JAMA Dermatology Pages 1045-1152

In This Issue October 2015 Volume 151, Number 10 JAMA Dermatology Pages 1045-1152

Research Opinion Long-term Management of Adult Vulvar Lichen Sclerosus 1061 Viewpoint 1055 Screening for Acral Lentiginous Vulvar lichen sclerosus (VLS) is an uncommon skin disease that is sometimes complicated Melanoma in Dark-Skinned Individuals by vulvar squamous neoplasia (VSN). Current guidelines of care advocate use of superpo- MA Marchetti and Coauthors tent topical corticosteroids (TSCs) as fi rst-line treatment to achieve remission. Less is known Editorial about maintenance therapy for VLS. In this prospective longitudinal cohort study, Lee et al 1057 Bringing Diagnostic Optical demonstrate that individualized preventive TCS regimens, with potency titrated to objec- Technologies Into the Clinic tive disease severity, reduced symptoms, scarring, and risk of VSN. Few cases of reversible V Neel cutaneous atrophy were observed. 1059 Reduced Risk of Squamous Cell Carcinoma With Adequate Treatment Editorial 1059 of Vulvar Lichen Sclerosus SM Cooper and Coauthors In Vivo Multiphoton Microscopy of Basal Cell Carcinoma 1068 Basal cell carcinoma (BCC) is the most common human cancer. Diagnosis is primarily via Clinical Review & Education clinical evaluation, with defi nitive diagnosis via biopsy and histopathologic evaluation. JAMA Dermatology Clinicopathological Diagnostic optical technologies off er the possibility of rapid, pain-free, and noninvasive Challenge light-based histopathologic examination. Most current in vivo optical imaging devices rely on variations in refractive indices, leading to low-contrast images that may prove diffi cult to interpret. Multiphoton microscopy (MPM) introduces additional degrees of contrast by taking advantage of endogenous fl uorophores in the skin. In this small pilot study, Balu et al demonstrate that in vivo MPM imaging can provide label-free contrast to reveal several characteristic features of BCC. Editorial 1057 Continuing Medical Education jamanetworkcme.com

In Situ and Invasive Melanoma in Denmark 1087 In Denmark, the incidence of malignant melanoma (MM) has doubled during the past 25 years. In this descriptive analysis of the offi cial national Danish Melanoma Group data- 1121 What is your diagnosis? base, Helvind et al demonstrate that the incidence, mortality, and characteristics over time of the MM population in Denmark correspond with fi ndings of similar studies world- HUMANITIES wide. Incidence of MM increased, with a relative increase in in situ tumors, indicating that Notable Notes secondary interventions such as screening were eff ective. A persisting increase in male 1074 Remembering Dr Walter Burgdorf LJ Hoenig mortality and incidence of MMs suggests that this increase is not due solely to overdiagno- sis and diagnostic drift, and that primary interventions need to be intensifi ed. 1102 As Smooth as Honey— The Historical Use of Honey as Topical Medication Botulinum Toxin A for Painful Cutaneous Leiomyomas 1096 R Zubair and N Aziz Cutaneous leiomyomas are smooth-muscle tumors that commonly arise from the arrector 1112 Let Food Be Thy Medicine pili muscle. Among aff ected individuals, 92% experience pain associated with these le- R Minocha sions, but the mechanism of this pain is poorly understood. Some data suggest that nerve conduction pathways could be targeted to minimize leiomyoma-associated pain. In this randomized trial, Naik et al demonstrate that intralesional botulinum toxin was associated with improvement in skin-related quality of life, even though pain at rest and pain severity improvements were not statistically signifi cant. Departments 1054 Staff Listing Toxic Skin Eff ects of BRAF Inhibitors for Metastatic Melanoma 1103 1068 CME Article BRAF inhibitors have revolutionized the treatment of stage IV metastatic melanoma. The 1147 Classifi ed Advertising MEK inhibitor trametinib dimethyl sulfoxide has also shown a survival benefi t in the same 1149 Journal Advertiser Index population. In this retrospective cohort study, Carlos et al compare the cutaneous toxic ef- 1150 Contact Information fects of BRAF inhibitor monotherapy with BRAF inhibitor–trametinib combination therapy 1152 CME Questions (CombiDT). Cutaneous squamous cell carcinoma was the most concerning cutaneous toxic Instructions for Authors eff ect related to BRAF inhibitor monotherapy. CombiDT therapy had an improved profi le www.jamadermatology.com/public of cutaneous toxic eff ects, although continuous dermatologic assessments should be pro- /instructionsforauthors.aspx vided for all patients receiving these treatments.

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