Controversies in Dermatology from the Scientific Advisory Committee

Faculty: Lindsay Ackerman, MD

Dr. Lindsay Ackerman presented a discussion of dermatology controversies from her work in the Scientific Advisory Committee (SAC) with US Dermatology Partners. She began with a review of superficial radiation (SRT) in the treatment of non-melanoma skin cancers (NMSC). In most cases, brachytherapy is the way in which SRT is delivered. Dr. Ackerman noted one of the main limitations in the research is the lack of long-term data (>5 years post-treatment). One of the main conclusions of the SAC is that smaller, low risk, trunk and extremity tumors would be ideal for SRT, but a simple excision or ED & C would likely yield an equivalent result without radiation and extra cost.

Next, she covered the use of low dose naltrexone (LDN) in dermatology. Naltrexone is an active opioid antagonist. Unfortunately, there are no published randomized controlled trials in regards to LDN use in dermatology. There is weak evidence based on case series and reports which reveal LDN may be useful, with minimal or no side effects as a treatment for psoriasis, lichen planopilaris, dermatomyositis, Hailey-Hailey disease, and in the pruritus of scleroderma. Dr. Ackerman went on to discuss the Dermtech pigmented lesion assay (PLA) . She mentioned all of the data for this product is provided solely from the Dermtech company. The product is an adhesive patch based, non-invasive molecular test for clinically atypical pigmented lesions. Dr. Ackerman reports the SAC concludes Dermtech PLA best offers a “niche role for cosmetically sensitive sites, patients leery of biopsy, and patients with high risk of hypertrophic scarring or other relative contraindications to standard biopsy”.

Dr. Ackerman further discussed the efficacy of photodynamic therapy (PDT) for the treatment of actinic keratoses (AKs). Photodynamic therapy involves the application of aminolevulinic acid (ALA) in a gel or solution form and exposure to red or blue light. She reports that most dermatology providers veer from the FDA guidelines regarding incubation and light source with “most of us using combinations of red and blue light and incubating for 30 minutes to 2 hours”. She reports the SAC concludes PDT is “ as effective, if not more effective, than alternative treatment options for AK field therapy, with potentially better cosmetic results than alternative options”. Lastly, Dr. Ackerman reviewed the use of Decision Dx-Melanoma which is a gene expression profile (GEP) test designed to identify the risk of recurrence or metastasis in Stage I, II and III melanoma based on the biologic profile of 31 genes within the tumor tissue.