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Given the precipitous rise in its incidence in recent decades, skin cancer has been recognized as a growing epidemic. We explore the sociological underpinnings of this epidemic, including: (1) aging of the demographic; (2) human ecologic factors (residing in areas with high ambient ultraviolet levels and a depleted ozone layer); (3) large-scale European migration to more equatorial latitudes; (4) social structures that for centuries minimized miscegenation and maximized segregation; (5) gender-based differences in sunbathing, tanning, sunscreen use, and clothing choice; (6) occupational ultraviolet exposure; (7) the complex interplay of socioeconomic status, race, and urbanization on skin cancer incidence and mortality; (8) the effects of war on skin cancer incidence; (9) cultural shifts in clothing, travel, outdoor sports, recreation, and attitudes towards being tan; and (10) the indirect effects of religion. We show that without these sociological factors, the most common type of cancer would not be nearly as common.

Background The importance of adequate ultraviolet A light (UVA) protection has become apparent in recent years. The United States and Europe have different standards for assessing UVA protection in sunscreen products. Objective We sought to measure the in vitro critical wavelength (CW) and UVA protection factor (PF) of commercially available US sunscreen products and see if they meet standards set by the United States and the European Union. Methods Twenty sunscreen products with sun protection factors ranging from 15 to 100+ were analyzed. Two in vitro UVA protection tests were conducted in accordance with the 2011 US Food and Drug Administration final rule and the 2012 International Organization for Standardization method for sunscreen effectiveness testing. Results The CW of the tested sunscreens ranged from 367 to 382 nm, and the UVA PF of the products ranged from 6.1 to 32. Nineteen of 20 sunscreens (95%) met the US requirement of CW >370 nm. Eleven of 20 sunscreens (55%) met the EU desired ratio of UVA PF/SPF > 1:3. Limitations The study only evaluated a small number of sunscreen products. Conclusion The majority of tested sunscreens offered adequate UVA protection according to US Food and Drug Administration guidelines for broad-spectrum status, but almost half of the sunscreens tested did not pass standards set in the European Union.

Background Sunscreens are known to protect from sun damage; however, their effects on the reversal of photodamage have been minimally investigated. Objective The aim of the prospective study was to evaluate the efficacy of a facial sun protection factor (SPF) 30 formulation for the improvement of photodamage during a 1-year use. Methods Thirty-two subjects applied a broad spectrum photostable sunscreen (SPF 30) for 52 weeks to the entire face. Assessments were conducted through dermatologist evaluations and subjects' self-assessment at baseline and then at Weeks 12, 24, 36, and 52. Results Clinical evaluations showed that all photoaging parameters improved significantly from baseline as early as Week 12 and the amelioration continued until Week 52. Skin texture, clarity, and mottled and discrete pigmentation were the most improved parameters by the end of the study (40% to 52% improvement from baseline), with 100% of subjects showing improvement in skin clarity and texture. Conclusion The daily use of a facial broad-spectrum photostable sunscreen may visibly reverse the signs of existing photodamage, in addition to preventing additional sun damage.

Endometrial cancer is one of the most common gynecological neoplasms in the United States. It is divided into type I and type II carcinomas based on histological features. The mixed endometrioid (type I) and serous (type II) adenocarcinomas of endometrium were reported in previous studies. The concurrence of their precursor lesions was not studied. In current study, we present five cases with concurrent precursor lesions of endometrioid (endometrial hyperplasia) and serous adenocarcinomas (endometrial intraepithelial carcinoma and p53 signature). Due to the potential progressive clinical outcome of precursor lesions of serous adenocarcinoma, caution needs to be performed to identify endometrial intraepithelial carcinoma and p53 signature in the background of endometrial hyperplasia.

Ultraviolet radiation plays a major role in the development of nonmelanoma and melanoma skin cancers. Photoprotection by sunscreens has been shown to prevent the development of actinic keratosis, squamous cell carcinoma, melanoma, and photoaging. However, these benefits are only derived if the users apply sunscreen appropriately and practice other sun protection measures. This review discusses the health benefits provided by sunscreen use, updates the latest regulatory landscape on sunscreen, and addresses the controversies and limitations associated with sunscreen use.

