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In This Issue of JAMA Dermatology
February 2018

Highlights

JAMA Dermatol. 2018;154(2):125. doi:10.1001/jamadermatol.2017.3818
Research

Dermatologists are sued less frequently than those in other specialties, but about 36% will be sued at least once by age 45 years. Recognizing malpractice trends is important for establishing safeguards for patient care and minimizing liability. In this analysis of malpractice data from a national registry, Kornmehl et al demonstrate that dyschromia was the most common adverse outcome alleged in lawsuits. Clinicians may not associate dyschromia with substantial morbidity, and clinician and patient perceptions of adverse outcomes may differ. Improving clinical and communication skills may help reduce dermatologists’ liability. Konda and Torres provide an Editorial.

Editorial

Keratinocyte carcinoma (KC) in the form of cutaneous basal cell carcinoma (CBCC) and squamous cell carcinoma (CSCC) accounts for about three-quarters of all US cancers. Topical fluorouracil reduces CSCC precursors and can cure superficial CBCC and CSCC in situ. In this randomized clinical trial of veterans at high risk for KC, Weinstock et al demonstrate that a 2- to 4-week course of topical fluorouracil, 5%, applied twice daily reduced the risk of CSCC for 1 year. Effective chemoprevention of cutaneous CSCC for a year is achievable with this regimen, suggesting a possible role for annual use in high-risk patients.

Continuing Medical Education

Staging is an important tool in the prognostic stratification and clinical management of cancer. For CSCC, cancer staging is pivotal to separating the rare high-risk cases from the low-risk majority. The seventh edition of the AJCC Cancer Staging Manual (AJCC 7) failed to accurately stratify CSCC disease-related outcomes. In this cohort study, Karia et al found that the AJCC 8 demonstrated improved homogeneity and monotonicity compared with AJCC 7, with T2, T3, and T4 cases accounting for almost all of the poor outcomes.

Calciphylaxis is a rare disease characterized by vascular calcification and cutaneous necrosis. Chronic nonhealing wounds may be complicated by infection and sepsis, leading to a high mortality rate. Hypercoagulable conditions are frequently observed in patients with calciphylaxis and in those with chronic kidney disease (CKD), but rigorous studies of the association remain limited. In this matched case-control analysis, Dobry et al discovered significant associations between development of calciphylaxis and presence of lupus anticoagulant, protein C deficiency, and combined thrombophilia. Prospective screening for these factors may help identify patients with CKD at increased risk for calciphylaxis.

Clinical Review and Education

Nongenital molluscum contagiosum (NMG) is a common skin infection that is caused by a poxvirus and occurs commonly in children. The infection usually resolves within months without immune deficiency, but treatment may be desired for social or cosmetic reasons. In this summary of an updated Cochrane review of NGM treatments, imiquimod, 5%, cream was not found to be more effective than placebo, and it caused more local adverse effects. No evidence clearly supported any treatment, making “benign neglect” a reasonable approach to managing NGM.

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