The National Cancer Institute's "Melanoma Action Plan" calls for reduction of melanoma mortality through early detection. Routine skin self-examination (SSE) has the potential to increase chances of early detection and treatment and may be the key to melanoma survival. We provide a focused review of the accuracy of SSE for detecting premalignant lesions and cutaneous risk factors for melanoma, with suggestions for future directions for enhancing measurement of SSE accuracy and ways in which to improve the public's perceptions of melanoma efficacy. We examined published data on the efficacy of skin self-examination for the early detection of melanoma. We searched the MEDLINE database for publications between January 1, 1987 and June 1, 2007 using search terms for "melanoma" and "self-examination." We found that sensitivity of skin self-examination is low, ranging from 25% to 93%, while specificity is generally higher (83% to 97%). Attempts to increase improve the lay public's perceptions of the early signs of melanoma have proved effective, while those aimed at increasing accuracy of SSE with targeted interventions have been moderately successful. SSE's insensitivity for detection of pigmented lesions should prompt further investigation of educational interventions to enhance its accuracy and lead to its adoption as a cheap, simple screening tool. Assessment of the accuracy and efficacy of SSE should proceed using standardized definitions and measurements such that it is easier to pool data on the overall value of SSE as a screening modality.

Acquired reactive perforating collagenosis (ARPC) is an uncommon dermatosis characterized by transepidermal elimination of altered collagen. It is commonly seen in patients with diabetes mellitus and/or chronic renal insufficiency. Rarely, it has been reported in association with malignancy and other conditions. We report a 30-year-old woman with insulin-dependent diabetes mellitus who presented with multiple, discrete, violaceous, hyperkeratotic papules on the extensor aspects of both legs, characteristic of ARPC. Four months later, metastatic papillary thyroid cancer was diagnosed. This case further supports the possibility that ARPC may represent a paraneoplastic phenomenon.

There are a variety of conditions that manifest not only in bone but also in skin. Bone and skin structures can share common embryologic origins, and genetic defects that occur early in cell differentiation may lead to disease in both organ systems. Alternatively, diseases of bone and skin may be caused by defects in genes that participate in directing or controlling both systems. Many diseases of bone and skin can manifest with atypical radiologic findings or mimic malignant bone lesions. Upon encountering such a disease process, a radiologist who is familiar with both aspects of the disorder and consequently looks for associated skin findings can greatly benefit the patient by making a definitive diagnosis. Similarly, a clinician who encounters suggestive skin lesions should be prompted to look for concomitant skeletal lesions. By synthesizing knowledge of bone and skin manifestations, radiologists and clinicians can help correctly diagnose a number of these disease processes, thereby helping patients avoid further, often nonspecific invasive workup and advancing patient care.

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