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Get Educated and Get Undressed, You Might Just Save Your Partners Life: A Case Report
Melanoma is a potentially fatal skin cancer with well established risk factors. While skin of color patients have a lower overall incidence of melanoma, delays in diagnosis translate to worse outcomes. Cultural misconceptions, lack of sun protective habits, occupational exposures, and systemic barriers contribute to this disparity. This case report describes an 83-year-old Hispanic male whose invasive scalp melanoma was discovered by his spouse after she received skin cancer education during her routine dermatology visit. A biopsy showed stage pT2b malignant melanoma with a Breslow thickness of at least 1.6 mm, ulceration, and 8+mitoses/mm2. The patient underwent successful excision followed by adjuvant pembrolizumab and ongoing surveillance with dermatology and medical oncology. His history included extensive sun exposure as a farmer in the Dominican Republic, no sunscreen use, and prior sunburns. This case highlights the life-saving impact of partner involvement and patient education in early melanoma detection. Research supports that married patients are more likely to present with earlier-stage tumors and are more likely to follow the recommended interventions. This case underscores the need for targeted education for high-risk occupations such as those working in agricultural settings, where economic and environmental barriers may affect overall photoprotection. Dermatology clinicians must advocate for enhanced outreach, workplace protections, and patient education strategies, particularly for underserved populations. Tools like brochures, ABCDE bookmarks, and patient handouts are invaluable. Finally, empowering couples to regularly perform skin checks can lead to earlier detection and improved outcomes, making skin checks a shared and proactive health habit.
Copyright (c) 2026 Jamie Restivo, B.S., B.A., MPAS, PA-C, Constance Hayes, DNP, APRN, FNP-C, DCNP, Suzanne Brown, MHS, PA-C, Julie Dodge, MHS, PA-C, Lauren DeBusk, MD http://creativecommons.org/licenses/by/4.0
Reassessment of Published Comparative Performance Model for 31-GEP and CP-GEP in Sentinel Lymph Node Biopsy Prediction in Cutaneous Melanoma
Background A recent large study of the CP-GEP for prediction of sentinel lymph node biopsy (SLNB) results in cutaneous melanoma (CM) failed to meet its primary endpoint of attaining a negative predictive value (NPV) >95%, indicating the test alone cannot be safely used to guide decisions to forgo SLNB under current clinical standards. In a separate analysis, CP-GEP performance from the study was compared to another SLNB predictive test, i31-GEP/i31-SLNB, by reanalyzing the largest i31-SLNB validation cohort. However, the reanalyzed data used in the analysis does not reflect the validation cohort, misrepresenting i31-SLNB performance. Objective To detail calculation errors in the comparative model of the i31-SLNB and CP-GEP for predicting SLNB positivity, and re-evaluate the tests’ performances by reconstructing the analyses using the datasets from the original publications. Methods From patients who underwent SLNB with T1-T3 tumors, NPVs were calculated and false omission rate (FOR=1−NPV) modeled as a function of prevalence for each of the i31-SLNB and CP-GEP. NPVs among all SLN-assessed patients in other published United States-based cohorts of varying SLN positivity prevalences were analyzed. Results In each respective cohort, 96.1% NPV for the i31-SLNB (n=1,152) and 92.9% NPV for the CP-GEP (n=1,761) were observed. Modeled FOR indicated less frequent false negatives for the i31-SLNB than CP-GEP across SLN positivity prevalences. Further, in reported United States-based cohorts, the i31-SLNB had 100% NPV in two additional cohorts with 20.5% and 6.4% SLN positivity prevalence, while the CP-GEP had 93.8% NPV in one additional cohort with 21.2% SLN positivity prevalence. Conclusion Although both tests were designed to attain >95% NPV in prediction of CM SLN metastasis in SLNB-eligible patients, only the i31-SLNB met this benchmark, supporting its utility as the only GEP to identify patients at low risk (<5%) who may forgo SLNB. In contrast, the CP-GEP test designates a larger proportion of patients as low risk but does not achieve a NPV >95%, suggesting that SLNB should still be considered rather than omitted based on this result alone.
