Photoacoustic imaging for cutaneous melanoma assessment: a comprehensive review.

Significance: Cutaneous melanoma (CM) has a high morbidity and mortality rate, but it can be cured if the primary lesion is detected and treated at an early stage. Imaging techniques such as photoacoustic (PA) imaging (PAI) have been studied and implemented to aid in the detection and diagnosis of CM. Aim: Provide an overview of different PAI systems and applications for the study of CM, including the determination of tumor depth/thickness, cancer-related angiogenesis, metastases to lymph nodes, circulating tumor cells (CTCs), virtual histology, and studies using exogenous contrast agents. Approach: A systematic review and classification of different PAI configurations was conducted based on their specific applications for melanoma detection. This review encompasses animal and preclinical studies, offering insights into the future potential of PAI in melanoma diagnosis in the clinic. Results: PAI holds great clinical potential as a noninvasive technique for melanoma detection and disease management. PA microscopy has predominantly been used to image and study angiogenesis surrounding tumors and provide information on tumor characteristics. Additionally, PA tomography, with its increased penetration depth, has demonstrated its ability to assess melanoma thickness. Both modalities have shown promise in detecting metastases to lymph nodes and CTCs, and an all-optical implementation has been developed to perform virtual histology analyses. Animal and human studies have successfully shown the capability of PAI to detect, visualize, classify, and stage CM. Conclusions: PAI is a promising technique for assessing the status of the skin without a surgical procedure. The capability of the modality to image microvasculature, visualize tumor boundaries, detect metastases in lymph nodes, perform fast and label-free histology, and identify CTCs could aid in the early diagnosis and classification of CM, including determination of metastatic status. In addition, it could be useful for monitoring treatment efficacy noninvasively.

Photoprotective measures among adolescents stratified by region: An analysis utilizing the National College Health Assessment.

BACKGROUND/PURPOSE: Exposure to sunlight has been shown to cause pigmentary alterations, photoaging and photocarcinogenesis. Understanding photoprotective patterns in adolescent populations is beneficial to public health initiatives. We utilized data provided by the American College Health Association's National College Health Assessment to evaluate photoprotective behaviors among adolescent populations. METHODS: Behavioral questions related to photoprotection were analyzed from the American College Health Association (ACHA) National College Health Assessment (NCHA) (Version III). RESULTS: When comparing races, Black/African American respondents had the lowest association of practicing photoprotective behaviors in comparison to white respondents (p < .05). When comparing US geographic regions, the south had the lowest association of photoprotective measures (p < .05). LIMITATIONS: The response rate of each institution varied, although there was still a large quantity of respondents. Finally, we cannot discern the specific reasoning for adolescent populations not using sunscreen. CONCLUSION: These data identify demographics where efforts to enhance education on photoprotective behaviors, specifically among skin of color and southern population, to support public health initiatives.

Worsening of Acne Scars from Trichloroacetic Acid CROSS Delivered via Micropipette: A Case Report.

Application of trichloroacetic acid (TCA) via the "Chemical Reconstruction of Skin Scars" (CROSS) method is a well-established treatment for acne scars. Generally, an applicator, such as a needle, is repeatedly moved between the TCA container and the patient, potentially resulting in accidental spills. To mitigate this risk, we investigated a repeating electronic micropipette with self-contained fluid reservoir as a novel TCA applicator. A 46-year-old African American male patient with long-standing ice pick and boxcar acne scars on the face initially underwent six 100% TCA CROSS treatments using a 30-gauge needle, which resulted in significant improvement in scarring. Immediately after 100% TCA CROSS treatment using a repeating electronic micropipette, the patient experienced increased pain and hyperpigmentation. Two months later, the patient had more prominent scars with persistent erythema and increased atrophy. An additional treatment with 100% TCA CROSS using a 30-gauge needle led to subsequent improvement. TCA CROSS delivered via a repeating electronic micropipette may result in less precise application of TCA relative to a 30-gauge needle, with subsequent necrosis of adjacent healthy tissue and worsening of acne scars. Miniscule volumes of concentrated TCA should be applied with a precision applicator, such as a 30-gauge needle, to prevent TCA spread to adjacent healthy skin.

Characterizing the role of dermatologists in developing artificial intelligence for assessment of skin cancer.

