JAMA dermatology最新文献

Mohs Surgery vs Wide Local Excision in Primary High-Stage Cutaneous Squamous Cell Carcinoma.

IF 11.5 1区医学

JAMA dermatology Pub Date : 2025-02-19 DOI: 10.1001/jamadermatol.2024.6214

David M Wang, Michelangelo Vestita, Fadi G Murad, Frederick C Morgan, Rachael Rowley, Eleni M Rettig, William Lotter, Abigail B Waldman, Emily S Ruiz, Chrysalyne D Schmults

{"title":"Mohs Surgery vs Wide Local Excision in Primary High-Stage Cutaneous Squamous Cell Carcinoma.","authors":"David M Wang, Michelangelo Vestita, Fadi G Murad, Frederick C Morgan, Rachael Rowley, Eleni M Rettig, William Lotter, Abigail B Waldman, Emily S Ruiz, Chrysalyne D Schmults","doi":"10.1001/jamadermatol.2024.6214","DOIUrl":"10.1001/jamadermatol.2024.6214","url":null,"abstract":"Importance: High-stage cutaneous squamous cell carcinoma (cSCC) has an increased risk of recurrence, metastasis, and mortality. Studies investigating the outcomes of high-stage cSCC among patients treated with Mohs surgery compared with those treated with wide local excision (WLE) are limited.Objective: To assess the outcomes of primary high-stage cSCC among patients treated with Mohs surgery compared with those treated with WLE.Design, setting, and participants: This retrospective cohort study using propensity score weighting was conducted in a tertiary academic medical center in Boston, Massachusetts. Patients were included if they had primary high-stage cSCC and had been treated with either Mohs surgery or WLE between January 1, 2000, and December 31, 2019. Data analysis was performed between November 3 and 6, 2023.Exposures: Primary surgical treatment with Mohs surgery or WLE.Main outcomes and measures: Outcomes included local recurrence, nodal metastasis, distant metastasis, any recurrence (ie, a composite outcome of recurrence or metastasis), and disease-specific death. Propensity scores were estimated via logistic regression using baseline patient and tumor characteristics. Competing risk regression analysis was used to compute crude and inverse probability of treatment weighting (IPTW), cause-specific hazard ratios (HRs), and Fine-Gray subdistribution HRs and to derive cumulative incidence functions stratified by Mohs and WLE.Results: This study included 216 patients with high-stage cSCC who had a mean (SD) age of 73.5 (13.3) years; 151 (69.9%) were men and 65 (30.1%) were women. The median follow-up time was 33.1 months (IQR, 11.3-77.6 months). After IPTW, the baseline characteristics were well balanced between the WLE and Mohs surgery treatment groups, with absolute standardized differences of less than 0.10 across all characteristics. In the IPTW competing risks model, the 3-year cumulative incidence of all adverse outcomes were greater among patients in the WLE group compared with those in the Mohs surgery group, including local recurrence (19.8% vs 9.6%; weighted cause-specific HR, 2.33 [95% CI, 1.39-3.92]; P = .001), nodal metastasis (17.9% vs 11.0%; weighted cause-specific HR, 1.80 [95% CI, 1.07-3.02]; P = .03), distant metastasis (8.4% vs 4.4%; weighted cause-specific HR, 2.10 [95% CI, 0.97-4.57]; P = .06), any recurrence (32.0% vs 15.8%; weighted cause-specific HR, 2.38 [95% CI, 1.57-3.61]; P < .001), and disease-specific death (17.5% vs 7.1%; weighted cause-specific HR, 2.74 [95% CI, 1.54-4.88]; P = .001).Conclusions and relevance: The findings of this cohort study suggest that Mohs surgery was associated with improved outcomes in the treatment of primary high-stage cSCC compared with WLE. These findings further suggest that Mohs surgery or alternative methods of peri","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":""},"PeriodicalIF":11.5,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11840687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Histopathologic Grading of Acute Cutaneous Graft-vs-Host Disease and Nonrelapse Mortality.

