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[PMID]: 29524770
[Au] Autor:Bakonyi M; Gácsi A; Kovács A; Szucs MB; Berkó S; Csányi E
[Ad] Address:Institute of Pharmaceutical Technology and Regulatory Affairs, University of Szeged, Szeged, H-6720, Hungary.
[Ti] Title:Following-up skin penetration of lidocaine from different vehicles by Raman spectroscopic mapping.
[So] Source:J Pharm Biomed Anal;154:1-6, 2018 Mar 06.
[Is] ISSN:1873-264X
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:The application of local anesthetics, usually administered by subcutaneous injection, is common in the course of diagnostic, therapeutic, and cosmetic dermatology procedures. The effective dermal delivery of lidocaine could offer a solution to many adverse effects caused by needle insertion, such as pain, local reactions or toxicity, and additionally, it avoids the disruption of anatomical landmarks. Therefore, novel dermal formulations of local anesthetics are needed to overcome the barrier function of the skin and provide sufficient and prolonged anesthesia. In our study, we aimed to investigate and compare the penetration profiles of four different lidocaine containing formulations (hydrogel, oleogel, lyotropic liquid crystal and nanostructured lipid carrier) by Raman microscopic mapping of the drug. The application of Raman spectroscopy provided information about the spatial distribution of lidocaine in the skin ex vivo. The penetration of lidocaine from lyotropic liquid crystal and nanostructured carrier reached deeper skin layers and a higher amount of the drug was diffused into the skin, compared with hydrogel and oleogel. This study confirmed that nanostructured carriers can improve skin penetration properties of lidocaine and proved the applicability of Raman spectroscopy in the research of dermatological preparations ex vivo as a nondestructive, relatively easy and fast technique.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:Publisher

  2 / 179893 MEDLINE  
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[PMID]: 29524584
[Au] Autor:Elder DE; Piepkorn M; Barnhill RL; Longton GM; Nelson HD; Knezevich SR; Pepe MS; Carney PA; Titus LJ; Onega T; Tosteson ANA; Weinstock MA; Elmore JG
[Ad] Address:Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
[Ti] Title:Pathologist Characteristics Associated with Accuracy and Reproducibility of Melanocytic Skin Lesion Interpretation.
[So] Source:J Am Acad Dermatol;, 2018 Mar 07.
[Is] ISSN:1097-6787
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Diagnostic interpretations of melanocytic skin lesions vary widely among pathologists, yet the underlying reasons remain unclear. OBJECTIVE: Identify pathologist characteristics associated with rates of accuracy and reproducibility. METHODS: Pathologists independently interpreted the same set of biopsies of melanocytic lesions on two occasions. Diagnoses were categorized into one of five classes according to the MPATH-Dx system. Reproducibility was determined by pathologists' concordance of diagnoses across two occasions. Accuracy was defined by concordance with a consensus reference standard. Associations of pathologist characteristics with reproducibility and accuracy were assessed individually and in multivariable logistic regression models. RESULTS: Rates of diagnostic reproducibility and accuracy were highest among pathologists with board certification and/or fellowship training in dermatopathology, and those with ≥5 years of experience. In addition, accuracy was high among pathologists with higher caseload composition and volume of melanocytic lesions. LIMITATIONS: Data gathered in a test set situation using a classification tool not currently in clinical use. CONCLUSION: Diagnoses are more accurate among pathologists with specialty training and those with more experience interpreting melanocytic lesions. These findings support the practice of referring difficult cases to more experienced pathologists to improve diagnostic accuracy, although the impact on patient outcomes of these referrals requires additional research.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:Publisher

