Bernice Kwong, MD

Clinical Professor

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credentials
Publications

Specialties

Dermatology

Work and Education

Professional Education

Yale School Of Medicine, New Haven, CT, 06/30/2007

Internship

Yale New Haven Dept of Internal Medicine, New Haven, CT, 06/30/2008

Residency

Stanford University Dept of Dermatology, Stanford, CA, 06/30/2012

Board Certifications

Dermatology, American Board of Dermatology

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All Publications

Immunotherapy for keratinocyte cancers. Part II: Identification and management of cutaneous side effects of immunotherapy treatments. Journal of the American Academy of Dermatology Chang, A. L., Zaba, L., Kwong, B. Y. 2023; 88 (6): 1243-1255

Abstract

Keratinocytic cancers (KCs), specifically cutaneous squamous cell and basal cell carcinomas, can respond to topical, intralesional, or systemic immunotherapies, but cutaneous adverse events (CAEs) may occur. Understanding these risks, early recognition of these CAEs, and effective treatment may enable patients to continue their anticancer immunotherapies without dose impact. Immune checkpoint inhibitor-related CAEs after KCs can have multiple clinical presentations, with specific observed types including psoriasis and bullous pemphigoid. Cutaneous toxicities can require biopsies to confirm the diagnosis, especially in patients who are not responsive to topical or oral steroids, since the selection of biologic drugs depends on accurate diagnosis. Different types of CAEs from immune checkpoint inhibitors have been associated with different oncologic outcomes in various primary cancer types, and this remains to be determined for KC patients. CAE characterization and management after immune checkpoint inhibitors in KC patients is a rapidly growing field that needs specific and prospective studies.

View details for DOI 10.1016/j.jaad.2022.07.062

View details for PubMedID 37268391

Evolution of a Project to Improve Inpatient-to-Outpatient Dermatology Care Transitions: Mixed Methods Evaluation. JMIR dermatology Kling, S. M., Aleshin, M. A., Saliba-Gustafsson, E. A., Garvert, D. W., Brown-Johnson, C. G., Amano, A., Kwong, B. Y., Calugar, A., Shaw, J. G., Ko, J. M., Winget, M. 2023; 6: e43389

Abstract

BACKGROUND: In-hospital dermatological care has shifted from dedicated dermatology wards to consultation services, and some consulted patients may require postdischarge follow-up in outpatient dermatology. Safe and timely care transitions from inpatient-to-outpatient specialty care are critical for patient health, but communication around these transitions can be disjointed, and workflows can be complex.OBJECTIVE: In this 3-phase quality improvement effort, we developed and evaluated an intervention that leveraged an electronic health record (EHR) feature, known as SmartPhrase, to enable a new workflow to improve transitions from inpatient care to outpatient dermatology.METHODS: Phase 1 (February-March 2021) included interviews with patients and process mapping with key stakeholders to identify gaps and inform an intervention: a SmartPhrase table and associated workflow to promote collection of patient information needed for scheduling follow-up and closed-loop communication between dermatology and scheduling teams. In phase 2 (April-May 2021), semistructured interviews-with dermatologists (n=5), dermatology residents (n=5), and schedulers (n=6)-identified pain points and refinements. In phase 3, the intervention was evaluated by triangulating data from these interviews with measured changes in scheduling efficiency, visit completion, and messaging volume preimplementation (January-February 2021) and postimplementation (April-May 2021).RESULTS: Preintervention pain points included unclear workflow for care transitions, limited patient input in follow-up planning, multiple messaging channels (eg, EHR based, email, and phone messages), and time-inefficient patient tracking. The intervention addressed most pain points; interviewees reported the intervention was easy to adopt and improved scheduling efficiency, workload, and patient involvement. More visits were completed within the desired timeframe of 14 days after discharge during the postimplementation period (21/47, 45%) than the preimplementation period (28/41, 68%; P=.03). The messaging workload also decreased from 88 scheduling-related messages sent for 25 patients before implementation to 30 messages for 8 patients after implementation.CONCLUSIONS: Inpatient-to-outpatient specialty care transitions are complex and involve multiple stakeholders, thus requiring multifaceted solutions. With deliberate evaluation, broad stakeholder input, and iteration, we designed and implemented a successful solution using a standard EHR feature, SmartPhrase, integrated into a standardized workflow to improve the timeliness of posthospital specialty care and reduce workload.

View details for DOI 10.2196/43389

View details for PubMedID 37632927

Development of a Framework for Addressing Skin Biopsy Tray Waste in Dermatology Clinics: A Quality Improvement Study. JAMA dermatology Wolstencroft, P. W., Zacher, N. C., Scotellaro, K., Centkowski, S., Kwong, B. Y. 2023

Abstract

The US health care system generates substantial global waste. Skin biopsies are frequently performed by dermatologists and represent a practical and scalable opportunity for waste reduction interventions in dermatology clinics.To develop and implement a systematic framework for decreasing skin biopsy tray waste in dermatology clinics.This quality improvement study was conducted at 4 outpatient clinic sites within a single institution between October 2021 and April 2022. The clinic site with the greatest skin biopsy tray waste production was selected for intervention. Waste audits before and after the intervention quantified the number of wasted supplies per skin biopsy tray in dermatology clinics. The participants were dermatology residents, faculty, nurses, medical assistants, and clinic managers.Provision of educational materials about climate change and health care and standardizing biopsy tray setup to decrease wasted supplies.Quantity of wasted skin biopsy tray supplies (gauze squares, alcohol pads, cotton swabs, and adhesive bandages) before and after interventions.In waste audits in 4 outpatient dermatology clinics (comprising 98 skin biopsy trays), prior to intervention, 100% of skin biopsy trays had more than 2 wasted supplies within targeted outpatient dermatology clinics at the Stanford Cancer Institute with a mean (SD) of 10.1 (3.4) wasted items per biopsy tray. Following the quality improvement-based interventions, only 16% of skin biopsy trays had more than 2 wasted supplies and the mean (SD) number of wasted supplies per tray decreased to 1.6 (1.3).Results of this quality improvement study suggest that through collaboration with all members of the clinical team including physicians, medical assistants, nurses, and clinic managers, skin biopsy tray setup modifications may be associated with reduced waste in outpatient dermatology clinics. This study presents a framework that accounts for different factors in the production of waste in individual clinic settings, and thus can be adapted within additional dermatology clinics.

View details for DOI 10.1001/jamadermatol.2023.0511

View details for PubMedID 36930161

Association of Intraoperative Antibiotic Irrigation With Systemic Contact Dermatitis. JAMA dermatology So, J. Y., Suzuki, N., Chen, J. K., Pugliese, S., Kwong, B. Y., Meng, L., Honari, G. 2022

Abstract

This case series describes the development of morbilliform drug eruption after breast surgery.

View details for DOI 10.1001/jamadermatol.2022.4458

View details for PubMedID 36383358

Expert consensus recommendations for managing hyperglycemia and rash in patients with PK3CA-mutated, hormone receptor-positive (HR plus ), human epidermal growth factor receptor 2-negative (HER2-) advanced breast cancer (ABC) treated with alpelisib (ALP) Gallagher, E. J., Moore, H., Lacouture, M. E., Dent, S., Farooki, A., Goncalves, M. D., Isaacs, C., Johnston, A., Juric, D., Quandt, Z., Spring, L., Berman, B., Decker, M., Hortobagyi, G. N., Kaffenberger, B., Kwong, B. Y., Pluard, T. J., Rao, R. D., Schwartzberg, L. S., Broder, M. S. LIPPINCOTT WILLIAMS & WILKINS. 2022: 422

View details for Web of Science ID 000891944700418

Consensus on the Clinical Management of Chronic Radiation Dermatitis and Radiation Fibrosis: A Delphi Survey. The British journal of dermatology Wilson, B. N., Shah, R., Menzer, C., Aleisa, A., Sun, M. D., Kwong, B. Y., Kaffenberger, B. H., Seminario-Vidal, L., Barker, C. A., Stubblefield, M. D., Romesser, P. B., Fabbrocini, G., Alam, M., Abdulla, F., Dulmage, B., Sibaud, V., Anadkat, M., Mazer, J., Parikh, D., McLellan, B., Cartier, H., Pugliese, S., Wolkerstorfer, A., Laubach, H., LeBoeuf, N., Leventhal, J., Wan, D. C., Choi, J., Thanh Nga, T., Anderson, R. R., Markova, A., Rossi, A. 2022

View details for DOI 10.1111/bjd.21852

View details for PubMedID 36047980

Teledermatology to Facilitate Patient Care Transitions From Inpatient to Outpatient Dermatology: Mixed Methods Evaluation. Journal of medical Internet research Kling, S. M., Saliba-Gustafsson, E. A., Winget, M., Aleshin, M. A., Garvert, D. W., Amano, A., Brown-Johnson, C. G., Kwong, B. Y., Calugar, A., El-Banna, G., Shaw, J. G., Asch, S. M., Ko, J. M. 2022; 24 (8): e38792

Abstract

BACKGROUND: Both clinicians and patients have increasingly turned to telemedicine to improve care access, even in physical examination-dependent specialties such as dermatology. However, little is known about whether teledermatology supports effective and timely transitions from inpatient to outpatient care, which is a common care coordination gap.OBJECTIVE: Using mixed methods, this study sought to retrospectively evaluate how teledermatology affected clinic capacity, scheduling efficiency, and timeliness of follow-up care for patients transitioning from inpatient to outpatient dermatology care.METHODS: Patient-level encounter scheduling data were used to compare the number and proportion of patients who were scheduled and received in-clinic or video dermatology follow-ups within 14 and 90 days after discharge across 3 phases: June to September 2019 (before teledermatology), June to September 2020 (early teledermatology), and February to May 2021 (sustained teledermatology). The time from discharge to scheduling and completion of patient follow-up visits for each care modality was also compared. Dermatology clinicians and schedulers were also interviewed between April and May 2021 to assess their perceptions of teledermatology for postdischarge patients.RESULTS: More patients completed follow-up within 90 days after discharge during early (n=101) and sustained (n=100) teledermatology use than at baseline (n=74). Thus, the clinic's capacity to provide follow-up to patients transitioning from inpatient increased from baseline by 36% in the early (101 from 74) and sustained (100 from 74) teledermatology periods. During early teledermatology use, 61.4% (62/101) of the follow-ups were conducted via video. This decreased significantly to 47% (47/100) in the following year, when COVID-19-related restrictions started to lift (P=.04), indicating more targeted but still substantial use. The proportion of patients who were followed up within the recommended 14 days after discharge did not differ significantly between video and in-clinic visits during the early (33/62, 53% vs 15/39, 38%; P=.15) or sustained (26/53, 60% vs 28/47, 49%; P=.29) teledermatology periods. Interviewees agreed that teledermatology would continue to be offered. Most considered postdischarge follow-up patients to be ideal candidates for teledermatology as they had undergone a recent in-person assessment and might have difficulty attending in-clinic visits because of competing health priorities. Some reported patients needing technological support. Ultimately, most agreed that the choice of follow-up care modality should be the patient's own.CONCLUSIONS: Teledermatology could be an important tool for maintaining accessible, flexible, and convenient care for recently discharged patients needing follow-up care. Teledermatology increased clinic capacity, even during the pandemic, although the timeliness of care transitions did not improve. Ultimately, the care modality should be determined through communication with patients to incorporate their and their caregivers' preferences.

