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Journal of the American Academy of Dermatology

Journal Club: July 2012

Geeta Yadav

on 28 September 2012

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Transcript of Journal of the American Academy of Dermatology

By: Geeta Yadav, PGY-3 JAAD: July 2012
Journal Club Are negative margins from diagnostic biopsies of NMSC reliable predictors for complete removal?
Authors did a retrospective review of of 216 cases of NMSC where pathology for both biopsy and subsequent excision is available.
For well-differentiated SCC: Yes - no tumor seen on reexcision
For BCC: No - residual tumor found in 70% of reexcision Livedoid vasculopathy is a disease of unknown etiology, characterized by multiple painful recurrent ulcerations on the feet and atrophic scars
Researchers looked at multiple non-specific markers of immune system activation and inflammation (e.g. hs-CRP, ANA) and ultrasound studies of the vessels
Main difference between matched controls was the lack of response — in cases — to NO and vascular dilation. This is evidence for endothelial dysfunction as a possible cause of LV. Retrospective review of patients at the Mayo clinic over 20 year period
Steroids applied 3 x daily, moisturizers at all other times, removed every 3 hours to allow patient to void or ambulate
Mean duration was 3.6 days after which 90% of patients had > 50% improvement, the majority had > 75% improvement Wearing a temporary tattoo makes medical students more likely to appreciate the psychological burden of psoriasis...but does the same for all other diseases students were questioned about! GR as primary tx resulted in complete clearance in 83% of pts
Combined w partial excision 90% clearance
Recurrence-prophylactic group 97% (those who had radical excision and prophylatctic rad) Superficial and nodular subtypes are generally lower risk while micronodular and infiltrative BCC are higher risk
Anatomically high risk areas include: face, acral extremities, and genitalia
Relationship between max. depth of invasion against a series of possible predictors (like age, gender, solar elastosis, histological subtype)

Only 62% concordance between subtype identified on initial biopsy specimen and subsequent excisions, with 44% of those biopsy specimens containing a secondary subtype (e.g. nodular type with a secondary micronodular component) - but these were not significantly deeper than superficial or nodular tumors without a secondary subtype

In contrast to the widely held perception that micronodular BCCs are associated with more aggressive course, the data collected showed that nodular pattern correlates with greater depth
Risk factors (e.g. obesity, smoking, diabetes, HTN, hyperlipidemia) in the study population were greater than the reported average for the general population
25% of hypertensive patients were undiagnosed, and of those diagnosed only 60% were at their treatment goal
19% of the hyperlipiedmiec population in the study had unrecognized hyperlipidemia, of those with recognized hyperlipidemia only 50% were at goal for LDL cholesterol and only 36% were on a statin
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