Optimizing Palliative Focal Radiation Therapy Dose in Cutaneous T-Cell Lymphoma: How Low Can You Go?

PURPOSE: Primary cutaneous T-cell lymphomas (CTCLs) are radiosensitive tumors with variable and often relapsing courses. Local disease can be treated with low-dose focal palliative radiation therapy (RT), though little data supports the use of a specific dose. This study assesses clinical outcomes after focal RT to a total dose of 4 Gy, 8 Gy, or 12 Gy. METHODS AND MATERIALS: An International Review Board-approved, retrospective, single-institution study was performed of 225 lesions in 41 patients with primary CTCL treated with low-dose focal RT from 2015 to 2020. Patient, tumor, and treatment characteristics were reviewed. The primary outcome was freedom from treatment failure (FFTF), defined as time to requiring local retreatment, and secondary outcomes included response rates and toxicities. RESULTS: Of the 225 lesions, 90 received 4 Gy, 106 received 8 Gy, and 29 received 12 Gy. Lesions treated with 12 Gy (96%) or 8 Gy (92%) had a significantly higher 1-year FFTF compared with 4 Gy (77%) (P = .034). Overall response rate and complete response rate were not significantly different between different doses (P = .117), though there was a trend toward higher overall response rate at initial assessment with 8 Gy versus 4 Gy (91.5% vs 82.2%, P = .057). Toxicity was low, with 7.1% of lesions having grade 2 or higher radiation dermatitis. CONCLUSIONS: In primary CTCL lesions treated with focal palliative RT, a dose response was noted favoring 8 to 12 Gy, with 1-year FFTF rates over 90%. However, 4 Gy resulted in substantially better outcomes than previously reported, with 77% requiring no further treatment at 1 year and comparable response rates to higher doses. While our data substantiates 8 to 12 Gy as the standard of care, it also suggests that 4 Gy should be considered an acceptable alternative in situations with concern for radiation toxicities, such as with fragile or heavily pretreated skin.

A Short Isoform of Spermatogenic Enzyme GAPDHS Functions as a Metabolic Switch and Limits Metastasis in Melanoma.

Despite being the leading cause of cancer deaths, metastasis remains a poorly understood process. To identify novel regulators of metastasis in melanoma, we performed a large-scale RNA sequencing screen of 48 samples from patient-derived xenograft (PDX) subcutaneous melanomas and their associated metastases. In comparison with primary tumors, expression of glycolytic genes was frequently decreased in metastases, whereas expression of some tricarboxylic acid (TCA) cycle genes was increased in metastases. Consistent with these transcriptional changes, melanoma metastases underwent a metabolic switch characterized by decreased levels of glycolytic metabolites and increased abundance of TCA cycle metabolites. A short isoform of glyceraldehyde-3-phosphate dehydrogenase, spermatogenic (GAPDHS) lacking the N-terminal domain suppressed metastasis and regulated this metabolic switch. GAPDHS was downregulated in metastatic nodules from PDX models as well as in human patients. Overexpression of GAPDHS was sufficient to block melanoma metastasis, whereas its inhibition promoted metastasis, decreased glycolysis, and increased levels of certain TCA cycle metabolites and their derivatives including citrate, fumarate, malate, and aspartate. Isotope tracing studies indicated that GAPDHS mediates this shift through changes in pyruvate carboxylase activity and aspartate synthesis, both metabolic pathways critical for cancer survival and metastasis. Together, these data identify a short isoform of GAPDHS that limits melanoma metastasis and regulates central carbon metabolism. SIGNIFICANCE: This study characterizes metabolic changes during cancer metastasis and identifies GAPDHS as a novel regulator of these processes in melanoma cells.

Wound care quality of life in aging patients undergoing electrodessication and curettage on the back.

Patient satisfaction is an important consideration when determining the optimal treatment for non-melanoma skin cancer (NMSC). One critical aspect of patient satisfaction is post-procedural wound care quality of life (QOL), especially as the elderly population grows. This study aimed to evaluate post-procedural wound care QOL in elderly patients undergoing electrodessication and curettage (ED&C) for NMSC in difficult-to-reach areas, namely the posterior shoulder and back. To do so, patient demographics, functionality, co-morbidities, and post-procedural wound care QOL were assessed in twenty elderly patients (age > 65) who underwent ED&C for NMSC at a single academic dermatologic surgery clinic. Independent t-tests were used to evaluate how QOL related to patient age, gender, living situation, relationship status, co-morbidities, and functionality. Patients who lived alone had better-wound care QOL compared to patients who did not live alone (p = 0.04). Patients reported concerns about knocking the wound and did not feel they could care for the wound independently. Patients who were married, female, or had a lower comorbidity score reported poorer QOL, although this finding was not statistically significant. This study indicates that patients' QOL can be negatively affected by post-procedural wounds located in difficult-to-reach areas. As dermatologists strive to improve patient satisfaction, wound care quality of life should be considered when choosing treatment for NMSC.

Metastatic basal cell carcinoma with evidence of intravascular invasion: A case report.

