PracticeUpdate Dermatology February 2019

EDITOR’S PICKS 9

Reexamining the Role of SLN Biopsy in Melanoma Journal of the American Academy of Dermatology Take-home message • The Multicenter Selective Lymphad- enectomy Trials indicated that there are no overall or melanoma-specific survival advantages to performing sentinel lymph node (SLN) biopsy fol- lowed by an immediate completion lymph node dissection in patients with positive SLNs compared with wide excision and observation. In this commentary, the authors express concerns that SLN biopsy may solely be a staging procedure that stratifies patients into trials or to receive adjuvant therapy and which comes at a high cost of significant patient morbidity. • The authors suggest that the role of SLN biopsy in the management of melanoma patients should be reex- amined, considering that the potential marginal benefit of SLN biopsy has not been well-established. InYoung Kim MD, PhD Abstract The Multicenter Selective Lymphadenectomy Trials (MSLT) were practice changing rand- omized, controlled trials. MSLT-I demonstrated that in patients with cutaneous melanoma wide excision and sentinel lymph node biopsy (SLNB) followed by immediate completion lymph node dissection (ICLND) for patients with positive sentinel nodes did not provide overall or mel- anoma specific survival advantage over wide excision and observation. MSLT-II demonstrated that ICLND did not increase overall or melano- maspecific survival compared to close clinical observation and delayed CLND even among patients with melanoma and positive senti- nel-nodes. These results indicate that SLNB followed by ICLND has no survival value and SLNB should now be regarded solely as a stag- ing procedure. Its role as a staging procedure in the management of patients with melanoma deserves reappraisal. Time to Reconsider the Role of Sentinel Lymph Node Biopsy in Melanoma. J Am Acad Derma- tol 2018 Nov 21;[EPub Ahead of Print], M Bigby, S Zagarella, M Sladden, CM Popescu. www.practiceupdate.com/c/76993

Abstract BACKGROUND Adherence to topical psoriasis treatments is low, which leads to unsatisfac- tory treatment results. Smartphone applications (apps) for patient support exist but their poten- tial to improve adherence has not been systematically evaluated. OBJECTIVES To evaluate whether a study-spe- cific app improves adherence and reduces psoriasis symptoms compared with standard treatment. METHODS We conducted a randomized con- trolled trial (RCT, clinicaltrials.gov registration: NCT02858713). Patients received once-daily medication [calcipotriol/betamethasone dipro- pionate (Cal/BD) cutaneous foam] and were randomized to no app (n = 66) or app inter- vention (n = 68) groups. In total, 122 patients (91%) completed the 22-week follow-up. The primary outcome was adherence, which was defined as medication applied ≥ 80% of days during the treatment period and assessed by a chip integrated into the medication dispenser. Secondary outcomes were psoriasis severity measured by the Lattice System Physician's Global Assessment (LS-PGA) and quality of life, measured using the Dermatology Life Quality Index (DLQI) at all visits. RESULTS Intention-to-treat analyses using regression was performed. More patients in the intervention group were adherent to Cal/ BD cutaneous foam than those in the non- intervention group at week 4 (65% vs. 38%,

P = 0·004). The intervention group showed a greater LS-PGA reduction than the noninter- vention group at week 4 (mean 1·86 vs. 1·46, P = 0·047). A similar effect was seen at weeks 8 and 26, although it did not reach statistical significance. CONCLUSIONS This RCT demonstrates that the app improved short-term adherence to Cal/ BD cutaneous foam treatment and psoriasis severity. A Smartphone Application Supporting Patients With Psoriasis Improves Adherence to Topi- cal Treatment: A Randomized Controlled Trial. Br J Dermatol 2018 Nov 01;179(5)1062-1071, MT Svendsen, F Andersen, KH Andersen, et al. the long-term outcomes of topical treatment for a wide range of skin diseases. " " Developing approaches – whether technological or psychosocial – that lead patients to develop solid medication use habits could be a profound way to improve

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VOL. 3 • NO. 1 • 2019