Diagnostic Accuracy of Patients in Performing Skin Self-examination and the Impact of Photography
Early identification and excision of malignant melanomas while they are relatively thin may be important in reducing mortality, and skin self-examination (SSE) is routinely recommended to patients as a means to detect new or changing nevi. In this study, Oliveria et al determined the sensitivity and specificity of SSE to detect new and changing moles in highly motivated patients with 5 or more atypical nevi. The sensitivity of SSE to detect new and cosmetically altered moles was 62%, which increased substantially to 72% with the use of digital photography. The specificity was 96% without photographs and 98% with photographs, suggesting that patients had few false positives both with and without access to baseline digital photographs.
Sentinel Node Biopsy for High-Risk Nonmelanoma Cutaneous Malignancy
The presence of regional lymph node metastasis is the most powerful prognostic factor for predicting recurrence and survival in patients with most solid tumors whose primary spread is lymphatic. Limited, selected, less invasive surgical methods for detection of occult metastases have gradually replaced radical lymph node dissection. Indeed, lymphatic mapping and sentinel lymph node biopsy (SLNB) have become the standard of care for melanoma at virtually all major melanoma centers. In this consecutive clinical case series, Wagner et al demonstrate the feasibility of SLNB in 24 patients with selected high-risk skin cancers, including squamous cell carcinoma, Merkel cell carcinoma, and adenocarcinoma.
Early Detection of Asymptomatic Pulmonary Melanoma Metastases by Routine Chest Radiographs Is Not Associated With Improved Survival
The lungs represent a common site of cutaneous melanoma metastasis. Chest radiography (CR) is routinely used in postmelanoma surveillance, despite the fact that its utility and impact on survival are still uncertain. In this retrospective analysis, Tsao et al use a historical cohort of patients with melanoma to determine if there is an apparent survival prolongation associated with earlier detection of asymptomatic pulmonary metastasis by routine CR. The high false-positive rate and lack of a survival advantage in patients in whom asymptomatic pulmonary metastases were discovered further challenges the use of CR in postmelanoma surveillance.
Photodynamic Therapy Using Topical Methyl Aminolevulinate vs Surgery for Nodular Basal Cell Carcinoma: Results of a Multicenter Randomized Prospective Trial
Photodynamic therapy (PDT) is increasingly used as a noninvasive treatment for nodular basal cell carcinoma (nBCC) despite the lack of sound evidence for this therapy. Topical PDT has been most commonly practiced with 5-aminolevulinic acid (ALA). Methyl aminolevulinate (MAL) offers several advantages over ALA, including enhanced lipophilicity, improved skin penetration, and specificity for neoplastic cells. In this prospective, randomized multicenter trial, Rhodes et al compare topical MAL-PDT with simple surgical excision for primary nBCC, demonstrating the efficacy of this treatment as well as the cosmetic advantages over surgery.
Treatment of Refractory Pemphigus Vulgaris With Rituximab (Anti-CD20 Monoclonal Antibody)
Pemphigus vulgaris (PV) is a severe antibody-mediated autoimmune bullous disease that involves skin and mucous membranes. The mainstays of therapy remain systemic corticosteroid treatment and various other adjuvant immunosuppressive drugs. Rituximab is a genetically engineered chimeric murine/human anti-CD20 monoclonal antibody that targets B cells. In this case series, Dupuy et al review the responses in 3 patients with severe, refractory PV to weekly intravenous rituximab infusions. Each patient had a clinical response following the first series of 4 infusions, which allowed for tapering of corticosteroids and other immunosuppressant therapies.
A, Erosive lesions involving the leg. B, Noticeable clinical remission at week 10 after treatment with rituximab.