JAMA dermatology最新文献

3D Total-Body Photography in Patients at High Risk for Melanoma: A Randomized Clinical Trial.

IF 11.5 1区医学

JAMA dermatology Pub Date : 2025-03-26 DOI: 10.1001/jamadermatol.2025.0211

H Peter Soyer, Dilki Jayasinghe, Astrid J Rodriguez-Acevedo, Louisa G Collins, Liam J Caffery, David C Whiteman, Brigid Betz-Stablein, Sonya R Osborne, Anna Finnane, Caitlin Horsham, Clare Primiero, Leonard C Gray, Monika Janda

{"title":"3D Total-Body Photography in Patients at High Risk for Melanoma: A Randomized Clinical Trial.","authors":"H Peter Soyer, Dilki Jayasinghe, Astrid J Rodriguez-Acevedo, Louisa G Collins, Liam J Caffery, David C Whiteman, Brigid Betz-Stablein, Sonya R Osborne, Anna Finnane, Caitlin Horsham, Clare Primiero, Leonard C Gray, Monika Janda","doi":"10.1001/jamadermatol.2025.0211","DOIUrl":"10.1001/jamadermatol.2025.0211","url":null,"abstract":"Importance: Three-dimensional (3D) total-body photography (TBP) can support clinicians in monitoring and identifying changes to skin lesions in patients at high risk of melanoma.Objective: To assess clinical outcomes between patients at high risk of melanoma receiving usual clinical care compared with those receiving usual care plus 3D TBP and sequential digital dermoscopy imaging (SDDI) every 6 months via teledermatology.Design, setting, and participants: This randomized clinical trial was conducted at a research hospital in Brisbane, Australia, from April 2018 to October 2021, with adult patients (≥18 years) at high risk of developing a primary or subsequent melanoma. Data analysis was conducted from March 2022 to June 2024.Intervention: Usual care plus 3D-TBP in person and SDDI via teledermatology at baseline, 6, 12, 18, and 24 months. The control group continued usual care and completed online surveys every 6 months.Main outcome measures: Number and rates of excisions and/or biopsies of lesions suggestive of melanoma, and results of histopathologic testing.Results: The analysis included 314 participants (mean [SD] age, 51.6 [12.8] years; 194 females [62%]) who completed all of the study procedures (158 in the intervention and 156 in the control). In all, 1527 excisions (905 intervention and 622 in the control) were performed among 226 participants (122 intervention and 104 controls), with 67 (4%) histopathologically confirmed as melanoma and 402 (26%) as keratinocyte cancer (KC). The mean (SD) number of lesions of any type excised per person was significantly higher in the intervention (5.73 [6.77]; 95% CI, 4.66-6.79) compared to the control group (3.99 [5.72]; 95% CI, 3.08-4.89; P = .02). Fewer melanomas were detected among the intervention group compared with the control (24 [35%] vs 43 [64%], respectively), and therefore, a lower incidence rate: 2.03 (95% CI, 1.30-3.02) vs 3.62 (95% CI, 2.62-4.88), respectively. After 1 year of follow-up, the intervention had a lower, but not statistically significant, rate of melanoma per person: 0.08 (95% CI, 0.03-0.13) compared with 0.16 (95% CI, 0.08-0.25) in the control; an average of 0.86 (95% CI, 0.55-1.16) vs 0.42 (95% CI, 0.24-0.59) KCs per person; and 2.01 (95% CI, 1.50-2.51) vs 1.39 (95% CI, 0.98-1.82) excisions or biopsies per person, respectively.Conclusions and relevance: The results of this randomized clinical trial indicate that the addition of 3D-TPB and SDDI to usual care in a teledermatology setting without AI (artificial intelligence) increased the number and rate of skin excisions and biopsies performed. Further studies are required to compare teledermatology to usual care rather than adding it, and to study whether the use of AI can improve the teledermatology outcomes. Larger studies in multiple settings with a greater num","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":""},"PeriodicalIF":11.5,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11947971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Late-Onset Diffuse Xanthomas in an Adult Man.

IF 11.5 1区医学

JAMA dermatology Pub Date : 2025-03-26 DOI: 10.1001/jamadermatol.2025.0189

Reid Weisberg, Sameera Husain, Jason E Liebowitz

引用次数: 0

Error in Box.

IF 11.5 1区医学

JAMA dermatology Pub Date : 2025-03-26 DOI: 10.1001/jamadermatol.2025.0619

引用次数: 0

Error in Abstract.

IF 11.5 1区医学

JAMA dermatology Pub Date : 2025-03-26 DOI: 10.1001/jamadermatol.2025.0620

引用次数: 0

Lichen Sclerosus of the Neovagina and Neovulva.

