Browsing by Author "Que, Syril Keena T."

Now showing 1 - 7 of 7
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    Cutaneous Squamous Cell Carcinoma: An Updated Review
    (MDPI, 2024-05-08) Jiang, Rina; Fritz, Mike; Que, Syril Keena T.; Dermatology, School of Medicine
    Representing the second most common skin cancer, the incidence and disease burden of cutaneous squamous cell carcinoma (cSCC) continues to increase. Surgical excision of the primary site effectively cures the majority of cSCC cases. However, an aggressive subset of cSCC persists with clinicopathological features that are indicative of higher recurrence, metastasis, and mortality risks. Acceleration of these features is driven by a combination of genetic and environmental factors. The past several years have seen remarkable progress in shaping the treatment landscape for advanced cSCC. Risk stratification and clinical management is a top priority. This review provides an overview of the current perspectives on cSCC with a focus on staging, treatment, and maintenance strategies, along with future research directions.
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    Evaluation of the utility of localized adjuvant radiation for node-negative primary cutaneous squamous cell carcinoma with clear histologic margins
    (Elsevier, 2019) Ruiz, Emily Stamell; Koyfman, Shlomo A.; Que, Syril Keena T.; Kass, Jason; Schmults, Chrysalyne D.; Dermatology, School of Medicine
    Background Though NCCN recommends consideration of localized adjuvant radiation following clear-margin surgery for cutaneous squamous cell carcinoma (CSCC) with large caliber (≥0.1mm) nerve invasion (LCNI) and other high-risk features, only a single small study has compared surgery plus adjuvant radiation (S+ART) to surgical monotherapy (SM) for CSCC. Objectives Compare surgery plus adjuvant radiation (S+ART) to surgical monotherapy (SM) for primary CSCCs with LCNI and other risk factors. Methods Matched retrospective cohort study of primary CSCCs (matched on gender, age, immune status, type of surgery, diameter, differentiation, depth and LCNI) treated with S+ART versus SM. Subgroup analysis of CSCCs with LCNI was performed. Results 62 CSCCs were included in matched analysis (S + ART: 31, SM: 31) and 33 in LCNI analysis (S+ART: 16, SM: 17). There was no significant difference in local recurrence (LR), metastasis, or death from disease in either analysis. Risk of LR was low (7, 8%) with 3 of the LRs being effectively treated upon recurrence. Limitations Single academic center, non-randomized design. Conclusion Adjuvant radiation did not improve outcomes compared to SM due to a low baseline risk of recurrence; although ART for named nerve invasion and LCNI of 3 or more nerves has been shown to improve outcomes in a prior study. Randomized studies are needed to define the subset of CSCC for whom adjuvant radiation has utility.
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    Hydrocolloid dressing versus conventional wound care after dermatologic surgery
    (Elsevier, 2021-12-21) Holmes, Samantha P.; Rivera, Sydney; Hooper, Perry B.; Slaven, James E.; Que, Syril Keena T.; Medicine, School of Medicine
    Background: Hydrocolloid dressings (HCD) are helpful in chronic wound care, but research is limited in acute postoperative wounds. HCD can potentially be incorporated into a simplified wound care regimen after excisional surgeries. Objective: To examine whether a one-time HCD application after dermatologic surgery results in greater patient satisfaction and improved postoperative outcomes compared with conventional daily dressings (CDD). Methods: We examined patients who underwent Mohs or standard surgical excision with linear closure followed by HCD. The patients additionally had a history of excisional surgery with CDD in the past 5 years. A modified version of the validated Bluebelle Wound Healing Questionnaire was administered. Results: The survey response rate was 74.4% (64/86). Compared with CDD, HCD rated higher in comfort, convenience, scar appearance, and simplicity of wound care instructions (P < .0001). Nearly all patients (96.8%) preferred HCD over CDD. Limitations: Variability in time from prior dermatologic surgery may introduce recall bias. Prior surgeries involving CDD were sometimes performed by a different surgeon, which could introduce other confounding factors. Conclusions: A simplified wound care regimen involving HCD can potentially lead to increased comfort, convenience, simplicity, and a subjective improvement in scar appearance, though additional studies are needed.
