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Melanoma is the third most common cancer among adolescents and young adults (AYAs). Women with melanoma have a survival advantage compared with men in study populations composed of middle-aged and older individuals, but few studies have addressed differences in melanoma mortality among younger patients. In this population-based cohort study, Gamba et al demonstrate that male sex is associated with worse survival among white AYAs after controlling for thickness and other prognostic factors. The biological basis for this sex disparity merits further investigation, and this alarming difference in outcome highlights the need for behavioral interventions to promote early detection strategies in young men.
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Subsequent melanomas in patients with multiple primary melanomas (MPMs) are well known to be thinner, on average, than the prior melanomas and might therefore have a better outcome. Because individuals with a first primary melanoma are at increased risk of additional tumors, prognostic information is essential. In this survival analysis, Kricker et al demonstrate no significant survival differences between patients with a single primary melanoma (SPM) and those with MPM. However, a greater increase in the risk of death with thick SPMs than thick MPMs was seen, indicating a possible difference between patient outcomes in these 2 groups.
Evidence supports observations of an association between atypical nevi, which have unusual clinical and pathologic features, and an increased overall melanoma risk. Atypical nevi are common, and many are biopsied to evaluate for melanoma. A lack of consensus exists regarding appropriate management of biopsy-proven atypical nevi with positive histologic margins. In this retrospective outcome study, Reddy et al demonstrate that excision of biopsy-diagnosed mildly or moderately atypical nevi is unlikely to result in a clinically significant change in diagnosis, and the risk of transformation to melanoma appears to be very low.
Continuing Medical Education
Antimalarial drugs can induce tissue pigmentation in skin, joints, trachea, and cartilage. In patients with systemic lupus erythematosus (SLE) treated with antimalarials, most reported cases involve chloroquine treatment and only rarely hydroxychloroquine (HCQ). In this retrospective case-control study, Jallouli et al demonstrate a 7.3% incidence of pigmentation among HCQ-treated patients with SLE. Localization, history, and histopathologic findings support the association of HCQ-induced pigmentation with ecchymosis or bruising.
Bullous pemphigoid (BP) is the most common subepidermal blistering disease. It affects mainly the elderly, and the associated morbidity is significant. Previous studies have described patients with pruritus and immunopathologic features of BP but without blister formation. As a result, nonbullous skin lesions or pruritus alone may be misdiagnosed as xerosis, cutaneous drug reaction, dermatitis, renal or liver impairment, or scabies in elderly patients. In this case series, Bakker et al describe 15 patients with pruritic nonbullous pemphigoid. In 11 of these patients, treatment with potent topical corticosteroids or methotrexate sodium led to remission. It remains unclear why this patient subset does not develop the classic blisters of BP.
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In This Issue of JAMA Dermatology. JAMA Dermatol. 2013;149(8):897. doi:10.1001/jamadermatol.2013.4078
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