Although basal cell carcinoma is the most common malignancy in humans, intravascular basal cell carcinoma is rarely reported in the literature. A 78-year-old male presented for Mohs Micrographic surgery of a 1.5 by 1.5 cm2 nodular and focally infiltrative basal cell carcinoma on the left parietal scalp. In the fifth stage, intravascular tumor cells were noted, and the patient was still positive in five out of six specimens with a defect measuring 6.5 × 7.0 cm2. Mohs surgery was stopped due to concern of widespread disease. A positron emission tomography/computed tomography scan was ordered that demonstrated diffuse prominent activity in the cervical level IIa nodes, right sacrum, right scapula, and the third left rib, concerning for metastatic disease. This case emphasizes the importance of vigilance to examine high-risk basal cell carcinoma pathology for intravascular invasion in addition to perineural invasion, especially in the setting of high risk factors for metastatic basal cell carcinoma.

Multimedia Technology Used to Supplement Patient Consent for Mohs Micrographic Surgery.

BACKGROUND: The patient consent process traditionally relies on conversations between the physician and the patient and rarely utilizes supplemental multimedia aids. OBJECTIVE: To determine whether the addition of an educational video on Mohs micrographic surgery (MMS) can improve patient satisfaction with the consent process. MATERIALS AND METHODS: This prospective observational quality improvement study compared the outcomes of traditional patient consent alone versus standard consent plus an educational video among patients undergoing their first MMS for a primary skin cancer. End points were patient satisfaction and preferences measured by postprocedure questionnaires. RESULTS: The addition of a supplemental video to the consent process did not affect overall patient satisfaction, which was very high in both video and control groups. However, specific components of patient satisfaction were improved such as patient perception of the opportunity to ask questions and understand the procedure. CONCLUSION: Multimedia aids can be effective tools in the patient consent process.

The Sign of Leser-Trelát and Malignant Acanthosis Nigricans Associated With Fallopian Tube Carcinoma.

BACKGROUND: The sign of Leser-Trelát is controversial and rarely reported in gynecologic malignancies. It is characterized by rapid development of new or enlarging seborrheic keratoses. CASE: A 78-year-old woman presented with unintentional weight loss and new-onset erythematous patches and plaques with thickened, rugated skin and stuck-on brown waxy papules on the chest and back. Her symptoms were concerning for a paraneoplastic eruption; workup revealed an elevated CA 125 level and an ovarian mass on abdominal computed tomography scan. Exploratory laparotomy revealed a stage IIIC serous fallopian tube carcinoma and a synchronous low-grade endometrioid adenocarcinoma of the endometrium. CONCLUSION: The sign of Leser-Trelát can be associated with fallopian tube carcinoma. When recognized, paraneoplastic dermatoses can prompt clinicians to initiate a workup for occult malignancy.

The mediating role of internalized racism in the relationship between racist experiences and anxiety symptoms in a Black American sample.

OBJECTIVES: The current study explores the potential mediating role of internalized racism in the relationship between racist experiences and anxiety symptomology in a Black American sample. METHOD: One hundred and 73 Black American participants, between 18 and 62 years of age, completed a questionnaire packet containing measures of anxious arousal and stress symptoms, internalized racism, and experiences of racist events. RESULTS: Results indicated that internalized racism mediated the relationship between past-year frequency of racist events and anxious arousal as well as past-year frequency of racist events and stress symptoms. CONCLUSIONS: Internalized racism may be 1 mechanism that underlies the relationship between racism and anxious symptomology for Black Americans. These preliminary findings suggest that internalized racism may be an avenue through which clinicians can target the anxiety elicited by racist experiences. The clinical implications of these findings and future research directions are discussed. (PsycINFO Database Record

Social connectedness and intolerance of uncertainty as moderators between racial microaggressions and anxiety among Black individuals.

The current study investigated whether a cultural factor (i.e., social connectedness) and a dispositional characteristic (i.e., intolerance of uncertainty) would serve as risk factors or protective factors in the association between perceived racial microaggressions and anxiety symptoms in a sample of 126 Black American individuals. Results demonstrated that perceived racial microaggression was positively associated with anxiety symptoms in Black Americans. In addition, hierarchical regression analyses identified ethnic social connectedness and intolerance of uncertainty as moderators for anxiety symptoms. Specifically, social connectedness to one's ethnic community served as a buffer and intolerance of uncertainty acted as an exacerbating factor in the relationship between perceived racial microaggressions and anxiety symptoms. Future research directions and clinical implications are discussed.

Student perspectives on sexual health: implications for interprofessional education.

Interprofessional collaboration requires that health professionals think holistically about presenting concerns, particularly for multimodal problems like sexual dysfunction. However, health professions students appear to receive relatively little sexual health education, and generally none is offered on an interprofessional basis. To assess current degree of interprofessional thinking in sexual health care, 472 health professions students in Georgia, United States, were presented with a sexual dysfunction vignette and asked to rate the relevance of, and their familiarity with, interventions offered by several professionals. They also were asked to identify the most likely cause of the sexual dysfunction. Students rated relevance and familiarity with interventions as highest for physicians and lowest for dentists, with higher ratings of nurses by nursing students. More advanced students reported greater familiarity with mental health, physician, and physical therapy interventions. Finally, nursing students were less likely to attribute the dysfunction to a physical cause. These findings indicate that students may prioritize biomedical approaches in their initial assessment and may need additional supports to consider the spectrum of biopsychosocial factors contributing to sexual functioning. To encourage interprofessional critical thinking and prepare students for interprofessional care, sexual health curricula may be improved with the inclusion of interprofessional training. Specific recommendations for curriculum development are offered.