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Thallium is a colorless, tasteless, and odorless toxic heavy metal. In this case report of 2 patients with deliberate thallium poisoning, Lu et al describe the clinical features of short-term thallium intoxication, including perioral numbness, facial dermatitis, diffuse alopecia, and polyneuropathy. Although the dermatologic symptoms improved as the blood thallium levels decreased, the painful polyneuropathy persisted. Electron microscopy examination of skin biopsy specimens from these patients confirmed continued long-term damage to small sensory nerve fibers 1 year after thallium intoxication, suggesting this as the underlying mechanism of the polyneuropathy.
Malignant melanoma is an aggressive form of skin cancer for which incidence and mortality rates continue to rise unabated. Although screening offers a potential means for reducing the burden of disease, screening programs remain underused in contrast to other early-detectable skin cancers. In this simulated Markov model, Losina et al compare 4 screening strategies, demonstrating that 1-time melanoma screening of the general population older than 50 years is cost-effective compared with other cancer screening programs in the United States. Biannual screening in siblings of patients with melanoma was also found to be cost-effective.
Thirty percent of cases of relapsing polychondritis (RP) are associated with rheumatologic or autoimmune diseases. Although RP has been reported in the setting of myelodysplastic syndrome, only rarely is RP associated with malignancy. In this case report, Yanagi et al report a case of RP following splenic non-Hodgkin lymphoma and review the literature associating RP with lymphoma. Drawing on the association of RP with myelodysplastic syndrome and, less frequently, with lymphoma, they speculate that some cases of RP may represent a paraneoplastic condition of a concurrent hematologic malignancy.
Skin eruptions in immunocompromised patients present a diagnostic challenge. Many of the classic clinical features that aid in diagnosis are mediated by intact immunologic mechanisms that are absent in such patients, and yet the clinical situation often demands immediate recognition and treatment of such eruptions. In this case series, Webber et al describe the features of a clinically distinct, chemotherapy-induced eruption of the intertriginous areas in 16 pediatric patients. Because the eruption was asymptomatic and spontaneously resolved without apparent sequelae, recognition of this pattern can be helpful in ruling out more serious conditions and reassuring patients of an expected benign and self-limited course.
AS the incidence and mortality rates of melanoma continue to rise, strategies for early detection become more essential. Since patients initially discover half of all melanomas, skin self-examination (SSE) remains a valuable tool for early detection. Yet it is limited by failing eyesight, poor memory in the case of the elderly, and a higher incidence of melanoma on the back where it is less likely to be detected by SSE. In this randomized controlled trial, Robinson et al hypothesize that partners who engage in skin examination skills training together with positive reinforcement of visual discriminatory abilities of partners will provide behaviors for each other to model and reinforce. The authors report that dyadic learning with a partner may be more effective than solo-based learning for SSE.
This Month in Archives of Dermatology. Arch Dermatol. 2007;143(1):15. doi:10.1001/archderm.143.1.15