First-line Advanced Cutaneous Melanoma Treatments: Where Do We Stand?

Cutaneous melanoma has always been a dreaded diagnosis because of its high mortality rate and its proclivity for invasiveness and metastasis. Historically, advanced melanoma treatment has been limited to chemotherapy and nonspecific immunotherapy agents that display poor curative potential and high toxicity. However, during the last decade, the evolving understanding of the mutational burden of melanoma and immune system evasion mechanisms has led to the development of targeted therapy and specific immunotherapy agents that have transformed the landscape of advanced melanoma treatment.

Teledermatology for diagnosing skin cancer in adults.

Background: Early accurate detection of all skin cancer types is essential to guide appropriate management and to improve morbidity and survival. Melanoma and squamous cell carcinoma (SCC) are high-risk skin cancers which have the potential to metastasise and ultimately lead to death, whereas basal cell carcinoma (BCC) is usually localised with potential to infiltrate and damage surrounding tissue. Anxiety around missing early curable cases needs to be balanced against inappropriate referral and unnecessary excision of benign lesions.

Does the dual use of toluidine blue and hematoxylin and eosin staining improve basal cell carcinoma detection by Mohs surgery trainees?

Background: Although a number of Mohs surgeons currently use Toluidine blue stain, alone or in combination with hematoxylin and eosin (H&E), the effects on the trainees' histologic accuracy of adding toluidine blue to their H&E training was unknown.

Objective: To assess a trainees' histological accuracy when trained in a unit that routinely employs the dual staining technique and to determine whether the addition of toluidine blue improves, or impairs, the training process.

Methods: A fellow examined slides from 403 consecutive Mohs cases over 3 months, from the start of his training period.

Electrical impedance spectroscopy as a potential adjunct diagnostic tool for cutaneous melanoma.

Background: Previous studies have shown statistically significant differences in electrical impedance between various cutaneous lesions. Electrical impedance spectroscopy (EIS) may therefore be able to aid clinicians in differentiating between benign and malignant skin lesions.

Objectives: The aim of the study was to develop a classification algorithm to distinguish between melanoma and benign lesions of the skin with a sensitivity of at least 98% and a specificity approximately 20 per cent higher than the diagnostic accuracy of dermatologists.

Teledermatology - the Cardiff experience.

This paper describes the development and on-going management of an email-based teledermatology service, providing General Practitioners in the metropolitan area of Cardiff, UK, with rapid access to a hospital-based Consultant Dermatologist. The paper describes the ethos behind the establishment of the service, details the equipment and methods used to deliver it, and presents results from the first four years of operation. It also discusses the lessons learnt in moving from an initial pilot to a supported service.

Nocturnal sedation in a child with facial ulceration.

Mostly, herpes zoster affects adults and therefore childhood presentation can represent a diagnostic challenge. Childhood herpes zoster, when it occurs, can also be associated with peripheral nerve complications, as illustrated by this case. A 3-year-old child who had herpes zoster developed a nasolabial scar resulting in a shallow non-healing ulcer from being repeatedly picked.

Imiquimod 5% cream monotherapy for cutaneous squamous cell carcinoma in situ (Bowen's disease): a randomized, double-blind, placebo-controlled trial.

Background: We conducted a double-blind, placebo-controlled, randomized trial to evaluate the preliminary efficacy and safety of imiquimod 5% cream treatment for cutaneous squamous cell carcinoma (SCC) in situ.

Methods: In all, 31 patients with biopsy-proven cutaneous SCC in situ were randomly assigned to placebo (vehicle) (n = 16) or imiquimod 5% cream (n = 15) daily for 16 weeks. Patients were assessed at week 28 for the primary end point, resolution of cutaneous SCC in situ.

Computerized bipolar diathermy with scissors and forceps in cutaneous surgery.

Background: Bipolar diathermy coagulates tissue as effectively as monopolar with less lateral tissue injury and no risk of interference with cardiac pacemakers or joint prostheses.

Objective: To test a novel computerized bipolar diathermy machine for combined cutting and coagulation in dermatologic surgery.

Methods: A divided cable was used to deliver current from a computerized bipolar diathermy unit to both scissors and forceps.