Copyright (c) 2026 Peter A. Prieto, MD, Eric Whitman, MD, J. Michael Guenther, MD http://creativecommons.org/licenses/by/4.0
Non-scarring Alopecia in Pemphigus Foliaceus
SKINmages: Clinical Images in Dermatology
Copyright (c) 2026 Simone Moore, Michelle Sikora, Sophia Manduca, Dr. Vignesh Ramachandran, MD, Dr. Ata S. Moshiri, MD, MPH, Dr. Kristen I. Lo Sicco, MD, Dr. Prince Adotama, MD http://creativecommons.org/licenses/by/4.0
Subcutaneous Nodules as the Initial Presentation of Rare Primary Cutaneous Marginal Zone B-cell Lymphoma: Case Report
Background: Primary cutaneous marginal zone B-cell lymphoma (PCMZL) is a rare subtype of extranodal marginal zone lymphoma that typically remains confined to the skin. While generally indolent with a favorable prognosis, its diagnosis can be challenging due to overlap with other cutaneous lymphoid proliferations. Case Presentation: A 74-year-old man presented with longstanding subcutaneous nodules (>2 cm) on both cheeks, the submental region, and the right jaw, without overlying epidermal changes. Biopsies demonstrated a low-grade B-cell lymphoma with IgM expression and plasmacytic differentiation, and next-generation sequencing identified a MYD88 p.L265P mutation. Imaging revealed mediastinal lymphadenopathy, metabolically active nodes, and splenomegaly. Given the indolent course of PCMZL, observation was initially recommended. However, due to cosmetic concerns, rituximab therapy was initiated with a planned course of eight weekly infusions. Discussion: PCMZL comprises approximately 25-30% of primary cutaneous B-cell lymphomas. It presents with erythematous or violaceous papules, plaques, or nodules, most often on the trunk and extremities. Accurate diagnosis requires integration of clinical, histopathologic, and molecular findings. Although prognosis is excellent, relapse occurs in up to 50% of patients. Management strategies vary and may include observation, surgical excision, radiotherapy, or systemic therapies such as rituximab. In this case, therapy was driven by patient preference, underscoring the importance of individualized care even in indolent disease. Conclusion: PCMZL should be considered in the differential diagnosis of persistent subcutaneous nodules. This case emphasizes both the rarity of the disease and the role of patient-centered factors in guiding treatment.
primary cutaneous marginal zone B-cell lymphoma
Copyright (c) 2026 Lyudmyla Susla, Alexa Israeli, DO, Sarah Croft, DO http://creativecommons.org/licenses/by/4.0
Beyond the Follicle: Exploring Psychiatric Comorbidities in Androgenetic Alopecia
Androgenetic alopecia (AGA) is commonly treated with finasteride a 5-alpha-reductase inhibitor. Post-finasteride syndrome (PFS) is a constellation of neuropsychiatric and sexual adverse events following finasteride. Further complicating the formal diagnosis of PFS, baseline risk of psychiatric comorbidities in AGA remains unclear as the androgens responsible for AGA also play a key role in regulating mood, behavior, and neural plasticity. This systematic review characterizes the prevalence and types of psychiatric conditions in patients with AGA to contextualize potential vulnerability to PFS. Following PRISMA guidelines and PROSPERO registration, we conducted a systematic review of PubMed and Cochrane Library through February 2025 for studies reporting psychiatric comorbidities in AGA patients. Twenty-six studies met inclusion criteria, encompassing five psychiatric domains: anxiety/depression, schizophrenia or psychotic disorders, obsessive-compulsive traits, personality disorders, and general psychological distress. Depression and anxiety were consistently elevated in AGA patients versus controls, with symptom severity correlating with alopecia extent. Depression was more prevalent in women (55%) than men (3%). Whereas men exhibited higher rates of anxiety (78%) and aggression (22%) compared to women 41% and 4%, respectively. Personality disorders were also more frequent in AGA, though causality and directionality remain uncertain. Data on schizophrenia and obsessive–compulsive traits were inconsistent. Patients with AGA appear to have elevated baseline psychiatric vulnerability that may overlap with or predispose to PFS-like symptoms. Mental health screening prior to finasteride initiation may be beneficial. A personalized approach to AGA treatment is essential to optimize outcomes and minimize harm.
Copyright (c) 2026 Rachel Greene, Esther Choi, Amylee Martin, Milan Hirpara, Cristina Nguyen, Natasha Mesinkovska http://creativecommons.org/licenses/by/4.0
Integrating 31-Gene Expression Profiling in a Spitzoid Melanocytic Lesion: A Case Report in a 24-Year-Old Patient
Diagnosing melanocytic lesions such as Spitz nevi, atypical melanocytic proliferations, and melanoma can be particularly challenging due to overlapping clinical and histopathologic features. In such cases, MyPath is designed to aid in diagnosis of ambiguous melanocytic lesions. In contrast, DecisionDx-Melanoma is not used for diagnostic uncertainty but for prognostic risk stratification in patients with Stage I-III invasive cutaneous melanoma. We present the case of a 24-year-old Caucasian female with an atypical melanocytic proliferation exhibiting spitzoid features on the left medial knee. Biopsy showed a malignant melanoma (Breslow depth 0.4 mm), and a wide local excision was performed. Additional spitzoid lesions were identified, as well as two melanoma in situs. Molecular testing of the primary lesion on the patient’s knee using the 31-gene expression profile (31-GEP) classified the tumor as Class 1A, indicating a low risk of metastasis and a melanoma-specific survival rate of 99.9%. This test provided valuable insight into sentinel lymph node biopsy (SLNB) risk and overall prognosis. This case underscores the value of molecular testing in guiding clinical decision-making and surveillance while minimizing overtreatment.
