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Editorial, JCMS Vol. 1(3)

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I am very pleased with the response we have received for our new Journal. The Journal continues to receive high quality basic science and clinical articles. In this issue, Tron and co-workers focus on a rapidly developing area in melanoma research: namely, tumour suppressor genes. Genes such as p16, p53, and p21 may regulate tumour development. Lack of these tumour suppressor genes or defects in tumour suppressor genes have been found in some patients with familial melanoma. The methodology outlined in this article represents a novel approach to the identification of these genes in melanoma.

On a more clinical note, Berg et al. describe Mohs' micrographic surgery in Canada. While Mohs' micrographic surgery was initially described in 1941 and has gained wide acceptance over the past two decades, it has been rather slow to develop in Canada due, at least in part, to government regulations and universal coverage (see Point-Counterpoint). In spite of this lack of full government support, excellent units have been developed in Canada at centres such as the University of British Columbia and the University of Toronto. However, the severe restrictions placed on health care throughout North America are having a significant impact on our abilities to continue to provide this and other innovative treatments. Two of our recent graduates, one in practice in the United States, and one in practice in Canada, have underscored these issues in their Point-Counterpoint editorials on Candian versus American health care.

As part of our CME, we are further addressing the issues of critical appraisal in dermatology by reviewing the case control study. Since dermatologists are faced with diseases with long latency periods and since, as secondary and tertiary specialists, dermatologists see clinical entities that are rare, the case control design is particularly relevant to examining new therapeutic strategies.

A common dermatologic disease, psoriasis, has relied on relatively empiric therapies with nonspecific mechanisms of action. Over the past several years, however, there have been great inroads in our understanding of the immunopathogenesis of psoriasis with more specific therapies modulating cytokine effects, adhesion molecules, or angiogenesis. In our review section, we feature an excellent update on the immunotherapy of psoriasis, with emphasis on novel therapeutic approaches.

Although tremendous innovation has occurred in the immunotherapy of both psoriasis and other skin diseases, the budgetary constraints placed on healthcare expenditures have necessitated addressing pharmacoeconomic issues in drug development. The review by Gupta et al. serves as an introduction to pharmacoeconomic issues for dermatologists.

I hope our readers had an enjoyable holiday season. As well, I hope that the Journal of Cutaneous Medicine and Surgery is continuing to meet the important need of addressing issues in basic and clinical research and education in dermatology.

Daniel N. Sauder
Editor in Chief
Division of Dermatology
University of Toronto

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