Conversion of a Validated Melanoma Risk Stratification Tool Into a Tablet-Based Patient Questionnaire for Targeted Melanoma Screening in Primary Care Settings: A Pilot Study.

BACKGROUND: Risk stratification can identify individuals in primary care settings who are at increased risk of developing melanoma. OBJECTIVE: Converting and implementing a validated risk stratification tool as a patient self-administered tablet-based survey. METHODS: Mackie risk stratification tool was transformed into a patient questionnaire. The questionnaire was completed in academic dermatologist practices by patients and dermatologists and revised to optimize sensitivity and specificity using physician assessment as gold standard. The optimized survey was administered before routine primary care visits during 2019 to 2021. High-risk patients were referred to dermatology. The number needed to screen (NNS), sensitivity, specificity, positive predictive value, and negative predictive value to identify a melanoma were calculated. RESULTS: Of the 7,893 respondents, 5,842 (74%) and 2,051 (26%) patients were categorized as low-risk and high-risk population, respectively. The NNS to identify 1 melanoma was 64 in the high-risk population. CONCLUSION: Incorporating self-administered patient-risk stratification tools in primary care settings can identify high-risk individuals for targeted melanoma screening. Further studies are needed to optimize specificity and sensitivity in more targeted populations.

Sunscreen use while driving.

BACKGROUND: Data regarding patient perceptions and behaviors about sun-protection measures while driving are lacking. OBJECTIVES: This study evaluates patients' awareness of the importance of sun protection while in an automobile, and assesses perceptions about and compliance with sun protection. A secondary objective was to detect any significant laterality in melanoma and nonmelanoma skin cancers. METHODS: We performed a retrospective survey of patients seen at a Mohs micrographic surgery clinic. RESULTS: Significantly fewer patients reported wearing sunscreen while in an automobile when compared with general daily sunscreen use (52% vs 27%, P < .05). Most respondents did not think they needed to use sunscreen while driving, especially if the windows were closed. Those who believed they were protected from sun damage while in a car were much less likely to use sunscreen (12% vs 46%, P < .05). There was a significant left-sided predominance of nonmelanoma skin cancers, except in patients who used automobiles with tinted windows. LIMITATIONS: This retrospective survey study design is not as ideal as a randomized controlled trial. Additional limitations of this study include small sample size, selection bias, and recall bias. CONCLUSION: Our results reveal poor patient awareness of and compliance with sun-protection measures while in an automobile. Skin cancer prevention efforts should be modified to specifically address automobile-related sun exposure.

High cell density attenuates reactive oxygen species: implications for in vitro assays.

In vitro cell-based assays are an essential and universally used step in elucidation of biological processes as well as in drug development. However, results obtained depend on the validity of protocols used. This statement certainly pertains to in vitro assays of oxidative stress. The holy grail of in vitro models is reliability and predictability of outcomes that relate to a single variable like addition of hydrogen peroxide or xanthine oxidase. Without such validated outcomes, comparison of results among different laboratories is not possible. Achieving this goal requires a thorough understanding of the complex interplay between the cells, their environment, and the experimental assays. Furthermore, as this knowledge is attained, it must be disseminated and used to update and standardize existing protocols. Here, we confirm and extend the effect of pyruvate and cell density on in vitro oxidative stress assays. Cell viability was assessed using a colorimetric assay measuring the reduction of a tetrazolium salt (XTT) into a colored formazan dye. Extracellular hydrogen peroxide concentrations were measured using the foxp3 assay. We confirmed a previously reported finding that pyruvate, a common ingredient in cell culture media, acts as an extracellular scavenger of reactive oxygen species. We also demonstrated that cell density directly correlates with resistance to oxidative stress in tissue culture. It is theorized that the protective effect due to cell density predominantly relates to intracellular factors such as reduced glutathione and extracellular factors such as catalase.

Acquired cutis laxa in a 55-year-old female with multiple myeloma and serologic evidence of systemic lupus erythematosus.