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[PMID]: 29524583
[Au] Autor:Chen L; Parsons AM; Aria AB; Ciurea AM; Patel AB; Chan C; Griffin JR; Nguyen TH; Migden MR
[Ad] Address:Department of Dermatology, The University of Texas McGovern Medical School at Houston, Houston, Texas.
[Ti] Title:Surgical Site Identification with Personal Digital Device: A Prospective Pilot Study.
[So] Source:J Am Acad Dermatol;, 2018 Mar 07.
[Is] ISSN:1097-6787
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Various means to facilitate accurate biopsy site identification have been proposed. OBJECTIVE: To determine the accuracy of biopsy site identification using photos taken with a patient's digital device by a dermatologist versus professional medical photography. METHODS: Photographs of circled biopsy sites were taken with personal digital devices by the principal investigator (PI). Another set of photographs were taken by a professional photographer. Secondary photographs were taken of the biopsy site location pointed to by the staff and PI based on the personal digital device image and professional medical photography, respectively. Based on secondary photographs, two independent dermatologists determined if the skin biopsy locations pointed out by the staff were consistent with the ones pointed out by PI. RESULTS: Per Dermatologist A, the staff correctly identified all 53/53 biopsy sites. Per Dermatologist B, the staff were correct on 51/53 observations. Dermatologist C, the final arbiter, concurred with Dermatologist A in the two cases that Dermatologist B was not certain of the biopsy site location. LIMITATIONS: The mean interval from initial biopsy to re-identification of the site was 36.2 days. CONCLUSION: Utilizing patients' personal digital devices is a cost-effective, HIPAA compliant, and readily available means to identify skin biopsy sites.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:Publisher

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[PMID]: 29524457
[Au] Autor:Pandeya N; Kvaskoff M; Olsen CM; Green AC; Perry S; Baxter C; Davis MB; Mortimore R; Westacott L; Wood D; Triscott J; Williamson R; Whiteman DC
[Ad] Address:Population Health Department, QIMR Berghofer Medical Research Institute, Herston, QLD 4006, Australia; School of Public Health, The University of Queensland, Herston, QLD 4006, Australia.
[Ti] Title:Factors related to nevus-associated cutaneous melanoma: a case-case study.
[So] Source:J Invest Dermatol;, 2018 Mar 07.
[Is] ISSN:1523-1747
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:A proportion of cutaneous melanomas display neval remnants on histologic examination. Converging lines of epidemiologic and molecular evidence suggest that melanomas arising from nevus precursors differ from melanomas arising de novo. In a large, population-based study comprising 636 cutaneous melanomas subjected to dermatopathology review, we explored the molecular, host and environmental factors associated with the presence of neval remnants. We found nevus-associated melanomas were significantly associated with younger age at presentation, non-brown eye color, trunk site, thickness <0.5mm and BRAF mutation. Compared with patients with de novo melanomas, those with nevus-associated tumors were more likely to self-report many moles on their skin as a teenager (OR 1.94, 95% CI 1.01-3.72) but less likely to report many facial freckles (OR 0.49, 95% CI 0.25-0.96). They also had high total nevus counts (OR 2.18, 95% CI 1.26-3.78). On histologic examination, nevus-associated melanomas exhibited less dermal elastosis in adjacent skin compared with de novo melanomas (OR 0.55, 95% CI 0.30-1.01). These epidemiologic data accord with the emerging molecular paradigm that nevus-associated melanomas arise through a distinct sequence of causal events which differ from those leading to other cutaneous melanomas.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:Publisher

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[PMID]: 29380438
[Au] Autor:Bhattacharya S; Duverger O; Brooks SR; Morasso MI
[Ad] Address:Laboratory of Skin Biology, National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, MD, USA.
[Ti] Title:Homeobox transcription factor DLX4 is not necessary for skin development and homeostasis.
[So] Source:Exp Dermatol;27(3):289-292, 2018 Mar.
[Is] ISSN:1600-0625
[Cp] Country of publication:Denmark
[La] Language:eng
[Ab] Abstract:Dlx4 is a member of a family of homeobox genes with homology to Drosophila distal-less (dll) gene. We show that Dlx4 expression pattern partially overlaps with its cis-linked gene Dlx3 during mouse development as well as in neonatal and adult skin. In mice, Dlx4 is expressed in the branchial arches, embryonic limbs, digits, nose, hair follicle and in the basal and suprabasal layers of mouse interfollicular epidermis. We show that inactivation of Dlx4 in mice did not result in any overtly gross pathology. Skin development, homeostasis and response to TPA treatment were similar in mice with loss of Dlx4 compared to wild-type counterparts.
[Pt] Publication type:LETTER
[Em] Entry month:1801
[Cu] Class update date: 180311
[Lr] Last revision date:180311
[St] Status:In-Data-Review
[do] DOI:10.1111/exd.13503

