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American Academy of Dermatology (AAD): Summer Academy 2014
AUDIO: Firm policies prevent office discord
CHICAGO – Physicians can curb staff conflicts by enacting firm rules about appropriate employee conduct before such problems occur. Practical tips for promoting proper conduct were key themes of a session on office politics at the American Academy of Dermatology summer meeting.
In an interview after the session, presenter Dr. Seemal R. Desai of the University of Texas, Dallas, spoke about the significant impact that office politics can have on practices and patient care. He shared proactive strategies that doctors can employ to mitigate staff disagreements and reduce future issues.
While practices can face a host of varying situations, the same strong tenants can address most conflicts, Dr. Desai said. Listen and find out what approaches to office politics are most helpful. Dr. Desai had no relevant conflicts to disclose.
On Twitter @legal_med
CHICAGO – Physicians can curb staff conflicts by enacting firm rules about appropriate employee conduct before such problems occur. Practical tips for promoting proper conduct were key themes of a session on office politics at the American Academy of Dermatology summer meeting.
In an interview after the session, presenter Dr. Seemal R. Desai of the University of Texas, Dallas, spoke about the significant impact that office politics can have on practices and patient care. He shared proactive strategies that doctors can employ to mitigate staff disagreements and reduce future issues.
While practices can face a host of varying situations, the same strong tenants can address most conflicts, Dr. Desai said. Listen and find out what approaches to office politics are most helpful. Dr. Desai had no relevant conflicts to disclose.
On Twitter @legal_med
CHICAGO – Physicians can curb staff conflicts by enacting firm rules about appropriate employee conduct before such problems occur. Practical tips for promoting proper conduct were key themes of a session on office politics at the American Academy of Dermatology summer meeting.
In an interview after the session, presenter Dr. Seemal R. Desai of the University of Texas, Dallas, spoke about the significant impact that office politics can have on practices and patient care. He shared proactive strategies that doctors can employ to mitigate staff disagreements and reduce future issues.
While practices can face a host of varying situations, the same strong tenants can address most conflicts, Dr. Desai said. Listen and find out what approaches to office politics are most helpful. Dr. Desai had no relevant conflicts to disclose.
On Twitter @legal_med
EXPERT ANALYSIS FROM the aad summer academy 2014
Firm policies help address staff who behave badly
CHICAGO – Strong policies and open communication within a physician practice are key to resolving office conflicts and curtailing bad behavior by staff.
"Clear communication is essential," said Dr. Joseph S. Eastern, who practices dermatology and dermatologic surgery in Belleville, N.J. "Destructive political situations are often rooted in communication failure. Policies are also essential. Predictable conflicts can be prevented if policies have been agreed upon in advance; crises often result when there is no policy in place to address the issue in question."
Dr. Eastern and other presenters discussed common challenges that arise in staff environments during the recent American Academy of Dermatology summer meeting. Frequent challenges include employees who chronically leave early, staff members who abuse sick policies, and inappropriate interoffice relationships. Texting and Internet overuse are also growing burdens facing medical practices.
Firm policies that outline acceptable behavior by staff, and potential discipline for policy violations help tackle such difficult situations before they grow out of hand, presenters said.
"Every office should have a formal policy [that limits personal cell phone and Internet use during office hours]," Dr. Eastern said in an interview. "Mine is fairly straightforward: Using office time for personal texting and Web surfing is theft – pure and simple – theft of my time. I make this crystal clear. It is never permissible to steal any office property, least of all our most marketable commodity – office time."
In some circumstances, new rules may need to be drafted or old policies revised. For instance, in the case of employees who start dating. Smaller offices may not have specific policy language that addresses such relationships, said Dr. Seemal R. Desai of the University of Texas Southwestern Medical Center in Dallas and a dermatologist in private practice in Plano. Another challenge that may not be automatically outlined is staff members who constantly seek curbside consults with physicians to ask for personal medical advice. Both issues may lend themselves to consideration and institution of new standards.
Discuss problems or complaints early with employees in a nonconfrontational way, added Dr. Desai. This could mean a one-on-one chat with a staff member or a conversation with two employees who are in conflict.
"Approach the conversation with a really open attitude to try to hear the concerns," Dr. Desai said in an interview. "Not every situation that at first seems like a negative one, really ends up being that way."
Make sure staff are aware of policies and stick to them, Dr. Eastern notes. The worst way physicians can react to an issue is to ignore it. Ongoing office politics not only can cause tension among employees but also can reduce productivity and affect patient care.
