Guidance Released on the Management of Cutaneous Lymphoma During the Pandemic
Risk factors that have been identified for severe disease from SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) include older age and immunosuppressive conditions such as cancer. Patients with primary cutaneous lymphoma tend to be older and are on long-term immunosuppressant medications to maintain disease control.
To ensure patients receive the best of care during the coronavirus disease (COVID-19) pandemic, the United States Lymphoma Consortium released guidelines for treating patients with primary cutaneous lymphoma. “We must dynamically adjust treatment plans to provide optimal care for our lymphoma patients while protecting them from COVID-19 complications,” the authors said.
They recommend the use of telemedicine visits to avoid unnecessary exposure, except for patients who require in-person evaluation and/or therapy. To help clinicians determine the best options for patients, the authors stratified types of cutaneous lymphoma and therapies by low, intermediate or high risk. Recommendations for these groups are outlined in the eTable below.
The risk of travel and exposure likely outweight the benefits of in-office treatments, such as ultraviolet light therapy and total body electron beam radiation therapy, the authors noted. In addition, they recommend the least frequent laboratory monitoring possible to limit exposure during travel while ensuring patients’ safety.
The authors strongly discourage the use of allogeneic stem cell transplant and treatment with combination chemotherapy, alemtuzumab, or fludarabine due to the fact that they often lead to significant cytopenias, which are known risk factors for COVID-19 complications. They recommend alternative lower risk therapies whenever possible for patients.
Reference
Zic JA, Ai W, Akilov OE, et al. United States Cutaneous Lymphoma Consortium recommendations for treatment of cutaneous lymphomas during the COVID-19 pandemic. J Am Acad Dermatol. Published online April 16, 2020. doi:10.1016/j.jaad.2020.04.049
The Skin Cancer Foundation Awards Research Grants
The Skin Cancer Foundation awarded a combined total of $125,000 in grants to three studies on skin cancer. The 2020 grant recipients include Matthew Hangauer, PhD, of the University of California San Diego, who received the Ashley Trenner Research Grant Award for the study of “Targeting Immunotherapy-tolerant Melanoma Persister Cells”; Lee E. Wheless, MD, PhD, of Vanderbilt University, who received the Dr Marcia Robbins-Wilf Research Grant Award for the study “Using Bioinformatics to Stratify Skin Cancer Risk in Organ Transplant Recipients”; and Vishal Patel, MD, of George Washington University, who received the Todd Nagel Memorial Research Grant Award for the study “Delphi Consensus Determination of a Tumor Stage Based Approach to High-risk Cutaneous Squamous Cell Carcinoma.”
In 2020, The Skin Cancer Foundation’s Research Grants program received 41 applications from 26 institutions. Applicants included dermatology residents, fellows, and young faculty, and proposals are for 1-year clinical studies on new ideas and technologies across the spectrum of cutaneous malignancy, including melanoma, basal cell carcinoma, squamous cell carcinoma, atypical moles, actinic keratosis, and rarer skin cancers.
Logo courtesy of The Skin Cancer Foundation.
Reference
The Skin Cancer Foundation awards $125,000 in research grants. The Skin Cancer Foundation. May 6, 2020. Accessed May 6, 2020. https://www.skincancer.org/press/2020-the-skin-cancer-foundation-awards-125000-in-research-grants/
Minority Populations Less Aware of Melanoma
The Hispanic population is the fastest growing group in the United States. However, previous research has shown that Hispanics are at a greater risk of late-stage diagnosis, increased tumor thickness, and decreased survival rates than white counterparts. A recent study published online in the Journal of the American Academy of Dermatology found that minorities were less likely to know what melanoma is compared with white participants.
A cross-sectional survey was conducted among 285 participants from May to November 2017. The survey collected information on participant knowledge and awareness of melanoma.
Upon analyzing the survey results, approximately 39% of all participants were unaware of melanoma. However, 65% of participants were able to successfully identify early signs of disease development.
Further, approximately 86% of Fitzpatrick skin types I and II identified melanoma as a cancer, whereas only approximately 46% of phototypes III and IV and 58% of phototypes V and VI were able to identify melanoma as malignancy. In particular, Hispanic participants were less likely to know the meaning of melanoma than participants who identified as Caucasian, US natives, or who indicated any college education.
The study authors concluded that minorities would greatly benefit from educational programs regarding melanoma, especially considering their higher rates of severe malignancy. Education should be geared towards early detection, they added.
Reference
Sanchez DP, Maymone MBC, McLean EO, et al. Racial and ethnic disparities in melanoma awareness: a cross-sectional survey. J Am Acad Dermatol. Published online May 4, 2020. doi:10.1016/j.jaad.2020.04.137
Childhood BMI Significantly Associated with HS Risk
Risk factors related to body weight at birth and throughout childhood regarding the development of hidradenitis suppurativa (HS) lack evidence in the literature. A research group found that childhood body mass index (BMI) was positively and significantly associated with the development of HS in adulthood, as published in JAMA Dermatology.
The cohort study set out to investigate the association of birth weight, childhood BMI, change in BMI during childhood, and childhood height in a Danish population. The cohort population included 347,200 schoolchildren born between 1930 to 1996 from the Copenhagen School Health Records Register who were linked to the Danish National Patient Register of hospital discharge diagnoses in order to identify cases of HS. Among patient factors, birth weight was reported by parents or guardians whereas childhood weight and height were as measured by school physicians or nurses at ages 7 through 13 years. The follow-up period for adulthood follow-up was from 1977 to 2017.
Among the included population, 1037 individuals received a diagnosis of HS; of this subgroup, 677 were females at a median age at diagnosis of 39 years (range, 15-73 years). When birth weight and HS diagnosis was analyzed, a nonlinear association was demonstrated, noting that the lightest (2.00-2.75kg; hazard ratio [HR], 1.36; 95% CI, 1.10-1.68) and the heaviest (4.26-5.50kg; HR, 1.39; 95% CI, 1.01-1.93) babies had an increased risk of HS vs babies born at weights between 3.26 kg to 3.75 kg (P=.04). A significantly increased risk of HS was also noted in children who were at a normal weight age 7 years and then overweight at age 13 years as well as in children with persistent overweight at both ages.
Interestingly, children who were overweight at age 7 years but who were in the normal weight range at age 13 years did not have a significantly increased risk of HS (HR, 1.05 [95% CI, 0.67-1.67]). Childhood height was not found to be associated with risk of HS for all ages.
The authors concluded that returning to a normal weight before puberty reduces risks of HS to levels observed in children who were never overweight.
Reference
Jørgensen AHR, Aarestrup J, Baker JL, Rhomsen SF. Association of birth weight, childhood body mass index, and height with risk of hidradenitis suppurativa. JAMA Dermatol. Published online April 29, 2020. doi:10.1001/jamadermatol.2020.1047
