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This Month in Archives of Dermatology
December 2009

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ROBIN L.TRAVERSMD

Arch Dermatol. 2009;145(12):1358. doi:10.1001/archdermatol.2009.314
Psychological Responses and Coping Strategies Among Patients With Malignant Melanoma

Despite advances in treatment, the diagnosis of melanoma remains a difficult event in the lives of many patients and their families. The distress evoked by such changes may have wide-ranging implications. In this systematic review of the literature on psychological morbidity among individuals diagnosed with melanoma, Kasparian et al note that approximately 30% of patients with melanoma report clinically relevant levels of psychological stress, with anxiety being more prevalent than depression. Recognition and understanding of these emotional issues will allow improved strategies to be developed to address these concerns.

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Disparity in Melanoma

Melanoma is among the top 10 new cancer diagnoses among American men and women. Improved secondary prevention measures with earlier detection of thin melanoma likely account for the improved survival among whites. Such advances have not occurred in other racial and ethnic groups. In this cross-sectional and retrospective analysis of melanoma cases reported to the Florida Cancer Data System, Hu et al demonstrate that both white Hispanics and blacks have significantly more advanced melanoma at diagnosis than white non-Hispanics. This persistence of disparity in melanoma stage at diagnosis warrants closer examination of secondary prevention efforts in minority groups.

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Follicular Red Dots

Scalp dermoscopy plays an important role in the diagnosis of hair and scalp disorders. Specific dermoscopic patterns have been associated with several disorders causing noncicatricial alopecia, such as androgenetic alopecia, alopecia areata, trichotillomania, and tinea capitis. These patterns can be of help to the clinician in the differential diagnosis of hair disorders. In this case report, Tosti et al describe a new dermoscopic pattern referred to as “follicular red dots” that was found in scalp lesions of 5 patients with active discoid lupus erythematosus. These dots seem to be related to the presence of dilated infundibula surrounded by dilated vessels with pronounced red blood cell extravasation. This pattern was not identified in images of cicatricial alopecia resulting from other diseases.

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Applicability and Prognostic Value of the New TNM Classification System in 135 Patients With Primary Cutaneous Anaplastic Large Cell Lymphoma

Primary cutaneous anaplastic large cell lymphoma (C-ALCL) is a non-Hodgkin lymphoma of T-cell origin that presents in the skin without evidence of extracutaneous disease at the time of diagnosis. There are overlapping clinical, histologic, and immunophenotypical features with lymphomatoid papulosis. Recently, a new TNM classification system has been developed for primary cutaneous lymphomas other than mycosis fungoides and Sézary syndrome. Recent studies have started to evaluate the clinical usefulness of this system. In this retrospective cohort analysis of 135 patients with C-ALCL, Benner and Willemze demonstrate that this new TNM system can be applied well and may provide prognostic information when combined with site of presentation data.

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Factors That Affect Skin Aging

Aging is attributed to both intrinsic and extrinsic processes. Photoaging, characterized by coarse wrinkling, hyperpigmentation, hypopigmentation, and telangiectasia, is the most recognized form of extrinsic aging. Intrinsic aging is characterized by finely wrinkled skin, cherry hemangiomas, and seborrheic keratoses. The study of twins provides the opportunity to control for genetic susceptibility. In this survey and clinical evaluation of twins at the annual Twins Days Festival in Twinsburg, Ohio, Martires et al demonstrate that environmental and genetic factors affect photoaging and skin cancer development. Weight and alcohol intake were correlated negatively with photoaging, whereas cigarette smoking was associated with marginally greater photodamage.

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