Copyright (c) 2026 Savanna Perry, PA-C, TJ Chao, MPAS, PA-C , Sandra Cyril, MCMSc, PA-C, Danielle DuBiel, MPAS, PA-C, Nicole Madera, MMS, PA-C, Mary Manuel, MSN, NP-C , Zenia Robinson, PA-C http://creativecommons.org/licenses/by/4.0
Disparities in Malignant Melanoma Diagnosis in American Indian/Alaska Native Versus White Patients
Introduction: Malignant melanoma (MM) is a highly aggressive skin cancer with increasing incidence among American Indian/Alaska Native (AI/AN) individuals, who are more likely to present with advanced disease and have lower survival rates, yet literature on this population remains scarce. Objective: To analyze melanoma disparities in AI/AN individuals, focusing on diagnosis stage, socioeconomic factors, tumor characteristics, and overall survival. Methods: A retrospective cohort study using the National Cancer Database (2004–2021) compared AI/AN (n=459) and White (n=422,615) melanoma patients. Demographic, socioeconomic, and clinical factors were analyzed using chi-square tests, t-tests, and Kaplan-Meier survival analysis (p<0.05). Results: AI/AN patients had higher rates of late-stage diagnosis (p<0.001), lower income and education levels (p<0.001), and were more likely to be uninsured or covered by Medicaid (p<0.001). They were less likely to receive care at academic centers (p=0.024) and more likely to reside in rural areas (p<0.001). Overall survival differences between AI/AN and White patients were not statistically significant (p=0.988), but the survival data were limited. Conclusion: AI/AN individuals face significant disparities in melanoma diagnosis and access to care. Further research using larger datasets with fewer exclusions is needed to better understand survival disparities.
Copyright (c) 2026 Dr. Xinxin Wu, Julia Russolillo, Dr. Peter T. Silberstein http://creativecommons.org/licenses/by/4.0
New Onset Ulcers in a Patient with Dermatomyositis
Ecthyma gangrenosum (EG) is a rare cutaneous infection caused by Pseudomonas aeruginosa, typically affecting immunocompromised individuals. We present a 42-year-old female with dermatomyositis and recent MDA-5 antibody positivity who developed acute-onset painful ulcers on her hands, face, elbow, and chest. The patient was immunosuppressed due to medications for a previous liver transplant, including tacrolimus, mycophenolate mofetil, prednisone, and monthly intravenous immunoglobulin. Physical examination revealed shallow ulcers with central eschars and fibrinous material resembling characteristic anti-MDA5 dermatomyositis ulcers. Laboratory findings showed leukopenia, elevated erythrocyte sedimentation rate, and mildly elevated muscle enzymes. Superficial wound and tissue cultures confirmed Pseudomonas aeruginosa infection, establishing the diagnosis of ecthyma gangrenosum. The patient was successfully treated with intravenous cefepime followed by oral ciprofloxacin with complete resolution of the ulcers. This case highlights the importance of considering infectious etiologies in immunocompromised patients even when lesions appear consistent with autoimmune disease manifestations. EG can present without systemic signs of infection, emphasizing the need for prompt microbiological evaluation of suspicious lesions in immunocompromised individuals to ensure appropriate diagnosis and treatment.
Copyright (c) 2026 Jessica Colon, Andrea D. Maderal, Ruby Kwak http://creativecommons.org/licenses/by/4.0
Impact of Anatomical Location on Stage Requirements in Mohs Micrographic Surgery: A Retrospective Cross-Sectional Study of 501,209 Cases Using TriNetX (2004–2024)
Objective To analyze the number of stages required for tumor clearance in Mohs micrographic surgery (MMS) by anatomical location and diagnosis. Methods The number of stages required for tumor clearance in Mohs micrographic surgery (MMS) varies by anatomical location and diagnosis. This study analyzed 501,209 MMS cases from the TriNetX database. Cases were categorized using CPT codes (single-stage: 17311/17313, multi-stage: 17312/17314) and linked to anatomical sites via ICD-10 codes. Tumors were stratified into non-melanoma skin cancer subtypes: squamous cell carcinoma in situ, basal cell carcinoma, and squamous cell carcinoma. Results Tumors on the ears required more stages across all subtypes (P<0.00001), as did nasal tumors for BCC (P<0.00001) and SCC (P<0.01). BCC on the eyelids required fewer stages (P<0.00001), while SCC and SCCIS required more (P<0.01, P<0.05). Trunk and extremity tumors generally required fewer stages (P<0.00001), except SCCIS of the upper extremity (P<0.05). SCC and SCCIS of the lips (P<0.01) and scalp/neck (P<0.01) required more stages, whereas BCC at these sites needed fewer (P<0.00001). Conclusions Findings suggest that margin selection, tumor visibility, and risk perception influence MMS stage count. Smaller margins in cosmetically sensitive areas (ears, nose) may increase stage numbers, while broader margins on less visible sites (trunk, extremities) facilitate clearance in fewer stages. Understanding these trends may improve surgical planning and resource management.
