMCID: PMC6938883 DOI: 10.1016/j.jdcr.2019.10.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Costello CM, Cumsky HJL, Maly CJ, Harvey JA, Buras MR, Pallagi PJ, Gustaveson AL, Singh DP, Nelson SA, Pittelkow MR, Mangold AR. Improving Access to Care Through the Establishment of a Local, Teledermatology Network. Telemed J E Health 2019; 26:935-940. [PMID: 31613713 DOI: 10.1089/tmj.2019.0051] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Access to dermatologic care is a major issue in the United States, especially within the un- and underinsured populations; technology, including teledermatology, will pay a role in improving access to care. Methods: We performed a prospective study between November 2016 and September 2017. We leveraged a partnership between Mayo Clinic and Mountain Park Health Clinic, a community clinic that primarily serves un- and underinsured populations. We implemented a mobile phone-based store and forward (SAF) teledermatology service, which integrated an external community health clinic to an existing electronic health record (EHR) using standardized data capture forms, real-time support, and simple workflows. Results: Thirty-seven patients were enrolled in the study, 65% female and 35% male with an average age of 47.9 (SD = 15.9). The ethnic breakdown was: 81.1% Hispanic, 13.5% Caucasian, and 5.4% African American. The majority, 62.2%, did not have a high school education, 45.9% were unemployed, and 51.4% were uninsured. 64.9% earned less than $25,000 for annual household income. Teledermatology consultation increased the absolute diagnostic and management concordance by 36.6% (p = 0.01, 95% CI 12.2%-61.0%) and 34.2% (p < 0.01, 95% CI 11%-57%), respectively. Primary care providers had a significant increase in mean confidence in the diagnosis and management of dermatology conditions pre and poststudy (3.60 vs. 3.70 and 3.21 vs. 3.60, respectively; p < 0.01). Ninety-six percent of the primary care providers agreed (52.0%) and strongly agreed (44.0%) that they would send another patient for teleconsultation. Conclusion: We successfully implemented a SAF teledermatology consultative service in a community health clinic outside our EHR. A similar approach can be used by other large health care organizations to provide integrated, high-quality consultation to clinics with rural, un- and underinsured populations.
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Besch-Stokes JG, Costello CM, Bhullar PK, Maly CJ, Rosenthal AC, DiCaudo DJ, Pittelkow MR, Mangold AR. Regression of mycosis fungoides with large-cell transformation following skin biopsy. J Eur Acad Dermatol Venereol 2019; 34:e82-e84. [PMID: 31566801 DOI: 10.1111/jdv.15976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kohorst JJ, Bailey CH, Andersen LK, Pittelkow MR, Davis MDP. Prevalence of Delusional Infestation-A Population-Based Study. JAMA Dermatol 2019; 154:615-617. [PMID: 29617524 DOI: 10.1001/jamadermatol.2018.0004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Kotwal A, Turcu AF, Sonawane V, Bahn RS, Pittelkow MR, Bridges A, Stan MN. Clinical Experience with Rituximab and Intravenous Immunoglobulin for Pretibial Myxedema: A Case Series. Thyroid 2019; 29:692-699. [PMID: 30854936 DOI: 10.1089/thy.2018.0706] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Severe pretibial myxedema (PTM) can be difficult to manage, highlighting the need to investigate newer therapies. Rituximab (RTX) and intravenous immunoglobulin (IVIg) have been tried in Graves' orbitopathy. Since PTM and orbitopathy share a similar underlying pathophysiology, this study aimed to explore these therapies for progressive PTM. Methods: The electronic database was screened for PTM patients evaluated at the Mayo Clinic, Rochester, from 2002 to 2016, and three patients who received IVIg and five who received RTX are reported. PTM pattern was classified as non-pitting edema, plaque and induration, nodular/nummular, and elephantiasis. PTM was confirmed by biopsy in six patients. Results: The patients' median age was 53.8 years, 75% were female, and all but one patient were either active or former smokers. All patients were euthyroid and had progressed despite various therapies prior to starting these agents. Six patients had a plaque and induration pattern, and two had a nodular pattern with elephantiasis. After therapy, six (75%) patients had PTM stability or improvement both subjectively and objectively (80% with RTX and 66% with IVIg). The three patients (one in the IVIg group and two in the RTX group) who had subjective improvement had a plaque pattern. One patient with elephantiasis had a transient response to IVIg and another had stability after RTX. Thyrotropin receptor antibody values and orbitopathy also improved in patients who demonstrated PTM improvement. No serious adverse events were reported, but one patient each had transient hypertension and injection-site thrombophlebitis after IVIg. Conclusions: Immunomodulation therapy was followed by PTM improvement or stability in most patients, with a slightly better response after RTX compared to IVIg. A validated response assessment instrument and larger series of patients are required to determine if the underlying disease process could be curtailed with these agents.
