Core Crusher 2022

Join the George Washington University School of Medicine & Health Sciences
and Derm In-Review for the fourth annual Core Crusher!

Directed by Adam Friedman, MD, FAAD
Hosted by The George Washington University School of Medicine & Health Sciences
In Partnership with Derm In-Review
Supported by Regeneron & Sanofi Genzyme

Dr. Kaiane Habeshian – Pediatric Dermatology
Dr. Vishal Patel – Surgical Dermatology
Dr. Michael Cardis – Dermatopathology
Dr. Pooja Sodha – Cosmetic Dermatology
Dr. Adam Friedman – Medical Dermatology
Dr. Karl Saardi – Medical Dermatology


*Some slide handouts have been modified to protect patient privacy and copyright. 

Questions & Answers

Read the answers to all of your questions we didn’t have time to answer during the live event! 


Pediatric Dermatology – Dr. Kaiane Habeshian

Is cancer or intussusception the most common complication of Peutz Jegher if asked multiple choice? Or would that not be asked?
Great question! That would be the most common complication of the polyp itself (in addition to the risk of transforming to CA).

What tips do you have to distinguish angiofibromas from trichoepitheliomas on kodas?
Tricoephitheliomas are more skin colored and located on the nose/peri-nasal region vs. angofibromas are red to brown and photodistributed involving the cheeks and sparing the nasolabial folds. Both can become larger and more extensive over time.


Surgical Dermatology – Dr. Vishal Patel

Bolognia says that mutation most common in CSD skin is KIT, not BRAF. Do you have a paper or good reference to read about the genetics of melanoma with this updated info?
Shain, A., Bastian, B. From melanocytes to melanomas. Nat Rev Cancer 16, 345–358 (2016).

I thought cardiac transplant was the historic answer for highest risk of SCC….is lung now the correct answer? Do you think lung is “too new” to be the boards answer?
Yes, lung is the highest risk OTR for CSCC. This is well accepted now.

Uptodate recommends hepatitis B and pregnancy tests as part of pre tx workup for smoothened inhibitors too.
Yes, pregnancy testing is recommended for relevant populations given the embryo-fetal toxicity, but I am not aware of hepatitis screening for either drug.

So is there increased risk of SCC in lung transplant compared to heart transplant?
Yes, lung is the highest risk OTR for CSCC. This is well accepted now.


Cosmetic Dermatology – Dr. Pooja Sodha

Can you explain frequency doubling?
The phenomenon that an input wave in a nonlinear material can generate a wave with twice the optical frequency.

I believe diode lasers can be used safely up to fitz 4 for hair removal. In a fitz 4 pt, would you use diode or ND YAG for hair removal?
Yes, you are correct. Hopefully they would not put both options for FST 4. But even if both options are presented, the focus should be on safe and effective treatment. Even at 800-810 nm the absorption for melanin is quite high, and I do worry about epidermal photothermolysis. I would prefer 1064 nm for FST 4. Certainly for V and VI, make sure to select 1064nm.

Why is a QS/picosecond double frequency 1064 laser for red pigment tattoos considered a 1064nm laser when it has a 532nm wavelength? Why can’t you use a double frequency KTP laser to target red pigment in tattoos?
They are different. Frequency doubling with a KTP crystal halves the wavelength (doubling the frequency) to produce 532nm laser. I just wanted to bring to your attention that Qs/Ps 532 nm can also be written as frequency doubled Qs/Ps 1064. Frequency doubling 532nm would halve the wavelength to 266nm which would not target red pigment for two reasons – (1) not enough depth penetration at 266 nm and (2) chromophore is not red pigment at this wavelength.


Medical Dermatology – Dr. Adam Friedman

Can you review when to screen for familial melanoma syndrome?
If I am interpreting correctly,  current screening for melanoma recommendations  in FAMMM should begin at age 10 with a baseline total body skin examination.

How can you distinguish ecthyma gangrenosum from n. meningitidis clinically?
Meningococcemia is typically seen in kids and complement deficient individuals (normally infection is asx), starts as petechiae and evolves into broad echymotic and necrotic plaques. Patient is usually very sick, potentially DIC  Ecythema gangrenosum does not begin as petechiae, rather more typically dusky somewhat defined papule or plaque, that evolves into an ulcer with a central gray/black eschar. Most common location is anogenital. Patients are also sick as this is cutaneous spread from pseudomonal septicemia in immunocompromised individuals.