Oscar Samuel Hoffman (1856-1926) was the first Jewish physician to settle in Omaha, Nebraska in 1883. He taught dermatology for 25 years at the Omaha Medical College and University of Nebraska, after completing postgraduate work in Vienna under the noted dermatologist Moritz Kaposi (1837-1902). His expertise, however, also included obstetrics, and he became the Professor of Obstetrics and Dermatology at Omaha Medical College. On July 14, 1913, Hoffman delivered Leslie Lynch King, Jr., better known by his later name, Gerald R. Ford, Jr., who became the 38 President of the United States in 1974. This contribution tells the story of that historic birth.

For over forty years, the Editorial Board of Clinics in Dermatology has been working behind the scenes to help our Editor-in Chief, Dr. Lawrence Parish, bring to readers the best contributions in dermatology. Herein, we tell the story of the beginnings of Clinics in Dermatology and provide a list of the inaugural board members of which we highlight four: Drs. Jean Civatte, John Thorne Crissey, Francisco Kerdal-Vegas, and Joseph A. Witkowski. In addition we showcase our present 44 Editorial Board members including our Managing Editor Dr. Hirak Behari Routh,our Senior Deputy Editors Dr. Larry E. Millikan, and Dr. Marcia Ramos-e-Silva, and our esteemed Chief Editor Dr. Lawrence Charles Parish and Chief Editor Designate, Dr. Vinod E. Nambudiri. We are proud that all our Editorial Board members come with stellaracademic achievements in dermatology and from all over the world. We are an active Editorial Board, who work together, issue after issue, to provide the best in peer review contributions and theme issues. We look forward to continuing in this role for many years to come and weare grateful to our current publisher, Elsevier, and to our many authors, and dear readers for their ongoing support and encouragement.

We commemorate and celebrate the historic careers and the medical and dermatologic contributions of seven distinguished European and Canadian Jewish women who were pioneers in dermatology. Although there may be other notable women, we have selected these dermatologists as examples of courage and determination. Each struggled to overcome professional barriers to women in medicine, and all had experienced antisemitism, especially those who fell under Nazi rule. We honor their achievements: Lili Farkas (1899-1992), Vera Shukhman (1900-1987), Stefania Jablonska (1920-2017), Halina Szenicer-Rotstein (1907-1942), Fanny Cohn (1899-1990), Marie Caroline Kaufmann-Wolf (1877-1922), and Rickey Kanee Schachter (1918-2007).

In 2023, Clinics in Dermatology marked its 40th anniversary, celebrating a remarkable journey of excellence since its inception in 1983. Led by its founding editor, Dr Lawrence Charles Parish, the journal has consistently delivered cutting-edge research and clinical insights, becoming a cornerstone resource in dermatology. The journal has published 3,667 documents. In all publications, 4,311 authors from 4,248 departments and 78 countries played a pivotal role. We provided data about the total number of publications and citations for each contributor (author, department, and country). By coword analysis, we presented the central theme of publications, which may offer a nuanced understanding of Clinics in Dermatology's diverse and influential contributions to dermatologic science.

The presence of congenital melanocytic nevi (CMN) is determined in utero. The location, size, and number of CMN may be of cosmetic concern with significant psychosocial implications. They may also be associated with symptoms such as pruritus, eczema/xerosis, and skin fragilit; however, the most medically concerning issue is the association of CMN with the risk of developing cutaneous melanoma, extracutaneous melanoma, and neurocutaneous melanocytosis (NCM). Patients with CMN are currently risk-stratified based on the projected adult maximum diameter of the largest CMN and the number of CMN (satellites) present. In small and medium CMN the absolute risk of developing cutaneous melanoma is estimated to be approximately 0.3% with a relative risk of 9.5. While patients with large CMN are at increased risk for developing primary cutaneous melanoma within the CMN, they are also at increased risk for developing primary melanoma within the central nervous system (CNS) in association with CNS melanocytic deposits, an entity known as NCM. The absolute risk for developing melanoma in patients with large CMN is estimated to be between 1.25-10% with a relative risk between 52-1046. Regarding the risk for the presence of NCM, the risk correlates with the number of CMN, with the lowest risk in those with a single CMN and with risk escalation as the number of CMN increase. We have provided an overview of the existing evidence about the risk of melanoma and NCM in patients with CMN. The role of the clinical examination, dermatoscopy, MRI scanning of the CNS, and the role of surgery in the management of CMN of varying sizes is discussed.

