Ryan M Svoboda

Oxybenzone and Sunscreens: A Critical Review of the Evidence and a Plan for Discussion with Patients

There has been recent extensive controversy concerning potential environmental and health hazards of oxybenzone (also known as benzophenone-3 and Eusolex 4360). Although there has been widespread related media attention, there is little definitive scientific research supporting the associated concerns.xa0Given these controversies, it is critical that dermatologists have a clear understanding of the underlying issues related to oxybenzone in order to effectively counsel their patients. The purpose of this article is to provide dermatologists with a framework for presenting this issue to patients. Within, we address questions such as:xa01) Is oxybenzone the reason for coral bleaching? 2) Is there data to suggest that oxybenzone is harmful to humans? 3) Why is oxybenzone used in the majority of US sunscreens? and 4) Are there other potential problems with oxybenzone restrictions that could lead to more skin cancer in the future? After a careful review of the evidence, we conclude that, in our opinion, there is little definitive scientific research supporting the associated concerns and that before this evidence exists, given the benefits of oxybenzone-containing sunscreens in skin cancer prevention, this ban is premature.xa0 Banning an ingredient commonly used in most sunscreens may lead to confusion among consumers and have the untoward outcome of less sunscreen being used overall.

Clinical Experience with a Novel Topical Adhesive for Dermatologic Excisional Wound Closure: A Case-Series

Background. The topical adhesive, 2-octyl cyanoacrylate, has been used as an alternative to sutures for closure of skin in a variety of surgical procedures. While potential benefits exist, reports of allergic contact dermatitis and exothermic reactions have been a barrier to widespread adoption by dermatologic surgeons. Objective. To describe our experience using a novel formulation of 2-octyl cyanoacrylate for skin closure after surgical excision of cutaneous lesions. Methods. We describe the results of 9 office-based dermatologic excisions in 8 patients utilizing a novel formulation of 2-octyl cyanoacrylate for skin closure. At two weeks of follow-up, all incisions were examined for cosmetic result and signs of infection as per the office’s standard of care. Results. At follow-up, there were no signs of infection. One wound demonstrated mild tissue hypertrophy, while another showed very minimal skin separation (< 1mm) that did not require reintervention. No incidences of contact dermatitis, application discomfort, or burns were noted. Patient satisfaction was high. Conclusion. A novel formulation of 2-octyl cyanoacrylate topical adhesive demonstrates feasibility as a potential alternative to the use of sutures for skin closure following dermatologic excisions. Larger studies are imperative to fully describe the outcomes associated with use of this new preparation.

Bioimpedance measurement as an assessment of margin positivity in Mohs surgical specimens of non-melanoma skin cancer: Management implications

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Trends in US sunscreen formulations: Impact of increasing spray usage

Among the 3 central dermatopathologists All diagnosesy 0.91 0.86-0.95 92 KC 0.91 0.83-0.97 95 BCC 0.96 0.92-0.99 97 BCC, aggressivez 0.57 0.45-0.70 83 BCC, all subtypes 0.78 0.72-0.84 80 SCC 0.90 0.82-0.96 95 SCC, invasive 0.79 0.67-0.88 92 SCC, in situ 0.52 0.29-0.72 92 AK 0.77 0.63-0.90 94 Between local pathologists and central dermatopathologists All diagnosesx 0.83 0.76-0.90 90 KC 0.78 0.66-0.90 93 BCC 0.93 0.87-0.99 97 SCC 0.83 0.73-0.93 94 SCC, invasive 0.82 0.70-0.94 95 SCC, in situ 0.48 0.20-0.75 94 AK 0.56 0.34-0.78 93 Between dermatopathologist 1 and local pathologists All diagnosesk 0.79 0.77-0.82 86 KC 0.83 0.80-0.87 93 BCC 0.92 0.90-0.95 96 SCC 0.78 0.73-0.83 94 SCC, invasive 0.75 0.68-0.81 95 AK 0.59 0.52-0.66 91 Intrarater (test-retest) reliability of dermatopathologist 1 All diagnoses{ 0.83 0.76-0.90 89 KC 0.91 0.83-0.98 96 BCC 0.92 0.86-0.98 96 SCC 0.92 0.84-1.0 97 AK 0.56 0.36-0.77 91

Assessment of Clinician Accuracy for Diagnosing Melanoma Based on Electrical Impedance Spectroscopy Score Plus Morphology Versus Lesion Morphology Alone

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Comparing Electrical Impedance Spectroscopy to Traditional Clinical Adjunctive Tools in the Detection of Melanoma

• Only biopsy-positive lesions were included in the data analysis • There were few advanced lesions • EIS potentially has a lower incidence of false negative results than other common diagnostic adjuncts in the detection of melanoma • There appears to be a moderate positive correlation between increasing EIS score and advancing tumor stage • A subset of 265 lesions from the EIS pivotal trial (2,416 total lesions from 22 sites in 7 countries) was analyzed, representing all biopsy-proven melanoma specimens in the sample • Prior to biopsy, each lesion was characterized by: • Clinical ABCD rule • ABCD rule of dermoscopy (cutoff >4.75 for +ve score) • 7-point checklist (cutoff ≥3 for +ve score) • Weighted 7-point checklist (cutoff ≥3 for +ve score) • EIS (cutoff ≥4 for +ve score)

Scrotal rash in a 68-year-old man

A68-year-oldwhitemanpresentedwith a 2-month history of a pruritic rash at the base of his scrotum. The patient had used topical ketoconazole 2% cream twice daily for 2 weeks with no effect. His medical, family, and social histories were noncontributory. The physical examination revealed a pink plaque with focal areas of brown-gray discoloration andmild scale on the inferior portion of the scrotum (Fig 3). A shave biopsy specimen was obtained (Fig 4).