Pub Date : 2025-12-03DOI: 10.1001/jamadermatol.2025.4792
Deonna M Ackermann, Ellie Medcalf, Robin M Turner, Jolyn K Hersch, Monika Janda, Pascale Guitera, H Peter Soyer, Karen Bracken, Linda K Martin, Victoria Mar, Katy J L Bell
<p><strong>Importance: </strong>Patient-performed teledermoscopy may improve access to dermatologic care, but evidence to guide dermatoscope selection for patient use is limited.</p><p><strong>Objective: </strong>To compare a lower-cost, ambient-light, nonpolarized dermatoscope with a higher-cost, illuminated, polarized dermatoscope for patient-performed teledermoscopy following treatment for early-stage melanoma.</p><p><strong>Design, setting, and participants: </strong>This randomized study within a trial was embedded within the MEL-SELF trial and recruited adults previously treated for early-stage melanoma (American Joint Committee on Cancer stages 0-II) in the patient-led surveillance arm of MEL-SELF from specialist and general practitioner-led skin cancer clinics in Australia from December 2021 to June 2024 with 12-month follow-up. Data were analyzed from February 6, 2025, to August 15, 2025.</p><p><strong>Interventions: </strong>Participants were randomized (1:1) to receive a polarized (128 [51.0%]) or ambient-light (123 [49.0%]) dermatoscope smartphone attachment. Optional online training was provided. Participants submitted clinician-identified and self-detected lesion images via a secure teledermatology platform at 3-month intervals.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was the proportion of participants submitting baseline images of sufficient quality for a teledermatologist to provide a management recommendation. Secondary outcomes included the proportion receiving a management recommendation for at least 1 image during the study period, per-image recommendation proportions, device costs, and qualitative assessments of image quality and usability.</p><p><strong>Results: </strong>Of 251 participants (mean [SD] age, 56.0 [11.6] years; 147 female individuals [59%]), 175 (69.7%) received a teledermatologist management recommendation for baseline images (polarized: 92 [71.9%]; ambient light: 83 [67.5%]; difference, 4.4%; 95% CI, -7.0% to 15.8%). By 12 months, the proportion receiving at least 1 recommendation was similar between groups (polarized: 104 of 128 [81.3%]; ambient light: 94 of 123 [76.4%]; difference, 4.3%; 95% CI, -8.1% to 16.6%). However, a per-image analysis showed more polarized images (913 of 961 [95.0%]) than ambient-light images (706 of 775 [91.1%]) were reportable and supported a recommendation (difference, 3.9%; 95% CI, 1.5% to 6.3%; self-directed lesions: 6.8%; 95% CI, 3.3% to 10.2%). Teledermatologists provided more positive feedback for polarized images; blurriness (n = 14 vs 9) and poor lighting (n = 6 vs 0) were more frequent with ambient-light images. Patient usability ratings were similar (moderately/very easy: 39.8% vs 36.6%; difference, 3.2%; 95% CI, -8.8% to 15.3%), but ambient-light dermatoscope users reported more image quality issues. The polarized device was more expensive ($324.16 vs $35.40).</p><p><strong>Conclusions and relevance: </strong>The results of this study withi
重要性：患者进行的远镜检查可以改善皮肤科护理的可及性，但指导患者使用的远镜选择的证据有限。目的：比较低成本、环境光、非偏光的皮肤镜与高成本、照明、偏光的皮肤镜在早期黑色素瘤治疗后患者进行远镜检查的效果。设计、环境和参与者：该试验中的随机研究嵌入MEL-SELF试验中，招募了2021年12月至2024年6月期间在澳大利亚专科医生和全科医生主导的皮肤癌诊所接受过早期黑色素瘤（美国癌症0-II期联合委员会）患者主导的MEL-SELF监测组中接受过治疗的成年人，随访12个月。数据分析时间为2025年2月6日至2025年8月15日。干预措施：参与者随机（1:1）接受偏振光（128[51.0%]）或环境光（123[49.0%]）皮肤镜智能手机附件。提供了可选的在线培训。参与者每隔3个月通过安全的远程皮肤科平台提交临床识别和自我检测的病变图像。主要结果和测量：主要结果是参与者提交足够质量的基线图像的比例，以便远程皮肤科医生提供管理建议。次要结果包括在研究期间接受至少1张图像管理推荐的比例，每张图像推荐比例，设备成本以及图像质量和可用性的定性评估。结果：251名参与者（平均[SD]年龄56.0[11.6]岁；147名女性[59%]）中，175名（69.7%）接受了远程皮肤科医生的基线图像管理建议（偏光：92[71.9%]；环境光：83[67.5%]；差异为4.4%；95% CI为-7.0%至15.8%）。到12个月时，接受至少1项建议的比例在两组之间相似（偏光：128 / 104[81.3%]；环境光：123 / 94[76.4%]；差异为4.3%；95% CI为-8.1%至16.6%）。然而，单幅图像分析显示，报告的极化图像（961张中的913张[95.0%]）比环境光图像（775张中的706张[91.1%]）更多，并支持推荐（差异为3.9%;95% CI， 1.5%至6.3%；自定向病变：6.8%;95% CI， 3.3%至10.2%）。远程皮肤科医生对偏光图像提供了更多的积极反馈；模糊（n = 14 vs 9）和光线不足（n = 6 vs 0）在环境光图像中更为常见。患者可用性评分相似（中度/非常容易：39.8% vs 36.6%；差异，3.2%;95% CI, -8.8%到15.3%），但环境光皮肤镜用户报告了更多的图像质量问题。偏光装置更贵（324.16美元对35.40美元）。结论和相关性：本研究在一项试验中的结果表明，这两种设备使患者能够进行皮肤镜检查并接受远程皮肤病学建议。偏振器件的适度图像质量优势必须与其高得多的成本相权衡。试验注册：anzctr.org.au标识符：ACTRN12621000176864。
