This Month in Archives of Dermatology Diagnostic Accuracy of Patients in Performing Skin Self-examination and the Impact of Photography E arly identification and excisionof malignant melanomas while they are relatively thin may be impor- tant in reducing mortality, and skin self-examination (SSE) is routinely rec- ommended to patients as a means to detect new or changing nevi. In this study, Oliveria et al determined the sensitivity and specificity of SSE to de- tect new and changing moles in highly motivated patients with 5 or more atypical nevi. The sensitivity of SSE to detect new and cosmetically altered moles was 62%, which increased sub- stantially to 72% with the use of digi- tal photography. The specificity was 96% without photographs and 98% with photographs, suggesting that pa- tients had few false positives both with and without access to baseline digital photographs. See page 57 Sentinel Node Biopsy for High-Risk Nonmelanoma Cutaneous Malignancy T he presence of regional lymphnode metastasis is the most powerful prognostic factor for pre- dicting recurrence and survival in pa- tients with most solid tumors whose primary spread is lymphatic. Lim- ited, selected, less invasive surgical methods for detection of occult me- tastases have gradually replaced radi- cal lymph node dissection. Indeed, lymphatic mapping and sentinel lymph node biopsy (SLNB) have be- come the standard of care for mela- noma at virtually all major mela- noma centers. In this consecutive clinical case series, Wagner et al dem- onstrate the feasibility of SLNB in 24 patients with selected high-risk skin cancers, including squamous cell car- cinoma, Merkel cell carcinoma, and adenocarcinoma. See page 75 Early Detection of Asymptomatic Pulmonary Melanoma Metastases by Routine Chest Radiographs Is Not Associated With Improved Survival T he lungs represent a common site of cutaneous melanoma metastasis.Chest radiography (CR) is routinely used in postmelanoma surveil- lance, despite the fact that its utility and impact on survival are still uncer- tain. In this retrospective analysis, Tsao et al use a historical cohort of pa- tients with melanoma to determine if there is an apparent survival prolongation associated with earlier detection of asymptomatic pulmonary metastasis by routine CR. The high false-positive rate and lack of a survival advantage in patients in whom asymptomatic pulmonary metastases were discovered fur- ther challenges the use of CR in postmelanoma surveillance. See page 67 Photodynamic Therapy Using Topical Methyl Aminolevulinate vs Surgery for Nodular Basal Cell Carcinoma Results of a Multicenter Randomized Prospective Trial P hotodynamic therapy (PDT) is increasingly used as a noninvasive treat-ment for nodular basal cell carcinoma (nBCC) despite the lack of sound evidence for this therapy. Topical PDT has been most commonly practiced with 5-aminolevulinic acid (ALA). Methyl aminolevulinate (MAL) offers several ad- vantages over ALA, including enhanced lipophilicity, improved skin penetra- tion, and specificity for neoplastic cells. In this prospective, randomized mul- ticenter trial, Rhodes et al compare topical MAL-PDT with simple surgical excision for primary nBCC, demonstrating the efficacy of this treatment as well as the cosmetic advantages over surgery. See page 17 Treatment of Refractory Pemphigus Vulgaris With Rituximab (Anti-CD20 Monoclonal Antibody) P emphigus vul-garis (PV) is a severe antibody-me- diated autoimmune bullous disease that involves skin and mu- cous membranes. The mainstays of therapy remain systemic cor- ticosteroid treatment and various other ad- juvant immunosup- pressive drugs. Ritux- imab is a genetically engineered chimeric murine/human anti-CD20 monoclo- nal antibody that targets B cells. In this case series, Dupuy et al review the responses in 3 patients with severe, refractory PV to weekly intravenous rituximab infusions. Each patient had a clinical response following the first series of 4 infusions, which allowed for tapering of corticosteroids and other immuno- suppressant therapies. See page 91 SECTION EDITOR: ROBIN L. TRAVERS, MD BA A, Erosive lesions involving the leg. B, Noticeable clinical remission at week 10 after treatment with rituximab. THIS MONTH IN ARCHIVES OF DERMATOLOGY (REPRINTED) ARCH DERMATOL / VOL 140, JAN 2004 WWW.ARCHDERMATOL.COM 8 ©2004 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ by a Carnegie Mellon University User on 04/05/2021