Differential effects of social versus monetary incentives on inhibitory control under acute inflammation.

While the impact of chronic, low-grade inflammation on cognitive functioning is documented in the context of neurodegenerative disease, less is known about the association between acute increases in inflammation and cognitive functioning in daily life. This study investigated how changes in interleukin-6 (IL-6) levels were associated with performance on an inhibitory control task, the go/no-go task. We further examined whether the opportunity to earn different incentive types (social or monetary) and magnitudes (high or low) was associated with differential performance on the task, depending on IL-6 levels. Using a within-participant design, individuals completed an incentivized go/no-go task before and after receiving the annual influenza vaccine. Multilevel logistic regressions were performed on the trial-level data (Nobs = 30,528). For no-go trials, we did not find significant associations between IL and 6 reactivity between the sessions and changes in trial accuracy. For go trials, we found significant differences in the associations between IL and 6 reactivity and changes in accuracy from session 1 to session 2 as a function of the incentive condition. Notably, greater IL-6 reactivity was consistently associated with fewer omission errors (i.e., greater accuracy on go trials) on high-magnitude social incentives (i.e., viewing a picture of a close-other picture) when compared to both low-magnitude social and high-magnitude monetary incentives. Together, these results suggest that mild fluctuations in inflammation might alter the valuation of an incentive, and possibly a shift toward devoting greater attentional resources when a large social incentive is on the line. Overall, this study sheds light on how everyday, low-grade fluctuations in inflammation may influence cognitive abilities essential for daily life and effective inhibitory control.

The roles of inflammation, affect, and interoception in predicting social perception.

"Sickness behavior" is an orchestrated suite of symptoms that commonly occur in the context of inflammation, and is characterized by changes in affect, social experience, and behavior. However, recent evidence suggests that inflammation may not always produce the same set of sickness behavior (e.g., fatigue, anhedonia, and social withdrawal). Rather, inflammation may be linked with different behavior across contexts and/or across individuals, though research in this area is under-developed to-date. In the present study (n = 30), we evaluated the influence of affective context and individual differences in difficulty detecting bodily sensations (i.e., interoceptive difficulty) on social perception following an inflammatory challenge. Inflammation was induced using the influenza vaccine and inflammatory reactivity was operationalized as changes in circulating levels of interleukin-6 (IL-6) before the vaccine and approximately 24 h later. Twenty-four hours after administration of the influenza vaccine, we manipulated affective context using a well-validated affect misattribution task in which participants made trustworthiness judgments of individuals with neutral facial expressions following the rapid presentation of "prime" images that were positive or negative in affective content. Interoceptive difficulty was measured at baseline using a validated self-report measure. Results revealed significant interactions between inflammatory reactivity to the influenza vaccine and affective context on social perception. Specifically, individuals with greater inflammatory reactivity were more biased by affective context when judging the trustworthiness of neutral faces. In addition, interoceptive difficulty and affective context interacted to predict social perception such that individuals with greater interoceptive difficulty were more biased by affective context in these judgments. In sum, we provide some of the first evidence that inflammation may amplify the saliency of affective cues during social decision making. Our findings also replicate prior work linking interoceptive ability to the use of affect-as-information during social perception, but in the novel context of inflammation.

Support-Giving Is Associated With Lower Systemic Inflammation.

BACKGROUND: Support-giving has emerged as a health-relevant social behavior, such that giving more support is associated with better physical health. However, biological mechanisms by which support-giving and health are linked remain unclear. Whether support-giving uniquely relates to health relative to other psychosocial factors is also an open research question. PURPOSE: Two studies test the hypothesis that support-giving is uniquely (over-and-above other psychosocial factors) related to lower systemic inflammation, a biological correlate of health. METHODS: Cross-sectional associations of support-giving with markers of systemic inflammation (i.e., interleukin-6 [IL-6], C-reactive protein [CRP]) were examined in two independent samples of midlife adults (Study 1, n = 746; Study 2, n = 350). RESULTS: Consistent with hypotheses, giving to more social targets (to family and friends, and also volunteering for various causes), but not receiving support from similar targets, was associated with lower IL-6. In conceptual replication and extension with a different measure of support-giving, higher frequency of support-giving behavior was associated with lower IL-6, even after adjusting for social network size and individual differences in social desirability. There were no associations between support-giving and CRP in either sample. CONCLUSIONS: Future research needs to establish causality and directly test mechanistic pathways, but together, findings reaffirm the health-relevance of support-giving behavior and shed light on a promising biological mechanism by which such effects may occur.

