In November 2022, the Centers for Disease Control and Prevention updated a 2016 practice guideline for opioid prescription.1 This update consists of 12 key recommendations and five guiding principles related to clinical scenarios excluding sickle cell disease, nonsurgical cancer-related pain, palliative care, and end-of-life care. Dermatologists prescribe opioids in acute scenarios, including postoperatively following Mohs micrographic surgery and reconstruction, and for subacute or chronic pain related to inflammatory conditions, such as hidradenitis suppurativa, psoriasis, chronic ulcers, blistering skin diseases, and erosive lichen planus.
As medical students navigating the new landscape of residency selection after the switch to a pass/fail USMLE (United States Medical Licensing Examination) Step 1, we read a recent viewpoint by Ozair et al [1] with great interest. We hope to offer a unique perspective and present additional potential solutions for residency programs and medical schools to consider.
We agree with the authors’ observation that research productivity is now necessary for a successful match with competitive specialties. Ozair et al [1] discussed the disadvantages for international medical graduates (IMGs) and provided a cost-benefit analysis of students trying to maximize research output. We would add that research by medical students relies on access to well-funded research institutions and adequate mentorship. This impacts IMGs as well as students attending institutions without home residency programs [2]. To gain access to research experiences, medical students increasingly undertake research years [3]. These research fellowships, some of which are paid whereas others are not, are competitive and limited. Unpaid research fellowships pose several problems, such as potential loss of student status and subsequent requirement for loan repayments, loss of health insurance, and need to fund living expenses and relocation costs [3]. Students with already-limited access to research experiences can face prohibitively high financial burdens in this context.
Background: Since the implementation of social distancing practices during the global coronavirus disease 2019 (COVID-19) pandemic there have been a myriad of definitions for ‘social distancing.’ The objective of this study was to determine students’ awareness of the various definitions of social distancing, how strictly they adhered to social distancing guidelines, and how they perceived the importance of various social distancing practices.
Methods: This cross-sectional survey was distributed via email to students at Emory-affiliated graduate schools, including the Medical, Nursing, and Public Health Schools.
Results: Of the 2,453 recipients of the survey, 415 students responded (16.9% response rate). The majority of respondents were medical students (n=225, 55.6%). Of the respondents, 357 noted that they “frequently” or “always” abided by social distancing. The most common definition of social distancing with which respondents were familiar was the Centers for Disease Control and Prevention (CDC)’s (n=276 of 369 responses, 74.8%). There were significant differences across groups when grouping students by the definition of social distancing that they were aware of, the social distancing guideline they most closely followed, and their school of attendance regarding the importance of specific social distancing examples (p<0.05 for each).
Conclusions: A survey of healthcare students identified differences in the importance of social distancing practices based on the definition of social distancing that they were aware of. The results of this study underscore the importance of having unified definitions of public health messaging, which ultimately may impact disease spread.
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.
Becker's nevus is a cutaneous hamartoma that may be present at birth, but more commonly is noticed during puberty. It classically manifests unilaterally on the shoulder and upper trunk as a tan to brown patch or thin plaque. "It typically has an irregular margin, breaks up into islands at the periphery, and has an average size of 125 square centimeters. Numerous skin, soft-tissue, and bony anomalies have been reported in association with Becker's nevus. We describe a patient with Becker's nevus of considerable size who has a concurrent epidermal nevus.
We present the case of a 29-year-old black female with an initial clinical and histopathologic diagnosis of actinic lichen nitidus. Three years later, she presented with scattered hyperpigmented macules with oval pink/violaceous plaques bilaterally on her forearms and on her neck, clinically consistent with actinic lichen planus. She was treated with topical steroids at each visit, with subsequent resolution of her lesions. In this report, we discuss the spectrum of actinic lichenoid dermatoses and of disease that presents even in the same patient.
Electronic brachytherapy (EBT) garnered interest among dermatologists as a noninvasive treatment for keratinocyte carcinomas. While the magnitude of use and cost burden had not yet been quantified, this interest prompted an official statement from the American Academy of Dermatology supporting its use as secondary option in special circumstances, and led to changes to billing and coding for the procedure. Using provider level Medicare claims, this study demonstrates increased use of EBT between 2012 and 2015. We also showed that very few dermatologists utilized EBT, with only 39 dermatologists billing for EBT in 2015. This study documents that large scale policy changes were implemented in response to the practice behaviors of a small number of dermatologists, and provides information regarding the cost of EBT for consideration on how to best optimize its use in clinical practice.
To the Editor: Long-term survivors of solid organ transplants are at an increased risk of malignancies, most commonly skin cancer.1 While the risks of heart, lung, kidney, kidney-pancreas, liver, and hematopoietic cell transplant recipients are established, there are limited data on pancreatic islet cell transplant (ICT) recipients.2 ICT is an effective beta-cell replacement therapy performed to normalize glycemic control in patients with type 1 diabetes mellitus3 and/or as a treatment for patients with chronic pancreatitis.4 This study aims to identify and compare the incidence of nonmelanoma skin cancer (NMSC) in allogeneic and autologous ICT recipients.
Panfolliculoma is a rare benign neoplasm defined by differentiation toward all components of the hair follicle. Fewer than 40 previous cases have been described in the literature. We present a rare case of panfolliculoma in a patient with SUFU-associated basal cell nevus syndrome (BCNS), which, to our knowledge, has never previously been reported.
Introduction: The shift of Step 1 to Pass/Fail has generated several questions and concerns about obtaining residency positions among allopathic and osteopathic students alike. Determining the perspectives of Dermatology Program Directors in regards to post-Step 1 Pass/Fail is critical for students to better prepare for matching into dermatology.
Methods: After receiving Institutional Review Board (IRB) exemption status, the program directors were chosen from 144 Accreditation Council for Graduate Medical Education (ACGME) and 27 American Osteopathic Association (AOA) Dermatology programs using contact information from their respective online website databases. An eight-item survey was constructed on a three-point Likert scale, one free text response, and four demographic questions. The anonymous survey was sent out over the course of three weeks with weekly individualized reminder requests for participation.
Results: A total of 54.54% of responders had “Letters of Recommendation” in their top 3. Forty-five percent of responders had “Completed Audition Rotation at Program” in their top 3. And, 38.09% of responders had “USMLE Step 2 CK Scores” in their top 3.
Conclusion: Approximately 50% of responders agreed that all medical students will have more difficulty matching dermatology. Based on the survey study, Dermatology program directors want to focus more on letters of recommendation, audition rotations, and Step 2 CK scores. Because each field seems to prioritize different aspects of an application, students should attempt to gain as much exposure to different fields such as through research and shadowing to narrow down their ideal specialties. Consequently, the student will have more time to tailor their applications to what residency admissions are looking for.