No abstract

Six-monthly CT scan of the chest, abdomen and pelvis is a cost-effective technique for the early detection of metastases in the first 4 years of follow-up in patients with AJCC stage IIC and III melanoma, and in the first 3 years in patients with AJCC stage IIB melanoma. In addition, brain MRI has been shown to be cost-effective only in the first year of follow-up in patients with AJCC stage IIC and III melanoma.

Both clinical and pathologic findings must be considered when diagnosing figurate skin lesions, which are often seen in routine practice. Although a skin biopsy may sometimes be diagnostic, more often the information provided is nonspecific. In an attempt to offer an approach to diagnosing these dermatoses, we have classified annular lesions according to the presence of lymphocytic, neutrophilic-eosinophilic, or granulomatous infiltrates, and infiltrates containing plasma cells. Neoplastic annular lesions are included in a separate group. Lesions containing lymphocytic infiltrates include superficial and deep erythema annulare centrifugum and the differential diagnosis includes a large number of conditions. In the neutrophilic-eosinophilic class, we include annular psoriasis, vasculitis, linear immunoglobulin A dermatosis, eosinophilic dermatitis, erythema marginatum rheumatica, and annular erythema of infancy. Sarcoidosis and granuloma annulare are the prototypical annular lesions containing granulomas. Secondary syphilis is typical of lesions containing plasma cells. Mycosis fungoides is the principal skin tumor that may initially manifest with annular lesions.

A Lipschütz ulcer or 'ulcus vulvae acutum' is an acute simple ulceration of the vulva or vagina of non-venereal origin which can be associated with lymphadenopathy. Three cases are described with accompanying clinical photographs. Two cases refer to adolescents, one an infant, all without any history of sexual contact. The cases serve to illustrate a little known but potentially important differential diagnosis of vulval ulceration.

Background: Sentinel lymph node biopsy is the most important tool available for node staging in patients with melanoma. Objectives: To analyze sentinel lymph node detection and dissection with radio guidance from a portable gamma camera. To assess the number of complications attributable to this biopsy technique. Methods: Prospective observational study of a consecutive series of patients undergoing radioguided sentinel lymph node biopsy. We analyzed agreement between nodes detected by presurgical lymphography, those detected by the gamma camera, and those finally dissected. Results: A total of 29 patients (17 women [62.5%] and 12 men [37.5%]) were enrolled. The mean age was 52.6 years (range, 26-82 years). The sentinel node was dissected from all patients; secondary nodes were dissected from some. In 16 cases (55.2%), there was agreement between the number of nodes detected by lymphography, those detected by the gamma camera, and those finally dissected. The only complications observed were seromas (3.64%). No cases of wound dehiscence, infection, hematoma, or hemorrhage were observed. Conclusions: Portable gamma-camera radio guidance may be of use in improving the detection and dissection of sentinel lymph nodes and may also reduce complications. These goals are essential in a procedure whose purpose is melanoma staging.