{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T16:55:58Z","timestamp":1791564958206,"version":"4.3.4"},"reference-count":53,"publisher":"American Medical Association (AMA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Dermatol"],"published-print":{"date-parts":[[2025,1,1]]},"abstract":"Importance<\/jats:title>Merkel cell carcinoma (MCC) is a rare but aggressive skin cancer. Quantifying the contribution of major potentially modifiable risk factors to the burden of MCC may inform prevention efforts.<\/jats:p><\/jats:sec>Objective<\/jats:title>To estimate the population attributable fraction of MCC cases in the US that were attributable to major immunosuppressing conditions (eg, HIV, solid organ transplant, chronic lymphocytic leukemia [CLL]), ambient UV radiation [UVR] exposure, and Merkel cell polyomavirus [MCPyV]).<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This epidemiological assessment combined data from population-based registries and case series and included cases of MCC that were diagnosed from January 2001 to December 2019 diagnosed in people with HIV, solid organ transplant recipients, and patients with CLL who were identified through population-based cancer registries and linkages with HIV and transplant registries. UVR-based on cloud-adjusted daily ambient UVR irradiance was merged with cancer registry data on the county of residence at diagnosis. Studies reporting the prevalence of MCPyV in MCC specimens collected in the US were combined via a meta-analysis.<\/jats:p><\/jats:sec>Exposures<\/jats:title>HIV, solid organ transplant, CLL, UVR, and MCPyV.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Population attributable fraction of MCC cases attributable to major risk factors.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 38\u202f020 MCCs were diagnosed in the US among xx patients (14\u202f325 [38%] female individuals; 1586 [4%] Hispanic, 561 [1%] non-Hispanic Black, and 35\u202f171 [93%] non-Hispanic White individuals). Compared with the general US population, MCC incidence was elevated among people with HIV (standardized incidence ratio [SIR], 2.78), organ transplant recipients (SIR, 13.1), and patients with CLL (SIR, 5.75). Due to the rarity of these conditions, only 0.2% (95% CI, 0.1%-0.3%) of MCC cases were attributable to HIV, 1.5% (95% CI, 1.4%-1.7%) to solid organ transplant, and 0.8% (95% CI, 0.5%-1.3%) to CLL. Compared with individuals of racial and ethnic minority groups, MCC incidence was elevated among non-Hispanic White individuals at lower and higher ambient UVR exposure levels (incidence rate ratios: 4.05 and 4.91, respectively, for MCC on the head and neck). Overall, 65.1% (95% CI, 63.6%-66.7%) of MCCs were attributable to UVR. Based on a meta-analysis of 19 case series, 63.8% (95% CI, 54.5%-70.9%) of MCCs were attributable to MCPyV. Studies were identified from a MEDLINE search performed on October 12, 2023.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>The results of this study suggest that most MCC cases in the US were attributable to ambient UVR exposure or MCPyV, with a small fraction due to immunosuppressive conditions. Efforts to lower MCC incidence could focus on limiting UVR exposure.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamadermatol.2024.4607","type":"journal-article","created":{"date-parts":[[2024,11,27]],"date-time":"2024-11-27T16:34:05Z","timestamp":1732725245000},"page":"47","source":"Crossref","is-referenced-by-count":20,"title":["Merkel Cell Carcinoma and Immunosuppression, UV Radiation, and Merkel Cell Polyomavirus"],"prefix":"10.1001","volume":"161","author":[{"given":"Jacob T.","family":"Tribble","sequence":"first","affiliation":[{"name":"Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth M.","family":"Pfeiffer","sequence":"additional","affiliation":[{"name":"Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isaac","family":"Brownell","sequence":"additional","affiliation":[{"name":"Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth K.","family":"Cahoon","sequence":"additional","affiliation":[{"name":"Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael R.","family":"Sargen","sequence":"additional","affiliation":[{"name":"Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meredith