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In This Issue of JAMA Dermatology
January 2014


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JAMA Dermatol. 2014;150(1):3. doi:10.1001/jamadermatol.2013.6515

Nodal metastases from cutaneous squamous cell carcinoma (cSCC) are rare. Identifying patients at greatest risk remains a challenge because clear prognostic data are lacking. In this case series, Schmitt et al evaluate patients with nonanogenital cSCC having sufficient tumor characteristics to allow staging and who underwent sentinel lymph node (SLN) biopsy. A positive SLN was found in 12.3% of patients, mostly in those with T2 lesions. Sentinel lymph node biopsy accurately identifies SLNs and is well tolerated, although the survival benefit of early detection of subclinical nodal metastases is unknown.

Related Editorial

Continuing Medical Education

Bullous pemphigoid (BP) is the most common cutaneous autoimmune blistering disease. BP autoantibodies target 2 hemidesmosomal proteins of the basement membrane zone, BP180 and BP230. Anti-BP 180 autoantibodies are detected in many BP cases, and serum levels correlate with disease activity. In this multicenter prospective study of consecutive BP cases, Fichel and colleagues demonstrated that superpotent topical corticosteroids alone produced a marked decrease in anti-BP 180 autoantibodies in most patients, corresponding with an early therapeutic response. In addition, dementia and extensive initial disease were independent risk factors for BP relapse during the first year of treatment. In an Invited Commentary, Fine discusses the findings in the context of previous research.

Invited Commentary

Many members of melanoma families exhibit atypical nevi, and the presence of multiple atypical nevi implies a higher risk of carrying a mutation in a melanoma-predisposing gene. In this 20-year follow-up study of children from familial melanoma families, Vredenborg and colleagues demonstrated that the number and distribution of melanocytic nevi were major indicators of risk of melanoma. Nevi 5 mm or larger on the buttock were particularly associated with a higher lifetime risk of melanoma.

Neurofibromatosis type 1 (NF1) is a hereditary autosomal dominant condition that occurs in 1 in 3500 births. The diagnosis of NF1 is made on the basis of 7 clinical criteria, but these are often of limited value before the age of 2 years. In this retrospective medical record review of patients with NF1, Ferrari and colleagues found a high prevalence of juvenile xanthogranuloma and nevus anemicus among patients with NF1 younger than 2 years. Although the prevalence of juvenile xanthogranuloma and nevus anemicus in the general population is not precisely known, they are certainly much less frequent. Thus, both cutaneous signs appear as good criteria for NF1 diagnosis in infancy and early childhood.

To determine the impact of social media in dermatology, Amir and colleagues evaluated the social media presence of current dermatology journals as well as professional and patient-centered dermatology organizations. Although some journals were found to be active in social media, most lagged behind patient-centered and professional dermatology organizations. With continued technological evolution, organizations that fail to recognize the opportunities provided by social networking sites may risk becoming marginalized by their inability to assimilate social media as an expected form of communication.