Emilie A. Foltz

The landscape of dermatology is undergoing a significant transformation as the field grapples with the implications of diversity, equity, and inclusion (DEI) initiatives. These efforts are pivotal in addressing and reducing disparities in patient outcomes, particularly for people of color (POC). This summary examines the disparities in dermatology, the importance of DEI initiatives, the impact of a recent Supreme Court decision, and the ongoing debates within the American Academy of Dermatology (AAD) regarding DEI policies.

First-generation college students in medicine are crucial to advancing health equity and innovation in the evolving medical field. These students, often the first in their extended families to graduate, bring diverse perspectives, resilience, and a strong commitment to underserved communities. Their unique backgrounds enhance patient care, foster innovation, and help address physician shortages in underserved areas. However, they face challenges such as financial constraints and lack of mentorship. This paper underscores the need for institutional support systems to help these students succeed. Ultimately, their inclusion is essential for creating a more equitable and compassionate healthcare system, making their development a strategic imperative for the future of medicine.

Teaching the foundation of dermatology for non-dermatologists has proven difficult, especially in a compact undergraduate medical education system. This has consequently led to insufficient preparation of non-dermatologists, including primary care residents, to identify, describe, and manage skin conditions. We present a grammatical approach for learning and describing skin lesions that will provide an early, expandable framework built from easily digestible components. From results in our own institution, we hope this tool will empower trainees of all expertise and specialties to apply their knowledge at the bedside and aid in communication and collaboration with dermatology consultants when needed. Twenty-one first-year medical students at the University of Texas at Austin Dell Medical School voluntarily completed our learning module with a pre- and post-survey, which recorded their confidence in verbally describing common skin lesions and formulating differential diagnoses. Among the respondents, 85.7% reported that the learning tool helped them better organize their descriptions of skin findings. There was a statistically significant increase in confidence after the learning tool for describing skin lesions (p<0.05) and formulating a differential diagnosis (p<0.05). These results suggest the grammatical approach improves the confidence of trainees by both describing skin lesions and formulating differential diagnoses based on the lesion’s description.

Introduction: Teledermatology, defined as the use of remote imaging technologies to provide dermatologic healthcare services to individuals in a distant setting, has grown considerably in popularity since its widespread implementation during the COVID-19 pandemic. Teledermoscopy employs a smartphone dermatoscope attachment paired with a smartphone camera to visualize colors and microstructures within the epidermis and superficial dermis that cannot be seen with the naked eye ABCD criteria alone. Methods: Our retrospective observational cohort and case–control study evaluated the utility of loaning a smartphone dermatoscope attachment to patients for remote triage of self-selected lesions of concern for skin cancer. The primary outcome was the number (percentage) of in-person follow-up visits required for patients who submitted lesion images, either with or without accompanying dermoscopic images. A medical record review was conducted on all Oregon Health & Science University Department of Dermatology spot check image submissions utilizing the smartphone dermatoscopes between August 2020 and August 2022. De-identified dermoscopic images of lesions that included corresponding non-dermoscopic clinical images in their submission (n = 70) were independently reviewed by a blinded expert dermoscopist. The expert used standard clinical algorithms (ABCD criteria for clinical images; dermoscopy three-point checklist for dermoscopic images) to determine whether the imaged lesion should be converted to an in-person visit for further evaluation and consideration for biopsy. Results: Of the 70 lesions submitted with corresponding clinical and dermoscopy images, 60 met the criteria for in-person evaluation from clinical (non-dermoscopic) image review compared to 28 meeting the criteria for in-person evaluation from dermoscopic images of the same lesion. Thus, a 53% reduction in conversion to an in-person consultation with the addition of smartphone dermatoscope images in virtual lesion triage was observed (p < 0.001, McNemar’s Test). Conclusion: Implementing patient-led teledermoscopy may reduce the frequency of in-person visits for benign lesions and consequently improve access to in-person dermatology consultations for patients with concerning and possibly malignant lesions.

