Tolaymat, Leila

ABSTRACT Background Plasma cell mucositis (PCM) is a rare, chronic inflammatory condition of mucosal surfaces that is likely underdiagnosed and underreported, with limited data on its clinical characteristics, extracavitary involvement, and treatment outcomes. Objectives To characterize the clinical presentation, comorbidities, and treatment patterns of PCM in a cohort of patients from a tertiary care center. Methods We conducted a retrospective cohort study of histopathologically confirmed PCM cases diagnosed at a tertiary care center between 2004 and 2024. Cases were identified based on clinicopathologic correlation demonstrating a polyclonal plasma cell–rich infiltrate. Demographic data, clinical features, comorbidities, laboratory findings, and treatment outcomes were collected and analyzed descriptively. Results Ten patients were included, of whom 7 (70%) were aged ≥ 50 years and 6 (60%) were male. Genital involvement was observed in 6 patients (60%), whereas oral involvement occurred in 4 (40%). Symptom duration exceeded 2 years in 6 patients (60%). Concurrent malignancies were identified in 4 patients (40%), and autoimmune conditions in 2 (20%). Treatment responses were heterogeneous; topical corticosteroids were the most consistently effective therapy, while systemic immunosuppressive agents were required in 3 patients (30%) with variable outcomes. Patch testing identified contact allergens in 2 patients, with improvement following allergen avoidance. Conclusions PCM is a rare and often chronic condition with heterogeneous clinical manifestations and variable therapeutic responses. Genital involvement may be more common than previously recognized. Management remains challenging, highlighting the need for improved understanding of disease pathogenesis and development of more effective treatment strategies.

Localized cutaneous squamous cell carcinoma (cSCC) has a favorable prognosis, unlike advanced disease, especially with clinical perineural invasion (PNI), which poses substantial management challenges due to aggressivity and higher recurrence, metastasis, and mortality risks. PNI, a high-risk staging feature, has worse outcomes, particularly when clinically evident rather than incidental. Clinical PNI (cPNI) is evident by clinical symptoms (such as pain, paresthesia, or motor deficits) or radiologic findings, whereas incidental PNI (iPNI) is identified only histologically without associated symptoms or radiologic evidence. PNI remains a novel area with varying practice patterns across institutions. Improving risk stratification and tailoring multidisciplinary approaches are critical for optimizing outcomes. Our review outlines clinical practice patterns at our institution, providing insights into managing cSCC with PNI, focusing on diagnosis, imaging, staging, and emerging immunotherapies. A structured search was conducted using the terms “perineural invasion,” “cutaneous squamous cell carcinoma,” and “immunotherapy.” cPNI has a poor prognosis and requires nuanced clinical decision-making. Surgery and radiation remain central to management. Adjuvant therapy offers substantial survival benefit in cSCC with PNI, with improved disease-free and overall survival compared with surgery alone, supporting its use in appropriately selected high-risk patients. Traditional systemic therapies, including cisplatin and cetuximab, remain foundational but have shown only moderate response rates and limited durability in advanced or neurotropic cSCC. In contrast, immunotherapy—now preferred for advanced or unresectable cases—has transformed management, with programmed cell death protein-1 (PD-1) inhibitors showing promising results (up to 69% response rate) and disease stabilization. Neoadjuvant immunotherapy may enable tumor downstaging, improve radiation planning, and reduce surgical morbidity. Imaging for squamous cell carcinoma (SCC) with PNI aids staging and surveillance, but symptoms remain key for detecting recurrence. Our multidisciplinary approach emphasizes personalized care. Larger trials are needed to define the optimal role and sequencing of immunotherapy in this high-risk patient population.

Background: Home telemetry has been shown to reduce 30-day readmissions in patients at high risk for readmission. It remains unclear whether this finding is due to the telemetry itself or the nurse contact that follows detection of an abnormal parameter. Purpose: This study was a subgroup analysis from a prior trial comparing patients on home telemetry for 30 days to usual care after discharge to determine if nurse contact affected readmission rates. Methods: Patients randomized to telemetry who had at least 1 nurse contact were compared to those who had none to see if the contact reduced the rate of readmissions. Results: Of 449 home telemetry patients, 292 (65.0%) received 1 or more nurse contacts. Single and multivariable logistic regression models exploring the association of contact with 30-day readmission did not find any statistically significant associations of nurse contact with readmission (all unadjusted P ≥ .13, all adjusted P ≥ .18). Conclusion: Our subset analysis did not show that the nurse contact was the factor that reduced readmission in patients on home telemetry.

