The goal of our study was to determine current melanoma reporting methods available to dermatologists and dermatopathologists and quantify changes in reporting methods from 2012 to 2014. A cross-sectional study design was utilized consisting of website perusal of reporting procedures, followed up by telephone and email inquiry of reporting methods from every state cancer registry. This study was conducted over a six-month period from February to August 2014. A previous similar survey was conducted in 2012 over the same time frame and results were compared. Kansas state cancer registry provided no data. As of August 2014, 96% of 49 state cancer registries had electronic methods available to all designated reporters. Seven (14%) states required an electronic-only method of reporting melanoma cases. Eighty-six percent allowed hard copy pathology report submission. Compared to the 2012 survey, 2 additional states were found to have initiated electronic reporting methods by 2014. In conclusion, a variety of methods exist for reporting diagnosed melanoma cases. Although most state cancer registries were equipped for electronic transmission of cases for mandated reporters, a number of states were ill-equipped for electronic submission from outpatient dermatologists. There was a general trend towards electronic versus nonelectronic reporting from 2012 to 2014.

Coronavirus disease 2019 (COVID-19) has led dermatology practices to severely limit in-person appointments due to social distancing and shelter-in-place measures.1 Even as infection rates fall and practices reopen, epidemiologic modeling predicts future resurgences of COVID-19, likely compelling practices to intermittently restrict in-person appointments again.2 Principles of scarce health care resource distribution have been applied during the COVID-19 pandemic, commonly for critical care resources.3 , 4 However, these principles have not been modified for or applied to limited in-person dermatology appointments during the pandemic. Guiding principles can inform dermatologists about how to prioritize patients and skin diseases in this context.

Background: Timely treatment for melanoma may affect survival, and characterizing the predictors of delay may inform intervention strategies. Objective: To determine characteristics associated with the interval between diagnosis and surgery in melanoma. Methods: The National Cancer Database was used to examine factors associated with the interval between diagnosis and surgery among 213 146 patients with stage I, II, or III cutaneous melanoma. Results: Among privately insured patients, time to surgery was longer for patients aged 50 to 70 years (hazard ratio [HR], 0.96) and older than 70 years (HR, 0.83) compared with those younger than 50 years. In contrast, patients without private insurance experienced a shorter surgical wait time if older (HR for age 50-70 years, 1.07; HR for age >70 years, 1.05). Other factors associated with longer surgical interval included nonwhite race, less education, higher comorbidity burden, advanced stage, and head or neck melanoma location. Limitations: Use of zip code–level data for income and education level. Conclusion: Patients with melanoma experience disparities in timely receipt of surgery.

Chronic pruritus has significant negative effects on health-related quality of life (QoL) and accounts for 7 million, or 1%, of all outpatient visits annually in the United States (Shive et al., 2013). Chronic pruritus is associated with comorbidities such as anxiety and depression, as well as negative effects on sleep quality (Yosipovitch and Bernhard, 2013). Little is known about how patient-reported QoL impairment due to pruritus is related to healthcare utilization. This national survey of U.S. veterans aimed to assess the association between itch severity and itch-related QoL impact with healthcare utilization.

Sexual minority persons – including lesbian, gay, bisexual persons – face unequal cancer risks and are a National Institutes of Health-designated health disparity population.1 While multiple studies demonstrated higher prevalence of skin cancer and associated risk factors in gay and bisexual men,2–4 two studies showed that sexual minority women (SMW) had lower prevalence of indoor tanning and skin cancers as compared with heterosexual women.4,5 Scant data exist on additional skin cancer risk behaviors among sexual minority women.

Women are entering medicine at increasing rates, particularly in dermatology. In this study, we compared women's influence and status in academic dermatology with that of men by examining authorship roles in peer-reviewed dermatology literature. We examined the literature in 2009 and compared that to 10 years prior (1999). A total of 1399 articles were reviewed, 594 of which met study criteria and were included in statistical analysis. There was a marked increase in senior female authorship over a decade (22% vs. 38%, p < 0.001). Female first authorship increased as well (41% vs. 51%, p < 0.001). In contrast, changes in male senior and first authorship were not statistically significant. Federal funding for female senior authors increased over a decade (19% vs. 37%, p = 0.05), and female senior authors in the 2009 cohort were more likely to hold a dual MD/PhD degree (0% vs. 11%, p = 0.04) or pure PhD degree (11% vs. 27%, p = 0.04). Women are approaching parity with men in terms of authorship in the dermatology literature, and additional research training and attainment of federal funding have helped women publish as senior authors.

Much has been written about big data in medicine, but few articles have focused on the potential for better data to transform dermatology.1 We provide a conceptual framework for how technologic advances could enable standardized data collection and analysis from patient-provider encounters and improve patient care, advance our understanding of dermatologic diseases, and streamline billing and reimbursement. We also briefly address some of the challenges unique to dermatology, though our primary goal is to describe the rationale for supporting improvements in routine clinical data collection.

