Sun-Protective Clothing Worn Regularly during Early Childhood Reduces the Number of New Melanocytic Nevi: The North Queensland Sun-Safe Clothing Cluster Randomized Controlled Trial.

Numerous pigmented moles are associated with sun exposure and melanomarisk. This cluster randomized controlled trial aimed to determine if sun-protective clothing could prevent a significant proportion of the moles developing in young children (ACTRN12617000621314; Australian New Zealand Clinical Trials Registry. Twenty-five childcare centers in Townsville (19.25° S), Australia, were matched on shade provision and socioeconomic status. One center from each pair was randomized to the intervention arm and the other to the control arm. Children at 13 intervention centers wore study garments and legionnaire hats at childcare and received sun-protective swimwear and hats for home use, while children at the 12 control centers did not. The 1-35-month-old children (334 intervention; 210 control) were examined for moles at baseline (1999-2002) and were re-examined annually for up to 4 years. Both groups were similar at baseline. Children at intervention centers acquired fewer new moles overall (median 12.5 versus 16, p = 0.02; 0.46 versus 0.68 moles/month, p = 0.001) and fewer new moles on clothing-protected skin (6 vs. 8; p = 0.021 adjusted for confounding and cluster sampling) than controls. Intervention children had 24.3% fewer new moles overall (26.5 versus 35) and 31.6% (13 versus 19) fewer moles on clothing-protected skin than controls after 3.5 years. Sunlight's influence on nevogenesis is mitigated when children regularly wear UPF 30-50+ clothing covering half their body, implying that increased clothing cover reduces melanoma risk. Sun-protective clothing standards should mandate reporting of the percentage of garment coverage for childrenswear.

Effect of a Single Preoperative Dose of Oral Antibiotic to Reduce the Incidence of Surgical Site Infection Following Below-Knee Dermatological Flap and Graft Repair.

BACKGROUND: Surgical site infection (SSI) rates for below-knee dermatological surgery are unacceptably high, particularly following complex flap and graft closures. The role of antibiotic prophylaxis for these surgical cases is uncertain. OBJECTIVE: To determine whether SSI following complex dermatological closures on the leg could be reduced by antibiotic prophylaxis administered as a single oral preoperative dose. METHODS: A total of 115 participants were randomized to 2 g of oral cephalexin or placebo 40-60 minutes prior to surgical incision in a prospective, randomized, double-blind, placebo-controlled trial at a primary care skin cancer clinic in North Queensland, Australia. RESULTS: Overall 17/55 (30.9%) controls and 14/55 (25.5%) intervention participants developed infection (P = 0.525). There was no difference between the study groups in adverse symptoms that could be attributed to high-dose antibiotic administration (P = 1). CONCLUSION: A single oral 2-g dose of cephalexin given before complex below-knee dermatological closure did not reduce SSI.

Association Between Energy Prices and US Hospital Patient Outcomes.

OBJECTIVE: To evaluate associations between changing energy prices and US hospital patient outcomes. METHODS: Generalized estimating equations were used to analyze relationships between changes in energy prices and subsequent changes in hospital patient outcomes measures for the years 2008 through 2014. Patient outcomes measures included 30-day acute myocardial infarction, heart failure, and pneumonia mortality rates, and 30-day acute myocardial infarction, heart failure, and pneumonia readmission rates. Energy price data included state average distillate fuel, electricity and natural gas prices, and the US average coal price. All of the price data were converted to 2014 dollars using Consumer Price Index multipliers. RESULTS: There was a significant positive association between changes in coal price and both short-term (P = 0.029) and long-term (P = 0.017) changes in the 30-day heart failure mortality rate. There was a similar significant positive association between changes in coal price and both short-term (P <0.001) and long-term (P = 0.002) changes in the 30-day pneumonia mortality rate. Changes in coal prices also were positively associated with long-term changes in the 30-day myocardial infarction readmission rate (P < 0.001). Changes in coal prices (P = 0.20), natural gas prices (P = 0.040), and electricity prices (P = 0.040) were positively associated with long-term changes in the 30-day heart failure readmission rate. CONCLUSIONS: Changing energy prices are associated with subsequent changes in hospital mortality and readmission measures. In light of these data, we encourage hospital, health system, and health policy leaders to pursue patient-support initiatives, energy conservation programs, and reimbursement policy strategies aimed at mitigating those effects.

