eightY-Second issue
April 2, 2025
Derm clinics after adopting 3D-TBP + dermoscopy every 6 months.
Three-dimensional (3D) total-body photography (TBP) with sequential digital dermoscopy imaging (SDDI) has been proposed to enhance early melanoma detection in high-risk patients. This randomized clinical trial assessed whether adding 3D-TBP and SDDI would improve outcomes compared to standard surveillance alone.What did they find?
Three-dimensional (3D) total-body photography (TBP) with sequential digital dermoscopy imaging (SDDI) has been proposed to enhance early melanoma detection in high-risk patients. This randomized clinical trial assessed whether adding 3D-TBP and SDDI would improve outcomes compared to standard surveillance alone.What did they find?
- 314 patients (mean age 51.6 years, 62% female) were randomized to either 3D-TBP + SDDI + usual care or usual care alone.
- The intervention group had more lesions excised per person (5.73 vs. 3.99; P = 0.02), including higher rates of benign and keratinocyte cancer excisions.
- Melanoma detection rates per person were lower in the intervention group (0.08 vs. 0.16), though not statistically significant.
- The number needed to excise remained similar between groups (3.2 vs. 3.3).
- Intervention increased healthcare utilization without significantly improving melanoma detection.
Evaluating cancer risk in a large cohort of patients with vitiligo: Insights from a comprehensive cohort population-based study
Journal of the American Academy of Dermatology
Journal of the American Academy of Dermatology
From hypopigmentation to… protection? Exploring vitiligo’s role in the risk of cancer.
Vitiligo is an autoimmune condition characterized by the selective destruction of melanocytes, leading to patches of depigmented skin. It’s association with cancer remains unclear, with conflicting evidence regarding the risk of both cutaneous and internal malignancies. Given the chronic immune activation and autoimmune dysregulation in vitiligo, along with the emerging use of JAK inhibitors, which may elevate malignancy risk, assessing potential cancer risks in this population is crucial. In this large-scale study, researchers analyzed data from Israel’s largest healthcare provider between 2000 and 2023 to assess the relationship between vitiligo and malignancy
What did they find?
Main Takeaway: This study found no significant difference in overall cancer risk for vitiligo patients, though those aged 20-49 years had a slightly higher incidence. Notably, vitiligo was linked to a lower risk of melanoma, lung, and bladder cancer.
Vitiligo is an autoimmune condition characterized by the selective destruction of melanocytes, leading to patches of depigmented skin. It’s association with cancer remains unclear, with conflicting evidence regarding the risk of both cutaneous and internal malignancies. Given the chronic immune activation and autoimmune dysregulation in vitiligo, along with the emerging use of JAK inhibitors, which may elevate malignancy risk, assessing potential cancer risks in this population is crucial. In this large-scale study, researchers analyzed data from Israel’s largest healthcare provider between 2000 and 2023 to assess the relationship between vitiligo and malignancy
What did they find?
- A total of 25,008 patients with vitiligo and 245,550 matched controls were included.
- The overall cancer incidence rates did not differ between those with and without vitiligo (499 vs. 487 cases per 100,000 person-years, respectively; P=0.582), even after adjusting for sociodemographic and clinical factors (P=0.999).
- Age stratification revealed that vitiligo patients aged 20-49 years had a slightly higher cancer incidence compared to controls (299 vs. 254 cases per 100,000 person-years; HR: 1.2, 95% CI: 1.04-1.38; P = 0.013).
- No significant differences were found in the risk of most cancer types. However, vitiligo was associated with a lower risk of:
- Melanoma (HR: 0.70, 95% CI: 0.50-0.99; P = 0.033)
- Lung cancer (HR: 0.73, 95% CI: 0.57-0.93; P = 0.007)
- Bladder cancer (HR: 0.70, 95% CI: 0.52-0.94; P = 0.013)
- Melanoma (HR: 0.70, 95% CI: 0.50-0.99; P = 0.033)
Main Takeaway: This study found no significant difference in overall cancer risk for vitiligo patients, though those aged 20-49 years had a slightly higher incidence. Notably, vitiligo was linked to a lower risk of melanoma, lung, and bladder cancer.
