The requirements that iPLEDGE, a computer-based risk management program (http://www.ipledgeprogram.com), places on prescribing isotretinoin typically mean that patients are seen on a monthly basis in the physician's office for 5 to 6 months, 1 which may lead to time and financial burdens on patients and caregivers, such as missed work and school. To our knowledge, these losses of time have not previously been quantified in the literature. Electronic visits (e-visits) represent a potential alternative to some follow-up visits for patients enrolled in the iPLEDGE program. Such e-visits have been shown to have utility for follow-up appointments among patients with acne, resulting in equivalent patient satisfaction compared with faceto-face appointments with a physician. 2-4 To our knowledge, the patient's and/or caregiver's interest and willingness to pay for e-visits, which is especially important for the financial feasibility of such visits, have not been measured in patients prescribed isotretinoin. We used a survey to quantify the perceived burden of follow-up visits, as well as interest in, perceived safety of, and willingness to pay for e-visits.

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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.

Discussion | This study provides a framework that facilitates meaningful clinical interpretation of the numerical mMASI score. The ranges for mMASI provided herein correspond to global levels of severity using the MSS. Such categorization in MSS levels can assist clinicians in interpreting clinical trial data, severity of disease, and response to treatment. The mMASI is a simple, reliable validated tool that is a modification of the most commonly used outcome measure for melasma. This user-friendly tool can now be correlated with the newly proposed clinical ranges of severity presented in the Figure, which can be used to assist researchers in determining entry criteria for clinical trains for melasma and improvement of melasma with treatment.

BACKGROUND Mohs micrographic surgery (MMS) is often the treatment of choice for skin cancer removal as it maximizes normal tissue sparing and can be paired with a reconstructive approach that optimizes function and cosmesis. Many tumors on the eyelid, nose, ear, and genitals are particularly well suited for MMS but can be challenging for the dermatologic surgeon. OBJECTIVE To review the complex anatomy, as well as the authors' approach to executing and interpreting Mohs layers, at each of these anatomical sites. METHODS A review of the literature on MMS of the eyelid, nose, ear, and genitals was performed using the PubMed database and relevant search terms. CONCLUSION These sites present potential pitfalls for tumor resection and reconstruction, but with the proper technique, the dermatologic surgeon can minimize tumor recurrence and MMS complications. Warning signs for potentially difficult tumor resection can signify when an interdisciplinary approach is warranted.