View details for DOI 10.2196/38792

View details for PubMedID 35921146

Acanthosis nigricans in the setting of severe pulmonary disease exacerbated by COVID-19 infection. JAAD case reports Hirotsu, K. E., Chiang, A., Bahrani, E., Cloutier, J. M., Rieger, K. E., Kwong, B. Y., Aleshin, M. 2022

View details for DOI 10.1016/j.jdcr.2022.04.017

View details for PubMedID 35529073

Exploring Potential Innate Immune Targets to Treat Fibrosis and Chronic Inflammation in Chronic Graft-Versus-Host Disease Paulson, N., De Souza, C., Cui, L., Lerbs, T., Poyser, J., Kooshesh, M., Saleem, A., Rieger, K., Brown', R., Kwong, B., Fernandez-Po, S., Arai, S., Shizuru, J., Mueller, A., Wernig, G. SPRINGERNATURE. 2022: 557

View details for Web of Science ID 000770361801147

Histologic subtype of cutaneous immune-related adverse events predicts overall survival in patients receiving immune checkpoint inhibitors. Journal of the American Academy of Dermatology Hirotsu, K. E., Scott, M. K., Marquez, C., Tran, A. T., Rieger, K. E., Novoa, R. A., Robinson, W. H., Kwong, B. Y., Zaba, L. C. 2021

View details for DOI 10.1016/j.jaad.2021.11.050

View details for PubMedID 34875301

Selective Targeting of Immune Modulatory Proteins to Mitigate Fibrosis and Inflammation in Sclerodermatous Graft-Vs-Host Disease Cui, L., De Souza, C., Lerbs, T., Poyser, J., Kooshesh, M., Saleem, A., Rieger, K., Brown, B., Kwong, B., Fernandez-Pol, S., Arai, S., Shizuru, J. A., Mueller, A. S., Wernig, G. AMER SOC HEMATOLOGY. 2021

View details for DOI 10.1182/blood-2021-151223

View details for Web of Science ID 000736398802184

A 10-year retrospective cohort study of ruxolitinib and association with non-melanoma skin cancer in polycythemia vera and myelofibrosis patients. Journal of the American Academy of Dermatology Lin, J. Q., Li, S. Q., Li, S., Kiamanesh, E. F., Aasi, S. Z., Kwong, B. Y., Chang, A. L. 2021

Abstract

BACKGROUND: Clinical trials report occurrence of non-melanoma skin cancers (NMSC) with ruxolitinib in polycythemia (PV) or myelofibrosis (MF) patients, however the level of risk and effect of covariates are not known in the real-world setting.OBJECTIVE: To systematically assess the risk of developing non-melanoma skin cancer (NMSC) after ruxolitinib exposure in PV or MF patients.METHODS: A 10-year retrospective cohort of PV or MF patients at Stanford Medical Center was identified and matched on age, gender, race, Charlson comorbidity index, disease diagnosis, and follow-up time. The main outcome measure was Hazard Ratio (HR) for NMSC (comprised of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC)) after ruxolitinib exposure, adjusted for covariates.RESULTS: The study cohort consisted of 564 patients (188 exposed to ruxolitinib for at least 4 weeks, 376 unexposed). Ruxolitinib-exposed PV or MF patients had an adjusted NMSC HR of 2.69 (95% Confidence Interval (CI), 1.03-7.02). In particular, ruxolitinib exposure was associated with SCC, HR=3.24 (95% CI, 1.45-7.22), with non-JAK2 mutated patients showing even higher SCC risk, HR=7.40 (2.54-21.63).LIMITATIONS: Retrospective design.CONCLUSIONS AND RELEVANCE: Our real-world results indicate that SCC risk is increased in PV or MF patients taking ruxolitinib and supports consideration of skin cancer monitoring.

View details for DOI 10.1016/j.jaad.2021.10.004

View details for PubMedID 34648874

Cutaneous Reactive Angiomatosis associated with Intravascular Cryoprotein Deposition as the Presenting Finding in a Patient with Underlying Lymphoplasmacytic Lymphoma: A Case Report and Review of the Literature. Journal of cutaneous pathology Zacher, N. C., Bailey, E. E., Kwong, B. Y., Rieger, K. E. 2021

Abstract

Cutaneous reactive angiomatosis, a group of disorders defined by benign vascular proliferation, is associated with a number of systemic processes, including intravascular occlusion by cryoproteins. We report a case of a 64-year-old female patient who presented with a one-year history of non-tender petechiae of the bilateral arms and lower legs. Dermoscopic evaluation showed increased vascularity with a globular pattern. Over a period of months, her findings progressed to erythematous to violaceous plaques with admixed hypopigmented stellate scarring of the bilateral lower extremities, forearms, and lateral neck. Biopsy showed increased thin-walled, small dermal blood vessels with focal inter-anastamosis. Some vessels were occluded by eosinophilic globules suspicious for cryoprotein. Subsequent laboratory studies confirmed a diagnosis of type 1 cryoglobulinemia, prompting a bone marrow biopsy that revealed lymphoplasmacytic lymphoma. Herein we report the fourth case of angiomatosis secondary to intravascular cryoproteins as the initial presentation of an underlying hematologic malignancy. We also present a review of the literature and emphasize the need for thorough initial work-up and close and prolonged clinical monitoring for underlying systemic disease in these patients. This article is protected by copyright. All rights reserved.

View details for DOI 10.1111/cup.14144

View details for PubMedID 34617316

Dermatologic toxicities of targeted antineoplastic agents and immune checkpoint inhibitor therapy in pediatric patients: A systematic review. Pediatric blood & cancer Liu, L. Y., Teng, J. M., Spunt, S. L., Strelo, J. L., Kwong, B. Y., Zaba, L. C. 2021: e29346

Abstract

Cutaneous adverse events (cAEs) from targeted antineoplastic agents and immune checkpoint inhibitors are common in children with cancer and may lead to dose reduction or cessation of critical oncologic treatment. Timely diagnosis and proper management of cAEs in pediatric oncology patients is essential to optimize ongoing cancer-directed therapy and improve quality of life. This systematic review of published studies summarizes dermatologic toxicities to targeted anticancer treatments and immune checkpoint inhibitors.

View details for DOI 10.1002/pbc.29346

View details for PubMedID 34569142

Clinical features of drug-induced hypersensitivity syndrome to BRAF inhibitors with and without previous immune checkpoint inhibition: a review. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer Maloney, N. J., Rana, J., Yang, J. J., Zaba, L. C., Kwong, B. Y. 2021

Abstract

PURPOSE: Cutaneous reactions to BRAF inhibitors are common, but severe reactions resembling or consistent with drug-induced hypersensitivity syndrome (DIHS)/drug reaction with eosinophilia and systemic symptoms (DRESS) are relatively rare. Several reports suggest that cutaneous reactions including DRESS/DIHS to BRAF inhibitors are more frequent and severe in the setting of previous immune checkpoint inhibition (ICI).METHODS: To characterize existing literature on these reports, we queried the PubMed/MEDLINE database for cases of DIHS/DRESS to BRAF inhibitors.RESULTS: We identified 23 cases of DIHS to BRAF inhibitors following checkpoint inhibition and 14 cases without prior checkpoint inhibitor therapy. In both cohorts, DIHS occurred relatively early, with median time to onset from drug exposure of 8-10days. Patients who received prior ICI were less likely to have peripheral eosinophilia (26% vs 71%), atypical lymphocytes (9% vs 50%), renal involvement (61% vs 79%), hepatic involvement (52% vs 86%), and lymphadenopathy (9% vs 43%) compared to patients who did not receive prior ICI. Thrombocytopenia was more common with prior ICI (17% vs 7%). Only patients who received prior ICI experienced hypotension (26%) during the course of their DIHS. All cases of BRAF-induced DIHS generally improved on systemic steroids/supportive care, and no cases of death were identified.CONCLUSION: Dermatologists should consider a diagnosis of DIHS following BRAF inhibitor initiation, particularly in the setting of past checkpoint inhibition, with atypical features including relatively rapid onset and steroid responsiveness, lack of peripheral eosinophilia, lymphocytosis, or lymphadenopathy, and increased risk of thrombocytopenia and hypotension.

View details for DOI 10.1007/s00520-021-06543-9

View details for PubMedID 34546454

NUTRITIONAL DEFICIENCY CONTRIBUTING TO REFRACTORY ERYTHRODERMA IN HEMATOPOETIC CELL TRANSPLANT PATIENTS: DISTINCTIVE CLINICAL AND HISTOPATHOLOGICAL FINDINGS. Journal of the American Academy of Dermatology Winge, M. C., Rieger, K. E., Kim, J., Weng, W., Johnston, L. J., Miklos, D. B., Strelo, J., Zaba, L. C., Pugliese, S. B., Novoa, R. A., Kwong, B. Y. 2021

View details for DOI 10.1016/j.jaad.2021.07.077

View details for PubMedID 34450206

Histopathologic correlation of skin manifestations of multisystemic inflammatory syndrome in adults (MIS-A) associated with SARS-CoV-2 infection. JAAD case reports So, N. A., So, J., Centkowski, S., Rana, J., Aleshin, M., Kwong, B. Y., Rieger, K., Zaba, L. C., Chiou, A. S. 2021

View details for DOI 10.1016/j.jdcr.2021.06.031

View details for PubMedID 34405113

Complete remission from intralesional talimogene laherparepvec for regionally advanced Merkel cell carcinoma in an immunocompromised solid organ transplant patient. JAAD case reports Hirotsu, K. E., Hua, V., Tran, A. T., Morris, L., Reddy, S. A., Kwong, B. Y., Zaba, L. C. 2021; 13: 144-146

View details for DOI 10.1016/j.jdcr.2021.05.005

View details for PubMedID 34195326

Drug-induced hypersensitivity syndrome like reaction with angioedema and hypotension associated with BRAF inhibitor use and antecedent immune checkpoint therapy. JAAD case reports Rana, J., Maloney, N. J., Rieger, K. E., Pugliese, S. B., Strelo, J. L., Liu, A., Zaba, L. C., Kwong, B. Y. 2021; 13: 147-151

View details for DOI 10.1016/j.jdcr.2021.04.033

View details for PubMedID 34195327

Association of ruxolitinib with NMSCs risk in patients with polycythemia vera and myelofibrosis Lin, J., Li, S., Li, S., Kiamanesh, E., Aasi, S., Kwong, B., Chang, A. ELSEVIER SCIENCE INC. 2021: S43

View details for Web of Science ID 000641872800241

Radiation Therapy for Primary Cutaneous Gamma Delta Lymphoma Prior to Stem Cell Transplantation. Cancer investigation Wu, Y. F., Skinner, L., Lewis, J., Khodadoust, M. S., Kim, Y. H., Kwong, B. Y., Weng, W., Hoppe, R. T., Sodji, Q., Hui, C., Kastelowitz, N., Fernandez-Pol, S., Hiniker, S. M. 2021: 111

Abstract

We present a patient with widespread PCGD-TCL of the bilateral arms and legs, who underwent radiotherapy with 34Gy in 17 fractions using circumferential VMAT and 3-D printed bolus to the 4 extremities prior to planned stem cell transplant, who was then found to have progression in the liver, lung, and skin, followed by drastic regression of all in and out-of-field lesions on imaging 1.5months later. The cause of regression may be related to a radiation-induced abscopal effect from the immunomodulatory effects of radiation, or related to immune reactivation in the setting of cessation of systemic immunosuppressive agents.