A geospatial analysis of the association between access to tanning bed facilities and melanoma
Journal of Investigative Dermatology
Journal of Investigative Dermatology
The longer the drive, the lower the risk
Exposure to UV rays from tanning beds has been shown to increase the risk of melanoma. Despite declining popularity, millions of adults still indoor tan, and melanoma incidence in females continues to rise. This study used geospatial analysis to examine the link between indoor tanning availability and melanoma incidence in New England, USA.
What did they find?
Main Takeaway: Limited access to indoor tanning was linked to lower melanoma rates, suggesting that policies restricting tanning facility availability may help reduce melanoma incidence.
Exposure to UV rays from tanning beds has been shown to increase the risk of melanoma. Despite declining popularity, millions of adults still indoor tan, and melanoma incidence in females continues to rise. This study used geospatial analysis to examine the link between indoor tanning availability and melanoma incidence in New England, USA.
What did they find?
- Grand Isle, Vermont had the highest county-level melanoma incidence (57.9 per 100,000).
- Massachusetts had the most tanning bed facilities (n = 283), while Vermont had the highest per capita rate (8 per 100,000).
- A 1-minute increase in travel time to tanning facilities (within <30 minutes) was linked to a 3.46% decrease in melanoma incidence.
- A 1-degree increase in latitude within the same county was linked to a 32.0% decrease in melanoma incidence.
Main Takeaway: Limited access to indoor tanning was linked to lower melanoma rates, suggesting that policies restricting tanning facility availability may help reduce melanoma incidence.
Abdominal wall skin biopsy safely diagnoses systemic amyloidosis
American Journal of Dermatopathology
American Journal of Dermatopathology
Filling the amyloid void
Amyloidosis is caused by extracellular deposition of insoluble amyloid fibrils in various organs. It is typically diagnosed through histologic examination of the affected organ, but systemic amyloidosis can also be identified via biopsy from a substitute site. Prior studies suggest amyloid deposits may appear on biopsies of unaffected skin. This study retrospectively analyzed 30 patients undergoing biopsy for suspected systemic amyloidosis, evaluating 36 samples from normal abdominal wall skin.
What did they find?
Main Takeaway: Skin biopsy of normal abdominal wall skin is a safe, non-invasive, and reliable method for diagnosing systemic amyloidosis with high sensitivity and specificity.
Amyloidosis is caused by extracellular deposition of insoluble amyloid fibrils in various organs. It is typically diagnosed through histologic examination of the affected organ, but systemic amyloidosis can also be identified via biopsy from a substitute site. Prior studies suggest amyloid deposits may appear on biopsies of unaffected skin. This study retrospectively analyzed 30 patients undergoing biopsy for suspected systemic amyloidosis, evaluating 36 samples from normal abdominal wall skin.
What did they find?
- 14 of 30 patients (46.7%) had systemic amyloidosis confirmed by skin biopsy.
- Amyloid deposition was seen in both the dermis and subcutaneous fat in 10 samples (71.5%), the dermis only in 1 sample (7.1%), and the subcutaneous fat only in 3 samples (21.4%).
- Of the 14 samples with amyloid deposition, the type of systemic amyloidosis was diagnosed by immunohistochemistry in 12 samples (86.7%).
- Skin biopsy demonstrated a 87.5% sensitivity (14/16) and 100% specificity (20/20) with 12.5% false negatives (2/16) and 0% false positives (0/20) in the diagnosis of systemic amyloidosis.
Main Takeaway: Skin biopsy of normal abdominal wall skin is a safe, non-invasive, and reliable method for diagnosing systemic amyloidosis with high sensitivity and specificity.
