Publications by authors named "Rigel Darrell"

Background: Patients with skin lesions suspicious for skin cancer or atypical melanocytic nevi of uncertain malignant potential often present to dermatologists, who may have variable dermoscopy triage clinical experience.

Objective: To evaluate the clinical utility of a digital dermoscopy image-based artificial intelligence algorithm (DDI-AI device) on the diagnosis and management of skin cancers by dermatologists.

Methods: Thirty-six United States board-certified dermatologists evaluated 50 clinical images and 50 digital dermoscopy images of the same skin lesions (25 malignant and 25 benign), first without and then with knowledge of the DDI-AI device output.

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  • - The expert panel focused on advancing the diagnosis and prognosis of cutaneous melanoma (CM) due to its high mortality rate, reviewing new tech advancements like gene expression profiling (GEP) and electrical impedance spectroscopy (EIS).
  • - A thorough literature search resulted in 200 articles, but only 19 were selected for review, leading to 7 consensus statements on testing approaches, categorized by varying levels of recommendation strength.
  • - Key findings suggest that specific GEP tests can help accurately diagnose unclear cases and enhance prognostic evaluations, ultimately supporting better clinical decisions for CM patients.
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  • A survey revealed that SPF is the top priority for patients when choosing sunscreen, but preferences differ based on whether they are in urban or rural areas.
  • There may be a lack of awareness about sunscreen recommendations among patients, indicating a need for better educational programs.
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Background: Current assessments on topical treatment attributes in actinic keratosis (AK) do not evaluate safety, effectiveness, and satisfaction from both clinician and patient perspectives, creating an unmet need for more comprehensive AK-specific measures that fully capture the patient experience.

Objective: To develop an actinic keratosis-specific expert panel questionnaire (AK-EPQ) of patient-reported outcomes and clinician-reported outcomes for use in research studies.

Methods: Using interviews of patients with AK and targeted literature reviews, a 9-person consensus panel of dermatologists with expertise in AK treatment was convened to develop the AK-EPQ to assess AK-specific patient-reported outcomes and clinician-reported outcomes.

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Sunscreen is an essential component of sun protection. The most important characteristics for patient selection of sunscreens have not been evaluated. A cross-sectional survey study was performed at an academic dermatology office.

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Background: The Patient-Reported Outcomes in Actinic Keratosis (PROAK) study evaluated patient- and clinician-reported outcomes (PRO; ClinRO) during 24 weeks of follow-up among adult patients with actinic keratosis (AK) on the face or scalp who were administered tirbanibulin 1% ointment in real-world community practices in the United States.  Methods: Quality of life (QoL) was assessed by Skindex-16 at week (W) 8. Additionally, effectiveness (Investigator Global Assessment [IGA]), PRO and ClinRO (Treatment Satisfaction Questionnaire for Medication and Expert Panel Questionnaire), safety, and tolerability were assessed at W8 and W24.

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  • During the COVID-19 pandemic, dermatologists increasingly used teledermatology, prompting a study to analyze how different platforms were adopted and their functionality among these practitioners.* -
  • Early adopters of teledermatology were found to use more platforms and reported better functionalities, such as image uploads and mobile app requirements, compared to those who adopted later.* -
  • The study identified poor image quality as a significant barrier to using teledermatology, particularly for those who adopted it after the pandemic started, suggesting that dermatology access may change after the public health emergency ends.*
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  • * Despite its benefits, telehealth faces challenges, particularly regarding the inability to perform complete physical exams, which is a key concern in fields like dermatology.
  • * The study's limitations include its retrospective nature and small sample size, suggesting the need for future research with larger groups that explores economic incentives and telemedicine training to improve its effectiveness.
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The retirement process is an individualized endeavor. Both financial and social aspects are important to consider when making plans for retirement. In this article, we discuss details of retirement planning, including the need to save, how much and when to start saving, and types of retirement plans.

