Nour Kibbi, MD, FAAD

All Publications

• Koebnerized vitiligo vulgaris following laser treatment of lichen planus pigmentosus successfully treated with topical ruxolitinib. JAAD case reports Bandali, T., Voller, L., Ko, J., Kibbi, N. 2024; 53: 136-138

  View details for DOI 10.1016/j.jdcr.2024.07.033

  View details for PubMedID 39507484

• Recommended Guidelines for Screening for Underlying Malignancy in Extramammary Paget's Disease Based on Anatomic Subtype. Journal of the American Academy of Dermatology Kibbi, N., Owen, J. L., Worley, B., Alam, M. 2024

  Abstract

  Extramammary Paget's disease (EMPD) may be associated with an underlying internal adenocarcinoma, referred to as secondary EMPD. Differences in this association by EMPD anatomic subtype and implications for screening are not fully understood.Define the rates of secondary EMPD and types of associated adenocarcinomas by EMPD anatomic subtype and propose a screening algorithm for underlying adenocarcinoma.Systematic literature review of EMPD (January 1990- November 2022). One hundred twenty-two studies met the inclusion criteria. A multidisciplinary expert panel reviewed the recommendation statements on adenocarcinoma screening.Perianal EMPD was associated with a high rate of underlying adenocarcinoma (25%, primarily colorectal) compared with penoscrotal and vulvar EMPD (6% each, primarily of genitourinary origin). Thorough screening in perianal EMPD includes a colonoscopy, urine cytology, and computed tomography (CT) of the chest, abdomen and pelvis. Cost-conscious screening tests in low-risk penoscrotal disease include urine cytology, heme-occult test, and prostate-specific antigen test (especially if under 70 years of age). For low-risk vulvar EMPD, urine cytology and mammography are recommended. EMPD with high-risk features may warrant more sensitive organ-specific testing.Selection bias; retrospective data without systematic follow-up.Screening for underlying adenocarcinoma in EMPD should be guided by anatomic location.

  View details for DOI 10.1016/j.jaad.2024.07.1531

  View details for PubMedID 39401611

• Development of an Objective Structured Assessment of Technical Skills (OSATS) for Sclerotherapy. Journal of the American Academy of Dermatology Ma, M. S., Zafar, F. S., Goldman, M. P., Munavalli, G. S., Zimmet, S. E., Nguyen, T. H., Mishra, V., Cartee, T. V., Mann, M., Hsu, J. T., Silapunt, S., Weiss, R. A., Weiss, M. A., Haq, M., Ahmed, A., Koza, E., Shi, V. J., Dave, L., Yi, M., Kang, B. Y., Cahn, B., Bae, Y. S., Kole, L. C., Friedmann, D. P., Chow, M. L., Minkis, K., Stücker, M., Schlick, C. A., Hoss, E., Hu, J. C., Kibbi, N., Saikaly, S. K., Greywal, T., Hooper, D., Vashi, N. A., Boucher, A., Ward, K. H., Neuhaus, I. M., Ghareeb, E., Luke, J., Karen, J. K., Suggs, A., Lucas, J., Decker, A., Brieva, J. C., Yoo, S. S., Suozzi, K., Alam, M. 2024

  View details for DOI 10.1016/j.jaad.2024.08.062

  View details for PubMedID 39288871

• Developing expert consensus for the use of hedgehog inhibitors in basal cell nevus syndrome. Archives of dermatological research Lukowiak, T. M., Cahn, B., Samie, F., Leffell, D. J., Oro, A., Kibbi, N., Kheterpal, M., Babakoohi, S., Khushalani, N. I., Stephenson, A., Ma, M. S., Shi, V. J., Ahmed, A., Koza, E., Haq, M., Yi, M. D., Nadir, U., Yoo, S., Brieva, J. C., Lucas, J., Haber, R., Alam, M. 2024; 316 (7): 453

  View details for DOI 10.1007/s00403-024-03157-z

  View details for PubMedID 38967654

  View details for PubMedCentralID 4362529

• Amelanotic Lentigo Maligna Melanoma Masquerading as Erythematotelangiectatic Rosacea. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.] Voller, L. M., Bailey, E. E., Rieger, K. E., Kibbi, N. 2024

  View details for DOI 10.1097/DSS.0000000000004264

  View details for PubMedID 38820431

• Redefine "benign": A misnomer in the context of patients with genetic skin tumour syndromes. The British journal of dermatology Robinson, J., Kibbi, N., Rajan, N. 2024

  View details for DOI 10.1093/bjd/ljae185

  View details for PubMedID 38728435

• Anatomic Subtype Differences in Extramammary Paget Disease: A Meta-Analysis. JAMA dermatology Kibbi, N., Owen, J. L., Worley, B., Wang, J. X., Harikumar, V., Aasi, S. Z., Chandra, S., Choi, J. N., Fujisawa, Y., Iavazzo, C., Kim, J. Y., Lawrence, N., Leitao, M. M., MacLean, A. B., Ross, J. S., Rossi, A. M., Servaes, S., Solomon, M. J., Alam, M. 2024

