The public health effect of melanoma in the United States is undeniable as f60,000 diagnoses of invasive melanoma and 8,000 deaths from melanoma are expected in 2007. Due to the poor outcomes associated with treating advanced cases of melanoma, substantial public health resources have been devoted to prevention efforts. Of the various factors involved in the pathogenesis of melanoma, including genetic predisposition, immunosuppression, and UV radiation, decreasing UV exposure has attracted the most attention for decreasing the public health effect of melanoma. Although sun avoidance may be an important measure for reducing the public health effect of melanocytic and keratinocytic malignancies, educational and media campaigns to encourage sun avoidance have failed to achieve the desired behavior changes in young people, have had limited effect on elderly patients who have already experienced decades of damaging sun exposure, and most importantly have failed to decrease the incidence of melanoma. We believe the best method to reduce deaths from melanoma is to emphasize early detection and treatment of suspicious lesions through combined efforts of both patients and providers. The public health effect of melanoma is undeniable as f60,000 diagnoses of invasive melanoma and 8,000 deaths from melanoma are expected in 2007 (1). Due to the poor outcomes associated with treating advanced cases of melanoma, substantial public health resources have been devoted to prevention efforts. Of the various factors involved in the pathogenesis of melanoma, including genetic predisposition, immunosuppression, and UV radiation, decreasing UV exposure has attracted the most attention for decreasing the public health effect of melanoma.Although sun avoidance may be an important measure for reducing the public health effect of melanocytic and keratinocytic malignancies, educational and media campaigns to reduce sun exposure have failed to achieve the desired behavior changes in young people, have had limited effect on elderly patients who have already experienced decades of damaging sun exposure, and most importantly have failed to decrease the incidence of melanoma. In examining the recent trends in and attitudes toward sun exposure and sun protection in U.S. adolescents, Cokkinides et al. (2) found that between 1998 and 2004, despite widespread sun protection campaigns, there was only a small nonsignificant reduction in the high baseline sunburn frequency and at best modest changes in sun protection practices. Furthermore, a recent analysis of the Behavioral Risk Factor Surveillance System has documented an increased prevalence of sunburns in the United States in adults (3). This does not suggest that we are about to see a major decrease in melanoma incidence. Even in places such as Australia, where primary prevention through sun avoidance has been widely embraced for many years, and sophisticated campaigns mounted, sunburn rates and melanoma incidence are still increasing (4). Furthermore, success in reducing UV exposure, we...

Lichen planus (LP) is an inflammatory dermatitis of idiopathic origin that can involve the skin, mucous membranes, hair and nails. Histologically, LP is characterized by compact orthokeratosis, wedge-shaped hypergranulosis, irregular acanthosis, damage to the basal cell layer and a band-like inflammatory infiltrate in the upper dermis. Lymphocytes are the predominant cells making up the infiltrate, along with a few macrophages, eosinophils and plasma cells. In addition, melanophages are often found in the upper dermis adjacent to the damaged basal cells.(1) We describe a patient with a lesion of the toenail clinically and histopathologically consistent with LP, but with a band-like inflammatory infiltrate composed primarily of plasma cells. Previously, only three other cases of LP with plasma cell predominant infiltrate have been reported, none of which involved the nail matrix.

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