View details for DOI 10.1080/07357907.2021.1919696

View details for PubMedID 33899635

Clinical Characterization of Mogamulizumab-Associated Rash During Treatment of Mycosis Fungoides or Sezary Syndrome. JAMA dermatology Hirotsu, K. E., Neal, T. M., Khodadoust, M. S., Wang, J. Y., Rieger, K. E., Strelo, J., Hong, E., Kim, Y. H., Kwong, B. Y. 2021

Abstract

Importance: Mogamulizumab is a monoclonal antibody against CCR4 approved for treatment for mycosis fungoides (MF) and Sezary syndrome (SS). Mogamulizumab-associated rash (MAR) is difficult to differentiate from cutaneous MF or SS, which can lead to unnecessary discontinuation of drug use because of concern for severe drug reaction or incorrect presumption of disease relapse or progression in the skin.Objective: To examine the most common clinical presentations of MAR in patients with MF or SS and the diagnostic and management challenges.Design, Setting, and Participants: This retrospective case series assessed patients from a multidisciplinary cutaneous lymphoma clinic and supportive oncodermatology clinic at a major academic referral center who had a diagnosis of MF or SS and received mogamulizumab from January 1, 2013, to January 1, 2020. Treatment was followed by new or worsening rash with skin biopsy results compatible with drug eruption determined by clinicopathologic correlation and molecular testing to exclude active malignant disease.Exposures: At least 1 dose of mogamulizumab.Main Outcomes and Measures: Mogamulizumab-associated rash was characterized by clinical features, including time to onset, clinical presentation, histopathologic features, and management approach.Results: The study included 19 patients with MF or SS who developed MAR (median age, 65 years; age range, 38-82 years; 10 [52.6%] male). Median time to MAR onset was 119 days (range, 56 days to 3.8 years). Patients with MAR exhibited 4 predominant clinical presentations: (1) folliculotropic MF-like scalp plaques with alopecia, (2) papules and/or plaques, (3) photoaccentuated dermatitis, and (4) morbilliform or erythrodermic dermatitis. The most common anatomical region involved was the head and neck, including the scalp. Histopathologic findings were variable and did not correspond to primary clinical morphologic findings. Immunohistochemistry and T-cell clonality ancillary testing were helpful to distinguish MAR from disease. Most patients with MAR (14 of 19) discontinued mogamulizumab treatment; however, no life-threatening severe cutaneous adverse drug reactions occurred, and the decision for drug therapy cessation was usually multifactorial. Four patients were treated again with mogamulizumab with no life-threatening drug-related events. Approaches to management of MAR include topical corticosteroids, systemic corticosteroids, and/or methotrexate.Conclusions and Relevance: This case series found that mogamulizumab-associated rash had a heterogeneous clinical presentation with variable and delayed onset in patients with MF or SS. Mogamulizumab-associated rash exhibited a predilection for the head and neck and was difficult to clinically distinguish from relapse or progression of disease. Recognition of the most common clinical presentations can help prevent unnecessary discontinuation of mogamulizumab treatment. The presence of MAR does not necessitate permanent discontinuation of or avoidance of retreatment with mogamulizumab.

View details for DOI 10.1001/jamadermatol.2021.0877

View details for PubMedID 33881447

Using Visual Arts Education in Dermatology to Benefit Resident Wellness and Clinical Communication. MedEdPORTAL : the journal of teaching and learning resources Kumar, A. M., Lee, G. H., Stevens, L. A., Kwong, B. Y., Nord, K. M., Bailey, E. E. 2021; 17: 11133

Abstract

Introduction: Art education interventions improve observation skills among dermatology residents, but there is limited data regarding their benefits to wellness and clinical communication.Methods: Residents in the Stanford dermatology residency program participated in an arts-based education session, repeated in the fall of 2018 and 2019, that included a rotation of observational exercises adapted from the Artful Thinking program through Harvard Project Zero. The 2018 session featured exercises on identification and understanding of visual observation, while the 2019 session featured exercises on perspectives and objectivity of visual observation. Participants completed preintervention, postintervention, and 3-month follow-up surveys in fall 2018 and a postintervention survey in fall 2019.Results: Twenty-one residents participated in the 2018 education session and produced an adequate response rate (62%-90%) across surveys. At 3 months, five of 13 residents (39%) reported new use of art for mindfulness and stress reduction, 12 of 13 (92%) could recall an example of use of observation to improve patient communication, and four of 13 (31%) confirmed and described adjustments to their handoff technique. In 2019, 13 out of 18 participants (72%) completed the postintervention survey. Responses reinforced themes from the prior iteration but focused on perspective, objectivity, context, and uncertainty in observations. Respondents also identified additional arenas of communication to benefit from these observational techniques.Discussion: Dermatology residents increased use of art for personal wellness and adjusted clinical communication strategies after a single arts-based education session. Annual repetition with novel exercises maintained engagement and yielded additional participant insights.

View details for DOI 10.15766/mep_2374-8265.11133

View details for PubMedID 33816794

Anti-Cancer Therapy Related Hand-Foot Syndrome in Patients with Systemic Sclerosis: Case Series and Literature Review (vol 1, 100021, 2020) CURRENT PROBLEMS IN CANCER: CASE REPORTS Grinnell, M., Rieger, K. E., Katsumoto, T. R., Kwong, B. Y., Zaba, L. C. 2021; 3

View details for DOI 10.1016/j.cpccr.2021.100070

View details for Web of Science ID 001026245200004

Telescope punch biopsy of normal-appearing skin to diagnose intravascular lymphoma. The British journal of dermatology Winge, M. C., Iberri, D. J., Novoa, R. A., Kwong, B. Y., Zaba, L. C. 2021

View details for DOI 10.1111/bjd.19711

View details for PubMedID 33523506

Dermatologic Events Associated with the Anti-CCR4 Antibody Mogamulizumab: Characterization and Management. Dermatology and therapy Musiek, A. C., Rieger, K. E., Bagot, M., Choi, J. N., Fisher, D. C., Guitart, J., Haun, P. L., Horwitz, S. M., Huen, A. O., Kwong, B. Y., Lacouture, M. E., Noor, S. J., Rook, A. H., Seminario-Vidal, L., Vermeer, M. H., Kim, Y. H. 2021

Abstract

The CCR4-directed monoclonal antibody mogamulizumab has been shown to significantly improve progression-free survival and overall response rate compared with vorinostat in adults with relapsed/refractory mycosis fungoides (MF) and Szary syndrome (SS). One of the most common adverse events seen with mogamulizumab in MF/SS patients is rash. Because of the protean nature of MF/SS and the variable clinical and histopathological features of mogamulizumab-associated rash, healthcare providers may have difficulty distinguishing rash from disease, and may not be aware of appropriate treatment strategies for this generally manageable adverse event. The objective of this report was to combine results from published literature with experiences and recommendations from multiple investigators and institutions into clinical best practice recommendations to assist healthcare providers in identifying and managing mogamulizumab-associated rash. Optimal management, which includes biopsy confirmation and steroid treatment, requires a multidisciplinary approach among oncology, dermatology, and pathology practitioners. INFOGRAPHIC.

View details for DOI 10.1007/s13555-021-00624-7

View details for PubMedID 34816383

Anti-cancer therapy related hand-foot syndrome in patients with systemic sclerosis: Case series and literature review CURRENT PROBLEMS IN CANCER: CASE REPORTS Grinnell, M., Rieger, K. E., Katsumoto, T. R., Kwong, B. Y., Zaba, L. C. 2020; 1

View details for DOI 10.1016/j.cpccr.2020.100021

View details for Web of Science ID 001026213000005

Disseminated non-Langerhans cell histiocytosis with an IRF2BP2-NTRK1 gene fusion identified by next-generation sequencing. JAAD case reports Chan, W. H., Shah, A., Bae, G., Hambro, C., Martin, B. A., Brown, R., Novoa, R., Kwong, B. Y. 2020; 6 (11): 115658

View details for DOI 10.1016/j.jdcr.2020.05.032

View details for PubMedID 33134460

Epidermal growth factor receptor inhibitor therapy-associated erythema dyschromicum perstans-like eruption: a case series. The British journal of dermatology Ransohoff, K. J., Pugliese, S. B., Zaba, L. C., Rieger, K. E., Kwong, B. Y. 2020

Abstract

Epidermal growth factor receptor inhibitors (EGFRi) are used for a variety of solid malignancies. Cutaneous adverse events are common, and include papulopustular eruptions (PPEs) in up to 90% of patients, xerosis, mucositis, paronychia, hypertrichosis, and enhanced radiation dermatitis.1-3 Here, we present a novel case series of eight patients who developed erythema dyschromicum perstans (EDP)-like eruptions while receiving EGFRis.

View details for DOI 10.1111/bjd.19396

View details for PubMedID 32652530

Outcomes of Embedding Dermatologic Care Within Oncology Practices for Patients With Cancer. JAMA dermatology Kwong, B. Y. 2020

View details for DOI 10.1001/jamadermatol.2020.1794

View details for PubMedID 32609297

Differentiation syndrome during ivosidenib treatment with immunohistochemistry showing isocitrate dehydrogenase R132H mutation. Journal of cutaneous pathology Tabata, M. M., Chase, M., Kwong, B. Y., Novoa, R. A., Fernandez-Pol, S. 2020

Abstract

We report a case of differentiation syndrome in a patient receiving the IDH1 inhibitor ivosidenib, with skin biopsy showing isocitrate dehydrogenase (IDH) R132H-mutated leukemia cutis. A 72-year-old man with IDH1-mutated acute myeloid leukemia (AML), status-post allogeneic cell transplantation, on ivosidenib for six months, was admitted for culture-negative neutropenic fever, pink and purpuric plaques and patches on the legs, abdomen and back, edema, hypotension, and shortness of breath. Skin biopsy revealed an infiltrate of atypical, immature, myeloperoxidase-positive mononuclear cells compatible with leukemia cutis or Sweet syndrome. Although dermal edema and interstitial neutrophilic infiltrate with karyorrhexis characteristic of Sweet syndrome were not seen, the atypical cells lacked expression of CD117 and CD34, which were expressed in the original leukemia. Additional immunohistochemical staining of suspected blasts was strongly positive for IDH1 R132H, suggesting a diagnosis of leukemia cutis. As the immunophenotype of blasts in skin infiltrates can significantly differ from the immunophenotype seen in blood and bone marrow, this case demonstrates that mutation-specific antibodies such as anti-IDH1 R132H may be useful to help distinguish malignant from non-malignant infiltrates in the skin. Furthermore, differentiation syndrome may demonstrate histologic features of leukemia cutis on skin biopsy. This article is protected by copyright. All rights reserved.