  Abstract

  Importance: Extramammary Paget disease (EMPD) is a rare, highly recurrent cutaneous malignant neoplasm of unclear origin. EMPD arises most commonly on the vulvar and penoscrotal skin. It is not presently known how anatomic subtype of EMPD affects disease presentation and management.Objective: To compare demographic and tumor characteristics and treatment approaches for different EMPD subtypes. Recommendations for diagnosis and treatment are presented.Data Sources: MEDLINE, Embase, Web of Science Core Collection, and Cochrane Reviews CENTRAL from December 1, 1990, to October 24, 2022.Study Selection: Articles were excluded if they were not in English, reported fewer than 3 patients, did not specify information by anatomic subtype, or contained no case-level data. Metastatic cases on presentation were also excluded.Data Extraction and Synthesis: Abstracts of 1295 eligible articles were independently reviewed by 5 coauthors, and 135 articles retained. Reporting was in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. The analysis was cunducted in August 2019 and updated in November 2022.Findings: Most vulvar EMPD cases were asymptomatic, and diagnosis was relatively delayed (mean, 25.1 months). Although most vulvar EMPD cases were intraepidermal (1247/1773 [70.3%]), radical surgeries were still performed in almost one-third of cases. Despite this aggressive surgical approach, 481 of 1423 (34%) recurred, commonly confined to the skin and mucosa (177/198 [89.4%]). By contrast, 152 of 1101 penoscrotal EMPD cases (14%) recurred, but more than one-third of these recurrences were regional or associated with distant metastases (54 of 152 [35.5%]). Perianal EMPD cases recurred in one-third of cases (74/218 [33.9%]), with one-third of these recurrences being regional or associated with distant metastasis (20 of 74 [27.0%]). Perianal EMPD also had the highest rate of invasive disease (50% of cases).Conclusions and Relevance: The diagnosis and treatment of EMPD should differ based on anatomic subtypes. Considerations for updated practice may include less morbid treatments for vulvar EMPD, which is primarily epidermal, and close surveillance for local recurrence in vulvar EMPD and metastatic recurrence in perianal EMPD. Recurrences in penoscrotal subtype were less common, and selective surveillance in this subtype may be considered. Limitations of this study include the lack of replication cohorts and the exclusion of studies that did not stratify outcomes by anatomic subtype.

  View details for DOI 10.1001/jamadermatol.2024.0001

  View details for PubMedID 38446447

• A Severe Case of Pan-Facial Vitamin C Serum-Induced Foreign Body Granulomatous Reaction. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.] Petric, U. B., Marks, D., Dickman, M., Rieger, K. E., Kibbi, N. 2024

  View details for DOI 10.1097/DSS.0000000000004118

  View details for PubMedID 38358735

• Identifying critical quality metrics in Mohs Surgery: A national expert consensus process. Journal of the American Academy of Dermatology Dodson, J. A., Ibrahim, S. A., Rogers, H., Council, M. L., Nehal, K. S., Tung, R., Leffell, D. J., Zeitouni, N. C., Totonchy, M. B., Fosko, S. W., Lee Soon, S., Blalock, T. W., Brodland, D. G., Billingsley, E. M., Scott, J. F., Leach, B. C., Ratner, D., Washington, C., Hanke, C. W., Otley, C. C., Golda, N., Nijhawan, R. I., Brewer, J., Demer, A., Fish, F., Harmon, C. B., Zitelli, J., Knackstedt, T., Singh, G., Mollet, T., Carr, D. R., Albertini, J. G., Moody, B. R., McDonald, M., Bordeaux, J. S., Massey, P. R., MacCormack, M. A., Vidimos, A., Arpey, C. J., Arron, S. T., Ibrahimi, O. A., Jiang, S. B., Miller, C. J., Maher, I. A., Wysong, A., Leshin, B., Goldman, G. D., Kibbi, N., Feng, H., Collins, L. 2023

  Abstract

  Amid a movement toward value-based healthcare, increasing emphasis has been placed on outcomes and cost of medical services. To define and demonstrate the quality of services provided by Mohs surgeons, it is important to identify and understand the key aspects of Mohs micrographic surgery (MMS) that contribute to excellence in patient care.The purpose of this study is to develop and identify a comprehensive list of metrics in an initial effort to define excellence in MMS.Mohs surgeons participated in a modified Delphi process to reach a consensus on a list of metrics. Patients were administered surveys to gather patient perspectives.Twenty-four of the original 66 metrics met final inclusion criteria. Broad support for the initiative was obtained through physician feedback.Limitations of this study include attrition bias across survey rounds and participation at the consensus meeting. Furthermore, the list of metrics is based on expert consensus instead of quality evidence-based outcomes.With the goal of identifying metrics that demonstrate excellence in performance of MMS, this initial effort has shown that Mohs surgeons and patients have unique perspectives and can be engaged in a data-driven approach to help define excellence in the field of MMS.

  View details for DOI 10.1016/j.jaad.2023.10.069

  View details for PubMedID 38081390

• Histopathologic Characterization of Incidental Lesions Encountered During Mohs Micrographic Surgery With MART-1 Immunohistochemistry. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.] Hirotsu, K. E., Kibbi, N., Rieger, K. E., Aasi, S. Z. 2023

  Abstract

  As the use of melanoma antigen recognized by T cells (MART-1) immunohistochemistry (IHC) with Mohs surgery increases for the treatment of melanoma in situ and invasive melanoma, surgeons should be aware of MART-1 staining patterns of incidental lesions often encountered on frozen sections. Lack of this knowledge can lead to unnecessary additional surgery, increased health care costs, and loss of valuable laboratory staff time and resources.To characterize the histopathologic features of incidental lesions encountered during Mohs surgery for melanoma. To review key diagnostic and differentiating features on hematoxylin and eosin staining (H&E) and MART-1 IHC of these lesions.A comprehensive review of frozen-section histopathology slides from Mohs cases with MART-1 IHC at our institution was conducted from 2021 to 2023.Incidental benign and malignant lesions were identified and characterized on H&E frozen sections and MART-1 IHC. Although such entities can share MART-1 staining characteristics with melanoma in situ or melanoma, distinguishing characteristics on H&E and lack of histopathologic criteria for melanoma on MART-1 IHC can be used to distinguish these incidental lesions from melanoma.Staining of frozen sections for Mohs micrographic surgery with H&E and MART-1 IHC together can differentiate common incidental benign and malignant cutaneous lesions from melanoma.

