Ninety-SIXTH issue
OCTOBER 15, 2025
Facilitators and barriers to the timely diagnosis and treatment of melanoma in Latino persons
JAMA Dermatology
JAMA Dermatology
The tumor doesn’t wait, but the system sure does.
Melanoma mortality has declined among non-Hispanic White patients. Latino patients, the second-largest racial and ethnic group in the United States, still experience later-stage diagnoses and worse outcomes. This qualitative study interviewed 20 Latino patients with melanoma to identify facilitators and barriers to timely diagnosis and treatment.
What did they find?
Main Takeaway: Timely melanoma care for Latino patients is hindered by multilevel barriers. Effective solutions should combine patient activation, clinician education, language-concordant services, and structural improvements that streamline insurance approvals and referrals.
Melanoma mortality has declined among non-Hispanic White patients. Latino patients, the second-largest racial and ethnic group in the United States, still experience later-stage diagnoses and worse outcomes. This qualitative study interviewed 20 Latino patients with melanoma to identify facilitators and barriers to timely diagnosis and treatment.
What did they find?
- Facilitators included:
- Self-advocacy in navigating appointments, referrals, and follow-up
- Language-concordant care that improved understanding of diagnosis and treatment
- Barriers included:
- Insurance authorization delays, especially in public or managed care plans
- Referral bottlenecks from primary care to dermatology
- Low awareness of melanoma risk and warning signs
- Limited Spanish-language resources or interpreters, which often placed translation on family members
- These barriers operated at individual, cultural, and system levels. Patients reported that even after diagnosis, care was slowed by authorization hurdles and poor referral coordination.
Main Takeaway: Timely melanoma care for Latino patients is hindered by multilevel barriers. Effective solutions should combine patient activation, clinician education, language-concordant services, and structural improvements that streamline insurance approvals and referrals.
Ocular and auditory comorbidities in patients with vitiligo
Journal of the American Academy of Dermatology
Journal of the American Academy of Dermatology
Eye spy a vitiligo surprise, sight and sound meet skin
Vitiligo is an autoimmune disorder that depletes melanocytes in the skin and in pigmented tissues of the eye and inner ear. Although syndromic conditions link depigmentation with ocular and auditory disease, large, real-world data for isolated vitiligo have been limited. To clarify risk and inform care, researchers analyzed the Republic of Korea’s National Health Insurance database, including 147,610 patients with vitiligo, and compared ocular and auditory comorbidities with matched controls.
What did they find?
Main Takeaway: Vitiligo is linked to higher rates of ocular and auditory disorders across age groups, supporting the view that vitiligo is a systemic disease. Care should include coordinated ophthalmologic and audiologic screening, attention to older adults, and risk–benefit discussions when initiating phototherapy.
Vitiligo is an autoimmune disorder that depletes melanocytes in the skin and in pigmented tissues of the eye and inner ear. Although syndromic conditions link depigmentation with ocular and auditory disease, large, real-world data for isolated vitiligo have been limited. To clarify risk and inform care, researchers analyzed the Republic of Korea’s National Health Insurance database, including 147,610 patients with vitiligo, and compared ocular and auditory comorbidities with matched controls.
What did they find?
- Children/adolescents with vitiligo (n=34,200) had a higher risk of dry eye (aOR 1.30, 95% CI 1.23-1.38; P<0.001), glaucoma (aOR 1.43, 95% CI 1.05-1.96; P=0.025), retinal disease (aOR 1.26, 95% CI 1.14-1.40; P<0.001), and visual impairment (aOR 1.16, 95% CI 1.05-1.29; P=0.005) compared to matched controls.
- Adults with vitiligo (n=113,410) had a higher risk of dry eye (aOR 1.39, 95% CI 1.36-1.41; P<0.001), nonanterior uveitis (aOR 1.66, 95% CI 1.27-2.17; P<0.001), cataract (aOR 1.27, 95% CI 1.13-1.18; P<0.001), glaucoma (aOR 1.19, 95% CI 1.15-1.24; P<0.001), and retinal disease (aOR 1.26, 95% CI 1.23-1.29; P<0.001) compared to matched controls.
- Older age (≥ 65) increased the risk for cataract, overall retinal disease, and overall hearing loss (all P<0.05) compared to the younger age group.
- The use of phototherapy for treatment of vitiligo (n=28,385, 25.0%) was associated with a small increased risk of glaucoma (aOR 1.09, 95% CI 1.02-1.17; P=0.017).