Ultraviolet radiation (UVR) has known adverse effects on the skin and eyes. Practitioners are becoming more aware of the importance of outdoor photoprotection. However, little attention is directed to the exposure of the skin and eyes to UVR through the window glass or sunglasses. The amount of ultraviolet transmission through glass depends mainly on the type of the glass. All types of commercial and automobile glass block the majority of ultraviolet-B; however, the degree of ultraviolet-A transmission depends on the type of glass. Laminated glass offers better UVA protection than tempered glass; new safety regulations for automobiles may result in increased use of laminated glass for side windows. Window films can be applied to glass to increase UVR protection. Sunglasses need to be compliant with one of the national standards; a wraparound style or side shields offer the best protection. Increased understanding by practitioners on the transmission of UVR through glass, window films, and sunglasses would allow them to better educate the public and to better manage photosensitive patients.

Objectives: The purpose of this study was to describe the rate of medication short-term supply dispensings (tider), patient and medication characteristics associated with a tider, and costs for tider dispensings in an integrated healthcare delivery system in Colorado, United States. Methods: This was a retrospective study conducted in an integrated healthcare delivery system’s outpatient clinics. All patients who had a prescription dispensed for a study medication at any of the system’s 28 outpatient pharmacies during the first quarter of 2016 were included. A tider was identified as a 3-day supply of a prescription medication that was dispensed at no charge to a patient. The quarterly tider rate and the per member per month (PMPM) cost of tiders were estimated. Patient and medication characteristics associated with a tider were assessed. Results: A total of 444,225 study medications were dispensed for 135,907 patients during the study period. There were 3,430 (0.77%, 95%CI 0.75%:0.80%) medications dispensed as a tider. The PMPM cost of tider medications and their dispensing fees was USD 0.03. There were 1,092 (0.8%) and 134,815 (99.2%) patients who did and did not, respectively, have at least one tider dispensed during the study period. Patient characteristics strongly associated with having had a tider dispensed included being older, male, and a Medicare beneficiary. Cardiovascular and neuromuscular medications had the highest rates of tider dispensing. Conclusions: The rate of tider dispensing was relatively low; however, approximately one out of 125 patients had at least one tider. Patients who had a tider were more likely to be older, female, a Medicare beneficiary, and having had a previous tider dispensing and a higher burden of chronic disease. The tider medication was more likely to be a cardiovascular or neuromuscular medication class and more likely to be dispensed on a weekend. The total cost of dispensing a tider appears reasonable since the benefits of providing patients with needed medications likely outweigh the cost. Future studies should be performed to assess the impact of tider dispensing on health outcomes.

Surgery is the treatment of choice for lentigo maligna (LM) and lentigo maligna melanoma (LMM). However, not all patients are good surgical candidates for reasons such as large lesion size, anatomically sensitive location, medical comorbidities, or patient preference. Non-surgical treatment options include topical imiquimod, topical retinoids, cryotherapy, elecrodessication and curettage, ablative CO2 laser, and radiation therapy. Off-label use of topical imiquimod for lentigo maligna type melanoma in situ has been reported in the literature since 2000 [1]. Studies are limited to small series with short follow up [1–5]. Two LM cases are presented to illustrate treatment challenges with topical imiquimod and variability of treatment response.

As use of digital breast tomosynthesis becomes increasingly widespread, new management challenges are inevitable because tomosynthesis may reveal suspicious lesions not visible at conventional two-dimensional (2D) full-field digital mammography. Architectural distortion is a mammographic finding associated with a high positive predictive value for malignancy. It is detected more frequently at tomosynthesis than at 2D digital mammography and may even be occult at conventional 2D imaging. Few studies have focused on tomosynthesis-detected architectural distortions to date, and optimal management of these distortions has yet to be well defined. Since implementing tomosynthesis at our institution in 2011, we have learned some practical ways to assess architectural distortion. Because distortions may be subtle, tomosynthesis localization tools plus improved visualization of adjacent landmarks are crucial elements in guiding mammographic identification of elusive distortions. These same tools can guide more focused ultrasonography (US) of the breast, which facilitates detection and permits US-guided tissue sampling. Some distortions may be sonographically occult, in which case magnetic resonance imaging may be a reasonable option, both to increase diagnostic confidence and to provide a means for image-guided biopsy. As an alternative, tomosynthesis-guided biopsy, conventional stereotactic biopsy (when possible), or tomosynthesis-guided needle localization may be used to achieve tissue diagnosis. Practical uses for tomosynthesis in evaluation of architectural distortion are highlighted, potential complications are identified, and a working algorithm for management of tomosynthesis-detected architectural distortion is proposed.