  View details for DOI 10.1097/DSS.0000000000004048

  View details for PubMedID 38064448

• Perceptions of US-Based Muslim Patients of Their Dermatology Care. JAMA dermatology El-Banna, G., Rezaei, S. J., Chang, M., Merrell, S. B., Bailey, E. E., Kibbi, N. 2023

  Abstract

  Cultural humility training is of growing interest, yet the religious and cultural accommodations of Muslim patients in dermatology have not been studied.To explore the perceptions of Muslim patients of their dermatology care.This qualitative mixed-methods study, consisting of surveys and semistructured interviews, recruited participants from 2 clinical sites within a large academic health care system in California. Participants were adult, English-speaking, Muslim patients who were evaluated at least once by a medical or surgical dermatologist between January 2022 and January 2023.A survey obtained the following data: demographics, religious practices pertinent to dermatology care, and experiences of bias outside and inside the dermatology clinic. Semistructured interviews covered topics related to positive and negative experiences in the dermatology clinic, accommodation of cultural and religious needs in dermatology, and future interventions.A total of 21 patients (mean [SD] age, 36.4 [11.6] years; range, 26-71 years) participated in the study: 5 male individuals (24%) and 16 female individuals (76%), including 10 female individuals who wore hijab. Eleven participants identified as Middle Eastern (52%), 8 as South Asian (38%), 1 as North African (5%), and 1 as Pacific Islander (5%). Survey results showed variations in the impact of Islamic practices on dermatology care. Interviews showed that Muslim participants did not perceive dermatology care as a priority and expressed interest in community events focused on general dermatology education. They also experienced stigmatization of their skin disease and cosmetic care. Prior experiences with Islamophobia and colorism hindered the Muslim patient-dermatologist relationship and disclosure of the need for accommodations. There were instances when participants experienced bias and poor cultural humility from dermatologists. Finally, Muslim participants had unique religious and cultural needs pertinent to their care, including clinician gender concordance, medication timing adjustment while fasting, and halal medication ingredients.This qualitative mixed-methods study explored the experiences of Muslim patients in dermatology in the US. Recommendations supported by this study include incorporating religion into cultural humility training, increasing diversity in the dermatology workforce, implementing policies for clearer medication labeling, supporting dermatology research in subpopulations of Muslim individuals in the US, and partnering with community organizations for dermatology education.

  View details for DOI 10.1001/jamadermatol.2023.4439

  View details for PubMedID 37966806

  View details for PubMedCentralID PMC10652213

• Clinical Outcomes in Sebaceous Carcinoma: A Retrospective Two-Center Cohort Study. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.] Kibbi, N., Petric, U. B., El-Banna, G., Beaulieu, D. M., Rajan, N., Srivastava, D., Aasi, S. Z. 2023

  Abstract

  Sebaceous carcinoma (SC) is a rare, potentially recurrent, and life-threatening cutaneous malignancy that can be associated with Muir-Torre syndrome (MTS), a DNA mismatch repair-driven genodermatosis. Earlier studies examining factors associated with recurrence have focused on periocular tumors only.Examine outcomes of SC and identify factors associated with recurrence.Retrospective study from 2 tertiary care centers.Sixty-seven cases from 63 patients were identified, including 7 cases of MTS and 13 arising in the context of immunosuppression. Fifty-five cases (82.1%) were treated with complete circumferential peripheral and deep margin assessment (CCPDMA) methods. Five recurrences developed during the postoperative period. On univariate analysis, periocular location (odds ratio [OR] 7.6, p = .0410), and lesion size ≥2 cm (OR 9.6, p = .005) were associated with recurrence, whereas CCPDMA (OR 0.052, p = .0006) was inversely associated with recurrence. On multivariate analysis, only lesion size ≥2 cm (OR 9.6, p = .0233) and CCPDMA approaches (OR 0.052, p = .007) were significant.Non-complete circumferential peripheral and deep margin assessment methods and large lesion size were independent risk factors predicting recurrence, whereas anatomic subtype and MTS status were not. These findings can assist in identifying SC cases that may benefit from more aggressive treatment and closer surveillance.

  View details for DOI 10.1097/DSS.0000000000004016

  View details for PubMedID 37962979

• Risk of Multiple Primary Cancers in Patients With Merkel Cell Carcinoma: A SEER-Based Analysis. JAMA dermatology Eid, E., Maloney, N. J., Cai, Z. R., Zaba, L. C., Kibbi, N., John, E. M., Linos, E. 2023