Support-giving behavior and health are linked such that more support-giving is related to better health and longevity for the person giving. How such a link occurs, however, is an open question for research. Two cross-sectional studies test the hypothesis that support-giving behavior relates to lower systemic inflammation, a potential biological pathway linking supportive behavior with health. Results of Study 1 show that giving to more social targets (to family and friends, and also volunteering) is associated with lower inflammation. Receiving support was not associated with inflammation. In a replication and extension, Study 2 shows that a greater frequency of giving is also related to lower systemic inflammation, over and above the size of one's social network and individual differences in reporting socially desirable responses. Although more research is needed to establish whether support-giving causes systemic inflammation to change, the current findings highlight a promising pathway by which support-giving behavior benefits health.

A Systematic Review of Self-Management Interventions Conducted Across Global Settings for Depressive Symptoms in Persons with HIV.

Depressive symptoms can affect health outcomes in people living with HIV (PLWH) including adherence to treatment and disease prognosis. Self-management interventions targeting depressive symptoms have been effective in preventing these negative sequelae of depressive symptoms. The processes of self-management include learning skills related to living with the illness needs, accessing resources to manage the illness, and coping with the illness. A systematic literature review was conducted to appraise and synthesize the current evidence of self-management interventions targeting depressive symptoms in PLWH. Following the PRISMA guidelines, an electronic search of 4 databases was conducted. Original studies written in English that used a randomized controlled trial design to test the effect of self-management intervention on depressive symptoms were included. Studies were selected that were published on/before April 19, 2022, thus yielding 13 relevant articles. Risk of bias was assessed using the NIH Quality Assessment Tool for Controlled Intervention Studies and narrative synthesis was used to synthesize the results. 40 to 755 participants were included in the studies, with each using various measures to assess depressive symptoms pre-and post-intervention, and timepoints for assessing depressive symptoms post-intervention varied. While 12 studies showed a significant reduction in depressive symptoms post-intervention, only 4 studies that used individual coaching or technology showed lower depressive symptoms in intervention groups in comparison to the control groups. This review can be used to inform scale-up and dissemination of these interventions to improve depressive symptoms in PLWH.

RESUMEN: Los síntomas depresivos pueden afectar el estado de salud en personas que viven con el VIH (PLWH, por sus siglas en inglés), incluyendo la adherencia al tratamiento y el pronóstico de la enfermedad. Las intervenciones de autocuidado enfocadas a los síntomas depresivos han sido eficaces para prevenir estas secuelas negativas de los síntomas depresivos. Los procesos de autogestión incluyen habilidades de aprendizaje relacionadas con enfocarse a vivir con la enfermedad necesidades, acceder a recursos para manejar la enfermedad y afrontar a la enfermedad. Se realizó una revisión sistemática de la literatura para evaluar y sintetizar la evidencia actual de las intervenciones de autocuidado dirigidas a los síntomas depresivos en personas que viven con el VIH. Siguiendo las directrices PRISMA, se realizó una búsqueda electrónica en 4 bases de datos. Se incluyeron estudios originales escritos en inglés que utilizaron un diseño de ensayo controlado aleatorio para evaluar el efecto de la intervención de autocuidado sobre los síntomas depresivos. Se seleccionaron estudios que se publicaron el 19 de abril de 2022 o antes, obteniendo 13 artículos relevantes. El riesgo de sesgo se evaluó mediante la herramienta de evaluación de la calidad de los NIH para estudios de intervención controlados y se utilizó la síntesis narrativa para sintetizar los resultados. Se incluyeron de 40 a 755 participantes en los estudios. Los estudios utilizaron diversas medidas para evaluar los síntomas depresivos antes y después de la intervención, y los puntos temporales para evaluar los síntomas depresivos después de la intervención variaron. Mientras que 12 estudios mostraron una reducción significativa en los síntomas depresivos después de la intervención, solo 4 estudios que usaron entrenamiento individual o tecnología mostraron síntomas depresivos más bajos en los grupos de intervención en comparación con los grupos de control. Esta revisión se puede utilizar para informar la ampliación y difusión de estas intervenciones para mejorar los síntomas depresivos en las personas que viven con el VIH.

