Although store-and-forward teledermatology (SFTD) may have a diagnostic advantage when evaluating skin growths rather than generalized dermatoses, the use of SFTD as a routine tool in the daily practice at skin cancer clinics remains limited. In this multicenter longitudinal evaluation study, Moreno-Ramirez et al evaluated the clinical effectiveness, validity, and accuracy of an SFTD triage system aimed at selecting patients with suspect skin growths for skin cancer clinic evaluation. The waiting interval to attend the clinic was significantly reduced after SFTD consultation, and the pick-up rates were 2.02% for malignant melanoma and 27.94% for patients with nonmelanoma skin cancers or precancers.
Vascular malformations are the second most common endothelial neoplasm in humans. These lesions result from the failure of endothelial cell remodeling and programmed cell death, leading to abnormal persistence of blood vessels. In this observation, Perry et al demonstrate that the constitutive activation of the Akt1 oncogene in murine endothelial cells led to the development of vascular malformations and suggest that Akt1 inhibition might offer a potential avenue for systemic or topical therapy of these lesions.
Recurrent aphthous stomatitis (RAS) is a common, painful ulcerating condition that affects 20% of healthy individuals. Thalidomide is one of the few drugs found to be effective, but the adverse effect profile limits its usefulness. Pentoxifylline is a drug used in the treatment of peripheral vascular disease. Like thalidomide, it inhibits tumor necrosis factor α production without many of the potential adverse effects. In this randomized, double-blind, placebo-controlled trial, Thornhill et al demonstrated that patients with RAS who took pentoxifylline, 400 mg, 3 times daily had more ulcer-free days, lower median pain scores, and a reduction in median ulcer size, number, and severity, although only the difference with respect to ulcer size reached the level of statistical significance.
Malignant melanoma is associated with complex genetic heterogeneity. Germline mutations in the CDKN2A gene have been observed in up to 40% of melanoma-prone families, but the penetrance of these mutations varies widely. MC1R is a gene that contributes to melanoma risk in families with CDKN2A mutations. In this case report, Figl et al describe a young woman who developed 8 invasive melanomas and 6 in situ melanomas following irradiation and chemotherapy for Hodgkin lymphoma. Genetic testing revealed not only a constitutional CDKN2 mutation but also 2 high-risk MC1R variant alleles. This report demonstrates the variability of penetrance of CDKN2A mutations that may exist within the same family due to either genetic factors such as the presence of MC1R mutations or exogenous factors such as immunosuppression.
Permanent cosmetic fillers are generally regarded as safe and well tolerated, although a weak foreign body–type granulomatous reaction consistent with sarcoidal granulomas is a rare adverse effect. In this case report, Fischer et al describe permanent filler–associated granulomas as an inflammatory response to peginterferon alfa-2a therapy for chronic hepatitis C infection. Treatment with allopurinol was well tolerated and did not interfere with the outcome of antiviral therapy. The risk of severe interaction with interferon or other immunostimulatory medications should be included in the consent form for injectable aesthetic microimplants.
This Month in Archives of Dermatology. Arch Dermatol. 2007;143(4):450. doi:10.1001/archderm.143.4.450