Summary Endogenous production and ultraviolet-generated free radicals in the skin can lead to photoaging and even skin cancer. Topical antioxidants have been found to provide benefits against ultraviolet damage and these ingredients have been incorporated into various cosmetic products and claimed to have substantial effects. Currently, there is a lack in a standardized rating system to measure the concentration and activity levels of antioxidants in these products. As a result, it is difficult for consumers and clinicians to evaluate and select commercial products based on readily accessible evidence. In this review, we will describe four assays which have been used to measure antioxidants in various products, and the strengths and weaknesses of each test will be detailed. We will highlight key considerations for clinicians when interpreting the results of antioxidant tests when evaluating commercial products containing antioxidants.

Adequate photoprotection plays a paramount role in reducing the burden of both photoaging and photocarcinogenesis. The scope of photoprotective strategies employed by the public, from most to least effective, includes: sun avoidance, seeking shade, the use of protective clothing, and the application of sunscreen. Among these options, sunscreen use remains the strategy most frequently employed by the public--a reversal of the preferred order of photoprotection. Given this trend, it is clear why sunscreens invariably take center stage in any discussion regarding obtaining adequate photoprotection.

Excessive exposure from ultraviolet (UV) radiation contributes to the development of skin cancers and photoaging. Topical sunscreen products remain one of the most widely used forms of protection for the majority of the public. The objective of this analysis was to examine photoprotection trends (e.g., SPF value) and the degree of UVA I protection from 1997 to 2009 in the United States. Sunscreen products purchased and evaluated in 1997 (N = 59), 2003 (N = 188) and again in 2009 (N = 330), totaling 577, were included in this analysis. Information regarding (1) the SPF value, (2) name and concentration of the active ingredients, (3) type of products (i.e., daily vs. recreational/beach), and (4) claims of UVA protection was recorded and analyzed. In addition, the critical wavelength (CW) of 330 products from 2009 was determined. The results showed an increase in the SPF values of products from 1997 to 2009. The percentage of low SPF products (SPF 4–14) decreased from 27% in 1997 to 6% in 2009. The number of products containing a known UVA-I filter (i.e., avobenzone or zinc oxide) increased from 5% in 1997 to 70% in 2009. Lastly, approximately, 225 (68%) of the products tested in 2009 attained CW > 370 nm. In the past decade, sunscreen products have undergone fundamental improvements, the most significant of which is the breadth of protection against UVA I.

ANPR: Advance Notice of Proposed Rulemaking CW: critical wavelength FDA: Food and Drug Administration MED: minimal erythema dose PPD: persistent pigment darkening SPF: sun protection factor TEA: Time and Extent Application INTRODUCTION On June 17, 2011, the US Food and Drug Administration (FDA) issued its long awaited final ruling on labeling and effectiveness testing of sunscreen products in the United States. At the same time, the FDA published 3 other documents: (1) a Draft Enforcement Guidance for Industry document, further explaining the final rule, (2) a Proposed Rule on sunscreens with sun protection factors (SPFs) greater than 50, seeking additional comments on its proposal to cap SPF at 501, and (3) an Advance Notice of Proposed Rulemaking (ANPR), requesting information about alternative dosage forms of sunscreen products (ie, sprays), and proposing that certain dosage forms (wipes, towelettes, powders, body washes, and shampoos) to be considered not eligible for review under the sunscreen monograph process. Only the final rule regarding labeling and testing of sunscreens has been approved, whereas the regulations and suggestions in the other 3 documents, hence the sunscreen monograph itself, have not been finalized. This announcement signals a recognition by the FDA of the clinical benefits of photoprotection, with sunscreens as one of the measures. Furthermore, it provides a much anticipated standard for testing and labeling UVA protection in sunscreens.

