BACKGROUND:Undergraduate United States (US) medical education may not provide adequate education on clinical practice guidelines (CPGs). OBJECTIVES:To identify types of information about CPG development and usage that US medical students and a global subset of CPG development experts considered important to teach students, to detect potential barriers that may limit the implementation of improved and comprehensive CPG education, and to understand the current education regarding CPGs. STUDY DESIGN AND SETTING:Third- and fourth-year US medical students and CPG development experts participated in focus groups between September 2022 and August 2024. Verbal consent for audio recordings was obtained, with analysis via an inductive thematic approach. RESULTS:Three focus groups of US medical students (n = 20) and two focus groups of experts (n = 28) were convened. Experts emphasized the need to teach students the purpose of CPGs through hands-on learning activities. Both students and experts agreed that educational materials on CPGs should include the purpose of CPGs, how to evaluate the quality of CPGs and apply CPG recommendations to individual patient scenarios, and that time constraints for students within an already busy US medical school curriculum and resistance among lecturers and curriculum developers to altering traditional curricula may be barriers to implementing CPG education. Students and experts did not agree on when this education should be delivered in medical schools, with experts believing that education should be introduced during the students' preclinical years. CONCLUSION:US medical students believe that their CPG education needs to be bolstered. These findings support the development of new, structured, and expanded educational modules on various crucial aspects of CPG development and application able to be integrated into existing US medical school curricula in both the preclinical and clinical years. Further work should examine the perspectives of non-US medical students and instructors to inform globally adaptable educational approaches.

OBJECTIVES:To systematically evaluate submissions to the CAPER database by analyzing procedural context, characteristics of reported adverse events (AEs), and provider involvement in order to identify patterns with potential implications for patient safety. METHODS:A retrospective review of all reports submitted to the CAPER database from March 2021 to August 2025 was conducted, categorizing cases by procedure type, reported AE, and provider involved. RESULTS:In total, 199 reports describing 298 AEs across 35 various cutaneous procedures were submitted to the CAPER registry from March 2021 to August 2025. Dermatologists performed 62% of reported procedures, while non-dermatologist physicians, non-physicians, and unknown providers accounted for 38%. Filler injections, ablative laser resurfacing, and non-ablative laser treatments were the most frequently reported procedures. Although dermatologists performed most procedures represented in the registry, 51% of reported AEs were associated with procedures performed by non-dermatology providers. Erythema and scarring were among the most frequently reported AEs, while rare but serious events, including vascular compromise and necrosis, were reported following injectable and energy-based procedures performed by a variety of provider types, including non-physicians. CONCLUSIONS:The CAPER registry provides valuable insight into AEs associated with cutaneous procedures and may help identify emerging safety concerns related to new devices or techniques. Broader engagement with AE reporting systems may inform best practices and improve patient safety, particularly as cutaneous procedures increasingly occur outside traditional clinical settings.

Background Gorlin syndrome (GS) is a rare genetic disorder characterized by a predisposition to developing numerous basal cell carcinomas (BCCs) throughout life. The absence of specific clinical guidelines for managing BCCs in GS has resulted in fragmented care and inconsistent treatment approaches. Objective To develop evidence-based guidelines for managing BCCs in GS, addressing both clinical and psychosocial challenges. Methods A multidisciplinary panel employed a modified Grading of Recommendations Assessment, Development and Evaluation approach, integrating systematic reviews, expert surveys, patient interviews, and Delphi consensus rounds to formulate recommendations. Results The final guidelines include 47 recommendations spanning topical therapies, systemic treatments, surgical interventions, and multimodal strategies. Additional recommendations emphasize shared decision-making, comprehensive monitoring, and psychosocial support to address the chronic nature of BCCs in GS. Specific therapies, including hedgehog inhibitors and field treatments, are recommended to reduce surgical fatigue and enhance quality of life. Limitations Given the scarcity of GS-specific data, expert consensus informed several recommendations, highlighting the need for ongoing research to strengthen the evidence base. Conclusion These guidelines provide a structured framework for improving BCC management in GS, thereby enhancing clinical outcomes and patient quality of life. This process serves as a model for creating patient-centered guidelines in rare conditions with limited evidence.

To the Editor: By 2050, most Americans will have ethnic skin or skin of color (SOC).1 We aimed to assess outcomes in patients with different Fitzpatrick skin types (FSTs) who had surgery to remove their nonmelanoma skin cancers.

