Evolving eponymous signs in diagnostic dermoscopy

Dermoscopy is a very useful technique devised for an earlier diagnosis of skin melanoma with a clinic-pathological correlation. Later it was found to be beneficial for the diagnosis of many other pigmented skin lesions, such as seborrheic keratosis, pigmented basal cell carcinoma, hemangioma, blue nevus, atypical nevus, and mole, which can often clinically simulate melanoma. Of late, its use in general clinical dermatology is growing with the recognition of new and specific patterns in conditions such as hair disorders, inflammatory disorders, and infections/infestation. It is still in the evolving phase and many new signs are described presently. Eponyms are used almost daily in dermatology practice. The eponyms in dermoscopy, trichoscopy, and onychoscopy are based on the imaginative capability of the authors and they have been very much successful in describing them. It becomes easier to memorize and identify the various appearances for early diagnosis and management. In this article we attempt to highlight the various dermoscopic signs described in dermatology.

High-frequency ultrasound in clinical dermatology: a review

Background Ultrasound was first introduced in clinical dermatology in 1979. Since that time, ultrasound technology has continued to develop along with its popularity and utility. Main text summary Today, high-frequency ultrasound (HFUS), or ultrasound using a frequency of at least 10 megahertz (MHz), allows for high-resolution imaging of the skin from the stratum corneum to the deep fascia. This non-invasive and easy-to-interpret tool allows physicians to assess skin findings in real-time, enabling enhanced diagnostic, management, and surgical capabilities. In this review, we discuss how HFUS fits into the landscape of skin imaging. We provide a brief history of its introduction to dermatology, explain key principles of ultrasonography, and review its use in characterizing normal skin, common neoplasms of the skin, dermatologic diseases and cosmetic dermatology. Conclusion As frequency advancements in ultrasonography continue, the broad applications of this imaging modality will continue to grow. HFUS is a fast, safe and readily available tool that can aid in diagnosing, monitoring and treating dermatologic conditions by providing more objective assessment measures.

The Role of DICOM in Artificial Intelligence for Skin Disease

There is optimism that artificial intelligence (AI) will result in positive clinical outcomes, which is driving research and investment in the use of AI for skin disease. At present, AI for skin disease is embedded in research and development and not practiced widely in clinical dermatology. Clinical dermatology is also undergoing a technological transformation in terms of the development and adoption of standards that optimizes the quality use of imaging. Digital Imaging and Communications in Medicine (DICOM) is the international standard for medical imaging. DICOM is a continually evolving standard. There is considerable effort being invested in developing dermatology-specific extensions to the DICOM standard. The ability to encode relevant metadata and afford interoperability with the digital health ecosystem (e.g., image repositories, electronic medical records) has driven the initial impetus in the adoption of DICOM for dermatology. DICOM has a dedicated working group whose role is to develop a mechanism to support AI workflows and encode AI artifacts. DICOM can improve AI workflows by encoding derived objects (e.g., secondary images, visual explainability maps, AI algorithm output) and the efficient curation of multi-institutional datasets for machine learning training, testing, and validation. This can be achieved using DICOM mechanisms such as standardized image formats and metadata, metadata-based image retrieval, and de-identification protocols. DICOM can address several important technological and workflow challenges for the implementation of AI. However, many other technological, ethical, regulatory, medicolegal, and workforce barriers will need to be addressed before DICOM and AI can be used effectively in dermatology.

The “throwaways”. Conflicts of interest in dermatology publications

ImportanceConflict of interest as it relates to medical education is a topic of concern. Dermatology journals, periodicals, editorials, and news magazines are influential resources that are not uniformly regulated and subject to influence from the pharmaceutical industry.ObjectiveThis study evaluates industry payments to physician editorial board members of common dermatology publications, including “throwaway” publications.DesignA list of editorial board members was compiled from a collection of clinical dermatology publications received over a 3-month period. To analyze the nature and extent of industry payments to this cohort, payments data from the Open Payments database from 2013 to 2019 were collected. Analysis of the total payments, number of transactions, categories of payments, payment sources, and physician specific characteristics was performed.ResultsTen publications were evaluated, and payments data for 466 physicians were analyzed. The total compensation across all years was $75,622,369.64. Services other than consulting, consulting, and travel/lodging payments comprised most of the payments. A faction of dermatologists received the majority of payments. The top payers were manufacturers of biologic medications. Payment amounts were higher for throwaway publications compared to peer-reviewed journals.ConclusionsEditorial board members of dermatology publications received substantial payments from the pharmaceutical industry. A minority of physicians receive the lion’s share of payments from industry. “Throwaway” publications have more financial conflict of interest than peer-reviewed journals. The impact of these conflicts of interest on patient care, physicians practice patterns, and patient perception of physicians is noteworthy.