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In This Issue of JAMA Dermatology
August 2014


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Copyright 2014 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA Dermatol. 2014;150(8):799. doi:10.1001/jamadermatol.2013.6550

The most important risk factors for melanoma include a predisposing genetic mutation, a history of melanoma, and multiple atypical nevi. The efficacy of various diagnostic screening interventions among these high-risk patients remains uncertain. In this prospective observational study, Moloney et al demonstrate that baseline total body imaging and sequential digital dermoscopy imaging were effective in diagnosing melanoma early in this extreme-risk population. Hypervigilance for difficult-to-detect thick melanoma subtypes was also considered crucial.


Continuing Medical Education

Regression in melanoma is defined as an area within the tumor in which neoplastic cells have disappeared or become reduced in number from the dermis and have been substituted by fibrosis. The influence of regression on melanoma prognosis remains a matter of controversy. In this retrospective study of melanomas thicker than 0.75 mm, Botella-Estrada et al demonstrate that regression did not show a statistically significant association with sentinel lymph node status. These data do not support the practice of sentinel lymph node biopsy in thin melanomas with regression in the absence of additional adverse prognostic characteristics.

Sagging eyelids, or dermatochalasis, are a frequent concern among older adults. Other than intrinsic skin aging, risk factors contributing to this condition remain unclear. In this observational study, Jacobs et al demonstrate that the nongenetic risk factors of age, male sex, lighter skin color, higher BMI, and smoking increased the risk of dermatochalasis. A high degree of heritability was also detected, and the C allele of rs11876749 on chromosome 18 showed some genome-wide protective effect for sagging eyelid severity.

Acne scarring has been associated with significant psychological consequences, yet effective treatment remains a challenge. Fractional resurfacing laser treatment to induce neocollagenesis has been used successfully. Needle rollers, which use a macroscopic approach to induce small epidermal and dermal perforations, have been reported to induce neocollagenesis and improve acne scarring. In this split-face randomized clinical trial, Alam et al demonstrate that there was improvement in the appearance of acne scars after 3 needling treatments, with minimal pain reported. Needling may offer benefits to patients with acne scarring without access to laser treatments or in combination with fractional laser treatments.

Methotrexate is frequently used in the management of long-term severe psoriasis. Liver fibrosis remains the main disadvantage of treatment, and monitoring of liver enzyme and procollagen III peptide levels has been recommended during therapy. Liver biopsy is the standard for diagnosing liver fibrosis, but the procedure is associated with significant morbidity and mortality. In this cohort study, Lynch et al demonstrate that transient elastography using pulse-echo ultrasonography and FibroTest (an indirect measure of hepatic fibrosis) were effective noninvasive tools for monitoring hepatotoxic effects in patients receiving methotrexate. The need for liver biopsy could be reduced if abnormalities in these tests were required before biopsy is considered.

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