Sun-protection Behaviors Among Active Members of the United States Lifesaving Association.

BACKGROUND: Ultraviolet radiation exposure is the most prominent modifible risk factor for developing both melanoma and non-melanoma skin cancers. OBJECTIVE: We sought to elucidate sun-protective behaviors among active members of the United States Lifesaving Association (USLA), a nationwide nonprofit organization comprising beach lifeguards, and to identify positive and negative predictors of sun protective behaviors. METHODS: This was a pilot, cross-sectional survey study. All USLA lifeguards aged 18 years or older were invited to complete a 19-item survey. Data were collected anonymously at the 2018 USLA National Lifeguard Championships in Virginia Beach, Virginia. Participant characteristics and sun-protective behaviors (e.g., hat, sunglasses, protective clothing, sunscreen, and seeking shade) were surveyed. A composite score (0-10 points) was created based on sun-protective behaviors. Simple linear regression models were fit to assess the relationship between lifeguard characteristics and the sun-behavior composite score and a multiple linear regression model was used to assess their overall positive or negative effect on composite scores. RESULTS: A total of 215 USLA lifeguards completed the survey study; of these, 64.2% were male and the average age was 34.2 years. The most common sun-protective behavior was wearing sunglasses (85%), followed by applying sunscreen (65%), wearing a hat (46.7%), seeking shade (38.6%), and wearing protective clothing (34.0%). The overall average composite score was 7.5±1.9 points. In the multiple linear regression model, female sex (ß=-0.85; p=0.0012), desiring a tan (ß=-1.26; p=0.0008), and working more summer daytime hours (ß=-0.49; p=0.049) negatively impacted composite scores. CONCLUSIONS: USLA beach lifeguards are subject to sun-exposure patterns and practiced sun-protective behaviors that potentially place them at higher risk for skin cancer.

Dermoscopy Proficiency Expectations for US Dermatology Resident Physicians: Results of a Modified Delphi Survey of Pigmented Lesion Experts.

Importance: Dermoscopy education in US dermatology residency programs varies widely, and there is currently no existing expert consensus identifying what is most important for resident physicians to know. Objectives: To identify consensus-based learning constructs representing an appropriate foundational proficiency in dermoscopic image interpretation for dermatology resident physicians, including dermoscopic diagnoses, associated features, and representative teaching images. Defining these foundational proficiency learning constructs will facilitate further skill development in dermoscopic image interpretation to help residents achieve clinical proficiency. Design, Setting, and Participants: A 2-phase modified Delphi surveying technique was used to identify resident learning constructs in 3 sequential sets of surveys-diagnoses, features, and images. Expert panelists were recruited through an email distributed to the 32 members of the Pigmented Lesion Subcommittee of the Melanoma Prevention Working Group. Twenty-six (81%) opted to participate. Surveys were distributed using RedCAP software. Main Outcomes and Measures: Consensus on diagnoses, associated dermoscopic features, and representative teaching images reflective of a foundational proficiency in dermoscopic image interpretation for US dermatology resident physicians. Results: Twenty-six pigmented lesion and dermoscopy specialists completed 8 rounds of surveys, with 100% (26/26) response rate in all rounds. A final list of 32 diagnoses and 116 associated dermoscopic features was generated. Three hundred seventy-eight representative teaching images reached consensus with panelists. Conclusions and Relevance: Consensus achieved in this modified Delphi process identified common dermoscopic diagnoses, associated features, and representative teaching images reflective of a foundational proficiency in dermoscopic image interpretation for dermatology residency training. This list of validated objectives provides a consensus-based foundation of key learning points in dermoscopy to help resident physicians achieve clinical proficiency in dermoscopic image interpretation.

Pigmented basal cell carcinoma: increased melanin or increased melanocytes?

