Sensitive Sites Research Articles

New Scholarship

New Scholarship

Emergency monitoring layout method for sudden air pollution accidents based on a dispersion model, fuzzy evaluation, and post-optimality analysis

Air pollutant distributions identified through monitoring form an important basis for devising adequate emergency responses against sudden air pollution accidents (SAPAs). However, studies on the optimisation of monitoring layouts for SAPAs, which can help us better understand air pollutant dispersion, are lacking. We developed an emergency monitoring layout optimisation method for SAPAs that combines an air pollutant dispersion model, a fuzzy comprehensive evaluation method (FCEM), and a post-optimality analysis technique (POAT) to identify the optimal monitoring layout scheme based on a field sulphur hexafluoride (SF6) leakage test. The impact of the number of monitoring sites on the results (coverage rate and accuracy) were investigated and analysed through a proposed comprehensive evaluation method. A monitoring result–monitoring number curve was plotted to determine the optimal number of monitoring sites. Two scenarios, i.e. with and without environmentally sensitive monitoring sites, were analysed. The results showed that the developed optimisation method can effectively consider the role of sensitive sites and obtain a feasible network for monitoring SAPAs. The coverage rates of the optimal monitoring layout schemes were 76.2% and 61.9% for the two case scenarios, respectively; the relative deviations of mean air pollutant concentrations at the sites were 14.6% and −12.2%, respectively. We investigated the effect of incorporating POAT into the method by comparing the optimal emergency monitoring layout schemes based on dispersion model–FCEM and model–FCEM–POAT. The results showed that the coverage rates of the optimised monitoring layout schemes improved when POAT was introduced. The proposed method can help determine an adequate, optimised emergency monitoring network for SAPAs.

Improving environmental management through indigenous peoples’ involvement

The objective of this paper is to investigate how indigenous peoples’ involvement can improve the environmental management practices of organizations in the natural resource extraction sector. Based on a qualitative study and semi-structured interviews with 33 respondents, this study sheds more light on the environmental involvement of a particular category of stakeholder rarely considered in the managerial literature. The findings show the risk management issues, corporate legitimacy objectives, and regulatory requirements underlying this type of environmental involvement. We also identify the main practices and benefits of fully engaging with indigenous peoples on environmental issues, particularly in terms of knowledge of local ecosystems and sensitive sites, biodiversity management, development of environmental values within the organization, and support in environmental monitoring. The paper contributes to the literature on both environmental management and relationships between extractive organizations and indigenous communities. Managerial implications and avenues for future research are also discussed.

PLANTS’ INNATE DEFENCE MECHANISMS AGAINST PHYTOPATHOGENS

Plants are affected by a number of severe conditions including damages caused by phytopathogens, which ultimately reduce productivity. Overtime, plants have evolved different mechanisms for defence against and resistance to invading pathogens, such as bacteria, viruses and fungi in different pathosystems. Defence mechanisms in plants could either be innate or artificial. Innate defence is said to occur when plants are naturally able to limit the development of a specific pathogen or the damage it may cause based on properties inherent in the plant without human intervention. This defence strategy could be divided into pre-existing and induced defence mechanisms. The pre-existing defence strategy comprises defence gardgets endogenously present in the plant even before pathogen colonization. It include the use of superficial structures (such as thick walled tissues, waxes and cuticle), biochemical substances (such as inhibitors released by plant into its environment) and defence through lack of essential factors (such as lack of host receptors and sensitive sites for toxins). The induced defence mechanism only becomes active in response to pathogen attack. It consists of defence through the formation of structures (such as cytoplasmic and cellular defence structures) and through biochemical reactions or the production of certain substances (such as pathogenesis related proteins and phenolics). Proper understanding of plant defence mechanisms against pathogens is important in developing new and improved disease resistant varieties.

Cutaneous keratinocyte cancers of the head and neck: Epidemiology, risk factors and clinical, dermoscopic and reflectance confocal microscopic features

Keratinocyte cancers are the most common malignancy among people with European ancestry, and are very common on sun-exposed areas of the head and neck. Incidence is directly correlated with latitude and annual ultraviolet radiation incidence, although there are a number of other environmental, occupational and genetic risk factors, and keratinocyte cancers become more common at middle age. Basal cell carcinomas (BCC) are the most common, comprising 80% of keratinocyte cancers, but have a very low rate of metastases and low mortality. Squamous cell carcinomas (SCC) make up 20% of keratinocyte cancers, and have relatively infrequent metastases, at 5–16%. While there are no precursor lesions for BCC, SCC represents the final stage in a spectrum of cellular atypia and dysplasia, from actinic keratoses to in situ SCC to invasive SCC. Dermoscopy is a well-established diagnostic tool for keratinocyte cancers, and reflectance confocal microscopy is emerging as another useful diagnostic tool, particularly on functionally and cosmetically sensitive sites like the face.