IF 11.5 1区医学

JAMA dermatology Pub Date : 2025-02-19 DOI: 10.1001/jamadermatol.2024.6147

Jennifer Chen, Caroline Raymundo, Abigail Martinez, Stephanie J Lee, Phillip A Stevenson, Michi M Shinohara

引用次数: 0

Febrile Ulceronecrotic Mucha-Habermann Disease.

IF 11.5 1区医学

JAMA dermatology Pub Date : 2025-02-19 DOI: 10.1001/jamadermatol.2024.6162

Yi-Hsuan Shen, Yu-Ting Hung

引用次数: 0

Risk of Cardiovascular Morbidity and Mortality in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis Survivors.

IF 11.5 1区医学

JAMA dermatology Pub Date : 2025-02-19 DOI: 10.1001/jamadermatol.2024.5881

Hsien-Yi Chiu, Ying-Ming Chiu

{"title":"Risk of Cardiovascular Morbidity and Mortality in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis Survivors.","authors":"Hsien-Yi Chiu, Ying-Ming Chiu","doi":"10.1001/jamadermatol.2024.5881","DOIUrl":"10.1001/jamadermatol.2024.5881","url":null,"abstract":"Importance: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) cause diffuse epidermal detachment and necrosis. Patients who survive the initial SJS/TEN episodes are affected by various sequelae.Objective: To investigate the risks of cardiovascular morbidity and mortality in SJS/TEN survivors.Design, setting, and participants: This was a nationwide population-based cohort study using data from Taiwan's National Health Research Institute Database linked to the National Register of Death databases for 1998 to 2021. Survivors of SJS/TEN were identified and matched with non-SJS/TEN participants by age, sex, and Charlson Comorbidity Index. Data analysis was performed from November 2023 to June 2024.Exposure: Cerebrovascular accidents (CVA) or ischemic heart disease (IHD) after SJS/TEN survival.Main outcomes and measures: Cox proportional hazards models were used to estimate the hazard ratios (HRs) of CVA and IHD morbidity and mortality after SJS/TEN survival.Results: The CVA cohort included 10 571 SJS/TEN survivors (mean [SD] age, 56.1 [18.5] years; 5358 females [50.7%] and 5213 males [49.3%]). The IHD cohort included 11 084 SJS/TEN survivors (mean [SD] age, 56.6 [18.6] years; 5561 females [50.2%] and 5523 males [49.8%]). The Cox proportional hazards model and competing risk regression model showed that compared with non-SJS/TEN participants, patients with SJS/TEN had higher risks of cardiovascular morbidity (CVA: HR, 1.65 [95% CI, 1.57-1.72] and subdistribution HR [sHR], 1.40 [95% CI, 1.33-1.46]; IHD: HR, 1.58 [95% CI, 1.51-1.65] and sHR, 1.32 [95% CI, 1.26-1.38]) and death due to cardiovascular disease (CVA: HR, 1.69; 95% CI, 1.46-1.96; IHD: HR, 1.55; 95% CI, 1.32-1.82). The increased cardiovascular mortality risks peaked at 1 year after SJS/TEN and persisted for 4 to 7 years. Older survivors and survivors admitted to an intensive care unit at SJS/TEN diagnosis had significantly higher cardiovascular mortality risk.Conclusions and relevance: In this cohort study, SJS/TEN had a lasting association with cardiovascular function after the acute phase. This suggests a need to mitigate the elevated cardiovascular morbidity and mortality risks among survivors. Further research using databases or registries with more comprehensive clinical data are needed to validate these results.","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":""},"PeriodicalIF":11.5,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11840681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Clinical Implications of Genetic Discoveries on Frontal Fibrosing Alopecia.

IF 11.5 1区医学

JAMA dermatology Pub Date : 2025-02-12 DOI: 10.1001/jamadermatol.2024.6433

F Buket Basmanav, Young-Ae Lee, Regina C Betz

引用次数: 0

Immune Checkpoint Inhibitors in Field Cancerization and Keratinocyte Cancer Prevention.

