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In This Issue of JAMA Dermatology
October 2014


JAMA Dermatol. 2014;150(10):1037. doi:10.1001/jamadermatol.2013.6560


Mitotic rate is recognized as having independent prognostic significance in melanoma survival. However, the clinical characteristics of rapidly growing tumors remain unclear. In this cross-sectional study, Shen et al found that melanomas occurring in men, in elderly patients, or on the head and neck all had a higher mitotic rate. Amelanotic tumors, those noted to be rapidly growing, and those discovered by the patients also had higher mitotic activity. Mitotically active melanomas were more often seen in the setting of chronic solar field damage. A high index of suspicion is warranted when patients report a history of morphologic change and rapid growth in this clinical setting.


Continuing Medical Education and Author Audio Interview

Despite the frequency of cellulitis diagnosis, gold standard diagnostic studies and evidence-based diagnostic criteria are lacking. Associated physical findings are nonspecific and may be present in a number of inflammatory skin conditions. Cellulitis mimickers are particularly difficult to recognize by physicians without dermatologic training. In this nonblinded randomized clinical trial, Arakaki et al determined that dermatology consultation for suspected cellulitis improved diagnostic accuracy and reduced unnecessary antibiotic use in the primary care setting. Outpatient dermatology consultation may be a cost-effective strategy that improves quality of care.

Invited Commentary

Nonmelanoma skin cancers (NMSCs) are the most common cancers in fair-skinned populations throughout the world. Exposure to UV radiation (UVR) is the primary cause of NMSCs, although the pattern of exposure that gives rise to different types of NMSC appears to vary. In this ecologic study, Xiang et al modeled NMSC incidence in relation to widely available demographic and UVR data: 80% of the variation in NMSC incidence rates was predicted by models that included ambient UVR, day-to-day variability of UVR, age group, sex, and study year.

Intralesional antigen therapy has been used in the treatment of anogenital warts (AGWs), but it has not been compared with existing therapies. In this double-blind randomized clinical trial, Kumar et al demonstrate that the efficacy and safety of intralesional Mycobacterium w (Mw) vaccine was comparable to that of imiquimod, 5%, cream in treatment of AGWs. Although it is invasive and associated with local immunologic reactions, intralesional Mw vaccine therapy reduced human papillomavirus (HPV)-6 and HPV-11 viral load and eliminated HPV within the AGW lesions.

Asteatotic eczema is typically associated with loss of cutaneous lipids, resulting in skin xerosis secondary to transepidermal water loss. Asteatotic eczema is more common in older patients, possibly because of age-dependent decreases in sebaceous and sweat gland activity. In this case series, Cassler et al describe 5 patients with a history of trauma and scar formation who presented with asteatotic eczema involving hypoesthetic skin. Prompt recognition and treatment of this condition may save unnecessary concern and stress. Hastening a plan to improve the skin barrier may result in lowered infection risk in this patient population.