S.","family":"Shiels","sequence":"additional","affiliation":[{"name":"Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qianlai","family":"Luo","sequence":"additional","affiliation":[{"name":"Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colby","family":"Cohen","sequence":"additional","affiliation":[{"name":"Florida Department of Health, Tallahassee, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Drezner","sequence":"additional","affiliation":[{"name":"HIV\/AIDS, Hepatitis, STD, and TB Administration, DC Health, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenda","family":"Hernandez","sequence":"additional","affiliation":[{"name":"University of Hawai\u2019i Cancer Center, Honolulu"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrianne","family":"Moreno","sequence":"additional","affiliation":[{"name":"Cancer Epidemiology and Surveillance Branch, Texas Department of States Health Services, Austin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Pawlish","sequence":"additional","affiliation":[{"name":"Cancer Epidemiology Services, New Jersey Department of Health, Trenton"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brittani","family":"Saafir-Callaway","sequence":"additional","affiliation":[{"name":"HIV\/AIDS, Hepatitis, STD, and TB Administration, DC Health, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric A.","family":"Engels","sequence":"additional","affiliation":[{"name":"Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karena D.","family":"Volesky-Avellaneda","sequence":"additional","affiliation":[{"name":"Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"key":"doi240052r1","doi-asserted-by":"publisher","first-page":"17077","DOI":"10.1038\/nrdp.2017.77","article-title":"Merkel cell carcinoma.","volume":"3","author":"Becker","year":"2017","journal-title":"Nat Rev Dis Primers"},{"issue":"5866","key":"doi240052r2","doi-asserted-by":"publisher","first-page":"1096","DOI":"10.1126\/science.1152586","article-title":"Clonal integration of a polyomavirus in human Merkel cell carcinoma.","volume":"319","author":"Feng","year":"2008","journal-title":"Science"},{"key":"doi240052r3","first-page":"9","article-title":"Malaria and some polyomaviruses (SV40, BK, JC, and Markel cell viruses).","volume":"104","author":"IARC Working Group on the Evaluation of Carcinogenic Risks to Humans","year":"2014","journal-title":"IARC Monogr Eval Carcinog Risks Hum"},{"key":"doi240052r5","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2022.868781","article-title":"Prevalence of Merkel cell polyomavirus in normal and lesional skin: a systematic review and meta-analysis.","volume":"12","author":"Wijaya","year":"2022","journal-title":"Front Oncol"},{"key":"doi240052r6","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1016\/j.ejca.2018.02.003","article-title":"The association between geographic location and incidence of Merkel cell carcinoma in comparison to melanoma: an international assessment.","volume":"94","author":"Stang","year":"2018","journal-title":"Eur J Cancer"},{"issue":"11","key":"doi240052r7","doi-asserted-by":"publisher","first-page":"2596","DOI":"10.1016\/j.jid.2021.04.007","article-title":"International increases in Merkel cell carcinoma incidence rates between 1997 and 2016.","volume":"141","author":"Olsen","year":"2021","journal-title":"J Invest Dermatol"},{"issue":"3","key":"doi240052r8","doi-asserted-by":"publisher","first-page":"3403","DOI":"10.18632\/oncotarget.6494","article-title":"Mutational landscape of MCPyV-positive and MCPyV-negative Merkel cell carcinomas with implications for immunotherapy.","volume":"7","author":"Goh","year":"2016","journal-title":"Oncotarget"},{"issue":"19","key":"doi240052r9","doi-asserted-by":"publisher","first-page":"5961","DOI":"10.1158\/1078-0432.CCR-18-4159","article-title":"The genomic landscape of Merkel cell carcinoma and clinicogenomic biomarkers of response to immune checkpoint inhibitor therapy.","volume":"25","author":"Knepper","year":"2019","journal-title":"Clin Cancer Res"},{"issue":"9305","key":"doi240052r10","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1016\/S0140-6736(02)07668-7","article-title":"Merkel cell carcinoma and HIV infection.","volume":"359","author":"Engels","year":"2002","journal-title":"Lancet"},{"issue":"4","key":"doi240052r11","doi-asserted-by":"publisher","first-page":"588","DOI":"10.1016\/j.jid.2022.09.008","article-title":"Risk of nonkeratinocyte skin cancers in people living with HIV during the era of antiretroviral