A healthy immune system helps protect patients against skin cancer. Both branches of the immune system, innate and adaptive, identify and remove cancer cells.Macrophages and natural killer (NK) cells are part of the innate or nonspecifi c immune system, and phagocytose cellular debris and foreign substances such as microbes or cancer cells. NK cells, a subset of white blood cells, are cytotoxic. 3 All cells in the body have major histocompatibility markers that identify cells as self rather than nonself or foreign. A cancer cell or a virus-infected cell loses its self marker. NK cells bind to these cells with no self marker and release cytotoxic granules into the cell to cause its death. 3 Components of the acquired, adaptive, or specifi c immune system also protect against cancer. Cytotoxic T cells are a part of the adaptive immune system. When something goes awry within a cell, major histocompatibility 1 markers bind to these abnormal cancer proteins and bring them to the cell membrane. This is a signal to the cytotoxic T cells to come and destroy proteins that are cancerous or otherwise malformed.© INGE BLESSAS/SHUTTERSTOCK.COM I mmunosuppression is becoming a common comorbidity in the United States. Advances in management of numerous conditions including HIV, hematologic malignancies such as chronic lymphocytic leukemia (CLL) and multiple myeloma, solid organ transplantation, and bone marrow transplantation have resulted in patients living longer with chronic immunosuppression. 1 Iatrogenic or medication-induced immunosuppression as a treatment for autoimmune conditions also is increasing. 2

The dermatology workforce includes physicians, nurse practitioners (NPs), and physician associates/assistants (PAs). The number of dermatologists is growing slowly while the growth of PAs working in dermatology is rapid and accelerating. To understand their characteristics, a descriptive study of PAs practicing in dermatology utilizing the National Commission on Certification of Physician Assistants (NCCPA) workforce dataset on PA practices was undertaken. NCCPA certifies PAs who practice in the United States and queries them about their role, employment, salary, and job satisfaction. Analyses consisted of descriptive statistics, Chi-Square, and Mann–Whitney tests for comparisons between PAs practicing in dermatology versus the total of all other PA specialties. As of 2021, 4,580 certified PAs reported practicing in dermatology—a nearly twofold increase since 2013, when 2323 worked in the specialty. This cohort's median age was 39 years, and 82% were female. Almost all (91.5%) are office based, and 81% work more than 31 h per week. The median salary was $125,000 (2020 dollars). Dermatology PAs work fewer hours and see more patients than their counterparts compared to all 69 PA specialties. At the same time, dermatology PAs are more satisfied and less burnt out when compared to all PAs. The increased number of PAs selecting dermatology as their discipline can help lessen the projected physician shortage in this field.

This case of a gentleman with a chronic foot lesion and onychodystrophy illustrates one of the various forms that pemphigus vulgaris can take. We present diagnostic testing, including histology, direct immunofluorescence testing (DIF), and indirect immunofluorescence (IIF). We discuss the incidence of pemphigus, the variants of pemphigus, and the treatment objectives in this patient population.