Shaping Skin Research Together
Top Ten Lists of Research Priorities
Each of the following Top Ten lists was developed using a systematic, multi-step process that included three survey rounds and a final workshop based on the James Lind Alliance methodology. Thank you to the 465 patients, clinicians, and researchers across Canada who shared their voice to help shape the skin research agenda.
Skin Cancer
Squamous Cell Carcinoma
Basal Cell Carcinoma
Merkel Cell Carcinoma
Inflammatory Skin Conditions
Psoriasis
Atopic Dermatitis
Hidradenitis Suppurativa
Wound healing, fibrosis, and regeneration
Burns
Chronic Wounds
Scars
- To what extent does adjuvant radiation therapy after surgery help prevent recurrence or metastasis of SCC?
- What genetic/molecular mechanisms drive SCC development and lead some tumours to metastasize?
- When should diagnostic imaging (e.g. CT scan, utrasound be cone to look tor sco metastasis and which ore the most eiTective methods?
- What is the role of sentinel lymph node biopsy or ultrasound monitoring of lymph nodes for SCC?
- What is the best way to identify perineural tumour spread before surgery?
- How effective and safe are chemopreventive agents (retinoids, nicotinamide, capecitabine) in the long-term prevention of SCC in immunosuppressed patients who have received an organ transplant?
- Which surgical and nonsurgical (radiation, systemic therapy) treatments are more effective (compared with each other) in treating low-risk, high-risk, and metastatic SCC?
- What staging system and risk factors are most useful to predict whether an SCC will be aggressive?
- What is the role of the immune system in the development of SCC?
- What is the role of chemoprevention in non-immunosuppressed patients?
- How effective is electrodesiccation and curettage for basal cell carcinoma when compared to excision?
- What is an effective protocol to identify potentially aggressive BCC and determine the best treatment options (including surgery)?
- What is the best way to promote early diagnosis?
- In people with BCC who undergo standard surgical excision, what surgical margin (i.e., how wide) should be used for each BCC subtype?
- What is the quality of registry data on BCC and how can they be improved?
- How can the process of BCC diagnosis by primary care providers be improved?
- How can development of BCC be prevented once skin has already been sun damaged?
- What is the best single or combination of systemic therapies (immunotherapy, targeted therapy, chemotherapy) for locally advanced or metastatic BCC?
- How should field treatments be used to prevent further BCC in patients with prior BCC?
- What are the molecular mechanisms that lead to the development of basal cell carcinomas?
- What is the optimal management of MCC that has spread microscopically to lymph nodes (clinically occult nodal disease)?
- What is the optimal role of radiotherapy in MCC management?
- Does combining immune therapy with other treatments (surgery, radiation, targeted therapy) safely lead to higher cure rates?
- What makes some people more susceptible to polyomavirus and subsequent MCC development?
- What genetic risk factors exist for MCC?
- How can occurrence of MCC be prevented?
- What biomarkers or tumour characteristics can help predict which individual patients will have a good result with systemic treatments?
- What factors help to predict how an individual MCC case will progress and how severe it will become?
- What are the best practice guidelines for follow-up surveillance after a diagnosis of MCC?
- What is the role of Mohs surgery in the treatment of MCC?
- What molecules and molecular pathways trigger inflammation and lead to different types of psoriasis?
- Does treating psoriasis help improve other health conditions (such as psoriatic arthritis, cardiovascular disease, metabolic syndrome and stress), and if so, does treating it early prevent their development entirely?
- What are the long-term benefits and risks of oral and biologic psoriasis treatments?
- What are the molecular mechanisms responsible when treatments stop working?
- Why do psoriasis treatments stop working well against psoriasis, and when they stop working well, what’s the best way to regain control of the disease?
- Do different genes lead to different type and severity of psoriasis?
- Is a person with psoriasis more likely to develop other health conditions (either as a consequence of psoriasis or due to the effect of treatments for psoriasis)? If so, which ones?
- What is the role of inflammation produced by nerves (neurogenic inflammation) and growth of new blood vessels (angiogenesis) in the development of psoriasis, and can these processes be targeted by new treatments?
- What is the safest and most effective topical treatment for the management of psoriasis?
- How do changes in female hormones, such as during puberty, pregnancy, miscarriage, menopause and contraceptive use, affect psoriasis and its treatment?
- What can be done to prevent the development of atopic dermatitis in the first place?
- How can we predict which patients will respond to which treatments for atopic dermatitis and which patients will not respond?
- What is the difference in the prevalence, presentation, and management of atopic dermatitis between patients of different ethnicities and skin tones?
