Congenital melanocytic nevus syndrome (CMNS) is the result of an abnormal proliferation of melanocytes in the skin and central nervous system caused by progenitor-cell mutations during embryonic development. Mutations in the NRAS gene have been detected in many of these cells. We present 5 cases of giant congenital melanocytic nevus, 3 of them associated with CMNS; NRAS gene mutation was studied in these 3 patients. Until a few years ago, surgery was the treatment of choice, but the results have proved unsatisfactory because aggressive interventions do not improve cosmetic appearance and only minimally reduce the risk of malignant change. In 2013, trametinib was approved for use in advanced melanoma associated with NRAS mutations. This drug, which acts on the intracellular RAS/RAF/MEK/pERK/MAPK cascade, could be useful in pediatric patients with CMNS. A better understanding of this disease will facilitate the development of new strategies.

This paper examines a novel approach to evaluating a nurse-run telephonic low back pain (LBP) disease management (DM) program offered by a fully-insured commercial health plan population with approximately 150,000 members located in the northeastern United States. Members with at least 6 member months of eligibility were identified to have LBP using administrative claims and eligibility data. The LBP program relies on telephonic nurse management augmented by printed materials, adapting and advocating HEDIS imaging guidelines, and drug utilization review. Outcomes of this LBP DM program were assessed using a pre-post population-based approach as recommended in the DMAA Outcomes Guidelines Report. Baseline year and program year populations were segmented into 5 LBP clinical categories and each was weight adjusted using population size. LBP-related medical service utilization and pharmacy utilization also were evaluated. Individuals under active LBP management exhibited a decrease in LBP-related imaging and surgeries. Overall analgesic use also decreased. These data suggest the LBP DM program is associated with a decrease in imaging, surgeries, and analgesic use. The magnitude of the clinically segmented weight-adjusted return on investment (ROI) was lower than the unadjusted ROI, but was directionally positive indicating program impact. This adjustment is necessary in order to gain insight into and consistency of the results of a comprehensive LBP DM program evaluation.