Human trafficking is a pervasive global health and human rights issue. The skin often bears the early and most visible signs of abuse and exploitation. Despite the visible nature of their trauma, affected patients frequently go unrecognized within health care settings due to a lack of standardized guidelines for identifying the dermatologic manifestations of trafficking. Herein, we address these challenges by equipping dermatologists and health care teams with the necessary tools to recognize, treat, and report the skin signs of human trafficking. In doing so, we hope to emphasize the importance of early identification and intervention, as well as bring awareness to critical signs, including dermatologic evidence of abuse, infectious diseases, sexually transmitted infections, substance use, and branding. In understanding this, we can bring awareness to dermatologists' critical role in caring for this patient population and their associated cutaneous manifestations. By advancing knowledge in this area, we hope to enhance the capacity of dermatologists to support trafficked individuals.

Dermatology is beginning to investigate the uses of virtual reality (VR) and augmented reality (AR) to enhance residency education and to provide patients with comprehensive and interactive experiences. Although the applications of VR and AR to improve patient clinical care are exciting, these technologic advances may have implications about regulatory considerations, patient safety, informed consent, and privacy. We review how using artificial intelligence, VR, and AR can enhance patient care and deliberate the complex issues surrounding these potential innovations.

Patients experiencing or having experienced trafficking frequently interact with the health care system, highlighting the need for health care providers to be equipped with the appropriate tools to serve these patients effectively. The third part of this series focuses on navigating encounters with trafficked persons within the dermatology clinic, emphasizing the importance of trauma-informed, patient-centered care. We reviewed the barriers trafficked patients face and mechanisms to overcome them, the importance of comprehensive needs assessments, and the implementation of effective health care protocols. We additionally review the role of dermatologists in mandatory reporting and the use of appropriate International Classification of Diseases, Tenth Revision codes for documenting a potential trafficking victim encounter in the electronic medical record. We conclude with recommendations for specialized training, emphasizing the critical role dermatologists play in identifying and supporting trafficked patients within the health care system.

Diseases reflective of multiorgan vascular injury of diverse etiology, peripheral nerve disease, dysautonomia syndromes, and intravascular lymphoma may exhibit abnormalities on a normal skin biopsy that may be instrumental in establishing a diagnosis. A retrospective review of our database was conducted to uncover cases where a normal skin biopsy was performed to rule in or out such systemic diseases as complement-driven thrombotic microvascular disease (including atypical hemolytic uremic syndrome, posttransplant thrombotic microangiopathy, and severe or critical COVID-19), systemic capillary leak syndrome, cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) intravascular B cell lymphoma, small fiber neuropathy, dysautonomia syndromes, and mast cell activation syndrome. Among the special studies were immunohistochemical staining to detect C5b-9, CD56, and myxovirus resistance protein A, as well as mast cell, B and T cell markers. Characteristic patterns were critical in establishing diagnoses such as : increased C5b-9 microvascular deposition in the deltoid area (atypical hemolytic uremic syndrome, posttransplant thrombotic microangiopathy, catastrophic antiphospholipid antibody syndrome, and severe or critical COVID-19); enhanced type I interferon signaling (systemic capillary leak syndrome); ultrastructural arteriopathic changes (CADASIL); reduced cutaneous autonomic innervation in the lower extremities (small fiber neuropathy and postural orthostatic tachycardia syndrome); presence of intravascular lymphocytes on biopsy of abdominal, thigh, and buttock skin (intravascular B cell lymphoma); and a higher than normal density of mast cells in the absence of other inflammatory cell types (mast cell activation syndrome). The skin is clearly a critical window for understanding extracutaneous disease, a concept well exemplified by the myriad of diseases suggested by the microscopic and/or ultrastructural examination of clinically normal skin and therefore establishing the normal skin biopsy as an important tool for understanding certain extracutaneous reactive, neoplastic and paraneoplastic syndromes as well as small fiber neuropathy.

Melanoma incidence has risen rapidly, at least until recently, while mortality has changed only a little, a phenomenon suggestive of overdiagnosis, which can be defined as the diagnosis as "melanoma" of a lesion that would not have had the competence to cause death or symptoms even if it had not been excised. Overdiagnosis has been attributed to efforts at early diagnosis ("overdetection"), and to changes in criteria resulting in diagnosis as melanoma of lesions previously termed nevi ("overdefinition"). In terms of overdefinition, there is evidence that criteria for the histopathologic diagnosis of melanoma has changed over a period of approximately two decades. Specialization may play a role in overdefinition; research has shown that when pathologists interpret the same lesion, dermatopathologists are more likely to diagnose low stage (AJCC T1a) melanomas and general/surgical pathologists are more likely to diagnose atypical nevi. An important subset that contributes to overdiagnosis is those melanomas that lack the property of tumorigenic vertical growth phase, thus lacking metastatic competence, and perhaps not warranting diagnosis as overt melanomas. Studies have defined subsets of patients with very low stage lesions diagnosed as melanomas in which observed survival has been 100%. In the past, many of these lesions would have been diagnosed as nevi, constituting overdefinition. Other key characteristics for very low risk (or no risk) lesions that are currently termed invasive "melanomas" include low Breslow thickness, Clark's level II invasion, absence of mitoses, and clinically, lack of observed or experienced dynamic changes. We propose a provisional terminology for diagnosing extremely low risk subgroups as "Melanocytic neoplasms of low malignant potential", aimed at reducing the negative personal and social effects of a cancer diagnosis for patients whose health and wellbeing are in reality not affected by an overdiagnosed "melanoma". With additional confirmation and appropriate consensus, it is likely that some of these subgroups can be reclassified as atypical or dysplastic nevi.

