Melanoma and non-melanoma cutaneous malignancies are some of the leading causes of cancer-related death in the United States. Though melanoma is more known to have a high mortality rate, the total mortality per year is nearly equal for between melanoma and non-melanoma skin cancer. Moreover, the non-melanoma types of cutaneous malignancies have potential to become locally invasive and even metastasize with very little to no treatment options when advanced. The development of these malignancies involves various genetic pathways through the four hallmarks of cancer development: malignant cell growth, apoptosis evasion, the use of supporting stroma and vascularization, and modulating and promoting an inadequate immune response. The genetic signaling pathways of basal cell carcinoma, squamous cell carcinoma, verrucous carcinoma, basosquamous cell carcinoma, melanoma, and cutaneous T-cell lymphoma interact with each other through genetic predisposition as well as with environmental exposures. Furthermore, solar ultraviolet radiation and chronic inflammatory states are found to initiate the progression of many of these cutaneous malignancies. This paper includes validated models of genetic pathways, emerging pathways, and crosstalk between genetic pathways through the four hallmarks of cancer development. Moreover, unlike most reviews addressing oncogenetics of the well-recognized, as well as newly dynamic, interrelated, interactive, complex, and adaptive flux states.
Quality photographic documentation of lesions prior to biopsy can decrease the risk of wrong site surgery, improve patient care, and save lives.
e21572 Background: Due to side effects and adverse psychosocial factors, there can often be a disconnect between clinical impression and the patient perspective of treatment. Melanoma patients frequently use social media to discuss their disease sentiments and outcomes, providing a window into patient insight, otherwise not readily attainable. We analyzed publicly available full text posts on multiple social media platforms concerning melanoma treatments PD-1 inhibitors (pembrolizumab/Keytruda, nivolumab), BRAF inhibitors (dabrafenib, vemurafenib), and CTLA-4 inhibitor (ipilimumab/Yervoy) associated with Patient Global Impression of Change (PGIC) terms to compare and identify patient burden. Methods: Millions (12,599,313) of publicly available online social media text data were extracted and run through Brandwatch Artificial Intelligence-powered database and machine learning algorithm to categorize treatment-specific posts with PGIC terms associated with sentiment. Results: Out of 52,962 posts related to a select list of melanoma treatments, we identified Keytruda (6,080), nivolumab (1,614), dabrafenib (529), vemurafenib (329), and ipilimumab (1715) posts. The top ten types of posts by volume for each treatment were predominantly positive for PGIC terms (improving, well, progress) while being associated with negative emotions (fear and sadness). Patient-perceived better treatments were associated with decrease fear. PD-1 inhibitor Keytruda displayed markedly less fear (56.9%) with a very high positive PGIC (92.3%) in comparison with PD-1 inhibitor nivolumab with decreased positive PGIC (78.0%) and increased fear (81.6%). Likewise, this patten was discovered for the BRAF inhibitors and CTLA-4 inhibitor, albeit less distinct: dabrafenib (positive PGIC 86.4%, fear 71.9%), vemurafenib (positive PGIC 78.0%, 81.6%), ipilimumab (positive PGIC 75.0%, fear 79.3%). Conclusions: Our initial results indicate that despite patients reporting good outcomes from melanoma treatment, they remain fearful. Nonetheless, a trend is identified between patient-perceived better treatment and decreased patient fear. This analysis can help bridge the gap of understanding patient perspective and provides an indication for translation into more effective clinical and pharmaceutical response.
e24177 Background: The link between melanoma patients’ emotions and their impressions of treatments response are poorly understood. With the rise of social media, patients use online platforms to communicate their concerns related to melanoma treatments. In this study, we utilize real-world data collected from social media with search terms focused on treatment-specific Patients’ Global Impression of Change (PGIC) compared with their emotions. We aim to identify and focus melanoma patient perspective trends to improve patient-centered care. Methods: Social media data mining of search terms were extracted from millions of publicly available interactions on Twitter and other online platforms from May/2008 to January/2020 using Crimson Hexagon (database of real-time social media posts). Results: For chemotherapy posts, the top three emotions by volume were negative alongside negative PGIC “worse” (Worse/Sadness 700, Worse/Fear 596, Worse/Disgust 403, and “decline” (Decline/Sadness 262, Decline/Fear 186, Decline/Disgust 57). Interestingly, Sadness, Fear, and Disgust were as prevalent alongside positive PGIC “well” and “cured” (Well/Sadness 3577, Well/Fear 2545, and Well/Disgust 1770; Cured/Sadness 518, Cured/Disgust 275, and Cured/Fear 167). For Keytruda treatment posts, emotions in negative PGIC “worse” were (Worse/Fear 117, Worse/Anger 68, Worse/Sadness 6). In positive PGIC “well”, results were (Well/Fear 880, Well/Sadness 366, Well/Anger 186). Further analysis will compare these emotional sentiments with a spectrum of PGIC terms and specific types of melanoma treatments. Conclusions: To our knowledge, this is the first investigation of online patient melanoma treatments associated with PGIC terms. The findings indicate a trend of negative emotions even when patients have reported wellness or being cured by treatment. While treatments may be effective, patients are not necessarily satisfied. Correlating changes in emotions with perceived changes in disease severity can provide insight into patient perspectives, which has implications in translating clinical response and a need for continued emotional support in patients with treatment response.
BACKGROUND Advanced Dermatology and Cosmetic Surgery (ADCS) is a practice with over 4.7 million dermatology patients, 350 providers, and 140 offices nationwide. During the coronavirus disease-19 lockdown all but 16 offices were closed, and the electronic medical record was integrated with video teledermatology. OBJECTIVE Although the pandemic has allowed for the exploration and enhancement of these services, robust studies of teledermatology are warranted to ensure optimal delivery of high-quality care while minimizing COVID-19 exposure. The purpose of this study is to identify determine the current knowledge of, utilization of, and sentiment about teledermatology in patients that have recently had the opportunity to use some modality to have a virtual encounter. Other aims include to explore the factors that deter patients from using teledermatology during and after the COVID-19 lockdown, and to elucidate the advantages and limitations that need to be addressed moving forward. METHODS An anonymous internet-based survey was distributed to adult ADCS Clinics patients who signed consent to accept email communication via Qualtrics. Based on patient participation in teledermatology, the survey had up to 62 questions that evaluated patient utilization and sentiment of the various technologies involved in teledermatology visits both during and after the COVID-19 lockdown. RESULTS The mean general satisfaction rating with teledermatology was 7.48 during and 7.92 after the lockdown, with 10 being very satisfied. Patients were somewhat satisfied with several aspects of teledermatology including convenience, simplicity, how well the concern was addressed, security, follow-up, and photo transmission. Patient satisfaction with how well their concern was addressed and with the security of their data was significantly greater after the lockdown compared to during, which was determined using an independent samples t-test with statistical significance at p < 0.05. Most patients utilized live video interaction both during and after the pandemic. CONCLUSIONS Overall, patients are satisfied with teledermatology and believe that it improves the provision of health services. The factors addressed can continue to be enhanced to facilitate optimal service delivery while minimizing COVID-19 exposure.
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