Ruzica Z. Conic

Determination of the impact of melanoma surgical timing on survival using the National Cancer Database

Background: The ideal timing for melanoma treatment, predominantly surgery, remains undetermined. Patient concern for receiving immediate treatment often exceeds surgeon or hospital availability, requiring establishment of a safe window for melanoma surgery. Objective: To assess the impact of time to definitive melanoma surgery on overall survival. Methods: Patients with stage I to III cutaneous melanoma and with available time to definitive surgery and overall survival were identified by using the National Cancer Database (N = 153,218). The t test and chi‐square test were used to compare variables. Cox regression was used for multivariate analysis. Results: In a multivariate analysis of patients in all stages who were treated between 90 and 119 days after biopsy (hazard ratio [HR], 1.09; 95% confidence interval [CI], 1.01‐1.18) and more than 119 days (HR, 1.12; 95% CI, 1.02‐1.22) had a higher risk for mortality compared with those treated within 30 days of biopsy. In a subgroup analysis of stage I, higher mortality risk was found in patients treated within 30 to 59 days (HR, 1.05; 95% CI, 1.01‐1.1), 60 to 89 days (HR, 1.16; 95% CI, 1.07‐1.25), 90 to 119 days (HR, 1.29; 95% CI, 1.12‐1.48), and more than 119 days after biopsy (HR, 1.41; 95% CI, 1.21‐1.65). Surgical timing did not affect survival in stages II and III. Limitations: Melanoma‐specific survival was not available. Conclusion: Expeditious treatment of stage I melanoma is associated with improved outcomes.

Prevalence of Comorbid Conditions and Sun-Induced Skin Cancers in Patients with Alopecia Areata

Alopecia areata is a multifactorial autoimmune disease causing non-scarring hair loss. Recent genome-wide association studies have pointed to connections between alopecia areata and other autoimmune disorders. Research of clinical conditions positively and negatively associated with alopecia areata is crucial for discovering the pathological mechanisms of disease and further treatment options.

Comorbidities in patients with alopecia areata

REFERENCES 1. Xing L, Dai Z, Jabbari A, et al. Alopecia areata is driven by cytotoxic T lymphocytes and is reversed by JAK inhibitors. Nat Med. 2014;20:1043-1049. 2. Gilhar A, Schrum AG, Etzioni A, et al. Alopecia areata: animal model illuminates autoimmune pathogenesis and novel immunotherapeutic strategies. Autoimmune Rev. 2016;15:726-735. 3. Jabbari A, Nguyen N, Cerise JE, et al. Treatment of an alopecia areata patient with tofacitinib results in regrowth of hair and changes in serum and skin biomarkers. Exp Dermatol. 2016;25: 642-643. 4. Craiglow BG, King BA. Killing two birds with one stone: oral tofacitinib reverses alopecia universalis in a patient with plaque psoriasis. J Invest Dermatol. 2014;134:2988-2990. 5. Liu LY, Craiglow BG, Dai F, et al. Tofacitinib for the treatment of severe alopecia areata and variants: a study of 90 patients. J Am Acad Dermatol. 2017;76:22-28. 6. Craiglow BG, Liu LY, King BA. Tofacitinib for the treatment of alopecia areata and variants in adolescents. J Am Acad Dermatol. 2017;76:29-32. 7. US National Institutes of Health ClinicalTrials.gov website. Efficacy study of tofacitinib in pediatric JIA population. Available at: http://clinicaltrials.gov/show/NCT02592434. Accessed December 23, 2016.

Role of graft-versus-host disease in the development of secondary skin cancers in hematopoietic stem cell transplant recipients: A meta-analysis

differentiation and proliferation and consequently inhibits the replication and assembly of human papilloma virus within the affected cells. Furthermore, acitretin has potent immunomodulatory and apoptotic effects that might play a role in this respect. Recurrence was only reported in 4 patients of the acitretin alone group. This represents a disadvantage of wart therapy by acitretin, which acts through regulation of keratinocyte differentiation and proliferation, a process that might be reversed after discontinuation of therapy. In conclusion, acitretin combined with Candida antigen is a promising, effective, and safe modality for the treatment of multiple recalcitrant warts and is superior to either agent alone.

The role of immunosuppression in squamous cell carcinomas arising in seborrheic keratosis

Background Seborrheic keratoses (SK) are common skin neoplasms considered to be benign. Reports of associated squamous cell carcinoma arising within seborrheic keratosis (SCC‐SK) have been described. Objective To describe the histopathologic characteristics of SCC‐SK and identify predisposing factors in formation of these rare lesions. Methods There were 162 cases of SCC‐SK in a span of a decade (2003‐2014). All of the histopathologic specimens and medical records were reviewed. Data from these patients were compared to a control group with seborrheic keratosis who were matched by age, sex, and location of lesion from the same time period (n = 162). Results SCC‐SK has the classic histopathologic features of SK, such as hyperkeratosis, parakeratosis, papillomatosis, and pseudohorn cysts. The areas of squamous cell carcinoma were characterized by areas of squamous dysplasia (100%), hypogranulosis (79.6%), squamous eddies (79.6%), solar elastosis (80.9%), and brown pigmentation (59.9%). Patients with a history of immunosuppression had an increased risk for developing SCC‐SK (19% vs 3%; P < .01), particularly when inhibition was transplant‐associated (10% vs 0%; P < .01). Limitations This was a single center, retrospective study. Conclusion SCC‐SK occurs more often in elderly men with a history of immunosuppression associated with organ transplants.