P1.03-17 Function of Antisense LncRNA RP11-539E17.5 and FAM83A-AS1 Up-Regulating FAM83A in Lung Adenocarcinoma Tumorigenesis and Development

Chromosome 8q24 lies in a gene desert with only a few predicted coding genes, but its variation is associated with multiple tumors. FAM83A in this region activates both PI3K/AKT/TOR and RAS/MAPK signaling cascades downstream of EGFR. The contribution of long noncoding gene in the antisense chain of FAM83A (RP11-539E17.5 and FAM83A-AS1) to the risk of lung adenocarcinoma (LUAD) need to be studied. We use systematic informatics method to identify the differential expression genes of the Cancer Genome Atlas (TCGA) LUAD transcriptome sequencing data. Then use data mining method to analysis the lncATLAS, USCS, Cistrome, and ENCODE database to infer the biological role of these two lncRNAs. Significant analysis of gene ontology (GO) terms enrichment analyzed the co-expression genes of RP11-539E17.5 in the LUAD and adjacent tissues. At last we use cell experiment to verify the lncRNA function. FAM83A-AS1 and RP11-539E17.5 located in Chromosome 8q24 were significantly different expressed between cancer and adjacent tissues (log2foldchange>5, p<0.05). The two lncRNA expression levels had notable correlation with FAM83A expression (coR> 0.8, P<0.005) and were significantly associated with patient overall survival and clinical stage (p<0.05). RP11-539E17.5, located in the enhancer element GH08J123181，belong to the enhancer lncRNA group. lncRNA subcellular localization data (lncATLAS) results showed that RP11-539E17.5 transcripts in K562 cells is mainly distributed in the nucleus, and most around the nucleolus and chromosomes. USCS, Cistrome, and ENCODE data mining identified four transcription factors (FOSL2, CTBP2, CEBPB, and MAFK) have significant correlation with the expression of FAM83A-AS1 and RP11-539E17.5. In K562 cell line with high expression of FAM83A-AS1, RP11-539E17.5 and FAM83A showed that expanded regions of RP11-539E17.5 gene sequence were marked by enhancer-specific modifications (H3K27ac domains and H3K4me3 domains). This region also showed an excellent source of DNase sensitive site, and with several binding sites for CTCF, FOSL2, CTBP2, CEBPB and MAFK. In addition, RP11-539E17.5 gene also with enriched DNA methylation feature. RP11-539E17.5 and FAM83A-AS1 knocked down both inhibited the expression of FAM83A the proliferation of PC9, and RP11-539E17.5 gene owning a more significant effect. GO terms enrichment analysis of the co-expressed genes with RP11-539E17.5 showed that the most significantly activated biological pathways is involved with Cell cycle，and cell mitotic signaling pathway, while the molecular function involved with transcription factor binding, DNA binding, ATP binding, endonuclease activity, DNA topoisomerase activity. We found a LncRNA RP11-539E17.5 with enhancer character up regulate FAM83A expression in LUAD. These results can lay a theoretical foundation for LUAD corresponding countermeasures.

Geoconservation of underground ecosystems in Santander (Colombia) from geotourism and geoeducation strategies

Colombia is characterized by presenting numerous resources in underground ecosystems, which are sensitive sites with special features within karstic landscapes. Santander is located in the central northern part of Colombia and contains not extensive explored extensive network of underground systems associated with highly fossiliferous carbonate rocks of the Cretaceous Rosablanca Formation, which is characterized by a very rich geodiversity exokarst and endokarst geoforms and biodiversity. Unfortunately, there is no environmental awareness in the community or action plans oriented to conservation and use of these underground systems.