Abstract: Background: It is generally recommended that patients not be on immunosuppressive medications for patch testing, as these medications may suppress delayed-type hypersensitivity and lead to false negative results. There is a paucity of literature describing organ transplant recipients who underwent patch testing. Objective: The aim of this study is to examine patch testing results in solid organ transplant recipients over a 13-year period at our institution. Methods: We performed a retrospective analysis of patch test data from adult transplant recipients at our institution. Transplant patients who underwent patch testing were identified from a clinical patch test database, and a chart review was conducted. Results: Eighteen patients were included in the study. Patients had received kidney, liver, or heart transplants. Seven patients (38.9%) had at least one positive reaction. The highest reaction rates were seen with methylisothiazolinone (12.5%), methyldibromo glutaronitrile (12.5%), and benzalkonium chloride (10.0%). Limitations included small sample size, data from a tertiary referral center, and retrospective analysis. Conclusions: Liver and kidney transplant recipients displayed allergic reactions during patch testing. Patients may benefit from patch testing even if receiving immunosuppressive therapy, but some reactions may be falsely negative because of immunosuppression.

Abstract Background Dermatological health-related quality of life (HRQoL) among solid organ transplant recipients (SOTRs) may be adversely affected by various factors, including skin cancer. However, there has been limited assessment of dermatological HRQoL in SOTRs. This study aimed to evaluate the impact of skin cancer on quality of life (QoL) in SOTRs and to compare HRQoL measures between SOTRs with and without skin cancer. Methods This cross-sectional study was conducted at the Mayo Clinic Florida from June 2023 to March 2024. Adult patients who underwent solid organ transplantation between June 1995 and December 2023 were assessed using the Dermatology Life Quality Index (DLQI) and Skindex-29 questionnaires. For SOTRs with keratinocyte carcinoma (KC), the Basal and Squamous Cell Carcinoma Quality of Life (BaSQoL) questionnaire was also administered. Results A total of 150 adult SOTRs were included, with 82 having developed post-transplant skin cancer, including melanoma and keratinocyte carcinomas (KC). SOTRs with skin cancer were older at first transplant (Median: 61.8 vs. 57.3 years, P = 0.0073) and had a higher proportion of males (76.8% vs. 55.9%, P = 0.0086). Fitzpatrick skin type III-VI was less prevalent (8.5% vs. 38.2%, P < 0.0001). The frequency of SCC and BCC was 92.7% and 41.5%, respectively. DLQI scores were higher in SOTRs with skin cancer, however, the difference was not statistically significant (P ≥ 0.065). SOTRs with skin cancer had higher total Skindex-29 scores (P = 0.012) and “emotion” subscale scores (P = 0.0049), indicating a negative impact on QoL. BaSQoL scores showed a moderate negative effect on QoL, with a higher number of KCs correlating with lower QoL (P < 0.05). Female gender had higher DLQI total score (P = 0.0042) and BaSQoL diagnosis and treatment (P = 0.031). Conclusions: SOTRs with skin cancer exhibited lower overall QoL, with a greater number of skin cancers linked to more pronounced negative impacts on QoL across all assessment instruments. Female gender was also associated with lower QoL scores. Recognizing the potential for reduced QoL in SOTRs is essential for developing tailored management strategies to support this population.

ABSTRACT Background Virtual interviews may limit an applicant’s ability to ascertain the culture of a training program. No-stakes campus visits (NSCVs) have been offered but their value is unknown. Objective The purpose of our study was to determine factors that influence applicants’ rank lists and determine barriers to and perceptions of NSCVs and their impact on applicants’ final rank lists. Methods All interviewed applicants of graduate medical education (GME) programs who agreed to participate in the study were emailed a survey after the 2023 National Resident Matching Program Match. The survey contained sections on demographics, perspectives on factors affecting ranking decisions, and perceptions of NSCVs. Results Of 796 applicants, 183 (22.9%) who interviewed at 16 different Mayo Clinic GME programs responded to the survey. Of 131 respondents who answered whether they accepted an NSCV offer, 39 (29.8%) accepted. Of 35 respondents who answered whether they thought attending NSCVs impacted their rank, 19 (54.3%) were either uncertain or said yes. Of 34 respondents who answered whether the NSCV influenced their ranking of the program, 16 (47.1%) said their rank did not change, 12 (35.3%) said they ranked the program higher, and 5 (14.7%) said they ranked the program lower. For respondents who did not attend NSCVs, financial burden and lack of time were primary reasons. Conclusions NSCVs are perceived positively by most respondents. Many either believed they influenced their position on the program’s rank list or were unsure. Most respondents said NSCVs either improved or did not change their ranking of the program.

