Tattoos have been a part of costume, expression, and identification in various cultures for centuries. Although tattoos have become more popular in western culture, many people regret their tattoos in later years. In this situation, it is important to be aware of the mechanisms of tattoo removal methods available, as well as their potential short- and long-term effects. Among the myriad of options available, laser tattoo removal is the current treatment of choice, given its safety and efficacy.

The computer-assisted diagnosis of melanoma is an exciting area of research where imaging techniques are combined with diagnostic algorithms in an attempt to improve detection and outcomes for patients with skin lesions suspicious for malignancy. Once an image has been acquired, it undergoes a processing pathway which includes preprocessing, enhancement, segmentation, feature extraction, feature selection, change detection, and ultimately classification. Practicality for everyday clinical use remains a vital question. A successful model must obtain results that are on par or outperform experienced dermatologists, keep costs at a minimum, be user-friendly, and be time efficient with high sensitivity and specificity.

The incidence of and mortality from anal cancer, predominantly squamous cell carcinoma (SCC), have been increasing since the 1980s, during an era when many common malignancies have seen decreases in mortality. Dermatologists may be more likely to see patients at an increased risk for anal SCC, such as those living with HIV, MSM and those presenting for management of anogenital warts, yet there is little guidance in the field on how to manage these patients. We underwent a project to review the evidence surrounding screening and prevention of anal SCC. HPV vaccination, the main preventative measure for anal SCC, is often underutilized and may not be effective for those most at risk. Screening methods currently include high-risk HPV and anal cytology testing, with high-resolution anoscopy (HRA) reserved for biopsy and confirmatory testing. High-risk HPV testing has been associated with high sensitivity for intraepithelial neoplasia, but low specificity in high-risk groups. Recent meta-analyses examining AIN detection using anal cytology estimate a similarly high sensitivity of 74-87%, with a relatively higher specificity (44-66%) for identifying high-grade AIN.HRA is the gold standard for diagnosis, but its accessibility and cost are deterrents from its use as a screening tool. Cervical cancer screening, initially adopted without significant evidence of its impact, has significantly decreased cervical cancer rates. The argument can be made that rates of anal SCC may also benefit from appropriate screening methods, particularly anal cytology. It is prudent for dermatologists to be aware of the methods available to them in the management of at-risk patients, the data supporting them, and the potential benefits of screening in order to counsel patients appropriately and address the increasing burden of disease.

Background: The methodology of utilizing ICD nosology to identify psoriasis case cohorts within an EMR database has not been validated extensively. Objective: To appraise the validity of the psoriasis case definition utilizing ICD-9 nosology and to compare performances of six distinct algorithms. Design: Retrospective chart review of a randomly selected subset (n=966) of 2,737 cases with ≥1 ICD-9 diagnosis code for psoriasis in 2004-2013. Results: Positive Predictive Values for the six algorithms ranged from 84.7% {Any Provider (AP) ≥ 1} to 97.7% {Dermatologist (Derm) ≥ 3}. Negative Predictive Values for the six algorithms evaluated ranged from 24.1% ('Derm ≥ 3') to 80.9% ('Derm≥1'). NPV for 'Derm≥1' was 80.9%, while NPV for all other algorithms was ≤ 35.1%. Percent misclassification for the six algorithms ranged from 11.0% ('Derm≥ 1') to 46.3% ('Derm≥ 3'). Increased frequency of code applied also resulted in corresponding significant increases in percent misclassification. Within class, percent misclassification for 'Derm ≥ 1' (11.0%) was significantly lower than for 'AP≥ 1' (15.3%, P<0.01). Conclusions: At least one ICD-9 code applied by a dermatologist represents the strongest performing algorithm to identify psoriasis cases.

Pemphigus foliaceus (PF) is a sporadic autoimmune blistering disease of unknown etiology. The production of immunoglobulin G4 antibodies against desmoglein-1 is responsible for the clinical manifestation of PF. We present a case of a woman with a recent diagnosis of myasthenia gravis (MG), who was also recently treated with radiation therapy for breast cancer. The clinical exam, supported by biopsy and direct immunofluorescence, were consistent with PF. We present this case to increase the awareness of the potential exacerbation or induction of PF with radiation, and of the association of PF and myasthenia gravis. Only five prior cases of radiation-exacerbated or radiation-induced PF have been reported in the literature to date. Furthermore, the co-existence of the autoimmune entities of myasthenia gravis and PF has been reported in the literature in only 9 cases and was also noted in this patient.