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This Month in Archives of Dermatology
Dec 2012

This Month in Archives of Dermatology

Arch Dermatol. 2012;148(12):1353. doi:10.1001/archdermatol.2011.564

Recent studies described the expression of a membrane molecule, PD-1, by the neoplastic T cells of various malignant T-cell lymphomas, including Sézary syndrome (SS) and mycosis fungoides (MF). In this study of a large group of biopsy samples obtained from patients with SS and different stages of MF, Çetinözman et al demonstrate differential expression of PD-1 in SS and MF, further supporting the view that SS and MF are distinct entities. It may well be that patients with SS may benefit from anti–PD-1 immunotherapy.

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Dermoscopy improves the diagnostic accuracy for melanocytic and nonmelanocytic pigmented lesions compared with inspection by the unaided eye. Dermoscopic features of squamous cell carcinoma (SCC) and keratoacanthoma remain less well characterized. In this observer-masked study of consecutive lesions, Rosendahl et al identify several dermoscopic criteria that helped differentiate these lesions from other nonpigmented lesions. White circles, keratin, blood spots, and white structureless zones were important diagnostic clues offering high specificity for differentiating keratoacanthoma and SCC from other raised, nonpigmented lesions.

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Lasers have been used to treat tattoos since the 1960s. The thermal relaxation time of tattoo pigment particles and melanosomes is less than 10 nanoseconds, suggesting that energy delivery in the picosecond range should be effective treatment. In this case series, Saedi et al demonstrate that a picosecond 755-nm alexandrite laser produced greater than 75% clearance in all patients treated, after an average of 4.25 treatment sessions. Adverse effects included pain, swelling, and blistering, which resolved quickly after treatment. These data suggest that this device is safe and effective for tattoo removal and seems to clear pigment in tattoos more rapidly than Q-switched lasers.

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Melanoma prognosis has improved in the last 30 years as a consequence of earlier diagnosis. However, very thick melanomas (VTMs) are still frequently identified. Risk factors associated with advanced tumors have remained unclear. In this retrospective case study, Grange et al demonstrate that VTMs were more often diagnosed in general practice settings, and rates of immediate clinical recognition by dermatologists were lower for VTMs. Also, VTMs were less likely to follow the ABCD rules (asymmetry, border irregularity, color variegation, and diameter >6 mm), and the most significant risks were observed for men, the elderly, and patients living alone. These data suggest that prevention programs should focus on atypical/non–ABCD criteria tumors in men, the elderly, and patients living alone.

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Morbihan disease (MD) is characterized by persistent erythema and solid edema of the upper two-thirds of the face and is generally regarded as a late-stage complication of rosacea. Reported systemic therapies for MD include anti-inflammatory drugs such as corticosteroids, antibiotics, thalidomide, and antihistamines. In this case series, Smith and Cohen demonstrate that treatment with long-term oral isotretinoin was a promising alternative, although substantial clinical improvement was not noted until 6 months of treatment in all 5 cases.

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