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Total-Body Examination vs Lesion-Directed Skin Cancer Screening
Skin cancer incidence has been rising dramatically, and this increase is expected to continue. Skin examination is simple and noninvasive, and melanoma-focused early detection initiatives exist. However, most skin cancers are nonmelanoma, and total-body examination screening in asymptomatic persons has not been proven cost-effective. In this population-based cross-sectional screening study, Hoorens et al demonstrate that total-body skin examinations yielded a higher absolute number of skin cancers, while lesion-directed screening (LDS) had a similar detection rate but was 5.6 times less time consuming. When performed by dermatologists, LDS is an acceptable screening method.
Continuing Medical Education
Laboratory Monitoring During Isotretinoin Therapy for Acne
Although oral isotretinoin can be dramatically effective for treating severe nodulocystic acne, it has been associated with several adverse effects, including teratogenicity, hyperlipidemia and pancreatitis, leukopenia, thrombocytopenia, and transaminitis. Monitoring of pregnancy during therapy is mandated by iPLEDGE, but evidence-based estimates of laboratory changes during isotretinoin therapy in large patient samples are limited. In this meta-analysis, Lee et al demonstrate that isotretinoin is associated with few high-risk laboratory changes. A decrease in the frequency of laboratory monitoring could help decrease health care spending as well as anxiety-provoking phlebotomy.
Vitiligo and Melanoma Response to Pembrolizumab
Vitiligo is an autoimmune skin disorder characterized by hypopigmented skin lesions, originating from immune-mediated loss of functional epidermal melanocytes. The association of vitiligo with tumor response in patients with melanoma who undergo immunotherapy has been reported but is still controversial. In this prospective observational study, Hua et al demonstrate that vitiligo was a clinically visible immune-related adverse event associated with clinical benefit in the context of pembrolizumab treatment. Improved understanding of immunity against melanocytes in melanoma, which clinically manifest as vitiligo, may contribute to the identification of novel immunotherapy targets.
Safety and Efficacy of Anakinra in Hidradenitis Suppurativa
Hidradenitis suppurativa (HS) is a chronic inflammatory disorder of skin areas rich in apocrine glands. Autoinflammatory mechanisms have been implicated in the origin of HS, and tumor necrosis factor antagonists have a demonstrated positive therapeutic result. Anakinra is a recombinant interleukin 1 (IL-1) receptor antagonist that blocks the biological activity of naturally occurring IL-1, a major mediator of the inflammatory response. In this double-blind, randomized, placebo controlled pilot study, Tzanetakou et al demonstrate that a 12-week course of daily subcutaneous anakinra was well-tolerated and has the potential to be an effective HS treatment.
Psoriasis and the Risk of Depression
The risk of depression and suicidal ideation is higher among patients with psoriasis, highlighting the substantial psychological impact of this chronic systemic disease. A history of cardiovascular disease may confound this relationship. In this population-based study, Cohen et al demonstrate that a self-reported history of psoriasis was independently associated with major depression, even when comorbidities such as cardiovascular disease were controlled for. The severity of psoriasis was unrelated to the risk of depression, suggesting that all patients with psoriasis may benefit from depression screening.
Highlights. JAMA Dermatol. 2016;152(1):3. doi:10.1001/jamadermatol.2015.3226
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