  Abstract

  The risk of subsequent primary cancers after a diagnosis of cutaneous Merkel cell carcinoma (MCC) is not well established.To evaluate the risk of subsequent primary cancers after the diagnosis of a first primary cutaneous MCC.This cohort study analyzed data from 17 registries of the Surveillance, Epidemiology, and End Results (SEER) Program from January 1, 2000, to December 31, 2019. In all, 6146 patients diagnosed with a first primary cutaneous MCC were identified.The primary outcome was the relative and absolute risks of subsequent primary cancers after the diagnosis of a first primary MCC, which were calculated using the standardized incidence ratio (SIR; ratio of observed to expected cases of subsequent cancer) and the excess risk (difference between observed and expected cases of subsequent cancer divided by the person-years at risk), respectively. Data were analyzed between January 1, 2000, and December 31, 2019.Of 6146 patients with a first primary MCC diagnosed at a median (IQR) age of 76 (66-83) years, 3713 (60.4%) were men, and the predominant race and ethnicity was non-Hispanic White (5491 individuals [89.3%]). Of these patients, 725 (11.8%) developed subsequent primary cancers, with an SIR of 1.28 (95% CI, 1.19-1.38) and excess risk of 57.25 per 10 000 person-years. For solid tumors after MCC, risk was elevated for cutaneous melanoma (SIR, 2.36 [95% CI, 1.85-2.97]; excess risk, 15.27 per 10 000 person-years) and papillary thyroid carcinoma (SIR, 5.26 [95% CI, 3.25-8.04]; excess risk, 6.16 per 10 000 person-years). For hematologic cancers after MCC, risk was increased for non-Hodgkin lymphoma (SIR, 2.62 [95% CI, 2.04-3.32]; excess risk, 15.48 per 10 000 person-years).This cohort study found that patients with MCC had an increased risk of subsequently developing solid and hematologic cancers. This increased risk may be associated with increased surveillance, treatment-related factors, or shared etiologies of the other cancers with MCC. Further studies exploring possible common etiological factors shared between MCC and other primary cancers are warranted.

  View details for DOI 10.1001/jamadermatol.2023.2849

  View details for PubMedID 37703005

• Elevated Risk of Visceral Malignant Neoplasms in Extramammary Paget Disease. JAMA dermatology Maloney, N. J., Yao, H., Aasi, S. Z., John, E. M., Linos, E., Kibbi, N. 2023

  Abstract

  This cross-sectional study evaluates the incidence and types of cancers that develop years after an extramammary Paget disease (EMPD) diagnosis.

  View details for DOI 10.1001/jamadermatol.2023.2679

  View details for PubMedID 37647047

• Association of histopathological grade with stage and survival in sebaceous carcinoma: a retrospective cohort study in the National Cancer Database. Journal of the American Academy of Dermatology Maloney, N. J., Zacher, N. C., Aasi, S. Z., Hirotsu, K. E., Zaba, L. C., Kibbi, N. 2023

  View details for DOI 10.1016/j.jaad.2023.07.1013

  View details for PubMedID 37532139

• Online risk calculator and nomogram for predicting sentinel lymph node positivity in Merkel Cell Carcinoma. Journal of the American Academy of Dermatology Maloney, N. J., Aasi, S. Z., Kibbi, N., Hirotsu, K. E., Zaba, L. C. 2023

  View details for DOI 10.1016/j.jaad.2023.05.042

  View details for PubMedID 37244414

• Sebaceous carcinoma epidemiology, associated malignancies and Lynch/Muir-Torre syndrome screening in England from 2008 to 2018. Journal of the American Academy of Dermatology Cook, S., Pethick, J., Kibbi, N., Hollestein, L., Lavelle, K., de Vere Hunt, I., Turnbull, C., Rous, B., Husain, A., Burn, J., Lüchtenborg, M., Santaniello, F., McRonald, F., Hardy, S., Linos, E., Venables, Z., Rajan, N. 2023

  Abstract

  Sebaceous carcinomas (SC) may be associated with the cancer predisposition syndrome Muir-Torre/Lynch syndrome (MTS/LS), identifiable by SC mismatch repair (MMR) screening, however there is limited data on MMR status of SC.To describe the epidemiology of SC, co-presentation of other cancers and population level frequency of MMR screening in SC.A population based retrospective cohort study of SC patients in the National Cancer Registration and Analysis Service in England.This study included 1077 SC cases (739 extraocular, 338 periocular). Age standardised incidence rates (ASR) were higher in males compared to females, 2.74 (95% CI 2.52-9.69) per 1,000,000 person years (PY) for males versus 1.47 PY (95% CI 1.4-1.62) for females. 19% (210/1077) of patients developed at least one MTS/LS associated malignancy. MMR immunohistochemical screening was performed in only 20% (220/1077) of SC tumors, of these 32% (70/219) of tumors were MMR deficient.Retrospective design.Incorporation of MMR screening into clinical practice guidelines for the management of SC will increase the opportunity for MTS/LS diagnoses, with implications for cancer surveillance, chemoprevention with aspirin and immunotherapy treatment targeted to MTS/LS cancers.

  View details for DOI 10.1016/j.jaad.2023.03.046

  View details for PubMedID 37031776

• Comparison of clinicopathologic features, survival, and demographics in sebaceous carcinoma patients with and without Muir-Torre syndrome. Journal of the American Academy of Dermatology Maloney, N. J., Zacher, N. C., Hirotsu, K. E., Rajan, N., Aasi, S. Z., Kibbi, N. 2023

  Abstract

  Visceral malignancies in patients with Lynch syndrome behave less aggressively than in those without Lynch syndrome. The behavior of sebaceous carcinoma (SC) in Muir-Torre syndrome (MTS), a variant of Lynch syndrome, is incompletely investigated.Investigate features and survival of SC patients with and without MTS.Retrospective cohort study in the Surveillance, Epidemiology, and End Results 17 database from 2000-2019 of patients with SC. Patients were classified as MTS or non-MTS cases based on a threshold score of 2 on the Mayo MTS Risk Score.We identified 105 (2.8%) MTS cases and 3677 (97.2%) non-MTS cases. On univariate analysis, MTS patients were younger, had a higher proportion of tumors outside the head/neck, and had fewer high-grade tumors. On Kaplan-Meier analysis, MTS patients trended toward having better SC-specific survival. On multivariate Cox proportional hazards analysis adjusting for other covariates, MTS status was an independent predictor of worse overall survival. However, there was no association between MTS status and SC-specific survival.Given relatively high disease-specific survival in SC, our study may have been underpowered to detect a difference on Kaplan-Meier analysis.Our study suggests SC does not behave more aggressively in patients with MTS.

