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In This Issue of JAMA Dermatology
September 2016


JAMA Dermatol. 2016;152(9):963. doi:10.1001/jamadermatol.2015.3282


More than 1 million US patients with melanoma are at risk to develop second primary melanomas. Patients with melanoma and their skin-check partners may self-manage early detection of new or recurrent melanoma with skin self-examination (SSE). In this randomized clinical trial, Robinson et al demonstrate that patients with melanoma and their partners reliably performed SSE after participating in a structured skills training program lasting approximately 30 minutes. Accurate SSE by those at risk may enhance early detection of second primary or recurrent melanomas.

Continuing Medical Education

Early androgenetic alopecia (AGA) is patterned hair loss occurring before age 30 years. Early AGA in men is frequently reported as the phenotypic equivalent of polycystic ovarian syndrome (PCOS) in women, which carries the risk of developing obesity, metabolic syndrome, and cardiovascular disease. In this case-control study, Sanke et al demonstrate that patients with early AGA had significantly elevated levels of luteinizing hormone, dehydroepiandrosterone sulfate, total testosterone, and prolactin along with decreased follicle-stimulating hormone and sex hormone–binding globulin. These men could be exposed to the same metabolic risks as women with PCOS, regardless of PCOS severity.

Large case series suggest that patients with folliculotropic mycosis fungoides (FMF) have a worse prognosis than patients with classic mycosis fungoides (MF), and the clinical staging system for MF cannot be used to classify FMF in a clinically meaningful way. A subgroup of patients with FMF may have a more favorable prognosis. In this prospective cohort study, van Santen et al demonstrate that additional histologic criteria can be used to differentiate between indolent and aggressive FMF, a finding that may have important therapeutic consequences.

An optimal strategy for management of the Merkel cell carcinoma (MCC) primary tumor site has yet to be determined. Because MCC is a radiosensitive tumor, adjuvant radiation therapy (RT) is commonly used. The utility of RT in patients at low risk for local recurrence is unclear. In this observational study, Frohm et al demonstrate that patients with a primary tumor diameter smaller than 2 cm treated with surgery alone had a low rate of local or satellite recurrences. This low rate of local recurrence suggests that adjuvant RT to the MCC site may be unnecessary in patients with low-risk primary lesions.

Gloves were first introduced to surgical practice more than a century ago. Whether the use of sterile vs nonsterile gloves makes a difference in the development of surgical site infection (SSI) in cutaneous and minor outpatient surgical procedures remains unclear. In this systematic review, Brewer et al found no difference in the rate of postoperative SSI between outpatient surgical procedures performed with sterile vs nonsterile gloves. More extensive surgery or complicated repairs may have a higher risk of SSI, which should be taken into consideration.

Author Audio Interview