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In This Issue of JAMA Dermatology
September 2018


JAMA Dermatol. 2018;154(9):985. doi:10.1001/jamadermatol.2017.3853


There are limited data among young adults regarding the association of melanoma risk with sunscreen use during childhood and young adulthood. In this population-based, case-control family study using Australian Melanoma Family Study data, Watts et al found that childhood and lifetime sunscreen use were significantly associated with a decreased risk of cutaneous melanoma among young adults. Sex, age, ancestry, educational level, skin pigmentation, and sunburn were factors associated with sunscreen use. Regular sunscreen use may reduce the risk of melanoma among young adults.

Despite receiving dermatologic care, many patients either do not use sun protection or do not use it effectively. In this longitudinal controlled cohort study, Mallett et al found that patients who received the Addressing Behavior Change intervention (a short question-and-diagnosis interaction with the dermatologist) rated the quality of dermatologist-patient communication more positively and reported fewer sunburns and higher rates of sunscreen use than did controls across time. This brief intervention may improve patients’ sun protection behavior.

The recently described pigmented lesion assay, a noninvasive gene expression test, has the potential to reduce the need for surgical biopsy of pigmented lesions. In their modeled cost-savings analysis of the pigmented lesion assay used to diagnose pigmented lesions suggestive of melanoma, Hornberger and Siegel found a 47% cost reduction per assessed lesion vs the standard of care and a lower false-negative rate. The pigmented lesion assay could improve both the quality and cost of pigmented lesion management.

Cutaneous leishmaniasis is generally considered a tropical disease, but its incidence among US patients is increasing. In this cross-sectional observational study, McIlwee et al report 41 novel cases of endemic cutaneous leishmaniasis since 2007, mostly in Texas; the endemic cases represented 59% of all cases identified. Human cutaneous leishmaniasis appears now to be endemic in the United States, acquired endemically more frequently than via travel, which argues in favor of making it a federally reportable disease.

Continuing Medical Education

Multiple erythema migrans might be associated with unfavorable antibiotic treatment outcome vs solitary erythema migrans. Both are manifestations of early Lyme borreliosis. In this cohort study of patients with Lyme borreliosis and either multiple erythema migrans or erythema migrans, Stupica et al found that multiple erythema migrans was associated with constitutional symptoms more often than erythema migrans. However, The outcome at 12 months after treatment was comparable between groups. Future studies should include follow-up of at least 12 months to assess post–Lyme borreliosis symptoms.