Need-to-know updates featured in articles, news briefs, podcasts, and videos keep everyone in the dermatology community in the vanguard of the effort to put a cure for melanoma within reach.

Melanoma Awareness Month

This online, on-demand virtual symposium brings together renowned experts in dermatology to discuss newer treatments for patients with psoriasis.

Maui Derm Tyk2 Psoriasis Archived Webcast

Patients with this rare and severe skin disorder may soon have a new therapeutic option.

Perspectives on Generalized Pustular Psoriasis

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Defining good standard of care related to managing and referring patients that require Mohs micrographic surgery, as well defining best practices during surgery, and improving communication with and working with other groups from the hospital, including oncology to manage patients with aggressive tumors, are just some of the areas that were covered during the American College of Mohs Surgery Annual Meeting held in Philadelphia recently.

Data that were presented at the meeting honed in on several of these issues, particularly referral practices related to Mohs micrographic surgery. One such piece of data was based on a survey of 2,007 US general dermatologists who are enrolled in the American Academy of Dermatology, of whom 402 responded.

Spyros M. Siscol, MD, who is a dermatology resident physician at the University of Kansas Medical Center and colleagues noted that the survey asked the dermatologists whether they had personal treated head and neck melanoma with excision, and if and when they referred patients with melanoma on the head and neck to a Mohs surgeon.

Of this group, 89 reported routinely treating head and neck melanoma with excision, and this group were less likely to refer to a surgeon. About 60% of the survey respondents “routinely referred head and neck lentigo maligna/melanoma in-situ” and 32% for invasive melanoma. Of those dermatologists who did not refer, lack of access to a Mohs surgeon was the most commonly cited reason.

“Improving access to local Mohs surgeons who treat melanomas with Mohs micrographic may limit the treatment of specialty site melanomas with wide local excision, thereby potentially minimizing recurrences and complication rates,” Siscos and colleagues concluded in their abstract.

Siscos SM, Neill BC, Bar A, Latour E, Tolkachjov S. Perceptions and practice habits of general dermatologists when considering Mohs surgery for treatment of melanoma on the head and neck: a nationwide cross-sectional survey. Presented at: 2022 American College of Mohs Surgery Annual Meeting; May 12-15, 2022, Philadelphia, Pennsylvania.

Articles

A survey asked dermatologists whether they had personal treated head and neck melanoma with excision, and if and when they referred patients with melanoma on the head and neck to a Mohs surgeon.

Access to Mohs Surgeon a Barrier to Referral

It is no secret the pivotal role that dermatologists play in educating their patients on preventing skin cancer, but data presented at the 2022 American College of Mohs Surgery Annual Meeting in Philadelphia serve as a good reminder that this education is important in all patients, regardless of age or gender.

Researchers from the University of Mississippi Medical Center reported on a set of 311 patients, most of whom were male and had an average age of 64, who had been diagnosed with keratinocyte carcinomas and their awareness and attitudes about sunscreen.

About two-fifths of the surveyed patients noted that they “never or rarely” apply sunscreen when in the sun for more than 15 minutes.

“Bivariate analysis showed a statistically significant negative correlation between age and sunscreen use (

 = .002),” the researchers noted, with women being more likely than men to using sunscreen.

noted some important counseling techniques for patients who may be reluctant to use sunscreen or have a different perspective on sun exposure; urging patience during counseling; understanding that different people with different professions may have different attitudes about sunscreen, for instance, lifeguards who enjoy being outside and may not be as concerned about the dangers of sun exposure than a person in another profession; and encouraging physicians to counsel patients about what sunscreen protection actually is, noting that patients may not be aware of the risk of melanoma on skin normally covered by clothing or hair.

The good news, from both that study and the data at the conference, is that dermatologists can make a difference.

“Increasing number of visits with a dermatologist or dermatologic surgeon was associated with higher use of sunscreen (

 = 0.011),” the University of Mississippi researchers noted in their abstract. “After controlling for relevant covariates, results of regression analysis showed that sunscreen knowledge (

 < .001) and positive attitudes towards sunscreen (

 < .001) were statistically significant predictors of sunscreen use and accounted for 20% of the variance in this health behavior.”

Pearlman R, Black W, Davis RE, et al. Sunscreen awareness, attitudes, and practices in patients with a history of keratinocyte carcinoma: A single-institution survey study. Abstract presented at 2022 American College of Mohs Surgery Annual Meeting, held May 12-15, 2022, in Philadelphia, Pennsylvania.

