Christopher J. Ballard

Eruptive dermatosis papulosa nigra as a possible sign of internal malignancy

A 42‐year‐old black woman presented with dermatosis papulosa nigra lesions of 15 years’ duration. Coincident with the diagnosis of symptomatic iron‐deficiency anemia about 1 year ago, she reported an “explosion” in number and size of the lesions progressing from her face to her trunk and arms. Physical examination revealed numerous 1–5‐mm, black, smooth, verrucous papules predominantly on the forehead, malar region of the face, neck, and upper trunk ( Figs 1 and 2 ). The lesions on the back were situated in a “Christmas tree” pattern and included two 1‐cm papules. She had multiple 1‐mm papules on the upper arms. A biopsy confirmed the diagnosis of dermatosis papulosa nigra, showing parakeratosis, acanthosis, hyperpigmentation, thick interwoven tracts of epithelial cells, and horn cysts. Given the eruptive nature of her disease, the possibility of an underlying malignancy was entertained. Six weeks later, she went to the emergency room for severe weakness; a colonoscopy revealed an ascending colon adenocarcinoma with a negative metastatic work‐up.

Cotton-Tipped Applicators Used in Surgery of the Nose

Background A variety of uses have been described for cotton-tipped applicators. Objective We describe an additional application in surgeries involving the nose. This technique uses 8-inch obstetrics-gynecology applicators with oversized cotton tips, unlike most articles, which report the use of 6-inch applicators with smaller cotton heads. The applicators function to stabilize and support the nasal structures and thus provide a steadier operating field. Conclusion It can be used in procedures of the nose, including curettage, electrocautery, hemostasis, and Mohs and other surgical excisions.

Journal ClubHelp in the Diagnosis of Melanoma

The oft-quoted line “It is what I say it is” is commonly applied to dermatologic diagnoses, and this saying can also be applied to histologic diagnoses. Whether evaluating a biopsy specimen at a single moment during the course of a disease accurately predicts the biologic course of that lesion is not always clear. This is especially true in the diagnosis of melanoma, in which excision of a potentially fatal lesion obviates learning its true biological potential. The alternative option—to leave untreated a lesion with unknown biologic potential—is unacceptable, because doing so places patients at risk (melanoma is predicted to kill nearly 9,000 Americans this year alone (American Cancer Society, 2009)). Thus, the overarching goal for melanoma clinicians is to accurately diagnose and subsequently excise true melanomas while leaving the remainder untreated.

Help in the Diagnosis of Melanoma

The oft-quoted line “It is what I say it is” is commonly applied to dermatologic diagnoses, and this saying can also be applied to histologic diagnoses. Whether evaluating a biopsy specimen at a single moment during the course of a disease accurately predicts the biologic course of that lesion is not always clear. This is especially true in the diagnosis of melanoma, in which excision of a potentially fatal lesion obviates learning its true biological potential. The alternative option—to leave untreated a lesion with unknown biologic potential—is unacceptable, because doing so places patients at risk (melanoma is predicted to kill nearly 9,000 Americans this year alone (American Cancer Society, 2009)). Thus, the overarching goal for melanoma clinicians is to accurately diagnose and subsequently excise true melanomas while leaving the remainder untreated.

Lasers alleviate acne

Propionibacterium acnes (P. acnes) and sebaceous glands are involved in the pathogenesis of acne. Although often effective, traditional therapies can have drawbacks, such as photosensitivity, other toxicities, polypharmacy and frequent dosing. Lasers have been studied to seek a solution that may overcome these disadvantages.