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This Month in Archives of Dermatology
Dec 2011

This Month in Archives of Dermatology

Arch Dermatol. 2011;147(12):1363. doi:10.1001/archdermatol.2011.504

Infantile hemangiomas (IHs) are common vascular tumors of infancy. Although spontaneous involution is common, ulceration, scarring, recurrent bleeding, and obstruction of vital structures can complicate untreated IHs. Corticosteroids were the mainstay of treatment of IHs until recently, when the effectiveness of propranolol has been established. In this multicenter retrospective chart review, Price et al demonstrate that propranolol therapy was more clinically effective and cost-effective than oral corticosteroids in treating IHs. It also resulted in fewer surgical interventions and demonstrated better tolerance, suggesting that propranolol should be considered a first-line agent in treating IHs.

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Nonmelanoma skin cancer (NMSC) is the most common malignant neoplasm in the United States, and the incidence has been rising over the past decades, particularly among young women. Epidemiologic evidence has established a clear association between solar radiation exposure and skin cancer. Exposure to UV-B radiation also results in cutaneous vitamin D synthesis. The relationship between vitamin D levels and NMSC is complex. In this cohort study, Eide et al demonstrated that an increased baseline serum 25-hydroxyvitamin D level was significantly associated with an increased NMSC risk. The authors describe the characteristics of a prospective cohort that would be essential to describe to elucidate the highly complex relationship between vitamin D and NMSC.

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S ézary syndrome (SS) presents with erythroderma, a clonal T-cell proliferation in the peripheral blood, lymph node enlargement, and visceral organ involvement. The 5-year survival rate may be as low as 30%. Although no uniform standard of care exists for SS, preservation of the immune response with extracorporeal photopheresis (ECP) and biologic therapies is associated with improved response rates. In this large retrospective cohort study, Raphael et al demonstrate a significantly improved clinical response rate with multimodality immunomodulatory therapy. A higher number of antigen-presenting cells was associated with a better outcome, consistent with the hypothesis that antigen-presenting cells are critical for processing tumor induced to undergo apoptosis by ECP.

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Hand-foot syndrome (HFS) is a localized subtype of toxic erythema of chemotherapy, characterized by a prodrome of dysesthesia followed by painful symmetric edema and erythema of the palms and soles that may evolve into blisters and erosions. In this case report, Hoesly et al describe a capecitabine-induced case of HFS that was complicated by pseudomonal superinfection resulting in bacterial sepsis and death. Although there have been reports of HFS leading to tissue necrosis and amputation, this might be the first reported death due to complications from this condition.

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The incidence rate of cutaneous melanoma (CM) is climbing rapidly, and mortality rates have not significantly diminished. Studies have demonstrated the role of numerous genes in the pathogenesis of CM, and an increased risk of second primary cancers among CM survivors has been demonstrated. In this cohort study, Yang et al demonstrate that CM survivors younger than 45 years at first diagnosis had a significantly increased risk of second primary CM. Genetic susceptibility, UV exposure, immunologic compromise, and surveillance bias likely contribute to this increased risk. These data suggest the need for continued surveillance in CM survivors.

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