A case of a hard inguinal nodule.

Dermatofibrosarcoma protuberans (DFSP) is an uncommon tumor with its onset typically in the second to fifth decades of life. It most commonly presents on the trunk, and recent cytogenetic studies suggest a neural origin. A case presentation and review of the recent literature on the diagnosis, differential diagnosis, and treatment of DFSP is presented.

The ABC rule for clinical detection of subungual melanoma.

BACKGROUND: Subungual melanoma is a relatively rare disease with reported incidence between 0.7% to 3.5% of all melanoma cases in the general population. Unlike the significant improvement in the diagnosis of cutaneous melanoma, the diagnosis of subungual melanoma has shown little, if any, improvement over the years. The widespread adoption of the ABCDs of cutaneous melanoma has helped increase public and physician awareness, and thus helped increase the early detection of cutaneous melanoma; the same criteria cannot be applied to the examination of the nail pigmentation. OBJECTIVE: We reviewed the world literature on subungual melanoma and arranged the available information into a system for the identification of subungual melanoma. This system has to be thorough, easy to remember, and easy to apply by both physician and lay public. A case to illustrate the delayed diagnosis often encountered in the current evaluation of nail melanoma is presented. METHODS: A thorough review of the world literature on subungual melanoma was undertaken. The important findings of various studies and case reports were compared among themselves and the salient features were summarized. The information was then categorized under the easily recalled letters of the alphabet, ABCD, that have already become associated with melanoma. RESULTS: The most salient features of subungual melanoma can be summarized according to the newly devised criteria that may be categorized under the first letters of the alphabet, namely ABCDEF of subungual melanoma. In this system A stands for a ge (peak incidence being in the 5th to 7th decades of life and African Americans, Asians, and native Americans in whom subungual melanoma accounts for up to one third of all melanoma cases. B stands for brown to black b and with breadth of 3 mm or more and variegated borders. C stands for change in the nail band or lack of change in the nail morphology despite, presumably, adequate treatment. D stands for the digit most commonly involved; E stands for extension of the pigment onto the proximal and/or lateral nailfold (ie, Hutchinson's sign); and F stands for family or personal history of dysplastic nevus or melanoma. CONCLUSION: Although each letter of the alphabet of subungual melanoma is important, one must use all the letters together to improve early detection and thus survival of subungual melanoma. Still, as with cutaneous melanoma, the absolute diagnosis of subungual melanoma is made by means of a biopsy.

Specialty board certification rates. A longitudinal tracking study of US medical school graduates.

This study is follow-up analysis of increments in specialty board certification rates occurring between 1971 and 1976 for 2,046 physicians who graduated in 1960, 1964, and 1968. Data obtained at 8-, 12-, and 16-year intervals following graduation from medical school indicate that it is not until 12 years' following receipt of the MD degree that most physicians will have entered the certification process or be certified. An additional increment is found 16 years following graduation. At eight and 12 years following graduation, the more recent graduates showed a much higher rate of board certification than earlier graduates at a comparable interval following graduation. Of the total study population, 81% are either board certified or in the certification process. When two essentially office-based specialties are excluded, 92% of the study population have formally entered the certification process.

Migration of physicians from one specialty to another. A longitudinal study of US medical school graduates.

To demonstrate the extent to which physicians change their specialty, randomized samples of the graduating classes of 1960, 1964, and 1968 were studied with respect to their self-designated specialties in 1971 and 1976. Of the 2,046 physicians in the three samples, 333 (16%) changed their specialty between 1971 and 1976. It was 8% for the 1960 cohort, 11% for 1964, and 29% for 1968. Of all the changes, 78% were from one specialty practice to another or back to a formal residency in a different specialty; 22% changed from one specialty residency to either practice or another residency in a different specialty. Between 1971 and 1976, a total of 127 (16%) of 783 primary care physicians changed their specialty. The magnitude of this change must be considered in planning for distribution of physicians by specialty.

Effectiveness of an international health elective as measured by NBME Part II.

A total of 434 third- and fourth- year medical students from 80 U.S. medical schools participate between 1968 and 1974 in Yugoslav or Israeli international fellowship programs sponsored by the Association of American Medical Colleges and the U.S. Public Health Service. Subsequently, the scores of these fellowship student on Part II of the examinations of the National Board of Medical Examiners (NBME) were compared with the scores of rejected applicants and with the national average to determine the cognitive impact of the fellowship experience on the participants. The results show that the international fellows scored significantly higher than the rejected applicants and the national average in only the preventive medicine/public health portion of the examination. The conclusion is drawn that the fellowship programs enhanced the participants' knowledge of preventive medicine and public health.