Diarrheal Diseases and Climate Change in Cambodia.

The DRIP-SWICCH (Developing Research and Innovative Policies Specific to the Water-related Impacts of Climate Change on Health) project aimed to increase the resilience of Cambodian communities to the health risks posed by climate change-related impacts on water. This article follows a review of climate change and water-related diseases in Cambodia and presents the results of a time series analysis of monthly weather and diarrheal disease data for 11 provinces. In addition, correlations of diarrheal disease incidence with selected demographic, socioeconomic, and water and sanitation indicators are described, with results suggesting education and literacy may be most protective against disease. The potential impact of climate change on the burden of diarrheal disease in Cambodia is considered, along with the implications of these findings for health systems adaptation.

Cluster randomised controlled trial: educational self-care intervention with older Taiwanese patients with type 2 diabetes mellitus--impact on blood glucose levels and diabetic complications.

AIMS: To investigate whether self care behaviours, medical outcomes and quality of life of Taiwanese elderly with Type 2 diabetes mellitus (DM) can be improved by delivery of an educational health care package. BACKGROUND: DM is a major health problem in developed and developing countries, with older adults constituting about half of the diabetic population. Type 2 DM is the most rapidly increasing chronic disease in Taiwan. METHODS: During 2005 and 2006, Taiwanese elderly with Type 2 DM (n = 500) were randomly allocated to either an intervention or control group. Data collection using validated instruments occurred at baseline and 6 months follow-up. Main outcome measures were blood glucose levels and diabetic complications. RESULTS: At baseline, 88.4% participants in the control and 78.8% in the experimental group had a blood glucose level above normal range (p = 0.076); respective results at 6 months were 92.4% for the control group and 60.4% for the experimental group (p < 0.001). The multivariate adjusted result showed that the intervention group was 11.1 times less likely to have blood glucose levels above normal (p = 0.002) at 6 months follow-up compared to the control group. Occurrence of complications was significantly fewer in the intervention group at baseline and at 6 month follow-up compared to the control group (baseline: 42.0% versus 82.1%, p = 0.003; 6 month follow-up: 48.4% versus 87.0%; p = 0.006). CONCLUSION: Although overall occurrence of complications remained unchanged, the educational health care package specifically developed for Taiwanese elderly with Type 2 DM improved blood glucose levels.

Women's decision satisfaction and psychological distress following early breast cancer treatment: a treatment decision support role for nurses.

This prospective cross-sectional study investigated Australian women's (n = 104) decision satisfaction with cancer treatment decision for early breast cancer as well as their psychological distress 3-4 months following surgery. Women's satisfaction was surveyed using the Treatment Decision Satisfaction Questionnaire, and the Brief Symptom Inventory-18 was used to measure psychological distress. Women who were living alone, who worked as professionals and who were not involved in the decision-making process by their doctors were less likely to be satisfied with their decision process, outcome and their overall treatment decision. Following treatment, 26.0% of women were distressed; 18.3% experienced anxiety; 19.2% somatization; and 27.9% depression. Women who experienced somatization were more likely to be dissatisfied with the treatment decision (P = 0.003) as were those who reported psychological distress (P = 0.020). Women who were involved in choosing their treatment were more satisfied with their decision. Many women experienced distress following breast cancer treatment and might have required referral for psychological assessment, management and long-term support. Women who experienced distress were more likely to be dissatisfied with the treatment decision (or vice versa).

Tick paralysis in spectacled flying-foxes (Pteropus conspicillatus) in North Queensland, Australia: impact of a ground-dwelling ectoparasite finding an arboreal host.

When a parasite finds a new wildlife host, impacts can be significant. In the late 1980s populations of Spectacled Flying-foxes (SFF) (Pteropus conspicillatus), a species confined, in Australia, to north Queensland became infected by paralysis tick (Ixodes holocyclus), resulting in mortality. This Pteropus-tick relationship was new to Australia. Curiously, the relationship was confined to several camps on the Atherton Tableland, north Queensland. It was hypothesised that an introduced plant, wild tobacco (Solanum mauritianum), had facilitated this new host-tick interaction. This study quantifies the impact of tick paralysis on SFF and investigates the relationship with climate. Retrospective analysis was carried out on records from the Tolga Bat Hospital for 1998-2010. Juvenile mortality rates were correlated to climate data using vector auto-regression. Mortality rates due to tick paralysis ranged between 11.6 per 10,000 bats in 2003 and 102.5 in 2009; more female than male adult bats were affected. Juvenile mortality rates were negatively correlated with the total rainfall in January to March and July to September of the same year while a positive correlation of these quarterly total rainfalls existed with the total population. All tick affected camps of SFF were located in the 80% core range of S. mauritianum. This initial analysis justifies further exploration of how an exotic plant might alter the relationship between a formerly ground-dwelling parasite and an arboreal host.