The availability of potent and broad-spectrum sunscreens can protect the skin from harmful effects induced by UV radiation. Aside from avoiding sunburn, modern-day sunscreen also has the potential to prevent skin cancer and slow photoaging, if it is used appropriately. This article traces through the evolution of sunscreens and highlights the clinical benefits, specifically in preventing skin cancers. Besides improved UV filter technology, development of UVA assessment methods and the regulatory standards are instrumental in the advancement of sunscreen efficacy. Lastly, compliance remains the most crucial factor for optimal sun protection. Sunscreen is often applied in too little amount, too late or not at all. Compliance may not improve if users do not change their behaviors and habits.

Background/purpose: Sunscreens are believed to be a valuable tool in providing photoprotection against the detrimental effects of UV radiation, a known carcinogen. However, a number of controversies have developed regarding their safety and efficacy. This review summarizes the relevant studies surrounding these controversies. Methods: Evidence of the prevention of skin cancer, an oft-cited reason for sunscreen use, was examined as it pertains to squamous cell carcinoma, basal cell carcinoma and melanoma. We also reviewed studies examining the effects of sunscreen on the synthesis of vitamin D, an essential nutrient whose role in health and disease continues to grow. Lastly, we analyzed studies surrounding the safety and toxicity of oxybenzone, retinyl palmitate and nanoparticles of zinc oxide (ZnO) and titanium dioxide (TiO2). Results: The overwhelming majority of available data is drawn from studies conducted using antiquated sunscreen formulations. Nonetheless, our research revealed that topical use of sunscreen protects against squamous cell carcinoma, does not cause vitamin D deficiency/insufficiency in practice and has not been demonstrated to adversely affect the health of humans. Conclusion: Given the established benefits of UV protection, the use of sunscreens remains an important part of an overall photoprotective strategy. Future sunscreens with improved formulation should ideally offer superior protection. With increased usage of sunscreen by the public, continuous and vigilant monitoring of the overall safety of future products is also needed.

The incidence of melanoma has increased during the last few years. Melanoma care and survival can be improved by early diagnosis, which can be facilitated by the use of noninvasive imaging modalities. Here we review 5 modalities available in clinical practice. Total body photography is used to follow patients at high risk for melanoma by detecting new lesions or subtle changes in existing lesions. Dermoscopy is an effective noninvasive technique for the early recognition of melanoma by allowing clinicians to visualize subsurface structures. Computer-assisted diagnostic devices are fully automated analysis systems with the capacity to classify lesions as benign or malignant with limited involvement from clinicians. Confocal scanning laser microscopy is an in vivo and noninvasive technology that examines the skin at a resolution comparable to that of histology. High-resolution ultrasound is an adjunct diagnostic aid mainly for the early detection of lymph node metastasis. Applications and limitations of each technology are discussed.

Background The importance of adequate ultraviolet A (UVA) protection has become apparent with improved understanding of the mechanism of UVA-induced damage to tissues. Currently in the United States, there is no regulation on testing and labeling of sunscreens for UVA protection. In August 2007, the Food and Drug Administration (FDA) addressed this issue in a proposed rule. Objectives We sought to assess in vitro the degree of UVA protection provided by 13 popular sunscreen products that are commercially available in the United States. Method Thirteen sunscreen products were purchased. UVA protection of each product was measured and assessed with 3 in vitro UVA labeling indices: (1) the FDA Proposed Amendment of Final Monograph, August 27, 2007; (2) European Commission Recommendation—the Colipa and critical wavelength methods; (3) and United Kingdom's Boots star rating system. Results Based on the new FDA-proposed guidelines, 8 products achieved the medium protection category, and 5 products achieved high protection. The latter 5 products also fulfilled the UVA protection based on the Colipa guideline desired by the European Commission Recommendation. Nine products achieved the desired critical wavelength value of 370 or higher. Based on the United Kingdom's Boots star rating system, 6 products achieved a rating of 3 stars, and the remaining 7 products achieved no star rating. Limitations The study only evaluated a small number of sunscreen products, and only in vitro methods were used to assess the degree of UVA protection. Conclusions The majority of the tested sunscreens in this study offered a medium degree of UVA protection. Compared with the sunscreens in the past, this study shows that UVA protection of sunscreens has improved. Sunscreens with avobenzone and octocrylene provided a higher degree of UVA protection. Globally, there is no uniform standard on testing and labeling sunscreens for UVA protection. In the United States, the FDA has just started to create a much-needed standard. This effort is necessary to educate the public better on how to choose products with adequate UVA protection