therapy.","volume":"143","author":"Luu","year":"2023","journal-title":"J Invest Dermatol"},{"issue":"2","key":"doi240052r12","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/dju382","article-title":"Risk of Merkel cell carcinoma after solid organ transplantation.","volume":"107","author":"Clarke","year":"2015","journal-title":"J Natl Cancer Inst"},{"issue":"4","key":"doi240052r13","doi-asserted-by":"publisher","first-page":"414","DOI":"10.1001\/jamadermatol.2022.0036","article-title":"Spectrum of nonkeratinocyte skin cancer risk among solid organ transplant recipients in the US.","volume":"158","author":"Sargen","year":"2022","journal-title":"JAMA Dermatol"},{"issue":"8","key":"doi240052r14","doi-asserted-by":"publisher","first-page":"e287","DOI":"10.1111\/ijd.12564","article-title":"Increased incidence of malignant melanoma and other rare cutaneous cancers in the setting of chronic lymphocytic leukemia.","volume":"54","author":"Brewer","year":"2015","journal-title":"Int J Dermatol"},{"issue":"8","key":"doi240052r15","doi-asserted-by":"publisher","first-page":"1444","DOI":"10.1038\/sj.bjc.6605306","article-title":"Chronic lymphocytic leukaemia patients have a high risk of Merkel-cell polyomavirus DNA-positive Merkel-cell carcinoma.","volume":"101","author":"Koljonen","year":"2009","journal-title":"Br J Cancer"},{"issue":"5","key":"doi240052r20","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1093\/oxfordjournals.aje.a121617","article-title":"Proportion of disease caused or prevented by a given exposure, trait or intervention.","volume":"99","author":"Miettinen","year":"1974","journal-title":"Am J Epidemiol"},{"issue":"1","key":"doi240052r21","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1214\/aos\/1176344552","article-title":"Bootstrap methods: another look at the jackknife.","volume":"7","author":"Efron","year":"1979","journal-title":"Ann Stat"},{"issue":"1","key":"doi240052r23","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1186\/s13690-023-01215-y","article-title":"Methods for meta-analysis and meta-regression of binomial data: concepts and tutorial with Stata command metapreg.","volume":"82","author":"Nyaga","year":"2024","journal-title":"Arch Public Health"},{"issue":"1","key":"doi240052r25","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1186\/s13073-021-00946-3","article-title":"Characterizing DNA methylation signatures and their potential functional roles in Merkel cell carcinoma.","volume":"13","author":"Gujar","year":"2021","journal-title":"Genome Med"},{"issue":"9","key":"doi240052r26","doi-asserted-by":"publisher","first-page":"2494","DOI":"10.1158\/1078-0432.CCR-20-0864","article-title":"Virus-positive Merkel cell carcinoma is an independent prognostic group with distinct predictive biomarkers.","volume":"27","author":"Harms","year":"2021","journal-title":"Clin Cancer Res"},{"issue":"5","key":"doi240052r27","doi-asserted-by":"publisher","first-page":"1134","DOI":"10.3390\/cancers13051134","article-title":"Distinct signatures of genomic copy number variants define subgroups of Merkel cell carcinoma Tumors.","volume":"13","author":"Hill","year":"2021","journal-title":"Cancers (Basel)"},{"issue":"3","key":"doi240052r28","doi-asserted-by":"publisher","first-page":"749","DOI":"10.1016\/j.jaad.2019.09.069","article-title":"Prevalence of delta-like protein 3 expression in Merkel cell carcinoma.","volume":"85","author":"Rand","year":"2021","journal-title":"J Am Acad Dermatol"},{"issue":"9","key":"doi240052r29","doi-asserted-by":"publisher","first-page":"810","DOI":"10.1634\/theoncologist.2019-0877","article-title":"Delta-like protein 3 expression and targeting in Merkel cell carcinoma.","volume":"25","author":"Xie","year":"2020","journal-title":"Oncologist"},{"issue":"1","key":"doi240052r30","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1111\/his.13483","article-title":"A monoclonal antibody against SV40 large T antigen (PAb416) does not label Merkel cell carcinoma.","volume":"73","author":"Pelletier","year":"2018","journal-title":"Histopathology"},{"issue":"6","key":"doi240052r31","doi-asserted-by":"publisher","first-page":"877","DOI":"10.1038\/modpathol.2017.8","article-title":"Reduced H3K27me3 expression in Merkel cell polyoma virus-positive tumors.","volume":"30","author":"Busam","year":"2017","journal-title":"Mod Pathol"},{"issue":"9","key":"doi240052r32","doi-asserted-by":"publisher","first-page":"931","DOI":"10.1001\/jamadermatol.2017.1296","article-title":"Activation