"Sentiments and feelings and themes in an office-based setting can really translate a lot into how you practice," Dr. Desai said "and how successful you are on a daily basis."
On Twitter @legal_med
CHICAGO – Strong policies and open communication within a physician practice are key to resolving office conflicts and curtailing bad behavior by staff.
"Clear communication is essential," said Dr. Joseph S. Eastern, who practices dermatology and dermatologic surgery in Belleville, N.J. "Destructive political situations are often rooted in communication failure. Policies are also essential. Predictable conflicts can be prevented if policies have been agreed upon in advance; crises often result when there is no policy in place to address the issue in question."
Dr. Eastern and other presenters discussed common challenges that arise in staff environments during the recent American Academy of Dermatology summer meeting. Frequent challenges include employees who chronically leave early, staff members who abuse sick policies, and inappropriate interoffice relationships. Texting and Internet overuse are also growing burdens facing medical practices.
Firm policies that outline acceptable behavior by staff, and potential discipline for policy violations help tackle such difficult situations before they grow out of hand, presenters said.
"Every office should have a formal policy [that limits personal cell phone and Internet use during office hours]," Dr. Eastern said in an interview. "Mine is fairly straightforward: Using office time for personal texting and Web surfing is theft – pure and simple – theft of my time. I make this crystal clear. It is never permissible to steal any office property, least of all our most marketable commodity – office time."
In some circumstances, new rules may need to be drafted or old policies revised. For instance, in the case of employees who start dating. Smaller offices may not have specific policy language that addresses such relationships, said Dr. Seemal R. Desai of the University of Texas Southwestern Medical Center in Dallas and a dermatologist in private practice in Plano. Another challenge that may not be automatically outlined is staff members who constantly seek curbside consults with physicians to ask for personal medical advice. Both issues may lend themselves to consideration and institution of new standards.
Discuss problems or complaints early with employees in a nonconfrontational way, added Dr. Desai. This could mean a one-on-one chat with a staff member or a conversation with two employees who are in conflict.
"Approach the conversation with a really open attitude to try to hear the concerns," Dr. Desai said in an interview. "Not every situation that at first seems like a negative one, really ends up being that way."
Make sure staff are aware of policies and stick to them, Dr. Eastern notes. The worst way physicians can react to an issue is to ignore it. Ongoing office politics not only can cause tension among employees but also can reduce productivity and affect patient care.
"Sentiments and feelings and themes in an office-based setting can really translate a lot into how you practice," Dr. Desai said "and how successful you are on a daily basis."
On Twitter @legal_med
CHICAGO – Strong policies and open communication within a physician practice are key to resolving office conflicts and curtailing bad behavior by staff.
"Clear communication is essential," said Dr. Joseph S. Eastern, who practices dermatology and dermatologic surgery in Belleville, N.J. "Destructive political situations are often rooted in communication failure. Policies are also essential. Predictable conflicts can be prevented if policies have been agreed upon in advance; crises often result when there is no policy in place to address the issue in question."
Dr. Eastern and other presenters discussed common challenges that arise in staff environments during the recent American Academy of Dermatology summer meeting. Frequent challenges include employees who chronically leave early, staff members who abuse sick policies, and inappropriate interoffice relationships. Texting and Internet overuse are also growing burdens facing medical practices.
Firm policies that outline acceptable behavior by staff, and potential discipline for policy violations help tackle such difficult situations before they grow out of hand, presenters said.
"Every office should have a formal policy [that limits personal cell phone and Internet use during office hours]," Dr. Eastern said in an interview. "Mine is fairly straightforward: Using office time for personal texting and Web surfing is theft – pure and simple – theft of my time. I make this crystal clear. It is never permissible to steal any office property, least of all our most marketable commodity – office time."
In some circumstances, new rules may need to be drafted or old policies revised. For instance, in the case of employees who start dating. Smaller offices may not have specific policy language that addresses such relationships, said Dr. Seemal R. Desai of the University of Texas Southwestern Medical Center in Dallas and a dermatologist in private practice in Plano. Another challenge that may not be automatically outlined is staff members who constantly seek curbside consults with physicians to ask for personal medical advice. Both issues may lend themselves to consideration and institution of new standards.
Discuss problems or complaints early with employees in a nonconfrontational way, added Dr. Desai. This could mean a one-on-one chat with a staff member or a conversation with two employees who are in conflict.
