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Nonmelanoma skin cancer associated with use of a tanning bed
Journal of the American Academy of Dermatology Volume 34, Number 3
Mycobacterium chelonae (M. chelonae subspecies chelonae): report of a patient with a sporotrichoid presentation who was successfully treated with clarithromycin and ciprofloxacin Zahid M A , Klotz SA, Goldstein E, et al. Clin Infect Dis 1994;18:999-1001. A 70-year-old man with obstructive pulmonary disease noticed sporotrichoid papules and vesicles on his left forearm 1 month after fishing in Florida. A biopsy specimen revealed granttloma, and tissue culture yielded Mycobacterium chelonae, a fast-growing nontuberculous mycobacteria. Treatment with clarithromycin, 500 mg twice daily, and ciprofloxacin, 750 mg twice daily, was curative within 6 weeks and without relapse at 6 months after discontinuation of treatment.
Pearls of wisdom
501
The role of arsenic in internal malignancy has been debated for years. This study examined a population known to have been exposed to arsenic-contaminated well water from 1955 through 1959. There were excessive cancer deaths in both sexes, but only when arsenic exposure was greater than 1 ppm. Although most patients in whom internal malignancy developed had skin signs of chronic arsenism, this was not universally tree. A new and important finding was that there is synergism between ingested arsenic exposure and smoking in the development of lung cancer. COMMENT: This study was well done. It is the first study to show a correlation between cigarette smoking, arsenic exposure, and ltmg cancer.
Mary E. Maloney, MD
COMMENT:A sporotrichoid pattern of infection is rare with
M. chelonae, a rapidly growing nontuberculous mycobacteria, which, like its biovariant, M. fortuitum, typically causes injection abscesses and soft-tissue infections. Organisms are typically resistant to antituberculous drugs, but may be sensitive to a variety of antibiotics (e.g., amikacin and cefoxitin). Clarithromycin, a new macrolide erythromycin, continues to show promise as an effective agent for such mycobacterial infections.
Kenneth J. Tomecki, MD
Delayed systemic reactions to corticosteroids W h i t m o r e SE. Contact Dermatitis 1995;32:193-8. This literature review summarizes the reported cases of generalized delayed skin reactions to corticosteroids administered by systemic, intraartieular, or intradermal routes. In 16 of 24 reported cases, positive patch tests or intradermal tests supported the diagnosis. Most reactions occurred 1 to 3 days after administration, and the eruptions ranged from facial edema or urticarial patterns to papulovesicular or exanthematous types. Because corticosteroids remain a mainstay of dermatologic therapy, we should be suspicious that a rare patient whose condition fails to improve or, indeed, worsens after cortieosteroid administration could have a delayed reaction to the corticosteroid itself.
Elizabeth F. Sherertz, MD
Ingested arsenic and internal cancer: a historical cohort study followed for 33 years Tsuda T, Babazono A, Y a m a m o t o E, et al. A m J Epidemiol 1995;141:198-209.
S u n l i g h t - - C a n it prevent as well as cause cancer? Studzinski G, M o o r e DC. Cancer Res 1995 ;55:401422. Solar deprivation with reduced circulating levels of vitanfin D3 may lead to increased incidence of cancer of the breast, colon, and prostate. Anlineoplastic and chemopreventive effects of this vitamin and its derivatives have been documented in human beings and animals. Heavily pigmented people moving from Africa to northern latitudes and exposed to diminished sunlight may have a deficit of UV light exposure. Recent findings of more aggressive behavior of prostate and breast cancer in black rather than in white Americans may be explained on this basis. Although more data are needed, one should consider that moderate sunlight exposure may be beneficial. COMMF~: This provocative theory and its corollary in favor of moderate solar exposure for every American should not be overlooked.
Robert A. Schwartz, AID, MPH
N o n m e l a n o m a skin cancer associated with use of a tanning bed L e v e r LR, Lawrence CM. N Engl J M e d 1995; 332:1450-1. A 43-year-old woman with minimal exposure to natural sunlight and no noted risk factors for skin cancer had multiple skin cancers after 3 years of twice-weekly tan-
Journal of the American Academy of Dermatology March 1996
502 Pearls of wisdom ning bed usage. The tanning bed used contained less than 1% UVB. COMMENT: This case is unique because of the minimal exposure to natural light throughout this woman's life. The UVA tanning bed is strongly implicated in the development of her skin cancer.
matched for major prognostic factors. In patients with intermediate-thickness melanoma treated with ELND, there was no significant improvement in survival; the risk of nodal metastases was not relatively more common than that of distant metastases.
