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In This Issue of JAMA Dermatology
December 2015


JAMA Dermatol. 2015;151(12):1275. doi:10.1001/jamadermatol.2014.2951


Histologic regression in primary melanoma is fairly commonly observed. Yet the prognostic significance of this regression remains unclear, and no consensus exists regarding the need for sentinel lymph node biopsy (SLNB) when it is present. In this systematic review of the literature, Ribero et al demonstrate that the risk of micrometastases in SLNB was significantly lower in patients with histologic regression in the primary tumor than in those without. Regression may be used in these cases to select the patients for whom SLNB is most appropriate.


Skin cancers are strongly associated with preventable risk behaviors related to UV exposure, including outdoor sun exposure and indoor tanning. Data suggest that gay and bisexual men may be more likely to engage in indoor tanning, but skin cancer prevalence among gay and bisexual men compared with heterosexual men has never been studied. In this cross-sectional study, Mansh et al demonstrate that gay and bisexual men tan more frequently and report higher skin cancer rates than heterosexual men. Prevention efforts targeted at sexual minority men might reduce risk factors for, and consequences of, skin cancer.


Dermatologists, pulmonologists, and rheumatologists study and treat patients with sarcoidosis with cutaneous manifestations. The validity of cutaneous sarcoidosis outcome instruments for use across medical specialties remains unknown. In this cross-sectional study, Yeung et al evaluate several reference instruments, demonstrating that the Cutaneous Sarcoidosis Activity and Morphology Instrument (CSAMI) and Sarcoidosis Activity and Severity Index (SASI) were reliable and valid in assessing cutaneous sarcoidosis among these specialists. The CSAMI Activity score also correlated with quality-of-life measures and suggested construct validity.

Despite its relevance to delivery of health care, the economic impact of store-and-forward teledermatology has only modest representation in the medical literature. In this randomized study in Veterans Affairs (VA) medical facilities, Datta et al compared the cost and utility of referrals to dermatology services using store-and-forward teledermatology or a conventional text-based referral process. Teledermatology was comparable in cost from a VA perspective and less costly from the societal perspective.

Dermatofibromasarcoma protuberans (DFSP) is a rare, slow-growing skin cancer that develops in the deep dermis to subcutaneous adipose tissues. The pathogenesis of DFSP involves a chromosome 17 and 22 translocation, inducing formation of a fusion gene between COL1A1 and PDGFB genes in most patients. In this study, Nakamura et al demonstrate that PDGFB expression was detected in 93% of patients with DFSP. In 1 tumor, the COL1A1-PDGFB fusion gene was not detected even though PDGFB protein was expressed. A novel COL1A2-PDGFB fusion gene was found in this tumor. These findings suggest that PDGFB protein expression may be a useful diagnostic tool when used in conjunction with previously described immunohistochemical markers.

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