View details for DOI 10.1111/cup.13780

View details for PubMedID 32588467

Use of teledermatology by dermatology hospitalists is effective in the diagnosis and management of inpatient disease. Journal of the American Academy of Dermatology Gabel, C. K., Nguyen, E., Karmouta, R., Liu, K. J., Zhou, G., Alloo, A., Arakaki, R., Balagula, Y., Bridges, A. G., Cowen, E. W., Davis, M. D., Femia, A., Harp, J., Kaffenberger, B., Keller, J. J., Kwong, B. Y., Markova, A., Mauskar, M., Micheletti, R., Mostaghimi, A., Pierson, J., Rosenbach, M., Schwager, Z., Seminario-Vidal, L., Sharon, V. R., Song, P. I., Strowd, L. C., Walls, A. C., Wanat, K. A., Wetter, D. A., Worswick, S., Ziemer, C., Kvedar, J., Mikailov, A., Kroshinsky, D. 2020

Abstract

BACKGROUND: Patient outcomes are improved when dermatologists provide inpatient consults. Inpatient access to dermatologists is limited, illustrating an opportunity to utilize teledermatology. Little is known about the ability of dermatologists to accurately diagnose and manage inpatients using teledermatology, particularly utilizing non-dermatologist generated clinical data.METHODS: This prospective study assessed the ability of teledermatology to diagnose and manage 41 dermatology consults from a large urban tertiary care center utilizing internal medicine referral documentation and photos. Twenty-seven dermatology hospitalists were surveyed. Interrater agreement was assessed by the kappa statistic.RESULTS: There was substantial agreement between in-person and teledermatology assessment of the diagnosis with differential diagnosis (median kappa = 0.83), substantial agreement in laboratory work-up decisions (median kappa = 0.67), almost perfect agreement in imaging decisions (median kappa = 1.0), and moderate agreement in biopsy decisions (median kappa = 0.43). There was almost perfect agreement in treatment (median kappa = 1.0), but no agreement in follow-up planning (median kappa = 0.0). There was no association between raw photo quality and the primary plus differential diagnosis or primary diagnosis alone.LIMITATIONS: Selection bias and single-center nature.CONCLUSIONS: Teledermatology may be effective in the inpatient setting, with concordant diagnosis, evaluation, and management decisions.

View details for DOI 10.1016/j.jaad.2020.04.171

View details for PubMedID 32389716

Shoshin beriberi in a patient with oral and cutaneous graft-versus-host disease. JAAD case reports Hodgkinson, L. M., Shah, A., Bae, G. H., Novoa, R., Kwong, B. Y. 2020; 6 (5): 420-421

View details for DOI 10.1016/j.jdcr.2020.02.031

View details for PubMedID 32382634

View details for PubMedCentralID PMC7200185

Disseminated Tuberculosis Presenting as Medium-Vessel Vasculitis in an Immunocompromised Host. Journal of cutaneous pathology Wang, J. Y., Brown, R. A., Pugliese, S., Kwong, B. Y., Novoa, R. A. 2020

Abstract

Cutaneous tuberculosis is an uncommon entity with several clinical forms recognized. Histopathologically, most cases are characterized by granulomatous inflammation and caseating necrosis, though less common findings, including vasculitis, have also been described. We report a 55-year-old male with a history of recently diagnosed dermatomyositis receiving immunosuppression with mycophenolate mofetil and prednisone, who developed multifocal soft tissue abscesses and an indurated erythematous plaque on the back. Skin biopsy of the back revealed a necrotizing medium-vessel vasculitis. M. tuberculosis was detected in the skin via acid-fast bacilli stain and confirmed by tissue culture and polymerase chain reaction. Cutaneous findings improved rapidly with anti-tuberculosis therapy. This case illustrates an uncommon clinical and histopathologic presentation of disseminated tuberculosis. This article is protected by copyright. All rights reserved.

View details for DOI 10.1111/cup.13678

View details for PubMedID 32133689

Drug Reaction and High Fatality Lung Disease in Systemic Onset Juvenile Idiopathic Arthritis (sJIA) Saper, V., Mellins, E., Kwong, B. MOSBY-ELSEVIER. 2020: AB95

View details for Web of Science ID 000517092700293

Clinicopathologic characterization of enfortumab vedotin-associated cutaneous toxicity in patients with urothelial carcinoma. Journal of the American Academy of Dermatology Hirotsu, K. E., Rana, J. n., Wang, J. Y., Raghavan, S. S., Rieger, K. E., Srinivas, S. n., Fan, A. C., Kwong, B. Y., Novoa, R. A., Zaba, L. n. 2020

View details for DOI 10.1016/j.jaad.2020.11.067

View details for PubMedID 33301805

Shoshin beriberi in a patient with oral and cutaneous graft-versus-host disease JAAD Case Reports Hodgkinson, L. M., Shah, A., Bae, G. H., Novoa, R., Kwong, B. Y. 2020; 6 (5): 420-421

View details for DOI 10.1016/j.jdcr.2020.02.031

ONS Guidelines for Cancer Treatment-Related Skin Toxicity. Oncology nursing forum Williams, L. A., Ginex, P. K., Ebanks, G. L., Ganstwig, K. n., Ciccolini, K. n., Kwong, B. K., Robison, J. n., Shelton, G. n., Strelo, J. n., Wiley, K. n., Maloney, C. n., Moriarty, K. A., Vrabel, M. n., Morgan, R. L. 2020; 47 (5): 53956

Abstract

Management of cancer treatment-related skin toxicities can minimize treatment disruptions and improve patient well-being.This guideline aims to support patients and clinicians in decisions regarding management of cancer treatment-related skin toxicities.A panel developed a guideline for management of cancer treatment-related skin toxicities using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) for certainty of evidence and the National Academies of Sciences, Engineering, and Medicine criteria for trustworthy guidelines. The Cochrane risk-of-bias tool assessed risk of bias. A quantitative or narrative synthesis of the evidence was completed.The panel issued seven conditional recommendations for epidermal growth factor receptor inhibitor rash, hand-foot skin reaction, hand-foot syndrome, and chemotherapy-induced alopecia. The panel suggested strategies for prevention and treatment for all toxicities except hand-foot syndrome, which only has a prevention recommendation.Cancer treatment-related skin toxicities can significantly affect quality of life. Incorporation of these interventions into clinical care can improve patient outcomes.//onf.ons.org/supplementary-material-ons-guidelines-cancer-treatment-related-skin-toxicity.

View details for DOI 10.1188/20.ONF.539-556

View details for PubMedID 32830806

Histopathologic Characterization of Mogamulizumab-associated Rash. The American journal of surgical pathology Wang, J. Y., Hirotsu, K. E., Neal, T. M., Raghavan, S. S., Kwong, B. Y., Khodadoust, M. S., Brown, R. A., Novoa, R. A., Kim, Y. H., Rieger, K. E. 2020

Abstract

Rash is one of the most common adverse events observed with mogamulizumab, an anti-C-C chemokine receptor 4 monoclonal antibody approved for previously treated mycosis fungoides (MF) and Sezary syndrome (SS). Given the nonspecific clinical presentations of this rash, histopathologic distinction from MF/SS is critical for informing clinical management. We performed a comprehensive characterization of the histopathologic findings in mogamulizumab-associated rash (MAR) with the integration of high-throughput sequencing of T-cell receptor (TCR) genes. Fifty-two biopsy specimens from 19 patients were evaluated retrospectively. Three major histologic reaction patterns were identified: spongiotic/psoriasiform dermatitis (33/52), interface dermatitis (11/52), and granulomatous dermatitis (8/52). Almost half of the specimens (21/52) showed at least 2 of these reaction patterns concurrently. Dermal eosinophils were not a consistent feature, being present in only half (27/52) of specimens and prominent in only 3. Features mimicking MF/SS, including lymphocyte exocytosis, lamellar fibroplasia, and adnexal involvement, were commonly seen but tended to be focal and mild. In 38/43 specimens with available immunohistochemistry, intraepidermal lymphocytes demonstrated a CD4:CD8 ratio 1:1. Low background levels of the patient's previously identified MF/SS-associated TCR sequence(s) were demonstrated in 20/46 specimens analyzed by high-throughput sequencing of TCR. We conclude that MAR may demonstrate diverse histologic features. Findings that may distinguish MAR from MF/SS include the inverted or normalized CD4:CD8 ratio within intraepidermal lymphocytes and demonstration of absent or nondominant levels of disease-associated TCR sequences. Correlation with the clinical findings and immunohistochemical and molecular characterization of the patient's MF/SS before mogamulizumab, when possible, may facilitate recognition of MAR.

View details for DOI 10.1097/PAS.0000000000001587

View details for PubMedID 32976123

Evidence-based, Skin-directed Treatments for Cutaneous Chronic Graft-versus-host Disease. Cureus Kim, Y. J., Lee, G. H., Kwong, B. Y., Martires, K. J. 2019; 11 (12): e6462

Abstract

Chronic graft-versus host disease (cGVHD) occurs in 30% to 70% of patients undergoing allogeneic hematopoietic cell transplantation (HCT). Cutaneous cGVHD affects 75% of cGVHD patients, causing discomfort, limiting the range of movement, and increasing the risk of wound infections. Furthermore, systemic immunosuppression is often needed to treat cGVHDand long-term use can lead to adverse events. Optimal use of skin-directed therapies is integral to the management of cutaneous cGVHDand may decrease the amount of systemic immunosuppressionrequired. This study reviewed English-language articles published from 1990 to 2017 that evaluated the effect of skin-directed treatments for cutaneous cGVHD. A total of 201 papers were identified, 164 articles were screened, 46 were read, and 18 publications were utilized in the review. Skin-directed treatments for cGVHD included topical steroids, topical calcineurin inhibitors, psoralen with ultraviolet A (PUVA) irradiation, ultraviolet A1 (UVA1) irradiation, and ultraviolet B (UVB) irradiation. We report the number of complete remissions, partial remissions, and systemic immunosuppression reduction in each study, as available. Twenty-twoout of 30 (73.3%) patients experienced overall improvement with topical calcineurin inhibitors. At least26 out of 76 patients (34.2%) receiving PUVA experienced complete remission, and 30 out of 76 patients (39.5%) experienced partial remission. In UVA1 studies, 44 out of 52 (84.6%) patients experienced overall improvement. In UVB studies, nine out of 14 patients (64.3%) experienced complete remissionand four out of 14 patients (28.6%) experienced partial remission. As more HCTs are performed, more individuals will develop cGVHD. Awareness and optimal use of skin-directed therapies for cutaneous cGVHD may help improve patient outcomes and quality of life.