IF 11.5 1区医学

JAMA dermatology Pub Date : 2025-02-12 DOI: 10.1001/jamadermatol.2024.5750

Charlotte Cox, Susan Brown, Euan Walpole, Edwige Roy, Lea Dousset, Rahul Ladwa, Kiarash Khosrotehrani

{"title":"Immune Checkpoint Inhibitors in Field Cancerization and Keratinocyte Cancer Prevention.","authors":"Charlotte Cox, Susan Brown, Euan Walpole, Edwige Roy, Lea Dousset, Rahul Ladwa, Kiarash Khosrotehrani","doi":"10.1001/jamadermatol.2024.5750","DOIUrl":"10.1001/jamadermatol.2024.5750","url":null,"abstract":"Importance: Therapies for individual keratinocyte carcinomas (KCs) do not prevent the onset of new KCs in a field of sun damage, and therefore the KC burden remains unchanged.Objective: To investigate the association of immune checkpoint inhibitors (ICIs) with changes in field cancerization evaluated by the number of actinic keratoses (AKs) and KCs at baseline compared with 12 months after starting ICI therapy.Design, setting, and participants: This prospective cohort study was performed at the outpatient oncology clinic of a single tertiary public hospital in Brisbane, Australia, from April 1, 2022, to November 30, 2023. Consecutive immunocompetent adults starting therapy with an inhibitor for programmed cell death 1 (PD-1) or programmed cell death ligand 1 (PDL-1) for any active cancer, with a planned treatment duration of at least 6 months, and who exhibited clinical AKs on their forearms were eligible. Those with immunosuppression, concurrent chemotherapy or radiotherapy, or recent topical fluorouracil use were excluded.Exposures: Intravenous ICI therapy, either PD-1 or PDL-1 inhibitors with or without a cytotoxic T-lymphocyte-associated protein 4 inhibitor, with therapy duration determined by the treating oncologist.Main outcomes and measures: Clinical AKs were counted and photographed before and 3, 6, and 12 months after starting ICI therapy. KC numbers were evaluated based on histopathology reports of all skin lesions excised 12 months before and after starting ICI therapy. Participants' medical history, primary cancer tumor response using Response Evaluation Criteria in Solid Tumors, and adverse events were recorded.Results: A total of 23 participants were recruited, of whom 17 (73.9%) were male, with a mean (SD) age of 69.7 (9.6) years. No participants withdrew; however, 4 died during the study due to disease progression. The mean (SD) AK number significantly decreased from 47.2 (33.8) at baseline to 14.3 (12.0) at 12 months (P < .001). Younger patients (8 of 12 [66.7%] vs 4 of 12 [33.3%]; P = .007) and those with a history of blistering sunburn (12 of 12 [100%] vs 0; P = .005) were more likely to reduce their AK numbers by 65% or greater. KC total numbers decreased from 42 in the 12 months before starting ICI therapy to 17 in the 12 months after. The number of cutaneous squamous cell carcinomas decreased from 16 to 5 in the same period.Conclusions and relevance: This pilot cohort study found that ICIs used for any cancer were associated with a significant reduction of AKs, suggesting potential as an immunopreventive strategy for high-risk individuals. Given the known effects of other chemopreventive agents on KCs, further investigation into ICIs managing field cancerization is required, especially considering toxicity and cost.","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":""},"PeriodicalIF":11.5,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11822595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The Role of Formulation in Benzene Formation in Benzoyl Peroxide Products.

IF 11.5 1区医学

JAMA dermatology Pub Date : 2025-02-12 DOI: 10.1001/jamadermatol.2024.6443

John S Barbieri, Courtney B Rubin, James P Pham, Michelle Wong

引用次数: 0

Actinic Keratosis Incidence in Solid Organ Transplant Recipients.

IF 11.5 1区医学

JAMA dermatology Pub Date : 2025-02-12 DOI: 10.1001/jamadermatol.2024.5997

Lucy J Navsaria, Kaiping Liao, Surya Veerabagu, Candice L Hinkston, Mackenzie R Wehner

引用次数: 0

JAMA Dermatology Editorial Fellowship-What We Have Learned.