BACKGROUND: The use of artificial intelligence (AI) for skin cancer assessment has been an emerging topic in dermatology. Leadership of dermatologists is necessary in defining how these technologies fit into clinical practice. OBJECTIVE: To characterize the evolution of AI in skin cancer assessment and characterize the involvement of dermatologists in developing these technologies. METHODS: An electronic literature search was performed using PubMed by searching machine learning or artificial intelligence combined with skin cancer or melanoma. Articles were included if they used AI for screening and diagnosis of skin cancer using data sets consisting of dermoscopic images or photographs of gross lesions. RESULTS: Fifty-one articles were included, and 41% of these had dermatologists included as authors. Articles that included dermatologists described algorithms built with more images versus articles that did not include dermatologists (mean, 12,111 vs 660 images, respectively). In terms of underlying technology, AI used for skin cancer assessment has followed trends in the field of image recognition. LIMITATIONS: This review focused on models described in the medical literature and did not account for those described elsewhere. CONCLUSIONS: Greater involvement of dermatologists is needed in thinking through issues in data collection, data set biases, and applications of technology. Dermatologists can provide access to large, diverse data sets that are increasingly important for building these models.

Incorporating Lesbian, Gay, Bisexual, and Transgender Training into a Residency Program.

Lesbian, gay, bisexual, and transgender (LGBT) patients experience vast health care disparities. Numerous government and professional organizations have attempted to address these disparities by calling for improvement in LGBT health and increased research endeavors. Despite these initiatives, residents still receive inadequate education and training in LGBT health. Here, the authors review these shortcomings and provide a framework for how to improve resident education and training in LGBT health. They describe methods of curricular enhancements and departmental/institutional climate optimization to improve resident competency. Finally, they discuss how LGBT-competent physicians can publicize their expertise and improve overall LGBT health care delivery.

Revisiting the pathobiology of scurvy: a review of the literature in the context of a challenging case.

Scurvy is a nutritional disorder resulting from vitamin C deficiency. Although rare in developing countries, scurvy continues to develop in settings of limited dietary intake such as post-gastrointestinal surgery and restrictive dietary habits. The disease primarily affects the skin and soft tissue. As the state of deficiency persists, hematological and immunological sequelae may develop. The classic signs of scurvy are not always present and can be altered by the presence of other comorbidities. In this article, we present a challenging case of scurvy in an older male from an urban tertiary healthcare setting. We review the atypical and uncommon clinical and pathological findings of scurvy including those seen in the skin, blood, and bone marrow. We also review contemporary research findings that provide a better understanding of the pathogenicity and clinical manifestations of vitamin C deficiency.

Monitoring the topical delivery of ultrasmall gold nanoparticles using optical coherence tomography.

BACKGROUND: Optical coherence tomography (OCT) is a promising imaging modality for skin cancer diagnosis. However, this capability has been hindered by the low contrast between normal and neoplastic tissue. To overcome this limitation, gold nanoparticles have been used to enhance the contrast in OCT images and are topically administered to reduce the risk of systematic side effects associated with intravenous injection. To ensure efficient penetration and distribution of the nanoparticles, an enhanced delivery strategy is required. In this porcine study, we assessed two delivery methods: (a) using dimethyl sulfoxide (DMSO) and (b) via sonophoresis. MATERIALS AND METHODS: The gold nanoparticles were topically applied on pig skin before evaluating DMSO and sonophoresis as penetration enhancers in topical administration. The OCT images were taken from the same locations to monitor signal change. CONCLUSION: The combination of DMSO and sonophoresis is an effective method to enhance the penetration and diffusion rate of nanoparticles during topical administration. SIGNIFICANCE: Topical administration of nanoparticles is advantageous in dermatological applications. Nevertheless, efficient topical delivery remains a challenge. DMSO and sonophoresis can be used as two effective approaches to enhance topical delivery of nanoparticles.

Health Care Disparities: a Practical Approach to Teach Residents about Self-Bias and Patient Communication.

Studies have shown that the education of resident physicians on health care disparities (HCDs) needs improvement. We implemented a system-wide program on HCD for residents and evaluated outcomes across 1 year. Designed in 2015 by a multidisciplinary team, the HCD program incorporated information about our health system's patient population and the tenets of unconscious bias. We used the ask-tell-ask model of communication to teach trainees how to identify patients' barriers to health care. In 2016, resident participants in the HCD program were asked to complete a modified version of the Bonham and Sellers RACE survey, which measures consideration of race in clinical care, at four time-points (pre-, post-, 3-months post-, and 1-year post-intervention). Of 186 PGY2 residents who completed the HCD program, 108 (58%) completed all 4 surveys across 1 year. The modified Bonham and Sellers RACE survey yielded a Cronbach's alpha of 0.885 and communality for the six questions ranging from 0.543 to 0.727. Using the modified RACE survey, resident respondents showed overall significantly increased consideration of race in clinical care from pre- to post-intervention time-points (p < 0.001). This study of our program on health care disparities showed that resident survey respondents increased self-reported consideration of race in clinical care after the intervention across 1 year.