Editorial Jane Lochrie, MD

Editorial

Jane Lochrie, MD

With patients dying without their loved ones by their side and our health care workers putting their lives on the line, it seems almost inappropriate to publish a “typical” issue of Worcester Medicine. As you probably know, our topics are selected four months before our publication date and our authors have put a lot of effort into their articles. Hence, we decided to publish this issue as scheduled. We plan to cover COVID-19: Lessons Learned in the near future.

In the first article, Dr. John Person gives a very personal history of dermatology in Worcester since the 1970s, when he started his practice in Worcester. He depicts the changes in the treatment of dermatological diseases, from having therapeutic x-ray machines in the office to today’s biologics.

Dr. Mary Maloney describes Mohs surgery and how it has changed over the years. This surgery excises a margin of tissue around a tumor and then the margin is examined to evaluate 100% of the margin, rather than samples of the margin. With this technique, the cure rate has increased to 99.9% for primary tumors and 95% for recurrent tumors. Less pain, high cure rates and tissue preservation are all benefits of Mohs surgery.

We are reminded of the importance of sunscreen by Dr. Riley McLean-Mandell. She reports that 19%-44% of patients with one skin cancer will go on to develop additional primary skin cancers. Her goal is to encourage everyone to use sunscreen and put herself out of a job.

Drs. Donece Hill, Paula Evans and Collen Massey describe the role of biologics in severe psoriasis. These drugs alter the immune system to prevent interactions with inflammatory cell pathways. Many of these drugs are marketed directly to the consumer, who doesn’t necessarily understand the side effects or the fact that many are not covered by insurance. There are options to help provide assistance, including patient assistance programs, copayment cards and free trial cards, sponsored by drug manufactures. The difficulty of Mohs surgery from the patient perspective is provided by Dr. Brianne Morin, who underwent surgery for basal cell cancer. She describes this as “the hardest and darkest time of her life” and feeling like a “monster.” She had seven surgeries after the initial Mohs surgery, and 18 months later, it is still very painful to write about it.

Stefanie Goodrich, PA-C, describes the pathogenesis, co-morbid conditions and old and new treatment options for psoriasis. She explains the new biologics and the areas that these medications target in the immune pathway.

The student perspective is a different this time. Instead of focusing on dermatology, Mina Botros, a first-year medical student and co-president of the Worcester Free Clinic Coalition, describes the students’ efforts to continue to care for the patients while the free medical programs are closed due to COVID-19. Under the supervision of faculty, they have set up a telehealth model to virtually meet with patients via Zoom.

In closing, I would encourage everyone to read our new President’s Message, two very important As I See It articles, Legal Consult, News from the Archives and Society Snippets.