Laser skin treatment in non-Caucasian patients

The demand for facial rejuvenation and cosmetic procedures is rising among all ethnicities and skin types. The authors present a review of lasers and how to select a laser based on skin type and the treatment goals of laser resurfacing: skin laxity, dyschromia, hair removal, keloid, and hypertrophic scarring. In addition, they discuss preprocedural and postprocedural considerations, potential complications, and their management to maximize patient outcomes and minimize risk.

Dermatology: how to manage rosacea in skin of colour

Rosacea is a common inflammatory skin disorder affecting the face. Common cutaneous symptoms include papules, pustules, persistent centrofacial erythema, telangiectasias, recurrent flushing, phymatous changes and a variety of ocular manifestations. Previous epidemiological studies have demonstrated that the incidence of rosacea is much lower in people with darker Fitzpatrick phototypes compared to fair-skinned individuals. In patients with darker skin, the centrofacial erythema can be masked and difficult to appreciate, impacting the ability for providers to make diagnoses and leading to misdiagnoses. Thus, it is difficult to say with certainty that the disparities in prevalence in rosacea amongst fair-skinned and darker individuals are true. The primary aim of this article is to raise awareness that rosacea is a global disease and to provide healthcare professionals with strategies to identify and manage rosacea amongst individuals with skin of colour.

Concomitant Squamous Cell Carcinoma and Mycosis Fungoides Within the Same Lesion: A Case Report and Literature Review

ABSTRACT

Concomitant squamous cell carcinoma (SCC) and mycosis fungoides (MF) within the same lesion are exceedingly rare, with only 3 cases previously reported. Cutaneous T-cell lymphoma (CTCL) predisposes patients to malignancies because of immune dysregulation, and treatments such as narrow-band ultraviolet-B phototherapy increase carcinogenic risk. We describe a 78-year-old man with stage IVA1 CTCL who presented with a scaly, painful tumor on his left temple. Biopsy revealed well-differentiated SCC with atypical lymphoid infiltrate consistent with MF, marked by immunohistochemical positivity for CD3, CD5, CD30, and a CD4:CD8 ratio of 50:1. Mohs surgery was performed, and histopathology analysis confirmed the coexistence of SCC and MF, with greater loss of CD7 expression in atypical lymphocytes. Concurrent SCC and MF demonstrate the need for vigilant surveillance for secondary cutaneous malignancies in patients with advanced CTCL. The case presented herein contributes to expand the reported literature and highlights the necessity of individualized management strategies optimized on an individual's Fitzpatrick skin type and unique risk factors.

Lack of Racial and Ethnic Diversity in Surgical Education, as Reflected by Skin Tone in General Surgery Textbooks

INTRODUCTION

Disparity in healthcare is an important and timely topic. One example of such disparity appears to be the disproportionate use of lighter skin tone illustrations in medical and surgical educational material.1 Visual representation of pathology in instructional material is one key element that informs decision making in surgical disease and could contribute to disparity in outcomes in underrepresented tonal groups. Our hypothesis is that visual examples (illustrations) of clinical pathology in major surgical texts are biased in that they are heavily weighted to Caucasian skin tones and therefore fail to accurately represent the racial distribution of patients in the United States population.

METHODS

Images from 4 commonly used general surgery textbooks were screened independently by 2 reviewers from Maimonides Medical Center and SUNY (State University of New York) Downstate College of Medicine. Human photographic and cartoon images (where skin tone could be determined), with adequate skin shown, were included. These images were assigned a Fitzpatrick skin photo type (FP) score (1-6). The distribution of images among the 6 FP categories were compared to the expected distribution of images in the United States population, as described from a previous National Health and Nutrition Examination Survey (NHANES). Differences in distribution were compared using a chi-squared test, with p-value <0.05 considered as statistically significant.

RESULTS

There were 556 total images deemed adequate for assessment from the 4 textbooks chosen. 169 from Sabiston, 61 from Mulholland and Greenfield, 177 from Schwartz, and 149 from ACS. About 539 of these images (96.9%) were depictions of patients with light skin tone (FP scores 1-3.) while less than 4% of images were of dark-skinned individuals (FP score between 4 and 6.) An FP score 1 accounted for most images, comprising 477 images (86.1%). There was a 1.8% analytical discrepancy noted between the textbook reviewers. The distribution on the general US population (NHANES) is: FP score 1: 1.6%, FP score 2: 33.1%, FP score 3: 47.8%, FP score 4: 4.9%, FP score 5: 3.6%, FP score 6: 9.0%.

CONCLUSIONS

Screening of commonly used general surgery textbooks showed a significant lack of diversity in image-based skin tone representation when compared to the United States population at large. The overwhelming majority of images were of light skin tones. Improving diversity of imagery in educational material, such as basic textbooks, might help reduce observed disparities in outcomes among surgical patients in the future.

Development of the selective micropulse individual retinal therapy depends on age and type on the Fitzpatrick scale

PURPOSE

To develop a selective micropulse individual retinal therapy (SMIRT) based on the age and appearance type of the patient, to derive a formula for calculating power, and evaluate clinical efficacy for the treatment of central serous chorioretinopathy (CSCR).

METHODS

73 patients (aged 30-65 years) with acute CSCR and types 1-4 on the Fitzpatrick scale were divided into 2 groups. In the first group (33 patients), the testing of the micropulse mode (50 µs, 2.4%, 10 ms, 100 µm, 0.4-1.9 W) on the Navilas 577 s laser system defined as selective by computer modeling was performed. A logistic regression function based on probability damage detection (PDD) of the 1584 laser spots from power, age, and type on the Fitzpatrick scale was constructed. PDD is the probability of detecting the laser spots using the autofluorescence method. The second group was divided into 4 subgroups of 10 eyes each. Groups 2.1, 2.2, and 2.3 were treated without preliminary testing. The power for Groups 2.1, 2.2, and 2.3 was obtained with the inverse PDD function, so that PDD was 50%, 70%, and 90%, respectively. Control group 2.4 went without treatment.

RESULTS

The transmission and absorption coefficients of laser radiation of the eye depend on the age and the Fitzpatrick scale type. In Groups 2.1-2.3, complete resorption of subretinal fluid was observed 3 months after CSCR treatment in 5 (P < 0.35), 8 (P < 0.023), and 10 eyes (P < 0.0008) out of 10, respectively.

CONCLUSION

The developed SMIRT is effective for CSCR treatment with PDD 90%.

Squamous cell carcinoma of the nail in patients with Fitzpatrick phototypes IV-VI: a systematic review

Squamous cell carcinoma of the nail unit (nSCC) is a rare malignant tumor of the hand and nail. Although skin cancer rarely affects individuals with phototypes IV-VI, its occurrence in these groups is often associated with greater morbidity and mortality. This study aims to characterize the clinical symptoms, presentations, and treatments of nSCC in patients with darker skin types. A systematic review of PubMed and Embase was performed in May 2023 for all peer-reviewed, English-language nSCC studies involving individuals with Fitzpatrick types IV-VI. Most tumors were located on the fingernails (84%), with the right third finger being the most frequently affected (31%). The nail bed (67%) exhibited a higher prevalence than the lateral/proximal nail folds (33%). The duration of symptoms before diagnosis ranged from 1 month to 7 years. nSCC was most commonly treated with Mohs surgery (38%), followed by amputation (35%). Our study was limited to case reports because of a lack of large nSCC studies that provide information on race or images of each patient. These tumors are generally slow-growing yet often misdiagnosed, leading to delays in presentation and diagnosis. Increased awareness about nSCC in phototype IV-VI individuals will reduce misdiagnoses, unnecessary treatment, and recurrences.