- What causes flares in atopic dermatitis?
- What are the molecular pathways involved in the development of atopic dermatitis that can be targeted by novel treatments?
- How do the environment, “good” bacteria, and genetics influence atopic dermatitis?
- Does restoring the skin’s protective barrier improve atopic dermatitis outcomes, and if so, how can it be repaired?
- What factors drive immune responses that contribute to atopic dermatitis, and how does managing these factors affect disease outcomes?
- How can clinically meaningful subtypes of atopic dermatitis be defined based on age at onset, genetics, environmental factors, and clinical features?
- What is the relationship between atopic dermatitis and immuno-regulatory conditions (e.g., autoimmune diseases, asthma, allergies)?
- What is the biological cause of hidradenitis suppurativa?
- What are the most effective and safe methods for the management of hidradenitis suppurativa-derived pain?
- What is the best management of an acute flare?
- What biological factors of hidradenitis suppurativa make it challenging to treat effectively, and how can they be overcome?
- Is there a relationship between hidradenitis suppurativa and autoimmune disease?
- To what extent is hidradenitis suppurativa caused by genetic factors?
- What is the most effective and safe group of treatments in treating hidradenitis suppurativa (e.g., antibiotics, hormonal treatments, biologics, immunosuppressants, metformin, steroids, inflammation modulators, antiseptics, surgery, laser hair removal)?
- Is there a relationship between hidradenitis suppurativa and hormonal factors (e.g., puberty, menstruation, polycystic ovary syndrome, pregnancy, post-delivery, menopause, and, hormonal regulatory conditions)?
- What novel therapeutic approaches can be developed to treat hidradenitis suppurativa more effectively than the current options?
- What is the impact (e.g., physical, psychological, financial, social, quality of life) of hidradenitis suppurativa and its treatments on people living with the disease?
- Which treatment practices lead to less scars?
- What is the best way to maintain sufficient moisture in burn scars?
- How do burn scars change over long periods of time (decades) and how should care be adjusted in response to these changes?
- What can be done to help with disrupted skin function (including excessive sensitivity, loss of glands, inability to sweat, and poor regulation of body temperature) in burn survivors?
- Which molecules trigger scars, burn wounds, and grafted areas to get worse?
- How do burn wounds affect quality of life, including psychosocial, work, and physical impacts, and what are most effective ways to improve quality of life (in both adults and children)?
- Do burn wound survivors have access to sufficient treatment resources once they have left the hospital?
- What health conditions and complications can arise as a result of burn wounds?
- What is the most effective way to treat pain, itch, and swelling in burn wounds and scars?
- What is the best way to prevent or treat rashes and hives that develop on old skin grafts?
- Comment les équipes et les cliniques de santé peuvent-elles être optimisées pour améliorer les résultats des patients?
- Comment les facteurs sociaux, notamment le statut socio-économique, la race et l’origine ethnique, affectent-ils la prévention et la prise en charge des plaies chroniques et leur impact sur la qualité de vie?
- Comment réduire le coût financier du traitement des plaies chroniques?
- Quel est l’impact des plaies chroniques sur les Canadiens, en particulier les personnes âgées (y compris le taux d’incidents multiples et récurrents, la prévalence des différents types de maladies et le fardeau de la maladie)?
- Comment détecter avec précision la présence d’infection dans les plaies chroniques?
- Quel est le moyen le plus efficace de traiter la douleur chronique dérivée des plaies et de minimiser la douleur résultant du traitement des plaies chroniques?
- Comment les comorbidités contribuent-elles au développement des plaies chroniques?
- Comment former les infirmières et les cliniciens à identifier plus efficacement les plaies chroniques?
- Quels traitements améliorent efficacement la microcirculation sanguine pour aider à la guérison des plaies chroniques?
- Quel est le meilleur plan de traitement pour la gestion du biofilm (une couche membranaire de bactéries ou de champignons) pour prévenir l’infection et favoriser la guérison des plaies chroniques?
- What is the best way to prevent wounded tissue from developing into problematic scars (e.g. keloids, hypertrophic scar formation, insensibility or discoloration of the skin)?
- What is the role of inflammation in scarring?
- What is the most effective way to heal or reduce the appearance of scars?
- What are the most effective topical treatments for scars?
- What factors influence the development of keloids and hypertrophic scarring?
- What are the psychological impacts of having scars and how can they be treated?
- How do genetic, hormonal, and environmental factors affect the development of scars?
- What is the best treatment for keloids, does it vary between patients, and how can it be improved?
- Are specialized dressings effective for treating scars?
- What can be done during surgery to reduce post-surgical scarring?
