In the 38 years he has mentored residents, lectured on dermatology, and run a clinical practice, Dr. Goldfarb has advocated the value of human connection with patients and residents. He believes it inspires trust, enables learning, creates a reciprocal environment of care, and is the central element to bring to a lecture hall, a clinical research unit, or a patient clinic.
CAR T cell therapy is a personalized immunotherapy technology. A patient’s T cells are collected, genetically altered to express chimeric antigen receptors, and reinfused. CAR T cells seek out and kill target cells that express the specified antigen, such as CD19 or B cell maturation antigen (BCMA). Additionally, CAR T cells are programmed to proliferate and produce memory CAR T cells in the presence of target cells. Ongoing research into chimeric antigen receptor (CAR) T cell therapy and chimeric autoantibody receptor (CAAR) T cell therapy for cancers and autoimmune diseases, including pemphigus vulgaris (PV) may lead to clinical trials.
There are rare but important causes of neonatal blistering, diaper rash, and solitary skin nodules. Incontinentia pigmenti (IP), for example, is an X-linked dominant disorder affecting the skin, eyes, and central nervous system. IP is suspected when blisters occur in a blaschkoid distribution. Because IP is lethal in males, presentation of a female patient whose mother has a history of miscarriages can indicate this disease. IP can be diagnosed based solely on rash and skin biopsy results, without genetic testing. Early diagnosis and treatment can significantly reduce morbidity and mortality by preventing seizures and promoting development.
Children with melanoma may present with different clinical characteristics than adults. They are more likely to present as amelanotic, rapidly growing nodules. Incorporate modified diagnostic criteria for pediatric melanoma and consider the evolution of a lesion. Pediatric melanoma is rare but often diagnosed too late.
Pustular psoriasis is a group of inflammatory skin diseases characterized by visible, sterile pustules on inflamed skin. It appears in generalized and localized forms and can occur in patients with or without a history of psoriasis. Pustular psoriasis has distinct genetic risk factors, inflammatory profile, and response to treatment compared to psoriasis. Thus, it may be its own unique disease. PPP is characterized by sterile pustules on the palms and soles. There is no consensus on optimal treatment , although acitretin, methotrexate, and phototherapy are among the more common treatments.
Although vaccines are typically discussed in primary care settings, dermatologists have an important role in vaccine education, especially when prescribing immunosuppressive medications that can increase risk of infections. Infections are more common in patients with chronic skin diseases due to disruption of the protective skin barrier, immune dysregulation associated with disease, and immunosuppressive treatments.
In 2023, the United States Preventive Services Task Force determined there was insufficient evidence to assess the balance of benefits and harms of screening for melanoma using a whole-body skin examination in the primary care setting in part due to the lack of randomized controlled studies. Such studies addressing the mortality benefit of screening for skin cancer would be a massive undertaking. On a practical level, there are not enough dermatologists in the country to screen all American adults for skin cancer.
The incidence of basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma is significantly lower in darker skin types. In Black people, BCC is 2000-fold less common, and SCC is 500–1000-fold less common compared to non-Hispanic white people. Melanoma-related mortality rates in the US-based Black population has been declining during the past 20 years. Non-white race is associated with later melanoma detection and lower survival rates. Multiple risk factors have been proposed for skin cancers in skin of color including immunosuppression and previous scaring. More research is needed to understand the primary drivers of skin cancer in skin of color.
In March 2022, Dr. Callender received the Dermatology Foundation’s Clark W. Finnerud Award presented to an individual who “most skillfully blends clinical practice with writing and teaching dermatology, thereby serving as a mentor and role model.”
The Distinguished Service Medallion is the highest honor the Foundation confers on a colleague in recognition of exemplary leadership and service to the specialty of dermatology.