Background: The objective of this study is to systematically analyze the current state of the literature regarding novel artificial intelligence (AI) machine learning models utilized in non-invasive imaging for the early detection of nonmelanoma skin cancers. Furthermore, we aimed to assess their potential clinical relevance by evaluating the accuracy, sensitivity, and specificity of each algorithm and assessing for the risk of bias. Methods: Two reviewers screened the MEDLINE, Cochrane, PubMed, and Embase databases for peer-reviewed studies that focused on AI-based skin cancer classification involving nonmelanoma skin cancers and were published between 2018 and 2023. The search terms included skin neoplasms, nonmelanoma, basal-cell carcinoma, squamous-cell carcinoma, diagnostic techniques and procedures, artificial intelligence, algorithms, computer systems, dermoscopy, reflectance confocal microscopy, and optical coherence tomography. Based on the search results, only studies that directly answered the review objectives were included and the efficacy measures for each were recorded. A QUADAS-2 risk assessment for bias in included studies was then conducted. Results: A total of 44 studies were included in our review; 40 utilizing dermoscopy, 3 using reflectance confocal microscopy (RCM), and 1 for hyperspectral epidermal imaging (HEI). The average accuracy of AI algorithms applied to all imaging modalities combined was 86.80%, with the same average for dermoscopy. Only one of the three studies applying AI to RCM measured accuracy, with a result of 87%. Accuracy was not measured in regard to AI based HEI interpretation. Conclusion: AI algorithms exhibited an overall favorable performance in the diagnosis of nonmelanoma skin cancer via noninvasive imaging techniques. Ultimately, further research is needed to isolate pooled diagnostic accuracy for nonmelanoma skin cancers as many testing datasets also include melanoma and other pigmented lesions.

The halo nevus is characterized by a ring of depigmentation appearing around an acquired or congenital melanocytic nevus. When observed in children, halo nevi are generally not a cause of concern. However, adult-onset halo nevi have an associated risk of primary cutaneous melanoma that corresponds to the risk of melanoma in patients with atypical nevi or a personal/familial history of melanoma. Thus, new-onset halo nevi in adults requires close follow-up and monitoring for malignancy. Herein we present a case of an adult patient who received sequential digital dermoscopy, reflectance confocal microscopy, and pigmented lesion assay gene expression profiling to monitor two halo nevi over a three-month period.

Early sun exposure in pediatric and adolescent years predisposes individuals to skin cancer, and provider counseling about photoprotective behaviors can reduce this risk in both children and adults. In the United States, people with dark skin tones have higher mortality rates from skin cancer, yet there is a lower incidence of skin malignancies in these populations. Research suggests this is due to inadequate understanding and medical training regarding dermatologic disease in skin of color.

In this letter, we examine the application of smartphone dermoscopy in teledermatology skin cancer screenings for individuals in rural communities. There is currently a paucity of literature that examines teledermoscopy in rural areas of the United States. This is significant in consideration of the barriers posed to individuals in rural areas seeking access to dermatology care. This manuscript addresses the intersection of technology and expanding access to underserved communities − issues paramount to the future of dermatology.

Background: Basal cell carcinoma (BCC) is the most common skin cancer, accounting for approximately 80% of nonmelanoma skin cancer diagnoses each year. Among other factors, the staging of BCC is influenced by its measured diameter. Stage 1 BCC is defined as a lesion measuring 2 cm across or less. Of note, there have been increasing publications reporting features of “small‐sized” BCCs, which can present smaller than 1 mm. However, few of these studies have characterized features of pigmented small‐sized BCC. The application of in‐vivo imaging such as dermoscopy and reflectance confocal microscopy (RCM) allows for the non‐invasive distinction of these lesions from benign and malignant melanocytic neoplasms, thereby reducing unnecessary biopsies.Methods: Within one year, three patients presented to Oregon Health and Science University's dermatology clinic with pigmented lesions of concern measuring less than 2 mm that were histologically confirmed as pigmented BCC. We sought to characterize the features of these lesions in a case series with the non‐invasive imaging modalities of dermoscopy and RCM.Results: All cases presented clinically as a small, brown, macule on the face. Each of the three cases exhibited differing features on dermoscopy. With the application of RCM, we were able to visualize characteristic BCC features, prompting removal by shave biopsy.Conclusion: To our knowledge, no other study has reported dermoscopic and RCM features of a cohort of pigmented BCCs 2 mm in diameter or smaller. We propose to define BCCs of this size as micro‐BCCs. The variability of dermoscopic findings observed in our study, combined with the small size of these pigmented lesions, shows the utility of RCM as a non‐invasive diagnostic tool for pigmented micro‐BCCs.