  View details for DOI 10.1016/j.jaad.2023.03.032

  View details for PubMedID 37003478

• Positive surgical margins in sebaceous carcinoma: risk factors and prognostic impact. Journal of the American Academy of Dermatology Maloney, N. J., Aasi, S. Z., Hirotsu, K. E., Zaba, L. C., Kibbi, N. 2023

  View details for DOI 10.1016/j.jaad.2023.01.049

  View details for PubMedID 36907557

• OBJECTIVE STRUCTURED ASSESSMENT OF TECHNICAL SKILLS IN SCLEROTHERAPY PROCEDURES Dave, L., Nadir, U., Yi, M., Ikmal-Hisham, F., Kang, B. Y., Pearlman, R., Walocko, F., Suozzi, K. C., Kibbi, N., Munavalli, G., Cartee, T. V., Mishra, V., Alam, M. WILEY. 2023: S66-S67

  View details for Web of Science ID 001042980400085

• OBJECTIVE STRUCTURED ASSESSMENT OF TECHNICAL SKILLS IN LASER PROCEDURES: VASCULAR LASER, ABLATIVE LASER, AND NONABLATIVE LASER Dave, L., Yi, M., Nadir, U., Ikmal-Hisham, F., Kang, B. Y., Pearlman, R., Walocko, F., Suozzi, K. C., Kibbi, N., DiGiorgio, C. M., Dover, J. S., Ibrahimi, O. A., Alam, M. WILEY. 2023: S65-S66

  View details for Web of Science ID 001042980400084

• Needs and Gaps in Resident Trainee Education, Clinical Patient Care, and Clinical Research in Cosmetic Dermatology: Position Statement of the Association of Academic Cosmetic Dermatology. Archives of dermatological research Minkis, K., Bolotin, D., Council, M. L., Bar, A., Farah, R. S., Kibbi, N., Miest, R. Y., Orringer, J. S., Ortiz, A., Suozzi, K. C., Vashi, N. A., Yoo, S. S., Albrecht, J., Blalock, T. W., Bruce, A. J., Deng, M., Desai, S., Eshaq, M., Fiessinger, L. A., Ghareeb, E., Greywal, T., Hebert, A. A., Hooper, D., Hordinsky, M., Hu, J. C., Jibbe, A., Joo, J., Kelly, K. M., Kenkare, S., Khetarpal, S., Kole, L. C., Kourosh, A. S., Kuhn, H., Lee, K. C., Lucas, R., Luke, J., Mafee, M., Mayo, T. T., Nawas, Z. Y., Olasz Harken, E. B., Pearlstein, M. V., Petronic-Rosic, V., Robinson, C. A., Rogge, M. N., Saikaly, S. K., Schenck, O. L., Schlick, C. A., Shahabi, L., Shipp, D. M., Shive, M., Silapunt, S., Stratman, E. J., Sulewski, R., Suggs, A. K., Tolaymat, L., Ward, K. H., Weinstein Velez, M., Zeichner, J., Kang, B. Y., Ibrahim, S. A., Christensen, R. E., Anvery, N., Dirr, M. A., Lawrence, N., Alam, M. 2022

  Abstract

  Cosmetic dermatology is a key subspecialty of academic dermatology. As such, academic centers are expected to demonstrate excellence in the teaching of cosmetic dermatology skills to trainees, the clinical delivery of cosmetic dermatology services to patients, and the performance of clinical research that advances knowledge and uncovers new therapies in cosmetic dermatology. The Association of Academic Cosmetic Dermatology (AACD), a newly formed medical professional society, includes as its principal aims the support of all of these areas. AACD is comprised of group of board-certified dermatologists who teach cosmetic and laser dermatology at US dermatology residency programs. An expert panel constituted by the AACD recently convened a workshop to review gaps pertaining to academic cosmetic dermatology. This panel considered needs and potential corrective initiatives in three domains: resident education, patient experience, and clinical research. The work of the panel was used to develop a roadmap, which was adopted by consensus, and which will serve to guide the AACD moving forward.

  View details for DOI 10.1007/s00403-022-02471-8

  View details for PubMedID 36463367

  View details for PubMedCentralID 6233736

• The association of academic cosmetic dermatology: improving cosmetic dermatology education through collaboration, research, and advocacy. Archives of dermatological research Minkis, K., Bolotin, D., Council, M. L., Bar, A., Farah, R. S., Kibbi, N., Miest, R. Y., Orringer, J. S., Ortiz, A., Suozzi, K. C., Vashi, N. A., Yoo, S. S., Albrecht, J., Blalock, T. W., Bruce, A. J., Deng, M., Desai, S., Eshaq, M., Fiessinger, L. A., Ghareeb, E., Greywal, T., Hebert, A. A., Hooper, D., Hordinsky, M., Hu, J. C., Jibbe, A., Joo, J., Kelly, K. M., Kenkare, S., Khetarpal, S., Kole, L. C., Kourosh, A. S., Kuhn, H., Lee, K. C., Lucas, R., Luke, J., Mafee, M., Mayo, T. T., Nawas, Z. Y., Olasz Harken, E. B., Pearlstein, M. V., Petronic-Rosic, V., Robinson, C. A., Rogge, M. N., Sachs, D. L., Saikaly, S. K., Schenck, O. L., Schlick, C. A., Shahabi, L., Shipp, D. M., Shive, M., Silapunt, S., Suggs, A. K., Tolaymat, L., Ward, K. H., Weinstein Velez, M., Zeichner, J., Kang, B. Y., Ibrahim, S. A., Christensen, R. E., Anvery, N., Dirr, M. A., Lawrence, N., Alam, M. 2022

