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In This Issue of JAMA Dermatology
November 2014


JAMA Dermatol. 2014;150(11):1133. doi:10.1001/jamadermatol.2013.6565


The numbers of nurse practitioners and physician assistants have grown greatly, and these mid-level clinicians have extended their scope of practice since 1997. In this analysis of the 2012 Medicare data, Coldiron and Ratnarathorn identified the most common procedures performed independently by mid-level practitioners: nearly 55% of these were in the area of dermatology. While the primary care clinician shortage has prompted consideration of widening the scope of practice for mid-level clinicians, it is important to recognize that mid-level clinicians are not limited to primary care and may be performing procedures for which they have little formal training.

Editorial and Related Article

Although skin cancer is the most common form of cancer in the United States, data on frequently encountered dermatologic symptoms are still emerging. In this large prospective clinicopathologic study of patients who filled out questionnaires to assess itch and pain intensity of their skin tumors at the time of excision, Yosipovitch et al demonstrate that itch and pain were common across all skin cancers but were mostly absent in melanoma. Pain was associated with deeper dermal processes, whereas itch was linked with more superficial basal cell carcinoma lesions.

Continuing Medical Education

Melanoma is the most fatal of all skin cancers, and its incidence continues to rise in the United States. Dedicated pigmented lesion clinics (PLCs) offer services that appeal to patients with melanoma, including total body skin examinations, total body digital photography, clinical trials, and multidisciplinary approaches. This retrospective medical record review by Vickery et al reveals that 14.9% of patient visits to a PLC were more frequent than the recommended follow-up schedule. More patients are being diagnosed with melanoma every day, and this current care model of allowing extra visits may not be sustainable in the long-term. Hybrid approaches may combat this supply-demand discrepancy.

Adverse effects of mutation-specific BRAF inhibitor therapy include induction of epithelial proliferations including cutaneous squamous cell carcinomas. Although RAS mutations are the major contributing pathogenic factor, oncogenic cutaneous viruses have also been hypothesized to play a role. In this retrospective study, Schrama et al demonstrate the presence of both high HPyV-6 DNA load and VP1 protein expression, suggesting that polyomaviruses may contribute to these epithelial proliferations, although the scale of the impact remains unclear.

Successful reconstruction of hand defects must allow patients to avoid postoperative hand dysfunction and return quickly to daily activities. Because of the hand’s finite reservoir of skin and thin dermis and subcutaneous fat, random pattern flaps have increased risk for necrosis or dehiscence. In this case report, Sobanko et al demonstrate a novel sliding fasciocutaneous flap with blood supply derived from dorsal perforating arteries and that uses bilevel undermining for improved flap mobility. Four variations of this flap are described, with low complication rates.