2. Keurentjes AJ, Kezic S, Rustemeyer T, Hulshof CTJ, van der Molen HF. Stimulating sunscreen use among outdoor construction workers: a pilot study. 

. 2022;10:857553. Published 2022 Apr 1. doi:10.3389/fpubh.2022.857553

Data from one study showed younger women more likely to use sunscreen than older adults. 

Sunscreen Education Needed for All Ages 

Patients with multiple myeloma (MM) may be more likely to develop melanoma than the general population, according to a poster presented at 2022 American College of Mohs Surgery Annual Meeting. They also may face a higher overall but not melanomas-specific mortality rate, the findings showed.

These results were based on an analysis of publicly available data from the Surveillance, Epidemiology, and End Results (SEER) 18 Registries, November 2020 submission. The study assessed data on 79,174 patients with MM, 261 of whom developed at least 1 melanoma.

Factors the researchers examined in this cohort of 177 men and 84 women included: sex, age at MM diagnosis, race, Hispanic origin, household income, urban versus rural geographic location, anatomic location of the tumor(s), Breslow thickness, all-cause mortality, melanoma-specific mortality, and survival duration.

The summary of that examination featured in the poster showed:

1. Melanoma incidence was higher in patients in the following categories:

12-119 months post-M/M diagnosis (P< .02)

Most races (P 0.001 for White, Black, and non-Hispanic patients)

Household income of $75.000 or greater (Observed/expected (O/E) ratio=1.51; P < .001)

Metropolitan counties (O/E=1.29: P< .001).

2. Melanoma patients with MM vs all melanomas demonstrated:

Thicker tumors, with 23.5% of Breslow depth >1 mm vs 16.2% (P< .001).

Independent predictors of melanoma-specific mortality including age of 80 years or older, White race, and tumors with Breslow depth >1 mm.

Increased all-cause mortality/shorter overall survival time (P< .001), but not melanoma-specific mortality.

A trend towards shorter overall survival (12.5 vs 32.9 months (P= .16).

Using this data, the authors concluded that, “Compared with the general population, patients with MM appear to demonstrate a higher incidence of melanoma and overall mortality.”

They also identified some other highlights. “Incidence trends were significant in female patients, White and Black race, non-Hispanic patients, patients with household incomes of $75,000 or more annually, and patients from metropolitan areas,” the authors wrote. Evaluated against all melanoma patients, those with MM were more likely to develop more melanomas on their trunks/extremities and to have thicker melanomas.

“The link between melanoma and chronic lymphocytic leukemia and lymphomas had been previously reported, but little was known about the prevalence and characteristics of melanoma in multiple myeloma,” noted the authors. “Our study sought to better understand the diagnosis of melanoma among patients with multiple myeloma.”

Singh P, Tomtschik J, Ibrahim S. Incidence and prognosis of melanoma in patients with multiple myeloma. Poster presented at 2022 American College of Mohs Surgery Annual Meeting, held May 12-15, 2022, in Philadelphia, Pennsylvania.

A poster presented at the 2022 American College of Mohs Surgery Annual Meeting not only suggested a link between multiple myeloma and a heightened rate of melanoma, but also demonstrated potential for higher overall mortality rates. 

Multiple Myeloma May Increase Incidence of Melanoma 

and joined the MJH Life Sciences team in April 2021. She graduated from Kent State University in 2018 with a bachelor's degree in journalism and a minor in sociology. Linda used to work as a creative writer for 

 and was a technical writer/regulatory specialist/purchasing agent at GM Industrial before coming on to the team. She enjoys reading, traveling, and learning new perspectives. You can reach her at 

The FDA issued a Complete Response Letter (CRL) to UCB regarding its Biologics License Application (BLA) for bimekizumab (Bimzelx, UCB), a potential treatment of adults with moderate to severe plaque psoriasis.

In the letter, the FDA states it cannot approve the BLA in its current form. Certain pre-approval inspection observations made during the approval process need resolved before going forward, according to the press release. “We are cooperating with the FDA and are working to address these observations as expeditiously as possible,” UCB stated.

This comes after the FDA’s approval of the biologic was delayed in 2021. The interleukin (IL)-17 inhibitor for plaque psoriasis and psoriatic arthritis blocks IL-17 A and IL-17 F cytokines.

Update on US FDA review of biologics license application (BLA) for bimekizumab | UCB. Accessed May 16, 2022. https://www.ucb.com/stories-media/Press-Releases/article/Update-on-US-FDA-Review-of-Biologics-License-Application-BLA-for-bimekizumab-0

UCB announced the FDA issued a CRL that stated that the FDA cannot approve the BLA in its current form.