View details for DOI 10.7759/cureus.6462

View details for PubMedID 32025391

View details for PubMedCentralID PMC6977575

Evidence-based, Skin-directed Treatments for Cutaneous Chronic Graft-versus-host Disease CUREUS Kim, Y., Lee, G., Kwong, B. Y., Martires, K. J. 2019; 11 (12)

View details for DOI 10.7759/cureus.6462

View details for Web of Science ID 000504829200003

Pityriasis rubra pilaris-like graft-vs-host disease following allogeneic stem cell transplant in two patients. Clinical case reports Wang, J. Y., Tabata, M. M., Pugliese, S., Phillips, D., Kim, J., Weng, W. K., Kwong, B. Y. 2019; 7 (12): 2491-2494

Abstract

Chronic cutaneous graft-vs-host disease (GVHD) has several atypical variants. We describe two cases of GVHD with clinical and histopathologic features of pityriasis rubra pilaris (PRP), which responded to additional immunosuppression. Recognition of this newly described PRP-like clinical presentation of GVHD may prompt early consideration of additional steroid-sparing therapies.

View details for DOI 10.1002/ccr3.2458

View details for PubMedID 31893086

View details for PubMedCentralID PMC6935619

Pityriasis rubra pilaris-like graft-vs-host disease following allogeneic stem cell transplant in two patients CLINICAL CASE REPORTS Wang, J. Y., Tabata, M. M., Pugliese, S., Phillips, D., Kim, J., Weng, W., Kwong, B. Y. 2019

View details for DOI 10.1002/ccr3.2458

View details for Web of Science ID 000496342800001

Eosinophilic Granulomatosis With Polyangiitis: Histopathological Confirmation Despite Negative Serology AMERICAN JOURNAL OF MEDICINE Kumar, A. M., Bae, G. H., Besen, J., Kwong, B. Y., Rieger, K. E. 2019; 132 (10): E741E743

View details for DOI 10.1016/j.amjmed.2019.04.032

View details for Web of Science ID 000493949700008

Periorbital dermatitis in patients receiving docetaxel in combination chemotherapy. BMJ case reports Tabata, M. M., Kwong, B. 2019; 12 (7)

Abstract

Recognition of new cutaneous side effects of combination chemotherapy can help prevent unnecessary cessation or reduction of cancer therapy. Periorbital rash has not been found with docetaxel alone, but here, we report it as a result of combination chemotherapy. A series of three patients who received docetaxel in combination with other chemotherapies developed clinically near-identical, distinctive periorbital rashes. Rashes resolved by resolving underlying docetaxel-induced epiphora in conjunction with ophthalmological consultation, topical skin-directed care, and in some cases, chemotherapy dose reduction. It is important for dermatologists and oncologists to recognise the increased severity of cutaneous reactions when docetaxel is used in combination chemotherapy.

View details for DOI 10.1136/bcr-2019-230023

View details for PubMedID 31331929

Association of Antibiotic Resistance With Antibiotic Use for Epidermal Growth Factor Receptor Inhibitor-Related Papulopustular Eruption JAMA DERMATOLOGY Hirotsu, K., Dang, T. M., Li, S., Neal, J. W., Pugliese, S., Subramanian, A., Kwong, B. Y. 2019; 155 (7): 84850

View details for DOI 10.1001/jamadermatol.2019.0063

View details for Web of Science ID 000482127300016

Radiation-induced morphea: Association with autoimmune comorbidities, severity, and response to therapy JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY Mittal, A., Mittal, V., Panse, G., Choi, J. N., Kwong, B. Y., Leventhal, J. S. 2019; 81 (1): 26062

View details for DOI 10.1016/j.jaad.2019.02.039

View details for Web of Science ID 000472175800045

Development andValidation of a Risk Prediction Model for In-Hospital MortalityAmong Patients With Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis-ABCD-10 JAMA DERMATOLOGY Noe, M. H., Rosenbach, M., Hubbard, R. A., Mostaghimi, A., Cardones, A. R., Chen, J. K., Cotliar, J., Davis, M. P., Dominguez, A., Fox, L. P., Hughey, L. C., Kaffenberger, B. H., Kroshinsky, D., Kwong, B. Y., Miller, D. D., Musiek, A., Ortega-Loayza, A. G., Sharon, V. R., Shinkai, K., Summers, E. M., Wanat, K. A., Wetter, D. A., Worswick, S., Margolis, D. J., Gelfand, J. M., Micheletti, R. G. 2019; 155 (4): 44854

View details for DOI 10.1001/jamadermatol.2018.5605

View details for Web of Science ID 000464040200008

Development and Validation of a Risk Prediction Model for In-Hospital Mortality Among Patients With Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis-ABCD-10. JAMA dermatology Noe, M. H., Rosenbach, M., Hubbard, R. A., Mostaghimi, A., Cardones, A. R., Chen, J. K., Cotliar, J., Davis, M. D., Dominguez, A., Fox, L. P., Hughey, L. C., Kaffenberger, B. H., Kroshinsky, D., Kwong, B. Y., Miller, D. D., Musiek, A., Ortega-Loayza, A. G., Sharon, V. R., Shinkai, K., Summers, E. M., Wanat, K. A., Wetter, D. A., Worswick, S., Margolis, D. J., Gelfand, J. M., Micheletti, R. G. 2019

Abstract

Importance: Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a spectrum of severe mucocutaneous drug reaction associated with significant morbidity and mortality. A previously developed SJS/TEN-specific severity-of-illness model (Score of Toxic Epidermal Necrolysis [SCORTEN]) has been reported to overestimate and underestimate SJS/TEN-related in-hospital mortality in various populations.Objective: To derive a risk prediction model for in-hospital mortality among patients with SJS/TEN and to compare prognostic accuracy with the SCORTEN model in a multi-institutional cohort of patients in the United States.Design, Setting, and Participants: Data from a multicenter cohort of patients 18 years and older treated for SJS/TEN between January 1, 2000, and June 1, 2015, were obtained from inpatient consult databases and electronic medical record systems at 18 medical centers in the United States as part of the Society for Dermatology Hospitalists. A risk model was derived based on data from 370 of these patients. Model discrimination (calculated as area under the receiver operating characteristic curve [AUC]) and calibration (calculated as predicted vs observed mortality, and examined using the Hosmer-Lemeshow goodness-of-fit statistic) were assessed, and the predictive accuracy was compared with that of SCORTEN. All analysis took place between December 2016 and April 2018.Main Outcomes and Measures: In-hospital mortality.Results: Among 370 patients (mean [SD] age 49.0 [19.1] years; 195 [52.7%] women), 54 (15.14%) did not survive to hospital discharge. Five covariates, measured at the time of admission, were independent predictors of in-hospital mortality: age in years (odds ratio [OR], 1.05; 95% CI, 1.02-1.07), body surface area (BSA) in percentage of epidermal detachment (OR, 1.02; 95% CI, 1.01-1.04), serum bicarbonate level below 20 mmol/L (OR, 2.90; 95% CI, 1.43-5.88), active cancer (OR, 4.40; 95% CI, 1.82-10.61), and dialysis prior to admission (OR, 15.94; 95% CI, 3.38-66.30). A severity-of-illness score was calculated by taking the sum of 1 point each for age 50 years or older, epidermal detachment greater than 10% of BSA, and serum bicarbonate level below 20 mmol/L; 2 points for the presence of active cancer; and 3 points for dialysis prior to admission. The score was named ABCD-10 (age, bicarbonate, cancer, dialysis, 10% BSA). The ABCD-10 model showed good discrimination (AUC, 0.816; 95% CI, 0.759-0.872) and calibration (Hosmer-Lemeshow goodness of fit test, P=.03). For SCORTEN, on admission, the AUC was 0.827 (95% CI, 0.774-0.879) and was not significantly different from that of the ABCD-10 model (P=.72).Conclusions and Relevance: In this cohort of patients with SJS/TEN, ABCD-10 accurately predicted in-hospital mortality, with discrimination that was not significantly different from SCORTEN. Additional research is needed to validate ABCD-10 in other populations. Future use of a new mortality prediction model may provide improved prognostic information for contemporary patients, including those enrolled in observational studies and therapeutic trials.

View details for PubMedID 30840032

Radiation-induced morphea: association with autoimmune comorbidities, severity, and response to therapy. Journal of the American Academy of Dermatology Mittal, A., Mittal, V., Panse, G., Choi, J. N., Kwong, B. Y., Leventhal, J. S. 2019

View details for PubMedID 30797843

Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: A Multicenter Retrospective Study of 377 Adult Patients from the United States (vol 138, pg 2315, 2018) JOURNAL OF INVESTIGATIVE DERMATOLOGY Micheletti, R. G., Chiesa-Fuxench, Z., Noe, M. H., Stephen, S., Aleshin, M., Agarwal, A., Boggs, J., Cardones, A. R., Chen, J. K., Cotliar, J., Davis, M. P., Dominguez, A., Fox, L. P., Gordon, S., Hamrick, R., Ho, B., Hughey, L. C., Jones, L. M., Kaffenberger, B. H., Kindley, K., Kroshinsky, D., Kwong, B. Y., Miller, D. D., Mostaghimi, A., Musiek, A., Ortega-Loayza, A. G., Patel, R., Posligua, A., Rani, M., Saluja, S., Sharon, V. R., Shinkai, K., St John, J., Strickland, N., Summers, E. M., Sun, N., Wanat, K. A., Wetter, D. A., Worswick, S., Yang, C., Margolis, D. J., Gelfand, J. M., Rosenbach, M. 2019; 139 (2): 49596

View details for DOI 10.1016/j.jid.2018.11.013

View details for Web of Science ID 000456162000049

Early Detection of Adverse Drug Reactions in Social Health Networks: A Natural Language Processing Pipeline for Signal Detection. JMIR public health and surveillance Nikfarjam, A. n., Ransohoff, J. D., Callahan, A. n., Jones, E. n., Loew, B. n., Kwong, B. Y., Sarin, K. Y., Shah, N. H. 2019; 5 (2): e11264

Abstract

Adverse drug reactions (ADRs) occur in nearly all patients on chemotherapy, causing morbidity and therapy disruptions. Detection of such ADRs is limited in clinical trials, which are underpowered to detect rare events. Early recognition of ADRs in the postmarketing phase could substantially reduce morbidity and decrease societal costs. Internet community health forums provide a mechanism for individuals to discuss real-time health concerns and can enable computational detection of ADRs.The goal of this study is to identify cutaneous ADR signals in social health networks and compare the frequency and timing of these ADRs to clinical reports in the literature.We present a natural language processing-based, ADR signal-generation pipeline based on patient posts on Internet social health networks. We identified user posts from the Inspire health forums related to two chemotherapy classes: erlotinib, an epidermal growth factor receptor inhibitor, and nivolumab and pembrolizumab, immune checkpoint inhibitors. We extracted mentions of ADRs from unstructured content of patient posts. We then performed population-level association analyses and time-to-detection analyses.Our system detected cutaneous ADRs from patient reports with high precision (0.90) and at frequencies comparable to those documented in the literature but an average of 7 months ahead of their literature reporting. Known ADRs were associated with higher proportional reporting ratios compared to negative controls, demonstrating the robustness of our analyses. Our named entity recognition system achieved a 0.738 microaveraged F-measure in detecting ADR entities, not limited to cutaneous ADRs, in health forum posts. Additionally, we discovered the novel ADR of hypohidrosis reported by 23 patients in erlotinib-related posts; this ADR was absent from 15 years of literature on this medication and we recently reported the finding in a clinical oncology journal.Several hundred million patients report health concerns in social health networks, yet this information is markedly underutilized for pharmacosurveillance. We demonstrated the ability of a natural language processing-based signal-generation pipeline to accurately detect patient reports of ADRs months in advance of literature reporting and the robustness of statistical analyses to validate system detections. Our findings suggest the important contributions that social health network data can play in contributing to more comprehensive and timely pharmacovigilance.