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Background: Dermatology trainees are expected to be proficient in basic and advanced surgical repairs. Objective Structured Assessments of Technical Skills (OSATS) are widely utilized tools that can be adapted to objectively assess trainee aptitude in particular types of surgical reconstruction.

Introduction Core outcome sets (COSs) are agreed outcomes (domains (subdomains) and instruments) that should be measured as a minimum in clinical trials or practice in certain diseases or clinical fields. Worldwide, the number of COSs is increasing and there might be conceptual overlaps of domains (subdomains) and instruments within disciplines. The aim of this scoping review is to map and to classify all outcomes identified with COS projects relating to skin diseases.Methods and analysis We will conduct a scoping review of outcomes of skin disease-related COS initiatives to identify all concepts and their definitions. We will search PubMed, Embase and Cochrane library. The search dates will be 1 January 2010 (the point at which Core Outcome Measures in Effectiveness Trials (COMET) was established) to 1 January 2024. We will also review the COMET database and C3 website to identify parts of COSs (domains and/or instruments) that are being developed and published. This review will be supplemented by querying relevant stakeholders from COS organisations, dermatology organisations and patient organisations for additional COSs that were developed. The resulting long lists of outcomes will then be mapped into conceptually similar concepts.Ethics and dissemination This study was supported by departmental research funds from the Department of Dermatology at Northwestern University. An ethics committee review was waived since this protocol was done by staff researchers with no involvement of patient care. Conflicts of interests, if any, will be addressed by replacing participants with relevant conflicts or reassigning them. The results will be disseminated through publication in peer-reviewed journals, social media posts and promotion by COS organisations.

BACKGROUND:Few studies show how dermatologic surgeons manage problems with site identification. OBJECTIVE:To estimate frequency and characterize management of skin cancer treated by surgery when the anatomic location of the tumor is in question. METHODS:Nationwide, prospective, multisite cohort study. RESULTS:Among 17,076 cases at 22 centers, 98 (0.60%) were lesions in question for which site identification was initially uncertain, with these more often in patients who were male, older, and biopsied more than 30 days ago. Surgeons employed on average 5.0 (95% CI: 4.61-5.39) additional techniques to confirm the site location, with common approaches including: re-checking available documentation (90 lesions, 92%); performing an expanded physical examination (89 lesions, 91%); and asking the patient to point using a mirror (61 lesions, 62%). In 15%, photographs were requested from the biopsying provider, and also in 15%, frozen section biopsies were obtained. In 10%, the referring physician was contacted. Eventually, surgeons succeeded in definitively identifying 82% (80 of 98) of initially uncertain sites, with the remaining 18% (18 of 98) postponed. Most postponed surgeries were at non-facial sites. LIMITATIONS:Sites were academic centers. CONCLUSIONS:When the anatomic location of the tumor is uncertain, dermatologic surgeons use multiple methods to identify the site, and sometimes cases are postponed.

A condition that may be underdiagnosed in patients with skin of color is rosacea. Rosacea is associated with multiple physical and psychosocial comorbidities, with previous studies reporting that its proposed inflammatory pathophysiology was associated with higher fasting blood glucose, which can lead to Type 2 Diabetes Mellitus (T2DM) and accelerate cardiovascular disease. The aim of this study was to determine the likelihood ratio of having T2DM in an adult US population with and without rosacea using the NIH's All of Us database. A total of 366,527 participants was analyzed, with the majority being female (59%), Caucasian (54%), and not having both rosacea and T2DM (88%). Participants with a diagnosis of rosacea were found to be more likely to have T2DM compared to participants without rosacea (likelihood ratio 2.53; 95% confidence interval: 2.39 – 2.68; p<0.001), which could influence the standard screening of T2DM in patients with rosacea. The subset of rosacea patients with skin of color also were more likely to have T2DM (<0.05%), although the number of affected patients was too low to determine statistical significance. As the NIH's All of Us database continues to grow in size and reach, it is likely that the cohort of skin of color patients will grow sufficiently to confirm this finding.