Bimekizumab Fails FDA Pre-Approval Inspection

Dustin Portela, DO, a board-certified dermatologist and dermatologic surgeon at Treasure Valley Dermatology in Boise, Idaho.

Dustin Portela, DO, a board-certified dermatologist and dermatologic surgeon at Treasure Valley Dermatology in Boise, Idaho, posted his lasted podcast episode. View the episode below:

Opinions expressed are that of Portela and do not express the views or opinions of Dermatology Times®.

Videos

In this week’s Pointers with Dr Portela, the 208SkinDoc hosts a podcast called, “Between Two Derms.” This week he covers cases in the clinic, psoriasis at the Met Gala and more. 

Pointers with Dr Portela: Between Two Derms Podcast

Ilya Petrou, MD, is a contributing writer for 

New study findings show that patients with chronic inflammatory skin diseases including psoriasis, atopic dermatitis (AD), alopecia areata (AA), vitiligo, an,hidradenitis suppurativa (HS) do not have an increased risk of venous thromboembolism (VTE) compared to healthy individuals without these dermatologic diseases. This data is important for dermatologists who are assessing treating patients with systemic immunomodulatory agents  known to modulate VTE such as corticosteroids as well as the newly FDA-approved Janus kinase (JAK) inhibitors.

Clincians should be aware that VTE is a common and potentially serious risk  in patients with chronic inflammatory diseases such as rheumatoid arthritis (RA) and inflammatory bowel disease (IBD), both of which have increased inherent risk for developing VTE in these patient populations. 

However, data on the risk of VTE in patients with chronic inflammatory skin diseases are mixed. Establishing a robust estimate of the background VTE risk in this patient population is critical to the treatment and management plans with new system immunomodulatory medications such as the JAK inhibitors. 

“For a long time, it has been thought that patients with RA and IBD have a higher inflammatory burden than patients with chronic inflammatory skin diseases. As such, patients with dermatologic conditions may not have the same baseline increased risk and therefore may not have the same increased risk for TVE compared to these patients who have this higher inflammatory burden from their IBD and RA disease,” said Maria Schneeweiss, MD. 

She is an instructor in medicine, Division of Pharmacoepidemiology and Pharmacoeconomics in the Department of Medicine at Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, and lead author of the study.

Schneeweiss and fellow colleagues recently conducted a study to assess the risk of VTE in patients with and without chronic inflammatory skin disease, evaluating patients from a US healthcare database (Optum’s deidentified Clinformatics Data Mart Database) from 2004-2019.

A total of 158,123 patients with dermatologist-recorded psoriasis (n=96,138), AA (n=17,889), AD (n=30,418), vitiligo (n=7,735), or HS (n=5,934), and 9 patients having two of these conditions, were identified and compared to a healthy control cohort of 1,570,387 patients without a chronic inflammatory skin disease. The incidence rate (per 1000 person-years) of outpatient or inpatient VTE for AD, HS, psoriasis, AA, and vitiligo was 1.83, 1.65, 1.57, 0.94, and 0.93, respectively. 

Results showed the incidence rate to be 1.53 in chronic inflammatory skin disease overall, compared to 1.76 in patients without a chronic inflammatory skin disease.

Knowing the background risk and rate of VTE in the specific dermatologic conditions being looked at can indicate early if a VTE signal is seen among patients who are using these new systemic immunomodulatory drugs like the JAK inhibitors. According to Schneeweiss, this allows clinicians to contextualize and discern whether it is due to the medication or the inherent increased risk attributable to the skin disease.

“In RA, we know that studies have been done showing that RA patients have a baseline increased risk of VTE. We did not find that in the dermatologic conditions studied. That will help us to contextualize if we see a signal with the JAK inhibitors, which may prove important to optimal treatment planning,” Schneeweiss said. 

That's especially noteworthy as an increasing number of new systemic immunomodulatory agents for the treatment of dermatologic conditions, including JAK inhibitors for AD, AA, and vitiligo, will likely be marketed in the near future. 

Many patients may also have overlapping dermatologic conditions or also have some other chronic inflammatory diseases, such as IBD and psoriasis.

Although the study revealed no risk inherent to the chronic inflammatory skin diseases, VTE remains a very important potential adverse event to be monitored going forward. There are many different factors to be considered when contemplating ideal therapy and, according to Schneeweiss, the treatment regimen must be specific to the individual patient's case.

