Approximately 250 000 cutaneous squamous cell carcinomas (CSCCs) are diagnosed annually in the United States. Though most CSCCs are easily cured, a subset of them recur, metastasize, and cause death. In this 10-year retrospective cohort study, Schmults et al identified 5 risk factors that contribute to poor outcomes: tumor diameter greater than 2 cm, poor differentiation, depth of invasion beyond the subcutaneous fat, perineural invasion, and location on the ear, temple, or anogenital region. Because these 5 risk factors may be among the most significant drivers of CSCC outcomes, clinical trials regarding nodal staging and adjuvant therapy may be targeted at patients with 1 or more of the risk factors.
Several instruments have been developed to measure disease severity in psoriasis. Among them, the Psoriasis Area and Severity Index (PASI) is most frequently used, not only for quantifying extent of disease but also as a validated measure of response to treatment. Without training, evaluators assign PASI scores with substantial variability. In this equivalency study, Armstrong et al demonstrate that an online PASI training video can be an effective tool in improving accuracy of PASI scoring.
Mucous membrane pemphigoid (MMP) is a heterogeneous group of autoimmune diseases encompassing chronic, inflammatory, subepithelial blistering diseases that predominantly affect mucous membranes and lead to scarring. The 2 major autoantigens of MMP are BP180 and laminin 332 (Lam332), which are both components of anchoring filaments. The MMP subtype that demonstrates anti-Lam332 antibodies has been reportedly associated with an increased relative risk of cancer. In this multicenter retrospective study, Bernard et al demonstrated the usefulness of a novel enzyme-linked immunosorbent assay to identify anti-Lam322 serum samples from patients with MMP. Anti-Lam322 antibodies were mainly detected in patients with severe MMP, but not preferentially among those with malignant neoplasms.
Pilomatricomas are benign cutaneous adnexal tumors that arise from the outer root sheath cells in the hair follicle. The prevalence of solitary pilomatricoma among the general population is unknown. In this retrospective medical record review, Handler et al demonstrate a prevalence rate of 2.6% for pilomatricoma among a cohort of 311 patients with Turner syndrome. Physicians caring for patients with Turner syndrome should be aware of the prevalence of pilomatricoma among these patients, and pilomatricoma should be suspected in patients with solitary, hard, mobile, nontender, bluish nodules on the head or neck.
For many dermatologic conditions, the health outcome measure of principal importance is self-reported quality of life. Although research on quality of life and dermatologic conditions is well represented in the literature, information on teledermatology's effect on quality of life is virtually absent. In this randomized clinical trial, Whited et al demonstrate that at 3 or 9 months after referral, store and forward teledermatology did not result in a statistically significant difference in skin-related quality of life compared with in-person consultations. These results have important operational implications for teledermatology.
In This Issue of JAMA Dermatology. JAMA Dermatol. 2013;149(5):521. doi:10.1001/jamadermatol.2013.15