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• Compared with the antipsoriatic retinoid etretinate, the new aromatic retinoid acitretin represents an important advance due to its rapid elimination kinetics. Since in psoriasis vulgaris retinoids are used predominantly in combination regimens, we investigated the therapeutic efficacy of acitretin and UV-B compared with placebo and UV-B in a double-blind, randomized multicenter trial in 82 patients with severe psoriasis. They were treated with 35 mg of the study medication during the first 4 weeks of therapy and 25 mg thereafter, concomitantly with UV-B irradiation in increasing energy doses. Forty patients who underwent therapy with acitretin and UV-B and 38 patients who underwent therapy with placebo and UV-B were evaluated for efficacy. The target variables—psoriasis severity index and total UV-B dose—were reported at intervals of 2 weeks over a maximum period of 8 weeks. At the end of treatment, the psoriasis severity index decrease was 79% in the acitretin and UV-B group and 35% in the placebo and UV-B group. The response rate, defined as greater than or equal to a 75% decrease of the psoriasis severity index, was 60% for the combination treatment and only 24% for the control treatment. This treatment response was achieved with markedly lower cumulative UV-B energy. The median cumulative UV-B energy applied to reach 75% clinical improvement was 11.8 J/cm 2 vs 6.9 J/ cm 2 . Side effects showed a similar pattern in both groups. Our data show that the acitretin dramatically improves the results of UV-B treatment in patients with severe psoriasis. In addition, it markedly decreases the effective cumulative UV-B dose, thereby reducing the potential long-term hazards of UV irradiation. We conclude that the acitretin plus UV-B combination treatment represents a highly effective therapeutic regimen in severe psoriasis. ( Arch Dermatol . 1990;126:482-486)

• Series of "private" photographs taken of patients over many years can greatly aid in following the course of development of malignant melanomas. In one case of superficial spreading melanoma, the pigmented lesion displayed spread around the entire circumference, maintaining its round shape throughout its course. The other tumors enlarged by focused spreading at various points along the border, changing in shape over several years of development. The temporary appearance of two closely adjacent pigmented lesions frequently occurred during the early development of malignant melanomas, followed by fusion after progressive spread. Lentigo maligna melanoma showed the greatest continuous alteration of shape. Different tumor types observed over similar periods of time showed different dynamics of growth with reference to shape (horizontal spreading growth) and depth of invasion (vertical growth). (Arch Dermatol116:182-185, 1980)

• Fifty-two congenital melanocytic nevi (CMN) as precursors to melanoma or severe melanocytic dysplasia were reviewed macroscopically and microscopically. Forty-eight "small" CMN measured less than 10 cm in diameter. Histologically, only five reached to the lower third of the dermis or subcutis ("deep type"); the remaining 47 were limited to the upper two thirds of the corium ("superficial type"). There were 47 invasive melanomas, two in situ melanomas, and three severe focal melanocytic dysplasias. All melanomas were of "epidermal" origin and primarily of the superficial spreading type. The age at diagnosis ranged from 18 to 79 years. Prepubertal melanomas were not observed. Melanoma may also arise on small CMN. The most frequent origin of the melanomas in small CMN and the preferred age at manifestation seem to be different from that for giant nevi. ( Arch Dermatol 1985;121:1274-1281)