Babar K. Rao

In vivo confocal microscopy in clinical practice: Comparison of bedside diagnostic accuracy of a trained physician and distant diagnosis of an expert reader

BACKGROUND Reflectance confocal microscopy (RCM) is an imaging tool that allows the visualization of cellular details without biopsy. To our knowledge, RCM sensitivity and specificity has not been studied in a telemedicine setting. OBJECTIVE We sought to assess RCM diagnostic accuracy in a support teleconsultation setting. METHODS Between June 2010 and September 2011, 340 lesions were imaged using a confocal scanning microscope. The images were evaluated by 2 readers, one on site, and the other at a distance. RESULTS A total of 334 cases were included. For each reader the sensitivity was greater than 90% and specificity for each reader was greater than 60%. Both readers had a combined sensitivity of 98.6% and 44% specificity. LIMITATIONS RCM may be limited in the correct classification of epithelial tumors. CONCLUSIONS RCM is a tool in the clinical diagnosis of skin lesions, providing a high diagnostic accuracy in teleconsultation use.

Diet in dermatology: Part II. Melanoma, chronic urticaria, and psoriasis

The roles of dietary factors in aggravating, preventing, or treating skin diseases are common questions encountered in dermatology practice. Part II of this two-part series reviews dietary modifications that can potentially be utilized in the management of melanoma, chronic urticaria, and psoriasis patients. Specifically, we examine the effect of alcohol consumption and supplementation with vitamins D and E, polyunsaturated fatty acids, selenium, green tea, resveratrol, and lycopene on melanoma risk. The relationships between chronic urticaria symptoms and dietary pseudoallergens, gluten, and vitamin D are analyzed. We explore weight loss, reduced alcohol consumption, and gluten avoidance as means of reducing psoriasis-associated morbidity, as well as the possible utility of supplementation with polyunsaturated fatty acids, folic acid, vitamin D, and antioxidants. With proper knowledge of the role of diet in these cutaneous disease processes, dermatologists can better answer patient inquiries and consider implementation of dietary modifications as adjuncts to other treatments and preventative measures.

Histologic outcomes of excised moderate and severe dysplastic nevi.

BACKGROUND Dysplastic nevi (DN) have been a matter of controversy since their initial description in 1978 because of differences in the clinical and histological terminology, and large studies on histological outcomes of excising moderate to severely DN have not previously been described. OBJECTIVE To determine the clinical characteristics of DN and histologic outcomes of excised moderate and severe DN. METHODS Retrospective chart review of patients with DN or Clarks nevi at the Dermatology Department at Rutgers–Robert Wood Johnson Medical School in Somerset, New Jersey, from January 2009 to June 2012. Three hundred ninety‐three lesions from 380 patients were included in this study. MAIN OUTCOME MEASURE Histologic results of excised moderate and severe DN. RESULTS Thirty‐four percent of DN were excised because of the presence of moderate or severe atypia, personal history of melanoma, or both. None of the excised lesions showed evidence of melanoma; 81.6% of excisions showed scar or granulation tissue. Only 14% of excised lesions were found to have residual lesions, and 4.4% showed recurrent nevi. CONCLUSION In 134 excisions of moderate to severe DN, no melanoma was identified. Most of the excisions showed scar or granulation tissue. The rate of residual lesions after shave biopsy of moderate or severe DN was lower than after punch biopsy.

Uses of non-invasive imaging in the diagnosis of skin cancer: an overview of the currently available modalities.

Emerging tools for the diagnosis of skin cancer are non‐invasive imaging devices that allow for skin visualization without biopsy. While the capabilities of non‐invasive imaging tools are far‐reaching, each varies in its resolution depth, image clarity, clinical applicability, accuracy, sensitivity, and specificity.

Methods and rates of dermoscopy usage: A cross-sectional survey of US dermatologists stratified by years in practice

inadequate response to narrowband UVB, PUVA, topical corticosteroids, and topical tacrolimus. B, Left upper back. Significant perifollicular repigmentation seen 1 week following 2 sessions of intralesional triamcinolone acetonide injection spaced 2.5 months apart. C, Left upper back. Complete repigmentation seen 1 year later. This patient only had a total of 2 injection sessions of intralesional triamcinolone acetonide as stated in B. J AM ACAD DERMATOL VOLUME 71, NUMBER 2 Letters 393

The science of cellulite treatment and its long-term effectiveness

Cellulite is a disorder in which adipose tissue extends through the dermis, producing a cosmetically displeasing dimpling in the affected areas. While many treatments claim to be able to improve the appearance of cellulite, the long-term effectiveness of these treatments and whether the logic behind these treatments can lead to a long-term improvement has not been extensively reviewed. In the following review, our goal is to assess the various cellulite treatments and evaluate the length of time results persist and whether the science behind the treatments warrants them as reliable and effective treatments for cellulite.

Identical twins with primary cutaneous melanoma presenting at the same time and location.

Thus far there have been very few cases that document such a rarity as the same cancer occurring in monozygotic twins, at the same time, in the same location. We report this extraordinary phenomenon in our patients, 71-year-old identical female twins, presenting with melanoma at the same time (within 10 days of each other) and location (the right calf).

Diet in dermatology

The roles of dietary factors in aggravating, preventing, or treating skin diseases are common questions encountered in dermatology practice. Part II of this two-part series reviews dietary modifications that can potentially be utilized in the management of melanoma, chronic urticaria, and psoriasis patients. Specifically, we examine the effect of alcohol consumption and supplementation with vitamins D and E, polyunsaturated fatty acids, selenium, green tea, resveratrol, and lycopene on melanoma risk. The relationships between chronic urticaria symptoms and dietary pseudoallergens, gluten, and vitamin D are analyzed. We explore weight loss, reduced alcohol consumption, and gluten avoidance as means of reducing psoriasis-associated morbidity, as well as the possible utility of supplementation with polyunsaturated fatty acids, folic acid, vitamin D, and antioxidants. With proper knowledge of the role of diet in these cutaneous disease processes, dermatologists can better answer patient inquiries and consider implementation of dietary modifications as adjuncts to other treatments and preventative measures.

Atypical pigmented acral lesion proven to be fungal using reflectance confocal microscopy

Rao Dermatology, New York; Rutgers Robert Wood Johnson edical School, Piscataway; and the Department of Dermatogy, Rutgers Robert Wood Johnson Medical School, Somerset. ing sources: None. ao is a consultant for Caliber Imaging and Diagnostics, Inc ochester, NY), the makers of confocal microscopes. The other thors have no conflicts of interest to declare. Reprint requests: Era Caterina Murzaku, Rutgers Robert Wood Johnson Medical School, 1 World’s Fair Dr, Somerset, NJ 08873. E-mail: murzakec@rwjms.rutgers.edu. J Am Acad Dermatol 2014;70:e77-9. 0190-9622/

An unusual case of coccidioidomycosis presenting with skin lesions.

36.00 a 2013 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2013.10.033