BACKGROUND Studies have demonstrated differences in colors and dermoscopic structures observed with polarized dermoscopes (PDs) and nonpolarized dermoscopes (NPDs). OBJECTIVE The objective was to evaluate whether diagnosis and diagnostic confidence changes when viewing dermoscopic images from NPDs and PDs. METHODS A total of 100 dermatologists participated in the study. Twenty-five pigmented lesions were shown in the study, consisting of 7 seborrheic keratoses (SK), 3 basal cell carcinomas, 2 atypical nevi, 5 malignant melanomas (MM), 3 dermatofibromas, 3 blue nevi, and 2 hemangiomas. Two images of each lesion (one NPD and one PD) were included. The McNemar test and paired t-test were used for the statistical analysis. RESULTS Ninety-one participants completed the study. Significant differences in the diagnoses were observed for the SK, atypical nevus, and MM images. Seventy-five percent and 59% of the final participants correctly diagnosed SK when presented with the NPD and PD images, respectively. For MM, 23 and 34% made the correct diagnoses with the NPD and PD images, respectively. CONCLUSIONS Viewing lesions with NPD versus PD can affect the diagnosis and diagnostic confidence of physicians that are novices with dermoscopy. Further studies including physicians at different expertise levels and a larger sample of lesions are needed to further explore the differences.

Cutaneous metastasis of prostatic adenocarcinoma is a rare phenomenon. We present a 56-year-old African American man with metastatic disease in the skin and subcutis of the suprapubic and scrotal area 2 years after his initial diagnosis presenting as scrotal and penile edema and plaque like scrotal rash. We also review the literature on this subject.

Photoaging refers to the long-term effects of ultraviolet radiation on chronically exposed skin.

Ultraviolet radiation is a major risk factor for the development of skin cancer, the most common form of cancer in the United States.

Ambient air pollution is a known public health hazard that negatively impacts non-cutaneous organs; however, our knowledge regarding the effects on skin remains limited. Current scientific evidence suggests there are four mechanisms by which ambient air pollutants cause adverse effects on skin health: (i) generation of free radicals, (ii) induction of inflammatory cascade and subsequent impairment of skin barrier, (iii) activation of the aryl hydrocarbon receptor (AhR) and (iv) alterations to skin microflora. In this review, we provide a comprehensive overview on ambient air pollutants and their relevant sources, and highlight current evidence of the effects on skin.

BACKGROUND Dermatofibroma (DF) is one of the most basic and common dermatologic diseases treated by practicing dermatologists on a daily basis. Although benign, it can be pruritic or tender. Furthermore, it is difficult to treat effectively with optimal cosmetic outcomes. OBJECTIVE We report a safe, effective, and cosmetically superior method of treating DF with the 600 nm pulsed dye laser (PDL). METHODS We used a 600 nm PDL to treat 20 lesions from 18 Caucasian patients. The laser parameter was set at a fluence of 7 J/cm2, a spot size of 7 mm and a pulse duration of 1.5 ms. Each lesion was treated three times at a 6- to 8-week interval. For each treatment, the lesion was double pulsed with a 20 to 30% overlap. Clinical improvement was graded by a single examiner in evaluating three clinical parameters: color, size/volume, and symptoms. For each parameter, improvement was ranked as no improvement, partial improvement, and complete response. RESULTS All 18 patients (17 women) completed the study. For the volume/size parameter, 15 of 20 lesions (75%) showed complete response. For improvement in color, 12 of 20 patients (60%) showed complete response. Only six lesions were symptomatic (i.e., tender and irritating), and all six lesions showed complete resolution of symptoms after the PDL treatments. After each treatment, all patients experienced blistering, crusting, and purpura that usually resolved after 10 days. CONCLUSIONS We have demonstrated for the first time that PDL (600 nm and 1.5 ms pulse duration) is an effective and safe treatment of DF. It may provide superior cosmetic outcomes compared with other modalities such as surgical excision.

