Treatment of severe psoriasis with ustekinumab during pregnancy.

We present the case of a female, aged 22 years, with a long history of recalcitrant pustular psoriasis and psoriatic arthritis, treated with ustekinumab during pregnancy. The result of treatment was an uncomplicated pregnancy with delivery, at term, of a healthy boy. To our knowledge, this is the first reported use of ustekinumab in a human during pregnancy. Following a description of the case, we discuss the characteristics of ustekinumab and review the known information from human case reports, case series, and animal studies regarding the use of TNF-a inhibitors and ustekinumab during pregnancy. We also provide a short discussion of administration of ustekinumab during the time period when a mother is nursing and the potential for complications to infants in this setting.

Surveillance of patients for early detection of melanoma: patterns in dermatologist vs patient discovery.

OBJECTIVE: To determine which groups of patients are most and least likely to detect their own melanomas independent of dermatologist evaluation. DESIGN: Retrospective analysis. SETTING: Academic dermatology department from January 1, 2003, through December 31, 2008. PATIENTS: One hundred sixty-seven consecutive patients with incident biopsy-confirmed melanomas. MAIN OUTCOME MEASURES: Proportion of melanomas found on dermatologist examination vs those brought to the attention of the examining dermatologist by the patient. Secondary analysis examined associations between who detected the melanoma (dermatologist vs patient) and patient age, personal history of skin cancer, family history of melanoma, and depth of lesion. RESULTS: Of the 167 melanomas, 101 (60.5%) were brought to the attention of the dermatologist by the patient. Detection by a dermatologist was significantly associated with patient age of 50 years or older (P = .002), personal skin cancer history (P < .001), and a lesion depth of less than 0.75 mm at the time of detection (P = .03). Only 3.0% of all melanomas in this study were detected by dermatologists in patients who had a low baseline risk of melanoma (age <50 years, no personal history of skin cancer, and no family history of melanoma). These patients were much more likely to detect their own melanoma (odds ratio, 7.32 [95% confidence interval, 2.69-19.90]). CONCLUSIONS: Screening for melanoma in asymptomatic patients younger than 50 years with no medical history of skin cancer or family history of melanoma yields few physician-detected melanomas because these patients are most likely to detect their melanomas themselves. Screening and surveillance efforts should focus on patients 50 years or older and those with a personal history of skin cancer or a family history of melanoma.

The influence of age and sex on reasons for seeking and expected benefits of skin cancer screening.

OBJECTIVE: To determine the influence of age and sex on why individuals seek skin cancer screening and their understanding of its benefits. DESIGN: Voluntary survey. SETTING: Academic dermatology department. PARTICIPANTS: Individuals 18 years or older being seen for skin cancer screening from May to October 2009. MAIN OUTCOME MEASURES: Patients' reasons for seeking and perceived benefits of skin cancer screening and understanding of screening recommendations. RESULTS: Of 546 patients, 487 eligible individuals (89.2%) participated in the survey. Most (80.6%) sought screening without a particular lesion of concern. Women were more likely than men to present with a lesion they believed could be skin cancer (24.6% vs 11.9%; P < .001) or because they were concerned about previous sun exposure (34.3% vs 23.8%; P < .05). Individuals younger than 50 years were more likely than older patients to seek screening because of a family history of melanoma (30% vs 18.9%; P < .01). Men 50 years or older were more likely than other patients to seek skin cancer screening because of a previous skin cancer diagnosis (64.6% vs 40.8%; P < .001). Most patients believed that screening reduces the risk of death from skin cancer and prevents skin cancer. There was no consensus among patients regarding the frequency with which healthy adults should be screened for skin cancer. CONCLUSIONS: There is a need for better educational campaigns with specific recommendation for who should be screened for skin cancer. Men 50 years or older, the group at highest risk for death from melanoma, are most likely to seek screening only after being diagnosed as having a skin cancer.