Nour Kibbi, MD, FAAD

All Publications

• 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

• 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