Background: The regenerative properties of platelet growth factors make platelet-rich-plasma (PRP) an attractive modality for treatment of aging skin. The main objective of this study was to determine efficacy and safety of PRP injections and microneedling compared with saline injections in women with aging skin of the face. Methods: In this prospective, randomized clinical trial, 18 women with facial aging were randomized to receive either PRP injections to the unilateral face and saline injections to the contralateral side, or vice versa. Microneedling was performed after injections on the entire face. Physician assessment, photographs, and treatment satisfaction questionnaires were used for outcome assessment at baseline and 16- and 24-week follow-ups. Results: There was no evidence of improvement and suggestion of worsening in skin laxity and rhytides from baseline to weeks 4, 16, and 24 for PRP and saline (all P ≤ 0.004) and no notable difference in skin roughness between baseline and follow-up time points for PRP or saline (all P ≥ 0.19). The degree of change in skin laxity, rhytides, and skin roughness from baseline to follow-up time points was similar for PRP and saline. All patients experienced some degree of pain/discomfort and burning/stinging sensation at treatment weeks 4, 8, and 12 for both saline and PRP. Conclusions: PRP injections did not seem to be effective for treatment of aging skin of the face in women, with no notable macroscopic improvement in appearance when compared with baseline or saline injections. Advanced age of study participants (>45 years) and less-sensitive methods of evaluation may be potential contributing factors to the lack of detected response.

Abstract Background: Post-menopausal women with estrogen receptor positive breast cancer (BC) are typically prescribed endocrine therapy with an aromatase inhibitor (AI) for 5-10 years following BC diagnosis. AIs have multiple established side effects related to estrogen deprivation including vasomotor symptoms, vaginal dryness, and accelerated bone thinning. Many patients also complain about the impact of AIs on skin quality; however, limited data currently exists, particularly with objective measurements of skin quality. Canfield Sciences VISIA-CA is a device that can be used to objectively measure skin changes using patented comparison to norms analysis with a skin feature database to grade the skin relative to others in the same age and skin type. Herein, we aim to evaluate changes in skin quality with the Canfield Sciences VISIA-CA Device after initiation of AI therapy and investigate potential benefits of skincare intervention. Trial Design: This is a pilot study aiming to describe changes in skin quality after initiation of AI therapy in BC survivors through use of VISIA-CA technology and patient reported outcome measures. This study will allow us to collect data and identify the trend (if any) for a future larger study. Patients who consent for participation are given a baseline survey to assess self-reported quality of life, perception of skin quality, and self-image prior to initiation of AI. Patients also receive baseline skin measurement with the VISIA-CA device and facial skin photography. Baseline skincare regimen is documented. Any patients on prescription tretinoin products at time of baseline assessment are excluded from the study. Patients return 6 months after initiation of AI for follow-up surveys, updated VISIA-CA measurement, and facial skin photography. Patients then meet with a Mayo Clinic Cosmetic Center aesthetician for skincare intervention with recommended topical treatments including daily facial cleanser, exfoliator, toner, hydrating crème, and retinol-based product. Patients return for additional visits with updated survey, VISIA-CA measurement, and facial skin photography at 1 month, 3 months, and 6 months after skincare intervention. Patients are asked to complete skincare compliance diary to document adherence on a weekly basis. Eligibility Criteria: Post-menopausal patients with newly diagnosed ER-positive BC at Mayo Clinic Florida are identified for participation in the study prior to beginning AI therapy. Specific Aims: 1.) Evaluate the incidence and severity of skin changes after initiation of AI therapy in BC survivors through use of Canfield Sciences VISIA-CA technology, facial skin photography, and validated patient reported outcome measures. 2.) Assess for objective improvements in skin quality measurements after skincare intervention including a retinol-based product Statistical Methods: Continuous variables will be summarized as mean (standard deviation) or median (range) and categorical variables will be reported as frequency (percentage). The changes of skin measurement and patient reported outcome measurements will be calculated and summarized for the following time frames: 1) from initiation of AI therapy to 26 weeks after 2) from the initiation of skincare intervention and 4 weeks, 12 weeks, and 26 weeks after. Appropriate statistical plots will be used to illustrate the change. Target Accrual: 50 patients. Schedule of Events Citation Format: Lauren Cornell, Leila Tolaymat, Pooja Advani, Saranya Chumsri, Pincelli Thais. Enhancing skin appearance and quality of life in breast cancer survivors on aromatase inhibitor therapy [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-19-12.