Mounds, Towns, and their Surrounds: An Archaeological, Historical, and Geophysical Approach to Burial Mounds, Residential Space, and Cultural Landscapes of the Late Woodland Springwells Site (a.d. 800–1400) at Historic Fort Wayne, Detroit

ABSTRACTHistoric Fort Wayne is located on the Detroit River in a landscape of heavy industry and marginalized urban neighborhoods (figure 1). Geophysical survey south of the Fort Wayne Mound—a Late Woodland Period burial mound enclosed by the Fort—indicates that pre-contact residential structures may be preserved at the site. Residential sites with mortuary monuments are uncommon in southeastern Michigan and represent an opportunity to better understand variation in Late Woodland settlement. Our approach combines existing archaeological research, historical records, and non-invasive geophysical survey in a culturally sensitive Native American site context presently unavailable for conventional archaeological excavation. We examine archaeological and historical records from Springwells and Late Woodland period settlements in the region to contextualize geophysical evidence from the site. The research prioritizes protection of Native American heritage sites in urban contexts together with ongoing archaeological interpretation of the Late Woodland cultural Landscape.

Gas molecular adsorption effects on the electronic and optical properties of monolayer SnP3

We have investigated the electronic and optical properties of monolayer SnP3 adsorbed by small gas molecules by using first-principle calculations based on density functional theory. Six initial adsorption sites were selected to explore the most sensitive site to investigate the optimal adsorption positions of CH4, H2O, NH3, NO, NO2, and SO2 adsorbed on the monolayer SnP3. Aiming at the optimal adsorption configurations, the adsorption energy, adsorption distance, and charge densities are computed to investigate the adsorption types. Our results reveal that monolayer SnP3 is sensitive to NO and SO2 via strong physical adsorption, and NO2 via chemical adsorption, thereby forming a new bond between O and P atoms. Analysis of the optical property shows that the adsorption of NO, NO2, and SO2 can remarkably influence the dielectric function and adsorption coefficient of monolayer SnP3. Our theoretical studies indicate that monolayer SnP3 is a good gas-sensitive material used for NO, NO2, and SO2 detection.

Microelectrode Arrays Modified with Nanocomposites for Monitoring Dopamine and Spike Firings under Deep Brain Stimulation in Rat Models of Parkinson's Disease.

Little is known about the efficacy of deep brain stimulation (DBS) as an effective treatment for Parkinson's Disease (PD) because of the lack of multichannel neural electrical and chemical detection techniques at the cellular level. In this study, a 7-mm-long and 250-μm-wide microelectrode array (MEA) was fabricated to provide real-time monitoring of dopamine (DA) concentration and neural spike firings in the caudate putamen (CPU) of rats with PD. Platinumn nanoparticles and reduced graphene oxide nanocomposites (Pt/rGO) were modified onto the sensitive microelectrode sites. The detection limit (50 nM) and sensitivity (8.251 pA/μM) met the specific requirements for DA detection in vivo. A single neural spike was isolated due to the high signal-to-noise ratio of the MEA. DBS was applied in the affected side of the globus pallidus internal (GPi) in PD rats. After DBS, the concentration of DA in the bilateral CPU increased markedly. The mean increment of the ipsilateral DA was 7.33 μM (increasing from 0.54 μM to 7.87 μM), which was 2.2-fold higher than the increment in the contralateral side. The mean amplitude of neural spikes in the bilateral CPU decreased more than 10%, and was more obvious in the ipsilateral side where the spike amplitude changed from 169 μV to 134 μV. Spike firing rate decreased by 65% (ipsilateral side) and 51% (contralateral side). The power of the local field potential decreased to 940 μW (ipsilateral side) and 530 μW (contralateral side) in 0-30 Hz. Collectively, our data show that the GPi-DBS plays a significant regulatory role in the bilateral CPU in terms of DA concentration, spike firing, and power; furthermore, the ipsilateral variations of the dual mode signals were more significant than those in the contralateral side. These results provide new detection and stimulation technology for understanding the mechanisms underlying Parkinson's disease and should, therefore, represent a useful resource for the design of future treatments.

Deletion of OGG1 Results in a Differential Signature of Oxidized Purine Base Damage in mtDNA Regions.

