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In This Issue of JAMA Dermatology
March 2016


JAMA Dermatol. 2016;152(3):239. doi:10.1001/jamadermatol.2015.3240


The incidence of melanoma has been rapidly increasing in the United States, especially among young women. In this population-based case-control study, Lazovich et al demonstrate that indoor tanning is strongly associated with increased melanoma risk among women. Among women younger than 30 years, indoor tanning was associated with a 6-fold increase in melanoma risk, and nearly all women in the study diagnosed as having melanoma when younger than 30 years had engaged in indoor tanning. The melanoma epidemic seems likely to continue unabated, especially among young women, unless exposure to indoor tanning is further restricted and reduced.


Continuing Medical Education

Onychomycosis is the most common disease of the nail in adults. In this decision analysis comparing 3 onychomycosis management algorithms, Mikailov et al demonstrate that empirical treatment with terbinafine for patients with onychomycosis is more cost-effective than confirmatory testing across all prevalence of disease, with minimal effect on patient safety. In contrast, confirmatory testing before treatment with efinaconazole, 10%, is associated with reduced costs. Experience with terbinafine over the past 2 decades has defined a relatively benign adverse effect profile and very few toxic injuries.


The risk of cancer in patients with psoriasis remains a cause of special concern owing to the chronic inflammatory nature of the disease, the use of immune-suppressive treatments and UV therapies, and the increased prevalence of comorbid, well-established risk factors for cancer. In this study of psoriasis patients, Chiesa Fuxench et al demonstrate a small increased risk of cancer overall in patients with psoriasis, driven by nonmelanoma skin cancer, lymphoma, and lung cancer. Dermatologists who care for patients with psoriasis should incorporate cancer screening guidelines and counseling into their daily practice.

In daily practice, most pathology laboratories process skin biopsy specimens without access to the clinical and/or dermoscopic images. In pigmented skin tumors, this information can be crucial to process and diagnose the lesion correctly. Ex vivo dermoscopy was introduced as a tool to reduce errors by aiding selection of areas in which to perform step sectioning. In this observational study, Haspeslagh et al demonstrate that ex vivo dermoscopy images are broadly similar to in vivo dermoscopy images and may provide direction to target tissue for processing and examination. Dermoscopy training is required for pathologist and technical staff.