Although uncommon, thin (<1-mm) melanomas have the potential to metastasize to the regional lymph node basin. Controversy exists regarding the utility of sentinel lymph node biopsy (SLNB) in the setting of nonulcerated, thin, primary melanomas. In this retrospective chart review, Lowe et al examined 46 individuals who underwent SLNB after being diagnosed with melanomas less than 1 mm in depth. The only predictive factor for the presence of sentinel lymph node disease in this cohort was the presence of a Clark level higher than III. These data support the reporting of Clark level for T1 (<1-mm) melanomas.
The abstract is an essential component of a biomedical publication and is often the only part that is read. This importance may be increased as searchable computerized bibliographic databases improve access to abstracts. The structured abstract format was first proposed in 1987 and has been widely but not universally adopted by medical journals. Dupuy et al demonstrate that the mean quality score of structured abstracts is higher than nonstructured abstracts in 3 leading dermatology clinical journals, suggesting that more widespread adoption of the structured format may improve abstract quality.
Strategies for secondary melanoma prevention include educational messages and screening efforts to improve the early detection of melanoma while the tumor is in the treatable stage (<1 mm in thickness). Carli et al performed a national survey of 11 centers belonging to the Italian Multidisciplinary Group on Melanoma and confirmed the importance of skin self-examination in diagnosing thin melanomas in an intermediate-risk population. Screening by dermatologists provided an important additive effect in these early detection efforts.
Abnormal humoral and cell-mediated immune mechanisms likely play an important role in the pathogenesis of vitiligo, a fairly common acquired disorder of cutaneous depigmentation. Corticosteroids remain the mainstay of topical vitiligo therapy, but newer topical immunomodulatory agents hold promise. In this randomized double-blind trial, Lepe et al find tacrolimus to be nearly as effective as clobetasol in repigmenting vitiliginous lesions in children, with the potential for fewer adverse effects.
Rapidly growing mycobacteria (RGM) include Mycobacterium fortuitum, Mycobacterium chelonae, and Mycobacterium abscessus. Primary cutaneous infections of RGM typically develop after minor trauma to the skin, nonsterile injections, or use of contaminated surgical instruments. In this review, Sniezek et al describe the clinical and epidemiologic findings of an RGM outbreak related to whirlpool footbath exposure in nail salons in Southern California. Such infections may occur only sporadically and may be underrecognized. Clinicians are encouraged to consider the possibility of RGM infection and inquire about recent pedicures in patients with recurrent lower extremity furunculosis unresponsive to oral antibiotics.
This Month in Archives of Dermatology. Arch Dermatol. 2003;139(5):565. doi:10.1001/archderm.139.5.565