View details for DOI 10.2196/11264

View details for PubMedID 31162134

Cardiotoxicity associated with immune checkpoint inhibitors in cutaneous oncology. Journal of the American Academy of Dermatology Tabata, M. M., Choi, S. n., Hirotsu, K. n., Kwong, B. n., Soleymani, T. n. 2019

View details for DOI 10.1016/j.jaad.2019.08.033

View details for PubMedID 31437546

Eosinophilic granulomatosis with polyangiitis: histopathological confirmation despite negative serology. The American journal of medicine Kumar, A. M., Bae, G. H., Besen, J. n., Kwong, B. Y., Rieger, K. E. 2019

View details for PubMedID 31100285

The Reply. The American journal of medicine Kumar, A. M., Bae, G. H., Besen, J. n., Kwong, B. Y., Rieger, K. E. 2019; 132 (11): e812

View details for DOI 10.1016/j.amjmed.2019.07.027

View details for PubMedID 31779785

Association of Antibiotic Resistance With Antibiotic Use for Epidermal Growth Factor Receptor Inhibitor-Related Papulopustular Eruption. JAMA dermatology Hirotsu, K. n., Dang, T. M., Li, S. n., Neal, J. W., Pugliese, S. n., Subramanian, A. n., Kwong, B. Y. 2019

View details for PubMedID 31017625

Reply to: "Use of immortal time within survival analysis" JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY Lee, C., Li, S., Duy Cong Tran, Zhu, G., Kim, J., Kwong, B. Y., Chang, A. S. 2019; 80 (1): E19E20

View details for DOI 10.1016/j.jaad.2018.08.042

View details for Web of Science ID 000452985600009

Characterization of dermatitis after PD-1/PD-L1 inhibitor therapy and association with multiple oncologic outcomes: A retrospective case-control study JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY Lee, C., Li, S., Duy Cong Tran, Zhu, G., Kim, J., Kwong, B. Y., Chang, A. S. 2018; 79 (6): 104752

View details for DOI 10.1016/j.placenta.2018.05.035

View details for Web of Science ID 000449687100018

Hedgehog Pathway Inhibitor for Treatment of Steroid-Refractory Sclerodermatous Chronic Graft-Versus-Host Disease (GVHD) Gupta, R., Albabtain, A., Arai, S., Kwong, B., Weng, W. AMER SOC HEMATOLOGY. 2018

View details for DOI 10.1182/blood-2018-99-113915

View details for Web of Science ID 000454842801189

Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: A Multicenter Retrospective Study of 377 Adult Patients from the United States JOURNAL OF INVESTIGATIVE DERMATOLOGY Micheletti, R. G., Chiesa-Fuxench, Z., Noe, M. H., Stephen, S., Aleshin, M., Agarwal, A., Boggs, J., Cardones, A. R., Chen, J. K., Cotliar, J., Davis, M. P., Dominguez, A., Fox, L. P., Gordon, S., Hamrick, R., Ho, B., Hughey, L. C., Jones, L. M., Kaffenberger, B. H., Kindley, K., Kroshinsky, D., Kwong, B. Y., Miller, D. D., Mostaghimi, A., Musiek, A., Ortega-Loayza, A. G., Patel, R., Posligua, A., Rani, M., Saluja, S., Sharon, V. R., Shinkai, K., St John, J., Strickland, N., Sun, N., Wanat, K. A., Wetter, D. A., Worswick, S., Yang, C., Margolis, D. J., Gelfand, J. M., Rosenbach, M. 2018; 138 (11): 231521

Abstract

Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a rare, severe mucocutaneous reaction with few large cohorts reported. This multicenter retrospective study included patients with SJS/TEN seen by inpatient consultative dermatologists at 18 academic medical centers in the United States. A total of 377 adult patients with SJS/TEN between January 1, 2000 and June 1, 2015 were entered, including 260 of 377 (69%) from 2010 onward. The most frequent cause of SJS/TEN was medication reaction in 338 of 377 (89.7%), most often to trimethoprim/sulfamethoxazole (89/338; 26.3%). Most patients were managed in an intensive care (100/368; 27.2%) or burn unit (151/368; 41.0%). Most received pharmacologic therapy (266/376; 70.7%) versus supportive care alone (110/376; 29.3%)-typically corticosteroids (113/266; 42.5%), intravenous immunoglobulin (94/266; 35.3%), or both therapies (54/266; 20.3%). Based on day 1 SCORTEN predicted mortality, approximately 78 in-hospital deaths were expected (77.7/368; 21%), but the observed mortality of 54 patients (54/368; 14.7%) was significantly lower (standardized mortality ratio= 0.70; 95% confidence interval= 0.58-0.79). Stratified by therapy received, the standardized mortality ratio was lowest among those receiving both steroids and intravenous immunoglobulin (standardized mortality ratio= 0.52; 95% confidence interval 0.21-0.79). This large cohort provides contemporary information regarding US patients with SJS/TEN. Mortality, although substantial, was significantly lower than predicted. Although the precise role of pharmacotherapy remains unclear, co-administration of corticosteroids and intravenous immunoglobulin, among other therapies, may warrant further study.

View details for PubMedID 29758282

Response to the Letter to the Editor entitled, "Use of immortal time within survival analysis": JAAD-D-18-01157. Journal of the American Academy of Dermatology Min Lee, C. K., Li, S., Tran, D. C., Zhu, G. A., Kim, J., Kwong, B. Y., Chang, A. L. 2018

View details for PubMedID 30205131

Reaction patterns of dermatitis arising during PD-1/PD-L1 inhibitor therapy and association with tumor response Lee, C., Li, S., Zhu, A., Kim, J., Duy Tran, Kwong, B., Chang, A. MOSBY-ELSEVIER. 2018: AB239

View details for Web of Science ID 000440565901438

Characterization of dermatitis after PD-1/PD-L1 inhibitor therapy and association with multiple oncologic outcomes: a retrospective case-control study. Journal of the American Academy of Dermatology Min Lee, C. K., Li, S., Tran, D. C., Zhu, G. A., Kim, J., Kwong, B. Y., Chang, A. L. 2018

Abstract

BACKGROUND: Cutaneous adverse events are common with Programmed Death (PD)-1/ PD-Ligand (L)1 inhibitors. However, the nature of the specific cutaneous adverse event of dermatitis has not been investigated across various PD-1/PD-L1 inhibitors. Oncologic outcomes potentially associated with dermatitis are not well characterized.OBJECTIVE: (s): To assess the nature of dermatitis after PD-1/PD-L1 inhibitor exposure and oncologic outcomes associated with dermatitis.METHODS: Retrospective, matched, case-control study conducted at a single academic center.RESULTS: The most common histologic patterns were lichenoid dermatitis (50%) and spongiotic dermatitis (40%). Overall tumor response rate was 65.0% for cases and 17.0% for controls (p=0.0007), odds ratio: 7.3 (95% CI 2.3-23.1). Progression Free Survival (PFS) and Overall Survival (OS) times were significantly longer for cases than controls by Kaplan-Meier analysis (p<0.0001 and 0.0203, respectively).LIMITATIONS: Retrospective design and relatively small sample size precluded matching on all cancer types.CONCLUSION: Lichenoid and spongiotic dermatitis associated with PD-1/PD-L1 inhibitors could be a sign of robust immune response and improved oncologic outcomes. The predictive value of PD-1/PD-L1 related dermatitis on cancer outcomes awaits investigation through prospective multicenter studies for specific cancer types.

View details for PubMedID 29857011

Association of tumor response to PD-1/PD-L1 immunotherapy and type of dermatitis that arises after the immunotherapy Lee, C., Li, S., Tran, D., Zhu, A., Kim, J., Kwong, B., Chang, A. ELSEVIER SCIENCE INC. 2018: S90

View details for Web of Science ID 000431188500527

Early detection of chemotherapeutic skin toxicities in social health networks using deep learning Ransohoff, J. D., Nikfarjam, A., Kwong, B., Shah, N., Sarin, K. Y. ELSEVIER SCIENCE INC. 2018: S42

View details for Web of Science ID 000431188500249

Antimicrobial resistance due to antibiotic use for EGFR inhibitor related papulopustular skin reaction Hirotsu, K., Subramanian, A., Neal, J., Li, S., Pugliese, S., Kwong, B. ELSEVIER SCIENCE INC. 2018: S176

View details for Web of Science ID 000431498600302

Granuloma annulare associated with immune checkpoint inhibitors JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY AND VENEREOLOGY Wu, J., Kwong, B. Y., Martires, K. J., Rieger, K. E., Chung, W. H., Iyer, G. V., Lacouture, M. E. 2018; 32 (4): E124E126

View details for PubMedID 28983973

View details for PubMedCentralID PMC5867195

Detecting Chemotherapeutic Skin Adverse Reactions in Social Health Networks Using Deep Learning. JAMA oncology Ransohoff, J. D., Nikfarjam, A. n., Jones, E. n., Loew, B. n., Kwong, B. Y., Sarin, K. Y., Shah, N. H. 2018; 4 (4): 58183

View details for PubMedID 29494731

Cutaneous Adverse Events of Targeted Therapies for Hematolymphoid Malignancies CLINICAL LYMPHOMA MYELOMA & LEUKEMIA Ransohoff, J. D., Kwong, B. Y. 2017; 17 (12): 83451

View details for DOI 10.1016/j.clml.2017.07.005

View details for Web of Science ID 000416105700021

Effect of voriconazole on risk of nonmelanoma skin cancer after hematopoietic cell transplantation JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY Kuklinski, L. F., Li, S., Karagas, M. R., Weng, W., Kwong, B. Y. 2017; 77 (4): 70612

Abstract

Voriconazole has previously been associated with increased risk for cutaneous squamous cell carcinoma (SCC) in solid organ transplant recipients. Less is known about the risk in patients after hematopoietic cell transplantation (HCT).We evaluated the effect of voriconazole on the risk for nonmelanoma skincancer (NMSC), including SCC and basal cell carcionoma, among those who have undergone allogeneic and autologous HCT.In all, 1220 individuals who had undergone allogeneic HCT and 1418 who had undergone autologous HCT were included in a retrospective cohort study. Multivariate analysis included voriconazole exposure and other known risk factors for NMSC.In multivariate analysis, voriconazole use increased the risk for NMSC (hazard ratio, 1.82; 95% confidence interval, 1.13-2.91) among those who had undergone allogeneic HCT, particularly for SCC (hazard ratio, 2.25; 95% confidence interval, 1.30-3.89). Voriconazole use did not appear to confer increased risk for NMSC among those who had undergone autologous HCT.This is a retrospective study.Voriconazole use represents an independent factor that may contribute to increased risk specifically for SCC in the allogeneic HCT population.

