Primary cutaneous malignant melanoma and its precursor lesions: diagnostic and therapeutic overview.

During the past few decades, scientific data relating to melanoma have flourished. New information regarding acquired nevi, dysplastic nevi (atypical nevi), and congenital nevi has given us a better understanding of these precursor lesions and their relationships to malignant melanoma. The roles of laboratory testing, photography, and newer diagnostic tools (eg, epiluminescence) to evaluate patients for melanoma or precursor lesions have fallen under close scrutiny. Traditional surgical therapeutic interventions continue to be replaced by less aggressive protocols based on prospective randomized studies. Many new interventions such as sentinel lymph node procedures are currently being evaluated at research/referral centers around the world. We present clinicians with an evidence-based summary of the current literature with regard to primary cutaneous melanoma, its diagnosis, precursor lesions, and therapy.

Gonadal mosaicism for incontinentia pigmenti in a healthy male.

Incontinentia pigmenti (IP) is a genodermatosis that segregates as an X linked dominant trait with male lethality. The disease has been linked to Xq28 in a number of studies. A few affected males have been documented, most of whom have a 47,XXY karyotype. We report a family with two paternally related half sisters, each affected with IP. The father is healthy, clinically normal, and has a 46,XY normal male karyotype. Linkage analysis of 12 polymorphic markers (two X linked and 10 autosomal) confirms paternity. X inactivation studies with the human androgen receptor (HUMARA) indicate that the paternal X chromosome is inactivated preferentially in each girl, implying that this chromosome carries the IP mutation, and that the father is a gonadal mosaic for the IP mutation.

Fibroblastic rheumatism.

BACKGROUND: Fibroblastic rheumatism was first described in the French literature in 1980. Since that time, 11 other patients with this disorder have been identified in the literature, mostly from France. This is a unique syndrome characterized by the sudden onset of symmetric polyarthritis and cutaneous nodules ranging from 5 to 20 mm in diameter, with predilection for the upper and lower extremities. While the cutaneous findings resolve spontaneously after several months, permanent joint sequelae are common. OBSERVATIONS: We present the first two patients with fibroblastic rheumatism reported in the United States. The clinical features and histologic findings were identical to those of patients described in the European literature. CONCLUSIONS: Fibroblastic rheumatism is a relatively rare syndrome characterized by the association of multiple cutaneous nodules with polyarthritis. The clustering of cases in France may, in part, be attributable to increased recognition by clinicians owing to prevalence of reports in the European literature. Perhaps, as clinicians in the United States become familiar with this disorder, further cases will be diagnosed, and the pathogenesis of the disorder will be elucidated.

Efficacy of topical 5% liquor carbonis detergens vs. its emollient base in the treatment of psoriasis.

Tar has been a mainstay in the treatment of psoriasis for centuries, but despite its widespread use, there is little evidence supporting its clinical efficacy without the combined use of ultraviolet radiation. The purpose of this study was to compare psoriasis improvement rates in patients using 5% liquor carbonis detergens (LCD) in an emollient base with the emollient base alone. Eighteen patients completed a randomized, bilaterally controlled, double-blind study. Emollient-treated plaques showed a mean improvement of 35.3% by 4 weeks of treatment, and LCD therapy produced a mean improvement of 48.7%, a difference which was statistically significant.

Congenital localized absence of the skin as a manifestation of epidermolysis bullosa.

BACKGROUND: Congenital localized absence of the skin has been observed in various subsets of inherited epidermolysis bullosa. Through electron microscopy and immunomapping, we attempt to clarify the relationship of congenital localized absence of the skin lesions to epidermolysis bullosa. OBSERVATIONS: The case of a child with epidermolysis bullosa simplex and congenital localized absence of the skin is presented. Electron microscopy and immunomapping of the areas of congenital localized absence of the skin and sites of skin fragility suggest that these lesions are pathogenically identical. CONCLUSION: After reviewing the literature, we believe that the term Bart's syndrome should be used to identify patients with any type of epidermolysis bullosa who present with localized congenital absence of the skin on the extremities.

Basic mechanisms in the healing cutaneous wound.

The process of wound healing can be divided into substrate, proliferative, and remodeling phases. The basic biologic and physiologic events which transpire during these stages are examined in detail. Particular emphasis is placed on the interactions between platelets, macrophages, and other inflammatory cells, and fibroblasts in the healing wound. Recent advances in the roles played by interleukins, fibronectin, and epidermal growth factor are discussed.