Mafee, Mariam MD; Yi, Michael D. BS; Carr, David R. MD, MPH; Alam, Murad MD, MSCI, MBA Author Information

Acquired ichthyosis is an uncommon dermatologic disorder that presents in adulthood and is often associated with systemic conditions, including malignancies. We report the case of a 38-year-old male patient who developed diffuse scaling characterized by rhomboidal, fish-like scales predominantly affecting the trunk and limb extensors, with sparing of the flexures, palms, and soles. Initial therapeutic interventions with emollients and corticosteroids were unsuccessful. A skin biopsy confirmed the diagnosis of acquired ichthyosis, and subsequent diagnostic imaging revealed an underlying colon adenocarcinoma. Notably, the patient's family history was significant for his mother's colon adenocarcinoma, suggesting a potential genetic predisposition. This case highlights the critical importance of conducting a comprehensive diagnostic evaluation for underlying malignancies upon the diagnosis of acquired ichthyosis, particularly in patients with pertinent familial cancer histories. Although the patient was lost to follow-up, this case underscores the role of acquired ichthyosis as a potential paraneoplastic marker, emphasizing the need for early detection and management of associated malignancies.

Background: While oral isotretinoin has been a long-standing remedy for nodulocystic and persistent moderate to severe acne, its potential correlation with inflammatory bowel disease (IBD) has yet to find a consensus. Thus, this meta-analysis seeks to clarify this controversy by examining the risk of getting IBD and its two subtypes, Crohn's disease (CD) and ulcerative colitis (UC), after isotretinoin usage.

Therapeutic options for acne scars include subcision and suction with microdermabrasion, but these treatment modalities have not been studied in conjunction. To compare effectiveness of subcision alone versus subcision with suction for the treatment of facial acne scars. Randomized, split-faced, evaluator-blinded control trial. Participants underwent one subcision treatment on both sides of the face followed by 10 sessions of suction to one side. Photographs at baseline, 1-month, and 4-months were assessed. Primary outcome measures were the validated Acne Scar Severity Scale (ASSS) (0 = no acne scarring, 4 = severe), Acne Scar Improvement Grading Scale (ASIGS) (-100 to 100%), and modified Quantitative Global Scarring Grades (QGSG) (point-based questionnaire instrument), as well as subject preference. Twenty-eight treatment areas and 154 treatments were analyzed. Dermatologist raters found no differences between subcision alone and subcision-suction at 1-month or 4-months. Mean subject-assessed percent improvement for subcision-suction was higher than that for subcision alone at 1-month (37% versus 24%, p = 0.04) but not at 4-months (p = 0.37). Subjects preferred combination therapy to monotherapy at 1-month (50% vs. 21%) and 4-months (43% vs. 21%). While blinded raters did not detect significant differences, subjects perceived combination treatment as working more quickly than monotherapy, and preferred combination treatment at all time points.Clinical trial registration NCT01696513 on Clinicaltrials.gov.

Atopic dermatitis (AD), commonly known as eczema, is a chronic inflammatory skin condition that presents as dry, itchy skin that is prone to lichenification, blistering, bleeding, and infections. The prevalence of AD is increasing globally, with an estimated 230 million individuals living with AD in 2019. While efforts are ongoing to identify gene targets for drug development and the repurposing of existing biologics for the treatment of AD, the psychosocial burden of AD and the associated ease of access to appropriate health care remains largely unexplored. AD is associated with many psychosocial comorbidities including, among others, depression, anxiety, and sleep disturbances. A recent review reported that people living with AD were 36% more likely to attempt suicide. The aim of this study was to utilize the NIH All of Us Registered Tier Dataset Version 6, representing 331,360 participants, to quantify the extent of AD/eczema and common comorbid psychiatric diagnoses in the United State. Of the total 13,756 participants with a diagnosis of eczema, 6,650 (48.3%) had anxiety, 5,259 (38.2%) had at least one episode of major depressive disorder, 4,637 (33.7%) had a subtype of dyssomnia, and 345 (2.5%) had an eating disorder. Furthermore, survey information regarding access to appropriate psychiatric health care and utilization among these individuals with AD/eczema are being explored through this powerful database. The results of this study will bring quantitative data about the psychosocial burden of AD/eczema and participants' experiences in receiving appropriate care to the attention of dermatologists and the medical community to guide actionable change for patient care.

To the Editor: Patient satisfaction with out-of-pocket cost is understudied, with most prior work on willingness to pay and satisfaction with total health care expenditure, including out-of-pocket costs and insurance payments. However, anecdotal clinical experience suggests that the patient's cost of care may have an outsized role on perceived satisfaction.1,2 This prospective, single-center, randomized study at a US academic medical center was designed to determine patient satisfaction associated with out-of-pocket cost associated with cutaneous surgery.