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This Month in Archives of Dermatology
Arch Dermatol. 2002;138:873.
Evaluation of the Ability of Patients to Identify Enlarging Melanocytic
Nevi
Dermatologists often counsel their patients to perform skin self-examinations
as part of a melanoma screening process. Indeed, the self-reported history
of change within a melanocytic lesion is often considered a valuable additional
diagnostic criterion in the clinical setting for differentiating between a
benign nevus and one that requires histologic examination. However, the sensitivity
and specificity of patient's self-reported screening behaviors has not been
well documented. Dawid et al examine the reliability of patients detecting
changes in their melanocytic lesions and find a surprisingly low sensitivity
for detecting changes in the size of nevi.
(SEE ARTICLE)
Routine vs Extensive Malignancy Search for Adult Dermatomyositis and
Polymyositis: A Study of 40 Patients
Dermatomyositis-polymyositis (DM-PM) is a rare myopathy characterized
by muscle weakness and inflammation and typical erythematous and edematous
skin lesions. Although DM-PM has been associated with increased incidence
of malignancies, the precise risk and approach to screening remains controversial.
This retrospective review by Sparsa et al of 40 adult patients with DM-PM
reveals a malignancy temporally associated with the onset of DM-PM in 40%
of cases. This finding reaffirms that patients with DM-PM should undergo careful
evaluation and continued surveillance, reflective of current cancer screening
methodologies.
(SEE ARTICLE)
Necrotizing Fasciitis: Report of 39 Pediatric Cases
Necrotizing fasciitis (NF) is a rapidly progressive and potentially
fatal infection that is rare in adults and even rarer among pediatric patients.
Misdiagnoses among children may be accounted for not only by the scarcity
of this disorder but also by clinical features that differ from adult cases.
Fustes-Morales et al review 39 pediatric NF cases collected over a 30-year
span, presenting data that offer a clearer picture of the clinical features
of NF among children, with the hope that early recognition and prompt therapeutic
intervention will minimize the morbidity and mortality that accompanies this
infection.
(SEE ARTICLE)
Curettage of Giant Congenital Melanocytic Nevi in Neonates: A Decade Later
Managing treatment of a neonate with a giant congenital melanocytic
nevus (GCMN) always presents an enormous challenge. Poor cosmetic and functional
outcomes present a risk for many surgical therapeutic options. De Raeve and
Roseeuw review their 10-year experience with 16 children with GCMN who were
treated with neonatal curettage within the first 2 weeks of life. In most
of the patients, the cosmetic and functional results were good, and no melanomas
were observed. Neonatal curettage may represent a particularly good option
for the limbs or other difficult-to-excise locations.
(SEE ARTICLE)
Ultrastructural Aspects of Mucosas in Endemic Pemphigus Foliaceus
Endemic pemphigus foliaceus is an autoimmune blistering disease frequent
in deforested areas of Brazil. Ultrastructural changes of early acantholysis
are demonstrable in the oral mucosa, although this does not progress to frank
blistering. In this study, Guedes et al demonstrate similar ultrastructural
changes in other mucosal surfaces, including the uterine cervix, vaginal wall,
and foreskin. All of these changes likely reflect the action of anti–desmoglein-1
antibodies.
(SEE ARTICLE)
The Mechanical Properties of Skin in Osteogenesis Imperfecta
The collagen defects associated with osteogenesis imperfecta (OI) and
its subtypes are well described, but the functional changes in tissue mechanics
have not been well studied in the skin. In this study, preliminary suction
cup measurements in patients with OI are examined, revealing that skin from
patients with OI is stiffer and less elastic than age-matched controls. These
mechanical abnormalities offer a promising in vivo measurement tool for distinguishing
between OI subtypes and providing prognostic information.
(SEE ARTICLE)
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