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    Smoke Evacuation in Dermatology: A National Cross-Sectional Analysis Examining the Behaviors and Perceptions of Dermatologists and Dermatologic Surgeons
    (National Society for Cutaneous Medicine, 2021) Hooper, Perry; Holmes, Samantha; Que, Syril Keena T.; Dermatology, School of Medicine
    Background: Despite associated hazards of surgical smoke, there is limited data regarding smoke evacuation practices among dermatologists. Such information is especially relevant at this time as dermatologic procedures often involve exposure to aerosolized particles and known carcinogens. Objective: To examine the barriers underlying historically low utilization of smoke protection among dermatologists Methods: A survey was sent to dermatologists through the Association of Professors of Dermatology (APD) list-serv and a cross-sectional analysis of responses was performed. Results: A total of 85 dermatologists responded. Twenty-four (28.2%) reported use of smoke evacuators during > 50% of dermatologic procedures. The odds of using smoke evacuation was 2.8 times higher in dermatologists with 10 or more years of experience (95% CI, 1.1-7.5; p=0.0358). The most commonly reported barriers to smoke evacuation were limited staffing (63.5%) and set-up time (61.2%). Sixty-seven (78.8%) respondents reported that a hands-free evacuator could potentially increase the use of smoke evacuation in their practices. Limitations: Survey sent on academic listserv with relatively small sample size and limited generalizability. Conclusions: Smoke evacuation remains low among dermatologists despite the risks. Identifying reasons for low utilization and receptiveness to potential solutions is necessary to improve safety practices relating to smoke evacuation.
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    Smoke Evacuation: A Novel Solution in a Busy Clinical Environment
    (Elsevier, 2020) Hooper, Perry B.; Criscillies, Krystal; Que, Syril Keena T.; Dermatology, School of Medicine
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    The effect of tumor mitotic rate on melanoma-specific survival: An analysis of 54,598 cases
    (Elsevier BV, 2023-07) Iqbal, Arslan; Bell, Maria C.; Merkel, Emily A.; Somani, Ally-Khan; Slaven, James E.; Que, Syril Keena T.; Dermatology, School of Medicine
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    The influence of rurality on melanoma diagnosis in Indiana: A retrospective cohort study
    (Wiley, 2024) Xue, Gloria R.; Clark, Marie; Morr, Claudia; Slaven, James E.; Que, Syril Keena T.; Dermatology, School of Medicine
    Background: Research from across the United States has shown that rurality is associated with worse melanoma outcomes. In Indiana, nearly a quarter of all residents live in rural counties and an estimated 2180 cases of melanoma will be diagnosed in 2023. Aims: This study examines how geographical location affects the stage of melanoma diagnosis in Indiana, aiming to identify and address rural health disparities to ultimately ensure equitable care. Methods and results: Demographics and disease characteristics of patients diagnosed with melanoma at Indiana University Health from January 2017 to September 2022 were compared using Students t-tests, Wilcoxon tests, chi-squared or Fisher's exact tests. Patients from rural areas presented with more pathological stage T3 melanomas (15.0% vs. 3.5%, p < 0.001) in contrast to their urban counterparts. Additionally, rural patients presented with fewer clinical stage I melanomas (80.8% vs. 89.3%) and more clinical stage II melanomas (19.2% vs. 8.1%), compared to urban patients, with no stage III (p = 0.028). Concerningly, a significantly higher percentage of the rural group (40.7%) had a personal history of BCC compared to the urban group (22.6%) (p = 0.005) and fewer rural patients (78.0%) compared to urban patients (89.4%) received surgical treatment (p = 0.016). Conclusion: Patients from rural counties in Indiana have higher pathological and clinical stage melanoma at diagnosis compared to patients from urban counties. Additionally fewer rural patients receive surgical treatment and may be at higher risk of developing subsequent melanomas.