Monitoring patients taking methotrexate for hepatotoxicity. Does the standard of care match published guidelines?

Background: Controversy persists regarding the validity of published guidelines for the monitoring of methotrexate-induced hepatotoxicity.

Objective: The purpose of our study was to assess the standard of care by gastroenterologists in the monitoring of methotrexate-induced hepatotoxicity and to compare this standard of care with guidelines in the medical literature.

Methods: Gastroenterologists in Connecticut and Massachusetts were surveyed by a mail-in questionnaire that inquired about their protocol for the monitoring of hepatotoxicity in patients taking methotrexate.

Does pregnancy influence the prognosis of malignant melanoma?

The effect of pregnancy on the clinical course of malignant melanoma (MM) is unclear. Early clinical and laboratory evidence suggested a relation between hormones and MM and subsequently between pregnancy and MM. We reviewed the literature on MM and pregnancy to address three questions: What is the effect on prognosis if an MM is diagnosed during pregnancy? What is the effect of previous pregnancies on the prognosis of MM? What effect does a subsequent pregnancy have on the prognosis of MM? On the basis of a limited number of controlled studies, it does not appear that being pregnant before, after, or at the time of diagnosis of stage I MM influences the 5-year survival rate.

Infantile generalized pustular psoriasis associated with lytic lesions of the bone.

Generalized pustular psoriasis is rare in children, especially in those less than 1 year of age. Lytic lesions of the bone have been reported in children with psoriasis, but are rare. We describe an infant with the clinical and histopathologic features of generalized pustular psoriasis that began in the first few weeks of life.

Histopathologic correlates of structures seen on dermoscopy (epiluminescence microscopy).

Dermoscopy (epiluminescence microscopy) is an in vivo technique that enables the clinician to visualize a variety of structures in pigmented cutaneous lesions that are not discernible by naked-eye examination. To identify the histologic correlates of these structures, a series of 71 pigmented neoplasms was documented photographically with and without dermoscopy. These lesions then underwent total excision and careful step-sectioning so that the resulting histologic slides could be correlated with the dermoscopic photographs.

Spitz nevi.

The Spitz nevus has long been defined as a benign melanocytic lesion that shares many histologic features with malignant melanoma. Despite the diagnostic criteria established for these two entities, their histologic similarities continue to make their distinction somewhat difficult. Uncertainties also exist with regard to the natural history of the Spitz nevus; the true pattern of this lesion's biologic behavior remains elusive.

Ocular melanoma.

Ocular melanomas are the most common intraocular malignancy in adults. The majority of ocular melanomas are choroidal melanomas. These tumors can be difficult to diagnose, especially when they are small.

Verification of a formula for determination of preexcision surgical margins from fixed-tissue melanoma specimens.

Background: Recently our group reported on the shrinkage of 199 malignant melanoma surgical-excision specimens. In that report, a multivariate analysis revealed that the age of the patient was the only factor that significantly affected the percentage shrinkage of a surgical specimen. In addition, a formula was presented that extrapolates the actual surgical margins (in vivo) from the (contracted) fixed-tissue pathology report measurement and the reported in vivo lesion diameter.