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A 31-year-old white woman presents with an erythematous skin eruption of 2 weeks' duration that consists of papules on the cheeks and several disk-shaped papules and plaques on the back, posterior neck, and right upper anterior chest.

Two Cases of Episodic, Asymptomatic, Erythematous Eruptions

A 76-year-old woman seeks your attention for an asymptomatic “red spot” on her neck. She has a history of multiple non-melanoma skin cancers.

Squamous cell carcinoma in situ (Bowen  disease)

Lichenoid keratosis (an inflammatory variant of seborrheic keratosis)

A 76-year-old woman seeks your attention for an asymptomatic “red spot” on her neck. What does this look like to you?

Clinical Topics

What's This "Red Spot"?

A 67-year-old woman noted the appearance of several non-tender, rock-hard, purple-colored nodules on her legs. Her medical history was significant for distant non-Hodgkin lymphoma.

A 67-year-old woman noted the appearance of several non-tender, rock-hard, purple-colored nodules on her legs. Her medical history was significant for distant non-Hodgkin lymphoma. The violaceous color and configuration of the skin lesions suggests which of the following? 

Hard Purple Nodules: Your Dx?

An “alarming” rise in mortality from 

 (EO-CRC) over the past 20 years has been most pronounced in young adults, aged 20 to 44 years, according to research presented at the 2024 annual scientific meeting of the American College of Gastroenterology, held October 25-30, in Philadelphia, PA. 

The increased incidence of CRC among young adults prompted US professional organizations, including the

, to lower the recommended age from 50 to 

, investigators from Rutgers New Jersey Medical School in Newark, NJ, observed. Their study was designed to better understand the age at which deaths are occurring and at what stage of CRC disease. 

Led by Yazan Abboud, MD, from the department of internal medicine, the researchers compared EO-CRC mortality between young (age 20 to 44 years) and younger-age (45 to 54 years) cohorts across different stages of clinical diagnosis. Abboud and colleagues collected data on EO-CRC age-adjusted mortality rates between 2000 and 2020 from the database of the National Center of Health Statistics of the CDC. For stage-specific incidence-based mortality rates, the team collected data from the Surveillance, Epidemiology, and End Results 22 (SEER 22) database from 2004 to 2020. Stage at diagnosis was divided between early (in situ, localized) and late (regional, distant).

The researchers found overall that a decrease in EO-CRC mortality between 2000 and 2005 was followed by an increase between 2005 and 2022 (annual percentage change [APC], 0.87). Trends were similar to those overall in the cohort aged 45 to 54 years (107,280 deaths), with a decrease in mortality seen between 2000 and 2005 followed by an increase between 2005 and 2022 (APC, 0.87). For the youngest participants, aged 20 to 44 years (39,746 deaths) a steady increase in EO-CRC was seen across the study period, between 2000 and 2022 (APC, 0.93).

When Abboud and colleagues compared the increase in mortality between the age cohorts, the increase was greater among the 20- to 44-years-old vs the 45- to 54-year-olds, with nonidentical, nonparallel data and an average APC (AAPC)-difference of 0.85 (P <.01).

Deaths attributed to EO-CRC in the SEER 22 database numbered 147 026, according to the study abstract. Mortality for early-stage disease (4,026 deaths) increased (AAPC, 12.37) in the age 45 to 54 years cohort. Researchers said that the sample size was insufficient for analysis among those aged 20 to 44 years. For late-stage tumors (37 875 deaths) mortality increased (AAPC, 10.56) across the 2 cohorts: 45 to 54 years (AAPC, 11.17) and 20 to 44 years (AAPC, 13.87).

The concerning rise in EO-CRC mortality over the 2-decade study period was seen for both early- and late-stage tumors, the authors concluded. "These findings reinforce the need for increased advocacy for CRC screening in younger patients aiming to improve outcomes," they wrote.

 Abboud Y, Shah A, Hajifathalian K, Gaglio P, Al-Khazraji A. Rising mortality of early-onset colorectal cancer particularly in patients younger than 45 years: insights from the largest mortality databases in the US over two decades. Abstract presented at: American College of Gastroenterology 2024 Scientific Meeting; October 25-30, 2024; Philadelphia, PA. 

https://acgposters2024.eventscribe.net/fsPopup.asp?PosterID=683312&mode=posterInfo

ACG: Mortality associated with both early- and  late-stage EO-CRC rose most significantly among young adults aged 20 to 44 years between 2000 and 2022, new research reveals. 

Greatest Increase in Mortality from Early-Onset Colorectal Cancer Seen Among Youngest US Adults 

Vaccine hesitancy spread significantly in the wake of the 

, seeking out reliable sources of health information will help individuals make the best decisions to protect themselves.

In 2019, the World Health Organization (WHO) described vaccine hesitancy—the outright refusal or reluctance to get vaccinated regardless of the availability of vaccines—as a top-10 threat to global health.

At the time, WHO estimated that vaccinations prevented up to 3 million deaths each year; furthermore, an additional 1.5 million deaths could be prevented if global vaccine awareness, coverage, and efforts were enhanced. Vaccine hesitancy has been studied since the 1960s. In the wake of COVID-19 vaccination campaigns and residual anxiety, however, these research endeavors have more than tripled. A systematic literature review published in 

 found that there were 1160 scientific publications concerned with the subject in the pre–COVID-19 era (1968-2021), and this number jumped to a striking 4563 publications post COVID-19 (2021 onwards).

While vaccine hesitancy is fueled by a variety of factors that feed into vaccine hesitancy, the fact of the matter is that uncertainties about vaccinations—their safety, efficacy, etc—remain a major public health concern that has affected immunization rates ranging from polio and Ebola to COVID-19 and the flu. As flu season sits right around the corner, post–COVID-19 vaccine hesitancy remains a pertinent issue and a challenge worth exploring to ensure patients remain informed and able to protect their health to the best of their ability.

 evaluated the perspectives of self-described vaccine-hesitant adults from Black and Latinx communities and found that these groups shared similar anxieties about receiving their COVID-19 vaccination.3 Participants were not outright opposed to the vaccine but were undecided due to safety concerns. The authors focused on these communities due to data indicating that COVID-19 vaccination rates were lower in Black and Latinx vs White communities. While this gap has been shrinking, they added that Black and Latinx patients also endure worse clinical outcomes when diagnosed with COVID-19. This reality brought into question the role of social determinants of health and structural racism; however, these issues were not cited as reasons that put them more at risk for infection or to forego their vaccination.

Two online forums were conducted, 1 for each group, featuring 30 participants in each. Responses highlighted 5 major factors that contribute to individuals’ reluctance to get the COVID-19 vaccine:

: participants believed there are a lot of unknowns about the vaccine, undisclosed ingredients, lacking information about the short- or long-term effects, and the belief that it can be directly responsible for one’s death.

: reports on surges in cases and new variants led respondents to question how well the vaccine works to prevent infection or transmission, or if vaccination is truly enough to protect public health.

Vaccine hesitancy became a public health threat during the COVID-19 pandemic that lingers now and has affected uptake of other essential immunizations. 

The Legacy of Vaccine Hesitancy: From COVID-19 to Flu

Hassan M. Ismail, MD

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