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Melanoma Screening by Physicians Time for a Policy Change in the United States

from ArchDerm - 01 Oct 14

In the United States, the annual cost of melanoma is estimated to be $3.14 billion. This cost, which includes melanoma treatment and productivity losses secondary to melanoma, will continue to rise with the expected increasing melanoma incidence. The annual cost to treat melanoma is $291 million. Estimated productivity losses attributable to melanoma total $2.85 billion. The considerable economic burden of melanoma should call attention to this disease as a national health care priority.



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The Clinical Presentation of the High-Mitotic-Rate Melanoma

from ArchDerm - 01 Oct 14

Reason dictates that rapidly growing melanomas carry a worse prognosis than those that are quiescent. Indeed, much focus has been given to calculating the growth index of melanomas as defined by their mitotic rate—a process that requires counting the number of mitoses in several high-power fields. As expected, mitotic rate has been found to correlate with and predict morbidity and mortality for melanoma and therefore has become a routine part of the histologic examination of these tumors.



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Characteristics and Associations of High-Mitotic-Rate Melanoma

from ArchDerm - 01 Oct 14

ImportanceMitotic rate is now recognized as having independent prognostic significance in melanoma survival. However, its clinicopathologic associations have not been the focus of any previous study.ObjectiveTo identify a set of patient and tumor characteristics associated with high-mitotic-rate melanoma with the aim of facilitating the earlier detection of aggressive primary invasive melanoma.Design, Setting, and ParticipantsCross-sectional study of patients from a multidisciplinary melanoma cl



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The Impact of Dermatology Consultation on Diagnostic Accuracy and Antibiotic Use Among Patients With Suspected Cellulitis Seen at Outpatient Internal Medicine Offices A Randomized Clinical Trial

from ArchDerm - 01 Oct 14

ImportanceCellulitis is a common and costly problem, often diagnosed in the outpatient setting. Many cutaneous conditions may clinically mimic cellulitis, but little research has been done to assess the magnitude of the problem.ObjectiveTo determine if obtaining dermatology consultations in the outpatient primary care setting could assist in the diagnosis of pseudocellulitic conditions and reduce the rate of unnecessary antibiotic use.Design, Setting, and ParticipantsNonblinded randomized clinic



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Incidence of Nonmelanoma Skin Cancer in Relation to Ambient UV Radiation in White Populations, 1978-2012 Empirical Relationships

from ArchDerm - 01 Oct 14

ImportanceNonmelanoma skin cancers (NMSCs) are the most common cancers in fair-skinned populations. Their incidence continues to increase in many countries. Exposure to UV radiation (UVR) is the primary cause of NMSC, although the pattern of exposure that gives rise to different types of NMSC appears to vary.ObjectiveTo examine dose-response relationships between ambient UVR levels and NMSC incidence at the population level.Design, Setting, and ParticipantsPeer-reviewed literature published fro



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Intralesional Injection of Mycobacterium w Vaccine vs Imiquimod, 5%, Cream in Patients With Anogenital Warts A Randomized Clinical Trial

from ArchDerm - 01 Oct 14

ImportanceIntralesional antigen therapy has been used in the treatment of anogenital warts (AGWs), but it has not been compared with existing therapies. Evidence of its efficacy is not strong. ObjectiveTo compare the efficacy and safety of intralesional Mycobacterium w (Mw) vaccine with that of imiquimod, 5%, cream in the treatment of AGWs, as well as changes in human papillomavirus (HPV)-6 and HPV-11 viral loads.Design, Setting, and ParticipantsA double-blind randomized clinical trial was cond



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BRAF V600E Mutation Status of Involuting and Stable Nevi in Dabrafenib Therapy With or Without Trametinib

from ArchDerm - 01 Oct 14

ImportanceRecent advances in targeting BRAFV600E mutations, which occur in roughly 50% of melanomas and 70% of benign nevi, have improved response rates and survival in patients with melanoma. With increased survival, the importance of other comorbidities increases and requires consideration in long-term management. This case report discusses dynamic dermoscopic nevus changes that occur during dabrafenib therapy and offers some conclusions regarding BRAF mutations and the changes.ObservationsA m



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Mucocutaneous Granulomatous Disease in a Patient With Hermansky-Pudlak Syndrome

from ArchDerm - 01 Oct 14

ImportanceHermansky-Pudlak syndrome (HPS) is a rare genodermatosis characterized by oculocutaneous albinism, platelet dysfunction, and in some patients, pulmonary fibrosis and granulomatous colitis. The granulomatous inflammation in the bowel of patients with HPS can be indistinguishable clinically and histologically from that of Crohn disease (CD); however, mucocutaneous granulomatous lesions have not been considered among the typical skin findings of HPS.ObservationsWe report a case of an albi