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[PMID]: 29340955
[Au] Autor:Szolnoky G; Altmayer A; Varga J; Gavallér H; Kemény L; Forster T; Nemes A
[Ad] Address:Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary. szolnokygyozo@gmail.com.
[Ti] Title:Adult Atopic Dermatitis is Associated with Increased Aortic Stiffness.
[So] Source:Am J Clin Dermatol;19(1):135-137, 2018 02.
[Is] ISSN:1179-1888
[Cp] Country of publication:New Zealand
[La] Language:eng
[Pt] Publication type:LETTER; COMMENT
[Em] Entry month:1801
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:In-Process
[do] DOI:10.1007/s40257-018-0344-y

  7 / 179893 MEDLINE  
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[PMID]: 29238799
[Au] Autor:Friedman BJ; Stoner R; Sahu J; Lee JB
[Ad] Address:Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania.
[Ti] Title:Association of Clinical, Dermoscopic, and Histopathologic Findings With Gene Expression in Patients With Balloon Cell Melanoma.
[So] Source:JAMA Dermatol;154(1):77-81, 2018 Jan 01.
[Is] ISSN:2168-6084
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Importance: Balloon cell melanoma is a rare subtype of melanoma that is underrecognized clinically and is challenging to diagnose on histologic studies. Objective: To further characterize the clinical, dermoscopic, and histopathologic features of balloon cell melanomas and their correlation to gene expression. Design, Setting, and Participants: Case series of 2 patients with balloon cell melanoma whose medical records were retrieved from the database of Thomas Jefferson University Dermatopathology Center in Philadelphia, Pennsylvania. Both cases had been referred to the institution's dermatopathology laboratory and provided complete data on clinical, dermoscopic, and histopathologic findings and gene-expression profiles. Main Outcomes and Measures: Dermoscopic findings, histopathologic findings, and results of gene expression tests. Results: In the 2 patients included, translucent hypopigmented areas on gross examination and a translucent white-gray veil and dull yellow globules on dermoscopic examination correlated with the balloon cell melanocytic region demonstrated on histologic studies with hematoxylin-eosin stain. Specifically, dull yellow globules corresponded to the balloon cell melanocytic nests. Both lesions presented with a second, morphologically distinct population of melanocytes, common in balloon cell melanocytic neoplasms. In both cases, a prominent junctional component that consisted of cells demonstrating ample clear-to-granular cytoplasm and a central nucleus were present. Cytologic atypia was minimal to lacking in both cases, and architectural disorder served as a better clue to the diagnosis. Findings of a gene expression profiling test corroborated the diagnosis in both cases. Conclusions and Relevance: Balloon cell melanomas may present with characteristic clinical and dermoscopic findings, and a gene expression profiling test may provide additional useful diagnostic information in cases that are difficult to interpret.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180311
[Lr] Last revision date:180311
[St] Status:In-Data-Review
[do] DOI:10.1001/jamadermatol.2017.4700

