BACKGROUND: Submissions to the Journal of the American Academy of Dermatology (JAAD) undergo a rigorous peer-review process. However, little is known regarding the fate of manuscripts declined by the JAAD. OBJECTIVE: We sought to: (1) determine the proportion of manuscripts declined by the JAAD that are subsequently published elsewhere; (2) identify the journals in which they were published; and (3) study whether the authors of declined manuscripts adopted in their final publications the changes suggested by the JAAD reviewers. METHODS: We reviewed the outcomes of the 489 submissions declined by the JAAD during two 4-month periods: from March 1, 2004, to June 30, 2004, and from March 1, 2005, to June 30, 2005. RESULTS: Of the 981 manuscripts submitted to JAAD during the two 4-month periods studied, 489 manuscripts (50%) were declined. Among the declined manuscripts, 201 (41%) had been subsequently published in other medical journals as of March 1, 2007. Among the 55 journals that published manuscripts declined by JAAD, 23 (42%) were nondermatology journals. The median impact factor for these 55 journals was 1.638, compared with the JAAD's impact factor of 2.402. Among the declined manuscripts, Case Reports comprised the largest proportion (n = 149, 31%), followed by Original Research Reports (n = 90, 18%). Overall, 46 (51%) rejected Original Research Reports were subsequently published, compared with 145 (36%) rejected submissions in other categories that were later published (P < .01). Among the 101 subsequently published manuscripts for which full texts were available, 82% of the authors incorporated at least one change suggested by the JAAD reviewers. The manuscripts that adopted JAAD-reviewer suggestions were published in journals with higher impact factors than those that did not incorporate any JAAD-reviewer suggestions (P = .0305). LIMITATIONS: It is possible that the average lag time of 28 months in this study is not sufficient for some rejected manuscripts to reach subsequent publication. CONCLUSIONS: Approximately half of the manuscripts rejected by the JAAD were subsequently published in other journals within 28 months, among which, roughly 40% went to nondermatology journals. The median impact factor of the journals that published JAAD-rejected manuscripts was lower than that of the JAAD. Rejected Original Research Reports have a significantly higher probability of being subsequently published than other category submissions. This may be a result of relative quality of Original Research Reports versus submissions for other sections of the journal (eg, Case Reports). Manuscripts that adopted JAAD-reviewer suggestions were subsequently published in journals with higher impact factors than those that did not incorporate JAAD-reviewer suggestions. This indicates that peer-reviewer comments can be useful and important for improving the quality of scientific publications.