Inflammatory dermatopathology encompasses a wide array of nonneoplastic dermatologic conditions. This article will summarize the relevant clinical and histopathologic findings of rare and emerging inflammatory dermatolog...Inflammatory dermatopathology encompasses a wide array of nonneoplastic dermatologic conditions. This article will summarize the relevant clinical and histopathologic findings of rare and emerging inflammatory dermatologic diseases broadly categorized into postradiation morphea, reactive infectious dermatoses, vasculopathies and vasculitides, annular erythemas, and neutrophilic dermatoses.
This article highlights selected cutaneous mesenchymal tumors, emphasizing histopathology, immunophenotype, and molecular alterations. It outlines diagnostic pitfalls, distinguishing features, and clinical behavior of in...This article highlights selected cutaneous mesenchymal tumors, emphasizing histopathology, immunophenotype, and molecular alterations. It outlines diagnostic pitfalls, distinguishing features, and clinical behavior of indolent and malignant lesions. Awareness ensures accurate and appropriate treatment, and prevents overtreating benign mimics.
Refinements in histologic criteria, staging systems (American Joint Committee on Cancer 8th edition, Brigham and Women's Hospital), clinical guidelines (National Comprehensive Cancer Network [NCCN]), and molecular tools...Refinements in histologic criteria, staging systems (American Joint Committee on Cancer 8th edition, Brigham and Women's Hospital), clinical guidelines (National Comprehensive Cancer Network [NCCN]), and molecular tools like gene expression profiling have enhanced the precision of cutaneous squamous cell carcinoma diagnosis and treatment. In Merkel cell carcinoma, recent updates in viral pathogenesis, immunohistochemistry, and emerging biomarkers have aided in better diagnostics. As immunotherapies and precision oncology evolve, dermatopathologists remain essential in guiding patient-specific management strategies for both cutaneous squamous cell carcinoma and Merkel cell carcinoma.
Cutaneous adnexal tumors recapitulate hair follicles, sweat glands, and/or sebaceous glands. These tumors range from benign to malignant and might herald an underlying inherited tumor syndrome. Accurate classification of...Cutaneous adnexal tumors recapitulate hair follicles, sweat glands, and/or sebaceous glands. These tumors range from benign to malignant and might herald an underlying inherited tumor syndrome. Accurate classification of adnexal tumors is thus critical but can be challenging due to many knowledge gaps in this area. Recent advances have dramatically improved our understanding and diagnosis of adnexal tumors. Here, we review several recently described adnexal carcinomas and summarize new molecular drivers reported in previously established tumor entities. We highlight morphologic, immunohistochemical, and molecular clues helpful for diagnosis of these adnexal tumors.
Vulvar squamous cell carcinoma and its precursors are heterogeneous and classified into 3 biologically distinct subgroups: human papillomavirus (HPV)-associated, HPV-independent TP53-mutated, and HPV-independent TP53-wil...Vulvar squamous cell carcinoma and its precursors are heterogeneous and classified into 3 biologically distinct subgroups: human papillomavirus (HPV)-associated, HPV-independent TP53-mutated, and HPV-independent TP53-wild type. Although nomenclature is established for HPV-associated high-grade squamous intraepithelial lesion and TP53-mutated differentiated vulvar intraepithelial neoplasia lesions, terminology for precursors in the TP53-wild-type subgroup is evolving. Accurate classification is essential, as prognosis, progression risk, and recurrence rates differ among subgroups. Diagnosis relies on integrated assessment of clinical presentation, histopathology, and immunophenotype, particularly p16 and p53 expression.
This article highlights current advances in melanocytic lesions and their impact on histopathologic diagnosis and patient management. Special emphasis is given to the concept of melanocytoma and the study of dysplastic n...This article highlights current advances in melanocytic lesions and their impact on histopathologic diagnosis and patient management. Special emphasis is given to the concept of melanocytoma and the study of dysplastic nevi. Finally, the article describes the current status and possible future applications of immunohistochemistry, digital analysis, and artificial/augmented intelligence.
