Philip R. Cohen^1,2, Jin Ye Yeo³

¹Dermatology Department, University of California, Davis Medical Center, Sacramento, California, USA; ²Dermatology Department, Touro University California College of Osteopathic Medicine, Vallejo, California, USA; ³ATM Editorial Office, AME Publishing Company

Correspondence to: Jin Ye Yeo. ATM Editorial Office, AME Publishing Company. Email: editor@atmjournal.org

This interview can be cited as: Cohen PR, Yeo JY. Meeting the Editorial Board Member of ATM: Dr. Philip R. Cohen. Ann Transl Med. 2024. Available from: https://atm.amegroups.org/post/view/meeting-the-editorial-board-member-of-atm-dr-philip-r-cohen.

Expert introduction

Dr. Philip R. Cohen (Figure 1) is an Adjunct Professor in the Department of Dermatology at the University of California, Davis Medical Center, Sacramento, California, USA and an Adjunct Professor of Dermatology at the Touro University California College of Osteopathic Medicine, Vallejo, California, USA. He has many areas of interest in dermatology including not only forensic dermatology, but also the cutaneous manifestations of cancer and its treatment in oncology patients. Dr. Cohen is also passionate about mentoring students in writing medical literature. He has authored or co-authored more than 1050 publications.

Dr. Cohen received his medical degree from New York Medical College, Valhalla, New York, USA. At the University of Texas-Houston Medical School in Houston, Texas, USA, he completed a medical internship, a year of medical residency, and a dermatology research fellowship. He then completed his residency in dermatology at The College of Physicians & Surgeons of Columbia University in New York, New York, USA. Subsequently, he completed fellowships in dermatopathology at The University of Texas-Houston Medical School, Houston, Texas, USA and Mohs micrographic surgery at the Dermatologic Surgery Center of Houston, in Houston, Texas, USA.

Figure 1 Dr. Philip R. Cohen

Interview

ATM: What motivated you to pursue a career in dermatology?

Dr. Cohen: Dermatology is a fascinating medical specialty in my opinion. It allows the clinician to examine the skin, mucosa, hair, and nails of an individual and observe the features of the condition that are visible to the unaided eye. In addition, clinicians also currently have the opportunity to visualize more of the features of the condition with the assistance of a dermatoscope. Subsequently, clinicians are often readily able to biopsy the lesion for microscopic examination. Therefore, the dermatologist is in a unique situation to not only evaluate lesions clinically but also establish the diagnosis by assessing the associated pathologic changes; it provides the chance to continually establish clinicopathologic correlation of the morphology of the diseases and their pathology.

In addition, when I was much younger, I would receive numerous newsletters containing the obituaries of physicians from various specialties. I immediately noticed that most of the dermatologists lived well into their 80s and many into their 90s. I considered that choosing a medical specialty with such a good track record for longevity might be a good decision.

ATM: Can you elaborate on your work related to the cutaneous manifestations of cancer? What are some findings that stood out to you?

Dr. Cohen: All of my professional career has been focused on patient care. I have continually had the opportunity to make unique observations based on the individuals who I have had the privilege to treat. In 2012, I co-authored a paper regarding the ‘shield sign’ in two men with metastatic salivary duct carcinoma (1). Their cutaneous metastases presented as a previously undescribed cutaneous presentation of skin metastases: carcinoma hemorrhagiectoides.

Nearly a decade later in 2021, I again co-authored a paper with several of the same co-authors in which we proposed a new classification system for tumor lysis syndrome (2). One of the patients who we had previously described with carcinoma hemorrhagiectoides, had a phenomenal response to the first dose of antineoplastic therapy; the cutaneous metastases developed into ulcers. We hypothesized that most of the dermis, which had been replaced by tumor cells, disappeared as a result of the therapeutic response, and the overlying epidermis became necrotic and shed, leaving an ulcer. Based on his dramatic response to treatment, we proposed a new classification of tumor lysis syndrome which includes not only the systemic form of the condition, but also the new variant: cutaneous tumor lysis syndrome.

ATM: In your opinion, what are some areas of basal cell carcinoma research that need to receive more attention?

