Teledermatology is a rapidly growing discipline that addresses issues of access to and quality and cost of dermatologic care. In this prospective study of 49 consecutive patients judged by an internist to require dermatologic consultation for skin neoplasms, Shapiro et al compared skin biopsy triage decisions by 3 experienced observers using store-and-forward teledermatology and face-to-face consultations. Remarkably, 100% agreement in treatment plan was observed between the face-to-face and teledermatologic consultations. The authors comment on issues surrounding the cost-effectiveness of this technology that will ultimately impact the integration of teledermatology into real-world practice settings.
Malignant melanoma is more common among people with numerous nevi. Our current understanding of the evolution of nevi derives mainly from cross-sectional studies. In this population-based survey and 1-year prospective follow-up study of a cohort of 52 schoolchildren, Oliveria et al demonstrate the feasibility of performing a longitudinal study to address patterns of nevus evolution. In addition, they describe the prevalence and patterns of nevi among schoolchildren using digital photography and dermoscopic features to explore the interrelationship between nevi and host and environmental factors.
Lentigo maligna (LM) and LM melanoma are pigmented melanocytic neoplasms found mainly on the sun-exposed skin of the head and neck in elderly patients. In this retrospective follow-up study of 59 patients with LM or LM melanoma who had the lesion excised with serial excision, Bub et al describe the utility of radial histologic sectioning in preparing the tissue. This technique allows the dermatopathologist to examine multiple sections starting from the center of the tumor and working toward the periphery. The average margin excised was 0.55 cm, and patients were observed for a mean of 57 months after surgery. Only 3 local recurrences and no evidence of metastatic disease were observed, a cure rate that exceeds that of conventional surgery and carries the benefits of tissue conservation.
Scabies is a worldwide ectoparasitic disease of the skin caused by the mite Sarcoptes scabiei. Current therapies for ordinary scabies consist primarily of topical agents, although oral ivermectin has been used in some settings. The essential oil of the tea tree is an Australian Aboriginal traditional medication for bruises, insect bites, and skin infections, although little is known of its antiectoparasitic activity. The primary active components of tea tree oil (TTO) are oxygenated terpinoids. In this pilot study, Walton et al evaluated the antiscabetic efficacy of TTO through in vitro and in vivo assays and demonstrated that TTO may represent an effective novel agent for the treatment of scabies.
Hemangiomas of infancy (HOI) are the most common benign tumors of childhood. Most HOI are solitary localized lesions with a relatively low risk of complications. Multifocal hemangiomas, on the other hand, are associated with a higher potential for concomitant visceral hemangiomas. In this case series supplemented by an extensive review of previously reported cases, Metry et al demonstrate that large solitary segmental HOI may also be associated with extracutaneous hemangiomatosis. Evaluation of patients with segmental hemangiomas should be tailored to risk factors and signs and symptoms that may be present.
Multiple facial hemangiomas present in a segmental distribution.
This Month in Archives of Dermatology. Arch Dermatol. 2004;140(5):515. doi:10.1001/archderm.140.5.515