 David Cotter, MD, PhD

Dermatology Education Foundation (DERM) 2025 NP/PA CME Conference

 in Las Vegas, David Cotter, MD, PhD, of Las Vegas Dermatology, spoke about gene expression profiling of skin cancer.1

Cotter highlighted the integration of artificial intelligence (AI) and molecular testing in dermatology, specifically gene expression profiling, which examines gene activity in cells to predict behavior. He noted that the technique can be applied to single cells or tumor tissues, aiding in clinical decisions, such as risk stratification for those with melanoma via the I-31 gene expression profiling (GEP) test.

How Gene Expression Profiling Works in Skin Cancer, with David Cotter, MD, PhD

“Molecular testing in dermatology sounds complicated, but it's really simple,” Cotter explained. “It just means the testing of molecules in the skin. The way that we're going to be talking about that this year is looking at gene expression profiling. All gene expression profiling is a molecular technique that lets you look at what genes are turned on or off within a cell, and based on that, you can make predictions about the cellular behavior. Broad strokes, you can do this all the way down to the single cell level.”

Cotter clarified that gene expression profiling is not genetic testing but rather a genomic test focusing on RNA levels.

“Broadly, you can look at tumor tissue in mass and ask what the entire milieu of the gene expression is,” Cotter said. “You can even laser-dissect out certain parts of a tumor. Just look at tumor cells. Look at fibroblasts, keratinocytes, or the immune cells that are making up that tumor, and ask, ‘How are the genes turned on or off?’ And depending on what your question is or what clinical application you're thinking of, you may want to approach it one way or another.”

Cotter was also asked about how to approach patients in any discussions about gene expression profiling.

“The way that I usually approach the topic is, I say, ‘First of all, it's a really good thing you came in, as we biopsied that funny brown spot, and unfortunately, it came back as a melanoma,’” Cotter said. “We'll talk about what their stage is and what that means for them. But then I also tell them I'm going to order an additional molecular test that's going to give me insights into how the melanoma specifically is behaving. I tell them that I need to know everything that there is potentially to know about the melanoma so we can help answer any questions that come up, giving the best, highest level of care if patients are worried about ‘genetic testing.’”

To find out more about the topics highlighted in this interview, view Cotter’s full video segment above. For more presented at DERM 2025, view the 

The quotes used in this interview summary were edited for clarity.

Cotter D. Dark Waters: Navigating the Diagnosis of Melanoma and Gene Expression Profiling of Skin Cancer. Presented at DERM 2025 NP PA CME Conference; July 23-26, 2025; Las Vegas, Nevada.


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Cotter highlights his DERM 2025 conference presentation on navigating the diagnosis of melanoma and gene expression profiling of skin cancer.

The expanding use of artificial intelligence (AI) tools for clinicians, and specifically 

, has been increasingly discussed both in a positive and negative light.

 in Las Vegas, session presenter David Cotter, MD, PhD, of Las Vegas Dermatology, spoke with 

 about a talk he gave on this subject. The talk was titled ‘Artificial Intelligence: The New Lifeguards in Derm’ and Cotter spoke on some of the biggest highlights.

How to Use Artificial Intelligence Tools in Dermatology, with David Cotter, MD, PhD

“A couple of key takeaways, particularly for artificial intelligence and dermatology, is that I could have given an hour-long talk on AI for essentially any disease state we have in term, but this year, I decided to take that approach to do a high-level potpourri,” Cotter explained. “Because it's more important to understand what's happening in AI from large trends that are affecting the entire house of medicine. What we're beginning to see is how AI can offload some of our administrative burden. That's probably the largest upside, not just for dermatology, but for all of medicine.”

Cotter highlighted several points about AI’s capability to alleviate administrative burdens through tools like AI scribes and prior authorizations. AI also poses risks with its utilization in medicine. Cotter pointed out that insurance companies could be implementing AI to deny claims.

“In fact, there are class action lawsuits that are going on right now that allege that certain companies like Cigna are turning down claims every 1.2 seconds and claiming that they are physician-adjudicated, which just can't be correct,” Cotter said. “So a lot is happening in the AI space right now.”

