Publications by authors named "David R Carr"

Article Synopsis
  • - The study aimed to develop a deep learning segmentation model to locate basal cell carcinoma (BCC) on Mohs surgery (MMS) frozen section slides, which is crucial for precise tumor removal.
  • - Researchers utilized a dataset of 348 tissue slides and trained the model using the Ultralytics YOLOv8 framework, achieving varying sensitivity and specificity rates by BCC subtype.
  • - Results indicated good overall performance with a sensitivity of 71% and specificity of 75%, but highlighted the need for improved performance metrics for clinical application in segmentation studies.
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Basal cell carcinoma (BCC) is the most frequently diagnosed form of skin cancer, and its incidence continues to rise, particularly among older individuals. This trend puts a significant strain on health care systems, especially in terms of histopathologic diagnostics required for Mohs micrographic surgery (MMS), which is used to treat BCC in sensitive locations to minimize tissue loss. This study aims to address the challenges in BCC detection within MMS whole-slide images by developing and evaluating a deep learning model that bridges weakly supervised learning with interpretable segmentation-based methods through attention maps.

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Article Synopsis
  • Mohs micrographic surgery (MMS) is an effective treatment for melanoma in situ (MIS), but inconsistent surgical techniques make it hard to apply current data broadly.
  • To standardize MMS techniques for MIS in future studies, a modified Delphi method was used, involving expert input through voting on various surgical approaches.
  • The study generated 8 consensus recommendations, with five agreed upon in the first round and the others in the second, aimed at providing uniform guidelines to improve future clinical trials.
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Importance: Cutaneous squamous cell carcinoma (CSCC) is the second most common malignant disease in the US. Although it typically carries a good prognosis, a subset of CSCCs are highly aggressive, carrying regional and distant metastatic potential. Due to its high incidence, this aggressive subset is responsible for considerable mortality, with an overall annual mortality estimated to equal or even surpass melanoma.

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Poor differentiation is strongly associated with poor outcomes in cutaneous squamous cell carcinoma (CSCC). In addition, the National Comprehensive Cancer Network (NCCN) guidelines designate poorly differentiated tumors as "very high risk". Despite its clear prognostic implications, there is no standardized grading system for CSCC differentiation in common use today.

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Background: Poor differentiation predicts adverse outcomes in cutaneous squamous cell carcinoma (CSCC), but there is no standardized, reliable grading system.

Objective: To explore which histologic features have the greatest impact on CSCC differentiation interrater agreement.

Materials And Methods: In a prior study, 40 raters graded differentiation for 45 squamous cell carcinomas, and percent interrater agreements were calculated.

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Understanding patient non-adherence to prescribed antibiotics can inform clinical practices, patient counseling, and antibiotic efficacy study design in dermatology. The primary objective was to determine the rate of and reasons for antibiotic non-adherence in the dermatologic surgery setting. The secondary objective was to test the applicability of previously studied survey questions for antibiotic non-adherence screening in the dermatologic surgery setting.

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Basal cell carcinoma (BCC) is highly curable by surgical excision or radiation. In rare cases, BCC can be locally destructive or difficult to surgically remove. Hedgehog inhibition (HHI) with vismodegib or sonidegib induces a 50-60% response rate.

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Background: Imaging has been shown to impact management and disease outcomes in cutaneous squamous cell carcinoma, but the literature on optimal modalities is lacking.

Objective: To perform a systematic review evaluating the performance of various imaging studies for the detection of perineural spread, bony invasion, nodal metastasis (NM), and distant metastasis in cutaneous squamous cell carcinoma.

Materials And Methods: Four databases were searched for relevant terms.

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Background: Solid organ transplant recipients with cutaneous squamous cell carcinoma (CSCC) have an increased risk of poor outcomes. However, a recent study demonstrated that immunosuppression is not an independent risk factor for these poor outcomes after controlling for primary tumor stage.

Objective: To evaluate whether transplant status is an independent risk factor for poor outcomes in CSCC.

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Background: Amid a movement toward value-based healthcare, increasing emphasis has been placed on outcomes and cost of medical services. To define and demonstrate the quality of services provided by Mohs surgeons, it is important to identify and understand the key aspects of Mohs micrographic surgery (MMS) that contribute to excellence in patient care.

Objective: The purpose of this study is to develop and identify a comprehensive list of metrics in an initial effort to define excellence in MMS.

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Background: The performance of staging systems in non-head and neck cutaneous squamous cell carcinomas has not been well established.

Objective: To evaluate the performance of the American Joint Committee on Cancer 8th Edition and Brigham and Women's Hospital staging systems in non-head and neck squamous cell carcinomas.

Materials And Methods: Eligible tumors were identified and staged from an existing retrospective database.

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Article Synopsis
  • Reconstruction of a large conchal bowl defect is difficult due to its complex shape and the need for strong structural support.
  • Traditional methods involve multi-stage repairs, like using a pedicled flap from behind the ear.
  • For significant cartilage loss but preserved skin, the retroauricular pull-through sandwich flap is recommended, which integrates a cartilage graft and a flap to cover the front of the ear.
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Article Synopsis
  • * Rarely, this type of nevus can transform into melanoma, especially in individuals with significant sun damage.
  • * The case study discusses an elderly man who developed melanoma within a nevus spilus, leading to multiple surgeries due to difficulties in accurately assessing the excision margins, which can resemble melanoma itself.
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Sentinel lymph node biopsy is increasingly used to detect subclinical nodal metastases in extramammary Paget disease. We performed a comprehensive systematic review of the literature to further explore the role of sentinel lymph node biopsy in extramammary Paget disease. Five databases were searched for relevant terms.

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Approximately 4.5% of adults in the United States identify as members of the lesbian, gay, bisexual, transgender (LGBT) community, and this population has a variety of health care disparities. Dermatologists have the potential to greatly impact the health of this community, but learning experiences in dermatology residency are lacking.

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Graduate medical education (GME) in the USA is an increasingly organized and formalized process overseen by regulatory bodies, notably the American Council of Graduate Medical Education (ACGME), and associated specialty-specific Residency Review Committees (RRCs) to ensure that trainees, including residents and fellows, receive comprehensive, high-quality didactic education, clinical training, and research experience. Among the required elements of GME, performance of independent research is emphasized less than clinical and didactic education. In general, there are no ACGME requirements that trainees successfully publish papers in the peer reviewed.

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