{"title":"Mobile Dermatoscope Type in Patient-Performed Teledermoscopy: A Study Within A Trial.","authors":"Deonna M Ackermann, Ellie Medcalf, Robin M Turner, Jolyn K Hersch, Monika Janda, Pascale Guitera, H Peter Soyer, Karen Bracken, Linda K Martin, Victoria Mar, Katy J L Bell","doi":"10.1001/jamadermatol.2025.4792","DOIUrl":"10.1001/jamadermatol.2025.4792","url":null,"abstract":"<p><strong>Importance: </strong>Patient-performed teledermoscopy may improve access to dermatologic care, but evidence to guide dermatoscope selection for patient use is limited.</p><p><strong>Objective: </strong>To compare a lower-cost, ambient-light, nonpolarized dermatoscope with a higher-cost, illuminated, polarized dermatoscope for patient-performed teledermoscopy following treatment for early-stage melanoma.</p><p><strong>Design, setting, and participants: </strong>This randomized study within a trial was embedded within the MEL-SELF trial and recruited adults previously treated for early-stage melanoma (American Joint Committee on Cancer stages 0-II) in the patient-led surveillance arm of MEL-SELF from specialist and general practitioner-led skin cancer clinics in Australia from December 2021 to June 2024 with 12-month follow-up. Data were analyzed from February 6, 2025, to August 15, 2025.</p><p><strong>Interventions: </strong>Participants were randomized (1:1) to receive a polarized (128 [51.0%]) or ambient-light (123 [49.0%]) dermatoscope smartphone attachment. Optional online training was provided. Participants submitted clinician-identified and self-detected lesion images via a secure teledermatology platform at 3-month intervals.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was the proportion of participants submitting baseline images of sufficient quality for a teledermatologist to provide a management recommendation. Secondary outcomes included the proportion receiving a management recommendation for at least 1 image during the study period, per-image recommendation proportions, device costs, and qualitative assessments of image quality and usability.</p><p><strong>Results: </strong>Of 251 participants (mean [SD] age, 56.0 [11.6] years; 147 female individuals [59%]), 175 (69.7%) received a teledermatologist management recommendation for baseline images (polarized: 92 [71.9%]; ambient light: 83 [67.5%]; difference, 4.4%; 95% CI, -7.0% to 15.8%). By 12 months, the proportion receiving at least 1 recommendation was similar between groups (polarized: 104 of 128 [81.3%]; ambient light: 94 of 123 [76.4%]; difference, 4.3%; 95% CI, -8.1% to 16.6%). However, a per-image analysis showed more polarized images (913 of 961 [95.0%]) than ambient-light images (706 of 775 [91.1%]) were reportable and supported a recommendation (difference, 3.9%; 95% CI, 1.5% to 6.3%; self-directed lesions: 6.8%; 95% CI, 3.3% to 10.2%). Teledermatologists provided more positive feedback for polarized images; blurriness (n = 14 vs 9) and poor lighting (n = 6 vs 0) were more frequent with ambient-light images. Patient usability ratings were similar (moderately/very easy: 39.8% vs 36.6%; difference, 3.2%; 95% CI, -8.8% to 15.3%), but ambient-light dermatoscope users reported more image quality issues. The polarized device was more expensive ($324.16 vs $35.40).</p><p><strong>Conclusions and relevance: </strong>The results of this study withi","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":""},"PeriodicalIF":11.0,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12676473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145668078","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}
Pub Date : 2025-12-03DOI: 10.1001/jamadermatol.2025.4824
Jiaqi Ye, Wanlong Wu, Haixi Wu, Can Xia, Mingyu Ye, Kaile He, Jiaming Teng, Xiaoqing Zhao, Hao Li, Qian Zhao, Jie Zheng, Shuang Ye, Hua Cao
Importance: Cancer is a life-threatening complication of dermatomyositis (DM) and contributes significantly to mortality. A validated association-based tool is urgently needed to optimize early cancer detection and reduce diagnostic delays.
