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In This Issue of JAMA Dermatology
August 2019


JAMA Dermatol. 2019;155(8):875. doi:10.1001/jamadermatol.2018.3528


Saldanha and colleagues, using tissue samples from a retrospective cohort of 1239 patients, developed a 2-dimensional measure of tumor size, calculated tumor area, and compared its ability to provide malignant melanoma prognosis with Breslow thickness, a 1-dimensional measure that is the cornerstone of skin-cancer staging. Results showed that calculated tumor area provided prognostic value with greater relative importance than Breslow thickness, suggesting that further study to confirm the prognostic value of calculated tumor area for melanoma should be a high priority for dermatologic investigators. McCalmont provides the Editorial.


Morenz and coauthors used a mixed-methods survey study to examine the barriers faced by Native American patients in rural areas in accessing dermatological care. Results showed that substantial geographic and insurance coverage barriers exist for Native American individuals in rural communities. The mean distance between the closest dermatological clinic and a rural Indian Health Service or tribal hospital was 68 miles; 22% of the clinics did not accept any form of Medicaid; 22% did not accept Indian Health Service referrals for patients without insurance. Additionally, of the 303 US rural Indian Health Service or tribal facilities, only 9% were served by a telemedical program. Kohn and Introcaso provide the Editorial.


In this nonrandomized controlled intervention study, Albertini and colleagues evaluated the effectiveness of a data-based behavioral intervention for reducing the overuse of Mohs micrographic surgery (MMS). Outlier physicians, with 2 standard deviations above the mean stages-per-case for MSS, received a personalized performance report from a peer. After receiving individual reports of MMS practice patterns, outlier physicians showed an immediate and sustained reduction in mean stages-per-case compared with physicians who did not receive personalized practice reports. Resneck and Van Beek provide the Editorial.


Dieng and coauthors used a survey study to explore patients’ perceptions about skin self-examination after receiving treatment for localized melanoma for stage 0, I, or II disease. Interview results showed that patients were aware of the importance of thorough self-examination but were not confident in their ability to perform an adequate skin self-examination. Many participants were receptive to new digital technologies that assist in performing self-examinations, as long technical support for these new tools was available.

Lee and colleagues conducted a systematic review and meta-analysis of 46 studies to estimate the treatment responses to topical calcineurin inhibitor (TCI) monotherapy and TCI therapy paired with phototherapy for vitiligo and to examine the mechanism of action of TCIs for vitiligo treatment. Results showed that TCI therapy, whether alone or when paired with phototherapy, appears to have significant therapeutic effects on vitiligo and should be encouraged in patients with the disease.

Continuing Medical Education