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Prophylactic excision of nevocellular nevi
Volume 7 Number 3 September, 1982
Correspondence
409
REFERENCES 1. Golden SM, Merenstein GB, Todd WA, Hill J: Disseminated herpes simplex neonatorum: A complication of fetal monitoring. Am J Obstet Gyneco! 129:917-918, 1977. 2. Kaye EM, Dooling EC: Neonatal herpes simplex (type 2) meningoencephalitis in two term infants with fetal monitor scalp electrodes. Neurology 29:542, 1979. (Abst.) 3. Parvey LS, Ch'ien T: Neonatal herpes simplex virus infection introduced by fetal-monitor scalp electrodes. Pediatrics 65:1150-1153, 1980. 4. Adams G, Purohit DM, Bada HS, Andrews BF: Neonatal infection by herpes virus hominis type 2. A complication of intrapartum fetal monitoring. Pediatr Res 9:337, 1975. (Abst.) 5. Mortimer AM, Fulginiti VA, Brunell PA, et al: Perinatal herpes simplex virus infections. Pediatrics 66:147-149, 1980.
Prophylactic excision of nevocellular nevi To the Editor:
Fig. 3. Grouped vesicles of herpes simplex type II at the site of electrodes implantation. treated for 10 days with antibiotics. On the fifth day of her life, the infant was noted to have a vesicular eruption beginning at the site of the fetal scalp monitor (Fig. 3). Culture of vesicular fluid revealed herpes simplex type II. Repeat spinal tap and culture of eerebrospinal fluid showed no evidence of disseminated herpetic infection. Adenine arabinoside, 30 mg/kg/day, was administered intravenously for a total of 9 days. Viral cultures were negative on day 6 of therapy. The lesions crusted and healed without further incident. The child has continued to develop normally to date. Discussion. Inoculation of herpes simplex by electrodes is a risk of fetal scalp monitoring. The infection may become symptomatic anytime during the first month of life. ~ It is important for dermatologists to be aware of the technic of fetal scalp monitoring and the risk of fetal herpetic infection because we are often consulted in cases of maternal and neonatal infection.
Marshall A. Guill, M.D. Lieutenant-Colonel, MC, USA James K. Aton, M.D. Colonel, MC, USA Fort Gordon, GA 30905 Rhonda B. Rogers, M.D. Department of Dermatology Medical College of Georgia Augusta, GA 30912
Rhodes and associates, in their article entitled "The Malignant Potential of Small Congenital Nevocellular Nevi" (J AM ACAD D~rMATOL 6:230-241, 1982), determined that 8.1% of melanoma specimens in their series contained histologic features of congenital nevi. They conclude that "small congenital nevi may be precursors for at least some cases of cutaneous melanoma and ought to be considered for prophylactic excision." After the authors have considered a lesion for prophylactic excision, what is their recommendation? Are they suggesting that all small congenital nevocellular nevi be excised prophylactically; if not all, which ones and why those in particular? It seems as if Dr. Rhodes and his Boston colleagues have made a commendable effort to establish the malignant potential of small congenital nevi. However, their curiously ambiguous recommendation leads me to believe that they may have serious reservations about the clinical implications of their own findings.
David N. Silvers, M.D. Associate Clinical Professor of Dermatology and Dermatopathology Director, Section of Pathology College of Physicians and Surgeons of Columbia University 630 West 168th St. New York, NY 10032 Reply To the Editor: We thank Dr. Silvers for his comments and will try to address his criticism about our therapeutic rec-
Correspondence
409
REFERENCES 1. Golden SM, Merenstein GB, Todd WA, Hill J: Disseminated herpes simplex neonatorum: A complication of fetal monitoring. Am J Obstet Gyneco! 129:917-918, 1977. 2. Kaye EM, Dooling EC: Neonatal herpes simplex (type 2) meningoencephalitis in two term infants with fetal monitor scalp electrodes. Neurology 29:542, 1979. (Abst.) 3. Parvey LS, Ch'ien T: Neonatal herpes simplex virus infection introduced by fetal-monitor scalp electrodes. Pediatrics 65:1150-1153, 1980. 4. Adams G, Purohit DM, Bada HS, Andrews BF: Neonatal infection by herpes virus hominis type 2. A complication of intrapartum fetal monitoring. Pediatr Res 9:337, 1975. (Abst.) 5. Mortimer AM, Fulginiti VA, Brunell PA, et al: Perinatal herpes simplex virus infections. Pediatrics 66:147-149, 1980.
Prophylactic excision of nevocellular nevi To the Editor:
Fig. 3. Grouped vesicles of herpes simplex type II at the site of electrodes implantation. treated for 10 days with antibiotics. On the fifth day of her life, the infant was noted to have a vesicular eruption beginning at the site of the fetal scalp monitor (Fig. 3). Culture of vesicular fluid revealed herpes simplex type II. Repeat spinal tap and culture of eerebrospinal fluid showed no evidence of disseminated herpetic infection. Adenine arabinoside, 30 mg/kg/day, was administered intravenously for a total of 9 days. Viral cultures were negative on day 6 of therapy. The lesions crusted and healed without further incident. The child has continued to develop normally to date. Discussion. Inoculation of herpes simplex by electrodes is a risk of fetal scalp monitoring. The infection may become symptomatic anytime during the first month of life. ~ It is important for dermatologists to be aware of the technic of fetal scalp monitoring and the risk of fetal herpetic infection because we are often consulted in cases of maternal and neonatal infection.
Marshall A. Guill, M.D. Lieutenant-Colonel, MC, USA James K. Aton, M.D. Colonel, MC, USA Fort Gordon, GA 30905 Rhonda B. Rogers, M.D. Department of Dermatology Medical College of Georgia Augusta, GA 30912
Rhodes and associates, in their article entitled "The Malignant Potential of Small Congenital Nevocellular Nevi" (J AM ACAD D~rMATOL 6:230-241, 1982), determined that 8.1% of melanoma specimens in their series contained histologic features of congenital nevi. They conclude that "small congenital nevi may be precursors for at least some cases of cutaneous melanoma and ought to be considered for prophylactic excision." After the authors have considered a lesion for prophylactic excision, what is their recommendation? Are they suggesting that all small congenital nevocellular nevi be excised prophylactically; if not all, which ones and why those in particular? It seems as if Dr. Rhodes and his Boston colleagues have made a commendable effort to establish the malignant potential of small congenital nevi. However, their curiously ambiguous recommendation leads me to believe that they may have serious reservations about the clinical implications of their own findings.
David N. Silvers, M.D. Associate Clinical Professor of Dermatology and Dermatopathology Director, Section of Pathology College of Physicians and Surgeons of Columbia University 630 West 168th St. New York, NY 10032 Reply To the Editor: We thank Dr. Silvers for his comments and will try to address his criticism about our therapeutic rec-