Changing Moles Research Articles

Synthesis and optimization of molecular weight of chitosan and carboxymethyl cellulose based polyurethanes

For the first time in this research, using a mixture design approach, polyurethanes (PUs) based on chitosan (CSN) and carboxymethyl cellulose (CMC) were synthesized to develop a high molecular weight polymer. In the synthesis process, a reaction between isophorone diisocyanate (IPDI) and hydroxyl-terminated polybutadiene was carried out to synthesize a prepolymer containing free NCO groups at the corners. This prepolymer was further reacted with changing moles ratio of CSN and CMC following the principles of statistical mixture design. The structural confirmation of the developed PUs was carried out through spectroscopic techniques (FTIR and NMR). The molecular weights of the PU specimens were characterized using gel permeation chromatography. The findings demonstrated that the interaction between CMC and CSN led to a notable increase in the molecular weights of the samples, supported by a significant p-value of 0.006. Additionally, the analysis of variance (ANOVA) disclosed that the employed mixture design and the resulting interaction model effectively account for 98 % of the total variation observed in the molecular weights. The sample labeled as PUS-3 (CMC0.50:CSN0.50) emerged as the most significant formulation, exhibiting a noteworthy 27.9 % improvement in the polymer molecular weight compared to the base sample, denoted as PUS-1 (CMC1.00:CSN0.00).

28545 A man with halo nevi and premature hair graying

Case presentation: A 20-year-old male presented with a 5-month history of asymptomatic depigmented lesions on the trunk and patchy graying of hair. He noted an acute onset of depigmented patches slowly enlarging around nevi on his chest and abdomen. Three months later, he developed similar appearing areas of involvement disassociated from nevi on his chest and back and graying of his scalp hair. He denied any new or changing moles and reported no associated symptoms. Personal and family histories were negative for vitiligo, autoimmune conditions, and skin cancer. On physical examination, there were numerous depigmented macules and patches on the trunk and depigmented patches surrounding symmetric, evenly pigmented, well-demarcated 3-6 mm brown-black macules on the trunk. There was also patchy graying of the scalp hair. Wood’s lamp examination revealed fluorescence of depigmented macules and patches on the trunk. Labs were notable for mild anemia and TSH within normal limits. The patient also had a normal ocular exam by ophthalmology. Betamethasone dipropionate 0.05% ointment BID, gingko biloba (60 mg BID), and alpha lipoic acid (100 mg daily) were started with no improvement at 4 months.

Practices in higher-income communities are associated with shorter dermatologist wait times: A cross-sectional simulated telephone call study

Practices in higher-income communities are associated with shorter dermatologist wait times: A cross-sectional simulated telephone call study

Pigmentation and Pregnancy

Changes in melanocytic nevi during pregnancy are frequently attributed to the new hormonal milieu and are dismissed without concern for malignancy. Recent studies suggest that pregnancy itself does not induce significant change in nevi, and delays in the assessment of changing moles may contribute to the often more advanced nature of melanomas diagnosed during or soon after pregnancy. Nevi on the breasts and abdomen can grow as a result of skin expansion, but studies have found no significant changes in nevi located in more stable areas such as the back or lower extremities. There is also insufficient evidence to support the notion that nevi darken during pregnancy. As such, any changing nevus that would raise concern for malignancy in a nonpregnant patient should do so in a pregnant patient as well. Pregnancy can, however, induce physiologic pigmentary changes that are often worrisome to both patients and physicians. These benign changes include melasma, pigmentary demarcation lines, secondary areola, and linea nigra as well as other less common findings. It is important for physicians to recognize these changes as physiologic to provide adequate reassurance to their patients and avoid unnecessary stress.

Total Body Photography as an Aid to Skin Self-examination: A Patient's Perspective.

Skin self-examination can help patients who are at high risk for developing melanoma to become more involved in their own surveillance and treatment. This study examined the use of total body photography as an aid to skin self-examination from the patients' perspective. A total of 179 individuals at high risk for developing melanoma who had undergone total body photography (60.5% response rate) completed a self-reported questionnaire assessing the frequency of skin self-examination, perceived usefulness of total body photography, and a variety of potential demographic, clinical and psychological factors. Only approximately half of the participants indicated skin self-examination as useful and 78.9% preferred clinical skin examination by a specialist. Finding total body photography useful was associated with having received instructions on how to perform skin self-examination, the use of a (hand)mirror, and confidence to detect changing moles. These findings allow us to develop strategies to further improve patients' self-screening behaviours.