Time to stabilisation of the cervical spine when supported by a pillow in side lying.

Currently, there is little information to guide consumers, retailers and health professionals about the length of time it takes for the cervical spine to stabilise when resting on a pillow. The aim of this study was to determine the time required to achieve stabilisation of the cervical spine when supported by a polyester pillow and innerspring mattress in side lying. Twenty-four asymptomatic females rested in a standardised side lying position during the capture of 3D data from markers placed over cervical landmarks. Time to stabilisation was assessed for each axis, each landmark and globally for each participant. A large variation in global stabilisation times was identified between participants; however, 70.8% of participants had stabilised by 15 min or earlier. Fifteen minutes is the best estimate of the time to stabilisation of the cervical spine for young females in a side lying position when resting on a polyester pillow. PRACTITIONER SUMMARY: This study aimed to determine the time required to achieve stabilisation of the cervical spine when supported by a polyester pillow and innerspring mattress in side lying. Through a laboratory study using 3D VICON® motion analysis technology, we identified that 70.8% of participants had stabilised by 15 min.

Does taping torso scars following dermatologic surgery improve scar appearance?

BACKGROUND: Studies show that patients are significantly less satisfied with torso scars than scars elsewhere. Though not an uncommon practice, it is unknown if application of adhesive tapes following dermatological surgery help improve cosmesis. OBJECTIVE: To determine the effect of taping sutured torso wounds on overall scar appearance, scar width and patient satisfaction with the scar. PATIENTS/METHODS: Participants having elliptical torso skin excisions in a primary care setting in regional Australia were randomized in a single-blinded, controlled trial to 12 weeks taping (intervention) or usual care (control) following deep and subcuticular suturing. A blinded assessor reviewed scars at three and six months. RESULTS: Of 195 participants recruited, 136 (63 taped, 73 controls) completed six months of follow-up. Independent blinded assessment of overall scar appearance was significantly better in taped participants (p= 0.004). Taping reduced median scar width by 1 mm (p=0.02) and when stratified by gender, by 3.0 mm in males (p=0.04) and 1.0 mm in females (p=0.2). High participant scar satisfaction was not further improved by taping. CONCLUSION: Taping elliptical torso wounds for 12 weeks after dermatologic surgery improved scar appearance at six months.

Changing the risky beliefs of post-partum women about therapeutic sun-exposure.

BACKGROUND: Many post-partum women hold risky beliefs about perceived therapeutic benefits of sun-exposure in the post-partum period and infancy. QUESTION: Can a maternity hospital based educational intervention reduce the prevalence of such beliefs among post-partum women? METHODS: In this outcome evaluation of an interventional study, two groups of healthy post-partum women (hospital inpatients) were interviewed, 1-4 days following delivery. The first cross-section (106 women) was recruited prior to in-services for maternity staff; the second (203 women) was recruited after completion of the in-services. Data were compared between the groups. FINDINGS: More pre-intervention than post-intervention women reported they would expose their baby to sunlight to treat suspected jaundice (28.8% vs. 13.3%; p<0.001) or help his/her skin adapt to the sun (10.5% vs. 2.5%; p=0.003); or use sunlight to manage breastfeeding-associated sore/cracked nipples (7.6% vs. 2%; p=0.026). CONCLUSION: This simple, effective educational intervention could be implemented in programmes for parents, health professionals and students.

Higher energy prices are associated with diminished resources, performance and safety in Australian ambulance systems.