"Approach the conversation with a really open attitude to try to hear the concerns," Dr. Desai said in an interview. "Not every situation that at first seems like a negative one, really ends up being that way."
Make sure staff are aware of policies and stick to them, Dr. Eastern notes. The worst way physicians can react to an issue is to ignore it. Ongoing office politics not only can cause tension among employees but also can reduce productivity and affect patient care.
"Sentiments and feelings and themes in an office-based setting can really translate a lot into how you practice," Dr. Desai said "and how successful you are on a daily basis."
On Twitter @legal_med
EXPERT ANALYSIS FROM THE AAD SUMMER ACADEMY 2014
Infliximab may carry a higher infection rate in psoriasis patients
CHICAGO – Patients with psoriasis treated with infliximab had the highest incidence of serious infections in a retrospective analysis of commercial claims data.
After 5 years of follow-up among 22,753 patients, there were 554.7 hospitalized infectious events (HIEs) per 10,000 patient-years of exposure to infliximab (Remicade).
Among the other treatment groups, the incidence of HIEs varied within a comparatively narrow range of 261.2 for phototherapy to 341.4 per 10,000 patient-years of exposure to nonbiologic therapies, Dr. Alexa B. Kimball reported at the American Academy of Dermatology summer meeting.
The biologics etanercept (Enbrel), ustekinumab (Stelara), and adalimumab (Humira) fell somewhere in between with HIE incidence rates of 261.5, 287.1, and 321.9 per 10,000 patient years, respectively.
"It is reassuring that some of the rates we reported for patients on biologics were similar to that found in the phototherapy-treated population, which is not expected to have a reduced immune response to infection," Dr. Kimball of Massachusetts General Hospital, Boston, said in an interview. "Still, in any given patient, individual risk and benefits are important to assess when starting or continuing therapy."
In one other study evaluating the safety of anti–tumor necrosis factor agents, rates of serious infections and lymphoma were higher among patients with psoriasis and psoriatic arthritis treated with infliximab and adalimumab, compared with etanercept (Immunopharmacol. Immunotoxicol. 2012;34:548-60).
In the current analysis, hospitalizations for an infectious event were also higher in patients on concomitant corticosteroid therapy at baseline, Dr. Kimball reported.
Five-year HIE incidence rates were higher in patients with systemic corticosteroid exposure versus those without, regardless of treatment group: nonbiologics (649.2 vs. 251.6); etanercept (676.9 vs. 198.1); adalimumab (424.5 vs. 260.9); infliximab (990.2 vs. 443.3); ustekinumab (542.4 vs. 201.2); and phototherapy (320.3 vs. 235.3).
"This finding reinforces that combination therapy, especially with systemic steroids, may confer additional risk," Dr. Kimball said. "Patients on infliximab were also more likely to have psoriatic arthritis and may have a different underlying level of disease severity and risk, which we could not ascertain from these data."
The retrospective analysis was based on data obtained from the MarketScan Commercial Claims and Encounters and Medicare Supplemental and COB databases for patients with a diagnosis of psoriasis on or before Dec. 31, 2006, and at least one prescription claim for one of the above-mentioned therapies. Patients could belong to more than one treatment group.
A new HIE was defined as at least one overnight hospitalization with an ICD-9 infection code. Patients hospitalized in the previous 3 months for the same ICD-9 code were not eligible.
In all, there were 5,857 patients with any exposure to nonbiologics, 6,856 to etanercept, 3,314 to adalimumab, 1,044 to infliximab, 526 to ustekinumab, and 5,156 to phototherapy.
Unique exposures to these agents totaled 2,700; 3,433; 719; 301; 0; and 3,482, respectively, according to the poster.
Amgen sponsored the study. Dr. Kimball is a consultant for Amgen and several other pharmaceutical companies.
CHICAGO – Patients with psoriasis treated with infliximab had the highest incidence of serious infections in a retrospective analysis of commercial claims data.
After 5 years of follow-up among 22,753 patients, there were 554.7 hospitalized infectious events (HIEs) per 10,000 patient-years of exposure to infliximab (Remicade).
Among the other treatment groups, the incidence of HIEs varied within a comparatively narrow range of 261.2 for phototherapy to 341.4 per 10,000 patient-years of exposure to nonbiologic therapies, Dr. Alexa B. Kimball reported at the American Academy of Dermatology summer meeting.
The biologics etanercept (Enbrel), ustekinumab (Stelara), and adalimumab (Humira) fell somewhere in between with HIE incidence rates of 261.5, 287.1, and 321.9 per 10,000 patient years, respectively.