BACKGROUND The 1,450 nm laser has been effective in treating acne. Microdermabrasion may help treat acne and reduce skin barriers to increase the delivery rate of topical anesthetics. OBJECTIVES To evaluate the efficacy, safety, and pain associated with the treatment of inflammatory facial acne with the 1,450 nm laser alone versus microdermabrasion plus the 1,450 nm laser. METHODS Twenty patients with facial acne were treated with the 1,450 nm laser alone and microdermabrasion plus the 1,450 nm laser in a randomized, split-face trial. RESULTS Laser alone and microdermabrasion plus laser significantly reduced the total number of acne lesions. Mean reductions of 53.5% and 55.6% were found after three treatments for laser alone and microdermabrasion plus laser, respectively. Clinical improvement was maintained 12 weeks after the last treatment. Mean pain scores were 5.3±1.5 for microdermabrasion plus laser and 5.2±1.5 for laser alone. There was no statistical difference between treatment levels for efficacy or pain. There was an average 10% increase in sequential pain as the laser treatment progressed. CONCLUSION The 1,450 nm laser is effective, well tolerated, and safe for treating facial acne. This small pilot study did not demonstrate increased clinical efficacy or decreased associated pain with the addition of microdermabrasion to treatment with the 1,450 nm laser. A larger study may be needed to demonstrate any additional benefit.

Background Many factors have been identified as important determinants that increase the risk of malignant melanoma (MM) developing. Patients with classic atypical mole syndrome (CAMS) have multiple such factors and are known to be at high risk for MMs developing. Objective We sought to evaluate the risk for newly diagnosed MMs developing in patients with CAMS and in a heterogeneous group of patients at high risk (ie, those with high-risk non-CAMS [HRNCAMS]) who had 1 or more risk factors: personal history of nonmelanoma skin cancers; family history of melanoma; biopsy specimen–confirmed dysplastic nevi; and meeting 1 or 2 of the 3 CAMS criteria. We also aimed to report our experience treating these patients at high risk with annual total cutaneous examination, total cutaneous photography, and dermoscopy. Methods Consecutive medical records from a private dermatology practice were reviewed. A total of 258 patients were selected who fulfilled the criteria of having: (1) total cutaneous photography as an aid for follow-up; (2) total cutaneous examination at least once per year; (3) at least 6 months of clinical follow-up; and (4) no personal history of melanomas. A total of 160 patients with CAMS and 98 with HRNCAMS were included in this study. The 10-year risk for MM developing in these 2 cohorts was computed using the Kaplan-Meier method. Results In the CAMS cohort, 28 new MMs developed in 19 patients resulting in a cumulative 10-year risk of 14% (95% confidence interval: 7-20). In the HRNCAMS cohort, 10 new MMs developed in 9 patients, and the cumulative 10-year risk was 10% (95% confidence interval: 2-17). The difference between the 2 groups was not statistically significant ( P = .91). The MMs diagnosed in both cohorts were either in situ or less than 1 mm in Breslow thickness. There were no MM metastases or MM-related deaths in either cohort during a mean follow-up period of 120 months for the CAMS and 98 months for the HRNCAMS group. Conclusion Both the patients with CAMS and HRNCAMS were at very high risk for MMs developing. The combination of total cutaneous photography, total cutaneous examination, and dermoscopy were used in treating our patients. No MM 1 mm or greater in thickness developed during follow-up in either group.