Copyright (c) 2026 Travis S. Dowdle, MD, Ryan S. Koch, MD, Corley Pruneda, MD, Juan M. Pinto-Cuberos, MD, Renat Ahatov, MD, Frank T. Winsett, MD, Richard F. Wagner Jr., MD http://creativecommons.org/licenses/by/4.0
Triphasic Malignant and Benign Transformation within a Nevus Sebaceus: Concomitant Basal Cell Carcinoma, Squamous Cell Carcinoma, and Apocrine Adenoma
Nevus sebaceus is a congenital hamartoma that may undergo secondary neoplastic changes, most commonly benign adnexal tumors. Malignant transformation is rare, and the simultaneous occurrence of multiple neoplastic entities is exceedingly uncommon. We report a rare case of a 49-year-old man with a nevus sebaceus of the scalp harboring basal cell carcinoma, squamous cell carcinoma, and an adjacent apocrine adenoma, representing a rare triphasic transformation.
Copyright (c) 2026 Fiona Gruzmark, Taha Rasul, Benjamin Cooper, Anthony Concilla, Charles Perniciaro, Juan Rosario-Collazo http://creativecommons.org/licenses/by/4.0
Secondary Skin Involvement in Recurrent ALK-Negative Anaplastic Large Cell Lymphoma
Copyright (c) 2026 Isha Jhingan, Joshua M. Brady, Landon S. Hendrickson, Jeffrey D. McBride, Pamela S. Allen http://creativecommons.org/licenses/by/4.0
Characteristics of Best-Selling Topical Pain Relief Medications at Major Online Retailer
Introduction Treatment of acute and chronic pain is multimodal. Topical analgesics are a common formulation for targeting joint and muscle pain. There are a variety of cutaneous conditions that have neuropathic and inflammatory pain. Objective The purpose of this study was to assess characteristics of the best-selling topical pain relief medications at a major online retailer. Methods A cross-sectional study was performed. Amazon.com was queried under the “Pain Relief Medications and Treatments” category on October 15th, 2023. The results were sorted by “Best Seller.” No other restrictions on search were selected. Data for the 50 best-selling products was collected. Results The median price for a medication was $16.86 ($5.99-$39.99). The median price per ounce was $4.24 ($1.49-$20.00). The average consumer rating was 4.4/5, with an average of 7,564 consumer reviews. The ‘Joint and Muscle’ category contained 78% of the products, the next highest being ‘Arthritis’ (12%). Cream was the predominant vehicle type (76%), followed by gel (6%). The most abundant active ingredient was menthol (38%), then arnica (28%), 4% lidocaine (18%), and camphor (10%). Lidocaine 5% was present in one product. Regarding class of medication, 66% were natural, 16% were lidocaine, and 10% contained non-steroidal anti-inflammatory drugs. Overall, only 26% contained an FDA-approved ingredient. Top marketing claims included non-greasy (52%), maximum strength/powerful (42%), and natural/plant-derived (32%). Conclusion There are a variety of affordable topical pain medications with high consumer ratings. Consumers value creams most as formulations. Products contain a diversity of active ingredients, though most are not FDA-approved.