Cutis laxa (CL) is a rare connective tissue disorder characterized by loosely hanging skin folds. Histopathology reveals degenerative changes in the dermal elastic fibers, although loss of elastin can also occur in alveolar walls, blood vessels, and other organs. The coexistence of autoimmune diseases and monoclonal gammopathies is rare but well documented in the literature. Here we report an unusual case of cutis laxa (CL) preceding the development of serologic evidence of systemic lupus erythematosus (SLE) and a diagnosis of multiple myeloma (MM) by seven and eleven years respectively.

Basal Cell Carcinoma Review.

Basal cell carcinoma (BCC) is the most common malignancy and the incidence is rising. BCCs have low mortality but can cause significant morbidity primarily through local destruction. The pathogenesis is linked to the interplay between environmental and patient-derived characteristics. There are multiple therapeutic modalities, and appropriate selection requires knowledge of complications, cosmetic outcomes, and recurrence rates. This article reviews the epidemiology, staging, treatment, and prevention of BCC.

Tumescent contravenom: murine model for prehospital treatment of Naja naja neurotoxic snake envenomation.

BACKGROUND: Snake envenomation is a neglected global health problem. There is a need for a prehospital treatment of neurotoxic snakebite that prolongs survival and allows time for a victim to reach a hospital for antivenom therapy. Tumescent epinephrine consists of a large volume of dilute epinephrine (2 mg/l) injected subcutaneously. It functions as "contravenom" by causing capillary vasoconstriction and delaying venom absorption. METHODS: A murine model of neurotoxic envenomation using lidocaine as a surrogate for neurotoxic snake venom was first developed in a pilot study. A lethal dose of lidocaine was injected subcutaneously into control and treatment groups. Mice in the treatment group were then treated with a tumescent infiltration of dilute epinephrine in saline, while control mice either received no treatment or tumescent infiltration with saline alone. The experiment was repeated using lethal doses of neurotoxic Naja naja cobra venom. The main end-points were survival rate and survival time. RESULTS: None of the control mice survived a lethal (LD100 ) dosage of subcutaneous lidocaine. Mice given an LD100 of subcutaneous lidocaine and treated immediately with tumescent epinephrine had 80% survival. Following LD50 doses of Naja naja venom, 50% of control mice survived, while 94% survived when treated immediately with tumescent epinephrine (P < 0.01). All animals died following LD100 doses of Naja naja venom, but survival was significantly prolonged (P < 0.0001) by immediate tumescent epinephrine. CONCLUSIONS: Tumescent epinephrine, when given immediately after toxin injection, improves survival rates in mice following neurotoxic doses of lidocaine or Naja naja cobra venom.

Short duration testosterone infusions maintain male sex behavior in Syrian hamsters.

In most mammalian species, reduced androgen availability is associated with marked reductions in male sexuality; conversely, androgen replacement in castrated males restores sex behavior within a few weeks. Testosterone (T) pulse duration, amplitude, frequency, and inter-pulse interval may be as important as total amount of hormone in determining target tissue responsiveness. We remain ignorant of the number and duration of daily T pulses necessary and sufficient to sustain male mating behavior. An in-dwelling infusion system was employed to vary T-pulse frequencies and durations. Daily 4 h infusions of aqueous T (100 microg/0.064 ml) and twice daily 4 h pulses of T (each 50 microg/0.064 ml) were sufficient to maintain ejaculatory behavior of sexually experienced castrated hamsters for 11 weeks post-castration; castrated hamsters infused with vehicle ceased to display the ejaculatory pattern 3 weeks after gonadectomy. Circulating T concentrations of hormone-infused hamsters declined markedly 7 h after the termination of each infusion. These results establish that male sex behavior can be sustained with infusions of relatively low T concentrations for 4 h/day and suggests that the basal concentrations of T sustained by the gonad during inter-pulse intervals may not be necessary for maintenance of sex behavior. 4 h T infusions were sufficient to maintain penile and seminal vesicles weights, but not ventral prostate weights or flank gland dimensions; the threshold for maintaining male sex behavior is lower than that for some androgen-dependent peripheral structures. Development of effective androgen replacement regimens that sustain sex behavior in castrated animals may be useful in the design of androgen replacement therapy for hypogonadal men.