of protein kinase C e in Merkel cell polyomavirus-induced Merkel cell carcinoma.","volume":"153","author":"Costa","year":"2017","journal-title":"JAMA Dermatol"},{"issue":"4","key":"doi240052r33","doi-asserted-by":"publisher","first-page":"819","DOI":"10.1016\/j.jid.2016.10.028","article-title":"Polyomavirus-negative Merkel cell carcinoma: a more aggressive subtype based on analysis of 282 cases using multimodal tumor virus detection.","volume":"137","author":"Moshiri","year":"2017","journal-title":"J Invest Dermatol"},{"issue":"22","key":"doi240052r34","doi-asserted-by":"publisher","first-page":"5553","DOI":"10.1158\/1078-0432.CCR-16-0392","article-title":"Density, distribution, and composition of immune infiltrates correlate with survival in Merkel cell carcinoma.","volume":"22","author":"Feldmeyer","year":"2016","journal-title":"Clin Cancer Res"},{"issue":"1","key":"doi240052r35","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1158\/2326-6066.CIR-13-0034","article-title":"PD-L1 expression in the Merkel cell carcinoma microenvironment: association with inflammation, Merkel cell polyomavirus and overall survival.","volume":"1","author":"Lipson","year":"2013","journal-title":"Cancer Immunol Res"},{"issue":"10","key":"doi240052r36","doi-asserted-by":"publisher","first-page":"911","DOI":"10.1111\/j.1600-0560.2012.01964.x","article-title":"Immunohistochemical prognostication of Merkel cell carcinoma: p63 expression but not polyomavirus status correlates with outcome.","volume":"39","author":"Hall","year":"2012","journal-title":"J Cutan Pathol"},{"issue":"5","key":"doi240052r37","doi-asserted-by":"publisher","first-page":"1227","DOI":"10.1158\/1078-0432.CCR-11-2308","article-title":"Activation of PI3K signaling in Merkel cell carcinoma.","volume":"18","author":"Nardi","year":"2012","journal-title":"Clin Cancer Res"},{"issue":"12","key":"doi240052r38","doi-asserted-by":"publisher","first-page":"4645","DOI":"10.1172\/JCI64116","article-title":"Improved detection suggests all Merkel cell carcinomas harbor Merkel polyomavirus.","volume":"122","author":"Rodig","year":"2012","journal-title":"J Clin Invest"},{"issue":"9","key":"doi240052r39","doi-asserted-by":"publisher","first-page":"2240","DOI":"10.1002\/ijc.24676","article-title":"Merkel cell carcinoma subgroups by Merkel cell polyomavirus DNA relative abundance and oncogene expression.","volume":"126","author":"Bhatia","year":"2010","journal-title":"Int J Cancer"},{"issue":"21","key":"doi240052r40","doi-asserted-by":"publisher","first-page":"1510","DOI":"10.1093\/jnci\/djp332","article-title":"Association of Merkel cell polyomavirus-specific antibodies with Merkel cell carcinoma.","volume":"101","author":"Carter","year":"2009","journal-title":"J Natl Cancer Inst"},{"issue":"4","key":"doi240052r41","doi-asserted-by":"publisher","first-page":"516","DOI":"10.1038\/modpathol.2009.3","article-title":"Prevalence of Merkel cell polyomavirus in Merkel cell carcinoma.","volume":"22","author":"Duncavage","year":"2009","journal-title":"Mod Pathol"},{"issue":"1","key":"doi240052r42","doi-asserted-by":"publisher","first-page":"250","DOI":"10.1038\/jid.2008.215","article-title":"The presence of polyomavirus in non-melanoma skin cancer in organ transplant recipients is rare.","volume":"129","author":"Ridd","year":"2009","journal-title":"J Invest Dermatol"},{"issue":"2","key":"doi240052r43","doi-asserted-by":"publisher","first-page":"260","DOI":"10.1038\/bjc.2016.391","article-title":"History of chronic inflammatory disorders increases the risk of Merkel cell carcinoma, but does not correlate with Merkel cell polyomavirus infection.","volume":"116","author":"Sahi","year":"2017","journal-title":"Br J Cancer"},{"issue":"6","key":"doi240052r44","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1097\/00008390-199311000-00002","article-title":"How much melanoma is caused by sun exposure?","volume":"3","author":"Armstrong","year":"1993","journal-title":"Melanoma Res"},{"issue":"5","key":"doi240052r45","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1111\/1753-6405.12470","article-title":"Cancers in Australia attributable to exposure to solar ultraviolet radiation and prevented by regular sunscreen use.","volume":"39","author":"Olsen","year":"2015","journal-title":"Aust N Z J Public