The coronavirus disease 2019 (COVID-19) pandemic has fundamentally transformed the landscape of providing dermatologic care. In an age of lockdowns and social distancing, teledermatology (TD) has emerged as a powerful tool to deliver remote care. Here, we review literature on TD use during the pandemic to evaluate the positives and negatives of TD implementation. We especially consider the reception of TD in underserved communities and the developing world as well as the ethico-legal challenges wrought by the burgeoning utilization of this new paradigm of care. The potential of TD to occupy a more prominent role in dermatologic care in a post-COVID-19 world is also discussed.

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Muir-Torre syndrome (MTS) is an autosomal dominant cancer syndrome that is a phenotypic variant of hereditary nonpolyposis colorectal carcinoma (HNPCC), or Lynch syndrome. MTS is characterized by sebaceous neoplasms and HNPCC-associated malignancies such as colorectal, endometrial, and urothelial carcinomas. The Amsterdam criteria require the presence of at least one sebaceous adenoma, sebaceous epithelioma, sebaceous carcinoma, or keratoacanthoma (KA) with sebaceous differentiation in addition to a HNPCCassociated visceral malignancy. Multiple KAs and a visceral malignancy together with a family history of MTS are also diagnostic. MTS is precipitated by pathogenic variants of DNA mismatch repair genes such

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OBJECTIVE:The purpose of this study is to investigate the utility of the insulin curve with Oral Glucose Tolerance Test (OGTT) in identifying hyperinsulinemia in Polycystic Ovarian Syndrome (PCOS) patients. Further, to identify the clinical characteristics of the PCOS subpopulation that has a normal OGTT, but the presence of hyperinsulinemia by insulin curve, compared to PCOS patients without evidence of hyperinsulinemia.MATERIALS AND METHODS: A retrospective cross-sectional study was performed on all PCOS patients seen during the period of January 2018 to October 2018 at a large, academic-affiliated, urban fertility clinic, Texas Children's Hospital Family Fertility Center. Descriptive and demographic variables were gathered, including labs ordered at the time of diagnosis. The inclusion criteria included patients aged greater than 18, diagnosed with PCOS by the 2003 Rotterdam Consensus Criteria. A total of 227 patients met inclusion criteria. Of these patients, 107 had HgbA1c and three hour OGTT with insulin curve results. A Chi-square analysis statistical test was used for significance testing.RESULTS: Of the 107 patients with insulin curve results, 49.5% had evidence of hyperinsulinemia. The specificity and sensitivity of a patient's 2hour OGTT results as an indicator of hyperinsulinemia was 98% and 18.8%, respectively. The specificity and sensitivity of a patient's HgbA1c results as an indicator of hyperinsulinemia was 100% and 15%, respectively. The specificity and sensitivity of the presence of acanthosis nigricans as an indicator for hyperinsulinemia was 47% and 87%, respectively. There was no difference in acne, hirsutism, irregular periods, or polycystic ovaries between patients without hyperinsulinemia and those with a negative OGTT but positive insulin curve (p¼ .29, p¼ .76, p¼ .27, p¼ .45). However, there was a significant difference between these cohorts based on the presence/ absence of acanthosis nigricans and a normal weight versus BMI greater than 25 (p< .01, p< .05).CONCLUSIONS: Given these results, if healthcare providers are utilizing only the HgbA1c or OGTT as metabolic screening tests for impaired glucose tolerance in patients with PCOS, then there will be patients with hyperinsulinemia that will miss identification. Detecting hyperinsulinemia will allow providers to discuss more aggressive management options, such as metformin, for these patients at higher risk for developing overt gestational diabetes or type II diabetes.IMPACT STATEMENT: Through the use of routine screening with insulin curve testing, more patients with hyperinsulinemia will be detected than with the OGTT or HgbA1c tests alone, allowing for initiation of lifestyle modifications and metformin treatment before evidence of overt glucose intolerance.Reference: None. SUPPORT: None.

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