IF 11.5 1区医学

JAMA dermatology Pub Date : 2025-03-26 DOI: 10.1001/jamadermatol.2024.6682

Sorcha O'Sullivan, Natalia Castrejón de Anta, Stephen Mounsey, Jaime Eduardo Calonje, Fiona Lewis

引用次数: 0

Cost-Effectiveness Analysis of 3D Total-Body Photography for People at High Risk of Melanoma.

IF 11.5 1区医学

JAMA dermatology Pub Date : 2025-03-26 DOI: 10.1001/jamadermatol.2025.0219

Daniel Lindsay, H Peter Soyer, Monika Janda, David C Whiteman, Sonya Osborne, Anna Finnane, Liam J Caffery, Louisa G Collins

{"title":"Cost-Effectiveness Analysis of 3D Total-Body Photography for People at High Risk of Melanoma.","authors":"Daniel Lindsay, H Peter Soyer, Monika Janda, David C Whiteman, Sonya Osborne, Anna Finnane, Liam J Caffery, Louisa G Collins","doi":"10.1001/jamadermatol.2025.0219","DOIUrl":"10.1001/jamadermatol.2025.0219","url":null,"abstract":"Importance: Greater use of novel digital technologies could be associated with improved health outcomes and save health care costs by detecting smaller melanomas earlier (needing less treatment) or benign tumors (needing no treatment).Objective: To compare costs and health effects of 3-dimensional (3D) total-body photography (TBP) and sequential digital dermoscopy imaging (SDDI) vs usual care for early detection of melanoma.Design, setting, and participants: This prespecified cost-effectiveness analysis using randomized clinical trial (n = 309) data with 2 years of follow-up was conducted at a research hospital in Brisbane, Australia, and took a health system perspective. It included adults 18 years or older at high risk of developing a primary or subsequent melanoma.Intervention: The intervention group received usual care plus clinical skin examinations by junior clinicians at baseline and 6, 12, 18, and 24 months with 3D TBP-SDDI reviewed by a teledermatologist. The control group continued to receive usual care and completed online surveys every 6 months.Main outcomes and measures: Government health care costs, patient out-of-pocket costs, numbers of benign and malignant skin tumor excisions, and quality-adjusted life-years. Skin biopsy, excisions, pathology, and their costs were collected using administrative claims data. Quality of life was collected using the EuroQol-5D-5L.Results: The trial included 314 participants (mean [SD] age, 51.6 [12.8] years; 194 female individuals [62%]) who completed all of the study procedures (158 in the intervention and 156 in the control groups). Compared with controls, intervention group participants had fewer melanoma excisions, more keratinocyte carcinomas and benign excisions, and more biopsy specimens. Over 24 months, mean per-person costs (analyzed in Australian dollars and converted to US$) for the intervention group were $1708 (95% CI, $1455-$1961) vs $763 (95% CI, $655-$870) for controls, an incremental cost of $945 (95% CI, $738-$1157) to provide the intervention. Total quality-adjusted life-years per person were similar for the intervention (1.84; 95% CI, 1.82-1.86) and control groups (1.84; 95% CI, 1.83-1.86). The incremental cost per additional malignant skin tumor excised was $40 (95% CI, $34-$48).Conclusions and relevance: Over 2 years of the trial, the 3D TBP-SDDI model by junior clinicians and teledermatologist review generated higher costs and detected similar numbers of malignant tumors than usual care in a high-risk melanoma cohort. Cost-effectiveness is a necessary but not sufficient consideration for implementation. Other benefits of 3D TBP-SDDI may arise once artificial intelligence clinician support systems are integrated, and more research is needed to understand factors associated with costs and whether there are other bene","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":""},"PeriodicalIF":11.5,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11947968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Promises and Pitfalls of 3D Total-Body Photography for Melanoma Early Detection.

IF 11.5 1区医学

JAMA dermatology Pub Date : 2025-03-26 DOI: 10.1001/jamadermatol.2025.0207

Laura K Ferris, Adewole S Adamson

引用次数: 0

Folliculitis Decalvans.

IF 11.5 1区医学

JAMA dermatology Pub Date : 2025-03-19 DOI: 10.1001/jamadermatol.2025.0050

Lijuan Zhou, Jinran Lin, Wenyu Wu

引用次数: 0

Need for Consideration of Patient-Specific Risk Factors in Step Therapy.

IF 11.5 1区医学

JAMA dermatology Pub Date : 2025-03-19 DOI: 10.1001/jamadermatol.2025.0141

Andrea D Maderal

引用次数: 0

Risk Factor Number and Recurrence, Metastasis, and Disease-Related Death in Cutaneous Squamous Cell Carcinoma.

