Keloids are scars, unique to humans, that grow beyond the boundaries of a cutaneous
injury, inflammation, burn, or surgical incision. Although benign, keloids are often aesthetically
malignant. The etiology of keloids is uncertain. However, we do know that they occur
more often in African-American and Asian than Caucasian patients. There is no one
therapeutic modality that either prevents the formation of keloids or treats active or inactive
lesions. Consequently, there are many therapeutic options. In this review, an approach to
medical and surgical management of keloids is provided, as well as a review of experimental
Semin Cutan Med Surg 28:71-76 © 2009 Published by Elsevier Inc.
Malignant melanoma represents a significant and growing public health burden in the US and worldwide. It is estimated that 68, 130 cases of invasive malignant melanoma and at least 48,000 cases of melanoma in-situ will be diagnosed in the US this year. Melanoma is also one of the few remaining cancers with increasing US incidence. In the 1930s, the lifetime risk of an American developing invasive malignant melanoma was 1 in 1,500. Currently, that risk is 1 in 59. Deaths from malignant melanoma are also increasing. The mortality rate from malignant melanoma has risen about 2% annually since 1960. This year, it is estimated that 8,700 Americans will die from this cancer. The identification of individuals at high risk for malignant melanoma is important for the development of focused and efficient prevention efforts. Acute sun exposure resulting in sunburn remains a significant risk factor for the development of melanoma, but numerous other potential risk factors have been cited. Included among these are atypical mole syndrome/dysplastic nevus syndrome, blistering sunburns, immunosuppression, prior therapy with psoralen with ultraviolet A light (UVA) light, UV exposure at tanning salons, elevated socioeconomic status, and history of melanoma in a first-degree relative. With a better understanding of the reasons for the increasing rate of this cancer, and with enhanced early detection approaches, we may be able to decrease the incidence and mortality of malignant melanoma.
Semin Cutan Med Surg 29:204-209 © 2010 Published by Elsevier Inc.
The ability to detect early melanoma remains of paramount importance in our efforts to
curtail deaths related to this malignancy. Fortunately, our clinical skills at recognizing the
varied clinical presentation of early melanomas are continuously improving. Our enhanced
clinical acumen together with improved awareness of the danger signs of melanoma has
resulted in a greater proportion of thin melanomas being diagnosed today as compared to
the past. The implementation and utilization of in vivo imaging technologies in clinical
practice promises to further enhance our ability to detect melanoma while this cancer is
still thin and easily curable. This article describes the utility and application of the in vivo
imaging technologies that are currently in clinical use today including dermoscopy, total
body photography, individual lesion photography, and reflectance confocal microscopy.
Semin Cutan Med Surg 27:2-10 © 2008 Elsevier Inc. All rights reserved.
KEYWORDS melanoma, dermoscopy, total body photography, confocal, short term
The demographics of the United States continue to evolve, with a growing proportion of the
population consisting of non-Caucasian racial and ethnic groups. As darker skin types
become more prevalent, so will the need to better understand their skin, the conditions that
affect it, and optimal approaches for treatment. This population poses a special challenge
for practitioners in part as a result of the sequelae often associated with the conditions in
their own right—postinflammatory hyperpigmentation and scarring—and potential iatrogenic
adverse effects that may occur during treatment. Through careful consideration of
cultural, clinical, and therapeutic nuances, safe and effective management of common
disorders in skin of color is achievable.
Semin Cutan Med Surg 28:63-70 © 2009 Elsevier Inc. All rights reserved.
Between 1987 and 2007, different groups developed digital image analysis systems for the diagnosis of benign and malignant skin tumors. As the result of significant differences in the technical devices, the number, the nature and benign/malignant ratio of included skin tumors, different variables and statistical methods any comparison of these different systems and their results is difficult. For the use and comparison of the diagnostic performance of different digital image analysis systems in the future, some principle basic conditions are required: All used systems should have a standardized recording system and calibration. First, melanocytic and nonmelanocytic lesions should be included for the development of the diagnostic algorithms. Critical analyses of the results should answer the question if in future only melanocytic lesions should be analyzed or all pigmented and nonpigmented lesions. This will also lead to the answer if only dermatologists or all specialities of medical doctors will use such a system. All artifacts (eg, hairs, air bubbles) should be removed. The number of variables should be chosen according to the number of included melanomas. A high number of benign skin lesions should be included. Of all lesions only 10% or better less should be invasive melanomas. Each system should be developed by a training-set and controlled by an independent test-set. Each system should be controlled by the user with the final decision and responsibility and tested by independent users without any conflict of financial interest.