Granulomatous reactions from microneedling: A systematic review of the literature
Journal of Dermatologic Surgery
Journal of Dermatologic Surgery
Poke at your own risk! The fine line between microneedling and granulomas
Microneedling, a popular cosmetic procedure used for potential skin rejuvenation, is known to enhance transepidermal drug delivery, but may trigger unexpected granulomatous inflammation. This systematic review screened 1,042 articles and analyzed 13 studies involving 15 patients who developed granulomatous reactions post-microneedling.
What did they find?
Main Takeaway: Granulomatous reactions after microneedling are rare but can be severe and resistant to treatment, especially when topical agents are used without prior sensitivity testing.
Microneedling, a popular cosmetic procedure used for potential skin rejuvenation, is known to enhance transepidermal drug delivery, but may trigger unexpected granulomatous inflammation. This systematic review screened 1,042 articles and analyzed 13 studies involving 15 patients who developed granulomatous reactions post-microneedling.
What did they find?
- 60% (9 of 15 cases) involved vitamin C as the implicated topical agent.
- 53% (8 of 15 cases) used motorized microneedling devices, which may increase the risk of deeper antigen penetration.
- Patch testing was performed in only 4 of 15 cases (27%), despite suspected delayed-type hypersensitivity.
- Treatment success varied; topical steroids were most commonly used, but some patients required systemic agents like methotrexate or antitubercular therapy.
Main Takeaway: Granulomatous reactions after microneedling are rare but can be severe and resistant to treatment, especially when topical agents are used without prior sensitivity testing.
Bulging-Classification: A technique for reducing exacerbation of sunken cheek with masseter botox
Journal of Cutaneous Dermatology
Journal of Cutaneous Dermatology
Jaw-dropping results—no ifs, ands, or butts… just better cheeks!
Sunken cheeks are an undesirable side effect of botulinum toxin type A (BoNT-A) treatment for masseter hypertrophy, often causing a gaunt appearance. This prospective study evaluated a novel injection technique designed to prevent this effect by assessing masseter muscle volume and face shape. Forty-five participants received BoNT-A injections and were monitored over four weeks, with cheek volume assessed using validated midface scales and follow-ups at weeks 1, 2, and 4.
What did they find?
Sunken cheeks are an undesirable side effect of botulinum toxin type A (BoNT-A) treatment for masseter hypertrophy, often causing a gaunt appearance. This prospective study evaluated a novel injection technique designed to prevent this effect by assessing masseter muscle volume and face shape. Forty-five participants received BoNT-A injections and were monitored over four weeks, with cheek volume assessed using validated midface scales and follow-ups at weeks 1, 2, and 4.
What did they find?
- Before treatment, 9 participants had Grade 0, 62 had Grade 1, and 11 had Grade 2 sunken cheeks. By week 4, this shifted to 13, 59, and 10, respectively (P > 0.05, not significant).
- Four cases of mild sunken cheeks improved to full cheeks, and one moderate case improved to mild, though differences were not statistically significant (P > 0.05).
- Adverse events included bruising, swelling, masseter soreness, weakness, and paradoxical masseteric bulging, mostly resolving within two weeks.
- By week 4, 1 participant was somewhat satisfied, 16 were satisfied, and 26 were very satisfied with their results.
Phototherapy for vitiligo? Sure... if you live in a zip code with it
Phototherapy is a standard treatment for generalized vitiligo, but real-world data on its use are limited. This U.S. based study used a large national database to examine patterns in phototherapy access, considering socioeconomic and regional factors.
What did they find?
Phototherapy is a standard treatment for generalized vitiligo, but real-world data on its use are limited. This U.S. based study used a large national database to examine patterns in phototherapy access, considering socioeconomic and regional factors.
What did they find?
- Only 497 of 10,598 patients with vitiligo received any phototherapy between 2010 and 2022.
- Patients in the Northeast United States had 6x higher odds of receiving phototherapy than those in the Midwest, while those in the South had significantly lower odds.
- Asian patients had 2.6x higher odds of receiving phototherapy compared to White patients.
- Insurance status wasn’t significantly associated with access, though the low number of uninsured patients may have limited analysis.
DERMLITE Dermoscopy QUESTION OF THE WEEK
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