Health"},{"issue":"5","key":"doi240052r46","doi-asserted-by":"publisher","first-page":"1385","DOI":"10.1002\/ijc.32921","article-title":"Cutaneous melanomas attributable to ultraviolet radiation exposure by state.","volume":"147","author":"Islami","year":"2020","journal-title":"Int J Cancer"},{"issue":"1","key":"doi240052r47","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1111\/bjd.13870","article-title":"Merkel cell carcinoma and Merkel cell polyomavirus: a systematic review and meta-analysis.","volume":"173","author":"Santos-Juanes","year":"2015","journal-title":"Br J Dermatol"},{"issue":"1","key":"doi240052r48","doi-asserted-by":"publisher","first-page":"246","DOI":"10.1038\/jid.2008.229","article-title":"Merkel cell polyomavirus is more frequently present in North American than Australian Merkel cell carcinoma tumors.","volume":"129","author":"Garneski","year":"2009","journal-title":"J Invest Dermatol"},{"issue":"10","key":"doi240052r49","doi-asserted-by":"publisher","first-page":"1385","DOI":"10.1016\/j.humpath.2010.12.013","article-title":"Immunohistochemistry for Merkel cell polyomavirus is highly specific but not sensitive for the diagnosis of Merkel cell carcinoma in the Australian population.","volume":"42","author":"Paik","year":"2011","journal-title":"Hum Pathol"},{"issue":"1","key":"doi240052r51","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1111\/j.1365-2133.2008.08610.x","article-title":"Azathioprine treatment photosensitizes human skin to ultraviolet A radiation.","volume":"159","author":"Perrett","year":"2008","journal-title":"Br J Dermatol"},{"issue":"9","key":"doi240052r52","doi-asserted-by":"publisher","first-page":"1155","DOI":"10.1158\/1940-6207.CAPR-12-0185-T","article-title":"Deregulation of XPC and CypA by cyclosporin A: an immunosuppression-independent mechanism of skin carcinogenesis.","volume":"5","author":"Han","year":"2012","journal-title":"Cancer Prev Res (Phila)"},{"issue":"1","key":"doi240052r53","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1016\/j.jcv.2013.06.004","article-title":"Merkel cell polyomavirus infection occurs during early childhood and is transmitted between siblings.","volume":"58","author":"Martel-Jantin","year":"2013","journal-title":"J Clin Virol"},{"key":"doi240052r4","doi-asserted-by":"crossref","DOI":"10.22427\/ROC-MGRAPH-11","volume-title":"Report on Carcinogens: Monograph on Merkel Cell Polyomavirus","author":"National Toxicology Program","year":"2016"},{"key":"doi240052r17","volume-title":"International Classification of Diseases for Oncology: ICD-O3","author":"Jack","year":"2001"},{"key":"doi240052r18","volume-title":"Total Ozone Mapping Spectrometer Data Product: Erythemal UV Exposure","author":"National Aeronautics Space Administration","year":"2004"},{"key":"doi240052r50","volume-title":"StatPearls","author":"Moore","year":"2023"},{"key":"doi240052r16","unstructured":"Surveillance, Epidemiology, and End Results Program. SEER*Stat database: incidence\u2014SEER research plus data, 17 registries. Accessed January 20, 2024. http:\/\/www.seer.cancer.gov"},{"key":"doi240052r19","unstructured":"Surveillance, Epidemiology, and End Results Program. SEER*Stat database: incidence\u2014SEER research plus limited field data, 22 registries. Accessed January 20, 2024. http:\/\/www.seer.cancer.gov"},{"key":"doi240052r22","unstructured":"Registries and Surveillance, Epidemiology, and End Results Program. Epidemiology and end results program . Accessed January 20, 2024. https:\/\/www.cdc.gov\/cancer\/uscs\/public-use"},{"key":"doi240052r24","unstructured":"R Core Team. R: A language and environment for statistical computing. Accessed January 20, 2024. https:\/\/www.R-project.org\/."}],"container-title":["JAMA Dermatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamadermatology\/articlepdf\/2827131\/jamadermatology_tribble_2024_oi_240052_1736781516.24.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,15]],"date-time":"2025-01-15T16:01:11Z","timestamp":1736956871000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamadermatology\/fullarticle\/2827131"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,1]]},"references-count":53,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,1,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamadermatol.2024.4607","relation":{},"ISSN":["2168-6068"],"issn-type":[{"value":"2168-6068","type":"print"}],"subject":[],"published":{"date-parts":[[2025,1,1]]}}}