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In This Issue of JAMA Dermatology
October 2015


JAMA Dermatol. 2015;151(10):1047. doi:10.1001/jamadermatol.2014.2941


Vulvar lichen sclerosus (VLS) is an uncommon skin disease that is sometimes complicated by vulvar squamous neoplasia (VSN). Current guidelines of care advocate use of superpotent topical corticosteroids (TSCs) as first-line treatment to achieve remission. Less is known about maintenance therapy for VLS. In this prospective longitudinal cohort study, Lee et al demonstrate that individualized preventive TCS regimens, with potency titrated to objective disease severity, reduced symptoms, scarring, and risk of VSN. Few cases of reversible cutaneous atrophy were observed.


Basal cell carcinoma (BCC) is the most common human cancer. Diagnosis is primarily via clinical evaluation, with definitive diagnosis via biopsy and histopathologic evaluation. Diagnostic optical technologies offer the possibility of rapid, pain-free, and noninvasive light-based histopathologic examination. Most current in vivo optical imaging devices rely on variations in refractive indices, leading to low-contrast images that may prove difficult to interpret. Multiphoton microscopy (MPM) introduces additional degrees of contrast by taking advantage of endogenous fluorophores in the skin. In this small pilot study, Balu et al demonstrate that in vivo MPM imaging can provide label-free contrast to reveal several characteristic features of BCC.


Continuing Medical Education

In Denmark, the incidence of malignant melanoma (MM) has doubled during the past 25 years. In this descriptive analysis of the official national Danish Melanoma Group database, Helvind et al demonstrate that the incidence, mortality, and characteristics over time of the MM population in Denmark correspond with findings of similar studies worldwide. Incidence of MM increased, with a relative increase in in situ tumors, indicating that secondary interventions such as screening were effective. A persisting increase in male mortality and incidence of MMs suggests that this increase is not due solely to overdiagnosis and diagnostic drift, and that primary interventions need to be intensified.

Cutaneous leiomyomas are smooth-muscle tumors that commonly arise from the arrector pili muscle. Among affected individuals, 92% experience pain associated with these lesions, but the mechanism of this pain is poorly understood. Some data suggest that nerve conduction pathways could be targeted to minimize leiomyoma-associated pain. In this randomized trial, Naik et al demonstrate that intralesional botulinum toxin was associated with improvement in skin-related quality of life, even though pain at rest and pain severity improvements were not statistically significant.

BRAF inhibitors have revolutionized the treatment of stage IV metastatic melanoma. The MEK inhibitor trametinib dimethyl sulfoxide has also shown a survival benefit in the same population. In this retrospective cohort study, Carlos et al compare the cutaneous toxic effects of BRAF inhibitor monotherapy with BRAF inhibitor–trametinib combination therapy (CombiDT). Cutaneous squamous cell carcinoma was the most concerning cutaneous toxic effect related to BRAF inhibitor monotherapy. CombiDT therapy had an improved profile of cutaneous toxic effects, although continuous dermatologic assessments should be provided for all patients receiving these treatments.