Dermatology Commons^™

Bridging The Dermatology Divide: A Literature Review Of Artificial Intelligence–Enabled Point-Of-Care Tools For Skin Cancer Detection In Primary Care, Jared Hensley, Smaran Marupudi, Maria Villegas

School of Medicine Publications

The United States faces a critical dermatology workforce shortage, with more than 60% of counties lacking specialist access. Primary care providers (PCPs) are often tasked with managing suspicious skin lesions but demonstrate lower diagnostic accuracy than dermatologists. Artificial intelligence (AI) tools offer potential solutions, and meta-analytic evidence demonstrates that AI assistance improves PCP sensitivity by 13 percentage points and specificity by 11 percentage points. Yet only 1 Food and Drug Administration–authorized device (January 2024) is cleared for nondermatologist use in the United States. This device achieves 96% sensitivity but only 21% specificity, meaning most positive results are false alarms. A …

Under The Surface: A Rare Case Of The En Coup De Sabre Subtype Of Linear Morphea In The Rio Grande Valley, Miguel Lopez, Jared Hensley, Maria Villegas

School of Medicine Publications

Localized scleroderma, also referred to as 'morphea,' is a rare autoimmune disorder that affects the superficial layers of the skin and is characterized by both erythematous and bruise-like lesions with signs of central skin tightening or sclerosis; deeper lesions may be identified as edematous, erythematous plaques in the absence of well-defined borders. A subtype named en coup de sabre (ECDS) exists in the classification of linear morphea and presents with a linear induration on either the face or scalp. Our patient is a 21-year-old Hispanic female initially residing outside of the South Texas region who experienced an onset of skin …

Cutaneous Rosai-Dorfman Disease Misdiagnosed As Granulomatous Dermatitis: A Diagnostic Pitfall, Sri Naidnur, Jamie Hedrick, Smaran Marupudi, Kara Asbury, Kelly Maedo, Bryan Gammon, Rick Lin

School of Medicine Publications

Cutaneous Rosai-Dorfman disease (CRDD) is an uncommon non-Langerhans cell histiocytosis that may occur without systemic involvement and lacks specific clinical features. We report a 17-year-old female with a slowly enlarging chest lesion initially diagnosed as granulomatous dermatitis on a 4-mm punch biopsy. The lesion was treated as an inflammatory process without improvement. Complete excision revealed a multinodular dermal and subcutaneous infiltrate of large histiocytes demonstrating emperipolesis, confirming CRDD. Systemic evaluation was negative. The initial limited biopsy did not capture defining features, delaying diagnosis.

Persistent nodular lesions that fail to respond to therapy should prompt reconsideration and more representative tissue sampling. …

Implementing A Specific And Standardized Grading Scale For Therapeutic Injection Site Reactions To Improve Adverse Event Reporting, Priya Kale, Kavita Sarin

Research Colloquium

Up to 15.5% of patients taking biologic medication experience injection site reactions (ISRs) leading to morbidity, early discontinuation, and reduced treatment compliance. As biologic medications are increasingly used to treat chronic inflammatory conditions, including psoriasis and atopic dermatitis, there needs to be an improved understanding of ISRs. However, current methods of grading ISRs are nonspecific and unstandardized leading to a lack of understanding of medication-specific ISRs and ambiguity in perceptions of treatment tolerability. Here we aim to develop a standardized ISR grading scale for use in clinical trials. A scoping review was performed to evaluate current ISR grading scales and …

Regional Disparities In The Diagnostic Age Of Skin Carcinomas: An Analysis Of The Rio Grande Valley, Miguel A. Lopez, Natasha Quailes, Elias Arellano Villanueva, Maria Villegas

Research Colloquium

The Rio Grande Valley (RGV) is a region of South Texas with limited dermatologic diagnostic data, particularly among non-melanoma skin carcinomas. The rising rates of chronic conditions and mortality can be attributed to the limited access to healthcare in the region, with skin conditions taking less priority in patients with numerous comorbidities. Data on the age of diagnosis for skin carcinomas between 1995-2019 for Hispanic and non-Hispanic individuals was obtained from the Texas Cancer Registry. It is important to note that the TCR considers primary skin cancers, such as basal and squamous cell carcinoma coded as C44.0-C44.9, as non-reportable cases. …

An Analysis Of The Diagnostic Age Of Skin Carcinomas Across Central Texas, Miguel A. Lopez, Natasha Quailes, Elias Arellano Villanueva, Hamaad Gohar, Maria Villegas

Research Colloquium

Patients seeking healthcare in medically underserved regions often require travel to larger metropolitan hubs across the state of Texas. The Rio Grande Valley (RGV) is home to many such patients who often travel to central Texas for care, which compounds expense and inconvenience. Pockets of central Texas have been reported to have an increased number of dermatologists per 100,000 people. Bexar county ranks among the five most populous counties in the state, with increased access to dermatologic care compared to nearby regions. Using data from the Texas Cancer Registry, this project aims to identify the mean (M) age of diagnosis …

Actin Up And Factor’D In: ​ A Pediatric Spindle Cell Lesion Case Presentation, Michael Higham, Stephanie Campbell, Naomie Jean, Amanda Killeen

School of Podiatric Medicine Publications

Introduction: Solitary spindle cell nodules on the foot in pediatric patients are rare and diagnostically challenging. Dermatofibroma (benign fibrous histiocytoma), a common adult dermal lesion, is infrequently observed in children under 18.

