Joseph Caravaglio

Comparison of Regional and State Differences in Melanoma Rates in the United States: 2003 vs 2013

prevention programs for youth. For example, black sexual minority males reported the highest prevalence of indoor tanning, a rate equivalent if not higher than white females. Clinicians working with sexual minority males, particularly males of color, should consider assessing use of indoor tanning during routine evaluations. Future research would benefit from exploring motivations to tan among diverse groups of adolescents, as varied motives may drive sexual minorities’ use indoor tanning. For instance, appearance-based motives and the regulation of negative affect may be 2 prominent factors that predispose sexual minority youth to indoor tan.6

Performance of a computer-aided digital dermoscopic image analyzer for melanoma detection in 1,076 pigmented skin lesion biopsies

Background: Digital dermoscopic image analysis of pigmented skin lesions (PSLs) has become increasingly popular, despite its unclear clinical utility. Unbiased, high‐powered studies investigating the efficacy of commercially available systems are limited. Objective: To investigate the diagnostic performance of the FotoFinder Mole‐Analyzer in assessing PSLs for cutaneous melanoma. Methods: In this 15‐year retrospective study, the histopathologies of 1076 biopsied PSLs among a total of 2500 imaged PSLs were collected. The biopsied PSLs were categorized as benign or malignant (cutaneous melanoma) based on histopathology. Analyzer scores (0‐1.00) for these PSLs were obtained and grouped according to histopathology. Results: At an optimized cutoff score of 0.50, a sensitivity of 56% and a specificity of 74% were achieved. The area under the receiver operating characteristics curve was 0.698, indicating poor accuracy as a diagnostic tool. Limitations: This study had a retrospective design and involved only a single institution. Conclusion: Our study reveals a low sensitivity of the scoring function of this digital dermoscopic image analyzer for detecting cutaneous melanomas. Physicians must apply keen clinical judgment when using such devices in the screening of suspicious PSLs.

Metastatic Malignant Melanoma of the Urinary Bladder in a Patient With Benign Prostatic Hyperplasia and Urethral Stricture

Clinical Practice PointsOverall, metastatic disease to the bladder is unusual.The occurrence of metastasis to the bladder with melanoma is thought to be more common than the occurrence of primary disease.Given the increased incidence of melanoma in the United States and its propensity to metastasize, it is likely that metastatic malignant melanoma in the bladder will become a more common occurrence.Because metastatic melanoma to the bladder often presents with lower urinary tract symptoms, it is especially important for urologists to maintain a low threshold for further exploration to rule out malignancy in older men with concurrent benign prostatic hyperplasia.

A rare case of dermatofibrosarcoma protuberans of the forefoot.

Dermatofibrosarcoma protuberans is an extremely rare, potentially malignant tumor type that usually presents on the trunk or proximal extremities. The clinical presentation includes a gradually enlarging painless plaque-like or nodular lesion of the skin with surrounding red to blue discoloration. The diagnosis is based on clinical presentation, computed tomography or magnetic resonance imaging, and biopsy with histologic analysis. An early and timely diagnosis improves chances of complete surgical resection thus improving prognosis. Herein, we present a rare case of dermatofibrosarcoma protuberans with the hopes that its addition to the literature will aid in the earlier recognition of future patients and help prevent this potentially curable disease from becoming deadly.

A case of leukemia cutis presenting as blue toes in a patient with chronic lymphocytic leukemia

Blue toe syndrome (BTS) is a condition characterized by the blue or violaceous discoloration of one or more toes as a result of tissue ischemia. First described in 1976 in a report of 31 patients who presented with cyanotic toes secondary to embolic phenomena, it has since been linked with several different diseases including embolic, thrombotic, infectious and vasoconstrictive disorders.1, 2 Three fundamental mechanisms are thought to underlie the alteration in skin color: diminished arterial perfusion, impaired venous outflow, and abnormal circulating blood.1 Here we report an unusual case of leukemia cutis secondary to chronic lymphocytic leukemia manifesting as blue toe syndrome in the absence of background cryoglobulinemia or cold agglutinin disease.