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This Month in Archives of Dermatology
July 2012

This Month in Archives of Dermatology

Arch Dermatol. 2012;148(7):787. doi:10.1001/archdermatol.2011.539

Malignant melanoma is the most fatal form of skin cancer. Despite lower melanoma incidence rates, blacks disproportionately demonstrate later stage at diagnosis and higher melanoma-related mortality. In this cross-sectional, retrospective study, Myles et al establish that the most frequent anatomic sites for melanoma among black patients were the lower limbs and hip and trunk. Ambiguity of anatomic site data as reported by cancer registries prevented comparison of these findings with earlier data reporting a higher incidence on the foot. Nonetheless, these data update the epidemiology of melanoma in this population and can be used to improve early melanoma detection.

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Isotretinoin is the drug of choice to treat severe acne vulgaris. Ocular adverse effects result mostly from changes of the eyelids and the corneal surface or lacrimal abnormalities that lead to dry eye. In this retrospective cohort study, Neudorfer et al demonstrate a strong association between isotretinoin therapy and the development of clinically meaningful ocular adverse events including conjunctivitis, hordeolum, chalazion, blepharitis, eye pain, and dry eye, all attributable to meibomian gland dysfunction. These data highlight the need to educate patients about these risks and to recommend ocular lubricants as a primary preventive measure for patients receiving isotretinoin.

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The past 4 decades have seen a dramatic increase in the number of women entering medicine, and women now represent the majority of dermatology trainees. Numerous studies have demonstrated sex-based differences in advancement, leadership, productivity, and salary in academic medicine. In this national cross-sectional survey, Sadeghpour et al demonstrate that sex-based differences in academic dermatology have improved, but that they still exist. Enhancing the subjective rewards of academics and increasing family-friendly flexibility for early-career academicians are important measures toward closing these gaps.

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There is evidence that some tanning patterns may represent dependent behavior, the mechanism of which may be the release of endogenous opioids in response to skin exposure to UV radiation. In this longitudinal survey, Hillhouse et al demonstrate the validity of the Structured Interview for Tanning Abuse and Dependence (SITAD). Their data add to the increasing evidence that some forms of tanning behavior reflect dependence. The indoor tanning industry uses unlimited tanning packages to hook tanners into tanning. If addiction can be substantiated, stronger policy on the marketing of and access to tanning beds for minors should be considered.

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B-cell neoplasms can involve the skin as a primary cutaneous lymphoma or as a secondary process, usually presenting as isolated, grouped, or multiple erythematous to violaceous papules, plaques, or nodules. A rosacea-like clinical appearance is rare. In this case series, Barzilai et al describe 12 patients with B-cell lymphoproliferative neoplasms who presented with rosacea or rhinophyma-like lesions. This unusual rosacea-like presentation was more common among women and often led to delayed diagnosis. All patients had an indolent course as expected for their disease.

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