View details for PubMedID 28780363

Eruptive Keratoacanthomas Associated With Pembrolizumab Therapy. JAMA dermatology Freites-Martinez, A., Kwong, B. Y., Rieger, K. E., Coit, D. G., Colevas, A. D., Lacouture, M. E. 2017

Abstract

To our knowledge, there have been no previous reports of eruptive keratoacanthomas (KAs) in patients receiving pembrolizumab.To report the cases of 3 consecutive patients with pembrolizumab-induced eruptive KAs and their management.Case report study of 3 patients from 2 centers with pembrolizumab-treated cancer who all developed eruptive KAs.All 3 patients had AK treatment with clobetasol ointment and intralesional triamcinolone; 2 patients also underwent open superficial cryosurgery.Three consecutive patients with cancer, 2 men and 1 woman (median age, 83 years; range 77-91 years), experienced pembrolizumab-associated eruptive KAs. All patients presented with a sudden onset of multiple lesions on sun-exposed areas of their extremities after a median of 13 months (range, 4-18 months) of pembrolizumab therapy. On lesional biopsy, a lichenoid infiltrate was observed in the underlying dermis, predominantly composed of CD3+ T cells, scattered CD20+ B cells, and relatively few PD-1+ (programmed cell death 1-positive) T cells, an immunophenotypic pattern also observed in other cases of anti-PD-1-induced lichenoid dermatitis. Patients were treated with clobetasol ointment and intralesional triamcinolone, alone or in combination with open superficial cryosurgery. All KAs resolved in all patients, and no new lesions occurred during close follow-up. Pembrolizumab treatment was continued without disruption in all 3 cases, and all patients had complete responses of their primary cancers.Pembrolizumab is used in advanced melanoma, advanced non-small-cell lung cancer, and in head and neck cancer. A variety of dermatologic immune-related adverse events including maculopapular eruption, lichenoid reactions, pruritus, and vitiligo have been described. This case series demonstrates that pembrolizumab therapy may also be associated with eruptive KAs with characteristic dermal inflammation, which improved with corticosteroid treatment (topical and intralesional) alone or in combination with cryosurgery, allowing patients to continue therapy with pembrolizumab.

View details for DOI 10.1001/jamadermatol.2017.0989

View details for PubMedID 28467522

Mitigation of epidermal growth factor receptor inhibitor-induced side effects utilizing melanin and vascular-specific lasers: A case report series. Journal of cosmetic and laser therapy Kuo, K. Y., Kwong, B., Rahman, Z. 2017: 1-3

Abstract

The advent of targeted chemotherapy has led to the emergence of new dermatologic toxicities. We sought to use lasers and light devices to treat recalcitrant cutaneous adverse effects related to cancer treatment. Three stage III or IV cancer patients with cutaneous complications due to epidermal growth factor receptor (EGFR) inhibitors were treated with melanin and vascular-specific laser and light technologies. Two patients reported reduction in papulopustular eruption following pulse dye laser (PDL) treatment. Two patients noted reduction in hair growth following intense pulsed light (IPL) and/or Alexandrite laser treatments. One patient was treated with both the PDL and IPL and reported improvement of both EGFR-induced hypertrichosis and papulopustular eruption. Laser and light devices targeting melanin and hemoglobin can be utilized to mitigate the cutaneous adverse effects associated with EGFR inhibitors in patients who have failed traditional therapies. This represents a new option for the cancer patient who is suffering from chemotherapy-induced side effects.

View details for DOI 10.1080/14764172.2017.1299187

View details for PubMedID 28463045

Reversible cutaneous side effects of vismodegib treatment. Cutis Kwong, B. n., Danial, C. n., Liu, A. n., Chun, K. A., Chang, A. L. 2017; 99 (3): E19E20

View details for PubMedID 28398426

Localized bullous pemphigoid in a melanoma patient with dual exposure to PD-1 checkpoint inhibition and radiation therapy. JAAD case reports Hirotsu, K. n., Chiou, A. S., Chiang, A. n., Kim, J. n., Kwong, B. Y., Pugliese, S. n. 2017; 3 (5): 4046

View details for PubMedID 28884139

Limited Role of Random Skin Biopsy in the Diagnosis of Intravascular Lymphoma in Adult Patients with Hemophagocytic Lymphohistiocytosis ACTA HAEMATOLOGICA Cho, H. G., Sheu, S. L., Kuo, K. Y., Ally, M. S., Bailey, E. E., Kim, J., Kwong, B. Y. 2017; 138 (1): 3338

Abstract

This study examined the role of random normal skin biopsy in the diagnosis of intravascular lymphoma (IVL) in adult Western patients with clinically diagnosed hemophagocytic lymphohistiocytosis (HLH).In a retrospective chart review study, we analyzed a total of 59 skin biopsies that were performed to diagnose IVL in 21 adult patients with HLH seen at Stanford Hospital between 2004 and 2016.Out of the 59 skin biopsies, 42 were taken from clinically normal-appearing skin and 17 from clinically abnormal-appearing skin. None of the 59 biopsies revealed a diagnosis of primary or metastatic malignancy, regardless of the malignancy history, clinical presentation, and biopsy and histopathologic characteristics. A review of 8 positive IVL cases at Stanford Hospital including 1 case associated with HLH showed 1 positive diagnosis by a targeted skin biopsy and other positive diagnoses by bone marrow (n = 4), lung (n = 2), brain (n = 2), muscle (n = 1), and nerve (n = 1).Random skin biopsies have a limited role in diagnosing IVL in adult patients with HLH, in the setting of a single academic institution in the USA. A review of the literature emphasizes the role of a full body skin exam with a selective skin biopsy in these patients.

View details for PubMedID 28668948

Cutaneous Adverse Events of Targeted Therapies for Hematolymphoid Malignancies. Clinical lymphoma, myeloma & leukemia Ransohoff, J. D., Kwong, B. Y. 2017; 17 (12): 83451

Abstract

The identification of oncogenic drivers of liquid tumors has led to the rapid development of targeted agents with distinct cutaneous adverse event (AE) profiles. The diagnosis and management of these skin toxicities has motivated a novel partnership between dermatologists and oncologists in developing supportive oncodermatology clinics. In this article we review the current state of knowledge of clinical presentation, mechanisms, and management of the most common and significant cutaneous AEs observed during treatment with targeted therapies for hematologic and lymphoid malignancies. We systematically review according to drug-targeting pathway the cutaneous AE profiles of these drugs, and offer insight when possible into whether pharmacologic target versus immunologic modulation primarily underlie presentation. We include discussion of tyrosine kinase inhibitors (imatinib, dasatinib, nilotinib, bosutinib, ponatinib), blinatumomab, ibrutinib, idelalisib, anti-B cell antibodies (rituximab, ibritumomab, obinutuzumab, ofatumumab, tositumomab), immune checkpoint inhibitors (nivolumab, pembrolizumab), alemtuzumab, brentuximab, and proteasome inhibitors (bortezomib, carfilzomib, ixazomib). We highlight skin reactions seen with antiliquid but not solid tumor agents, draw attention to serious cutaneous AEs that might require therapy modification or cessation, and offer management strategies to permit treatment tolerability. We emphasize the importance of early diagnosis and treatment to minimize disruptions to care, optimize prognosis and quality of life, and promptly address life-threatening skin or infectious events. This evolving partnership between oncologists and dermatologists in the iterative characterization and management of skin toxicities will contribute to a better understanding of these drugs' cutaneous targets and improved patient care.

View details for PubMedID 28918995

Risk of Non-Melanoma Skin Cancer Following Hematopoietic Cell Transplantation and Voriconazole-Associated Risk Kuklinski, L. F., Li, S., Karagas, M. R., Kwong, B. Y., Weng, W. AMER SOC HEMATOLOGY. 2016

View details for Web of Science ID 000394452506161

Cutaneous Complications of Targeted Melanoma Therapy (17, 57, 2016) CURRENT TREATMENT OPTIONS IN ONCOLOGY de Golian, E., Kwong, B. Y., Swetter, S. M., Pugliese, S. B. 2016; 17 (12): 63

View details for PubMedID 27817056

General management strategy for epidermal growth factor receptor inhibitor-associated papulopustular eruption. Journal of the American Academy of Dermatology Farahnik, B., Kwong, B., Murase, J. 2016; 75 (5)

View details for DOI 10.1016/j.jaad.2016.07.036

View details for PubMedID 27745649

Cutaneous Complications of Targeted Melanoma Therapy. Current treatment options in oncology de Golian, E., Kwong, B. Y., Swetter, S. M., Pugliese, S. B. 2016; 17 (11): 57-?

Abstract

The landscape of advanced and metastatic melanoma therapy has shifted dramatically in recent years. Since 2011, eight drugs (ipilimumab, vemurafenib, dabrafenib, trametinib, cometinib, pembrolizumab, nivolumab, and talimogene laherparepvec) have received FDA approval for the treatment of advanced or metastatic melanoma, including combination regimens of both small molecule kinase and immune checkpoint inhibitors. These therapies have revolutionized the management of unresectable regional nodal and distant melanoma, providing hope of extended survival to patients. As the use of novel agents has increased, so have the cutaneous toxicities associated with these medications. While most skin reactions are low-grade and can be managed conservatively with topical therapies, malignant lesions and more serious or life-threatening drug reactions can arise during therapy, requiring prompt dermatologic recognition and treatment in order to improve patient outcome. Given the survival benefit attributed to these new agents, treating skin toxicity and maintaining patient quality of life is of paramount importance. Oncologists should be aware of the common cutaneous toxicities associated with these medications and should be encouraged to involve dermatologists in the collaborative care of advanced melanoma patients. Close communication between oncologists and dermatologists can help to avoid unnecessary dose reduction or treatment discontinuation and identify situations when treatment cessation is truly warranted.

View details for DOI 10.1007/s11864-016-0434-0

View details for PubMedID 27645330

Epidermotropic metastasis of primary lung adenocarcinoma. Journal of cutaneous pathology Scott, G. D., Kwong, B. Y., Novoa, R. A. 2016; 43 (9): 798-801

Abstract

Cutaneous metastasis of lung cancer is a rare event and usually portends a grim prognosis. Several cases of lung cancer with cutaneous metastasis have been reported, but these have been largely limited to the dermis. Here we describe a unique case of cutaneous metastatic lung adenocarcinoma largely limited to the epidermis, mimicking Paget's disease or a cutaneous adnexal tumor.