Mitochondrial oxidative stress accumulates with aging and age-related diseases and induces alterations in mitochondrial DNA (mtDNA) content. Since mtDNA qualitative alterations are also associated with aging, repair of mtDNA damage is of great importance. The most relevant form of DNA repair in this context is base excision repair (BER), which removes oxidized bases such as 8-oxoguanine (8-oxoG) and thymine glycol through the action of the mitochondrial isoform of the specific 8-oxoG DNA glycosylase/apurinic or apyrimidinic (AP) lyase (OGG1) or the endonuclease III homolog (NTH1). Mouse strains lacking OGG1 (OGG1−/−) or NTH1 (NTH1−/−) were analyzed for mtDNA alterations. Interestingly, both knockout strains presented a significant increase in mtDNA content, suggestive of a compensatory mtDNA replication. The mtDNA “common deletion” was not detected in either knockout mouse strain, likely because of the young age of the mice. Formamidopyrimidine DNA glycosylase (Fpg)-sensitive sites accumulated in mtDNA from OGG1−/− but not from NTH1−/− mice. Interestingly, the D-loop region was most severely affected by the absence of OGG1, suggesting that this region may be a hotspot for oxidative damage. Thus, we speculate that mtDNA alterations may send a stress message to evoke cell changes through a retrograde mitochondrial–nucleus communication.

Factors affecting temporal variations in vapor intrusion-induced indoor air contaminant concentrations

Temporal variability in indoor air contaminant concentrations at vapor intrusion (VI) sites has been a concern for some time. We consider the source of the reported variability at VI sites located near Hill Air Force Base (AFB) in Utah, an EPA experimental house in Indiana, and Naval Air Station North Island in California. We focus in particular on how the indoor/outdoor pressure differences and air exchange rates affected indoor air contaminant concentrations at these sites. We investigate how these dynamics differ for a site that is characterized by a preferential pathway (like Hill AFB) and VI sites that are not influenced by such pathways, using three-dimensional fluid dynamics models and statistical analysis of the aforementioned sites. A preferential pathway can dramatically increase a VI site's sensitivity to build pressurization, provided there exist a medium allowing effective communication between a contaminant-delivering preferential pathway and the indoor air space, e.g. a permeable subslab space that may be provided by a gravel layer. Preferential pathways may also erroneously indicate the presence of indoor contaminant sources. At sites characterized by significant advective transport from the subslab to the indoor air space, much of the short-term variability in indoor air contaminant concentration can be explained by an impact of fluctuations in indoor/outdoor pressure differences. Meanwhile, air exchange rate variation drives most of the short-term variability at sites characterized by minor variations in advective transport.

SIGLECs and their contribution to tuberculosis

Multiple host genes determine susceptibility or resistance to tuberculosis. In an exome-wide association study conducted among tuberculosis patients and their exposed but clinically asymptomatic household contacts, we found that the SNP rs61104666 located in the fifth exon of SIGLEC15 gene is associated with the disease. No other variant in SIGLEC15 has been reported previously to be associated with tuberculosis. The associated polymorphism results in a synonymous change (E292E) and therefore is unlikely to be involved in disease pathogenesis. Bioinformatic analysis of epigenetic marks in the genomic region reveals an enhancer mark present in lung and blood, downstream to the SIGLEC15 gene may harbor candidate causal SNPs which are in strong LD with the index SNP. This region overlaps with the 3′UTR region of the neighboring gene EPG5. EPG5 has role in autophagy, a phenomenon relevant to clearing of the infection. The region also harbors DNAse I sensitive sites with SNPs of low RegulomeDB score indicative of potential transcription binding sites. All these evidences suggest further exploration of the enhancer region to understand its role in disease manifestation.

Management feasibility of established invasive plant species in Queensland, Australia: A stakeholders' perspective.

Managing and monitoring invasive alien species (IAS) is costly, and because resources are limited, prioritization decisions are required for planning and management. We present findings on plant pest prioritization for 63 established invader species of natural and grazing ecosystems of Queensland, Australia. We used an expert elicitation approach to assess risk (species occurrence, spread, and impact) and feasibility of control for each IAS. We elicit semi-quantitative responses from diverse expert stakeholders to score IAS on three management approaches (biocontrol, chemical and mechanical) in relation to cost, effectiveness and practicality, and incorporate uncertainty in expert inputs and model outputs. In the process, we look for promising management opportunities as well as seek general trends across species' ecological groups and management methods. Stakeholders were cautiously optimistic about the feasibility of managing IAS. Taking into consideration all factors, the overall feasibility of control was uncorrelated with the stakeholders' level of confidence. However, within individual management criterion, positive trend was observed for the same bivariate traits for chemical control, and negative trends for biocontrol and mechanical controls. Utility and confidence in IAS management options were in the order: chemical > biocontrol = mechanical, with practicality and effectiveness being the main driver components. Management feasibility differed significantly between IAS life forms but not between habitats invaded. Lastly, we combined IAS risk assessment and management feasibility scores to create a risk matrix to guide policy goals (i.e. eradication, spread containment, protection of sensitive sites, targeted control, site management, monitoring, and limited action). The matrix identifies promising species to target for each of these policy outcomes. Overall, our general approach illustrates (i) the importance of understanding the feasibility of IAS control actions and the factors that drive it, and (ii) demonstrates how quantifying management feasibility can be used to enhance traditional risk assessment rankings to improve policy outcomes.