  Abstract

  Cosmetic and laser procedures are increasingly popular among patients and are skills in which dermatologists are regarded as well trained. Most dermatology residents intend to incorporate cosmetic procedures into their practice and prefer to learn such procedures during residency through direct patient care. However, there are notable challenges in optimizing how residents are trained in cosmetic and laser dermatology. To address these barriers and elevate the practice of cosmetic dermatology in academic medicine, the Association of Academic Cosmetic Dermatology (AACD) was founded in 2021 as the lead professional society for dermatologists who direct the education of resident trainees in cosmetic and laser dermatology. The AACD, a group of board-certified dermatologists who teach cosmetic and laser dermatology to residents, aims to improve cosmetic dermatology education through collaboration, research, and advocacy.

  View details for DOI 10.1007/s00403-022-02489-y

  View details for PubMedID 36456760

• Multimedia in the modern journal. The British journal of dermatology Cotter, C., Guckian, J., Kibbi, N. 2022; 187 (5): 627-628

  View details for DOI 10.1111/bjd.21778

  View details for PubMedID 36323633

• Factors affecting outcomes of second intent healing of nasal defects after Mohs micrographic surgery. Archives of dermatological research Kim, D. N., Kibbi, N., Christensen, S. R., Leffell, D. J., Suozzi, K. C. 1800

  Abstract

  Reconstruction of nasal defects secondary to Mohs micrographic surgery (MMS) presents particular challenges related to the complex topography, skin quality, tissue laxity, and functional and aesthetic concerns of the region. Factors affecting outcomes resulting from second intent healing (SIH) on the nose have not been well described. The purpose of the study was to identify factors impacting outcomes of SIH for nasal tumors following MMS. Retrospective analysis was performed of all nasal lesions treated with MMS followed by SIH from a single surgical center over a 1.5-year period. Ninety-six cases were included. Chart review was performed, and data were collected including age, gender, nasal site, tumor type, defect size, depth, and number of MMS stages. Pre- and post-operative follow-up photographs were available for all cases. All five authors evaluated the photographs using the modified Manchester scar scale. Analysis was then conducted to identify features associated with good outcomes. Of the 96 tumors, 39 lesions (40.6%) were located on the nasal tip (including supratip), 32 (33.3%) on the ala/alar groove, 17 (17.7%) on the sidewall, and 8 (8.3%) on the dorsum. The average defect size was 0.83 cm2 (diameter of 1.06cm±0.4). Defect diameter and defect depth were the factors that significantly impacted scar outcome (p<0.001) in multivariate analysis. No significant functional deficits were reported. This retrospective study suggests that nasal defects with area less than 0.83 cm2 (or 1.06cm diameter) and depth of defect not extending beyond the superficial fat healed well by SIH regardless of location on the nose.

  View details for DOI 10.1007/s00403-021-02306-y

  View details for PubMedID 35112163

• Evidence-Based Clinical Practice Guidelines for Extramammary Paget Disease. JAMA oncology Kibbi, N., Owen, J. L., Worley, B., Wang, J. X., Harikumar, V., Downing, M. B., Aasi, S. Z., Aung, P. P., Barker, C. A., Bolotin, D., Bordeaux, J. S., Cartee, T. V., Chandra, S., Cho, N. L., Choi, J. N., Chung, K. Y., Cliby, W. A., Dorigo, O., Eisen, D. B., Fujisawa, Y., Golda, N., Halfdanarson, T. R., Iavazzo, C., Jiang, S. I., Kanitakis, J., Khan, A., Kim, J. Y., Kuzel, T. M., Lawrence, N., Leitao, M. M., MacLean, A. B., Maher, I. A., Mittal, B. B., Nehal, K. S., Ozog, D. M., Pettaway, C. A., Ross, J. S., Rossi, A. M., Servaes, S., Solomon, M. J., Thomas, V. D., Tolia, M., Voelzke, B. B., Waldman, A., Wong, M. K., Zhou, Y., Arai, N., Brackett, A., Ibrahim, S. A., Kang, B. Y., Poon, E., Alam, M. 2022

  Abstract

  Extramammary Paget disease (EMPD) is a frequently recurring malignant neoplasm with metastatic potential that presents in older adults on the genital, perianal, and axillary skin. Extramammary Paget disease can precede or occur along with internal malignant neoplasms.To develop recommendations for the care of adults with EMPD.A systematic review of the literature on EMPD from January 1990 to September 18, 2019, was conducted using MEDLINE, Embase, Web of Science Core Collection, and Cochrane Libraries. Analysis included 483 studies. A multidisciplinary expert panel evaluation of the findings led to the development of clinical care recommendations for EMPD.The key findings were as follows: (1) Multiple skin biopsies, including those of any nodular areas, are critical for diagnosis. (2) Malignant neoplasm screening appropriate for age and anatomical site should be performed at baseline to distinguish between primary and secondary EMPD. (3) Routine use of sentinel lymph node biopsy or lymph node dissection is not recommended. (4) For intraepidermal EMPD, surgical and nonsurgical treatments may be used depending on patient and tumor characteristics, although cure rates may be superior with surgical approaches. For invasive EMPD, surgical resection with curative intent is preferred. (5) Patients with unresectable intraepidermal EMPD or patients who are medically unable to undergo surgery may receive nonsurgical treatments, including radiotherapy, imiquimod, photodynamic therapy, carbon dioxide laser therapy, or other modalities. (6) Distant metastatic disease may be treated with chemotherapy or individualized targeted approaches. (7) Close follow-up to monitor for recurrence is recommended for at least the first 5 years.Clinical practice guidelines for EMPD provide guidance regarding recommended diagnostic approaches, differentiation between invasive and noninvasive disease, and use of surgical vs nonsurgical treatments. Prospective registries may further improve our understanding of the natural history of the disease in primary vs secondary EMPD, clarify features of high-risk tumors, and identify superior management approaches.