Dear Editor, Because ultraviolet (UV) radiation is a well-documented environmental trigger, cutaneous lupus (CLE) patients are advised to engage in photoprotective practices, including sunscreen use. Despite numerous studies demonstrating the efficacy of sunscreens,1,2 CLE patients have not fully embraced sunscreen use. Daily sunscreen use was reported only in 23.1% of CLE patients in Ireland.3 Our group previously found that 59% of CLE patients used sunscreen “often” or “always,” although those terms were not defined.4 The reasons for suboptimal sunscreen use in CLE patients are not clear.

Sunscreens serve as a critical tool in our armamentarium of photoprotective measures. Protective clothing and eyewear, behavioural modifications such as sun avoidance, seeking shade and, more curre...

Ultraviolet radiation plays a major role in the development of nonmelanoma and melanoma skin cancers. Photoprotection by sunscreens has been shown to prevent the development of actinic keratosis, squamous cell carcinoma, melanoma, and photoaging. However, these benefits are only derived if the users apply sunscreen appropriately and practice other sun protection measures. This review discusses the health benefits provided by sunscreen use, updates the latest regulatory landscape on sunscreen, and addresses the controversies and limitations associated with sunscreen use.

The incidence and mortality rates of melanoma have risen for many decades in the United States. Increased exposure to ultraviolet (UV) radiation is generally considered to be responsible. Sunburns, a measure of excess sun exposure, have been identified as a risk factor for the development of melanoma. Because sunburns are primarily due to UVB (280-320 nm) radiation, UVB has been implicated as a potential contributing factor to the pathogenesis of melanoma. The adverse role of UVA (320-400 nm) in this regard is less well studied, and currently there is a great deal of controversy regarding the relationship between UVA exposure and the development of melanoma. This article reviews evidence in the English-language literature that surrounds the controversy concerning a possible role for UVA in the origin of melanoma. Our search found that UVA causes DNA damage via photosensitized reactions that result in the production of oxygen radical species. UVA can induce mutations in various cultured cell lines. Furthermore, in two animal models, the hybrid Xiphophorus fish and the opossum (Mondelphis domestica), melanomas and melanoma precursors can be induced with UVA. UVA radiation has been reported to produce immunosuppression in laboratory animals and in humans. Some epidemiologic studies have reported an increase in melanomas in users of sunbeds and sunscreens and in patients exposed to psoralen and UVA (PUVA) therapy. There is basic scientific evidence of the harmful effects of UVA on DNA, cells and animals. Collectively, these data suggest a potential role for UVA in the pathogenesis of melanoma. To date evidence from epidemiologic studies and clinical observations are inconclusive but seem to be consistent with this hypothesis. Additional research on the possible role of UVA in the pathogenesis of melanoma is required.

Anticipation, a phenomenon in which an inherited disease is diagnosed at an earlier age in each successive generation of a family, has been demonstrated in certain neurological and haematological disorders. This study was conducted to determine whether anticipation occurs in familial non-Hodgkin's lymphoma (NHL). Eleven published reports of multigenerational familial NHL were analysed for evidence of anticipation, together with 18 previously unreported families with familial NHL. Differences in disease-free survival between generations were determined. The difference between age at onset for each affected parent–child pair was tested against the null hypothesis that there was no difference in age at onset. These analyses were also performed separately using only parent–child pairs with age of onset > 25 years to avoid ascertainment bias. In addition, the age at onset distribution of the studied cases was compared with that of the Surveillance Epidemiology and End Results (SEER) Program using data for 1973–98. The median ages at onset in the child and parent generations of all families (48.5 and 71.3 years respectively) and in the selected pairs (52.5 and 71.5 years respectively) were significantly different (P

"Fat fingers" are thick digitate linear, curvilinear, branched, or oval/circular dermoscopic structures typically seen in seborrheic keratoses where they represent the gyri of their cerebriform surfaces. Their recognition is very useful in the diagnosis of these lesions, especially when the classic features (eg, milia, comedo-like openings) are absent. Histologically and by confocal microscopy the "fat finger" gyri are accentuated by pigmented keratin filling the sulci. "Fat fingers" must be differentiated from other linear structures such as "network-like structures"; branched streaks; network; globules; pigmented ovoid-nests; and streaks/pseudopods seen in different melanocytic and non-melanocytic lesions.