Photography for the early diagnosis of malignant melanoma in patients with atypical moles.

Several articles have been published that carefully describe techniques for obtaining reliable photographic series of patients with the atypical mole syndrome. Four common methods of total body photography are described. Follow-up studies of the effectiveness of photodocumentation for patients with the atypical mole syndrome are reviewed.

Photographic utilization in dermatology clinics in the United States: a survey of university-based dermatology residency programs.

BACKGROUND: Photography has recently been introduced as an adjunct to the clinical management of patients with the dysplastic nevus syndrome (DNS). OBJECTIVE: Our purpose was to evaluate the methods used and the extent of clinical photography in dermatology residency programs in the United States. METHODS: Nonmilitary accredited dermatology residency programs in the United States were surveyed (73% response rate) regarding utilization and technical aspects of clinical photography. RESULTS: Forty-one percent of respondents used photography for the clinical management of 90% or more of patients with DNS. Twenty-four percent of respondents used photography for the clinical management of all patients with DNS. Eighty-one percent of respondents used slides, and 62% utilized total body photographs. The median number of photographs taken for a patient with DNS was 20. CONCLUSION: Dermatologic photography has been widely adopted for the clinical management of patients with DNS. Failure of the health insurance industry to recognize the value of this procedure may result in its underutilization.

Regional variation of nonimmunologic contact urticaria. Functional map of the human face.

BACKGROUND AND DESIGN: Benzoic acid (BA) was used to induce nonimmunologic contact irritation in 10 younger (23-47 years old) and 5 older (72-90 years old) healthy volunteers. BA 2.5% in petrolatum was applied to 8 locations on the face, neck and volar forearm. Changes in the skin blood flow were monitored using a laser Doppler flowmeter. Also measured at each location were baseline measurements of skin blood flow, transepidermal water loss, stratum corneum hydration, skin surface temperature and skin surface pH. RESULTS: The neck area exhibited the greatest reaction in both age groups while the forearm exhibited the least. At each site tested, the younger group consistently demonstrated greater reactivity to BA. A significant correlation was noted between stratum corneum hydration and irritation. CONCLUSIONS: This information provides a basis to further study the frequent poorly understood intolerance of the face to topical formulation.

Optical illusions in clinical dermatology: the Mach band phenomenon and afterimages.

A survey of dermatologists was conducted to determine whether the perceptions of afterimages and Mach bands impacted on clinical dermatology practice. 26.5% (13/49) of respondents indicated that they perceived one or both of these optical illusions. No false-positive potassium hydroxide interpretations of skin scrapings for hyphae were reported due to perceived afterimages, and no skin biopsies were reportedly performed as a result of Mach bands.

Mohs micrographic surgery.

Mohs micrographic surgery (MMS) is a specialized type of minimal marginal surgery that offers cure rates superior to other options in the treatment of contiguous skin cancers in selected settings. Developed by Dr. Frederic E. Mohs, the technique originally required in situ tissue fixation before excision. Most Mohs micrographic surgeons now use the fresh tissue technique exclusively. Horizontal frozen histologic sections of the excised tumor permit more complete microscopic examination of the surgical margin than traditional methods. Residual tumor is graphically mapped and malignant extensions are pursued with staged excisions until the tumor is removed. Maximum sparing of tumor-free adjacent tissue is achieved with histologic mapping of the tumor boundaries, thus optimizing subsequent wound reconstruction. The history, techniques, indications, cure rates, and current controversies of MMS are reviewed.

Cutaneous signs of selected systemic diseases.

In this work we will discuss three cutaneous markers of systemic disease. Acanthosis nigricans is the most widely known in this category. Cutaneous angiokeratomas are usually associated with enzyme defect disorders, such as Fabry's disease, and are linked in this work as a reactive pattern in hepatorenal failure. Mast cell disease may occur in a number of forms, often with systemic involvement.