Importance: Little evidence exists to guide the management of moderately dysplastic nevi excisionally biopsied without residual clinical pigmentation but with positive histologic margins (hereafter referred to as moderately dysplastic nevi with positive histologic margins). Objective: To determine outcomes and risk for the development of subsequent cutaneous melanoma (CM) from moderately dysplastic nevi with positive histologic margins observed for 3 years or more. Design, Setting, and Participants: A multicenter (9 US academic dermatology sites) retrospective cohort study was conducted of patients 18 years or older with moderately dysplastic nevi with positive histologic margins and 3 years or more of follow-up data collected consecutively from January 1, 1990, to August 31, 2014. Records were reviewed for patient demographics, biopsy type, pathologic findings, and development of subsequent CM at the biopsy site or elsewhere on the body. The χ2 test, the Fisher exact test, and analysis of variance were used to assess univariate association for risk of subsequent CMs, in addition to multivariable logistic regression models. To confirm histologic grading, each site submitted 5 random representative slide cases for central dermatopathologic review. Statistical analysis was performed from October 1, 2017, to June 22, 2018. Main Outcomes and Measures: Development of CM at a biopsy site or elsewhere on the body where there were moderately dysplastic nevi with positive histologic margins. Results: A total of 467 moderately dysplastic nevi with positive histologic margins from 438 patients (193 women and 245 men; mean [SD] age, 46.7 [16.1] years) were evaluated. No cases developed into CM at biopsy sites, with a mean (SD) follow-up time of 6.9 (3.4) years. However, 100 patients (22.8%) developed a CM at a separate site. Results of multivariate analyses revealed that history of CM was significantly associated with the risk of development of subsequent CM at a separate site (odds ratio, 11.74; 95% CI, 5.71-24.15; P <.001), as were prior biopsied dysplastic nevi (odds ratio, 2.55; 95% CI, 1.23-5.28; P =.01). The results of a central dermatopathologic review revealed agreement in 35 of 40 cases (87.5%). Three of 40 cases (7.5%) were upgraded in degree of atypia; of these, 1 was interpreted as melanoma in situ. That patient remains without recurrence or evidence of CM after 5 years of follow-up. Conclusions and Relevance: This study suggests that close observation with routine skin surveillance is a reasonable management approach for moderately dysplastic nevi with positive histologic margins. However, having 2 or more biopsied dysplastic nevi (with 1 that is a moderately dysplastic nevus) appears to be associated with increased risk for subsequent CM at a separate site.

BACKGROUND: Cutaneous T-cell lymphoma (CTCL) is a rare form of non-Hodgkin lymphoma arising in the skin. Geographic clustering of CTCL has recently been reported, but its association with environmental factors is unknown. Benzene and trichloroethylene (TCE) are environmental toxins with carcinogenic properties. The authors investigated associations between geographic clustering of CTCL incidence in the state of Georgia with benzene and TCE exposure. METHODS: The statewide county-level incidence of CTCL within Georgia was obtained from the Georgia Cancer Registry for the years 1999 to 2015. Standardized incidence ratios (SIRs) were calculated by dividing observed cases by expected cases using national incidence rates by age, sex, and race. Clustering of CTCL was analyzed using spatial analyses. County-level concentrations of benzene and TCE between 1996 and 2014 were collected from the Environmental Protection Agency’s National Air Toxics Assessment database. Linear regression analyses on CTCL incidence were performed comparing SIRs with levels of benzene and TCE by county. RESULTS: There was significant geographic clustering of CTCL in Georgia, particularly around Atlanta, which was correlated with an increased concentration of benzene and TCE exposure. Among the 4 most populous counties in Georgia, CTCL incidence was between 1.2 and 1.9 times higher than the state average, and benzene and TCE levels were between 2.9 and 8.8 times higher. CONCLUSIONS: The current results demonstrate nonrandom geographic clustering of CTCL incidence in Georgia. To the authors’ knowledge, this is the first analysis to identify a correlation between geographic clustering of CTCL and environmental toxic exposures.

Melanoma is usually apparent on the skin and readily detected by trained medical providers using a routine total body skin examination, yet this malignancy is responsible for the majority of skin cancer-related deaths. Currently, there is no national consensus on skin cancer screening in the USA, but dermatologists and primary care providers are routinely confronted with making the decision about when to recommend total body skin examinations and at what interval. The objectives of this paper are: to propose rational, risk-based, data-driven guidelines commensurate with the US Preventive Services Task Force screening guidelines for other disorders; to compare our proposed guidelines to recommendations made by other national and international organizations; and to review the US Preventive Services Task Force's 2016 Draft Recommendation Statement on skin cancer screening.