Hypopigmented mycosis fungoides (HMF) is a form of cutaneous T-cell lymphoma (CTCL), a heterogeneous group of extranodal non-Hodgkin’s lymphomas. HMF has a unique set of defining features that include light colored to achromic lesions, a predilection for darker skin phototypes, an early onset of disease, and predominance of CD8+ T-cells, among others. In the current review, we detail the known pathways of molecular pathogenesis for this lymphoma and posit that an active Th1/cytotoxic antitumor immune response in part explains why this variant is primarily seen in children/adolescents and young adults, who do not exhibit signs of immunosenescence. As a result of this potent cytotoxic response, HMF patients experience mostly favorable overall prognosis, while hypopigmentation may in fact represent a useful surrogate marker of cytotoxic immunity targeting the malignant cells. Understanding the molecular processes behind the specific features that define HMF may lead to improved diagnostic accuracy, personalized prognosis by risk stratification, and improved management of HMF. Moreover, improving our knowledge of HMF may aid our further understanding of other cutaneous lymphomas.

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Background Oral cavity cancers (OCCs) and oropharyngeal cancers (OPCs) continue to be a major source of morbidity and mortality worldwide requiring the shared effort of numerous specialists. Tobacco and alcohol consumption have long been identified as risk factors for both OCC and OPC. In addition, human papilloma virus (HPV) is gaining its position as the main causal agent for OPC. Objective The objective of this study is to analyze the epidemiology of OCC and OPC in Canada. Methods Data pertaining to the year of diagnosis, the patient’s sex, age at the time of diagnosis, province/territory, city and postal code of oral cavity, and oropharyngeal malignancies diagnosed during 1992-2010 were extracted from the Canadian Cancer Registry and Le Registre Québécois du Cancer. Results In total, 21 685 OCC cases and 15 965 OPC cases were identified from 1992 to 2010. Of those, 84.97% were oral cavity squamous cell carcinomas (SCCs), 88.10% were oropharyngeal SCCs, and both had a significant male predominance. While oral cavity SCC incidence stabilized over the study period, oropharyngeal SCC continued to increase. Oral cavity SCC incidence increased with age, while oropharyngeal SCC incidence peaked in the 50- to 59-year age group. Detailed geographic distribution analysis of patients at the provincial/territorial, city, and postal code levels identified several patient clusters. Conclusions This work highlights important epidemiological differences in trends between oral and oropharyngeal cancers, identifies high-incidence postal codes for each malignancy, and correlates incidence/mortality with known risk factors including alcohol/tobacco use and HPV infections, therefore providing a comprehensive understanding of epidemiology for these cancers in Canada.

Chronic wounds are a major problem: an estimated 6.5 million people in the United States have chronic wounds that are highly susceptible to infection and difficult to manage. 1 Early identification of problematic wounds allows effective treatment, capable of changing disease course. 2 Accurate documentation and measurement of wounds are critical. The gold standard for measuring wounds is a ruler: measuring the longest axis (length) and the greatest perpendicular width. This can overestimate wound area by up to 73.9%. Measuring wounds with digital photography has been shown to be more reliable. 3 Swift Medical (Toronto, Ontario, Canada) has created a mobile application (Swift app) for wound management. The application calculates wound dimensions, including surface area, allowing highly accurate and reliable measurements, enabling wound progress to be tracked over time. 4 There are also administrative advantages in digitizing the wound documentation and measurement workflow (eg, time saving and accessing images). The study objective was to investigate the impact of the Swift app on clinicians' time efficiency, specifically wound assessment and documentation time, compared to the ruler method. Twenty medical students and dermatology residents (Faculty of Medicine, McGill University) participated voluntarily. The Swift app was used to photograph, measure, and document model wound images, using an iPhone (Apple, Cupertino, California), following training on the app. The time taken for each participant to measure the wound images (20 in total) using the Swift app and ruler method was recorded. For the ruler method, participants were instructed to draw an image representing the wound and indicate where they measured length and width. Mixed analysis of variance was used to compare measurement type (time taken to measure wound length and width, ruler vs app) across the 20 wounds repeated by each subject. Reliability was determined using intraclass correlation coefficients (ICCs) calculated in R. 5 We compared time efficiencies when measuring and documenting wounds using the ruler method compared to the Swift app (Figure 1A [dashboard] and Figure 1B,C [drawing vs photo documentation comparison]). Measurement time by the ruler method was significantly slower than using the Swift app (Table 1; mean [SD], 48.17 [7.81] vs 30.77 [5.21] seconds; P < .001, ruler vs Swift app). For the ruler method, measurements took 16.85 seconds, while charting time took an additional 31.32 seconds. Hence, for combined measurement and documentation, the Swift app was 57% faster than the ruler method and paper charting.