Acral melanoma accounts for half of all melanomas in nonwhite patients and for 4% to 7% of melanomas in white individuals. Dermoscopy is a noninvasive technique that may offer clinicians an advantage in differentiating benign melanocytic lesions from early acral melanoma. In this retrospective review, Altamura et al describe the features of 723 acral melanocytic nevi in a white population in central Italy. Common and previously described patterns included the parallel-furrow, latticelike, nontypical, fibrillar, homogeneous, globular, and reticular patterns. A novel transition pattern was observed as well, combining the dermoscopic features of a typical pigment network in one area of the lesion with a parallel furrow or latticelike pattern in another part of the same lesion. This pattern was observed on the lateral aspect of the fingers, where volar skin converts into nonglabrous skin.
Therapeutic options for moderate to severe psoriasis include systemic options such as psoralen– UV-A (PUVA) as well as immunosuppressive agents such as methotrexate, cyclosporine, and newer biologic agents. Because immunosuppressive regimens may contribute to an increased risk of lymphoma, defining the baseline innate risk of lymphoma among patients with psoriasis is essential for evaluating the long-term safety of systemic therapies. In this prospective cohort study, Stern demonstrates that patients with psoriasis who were treated with PUVA had lymphoma incidence rates comparable to the general population, but those exposed to high levels of methotrexate had an increased risk of lymphoma.
Eighty percent of dermatologists with Internet access report using the Internet for medical updating and professional purposes. Locating online health information is made difficult because of the inconstant nature of Internet addresses, or uniform resource locators (URLs). As Web sites reorganize and change hardware configuration, files are commonly renamed, and thus the Internet address, or URL, for that file changes. In this study, Wren et al accessed all online publications in the 3 dermatology journals with the highest scientific impact and extracted all URLs that were located within text sections. Of these, 18.3% were found to be unavailable. Although the Internet remains an invaluable resource for physicians, the average life span of a Web site is insufficient to ensure long-term accuracy or availability of information. Policies for remediating these difficulties are proposed by the authors.
Wells syndrome, or eosinophilic cellulitis, was described in 1971 as a recurrent granulomatous dermatitis with eosinophilia. The clinical presentation of Wells syndrome is polymorphic; the histopathologic findings are nonspecific; and the response to therapy is inconstant. In this case series, Caputo et al categorize 7 clinical variants and identify 3 histopathologic phases, defending the view of Wells syndrome as a distinct entity that represents the benign cutaneous end of a spectrum of conditions linked to the immunobiologic characteristics of eosinophils.
The genus Malassezia, comprising 10 distinct species, is principally recovered from the skin of mammals and birds. Malassezia pachydermatis is the only non–lipid-dependent species of this genus, and it is part of the normal cutaneous microflora of dogs and many other mammals. In this case report, Fan et al describe the first skin M pachydermatis–induced skin infection in humans successfully treated with a combination of oral fluconazole and adjunctive cryotherapy.
Patient before and after treatment. A, Verrucous plaque on the right side of the face and a hemispheroid nodule on the left ala nasi. B, After treatment, hypopigmented scar on the right side of the face.
This Month in Archives of Dermatology. Arch Dermatol. 2006;142(9):1107. doi:10.1001/archderm.142.9.1107