Copyright (c) 2026 Joshua Burshtein, Aaron Burshtein http://creativecommons.org/licenses/by/4.0
From Quality to Quantity: AI-Driven Publication Inflation and Its Impact on Dermatology Applications
Introduction: Following the public release of ChatGPT and similar large language models (LLMs) in late 2022, AI-assisted writing has become increasingly accessible. The use of AI in academic writing is particularly concerning. In dermatology, where publication numbers per residency applicant have steadily risen in recent cycles, concerns exist about research authenticity and the weight of publications in applicant evaluations. Methods: To assess the presence of AI in dermatology publications, we analyzed 200 case reports from the Journal of the American Academy of Dermatology (JAAD) using ZeroGPT, an AI detection tool. Reports were selected chronologically to maintain objectivity: 100 from 2022, before AI became public, and 100 from late 2024-early 2025, after AI became readily available. Publications were further stratified based on the first author's academic status as a medical student (bachelor’s degree with medical school affiliation) or physician (MD/DO/MBBS). Mann-Whitney U Tests compared AI content detected in reports from 2022 and more recent years, and between author groups. Results: AI-identified content significantly increased after 2022, rising from 18.8 ± 12.6 to 38.6 ± 18.6 (p < 0.0001). No significant difference was found between medical student and physician first authors (p = 0.47). Conclusion: The post-2022 surge in AI-generated content, consistent across author levels, highlights AI’s widespread adoption. Given the recent rise in applicant publication numbers, residency programs should reassess the significance of publication numbers in their evaluations. Future research should investigate specific ways applicants are utilizing AI in research.
Copyright (c) 2026 Silvija Milanovic, Kelly Gahagan, Pooja Gurnani, Taylor Gray http://creativecommons.org/licenses/by/4.0
Microwave Therapy as a Novel, Safe, and Effective Treatment for Children and Adults with Molluscum Contagiosum
Introduction: Molluscum contagiosum (MC) is an easily transmitted poxvirus infection most commonly affecting children, where it normally causes multiple benign papules associated with itching, pain, and inflammation. Typical treatment guidance includes a watch and wait approach over 2 to 4 years with no current consensus on the best form of active therapy. This retrospective chart review aimed to determine whether microwave therapy could be a suitable and safe treatment modality for children and adults with MC. Methods: 35 patients were treated at a single podiatry clinic in Geelong, Australia, with microwave energy in up to 3 sessions, 4 weeks apart, being monitored for resolution and adverse events. Results: All patients’ lesions resolved after an average of 2.1 treatments. There was no difference in the number of treatments required for children versus adults to achieve complete resolution. Treatment-associated pain was transient, localized, and tolerable. No other adverse events were observed. Conclusion: These outcomes suggest that microwave therapy has the potential to be a new modality for the treatment of MC as it can be highly efficacious, safe, and equally applicable to children and adults.
Copyright (c) 2026 Dean Cronkwright, Dr. Joel Cohen http://creativecommons.org/licenses/by/4.0
Spotting the Signs: A Scoping Review of Pediatric Measles Rash Patterns in an Era of Variable Vaccination (2012–2024)
Background Although measles was declared nearly eliminated in the United States, recent years have seen a resurgence linked to vaccine hesitancy and declining herd immunity. Many clinicians lack firsthand experience diagnosing measles, and atypical presentations complicate recognition. Consolidated descriptions of the evolving clinical spectrum in the vaccine-hesitant era remain limited. Objective: To characterize the range of clinical presentations of pediatric measles in the context of vaccination status, immune history, and access to care. Methods We conducted a retrospective synthesis of 10 pediatric case reports and series published between 2012 and 2024, identified through targeted PubMed and Google Scholar searches. Inclusion criteria emphasized pediatric populations and documentation of rash morphology. Data extracted included symptomatology, vaccination history, diagnostic accuracy, and time to diagnosis. Results Among the cases reviewed, 80% exhibited the classic cephalocaudal rash progression, while several demonstrated atypical patterns, such as sparing of extremities or back-to-front distribution. Atypical presentations were more frequent in partially vaccinated or immunocompromised patients. Koplik spots were inconsistently reported. Diagnostic delays were common due to overlap with other pediatric conditions and low clinical suspicion, particularly among older children and adolescents. Conclusions The clinical presentation of measles in pediatric patients is increasingly variable in the vaccine-hesitant era, contributing to delayed recognition. Awareness of atypical rash distributions and inconsistent presence of pathognomonic findings is essential for timely diagnosis and outbreak control.
Copyright (c) 2026 Kallie Crowl, Anna Kotula, Radhika Misra http://creativecommons.org/licenses/by/4.0
Assessing AI Accuracy in Diagnosing Pyoderma Gangrenosum
Introduction Pyoderma gangrenosum (PG), often considered a diagnosis of exclusion, can be challenging to diagnose. A new deep convolutional neural network (CNN) outperformed dermatologists (sensitivity 97% vs. 73%, respectively) in diagnosing PG versus venous ulcer (VU) using 422 clinical wound photographs in a training setting. Our purpose was to test its performance using real-world photographs. Methods Clinical photos from 58 cases of suspected PG at our institution were obtained retrospectively, with 51 having confirmed PG diagnoses by board-certified dermatologists. The CNN predicted the probability of PG for each photo using 50% as the decision threshold. For patients with more than one photo, probabilities were averaged to generate one per patient. Results The CNN correctly identified 31 of 51 PG cases and 5 of 7 non-PG cases, yielding a sensitivity and specificity of 60.8% and 71.4%, respectively. Discussion Delayed or missed diagnoses of PG can lead to poor patient outcomes due to distinct treatment pathways for PG versus other causes of ulceration. Therefore, a reliable and prompt diagnostic tool is needed. Based on data from our prior retrospective study evaluating PG rating tools, the CNN outperforms the Delphi and Su methods but not PARACELSUS (sensitivities 12%, 25%, and 100%, respectively). Limitations of this study include a lack of standardized image quality, and the CNN’s ability to distinguish only between PG and VU. The CNN may hold value in validating practitioners’ diagnoses but further refinement and training using diverse, real-world datasets are necessary to enhance its diagnostic, clinical utility.
