Educational and practice gaps in the management of volar melanocytic lesions.

BACKGROUND: The benign and malignant patterns of acral melanocytic naevi (AMN) and acral melanomas (AM) have been defined in a series of retrospective studies. A three-step algorithm was developed to determine when to biopsy acral melanocytic lesions. This algorithm has only been applied to a Japanese population. OBJECTIVES: Our study aimed to review the current management strategy of acral melanocytic lesions and to investigate the utility of the three-step algorithm in a predominately Caucasian cohort. METHODS: A retrospective search of the pathology and image databases at Mayo Clinic was performed between the years 2006 and 2016. Only cases located on a volar surface with dermoscopic images were included. Two dermatologists reviewed all dermoscopic images and assigned a global dermoscopic pattern. Clinical and follow-up data were gathered by chart review. All lesions with known diameter and pathological diagnosis were used for the three-step algorithm. RESULTS: Regular fibrillar and ridge patterns were more likely to be biopsied (P = 0.01). The majority of AMN (58.1%) and AM (60%) biopsied were due to physician-deemed concerning dermoscopic patterns. 39.2% of these cases were parallel furrow, lattice-like or regular fibrillar. When patients were asked to follow-up within a 3- to 6-month period, only 16.7% of the patients returned within that interval. The three-step algorithm would have correctly identified four of five AM for biopsy, missing a 6 mm, multicomponent, invasive melanoma. CONCLUSION: We found one major educational gap in the recognition of low-risk lesions with high rates of biopsy of the fibrillary pattern. Recognizing low-risk dermoscopic patterns could reduce the rate of biopsy of AMN by 23.3%. We identified two major practice gaps, poor patient compliance with follow-up and the potential insensitivity of the three-step algorithm to small multicomponent acral melanocytic lesions.

The course of D-dimer, high-sensitivity C-reactive protein and pro-B-type natriuretic peptide in patients with non-ST-elevation myocardial infarction.

BACKGROUND: Elevated levels of high-sensitivity C-reactive protein (hs-CRP), B-type natriuretic peptide (BNP), and D-dimer each are associated with higher rates of death and recurrent ischemic events in patients with acute myocardial infarction (AMI). The aim of this study was to examine the dynamic course of D-dimer, hs-CRP, and pro-BNP in patients with Non-ST-Elevation Myocardial Infarction (NSTEMI). METHODS: The study group consisted of 82 patients presenting with symptoms suggestive of acute coronary syndrome (ACS). 40 of the patients were diagnosed as NSTEMI and for the rest AMI was ruled out. Blood was drawn at the time of admission, 6 and 12 hours after that. The samples were tested for hs-CRP, pro-BNP and fibrin D-dimer by a quantitative, point-of-care instrument system (Stratus CS). RESULTS: D-dimer and pro-BNP did not change between admission and 6 and 12 hours after admission in patients with acute NSTEMI, whereas hs-CRP went down 12 hours after admission compared to the admission value (14.9 +/- 19.4 (mg/mL) v 10.1 +/- 13.5 (mg/mL), p = 0.04). CONCLUSIONS: There was no dynamic change of D-dimer or pro-BNP during the first 12 hours after admission in patients with acute NSTEMI, whereas hs-CRP decreased 12 hours after admission in these patients.