Lower Socioeconomic Position Is Associated with Greater Activity in and Integration within an Allostatic-Interoceptive Brain Network in Response to Affective Stimuli.

Socioeconomic inequities shape physical health and emotional well-being. As such, recent work has examined the neural mechanisms through which socioeconomic position (SEP) may influence health. However, there remain critical gaps in knowledge regarding the relationships between SEP and brain function. These gaps include a lack of research on: (1) the association between SEP and brain functioning in later life, (2) relationships between SEP and functioning of the whole brain beyond specific regions of interest, and (3) how neural responses to positive affective stimuli differ by SEP. The current study addressed these gaps by examining the association between SEP (i.e., education, income) and neural responses to affective stimuli among 122 mid- to late-life adults. During MRI scanning, participants viewed 30 positive, 30 negative, and 30 neutral images; activation and network connectivity analyses explored associations between SEP and neural responses to these affective stimuli. Analyses revealed that those with lower SEP showed greater neural activity to both positive and negative images in regions within the allostatic-interoceptive network, a system of regions implicated in representing and regulating physiological states of the body and the external environment. There were no positive associations between SEP and neural responses to negative or positive images. In addition, graph-theory network analyses showed that individuals with lower SEP demonstrated greater global efficiency within the allostatic-interoceptive network and executive control network, across all task conditions. The findings suggest that lower SEP is associated with enhanced neural sensitivity to affective cues that may be metabolically costly to maintain over time and suggest a mechanism by which SEP might get "under the skull" to influence mental and physical well-being.

Threat-of-shock decreases emotional interference on affective stroop performance in healthy controls and anxiety patients.

Patients with anxiety disorders suffer from impaired concentration, potentially as a result of stronger emotional interference on attention. Studies using behavioural measures provide conflicting support for this hypothesis. Elevated state anxiety may be necessary to reliably document differences in emotional interference in patients versus healthy controls. The present study examines the effect of experimentally induced state anxiety (threat-of-shock) on attention interference by emotional stimuli. Anxiety patients (n = 36) and healthy controls (n = 32) completed a modified affective Stroop task during periods of safety and threat-of-shock. Results indicated that in both patients and controls, threat decreased negative, but not positive or neutral, emotional interference on attention (both p < .001). This finding supports a threat-related narrowing of attention whereby a certain level of anxiety decreases task-irrelevant processing.

Inflammatory reactivity to the influenza vaccine is associated with changes in automatic social behavior.

Recent evidence suggests differential patterns of social behavior following an inflammatory challenge, such that increases in inflammation may not uniformly lead to social withdrawal. Indeed, increases in inflammation have been associated with enhanced self-reported motivation to approach a specific close other, and greater neural sensitivity to positive social cues. However, no known studies have examined the association between inflammation in response to an inflammatory challenge and social behavior in humans, nor has past research examined specifically how approach and withdrawal behavior may differ based on whether the target is a close other or stranger. To address this, 31 participants (ages 18-24) received the influenza vaccine to elicit a low-grade inflammatory response. The morning before and approximately 24 h after the vaccine, participants provided a blood sample and completed a computer task assessing automatic (implicit) approach and withdrawal behavior toward a social support figure and strangers. Greater increases in the inflammatory cytokine interleukin-6 (IL-6) in response to the vaccine were associated with an increase in accuracy in avoiding strangers and a decrease in accuracy in approaching them. Increases in IL-6 were also associated with a decrease in reaction time to approach a support figure, but only when controlling for baseline IL-6 levels. There were no associations between change in IL-6 and changes in self-reported motivation to engage in social behavior with either close others, or strangers. Together, these findings reveal that increases in inflammation following the influenza vaccine are associated with automatic social behavior, especially behavior suggesting avoidance of unfamiliar social targets and ease in approaching a support figure. These data add to the growing literature suggesting that the association between inflammation and social behavior includes both social withdrawal and social approach, depending on the specific target.

Forms of Racial/Ethnic Discrimination and Suicidal Ideation: A Prospective Examination of African-American and Latinx Youth.