IF 11.5 1区医学

JAMA dermatology Pub Date : 2025-03-19 DOI: 10.1001/jamadermatol.2025.0128

Nina A Ran, Emily E Granger, David G Brodland, Javier Cañueto, David R Carr, Joi B Carter, John A Carucci, Kelsey E Hirotsu, Shlomo A Koyfman, Aaron R Mangold, Fabio Muradás Girardi, Kathryn T Shahwan, Divya Srivastava, Allison T Vidimos, Tyler J Willenbrink, Ashley Wysong, Emily S Ruiz

{"title":"Risk Factor Number and Recurrence, Metastasis, and Disease-Related Death in Cutaneous Squamous Cell Carcinoma.","authors":"Nina A Ran, Emily E Granger, David G Brodland, Javier Cañueto, David R Carr, Joi B Carter, John A Carucci, Kelsey E Hirotsu, Shlomo A Koyfman, Aaron R Mangold, Fabio Muradás Girardi, Kathryn T Shahwan, Divya Srivastava, Allison T Vidimos, Tyler J Willenbrink, Ashley Wysong, Emily S Ruiz","doi":"10.1001/jamadermatol.2025.0128","DOIUrl":"10.1001/jamadermatol.2025.0128","url":null,"abstract":"Importance: Cutaneous squamous cell carcinoma (CSCC) risk stratification is central to management, and physicians rely on tumor staging systems to estimate risk. The Brigham and Women's Hospital (BWH) T staging system predicts risk based on 4 tumor risk factors (RFs). However, stage is not precisely associated with the number of RFs, as BWH stage T2b includes CSCCs with 2 and 3 RFs.Objective: To determine how RF number is associated with the risk of recurrence, metastasis, and disease-related death.Design, setting, and participants: This retrospective multination cohort study of CSCCs diagnosed between October 1, 1991, and July 19, 2023, was conducted at 12 centers in the US (10), Spain (1), and Brazil (1). Invasive CSCCs with confirmed negative margins longer than 14 days were included. Tumors were excluded if they were metastatic at presentation or received adjuvant therapy. Data were analyzed from October 2023 to August 2024.Interventions or exposures: CSCCs were stratified by the number of the following RFs (0, 1, 2, 3, or 4): a diameter of 2 cm or larger, poorly differentiated histology, tumor extension beyond subcutaneous fat, and large caliber nerve invasion.Main outcomes and measures: Five-year cumulative incidences of local recurrence, nodal metastasis, distant metastasis, and disease-specific death.Results: A total of 16 844 CSCCs were included (5978 female individuals [35.5%]; median [IQR] age, 73.9 [65.7-81.8] years), with 0 (12 657 [75.1%]), 1 (2892 [17.2%]), 2 (1015 [6.0%]), 3 ( 225 [1.3%]) or 4 (55 [0.3%]) RFs. Median (IQ) follow up time was 33.6 (14.5-60.3) months. For local recurrence, the risk increased as the number of RF increased from 0 (1.7%; 95% CI, 1.5%-2.0%) to 1 (5.0%; 95% CI, 4.1%-5.9%) to 2 (8.8%; 95% CI, 7.0%-11.0%) to 3 (16.0%; 95% CI, 11.0%-22.0%) to 4 (33.0%; 95% CI, 19.0%-47.0%; P < .001 for between-group differences). This increase was also observed for nodal metastasis (0.6% [95% CI, 0.4%-0.7%] vs 3.6% [95% CI, 2.9%-4.4%] vs 11.0% [95% CI, 9.2%-13.0%] vs 20.0% [95% CI, 15.0%-26.0%] vs 28.0% [95% CI, 15.0%-42.0%], respectively; P < .001), distant metastasis (0.2% [95% CI, 0.1%-0.3%] vs 1.1% [95% CI, 0.7%-1.6%] vs 2.3% [95% CI, 1.4%-3.4%] vs 7.9% [95% CI, 4.6%-12.0%] vs 8.4% [95% CI, 2.6%-19.0%], respectively; P < .001), and disease-specific death (0.3% [95% CI, 0.2%-0.4%] vs 1.9% [95% CI, 1.4%-2.7%] vs 5.4% [95% CI, 4.0%-7.0%] vs 11.0% [95% CI, 6.7%-16.0%] vs 25% [95% CI, 12%-39%], respectively; P < .001). CSCCs with 3 RFs had higher cumulative incidences of local recurrence (1.6-fold), nodal metastasis (1.9-fold), distant metastasis (4.3-fold), and disease-specific death (1.9-fold) compared with those with 2 RFs.Conclusions and relevance: The results of this cohort study suggest that the number of RFs is an indicator of risk, and among BWH T2b tumors,","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":""},"PeriodicalIF":11.5,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11923772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0