The institution of medicine was built on a foundation of racism and segregation, the consequences of which still permeate the experiences of Black physicians and patients. To predict the future direction of medical inclusivity, we must first understand the history of medicine as it pertains to race, diversity, and equity. In this Commentary, we review material from publicly available books, articles, and media outlets in a variety of areas, including undergraduate medical education and professional medical societies, where we found an abundance of policies and practices that created a foundation of systemic racism in medical training that carried through the career paths of Black physicians. The objective of this Commentary is to present the history of race in the medical education system and medical society membership, acknowledge the present state of both, and offer concrete solutions to increase diversity in our medical community.

Background. Genital leiomyomas fall under the broader category of cutaneous leiomyomas, which are rare smooth muscle neoplasms accounting for 5% of all leiomyomas. Genital leiomyomas arising from the dartos muscle are exceedingly rare with fewer than 30 cases reported in the literature. They are typically benign and adequately treated with simple surgical excision; however, previously reported cases of malignant transformation and a possible link to the hereditary leiomyomatosis and renal cell cancer (HLRCC) syndrome warrant closer follow-up. Case Presentation. We report a case of a 47-year-old male refugee from Rwanda found to have a mobile, pea-sized, mildly painful scrotal lesion near the left penoscrotal junction and 1.5 cm indeterminate vascular mass in the right kidney. Surgical excision of the scrotal nodule was performed and the diagnosis of a dartoic leiomyoma was rendered. The presence of moderate nuclear atypia, rare mitotic activity, and close surgical margins prompted a wide reexcision. We report the surgical approach, pathologic findings, and clinical follow-up related to this scrotal lesion. Conclusion. Scrotal leiomyomas demonstrate a high rate of recurrence and pose a risk for malignant transformation. They may also indicate an underlying autosomal dominant syndrome associated with increased risk for development of an aggressive form of renal cell carcinoma. When discovered, management should include surgical excision, screening for syndromic features, and routine follow-up.

Introduction To evaluate the response of patients with high-risk bacillus Calmette-Guerin (BCG)–unresponsive non-muscle invasive bladder cancer (NMIBC) who we treated with intravesical CG0070, a conditionally replicating granulocyte macrophage colony-stimulating factor (GM-CSF) containing an RB promoter. Methods 15 patients with residual high grade BCG-unresponsive CIS +/- Ta/T1/T2 bladder cancer received one or more 6-week instillations of intravesical CG0070 and were retrospectively reviewed. Overall response including the number, location, grade and stage of recurrences, were recorded. Side effects of intravesical instillation of CG0070 were also investigated. 11 of the 15 patients had at least 2.5 years of follow up both before and after treatment, permitting statistical chi-square analysis for the 2.5 year pre- and post-CG0070 periods. Results Of the 15 patients, 5 had Ta + Cis, 4 had T1 + CIS, 4 had CIS alone, and 2 had T2 + CIS prior to CG0070 instillation. Complete response of CIS was seen in 60% at 6 months, 47% at 12 months, and 40% at 24 months. Overall, 40% of patients remained tumor free and none progressed. For the 11 patients amenable to statistical analysis, 32 recurrences were noted within 2.5 years before therapy and 13 2.5 years after (p <0.01). 40% of patients experienced no adverse events as a result of treatment. Most common side effects were hematuria (33.3%), malaise/fatigue (33.3%), and urgency/frequency (26.7%). Discussion Treatment with intravesical CG0070 for high-risk BCG-unresponsive bladder cancer appears to be a promising salvage regimen worthy of further investigation.