Nail psoriasis affects 20% to 30% of psoriasis patients and is an early predictor of psoriatic arthritis (PsA). We evaluated the prevalence, clinical characteristics, and impact on quality of life of patients with nail psoriasis. We conducted a multicenter retrospective cohort study of patients registered with The Malaysian Psoriasis Registry from January 1, 2007 to December 31, 2020. Of the 24,147 patients, 13,081 (54.2%) had nail psoriasis. Patients with nail psoriasis had later onset of psoriasis (34.0 ± 16.6 years vs 32.9 ± 17.6 years, P < .001) and longer disease duration (11.4 ± 10.5 years vs 8.5 ± 9.4 years, P < .01), with a man-to-woman ratio of 1.2:1. They were more likely to have a family history of psoriasis, cardiometabolic diseases, smoking history, higher body mass index, severe disease, PsA, face and scalp involvement, and higher mean Dermatology Life Quality Index scores (9.36 ± 6.84 vs 8.87 ± 6.60). Systemic treatment and biologics were more commonly prescribed in this cohort (25.0% vs 13.2%, P < .001). Overall, 54.2% of the Malaysian Psoriasis Registry patients had nail involvement. Nail psoriasis was associated with longer duration of psoriasis, older age of onset, male sex, and a family history of psoriasis. It proved to be an important predictor for PsA, severe psoriasis, face and scalp involvement, increased cardiometabolic risk, and a greater impairment of quality of life.

Clowns have long delighted circus crowds and are celebrated not only in popular culture but also in the dermatology literature as medical eponyms. This contribution discusses four such eponyms: 1) clown nose-like lesion, 2) clown eczema (perioral dermatitis) 3) clown alopecia pattern in frontal fibrosing alopecia and 4) clown's face of Brachman de Lange syndrome (Cornelia de Lange syndrome). This contribution also highlights the role of medical clowning in patient care by paying tribute to Cobo the Clown, also known as Barbara Joyce Cohen, who has served as a dedicated caring clown for over thirty years.

Mucosal melanomas are rare malignant tumors arising from the epithelia lining the inner mucosal surfaces of the body. Unlike cutaneous melanoma, we have a limited understanding of mucosal melanomas is currently limited. Mucosal melanomas are characterized by genetic alterations quite distinct from cutaneous melanomas; however, their causative and promoting factors are unknown. These melanomas are characteristically diagnosed at a later stage due to their occult locations, leading to a worse prognosis. Dedicated staging systems for mucosal melanomas exist only for sinonasal and conjunctival melanomas. Therefore, risk stratification of patients with mucosal melanomas, particularly those arising from the anogenital area, is challenging. Recent studies have shown that minor modifications of the AJCC 8 Edition cutaneous melanoma staging system can group patients fairly robustly; however, the proposed T-categorization systems have yet to be validated in larger cohorts. We summarize the demographic, clinical, histopathologic, and molecular features of common subtypes of mucosal melanomas and highlight the outstanding needs in this field.

Human trafficking is a global human rights violation affecting millions of individuals across diverse demographic characteristics with severe health consequences. Despite the frequent interactions that exploited individuals have with health care systems, many remain unrecognized, positioning health care providers, including dermatologists, as critical first responders. In the first part of this three-paper series, we discuss the current landscape of human trafficking from a health care perspective, emphasizing the role of dermatologists in recognizing and responding to this issue. This paper reviews the current understanding of trafficking, outlines the epidemiology and legal framework surrounding it, and discusses gaps in training for health care providers and policy that may hinder effective identification and intervention. It also explores state and national efforts to incorporate human trafficking education into health care training, emphasizing the need for standardized, trauma-informed approaches within dermatology. By fostering awareness and advocacy within the dermatology community, this paper aims to contribute to the broader efforts to combat human trafficking and improve the care and support provided to this patient population.