When detected and treated early, melanoma has an excellent prognosis. Unfortunately, as the tumor invades deeper into tissue the risk of metastatic spread to regional lymph nodes and beyond increases and the prognosis worsens significantly. Therefore, accurately detecting any regional lymphatic metastasis would significantly aid in determining a patient’s prognosis and help guide his or her treatment plan. In 1991, Don Morton and colleagues presented new paradigm in diagnosing regional lymphatic involvement of tumors termed sentinel lymph node biopsy (SLNB). By mapping the regional lymph system around a tumor and tracing the lymphatic flow, a determination of the most likely lymph node or nodes the cancer will spread to first is made. Then, a limited biopsy of the most likely nodes is performed rather than a more-invasive removal of the entire local lymphatic chain. In 20 years that have followed, a great deal of information has been gained as to its accuracy, prognostic value, appropriate candidates, and its impact on regional disease control and survival. The SLNB has been shown to accurately stage regional lymph node basins in stage I and II melanoma patients with minimal morbidity. More sensitive histologic techniques are now being applied that may allow even greater accuracy in the staging of melanoma patients. Although specific percent risk thresholds are still in question, recommendation for SLNB when melanomas are 1 mm or thicker has gained wide acceptance. SLNB may also be appropriate for patients with melanomas that are between 0.76 and 1 mm thick and have ulceration, high mitotic rates, or reach a Clark level IV. Therefore, melanomas with IB or greater staging should be considered for SLNB.
Semin Cutan Med Surg 29:238-248 © 2010 Published by Elsevier Inc.
Confocal microscopy is a new imaging modality for noninvasive real-time tissue imaging
with high resolution and contrast comparable with conventional histology. Application of
this technology to skin imaging during the last decade has been an exciting advance in
dermatology, allowing a virtual widow into living skin without the need for a conventional
biopsy or histologic processing of tissue. High-resolution noninvasive skin imaging with
confocal microscopy has potential broad applications in the clinical and research arenas,
including differentiating between benign and malignant skin lesions, tumor margin mapping,
monitoring response to medical or surgical treatments, and pathophysiologic study of
Semin Cutan Med Surg 27:37-43 © 2008 Elsevier Inc. All rights reserved.
The unique properties of hair in those patients of African descent allow a limitless range of
hair-care options. For the clinician, a general understanding of hair-care practices is an
important aid in the diagnosis and treatment of hair shaft and scalp disorders. This review
highlights common hair-care practices in women, men, and children of color. Cleansing,
moisturizing, and styling techniques are discussed, as well as potential complications
associated with their use.
Semin Cutan Med Surg 28:103-108 © 2009 Elsevier Inc. All rights reserved.
During the past 3 decades, the incidence, morbidity, and mortality of malignant melanoma have increased dramatically. Advanced melanoma has remained a disease that is for the most part incurable and has challenged all therapeutic efforts to make a dent in its natural history. Recent advances in the understanding of the molecular alterations in melanoma and in the immunologic mechanisms playing a role in this malignancy have brought hope that significant progress can be achieved, as evidenced by early encouraging clinical data. This review will summarize these recent developments and their impact on current clinical practice.
Semin Cutan Med Surg 29:249-257 © 2010 Elsevier Inc. All rights reserved.
As a noninvasive diagnostic method, real-time B-mode sonography belongs to the diagnostic
standard procedures in various fields of clinical medicine, for example, internal
medicine, gynecology, and otorhinolaryngology. During the past 3 decades, ultrasound
technology has been extended to clinical dermatology. High-frequency ultrasound systems
with 20- to 50-MHz probes are used for the assessment of tumoral and inflammatory
processes of the skin, providing information about their axial and lateral extension. They are
of special interest in preoperative situations and for the monitoring of skin conditions under
therapy. In contrast to high-frequency ultrasound systems, the value of ultrasound technology
with the use of 7.5- to 15-MHz probes generally is not accepted worldwide, although
it can be used easily and without significant side effects. Promising results have been
reported from specialized diagnostic centers, especially for the assessment of peripheral
lymph nodes and soft-tissue tumors. Although it is unable to provide malignancy specific
information, ultrasound is nonetheless helpful in the follow-up of patients undergoing, for
example, chemotherapy or radiotherapy. The 3-dimensional size and outline of a tumor as
well as its relation to surrounding structures like vessels can be described. Moreover,
information about the tumor quality (solid, cyst, complex) and the inner structure of a tumor
(hypoechoic, hyperechoic, homogenous, inhomogenous, calcification foci, necroses) can
be provided. In addition to conventional B-mode-sonography, newer ultrasound techniques
like native and signal-enhanced color Doppler sonography as well as ultrasound-guided
fine needle aspiration cytology are reviewed.
Semin Cutan Med Surg 27:44-51 © 2008 Elsevier Inc. All rights reserved.