Copyright (c) 2026 Nardin Awad, DO, Ayushya Ajmani, BA, Iman Salem, MD, Brian Simmons, MD http://creativecommons.org/licenses/by/4.0
Immunotherapy Refusal in Merkel Cell Carcinoma is Rare but Correlates with Refusal of Other Treatments: A National Cancer Database Study
Merkel cell carcinoma (MCC) is a rare, aggressive skin cancer for which immune checkpoint inhibitors are standard systemic therapy. Using the National Cancer Database (2011–2020), we identified 2,173 patients recommended immunotherapy; 93 (4.3%) refused. Refusal was more common among older patients (mean 79.7 vs 73.0 years), women, and those with greater comorbidity. In multivariable analysis, radiation refusal strongly predicted immunotherapy refusal (OR 15.06; 95% CI 7.42–30.60). Findings suggest that immunotherapy refusal often accompanies broader treatment hesitancy rather than isolated rejection, underscoring the need to address multimodal decision barriers in MCC care.
Copyright (c) 2026 Marcus L. Elias, Luke B. Elias, Annie R. Wang http://creativecommons.org/licenses/by/4.0
Acquired Nevus of Ito: A Case Report and Review of the Literature
Background Acquired dermal melanocytosis (ADM) usually affects the face, most often as acquired bilateral nevus of Ota-like macules (ABNOM). Extrafacial cases are rare and remain poorly characterized. Objective To report a rare case of acquired nevus of Ito on the neck and review the literature on extrafacial ADM. Methods We conducted a comprehensive search of PubMed and Google Scholar from 1977 onward to identify all reported cases of extrafacial ADM. Clinical and histopathological features were extracted and analyzed. Results Seventy-four cases were identified, including our patient. Lesions predominantly involved the back, upper extremities, and sacral region. Only three cases, including ours, involved the neck. Histopathology consistently showed dendritic melanocytes in the dermis, with many cases staining positive for S100, HMB-45, and MART-1. Conclusion Extrafacial ADM is an uncommon variant with overlapping histologic and pathophysiologic features to facial forms. This report expands the limited literature and highlights the importance of considering ADM in the differential diagnosis of new-onset dermal pigmentation on the neck and other non-facial sites.
Copyright (c) 2026 Hannah Gier, DO, Ben Witkoff, DO http://creativecommons.org/licenses/by/4.0
Dermatology Faculty Perspectives on Virtual and In-Person Residency Interviews
Background The COVID-19 pandemic led to the transition to virtual residency interviews. The Association of American Medical Colleges continues to recommend virtual interviews, but dermatology programs are reconsidering their preferences as pandemic restrictions have eased. We conducted a survey of dermatology faculty to assess their perspectives on virtual and in-person residency interview formats. Methods The survey was administered to faculty attending the 2024 Fall Association of Professors of Dermatology Meeting during a session on interview formats. Of 350 conference attendees, 160 responded to the survey (46% response rate), including 79 program directors or associate program directors. Results In the 2024–2025 application cycle, 13.9% of programs conducted in-person interviews, while the remainder conducted virtual interviews. Primary drivers of in-person interviews included the ability to assess applicants’ interpersonal skills, interactions, and program fit, as well exposing them to the geographic area. Those conducting virtual interviews cited equity (38.0%) and cost savings (27.9%) as their reasons. Without institutional constraints, respondents were split between wanting virtual (37.1%) and in-person (36.4%) interviews, and 24.5% favored a hybrid model. Most agreed that virtual interviews are more equitable (70.6%), though many believed that in-person interviews better aligned applicants with programs (59.2%). Conclusion While dermatology faculty acknowledge the equity and financial benefits of virtual interviews, the value of face-to-face interactions remains. These findings may help guide future decisions about interview formats and highlight the need for further evaluation of how these formats affect applicant experiences and the match process.