The spectrum of pediatric spindle cell tumors includes reactive entities like nodular fasciitis and dermatomyofibroma, benign neoplasms such as myofibroma, and malignant tumors including spindle cell rhabdomyosarcoma, fibrosarcoma, and dermatofibrosarcoma protuberans (DFSP). Accurate differential diagnosis is essential, as DFSP requires wide excision or Mohs surgery to reduce recurrence risk.

Methods (Case Presentation): An 11-year-old boy presented with a one-year history of a non-healing lesion on the heel, initially …

Under The Surface: A Rare Case Of Morphea In The Rio Grande Valley, Miguel A. Lopez, Jared Hensley, Maria Villegas

Research Symposium

Localized scleroderma, also referred to as “morphea,” is a rare autoimmune disorder that occurs in an estimated one out of 10,000 patients per year. Research on the demographics of morphea has shown an increased prevalence in female patients. Its presentation may consist of skin lesions confined to the epidermis and dermis that appear erythematous and bruise-like, with signs of central skin tightening or sclerosis; deeper lesions may be identified as edematous, erythematous plaques in the absence of well-defined borders. A subtype named “En coup de sabre,” exists among the classification of “linear morphea” and presents with a linear induration either …

Regional Disparities In Melanoma Mortality: A Study Of The Lower Rio Grande Valley In South Texas, Jared Hensley, Smaran Marupudi, Neharika Penmetcha, Blake C. Martin, Natasha Quailes, Elias Arellano Villanueva, Maria Villegas

Research Symposium

Background: Melanoma, a serious skin cancer with substantial morbidity, is influenced by demographic, geographic, and healthcare access factors. South Texas' Lower Rio Grande Valley (LRGV) region—including Starr, Willacy, Cameron, and Hidalgo counties—has a predominantly Hispanic population facing unique barriers to timely diagnosis and treatment. This study investigates the primary causes of death among melanoma patients in the LRGV compared to other Texas regions, aiming to uncover regional disparities that could guide public health interventions.

Methods: We conducted a retrospective cohort analysis using data from the Texas Cancer Registry (1995-2019). Patients were grouped into two cohorts: Group 1 (LRGV counties) and …

Leveraging Ai In Teledermatology: A Literature Review On Advancing Health Equity For Underserved Populations, Jared Hensley, Smaran Marupudi, Blake Martin, Neharika Penmetcha, Maria Villegas

Research Symposium

Background: Health disparities in dermatological care tend to disproportionately affect underserved populations, particularly those in rural and resource-limited settings. Teledermatology, augmented by artificial intelligence (AI), presents an opportunity to address these inequities by providing underserved populations with improved diagnostic capabilities. Despite its promise, AI models in teledermatology can often exhibit biases, such as reduced diagnostic efficacy for Fitzpatrick skin types IV-VI, due to their training on non-representative datasets. This literature review explores AI's role in teledermatology and potential strategies to enhance its utility for underserved populations.

Methods: A comprehensive review of peer-reviewed literature was conducted to evaluate the integration of …

Development Of Solitary Keratoacanthoma From A Cutaneous Wart, Joshua M. Ninan, Veronica Salazar

Research Symposium

Background: Common cutaneous warts, referred to in medicine as verrucae vulgaris, are proliferative lesions caused by human papillomavirus. These lesions are mostly benign and usually resolve without incident, except in the case of the patient mentioned in this report. Our patient developed a solitary keratoacanthoma, currently accepted as a clinical variant of squamous cell carcinoma, as a result of several risk factors and traumatic exposure. The current literature does not have an established association of HPV with solitary keratoacanthomas. This case report explores the presentation and pathogenesis of solitary keratoacanthomas within the setting of HPV.

Case Presentation: 48-year-old Caucasian female …

The Importance Of A Broad Differential Diagnosis: Hepatitis C Virus Associated Cryoglobulinemic Vasculitis, Shadi Jafari-Esfahani, Christine E. Loftis, Juan Naranjo, Emilia Dulgheru

Research Symposium

Introduction: Mixed cryoglobulinemia syndrome (MCS) is a systemic inflammatory syndrome affecting small-medium sized vessels due to the presence of type II or III cryoglobulins in the serum. MSC can manifest as systemic vasculitis with symptoms varying from weakness, arthralgia, palpable purpura, peripheral neuropathy, and renal involvement. The most common cause of MCS includes lymphoproliferative disorders, autoimmune diseases and viral infections, with hepatitis C virus (HCV) being the most common etiology.

Case Presentation: A 60-year-old lady was referred to our office for evaluation of rheumatoid arthritis. She reported history of bilateral thumb pain, bilateral knee pain associated with episodes of swelling, …

Patchy Alopecia In A Young Adult With A Generalized Rash, Oscar Rodrigo Zamudio Herrera, Nevin Varghese

Research Symposium

Background: Syphilis is a sexually transmitted infection that has been increasing in the United States. The prevalence of syphilis rose by 6.8% during 2019-to 2020. Secondary syphilis typically presents with a generalized maculopapular rash on palms and soles, however, can also have subtle dermatological findings such as alopecia. Syphilitic alopecia is an atypical manifestation of secondary syphilis, seen in 2.9 to 7% of the cases.

Case presentation: An 18-year-old Hispanic male presented to the clinic after noticing patchy loss of hair on the scalp for 2 weeks and one week of generalized non pruritic rash. His past medical history was …