A seven-point scoring system has been adopted by the Cancer Research Campaign to help non-dermatologists recognize melanoma (MM). Its value is reviewed in the light of increasing referrals of pigmented lesions. One-hundred and ninety-five patients (M:F, 43:152; mean age = 43 years, s.d. = 19) were asked whether their lesions possessed the seven points before diagnosis. The dermatologist assessed the signs. Six patients were unable to comply and some had multiple lesions; thus, 216 lesions were fully assessed by patient and dermatologist, and six by the dermatologist alone. Histology was obtained where appropriate. There were eight MMs, 95 naevi, 80 seborrhoeic warts, three dysplastic naevi, and 36 other lesions. Seven of the eight MMs were diagnosed clinically; the other was biopsied because of suspicious features and was a nodular MM. Four lesions suspected to be MMs proved benign. The predictive value (PV) of a clinical diagnosis of MM was 64% and of non-MM was 99%. Using accepted cutpoints for the seven-point system (refer if score greater than or equal to 3) patients' scores gave a PV for MM of 7% and for non-MM of 99%. Two MMs scored less than three. Dermatologists' scores gave a PV for MM of 8% and for non-MM of 99%. One MM scored less than 3. Univariate analyses showed that enlargement (P less than 0.05), dermatologists' assessments of an irregular margin (P less than 0.001), size (P less than 0.05) and pigmentary irregularity (P less than 0.05), and patients' assessments of size (P less than 0.05) were statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Therapeutic options for cutaneous T cell lymphoma (CTCL) include topical steroids, topical chemotherapy and phototherapy. Patients with limited disease that is unresponsive to these therapies present a particular challenge. We report successful treatment of a patient with two plaques of CTCL using topical photodynamic therapy (PDT). 5-aminolaevulinic acid (5-ALA) was applied 6-24 h preillumination with 100 J/cm2 red light. Treatment was repeated on four occasions with clinical and histological clearance. ALA-PDT may be a useful addition to the therapeutic options for CTCL. Further studies are required to define optimal treatment protocols.

Background: Acne is a common disfiguring skin condition that affects approximately 15% of the people in the UK. This study investigates the psychological and emotional impact of acne. Material and Methods: The study was conducted at the dermatology out-patient department of the Stirling Royal Infirmary in Stirling and at the dermatology out-patient department of Falkirk Royal Infirmary in Falkirk (Scotland). Patients were assessed pre-treatment, post-treatment (5 months) and follow-up (8 months). Clinical severity was assessed by a dermatologist at all three assessment time-points using the Leeds Acne Severity Grading Technique. The psychological well-being of acne patients was assessed using the following self-report psychological test measures: The Skindex, the Hospital Anxiety and Depression Scale (HADS), the Rosenberg Self-esteem Scale, and the Positive and Negative Affectivity Scales (PANAS). Patients were also asked to self-rate the severity of their skin disease. 34 acne patients completed all 3 assessments. Results: Results demonstrate that the clinical grade of acne improved significantly over treatment time, and at follow-up assessment. This indicates that the treatment prescribed by the dermatologists was generally effective, and that this improvement in the clinical severity of acne was maintained at the 8-month follow-up assessment, even though medical intervention had ceased. There was also evidence of moderate psychological distress pre-treatment, based on the psychological test measures employed. Treatment outcome results obtained from acne patients showed that there was a significant improvement over treatment time on how patients self-rated their self-esteem and positive affectivity, and a significant decrease on how patients selfrated their anxiety, depression, negative affectivity and Skindex scores. Conclusion: In conclusion this study has demonstrated that the psychological profile exhibited by acne patients pretreatment may be largely reversed over treatment time, and that this psychological improvement is generally maintained at follow-up assessment.

A case of extensive warts complicating sarcoidosis is reported. An excellent clinical response has been achieved by the use of oral etretinate (Tigason). Case historyThe patient, a 22-year-oId male Caucasian, presented with erythema nodosum in 1965, and 2 years later developed bilateral hilar lymphadenopathy with pulmonary infiltration. Raised, reddish-purple lesions were present on his arms, thighs and trunk, and biopsy of one revealed a few well defined non-caseating tubercles consistent with a diagnosis of sarcoidosis. The pulmonary lesions were treated with prednisolone, 10 mg daily, from 1970, and over the next 6 years this dose was gradually reduced.The patient developed troublesome common warts on his hands between the onset of the sarcoidosis and starting steroid therapy. However, 2 years after this therapy there was such an alarmingly rapid and extensive spread of multiple large warts that repeated diathermy under general anaesthesia was necessary. This aggressive therapy produced no improvement. Numerous filiform warts were present on the patient's neck and spread over the beard area. Massive and disabling confluent hyperkeratoses covered both hands including the palmar and dorsal surface and both wrists (Fig. i). Painful fissures caused such discomfort that the patient was unable to undertake fine manual work and he subsequently became unemployed.After steroid withdrawal, chest X-rays showed no evidence of progressive pulmonary sarcoidosis, and pulmonary function tests revealed only a slight reduction in lung volume and carbon monoxide gas transfer. There was moderate airways obstruction, reversed by salbutamol. Routine haematological and biochemical investigations were normal, but because the proliferation of warts was so extensive immune function was assessed. Chemotaxis and 0307-6938/83/0100-0033802.00 . <•. . 1983 Biackwell Scientific Publications

A 36-year-old female patient with severe autosomal recessive dystrophic epidermolysis bullosa, who had spent her entire life from age 2 as an inpatient in the dermatology unit, recently died of metastatic squamous cell carcinoma of the skin. The development of malignancy was not prevented by continuous medical and nursing supervision and, despite early detection, rapidly led to her death. Oral phenytoin and topical mupirocin ointment had not reduced blistering.