AI's role in the diagnosis of skin cancer was also highlighted by Cotter, with the discussion emphasizing its role as an aid rather than a standalone solution.

“Turns out that it’s not ready for prime time as a standalone technology, but we're not man versus machine,” Cotter said. “We're man-with-machine. When we utilize AI to augment our own skills that we've already owned after years of training, we can actually do better. We can increase our sensitivity and specificity in diagnosing lesions, either benign, indolent, fatal, or malignant skin cancers.”

Cotter further highlighted the need for clinicians to embrace AI to enhance diagnostic accuracy and patient care. He also noted the necessity for healthcare professionals to have a strong baseline knowledge to interact effectively with AI systems. This was demonstrated by the variability in responses from AI like ChatGPT regarding psoriasis treatments.

For any additional information on AI in dermatology, view Cotter’s full interview segment above. To find out more from DERM 2025, view the 

The quotes contained in this interview were edited for clarity.

Cotter D. Artificial Intelligence: The New Lifeguards in Derm. Presented at DERM 2025 NP PA CME Conference; July 23-26, 2025; Las Vegas, Nevada.

This interview with Cotter highlights his session on the use of AI tools in the dermatology field.

Top Clinical Insights from SDPA 2025: Eczema, Alopecia, Burnout, Vitiligo, JAK Inhibitors

In late June, physician assistants convened at the 

SDPA Annual Summer Dermatology Conference

 in Washington, DC, from June 25 – June 29th, to attend talks from other physician assistants and clinicians.

in people of color. This edition of HCPLive Five spotlights interviews on tips for treating chronic hand eczema, using trichoscopy to differentiate alopecia subtypes, preventing career burnout, breaking down vitiligo misconceptions, and the workup before initiating JAK inhibitors for alopecia.

Tips to Optimize Diagnosis, Management of Chronic Hand Eczema with Adam Friedman, MD

Adam Friedman, MD, professor, chair of dermatology, and director of the Supportive Oncodermatology Program at The George Washington University School of Medicine & Health Sciences, shared clinical insights on diagnosing and managing chronic hand eczema (CHE), emphasizing its diagnostic complexity. CHE has symptoms that overlap with conditions, such as psoriasis, lichen planus, and secondary syphilis. In his interview, Friedman underscored the importance of patient history, especially recurrence, duration, and occupational exposure, and highlighted visual cues to differentiate CHE from other dermatoses.

He also noted that CHE often lacks sharp demarcation, unlike palmoplantar psoriasis, which favors pressure-prone areas. Recognizing patterns like lichenification and confluence helps inform diagnosis.

Trichoscopy Provides Clearer Differentiation of Alopecia Subtypes, With Amy Spizuoco, DO, FAOCD

Amy Spizuoco, DO, FAOCD, a board-certified dermatologist at True Dermatology and a clinical instructor at Mount Sinai, highlighted how trichoscopy enhances diagnostic accuracy in alopecia by revealing key patterns such as black dots, yellow dots, exclamation hairs, and follicular loss. She explained that recognizing these visual cues, like exclamation hairs in alopecia areata or follicular plugging in telogen effluvium, can distinguish scarring from non-scarring forms and guide proper treatment.

Discussing Ways to Help Clinicians Facing Career Burnout, with Hope Cook, PA-C

Hope Cook, PA-C, a physician associate from Georgia Skin Cancer & Aesthetic Dermatology, shared strategies for addressing clinician burnout, emphasizing that burnout is not the end—it can mark a new beginning.

In her session and interview, she introduced her CPR framework: Cocooning (inner reflection and awareness), Planning (evaluating what needs to change), and Revamping or Resigning (deciding whether to reshape or leave one’s role). Using a controlled burn metaphor, Cook illustrated how burnout can clear space for growth and career renewal. Drawing from her book (“Healing Clinician Burnout: How to Revive Your Life and Career”) and podcast, she offered practical, realistic steps clinicians can take to move from feeling stuck to rediscovering purpose in their professional lives.

