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In This Issue of JAMA Dermatology
March 2017


JAMA Dermatol. 2017;153(3):247. doi:10.1001/jamadermatol.2016.1665


Atopic dermatitis (AD) is a common inflammatory skin disorder among children. Therapeutic options include topical steroids and topical calcineurin inhibitors (TCIs). Loss of function (LOF) mutations in the FLG gene and genetic variants of the interleukin 7–like cytokine thymic stromal lymphopoietin (TSLP) each demonstrate an association with AD severity and persistence. In this cohort study, Chang et al demonstrate that children with 2 FLG LOF alleles were less likely to experience skin clearance and use steroids, while TSLP rs1898671 homozygotes were less likely to report TCI use. The number of LOF alleles or single-nucleotide polymorphisms were more important than the absolute presence of these variants.



Melanoma arising in chronically photodamaged skin, especially on the head and neck, is often characterized by poorly defined clinical margins and unpredictable occult extension. Excision with standard margins may be inadequate among these patients and is associated with a higher risk of local recurrence. In this cohort study, Moyer et al demonstrate that staged excision with comprehensive permanent section margin control of these melanomas had low local recurrence rates, and patient satisfaction with reconstructive outcomes was high.


Squamous cell carcinoma (SCC) is potentially metastatic and life threatening. Surgical excision remains the standard treatment, but microinvasive SCC is limited to the papillary dermis and may be differentiated from invasive SCC. Photodynamic therapy (PDT) with methyl aminolevulinate (MAL) is an innovative treatment that has been approved for actinic keratosis, basal cell carcinoma, and Bowen disease. In this randomized clinical trial, Choi et al demonstrate that priming the treatment site with ablative fractional resurfacing prior to MAL-PDT was more efficacious than conventional MAL-PDT for microinvasive SCC.

The number of solid organ transplants performed in the United States is increasing, but the lifelong immunosuppression required to preserve graft function places organ transplant recipients (OTRs) at risk for skin cancer. Although this increased risk has been previously reported, incidence data across a wide transplant population are lacking. In this population-based cohort study, Garrett et al demonstrate that the incidence rate for posttransplant skin cancer overall was 1437 per 100 000 person-years. Elevated risk was imparted by increasing age, white race, male sex, and thoracic organ transplantation.

Seeking shade is widely practiced to avoid direct sun exposure. People often assume that their skin is fully protected as long as they are under the shade of an umbrella. Beach umbrellas may have high UV protection factor ratings but do not protect skin from UV rays with angles of approach diffused by atmospheric particles or reflected from the ground. In this randomized clinical trial, Ou-Yang et al demonstrate that umbrella shade alone may not provide sufficient sun protection during extended exposure to UV rays. Neither umbrella nor SPF 100 sunscreen alone completely prevented sunburn, highlighting the importance of combining sunscreen practices to optimize UV protection.