The most important predictive criterion for patient survival in early-stage cutaneous melanoma is the status of the regional lymph nodes. Sentinel lymph node (SLN) biopsy provides valuable prognostic information in this regard. Age, sex, tumor thickness, Clark level, ulceration, lymphovascular invasion, mitotic index, and regression are some clinical and pathologic criteria that offer additional prognostic information. The recently developed antibody D2-40 reacts with endothelial cells of lymphatic vessels, and staining with D2-40 has identified lymphatic invasion (LI) in sections of primary melanomas. In this retrospective case series, Niakosari et al demonstrated that LI, as detected by D2-40 staining, was significantly associated with SLN positivity. Assessing LI by D2-40 staining and other clinicopathologic features may spare some patients the need for SLN biopsy.
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Sun exposure in childhood is strongly associated with the development of skin cancer later in life, and the Centers for Disease Control and Prevention found sufficient evidence that interventions targeting improvement of covering-up behaviors in primary schools are effective. In this qualitative survey, Geller et al demonstrate that none of the elementary schools in 9 Massachusetts districts had sun protection policies and that only 1 had any sun protection curriculum. However, nearly all principals were receptive to developing sun protection policies and making structural changes to increase the amount of shade if funding were made available.
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While incidence rates for many cancers have begun to decline, melanoma incidence rates continue to rise. Understanding the role of anatomic site on melanoma survival is essential for targeting public health messages on skin awareness and sun protection. In this retrospective cohort study using the large-scale SEER database, Lachiewicz et al demonstrate that scalp or neck melanomas were associated with nearly 2 times the rate of melanoma-specific death compared with extremity melanomas. The authors suggest not only that full medical skin examination include careful inspection of the head and neck but also that hairdressers be educated about head and neck melanoma.
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The ABCDE criteria have been widely adopted for melanoma screening. Diameter greater than 6 mm is the “D” criterion, yet small melanomas may be missed. Some have suggested that the D criterion be adjusted downward in light of the risk of these small-diameter melanomas. In this cohort study, Abbasi et al evaluated the relationship between in vivo lesion diameter and the diagnosis of melanoma among 1657 consecutive pigmented skin lesions biopsied by dermatologists. Lesion diameter greater than 6 mm was associated with a dramatic increase in diagnosed melanomas when compared with lesions 6 mm or smaller, and a downward revision of the diameter criterion to 5 mm would result in a significant loss of specificity. These data reaffirm the greater-than-6-mm D criterion is a useful guideline for the early detection of melanoma.
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Complete skin examination (CSE) along with dermoscopy can facilitate the early detection of melanoma. Many physicians, including dermatologists, feel that CSE coupled with dermoscopy is too time consuming to be incorporated into the routine office appointment. In this randomized, prospective multicenter study of 8 pigmented lesion clinics, Zalaudek et al demonstrate that the median time needed for CSE without dermoscopy was 70 seconds; with dermoscopy, 142 seconds. The authors suggest that it is feasible to incorporate CSE, with or without dermoscopy, into routine practice for the purpose of opportunistic skin cancer screening.
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This Month in Archives of Dermatology. Arch Dermatol. 2008;144(4):444. doi:10.1001/archderm.144.4.444
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