Breaking Down Vitiligo Misconceptions at SDPA 2025, With Gina Mangin, PA-C

Gina Mangin, MPAS, PA-C, from Sand Lake Dermatology Center, addressed common vitiligo misconceptions, underlining that treatment is possible, even after years of the disease. In an interview, she highlighted the importance of using a Wood’s lamp to confirm diagnosis, especially in patients with skin of color.

Mangin discussed when to escalate to systemic therapy, using markers like rapid progression, confetti depigmentation, and inflammatory borders to assess disease activity. She also said harder-to-treat areas like hands and feet may require both topicals and phototherapy. With new therapies emerging alongside narrowband UVB, Mangin shared her optimism about re-pigmentation and maintaining results through an aggressive, tailored approach.

The Workup Before Initiating a JAK Inhibitor for Alopecia, With David Cotter, MD, PhD

David Cotter, MD, PhD, an assistant clinical professor at the University of Nevada, outlined key steps in evaluating patients with alopecia areata before starting a JAK inhibitor. His recommended workup includes a CMP, fasting lipids, TB and hepatitis B screening, QuantiFERON gold, and often varicella zoster titers—even beyond guideline recommendations—to assess shingles risk. He also considers pregnancy and HIV testing when appropriate.

Cotter stressed that clinicians should feel confident prescribing JAK inhibitors, as long as baseline labs are clear. Follow-up labs are crucial at 12 weeks, with frequency adjusted by patient risk. While many patients see significant regrowth, safety monitoring remains essential throughout treatment.

Check out insights from SDPA 2025 on eczema, alopecia, vitiligo, burnout, and JAK inhibitor workups—key tips to improve dermatology care.

HCPLive Five at SDPA 2025

Before prescribing a patient with alopecia areata a JAK inhibitor, what should you do? At the 

2025 Society of Dermatology Physician Assistant (SDPA) annual summer meeting

, an assistant clinical professor at the University of Nevada, on the workup before initiating a JAK inhibitor for 

, key safety concerns for JAK inhibitors, and his perspective on JAK inhibitor use in younger patients.

“I hope that when people leave my talk that they have some tools to use when they get back to [the] clinic on Monday, [and] they feel comfortable prescribing JAK inhibitors,” Cotter said. “There's nothing wrong with reaching for them. It's so easy. You check some baseline labs… [and] if everything looks good at baseline, you start the medicine, and you can see your patient back in 4to 12 weeks and recheck labs. Usually by the 12-week mark, you're high-fiving because there's really clinically meaningful hair regrowth.”

For Cotter, the workup before initiating a JAK inhibitor for alopecia areata consists of a Comprehensive Metabolic Panel (CMP), fasting lipids test, checking for latent TB infection and hepatitis B serologies, and QuantiFERON gold. Patients may also receive a pregnancy or an HIV test. In Cotter’s practice, he also checks for varicella zoster (VZD) virus antibody titers.

“That's outside of the JAK guidelines, but I like to know if my patients are already immune to VZD, because when I think about all of the side effects of a JAK inhibitor, that keep me up at night,” Cotter said.

Cotter also recommends that individuals get a single vaccine. Still, he checks their baseline titers to see if they are immune to shingles at baseline, so he is aware of the odds of shingles reactivation.

Even after completing the proper workup before initiating JAK inhibitors, Cotter emphasized the importance of follow-up with repeat labs in a period of 4 – 12 weeks.

“What we do in our practice is we check patients at the 12-week mark, and we'll recheck their blood counts by ordering a CBC with [differential],” Cotter said. “We'll check liver function tests and fasting lipids. If everything is normal at the 12-week mark, we'll space those labs out to anywhere from Q6 to Q12 months, depending on the patient's baseline risk. So, a healthy 14-year-old who has no other medical complications, we'll check those labs annually, but say an 80-year-old chain smoker with cardiovascular risk factors, we're going to be checking those labs every 3 months.”

Cotter, D. Hair Loss Track: JAK-ing Up Alopecia Areata. Presented at the 2025 SDPA annual summer meeting 2025 on June 27th.

David Cotter, MD, PhD

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