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Asteatotic Eczema in Hypoesthetic Skin A Case Series

from ArchDerm - 01 Oct 14

ImportanceAsteatotic eczema (eczema craquelé, xerotic eczema) occurs most frequently in areas of dehydrated skin, most often during the winter months when decreased humidity results in increased water loss from the stratum corneum. We present 5 cases in which asteatotic eczema was found outside of its normal distribution, within desensitized skin and scars. ObservationsFive patients with a history of trauma and scar formation presented with erythematous, dry plaques with fine crackling involving



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Primary Systemic (Amyloid Light-Chain) Amyloidosis Masquerading as Pseudoxanthoma Elasticum Recognizing a Novel Clinicopathological Pattern

from ArchDerm - 01 Oct 14

ImportancePrimary systemic (amyloid light-chain [AL]) amyloidosis has a variety of cutaneous manifestations. In this case, we present a novel clinicopathological pattern of AL amyloidosis.ObservationsA woman in her 50s with a history of AL amyloidosis manifesting as macroglossia and bilateral carpal tunnel syndrome presented with skin-colored to yellow cobblestoned plaques to the neck and bilateral antecubital fossa. Although clinical similar to pseudoxanthoma elasticum (PXE), the skin changes w



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Dermatology and Dentistry Subcommittee of the 2012 International Tuberous Sclerosis Complex Clinical Consensus Conference

from ArchDerm - 01 Oct 14

The volunteer members of the Dermatology and Dentistry Subcommittee of the 2012 International Tuberous Sclerosis Complex Clinical Consensus Conference reviewed publications over a 15-year period ending in 2012 (Figure). By recognizing the transformative use of mammalian target of rapamycin inhibitors and placing it into the context of other treatments, this remarkable group of dedicated professionals helped to improve the care of patients with this disease complex.



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Dermatologic and Dental Aspects of the 2012 International Tuberous Sclerosis Complex Consensus Statements

from ArchDerm - 01 Oct 14

ImportanceThe 2012 International Tuberous Sclerosis Complex Clinical Consensus Conference was convened to update the last consensus statement in 1998. Skin and dental lesions are common in tuberous sclerosis complex (TSC) and are a frequent concern for patients. Recognition of these lesions is imperative for early diagnosis, given the treatment advances that may improve patient outcomes. ObjectiveTo detail recommendations for the diagnosis, surveillance, and management of skin and dental lesions







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Involvement of Plasmacytoid Dendritic Cells in the Immunological Response Against Orf Infection

from ArchDerm - 01 Oct 14

Plasmacytoid dendritic cells (PDCs) are specialized dendritic cells with a significant role in antiviral resistance. Plasmacytoid dendritic cells have never been studied in orf infection.



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The Impact Dermatologists Can Have on Misdiagnosis of Cellulitis and Overuse of Antibiotics Closing the Gap

from ArchDerm - 01 Oct 14

We have all experienced the patient with red legs, referred for refractory “cellulitis” not responding to systemic antibiotics. Primary care, urgent care, hospitalist, and emergency department physicians are on the front line seeing these patients; however, they often lack the training that allows them to recognize cellulitis mimickers. This constitutes a practice gap. Patients are overdiagnosed as having cellulitis, leading to inappropriate use of antibiotics and unnecessary hospitalizations dr



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Granuloma Inframammary Adultorum

from ArchDerm - 01 Oct 14

Granuloma inframammary adultorum represents a variant of erosive papulonodular dermatosis (EPND) with predominant clinical components of papules and nodules. We describe herein a patient who presented with worsening skin lesions.



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A Unilateral Orbital Mass

from ArchDerm - 01 Oct 14

Orbital fat herniation frequently presents as a prominent unilateral mass near the lateral canthus of the eye, where it poses a fundamental question: benign or malignant? As dermatologists, we will encounter this seldom-described benign mass. The differential diagnosis, pathophysiology, and treatment options are discussed in the context of a patient case.



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Zinc Deficiency and Canities An Unusual Manifestation

from ArchDerm - 01 Oct 14

Zinc is an essential trace element in health and disease. It chiefly functions as a cofactor to various metalloproteins and enzymes and is involved in transcription and gene expression. In contrast to Western countries, acquired zinc deficiency is common in South Asian countries principally in infants and young children due to poor diet and malnutrition. Herein we describe an infant with canities due to acquired zinc deficiency, which to our knowledge has not been described previously, and also



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Exogenous Pigmentation Mimicking Acral Melanoma A Case of Talon d’Oyer

from ArchDerm - 01 Oct 14

We report the case of a patient with a history of malignant melanoma who presented to our clinic with a “new brown spot” on her heel.



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Cutaneous Embolization of Doxorubicin Drug-Eluting Beads

from ArchDerm - 01 Oct 14

Transarterial chemoembolization (TACE) with drug-eluting microspheres (DEMs) is emerging as the therapy of choice by many interventional oncologists and radiologists for unresectable liver tumors. Improvements in drug delivery systems have been made by modification of the embolic agents and the introduction of microcatheters, allowing for precise drug delivery to tumors. Currently, DEMs are being used as the drug delivery system for TACE. We report herein a case of cutaneous embolization of doxo



 

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