OBJECTIVE: To evaluate the impact of changing energy prices on Australian ambulance systems. METHODS: Generalised estimating equations were used to analyse contemporaneous and lagged relationships between changes in energy prices and ambulance system performance measures in all Australian State/Territory ambulance systems for the years 2000-2010. Measures included: expenditures per response; labour-to-total expenditure ratio; full-time equivalent employees (FTE) per 10,000 responses; average salary; median and 90th percentile response time; and injury compensation claims. Energy price data included State average diesel price, State average electricity price, and world crude oil price. RESULTS: Changes in diesel prices were inversely associated with changes in salaries, and positively associated with changes in ambulance response times; changes in oil prices were also inversely associated with changes in salaries, as well with staffing levels and expenditures per ambulance response. Changes in electricity prices were positively associated with changes in expenditures per response and changes in salaries; they were also positively associated with changes in injury compensation claims per 100 FTE. CONCLUSION: Changes in energy prices are associated with changes in Australian ambulance systems' resource, performance and safety characteristics in ways that could affect both patients and personnel. Further research is needed to explore the mechanisms of, and strategies for mitigating, these impacts. The impacts of energy prices on other aspects of the health system should also be investigated.

Reducing barriers to testing for Chlamydia trachomatis by mailed self-collected samples.

BACKGROUND: Chlamydia trachomatis (chlamydia) is the most commonly notified sexually transmissible bacterial infection in Australia, where distance to health services can be a barrier. This study investigated the acceptability of a self-collection kit for chlamydia testing (sent by mail) and assessed the risk profiles of participants with respect to locality. METHODS: In total, 2587 self-collection kits were distributed opportunistically or sent directly to participants upon request, as was a self-administered questionnaire. RESULTS: The return rate was 13.2% (n=341) for samples and questionnaires. The return rate did not differ with location (P=0.522) but with mode of distribution (opportunistic: 9.7%; by request: 27.4%; P<0.001). Although 37% of participants had previously been tested for chlamydia, 77.5% said that they would not have sought testing otherwise. The median age of participants was 22.6 years, 33.8% were male and 9.1% were of Aboriginal descent. Overall, 9.0% (95% confidence interval (CI)=6.1-12.5) of participants were chlamydia-positive. Prevalence of chlamydia and Aboriginal participation increased with remoteness (P<0.001), and self-reported condom use was significantly reduced for remote and very remote locations (P=0.008). Within remote and very remote locations, 30.8% (95% CI=9.1-61.4) of Aboriginal participants and 38.9% of non-Indigenous participants were chlamydia-positive (P=0.718; 95% CI=17.3-64.3). DISCUSSION: Testing for chlamydia using a mailed self-collection kit opened access to a predominantly test-naïve population. The proposed model was able to reach remote populations. Actively requested kits were more likely to be returned.

Indigenous Australians' participation in pre-registration tertiary nursing courses: a mixed methods study.

Indigenous nurses have the potential to improve access to health services for Indigenous people by ensuring that services are culturally safe and respectful of Indigenous peoples' needs. Therefore, developing a well-educated Indigenous nursing workforce is one way to improve the poor health outcomes of Indigenous Australians. A mixed methods study was undertaken to determine the current rates of enrollment, progression and completion of Indigenous nursing students in Australia and to explore student and staff perceptions of barriers to completion and strategies for success. The results indicate that the national average completion rates are 36.3% for Indigenous nursing students and 64.6% for non-Indigenous nursing students - an average difference of 28.3%. Indigenous nursing students and academics identified barriers to completion, which were similar to those identified in previous research. Success strategies, however, revealed the importance of individual student characteristics; academics' knowledge, awareness, and understanding; relationships, connections, and partnerships; institutional structures, systems, and processes; and, family and community knowledge, awareness, and understanding. This paper offers an overview of the integration and interpretation process that makes up the final phase of a mixed methods study.

The carbon footprint of Australian ambulance operations.

OBJECTIVE: To determine the greenhouse gas emissions associated with the energy consumption of Australian ambulance operations, and to identify the predominant energy sources that contribute to those emissions. METHODS: A two-phase study of operational and financial data from a convenience sample of Australian ambulance operations to inventory their energy consumption and greenhouse gas emissions for 1 year. State- and territory-based ambulance systems serving 58% of Australia's population and performing 59% of Australia's ambulance responses provided data for the study. RESULTS: Emissions for the participating systems totalled 67 390 metric tons of carbon dioxide equivalents. For ground ambulance operations, emissions averaged 22 kg of carbon dioxide equivalents per ambulance response, 30 kg of carbon dioxide equivalents per patient transport and 3 kg of carbon dioxide equivalents per capita. Vehicle fuels accounted for 58% of the emissions from ground ambulance operations, with the remainder primarily attributable to electricity consumption. Emissions from air ambulance transport were nearly 200 times those for ground ambulance transport. CONCLUSION: On a national level, emissions from Australian ambulance operations are estimated to be between 110 000 and 120 000 tons of carbon dioxide equivalents each year. Vehicle fuels are the primary source of emissions for ground ambulance operations. Emissions from air ambulance transport are substantially higher than those for ground ambulance transport.

