Auricular ossification.

A patient with extensive bilateral auricular ossification presented with chondrodermatitis nodularis helicis on one side. The condition was otherwise asymptomatic. Ossification was detected on radiological and histological examination. Underlying medical conditions were not found. We believe this developed as a consequence of cold injury. Auricular ossification is an unusual cause of the so-called petrified external ear, in which the subcutaneous tissue is stony hard. It is more commonly caused by dystrophic calcification. Calcification and ossification are clinically identical and histological examination is required to definitively differentiate them.

A high incidence of melanoma found in patients with multiple dysplastic naevi by photographic surveillance.

OBJECTIVES: (1) To assess the incidence of melanoma in a cohort of patients with dysplastic melanocytic naevi (DMN) and the relationships between incident melanomas and preexisting naevi and between melanoma risk and numbers of DMN. (2) To examine the role of the patient versus the physician in detecting melanoma and the relative value of surveillance versus prophylactic excision. DESIGN: Prospective cohort study. PATIENTS AND SETTING: Two hundred and seventy-eight adults, each with five or more DMN, were followed up for a mean period of 42 months in a private dermatology practice. DMN were clinically diagnosed. RESULTS: Twenty new melanomas were detected in 16 patients, corresponding to an age-adjusted incidence of 1835/100000 person-years, 46 times the incidence in the general population. Eleven were detected because of changes evident in comparison with baseline photographs and nine were detected by patients or their partners. Thirteen of the 20 melanomas arose as new lesions and only three from DMN. Melanoma risk rose with increasing numbers of DMN. CONCLUSIONS: Increasing numbers of DMN are associated with increasing melanoma risk. Surveillance (baseline photography and follow-up) enabled early diagnosis of melanoma and was very much more cost-effective in preventing life-threatening melanoma than prophylactic excision of DMN.

The prevalence of seborrhoeic keratoses in an Australian population: does exposure to sunlight play a part in their frequency?

Although seborrhoeic keratoses (SKs) appear to be very common, there are very few studies reporting details of age-specific prevalence, distribution or possible cause. We report details on the frequency, nature and distribution of SKs in 100 Australian adults in the age groups 15-25, 26-50, 51-75 and those aged more than 75 years. There was an increase in prevalence of SKs from 12% of 15-25 year olds to 100% of those aged more than 50 years. The median number of lesions in those with them also increased with age from six per person in 15-25 year olds to 69 per person in those aged more than 75 years. There was no difference in prevalence or numbers of lesions/person between males and females. SKs on exposed areas were more often flat and more than 3 mm in diameter than those on the non-exposed areas. There was a higher prevalence of SKs on the exposed areas than non-exposed areas when taking into account the surface area. The data in this study demonstrate an increased frequency of SKs compared with those reported from the United Kingdom recently and from Australasia in the past, a phenomenon paralleling the changing frequency of skin cancer in these populations. This fact, plus the finding that SKs were more common as a function of skin surface area on the exposed areas of the body, suggests that sunlight may play a part in their development in those people who are predisposed to develop them.

Advice about management of skin conditions in the community: who are the providers?

A survey was undertaken in the central Victorian city of Maryborough to investigate the use of pharmacies and general practitioners as sources of advice about skin problems. In a 2 week period consumers purchasing either prescription or over the counter (OTC) products for skin, hair and nails in pharmacies were approached for interview. Simultaneously, each of the city's general practitioners (GP) completed questionnaires on all patients presenting with conditions of skin, hair and nails. Seventy per cent of the 315 consumers interviewed were purchasing OTC products and 50% prescription items. Of the OTC products, 42% were originally recommended by pharmacy staff and 18% by doctors. Over one-third of consumers buying OTC products described symptoms to pharmacy staff and in about half of the cases it was to the pharmacy assistant. One-third of people describing symptoms had already seen a doctor. Problems most frequently reported were dermatitis, skin dryness, acne and tinea. General practitioners recorded 265 conditions (of which 54% were new) in patients. The most common condition treated was solar keratosis, and GP wrote a prescription for 45% and recommended OTC products for 7% of conditions. People in Maryborough are seeking advice for their skin conditions from a variety of sources including GP, pharmacies and others.