Although suicide is the second leading cause of death among adolescents, research revealing potent predictors of suicidal thoughts above and beyond the effects of depressive symptoms is limited, especially among racial and ethnic minority youth. This prospective study examined two subtypes of racial/ethnic discrimination (i.e., overt and more subtle forms), among African American and Latinx youth. Both African American (n = 85) and Latinx (n = 73) adolescents completed measures of perceived discrimination, suicidal ideation, and depression at baseline (9th-grade spring) as well as a measure of suicidal ideation 1 year later. Factor analyses revealed subscales reflecting both overt and more subtle forms of racial/ethnic discrimination, consistent with the concept of microaggressions. Findings revealed that subtle forms of discrimination were concurrently associated with suicidal ideation among African American and Latinx youth and were prospectively associated with suicidal ideation among African American adolescents, above and beyond the effects of depressive symptoms. Findings underscore the deleterious effects of subtle forms of discrimination on adolescents' risk for suicidal thoughts.

Real World Dermatology: Evaluating the Safety of Combination Laser Procedures in a Single Clinic Session.

BACKGROUND: Studies show it is safe to have multiple sessions of single laser treatment over an appropriate time period, which allows for the skin to heal between treatments. Waiting to have several sessions may not be realistic for every patient. Physicians may combine laser treatments into a single session to accommodate for patient convenience and to achieve cosmetic improvement faster. Although individual laser therapies are reported to have minimal side effects, few studies explore the safety of multiple laser treatments in a single session. METHODS: This study is a retrospective chart review from a single-physician patient pool. Patients who received 1 laser treatment in a single session were compared to those who received 2 or more laser treatments in a single session. Patients were evaluated for treatment type and safety, measured by the Common Terminology Criteria for Adverse Events (CTCAE). The CTCAE is a validated severity scale (1-5) where 1 represents minimal adverse events and 5 represents death. Adverse event scores were acquired from follow-up visits, messages through the electronic health record, or follow-up phone calls. RESULTS: Over a 12-month period, 89 patients qualified for the study with 152 sessions recorded: 116 had 1 laser treatment and 36 had 2 or more laser treatments in a single session. All but 1 patient scored a 1 on the CTCAE, the other, a 2. CONCLUSION: This study suggests there is no difference in adverse events from a single laser treatment vs 2 or more laser treatments in a single session. J Drugs Dermatol. 2022;21(11):1181-1184. doi:10.36849/JDD.6766.

Probing the Electrostatic and Steric Requirements for Substrate Binding in Human Platelet-Type 12-Lipoxygenase.

Human platelet ALOX12 (hALOX12 or h12-LOX) has been implicated in a variety of human diseases. The present study investigates the active site of hALOX12 to more thoroughly understand how it positions the substrate and achieves nearly perfect regio- and stereospecificities (i.e., 100 ± 5% of the 12(S)-hydroperoxide product), utilizing site-directed mutagenesis. Specifically, we have determined that Arg402 is not as important in substrate binding as previously seen for hALOX15 but that His596 may play a role in anchoring the carboxy terminal of the arachidonic acid during catalysis. In addition, Phe414 creates a π-stacking interaction with a double bond of arachidonic acid (Δ11), and Ala417/Val418 define the bottom of the cavity. However, the influence of Ala417/Val418 on the profile is markedly less for hALOX12 than that seen in hALOX15. Mutating these two residues to larger amino acids (Ala417Ile/Val418Met) only increased the generation of 15-HpETE by 24 ± 2%, but conversely, smaller residues at these positions converted hALOX15 to almost 100% hALOX12 reactivity [Gan et al. (1996) J. Biol. Chem. 271, 25412-25418]. However, we were able to increase 15-HpETE to 46 ± 3% by restricting the width of the active site with the Ala417Ile/Val418Met/Ser594Thr mutation, indicating both depth and width of the active site are important. Finally, residue Leu407 is shown to play a critical role in positioning the substrate correctly, as seen by the increase of 15-HpETE to 21 ± 1% for the single Leu407Gly mutant. These results outline critical differences between the active site requirements of hALOX12 relative to hALOX15 and explain both their product specificity and inhibitory differences.