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[PMID]: 29214290
[Au] Autor:Perier-Muzet M; Gatt E; Péron J; Falandry C; Amini-Adlé M; Thomas L; Dalle S; Boespflug A
[Ad] Address:Dermatology Unit, Lyon Sud University Hospital, Pierre Bénite, France.
[Ti] Title:Association of Immunotherapy With Overall Survival in Elderly Patients With Melanoma.
[So] Source:JAMA Dermatol;154(1):82-87, 2018 Jan 01.
[Is] ISSN:2168-6084
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Importance: Melanoma treatment has been revolutionized with the development of immune-based therapies that offer durable clinical responses in a subset of patients. Clinical outcomes after treatment by immunotherapy can be influenced by the host's immune system. The immune system is modified with age by age-related immune dysfunction. Objective: To evaluate if age influences clinical outcome and immune adverse events in patients treated by immunotherapy for metastatic melanoma. Design, Setting, and Participants: This was a single-center cohort analysis in patients treated with immunotherapy for metastatic melanoma between January 2007 and February 2016, in the Lyon Sud Hospital, France. A total of 92 patients with metastatic melanoma treated with ipilimumab, nivolumab, or pembrolizumab were retrospectively analyzed. Main Outcomes and Measures: Overall survival, progression-free survival, and immune-related adverse events were evaluated for each treatment line according to the patients' age. Results: A total of 92 patients were eligible and included in this study for a total of 120 lines of treatment. Fifty-four patients were included in the cohort that was 65 years or younger (24 [44%] were female; mean [SD] age, 48.1 [12.5] years), and 38 patients were included in the cohort that was older than 65 years (12 [34%] were female; mean [SD] age, 74.8 [6.9] years). Mean follow-up duration starting at treatment initiation was 12.5 months. Patients older than 65 years treated with immunotherapy had a better mean progression-free survival (4.8 vs 3.4 months; P = .04) and overall survival (not reached vs 10.1 months; P = .009) than younger patients in univariate analysis, and after adjusting on prognosis covariates. This was particularly true with patients treated with anti-programmed cell death protein 1. Common immune-related adverse effects were similar in both cohorts. Conclusions and Relevance: Age might be associated with a better clinical outcome after treatment with immunotherapy in the real-life setting. In our cohort, older patients did not have more immune-related adverse events. Further studies are warranted to confirm our results and describe the underlying mechanisms involved.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180311
[Lr] Last revision date:180311
[St] Status:In-Data-Review
[do] DOI:10.1001/jamadermatol.2017.4584

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[PMID]: 29188286
[Au] Autor:Tan SY; Tsoucas D; Mostaghimi A
[Ad] Address:Harvard Medical School, Boston, Massachusetts.
[Ti] Title:Association of Dermatologist Density With the Volume and Costs of Dermatology Procedures Among Medicare Beneficiaries.
[So] Source:JAMA Dermatol;154(1):73-76, 2018 Jan 01.
[Is] ISSN:2168-6084
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Importance: The persistent shortage of dermatologists in the United States affects access to care and patient outcomes. Objective: To characterize the effect of geographic variations in dermatologist density on the provision of dermatology procedures within Medicare. Design, Setting, and Participants: This was a cross-sectional study using the 2013 Medicare Provider Utilization and Payment Database. Dermatology-related procedures were defined by the top 50 billing codes accounting for more than 95% of procedures billed by dermatologists. Billing codes corresponding to evaluation and monitoring visits and dermatopathology were excluded. Total costs were estimated from the Centers for Medicare & Medicaid Services physician fee schedule, based on the nonfacility national payment amount with no modifiers. Nationally representative administrative database that includes 100% of charges billed by noninstitutional clinicians covered under Medicare Part B. A total of 10 391 dermatologists practicing within the 50 states and Washington, DC, were included. The Medicare-eligible population was defined as all persons 65 years or older. Exposures: Density of dermatologists, categorized into first (5.3 per 100 000 persons ≥65 years) through fifth (54.8 per 100 000 persons ≥65 years) quintiles. Main Outcomes and Measures: Utilization of dermatology procedures (mean volume per 100 000 persons ≥65 years) and total cost (mean amount billed per person ≥65 years) by clinician type across quintiles of dermatologist density. Results: In 2013, dermatologists billed Medicare for 28 million procedures costing $2.21 billion. Mean billed amount by dermatologists per person 65 years or older was $15.87 in the lowest-density quintile vs $92.02 in the highest-density quintile. This trend suggests that each interval increase of 10 dermatologists per 100 000 persons 65 years or older is correlated with a $14.81 increase in Medicare spending on dermatology procedures (95% CI, 8.28-21.34; P = .005). Utilization of these procedures differed among clinician types, with dermatologists largely performing destruction of premalignant lesions and PCPs primarily doing injections. Conclusions and Relevance: There is evidence of supply-sensitive variation in the provision of dermatology procedures for the Medicare-eligible population; higher dermatologist density is correlated with increased utilization of dermatology procedures and subsequent billed charges to Medicare. Further research is needed to determine the effect of such variations on outcomes and whether incentives can better align dermatologists with areas of clinical need.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180311
[Lr] Last revision date:180311
[St] Status:In-Data-Review
[do] DOI:10.1001/jamadermatol.2017.4546

