Faculty Bibliography

Computer technology has advanced rapidly over the past 30 years as the computer has been more and more integrated into the practice of medicine. Current horizons of research have begun to make use of this newer technology in 1986. The numerous amounts of change and advances in computer systems with respect to medicine and specifically to dermatology will make the computer even more of an integral tool for the practice of this specialty in the future

This article highlights the process that a physician should undertake in selecting and implementing a business computer system for the office. Included are suggested approaches to identifying needs, establishing priorities, and communicating requirements to prospective vendors. Methods for reviewing various systems to evaluate whether they meet the practice's defined requirements are suggested

Hazard-rate analysis provides a unique means of assessing prognosis in patients with malignant disease. The hazard rate is the probability of a patient dying within a particular unit of time after definitive therapy. Hazard-rate analysis was performed on a series of 719 consecutive patients with clinical stage I cutaneous malignant melanoma (MM). The peak hazard rate for death from metastatic MM occurred during the 48th month of follow-up. Thereafter, the hazard rate declined and approached zero by the 120th month. When the patients were stratified by the thickness of their primary MM, thicker lesions reached their peak hazard-rate month earlier than thinner lesions. We conclude that after 120-month survival, the risk of dying from MM is virtually zero. However, since rare late deaths from MM occur, lifetime follow-up is recommended

Stage I cutaneous malignant melanomas between 0.76 and 1.69 mm thick (Breslow measurement) in BANS (upper part of the back, posterior aspects of the arms, posterior and lateral aspects of the neck, posterior aspect of the scalp) areas have been reported to portend a relatively poor prognosis compared to non-BANS sites. We were unable to confirm the 15% poorer survival for BANS area lesions (84% BANS, 99% non-BANS) originally reported. In this report of 211 patients, malignant melanomas in BANS sites had a 4.6% poorer 5-year cumulative survival rate (88.9% BANS, 93.5% non-BANS; p = 0.35). Although many more patients need to be studied, we believe this small difference in survival is insufficient to influence therapeutic management strategies

With the rate of melanoma increasing 1,000% in the past 50 years, the early detection of the disease is becoming more important. Data from 2,239 persons seen at the Manhattan Melanoma/Skin Cancer Detection Screening Program were analyzed to determine if a complete cutaneous examination would significantly increase the chance of detecting melanoma. Thirteen of the fourteen melanomas detected were on anatomic sites normally covered by clothing. Patients having complete skin examinations were 6.4 times more likely to have a melanoma detected than those having partial examinations (p = 0.025). These findings reinforce the importance of complete skin examination for the early detection of malignant melanoma

To determine the clinical prevalence of medium-sized (1.5- to 19.9-cm-diameter) congenital-nevus-like nevi (CNLN), a consecutive series of 601 patients (mostly adults) had total cutaneous examinations. In this series, 15 (2.5%) were found to have such lesions. In addition, 14 (2.3%) had nevi spili and 83 (13.8%) had cafe au lait spots. All three types of lesions were equally represented in both sexes and tended to spare the head, neck, and upper extremities. Compared with CNLN, nevi spili were found to have significantly larger diameters and lower mean age, suggesting that these are different types of lesions. Some recommend the surgical removal of all congenital nevocytic nevi because of their malignant potential. Since it is not possible to clinically distinguish congenital nevocytic nevi and CNLN and since the observed prevalence of these lesions in adults is over four times that previously reported in newborns, such a recommendation becomes less feasible