Objective: To develop and validate a practical prediction model for cancer-associated likelihood in adult patients with DM.
Design, setting, and participants: A retrospective multicenter cohort study including adults with DM or clinically amyopathic DM was carried out. Participants were recruited from the Department of Dermatology at Ruijin Hospital (training cohort) and the Department of Rheumatology at Renji Hospital (validation cohort) over the period from 2015 to 2022. Multivariate logistic regression and machine learning techniques were employed for model development and validation. The analysis took place in 2024.
Exposure: DM and clinically amyopathic DM.
Main outcomes and measures: The primary outcome was the occurrence of cancer in patients with DM. Model performance was assessed using the area under the curve to evaluate predictive accuracy.
Results: A total of 546 adults with DM or clinically amyopathic DM were included, with a mean (SD) age of 49.8 (14.2) years, comprising 166 male individuals (30.4%) and 380 female individuals (69.6%). Five factors significantly associated with concomitant cancers in patients with DM were used to construct the TIP-CA model: anti-transcriptional intermediary factor 1-γ (TIF1-γ) antibody (positive scored as 1; negative scored as 0), interstitial lung disease (present scored as -1; absent scored as 0), poikiloderma (present scored as 1; absent scored as 0), DM subtypes (DM scored as 1; clinically amyopathic DM scored as 0), and anemia (present scored as 1; absent scored as 0). The model demonstrated good discriminatory capability, achieving an area under the curve of 0.809 and 0.808 in the derivation and validation cohorts, respectively.
Conclusions and relevance: This cohort study found that the TIP-CA model effectively stratified cancer-associated likelihood in patients with DM using routinely available clinical data. By using data from multidisciplinary patient cohorts and incorporating machine learning techniques, the model minimized referral bias. This proposed model may have the potential to guide clinicians in implementing targeted cancer screening strategies and improve patient outcomes.
{"title":"A Novel Tool for Predicting Malignant Disease in Adult Patients With Dermatomyositis.","authors":"Jiaqi Ye, Wanlong Wu, Haixi Wu, Can Xia, Mingyu Ye, Kaile He, Jiaming Teng, Xiaoqing Zhao, Hao Li, Qian Zhao, Jie Zheng, Shuang Ye, Hua Cao","doi":"10.1001/jamadermatol.2025.4824","DOIUrl":"10.1001/jamadermatol.2025.4824","url":null,"abstract":"<p><strong>Importance: </strong>Cancer is a life-threatening complication of dermatomyositis (DM) and contributes significantly to mortality. A validated association-based tool is urgently needed to optimize early cancer detection and reduce diagnostic delays.</p><p><strong>Objective: </strong>To develop and validate a practical prediction model for cancer-associated likelihood in adult patients with DM.</p><p><strong>Design, setting, and participants: </strong>A retrospective multicenter cohort study including adults with DM or clinically amyopathic DM was carried out. Participants were recruited from the Department of Dermatology at Ruijin Hospital (training cohort) and the Department of Rheumatology at Renji Hospital (validation cohort) over the period from 2015 to 2022. Multivariate logistic regression and machine learning techniques were employed for model development and validation. The analysis took place in 2024.</p><p><strong>Exposure: </strong>DM and clinically amyopathic DM.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was the occurrence of cancer in patients with DM. Model performance was assessed using the area under the curve to evaluate predictive accuracy.</p><p><strong>Results: </strong>A total of 546 adults with DM or clinically amyopathic DM were included, with a mean (SD) age of 49.8 (14.2) years, comprising 166 male individuals (30.4%) and 380 female individuals (69.6%). Five factors significantly associated with concomitant cancers in patients with DM were used to construct the TIP-CA model: anti-transcriptional intermediary factor 1-γ (TIF1-γ) antibody (positive scored as 1; negative scored as 0), interstitial lung disease (present scored as -1; absent scored as 0), poikiloderma (present scored as 1; absent scored as 0), DM subtypes (DM scored as 1; clinically amyopathic DM scored as 0), and anemia (present scored as 1; absent scored as 0). The model demonstrated good discriminatory capability, achieving an area under the curve of 0.809 and 0.808 in the derivation and validation cohorts, respectively.