The incidence of and mortality from invasive melanoma in the United States has risen steadily for at least the past 2 decades. 1 Similar trends are being seen worldwide despite numerous efforts to enhance primary prevention and early detection, and these increasing rates are having an impact on the public health and economic burden of disease. In 2009, we reported on the status of US melanoma incidence at that time. 2 The purpose of this study was to provide updated information on trends in melanoma incidence and mortality that will help to elucidate the current state of this cancer in the United States.

our patients demonstrated a variable profile to the larger ERIVANCE trial, 2 the AEs in our study were not standardized and were patient reported. Our study had limitations. This was a retrospective medical record review and used a relatively small sample size and patient-reported AEs and assessed improvement based on clinical photos rather than measurement. Most importantly, none of our 7 patients terminated the medication owing to AEs.Conclusions | To our knowledge, this is the first study to demonstrate efficacy with 1-to 3-week drug holidays. An intermittent dosing schedule of vismodegib should be considered when treatment-related AEs would cause discontinuation of treatment. Dosing regimens as low as 1 week with and 3 weeks without medication continued to demonstrate clinical improvement in patients with BCCs in this cohort. Pharmacokinetic and prospective randomized clinical trials are needed to determine the ideal intermittent regimen without causing resistance.

The number of dermatology providers practicing per 100 000 people in each 3-digit postal section code is indicated by the colors on the map. Section codes without a dermatology provider are included in white. Note that the Great Lakes are included in US section coding and do not appear on the map.

helped initiate the study. We also thank the entire faculty and staff of UHealth Pediatrics Professional Arts Center for their support. They received no compensation for their contributions.

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