Many therapeutic modalities for actinic keratoses (AKs) currently exist, but only topical imiquimod works by enhancing the local immune response against dysplastic cells. In these phase 3, randomized, double-blind, vehicle-controlled studies, Korman et al confirm that 5% imiquimod cream is a safe and effective treatment for AKs. While the overall efficacy for dosing 3 times weekly was greater, twice-weekly dosing was also effective and associated with fewer application site reactions. These data suggest that dosing could be tailored to minimize adverse reactions.
Nonmelanoma skin cancers are the most frequently reported malignancy among immunosuppressed organ transplant recipients (OTRs). Systemic retinoids may prevent or reduce skin cancer development by induction of tumor cell apoptosis, induction of normal cellular differentiation, or immunomodulation. The chemopreventive efficacy of retinoids may be limited by adverse effects that prevent their long-term use in OTRs. In this retrospective study of OTRs who had received long-term systemic retinoids, Harwood et al demonstrate that a low-dose protocol significantly reduced squamous cell carcinoma development with an acceptable adverse-effects profile.
Early detection of skin cancers is critical for optimal management, and public education of primary and secondary prevention measures is essential. As a primary source for health information, the news media represent a powerful educational tool that might be used for this purpose. In this content analysis of 921 skin cancer articles released by the Associated Press between 1979 and 2003, Stryker et al reveal the lack of print media attention to skin cancer in general and to prevention in particular. Despite the fact that skin cancer incidence has steadily risen in the United States, print media attention to skin cancer was not shown to have increased. Neither prevention nor detection received as much attention as treatment, and specific sun protection practices were mentioned infrequently. The authors outline media advocacy strategies that may help shape news coverage of skin cancer prevention.
If detected and treated early, melanoma may be a curable disease. Improving the skills of the general public and general practitioners in early detection of melanoma requires an understanding of how the natural recognition process of melanoma works. The “ABCD” criteria are often taught as an analytic criteria recognition process. In this prospective survey, Gachon et al demonstrate that dermatologists unconsciously rely on overall pattern recognition and differential recognition processes (“ugly duckling sign”) rather than the analytic criteria recognition algorithmic approach in accurately making the diagnosis of melanoma. This global recognition is a natural learning process by which individuals learn to recognize most of the basic objects around us and could be useful in the field of education in melanoma detection.
Actinic keratoses are precursors to invasive squamous cell carcinoma. Accurate diagnosis and appropriate treatment of AKs might be expected to diminish the morbidity and mortality associated with squamous cell carcinoma. In this case series, Venna et al demonstrate that the positive predictive value of the clinical diagnosis of AK was only 74% among patients with a history of skin cancer and skin phototype I or II. Many of the incorrectly identified lesions were found to be forms of skin cancer, suggesting that the threshold for biopsy of suspect lesions in such high-risk patients should be lower.
Right nasojugal fold with a 4-mm erythematous, scaly papule with histologic confirmation.
This Month in Archives of Dermatology. Arch Dermatol. 2005;141(4):417. doi:10.1001/archderm.141.4.417