Resting-state connectivity of the bed nucleus of the stria terminalis and the central nucleus of the amygdala in clinical anxiety

Background: The central nucleus of the amygdala and bed nucleus of the stria terminalis are involved primarily in phasic and sustained aversive states. Although both structures have been implicated in pathological anxiety, few studies with a clinical population have specifically focused on them, partly because of their small size. Previous work in our group used high-resolution imaging to map the restingstate functional connectivity of the bed nucleus of the stria terminalis and the central nucleus of the amygdala in healthy subjects at 7 T, confirming and extending structural findings in humans and animals, while providing additional insight into cortical connectivity that is potentially unique to humans. Methods: In the current follow-up study, we contrasted resting-state functional connectivity in the bed nucleus of the stria terminalis and central nucleus of the amygdala at 7 T between healthy volunteers (n = 30) and patients with generalized and/or social anxiety disorder (n = 30). Results: Results revealed significant voxel-level group differences. Compared with healthy volunteers, patients showed stronger resting-state functional connectivity between the central nucleus of the amygdala and the lateral orbitofrontal cortex and superior temporal sulcus. They also showed weaker resting-state functional connectivity between the bed nucleus of the stria terminalis and the dorsolateral prefrontal cortex and occipital cortex. Limitations: These findings depart from a previous report of resting-state functional connectivity in the central nucleus of the amygdala and bed nucleus of the stria terminalis under sustained threat of shock in healthy volunteers. Conclusion: This study provides functional MRI proxies of the functional dissociation of the bed nucleus of the stria terminalis and central nucleus of the amygdala, and suggests that resting-state functional connectivity of key structures in the processing of defensive responses do not recapitulate changes related to induced state anxiety. Future work needs to replicate and further probe the clinical significance of these findings.

Creating Lasting Conditions for Meaningful Recess Reform: A 5-School Exploration.

BACKGROUND: When well implemented, recess is a critical part of the school day for children's healthy development. We explored the implementation of a recess improvement process in 5 elementary schools across 3 states. METHODS: We conducted a mixed-methods implementation study in which we visited each school 3 times over 1 school year, collecting observational, interview, survey, and focus group data. Qualitative data were coded thematically and analyzed across schools. Quantitative data were tabulated and aggregated over time and across schools. RESULTS: We observed improvements in aspects of recess quality at each school, with three schools demonstrating the most progress. Quantitative data showed null effects in aggregate; however one school demonstrated significant improvements. Four criteria contributed to the quality and sustainability of recess reform: staff engagement, integration with other programs, student leadership, and recess communications. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Program implementation research often refers to "buy-in" as a key ingredient to successful adoption. We provide a tool that helps to operationalize buy-in in the recess context. CONCLUSIONS: Changing the recess environment requires individual and institutional commitment to valuing recess as an important learning environment. School administrators must lead the change process and create institutional infrastructure to support success.

Is Discrimination Widespread or Concentrated? Evaluating the Distribution of Anti-Black Discrimination in Judicial, Hiring, and Housing Decisions.

Is anti-Black discrimination concentrated among a discriminatory few, or widespread across many decision-makers? The handful of studies that have addressed this question have reached divergent conclusions, with some suggesting that discrimination follows the 80/20 rule (i.e., a Pareto distribution) and others suggesting that discrimination is normally distributed. This paper explores the distribution of discrimination in hiring, housing, and judicial decisions. Study 1 examined the distribution of anti-Black discrimination in judges' repeated sentencing decisions. The distribution of discrimination was more consistent with a normal distribution than a Pareto distribution. In Study 2, meta-analyses of hiring and housing field experiments revealed anti-Black discrimination in more than 80% of studies. Simulations of widespread discrimination using a normal distribution were more consistent with these experimental data than were simulations of concentrated discrimination using a Pareto distribution. These findings suggest that discrimination is not concentrated in the behaviors of a few highly biased individuals.

Higher interleukin-6 is associated with greater momentary social connection in close relationships in daily life.

Recent evidence has documented associations between higher levels of inflammation and social approach behaviors toward close others in laboratory-based tasks. Yet it is unknown if this translates to interactions with close others in daily life. Given that momentary experiences of social connection have both relational and health consequences, this is a critical gap in our knowledge. To address the association between inflammation and momentary social connection experiences in close relationships, 55 participants provided blood samples on two consecutive days, which were assayed for circulating levels of the inflammatory marker interleukin-6 (IL-6). After providing the first blood sample, participants received the annual influenza vaccine as a mild inflammatory challenge. Participants also reported on cognitive, affective, and behavioral indicators of social connection with a specific close other multiple times across the two study days. Results indicated that levels of IL-6 were positively associated with temporally-proximal indicators of momentary social connection with a close other. Specifically, higher levels of IL-6 were associated with greater feelings of comfort from the close other, greater desire to be near them, and higher reported relationship quality. Greater IL-6 reactivity to the vaccine was only associated with increased reported relationship quality. These data add to the existing literature suggesting that higher levels of IL-6 may motivate social approach toward a close other, extending evidence to now include momentary social connection experiences in daily life.

