Introduction Past studies have shown mixed results about the accuracy of store-and-forward (SAF) teledermatology in the evaluation of skin lesions. The objective of this study is to determine the accuracy of SAF teledermatology in the diagnosis of skin lesions and biopsy decision compared to in-person clinical evaluation. Methods Histories and photographs of skin lesions gathered at clinic visits were sent as SAF consults to teledermatologists, whose diagnoses and biopsy decisions were recorded and compared statistically to the clinic data. Results and Discussion: We enrolled 206 patients with 308 lesions in the study. The study population was composed of 50% males ( n = 104), and most patients were white ( n = 179, 87%) and not Hispanic/Latino ( n = 167, 81%). There was good concordance for biopsy decision between the clinic dermatologist (CD) and teledermatologist (TD) (Cohen’s kappa (κ) = 0.51), which did not significantly differ when melanocytic lesions were excluded (κ = 0.54). The sensitivity and specificity of teledermatology based on biopsy decision was 0.71 and 0.85, respectively. Overall concordance in first diagnosis between the CD and TD was good (κ = 0.60). While there was no difference between CD and TD in proportion of correct diagnoses compared to histopathology, two skin cancers presentations were missed by TD. Study limitations included sample size, enrolment bias and differing amounts of teledermatologist case experience. Teledermatology has good concordance in diagnosis and biopsy decision when compared to clinic dermatology. Teledermatology may be utilized in the evaluation of skin lesions to expand access to dermatologic care.

Background Oropharyngeal cancers associated with high-risk human papillomavirus (HR-HPV) infection are increasing in the U.S., especially among men. We evaluated prevalence and predictors of concurrent (genital and oral) and concordant (same-type) HR-HPV infections in U.S. Methods We used National Health and Nutrition Examination Survey from 2009-2016. Predictors were assessed via multivariable logistic regression. Results Among 10,334 respondents, 172 (2.1%) had concurrent infections [109 (3.5%) men and 63 (0.76%) women]. Ninety-three (1.0%) had concordant infections [54 (1.6%) men and 39 (0.5%) women]. Predictors of concurrence in men were: no longer married vs. married [2.3 (OR); 1.3-4.9 (95% CI)], living with a partner vs. married [3.0; 1.2-7.5], and having 2-5 lifetime oral sex partners [3.0; 1.2-7.5]. In women they were: no longer married vs. married [3.6; 1.3-10.3], ≥2 recent sex partners [4.6; 1.4-15.6 for 2-5 partners and 3.9; 1.1-14.3 for 6+ partners], and marijuana use [2.2; 1.0-4.5]. The predictor of concordance in men and women was no longer married vs. married [3.5; 1.2-9.9 in men and 3.2; 1.1-9.4 in women]. Conclusions Concurrent and concordant HR-HPV infections occur at a high rate, especially among men, and are associated with behavioral factors. This underscores the importance of HPV vaccination, screening, and education in men.

Activation of the kynurenine pathway (KP), an important downstream effect of inflammation, is a driver of depression and neurodegeneration. Damage from the end product of KP activation, quinolinic acid, may be responsible specifically for impairment in hippocampally mediated memory function, among its effects. We hypothesized that associative memory – the ability to recall relationships between items – would be sensitive to KP activation because it is heavily dependent on the hippocampus. We tested a sample of N ​= ​80 adults with unmedicated depression using a face-name task which assesses the ability to recognize, as well as to recall correct pairings, of faces and names. Plasma samples were analyzed for KP metabolites – tryptophan (TRP), kynurenine (KYN), quinolinic acid (QUIN) and kynurenic acid (KYNA). Using linear models we examined whether the KYN/TRP and QUIN/KYNA ratios predicted performance of recognition memory and associative memory, accounting for item type and the number of learning exposures to items (1 vs. 3). We found that for rearranged items viewed three times, associative memory performance was inversely related to the QUIN/KYNA ratio (p ​= ​0.01, p ​= ​0.001 adjusted for age, gender and race/ethnicity). Recognition memory was not associated with KP activation. The results support our hypothesis that KP activation most sensitively impacts hippocampally mediated memory function.

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ohs micrographic surgery (MMS) is considered a standard of care treatment modality for nonmelanoma skin cancer (NMSC) of the head and neck. However, access to dermatologic care and MMS may be limited by wait times, cost, and the relative shortage of dermatologists in rural areas. 1 Insurance type is associated with increased stage at presentation, differences in treatment, and delays in care for patients with melanoma 2-4 and other noncutaneous cancers, including lung, prostate, breast, and colon cancer. [5][6][7][8][9][10] The objective of this study was to assess whether tumor and treatment characteristics differ based on insurance type among patients undergoing MMS for NMSC because there has been little research investigating this association.