Naheed R. Abbasi

Utility of Lesion Diameter in the Clinical Diagnosis of Cutaneous Melanoma

OBJECTIVE To determine the utility of the current diameter criterion of larger than 6 mm of the ABCDE acronym for the early diagnosis of cutaneous melanoma. DESIGN Cohort study. SETTING Dermatology hospital-based clinics and community practice offices. Patients A total of 1323 patients undergoing skin biopsies of 1657 pigmented lesions suggestive of melanoma. MAIN OUTCOME MEASURE The maximum lesion dimension (diameter) of each skin lesion was calculated before biopsy using a novel computerized skin imaging system. RESULTS Of 1657 biopsied lesions, 853 (51.5%) were 6 mm or smaller in diameter. Invasive melanomas were diagnosed in 13 of 853 lesions (1.5%) that were 6 mm or smaller in diameter and in 41 of 804 lesions (5.1%) that were larger than 6 mm in diameter. In situ melanomas were diagnosed in 22 of 853 lesions (2.6%) that were 6 mm or smaller in diameter and in 62 of 804 lesions (7.7%) that were larger than 6 mm in diameter. Conclusion The diameter guideline of larger than 6 mm provides a useful parameter for physicians and should continue to be used in combination with the A, B, C, and E criteria previously established in the selection of atypical lesions for skin biopsy.

More skin, more sun, more tan, more melanoma.

Although personal melanoma risk factors are well established, the contribution of socioeconomic factors, including clothing styles, social norms, medical paradigms, perceptions of tanned skin, economic trends, and travel patterns, to melanoma incidence has not been fully explored. We analyzed artwork, advertisements, fashion trends, and data regarding leisure-time activities to estimate historical changes in UV skin exposure. We used data from national cancer registries to compare melanoma incidence rates with estimated skin exposure and found that they rose in parallel. Although firm conclusions about melanoma causation cannot be made in an analysis such as this, we provide a cross-disciplinary, historical framework in which to consider public health and educational measures that may ultimately help reverse melanoma incidence trends.

A Small Study of the Relationship Between Abobotulinum Toxin A Concentration and Forehead Wrinkle Reduction

B otulinum toxin A has been used in the cosmetic treatment of facial rhytids for decades. Previous studies have examined the role of volume and concentration on the spread of onabotulinum toxin A, both on and off the face, and on the treatment of dynamic rhytids and muscle spasticity. Our clinical experience suggests that abobotulinum toxin A may in fact spread differently than its counterparts. To determine if this was true, we treated 10 patients with each of 2 concentrations of abobotulinum toxin A to assess differences in rhytid reduction on contralateral sides of the forehead. We hypothesized that dilution may affect capacity of the toxin to spread to neuromuscular receptors, which may in turn affect surface area of effect.

ILVEN‐like Persistent Psoriasiform Dermatitis Confined to a Congenital Becker Nevus

Abstract:  A 10‐year‐old boy presented with a 5‐year history of an intractably pruritic, recalcitrant psoriasiform plaque in a broad vertical band on the left buttock, with histologic as well as clinical features suggestive of an inflammatory linear verrucous epidermal nevus. This lesion was completely superimposed upon a congenital Becker nevus. We postulate that the restricted distribution and persistence of the psoriasiform plaque reflected an inflammatory response limited to the aberrant clone of cells composing the Becker nevus, a manifestation of cutaneous mosaicism that could be characterized as an “inflammatory Becker nevus.”