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Management of Melanoma in the Elderly
Melanoma incidence and mortality have increased steadily over the past 25 years. In addition to higher incidence rates, older patients have lower disease-specific survival rates than younger patients. In this retrospective population-based study, Ciocan et al demonstrate that primary tumor characteristics differed among older patients. In addition, time to definitive excision was longer, more of them had insufficient excision margins, sentinel lymph node biopsy was performed less frequently, and adjuvant therapy was less frequently started and was prematurely stopped. These data highlight needs for elderly access to settings for early diagnosis as well as the need for excision with appropriate margins.
Related Invited Commentary
Morphea in Adults and Children Cohort III
Morphea is an unpredictable disease. Small studies have implicated specific autoantibodies with morphea subtype or severity, but large-scale studies are lacking. In this nested case-control study, Warner Dharamsi et al demonstrate the presence of antinuclear antibodies (ANAs) and antihistone antibodies in patients with morphea vs healthy controls. There was no difference in ANA prevalence among morphea subtypes. The presence of autoantibodies was not associated with clinical measures of morphea activity, but in linear morphea, their presence was associated with greater disease severity. These data underscore the need to identify biomarkers of greater relevance to morphea.
Reversion of MRSA Skin Infections
Increases in methicillin-resistant Staphylococcus aureus (MRSA) infections in the outpatient setting have led to a growing trend of empirical antibiotic treatment for MRSA. Limited oral antibiotic availability and growing resistance to these antibiotics make this a controversial practice. In this retrospective medical record review, Patel et al demonstrate that patients with MRSA skin infections and soft-tissue infections demonstrated the ability to revert to subsequent methicillin-sensitive infections with significant frequency. These data reinforce the need for reculturing new infections in previously MRSA-positive patients to identify changes in antibiotic sensitivity.
Comorbidity in Psoriasis
Psoriasis is a common chronic inflammatory disease affecting 2% to 3% of the general population. Increasing evidence suggests that psoriasis has far-reaching systemic effects, but the degree to which psoriasis severity may affect the prevalence of comorbid diseases remains unclear. In this population-based cross-sectional study, Yeung et al demonstrate significant associations between psoriasis severity and chronic pulmonary disease, diabetes mellitus, mild liver disease, myocardial infarction, peptic ulcer disease, peripheral vascular disease, renal disease, and rheumatologic disease. Physicians need to be aware of these associations, especially when caring for patients with more severe psoriasis.
Author Audio Interview, Continuing Medical Education
Highlights. JAMA Dermatol. 2013;149(10):1129. doi:10.1001/jamadermatol.2013.4088
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