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In This Issue of JAMA Dermatology
November 2016

Highlights

JAMA Dermatol. 2016;152(11):1181. doi:10.1001/jamadermatol.2015.3296
Research

Disease activity in vitiligo is difficult to assess in the absence of inflammatory signs such as erythema or scaling. Limited evidence is available on circulating markers that are linked to progressive vitiligo. In this cross-sectional, prospective study, Speeckaert et al demonstrate that serum levels of soluble CD25 (sCD25) and sCD27 molecules were elevated in patients with vitiligo. Serum sCD25 levels were significantly lower in patients treated with topical calcineurin inhibitors, and serum sCD27 levels were lower in patients with recent repigmentation. These data demonstrate a potential for these biomarkers to be used in monitoring treatment responses.

Editorial

By definition, in situ melanoma is confined to the epidermis with theoretically no risk of metastasis. However, in situ melanoma does rarely metastasize, and patients die of the disease. The presence of occult invasion is a possible explanation for this occurrence. In this case series, Bax et al demonstrate that occult microinvasion was found in up to one-third of unequivocal in situ melanoma cases. History, physical examination (including of the lymph nodes), education, and surveillance recommendations should be based on a very low, but not zero, risk of melanoma metastasis.

Continuing Medical Education

Although basal cell carcinoma (BCC) is the most common cancer in the United States, the epidemiology remains difficult to study because of exclusion from national cancer registries. In this retrospective study using a Kaiser Permanente Northern California BCC registry, Ray et al describe several geographic clusters with modestly elevated incidence of BCC. Investigation of such spatial clusters may uncover previously unknown etiologies and offer opportunities for more effective direct screening and prevention efforts.

Human papillomavirus (HPV)-induced genital lesions are frequent in men who have sex with men (MSM) who are HIV-positive (HIV+). Anogenital warts (AGWs) are considered benign lesions caused by low-risk HPV types, whereas anogenital dysplasias are potential cancer precursors associated with high-risk HPV subtypes. In this retrospective virological analysis, Kreuter et al demonstrate that, in contrast to those found in immunocompetent patients, AGWs of HIV+ MSM may harbor high-grade dysplasia or even invasive squamous cell carcinoma. Many of these lesions contain only low-risk HPV types. All HPV-induced anogenital lesions in HIV+ MSM should be evaluated histopathologically and immunohistochemically, and HPV genotyping should be considered if areas of dysplasia are detected.

Psoriasis is associated with an increased risk of cardiovascular diseases. Subclinical atherosclerosis in patients with psoriasis has not been compared with other conditions also associated with increased cardiovascular risk. In this cross-sectional study, Mansouri et al demonstrate that patients with psoriasis have increased coronary artery calcium levels by mean Agatston scores, similar to that of patients with type 2 diabetes. These data suggest that patients with psoriasis harbor high rates of subclinical atherosclerosis independent of other cardiometabolic risk factors.

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