Sentinel lymph node biopsy is unreliable in predicting melanoma mortality for both younger and older patients.

BACKGROUND: Melanoma disease patterns vary with patient age. AIM: To evaluate sentinel lymph node biopsy (SLNB) in managing melanoma at differing patient ages. METHODS: Online prediction tools were applied to compare SLNB positivity (SLNB+) and survival risk at patient ages 20-80. Tübingen melanoma data were used to determine variations in the hazard ratio of SLNB+ for mortality at different patient ages. RESULTS: Regardless of tumour thickness, predicted SLNB+ rates were markedly higher than mortality rates for 20-year-old patients. For 80-year-old patients, it is the opposite. DISCUSSION: If 1000 20-year-olds with a 0.4 mm thickness non-ulcerated melanoma underwent SLNB, 100 would likely be positive. If all 100 were to be offered adjuvant drug therapy (ADT), fewer than three more melanoma deaths in those 1000 patients would be avoided. In total, 97 patients would have received medication they may never have needed. If 1000 80-year-olds with a 3 mm thickness non-ulcerated melanoma underwent SLNB, only 40 would likely be positive. In total, 274 patients would be predicted to die of melanoma, 245 being SLNB negative and 29 SLNB+. ADT linked to SLNB+ could deny treatment to 89% of these high-risk patients. LIMITATIONS: The authors relied on published risk data. CONCLUSION: SLNB has poor specificity at predicting mortality in young melanoma patients and poor sensitivity in older patients. SLNB is not indicated in managing cutaneous melanoma for patients under 40 or over 60 years of age. Many such patients could be managed with wide local excision alone in their clinician's office-based practice. For all cutaneous melanoma patients at all ages, linking ADT to BAUSSS biomarker, (an algorithm of Breslow thickness, age, ulceration, subtype, sex and Site) rather than SLNB+ is likely more appropriate. BAUSSS provides a more accurate melanoma-specific mortality risk assessment for patients without burdening them with added surgery, hospitalization, costs or morbidity risk.

Regression of Nevi After Candida Injection for the Treatment of Verruca Vulgaris.

The most common treatment methods for verruca vulgaris are destructive methods that are often painful and treat individual verruca. Thus immune modulators, including Candida immunotherapy, are used to treat persistent recalcitrant and multiple verrucas simultaneously. Very few side effects are reported with Candida immunotherapy; they include vitiligo and now halo nevi. Physicians need to be aware of and discuss side effects with patients undergoing Candida immunotherapy.

Targetoid hemosiderotic hemangioma: a case report of multiple asymptomatic lesions.

Targetoid hemosiderotic hemangioma (THH) is a benign vascular tumor characterized by a central violaceous papule with a clear periphery bordered by an ecchymotic ring. Originally coined by its characteristic halo appearance with hemosiderin deposits, not all THHs have this classic halo or hemosiderin composition. We report a unique case of THH in which the patient presented with multiple lesions with no prior trauma. Multiple THH lesions have been linked to minor trauma; however, the presence of 4 concurrent lesions with the absence of trauma makes this THH presentation atypical and unique.

The Webb and Rivera (WAR) score: a preoperative Mohs surgery assessment tool.

OBJECTIVE: To make available a simple, quantitative formula for preoperative assessment of both the complexity and the associated time required to complete Mohs surgical cases. It will improve office efficiency, technical performance, and resource management. DESIGN: Surveys were sent to 94 Mohs surgeons requesting information on 10 consecutive cases, including tumor size, recurrence, location, aggressiveness, stages required, and case duration. The data were then aggregated, scored, and statistically evaluated. SETTING: Private practice dermatology offices performing Mohs surgery were included. PARTICIPANTS: Sequential randomized selection of Mohs College and Mohs Society fellows was used for inclusion. Sequential selection of patients for data acquisition was performed by the surgeons. MAIN OUTCOME MEASURE: The statistical significance of a proposed preoperative assessment tool was to be determined. RESULTS: The score ρ values were 0.34 and 0.41 for the time and number of stages, respectively. In addition, the Mohs score obtained a statistically significant P value of <.001 for both the time and number of stages required. CONCLUSIONS: The Webb and Rivera (WAR) score is a low-effort, efficient, reproducible tool to be used in preoperative Mohs surgery planning and office efficiency improvement. The components of the score include maximum tumor dimension, recurrence, location, and aggressiveness. Each is assigned a numerical value that is totaled, resulting in a final quantitative score.