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  • Studies show that telemedicine adoption varies among dermatologists in the U.S., potentially worsening healthcare access inequalities.
  • A survey of 338 dermatologists revealed that academic and less experienced doctors were much more likely to adopt teledermatology before and after COVID-19.
  • Although pre-COVID adopters used teledermatology more frequently for patient visits, they anticipate reducing its use in the future compared to those who adopted it post-COVID.
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Background: The dermatology residency application process implemented a new system of preference signaling tokens (PSTs) in the 2021-2022 cycle to allow applicants to express a higher level of interest in specific programs. Limited data are available on the utilization and impact of these tokens.

Objective: To determine the impact of PSTs on the application process and where in the process PSTs had the greatest influence.

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The purpose of this study was to investigate whether EIS technology can further improve correct biopsy choices beyond clinical and dermoscopic evaluation for melanoma (MM), severe dysplastic nevi (SDN) and benign PSLs. Images of 49 MMs, SDNs and benign PSLs were randomly selected from a prior study and were provided in a reader-type survey study to dermatologists to evaluate for biopsy. A total of 33,957 biopsy decisions were analyzed.

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This study aimed to assess the current management of melanoma from relative to present guidelines and determine changes 5 years ago. An eight-question survey was sent to practicing US dermatologists using the same methodology and questions from our JAAD study. Overall, saucerization/scoop biopsy (48%) was the most commonly used method.

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  • Advanced nonmelanoma skin cancer (NMSC) poses a significant public health issue, and the introduction of immune checkpoint inhibitors (ICIs) has changed how these cases are managed.
  • A survey of U.S. dermatologists revealed a low average knowledge score of 40.6 out of 100 regarding ICI therapies, with 71% expressing a desire for more information about treating metastatic cutaneous squamous cell carcinoma (mcSCC) and locally advanced basal cell carcinoma (laBCC).
  • A notable referral pattern was identified, with the majority of referrals for mcSCC or laBCC going to Mohs surgeons, indicating gaps in dermatologists' understanding and treatment options in this area.
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Background: Prognostic assessment of cutaneous melanoma relies on historical, clinicopathological, and phenotypic risk factors according to American Joint Committee on Cancer(AJCC) and National Comprehensive Cancer Network (NCCN) guidelines but may not account for a patient's individual additional genetic risk factors.

Objective: To review the available literature regarding commercially available gene expression profile (GEP) tests and their use in the management of cutaneous melanoma.

Methods: A literature search was conducted for original, English-language studies or meta-analyses published between 2010 and 2021 on commercially available GEP tests in cutaneous melanoma prognosis, clinical decision-making regarding sentinel lymph node biopsy, and real-world efficacy.

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Cutaneous melanoma (CM) survival is assessed using averaged data from the American Joint Committee on Cancer 8th edition (AJCC8). However, subsets of AJCC8 stages I-III have better or worse survival than the predicted average value. The objective of this study was to determine if the 31-gene expression profile (31-GEP) test for CM can further risk-stratify melanoma-specific mortality within each AJCC8 stage.

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The effects of solar radiation on human skin differ based on the skin phototype, presence or absence of photodermatoses, biologic capacity to repair DNA damage, wavelength, intensity of sun exposure, geographic latitude, and other factors, underscoring the need for a more tailored approach to photoprotection. To date, the focus of photoprotection guidelines has been to prevent sunburn and DNA damage induced by UV radiation, both UVB and UVA; however, several recent studies have shown that visible light also generates reactive oxygen and nitrogen species that can contribute to skin damage and pigmentation on the skin, particularly in people with skin of color. Therefore, individuals with dark skin, while naturally better protected against UVB radiation by virtue of the high eumelanin content in melanocytes, may need additional protection from visible light-induced skin damage.

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The negative effects of sun exposure have become better accepted among health care professionals and the lay public over recent decades. Most attention has been focused on the effects of UV light, particularly UVB wavelengths (290-320 nm). Accordingly, products to protect skin from sunlight-associated harm (sunscreens) have been developed to minimize UVB exposure.

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