Onychocytic Matricoma Presenting as Longitudinal Melanonychia in a Skin of Color Patient.

Introduction: Onychocytic matricoma (OCM) is a benign acanthoma of the nail matrix that presents with longitudinal melanonychia and nail thickening. Only 18 previously reported cases of OCM are in the literature since it was first described in 2012. Case Presentation: The purpose of this case report was to report a unique presentation of OCM in the toenail of a Black patient as well as to review the clinical presentation, histologic features, and management of this rare entity. Previously described cases presented on the fingernails and were predominantly in white males. Conclusion: OCM is a benign entity that may mimic a nail unit melanoma or squamous cell carcinoma especially when pachyonychia is present. Despite some clinical clues to suggest a diagnosis of OCM, a nail matrix biopsy is often required to rule out malignancy.

Do Walk Step Reminders Improve Physical Activity in Persons Living With HIV in New York City?-Results From a Randomized Clinical Trial.

ABSTRACT: Supervised physical activity can increase functional capacity in persons with HIV (PWH); however, aerobic interventions have shown little improvement in overall physical activity in PWH. In response, we sought to assess the effect of wearing a fitness tracker (FitBit) paired with walk step reminders delivered through an mHealth application to improve physical activity and decreasing body mass index among PWH in New York City. There was no significant difference in the frequency of walk steps between participants in the control group and intervention group from baseline to 6-month follow-up. These findings show that walk step reminders alone were inadequate for sustained improvement of physical activity. This study highlights the need to develop and test the comparative efficacy of physical activity interventions that are tailored to the unique needs and capabilities of PWH. Future interventions should incorporate fitness tracking with tailored interventions focused on the promotion of physical activity.Clinical Trials.Gov Registration number: NCT03205982.

Theoretically Guided Iterative Design of the Sense2Quit App for Tobacco Cessation in Persons Living with HIV.

The use of mobile health (mHealth technology) can be an effective intervention when considering chronic illnesses. Qualitative research methods were used to identify specific content and features for a mobile app for smoking cessation amongst people living with HIV (PWH). We conducted five focus group sessions followed by two Design Sessions with PWH who were or are currently chronic cigarette smokers. The first five groups focused on the perceived barriers and facilitators to smoking cessation amongst PWH. The two Design Sessions leveraged the findings from the focus group sessions and were used to determine the optimal features and user interface of a mobile app to support smoking cessation amongst PWH. Thematic analysis was conducted using the Health Belief Model and Fogg's Functional Triad. Seven themes emerged from our focus group sessions: history of smoking, triggers, consequences of quitting smoking, motivation to quit, messages to help quit, quitting strategies, and mental health-related challenges. Functional details of the app were identified during the Design Sessions and used to build a functional prototype.

Pediatric Atypical Melanocytic Proliferations: Single-Site Retrospective Cohort Assessment of Treatment and Long-Term Follow-Up.

Atypical and malignant cutaneous tumors are understudied in the pediatric population, with limited data on long-term follow-up. This study examines pediatric (0-18 years) atypical melanocytic proliferations over a twenty-year period (January 2002-December2022) using the EPIC SlicerDicer at our institution. Over a twenty-year period, there were 55 cases of pediatric melanoma (53 patients). The median follow-up time was 8 years, 11 months. A proportion of 96% were treated with wide local excision (WLE), and 47% had a sentinel lymph node biopsy (SLNB) (35% positive rate). There were 101 atypical Spitz tumor cases (85% atypical Spitz tumors, 15% Spitz melanoma), with a median follow-up duration of 9 years. A proportion of 77% were treated with WLE (with one patient dying of metastatic disease). There were 10 cases of atypical melanocytic proliferations not otherwise specified, including 5 pigmented epithelioid melanocytomas (PEM), 4 deep-penetrating nevi, and 1 atypical cellular blue nevus. This study adds to the growing body of knowledge on pediatric atypical cutaneous melanocytic proliferations, aligning with many described characteristics such as disease location and overall survival rates, with distinct exceptions (higher melanoma positive SLNB rate, lower atypical Spitz tumor WLE rate, and a case of fatal metastatic atypical Spitz tumor).