In the past 2 decades, several molecular methods have been developed as an adjunct for the assessment of melanocytic neoplasms. Some tests can assist in the diagnostic workup of neoplasms with ambiguous histopathologic f...In the past 2 decades, several molecular methods have been developed as an adjunct for the assessment of melanocytic neoplasms. Some tests can assist in the diagnostic workup of neoplasms with ambiguous histopathologic findings. Others can optimize the selection of patients for targeted therapy. Some tests also aim to provide prognostic information. Scenarios when ordering these tests may be appropriate and helpful are discussed in this article as well as pitfalls in the interpretation of test results. Due to the inherent limitations in sensitivity and specificity of various tests, correlation with the histopathologic findings is paramount.
In the context of the climate crisis, persons experiencing homelessness face a disproportionately increased risk of dermatologic disease. Contributing epidemiologic factors include increased baseline health susceptibilit...In the context of the climate crisis, persons experiencing homelessness face a disproportionately increased risk of dermatologic disease. Contributing epidemiologic factors include increased baseline health susceptibilities, increased environmental exposures, and systemic barriers to climate resilience. Migrant populations, while distinct, can face overlapping challenges, with climate change acting as a housing crisis multiplier in both groups. Addressing these dermatologic impacts requires a coordinated approach from dermatologists globally.
Children's health is disproportionately impacted by the burning of fossil fuels and the subsequent production of greenhouse gases and air pollution. This is due to their developing physiology, unique behavior patterns, g...Children's health is disproportionately impacted by the burning of fossil fuels and the subsequent production of greenhouse gases and air pollution. This is due to their developing physiology, unique behavior patterns, greater body surface area to volume ratio, and reliance on adults for their essential needs. Importantly, increases in air pollution and global warming negatively influence the skin health of children, including increasing the risk of inflammatory dermatoses, climate-sensitive infections, and psychocutaneous disease.
Climate change is reshaping the epidemiology of dermatologic diseases in the Global South through rising temperatures, UV radiation, extreme weather events, and shifting ecosystems. These environmental stressors exacerba...Climate change is reshaping the epidemiology of dermatologic diseases in the Global South through rising temperatures, UV radiation, extreme weather events, and shifting ecosystems. These environmental stressors exacerbate thermal injuries, infectious and inflammatory dermatoses, and neglected tropical diseases such as cutaneous leishmaniasis, mycetoma, and scabies. Vulnerable populations-including displaced communities, persons with albinism, and outdoor workers-face disproportionate risk. This article highlights the dermatologic impacts of climate change, emphasizing the need for integrated surveillance, accessible care, and climate-resilient health systems. Addressing these challenges requires urgent, interdisciplinary action to protect skin health and equity in an increasingly warming and unstable world.
Human activities have led to climate change, resulting in global warming, ocean warming, and more frequent extreme weather events (EWEs). Each of these has the potential to amplify infectious diseases with skin manifesta...Human activities have led to climate change, resulting in global warming, ocean warming, and more frequent extreme weather events (EWEs). Each of these has the potential to amplify infectious diseases with skin manifestations. Alterations in the skin microbiome due to rising temperatures and humidity may increase infection risk. Global warming has led to expanding geographic ranges of vector-borne diseases. Warming waters have similarly increased the risk of waterborne diseases. EWEs are associated with increased incidence of cutaneous infections. Land-use change, both a cause and effect of climate change, increases the risk of zoonotic spillover.
Recent climate science trends have identified that extreme weather events, including heat waves, wildfires, and flooding, are becoming more frequent and intense worldwide. These climatic events have negative impacts on d...Recent climate science trends have identified that extreme weather events, including heat waves, wildfires, and flooding, are becoming more frequent and intense worldwide. These climatic events have negative impacts on dermatologic health, particularly on multiple inflammatory and infectious skin diseases. It is increasingly important for dermatologists to be knowledgeable about these impacts in order to appropriately diagnose, treat, and prevent these illnesses for their patients.
Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disease driven by immune dysregulation and skin barrier defects. This article summarizes the impact of climate change on AD outcomes, focusing on articles...Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disease driven by immune dysregulation and skin barrier defects. This article summarizes the impact of climate change on AD outcomes, focusing on articles published since April 2023. Climate change amplifies environmental stressors, temperature extremes, altered humidity, and rising air pollution, that can trigger or worsen AD symptoms by increasing oxidative stress, disrupting the skin's microbiome, and weakening barrier function. Studies suggest associations between climate variables and AD outcomes, although findings are inconsistent. Strategies such as patient education, indoor air filtration, and broader policy measures to reduce pollution may mitigate climate-related risks.
