BACKGROUND Prescription opioid use often precedes opioid misuse, abuse, and addiction. OBJECTIVE To characterize the national opioid prescription practices of Mohs surgeons, with general dermatologists serving as a comparison group. METHODS A retrospective cross-sectional study using Medicare prescription data to analyze opioid prescription characteristics. RESULTS In 2014, 2,190 Mohs surgeons prescribed a total of 86,526 opioids, whereas 10,347 non-Mohs dermatologists prescribed 45,033 opioids. Among Mohs surgeons, 51.8% prescribed more than 10 opioids, whereas 93.3% of non-Mohs dermatologists prescribed 0 to 10. The estimated opioid prescription rates for Mohs surgeons and non-Mohs dermatologists were 5.9% and 0.7%, respectively. Among those prescribing at least 10 opioid claims, the mean number of opioids supplied and mean opioid prescription rate was 72.4 and 13.5, respectively, for Mohs surgeons versus 32.5 and 5.1 , respectively, for non-Mohs dermatologists. The mean days' supply of opioids was 3.9 for Mohs surgeons versus 7.9 for non-Mohs dermatologists. There was a minimal-to-moderate association between the number of procedures performed and the number of opioids prescribed. Men and Mohs surgeons located in southern states tend to prescribe a greater number of opioids. CONCLUSION Mohs surgeons prescribed short courses of opioids and less than both the national average and providers that care for patients in pain.

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Objective: To update guidance regarding the management of psoriatic disease during the COVID-19 pandemic.Study Design: The task force (TF) includes 18 physician voting members with expertise in dermatology, rheumatology, epidemiology, infectious diseases, and critical care. The TF was supplemented by nonvoting members, which included fellows and National Psoriasis Foundation staff. Clinical questions relevant to the psoriatic disease community were informed by inquiries received by the National Psoriasis Foundation. A Delphi process was conducted.

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1604 Background: Low socioeconomic status and long distances to a diagnosing provider are factors associated with poor melanoma outcomes, including advanced stage at presentation. Telemedicine offers improved access to diagnostic services for patients in medically underserved communities. Dermoscopy is an established skin imaging method with greater diagnostic accuracy for skin cancers compared to naked eye examination alone. We evaluated the safety and efficacy of a dermoscopy-enhanced, store-and-forward telemedicine-based skin cancer diagnostic platform in a prospective clinical trial. Methods: Participants were recruited primarily through advertisements in local newspapers. Subjects with self-identified skin lesions concerning for malignancy could have up to three lesions evaluated. Clinical and dermoscopic images of each lesion were captured, and were stored-and-forwarded to a team of three dermatologists (TeleTeam) working remotely, and independently. Participants were also evaluated face-to-face by a dermatologist (F2F). Participants were offered biopsies by the F2F (if needed) at the time of the visit, or at a follow up visit if the biopsy was only recommended by one or more members of the TeleTeam. The TeleTeam was blinded to the F2F recommendations. Results: We enrolled 146 subjects with 375 lesions of concern for skin cancer between September 2020 and December 2022. Baseline characteristics: 94 (64%) female; median age 65 years (range: 25-90 years); 92 (63%) non-Hispanic White; 22 (15%) Black; 11 (7%) Hispanic White; 8 (6%) Asian; 13 (9%) other or preferred not to say. Nineteen participants (13%) had a prior skin cancer including 2 with melanoma (one also with basal cell carcinoma (BCC)), and 17 with keratinocyte cancers (BCC and/or squamous cell carcinoma (SCC)). Overall, 363/375 (97%) skin lesions were clinically or histopathologically benign; 14/146 (10%) patients had a malignant or atypical skin growth. These included 12 skin cancers: 1 stage IA melanoma (0.5mm in thickness); 1 in-situ melanoma; 8 BCC; 2 in-situ SCC; and 2 moderately or severely atypical nevi. F2F recommended biopsy for both melanomas, 7 BCC and 1 SCC. TeleTeam recommended biopsy for both melanomas, 7 BCC, 2 SCC, and both moderately or severely atypical nevi. F2F identified 10/14 malignant or atypical skin growths; the TeleTeam identified 13/14. The benign:malignant ratio of the F2F and TeleTeam recommended biopsies were 2.7:1 and 5.8:1, respectively. The TeleTeam benign:malignant ratio decreased to 4.5:1 after the first 35 subjects were evaluated. Conclusions: Dermoscopy-enhanced teledermatology evaluation appears to be a safe and effective method to triage skin lesions for in-person medical evaluation and biopsy to diagnose skin cancer. Deployment of this diagnostic modality may help reduce melanoma health disparities arising in communities lacking dermatologists. Clinical trial information: NCT04411810 .

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