Clinical and dermoscopic stability and volatility of melanocytic nevi in a population-based cohort of children in Framingham school system.

Nevi are important risk markers of melanoma. The study aim was to describe changes in nevi of children using longitudinal data from a population-based cohort. Overview back photography and dermoscopic imaging of up to 4 index back nevi was performed at age 11 years (baseline) and repeated at age 14 years (follow-up). Of 443 children (39% females) imaged at baseline, 366 children (39% females) had repeated imaging 3 years later. At age 14, median back nevus counts increased by two; 75% of students (n=274) had at least one new back nevus and 28% (n=103) had at least one nevus that disappeared. Of 936 index nevi imaged dermoscopically at baseline and follow-up, 69% (645 nevi) had retained the same dermoscopic classification from baseline evaluation. Only 4% (n=13) of nevi assessed as globular at baseline were classified as reticular at follow-up, and just 3% (n=3) of baseline reticular nevi were classified as globular at follow-up. Of 9 (1%) index nevi that disappeared at follow-up, none showed halo or regression at baseline. In conclusion, the relative stability of dermoscopic pattern of individual nevi in the face of the overall volatility of nevi during adolescence suggests that specific dermoscopic patterns may represent distinct biological nevus subsets.

Defining the patient at high risk for melanoma.

In this practical review, we aim to help clinicians identify patients who are at significant risk of developing malignant melanoma. Universal screening is challenging, thus it is important to effectively single out patients who have a high risk of developing the disease. We provide a summary of pertinent questions to review when taking the patient's history, point out the phenotypic features to note during skin examination, and suggest risk stratification as a means to plan initial and long-term surveillance strategy. We mention personal and family history of melanoma as prime risk factors for melanoma, yet the review also focuses on the patient who has no history of melanoma, either in himself or his family, and the proper ways to evaluate his likelihood of developing the disease.

Estimated equivalency of vitamin D production from natural sun exposure versus oral vitamin D supplementation across seasons at two US latitudes.

BACKGROUND: The relationship between oral vitamin D supplementation and cutaneous photosynthesis is not well understood. OBJECTIVE: We sought to provide estimates of the equivalency of vitamin D production from natural sun exposure versus oral supplementation. METHODS: Using the FastRT simulation tool, we determined sun exposure times needed to achieve serum vitamin D(3) concentrations equivalent to 400 or 1000 IU vitamin D for individuals of various Fitzpatrick skin types living in Miami, FL, and Boston, MA, during the months of January, April, July, and October. RESULTS: Peak ultraviolet B irradiation for vitamin D synthesis occurs around 12 pm Eastern Standard Time (EST). In Boston, MA, from April to October at 12 pm EST an individual with type III skin, with 25.5% of the body surface area exposed, would need to spend 3 to 8 minutes in the sun to synthesize 400 IU of vitamin D. It is difficult to synthesize vitamin D during the winter in Boston, MA. For all study months in Miami, FL, an individual with type III skin would need to spend 3 to 6 minutes at 12 pm EST to synthesize 400 IU. Vitamin D synthesis occurs faster in individuals with lighter Fitzpatrick skin types. The duration to attain 1000 IU of vitamin D is longer in all scenarios. LIMITATIONS: Results of the computer model are only approximations. In addition, calculations were made based on the assumption that (1/4) of 1 minimal erythema dose directed at (1/4) body surface area is equal to 1000 IU of oral vitamin D. CONCLUSIONS: Although it may be tempting to recommend intentional sun exposure based on our findings, it is difficult, if not impossible to titrate one's exposure. There are well-known detrimental side effects of ultraviolet irradiation. Therefore, oral supplementation remains the safest way for increasing vitamin D status.

Joint activation of the supplementary motor area and presupplementary motor area during simultaneous motor and language functional MRI.

Recent research showed that the supplementary motor area (SMA) can be divided into a rostral pre-SMA, involved in higher-level processing and a caudal SMA proper, involved with motor execution. As surgical insults to the medial frontal lobes may cause variable neurological deficits and an incomplete understanding of structure-function relationships of the SMA exists, we sought to determine whether a common locus of functionality can be established using functional MRI. Results reveal a commonly activated region between these two areas, using simultaneous motor and language tasks. A higher percentage signal change was measured in comparison with those found using individual tasks. Results contribute to the structural and functional knowledge of the SMA and may enable distinction between permanent and transient SMA syndromes.

Current and emerging technologies in melanoma diagnosis: the state of the art.

Relative to other specialties, dermatologists have been slow to adopt advanced technologic diagnostic aids. Most skin disease can be diagnosed by simple visual inspection, and the skin is readily accessible for a diagnostic biopsy. Diagnostic aids, such as total body photography and dermoscopy, improve the clinician's ability to diagnose melanoma beyond unaided visual inspection, however, and are now considered mainstream methods for early detection. Emerging technologies such as in vivo reflectance confocal microscopy are currently being investigated to determine their utility for noninvasive diagnosis of melanoma. This review summarizes the currently available cutaneous imaging devices and new frontiers in noninvasive diagnosis of skin disease. We anticipate that multimodal systems that combine different imaging technologies will further improve our ability to detect, at the bedside, melanoma at an earlier stage.

An unusual cause of overdose after baclofen pump implantation: case report.

OBJECTIVE AND IMPORTANCE: Intrathecal baclofen delivery for the treatment of spasticity has been used for almost 20 years with a great deal of success. A wide variety of complications and pitfalls have been described. This report details a novel complication involving inadvertent and initially unrecognized canalization of the subdural space with the spinal catheter, which ultimately resulted in an overdose. CLINICAL PRESENTATION: An intrathecal pump system was implanted in a 15-year-old girl with spasticity. This initially resulted in a lack of therapeutic effect. The diagnostic workup ultimately led to contrast administration through the pump system, which precipitated a baclofen overdose when sequestered medication in the subdural compartment was released into the intrathecal space. INTERVENTION: The spinal catheter was subsequently revised, and the patient made a full recovery. CONCLUSION: The possibility of a subdural catheter should be included in the differential diagnosis in patients who experience a lack of drug effect after pump implantation, despite increases in dosage. Close monitoring is required because of the risk of spontaneous or induced overdose, which may occur when a communication develops between the subdural and intrathecal compartments.