BACKGROUND: Studies on the precise cause of increased melanization in pigmented basal cell carcinomas (BCC) are limited. We aimed to determine whether the cause of melanization is from increased number of melanocytes or increased melanin pigment, and if there is a difference in the number of melanocytes on different sun-exposed locations. METHODS: A retrospective review of 45 skin biopsies from January 2011 to February 2011 was performed; 30 were diagnosed as pigmented BCC and 15 as non-pigmented BCC. Immunohistochemistry for MART-1 (melanoma-associated antigen recognized by T-cell 1)/Melan-A (clone M2-7610 + M2-9E3; Leica Microsystems Inc. Buffalo Grove, IL, USA) from Biocare Medical (Concord, CA, USA) was performed on all biopsies. Associations between histopathologic features, number of melanocytes, location, and specific diagnoses were analyzed by Mann-Whitney U test. RESULTS: The mean melanocyte count per high powered field in pigmented BCCs from sun-exposed skin was 101.9 and from intermittently sun-exposed skin was 122.5, as compared to the controls (nodular non-pigmented BCC) of 27.4 (p = 0.002) and 34.9 (p = 0.002), respectively. CONCLUSIONS: Pigmented BCCs have a higher mean melanocyte count as compared to non-pigmented BCCs irrespective of location. Therefore, the pigment is not only due to increased melanin, but also due to increased melanocytes.

Impact of a Pediatric Dermatology Service on Emergency Department Utilization for Children with Dermatitis.

BACKGROUND: Atopic dermatitis (AD) is the most common chronic pediatric skin disease, and it can profoundly affect a family's quality of life. Children with flaring AD often seek treatment in emergency departments (EDs), which leads to expensive care and ineffective long-term disease control. OBJECTIVES: The objective of the current study was to determine the effect of a pediatric dermatology service (PDS) on ED use and charges and of disease outcomes for patients diagnosed with AD before and after establishing an intramural PDS. METHODS: This retrospective study reviewed electronic medical records of patients presenting to an urban children's hospital ED with diagnoses encompassing the terms AD, eczema, dermatitis and International Classification of Diseases, Ninth Revision (ICD-9) codes 691.8 and 692.9 during the year before (pre-PDS period) and 3 years after establishing a PDS. RESULTS: There were 205 ED visits for dermatitis in the pre-PDS period and 130 in the with-PDS period, a 36.6% decrease (p < 0.001). In the pre-PDS period, 53.7% (n = 110/205) of patients presenting to the ED had moderate dermatitis, compared with 26.2% (n = 34/130) in the with-PDS period, a 69.1% decrease (p < 0.001). Total ED charges were $142,885 for the pre-PDS period and $90,610 for the with-PDS period, a $52,275 decrease. CONCLUSIONS: This study provides a salient example of achieving the triple aim of health care reform: improving health outcomes (decreased ED visits) improving the patient experience (transitioning care from the ED to the more appropriate ambulatory clinical setting), and decreasing the cost of care (decreased ED charges).

Treating acne scars in patients with Fitzpatrick skin types IV to VI using the 1450-nm diode laser.

Individuals with Fitzpatrick skin types IV to VI are becoming a larger proportion of our patient base. Although acne scarring can be difficult to treat in all skin types, it presents a greater challenge in darker skin types due to an increased risk for scarring and postinflammatory hyperpigmentation (PIH). Few studies have focused on infrared laser treatment of acne scarring in darker skin types. In this study, we assess the efficacy and side-effect profile of a 1450-nm diode laser for the treatment of acne scars in participants with Fitzpatrick skin types IV to VI. Our findings show the nonablative 1450-nm diode laser to be safe and effective in improving the appearance of atrophic acne scars in darker skin types. Postinflammatory hyperpigmentation was a common occurrence.

A case of non-Hodgkin's lymphoma-associated pemphigus foliaceus and use of rituximab for treatment.

BACKGROUND: Pemphigus foliaceus (PF), an autoimmune skin disorder resulting in the formation of superficial blisters, is a rarely reported skin manifestation of non-Hodgkin's lymphoma (NHL). Typical therapies for PF in non-malignant cases include immunosuppressants such as corticosteroids. We report the case of a patient undergoing therapy for NHL who subsequently developed PF which resolved following treatment with rituximab, an anti-CD20 monoclonal antibody. CASE REPORT: A 73-year-old Caucasian male who received a course of rituximab for NHL 3 years prior, presented with atypical urticarial lesions that developed into blisters. Pathological determination identified the lesions as PF. Traditional corticosteroid therapy failed to resolve the PF lesions. However, in this clinical situation, the patient responded to a repeat rituximab administration with complete resolution of the PF lesions. DISCUSSION: Paraneoplastic pemphigus, the most serious form of pemphigus, is more commonly associated with malignancies, such as NHL, whereas PF is seen in non-malignant cases. Although our patient was undergoing therapy for a malignancy, the less severe pemphigus emerged and responded to a non-traditional therapy. As such, we recommend that consideration is given to alternative therapies, including monoclonal antibodies, in cases of PF with atypical presentations and pathology associated with malignancy.