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This Month in Archives of Dermatology
April 2006

This Month in Archives of Dermatology

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Copyright 2006 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2006

Arch Dermatol. 2006;142(4):425. doi:10.1001/archderm.142.4.425
Multiple Pruritic Papules From Lone Star Tick Larvae Bites

Patients with multiple pruritic papules that appear to be insect or arthropod bite reactions often present a clinical challenge. In addition to the “usual suspects,” Fisher et al add multiple Lone Star tick larvae bites to the list of diagnostic possibilities in this case report, highlighting the risks of tick-borne diseases as well as the role of tick bites in primary skin disorders. The diagnostic challenge in identifying ticks as the causative organism in these rare cases lies in the ability to recognize the 6-legged larval form as opposed to the 8-legged adult form.

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Differences in Biopsy Techniques of Actinic Keratoses by Plastic Surgeons and Dermatologists

Actinic keratoses (AKs) are among the most common reasons for which patients consult dermatologists. In diagnostically uncertain cases, a biopsy is often performed, but only rarely is excision considered an appropriate treatment method. In this blinded, comparative, retrospective study, Sellheyer and Bergfeld analyzed differences in biopsy techniques used by dermatologists and plastic surgeons. Dermatologists performed shave biopsies of AKs in almost 9 of 10 cases. This was in sharp contrast to plastic surgeons who performed excisional biopsies in 50% of cases, with more than half located in the cosmetically important central face. These data suggest that care provided by dermatologists in the evaluation and treatment of AKs may be more cost-effective than care by plastic surgeons.

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Skin Cancer Examination Teaching in US Medical Education

As the incidence of melanoma and nonmelanoma skin cancers increases, early detection offers the best short-term hope for improved outcomes. Skin cancer examination (SCE) is a noninvasive screening tool that requires no special equipment and is reasonably cost-effective compared with other conventional cancer screening strategies. However, most patients, including those in high-risk groups, do not receive skin examinations as part of routine primary care. Because most patients with skin lesions are seen by nondermatologists, training of medical students in the SCE is an important antecedent to physician practice. In this evaluation and survey of students at 7 US medical schools, Moore et al demonstrated low levels of observation, training, and practice of the SCE, and most students rated themselves as unskilled in the examination.

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Multiple Primary Melanoma

Although previously published studies have evaluated the occurrence of additional primary melanomas among patients with a previous melanoma diagnosis, the methods used to ascertain these data likely underestimated the frequency of second tumors. In this population-based, case-control study in New Hampshire, Titus-Ernstoff et al demonstrated that 7.6% of patients with melanoma developed a second primary tumor within 2 years of initial diagnosis, a figure much higher than has been previously estimated. These findings highlight the importance of close surveillance of patients with a history of melanoma.

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Morphologic Changes of Acquired Melanocytic Nevi With Eccentric Foci of Hyperpigmentation (“Bolognia Sign”) Assessed by Dermoscopy

The “Bolognia sign” was described in 1994 as a melanoma-simulating type of melanocytic nevus characterized by eccentric peripheral hyperpigmentation. In this case report, Pizzichetta et al describe a 5-year-old girl with several melanocytic nevi demonstrating the Bolognia sign. Over the course of 39 months, dermoscopy revealed evolution of these lesions into a globular type of acquired melanocytic nevi that appeared to be completely benign. These observations suggest that dermoscopic follow-up of melanocytic nevi with foci of eccentric hyperpigmentation in children might represent a valid alternative to surgical excision of such lesions.

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First dermoscopic image shows homogeneous light brown pigmentation, regular light brown globules, and irregular dark dots localized at the right periphery of the lesion. In this area, blue-gray pigmentation can also be observed. The second dermoscopic image, taken 5 months later, shows a lesion with subtle changes: mild reduction of the blue-gray area and of the irregular dark dots.

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