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    Screening labs, complacency, and the ABCDEs of pediatric melanoma

    Takeaway Part three


    The most important lesson we learned in that study was that the presentations of melanoma are vastly different in prepubertal patients. That age group requires a higher index of suspicion for lesions with these atypical presentations.

    As far as the eczema coxsackium paper5, I have to give 100% of the credit to my colleague and friend [Dr.] Erin Mathes, who is a pediatric dermatologist at UCSF. Dr. Mathes, one of our fellows Dr. Vikash Oza, and Dr. Frieden really spearheaded that work. We were observing these variant hand-foot-mouth disease (HFMD) presentations and there had been some reports coming out of other countries around the same time. I take really little to no credit for that paper other than contributing a few cases, reviewing, and helping to edit the final product. I think it was a very important paper that we all learned from. The CVA6-associated enterovirus outbreak was responsible for an exanthem potentially more widespread, severe, and varied than classic HFMD that could be confused with bullous impetigo, eczema herpeticum, vasculitis, and primary immunobullous disease.

    Dr. Siegfried: What do you enjoy the most, what takes most of your time? Is it patient care, teaching, research?

    Dr. Cordoro: I love that you asked me that question. It’s patient care. I am first and foremost a clinician, and I’m happiest when I am behind a closed door with a complicated patient. The bonus is, I’m in an academic environment where my passion for teaching is married to patient care. Every patient I see presents a learning opportunity for our trainees and for me.

    Dr. Siegfried: I know you’re working a lot on psoriasis. Is there anything else that’s really exciting you and making you enthusiastic?

    Dr. Cordoro: Psoriasis is probably my favorite disease. I am working with the Pediatric Dermatology Research Alliance (PeDRA). We have a psoriasis investigator group, and we’re composing a survey to determine current management patterns for pediatric psoriasis in the United States [The MAPP US Study: Management Approaches to Pediatric Psoriasis in the United States], because we assume that there’s a huge divergence in the way patients are approached in this country and among clinicians in other countries. We’ll extend the survey to Canada as well. We’re trying to gather data to inform future research and move us closer to achieving consensus in the area of management and risk stratification for purposes of evaluating children with psoriasis for comorbidities.

    READ: Intralesional therapy for metastatic melanoma

    Of course psoriasis projects are always hot on the front burner. Other projects at the moment include a study exploring refractory pediatric lupus panniculitis (LEP). Most of the published articles about lupus panniculitis indicate that pediatric patients get better with hydroxychloroquine (Plaquenil), rarely requiring additional medications. My experience with three or four patients with severe, refractory, disfiguring disease on massive systemic immunosuppression prompted further investigation. Other than those cases ultimately diagnosed with subcutaneous panniculitis-like T cell lymphoma, there is not much published about refractory LEP. 

    My other passion is procedural dermatology. I enjoy an active laser practice and we are putting together our experience using the long-pulsed Nd:YAG laser to treat pediatric vascular malformations such as glomuvenous and venous malformations.  There are gaps in the pediatric procedural literature and based on years of practice, we are looking forward to being able to make a contribution in this area.

    In case you missed it

    Check out part two of this three part series: Pediatric psoriasis, eczema:Triggers and therapies

    Check out part one of this three part series: Clinical pearls in pediatric dermatology

    Elaine Siegfried, M.D.
    Elaine Siegfried, M.D., is professor of pediatrics and dermatology, Saint Louis University Health Sciences Center, St. Louis, Mo. She ...


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