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This Month in Archives of Dermatology
Oct 2012

This Month in Archives of Dermatology

Arch Dermatol. 2012;148(10):1118. doi:10.1001/archdermatol.2011.554

Granuloma annulare (GA) is a benign, self-limited granulomatous skin disease characterized by flesh-colored to erythematous or violaceous papules in an annular pattern. Many precipitating factors have been reported for the generalized and more chronic form of GA, and an association with diabetes mellitus has been debated. In this case-control study, Wu et al report an association between generalized GA and dyslipidemia. The annular lesion morphologic characteristic was also associated with hypercholesterolemia and dyslipidemia. These data suggest that a diagnosis of GA warrants an evaluation for co-occurrence of dyslipidemia.

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While malignant melanoma (MM) incidence continues to rise, regular clinical skin examination (CSE) and skin self-examination (SSE) may improve detection of thinner, more curable tumors. Frequency of SSE is between 23% and 61% annually. In this cross-sectional, web-based survey, Kasparian et al report that, among individuals with no history of melanoma, greater frequency of SSE was associated with greater perceived risk of MM, greater perceived severity of the consequences of MM, greater confidence in ability to perform SSE, and greater perceived benefits of SSE. Among those with a personal or family history of MM, perceived benefit of SSE was a common determinant of SSE across all groups. The association of these psychosocial factors with SSE behaviors suggests opportunities for psychosocial interventions to be integrated into clinical care.

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Paraneoplastic pemphigus (PNP) is a rare type of pemphigus characterized by autoantibodies directed against a complex of desmosomal proteins; PNP is most commonly associated with lymphoproliferative disorders, although nonlymphoid malignant neoplasms have been reported. Previously reported mortality rates range from 75% to 90%, with a mean survival of less than 1 year. In this multicenter retrospective cohort study, Leger et al demonstrate a more heterogeneous prognosis than previously reported. Patients with PNP having erythema multiforme–like skin lesions and histologic keratinocyte necrosis were more likely to have a more severe and rapidly fatal outcome.

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Classification systems of melanocytic neoplasms that combine histomorphologic findings with molecular genetic characteristics have added a new dimension to traditional categorization. Chromosomal aberrations that can be detected using a 4-color fluorescence in situ hybridization (FISH) probe were shown to correlate with malignant melanocytic neoplasms. In this retrospective medical record review of patients 50 years or older followed by prospective masked histopathologic and cytogenetic analyses, Horst et al demonstrate that none of the cases showing histopathologic features typical of Spitz nevi had detectable chromosomal abnormalities by FISH. These data are reassuring of Spitz nevus diagnosis in older patients and suggest no correlation of increased malignant potential with advanced age.

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Human growth hormone (HGH) and insulinlike growth factor 1 (IGF-1) have been implicated in the malignant transformation and progression of a variety of cancers. In this case series, Handler et al describe 2 patients who developed new-onset cutaneous melanoma subsequent to the initiation of exogenous HGH therapy. A common environmental component (HGH or other shared exposure) may have contributed to the development of both melanomas. Because of the increased use of exogenous HGH as an antiaging agent, the growth-promoting effects of this hormone merit increased surveillance of its use.

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