  View details for DOI 10.1001/jamaoncol.2021.7148

  View details for PubMedID 35050310

• A novel NFkB1 mutation linking pyoderma gangrenosum and common variable immunodeficiency. JAAD case reports Sun, Q., Gehlhausen, J. R., Freudzon, M., Kibbi, N., Bale, A., Choate, K., Tomayko, M., Odell, I., Ramachandran, S. 2021; 18: 61-63

  View details for DOI 10.1016/j.jdcr.2021.10.015

  View details for PubMedID 34825039

• Verrucous candidiasis of the lip: A harbinger of squamous cell carcinoma. JAAD case reports Wang, J. X., Yu, S. H., Hall, R. R., McNiff, J., Leffell, D. J., Kibbi, N. 2021; 16: 168-170

  View details for DOI 10.1016/j.jdcr.2021.08.015

  View details for PubMedID 34646926

• Development of Objective Structured Assessment of Technical Skills in Facial Cosmetic Procedures: Botulinum Toxin Neuromodulator and Soft Tissue Filler Injection. Journal of the American Academy of Dermatology Suozzi, K. C., Kibbi, N., Lee, K. C., Worley, B., Furlan, K. C., Kang, B. Y., Ibrahim, S. A., Poon, E., Alam, M., Cosmetic Education Work Group. Cosmetic Education Work Group,,, Harikumar, V., Keimig, E. L., Alster, T. S., Bolotin, D., Dover, J. S., Galadari, H., Goodman, G. J., Hexsel, D., Kaminer, M. S., Kim, J. Y., Karen, J., Lask, G., Lewis, A. B., Maher, I. A., Paul, B. C., Negishi, K., Touma, D. J., Waldman, A., Beer, K., Bertucci, V., Burgess, C. M., Casabona, G., De Boulle, K. L., Fitzgerald, R., Green, J. B., Goldman, M. P., Humphrey, S., Ibrahim, S. F., Ibrahimi, O. A., Jagdeo, J., Kim, H. S., Lawrence, N., Marmur, E., Matarasso, S. L., McDonald, M., Obagi, S., Ortiz, A. E., Philipp-Dormston, W. G., Rossi, A. M., Solish, N., Taylor, S. C., Trindade de Almeida, A. R., Weinkle, S. H. 2021

  View details for DOI 10.1016/j.jaad.2021.08.063

  View details for PubMedID 34499988

• Dermatofibrosarcoma protuberans in pregnancy: a case series and review of the literature INTERNATIONAL JOURNAL OF DERMATOLOGY Kibbi, N., Wang, D., Wang, W., Galan, A., Leffell, D. J., Christensen, S. R., Panse, G. 2021

  Abstract

  Dermatofibrosarcoma protuberans (DFSP) is a rare cutaneous sarcoma, which has been reported in pregnancy. This case series reports the clinical and histopathological findings of DFSP in pregnancy.Eighteen cases of DFSP, including six unreported cases and 12 cases from the literature, were identified. Age, anatomic location, tumor size, changes in tumor characteristics during pregnancy, histopathological features, and treatment were recorded. Follow-up data, when available, were noted.The average age of the cohort was 30.6 years (range 19-38). Ten tumors (55.6%) were located on the trunk, four (22.2%) on the head and neck, three (16.7%) on the extremities,and one (5.6%) in the genitalia. Most tumors demonstrated features of conventional DFSP (12/18, 66.7%), while the remaining were identified as DFSP with fibrosarcomatous (FS) change (3/18, 16.7%), atrophic DFSP (2/18, 11.1%), and myxoid DFSP (1/18, 5.6%). Treatment was reported in 17 cases, at least nine of which were treated postpartum. Ten patients were treated with excision, while seven underwent Mohs micrographic surgery. Three patients recurred on follow-up, one with local recurrence and two with distant metastasis.DFSP can undergo enlargement or change in size or color in pregnancy, possibly mediated by hormones. While the majority of cases in this series represented conventional DFSP, unusual clinical and histopathological variants were also present. Treatment in most cases can be safely delayed until after delivery, but recurrent or very large tumors may require treatment prepartum. Close monitoring for recurrence or metastasis is advised.

  View details for DOI 10.1111/ijd.15497

  View details for Web of Science ID 000636725000001

  View details for PubMedID 33818755

• Reflectance Confocal Microscopy as a Promising Adjunctive Tool for Treatment Planning in Extramammary Paget's Disease. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.] Kibbi, N. 2020

  View details for DOI 10.1097/DSS.0000000000002852

  View details for PubMedID 33481445

• Broad versus narrow clinical practice guidelines: avoiding rules for the high risk 1. Archives of dermatological research Harikumar, V., Worley, B., Ibrahim, S. A., Kang, B. Y., Maher, I. A., Cartee, T. V., Sobanko, J. F., Kibbi, N., Owen, J. L., Reynolds, K. A., Bolotin, D., Waldman, A. H., Minkis, K., Petersen, B., Council, M. L., Nehal, K. S., Xu, Y. G., Jiang, S. B., Somani, A., Huang, C. C., Eisen, D. B., Ozog, D. M., Lee, E. H., Samie, F. H., Neuhaus, I. M., Leitenberger, J. J., Mann, M. W., Lawrence, N., Zeitouni, N. C., Golda, N., Behshad, R., Ibrahim, S. F., Yu, S. S., Shin, T. M., Stebbins, W. G., Alam, M. 2020