View details for DOI 10.1111/cup.12741

View details for PubMedID 27234927

Eosinophil-Rich Acute Febrile Neutrophilic Dermatosis in a Patient With Enteropathy-Associated T-cell Lymphoma, Type 1. American Journal of dermatopathology Soon, C. W., Kirsch, I. R., Connolly, A. J., Kwong, B. Y., Kim, J. 2016; 38 (9): 704-708

Abstract

The presence of eosinophils within the neutrophilic infiltrates of acute febrile neutrophilic dermatosis (Sweet syndrome) is documented in the literature. Here, the authors describe a case of eosinophil-rich acute febrile neutrophilic dermatosis in the setting of new onset enteropathy-associated T-cell lymphoma (EATL), type 1. Histopathologic evaluation of the skin biopsies demonstrated a mixed superficial perivascular and inflammatory infiltrate composed of neutrophils, lymphocytes, and abundant eosinophils. EATL, type 1 is an aggressive although rare primary intestinal lymphoma that may be associated with celiac disease. This lymphoma is associated with a poor prognosis due to treatment resistance or bowel perforation. To the authors' knowledge, Sweet syndrome has not been reported in a patient with EATL.

View details for DOI 10.1097/DAD.0000000000000549

View details for PubMedID 27097333

Enhanced radiation dermatitis associated with concurrent palliative radiation and vemurafenib therapy. Cutis Kuo, K. Y., Jiang, W., Swetter, S. M. 2016; 97 (2): E4-6

View details for PubMedID 27622267

Retrospective analysis of inpatient dermatology consultations for cancer patients Guerrero, A. M., Zhu, G. A., Kwong, B. ELSEVIER SCIENCE INC. 2016: S28

View details for DOI 10.1016/j.jid.2016.02.182

View details for Web of Science ID 000380028800155

Immunohistochemical analysis of lichenoid reactions in patients treated with anti-PD-L1 and anti-PD-1 therapy. Journal of cutaneous pathology Schaberg, K. B., Novoa, R. A., Wakelee, H. A., Kim, J., Cheung, C., Srinivas, S., Kwong, B. Y. 2016; 43 (4): 339-346

Abstract

Recent advances in the immunotherapeutic treatment of cancer have led to the development of multiple new directed therapies including monoclonal antibodies that block the immune checkpoint T-cell receptor programmed death 1 (PD-1) and the PD-1 ligand, programmed death ligand 1 (PD-L1). Various immune-related toxicities have been associated with these drugs including, most commonly, skin rashes.Five cases of lichenoid dermatitis, including one case of lichenoid mucositis and one case of lichen sclerosus, associated with anti-PD-L1 and anti-PD1 therapy were compared with three biopsies of non-drug-related lichen planus (LP) and three lichen planus-like keratoses (LPLK) used as controls.Histopathologic and immunophenotypic analysis of these lichenoid lesions demonstrated significantly greater histiocytic infiltrates than observed in control lichenoid reactions (p = 0.0134). We also observed increased spongiosis and epidermal necrosis. No significant differences were seen in expression of CD3, CD4:CD8, CD20, PD-1, CD25, Foxp3, CXCL13 and PD-L1 expression.These findings expand the literature of immune-related toxicities of PD-L1 and PD-1 blockade to include lichenoid dermatitis and lichenoid mucositis. Of note, these cutaneous side effects were amenable to topical treatment, without the need for medication dose reduction or discontinuation.

View details for DOI 10.1111/cup.12666

View details for PubMedID 26762844

Acral verruca-like presentation of chronic graft-vs.-host disease JOURNAL OF CUTANEOUS PATHOLOGY Park, J. H., Lester, L., Kim, J., Kwong, B. Y. 2016; 43 (3): 236-241

Abstract

Chronic graft-vs.-host disease (GVHD) is a severe and potentially fatal complication in patients after undergoing allogeneic stem cell transplant. This disease may be hard to diagnose as it has numerous cutaneous presentations.We report four cases of patients seen at Stanford Hospital between January 2013 to December 2014 with hematologic malignancy who developed hyperkeratotic papules and plaques on the palms and soles after allogeneic hematopoietic stem cell transplant.In all four cases, standard treatments for verruca vulgaris failed. Histopathology uniformly showed basal vacuolar alteration at the dermal-epidermal junction and necrotic keratinocytes around the eccrine glands, consistent with GVHD. Interestingly, all four patients responded to topical immunosuppression.Acral verrucous lesions represent an underrecognized presentation of chronic GVHD. We describe four patients with verruca-like lesions on the palms and soles following allogeneic HSCT. Histopathology confirmed GVHD, and lesions improved with immunosuppression. It is important for dermatologists and dermatopathologists to recognize this rare presentation of cutaneous GVHD.

View details for DOI 10.1111/cup.12640

View details for Web of Science ID 000372901600006

Successful Treatment of Primary Cutaneous Aspergillus Ustus Infection in Post-Allogeneic Stem Cell Transplant Patient Sutherland, K., Kwong, B., Latchford, T., Miklos, D. B. ELSEVIER SCIENCE INC. 2016: S177

View details for DOI 10.1016/j.bbmt.2015.11.547

View details for Web of Science ID 000370910300238

MITIGATION OF EPIDERMAL GROWTH FACTOR INHIBITOR INDUCED SIDE EFFECTS UTILIZING MELANIN AND VASCULAR SPECIFIC LASERS Kuo, K., Kwong, B., Rahman, Z. WILEY-BLACKWELL. 2016: 2930

View details for Web of Science ID 000373105000085

Acral verruca-like presentation of chronic graft-vs.-host disease. Journal of cutaneous pathology Park, J. H., Lester, L., Kim, J., Kwong, B. Y. 2016; 43 (3): 236-241

Abstract

View details for DOI 10.1111/cup.12640

View details for PubMedID 26449730

Ibrutinib-associated rash: a single-centre experience of clinicopathological features and management. British journal of haematology 2016

View details for PubMedID 27539794

Recurrent Subepidermal Blistering Dermatosis Heralding Disease Relapse in IgA Kappa Multiple Myeloma: Report of a Case and a Review of the Literature. Clinical lymphoma, myeloma & leukemia Leatham, H. W., Novoa, R., Liedtke, M., Kwong, B. Y. 2016; 16 (1): e1-5

View details for DOI 10.1016/j.clml.2015.11.007

View details for PubMedID 26708980

Ibrutinib-Associated Rash: Single-Center Experience of Clinicopathologic Features and Management Iberri, D. J., Kwong, B., Stevens, L., Coutre, S. E., Kim, J., Sabile, J., Advani, R. H. AMER SOC HEMATOLOGY. 2015

View details for Web of Science ID 000368021803163

JAK2-positive cutaneous myelofibrosis presenting as sclerosing extramedullary hematopoietic tumors on the scalp: case presentation and review of the literature. Journal of cutaneous pathology LeBlanc, R. E., Lester, L., Kwong, B., Rieger, K. E. 2015; 42 (11): 858-862

Abstract

We report the second case of cutaneous myelofibrosis with a documented JAK2 activating mutation involving the scalp of a 67-year-old woman with primary myelofibrosis in her marrow. In contrast to the previous case, the biopsy revealed extensive lesional collagen deposition and closely mimicked a fibrohistiocytic proliferation. Similar rare lesions occurring in the setting of myeloproliferative neoplasms have been called sclerosing extramedullary hematopoietic tumors. These entities appear histomorphologically and etiologically distinct from extramedullary hematopoiesis, and their diagnosis should prompt the workup for a myeloproliferative neoplasm in the absence of an antecedent diagnosis. The presence of the JAK2 mutation in our case confirmed that the lesions represented skin involvement by a neoplastic myeloid proliferation and not compensatory extramedullary hematopoiesis. Our patient died of disease several months following the appearance of her lesions, which is in keeping with other reports that suggest that cutaneous myelofibrosis may serve as an independent poor prognostic sign in otherwise advanced primary myelofibrosis. A review of the literature further emphasizes the importance of distinguishing this entity from mesenchymal neoplasms and acute myeloid leukemia involving the skin.

View details for DOI 10.1111/cup.12553

View details for PubMedID 26153565

JAK2-positive cutaneous myelofibrosis presenting as sclerosing extramedullary hematopoietic tumors on the scalp: case presentation and review of the literature JOURNAL OF CUTANEOUS PATHOLOGY LeBlanc, R. E., Lester, L., Kwong, B., Rieger, K. E. 2015; 42 (11): 858-862

Abstract

View details for DOI 10.1111/cup.12553

View details for Web of Science ID 000368293300010

Pruritus as a Paraneoplastic Symptom of Thymoma JOURNAL OF THORACIC ONCOLOGY Padda, S. K., Shrager, J. B., Riess, J. W., Pagtama, J. Y., Tisch, A. J., Kwong, B. Y., Liang, Y., Schwartz, E. J., Loo, B. W., Neal, J. W., Hardy, R., Wakelee, H. A. 2015; 10 (11): E110-E112

View details for DOI 10.1097/JTO.0000000000000623

View details for PubMedID 26536199

Management of Dermatologic Complications of Lung Cancer Therapies. Current treatment options in oncology Pugliese, S. B., Neal, J. W., Kwong, B. Y. 2015; 16 (10): 50-?

Abstract

In recent years, oncogene-directed targeted agents and immunotherapies have expanded the treatment armamentarium for advanced lung cancer and, in particular, non-small cell lung cancer (NSCLC). Along with extended survival, these agents are accompanied by a host of cutaneous complications that affect the skin, hair, and nails. These skin complications range from the well-characterized papulopustular (acneiform) eruption of the epidermal growth factor receptor (EGFR) inhibitors to the emerging characterization of lichenoid skin eruptions seen during treatment with antibodies targeting the programmed cell death protein 1 (PD-1) and programmed cell death protein 1 ligand (PD-L1). When promptly recognized and accurately diagnosed, most cutaneous adverse events can be managed with supportive treatments, avoiding the need to interrupt antitumor therapy. Furthermore, preemptive management of skin problems can lead to significantly decreased severity of many cutaneous complications of these therapies. We encourage close collaboration between dermatologists and oncologists to better characterize cutaneous toxicity, select appropriate management, and avoid unnecessary dose reduction or discontinuation while simultaneously improving patient quality of life.

View details for DOI 10.1007/s11864-015-0368-y

View details for PubMedID 26338208

Management of Dermatologic Complications of Lung Cancer Therapies. Current treatment options in oncology Pugliese, S. B., Neal, J. W., Kwong, B. Y. 2015; 16 (10): 368-?

Abstract

View details for DOI 10.1007/s11864-015-0368-y

View details for PubMedID 26338208

ETV3-NCOA2 in indeterminate cell histiocytosis: clonal translocation supports sui generis. Blood Brown, R. A., Kwong, B. Y., McCalmont, T. H., Ragsdale, B. n., Ma, L. n., Cheung, C. n., Rieger, K. E., Arber, D. A., Kim, J. n. 2015

View details for PubMedID 26438513

Bernice Kwong, MD

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