From diagnosis to intervention: a review of telemedicine's role in skin cancer care

Skin cancer treatment is a core aspect of dermatology that relies on accurate diagnosis and timely interventions. Teledermatology has emerged as a valuable asset across various stages of skin cancer care including triage, diagnosis, management, and surgical consultation. With the integration of traditional dermoscopy and store-and-forward technology, teledermatology facilitates the swift sharing of high-resolution images of suspicious skin lesions with consulting dermatologists all-over. Both live video conference and store-and-forward formats have played a pivotal role in bridging the care access gap between geographically isolated patients and dermatology providers. Notably, teledermatology demonstrates diagnostic accuracy rates that are often comparable to those achieved through traditional face-to-face consultations, underscoring its robust clinical utility. Technological advancements like artificial intelligence and reflectance confocal microscopy continue to enhance image quality and hold potential for increasing the diagnostic accuracy of virtual dermatologic care. While teledermatology serves as a valuable clinical tool for all patient populations including pediatric patients, it is not intended to fully replace in-person procedures like Mohs surgery and other necessary interventions. Nevertheless, its role in facilitating the evaluation of skin malignancies is gaining recognition within the dermatologic community and fostering high approval rates from patients due to its practicality and ability to provide timely access to specialized care.

Effectiveness of atopic dermatitis patient education programs - a systematic review and meta-analysis

Patient education in atopic dermatitis (AD) has worked in parallel to the gold standard of pharmacological treatment as a foundational component of therapeutic regimens. In addition to improving patient education, past investigations of educational interventions have demonstrated profound reductions in disease severity for patients living with AD. However, prior meta-analytical work has focused mostly on comparing in-person interventions, and thus the need to determine the effectiveness of virtual methodologies in the current post-COVID era remains. In this study, we conducted a systematic review of the literature to determine the effectiveness of online programming in AD education compared to in-person interventions. A comprehensive search was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions 2019. Studies were retrieved based on articles published up to 04 April 2023. Adherence to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Statement guided the reportage process for this systematic review and meta-analysis. The primary outcome of our meta-analysis was the effect of various educational modalities on atopic dermatitis severity as measured by multiple scales across the studies, the most common including SCORAD, Dermatology Life Quality Index (DLQI), Patient Oriented Eczema Measure (POEM), and Eczema Area and Severity Index (EASI). Most studies were randomized controlled trials, primarily from North America and Western Europe and focused on patient and/or caregiver education about disease management, self-care techniques, avoidance of triggers, and comprehensive understanding of the disease process. Our pooled analyses showed that targeted educational programs in understudied adult populations can be as impactful as those in pediatric groups. Moreover, virtual interventions can be employed as constructive tools for reducing barriers of access to patient education. Future research on educational interventions should utilize various methodologies to encourage individual learning preferences with a focus on adult cohorts.

Trends in Mohs surgery fellowship directors

The purpose of this study is to illustrate demographic trends among Mohs Micrographic Surgery (MMS) Fellowship Directors. Our search was constructed from the 2022 to 2023 Mohs Micrographic Surgery Fellowship Directory on the Accreditation Council for Graduate Medical Education (ACGME) website. Datapoints gathered included: age, sex, residency/fellowship training location, time since training completion until FD appointment, length in FD role, and personal research H-index. We identified 77 FDs, of which all 77 were included in this study. The mean age was 55.5 years; 55 (71.4%) were men and 20 (26.0%) were women. Most of the FDs who completed the survey did not self-report ethnicity or race, so these measures were not included. The top residency institutions that produced the most FDs were Cleveland Clinic (n = 4), Mayo Clinic (n = 4), New York University Medical Center (NYU, n = 4), and University of California-Los Angeles (UCLA, n = 4); the top fellowship institutions were NYU (n = 7), UCLA (n = 5), Cleveland Clinic (n = 4), and Geisinger Medical Center (n = 4). The mean H-index was 15.9, the mean number of peer-reviewed publications was 71, and the mean time from training completion until FD appointment was 10 years. Our results indicate that a majority of FDs are men (71.4%) and that FDs are more likely to have graduated from certain residency and fellowship programs.

A Cost-Based Analysis of Anti-aging Products Across Four Major United States Retailers

Background In the field of aesthetic dermatology, there is currently very little data on affordability and cost analysis regarding cosmeceuticals as more demand from patients showing interest in cosmeceutical products to reduce and prevent aging continues to grow. Photoaging, a form of extrinsic aging from sun exposure, can be ameliorated by applying sunscreen and retinol products. Topical ascorbic acid and niacinamide have been shown to target the oxidative stress process that contributes to photoaging. These four products have been identified as the cosmeceutical ingredients with the most evidence-based data on photoaging prevention and treatment. Objective Given the demand for effective skin care, the paucity of data on cost differentiation, and the availability of cosmeceutical products, we analyzed the unit cost of four anti-aging products from major online and physical retailers in the United States. Such a cost comparison may facilitate more economically appropriate recommendations on skin care to consumers. Methods and materials We analyzed sunscreen, topical vitamin C (ascorbic acid), topical vitamin B3 (niacinamide), and topical vitamin A (retinol) products sold by four major United States retailers: Walmart, Ulta, Walgreens, and Amazon. The average cost in dollars per ounce (dollar/oz) was calculated for each product category at each retailer. Statistical analyses were done to determine statistical significance for each product category between retailers as well as between each category of product. Results Between the four retailers, Walmart offered the lowest cost per ounce for every product. In contrast, Amazon offered the highest cost per ounce for every product except for sunscreen. We also found that sunscreen products are less expensive per ounce as compared to retinol, ascorbic acid, and niacinamide products. Conclusion Dermatologists should be knowledgeable of product costs when providing patients with anti-aging product recommendations. Our study provides data on the financial cost by retail location of evidence-based anti-aging cosmeceuticals to better guide physicians in patient consulting and economical resource sharing.

Monodactylous Longitudinal Melanonychia in Pediatric Skin of Color: A Case Series and Review

Introduction

Longitudinal melanonychia, a pigmented longitudinal streak on the nail, is a common clinical finding that may be associated with subungual melanoma with varying presentation depending on race and skin tone. It has been long reported that darker skinned ethnicities have a higher prevalence of longitudinal melanonychia in the US population (e.g., African Americans with 77% prevalence) [Indian J Dermatol. 2021;66(4):445], but unfortunately, there are limited studies exclusively looking at longitudinal melanonychia in pediatric patients of color.

Case Presentation

In this case series, we review the current literature and report the findings of 8 cases of longitudinal melanonychia in children with skin types IV or greater. Out of the 8 cases identified, only 4 returned to the clinic for monitoring (n = 4), and there was an average of 20.8 months between the initial and final visits. Of the patients that returned for follow-up, 2 showed no relevant changes in the nail pigmentation, 1 showed fading of the band, and 1 patient showed enlargement of the band to involve the whole nail.

Conclusion

Although many sources recommend a conservative approach to treatment that involves monitoring and follow-up, our findings indicate that a wait-and-see method cannot be applied to all cases in the pediatric population due to disruptions in continuity of care. An individualized approach considering such factors should be employed for each patient, and certain high-risk features of the ABCDEF nail melanoma model may be relevant in pediatric cases.