Copyright (c) 2026 Tara Foroohar, Scott Worswick, Geena Conde, Timmie Mishra http://creativecommons.org/licenses/by/4.0
Better Therapeutic Outcomes for Atopic Dermatitis Patients Guided by Gene Expression Profiling
Copyright (c) 2026 Marcia J. Glenn, MD, Amanda Caldwell, FNP-C, Valerie Cooper, PA-C, MPAS, Vivian Hunt, APRN, DCNP, Chioma Okpala, BSc. http://creativecommons.org/licenses/by/4.0
Multiple Persistent Nodular Lesions in an Infant: Diagnosing Disseminated Juvenile Xanthogranuloma
We present a 21-month-old female with multiple cutaneous xanthogranulomas (JXG), exhibiting classic “setting sun” pattern which is characterized by an orange-yellow background with an erythematous border. Multiple cutaneous JXG lesions as seen in this patient are rare (4% of patients) and associated with a higher risk of extracutaneous involvement. This case highlights the importance of considering JXG in the differential diagnosis of a generalized persistent eruption in children and the use of dermatoscopy to identify classic pattern findings as a helpful non-invasive diagnostic tool. Since disseminated lesions occur in a minority of patients and carry an increased risk of systemic involvement, particularly ocular complications, referral to ophthalmology and ongoing surveillance is recommended.
Copyright (c) 2026 Dr. Sumeyye Ozer, Kourtney Kelly, Dr. Banu Farabi, Dr. Adnan Mir, Dr. Shoshana Marmon http://creativecommons.org/licenses/by/4.0
Mycobacterium Abscessus Cutaneous Infection Secondary to Tattooing: A Case Report
Mycobacterium abscessus complex (MABC) comprises a group of rapidly growing, nontuberculous mycobacteria (NTM) capable of causing a wide spectrum of infections. MABC is classified into three subspecies namely abscessus, bolletii, and massiliense, each with distinct antibiotic resistance patterns. Over the past decade, cases of NTM inoculation during tattooing have increased, with Mycobacterium abscessus being the most commonly implicated NTM pathogen. Herein we describe the case of a 37-year-old woman who presented with erythematous papules over a tattoo on her right upper chest 15 days after getting a tattoo. Importantly, our report highlights the challenges in diagnosing Mycobacterium abscessus infections due to its multidrug resistance and discusses the available treatment options. Furthermore, our case also highlights the need for stricter regulation and enforcement of sterile practices during the production and use of tattoo inks, as well as the sterilization of tattooing equipment, to help reduce the risk of infection.
Copyright (c) 2026 Ifeanyi Kingsley Uche, PhD, Ezinne B. Ezenekwe, MD, MPH, John O. Nnadi, MD http://creativecommons.org/licenses/by/4.0
Diffuse Lichen Planus in a 6-Year-Old Female
Pediatric lichen planus (LP) is rare and may be triggered by vaccines through autoimmune mechanisms such as molecular mimicry. We present a case involving a 6-year-old girl who presented with pruritic, violaceous papules and hyperpigmented patches consistent with LP, which developed two months after MMR, varicella, and TDap vaccination. Initial treatment with high-potency topical corticosteroids failed, prompting initiation of a systemic prednisolone taper, which led to marked clinical improvement. This case contributes to the limited pediatric literature of diffuse LP, emphasizing the importance of early recognition and individualized management of widespread disease.
Copyright (c) 2026 Aysham Chaudry, DO, Daniel L. Fischer, DO, MA http://creativecommons.org/licenses/by/4.0
Improving Dermatologic Health Equity: Community-Based Outreach in the Hispanic Population of Charlottesville
Limited English proficiency and unfamiliarity with the healthcare system are significant barriers to dermatologic care for Hispanic populations in the United States. To address this disparity, we developed and implemented a community-based dermatology outreach program as part of the broader Latino Health Initiative in Charlottesville, Virginia. This program aimed to improve dermatologic health equity through culturally tailored education, free skin screenings, and facilitated specialty referrals. From 2022 to 2025, seventy-five community members were screened at local events, with nearly all participants receiving at least one dermatologic diagnosis. Common conditions included inflammatory dermatoses, acneiform disorders, pigmentation abnormalities, and infectious skin diseases. Over half of participants were referred to specialty care, with bilingual volunteers coordinating follow-up to prevent care gaps. Educational efforts included in-person presentations, social media outreach, and distribution of bilingual materials. Participant feedback indicated increased awareness of skin conditions and greater confidence in seeking care. This initiative highlights the importance of accessible, linguistically and culturally competent dermatologic services in reducing health disparities. Community-based outreach programs such as this serve as a scalable model for improving skin health equity among underserved populations and fostering trust in the healthcare system.