The mutation profile of EGFR in resectable Chinese lung cancer patients.

e20519 Background: The frequency of EGFR mutation in Asian advanced lung cancer patients is about 40% and the application of EGFR tyrosine kinase inhibitors (TKIs) has become a standard treatment therapy. Several studies showed that usage of EGFR TKIs in adjuvant or neo-adjuvant therapy was promising, while the mutation profile of EGFR mutations in resectable Chinese lung cancer patients was still scanty. Our study investigated EGFR mutation profile and its correlation with clinicopathological factors. Methods: 343 resectable patients with lung cancer were selected for eligibility criteria, and tumor tissues were collected for gene detection. EGFR genetic testing was performed by amplification refractory mutation system PCR (ARMS-PCR) with specific sensitive mutation sites. The clinicopathological factors of study population were recorded based on pre-design protocol. Chi-square or fish exact test were used to statistic analysis Results: A total of 343 patients were enrolled in study. 42.6% (146/343) patients were male, 20.4% (68/333) patients were smokers, the adenocarcinoma accounted for 93.8 % (319/340), and stage 0, I, II, III was 7.3% (25/343), 68.8% (236/343), 8.5% (29/343), 15.5% (53/343), respectively. The frequency of EGFR mutation was 54.2% (186/343) in whole population, and the proportion of EGFR L858R, 19Del, 719X, 768I, 861Q mutation was 31.2% (107/343), 21.3% (73/343), 1.2% (4/343), 1.0% (3/343), 1.0% (3/343), respectively. 1.2% (4/343) patients presented EGFR co-mutation (EGFR G719X/S768I; L858R/S768I; G719X/S768I; L858R/L861Q) .The mutation frequency of EGFR mutation was associated with sex, smoking, differentiation, pathology (P = 0.0076, &lt; 0.0001, &lt; 0.0001, &lt; 0.0001, respectively). In subgroup analysis, the incidence of two main mutation types, EGFR L858R and 19del, were associated with disease stage (P = 0.044) and age (P = 0.035). Conclusions: EGFR mutation in resectable lung cancer was a common phenomenon as advanced stage and our study might provide useful informations for using EGFR-TKIs in further adjuvant or neo-adjuvant therapy.

Methods for Assessment and Monitoring of Light Pollution around Ecologically Sensitive Sites.

Simple SummaryImaging and photometric techniques are used to characterize the brightness of nighttime conditions in protected areas in support of conservation efforts.Since the introduction of electric lighting over a century ago, and particularly in the decades following the Second World War, indications of artificial light on the nighttime Earth as seen from Earth orbit have increased at a rate exceeding that of world population growth during the same period. Modification of the natural photic environment at night is a clear and imminent consequence of the proliferation of anthropogenic light at night into outdoor spaces, and with this unprecedented change comes a host of known and suspected ecological consequences. In the past two decades, the conservation community has gradually come to view light pollution as a threat requiring the development of best management practices. Establishing those practices demands a means of quantifying the problem, identifying polluting sources, and monitoring the evolution of their impacts through time. The proliferation of solid-state lighting and the changes to source spectral power distribution it has brought relative to legacy lighting technologies add the complication of color to the overall situation. In this paper, I describe the challenge of quantifying light pollution threats to ecologically-sensitive sites in the context of efforts to conserve natural nighttime darkness, assess the current state of the art in detection and imaging technology as applied to this realm, review some recent innovations, and consider future prospects for imaging approaches to provide substantial support for darkness conservation initiatives around the world.

MFEprimer-3.0: quality control for PCR primers.

