ImportanceDermatology is one of the least diverse specialties, while patients from minority racial and ethnic groups and other underserved populations continue to face numerous dermatology-specific health and health care access disparities in the US.ObjectivesTo examine the demographic characteristics and intended career goals of graduating US allopathic medical students pursuing careers in dermatology compared with those pursuing other specialties and whether these differ by sex, race and ethnicity, and/or sexual orientation.Design, Setting, and ParticipantsThis secondary analysis of a repeated cross-sectional study included 58 077 graduating allopathic medical students using data from the 2016 to 2019 Association of American Medical Colleges Graduation Questionnaires.Main Outcomes and MeasuresThe proportion of female students, students from racial and ethnic groups underrepresented in medicine (URM), and sexual minority (SM) students pursuing dermatology vs pursuing other specialties. The proportions and multivariable-adjusted odds of intended career goals between students pursuing dermatology and those pursuing other specialties and by sex, race and ethnicity, and sexual orientation among students pursuing dermatology.ResultsA total of 58 077 graduating students were included, with 28 489 (49.0%) female students, 8447 (14.5%) URM students, and 3641 (6.3%) SM students. Female students pursuing dermatology were less likely than female students pursuing other specialties to identify as URM (96 of 829 [11.6%] vs 4760 of 27 660 [17.2%]; P < .001) or SM (16 [1.9%] vs 1564 [5.7%]; P < .001). In multivariable-adjusted analyses, students pursuing dermatology compared with other specialties had decreased odds of intending to care for underserved populations (247 of 1350 [18.3%] vs 19 142 of 56 343 [34.0%]; adjusted odd ratio [aOR], 0.40; 95% CI, 0.35-0.47; P < .001), practice in underserved areas (172 [12.7%] vs 14 570 [25.9%]; aOR, 0.40; 95% CI, 0.34-0.47; P < .001), and practice public health (230 [17.0%] vs 17 028 [30.2%]; aOR, 0.44; 95% CI, 0.38-0.51; P < .001) but increased odds of pursuing research (874 [64.7%] vs 29 121 [51.7%]; aOR, 1.76; 95% CI, 1.57-1.97; P < .001) in their careers. Among students pursuing dermatology, female, URM, and SM identities were independently associated with increased odds of caring for underserved populations (eg, URM: aOR, 4.05; 95% CI, 2.83-5.80) and practicing public health (eg, SM: aOR, 2.55; 95% CI, 1.51-4.31). URM students compared with non-URM students pursuing dermatology had increased odds of intending to practice in underserved areas (aOR, 3.93; 95% CI, 2.66-5.80), and SM students compared with heterosexual students pursuing dermatology had increased odds of intending to become medical school faculty (aOR, 1.60; 95% CI, 1.01-2.57), to pursue administrative roles (aOR, 1.60; 95% CI, 1.01-2.59), and to conduct research (aOR, 1.73; 95% CI, 1.01-2.98).Conclusions and RelevanceThe findings of this cross-sectional study suggest that diversity gaps continue to exist in the dermatology workforce pipeline. Efforts are needed to increase racial and ethnic and sexual orientation diversity and interest in careers focused on underserved care and public health among students pursuing dermatology.

