Conference Coverage

Cancer-related clinical pearls from pediatric dermatology


 

EXPERT ANALYSIS FROM SDEF HAWAII DERMATOLOGY SEMINAR


BCNS is caused by mutations in the PTCH (Patched) gene found on chromosome arm 9q. The major features of BCNS include odontogenic keratocysts, palmoplantar pits, ectopic calcification, and, of course, basal cell carcinomas. The associated findings in BCNS, in addition to medulloblastoma, include macrocephaly and dysmorphic features such as cleft lip or palate, frontal bossing, and hypertelorism.

Dr. Lawrence F. Eichenfield is the vice chair of the department of dermatology and a professor of dermatology and pediatrics at the University of California, San Diego

Dr. Lawrence F. Eichenfield

Children with BCNS can develop hundreds of initially tiny skin tumors. Session chair Lawrence F. Eichenfield, MD, observed that treatment can be tricky. Hedgehog pathway inhibitors such as vismodegib (Erivedge) are contraindicated in children. He shared a tip he learned from a colleague: treat these numerous microbasal cells using a stacked pulse dye laser without cooling.

“I’ve treated a hundred at a time. It’s incredibly successful. It’s locally destructive. It leaves a little bit of hypopigmentation but no scar, which the CO2 laser will do in this instance. It’s actually a pretty cool modality,” said Dr. Eichenfield, professor of dermatology and pediatrics at Rady Children’s Hospital and the University of California, San Diego.

Follicular eruptions in cancer patients on MAPK inhibitors

Cutaneous reactions to anticancer drugs aimed at inhibiting the key MAPK (mitogen-activated protein kinase) pathway in children are common and diverse. Dr. Huang focused on the most common one: follicular eruptions, which occur in up to 80% of pediatric cancer patients on targeted therapy. These eruptions can express themselves in a variety of ways and are easily mistaken for comedonal acne, varicella zoster infection, herpes simplex, or bacterial folliculitis.

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