Elizabeth A. Abel, MD
Jeffrey P. CalIen, MD
The Rieger flap for nasal reconstruction Surgical management of regional lymph nodes in patients with melanoma: experience with 4682 patients Slingluff CL, Stidham KR, Ricci WM, et al. Ann Surg 1994;219:120. Elective lymph node dissection (ELND) was performed in 911 of 3550 patients with melanoma who had clinically negative lymph nodes. The incidence of pathologically positive nodes in the five melanoma thickness groups was: 0 (tumor thickness, 0.76 ram), 5% (0.76 to 1.5 mm), 16% (1.5 to 2.5 mm), 24% (2.5 to 4.0 mm), and 36% (>4 ram). Patients with clinically negative nodes treated with and without ELND were compared and
Johnson TM, N A Swanson NA, Baker SR, et al. Arch Otolaryngol Head Neck Surg 1995;121:634-7. Reconstruction of the nose has well-known complications, including contouring, color and consistency match, texture, cosmetic deformity, and function. The authors succinctly outline the uses of this flap and the surgical techniques to get the best results. COMME~: This excellent article expands the uses of this flap in nasal reconstruction and should contribute significantly to cosmetic surgical repah's.
Mary E. Maloney, MD
IOTADERMA No. 26. In Halzoun syndrome, what parasite migrates to the nasopharynx, produces large adults that block the airways, and causes deafness and facial edema?
Jeffrey D. Bernhard, MD Answer will appear in the April issue of the Jotma'4AL.
ANSWER TO IOTADERMA NO. 25: Morton's neuroma. (Question: In what condition can pain and paresthesias of the forefoot that occur during standing or walking be relieved by sitting and taking off the shoes?) REFERENCE Wiener SL. Differentialdiagnosis of acute pain by body region. New York: McGraw-Hill, 1993:694-5.
Mycobacterium chelonae (M. chelonae subspecies chelonae): report of a patient with a sporotrichoid presentation who was successfully treated with clarithromycin and ciprofloxacin Zahid M A , Klotz SA, Goldstein E, et al. Clin Infect Dis 1994;18:999-1001. A 70-year-old man with obstructive pulmonary disease noticed sporotrichoid papules and vesicles on his left forearm 1 month after fishing in Florida. A biopsy specimen revealed granttloma, and tissue culture yielded Mycobacterium chelonae, a fast-growing nontuberculous mycobacteria. Treatment with clarithromycin, 500 mg twice daily, and ciprofloxacin, 750 mg twice daily, was curative within 6 weeks and without relapse at 6 months after discontinuation of treatment.
Pearls of wisdom
501
The role of arsenic in internal malignancy has been debated for years. This study examined a population known to have been exposed to arsenic-contaminated well water from 1955 through 1959. There were excessive cancer deaths in both sexes, but only when arsenic exposure was greater than 1 ppm. Although most patients in whom internal malignancy developed had skin signs of chronic arsenism, this was not universally tree. A new and important finding was that there is synergism between ingested arsenic exposure and smoking in the development of lung cancer. COMMENT: This study was well done. It is the first study to show a correlation between cigarette smoking, arsenic exposure, and ltmg cancer.
Mary E. Maloney, MD
COMMENT:A sporotrichoid pattern of infection is rare with
M. chelonae, a rapidly growing nontuberculous mycobacteria, which, like its biovariant, M. fortuitum, typically causes injection abscesses and soft-tissue infections. Organisms are typically resistant to antituberculous drugs, but may be sensitive to a variety of antibiotics (e.g., amikacin and cefoxitin). Clarithromycin, a new macrolide erythromycin, continues to show promise as an effective agent for such mycobacterial infections.
