During his session, “What's New in Dermatologic Surgery,” presented at the 2022 Fall Clinical Dermatology Conference, Brett Coldiron, MD, went over the current and upcoming practices and treatments physicians should keep an eye out for.

He started by reiterating that Mohs micrographic surgery is still a highly effective initial treatment for high-risk facial basal cell carcinoma (BCC) because it could improve outcomes for incompletely excised and recurrent BCC.

“My hope,” Dr Coldiron shared, “is that the rest of the world may catch on and that this could be useful in convincing medical gate keepers.”

Next, he went on to compare curettage vs cryosurgery for superficial BCC by presenting a study published in the Journal of the European Academy of Dermatology and Venereology. The study found that the cryosurgery group presented no tumor recurrence compared with the curettage group, which had 5 tumors. Additionally, curettage wounds were shown to have shorter healing times whereas cosmesis was similar in both groups.

Dr Coldiron continued by discussing squamous cell carcinoma (SCC) with bone invasion using findings gathered from 76 cases in 49 publications. All findings showed that recurrent tumors and nonsurgical treatment modality were predictors of disease progression.

“In other words, we must cut the whole tumor out or the patients will do poorly,” he stated.

Dr Coldiron then reviewed a cohort study from Australia. In patients with invasive cutaneous melanoma, the influence of the time interval between diagnostic excision of a primary melanoma and sentinel node biopsy (SNB) on the sentinel node (SN) positivity rate and survival was assessed. No significant association between time to SNB and SN positivity was shown. Despite this, surgical oncologists argue that it is okay to carry melanoma until they can perform a wide excision and node biopsy. Yet, Dr Coldiron argued that it is a wonder about why there would be a need for wide excision at all.

He also briefly went over cutaneous leiomyosarcoma and its recurrence rate, noting several older studies have shown that Mohs surgery has the highest cure rate. Following this, Dr Coldiron shifted into a discussion on hospital operating rooms and their impact on climate change by arguing that they are wasteful. He suggested that it is important for physicians to move all procedures to their clinics where local anesthesia and reusable devices can reduce the footprint dramatically.

Next, Dr Coldiron addressed the role of human papillomavirus (HPV) infection in keratinocyte skin cancer development by sharing that 90% of actinic keratoses and cutaneous SCC associated dysplasia are in beta and gamma HPV families. He stated that although the Gardasil 9 vaccine is the default in the prevention of HPV, it only covers alpha HPV (genital, cervical, and head and neck SCC). Therefore, a beta, gamma HPV vaccine is needed.

Another topic Dr Coldiron touched upon was why melanoma is commonly underreported, listing the following commonly cited reasons:

• Time consuming

• No registrar at the office or dermatopathology laboratory

• Ignoring the problem (despite significant legal penalties)

He concluded by inviting his colleagues to take part in increasing melanoma reporting by collaborating with medical offices and volunteer initiatives. He shared that he is currently working to organize a statewide melanoma reporting hub in Cincinnati, OH, using a cloud-based fax site and University of Cincinnati registrar students to help. He argued that skin cancer surgeons in other states should do the same.

“This is because significant quality improvement will result in overwhelming support for sunscreen use and tanning bed restrictions,” he stated.

Reference
Coldiron B. What's new in dermatologic surgery. Presented at: Fall Clinical Dermatology Conference 2022; October 20–23, 2022; Las Vegas, NV.