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A 5-year-old, otherwise healthy, female presented to the dermatology clinic with a 1-year history of a raised lesion on her right upper chest ( Figure 1). Her parents originally believed it was a mosquito bite; however, it continued to enlarge over time. While occasionally tender, no bleeding, crusting, or discharge from this solitary lesion was reported.Physical examination revealed a 2.0-cm by 1.5-cm rubbery, smooth, mobile tumor with overlying telangiectasias and erythema on the right chest. The tumor was nontender; neither tent sign nor punctum was visible. A skin biopsy and subsequent excision revealed a well-demarcated dermal tumor composed of mononuclear histiocytes and osteoclast-like giant cells arranged in a plexiform pattern on hematoxylin and eosin (H&E)-stained sections. (Figure 2A).Throughout the specimen, no necrosis or cellular pleomorphism was appreciated ( Figure 2B). The lesional cells were highlighted with vimentin and CD68 ( Figure 2C). MITF, S-100, and pancytokeratin stains were negative. Smooth muscle actin highlighted small vascular channels but was negative in the lesional cells. Between the plexifom collections of histocytes, a collagen stroma was noted, which showed some areas of sclerosis. These features established the diagnosis of plexiform fibrohistiocytic tumor. In the excisional specimen, the tumor extended to the margins, and re-excision did not show any residual lesion. | ME THODSA review of previously published literature was performed to identify case reports, case series, reviews, and retrospective studies that described novel cases of plexiform fibrohistiocytic tumor (PFT).Using the National Center for Biotechnology Information PubMed tool, the search was narrowed using the key terms of "plexiform," "fibrohistiocytic," and "tumor." The inclusion criteria included the aforementioned study types whose individual cases demonstrated histologic evidence of PFT diagnosis, namely histiocytes and giant cells arranged in a plexiform pattern of dermal tumor nodules.Exclusion criteria included studies published in a language other than English and lack of appropriate histologic diagnostic features.Tumors occurring in adults were included as well for completeness. AbstractPlexiform fibrohistiocytic tumor (PFT) is a rare neoplasm of mesenchymal origin that can be identified by its propensity for children and adolescents combined with a characteristic histologic arrangement of histiocytes and osteoclast-like giant cells whorled within tumor islands. A 5-year-old female presented with a raised, intermittently tender, and slowly enlarging tumor on her chest, which was histologically confirmed to be a PFT. We present this case along with a comprehensive review of PFT cases reported in the literature to describe the demographic, histologic, and rarely metastatic behavior of this entity. It is important to include PFT on the differential diagnosis of an enlarging tumor in the pediatric population. K E Y W O R D Sdermatopathology, lumps/bumps, neoplasms-benign

ebaceous neoplasms (SNs), including sebaceous adenoma, sebaceous epithelioma, and sebaceous carcinoma, are defining features of Muir-Torre syndrome (MTS), a variant of Lynch syndrome (LS). 1 Universal screening of SNs with mismatch repair protein (MMRP) immunohistochemistry (IHC) has previously been recommended by some physicians to detect potential probands 2 but has been debated given the high costs and variable sensitivities of detecting MTS, ranging from 25% to 85% depending on the IHC panel used. [3][4][5] Sensitivity may increase with targeted screening, such as when a patient (of any age) presents with multiple SNs. 6 Because MTS is caused by germline genetic mutations, it is presumed that individual SNs should harbor the same mutation.However, data evaluating intrapatient concordance of MMRP IHC staining patterns between different SNs are limited. This case series examined patients with MTS who had multiple SNs to determine the concordance of MMRP IHC staining patterns between lesions and with germline mutation. MethodsThis retrospective study was approved by the institutional review board of the University of Pennsylvania (protocol No. 828426). Need for informed consent was waived because the research was deemed to be of minimal risk to participants. IMPORTANCE Appropriate use criteria for Muir-Torre syndrome (MTS) screening suggest that mismatch repair protein (MMRP) immunohistochemical (IHC) testing is usually appropriate in patients with 2 or more sebaceous neoplasms (SNs). While MTS is known to be caused by a germline mutation in mismatch repair genes, data are limited as to whether individual sebaceous tumors in these patients with multiple lesions show identical MMRP IHC staining patterns.OBJECTIVE To determine concordance of MMRP IHC staining patterns in lesions of patients with MTS who have multiple SNs. DESIGN, SETTING, AND PARTICIPANTSThis retrospective single-center case series evaluated 38 SNs in 11 patients with MTS confirmed by genetic testing for MMRP IHC staining patterns. Tumor sites were classified as either facial or extrafacial. Data were collected between