William Black

Distinction of melanoma in situ from solar lentigo on sun-damaged skin using morphometrics and MITF immunohistochemistry.

Distinction between melanoma in situ (MIS) and solar lentigo (SL) on chronically sun-damaged skin (CSDS) by hematoxylin and eosin (H&E) criteria alone can be difficult and in frozen section (FS) material, may be virtually impossible without immunohistochemistry (IHC). In this study, we used microphthalmia-associated transcription factor (MITF) IHC-directed image analysis to compare melanocyte nuclear morphometrics of MIS, SL, and sections of sun-damaged skin from redundant tissue acquired during Mohs micrographic surgery. The mean nuclear diameter and melanocytic density figures for MIS were greater than those for SL and CSDS by both independent t-test and analysis of variance statistics. No significant differences in these parameters were found between SL and sun-damaged skin. Cutoff values that favored MIS over SL included melanocyte density ≥10 nuclei per 200 μm, nuclear diameter ≥9 μm, and a product of density and diameter of 80 or more, as each of these values was associated with 100% specificity of MIS diagnosis. Our results suggest that image analysis of melanocytes labeled with MITF IHC can be used to produce morphometric data that distinguish MIS from SL and CSDS. The study was conducted using permanent sections, but previous studies with FSs indicate that the findings would apply to FSs as well. Quantitative assessment of melanocytic parameters using image analysis will likely become increasingly important as an adjunct to conventional histopathology for the diagnosis and surgical management of MIS on sun-damaged skin.

A cross-sectional study of skin cancer patients' willingness and ability to take biopsy “selfies” to aid in later treatment

Future research should investigate why patients with this condition present to the ED so frequently. A previous study found only 2% of skin-related ED presentations were classified as ‘‘emergent.’’ Exploring if this high rate of nonemergent presentation is also seen with cellulitis plus abscess is important, considering the high costs associated with ED care. The high rate of cellulitis plus abscess may be, in part, a result of misdiagnosis. In the inpatient setting, 74% of cellulitis diagnoses were deemed incorrect after consultation with a dermatologist. A similarly high rate of ED misdiagnosis could result in the administration of unnecessary antibiotics and extra costs. A high rate of misdiagnosis would suggest a need for dermatology consultation to be more readily available in the ED, and more focused education for ED physicians on cellulitis and the skin conditions that can mimic it. This study had limitations typical of a claims database study. We used patient’s history ICD-9 claims to determine the reason for their ED visit, making our data subject to coding errors. We could not assess severity of disease, only the presence of disease. Further confirmation of the diagnosis could have been made through searching for a second ICD-9 code in the patient’s history, such as an identical code from an outpatient follow-up appointment.

Skin cancer knowledge, attitudes, beliefs, and prevention practices among medical students: A systematic search and literature review

Background As future physicians, medical students will play an important role in the prevention of skin cancers by becoming directly involved in skin cancer prevention education and counseling patients about the hazards of ultraviolet light. Objective We assessed the skin cancer-related knowledge, attitudes, beliefs, and prevention practices reported in previous studies of medical students. Methods The search for relevant articles was performed in four electronic databases: PubMed (Medline), Cumulative Index to Nursing and Allied Health, ERIC, and PsycINFO. Studies were included if they met the following criteria: 1) targeted medical students; 2) assessed sun avoidance, sun protection, skin self-examination, and/or indoor tanning behaviors; 3) were published in peer-reviewed journals; and 4) complete data were available for extraction. Results A total of 21 studies are included in this review. Important findings include moderate-to-high levels of skin cancer knowledge and low levels of both sunscreen and ultraviolet light knowledge. The attitudes and knowledge of medical students reflect a low level of concern with regard to the perceived importance of skin cancer compared with other forms of cancer despite a high level of concern for the importance of skin cancer prevention. Furthermore, this review demonstrated that medical students fail to protect themselves routinely from the sun and have a high interest in tanning bed use. Conclusion This review demonstrates the need to educate medical students about skin cancer and skin cancer preventive behaviors. New strategies and educational campaigns should be developed to communicate better information on skin cancer morbidity, mortality, and prevention to medical students. This will pay dividends by improving the practice of these future physicians in all specialties.