Dr. Cohen: Basal cell carcinoma is the most common skin malignancy. There are several clinical variants of the tumor; many of these subtypes have characteristic associated pathologic changes. In 2022, I described cutaneous basal cell carcinoma in situ (3). Previously, this pathologic variant of basal cell carcinoma had been referred to as a superficial basal cell carcinoma; however, based on the definitions provided by the National Cancer Institute, the pathologic changes observed in the ‘superficial’ basal cell carcinoma fulfill the definition of an ‘in situ’ neoplasm. A follow-up electron microscopy study in 2024 with co-authors documented the intact basement membrane of the epidermis in basal cell carcinoma in situ and the disrupted epidermal basement membrane in both nodular and sclerosing basal cell carcinoma (4). In addition, in 2024, I co-authored a review of the world literature regarding cutaneous basal cell carcinoma in situ which highlighted the molecular features observed in this variant of basal cell carcinoma (5).

ATM: Your research focus also includes forensic dermatology. What inspired your interest in this area?

Dr. Cohen: I find forensic medicine to be fascinating; I am also intrigued by forensic pathology. In my opinion, forensic dermatology is a logical extension of forensic pathology which incorporates the philosophy and approach to disease assessment by dermatology.

In forensic pathology, the external examination of a decedent during a forensic autopsy is based on pattern recognition of the injuries and wounds by the forensic pathologist. This is like the evaluation performed by a dermatologist of a patient with mucocutaneous or nail or hair lesions of a dermatologic condition.

Based on the clinical impression, the forensic pathologist proceeds with the internal examination to ascertain if the findings confirm the suspected etiology to account for the changes noted on the external examination. For the dermatologist, a biopsy of the lesion provides the opportunity to objectively confirm the diagnosis of the condition.

My goal is to expand awareness of the potential possibilities of dermatologists contributing their expertise in assisting forensic pathologists in establishing the cause, mechanism, and manner of death in the decedents they are evaluating.

ATM: In your experience, what are some of the most significant advancements you have provided in forensic dermatology?

Dr. Cohen: Forensic dermatology is a new medical subspecialty of dermatology and forensic pathology that I am passionate about establishing and popularizing. My goal is to actively contribute to the medical literature in this area.

In 2023, I co-authored a paper on the colorimetric scale for skin of color (6). The article proposed a practical scale for the clinical assessment, dermatology management, and forensic evaluation of individuals with skin of color. In addition, the colorimetric scale is useful for not only forensic pathologists and forensic dermatologists, but also for other clinicians to provide a non-racial and non-ethnic designation of skin color types for their patients.

Also, in 2023, I published additional papers on the potential role of forensic dermatology. One includes identifying human trafficking victims based on the injuries that involve their skin, hair, nails, and mucosa (7). Indeed, the presence of an uncommon infection affecting the skin, such as new world leishmaniasis, that only occurs in a specific and restricted geographic endemic area can also be a subtle clue to human trafficking.

A third paper in 2023 discusses how the cutaneous manifestations of drug reactions can mimic traumatic injuries (8). Importantly, several dermatoses can be misinterpreted for traumatic injuries; specifically adverse reactions to medications can mimic assault, burns, elder abuse, and mutilation or torture. An essential aspect of the forensic evaluation during an autopsy includes a complete cutaneous examination; therefore, to aid in differentiating medication-associated dermatoses that can mimic traumatic injury, the evaluation of the decedent by a forensic dermatologist may be helpful to establish the etiology of observed skin changes.

A paper in 2024 focused on the identification of decedents by restoring mummified fingerprints (9). Therefore, forensic dermatology can have an integral role in the investigation of mummy dermatoglyphics to obtain fingerprints from mummified digits.

Other papers, that I have co-authored, are anticipated to be published in 2024. The first is an article on the previous contributions of individuals to the field of forensic dermatology (10). The second is a comprehensive review on forensic onychology of heavy metal exposure which extensively discusses the forensic dermatology of the manifestations of heavy metal toxicity in nails (11). The third is a recently submitted paper that provides a useful approach for dermatologists to serve as consultants to forensic pathologists by providing a template for the dermatologist to use in the preparation of a forensic dermatology expert analytical report (12).