"It is reassuring that some of the rates we reported for patients on biologics were similar to that found in the phototherapy-treated population, which is not expected to have a reduced immune response to infection," Dr. Kimball of Massachusetts General Hospital, Boston, said in an interview. "Still, in any given patient, individual risk and benefits are important to assess when starting or continuing therapy."
In one other study evaluating the safety of anti–tumor necrosis factor agents, rates of serious infections and lymphoma were higher among patients with psoriasis and psoriatic arthritis treated with infliximab and adalimumab, compared with etanercept (Immunopharmacol. Immunotoxicol. 2012;34:548-60).
In the current analysis, hospitalizations for an infectious event were also higher in patients on concomitant corticosteroid therapy at baseline, Dr. Kimball reported.
Five-year HIE incidence rates were higher in patients with systemic corticosteroid exposure versus those without, regardless of treatment group: nonbiologics (649.2 vs. 251.6); etanercept (676.9 vs. 198.1); adalimumab (424.5 vs. 260.9); infliximab (990.2 vs. 443.3); ustekinumab (542.4 vs. 201.2); and phototherapy (320.3 vs. 235.3).
"This finding reinforces that combination therapy, especially with systemic steroids, may confer additional risk," Dr. Kimball said. "Patients on infliximab were also more likely to have psoriatic arthritis and may have a different underlying level of disease severity and risk, which we could not ascertain from these data."
The retrospective analysis was based on data obtained from the MarketScan Commercial Claims and Encounters and Medicare Supplemental and COB databases for patients with a diagnosis of psoriasis on or before Dec. 31, 2006, and at least one prescription claim for one of the above-mentioned therapies. Patients could belong to more than one treatment group.
A new HIE was defined as at least one overnight hospitalization with an ICD-9 infection code. Patients hospitalized in the previous 3 months for the same ICD-9 code were not eligible.
In all, there were 5,857 patients with any exposure to nonbiologics, 6,856 to etanercept, 3,314 to adalimumab, 1,044 to infliximab, 526 to ustekinumab, and 5,156 to phototherapy.
Unique exposures to these agents totaled 2,700; 3,433; 719; 301; 0; and 3,482, respectively, according to the poster.
Amgen sponsored the study. Dr. Kimball is a consultant for Amgen and several other pharmaceutical companies.
CHICAGO – Patients with psoriasis treated with infliximab had the highest incidence of serious infections in a retrospective analysis of commercial claims data.
After 5 years of follow-up among 22,753 patients, there were 554.7 hospitalized infectious events (HIEs) per 10,000 patient-years of exposure to infliximab (Remicade).
Among the other treatment groups, the incidence of HIEs varied within a comparatively narrow range of 261.2 for phototherapy to 341.4 per 10,000 patient-years of exposure to nonbiologic therapies, Dr. Alexa B. Kimball reported at the American Academy of Dermatology summer meeting.
The biologics etanercept (Enbrel), ustekinumab (Stelara), and adalimumab (Humira) fell somewhere in between with HIE incidence rates of 261.5, 287.1, and 321.9 per 10,000 patient years, respectively.
"It is reassuring that some of the rates we reported for patients on biologics were similar to that found in the phototherapy-treated population, which is not expected to have a reduced immune response to infection," Dr. Kimball of Massachusetts General Hospital, Boston, said in an interview. "Still, in any given patient, individual risk and benefits are important to assess when starting or continuing therapy."
In one other study evaluating the safety of anti–tumor necrosis factor agents, rates of serious infections and lymphoma were higher among patients with psoriasis and psoriatic arthritis treated with infliximab and adalimumab, compared with etanercept (Immunopharmacol. Immunotoxicol. 2012;34:548-60).
In the current analysis, hospitalizations for an infectious event were also higher in patients on concomitant corticosteroid therapy at baseline, Dr. Kimball reported.
Five-year HIE incidence rates were higher in patients with systemic corticosteroid exposure versus those without, regardless of treatment group: nonbiologics (649.2 vs. 251.6); etanercept (676.9 vs. 198.1); adalimumab (424.5 vs. 260.9); infliximab (990.2 vs. 443.3); ustekinumab (542.4 vs. 201.2); and phototherapy (320.3 vs. 235.3).
"This finding reinforces that combination therapy, especially with systemic steroids, may confer additional risk," Dr. Kimball said. "Patients on infliximab were also more likely to have psoriatic arthritis and may have a different underlying level of disease severity and risk, which we could not ascertain from these data."
