A series of melanomas smaller than 4 mm and implications for the ABCDE rule.

BACKGROUND: Although multiple studies have reported that a significant number of melanomas have diameters of less than or equal to 6 mm at the time of diagnosis, there has been only one series evaluating the proportion of melanomas less than 4 mm in diameter. OBJECTIVE: The objective of this study was to determine the proportion of melanomas, in a single-practitioner, general dermatology practice, with clinical diameters less than 4 mm. METHODS: Information regarding each new diagnosis of melanoma had been recorded during the study period of 2000-2004. Patient records and pathology reports were examined from these patients. RESULTS: Thirteen (13.7%) of the 95 melanomas had diameters less than 4 mm at the time of presentation, including five invasive and eight in situ melanomas. The defining clinical characteristic of these lesions was intensity of pigment. Three of these 13 melanomas, including one invasive and two in situ lesions, showed features of regression. CONCLUSIONS: The findings of this study support those authors who have suggested elimination of the 6-mm diameter criterion in the ABCDE rule. In addition, this study provides further evidence that dark colour as a diagnostic criterion for melanoma should be given more emphasis. The substitution of 'D' to represent dark instead of diameter is worthy of consideration to enhance the value of the ABCDE mnemonic.

Problematic wandering behavior in the cognitively impaired elderly. A single-subject case study.

Three psychosocial factors that may influence wandering behavior have been previously identified: lifelong patterns of coping with stress, previous work roles, and a need to search for persons or places associated with security. Strategies for managing wandering behavior include environmental modifications, planned activities, physical exercise, and attention to psychosocial history. However, limited attention has been given to testing psychosocial approaches that could be used by nursing home staff when interacting with residents who wander. The findings of this study suggest that providing sufficient staff time for interacting with residents, programs that address residents' needs for activity and rest, and appropriate environmental modifications should occur in conjunction with the decreased use of antipsychotic medications and physical restraints.

Management of patients taking anticoagulants and platelet inhibitors prior to dermatologic surgery.

BACKGROUND: The use of anticoagulants and platelet inhibitors can increase the risk of intraoperative and postoperative hemorrhagic complications in cutaneous surgery. Currently there are no general guidelines and no consensus among dermatologic surgeons on how to manage patients taking these medicines. OBJECTIVE: To address many of the issues involved in the management of these patients. CONCLUSION: General recommendations are made for managing patients taking anticoagulants and platelet inhibitors prior to dermatologic surgery.

Oral lesions in systemic lupus erythematosus. Do ulcerative lesions represent a necrotizing vasculitis?

BACKGROUND: It has been suggested that oral lesions in patients with systemic lupus erythematosus (SLE) may be grouped clinically as erythema, discoid lesions, or oral ulcerations. Oral ulcerations have been said to foretell a severe systemic disease flare and the proposal that oral ulcers represent a mucosal vasculitis has been suggested to explain this hypothesis. OBJECTIVE: Our objective was to test the hypothesis that oral ulcers in patients with SLE result from vasculitis. METHODS: We studied 10 patients with American College of Rheumatology (ACR) criteria for a diagnosis of SLE who had oral lesions of lupus (six prospectively and four retrospectively) clinically and by routine and immunofluorescence microscopy. Biopsy specimens were reviewed in a single-blinded fashion. RESULTS: In our patients, no oral lesion, regardless of morphology, demonstrated vasculitis histologically. All lesions demonstrated an interface mucositis. CONCLUSION: Our data strongly contradict the hypothesis that leukocytoclastic vasculitis explains a possible unproven correlation between oral ulceration and disease flares in patients with SLE.

Severe allergic keratoconjunctivitis and erythema multiforme after a routine eye examination: discerning the cause.

Acute allergic dermatitis of the eyelids with keratoconjunctivitis is associated with a specific triggering factor. Therapy for the acute inflammation can complicate the search for such a factor if the process worsens. We report a case of acute contact dermatitis and keratoconjunctivitis after a routine eye examination to demonstrate the difficulty in evaluating such patients and the role of skin patch testing in determining the cause.

Lateral preferences and performance on non-verbal laterality tests in a normal population.

The goal of the present study was to determine if, in a normal population, handedness, footedness, eyedness, earedness and overall congruency across lateral preferences were predictive of perceptual asymmetry on non-verbal tasks. In Experiment 1, subjects had to decide whether a laterally presented facial expression matched a previously presented target. In Experiment 2, subjects had to determine whether the tone of voice heard on dichotic and binaural presentations was the same or different. Eye preference was the most successful variable in predicting both visual field and ear advantages. Knowledge of a person's eye preference however, did not allow for a very accurate prediction of perceptual asymmetry. Nonetheless, the findings suggest that eye preference should be taken into account in future non-verbal laterality studies.