Clinics in dermatology最新文献

Mentorship is a critical aspect of personal and professional development throughout anyone's life. Unlike careers in many other fields, a medical career is a long, multistep process that can begin in high school and continue throughout a physician's career. When considering competitive specialties such as dermatology, mentors are increasingly crucial in helping students successfully match to programs of their choice, but the variability and extent of mentorship can raise ethical concerns. We discuss the evolution of mentorship in dermatology and the potential ethical issues involved. We propose possible solutions to the ethical conflict between mentor and mentee.

Malignant blue melanomas arise from blue nevi and all related intradermal melanocytic proliferations. They harbor specific, mutually exclusive mutations in the G-coupled protein pathway, mainly involving GNAQ or GNA11. Other rare genetic drivers include CYSLTR2 or PCLB4 mutations. PKC and GRM1-gene fusions have been recently added to this list. Malignant blue melanomas have a predilection for the scalp area, presenting as rapidly growing nodules within a pre-existing lesion. Histopathologically, these tumors are located in the dermis and subcutaneous fat and consist of large nodules or expanding dense sheets. Tumor necrosis is commonly seen. Large spindle-shaped and epithelioid melanocytes with high-grade cytologic atypia and frequent mitotic figures are at higher magnification. A benign blue nevus or intermediate-grade blue melanocytoma is frequently found on the side of the central mass. Loss of nuclear BAP1 immunoreactivity is a poor prognostic factor.

Desmoplastic melanoma is a rare fibrosing variant of melanoma. It typically affects elderly patients but can occasionally affect young or middle-aged individuals. Desmoplastic melanoma is relevant as a diagnostic pitfall for pure tumor variants' distinct histopathologic and clinical features. The latter includes a lower regional lymph node involvement frequency and a more favorable prognosis among thick melanomas. Classic cases of desmoplastic melanoma tend to carry a high mutation burden. Patients with metastases from those tumors tend to respond favorably to novel immunotherapies.

Primary dermal melanoma (PDM) is a rare subtype of melanoma with an estimated incidence of <1%. PDM manifests entirely in the dermis or subcutis and histopathologically mimics cutaneous melanoma metastasis due to its lack of connection to the overlying epidermis. A thorough history and examination, including imaging evaluation for metastatic disease, reveals no prior history or concurrent primary cutaneous or metastatic melanoma lesion. Despite its histopathologic similarities to melanoma metastasis, PDM is associated with an unexpectedly favorable prognosis. This review discusses the clinical and histopathologic features of PDM as a distinct subtype of melanoma, as well as the current approach to clinical staging and management.

The new revised MPATH-Dx (version 2.0) reporting schema for melanocytic lesions is presented. Principal changes include the simplification of the previous five-class version 1.0 to a four-class hierarchy of melanocytic lesions to improve diagnostic agreement and to provide more explicit guidance for the management of patients. Version 2.0 also has clearly defined histopathologic criteria for classification of class I and II lesions, which are now designated as low-grade (mild-to-moderate) atypia and high-grade (high-end moderate-to-severe) atypia, respectively. This new revised schema also includes specific provisions for the less common World Health Organization pathways to melanoma, provides guidance for classifying "intermediate" class II tumors (melanocytomas), and recognizes a subset of pT1a melanomas with very low risk and possible eventual reclassification as a neoplasm falling short of fully evolved melanoma.

Although the prevalence is still being determined, more medical students are using application consulting companies when applying to competitive residencies such as dermatology. We outline the structure of these companies, the scope of services provided, and the associated costs. We also discuss the ethical implications of using such firms in the residency application process and the impact of these practices on the candidate selection process. Finally, we offer possible solutions and measures that mitigate the impact of the use of consulting firms in residency applications.

We highlight the contribution of notable Jewish women in American dermatology. Although not intended to be a thorough listing, we selected nine representatives as examples of early pioneer women in American dermatology and research and those who were political leaders, authors and journal editors, and teachers and role models. All struggled to overcome professional barriers to women in medicine; many experienced antisemitism, especially those who were forced to flee Nazi Germany. Despite persecution and upending their lives, they rebuilt their careers and made outstanding contributions to the field of dermatology.