ATM: What do you believe are the most important advances for dermatologists today?

Dr. Cohen: The new therapeutic advances in cutaneous diseases—for example, psoriasis, atopic dermatitis, prurigo nodularis, alopecia, vitiligo, and many others—and cutaneous malignancies are increasing at an exponential rate. Currently, there is an opportunity to provide superlative care for individuals with skin conditions and neoplasms. In 2022, I co-authored a paper regarding the potential to incorporate precision dermatology (dermatologic disease-directed targeted therapy: D³T²) in the management of these patients (13). The continuing development of new disease biomarkers shall be an important diagnostic assessment to possibly achieve the best treatment outcomes and hopefully will enable clinicians to best select the optimum personalized therapeutic interventions for their patient’s skin conditions.

ATM: How has your experience been as an Editorial Board Member of ATM?What are your aspirations for the future of ATM?

Dr. Cohen: I am pleased and honored to have been invited to participate in this interview. I sincerely hope that the journal will continue to be a premier source of academic contributions regarding translational research that emphasizes not only clinical studies, but also basic research, preclinical research, and health policy research.

Reference

1. Cohen PR, Prieto VG, Piha-Paul SA, Kurzrock R. The "shield sign" in two men with metastatic salivary duct carcinoma to the skin: cutaneous metastases presenting as carcinoma hemorrhagiectoides. J Clin Aesthet Dermatol 2012;5(9):27-36.
2. Cohen PR, Prieto VG, Kurzrock R. Tumor Lysis Syndrome: Introduction of a Cutaneous Variant and a New Classification System. Cureus 2021;13(3):e13816.
3. Cohen PR. Cutaneous Basal Cell Carcinoma In Situ: A Case Series. Cureus 2022;14(9):e29479.
4. Kaur H, de Mesy Bentley KL, Rahman SM, Cohen PR, Smoller BR. Cutaneous Superficial Basal Cell Carcinoma is a Basal Cell Carcinoma In Situ: Electron Microscopy of a Case Series of Basal Cell Carcinomas. Dermatol Ther (Heidelb) 2024;14(5):1359-1366.
5. Cohen PR, Kurzrock R.  Cutaneous Basal Cell Carcinoma In Situ:  A Review of the World Literature.   Cureus.  2024;16(9):e69691.
6. Cohen PR, DiMarco MA, Geller RL, Darrisaw LA.  Colorimetric Scale for Skin of Color:  A Practical Classification Scale for the Clinical Assessment, Dermatology Management, and Forensic Evaluation of Individuals With Skin of Color.  Cureus.  2023;15(11):e48905.
7. Cohen PR. Identifying Human Trafficking Victims: A Potential Role for Forensic Dermatology. Cureus 2023;15(11):e48905.
8. Cohen PR. The Cutaneous Manifestations of Drug Reactions Can Mimic Traumatic Injuries: Case Reports and the Potential Role of Forensic Dermatology. Cureus 2023;15(10):e47734.
9. Cohen PR, Abdulkarim B, Wnuk M, Sutton L, Hoenig LJ. Identification of Decedents by Restoring Mummified Fingerprints: Forensic Dermatology in the Investigation of Mummy Dermatoglyphics. Clin Dermatol. Published online September 9, 2024.
10. Cohen PR.  What is Forensic Dermatology?  Skinmed.  In press.
11. Cohen PR, Sutton L.  Forensic Onychology of Heavy Metal Exposure:  Forensic Dermatology of the Manifestations of Heavy Metal Toxicity in Nails.  Dermatol Online J.  In press.
12. Cohen PR, Sutton L.  Forensic Dermatology Expert Analytical Report:  A New Frontier of Forensic Medicine.  Submitted.
13. Cohen PR, Kurzrock R. Dermatologic Disease-Directed Targeted Therapy (D³T²): The Application of Biomarker-Based Precision Medicine for the Personalized Treatment of Skin Conditions-Precision Dermatology. Dermatol Ther (Heidelb) 2022;12(10):2249-2271.