PeDRA

Pediatric Dermatology Research Alliance

Skin Tumors and Reactions to Cancer Therapies

Keratinocyte Carcinoma in Pediatric Solid Organ Transplant Patients

By

Fellow

Muskaan Sachdeva, BHSc
University of Toronto

Mentor

Cathryn Sibbald, MScPhm, MD, FRCPC, MSc
University of Toronto
The Hospital for Sick Children

Overview

Keratinocyte carcinomas (KC), which include basal cell and squamous cell carcinomas, are the most common malignancy in organ transplant recipients. Specifically, the incidence of basal cell carcinoma is 10 times higher, and squamous cell carcinoma is 100 times more frequent in adult transplant recipients than the general population. Although the success of transplants has vastly improved for children, limited research exists on the risk of post-transplant KC in pediatric populations, with a recent study excluding these cancers. Pediatric transplant patients are immunocompromised for longer durations than patients transplanted in adulthood, and therefore the onset of KC in pediatric transplant recipients may occur at an earlier age. Analysis of specific pediatric data is important to fully quantify and understand the risk of KC in this population.

Status

This project was funded through a 2020 PeDRA Research Fellowship Grant.

The impact of dilute bleach compresses on the incidence and severity of radiation dermatitis

By

Fellow

Danny Linggonegoro
Harvard Medical School

Mentor

Jennifer Huang, MD
Harvard Medical School

Overview

Acute radiation skin toxicity is one of the most common side effects encountered in those undergoing radiation therapy, affecting nearly all patients; however, no standard criterion currently exists for the prevention of acute radiation induced skin toxicity.
This study aims to:
1. Determine if dilute bleach compresses can attenuate the incidence and severity of radiation dermatitis.
2. Evaluate and describe patient-reported outcomes.

Status

This project was funded through a 2020 PeDRA Research Fellowship Grant.

Preventative Skin Care for Children Undergoing Targeted CNS Tumor Therapy

By

Principal Investigator:

Jennifer Huang, MD
Boston Children’s Hospital

Overview:

Cancer treatments targeting MEK and BRAF proteins are used to treat childhood brain tumors. Treatments can often cause cutaneous problems, sometimes leading to discontinuation of life-saving treatments. Our study aims to develop an effective skin care routine to decrease incidence and severity of these reactions. In this prospective single-arm trial, all participants will receive a preventative skin care regimen (sun protection, dry skin care) as well as every-other-day dilute bleach baths for twelve weeks. We will examine both groups at baseline, 6 weeks, and 12 weeks. We will compare this cohort to a historical cohort that did not receive any preventative skin care regimen or dilute bleach baths. We predict that preventative skin care and dilute bleach baths will be more effective than no preventative skin care regimen or dilute bleach baths in decreasing the incidence and severity of these cutaneous reactions.

Status:

This project was funded by a 2019 PeDRA Research Grant.

What does a pediatric BAP1 inactivated melanocytic tumor (BIMT) look like?

By

Principal Investigator:

Elena Hawryluk, MD, PhD
Massachusetts General Hospital

Overview:

Spitz nevi are a type of skin growth that occur most commonly in children. This study seeks to better understand Spitz nevi in children by determining possible overlap with a different entity known as BAP1 inactivated melanocytic tumors (BIMTs). BIMTs have many microscopic features that overlap with Spitz nevi, but are not well studied in children. Providers encountering BIMTs in children are not in agreement for the most appropriate management for these patients given the lack of data on these tumors.
We propose to study these tumors by performing special stains (BAP1, BRAF) on previously collected tissue for 30 identified cases of combined Spitz and dermal nevi. By better understanding these skin growths, we will be able to better assess if this subset of Spitz nevi should be re-characterized as BIMTs, and help shed light on the understanding and management of these poorlycharacterized skin growths in the pediatric population.

Status:

This project was funded by a 2019 PeDRA Research Grant.