The energy burden and environmental impact of health services.

OBJECTIVES: We reviewed the English-language literature on the energy burden and environmental impact of health services. METHODS: We searched all years of the PubMed, CINAHL, and ScienceDirect databases for publications reporting energy consumption, greenhouse gas emissions, or the environmental impact of health-related activities. We extracted and tabulated data to enable cross-comparisons among different activities and services; where possible, we calculated per patient or per event emissions. RESULTS: We identified 38 relevant publications. Per patient or per event, health-related energy consumption and greenhouse gas emissions are quite modest; in the aggregate, however, they are considerable. In England and the United States, health-related emissions account for 3% and 8% of total national emissions, respectively. CONCLUSIONS: Although reducing health-related energy consumption and emissions alone will not resolve all of the problems of energy scarcity and climate change, it could make a meaningful contribution.

Risk factors for surgical site infection after dermatological surgery.

OBJECTIVES: Surgical site infection (SSI) following minor surgery contributes to patient morbidity and compromises cosmetic outcomes. The purpose of this study was to determine the incidence of and risk factors for SSI after dermatological surgery in general practice. METHODS: A prospective, observational study which assessed infection among 972 patients was conducted in regional north Queensland, Australia. Consecutive patients presenting for minor skin excisions were invited to participate. Wounds were assessed for SSI at the time of removal of sutures. RESULTS: Infection occurred in 85 of the 972 excisions; thus, the overall incidence of infection was 8.7% (95% confidence interval 6.5-11.0). Excisions in the upper (P<0.001) or lower (P<0.001) extremities, excisions of basal cell carcinoma (BCC) (P=0.001) or squamous cell carcinoma (SCC) (P=0.001), and re-excision of skin cancer were found to be independent risk factors for wound infection. The length of the excision (P<0.001) and the patient's status as an ex-smoker (P=0.019) were additional independent risk factors for infection. Diabetes was not found to be an independent risk factor for infection (P=0.891). CONCLUSIONS: Prophylactic antibiotics are probably prescribed excessively or inappropriately for dermatological surgery, and overall we wish to discourage their use. The results of this study may encourage the more judicial use of prophylactic antibiotics by defining high-risk procedures, such as excisions from the extremities, excision of BCC or SCC, and larger excisions, and patients who are at high risk for infection, such as ex-smokers.

Prognosis of sentinel node staged patients with primary cutaneous melanoma.

BACKGROUND: This study investigated survival probabilities and prognostic factors in sentinel lymph node biopsy (SLNB) staged patients with cutaneous melanoma (CM) with the aim of defining subgroups of patients who are at higher risk for recurrences and who should be considered for adjuvant clinical trials. METHODS: Patients with primary CM who underwent SLNB in the Department of Dermatology, University of Tuebingen, Germany, between 1996 and 2009 were included into this study. Survival probabilities and prognostic factors were evaluated by Kaplan-Meier and multivariate Cox proportional hazard models. RESULTS: 1909 SLNB staged patients were evaluated. Median follow-up time was 44 months. Median tumor thickness was 1.8 mm, ulceration was present in 31.8% of cases. The 5-year Overall Survival (OS) was 90.3% in SLNB negative patients (IB 96.2%, IIA 87.0%, IIB 78.1%, IIC 72.6%). Patients with micrometastases (stage IIIA/B) had a 5-year OS rate of 70.9% which was clearly less favorable than for stages I-II. Multivariate analysis revealed tumor thickness, ulceration, body site, histopathologic subtype and SLNB status as independent significant prognostic factors. CONCLUSION: Survival rates of patients with primary CM in stages I-II were shown to be much more favorable than previously reported from non sentinel node staged collectives. For future clinical trials, sample size calculations should be adapted using survival probabilities based on sentinel node staging.

Investigating changes in quality of life and function along the lifespan for people with spinal cord injury.

