We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
In This Issue of JAMA Dermatology |

Highlights FREE

JAMA Dermatol. 2014;150(11):1133. doi:10.1001/jamadermatol.2013.6565.
Text Size: A A A
Published online


The numbers of nurse practitioners and physician assistants have grown greatly, and these mid-level clinicians have extended their scope of practice since 1997. In this analysis of the 2012 Medicare data, Coldiron and Ratnarathorn identified the most common procedures performed independently by mid-level practitioners: nearly 55% of these were in the area of dermatology. While the primary care clinician shortage has prompted consideration of widening the scope of practice for mid-level clinicians, it is important to recognize that mid-level clinicians are not limited to primary care and may be performing procedures for which they have little formal training.

Although skin cancer is the most common form of cancer in the United States, data on frequently encountered dermatologic symptoms are still emerging. In this large prospective clinicopathologic study of patients who filled out questionnaires to assess itch and pain intensity of their skin tumors at the time of excision, Yosipovitch et al demonstrate that itch and pain were common across all skin cancers but were mostly absent in melanoma. Pain was associated with deeper dermal processes, whereas itch was linked with more superficial basal cell carcinoma lesions.

Melanoma is the most fatal of all skin cancers, and its incidence continues to rise in the United States. Dedicated pigmented lesion clinics (PLCs) offer services that appeal to patients with melanoma, including total body skin examinations, total body digital photography, clinical trials, and multidisciplinary approaches. This retrospective medical record review by Vickery et al reveals that 14.9% of patient visits to a PLC were more frequent than the recommended follow-up schedule. More patients are being diagnosed with melanoma every day, and this current care model of allowing extra visits may not be sustainable in the long-term. Hybrid approaches may combat this supply-demand discrepancy.

Adverse effects of mutation-specific BRAF inhibitor therapy include induction of epithelial proliferations including cutaneous squamous cell carcinomas. Although RAS mutations are the major contributing pathogenic factor, oncogenic cutaneous viruses have also been hypothesized to play a role. In this retrospective study, Schrama et al demonstrate the presence of both high HPyV-6 DNA load and VP1 protein expression, suggesting that polyomaviruses may contribute to these epithelial proliferations, although the scale of the impact remains unclear.

Successful reconstruction of hand defects must allow patients to avoid postoperative hand dysfunction and return quickly to daily activities. Because of the hand’s finite reservoir of skin and thin dermis and subcutaneous fat, random pattern flaps have increased risk for necrosis or dehiscence. In this case report, Sobanko et al demonstrate a novel sliding fasciocutaneous flap with blood supply derived from dorsal perforating arteries and that uses bilevel undermining for improved flap mobility. Four variations of this flap are described, with low complication rates.





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Related Content

Customize your page view by dragging & repositioning the boxes below.