Consensus-based recommendations for management of pediatric Mycosis Fungoides: the ARMFUL (AppRoach Mycosis FUngoides in chiLdren) study

By

Co-Principal Investigators:

Alex Zvulunov, MD, MHA
Ben-Gurion University


Elena Pope, MD, MsC
University of Toronto

Overview:

Mycosis fungoides is a rare type of skin cancer, increasingly diagnosed in pediatric populations. To date there is little knowledge on how to manage this condition in children, most guidance comes from adult data. We propose to form an international research group, ARMFUL (AppRoach Mycosis FUngoides in chiLdren) and come up with guidelines of care using a consensus approach. We believe that by including a large representation from all key specialists involved in the care of these patients as well as patients and their families, we would be able to have these guidelines widely adopted.

Status:

This was funded through a 2019 PeDRA Consensus Guidelines Grant.

Dilute bleach compresses to reduce the severity of radiation dermatitis in children with cancer

By

Principal Investigator

Amy Paller, MD
Northwestern University

Overview

Many years ago, we were able to show that dilute bleach baths reduce the severity of pediatric atopic dermatitis. This simple and inexpensive technique is now standard-of-care and has benefitted children worldwide. T. Leung showed that this same concentration of bleach has a direct anti-inflammatory effect on keratinocytes and reduces radiation dermatitis severity in a mouse model. Radiation dermatitis remains an issue for children (and adults) treated with irradiation for cancer. We propose a double-blind study of bleach compresses vs. water to reduce the severity in cancer patients. This study will be a two-site study at Northwestern/Lurie Children’s (Paller, Vivar, Yun, etc) and Harvard/Boston’s Children’s (Huang). We envision starting the compressing 1-week before and continuing daily during the danger period (several weeks). We have joined forces with radiation oncologists at both sites already and hope to recruit approximately equal numbers of patients at both sites. Parallel studies in children and adults will be performed.

Status

Protocol development is underway.

This project received a 2019 PeDRA Study Support Grant to develop a power analysis and the statistical plan for analysis at the end of the study utilizing an in-house statistician at Northwestern University.

Patient education for children at risk for skin cancer

By

Principal Investigator:

Carrie Coughlin, MD
Washington University School of Medicine

Overview:

Though children are at risk for skin cancer and cutaneous complications of immunosuppressive therapy, there is a paucity of pediatric-specific educational materials.  Moreover, there are no materials produced by dermatologists and vetted by clinicians from multiple institutions to educate pediatric patients and their parents. 

In collaboration with the Society for Pediatric Dermatology and American Academy of Pediatrics, this project produced a general information sheet applicable to immunosuppressed/at risk children.  Additional educational materials for at-risk subgroups will be created in future, with the goal of partnering with research and clinical groups who are involved with these populations.  Over time, we aim to become the primary source for information about skin complications/care/screening.

Status:

An educational handout was published in Pediatric Dermatology in 2017. Work continues on additional educational materials

Melanoma and nonmelanoma skin cancer in children and young adults

By

Co-Principal Investigators:

Jen Huang, MD
Harvard Medical School

Larry Eichenfield, MD
UCSD

Overview:

This study is a collaboration of 10 major hospitals across the country with the unified goal of improving our understanding of skin cancer in children.  It is a multi-center retrospective case controlled study of all children < 20 years of age with the diagnosis of melanoma or nonmelanoma skin cancer (NMSC) over a 20 year period from 1995 to 2015.  We aimed to characterize the clinical and histopathologic features of melanoma and NMSC in children and to identify risk factors associated with development of these skin cancers, including exposure to chemotherapeutic agents, radiation therapy, immunosuppressive medications, and photosensitizing agents. 

The major goal of the study is to understand what risk factors are associated with development of melanoma and NMSC in children and young adults.  There have been no prior studies addressing this question.  By achieving our study goal, we hope to improve guidelines for skin cancer screening for children.

Status:

One publication in print – Huang, et al., 2019; (see publications page). Analysis is underway for additional publications.

This project received a 2019 PeDRA Study Support Grant to fund a biostatistician at Boston Children’s Hospital to assist in the final stages of data analysis and provide support as abstracts and manuscripts are prepared.