- Auditory disorders were more prevalent in adults with vitiligo, including hearing loss (aOR 1.22, 95% CI 1.18-1.26; P<0.001), benign paroxysmal positional vertigo (aOR 1.20,95% CI 1.16-1.25; P<0.001), and vestibular neuronitis (aOR 1.32, 95% CI, 1.19-1.46; P<0.001).
Main Takeaway: Vitiligo is linked to higher rates of ocular and auditory disorders across age groups, supporting the view that vitiligo is a systemic disease. Care should include coordinated ophthalmologic and audiologic screening, attention to older adults, and risk–benefit discussions when initiating phototherapy.
Incidence and mortality of of melanoma in situ and malignant melanoma in England between 2001 and 2020
British Journal of Dermatology
British Journal of Dermatology
SPF is the hottest craze, but older men are still catching the rays
In England, melanoma incidence has risen for decades, while mortality has recently declined. To clarify these trends, researchers analyzed National Disease Registration Service data from 2001 to 2020 covering 307,078 melanomas (86,792 MIS and 220,286 MM), evaluating incidence and mortality by age and sex.
What did they find?
Main Takeaway: Melanoma incidence in England has begun to stabilize, particularly in younger generations, while mortality is declining, likely reflecting better diagnostics, improved therapies, and lasting effects of sun-awareness campaigns. However, the burden continues to grow in older men, underscoring the need for targeted prevention and early detection.
In England, melanoma incidence has risen for decades, while mortality has recently declined. To clarify these trends, researchers analyzed National Disease Registration Service data from 2001 to 2020 covering 307,078 melanomas (86,792 MIS and 220,286 MM), evaluating incidence and mortality by age and sex.
What did they find?
- 86,792 MIS and 220,286 MM cases were recorded from 2001 to 2020.
- Age-standardized incidence of MM increased from 14.6 to 28.7 per 100,000 (2001–2019), but growth slowed markedly after 2014.
- MIS incidence rose from 4.5 to 13.3 per 100,000 (2001–2019), plateauing after 2015.
- Mortality from MM began to decline after 2014 (-2.7% per year), especially in those <75 years, while deaths continue to rise in older adults (>75 years).
- Incidence and mortality remain highest in older men, who also showed the steepest continued increases.
Main Takeaway: Melanoma incidence in England has begun to stabilize, particularly in younger generations, while mortality is declining, likely reflecting better diagnostics, improved therapies, and lasting effects of sun-awareness campaigns. However, the burden continues to grow in older men, underscoring the need for targeted prevention and early detection.
Lower lip lesions in fair-skinned patients: Time to make specific diagnoses other than actinic cheilitis
The American Journal of Dermatopathology
The American Journal of Dermatopathology
Lies of the lips
Actinic chelitilis (AC) is a common diagnosis for lower lip lesions, particularly in fair-skinned patients with chronic sun damage. However, AC lacks standardized diagnostic criteria, leading to potential misclassification and limit cross-study comparisons. In this retrospective study, researchers reexamined the histopathologic features of biopsies and vermillionectomy specimens (839 slides total) from 117 patients clinically diagnosed with AC.
What did they find?
Main Takeaway: Actinic cheilitis is not a specific diagnosis. In this cohort, all cases initially labeled AC were reclassified to more specific entities, underscoring the need for greater diagnostic precision to improve patient care.
Actinic chelitilis (AC) is a common diagnosis for lower lip lesions, particularly in fair-skinned patients with chronic sun damage. However, AC lacks standardized diagnostic criteria, leading to potential misclassification and limit cross-study comparisons. In this retrospective study, researchers reexamined the histopathologic features of biopsies and vermillionectomy specimens (839 slides total) from 117 patients clinically diagnosed with AC.
What did they find?
- In all analyzed specimens, a more specific diagnosis could be made than AC.
- Solar elastosis with normal or atrophic epithelium was observed in 603 slides from 83 patients, with solar elastosis as the only finding in 33 patients.
- Lichen simplex chronicus was seen in 105 slides from 30 patients, while lichen planus was diagnosed in 4 slides from 4 patients.
- Actinic keratosis or superficially invasive squamous cell carcinoma was found in 85 slides from 50 patients.
Main Takeaway: Actinic cheilitis is not a specific diagnosis. In this cohort, all cases initially labeled AC were reclassified to more specific entities, underscoring the need for greater diagnostic precision to improve patient care.