Sustainable dermatology and high-value care are closely connected, both prioritizing evidence-based practices that improve patient outcomes, minimize waste, conserve time, and lower costs thereby improving overall effici...Sustainable dermatology and high-value care are closely connected, both prioritizing evidence-based practices that improve patient outcomes, minimize waste, conserve time, and lower costs thereby improving overall efficiency. Key approaches include preventive medicine, personalized monitoring, optimized dermatologic practices, and reduced resource consumption. Incorporating sustainability measures, such as effective waste segregation and eco-friendly procurement, complements these strategies. This article underscores the importance of updated guidelines, systemic reforms, and education to ensure lasting benefits for patients, health care providers, and the environment.
The scope of procedural dermatology encompasses practices such as skin surgery, energy devices, medical and cosmetic injectables, and chemical peels performed with a wide range of dermatological and aesthetic indications...The scope of procedural dermatology encompasses practices such as skin surgery, energy devices, medical and cosmetic injectables, and chemical peels performed with a wide range of dermatological and aesthetic indications. Procedural dermatology is a significant contributor to global carbon emissions with an estimated annual footprint of 2.76 million tons CO2e. This narrative review synthesizes current literature up to 2025 on sustainable lower carbon practices across procedural dermatology, drawing from guidelines and life cycle analyses.
Biologic medications have revolutionized the treatment of many dermatologic diseases, but they also necessitate unique packaging and shipping requirements to maintain their stability, typically involving temperature-cont...Biologic medications have revolutionized the treatment of many dermatologic diseases, but they also necessitate unique packaging and shipping requirements to maintain their stability, typically involving temperature-controlled environments, polystyrene, and single-use plastic injector pens, contributing significantly to medical waste and carbon emissions. It is essential to consider the environmental impact of these treatments. Collaborative efforts among pharmaceutical companies, specialty pharmacies, insurance companies, health care providers, and patients are essential to reduce waste and promote sustainability. Dermatologists, in particular, have a critical role in addressing the environmental impact of biologic therapies, by advocating for systemwide changes.
Microplastics and nanoplastics are found ubiquitously in the environment and might pose risks to skin health. Some particles can penetrate the skin, especially if the skin barrier is compromised. In-vitro studies show th...Microplastics and nanoplastics are found ubiquitously in the environment and might pose risks to skin health. Some particles can penetrate the skin, especially if the skin barrier is compromised. In-vitro studies show that micro-plastics and nano-plastics (MNPs) may cause oxidative stress, trigger inflammation, and induce senescence in fibroblasts. Dermatologists should consider the potential impact of MNPs on skin homeostasis and promote adequate use and disposal of plastics in their personal and occupational settings. This article calls for research on the topic and advocates for plastic-free or bio-degradable alternatives that do not exert adverse effects to mitigate potential risks.
As we strive to deliver the highest level of care to our patients, we also have a responsibility to be intentional in our practice choices, recognizing their direct and indirect contributions to healthcare waste (HCW). W...As we strive to deliver the highest level of care to our patients, we also have a responsibility to be intentional in our practice choices, recognizing their direct and indirect contributions to healthcare waste (HCW). Within dermatology, HCW is generated through daily clinic operations and both the consumption and disposal of procedural waste; this is in turn associated with greenhouse gas emissions and other environmental impacts with potential downstream health harms. There are multiple mechanisms by which we can optimize dermatology waste management, ranging from modifying clinic workflows to being scrupulous with procedural supplies and intentional with waste disposal.
The "Superfund" program was established in 1980 to manage the cleanup of hazardous waste sites across the United States. Proximity to these sites has been associated with an increased risk of autoimmune, inflammatory, an...The "Superfund" program was established in 1980 to manage the cleanup of hazardous waste sites across the United States. Proximity to these sites has been associated with an increased risk of autoimmune, inflammatory, and neoplastic skin conditions. Climate change poses a growing threat as warming temperatures and natural disasters threaten to destabilize waste sites. Vulnerable populations such as low-income and minority groups are more likely to live near a Superfund site, highlighting the environmental health disparities linked to pollutants and toxic exposures. Further research is warranted to better understand the mechanistic role that environmental toxins play in cutaneous disease development.