Dermatologists often counsel their patients to perform skin self-examinations as part of a melanoma screening process. Indeed, the self-reported history of change within a melanocytic lesion is often considered a valuable additional diagnostic criterion in the clinical setting for differentiating between a benign nevus and one that requires histologic examination. However, the sensitivity and specificity of patient's self-reported screening behaviors has not been well documented. Dawid et al examine the reliability of patients detecting changes in their melanocytic lesions and find a surprisingly low sensitivity for detecting changes in the size of nevi.
Dermatomyositis-polymyositis (DM-PM) is a rare myopathy characterized by muscle weakness and inflammation and typical erythematous and edematous skin lesions. Although DM-PM has been associated with increased incidence of malignancies, the precise risk and approach to screening remains controversial. This retrospective review by Sparsa et al of 40 adult patients with DM-PM reveals a malignancy temporally associated with the onset of DM-PM in 40% of cases. This finding reaffirms that patients with DM-PM should undergo careful evaluation and continued surveillance, reflective of current cancer screening methodologies.
Necrotizing fasciitis (NF) is a rapidly progressive and potentially fatal infection that is rare in adults and even rarer among pediatric patients. Misdiagnoses among children may be accounted for not only by the scarcity of this disorder but also by clinical features that differ from adult cases. Fustes-Morales et al review 39 pediatric NF cases collected over a 30-year span, presenting data that offer a clearer picture of the clinical features of NF among children, with the hope that early recognition and prompt therapeutic intervention will minimize the morbidity and mortality that accompanies this infection.
Managing treatment of a neonate with a giant congenital melanocytic nevus (GCMN) always presents an enormous challenge. Poor cosmetic and functional outcomes present a risk for many surgical therapeutic options. De Raeve and Roseeuw review their 10-year experience with 16 children with GCMN who were treated with neonatal curettage within the first 2 weeks of life. In most of the patients, the cosmetic and functional results were good, and no melanomas were observed. Neonatal curettage may represent a particularly good option for the limbs or other difficult-to-excise locations.
Endemic pemphigus foliaceus is an autoimmune blistering disease frequent in deforested areas of Brazil. Ultrastructural changes of early acantholysis are demonstrable in the oral mucosa, although this does not progress to frank blistering. In this study, Guedes et al demonstrate similar ultrastructural changes in other mucosal surfaces, including the uterine cervix, vaginal wall, and foreskin. All of these changes likely reflect the action of anti–desmoglein-1 antibodies.
The collagen defects associated with osteogenesis imperfecta (OI) and its subtypes are well described, but the functional changes in tissue mechanics have not been well studied in the skin. In this study, preliminary suction cup measurements in patients with OI are examined, revealing that skin from patients with OI is stiffer and less elastic than age-matched controls. These mechanical abnormalities offer a promising in vivo measurement tool for distinguishing between OI subtypes and providing prognostic information.
This Month in Archives of Dermatology. Arch Dermatol. 2002;138(7):873. doi:10.1001/archderm.138.7.873