Ajay Nair Sharma

This Perspectives on the Science article summarizes a multidisciplinary Society of Cutaneous Oncology Journal Club discussion of Kavanagh et al., Local Recurrence Following Complete Surgical Excision of Primary Merkel Cell Carcinoma. The discussion examines uncertainty in local recurrence risk after margin-negative excision, variation in postoperative radiation therapy practice, and future evidence-generation approaches that integrate curated multi-institutional data, causal inference, and probabilistic modeling to support decision-making under uncertainty.

Hypertrophic scars and keloids represent abnormal wound healing, manifesting as raised scars confined to or extending beyond the wound margin, respectively. Understanding the risk factors associated with these scarring types is crucial for prevention and management. Utilizing the TriNetX global health research network database, we analyzed the data of 6,249 patients with hypertrophic scars or keloids. We employed the ICD-10 code L91.0 for identification, generating a control cohort matched by age, sex, and race. Associations between scarring and race, ethnicity, and various comorbidities were quantified. The analysis revealed that hypertrophic scars and keloids were more commonly associated with Black/African American individuals (OR=1.74, P<0.01) and less so with White races and Hispanic ethnicity. Significant comorbidities associated with increased risk included scarring alopecia, rosacea, atopic dermatitis, and acne. Inadequate sample size limited analysis for conditions like vitiligo. The findings suggest a higher prevalence of these scars in Black/African American races, potentially linked to melanocyte-mediated fibroblast and extracellular matrix activities. A notable correlation with inflammatory conditions suggests shared cytokine pathways, highlighting IL-4 and IL-13 as therapeutic targets. The strong association between scarring alopecia and skin cancers may implicate chronic inflammation and treatment-related scarring. Limitations of the study include its retrospective design, possible misdiagnosis, and small sample sizes for certain comorbidities. J Drugs Dermatol. 2025;24(2):212-215. doi:10.36849/JDD.8401R1keloids, race, ethnicity, scar, comorbidities, skin of color, disparities, health equity

Objectives: Iatrogenic cutaneous siderosis is a well‐recognized dermatologic complication after parenteral iron infusion. The condition manifests as discrete, hyperpigmented patches near the site of injection. Most cases do not resolve spontaneously, leading to significant aesthetic and psychological distress to patients. A recent case of iatrogenic cutaneous siderosis at our institution prompted a systematic review of the efficacy of energy‐based devices previously reported in the treatment of this condition.Methods: PubMed and Cochrane databases were searched for all peer‐reviewed articles published using the following search terms: “iron OR heme OR hemosiderosis OR siderosis” and “hyperpigmentation OR staining OR tattoo.” Articles reporting on energy‐based devices in the treatment of iron‐induced hyperpigmentation were included.Results: A total of seven articles and 54 total patients were included in this review. All patients, including the patient treated at our institution, were female, with an average age of 44 years. Hyperpigmentation was most commonly associated with intravenous iron infusion (48/54, 89%), on the arm or forearm (44/54, 81%), and used for the treatment of underlying iron deficiency anemia (54/54, 100%). The application of six different nanosecond or picosecond quality‐switched laser systems was reported in the treatment of cutaneous siderosis, with wavelengths ranging from 532 to 1064 nm. Spot sizes varied between 2 and 7 mm, with energy fluences spanning 0.5–40 J/cm² depending on both the device and spot size. Outcomes were measured after an average of 5.4 laser treatments and 10.4 months, with over half of all reported patients experiencing complete clearance (27/50, 54%). Our patient received treatment in three test areas with picosecond alexandrite 785 nm, nanosecond Nd:YAG 532 nm, and picosecond Nd:YAG 532 nm devices. The nanosecond Nd:YAG 532 nm treated area demonstrated the greatest improvement, and the entire arm was subsequently treated with this device.Conclusions: Despite the often intractable nature of iatrogenic cutaneous siderosis, laser surgery is a reasonable and safe treatment modality for patients seeking cosmetic improvement of this dyschromia. Dermatologists should be aware of this entity and the efficacy of the energy‐based devices currently in our armamentarium. A combination approach may need to be utilized with different wavelengths and pulsed widths to target iron pigment in both dermal and subcutaneous layers.