The retrospective analysis was based on data obtained from the MarketScan Commercial Claims and Encounters and Medicare Supplemental and COB databases for patients with a diagnosis of psoriasis on or before Dec. 31, 2006, and at least one prescription claim for one of the above-mentioned therapies. Patients could belong to more than one treatment group.
A new HIE was defined as at least one overnight hospitalization with an ICD-9 infection code. Patients hospitalized in the previous 3 months for the same ICD-9 code were not eligible.
In all, there were 5,857 patients with any exposure to nonbiologics, 6,856 to etanercept, 3,314 to adalimumab, 1,044 to infliximab, 526 to ustekinumab, and 5,156 to phototherapy.
Unique exposures to these agents totaled 2,700; 3,433; 719; 301; 0; and 3,482, respectively, according to the poster.
Amgen sponsored the study. Dr. Kimball is a consultant for Amgen and several other pharmaceutical companies.
AT THE AAD SUMMER ACADEMY 2014
Key clinical point: The risk of being hospitalized for an infectious event was higher with exposure to infliximab.
Major finding: The incidence of hospitalized infectious events was 554.7 per 10,000 patient-years of exposure to infliximab, compared with 261.2-341.4 events per 10,000 patient-years of exposure to other therapies.
Data source: Retrospective database analysis of 22,753 patients with psoriasis.
Disclosures: Amgen sponsored the study. Dr. Kimball is a consultant for Amgen and several other pharmaceutical companies.
VIDEO: Stress and inflammatory skin diseases – Does the science prove a link?
CHICAGO – The data are still being developed, but evidence of a direct link between stress and inflammatory skin conditions continues to mount.
The research is especially compelling for psoriasis; experimental data suggest that stress triggers the nerves to release elevated levels of neuropeptides and neurotransmitters, which in turn affect the nervous system.
Dr. Richard Granstein, chairman of the dermatology department at Weill Cornell Medical College in New York, gave an exclusive interview to Frontline Medical News in which he described studies of how calming the nerves clearly interrupts psoriatic and other inflammatory skin conditions. Dr. Granstein discussed the implications of this new, and still controversial, line of research, and what this means for clinicians: Should they prescribe stress management programs to their patients with these skin conditions?
Dr. Granstein disclosed he has financial relationships with Velius and Clinique.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @whitneymcknight
CHICAGO – The data are still being developed, but evidence of a direct link between stress and inflammatory skin conditions continues to mount.
The research is especially compelling for psoriasis; experimental data suggest that stress triggers the nerves to release elevated levels of neuropeptides and neurotransmitters, which in turn affect the nervous system.
Dr. Richard Granstein, chairman of the dermatology department at Weill Cornell Medical College in New York, gave an exclusive interview to Frontline Medical News in which he described studies of how calming the nerves clearly interrupts psoriatic and other inflammatory skin conditions. Dr. Granstein discussed the implications of this new, and still controversial, line of research, and what this means for clinicians: Should they prescribe stress management programs to their patients with these skin conditions?
Dr. Granstein disclosed he has financial relationships with Velius and Clinique.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @whitneymcknight
CHICAGO – The data are still being developed, but evidence of a direct link between stress and inflammatory skin conditions continues to mount.
The research is especially compelling for psoriasis; experimental data suggest that stress triggers the nerves to release elevated levels of neuropeptides and neurotransmitters, which in turn affect the nervous system.
Dr. Richard Granstein, chairman of the dermatology department at Weill Cornell Medical College in New York, gave an exclusive interview to Frontline Medical News in which he described studies of how calming the nerves clearly interrupts psoriatic and other inflammatory skin conditions. Dr. Granstein discussed the implications of this new, and still controversial, line of research, and what this means for clinicians: Should they prescribe stress management programs to their patients with these skin conditions?
Dr. Granstein disclosed he has financial relationships with Velius and Clinique.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @whitneymcknight
EXPERT ANALYSIS FROM THE AAD SUMMER ACADEMY 2014
Dermatologist biopsy rate undercut by digital device
CHICAGO – The number of skin lesions biopsied to rule out melanoma remains exceedingly high among U.S. dermatologists, compared with the MelaFind digital skin analysis device.
Dermatologists performed approximately 22 biopsies of histologically benign lesions for every one melanoma or severely dysplastic nevus removed, according to a dermatopathology review of 1,100 lesions from patients in approximately 500 practices nationwide.
