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In This Issue of JAMA Dermatology
June 2018

Highlights

JAMA Dermatol. 2018;154(6):639. doi:10.1001/jamadermatol.2017.3838

Vascular malformations (VAMs) are abnormalities in blood vessel morphogenesis with a prevalence rate of 1.2% to 1.5% among children. Patients with VAMs have a lower health-related quality of life than the general population, but the factors related to this have been largely unknown. In this systematic review and meta-analysis, Nguyen et al demonstrate that patients with VAMs have more pain and greater mental stress than the general population. Head and neck involvement was particularly problematic because of visibility and influence on sleep functions. Understanding of the type, quality, and location of VAMS will help guide patient care.

Editorial

Continuing Medical Education

Breast cancer is the most common malignant neoplasm among women in the United States. Cytotoxic chemotherapy and endocrine therapy (ET) remain the cornerstones of treatment. Despite their benefits, ETs are known to have substantial adverse effects. Alopecia accounts for 8% of patients who discontinue aromatase inhibitor treatment. Even patients with grade 1 alopecia are greatly emotionally affected. In this cohort study, Freites-Martinez et al demonstrate that ETs were associated with a pattern alopecia similar to androgenetic type, and this alopecia had a significant negative effect on quality of life. Topical minoxidil, 5%, treatment improved alopecia in 80% of patients.

Editorial

The past few years have brought substantial progress in the treatment of moderate to severe psoriasis with biologic therapy. However, scalp, palmoplantar, and fingernail psoriasis remain challenging to treat. In this secondary analysis of 2 randomized clinical trials, Foley et al demonstrate that compared with adalimumab, guselkumab significantly improved psoriasis on the scalp, palms, and soles. The magnitude of improvement of fingernail psoriasis did not differ. When making decisions about treatment options for patients with moderate to severe psoriasis, these data will help guide treatment based on body area involvement.

Germline variants in the MC1R gene are common and confer moderate melanoma risk in those with varied skin types. Approaches to precision skin cancer prevention that include genetic information may promote risk awareness and risk reduction in the general population. In this randomized clinical trial, Hay et al document relatively high rates of interest and follow-through for skin cancer genetic testing in primary care settings. These data offer insight into how precision skin cancer risk assessments might be received in unselected populations.

Skin cancer presents a global health challenge, and teledermatology referrals may result in earlier assessment and treatment when clinically indicated. Dermoscopy is a noninvasive diagnostic technique that links clinical dermatology with dermatopathology of pigmented and nonpigmented skin lesions by enabling visualization of morphological features not seen by the naked eye. In this decision-analytic modeling study, Snoswell et al demonstrate that incorporating teledermoscopy as a referral method for skin cancer in Australia has the potential to benefit patients by providing earlier clinical resolution, but at additional cost to Medicare.

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