Kenneth J. Tomecki, MD
Delayed systemic reactions to corticosteroids W h i t m o r e SE. Contact Dermatitis 1995;32:193-8. This literature review summarizes the reported cases of generalized delayed skin reactions to corticosteroids administered by systemic, intraartieular, or intradermal routes. In 16 of 24 reported cases, positive patch tests or intradermal tests supported the diagnosis. Most reactions occurred 1 to 3 days after administration, and the eruptions ranged from facial edema or urticarial patterns to papulovesicular or exanthematous types. Because corticosteroids remain a mainstay of dermatologic therapy, we should be suspicious that a rare patient whose condition fails to improve or, indeed, worsens after cortieosteroid administration could have a delayed reaction to the corticosteroid itself.
Elizabeth F. Sherertz, MD
Ingested arsenic and internal cancer: a historical cohort study followed for 33 years Tsuda T, Babazono A, Y a m a m o t o E, et al. A m J Epidemiol 1995;141:198-209.
S u n l i g h t - - C a n it prevent as well as cause cancer? Studzinski G, M o o r e DC. Cancer Res 1995 ;55:401422. Solar deprivation with reduced circulating levels of vitanfin D3 may lead to increased incidence of cancer of the breast, colon, and prostate. Anlineoplastic and chemopreventive effects of this vitamin and its derivatives have been documented in human beings and animals. Heavily pigmented people moving from Africa to northern latitudes and exposed to diminished sunlight may have a deficit of UV light exposure. Recent findings of more aggressive behavior of prostate and breast cancer in black rather than in white Americans may be explained on this basis. Although more data are needed, one should consider that moderate sunlight exposure may be beneficial. COMMF~: This provocative theory and its corollary in favor of moderate solar exposure for every American should not be overlooked.
Robert A. Schwartz, AID, MPH
N o n m e l a n o m a skin cancer associated with use of a tanning bed L e v e r LR, Lawrence CM. N Engl J M e d 1995; 332:1450-1. A 43-year-old woman with minimal exposure to natural sunlight and no noted risk factors for skin cancer had multiple skin cancers after 3 years of twice-weekly tan-
Journal of the American Academy of Dermatology March 1996
502 Pearls of wisdom ning bed usage. The tanning bed used contained less than 1% UVB. COMMENT: This case is unique because of the minimal exposure to natural light throughout this woman's life. The UVA tanning bed is strongly implicated in the development of her skin cancer.
matched for major prognostic factors. In patients with intermediate-thickness melanoma treated with ELND, there was no significant improvement in survival; the risk of nodal metastases was not relatively more common than that of distant metastases.
Elizabeth A. Abel, MD
Jeffrey P. CalIen, MD
The Rieger flap for nasal reconstruction Surgical management of regional lymph nodes in patients with melanoma: experience with 4682 patients Slingluff CL, Stidham KR, Ricci WM, et al. Ann Surg 1994;219:120. Elective lymph node dissection (ELND) was performed in 911 of 3550 patients with melanoma who had clinically negative lymph nodes. The incidence of pathologically positive nodes in the five melanoma thickness groups was: 0 (tumor thickness, 0.76 ram), 5% (0.76 to 1.5 mm), 16% (1.5 to 2.5 mm), 24% (2.5 to 4.0 mm), and 36% (>4 ram). Patients with clinically negative nodes treated with and without ELND were compared and
Johnson TM, N A Swanson NA, Baker SR, et al. Arch Otolaryngol Head Neck Surg 1995;121:634-7. Reconstruction of the nose has well-known complications, including contouring, color and consistency match, texture, cosmetic deformity, and function. The authors succinctly outline the uses of this flap and the surgical techniques to get the best results. COMME~: This excellent article expands the uses of this flap in nasal reconstruction and should contribute significantly to cosmetic surgical repah's.
Mary E. Maloney, MD
IOTADERMA No. 26. In Halzoun syndrome, what parasite migrates to the nasopharynx, produces large adults that block the airways, and causes deafness and facial edema?
Jeffrey D. Bernhard, MD Answer will appear in the April issue of the Jotma'4AL.
ANSWER TO IOTADERMA NO. 25: Morton's neuroma. (Question: In what condition can pain and paresthesias of the forefoot that occur during standing or walking be relieved by sitting and taking off the shoes?) REFERENCE Wiener SL. Differentialdiagnosis of acute pain by body region. New York: McGraw-Hill, 1993:694-5.