This compares with a biopsy ratio of 7.6:1 reported in a pivotal prospective study of the MelaFind device (Arch. Dermatol. 2011;147:188-94), Dr. Clay J. Cockerell reported at the American Academy of Dermatology summer meeting.
The noninvasive MelaFind device was designed to aid dermatologists in diagnosing melanoma and uses multispectral light to characterize the morphologic disorganization of clinically atypical pigmented lesions.
It is approved in the European Union and gained U.S. approval in November 2011, with a long list of indications and caveats regarding how the device should be used and by whom.
The 22:1 biopsy rate among dermatologists is "pretty high" and likely reflects several factors, according to past AAD president Dr. Cockerell, who is director of the division of dermatopathology at the University of Texas Southwestern Medical Center and in group practice in Dallas.
Overall, clinicians are conservative regarding pigmented lesions, particularly in litigious areas of the country, and the device may have made some clinicians "more of a student of pigmented lesions, pushing them to look more carefully, and heightening awareness," he said in an interview.
Biopsies also may have been conducted by physician assistants and nurse practitioners, who may have a lower threshold for biopsy than dermatologists.
Lesion data were collected at Dr. Cockerell’s facility over a 3-week period for 1,400 lesions, but information was not available on how many practices had a MelaFind device, who performed the biopsy, the level of that clinician’s expertise in pigmented lesion management, or the proportion of high-risk patients, a group for whom biopsy ratios can reach 33:1 to 53:1, he said.
A total of 300 lesions were excluded from analysis because they were ineligible for use with the MelaFind device based on its indications.
Still, the MelaFind biopsy ratio is better than that observed in the real-world and was seen in lesions that were more clinically difficult, Dr. Cockerell reported in a poster.
The proportion of lesions that were melanoma or high-grade dysplastic nevi was higher in the pivotal study than in the real world data (11% vs. 4%), as was the proportion of nevi that were low-grade dysplastic nevi (79.3% vs. 41%).
Invasive melanomas, however, were thicker in the real life review (1.1 vs. 0.36 mm), raising a red flag that patients are still not fully educated on the need for early evaluation of suspicious lesions, he said.
"Biopsies, at least in our part of the country and I think in other parts as well, are performed in a seasonal fashion," Dr. Cockerell said. "There are people who don’t go to the dermatologist and don’t get a skin biopsy done for the first 5-6 months of the year because they’re waiting to get their deductible met. If they had a melanoma and put off a biopsy until June, it’s had 6 months of growth time. The doubling time can be very rapid."
Although the MelaFind-computed scores are subjective and do not state whether a biopsy is warranted, the data would be useful if sent along with a specimen to aid dermatopathologists in rendering a more definitive diagnosis, he said. Optimally, the device is "handcrafted" for practices and clinics that follow patients with hundreds of dysplastic nevi where repeated biopsies are not practical, an avenue Dr. Cockerell said he hopes to pursue in the future.
Mela Sciences sponsored the study. Dr. Cockerell and his coauthors disclosed no conflicting financial interests.
CHICAGO – The number of skin lesions biopsied to rule out melanoma remains exceedingly high among U.S. dermatologists, compared with the MelaFind digital skin analysis device.
Dermatologists performed approximately 22 biopsies of histologically benign lesions for every one melanoma or severely dysplastic nevus removed, according to a dermatopathology review of 1,100 lesions from patients in approximately 500 practices nationwide.
This compares with a biopsy ratio of 7.6:1 reported in a pivotal prospective study of the MelaFind device (Arch. Dermatol. 2011;147:188-94), Dr. Clay J. Cockerell reported at the American Academy of Dermatology summer meeting.
The noninvasive MelaFind device was designed to aid dermatologists in diagnosing melanoma and uses multispectral light to characterize the morphologic disorganization of clinically atypical pigmented lesions.
It is approved in the European Union and gained U.S. approval in November 2011, with a long list of indications and caveats regarding how the device should be used and by whom.
The 22:1 biopsy rate among dermatologists is "pretty high" and likely reflects several factors, according to past AAD president Dr. Cockerell, who is director of the division of dermatopathology at the University of Texas Southwestern Medical Center and in group practice in Dallas.
Overall, clinicians are conservative regarding pigmented lesions, particularly in litigious areas of the country, and the device may have made some clinicians "more of a student of pigmented lesions, pushing them to look more carefully, and heightening awareness," he said in an interview.