</p><p><strong>Conclusions and relevance: </strong>This cohort study found that the TIP-CA model effectively stratified cancer-associated likelihood in patients with DM using routinely available clinical data. By using data from multidisciplinary patient cohorts and incorporating machine learning techniques, the model minimized referral bias. This proposed model may have the potential to guide clinicians in implementing targeted cancer screening strategies and improve patient outcomes.</p>","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":""},"PeriodicalIF":11.0,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12676475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145668009","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}
Pub Date : 2025-12-03DOI: 10.1001/jamadermatol.2025.4630
Jennifer Strong, Yoshine Saito, Winnie Trang, Andrea Beri, Alexandra Firek, Steven Mario Munoz, Dennis D Hickstein, Steven Z Pavletic, Richard W Childs, Dimana Dimitrova, Jennifer A Kanakry, Christopher G Kanakry, Edward W Cowen, Leslie Castelo-Soccio, Isaac Brownell
{"title":"Demodicosis and Ivermectin-Associated Mazzotti-Like Reactions After Hematopoietic Cell Transplant.","authors":"Jennifer Strong, Yoshine Saito, Winnie Trang, Andrea Beri, Alexandra Firek, Steven Mario Munoz, Dennis D Hickstein, Steven Z Pavletic, Richard W Childs, Dimana Dimitrova, Jennifer A Kanakry, Christopher G Kanakry, Edward W Cowen, Leslie Castelo-Soccio, Isaac Brownell","doi":"10.1001/jamadermatol.2025.4630","DOIUrl":"10.1001/jamadermatol.2025.4630","url":null,"abstract":"","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":""},"PeriodicalIF":11.0,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12676477/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145668055","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}
Pub Date : 2025-12-01DOI: 10.1001/jamadermatol.2025.3578
Elias A T Koch, Michael Sticherling, Nicola Wagner
{"title":"Pemphigus Foliaceous With Secondary Herpes Simplex Infection.","authors":"Elias A T Koch, Michael Sticherling, Nicola Wagner","doi":"10.1001/jamadermatol.2025.3578","DOIUrl":"10.1001/jamadermatol.2025.3578","url":null,"abstract":"","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":"1275-1276"},"PeriodicalIF":11.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145345295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1001/jamadermatol.2025.3537
Luiza Kalil, Brittany G Craiglow, Brett King
{"title":"Successful Treatment of Alopecia Areata With One JAK Inhibitor After Failure of Other JAK Inhibitors.","authors":"Luiza Kalil, Brittany G Craiglow, Brett King","doi":"10.1001/jamadermatol.2025.3537","DOIUrl":"10.1001/jamadermatol.2025.3537","url":null,"abstract":"","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":"1285-1287"},"PeriodicalIF":11.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12509074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251105","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}
Pub Date : 2025-12-01DOI: 10.1001/jamadermatol.2025.3369
Yaelle Shaked, Alyssa Swearingen, Jennifer A Stein, David Polsky
{"title":"Navigating Melanoma In Situ in the Age of Overdiagnosis.","authors":"Yaelle Shaked, Alyssa Swearingen, Jennifer A Stein, David Polsky","doi":"10.1001/jamadermatol.2025.3369","DOIUrl":"10.1001/jamadermatol.2025.3369","url":null,"abstract":"","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":"1209-1210"},"PeriodicalIF":11.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1001/jamadermatol.2025.3928
Christopher Willy Schwarz, Mads Kirchheiner Rasmussen, Trine Bertelsen, Lars Iversen, Lone Skov, Nikolai Loft
{"title":"Comparative Cancer Risk in Patients With Psoriasis Treated With Adalimumab, Secukinumab, or Ustekinumab.","authors":"Christopher Willy Schwarz, Mads Kirchheiner Rasmussen, Trine Bertelsen, Lars Iversen, Lone Skov, Nikolai Loft","doi":"10.1001/jamadermatol.2025.3928","DOIUrl":"10.1001/jamadermatol.2025.3928","url":null,"abstract":"","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":"1289-1291"},"PeriodicalIF":11.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12547669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145345291","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}
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