  10 / 179893 MEDLINE  
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[PMID]: 29188268
[Au] Autor:Dieng M; Kasparian NA; Cust AE; Costa DSJ; Tran A; Butow PN; Menzies SW; Mann GJ; Morton RL
[Ad] Address:National Health and Medical Research Council (NHMRC) Clinical Trial Centre, The University of Sydney, Camperdown, Australia.
[Ti] Title:Sensitivity of Preference-Based Quality-of-Life Measures for Economic Evaluations in Early-Stage Melanoma.
[So] Source:JAMA Dermatol;154(1):52-59, 2018 Jan 01.
[Is] ISSN:2168-6084
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Importance: The diagnosis of a life-threatening disease like melanoma can affect all aspects of a person's life, including health-related quality of life (HRQOL) and psychological aspects of melanoma such as fear of cancer recurrence (FCR). Economic evaluations of psychological interventions require preference-based (utility) instruments that are sensitive to changes in well-being and HRQOL; however, very few studies have evaluated the sensitivity of these instruments when used for people with melanoma. Objective: To compare utility scores from the multiple-attribute instrument Assessment of Quality of Life-8-Dimension Scale (AQoL-8D) with the mapped utility scores of the Functional Assessment of Cancer Therapy-Melanoma (FACT-M) and to investigate the sensitivity of both instruments in identifying the influence of FCR on HRQOL. Design, Setting, and Participants: This assessment of data from a randomized clinical trial of a psychoeducational intervention to reduce FCR, conducted at 3 high-risk melanoma clinics in Australia, evaluated 164 patients with early-stage melanoma and a high risk of developing a second primary melanoma. Main Outcomes and Measures: The FACT-M and AQoL-8D were used to assess HRQOL and FCR among the study participants. Concurrent validity was assessed by comparing the total and subdomain scores of the 2 instruments, and the strength of associations was assessed using Pearson correlation coefficient. Convergent validity was assessed by comparing participants' HRQOL, demographic, and clinical characteristics using the χ2 test and F statistic. Both the FACT-M and AQoL-8D utilities were regressed on FCR Inventory (FCRI) severity scores to estimate the effect of elevated FCR on HRQOL. Results: A total of 164 participants completed the baseline questionnaires, but only 163 met all inclusion criteria and underwent the full analysis: 72 were women; 91 were men; and mean (SD) age was 58.2 (12.1) years. Both the AQoL-8D and FACT-M instruments showed good concurrent validity and could differentiate between relevant subgroups including level of FCRI severity. The AQoL-8D and FACT-M utilities were strongly correlated (r2 = 0.57). Respondents had a mean (SD) AQoL-8D utility of 0.77 (0.2), and a mean (SD) FACT-M utility score of 0.76 (0.07). High levels of FCRI severity were associated with a decrease in utility of 0.12 (95% CI, -0.19 to -0.05) as measured by AQoL-8D, and a decrease of 0.03 (95% CI, -0.05 to -0.01) as measured by the FACT-M. Conclusions and Relevance: For economic evaluations of psychological interventions in melanoma, the AQoL-8D and FACT-M are valid measures of utility; however, the AQoL-8D demonstrates greater sensitivity to FCRI severity. Our results suggest a significant association between FCR and HRQOL.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180311
[Lr] Last revision date:180311
[St] Status:In-Data-Review
[do] DOI:10.1001/jamadermatol.2017.4701


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