Highlights from Day 2 | Practical Symposium 2015

June 20, 2015

 

 

Friday | June 19, 2015

 

Vail, Colorado – Friday's sessions at the 2nd annual Practical Symposium highlighted psoriasis, skin cancers, innovative treatment options  and a buzzworthy silicone solution for scars.

Highlights included the following:

  • Radiation Renaissance– With the evolution of surgical techniques such as Mohs Surgery, superficial radiation therapy (SRT) has also made a comeback with the ever increasing incidents of non-melanoma skin cancers, said Mark S. Nestor, M.D., Ph.D., "Sensus Healthcare has brought to market a new in-office treatment device that is simple to use, and delivers high cure rates and low morbidity. Dr. Nestor is director of the Center for Cosmetic Enhancement and the Center for Clinical and Cosmetic Research, Aventura, Florida.

  • Brian Berman, M.D., Ph.D., added that Sensus’ SRT-100 can prevent keloid recurrence, "We use a biologically effective dose of 30 Gy. We've chosen to use 3 fractions of 6 Gy," delivered on 3 consecutive days starting within 48 hours of surgery, to minimize side effects. He is a voluntary professor of dermatology and cutaneous surgery, University of Miami.

  • Strategies for Scars – Dr. Nestor noted that patient satisfaction depends largely on aesthetic results of skin cancer treatments. Attendees then gathered near the podium as Oscar Atkinson, CEO of Silicone Arts Labs, demonstrated Dermaflage, a novel silicone formulation that treats mature scars while covering them with techniques borrowed from Hollywood special effects artists.

  • How to Diagnose the Most Important Scaly Disease: Psoriasis – Clinically, said Mark Lebwohl, M.D., "If it's sharply demarcated, red and scaly, think psoriasis. The diagnosis is missed most often on the palms and soles." He is the Sol and Clara Kest Professor and Chairman, Department of Dermatology, Mount Sinai School of Medicine.

  • "Clinicians don't biopsy classic inflammatory diseases as they already know the diagnosis," added Dallas-based dermatologist and dermatopathologist Clay J. Cockerell, M.D. "They usually biopsy unusual or weird clinical presentations." Tough cases include very early lesions, with features not fully expressed, and psoriasis superimposed with spongiosis will.

  • Lymphocytes Gone Wild: Cutaneous Lymphomas – With some primary cutaneous T-cell lymphomas, said Scott Wickless, D.O., "The average time from initial presentation to a dermatologist to diagnosis is up to 8 years. The good news is, it's slow and indolent. The bad news is, from a medicolegal standpoint, you don't want to miss it." Dr. Wickless is a dermatopathologist at Cockerell Dermatopathology.

  • What's New in the Histologic Diagnosis and Treatment of Melanoma? – Myriad’s MyPath Melanoma, is a diagnostics tool we use in our practice, it is used to determine what may be going on beyond the histopathological level.  It looks at the expression of 23 genes to determine whether the lesion is benign or malignant.  It evaluates the expression levels in the lesion itself and also looks at the tumor microenvironment, said Dr. Cockerell. Another promising tool is DecisionDx offered by Castle Biosciences which is a prognostic indicator of how melanoma is behaving and may behave going forward, respectively, said Dr. Cockerell. "But you still need to do good clinical correlation."

  • The Most Common Cancers in the World: SCC and BCC – "I've had more deaths over the years from aggressive SCC than melanoma," said Roger Ceilley, M.D., clinical professor of dermatology, University of Iowa. He addressed new treatments including ingenol mebutate and vismodegib, and the growing need for SRT.

  • Antoanella Calame, M.D., took a case-based approach to lampoon jargon like "atypical squamous proliferation. This is not a diagnosis; it's a description." And the and proliferation of purported micronodules in BCC reports is "a fad, like gluten-free food. One small nodule does not make it micronodular." Finally, asked Dr. Calame, "Can this weather be any more beautiful? And I'm from San Diego."

The evening concluded with a cocktail reception, featuring Coquerel wines, hors d'oeuvres and collegial conversation between attendees and industry representatives.

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The Practical Symposium is a Cockerell Educational Foundation event.

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