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In This Issue of JAMA Dermatology
May 2014


JAMA Dermatol. 2014;150(5):467. doi:10.1001/jamadermatol.2013.6535


As physicians receive and provide free drug samples in clinical practice, it is important to understand how physician access to these samples affects prescribing behavior. In this cross-sectional study, Hurley et al use local and national data to highlight how the provision of samples is associated with dermatologist prescribing behavior and how the availability of samples correlates with the prescription of more expensive branded generic drugs over less expensive alternatives. Dermatologists should be aware that prescribing preferences are at least partly related to which drugs are made available as free samples and that these preferences may also increase health care expenses.


Infective endocarditis (IE) is uncommon, but it carries a high mortality rate due to associated septic shock, heart failure, or stroke. A cutaneous portal of entry is often found, and dermatologic lesions suggestive of septicemia may help physicians reach a clinical diagnosis. In this observational, population-based study, Servy et al report that IE dermatologic manifestations were significantly associated with symptomatic and asymptomatic cerebral embolic events. The presence of these cutaneous lesions might attest to an active embolic process responsible for systemic complications and should alert physicians to the possibility of extracardiac complications.

The incidence of melanoma and nonmelanoma skin cancers has been increasing rapidly. Exposure to UV radiation is among the most preventable known risk factors for skin cancer, and indoor tanning is particularly dangerous for young users. Despite the risks, indoor tanning remains common among US adolescents. In this cross-sectional study of US high school students, Guy et al demonstrate that the prevalence of indoor tanning was greater among female, older, and non-Hispanic white students and was associated with other risk-taking behaviors, such as binge drinking, unhealthy weight control practices, and having sexual intercourse.

Continuing Medical Education

Strong links between indoor tanning behavior and skin cancer have been demonstrated across several studies, and understanding the complex belief systems that underlie indoor tanning in young women is a crucial step in developing deterrent interventions. In this cross-sectional web-based survey, Noar et al demonstrate that appearance is only 1 of the motivations for indoor tanning. Dermatologists should address additional motivating factors, such as mood enhancement and health improvement. Perceptions of parental approval also have a strong role, and dermatologists might take advantage of opportunities to discuss indoor tanning with parents of adolescents and young adults.

Sex, age at diagnosis, tumor thickness, and tumor ulceration are independent prognostic factors for cutaneous melanoma (CM). Previous studies demonstrated only that the proportion of ulcerated to nonulcerated CM rose with increasing tumor depth without adjusting for the population at risk. In this population-based study using a large-scale database, Richardson et al demonstrate that the incidence of tumor ulceration was stable across increasing tumor depth for all age and sex groups except older men. Male sex was found to be an age-specific effect modifier for ulcerated CM by tumor depth. For men, age at diagnosis modifies the effect of tumor depth on ulceration.