Biopsies also may have been conducted by physician assistants and nurse practitioners, who may have a lower threshold for biopsy than dermatologists.
Lesion data were collected at Dr. Cockerell’s facility over a 3-week period for 1,400 lesions, but information was not available on how many practices had a MelaFind device, who performed the biopsy, the level of that clinician’s expertise in pigmented lesion management, or the proportion of high-risk patients, a group for whom biopsy ratios can reach 33:1 to 53:1, he said.
A total of 300 lesions were excluded from analysis because they were ineligible for use with the MelaFind device based on its indications.
Still, the MelaFind biopsy ratio is better than that observed in the real-world and was seen in lesions that were more clinically difficult, Dr. Cockerell reported in a poster.
The proportion of lesions that were melanoma or high-grade dysplastic nevi was higher in the pivotal study than in the real world data (11% vs. 4%), as was the proportion of nevi that were low-grade dysplastic nevi (79.3% vs. 41%).
Invasive melanomas, however, were thicker in the real life review (1.1 vs. 0.36 mm), raising a red flag that patients are still not fully educated on the need for early evaluation of suspicious lesions, he said.
"Biopsies, at least in our part of the country and I think in other parts as well, are performed in a seasonal fashion," Dr. Cockerell said. "There are people who don’t go to the dermatologist and don’t get a skin biopsy done for the first 5-6 months of the year because they’re waiting to get their deductible met. If they had a melanoma and put off a biopsy until June, it’s had 6 months of growth time. The doubling time can be very rapid."
Although the MelaFind-computed scores are subjective and do not state whether a biopsy is warranted, the data would be useful if sent along with a specimen to aid dermatopathologists in rendering a more definitive diagnosis, he said. Optimally, the device is "handcrafted" for practices and clinics that follow patients with hundreds of dysplastic nevi where repeated biopsies are not practical, an avenue Dr. Cockerell said he hopes to pursue in the future.
Mela Sciences sponsored the study. Dr. Cockerell and his coauthors disclosed no conflicting financial interests.
CHICAGO – The number of skin lesions biopsied to rule out melanoma remains exceedingly high among U.S. dermatologists, compared with the MelaFind digital skin analysis device.
Dermatologists performed approximately 22 biopsies of histologically benign lesions for every one melanoma or severely dysplastic nevus removed, according to a dermatopathology review of 1,100 lesions from patients in approximately 500 practices nationwide.
This compares with a biopsy ratio of 7.6:1 reported in a pivotal prospective study of the MelaFind device (Arch. Dermatol. 2011;147:188-94), Dr. Clay J. Cockerell reported at the American Academy of Dermatology summer meeting.
The noninvasive MelaFind device was designed to aid dermatologists in diagnosing melanoma and uses multispectral light to characterize the morphologic disorganization of clinically atypical pigmented lesions.
It is approved in the European Union and gained U.S. approval in November 2011, with a long list of indications and caveats regarding how the device should be used and by whom.
The 22:1 biopsy rate among dermatologists is "pretty high" and likely reflects several factors, according to past AAD president Dr. Cockerell, who is director of the division of dermatopathology at the University of Texas Southwestern Medical Center and in group practice in Dallas.
Overall, clinicians are conservative regarding pigmented lesions, particularly in litigious areas of the country, and the device may have made some clinicians "more of a student of pigmented lesions, pushing them to look more carefully, and heightening awareness," he said in an interview.
Biopsies also may have been conducted by physician assistants and nurse practitioners, who may have a lower threshold for biopsy than dermatologists.
Lesion data were collected at Dr. Cockerell’s facility over a 3-week period for 1,400 lesions, but information was not available on how many practices had a MelaFind device, who performed the biopsy, the level of that clinician’s expertise in pigmented lesion management, or the proportion of high-risk patients, a group for whom biopsy ratios can reach 33:1 to 53:1, he said.
A total of 300 lesions were excluded from analysis because they were ineligible for use with the MelaFind device based on its indications.
Still, the MelaFind biopsy ratio is better than that observed in the real-world and was seen in lesions that were more clinically difficult, Dr. Cockerell reported in a poster.
The proportion of lesions that were melanoma or high-grade dysplastic nevi was higher in the pivotal study than in the real world data (11% vs. 4%), as was the proportion of nevi that were low-grade dysplastic nevi (79.3% vs. 41%).