“When looking at potential systemic immunomodulatory therapies, including the JAK inhibitors, going forward, I think the treatment and management will be very specific to the patient," said Schneeweiss. "It will be a discussion between the patient and the provider, putting into context other risks that we know may raise the risk of VTE. However, when factoring the chronic inflammatory skin conditions into that equation, the risk for VTE does not appear to be high."

Schneeweiss reported no relevant conflicts of interest.

1. Schneeweiss MC, Kim SC, Wyss R, Jin Y, et al. Incidence of venous thromboembolism in patients with dermatologist-diagnosed chronic inflammatory skin diseases. 

.2021 Jul 1;157(7):805-816. doi: 10.1001/jamadermatol.2021.1570.

Patients with chronic inflammatory skin diseases do not have an increased risk of venous thromboembolism (VTE) compared to a matched healthy control cohort. This knowledge can be useful to clinicians when contemplating systemic immunomodulatory therapies in their dermatologic patients. 

Refocusing on Venous Thromboembolism and Chronic Inflammatory Skin Diseases 

Podcasts

In this episode, the topics up for discussion include possible technologies to help atopic dermatitis patient adherence with treatment along with new strategies to improve patient experiences at the practice. 

The Cutaneous Connection: Adherence to Atopic Dermatitis Treatment

While only 5% of older adults lacked prescription drug coverage in 2021 – down from 32% in 1998 – 20% reported financial hardship from prescription drug purchases, according to a 

, requiring multiple daily medications, and reporting a low annual household income 

 the most. Even those with insurance from lower income households still struggled when needing multiple daily medications.

The researchers said that among older adults in the United States, policies that reduce the out-of-pocket 

 for prescription drugs appeared to reduce the burden of these expenditures, and suggest that managed care policymakers should consider policies that reduce out-of-pocket costs for older adults in an effort to promote medication access. Such policies may enable older adults to reallocate funds for vital expenses like food and shelter, especially for older adults from vulnerable populations.

The report states that the inability to pay for prescription drugs is an important determinant of medication adherence that may lead patients to ration or split doses, delay refills or new prescriptions, and even stop taking medications altogether. Cost-related nonadherence compromises the therapeutic effectiveness in managing most chronic diseases, persists even when patients cut back on basic health-related social needs, and consequently leads to higher preventable health care expenditures.

The data were from four nationally distributed, cross-sectional surveys of older adults to track coverage for and financial hardship from purchasing prescription drugs.

This was orginally posted on Medical Economics. 

Lower household income and requiring multiple medications play large roles.

Many older adults can’t afford prescription drug insurance

Artificial intelligence is being incorporated into many areas of life, and health care is no exception. But what do patients think about AI intruding into their diagnosis and treatment?

A patient survey reveals that 66% considered 

 playing a big role in their diagnosis or treatment thought it was very important, with 29.8% rating AI use as somewhat important.

However, not everyone was comfortable with 

 playing a big part in their health care. Of those surveyed, 31% said AI usage made them very uncomfortable and another 40.5% were somewhat uncomfortable receivinga diagnosis from an AI algorithm that was accurate 90% of the time but incapable of explaining its rationale.

Overall, most patients believe aI would make health care much better (10.9%) or somewhat better (44.5%) comparted to 4.3% who thought it would make it somewhat worse or much worse (1.9%). The remaining 19% did not know one way or the other.

For respondents who answered “don’t know” 59.7% of them wanted to be told when AI played a small role in their diagnosis or treatment, and were very uncomfortable with receiving an AI diagnosis that was accurate 98% of the time but could not be explained.

Comfort level varied depending on which application AI was being applied to. For example, 55% were either very or somewhat comfortable with AI reading chest radiographs, but that number dropped to 31.2% when the task was making a cancer diagnosis.

Most respondents were concerned about misdiagnosis (91.5%), privacy breaches (70.8%), less time with clinicians (69.6%) and higher costs (68.4%). Respondents who identified as racial or ethnic minorities ranked these issues higher than white respondents.

The researchers recommended that clinicians, policy makers, and developers should be aware of patients’ views regarding AI. Education for patients on how AI is being incorporated into care and the extent to which clinicians rely on AI to assist with decision-making may be necessary.

This was originally posted on Medical Economics. 

Many patients worry about privacy and accuracy.

Pointers with Dr Portela: Between Two Derms Podcast

Refocusing on Venous Thromboembolism and Chronic Inflammatory Skin Diseases

The Cutaneous Connection: Adherence to Atopic Dermatitis Treatment

Many older adults can’t afford prescription drug insurance

Majority of patients OK with artificial intelligence helping with diagnosis or treatment options

Perspectives on Generalized Pustular Psoriasis