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Timing of New Keratinocyte Carcinomas (KCs) After a First KC
Patients with KC (basal cell carcinoma and cutaneous squamous cell carcinoma) often develop new KCs, but the magnitude and patient characteristics related to this increased risk are poorly understood. In this prospective cohort study, Wehner et al demonstrate that the risk for a second KC after a first lifetime KC was significantly lower over time than the risks for a third KC after a second, a fourth after a third, and so on. At 10 years, approximately 40% of patients diagnosed with a first lifetime KC will not have developed another tumor.
Contraceptive Education for Isotretinoin Users
Federal monitoring of isotretinoin prescriptions through programs such as iPLEDGE have not been shown to decrease pregnancies among isotretinoin-treated patients. In this survey study, Werner et al found that, prior to reviewing a contraceptive information sheet, more than half of women overestimated the typical effectiveness of many contraceptive methods. After viewing the educational handout, participants were better able to correctly identify contraceptive effectiveness. These data demonstrate that even a small investment in time can greatly enhance the understanding of contraceptive options.
Lower Extremity Lymphedema in Military Trainees
In August 2011, 4 male Air Force basic trainees were hospitalized with pitting lower extremity edema, erythema, and pain. Although the admitting diagnosis was bilateral lower extremity cellulitis, the bilateral distribution and timing of symptom onset argued against this diagnosis. In this observational study, Fajardo et al identify a total of 55 trainees who developed bilateral lower extremity inflammatory lymphedema. Multiple training-related risk factors were ruled out, and cases were believed to be most likely secondary to prolonged standing with gravity-dependent venous congestion and inflammatory vasculitis. The potential roles of undiagnosed venous reflux disease and the training environment remain to be elucidated.
Association Between Eczema and Stature
Atopic dermatitis (eczema) is a chronic inflammatory disorder associated with other symptoms and comorbid medical disorders that may affect growth in childhood and adolescence, such as asthma, quality-of-life impairment, sleep disturbance, and the use of potent topical and systemic corticosteroids. In this analysis of data culled from 9 US population-based studies, Silverberg and Paller demonstrated that, in general, eczema in childhood is not associated with short stature. Severe eczema accompanied by sleep impairment may contribute to reversible growth impairment in childhood.
BRAFV600E Protein Expression in Malignant Melanoma
BRAFV600E mutations are present in approximately 50% of cutaneous malignant melanomas (CMMs). With the development of BRAF inhibitors, the therapeutic responses in patients with BRAFV600E metastatic CMM have been significantly improved. The use of BRAFV600E mutation–specific monoclonal antibody VE1 immunohistochemical analysis may facilitate rapid detection of BRAFV600E mutations in CMMs and demonstrate heterogeneity among tumors. In this retrospective cohort study, Eriksson et al found VE1 analysis to be a useful and rapid assay for BRAFV600E in primary and metastatic CMMs. Confirmatory BRAF mutation testing should be expedited for tumors with positive results.
Continuing Medical Education
Highlights. JAMA Dermatol. 2015;151(4):361. doi:10.1001/jamadermatol.2014.2911
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