Primary dermal melanoma: clinical behaviour, prognosis and treatment.

PURPOSE: Primary dermal melanoma (PDM) is a subtype of cutaneous melanoma, confined to the dermis, which poses a challenging clinical dilemma. It may represent a true primary melanoma or a dermal cutaneous metastasis. This study aimed to delineate the histopathological characteristics and prognosis of PDM in a large patient cohort to guide appropriate treatment strategies. METHODS: A search of the Melanoma Research Database at Melanoma Institute Australia was conducted to identify all possible PDM patients at our institution diagnosed from 1978 to 2013. Overall, melanoma-specific and disease-free survival outcomes of the PDM group were compared to those of similar cohorts of Stage I-II and Stage IV M1a melanoma patients based on propensity score matching. RESULTS: Sixty-two PDM patients were identified from the MRD with a median follow-up of 6.3 years. Five-year survival was 87.1% and overall survival was 74.2%. PDMs had a significantly improved overall survival (p = 0.0002) and melanoma-specific survival (p = 0.001) compared to Stage I-II controls, however there was no difference in disease-free survival (p = 0.08). PDMs also demonstrated improved overall survival (p < 0.0001), melanoma-specific survival (p < 0.0001) and disease-free survival (p < 0.0001) compared to Stage IV M1a controls. CONCLUSION: These findings demonstrate that PDMs have a more favorable prognosis compared to stage I-II cutaneous melanomas and suggest that these are in fact true primary lesions. This study thus provides evidence to justify a treatment approach, by way of a wide local excision and possibly sentinel lymph node biopsy, as for early stage primary cutaneous melanomas.

Mobile phone photo messaging assisted communication in the assessment of hand trauma.

BACKGROUND: The aim of the present study was to incorporate the use of mobile phone photo-messaging into clinical practice, in order to explore its potential advantages and limitations in the context of communication between the registrar and consultant for the assessment of hand trauma. METHODS: Two Nokia 7650 mobile phones (Nokia, Sydney, Australia) were obtained. These were used for correspondence between the registrar and the consultant for all hand trauma seen in the emergency department over a 2-month period. RESULTS: There were 27 cases recorded. Deductions were drawn form the use of the phone and the collected data was qualitatively interpreted. CONCLUSION: The present paper describes our findings and approval of the use of mobile phones with photo-messaging capabilities for the purpose of enhancing communication in a clinical setting. Low cost and ease of use make the phones easily incorporated into clinical practice.