Objective To measure the performance of smart phone applications which evaluate photographs of skin lesions and provide the user feedback as to their likelihood of malignancy. Design Case-control diagnostic accuracy study Setting Academic dermatology department Participants Digital clinical images of pigmented cutaneous lesions (60 melanoma cases and 128 benign lesion controls), all with histologic diagnosis rendered by a board-certified dermatopathologist, obtained prior to biopsy in patients undergoing lesion removal as part of routine care. Main Outcome Measures Sensitivity, specificity, and positive and negative predictive values of four smart phone applications designed to aid non-clinician users in determining if their skin lesion is benign or malignant. Results Sensitivity of the four tested applications ranged from 6.8% to 98.1%. Specificity ranged from 30.4% to 93.7%. Positive predictive value ranged from 33.3% to 42.1%, and negative predictive value ranged from 65.4% to 97.0%. The highest sensitivity for melanoma diagnosis was observed for an application that sends the image directly to a board-certified dermatologist for analysis and the lowest sensitivity was observed for applications that use automated algorithms to analyze images. Conclusions The performance of smart phone applications in assessing melanoma risk is highly variable, and 3 out of 4 smart phone applications incorrectly classified 30% or more of melanomas as unconcerning. Reliance on these applications, which are not subject to regulatory oversight, in lieu of medical consultation, has the potential to delay the diagnosis of melanoma and to harm users.

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The IL-36 family of cytokines and receptors seems to play a role in the pathogenesis of both pustular psoriasis, and the much more common variant, plaque-type psoriasis. Human skin biopsies from patients with psoriasis show overexpression of IL-36 and mice that lack the inhibitory IL-36 receptor (IL-36Ra) antagonist develop psoriasis, suggesting that signaling through the IL-36R may drive the skin lesions of psoriasis. Currently, no drugs targeting IL-36 are used in the treatment of psoriasis. The patent WO2013074569 describes an antibody to the IL-36R that is proposed as a potential therapy for psoriasis.

Iatrogenic injuries to the upper gastrointestinal tract in neonates are rare but may lead to significant morbidity and mortality if undiagnosed. The clinical presentation of such injuries is usually nonspecific and symptoms may be overlooked, particularly in sick preterm neonates. Therefore, it is important to recognize the findings on plain chest radiographs obtained regularly in neonatal intensive care units (NICUs) on intubated patients. The purpose of this pictorial essay is to describe the imaging findings of various iatrogenic injuries to the pharynx and esophagus in the neonatal period in a cohort of seven cases.