Risk of sun‐induced skin cancers in patients with alopecia areata, alopecia totalis and alopecia universalis

Alopecia areata (AA) is an autoimmune non-scarring hair loss characterized by round patches on the scalp and body. It can progress to alopecia totalis (AT) where there is total loss of scalp hair and alopecia universalis (AU) in where hair loss encompasses the entire body. The pathophysiologic mechanism is unclear, but is thought to be due to peribulbar T-cell inflammation which results in premature induction of anagen follicles to catagen and telogen, without causing destruction of the hair follicle. This article is protected by copyright. All rights reserved.

Updates in therapeutics for folliculitis decalvans: A systematic review with evidence-based analysis

REFERENCES 1. Chu SY, Chen YJ, Tseng WC, et al. Psychiatric comorbidities in patients with alopecia areata in Taiwan: a case-control study. Br J Dermatol. 2012;166:525-531. 2. Villasante Fricke AC, Miteva M. Epidemiology and burden of alopecia areata: a systematic review. Clin Cosmet Investig Dermatol. 2015;8:397-403. 3. Koo JY, Shellow WV, Hallman CP, Edwards JE. Alopecia areata and increased prevalence of psychiatric disorders. Int J Dermatol. 1994;33:849-850. 4. Sellami R, Masmoudi J, Ouali U, et al. The relationship between alopecia areata and alexithymia, anxiety and depression: a case-control study. Indian J Dermatol. 2014;59:421. 5. Ruiz-Doblado S, Carrizosa A, Garcia-Hernandez MJ. Alopecia areata: psychiatric comorbidity and adjustment to illness. Int J Dermatol. 2003;42:434-437.

Comorbid conditions in lichen planopilaris: A retrospective data analysis of 334 patients

Background Lichen planopilaris (LPP) is a rare, cicatricial, lymphocyte-mediated alopecia that is thought to have an autoimmune pathogenesis and possibly related to other autoimmune diseases. However, data are limited and studies that examine comorbid conditions are lacking. Objectives We sought to determine the prevalence of systemic comorbid conditions, nutritional deficiencies, psychological problems, and skin cancers in patients with LPP. Methods We identified 334 patients with LPP who were seen in the Department of Dermatology at the Cleveland Clinic Foundation between 2000 and 2016. Patients with LPP were compared with 78 control patients with a diagnosis of seborrheic dermatitis. Results There were more female patients with LPP compared with the controls (93.1% vs. 79.5%; p < .001) but the average age did not differ (54.77 ± 12.83 vs. 52.19 ± 15.37; p = .12). Conditions positively associated with LPP were Hashimoto’s thyroiditis (6.3% vs. 0%; p = .023), hypothyroidism (24.3% vs. 12.8%; p = .028), and hirsutism (11.4% vs. 1.3%; p = .006). Negatively associated conditions were allergic rhinitis (15% vs. 24.4%; p = .046), diabetes mellitus type II (11.7% vs. 21.8%; p = .019), hyperlipidemia (38.6% vs. 52.6%; p = .024), vitamin D deficiency (50% vs. 65.4%; p = .014), depression (15.6% vs. 28.9%; p = .018), and sleep problems (7.5% vs. 29.5%; p < .001). Conclusions Our study further emphasizes that dermatologists should screen patients with LPP for autoimmune disorders that are associated with LPP and complete a full metabolic workup to avoid missing other abnormalities. The importance of atopy, autoimmune disorders, endocrine disorders, nutritional deficiencies, psychological problems, and skin cancers in patients with scarring alopecia should be better understood.

Abstract 24. Melanoma: How Much Does Time To Treatment Matter?

RESULTS: Patients with longer times to treat tended to be male, use Medicare, have melanoma on the head and neck and have a higher melanoma stage. Younger age at diagnosis, lack of comorbidities, and lower melanoma stage favorably affected survival. After multivariate adjustment, there was no difference between patients treated in 1–30 days, 31–60 (HR 1.02, 95%CI 0.99–1.04) and 61–90(1.03, 95%CI 0.99–1.08). Patients who were treated between 91–120 days (HR 1.09, 95%CI 1.01–1.18) are 9% more likely to die compared to patients who were treated within 30 days.

Mixed Versus Pure Variants of Desmoplastic Melanoma: The Cleveland Clinic Experience

Background Desmoplastic melanoma (DM) is a subvariant of spindle cell melanoma, accounting for less than 4% of all cutaneous melanomas. It occurs later in life and is associated with chronic sun exposure. Desmoplastic melanoma prognosis is considered more favorable than other variants, with lower rates of metastasis and higher survival. Recently, DM has been further subclassified into pure and mixed, calling into question surgical management and patient outcomes as well as viability of current nationwide databases without this distinction. Methods We identified all patients with a histopathologic diagnosis of DM from the Cleveland Clinic electronic melanoma database (n = 58) from 1997 to 2013. Clinical and histopathologic data were collected. Comparison in clinical variables was performed between patients who had pure (n = 15) and mixed (n = 43) variants of DM. Results There were no differences in age, sex, location of lesion, Breslow depth, ulceration, or regression. Patients with mixed DM were more likely to have lymphovascular invasion (P = 0.03) compared with pure DM. There was no difference in performance of sentinel lymph node biopsy (P = 0.25) or sentinel lymph node positivity (P = 0.31) between the 2 groups. Recurrence was present in 13.3% of pure and 30.2% of mixed patients. Overall, Kaplan-Meier 3-year survival was 75% for pure and 80% for mixed DM (P = 0.53). Conclusions Pure and mixed DMs seem to have similar clinical characteristics and outcomes. This indicates that analysis of national datasets without this subclassification remains viable.