Mitotic rate in cutaneous melanomas ≤1 mm in thickness: a prospective study.

The mitotic rate (MR) of malignant melanoma (MM) refers to the number of mitoses per square millimeter. Studies have suggested that it is an independent prognostic variable predicting survival in patients with MM, and it was recently included in the American Joint Committee on Cancer (AJCC) recommendations for diagnosis and treatment of MM. The AJCC melanoma staging committee recommends using the "hot-spot" approach to determine the MR, whereby it is reported as the maximum dermal mitotic figures identified in a 1-mm area of the melanoma. The AJCC has recommended that the MR be determined in all melanomas, irrespective of Breslow depth or other features. We aimed to quantify the MR in MM ≤1 mm in thickness and to identify statistical associations between the MR, Breslow depth, and Clark level. In addition, we hoped to identify practical issues in determining the MR via the hot-spot technique. We conducted a prospective study to determine the MR, Breslow depth, and Clark level in MM ≤1 mm in thickness. Seven melanomas were identified with epidermal mitoses only (7.4%). Sixteen melanomas had dermal mitoses (16.8%); of these, the majority (75.0%) contained only one mitotic figure. Seventy-nine melanomas had no dermal mitoses (83.2%). Seven lesions (7.4%) demonstrated multiple mitoses; 4 with ≥2 dermal mitoses/mm and 3 with multiple epidermal mitoses. We conclude that thin MM with >1 mitosis/mm is rare and discuss practical and theoretical issues with determining the MR using the hot-spot approach.

Unusual and recently described cutaneous atrophic disorders.

Cutaneous atrophic conditions are typically caused by changes in the dermis or subcutaneous tissue, sometimes consisting of the loss of a single fiber type. Since a significant decrease of subepidermal tissue is necessary for these lesions to be macroscopically atrophic, many conditions may not be appreciated as atrophy in the clinical setting. Clinicians should be familiar with the common or classic disorders causing cutaneous atrophy; however, there are a few new or rarely described atrophic conditions which are more difficult to identify and may not be atrophic clinically. This paper serves to describe the salient clinical and histological features of these new or rare disorders.

Venous ulcers.

Chronic venous ulceration is a common and important medical problem, which causes significant morbidity. Venous ulcers are expensive to treat, have substantial economic effects in terms of days of work lost, and adversely impact patient's quality of life. History and clinical findings are helpful in making the diagnosis of venous ulceration, but additional diagnostic testing is helpful in confirming the diagnosis and excluding arterial disease. The objectives of venous ulcer management include healing of the ulcer, prevention of recurrence, and improvement of edema. Compression is the cornerstone of venous ulcer therapy. Adjunctive modalities such as biologic skin substitutes, dressings, debridement, surgical intervention, and drugs may also facilitate the healing process.