Second primary melanomas treated with BRAF blockers: study by reflectance confocal microscopy

New primary melanomas arising in patients with stage IV melanoma and receiving BRAF inhibitors have recently been reported. This raises the question of the nature of the earliest cellular events identifiable within pre-existing moles. To use reflectance confocal microscopy (RCM) to investigate changing moles in patients using vemurafenib. In the first part of the study 23 lesions were examined by RCM before excision (performed because of digital dermoscopy changes) and histopathological examination. In the second part, 10 randomly chosen lesions in two patients were examined before and after 3 months of vemurafenib treatment. The first step permitted the highlighting of an unusual RCM pattern identified in five lesions characterized by areas of marked atypia in otherwise nondysplastic lesions. In the second step, four initially nondysplastic lesions developed focal or multifocal areas of marked atypia under treatment, which were not always correlated with digital dermoscopy changes, but did correlate with histopathology. All four lesions were finally diagnosed as melanomas. Although the clinical relevance of such findings remains questionable, RCM allowed us to observe, at the cellular level, the earliest events occurring within vemurafenib-induced changing moles. Moreover, repeated RCM examinations permitted to confirm that microscopic marked atypia that led to the histopathological diagnosis of melanoma appeared under treatment and were not pre-existing.

To Biopsy or Not to Biopsy Changing Moles in Children and Adolescents: Are We Removing Too Many Pigmented Nevi in This Age Group?

To Biopsy or Not to Biopsy Changing Moles in Children and Adolescents: Are We Removing Too Many Pigmented Nevi in This Age Group?

Atypical histologic and immunohistochemical findings in melanocytic nevi after liquid nitrogen cryotherapy

Two patients with atypical histologic and immunohistochemical findings in nevi after cryotherapy are reported. Patient 1, a 32-year-old white woman, presented to our cancer center with two changing moles that had been treated with liquid nitrogen therapy by her primary care provider. After cryotherapy, these two lesions showed paradoxical loss of maturation, with aberrant expression of HMB-45 in the dermal component, thereby mimicking melanoma. Although the overall Ki-67 labeling was low, focally there was no diminution in Ki-67 immunoreactivity with descent into the dermis. Patient 2, a 39-year-old white man, had a nevus treated with liquid nitrogen by his primary care physician and presented to us with a changing mole. Histologically, there was loss of maturation and aberrant HMB-45 expression. These features may pose a diagnostic dilemma, and highlight the importance of clinicopathologic correlation in arriving at the correct diagnosis.

Malignant melanoma and breast carcinoma: a bidirectional correlation

Epidemiologic and genetic studies have suggested a bidirectional association between breast carcinoma (BC) and malignant melanoma (MM). We present a series of patients with MM and BC detected in our department within a span of 6 months, raising concerns for the high associations between the two malignancies. This led us to match the concordance of the two tumours in the National Irish Cancer Registry. The national figures provide evidence of a link between BC and MM. We recommend increased awareness among clinicians leading to more detailed surveillance of both second primary tumours. All MM patients with a family history of BC should be referred to a breast clinic. Women above the age of 40 with MM should undergo annual mammography and those less than 40 may be better evaluated with a breast MRI. All breast cancer patients should be made aware of the significance of changing moles and those with suspicious lesions referred to a dermatologist for evaluation.

Even patients with changing moles face long dermatology appointment wait-times: A study of simulated patient calls to dermatologists

Previous studies have shown long wait-times for general dermatology patients seeking routine appointments. No evidence has been gathered on wait-times for patients with urgent problems or on the impact of physician extenders on access to dermatologic care. To evaluate access for patients with an urgent problem, we performed scripted patient telephone calls to 851 dermatologists to assess wait-times for both patients with Medicare and those paying out-of-pocket complaining of a changing mole. Mean wait-times were similarly long for patients paying out-of-pocket (38.2 days) and those on Medicare (38.9 days; P = .85). Acceptance rates and wait-times varied greatly by geographic area (range of mean wait-times, 19.7-73.4 days). Many dermatologists (23.3%) employed a physician extender, and the wait-times for these extenders (27.9 days) were significantly shorter than those for the physicians supervising them (45.8 days; P < .001). The metropolitan areas sampled represented about one tenth of practicing dermatologists in the United States, and no remote or highly rural communities were included. Patients with a changing pigmented lesion, a possible indicator of malignancy, face wait-times just as long as those previously published for patients with routine complaints. Medicare patients did not experience any greater barriers to access. Although the use of physician extenders remains controversial, these practitioners were able to schedule patients more quickly than their supervising physicians.

Prevention and early diagnosis of melanoma: a regional experience in Italy

AbstractBackground Over the 1980s several education campaigns for prevention and early diagnosis of cutaneous melanoma have been reported from various parts of the world.Aim To improve incidence and prognosis of cutaneous melanoma in 1985 we started, in our area, an information and health education campaign aimed at identifying precursors of melanoma (congenital melanocytic nevi), suspicious lesions (changing moles) and subjects with increased risk of melanoma.Method Precursors and suspicious lesions were promptly removed, and high‐risk persons entered the follow‐up program.Result As a general effect of these activities the percentage of thin melanomas diagnosed in our division after 1985 increased from 25 to 37.Conclusion We believe that education campaigns and screening of a targeted population, particularly of subjects presenting increased risk of melanoma, may be helpful in the early diagnosis of melanoma.