Beyond repigmentation: A prospective study of patients with stable vitiligo treated with suction blister epidermal grafting plus phototherapy
Dermatologic Surgery
Dermatologic Surgery
When you’re finally getting your color back but your hair follicles didn’t get the memo
Vitiligo, an autoimmune condition causing depigmented patches, affects 0.5-2% of the global population and deeply impacts quality of life. Researchers from Peking Union Medical College Hospital conducted a prospective study of 23 patients (40 lesions) with stable vitiligo to evaluate suction blister epidermal grafting (SBEG) combined with narrow-band UVB (NB-UVB) phototherapy. Outcomes assessed included repigmentation rates and quality-of-life scores (DLQI and VitiQoL) at 3 and 6 months post-surgery.
What did they find?
Vitiligo, an autoimmune condition causing depigmented patches, affects 0.5-2% of the global population and deeply impacts quality of life. Researchers from Peking Union Medical College Hospital conducted a prospective study of 23 patients (40 lesions) with stable vitiligo to evaluate suction blister epidermal grafting (SBEG) combined with narrow-band UVB (NB-UVB) phototherapy. Outcomes assessed included repigmentation rates and quality-of-life scores (DLQI and VitiQoL) at 3 and 6 months post-surgery.
What did they find?
- Mean repigmentation rates reached 63.35% at 3 months and 70.23% at 6 months, with 87.5% of patients achieving moderate-to-excellent response.
- Lesions with terminal hair showed significantly lower pigment recovery (46.7% vs. 74.4%, P = 0.0499), suggesting hair growth interferes with graft adherence.
- DLQI scores improved from 7.37 to 4.06 (P = 0.0213) showing measurable psychosocial benefit.
- The most common adverse effect was hyperpigmentation (80%), however no infection, scarring, or Koebner phenomenon was observed.
Split-face comparison of fractional 1064 nm Nd:YAG picosecond and Q-switched lasers for photoaging
Journal of Cosmetic Dermatology
Journal of Cosmetic Dermatology
Mirror, mirror, who’s smoother now?
Fractional laser resurfacing remains a gold standard for photoaged skin, but innovation has sparked debate about whether picosecond lasers truly outperform their Q-switched predecessors. This split-face, prospective clinical study directly compared the fractional 1064 nm Nd:YAG picosecond laser (FxPico) to the fractional Q-switched 1064 nm Nd:YAG laser (QSF-Nd:YAG) in improving signs of photoaging, including wrinkles, pores, and overall texture. Beyond surface results, the team also analyzed histological changes to quantify collagen and elastin remodeling.
What did they find?
Fractional laser resurfacing remains a gold standard for photoaged skin, but innovation has sparked debate about whether picosecond lasers truly outperform their Q-switched predecessors. This split-face, prospective clinical study directly compared the fractional 1064 nm Nd:YAG picosecond laser (FxPico) to the fractional Q-switched 1064 nm Nd:YAG laser (QSF-Nd:YAG) in improving signs of photoaging, including wrinkles, pores, and overall texture. Beyond surface results, the team also analyzed histological changes to quantify collagen and elastin remodeling.
What did they find?
- 24 adults with moderate photoaging were included in the study, undergoing three sessions each, 4 weeks apart.
- Both sides improved in wrinkles, pore size, and texture (P < 0.05), with no statistically significant difference between lasers.
- Patients reported increased pain with FxPico (P < 0.05).
- Both lasers increased collagen and reorganized elastin, with FxPico showing slightly greater neocollagenesis; however, this was not statistically significant.
- Both lasers had some mild transient erythema/edema, but no PIH, scarring, or serious adverse events.
When melasma said it’s deeper than you thought
Melasma is a common pigmentary disorder with complex histopathology and limited noninvasive diagnostic tools. This observational study used two-photon microscopy (TPM), a laser-based imaging method, to evaluate pigment and cellular changes before and after treatment with hydroquinone 2% cream.
What did they find?
Melasma is a common pigmentary disorder with complex histopathology and limited noninvasive diagnostic tools. This observational study used two-photon microscopy (TPM), a laser-based imaging method, to evaluate pigment and cellular changes before and after treatment with hydroquinone 2% cream.
What did they find?
- Lesions had significantly more melanin across all epidermal layers compared to surrounding skin (P < 0.001).
- Modified MASI scores improved by 29.8% from baseline (P < 0.001).
- Pigmentary scores on dermoscopy improved by 36.2% (P < 0.001).
- TPM showed significant reductions in epidermal melanin and activated melanocytes (P < 0.001).
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Copyright © 2025 - All Rights Reserved.
Copyright © 2025 - All Rights Reserved.