Quality control (QC) for lab-designed primers is crucial for the success of a polymerase chain reaction (PCR). Here, we present MFEprimer-3.0, a functional primer quality control program for checking non-specific amplicons, dimers, hairpins and other parameters. The new features of the current version include: (i) more sensitive binding site search using the updated k-mer algorithm that allows mismatches within the k-mer, except for the first base at the 3′ end. The binding sites of each primer with a stable 3′ end are listed in the output; (ii) new algorithms for rapidly identifying self-dimers, cross-dimers and hairpins; (iii) the command-line version, which has an added option of JSON output to enhance the versatility of MFEprimer by acting as a QC step in the ‘primer design → quality control → redesign’ pipeline; (iv) a function for checking whether the binding sites contain single nucleotide polymorphisms (SNPs), which will affect the consistency of binding efficiency among different samples. In summary, MFEprimer-3.0 is updated with the well-tested PCR primer QC program and it can be integrated into various PCR primer design applications as a QC module. The MFEprimer-3.0 server is freely accessible without any login requirement at: https://mfeprimer3.igenetech.com/ and https://www.mfeprimer.com/. The source code for the command-line version is available upon request.

Deferred verification: the role of new verification technologies and approaches

ABSTRACTResearchers have recently proposed a new approach to nuclear-arms-control verification, dubbed “deferred verification.” The concept forgoes inspections at sensitive nuclear sites and of nuclear weapons or components in classified form. To implement this concept, a state first divides its nuclear program into a closed segment and an open segment. The total fissile-material inventory in the closed segment, which includes the weapon complex, is known and declared with very high accuracy. Essentially no inspections take place in the closed segment. In contrast, inspectors have access to the open segment, which includes in particular the civilian nuclear sector. The fissile-material inventory in the open segment is known with less accuracy, but uncertainties can be reduced over time using nuclear-archaeology methods. Deferred verification relies primarily on established safeguards techniques and avoids many unresolved verification challenges, such as the need for information barriers for warhead confirmation measurements. At the same time, deferred verification faces some unique challenges. Here, we explore some of these challenges and offer possible solutions; to do so, we examine possible noncompliance strategies in which a state would seek to withhold a higher-than-declared inventory.

Time course of rapid bone loss and cortical porosity formation observed by longitudinal μCT in a rat model of CKD.

Rodent studies of bone in chronic kidney disease have primarily relied on end-point examinations of bone microarchitecture. This study used longitudinal in vivo microcomputed tomography (in vivo μCT) to characterize the onset and progression of bone loss, specifically cortical porosity, in the Cy/+ rat of model of CKD. Male CKD rats and normal littermates were studied. In vivo μCT scans of the right distal tibia repeated at 25, 30, and 35 weeks were analyzed for longitudinal changes in cortical and trabecular bone morphometry. In vitro μCT scans of the tibia and femur identified spatial patterns of bone loss across distal, midshaft and proximal sites. CKD animals had reduced BV/TV and cortical BV at all time points but developed cortical porosity and thinning between 30 and 35 weeks. Cortical pore formation was localized near the endosteal surface. The severity of bone loss was variable across bone sites, but the distal tibia was representative of both cortical and trabecular changes. The distal tibia was found to be a sensitive suitable site for longitudinal imaging of both cortical and trabecular bone changes in the CKD rat. CKD trabecular bone loss progressed through ~30 weeks followed by a sudden acceleration in cortical bone catabolism. These changes varied in timing and severity across individuals, and cortical bone loss and porosity progressed rapidly once initiated. The inclusion of longitudinal μCT in future studies will be important for both reducing the number of required animals and to track individual responses to treatment.

Total Body Skin Examination Practices: A Survey Study Amongst Dermatologists at High-Risk Skin Cancer Clinics.

Although total body skin examination (TBSE) is the primary screening mechanism for melanoma, there is no consensus on which anatomic sites a screening TBSE should include. We sought to establish which anatomic sites are examined during routine (>90%) TBSEs of patients at high risk for skin cancer. A Google survey was emailed to 173 international dermatologist skin cancer specialists. More than 75% of participants reported routinely examining the scalp, ears, face and neck, trunk, breasts, inframammary areas, axillae, extremities, palms and soles, nails, interdigital spaces, and buttocks. The least frequently inspected anatomic sites included genitalia, with male genitalia more frequently examined than female (penis n = 39; 52%; labia majora n = 21; 28%; P = 0.003), the perianal region (n = 26; 34.7%), and the ocular conjunctiva and oral mucosa (n = 35; 46.7%). Participants cited not screening these areas because of perceived patient discomfort, low prevalence of malignancy, and the expectation that other specialists examine the area. The role of routine surveillance of neglected anatomic sites is unclear and warrants further discussion weighing potential mortality benefit against the incidence of melanoma in obscure sites, morbidity of intervention in sensitive sites, cost-effectiveness, and potential for patient discomfort.