  View details for DOI 10.1007/s00403-020-02160-4

  View details for PubMedID 33175206

• Comparative utility of appropriate use criteria versus clinical practice guidelines. Archives of dermatological research Worley, B., Kyllo, R., Harikumar, V., Kang, B. Y., Ibrahim, S. A., Maher, I. A., Sobanko, J. F., Cartee, T. V., Kibbi, N., Owen, J. L., Reynolds, K. A., Bolotin, D., Waldman, A. H., Minkis, K., Petersen, B., Council, M. L., Nehal, K. S., Xu, Y. G., Jiang, S. B., Alam, M. 2020

  View details for DOI 10.1007/s00403-020-02161-3

  View details for PubMedID 33155073

• Multisociety and multispecialty clinical practice guidelines. Archives of dermatological research Sobanko, J. F., Harikumar, V., Kang, B. Y., Ibrahim, S. A., Worley, B., Cook, J. L., Kantor, J., Lawrence, N., Miller, A., Albertini, J. G., Van Beek, M., Lober, C. W., Bordeaux, J. S., Maher, I. A., Cartee, T. V., Kibbi, N., Owen, J. L., Reynolds, K. A., Bolotin, D., Waldman, A. H., Minkis, K., Petersen, B., Council, M. L., Nehal, K. S., Xu, Y. G., Jiang, S. B., Alam, M. 2020

  View details for DOI 10.1007/s00403-020-02162-2

  View details for PubMedID 33150544

• Development of international clinical practice guidelines: benefits, limitations, and alternative forms of international collaboration. Archives of dermatological research Alam, M. n., Harikumar, V. n., Kang, B. Y., Ibrahim, S. A., Kibbi, N. n., Owen, J. L., Maher, I. A., Cartee, T. V., Sobanko, J. F., Reynolds, K. A., Bolotin, D. n., Waldman, A. H., Minkis, K. n., Petersen, B. n., Council, M. L., Nehal, K. S., Xu, Y. G., Jiang, S. B., Somani, A. K., Bichakjian, C. K., Huang, C. C., Eisen, D. B., Ozog, D. M., Lee, E. H., Samie, F. H., Neuhaus, I. M., Bordeaux, J. S., Wang, J. V., Leitenberger, J. J., Mann, M. W., Lawrence, N. n., Zeitouni, N. C., Golda, N. n., Behshad, R. n., Ibrahim, S. F., Yu, S. S., Shin, T. M., Stebbins, W. G., Worley, B. n. 2020

  View details for DOI 10.1007/s00403-020-02166-y

  View details for PubMedID 33216212

• Principles for developing and adapting clinical practice guidelines and guidance for pandemics, wars, shortages, and other crises and emergencies: the PAGE criteria. Archives of dermatological research Alam, M. n., Harikumar, V. n., Ibrahim, S. A., Kang, B. Y., Maher, I. A., Cartee, T. V., Sobanko, J. F., Kibbi, N. n., Owen, J. L., Reynolds, K. A., Bolotin, D. n., Waldman, A. H., Minkis, K. n., Petersen, B. n., Council, M. L., Nehal, K. S., Xu, Y. G., Jiang, S. B., Somani, A. K., Bichakjian, C. K., Huang, C. C., Eisen, D. B., Ozog, D. M., Lee, E. H., Samie, F. H., Neuhaus, I. M., Bordeaux, J. S., Wang, J. V., Leitenberger, J. J., Mann, M. W., Lawrence, N. n., Zeitouni, N. C., Golda, N. n., Behshad, R. n., Ibrahim, S. F., Yu, S. S., Shin, T. M., Stebbins, W. G., Worley, B. n. 2020

  View details for DOI 10.1007/s00403-020-02167-x

  View details for PubMedID 33206210

• Predicting outcomes following second intent healing of periocular surgical defects. Archives of dermatological research Kibbi, N. n., Khan, Y. n., Leffell, D. J., Christensen, S. R., Suozzi, K. C. 2020

  Abstract

  Traditionally, second intent healing (SIH) in the periocular region is reserved for small and/or concave defects, particularly those located on the medial canthus.The purpose of this study was to identify factors impacting outcomes of SIH for periocular tumors following Mohs micrographic surgery (MMS).Retrospective analysis was performed of all periocular lesions treated with MMS followed by SIH from a single academic surgical center over a 5-year period. Data regarding tumor characteristics and follow-up was recorded. The modified Manchester scale was utilized to evaluate scar outcomes.Of the 39 tumors included, 14 (35.9%) were located on the lower eyelid, 12 (30.8%) on the upper eyelid, 6 (15.4%) on the lateral canthus, and 7 (17.9%) on the medial canthus. Involvement of the eyelid margin was seen in 11 (28.2%) of cases. The average defect diameter and area were 1.3 cm and 1.04 cm-squared. Twenty-three cases (59.0%) healed with optimal results. Larger defects were significantly associated with poorer outcomes of SIH (odds ratio 0.205, p = 0.017 by multivariate analysis). Anatomic location, involvement of the lid margin, age, and follow-up interval were not significant factors; however, medial canthus defects were least likely to heal with optimal results. On average, medial canthal lesions were larger in size (mean diameter 1.76 cm, mean area 1.97 cm-squared).This retrospective study suggests that periorbital defects in all locations with area less than 1.04 cm2 heal well by SIH. In this cohort, larger lesions on the medial canthus healed with worse outcomes.

  View details for DOI 10.1007/s00403-020-02122-w

  View details for PubMedID 32833078