Copyright (c) 2026 Catherine E. Lyons, BS BA, Aaron D. Smith, BS, Nicole L. Edmonds, MD, David Martin, Hilda Landaverde, Paige Saunders, R Hal Flowers, MD, Max Luna, MD http://creativecommons.org/licenses/by/4.0
Identifying Rare Fungal Disease: A Cutaneous Blastomycosis Case Report
Introduction Blastomycosis is a fungal infection caused by inhalation of Blastomyces dermatitidis spores. Half of infections are asymptomatic, but mild disease presents with pulmonary findings such as pneumonia that is generally self-limited in immunocompetent patients. Disseminated disease occurs more commonly in immunocompromised patients with the most common extrapulmonary finding being skin lesions. Case Report The patient is a 32 year old immunocompetent male living in Southern Illinois with no significant past medical history. The patient endorsed several months of hemoptysis and dyspnea. On presentation to dermatology, the patient had a 5 cm erythematous ulcerated plaque on his right upper chest. Tissue culture showed deep fungal infection that was positive for blastomycosis. The patient was referred to infectious disease and placed on a 6-12 month regimen of itraconazole. After the first month of treatment, the patient noted that his lesion had decreased in size and that he was no longer coughing up blood. Discussion Cutaneous blastomycosis presents a diagnostic challenge due to rarity and its varied clinical manifestations. This geographical prevalence is significant for patient diagnosis, especially for those originating from these areas. Despite its infrequent occurrence, cutaneous blastomycosis should be included in differentials for ulcerated skin lesions, especially in patients with predisposing risk factors like outdoor occupations, recreational activities in wooded areas, or immunocompromised states. The disease often masquerades as other common dermatological conditions.
Copyright (c) 2026 Maryam Makhdoom, Molly Smith, Hal Lewis http://creativecommons.org/licenses/by/4.0
Ethnic Disparity in Clinical Trials for Seborrheic Dermatitis Shampoos: Clinical Considerations for Improving Outcomes
Copyright (c) 2026 Victoria Ayodele, Ayomide Akinsooto, Jennifer Krejci http://creativecommons.org/licenses/by/4.0
Biology Beyond the Margins: Impact of 40-Gene Expression Profiling on Risk Stratification in Cutaneous Squamous Cell Carcinoma
Background Cutaneous squamous cell carcinoma (cSCC) causes more annual mortality than metastatic melanoma. However, risk stratification protocols remain based solely on clinicopathologic features, excluding tumor biology. (Table 1) Objective To illustrate how integration of 40-gene expression profile (GEP) testing influences prognostic assessment and post-treatment management in high-risk cSCC. Methods We present a case report of a 70-year-old male whose incidental cSCC was reclassified as high-risk following 40-GEP testing despite histologic clearance, resulting in enhanced surveillance. Results Tumor profiling yielded a Class 2A (higher risk) result, which altered post-operative follow-up strategies beyond conventional staging. Conclusion Gene expression profiling provides valuable, individualized prognostic data, which may improve management of high-risk cSCC patients and should be considered for broader integration into clinical guidelines.
Copyright (c) 2025 Heather Gates, PA-C, DFAAPA, Cynthia Trickett, PA-C, Tiffani Botts Massey, PA-C, Francine Phillips, PA-C, Patrice Simon, PA-C, Angela Rosenberg, DO, Darrell Rigel, MD http://creativecommons.org/licenses/by/4.0
Prevalence of Self-Reported Physician Diagnosis of Chronic Hand Eczema in Adults: A Cross-Sectional Study of More Than 10,000 Participants in the General Population – Results From the CHECK Study in the United States
Copyright (c) 2025 Raj Chovatiya, Sanjeev Balu, Aseel Bin Sawad, Eydna Didriksen Apol, Shannon Schneider, Douglas Maslin, Lysel Brignoli, Perrine Le Calvé, Eric Simpson http://creativecommons.org/licenses/by/4.0
Achievement of Treat-to-Target Thresholds with Envudeucitinib, a Selective TYK2 Inhibitor, in Moderate-to-Severe Plaque Psoriasis: Results from STRIDE and OLE
Copyright (c) 2025 April Armstrong, Benjamin Ehst, Jason Hawkes, Grace Ma, Elena Hitraya, Kim Papp http://creativecommons.org/licenses/by/4.0
Cost-Per-Responder Analysis of Delgocitinib Topical Cream Versus Dupilumab Subcutaneous Injection for Moderate to Severe Atopic Hand Eczema in the United States
Copyright (c) 2025 Sanjeev Balu, Amanda Falah Rasmussen, Aseel Bin Sawad, Eydna Didriksen Apol, Pravin Kamble, Douglas Maslin, Anne Sofie Loftager http://creativecommons.org/licenses/by/4.0