OBJECTIVE: To track changes in quality of life and function for people with spinal cord injury (SCI) along the lifespan. DESIGN: A wave panel design in which data were collected annually over 5 years across 6 strata that represented different periods since injury. SETTING: Telephone interviews with participants in their home environment. PARTICIPANTS: People (n=270) who had sustained a traumatic SCI in Queensland, Australia, over the previous 60 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Quality of life was measured using the World Health Organization Quality of Life-8. Human functioning was measured in 3 components. Body structure/function was measured using the Secondary Conditions Surveillance Instrument. Activity was measured using the motor subscale of the FIM (mFIM) and the Clinical Outcomes Variables Scale. Participation was measured using the Community Integration Measure (CIM) and the Impact on Participation and Autonomy questionnaire. RESULTS: Quality of life remained relatively constant across the lifespan. For body structure/function, there was a significant increase in secondary conditions with time since injury. There was a significant decrease in activity as measured by the mFIM for higher functioning individuals. Participation, as measured by the CIM, showed a significant increase with time since injury, but not when adjusted for the American Spinal Injury Association Impairment Scale, income level, and living situation. CONCLUSIONS: The findings of this study highlight that people with SCI are able to maintain quality of life and participation along the lifespan; however, increases in secondary conditions and a decline in function over time are likely. Rehabilitation services could work more effectively at addressing secondary prevention through enhanced monitoring over time, while broader societal responses are likely to hold the key to optimizing human functioning.

Hazard rates for recurrent and secondary cutaneous melanoma: an analysis of 33,384 patients in the German Central Malignant Melanoma Registry.

BACKGROUND: Knowledge about the risk for recurrence and secondary cutaneous melanoma (CM) is an important basis for patient counseling and planning of follow-up examinations. OBJECTIVES: This study aimed to analyze stage- and time-dependent hazard rates (HR) and discusses current surveillance recommendations. METHODS: Follow-up data of 33,384 patients with incident CM in stages I to III (American Joint Committee on Cancer 2002) were recorded by the German Central Malignant Melanoma Registry in 1976 through 2007. Survival was based on Kaplan-Meier estimates and HRs were calculated. RESULTS: Recurrences were recorded in 4999 patients (stage I, 7.1%; stage II, 32.8%; and stage III, 51.0%). Ten-year recurrence-free survival was 78.9% (95% confidence interval 73.1-90.5); in stage I, 89.0%; stage II, 56.9%; and stage III, 36.0%. Whereas HR for recurrent CM showed a constantly low level less than or equal to 1:125 per year for stage IA, clearly higher HRs of greater than or equal to 1:40 were recorded in stage IB for the first 3 years and generally in stages II to III. Of all patients 2.3% developed secondary melanomas, with a consistently low HR of less than 1:220 per year. LIMITATIONS: As German recommendations discontinued regular follow-up examinations after 10 years, no information can be given beyond this time point. Follow-up data of longer than 5 years were available in 41.4% of patients. CONCLUSION: For patients at stage IA with thin melanoma and low HR for recurrent CM the need for surveillance remains questionable. For patients with higher HR greater than 1:40 per year, intensified surveillance strategies should be taken into account.

Dermoscopy improves diagnosis of tinea nigra: a study of 50 cases.

BACKGROUND/OBJECTIVES: Tinea nigra is a relatively uncommon dematiaceous fungal infection of the palms and soles, which clinically may mimic a melanocytic lesion. We sought to ascertain how frequently misdiagnosis of this infection occurred and whether the use of dermoscopy helped in its diagnosis. METHODS: Fifty consecutive cases of tinea nigra diagnosed at a dermatopathology laboratory were examined with regard to the clinical diagnosis, use of dermoscopy and the mode of management. RESULTS: Of the 50 cases, 21 (42.0%) were treated by shave or surgical excision. The clinical diagnosis of tinea nigra was made in five cases (10.0%) and suggested along with other diagnoses in a further two cases (4.0%). The dermatologists (n = 9) gave the correct diagnosis in four patients (44.4%), the general practitioners (n = 38) gave the correct diagnosis in one patient (2.6%) and the three surgeons involved did not give the correct diagnosis. When dermoscopy was used, in seven of 13 (53.8%) cases tinea nigra was suggested as a probable diagnosis but when dermoscopy was not used (n = 37) tinea nigra was not clinically diagnosed (P < 0.001). CONCLUSIONS: The diagnosis of tinea nigra is significantly improved by dermoscopy, the disease should be considered as a cause of palmar or plantar pigmentation.