Invasive melanomas, however, were thicker in the real life review (1.1 vs. 0.36 mm), raising a red flag that patients are still not fully educated on the need for early evaluation of suspicious lesions, he said.
"Biopsies, at least in our part of the country and I think in other parts as well, are performed in a seasonal fashion," Dr. Cockerell said. "There are people who don’t go to the dermatologist and don’t get a skin biopsy done for the first 5-6 months of the year because they’re waiting to get their deductible met. If they had a melanoma and put off a biopsy until June, it’s had 6 months of growth time. The doubling time can be very rapid."
Although the MelaFind-computed scores are subjective and do not state whether a biopsy is warranted, the data would be useful if sent along with a specimen to aid dermatopathologists in rendering a more definitive diagnosis, he said. Optimally, the device is "handcrafted" for practices and clinics that follow patients with hundreds of dysplastic nevi where repeated biopsies are not practical, an avenue Dr. Cockerell said he hopes to pursue in the future.
Mela Sciences sponsored the study. Dr. Cockerell and his coauthors disclosed no conflicting financial interests.
AT THE AAD SUMMER ACADEMY 2014
Key clinical point: The MelaFind device may be helpful to dermatologists when deciding which clinically ambiguous lesions may be early melanoma.
Major finding: The biopsy rate for melanoma or severely dysplastic nevi was 22:1 among clinicians in the review and 7.6:1 with the MelaFind in a prior prospective study.
Data source: A retrospective analysis of 1,100 biopsied skin lesions from patients in 500 U.S. practices.
Disclosures: Mela Sciences sponsored the study. Dr. Cockerell and his coauthors disclosed no conflicting financial interests.
AUDIO: Unusual approaches to unusual tumors
CHICAGO – Doctors who don’t abide by accepted norms can sometimes achieve better outcomes when treating patients who have unusual and tenacious tumors. This was the theme of a session covering cases of confounding tumors at the American Academy of Dermatology summer meeting.
In an interview after the session, panel moderator and case presenter Dr. John A. Carucci, chief of Mohs and dermatologic surgery at New York (N.Y.) University, shared his thoughts on when certain kinds of imaging are more appropriate than others, even if it’s not the "usual way."
Dr. Carucci also addressed the use of postsurgical negative pressure wound therapy, radiation therapy in conjunction with Mohs surgery, and potentially controversial topics such as the use of a protein kinase inhibitor as a neoadjuvant therapy.
And what new information on staging squamous cell carcinomas has Dr. Carucci and his colleagues excited? Listen and find out. Dr. Carucci said that he had no financial conflicts to disclose.
On Twitter @whitneymcknight
CHICAGO – Doctors who don’t abide by accepted norms can sometimes achieve better outcomes when treating patients who have unusual and tenacious tumors. This was the theme of a session covering cases of confounding tumors at the American Academy of Dermatology summer meeting.
In an interview after the session, panel moderator and case presenter Dr. John A. Carucci, chief of Mohs and dermatologic surgery at New York (N.Y.) University, shared his thoughts on when certain kinds of imaging are more appropriate than others, even if it’s not the "usual way."
Dr. Carucci also addressed the use of postsurgical negative pressure wound therapy, radiation therapy in conjunction with Mohs surgery, and potentially controversial topics such as the use of a protein kinase inhibitor as a neoadjuvant therapy.
And what new information on staging squamous cell carcinomas has Dr. Carucci and his colleagues excited? Listen and find out. Dr. Carucci said that he had no financial conflicts to disclose.
On Twitter @whitneymcknight
CHICAGO – Doctors who don’t abide by accepted norms can sometimes achieve better outcomes when treating patients who have unusual and tenacious tumors. This was the theme of a session covering cases of confounding tumors at the American Academy of Dermatology summer meeting.
In an interview after the session, panel moderator and case presenter Dr. John A. Carucci, chief of Mohs and dermatologic surgery at New York (N.Y.) University, shared his thoughts on when certain kinds of imaging are more appropriate than others, even if it’s not the "usual way."
Dr. Carucci also addressed the use of postsurgical negative pressure wound therapy, radiation therapy in conjunction with Mohs surgery, and potentially controversial topics such as the use of a protein kinase inhibitor as a neoadjuvant therapy.
And what new information on staging squamous cell carcinomas has Dr. Carucci and his colleagues excited? Listen and find out. Dr. Carucci said that he had no financial conflicts to disclose.
On Twitter @whitneymcknight
EXPERT ANALYSIS FROM THE AAD SUMMER ACADEMY 2014
