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In This Issue of JAMA Dermatology
November 2019


JAMA Dermatol. 2019;155(11):1213. doi:10.1001/jamadermatol.2018.3543


In this national cross-sectional analysis, Lee and colleagues reviewed trends in the use of comprehensive margin assessment surgery among US adults with melanoma by tracking claims data for Mohs surgery. The primary outcome was the likelihood of a melanoma being treated with Mohs surgery over time, evaluated by multivariable logistic regression and expressed as the odds of treatment per additional calendar year. Results showed that there was marked geographic variation in surgical practices, but the use of Mohs surgery with and without immunohistochemistry is increasing. Miller and colleagues provide a Viewpoint.


Kim and colleagues performed this cohort study to examine whether vitamin A intake is associated with cutaneous squamous cell carcinoma risk among US adults. Data were collected from the Nurses’ Health Study and the Health Professionals Follow-up Study. Diet was assessed repeatedly, and incident squamous cell carcinoma was confirmed by pathologic reports. During a follow-up period of more than 26 years, higher total vitamin A intake was associated with a reduction in cutaneous squamous cell carcinoma risk.

For this registry cohort study, Margolis and colleagues compared results of targeted sequencing of FLG loss-of-function variants in African American and white children in the United States and the association of these variants with onset and persistence of atopic dermatitis. Results demonstrated that FLG loss-of-function variants differed significantly by race, were associated with race, and overall differences were noted with respect to whether any variant was present as well as the frequency of individual variants. These findings suggest that using FLG loss-of-function variants to diagnose atopic dermatitis may be difficult because common variants in one race may be absent or rare in another.

In this cohort study using US electronic health record data, Reddy and colleagues compared overall and subgroup incidence of long-term opioid use in a population of opioid-naive patients with hidradenitis suppurativa. Among patients with hidradenitis suppurativa, advancing age, ever smoking, history of depression, and baseline Charlson comorbidity index score were associated with higher odds of long-term opioid use. These results suggest that patients with hidradenitis suppurativa may benefit from periodic assessment of pain and screening for opioid misuse.

Continuing Medical Education

Dick and colleagues performed this meta-analysis to evaluate the accuracy of computerized systems in the diagnosis of melanoma in patients with skin lesions. A total of 70 studies that reported on the accuracy of automated systems for melanoma were selected. Results showed that the accuracy of computer-aided diagnosis is comparable to that of human experts. However, current studies are heterogeneous and most deviate significantly from real-world scenarios and are prone to biases.