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Cumsky HJL, Maly CJ, Costello CM, Buras MR, Ranieri LM, Grover ML, Comfere NI, Nelson SA, Pittelkow MR, Mangold AR. Impact of standardized templates and skin cancer learning modules for teledermatology consultations. Int J Dermatol 2019; 58:1423-1429. [PMID: 30916785 DOI: 10.1111/ijd.14437] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 02/20/2019] [Accepted: 02/27/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Little research has been done in teledermatology to examine the effects of standardized templates and subject-specific learning modules. METHODS We performed a prospective study examining the effects of standardized templates and standardized cutaneous oncology learning modules on teledermatology referrals at Mayo Clinic. This data was then compared to previous teledermatology referrals before standardized templates were adopted. RESULTS A total of 42 teledermatology consultations were performed during the 4-month study period. The use of standardized templates resulted in an absolute reduction in face-to-face referrals. Teledermatology consultation increased the absolute diagnostic and management concordance by 26.2% (P = 0.02) and 33.3% (P < 0.01), respectively, and decreased the absolute diagnostic and management discordance by 19.1% (P = 0.03) and 31.0% (P < 0.01), respectively. The largest knowledge gaps were identified in cutaneous oncology. Educational intervention improved theoretical referral rates and confidence in diagnosis and management overall. CONCLUSION The implementation of standardized intake templates reduces the rate of face-to-face referrals. Teledermatology improves primary care-based dermatological care and reduces theoretical referral rates.
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Yonan YA, Cumsky HJL, Costello CM, Maly CJ, Rosenthal AC, Reeder CB, Rule WG, Pittelkow MR, Craig FE, DiCaudo DJ, Mangold AR. Syringotropic and folliculotropic mycosis fungoides with mycosis fungoides-associated vasculopathic ulcers. JAAD Case Rep 2019; 5:231-233. [PMID: 30834284 PMCID: PMC6384313 DOI: 10.1016/j.jdcr.2019.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Cumsky HJL, Costello CM, Zhang N, Butterfield R, Buras MR, Schmidt JE, Drenner K, Nelson SA, Ochoa SA, Baum CL, Pittelkow MR, DiCaudo DJ, Sekulic A, Mangold AR. The prognostic value of inositol polyphosphate 5-phosphatase in cutaneous squamous cell carcinoma. J Am Acad Dermatol 2019; 80:626-632.e1. [PMID: 30359624 PMCID: PMC10577667 DOI: 10.1016/j.jaad.2018.10.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 09/13/2018] [Accepted: 10/06/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Inositol polyphosphate 5-phosphatase (INPP5A) has been shown to play a role in development and progression of cutaneous squamous cell carcinoma (cSCC). The goal of the current study was to explore the prognostic value of INPP5A expression in cSCC. METHODS A total of 189 cases of actinic keratosis and SCC in 174 patients were identified; clinical and outcome data were abstracted, histopathology was rereviewed, and immunohistochemical staining and interpretation was performed for INPP5A. RESULTS The majority of tumors (89.4%) had an INPP5A score of 2 or 3. No patients had complete loss of INPP5A. Tumors with an INPP5A score of 1 were more likely to be intermediate- to high-risk tumors (Brigham and Women's Hospital stage ≥T2a 85.0% vs 23.7% [P < .0001]) characterized by a larger diameter (2.4 cm vs 1.3 cm [P = .0004]), moderate-to-poor differentiation (86.7% vs 17.6% [P < .0001]), and perineural invasion (37.5% vs 5.3%, [P < .0001]). An INPP5A score of 1 was associated with a worse 3-year survival (a rate of 42.3% [hazard ratio, 2.81, P = .0006]) and a local metastasis rate of 48.0% (hazard ratio, 4.71; P < .0001). CONCLUSIONS Low INPP5A scores are predictive of aggressive tumors and may be a useful adjunct to guide clinical management of cSCC.
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