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In This Issue of JAMA Dermatology
May 2016


JAMA Dermatol. 2016;152(5):501. doi:10.1001/jamadermatol.2015.3254


Hedgehog pathway inhibitors, particularly smoothened inhibitors, are a new type of targeted therapy for advanced basal cell carcinoma. Cutaneous squamous cell carcinoma (CSCC) has been reported following vismodegib treatment, but no systemic assessment of this risk has been completed. In this case-control study, Mohan et al demonstrate an increased CSCC risk after vismodegib therapy, highlighting the importance of continued skin surveillance after treatment. Hedgehog pathway inhibition activates the RAS/MAPK pathway, thereby circumventing hedgehog pathway dependency for tumor growth. This RAS pathway dysregulation may promote CSCC and other second cancers.


Solid-organ transplant recipients (OTRs) are at increased risk for skin cancer because of long-term immunosuppression. Mammalian target of rapamycin inhibitors (mTORs), such as sirolimus, reduce the growth and proliferation of tumor cells, and cancer formation is a major reason for conversion from calcineurin inhibitors to mTORs. In this retrospective cohort study, Karia et al demonstrate that patients taking sirolimus after developing posttransplant cancer had a lower risk of developing subsequent skin cancer and no increased risk for overall mortality.

Rosacea is a common inflammatory facial skin disorder. The pathogenesis is poorly understood, although increased matrix metalloproteinase (MMP) activity may play an important role. Glioma accounts for 80% of primary central nervous system malignant tumors, and glioma also shows upregulation of MMP. In this nationwide cohort study, Egeberg et al demonstrate that rosacea was associated with a significantly increased risk for glioma. Increased focus on neurologic symptoms such as headache, memory loss, seizures, visual changes, or personality changes in patients with rosacea may be warranted.

Continuing Medical Education

Basal cell carcinoma (BCC) is the most common type of skin cancer and is usually nonpigmented. Dermoscopic features of pigmented BCC have been well described, but few studies have focused on the dermoscopic features of nonpigmented BCCs, particularly using polarized dermoscopy. In this study, Navarrete-Dechent et al demonstrate that the combined presence of shiny white blotches and strands in polarized dermoscopic images was associated with high diagnostic specificity for nonpigmented BCC. These features should be added to criteria for BCC detection.

Hidradenitis suppurativa (HS) is a potentially debilitating chronic inflammatory disease with implications for quality of life. Its inherent unpredictability poses considerable challenges to patient and physician alike, and studies evaluating predictors of disease severity remain limited. In this retrospective cohort study, Garg et al demonstrate that HS had a progressive course of disease. Clinical factors that played a role in developing partnered short- and long-term treatment strategies included dermatologist referral, tobacco smoking, and age. Obesity and sex did not seem to influence treatment decisions in HS.